Kameshwar Prasad

Leprosy elimination: A myth busted.

Background: Leprosy is mainly a chronic infectious disease caused by Mycobacterium leprae. The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract and eyes. Though the target of leprosy elimination was achieved at national level in 2006 even then a large proportion of leprosy cases reported globally still constitute from India. Aim and Objective: To study the clinico-epidemiological profile of new cases of leprosy in a rural tertiary hospital. Materials and Methods: Thirty-five newly diagnosed cases of leprosy presented in out-patient/admitted in the department of Dermatology, Venereology and Leprosy (between September 2012 and August 2013) were included in the study. Detailed history regarding leprosy, deformity, sensory loss, skin smear for AFB and histopathological examination were done in every patient. Results: The incidence was more in age group of 20 to 39 years (48.57%) and 40 to 59 years (37.14%). 68.57% were males. 48.57% cases were found to have facial deformity and ear lobe thickening was found to be pre-dominant form of facial deformity. Ulnar (88.87%) and common peroneal nerve (34.28%) were the most commonly involved nerves. The split skin smear examination was found to be positive in 27 out of 35 cases. On histopathological examination 10 patients (28.57%) were of lepromatous pole (LL), 4 (11.43%) were of indeterminate, 6 (17.14%) were of tuberculoid type (TT), 4 BT (11.4%) and 1 BL type (2.8%). Conclusions: This study helps in concluding that leprosy is still not eliminated. Active surveillance is still needed to detect the sub-clinical cases and undiagnosed cases.

Dermatoses due to quackery: A case snippet and concise review of literature

A wide prevalence of socio-religious, cultural, and tribal practices in India often leads to a multitude of skin conditions, which can misled the dermatologists in arriving at a diagnosis. With increasing globalization and migration, the practice of indigenous customs and traditions are crossing boundaries, making it imperative for the dermatologists to be acquainted with the cutaneous side effects of these practices. Here, we report a unique case of thermal burn in a circumferential pattern over the umbilical region, a result of the placement of burning lamp over umbilicus to alleviate abdominal discomfort.

Hailey-Hailey disease.

The prevalence of Hailey–Hailey disease (HHD) also known as fami l ia l benign chronic pemphigus is 1:50,000.[1] It is an autosomal dominant disorder caused due to mutation in ATP2C1 gene.[2,3] The gene encodes an adenosine triphosphate–powered calcium pump in the Golgi apparatus of epidermal cells.[4] Faulty calcium pump action leads to disorganized function of desmogleins, which are calcium-dependent adherence proteins (cadherins). Flaccid vesicles or bullae are the primary lesions in Hailey–Hailey disease. These lesions rupture easily leaving behind macerated erosions. Most commonly Hailey–Hailey disease

Linear rays of depigmentation along lymphatics after intralesional corticosteroid therapy

Department of Dermatology, Venereology and Leprosy, Mahatma Gandhi Institute of Medical Sciences, Maharashtra, India A 53‐year‐old female, diagnosed as hypertrophic lichen planus presented to us with white colored patches over her ankles with linear white lines radiating to her legs. She received intralesional injections of triamcinolone acetonide in the skin lesions on multiple occasions in the past for hypertrophic lichen planus. Her general and systemic examinations were normal. Cutaneous examination showed bilaterally symmetrical depigmented patches over both ankles and curvilinear rays of depigmented lines arising from the superior margin of depigmented patch [Figure 1]. The lines extended up to the middle third of both legs [Figure 2]. However, she had no signs suggestive of exogenous Cushing’s syndrome. We diagnosed post‐intralesional steroid induced depigmentation along the dermal lymphatics and reassured her about the benign nature of the condition and treated her with repigmenting therapy (topical psoralen ultraviolet A therapy and topical calcineurin inhibitor).

Liposomal doxorubicin-induced palmoplantar erythrodysthesia syndrome

366 Indian Dermatology Online Journal September-October 2015 Volume 6 Issue 5 found that a high serum IgE level and early onset of atopic dermatitis were both risk factors.[3] Defective cytokine secretion and decreased cell-mediated immunity in skin affected by atopic dermatitis and other diseases also appear to play a role in the pathogenesis of KVE. Early use of both antiviral drugs and antibiotics is extremely important; their use should not be delayed pending laboratory tests. When a bacterial infection is not present, patients should be given a topical antibiotic cream.[6] Patients with recurrent HSV infections and chronic skin disease predisposing to KVE should be offered prophylaxis. KVE can be life threatening. This case illustrates the need for both timely treatment and the use of appropriate laboratory tests to confirm the diagnosis. Physicians should recognize the early presentation. Effective treatment is available in the form of antiviral drugs and should not be delayed.

A fatal case of Nicolau syndrome

Nicolau syndrome (embolia cutis medicamentosa) is a rare cutaneous adverse reaction occurring at the site of intramuscular, intra-articular or, rarely, subcutaneous injection of particular drugs. We hereby report a fatal case of Nicolau syndrome in a 13-year-old young male patient.

A rare presentation of verrucous/hypertrophic lupus erythematosus: A variant of cutaneous LE.

A 32‐year‐old male patient presented with complaints of small, round, well‐defined, non itchy, whitish, scaly skin lesions on the right ear [Figure 1] and lower lip accompanied with thick, vegetative, whitish skin lesions over both elbow and forearm since 1 year [Figure 2]. The lesions were slowly progressive and were not associated with local or systemic complaints. There was no involvement of other body parts. Examination revealed single, round, well‐defined, atrophic scaly plaque of about 1‐cm diameter with hyperpigmented border on helix of the right ear and similar lesion on the lower lip. Large, hypertrophic, verrucous, whitish plaques of irregular dimensions (approximately 5 × 5 cm) were present on both elbows (three on right and two on left). Routine serum biochemistry along with urinalysis was within normal reference range. Antibody to native double‐stranded DNA was found to be within the normal range (14.2 U; normal range 0‐30 U).

Abdomino‐pelvic actinomycetoma successfully treated with combination chemotherapy

Mycetoma is a chronic granulomatous infection caused by either bacteria (actinomycetoma) or true fungi (eumycetoma). Eumycetoma is more common in northern India, while actinomycetoma is common in southern India. Actinomycetoma is a granulomatous chronic infection caused by filamentous bacteria and is characterised by oedema, erythematous nodules, and sinuses that drain secretions containing grains. A 29-year-old unmarried male farm worker presented with widespread multiple red ulcerated lesions with discharging sinuses over the abdomino-pelvic region for 10 months. He denied any history of trauma or recent surgical treatment. On examination, the patient was underweight (35 kg) and had multiple erythematous ulcerated nodules ranging from 3–6 cm in size over the lower left abdomen, pelvic and groin region with discharging sinuses. (Fig. 1) The ulcers had exuberant pouting granulation tissue, so-called proud flesh. A differential diagnosis of actinomycosis, actinomycetoma and atypical mycobacterial infection was made. A fine needle aspiration cytology showed acute inflammatory exudates containing neutrophils, phagocytic macrophages and illdefined clusters of histiocytes. Serology for retrovirus, hepatitis B and hepatitis C was negative. Routine serum biochemistry and urinalysis were within the normal reference range. A biopsy from the wound showed an acute inflammatory granulomatous response, an agglomeration of filaments and granules of bacterial colonies with a peribacterial radial deposition of intensely eosinophilic materialSplendore–Hoeppli reaction (Fig. 2). We were able to rule out fungal mycetoma in our patient as his biobsy showed the Splendore–Hoeppli phenomenon which is usually lacking in mycetoma of fungal origin. However, a culture of tissue material on Sabouraud dextrose agar, chocolate agar and Lowenstein–Jensen media did not yield any fungal, bacterial or mycobacterial growth, respectively, after 4 weeks of incubation. An abdominal ultrasound did not reveal any abnormality, except soft tissue oedema of the abdominal wall. As the microbiological studies were unable to provide a definite causative organism and background of similar clinical features, we made a provisional diagnosis of abdomino-pelvic actinomycosis and actinomycotic mycetoma. We decided to treat the patient first with parenteral benzathine penicillin 2.4 million units per week for 8 weeks to cover the organisms responsible for Actinomycosis (e.g. Actinomyces israelii). After eight shots of parenteral penicillin therapy, the patient showed a gradual improvement with healing of the lesions, but he reported having some new lesions. Bearing in mind the slow resolution of lesions and recurrence, we decided to revise our diagnosis to Actinomycotic mycetoma (actinomycetoma) and hence, we prescribed the patient combination chemotherapy comprising double strength co-trimoxazole and rifampicin to cover filamentous bacteria (Nocardia brasiliensis, Actinomadura madurae) in addition to penicillin therapy. After 6 weeks of combination therapy, the patient showed complete healing of wounds with atrophic scars. Up to the time of writing, the patient has been in remission and had gained weight. (Fig. 3) As the patient