Ishmeet Kaur

Solitary Digital Nodule in an Infant

A 5-month-old female infant was brought to the Dermatology Department with a single, asymptomatic, firm pinkish nodule present over the distal digit of the left second toe. It began as the size of a lentil at birth and progressively increased to attain the present size ( Fig. 1 ). The lesion covered almost the entire second toenail. Parents denied a history of preceding trauma. The baby was playful, her medical and family history being unremarkable. The increasing size of the lesion was of great concern to the parents. What is your diagnosis? Received: May 16, 2017 Accepted: June 8, 2017 Published online: July 20, 2017

Dermatoscopic features of lichen nitidus

Dermatoscopy is a noninvasive, painless, and easily repeatable technique that reveals interesting and characteristic features associated with various cutaneous conditions. Lichen nitidus is a rare dermatosis of childhood. We describe the dermatoscopic features in 8 cases of lichen nitidus, which can aid noninvasive diagnosis. The report serves to emphasize the need for examining these lesions using both polarized and nonpolarized modes.

Frictional (Sock) alopecia of the legs: Trichoscopy as an aid

Alopecia of the lower limbs is a rarely reported entity. Friction due to footwear, socks, and tight clothing is one of the causes of lower limb alopecia. The typical site of involvement and improvement after removal of triggering factor are an important clue to the diagnosis. Alopecia areata remains a close differential, and dermoscopy/trichoscopy can serve as an adjunctive aid in the diagnosis.

Atypical presentation of immunoglobulin A vasculitis in disseminated tuberculosis

Atypical presentation of immunoglobulin A vasculitis in disseminated tuberculosis Immunoglobulin A vasculitis (IgAV) is the most common type of vasculitis in children. It usually presents as a tetrad of palpable purpura, abdominal pain, arthritis, and renal involvement. Although skin ulcers and bullae have been observed in adult patients, they are rare phenomena in the pediatric population. A 12-year-old boy presented with recurrent episodes of multiple red-purple raised lesions over bilateral lower legs for the past 2 years, associated with episodic fever. In the current episode, of 3 weeks duration, there was history of multiple fluidfilled lesions that progressed to deep painful ulcers over the lower legs. He complained of abdominal pain and arthralgia of multiple joints. There was no history of renal or pulmonary complaints. Examination of legs revealed multiple palpable purpura with hemorrhagic bullae over the ankles (Fig. 1a,b) that progressed to deep tender punched-out ulcers covered with a black eschar and purulent discharge (Fig. 2). He had received oral dapsone 100 mg for 1 year and colchicine with prednisolone for 3 months with only partial clearance of the lesions. His hematological and biochemical investigations were unremarkable except for raised ESR (48 mm). Stool for occult blood was positive, and Mantoux was highly positive (22 mm). urinalysis showed the presence of proteinuria (820 mg/24 h) with hematuria. Skin biopsy showed features of leukocytoclastic vasculitis (Fig. 3), and direct immunoflourescence revealed IgA deposition around the superficial blood vessels in the papillary dermis (Fig. 4). ANA, cANCA, and pANCA were negative. Ultrasound of the abdomen revealed multiple mesenteric and pelvic lymph nodes suggestive of abdominal Kochs. Chest x-ray showed the presence of pleural effusion with raised adenosine deaminase levels as 47.2 U/l. A diagnosis of ulcerative variant of IgAV with disseminated tuberculosis was made and antituberculosis treatment (ATT) Category-1 drugs along with oral nonsteroidal anti-inflammatory drugs were initiated. At 2 months, lesions had improved, stool for blood was negative, and there was no evidence of proteinuria. The patient was followed up for the next 12 months, during which he did not have any further such episodes. In IgAV, patients can also present with bullous lesions and/or ulcers. This presentation, however, is seen more commonly in adult population and is rare in children. In a review of 100 cases of IgAV by Saulsbury et al., only 2% presented with hemorrhagic bullae. It has also been proposed that bullous and (a)