Mohammad Adil

Erythromelanosis follicularis faciei et colli: A clinicoepidemiologic study

We describe 25 cases of erythromelanosis follicularis faciei et colli from India. The male:female ratio was 5.25:1 and the average age of onset was 12.3 years. The cheeks, preauricular area, and submandibular region were the sites most commonly affected. Keratosis pilaris was seen in 22 (88%) of the patients.

A case of giant lupus vulgaris

Lupus vulgaris, the commonest form of tuberculosis of the skin, presents with a plaque that enlarges slowly with advancing edges while showing atrophy at other areas. It may be acquired by the blood stream, via lymph, by contiguous spread or from external inoculation. We describe a case of lupus vulgaris with a large erythematous-scaly plaque of 44 × 26 cm over the back and a similar 7 × 5 cm plaque over the right thigh. The plaque over the back was gradually progressive for the previous ten years and showed scarring and atrophy at places. Histopathology of the area showed caseating granulomas with Langhans giant cells, epitheloid cells and lymphocytes. A diagnosis of lupus vulgaris was made. This case is being presented owing to the large size of the lesion.

Reticulate dyschromia, congenital atrichia, papules, and speech delay in a child: An intriguing diagnostic dilemma

Disorders of reticulate dyschromia can be diagnosed on the basis of the distribution and type of pigmentation in association with coexisting abnormalities. We describe a 4-year-old male child with reticulate dyschromia of the dorsal aspects of hands and feet and over the axillae, buttocks, and groins. The child had near complete absence of hair over body since birth. Skin-colored firm papules were present over dorsal aspects of hands and feet, and milestones were delayed for speech. We discuss the probable differentials in this article and why it fits none of the existing differentials.

Efficacy of intralesional MMR vaccine in treatment of single or multiple refractory cutaneous warts

Introduction. The management of refractory warts continues to be a challenging task for the dermatologist. There are recent trends towards the use of intralesional immunotherapy by different antigens as they boost the cell-mediated immunity against human papilloma virus. Objective. To evaluate the efficacy of intralesional MMR (measles, mumps, rubella) vaccine in the treatment of single or multiple refractory cutaneous warts. Material and methods. The study included 200 patients with single or multiple refractory cutaneous warts. They were injected with the MMR vaccine 0.5 ml intralesionally in a single wart or in the largest wart in the case of multiple cutaneous warts, every 2 weeks for a maximum of 5 treatments or the complete resolution of warts, whichever was earlier. The follow-up was done at the end of 5 MMR injections, at 3 months and at 6 months. Results. Out of 200 patients, 191 completed the study. At the end of the study, 120 (62.8%) patients had complete resolution of all lesions, 8 (4.2%) had a partial response while no response was found in 63 (33%) of the patients. Conclusions. Intralesional immunotherapy with the MMR vaccine is an effective and safe modality for the treatment of single or multiple refractory cutaneous warts.

Clinico-epidemiological study of morphea from a tertiary care hospital

INTRODUCTION Morphea is an uncommon disease that presents with skin induration and sclerosis. The disease is common in Caucasians and there are few studies describing the clinicoepidemiological profile of these patients from the Indian subcontinent. METHODS This prospective study was conducted during a three year period from June 2014 to May 2017. All patients of morphea presenting to the dermatology outpatient department were evaluated for parameters like age, sex, duration, age of onset, clinical subtype and possible disease associations and triggering factors. The data was analysed, tabulated and mean, standard deviation and percentages calculated. RESULTS 47 patients were incorporated into the study. These comprised of 10 (21.28%) males and 37 (78.72%) females. The average age of the patients was 23.92 ± 12.07 years with a mean age of onset being 22.13 ± 12.51 years. 22 (46.80%) patients presented within one year of onset of disease. Plaque morphea was the commonest type seen in 31 (65.96%) patients followed by linear morphea in 9 (19.15%) patients. We found preceding trauma in 3 patients and morphea developed following herpes zoster and intramuscular injection in one patient each. CONCLUSION Morphea is an uncommon disease that is seen predominantly in females and young individuals. Circumscribed plaque morphea is the commonest variant. Certain predisposing factors like trauma can precede it.

Fenómeno isotópico inverso en el síndrome de reacción por drogas con eosinofilia y síntomas sistémicos

Reverse isotopic phenomenon, or isotopic non-response, is an extremely rare phenomenon characterised by the absence of a skin disease at the site of another unrelated skin disease which is already healed. Sparing occurs at the healed site of an inflammatory disease. Most reports of reverse isotopic phenomenon show the sparing of the skin previously involved in herpes zoster. We describe a case of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome due to carbamazepine with isotopic non-response at the site of healed herpes zoster. A 60 year male presented to us with complaints of fever, breathlessness and red itchy rash over body since 7 days. The patient had developed herpes zoster on the lower part of the right chest around two months back, and was prescribed Tab Carbamazepine by a local physician for the residual pain. On examination, the patient was found to have generalised swelling, particularly prominent over the periocular areas. He was febrile (100.6 F) and had tachycardia (heart rate-110/min) and tachypnea (respiratory rate-22/min). The abdomen was distended and bowels sounds were not heard. There was mildly tender lymphadenopathy in inguinal and axillary areas. Cutaneous examination revealed erythematous maculopapular lesions predominantly distributed over the face, trunk and proximal extremities with tendency to coalesce such that the whole of the trunk was involved except the right T9 dermatome which was characteristically spared. [Fig. 1] The skin of the right T9 dermatome showed hyperpigmented scars of the healed herpes zoster. [Fig. 2] The rest of the cutaneous and systemic examination was normal. Investigations revealed leucocytosis (TLC15500/ cu mm; normal4000-11000/ cu mm) with eosinophilia (AEC1580/ cu mm; normal40-440/ cu mm). There was elevation of liver enzymes (SGOT660 IU; normal7-40 IU, SGPT590 IU; normal7-56 IU) and increased blood urea (120 mg/dl; normal10-40 mg/dl) and serum creatinine (1.9 mg/dl; normal0.3-1.2 mg/dl). The patient had a normal chest radiograph and a gas filled distended bowel suggestive of paralytic ileus. The patient had hyperamylesemia (260 U/l; normal40-140 U/l) suggestive of pancreatitis. He subsequently developed fatal acute respiratory distress

A Case of Erythema Annulare Centrifugum Following Wood Injury: Is it the First Report?

A 15 year old male presented to us with complaint of a red lesion over the right shin for 3 weeks that was constantly increasing in size. The patient gave history that he sustained injury at the site with a wooden object around 6 weeks back. The wood was implanted in the skin and was removed by an unqualified local practitioner. He was given some topical ointment for application and the wound healed in around 10 days’ time. Three weeks back, he noticed red scaly lesion over the site of trauma that started to spread outwards. There was no history of fever, pain, itching or discharge from the site. There was no history of similar lesions elsewhere on the body. The patient was apparently healthy and had not been ill lately. He was not taking any medications. On examination, a large annular plaque of the size of 10 cm diameter was seen on the lower half of the right anterior leg with erythema and slight swelling of the periphery and central clearing. The erythematous plaque was extending distally towards the ankle (Figure 1). The scales over the lesion were trailing behind the advancing edges. Rest of the cutaneous, mucosal and systemic examination was normal. A potassium hydroxide mount from the edge of the lesion was negative. Lab investigations including complete blood counts, liver and renal function tests, urine and stool examination, thyroid function tests were within normal range. Antinuclear antibodies, Rapid plasma reagin test, hepatitis and herpes viral serology, serology for Borrelia burgdorferi and HIV screening ELISA were negative. Chest radiograph was normal and Montoux test was negative. Histopathology of the skin from the lesion showed mounds of parakeratosis, spongiosis and dense lymphohistiocytic infiltrate in the upper dermis, particularly in the perivascular location (Figure 2). Based on these features,

Atrophoderma of Pasini and Pierini in a blaschkoid pattern

Idiopathic atrophoderma of Pasini and Pierini (IAPP) is a disease characterized by well-defi ned skin patches with a “cliffdrop” border that show no signs of sclerosis and induration [ 1 ] . Idiopathic atrophoderma of Pasini and Pierini can be distinguished from linear atrophoderma of Moulin (LAM) by the latter’s earlier onset, nonprogressive course, blaschkoid distribution, as well as lack of infl ammation and absence of dermal changes. Herein, we present a case of progressive IAPP in a blaschkoid distribution. A 41-year-old female patient presented to us with a sixmonth history of gradually progressive, band-like, asymptomatic, dark-colored streaks on the left side of the abdomen. There was no history of previous lesions at that particular site. Clinical examination revealed multiple linear, hyperpigmented, atrophic plaques in a blaschkoid distribution, extending from the anterior midline across the left upper abdomen to the mid-back (Figure 1 ). The plaques had “cliff-drop” borders, and the affected skin was found to be normal, showing no sclerosis, induration, or signs of infl ammation. Routine lab tests were within normal limits; ANA testing was negative. Histopathological examination showed an unremarkable epidermis, a mononuclear infi ltrate and edema in the dermis, as well as clumping and homogenization of dermal collagen fi bers (Figure 2 ). ELISA for Borrelia burgdorferi was negative. Based on the clinical and histopathological fi ndings, our patient was diagnosed with IAPP in a blaschkoid pattern. She

Autoimmune hypothyroidism in jobs syndrome: An extremely rare finding

4. James WD, Elton DM, Berger TG. Andrews’ Diseases of the Skin: Clinical Dermatology. 11th ed. UK: Saunders Elsevier; 2011. p. 675‐93. 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.

Unilateral striate-punctate keratoderma: An extremely rare presentation of punctate keratoderma

© 2017 Indian Journal of Dermatology, Venereology, and Leprology | Published by Wolters Kluwer Medknow 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. Access this article online