H Sripathi

Sutures and suturing techniques in skin closure

A surgical wound never attains the same cutaneous tensile strength as of normal uncut skin. Two weeks after suturing, 3-5% of original strength will be achieved by a surgical wound. By the end of third week, 20% of the ultimate wound strength is achieved, and by one month only 50% of wound strength is attained. All sutures are foreign bodies and produce an inflammatory response in the host dermis. Peak inflammatory response is seen between second and seventh day with abundance of polymorphonuclear leukocytes, lymphocytes, and large monocytes in dermis.[3] Between the third and eighth day, the epithelial cells deeply invade the suture tracts.

Zoonotic sporotrichosis of lymphocutaneous type in a man acquired from a domesticated feline source: report of a first case in southern Karnataka, India

Background  Sporotrichosis is commonly encountered due to traumatic implantation of thorns or decayed vegetation with the dimorphic fungi, Sporothrix schenckii. Zoonotic spread of Sporotrichosis is rare and we describe here the first case of feline transmission of lymphocutaneous sporotrichiosis encountered in India.

Efficacy and safety of Erbium-doped Yttrium Aluminium Garnet fractional resurfacing laser for treatment of facial acne scars

BACKGROUND Treatment of acne scars with ablative fractional laser resurfacing has given good improvement. But, data on Indian skin are limited. A study comparing qualitative, quantitative, and subjective assessments is also lacking. AIM Our aim was to assess the improvement of facial acne scars with Erbium-doped Yttrium Aluminium Garnet (Er:YAG) 2940 nm fractional laser resurfacing and its adverse effects in 25 patients at a tertiary care teaching hospital. METHODS All 25 patients received four treatment sessions with Er:YAG fractional laser at 1-month interval. The laser parameters were kept constant for each of the four sittings in all patients. Qualitative and quantitative assessments were done using Goodman and Barron grading. Subjective assessment in percentage of improvement was also documented 1 month after each session. Photographs were taken before each treatment session and 1 month after the final session. Two unbiased dermatologists performed independent clinical assessments by comparing the photographs. The kappa statistics was used to monitor the agreement between the dermatologists and patients. RESULTS Most patients (96%) showed atleast fair improvement. Rolling and superficial box scars showed higher significant improvement when compared with ice pick and deep box scars. Patients satisfaction of improvement was higher when compared to physicians observations. No serious adverse effects were noted with exacerbation of acne lesions forming the majority. CONCLUSION Ablative fractional photothermolysis is both effective and safe treatment for atrophic acne scars in Indian skin.Precise evaluation of acne scar treatment can be done by taking consistent digital photographs.

Childhood herpes zoster: a clustering of ten cases.

Herpes zoster occurs due to reactivation of the latent varicella zoster virus and is usually a disease of the elderly. Childhood herpes zoster is believed to be rare, though recent studies suggest increasing incidence in children. Here we report ten cases of childhood herpes zoster, seven of which occurred within a short span of six months, at a tertiary care level hospital in Pokhara, Nepal. Only three of the ten children reported previous history of varicella infection and none was immunized against varicella. Though childhood herpes zoster accounted for less than 1% of the total zoster cases in the past, recent reports show an increase in the number of cases in apparently healthy children. So far, no studies have been done linking childhood herpes zoster with HIV, though there are many studies linking it with other immunocompromised conditions.

A case of extensive erosive and bullous erythema elevatum diutinum in a patient diagnosed with human immunodeficiency virus (HIV)

A 35-year-old housewife presented to us with multiple painful progressively increasing raised and blistering lesions on dorsa of both feet of 8 months, duration. She also gave a history of recurrent high fever with chills and rigor, which subsided with antipyretics. The lesions were surgically removed by a local doctor but recurred in a month. Thereafter, various topical and oral medications were tried in vain. She also developed two asymptomatic skin-colored nodules on her left elbow. On examination, she had multiple polycyclic pigmented plaques with beaded vesiculated borders and a few bullae with hemorrhagic fluid on both dorsa of the feet; few areas were crusted and eroded (Figs. 1 and 2). Two firm, nontender nodules with yellow tinge, measuring 1 · 2 cm, were seen on the left elbow (Fig. 3). There was angular cheilitis and grayish thick coating of the tongue. Face, scalp and hair, external genitalia, palms, and soles were normal. Routine blood investigations revealed a low blood hemoglobin of 8.8 g % and a low total leukocyte count of 3600/cmm. Chest x-ray was normal. ELISA test for HIV was positive, which was reconfirmed by repetition. VDRL, TPHA, and Mantoux tests were negative, whereas USG abdomen revealed hepatomegaly. With a differential diagnosis of bullous lichen planus, cutaneous vasculitis, and erythema elevatum diutinum, skin biopsies from the elbow nodule and a representative lesion on the dorsum of the foot, stained with hematoxylin and eosin, showed dermal changes of leukocytoclastic vasculitis, characterized by thin-walled capillaries lined by plump endothelial cells with dense neutrophilic

Topical dinitrochlorobenzene (DNCB) for alopecia areata: Revisited

1. Rapp SR, Feldman SR, Exum ML, Fleischer AB Jr, Reboussin DM. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol 1999;41:401-7. 2. Reed WB, Becker SW, Rhode, Heiskell CL. Psoriasis and arthritis: A clinicopathological study. Arch Dermatol 1961;83:541-8. 3. Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB. Risk of myocardial infarction in patients with psoriasis. JAMA 2006;296:1735-41. 4. McDonald CJ, Calabresi P. Psoriasis and occlusive vascular disease. Br J Dermatol 1978;99:469-75. 5. McDonald CJ. Cardiovascular complications of psoriasis. In: Roenigk HH, Maibach HI, editors. Psoriasis. 2 nd ed. New York: Marcel Dekker Inc; 1991. p. 97-111. 6. Wakkee M, Thio HB, Prens EP, Sijbrands EJ, Neumann HA. Unfavourable cardiovascular risk profiles in treated and untreated psoriasis patients. Atherosclerosis 2007;190:1-9. 7. Ludwig RJ, Schultz JE, Boekncke WH, Podda M, Tandi C, Krombach F, et al. Activated, not resting, platelets increase leukocyte rolling in murine skin utilizing a distinct set of adhesion molecules. J Invest Dermatol 2004;122:830-6. 8. Malerba M, Gisondi P, Radaeli A, Sala R, Calzavara Pinton PG, Girolomoni G. Plasma homocysteine and folate levels in patients with chronic plaque psoriasis. Br J Dermatol 2006;155:1165-9.

Thoracopulmonary actinomycosis: the masquerader

Thoracopulmonary actinomycosis can mimic various lung pathologies such as bronchogenic carcinoma, tuberculosis and fungal pneumonia, to name but a few. The common causative agent is Actinomyces israelii. The disease is successfully diagnosed only if there is a high index of suspicion and a thorough evaluation with multidisciplinary involvement. We present a case of thoracopulmonary actinomycosis in a young immunocompetent man who did not have any predisposing illness, and who was treated initially for pulmonary tuberculosis. He showed good response to injection crystalline penicillin, which was later changed to oral amoxicillin.

Successful use of imiquimod 5% cream in Bowen's disease

A 32 year-old man presented to our clinic with genital warts, which had been present for the last six months. Dermatologic examination revealed multiple verrucous papules on the shaft of the penis and pubic area and depigmented macules on the glans penis, the shaft of the penis and the scrotum [Figure 1]. Imiquimod 5% cream had been applied to the warts every other night. After two months, he had noticed erythematous lesions on the dorsal surface of the penis and the scrotum. These lesions turned into depigmented areas in three months. Depigmentation never extended to the areas that had not been treated with imiquimod. No repigmentation was noted in a six-month follow-up period. The patient had no personal or family history of vitiligo.

A simple instrument designed to provide consistent digital facial images in dermatology

Photography has proven to be a valuable tool in the field of dermatology. The major reason for poor photographs is the inability to produce comparable images in the subsequent follow ups. Combining digital photography with image processing software analysis brings consistency in tracking serial images. Digital photographs were taken with the aid of an instrument which we designed in our workshop to ensure that photographs were taken with identical patient positioning, camera angles and distance. It is of paramount importance in aesthetic dermatology to appreciate even subtle changes after each treatment session which can be achieved by taking consistent digital images.

Unusual presentation of generalized macular amyloidosis in a young adult.

Macular amyloidosis is a common problem seen dermatology out-patient department. Generalized macular amyloidosis presenting with a poikilodermatous appearance is rare. In our case, an 18-year-old male presented with generalized hypopigmented macules with a poikilodermatous appearance of 10-year duration. His developmental milestones were normal with negative family history of similar complaints. Histopathology of hyperpigmented lesions revealed hyperkeratosis and acanthosis of epidermis and hypopigmented lesion showing only hyperkeratosis. Both lesions were showing the deposition of amorphous, hazy material in the tips of papillary dermis with perivascular inflammatory infiltrate. Congo red staining of the amorphous material was positive for amyloid.