Geeta Garg

Evaluation of cosmetic tattooing in localised stable vitiligo.

Thirty patients with localised stable vitiligo were selected from the Out Patient Department for cosmetic tattooing. Of them, 19 cases (63.3%) had skin patches, 9 cases (30%) had mucosal patches, and 2 cases (6.7%) had both skin and mucosal involvement. After complete clinical evaluation, cosmetic tattooing was performed on these patients, and they were followed up for 6 months. As results, 23 cases (76.7%) had excellent color matching, 2 cases (6.7%) had good color matching, and 5 cases (16.6%) had pigment shedding. Excellent results were seen in all mucosal patches. Dark complexion cases showed better results than fair complexion ones.

Comparative efficacy of cetirizine and levocetirizine in chronic idiopathic urticaria

H1 receptor antagonists are the mainstay of treatment for chronic idiopathic urticaria. Newer hydroxyzine derivatives such as cetirizine and levocetirizine have been found to be equally efficacious in preclinical studies in patients with chronic idiopathic urticaria. In this study, the clinical efficacy of cetirizine and levocetirizine has been studied sequentially in individual patients. Fifty chronic idiopathic urticaria patients received 10 mg of levocetirizine daily for 6 weeks. Some 45 patients out of these showed reasonably good clinical efficacy on a visual analog scale to qualify for comparison with levocetirizine. A total of 30 patients completed the study period of 6 weeks each of cetirizine and levocetirizine sequentially. Thus, the clinical efficacy of cetirizine and levocetirizine was comparable with a marginal advantage of better antipruritic effect with levocetirizine, probably at the cost of increased sedation.

Psoriasis herpeticum due to Varicella zoster virus: A Kaposi's varicelliform eruption in erythrodermic psoriasis

Kaposis varicelliform eruption (KVE) or eczema herpeticum is characterized by disseminated papulovesicular eruption caused by a number of viruses like Herpes simplex virus I and II, Coxsackie virus, and Vaccinia and Small pox viruses in patients with pre-existing skin disease. The occurrence of KVE with psoriasis has been reported recently as a new entity psoriasis herpeticum. The rare causation of psoriasis herpeticum due to Varicella zoster virus in a patient with underlying psoriasis is being reported for the first time.

Café-au-lait macules: are these markers of neoplasia of genetic origin?

We read with interest the report on the association of urticaria pigmentosa with café-au-lait spots, neurofibromas and neurofibroma-like neoplasms by Mohrenschlager et al. [1]. In this regard, we would like to highlight further some of the relevant literature pertaining to the known associations of café-au-lait macules (CALM) which may have some bearing on the understanding of their association with urticaria pigmentosa, as observed in this report. CALM have been commonly associated with diseases like neurofibromatosis type 1 (NF-1), segmental neurofibromatosis, tuberous sclerosis, Albright’s syndrome, Watson’s syndrome and temporal dysrhythmia. Rarely, these may represent an incomplete or monosymptomatic form of NF-1 or get associated with epidermal nevus syndrome, nevus lipomatoides superficialis, Fanconi’s syndrome, Cowden’s disease and juvenile xanthogranuloma [2, 3]. When present in normal individuals (10%), their size and number are usually restricted. An inquisitive look at the disorders associated with CALM shows that these lesions are quite commonly associated with disorders of benign or malignant proliferation of variable cell origin (table 1). Except for Watson’s syndrome and temporal dysrhythmia, all other disorders do show some tendency towards benign or malignant proliferations. When associated with juvenile xanthogranuloma, there is even an increased incidence of juvenile chronic myeloid leukemia [4]. Keeping all this in view, it appears that CALM has a definite role, primary or secondary, in getting associated with factors which lead to Table 1. Associated disorders of CALM along with various neoplasias

Enterococcal bacteremia complicating pemphigus vulgaris: successful treatment with linezolid.

To the Editor: Pemphigus, an autoimmune bullous disease, is often complicated by secondary infection in patients with extensive epidermal denudation. Infection is not an uncommon cause of death and is often aggravated by immunosuppressive therapy (1). Septicemia or bacteremia may be caused by a variety of pathogenic as well as commensal organisms. Linezolid, an oxazolidinone derivative, is a new class of antibacterial agent with a broad range of inhibitory activity against gram positive bacteria, enterococci and a few anaerobes. A patient of pemphigus vulgaris with multidrug resistant Enterococcus faecalis infection successfully treated with linezolid has been described. A 40-years-old male had active vesiculobullous lesions of pemphigus vulgaris with approximately 60–70% of skin denudation. He was febrile for two weeks but was not on any immunosuppressive therapy for pemphigus. Investigation profile for fever was negative except blood culture, which grew Enterococcus faecalis on two different occasions resistant to co-trimoxazole, ampicillin, penicillin, amoxycillin, cloxacillin, co-amoxiclav, cephlexin, ceftazidime, ciprofloxacin, erythomycin, gentamicin, amikacin and netilmycin. Diagnosis of Enterococcus faecalis bacteremia was made and the patient was treated with intravenous linezolid 600 mg twice daily for three days. As the patient was afebrile by the third day, oral formulation of linezolid in the same dosage was started and continued for the next two weeks. Immunosuppressive treatment for pemphigus was started one week after resolution of fever. The patient had maintained skin barriers in the next four weeks. Enterococcal bacteremia is not infrequently encountered in hospitalized patients requiring intensive care or those with significantly deranged skin barrier as in burns & pemphigus (2). Besides prolonged hospitalization, other risk factors for enterococcal bacteremia are cathetrization, hyperalimentation and other parentral instrumentations. Enterococci are also responsible for infections like pneumonia, skin and soft tissue infections and urinary tract infections with or without bacteremia in these settings (3). Although these organisms may be sensitive to combinations of antibiotics like penicillin, ampicillin and aminoglycosides, the prevalence of multidrug resistance is not uncommon in nosocomial strains of enterococci. Linezolid is an oxazolidinone derivative, which has high efficacy for enterococci like Enterococcus faecalis and Enterococcus faecium. It has a good oral bioavailability and no cross-resistance with other classes of antibiotics (4). The present patient probably developed Enterococcus faecalis bacteremia because of the large area of skin denudation similar to extensive burns. Linezolid is a very good alternative in such acutely ill patients with multidrug resistant enterococci and other gram-positive organism like The Journal of Dermatology Vol. 31: 580–581, 2004