Meenu Barara

Cryotherapy in treatment of keloids: Evaluation of factors affecting treatment outcome

Background: Keloids are cosmetically disfiguring benign fibrous outgrowths, which present as a major therapeutic dilemma due to their frequent recurrence. Despite a wide therapeutic armamentarium available for these scars, none has been found to be completely effective and satisfactory. Cryosurgery has offered some promise in the treatment of keloids.We conducted this study to evaluate the effect of cryotherapy in treatment of keloids and to relate the treatment outcome with the clinico-etiological factors. Materials and Methods: A hospital-based interventional study was conducted in 30 patients of keloids. Patients received two freeze thaw cycles of 15 seconds each at four weekly intervals for six sessions or flattening greater than 75%; whichever occurred earlier. Patients were assessed after three treatment sessions and at treatment completion regarding thickness and firmness of lesions. Patient satisfaction scale was used to evaluate the treatment outcome at completion of six treatment sessions. Paired Students t-test and Analysis of variance (ANOVA) were used for statistical analysis. Results: Average flattening noted after 3 and 6 sessions of cryotherapy was 30.76% and 58.13%, respectively. The duration of lesions and thickness of keloids correlated significantly with the result of treatment. The site and aetiology did not influence the outcome of cryosurgical treatment. Conclusion: Cryotherapy seems to be an effective treatment modality for keloids of recent onset, particularly smaller lesions. Duration and thickness of the keloids were found to be the most important factors in determining treatment outcome with cryotherapy in our study. Larger studies are, however, required to confirm the efficacy of this treatment modality and to validate our findings of the factors affecting treatment outcome.

Amyloidosis cutis dyschromica: a rare pigmentary disorder

Amyloidosis cutis dyschromica represents a rare type of primary cutaneous amyloidosis with few reported cases worldwide. It is characterized by asymptomatic, generalized hyperpigmentation with intermingled hypopigmented macules without atrophy or telangiectasia. We report herein a 19‐year‐old female who developed this pigmentary abnormality at 4 years of age. Her aunt and great grandfather also had similar skin pigmentation. An unusual finding in our patient was the presence of papules in addition to characteristic macules. Amyloid deposits were shown histopathologically in both dyschromic macules and papules.

Speckled lentiginous nevus syndrome with median nerve paresis: A rare syndrome with a new association

Speckled lentiginous nevus (SLN) represents a mosaic phenotype which consists of café au lait macule superimposed by melanocytic nevi. Recently, SLN syndrome has been characterized where ipsilateral neurological abnormalities have been reported in association with SLN with papular type of melanocytic nevi only. This case describes the presence of ipsilateral thenar muscle atrophy with median nerve paresis in nevus spilus which had melanocytic nevi of the macular type alone, thus delineating a new association in SLN syndrome, hitherto unreported.

Sexually transmitted diseases among men who have sex with men: A retrospective analysis from Suraksha clinic in a tertiary care hospital

BACKGROUND Men who have sex with men (MSMs) are a vulnerable population for spread of sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). Apart from being important for HIV transmission, they tend to have a different distribution patterns of STDs. Few Indian studies have looked into this aspect. OBJECTIVE We retrospectively analyzed the available data on MSM from Suraksha clinic of a tertiary care hospital in a metropolitan city from 2004 to 2010. MATERIALS AND METHODS A total of 75 MSM constituting 11.4% of the total 660 patients visited our Suraksha clinic in these 6 years. The clinical and behavioral profile of each patient along with the pattern of STDs was evaluated. OBSERVATIONS AND RESULTS 75% of the MSMs were promiscuous; one-third of them indulging in only homosexual activities. Syphilis was the most common STD, followed by condyloma acuminata, herpes genitalis, and gonorrhea. On comparing the data on the STD profiles of the heterosexual males, predisposition toward bacterial STDs among MSMs was observed. CONCLUSION Identification of MSMs is important as most of them are bisexual and promiscuous, thereby playing a role in spread of STDs in vast number of partners. The profile of STDs also differs in MSM, which makes it all the more important to identify them.

An unusual presentation of filariasis: cytology solves the puzzle.

Lymphatic filariasis is one of the leading causes of permanent disability in the world. Common manifestations of filariasis include early filariasis (acute lymphadenitis, lymphangitis, epididymo-orchitis), chronic obstructive filariasis (lymphedema, hydrocele, elephantiasis, chylous ascites, chyluria), and occult filariasis (tropical pulmonary eosinophilia, filarial arthritis). We describe a case with subcutaneous firm to cystic swellings, which on aspiration revealed a large number of microfilariae. Filariasis manifesting as subcutaneous nodules is an extremely rare presentation. Detection of microfilariae in fine needle aspiration cytology (FNAC) of subcutaneous nodules is highly unusual, although microfilariae have been reported in FNAC from lymph node, breast, thyroid, bone marrow, and body fluids.

Idiopathic thrombocytopenic purpura masquerading paediatric SLE

1. Halliday RB, OConnor BM, Baker AS. “Global Diversity of Mites”. In Peter H. Raven and Tania Williams. Nature and human society: The quest for a sustainable world: Proceedings of the 1997 Forum on Biodiversity. Washington DC: National Academies; 2000. p. 192-212. 2. Ralph GP. Effects of the haematophagous mite Ornithonyssus bursa on nestling starlings in New Zealand. New Zealand J Zool 1977;4:1. 3. Owen JP, Mullens BA. Influence of heat and vibration on the movement of the northern fowl mite (Acari: Macronyssidae). J Med Entomol 2004;41:865-72.