Kavita Bisherwal

Hypopigmented mycosis fungoides: Clinical, histological, and immunohistochemical remission induced by narrow-band ultraviolet B

Mycosis fungoides (MF) is the most common type of primary cutaneous lymphomas. Several clinical variants of MF have been described. Purely, hypopigmented variant of MF (HMF) is rare. Phototherapy, especially photochemotherapy (Psoralen and ultraviolet), is the most widely used method and is recommended as the first-line treatment for HMF. However, there are no standard guidelines for phototherapy as the disease is uncommon. We, hereby, report a 30-year-old woman with HMF in whom clinical, histopathological, and immunohistochemical remission was achieved following narrow-band ultraviolet B therapy.

Evaluation of cervical and anal intraepithelial neoplasia in women attending a sexually transmitted infection clinic

Background: The incidence of anal and cervical cancers and their precursors have increased in the past decades. Women with HIV and sexually transmitted infections are at a higher risk. Cervical human papilloma virus infection may serve as a reservoir and source of anal infection or vice versa. A higher incidence of anal cytological abnormality has been observed in patients with abnormal cervical cytology. Objectives: This cross sectional study was designed to estimate the prevalence and associations of anal and cervical cytological abnormalities in a cohort of sexually active women using Papanicolaou smears. Methods: We conducted a single centre study of 35 consecutive HIV positive and 40 HIV negative women attending the sexually transmitted infection clinic. Cervical and anal specimens were obtained for cytology after a detailed history and examination. Chi square test and coefficient of correlation were used for comparison. Results: Cervical dysplasia was observed in 22.6% (17.3% low-grade squamous intraepithelial lesion and 5.3% high grade squamous intraepithelial lesion) and anal dysplasia in 8% study subjects (6.7% low-grade squamous intraepithelial lesion and 1.3% high grade squamous intraepithelial lesion); no association was observed with HIV infection. A higher number of patients with cervical dysplasia (29.4%) were found to have concomitant anal dysplasia (P = 0.002). History of anal intercourse was reported in all patients with anal dysplasia and was higher (P < 0.037) in patients with cervical dysplasia. Limitations: The limitations included a small sample size, lack of correlation with histological findings and bias due to STI clinic-based recruitment of the study population. Conclusion: Cytology may be used to screen for cervical and anal dysplasia in women irrespective of HIV status. Women with cervical dysplasia may be preferentially screened for anal dysplasia and vice versa. Anal intercourse may be a risk factor for anal and cervical dysplasia.

Solitary collagenoma of the labium majus: A rare occurrence

Collagenomas are connective tissue nevi representing hamartomatous proliferation of collagen. Isolated collagenomas are of rare occurrence. They are sporadically acquired, and lesions are often localized to a single body region. We described a case of solitary collagenoma in a 23-year-old woman, confirmed on histopathology and special stains for collagen, involving an uncommon site such as labium majus. A high index of suspicion for a skin-colored circumscribed solitary growth and a low threshold for biopsy often help to arrive at a final diagnosis.

Pedunculated hemorrhagic cystic swelling: An unusual presentation of polydactyly

1. Burns DA. Necrobiotic disorders. In: Burns T, Breathnach S, Cox NH, Griffiths C, editors. Rook’s text book of dermatology. 8th ed. Oxford: Wiley‐Blackwell; 2010. p. 60.1‐60.12. 2. Garg S, Baveja S. Generalized granuloma annulare treated with monthly rifampicin, ofloxacin, and minocycline combination therapy. Indian J Dermatol2013;58:197‐9. 3. Naveen KN, Pai VV, Athanikar SB, Gupta G, Parshwanath HA. Remote reverse Koebner phenomenon in generalized granuloma annulare. Indian Dermatol Online J 2014;5:219‐21. 4. Dabski K, Winkelmann RK. Generalized granuloma annulare: Clinical and laboratory findings in 100 patients. J Am AcadDermatol1989;20:39‐47. 5. Rubel DM, Wood G, Rosen R, Jopp‐McKay A. Generalized granuloma annulare successfully treated with pentoxifylline. Australas J Dermatol 1993;34:103‐8. 6. Patrascu V, Giurca C, Ciurea RN, Georgescu CV. Disseminated granuloma annulare: Study on eight cases.Rom J MorpholEmbryol 2013;54:327‐31. How to cite this article: Nambiar KG, Jagadeesan S, Balasubramanian P, Thomas J. Successful treatment of generalized granuloma annulare with pentoxifylline. Indian Dermatol Online J 2017;8:218-20.

p16 immunostaining as a predictor of anal and cervical dysplasia in women attending a sexually transmitted infection clinic.

Background: Carcinogenesis caused by human papillomavirus (HPV) leads to over-expression of p16 protein. p16 may act as a marker of HPV integration with host genome and serve as a surrogate marker of HPV oncogenesis. Materials and Methods: A single center study of 75 women (35 HIV-positive and 40 HIV-negative women) was conducted. Anal and cervical specimens were obtained for cytology and p16 immunostaining. Results: The sensitivity of p16 to diagnose anal and cervical dysplasia was 50% and 58.8%, respectively, whereas specificity was 98.6% and 100%, respectively. Positive predictive value for anal and cervical was 75% and 100%, whereas negative predictive value was 95.8% and 89.2%, respectively. A strong relationship between the grade of dysplasia and intensity of p16 immunoscore was observed (Pearson correlation r = 0.666, P< 0.0001 and r = 0.496, P< 0.0001 for anal and cervical, respectively). Conclusion: p16 immunostaining with greater specificity for high-grade lesions may improve the diagnostic accuracy, especially for high-grade lesions which have a high risk of progression to malignancy and thereby necessitate treatment.

An asymptomatic inguinal swelling: Lymphatic filariasis.

Recently, there is an increasing trend of multiple pregnancies as a result of infertility treatment by ovulation induction. Moreover, the selective feticide that is sometimes performed to safeguard a precious pregnancy and avoid multiple births results in iatrogenic fetus papyraceus. Hence, more cases of congenital absence of skin in surviving co-twins following selective feticide are being reported.[1]

Subcutaneous emphysema mimicking angioedema

Sir, Subcutaneous emphysema is an uncommon entity that may be associated with an underlying pneumothorax. Timely intervention in the form of early diagnosis and treatment is important to avoid a fatal outcome.[1,2] It may mimic angioedema, a common and often a relatively benign disorder thereby leading to inappropriate management.[3] We report a case of a 65-year-old man who was referred to the dermatology outpatient department for evaluation of progressively increasing facial swelling of two days duration associated with difficulty in breathing. There was no preceding history of drug intake. There was no history of any food allergy, drug allergy, or similar such episodes in the past. He was a chronic smoker and a known case of chronic obstructive pulmonary disease (COPD). He developed acute respiratory distress three days ago and was subsequently diagnosed as a case of angioedema by a dermatologist and was prescribed tablet prednisolone 40 mg daily and tablet hydroxyzine 25 mg thrice daily with no symptomatic improvement over the next two days. Physical examination revealed the presence of a diffuse facial swelling predominantly involving periorbital region and both cheeks extending down to the supraclavicular region and upper chest. However, there was distinct sparing of the lips, which prompted us to look for other clues and to consider other differentials. Crepitus could be elicited on palpation of the swollen areas., Chest radiograph (posteroanterior view), showed presence of opaque striations/ shadows in the scapular region suggesting subcutaneous emphysema without any evidence of pneumothorax [Figure 1]. Therefore, a final diagnosis of subcutaneous emphysema, resulting probably from the rupture of an apical lung bulla in a patient with pre-existing COPD was made. The patient was referred to medical emergency where he was treated with anxiolytics, bronchodilators, and administered ventilation with 100% oxygen leading to remarkable improvement in respiratory distress and satisfactory reduction in facial swelling over next three days.

Annular atrophic plaque over the arm

DOI: 10.4103/2229-5178.185474 melanoma. Perilesional depigmentation has been reported in metastatic melanoma.[8] This is the first Indian report of multiple brain metastases in acral lentiginous melanoma with acute hemiparesis as the presenting manifestation. It was noteworthy that he also had vitiligo. Since the chance of late metastasis cannot be ruled out even in treated cases, it is emphasized that all patients with acral lentiginous melanoma should be thoroughly investigated and followed up for a life time as brain metastases can be effectively treated when detected early.

Aquagenic syringeal acrokeratoderma.

1. Weedon D. Weedon’s Skin Pathology. 3rd ed. London: Churchill Livingstone, Elsevier, 2010. p. 799‐800. 2. Takeda H, Mitsuhashi Y, Hayashi M, Kondo S. Eccrine syringofibroadenoma: Case report and review of the literature. J Eur Acad Dermatol Venereol 2001;15:147‐9. 3. Bandyopadhyay D, Chattopadhyay S, Saha S. Reactive eccrine syringofibroadenoma on a leprous foot. Indian J Dermatol Venereol This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Incontinentia pigmenti in a male neonate

We report a case of incontinentia pigmenti in a 3-day-old male neonate presenting with multiple vesicular and hyperkeratotic papular crusted lesions over the right leg and trunk in a blaschkoid pattern since birth, with characteristic histopathological findings. A good clinical acumen is required for diagnosing a rare disorder in the absence of genetic analysis and karyotyping.