Mariette D'Souza

Quality of life in psoriasis: a study from south India.

BACKGROUND Psoriasis can have a profound impact on a patients quality of life. Very few Indian studies have examined this aspect of Indian patients of psoriasis. AIMS This study was conducted to assess the clinical severity, as well as physical and psychosocial disability, and stress incurred and to analyze their interrelationship in psoriasis patients aged more than 18 years. METHODS This hospital-based cross-sectional study was conducted in the Department of Dermatology, JIPMER, Pondicherry, India. Clinical severity, physical and psychosocial morbidity, and the stress incurred were measured using psoriasis area severity index (PASI), psoriasis disability index (PDI), and psoriasis life stress inventory (PLSI) respectively, the latter two of which were suitably modified and translated into the local language, viz., Tamil. Appropriate tests were conducted using SPSS for Windows (Release 7.5.1) statistical software. RESULTS Fifty patients (34 males, 16 females) were included in the study. The clinical PASI scores correlated significantly with the overall physical disability (PDI), individual aspects of the PDI (except the treatment-related activities), and the measurement of stress incurred (PLSI). A PASI score of more than 18 delineated a subgroup of patients with higher overall physical disability and higher stress rating. Among the physical and psychosocial factors investigated, daily activities, employment, and treatment were reported to be affected the most. Psoriasis sufferers are also most likely to feel self-conscious, be disturbed / inconvenienced by the shedding of the skin, live in a constant fear of relapse, and avoid social interactions. CONCLUSIONS The present study provides compelling evidence that psoriasis affects the quality of life, and it highlights the importance of adopting a multidimensional assessment of psoriasis.

Dyschromatosis universalis hereditaria.

Summary Dyschromatosis universalis hereditaria is a clinically heterogenous disorder. We report two unrelated Indian patients with dyschromatosis universalis hereditaria, who had generalized and progressive reticulate hyper‐ and hypo‐pigmentation of the skin. The oral mucosa and tongue also showed mottled pigmentation. Intriguingly, the palms and soles were also affected with a diffuse hyper‐pigmentation interspersed with spotty de‐pigmented macules. Dystrophic nail changes with pterygium formation were seen in one case. Histopathology revealed a variable degree of pigmentary incontinence. Although the precise aetiology of this disorder is not yet known, the clinicopathological findings implicate an inherent abnormality of melanosomes or melanin processing.

Unilateral nevoid hyperkeratosis of the nipple and areola.

To the Editor: A 35-year-old woman presented with hyperpigmented and thickened skin of the right nipple. These skin changes started 7 years ago (i.e., 3 years after her last childs birth), were slowly progressive for the first 5 years, with occasional itching, and had become nonprogressive for the past 2 years. The patient had had two normal pregnancies and had breast-fed both children. No discharge from the nipple, associated warts, ichtbyosis, or acanthosis nigricans were reported. No family member had similar lesions. The skin of the left nipple and areola was hyperpigmented and hypertrophic with a rugose appearance (Fig. 1). On palpation, the involved skin was not indurated; it was nontender and not adherent to tbe underlying structures. There was no discharge from the nipple and no significant lymphadenopathy. Other systems were clinically normal and all baseline investigations were within normal limits. Histopathologic examination showed hyperkeratosis, papillomatosis, and acanthosis with keratotic plugging, consistent with nevoid hyperkeratosis (Fig. 2).

Fine needle aspiration cytology (FNAC) of nerves in leprosy.

Leprosy is primarily a disease of the peripheral nerves and a technique that is simpler than nerve biopsy is required to evaluate nerve involvement, especially in pure neuritic (PN) leprosy. This study was designed to evaluate the role of FNAC of the nerve in the diagnosis and classification of leprosy. A prospective study was carried out on 25 patients with clinically active leprosy and at least one thickened peripheral sensory nerve. Nerve aspirates were evaluated by May-Grunwald-Giemsa and Fites staining. Lepromin test, slit skin smears (SSS), skin biopsies (except PN cases) and nerve biopsies were performed and compared with FNAC. FNAC of nerve from 23 cases (92%) yielded diagnostic aspirates. Acid fast bacilli were observed in six cases by FNAC. FNAC and nerve pathology were equally comparable with the other parameters evaluated. Based on the results, cytological criteria were developed for interpreting nerve aspirates and the cases were classified as paucibacillary (18), BB (2), BL (2), LL (1) and non-diagnostic (2). All PN cases showed diagnostic paucibacillary type cytology. FNAC of the nerve yields diagnostic aspirates in leprosy comparable with nerve pathology and the proposed cytological criteria may be useful in classification of nerve aspirates.

Psychosocial impact of cicatricial alopecias

Background: Cicatricial alopecias have a significant impact on the psychological status, quality of life, and social interaction of those suffering from it. Till date, limited or no data have been available regarding the psychosocial and quality of life aspects of cicatricial alopecias. Aims: To assess the psychosocial impact of cicatricial alopecias. Materials and Methods: Thirty patients fulfilling the criteria for cicatricial alopecia irrespective of their age and sex were included in the study. Psychosocial assessment was carried out in 23 patients who were capable of responding to the questionnaire, using an adopted and suitably modified version of Womens Androgenetic Alopecia Quality of Life Questionnaire. Results: We observed that 73.9% of our patients with cicatricial alopecias had moderate to severe psychosocial impact due to their hair loss. Patients of younger age group and with inactive disease, suffered from greater psychosocial impact of the disease. Patients with slight hair loss also had considerable psychological distress. The chronicity of disease duration did not seem to reduce the psychosocial impact of the disease. Both married and unmarried patients suffered equally from the psychosocial impact of the disease. Conclusion: The management of cicatricial alopecias needs a holistic approach. In addition to laying an emphasis on early diagnosis aided by clinco-pathological correlation, to prevent irreversible hair loss, the psychosocial impact of the disease should also be taken into consideration and addressed by the treating dermatologist.

Dermatitis cruris pustulosa et atrophicans revisited: our experience with 37 patients in south India.

Background  Dermatitis cruris pustulosa et atrophicans (DCPA) is a distinctive type of chronic superficial folliculitis, with a number of unique features such as its peculiar symmetric localization to legs, extreme chronicity, resistance to therapy, and inevitable alopecia and atrophy.

Multiple Trichoepitheliomas with Rare Features

A case of multiple trichoepitheliomas associated with epidermal cysts is reported. The trichoepithelioma lesions were florid and extensive with large nodulo‐cystic lesions on the face and a new variant simulating hidradenitis suppurativa near the gluteal cleft.

Systematized epidermal nevus with profuse papillomatous flexural lesions.

A case of systematized epidermal nevus with profuse papillomatous flexural lesions is reported for its striking morphologic features and unusual variations in histopathology at different sites.

Hemorrhagic skin nodules and plaques: A diagnostic clue to underlying primary plasma cell leukemia

Plasma cell leukemia (PCL) is a rare lymphoproliferative disorder characterized by a malignant proliferation of plasma cells (PC) in blood and marrow. Cutaneous involvement is very rare in PCL. We present the case of a 45-year-old lady who presented with multiple hemorrhagic nodules and plaques in the skin. Her total leucocyte count was 2,00,200/cmm with 85% abnormal plasmacytoid cells in peripheral smear. Biopsy of the skin lesions revealed diffuse infiltration by plasma cells with ‘choked’ blood vessels. A diagnosis of plasma cell leukemia with cutaneous involvement was made. On the second day of admission, the patient expired probably because of intracranial bleed due to thrombocytopenia. Post-mortem bone marrow and liver biopsy also showed diffuse infiltration by plasma cells. Monoclonality of the cells was proven by demonstrating the production of only kappa light chains.