Neeraj Srivastava

Ashy dermatosis-like pigmentation due to ethambutol.

Sir, A 30 year-old Indian woman presented to us with asymptomatic, multiple, hyperpigmented macules. She had been receiving treatment for abdominal tuberculosis in the form of levofloxacin (750 mg daily) and ethambutol (800 mg daily) for two months, followed by levofloxacin, rifampicin (450 mg daily) and isoniazid (300 mg daily) for eight months. Macular lesions appeared on her forearm about two weeks after starting the initial treatment course. No new lesions had appeared and existing lesions did not enlarge since ethambutol was stopped; however, the pigmentation had persisted.

Pityriasis Lichenoides Chronica: Onset At Birth

To the Editor: Pityriasis lichenoides is an uncommon idiopathic dermatosis, which has been divided in two forms, acute (pityriasis lichenoides et varioliformis acuta, PLEVA) and chronic (pityriasis lichenoides chronica, PLC) variants, on the basis of morphology, histopathology, and the course of skin lesions. A 5-month-oldmale infant presentedwith ahistory of reddish-brown papules with adherent scales since birth. These papules first appeared on his left thigh, and over time similar lesions appeared in crops over his trunk and upper and lower extremities. The parents reported a history of gradual involution of individual lesions over a coupleofweeks.During this period, thepapules flattened and scales separated spontaneously, leaving behind hypopigmentedmacules without scarring. At the time of examination, the papules and macules were present on A B

Pseudoxanthomatous mastocytosis: Pseudoxanthomatous mastocytosis

A 50‐year‐old woman presented with itchy, multiple, flat, yellowish, waxy papules and plaques diffusely involving her face, trunk, and upper extremities for 5 years ( Fig. 1 ). Itching was moderate to severe in intensity and was episodic, without any identifiable aggravating or relieving factors. On rubbing the lesions with a blunt object erythema was elicited. Her ophthalmological examination was normal. Her complete hemogram was normal along with other routine investigations. Patients slit skin smear for acid‐fast bacilli and rk39 dip‐stick ELISA for post‐kala‐azar dermal leishmaniasis were negative. Ultrasound examination of her abdomen was normal and skeletal survey showed no evidence of bony changes. Histological examination showed diffuse dense infiltrate of numerous mast cells filling up the papillary dermis and most of upper‐ and mid‐reticular dermis. Overlying epidermis showed moderate epidermal hyperplasia and hyperpigmentation. There was sparse scattering of neutrophils within the infiltrate. Extracellular mast cells granules were also seen ( Fig. 2 ). Diagnosis of diffuse cutaneous mastocytosis of pseudoxanthomatous variety was made.

Familial Behçet's disease

There are very few reports of Behetaets disease from India. Familial aggregation of Behetaets disease has been reported with restricted geographical distribution. We report here familial Behcets disease from India in two brothers aged 30 and 32 years. Both patients had recurrent oral and genital ulcers for approximately five years. They also had arthralgias on and off along with fever. Pathergy test was positive in both cases. Their younger brother and a sister had recurrent oral aphthous ulcers.

Papulonecrotic tuberculid of the glans: worm-eaten appearance.

(survival usually less than 12 months). Although no particular association has been found between plasmacytic infiltrates of the skin and the type of monoclonal globulin, there is a very good correlation between the immunoglobulin type of serum and cutaneous plasma cells (usually IgG/κ, in our case IgG/λ). In conclusion, cutaneous plasma cell infiltration may be the first manifestation of MM, and good awareness is needed for prompt diagnosis and treatment, particularly in the absence of the typical clinical signs and laboratory findings of MM.