Manjunath Mala Shenoy

Genital and perianal melanoacanthomas

Melanoacanthoma is a benign mixed tumor of melanocytes and keratinocytes. It has been regarded as a rare variety of Seborrheic keratosis. A 50-year-old male presented with multiple asymptomatic pigmented growths on the lower abdomen, inner thighs, external genitals and perianal areas. Histopathology revealed features of melanoacanthoma. The case is being reported for unusual sites of occurrence of an uncommon cutaneous tumor.

Nail changes in autoimmune blistering disorders: A case-control study

Background: Pemphigus and pemphigoid disorders produce blistering cutaneous lesions. Earlier case reports state that nail involvement is uncommon in these autoimmune blistering disorders. Aims and Objectives: To study nail changes in autoimmune blistering disorders. Methods: A case-control study was conducted where 40 cases and 40 controls were evaluated for nail changes. Results: Nail changes were seen in 72.5% of cases and 17.5% of controls. The most common nail findings were paronychia and onychorrhexis. Limitations: Small sample size; short study duration; nail biopsy could not be done. Conclusion: Our findings indicate that the inflammatory nature of the blistering cutaneous disease is often reflected conspicuously in the nails.

Two cases of axillary chromoblastomycosis.

Sir, Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue caused by dematiaceous fungi, the most common causative organisms being Fonsecaea pedrosoi, Phialophora verrucosa, Fonsecaea compacta and Cladophialophora carionni.[1] The hallmark of chromomycosis is sclerotic bodies which can be demonstrated in potassium hydroxide mount and routine hematoxylin and eosin staining.[2] Lower limbs are the most commonly affected sites. Unusual extracutaneous sites of involvement include pleural cavity, ileocecal region, laryngotracheal area and tonsils.[3] Dissemination, though rare, presents with multiple verrucous nodules and plaques over limbs, neck, face, lymph glands and tonsil according to reports.[4] The most frequent complication is secondary bacterial infection but malignancies have also been recorded.[2]

Dyslipidemia in Dermatological Disorders.

Dyslipidemias are one of the common metabolic disorders. A link between dermatological disorders like psoriasis and dyslipidemia has been established in the recent past. Many dermatological disorders could have a systemic inflammatory component which explains such association. Chronic inflammatory dermatological disorders could also have other metabolic imbalances that may contribute to dyslipidemia. Presence of such abnormal metabolism may justify routine screening of these disorders for associated dyslipidemia and other metabolic abnormalities and early treatment of such comorbidities to improve quality of life. Some of the drugs used by dermatologists such as retinoids are also likely to be a cause of dyslipidemia. Hence, it is imperative that the dermatologists obtain scientific knowledge on the underlying mechanisms involved in dyslipidemia and understand when to intervene with therapies. A systematic review of the English language literature was done by using Google Scholar and PubMed. In this review, attempts are made to list the dermatological disorders associated with dyslipidemia; to simplify the understanding of underlying mechanisms; and to give a brief idea about the interventions.

Glomus tumor of the nail unit

Glomus tumor is a benign tumor arising from the neuromyoarterial plexus concentrated beneath the nail. This plexus is an arteriovenous anastomosis functioning without the intermediary capillary bed. Etiology is not exactly known. It is debilitating to the patient because of the chronicity of symptoms and lack of proper investigation which will help in identifying the tumor at an early stage. We report a case of glomus tumor situated in the proximal nail fold region and causing longitudinal splitting of nail.

Pseudoxanthoma elasticum - "The multifaceted disorder"

Pseudoxanthoma elasticum (PXE) is a hereditary disorder that mainly involves the skin, eyes, and cardiovascular system. We report a case of a patient showing cobblestone-like yellowish papules over her neck and hands. There was a presence of calcifications below the chin that pointed at an initial diagnostic hint of PXE. A skin-biopsy specimen was taken and was stained with hematoxylin and eosin (H and E) that revealed fragmentation of the elastic fibers. On special staining, degeneration and calcification of the elastic fibers were seen that showed clumping in some areas of the dermis. These features were suggestive of histopathological diagnosis of PXE.

Dermoscopic features of distal lateral subungual onychomycosis

Background: Onychomycosis is a very common disease and accounts for upto 50% of the diseases affecting the nail apparatus. Diagnosis of onychomycosis is usually confirmed with the help of a potassium hydroxide (KOH) mount and fungal culture. Onychoscopy can be a handy and additional tool for the diagnosis. Aims and Objectives: To determine the dermoscopic findings in distal lateral subungual onychomycosis (DLSO). Materials and Methods: A prospective study of 60 nails with a clinical and mycological diagnosis (KOH with Chicago sky blue positive) of DLSO. Dermoscopic examination was performed using a Heine delta 20 plus dermatoscope and the features were recorded. Results: Longitudinal striae and jagged proximal edges seen in all 60 (100%) patients. Intermittent spiked pattern was seen in 47 nails (78.3%). Chromonychia and distal irregular termination were noticed in 23 (38.3%) and 7 (11.7%) nails, respectively. Conclusions: Onychoscopy can be used as an important diagnostic tool while evaluating nail disease, especially in DLSO. Limitations: Small study sample and lack of comparison with other nail diseases that manifests with distal onycholysis.

Revisiting hansen's disease: Recognizing the many neurodermatologic faces and its diagnostic challenges

Hansens disease (HD) looms still as a public health problem. Conventional wisdom and teaching largely view HD as a predominantly dermatologic disorder with much emphasis in the dermatology postgraduate curriculum. This review attempts to reorient this view and reemphasize that HD has primarily neurologic underpinnings since Mycobacterium leprae is an intracellular neurotropic bacterium. The main thrust of this article would, therefore, be a neurologists perspective of HD. The cutaneous manifestations of HD are the sequelae of the neurobiology of M. leprae, its selective predilection to human Schwann cells, neurovascular bundle and its localization in the intracutaneous nerve plexus of the skin. We discuss the nuances of HD as a “great imitator,” the many faces of its neurodermatologic clinical presentation, the neurologic basis of HD clinical examination, and its diagnostic and therapeutic challenges.

Nail evaluation in internal diseases: An indispensable exercise

Nails are the structures without any vital functions, but their diagnostic significance cannot be undermined. Nail unit constitutes the nail plate, nail bed, and nail folds which exhibit signs of the nail unit and internal disorders. Most nail changes are nonspecific, but some of them have high diagnostic significance. Many such changes have been described since the historic times, and many have been discussed in the recent literature. Diseases of the nail units such as infections may also indicate the presence of immunosuppression or diabetes. Interpretation of the nail changes requires an amount of expertise which any physician can obtain by careful observation. This article emphasizes the important nail signs in internal disorders.

Absent skin at birth with blistering: Bart's Syndrome?

Barts Syndrome is a disorder characterised by aplasia cutis congenita and epidermolysis bullosa. We report a case of a 4-day-old baby who had absent skin over the legs along with blistering and nail dystrophy. The diagnosis of Barts Syndrome was made based on history and clinical examination. However, detailed investigations and histopathological confirmation is needed for final diagnosis. The management is conservative and needs multidisciplinary support.