Goutam Dawn

A Clinical Study of Childhood Alopecia Areata in Chandigarh, India

Abstract: All new cases of alopecia areata (AA) were studied during the years 1983–1993. Eight hundred forty‐one cases were recorded, including 201 (23.9%) children less than 16 years of age. The female:male ratio was 1.4:1 (117 girls, 84 boys) for childhood AA. Alopecia was severe, (hat is, total, universal, or extensive, in 34(16.9%) children. Onset occurred in 77 (38.3%) children between ages 6 and 10 years, In 67 (33.3%) before 5 years of age, and in 57 (28.4%) between 11 and 16 years. Onset before 5 years of age was more often associated with severe alopecia than onset at ages 11 to 16 years (p < 0.01). Onset before 2 years of age was commonly associated with severe alopecia, seen in 6 (55.5%) of 11 children. Twenty‐five (12.4%) children had one or more family members with AA. Definite evidence of atopy was obtained In 35 (17.5%) children. Association of atopy with severe alopecia was not statistically significant at Initial presentation (16% vs 23.5% for circumscribed and severe alopecia, respectively; p > 0.05). Nail changes were found In 60 (30%) children and were more frequent in severe alopecia (53%) than in circumscribed alopecia (25.2%, p < 0.001). Associated vittllgo was found in seven (3.5%) children, and one child was hypothyroid. Childhood AA in Chandigarh, India, is remarkably similar to that seen in Western countries, except that an association of atopy with younger age at onset and severe alopecia was not confirmed.

ORAL MINIPULSE THERAPY IN VITILIGO

Dr. A.J. Kanwar, Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, 60012 Chandigarh (India) Though various modalities of treatments are available for vitiligo, none is uniformly effective. Systemic corticosteroids have been used in the treatment of vitiligo presuming it to be autoimmune in nature [ 1 ]. In order to reduce the side-effects, it can be administered in ‘pulse’ form with beneficial effects [2]. ‘Oral minipulse’ (OMP) therapy implies use of cyclical pulse dose corticosteroids in much smaller doses compared to the usual pulse therapy. Therefore, the sideeffects are further minimized, and this therapy can be used by patients at home with regular follow-up at the clinic [3]. Recently Pasricha and Khaitan [4] tried corticosteroid OMP therapy in 40 vitiligo patients with encouraging results. We report herein our results with OMP in vitiligo. Thirty-seven patients (23 male, 14 female) with rapidly spreading vitiligo covering more than 2% body surface area were recruited. Their ages ranged from 6 to 46 years (mean 22.62 years), and the duration of disease varied from 1.5 months to 5 years (mean 1.81 years). Of 37 patients, 31 (83.8%) had vitiligo vulgaris, while 6 (16.2%) had segmental vitiligo. All patients were screened for any contraindication for systemic corticosteroids. A single dose of OMP in adults consisted of 10 tablets of dexamethasone (0.5 mg each) given on 2 consecutive days in a week after breakfast in the morning. In children ( < 16 years old) the dose was halved. A minimum of 5 doses and a maximum of 25 doses were tried. No other treatment was prescribed during the study period. The therapeutic response was graded as no response, weak, moderate, excellent response and total clearance. Patients were reviewed every 5 weeks by the senior author. Thirty-two (86.4%) patients completed the trial, while 5 (13.6%) defaulted. In 14 (43.8%) patients, new lesions stopped appearing and there was mild to moderate repigmentation, while in 18 (56.2%) there was no response (table 1). Patients who showed a response mostly showed repigmentation within the first 15 weeks (doses) of treatment. Patients with segmental vitiligo were worst

Spectrum of Reticulate Flexural and Acral Pigmentary Disorders in Northern India

Reticulate pigmentary disorders are rare in India. Only 15 cases of reticulate acropigmentation of Kitamura (RAPK) and 9 cases of Dowling‐Degos disease (DDD) have been reported previously. To the best of our knowledge, there has been no earlier report of acropigmentation of Dohi. We herein describe 10 patients with various reticulate pigmentary abnormalitis: 6 with RAPK, 2 with DDD, 1 with RAPK‐DDD overlap, and 1 with acropigmentation of Dohi. Palmar pits and/or breaks in epidermal ridge pattern were absent in 2 of 6 patients with RAPK A 23‐year‐old male patient had RAPK‐DDD overlap. Periorbital pigmentation and pigmentation over the mucosal surface of the prepuce and corona of the glans penis were some unique features observed in this patient. His sister and mother had RAPK and DDD, respectively.

Nail changes in 1000 Indian patients with alopecia areata

Dermatol 1991;25:5 18-524. long-term hydroxyurea therapy. Aust J Dermatol 19943: 61 -64. Kennedy BJ, Smith LR, Goltz RW. Skin changes secondary to hydroxyurea therapy. Arch Dermatol 1975; I 1 1 : 183187. Renfro L, Kamino H, Raphael B, et al. Ulcerative lichen planus-like dermatitis associated with hydroxyurea. J Am Acad Dermatol 1991;24:143-145. Beers B, Kalish R, Kage VN, et al. Unilateral linear lichenoid eruption after bone marrow transplantation: an unmasking of tolerance to an abnormal keratinocyfe clone? J Am Acad Dermatol 1993;28:888-892. Boyd AS, Neldner KH. Lichen planus. J Am Acad Dermatol 1991;25:593-619,

NAIL PIGMENTATION DUE TO ROXITHROMYCIN

Nail pigmentation Roxithromycin Dr. Amrinder J. Kanwar, Additional Professor Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012 (India) Roxithromycin, the first of a new generation of macrolides, has an antibacterial spectrum similar to that of erythromycin for typical and atypical acute community-acquired infections. However, it has improved phar-macokinetics with proven efficacy, and better tolerance and compliance. The drug has been frequently used in infections of the upper and lower respiratory tract, ear, teeth, skin and soft tissue and genitourinary system [1–5]. The major adverse effects include nausea, abdominal pain and diarrhea. These are however, reduced in intensity and frequency as compared to other macrolides. Other side effects which may occasionally be seen are dyspepsia, flatulence, constipation, dizziness, pruritus, urticaria and skin rashes [4, 5]. We report a patient who developed nail pigmentation following roxithromycin. A 23-year-old male presented with pigmentation of finger nails of 2 months duration. The patient revealed that he had an episode of upper respiratory tract infection (URTI) 3 months before, for which roxithromycin, tablet 150 mg twice daily, was prescribed. He initially responded but as symptoms persisted, he continued the drug for another 2 weeks. On stopping the drug, he noticed a slight brownish discoloration of both thumb nails. He had a further episode of URTI for which he again took roxithromycin for 2 weeks. At that time, he noticed further darkening of pigmentation over both thumb

Post-kala-azar dermal leishmaniasis mimicking leprosy: experience with 4 patients, with some unusual features in 1

We report on 4 cases of post-kala-azar dermal leishmaniasis (PKDL). History of kala-azar was available in all 4 patients. Slit-skin smears (SSS) for leishmania donovani (LD) bodies were negative in all 4. In 3 patients hypopigmented lesions were present over the face. Papules and nodules over his lips, tongue, scrotum and dactylitis were some unusual features observed in 1 patient. Histopathological examination showed LD bodies in 2 patients; histopathology was nonspecific in the other 2. All the patients were treated with sodium stibogluconate, 20 mg/kg/day. Infiltrated papules and nodules had subsided by 3 months, while hypopigmented macules took longer to improve. In 3 patients there had previously been a misdiagnosis as leprosy sufferers and they had been treated with antileprosy drugs. Clinical and histopathological differences between PKDL and leprosy are discussed.

Mutilating Lesions in Porokeratosis of Mibelli

We report a case of mutilating porokeratosis of Mibelli with numerous lesions and bony changes.

Localization of Drug Rash over the Sites of Neuralgia

Dr. A.J. Kanwar, Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research Chandigarh, 160012 (India) Of various types of drug eruptions, only fixed drug eruption has been found to localize over sites of local injury, e.g. insect bites, vascular lesions, healed herpes zoster or cellu-litis [1]. However, no such predilection for localization has been observed regarding maculopapular rash or erythema multiforme. A case of phenytoin-induced maculopapular rash over the hemiplegic side in a patient with cerebral contusion was earlier reported by us [2]. We herein describe 2 other cases where drug rashes were localized predominantly over the sites of neuralgia. Case 1, a 48-year-old male, presented with a maculopapular rash over the face developing 3 days following intake of ampi-cillin for a sore throat. The rash was mostly localized in the turban area, i.e. the derma-tome supplied by the mandibular division of the trigeminal nerve on the right side. Other areas on the right side of the face were minimally affected. There was total sparing of the left side of the face as well as other parts of the body. The patient gave a history of paroxysms of excruciating pain over the lips, gums, cheek and chin on the right side lasting for 10 s to 1.5 min for the last 2 years. There was no difference in pulsations of facial and superfacial temporal arteries nor a difference in temperature between the right and left sides of the face. No sensory or motor deficit could be elicited. Ampicillin was substituted by erythromycin, and the rash completely subsided within 4 days. A neurology opinion was sought, and a diagnosis of rightsided trigeminal neuralgia was made. He was put on carbamazepine, 100 mg daily to start with, and it was gradually increased to 200 mg 4 times daily. There was 70% relief of pain after 6 weeks. Case 2, a 58-year-old male, presented with erythematous macules and large blisters over the left thigh and leg of 2 days’ duration. He gave a history of taking diclofenac sodium tablets for pain over the left thigh and leg 2 days prior to the development of the skin rash. The pain used to start at the lower back and to radiate to the left thigh and leg for the last year, and it was diagnosed as sciatica by a neurologist. Examination revealed erythematous papules and bullae of variable sizes arising on an erythematous base. A few discrete iris lesions were seen at the periphery of the blisters. Nikolsky’s sign was positive. A diagnosis of erythema multiforme was made, and diclofenac sodium was incriminated as the probable etiologic agent. The drug was stopped, blisters were aspirated and application of a topical steroid-antibacterial combination was advised. All the lesions healed within 5 days. In both cases, the drug rash was localized to the areas of neuralgia. It needs further knowledge to explain this peculiar localization of a rash. Neuralgia might be due to an irritative lesion of the nerve root which can result in vasomotor instability at the cortical or subcortical level [3,4].