Nadia Iftikhar

Rare variants of Cutaneous Leishmaniasis: Whitlow, paronychia, and sporotrichoid

Cutaneous Leishmaniasis is endemic in certain areas of Pakistan, with the wet form of the disease being the most prevalent. It has a number of morphological variants, which are dependant on the immune status of the host, the subspecies of the Leishmania, and also, to some extent, on the site of involvement. We describe here a case of Leishmaniasis showing two very rare variants, whitlow and paronychial lesions, occurring concurrently with sporotrichoid spread. The patient responded to intramuscular sodium stibogluconate with resolution of the skin lesions.

Presentation of early onset psoriasis in comparison with late onset psoriasis: a clinical study from Pakistan.

BACKGROUND Early onset psoriasis and late onset psoriasis are known to have different clinical patterns in Caucasian population. However, there is paucity of data among Asian patients. AIMS To compare the clinical presentation of early onset psoriasis with late onset psoriasis in Pakistani population. METHODS During the study period, participating dermatologists filled a pre-tested questionnaire for each patient with psoriasis on first encounter. The questionnaire incorporated information regarding clinical and demographic features of psoriasis including age of onset, clinical type of psoriasis, nail or joint involvement, and PASI score. Patients were then divided into early onset (age of onset < 30 years, group I) and late onset (age of onset > or =30 years, group II) psoriasis. RESULTS Five hundred and fifteen questionnaires were filled and returned for evaluation. There was no statistically significant difference in both groups with regards to gender, family history (P = 0.09), nail (P = 0.69) and joint (P = 0.74) involvement, disease severity (P = 0.68), and clinical type of psoriasis (P = 0.06). No significant difference between disease severities measured by PASI score was observed in the two groups (P = 0.68). Presence of nail involvement was associated with joint disease in both groups (odds ratio 2.8, confidence interval 1.9-4.1). CONCLUSION Patients with early and late onset psoriasis in Pakistani population do not show different clinical and demographic features contrary to the Western patients.

Dermatologic, periodontal, and skeletal manifestations of Haim-Munk syndrome in two siblings

Haim-Munk syndrome is an extremely rare autosomal recessive disorder of keratinization characterized clinically by palmoplantar hyperkeratosis, severe early onset periodontitis, onychogryphosis, pes planus, arachnodactyly, and acro-osteolysis. Recently, germline mutations in the lysosomal protease cathepsin C gene have been identified as the underlying genetic defect in Haim-Munk syndrome and in the clinically related disorders, Papillon-Lefèvre syndrome and prepubertal periodontitis.

Trichostasis spinulosa: possible association with prolonged topical application of clobetasol propionate 0.05% cream

A 20‐year‐old woman of south Asian descent was concerned about her dark complexion, predominantly affecting the exposed areas of her body, including the face, neck, upper chest, and extremities. She tried multiple over‐the‐counter products, including topical hydroquinone, kojic acid, and various herbal formulations, without success. Three years previous to her presentation, she was given clobetasol propionate 0.05% cream by a friend, which she applied to the face, neck, upper chest, and arms.

Intertriginous eruption induced by terbinafine: a review of baboon syndrome.

A 60-year-old otherwise healthy man presented with a 1-week history of a mildly stinging erythematous eruption involving the buttocks and the flexural areas, including the axillae and the groins. His past medical history was significant for a recently diagnosed tinea pedis for which he was prescribed terbinafine HCl 125 mg tablets twice a day for 2 weeks about 10 days prior. On the third day of initiating treatment with terbinafine, a flexural rash was noted affecting the axillae. Despite the rash, he continued taking the medication for another few days, but as the rash worsened and progressed to involve the groins and upper inner thighs, he consulted his GP who immediately stopped the patient’s medication and referred him to a dermatologist. Physical examination revealed an erythematous eruption symmetrically involving the axillae, sides of the trunk, midsternal groove, antecubital fossae, groins, and the perianal and gluteal areas. It appeared as large welldemarcated dusky red patches with central confluence (Fig. 1). Superficial peripheral desquamation was also noted particularly around the axillae (Fig. 1). There were no raised or advancing margins at the periphery, and the superficial scrapings from the multiple affected sites showed no fungal elements on microscopy of the potassium hydroxide-treated samples. He was otherwise well, and there was no recent history of any upper respiratory tract infection, pharyngitis, or fever. He had not taken any other medications recently except terbinafine. According to his previous medical record, he had not been prescribed topical and/or oral terbinafine before. There was no personal and/or family history of atopic diatheses or any other drug hypersensitivity. His routine blood and urinalyses were unremarkable. Antistreptolysin titer was also within normal limits. Patch tests, carried out with terbinafine HCl, prepared in petrolatum and water as a vehicle, at different concentrations (5, 10, and 30% according to the guidelines of the International Contact Dermatitis Research Group) remained negative after 48 and 72 hours. Histopathologic examination of the biopsy from the affected sites showed a mixed, predominantly mononuclear perivascular infiltrate in the dermis. After clinicopathologic correlation, a diagnosis of drugrelated baboon syndrome (BS) or symmetrical drugrelated intertriginous and flexural exanthema (SDRIFE) was made. A drug provocation test was refused by the patient. He was treated with saline compresses and mild topical steroids. The eruption appeared to have cleared with desquamation when the patient was seen at the follow-up examination after 1 week.