Nilendu Sarma

Repigmentation of vitiligo with punch grafting and narrow-band UV-B (311 nm)--a prospective study.

Background  Phototherapy is already established as an effective mode of therapy in vitiligo. An evidence‐based study was carried out of the effect of narrow‐band (311 nm) ultraviolet‐B (NB‐UV‐B) radiation in 66 surgically treated patients with recalcitrant vitiligo in whom autologous mini‐punch grafting was deployed.

Epidemic of hand, foot and mouth disease in West Bengal, India in August, 2007: A multicentric study

Background: Hand, foot, and mouth disease (HFMD) is caused mostly by Coxsackievirus A16 (CA16) and enterovirus 71 (EV71). Epidemic of HFMD has occurred in India only once in Kerala in 2003. We report here a recent outbreak of HFMD in three districts of West Bengal, India. Materials and Methods: A case detection system developed with 1) three private clinics in three districts; two at Howrah and one at Hooghly, 2) Pediatrics Department of two medical colleges in Kolkata, 3) 12 practioners of these three districts with 4) a central referral center at Department of Dermatology, NRS Medical College, Kolkata where all cases from this system were confirmed by a single observer. Pediatric Dermatology unit of the Institute of Child Health, Kolkata was another independent unit. Results: A total of 38 cases of HFMD were reported till 08.10.07. Age group ranged from 12 months to 12 years (mean 40.76 months, SD 29.49). Males were slightly higher than females (M:F - 21:17). Disease was distributed mostly over buttocks, knees, hands, feet - both dorsum and palmar or the plantar surface and the oral mucosa. Highest severity noted over the buttocks and the knee. Healing time for skin lesions was 6-13 days (mean 9.13 days, SD 1.93). Oral lesions were found in 33 (86.8%) cases. Conclusion: This outbreak far away from the initial one confirmed regular outsourcing of the virus with possibilities of future epidemics. Also the fact that EV71 induced epidemic is on rise in this part of globe is alarming for India. We hope this early report will be of help for strategic planning for a better management of the disease and prevention of dreaded neurological complications in India.

Hand, foot, and mouth disease: current scenario and Indian perspective.

Hand, foot, and mouth disease (HFMD), first reported in New Zealand in 1957 is caused by Coxsackievirus A16 (CVA16) and human enterovirus 71 (HEV71) and occasionally by Coxsackievirus A4-A7, A9, A10, B1-B3, and B5. This is characterized by erythematous papulo vesicular eruptions over hand, feet, perioral area, knees, buttocks and also intraorally mostly in the children. HFMD has been known for its self limiting course. Only small scale outbreaks have been reported from United States, Europe, Australia, Japan and Brazil for the first few decades. However, since 1997 the disease has conspicuously changed its behavior as noted in different Southeast Asian countries. There was sharp rise in incidence, severity, complications and even fatal outcomes that were almost unseen before that period. Following the near complete eradication of poliovirus, HEV71, the non-polio enterovirus, may become the greatest threat to cause significant neurological complications. This adds to the fact that effective therapy or vaccine is still a far reaching goal. There are reports of disease activity in different corners of India since 2004. Although of milder degree, continuous progress to affect larger parts of the country may indicate vulnerability of India from possible future fatal outbreaks. Low level of awareness among the health care providers may prove critical.

Occupational allergic contact dermatitis among construction workers in India.

Background: Allergic contact dermatitis is one of the important occupational hazards in construction workers and it often leads to poor quality of life of the workers with substantial financial loss. However, this is often a neglected entity. There are no past studies on the construction workers in Indian subcontinent. Objective: This pilot study has been done to assess the allergological profile among the workers engaged in construction of roads and bridges. Materials and Methods: The study was conducted among the workers working on construction of a bridge, flyover, and roads in West Bengal, India. Sixteen workers were selected on clinical suspicion. Ten were selected randomly and patch tested with Indian standard battery of patch test allergens. Analysis of reactions and relevance of positive test was assessed as per standard guidelines. Results: All the workers were men. Average age of workers was 24.8 years (range, 19-34 years). Dermatitis affected exposed parts in 93.75% and covered areas in 62.5%. Total positive test was 24 and relevant 11. Most common allergens were chromate (relevant allergy/RA: in 60% of patch tested workers), epoxy resin (RA: 30%), cobalt (RA: 20%), nickel (RA: 20%), thiuram mixture (RA: 10%) and black rubber mix (RA: 10%). Two cases (20%) had irritant contact dermatitis. Conclusion: The result indicated that chromate is the most frequent allergen among construction workers in this part of India. High frequency of involvement of the covered areas as well as the exposed areas highlighted the fact that the allergens had access to most body parts of the workers.

Progressive and extensive ulcerations in a girl since 4 months of age: The difficulty in diagnosis of pyoderma gangrenosum

A female child developed multiple, progressive, therapy-resistant, painful large ulcers, vesicles, and pustules since her 4 months of age. The ulcers were large, some even measured more than 8 cm; most had violaceous undermined margin with surrounding erythematous halo, raw and crusted surface and were distributed extensively over scalp, face, ear, trunk, buttocks, thigh, legs, dorsum of hands, and feet without any mucosal involvement. After detail clinical examination and investigation, it was diagnosed as a case of pyoderma gangrenosum. Extensive search did not reveal any systemic abnormality or detect any infective etiology. The case highlights the problems of diagnosis of multiple ulcers at very early age.

Amiodarone-induced angioedema: report of two cases.

Sir, Amiodarone, a class II long-acting anti-arrhythmic, capable of blocking both α and β -adrenoceptors is an iodine-containing highly lipophilic benzofuran derivative. Adverse reactions are common and are duration-dependent. Frequent reactions include nausea and other GI symptoms. Ten percent of patients may develop photosensitization (possibly due to phototoxicity) and bluish skin pigmentation, but allergic skin reactions are rare. The most serious sideeffect related to amiodarone is pulmonary alveolitis and fibrosis. Only a single case of amiodarone-induced angioedema has been reported in the literature. We came across two unrelated cases of angioedema triggered by the use of amiodarone in the last couple of years.

Mycophenolate mofetil as adjuvant in pemphigus vulgaris

Pemphigus vulgaris (PV) is a life threatening autoimmune blistering disease of skin and mucous membranes. Advent of systemic steroids has greatly reduced the mortality rate. However, steroids and adjuvant immunosuppressive therapy are nowadays frequent contributory agents of morbidity and mortality of PV. Mycophenolate mofetil (MMF) has been reported to be an effective adjuvant to systemic steroids. It helps in increasing the immunosuppressive effect and minimizing the toxicities by steroid sparing effect. However, its efficacy in refractory cases of PV is not well documented. The lowest possible dose with satisfactory therapeutic efficacy and least side effects is known. We used MMF 1 g/day and systemic steroids in 3 Indian patients with pemphigus vulgaris who were resistant to systemic steroid monotherapy or combination treatment with azathioprine. In our experience, MMF offers an effective adjuvant with minimal side-effects in the treatment of resistant PV.

Herpes-simplex-induced lip leucoderma revisited

Correspondence and Opinions 9 McQuarrie DG: Squamous-cell carcinoma arising in a tattoo. Minn Med 1966;49:799–801. 10 Bashir AH: Basal cell carcinoma in tattoos: Report of two cases. Br J Plast Surg 1976;29:288–290. 11 Earley MJ: Basal cell carcinoma arising in tattoos: A clinical report of two cases. Br J Plast Surg 1983;36:258–259. 12 Wiener DA, Scher RK: Basal cell carcinoma arising in a tattoo. Cutis 1987; 39:125–126. 13 Wilkin JK, Strobel D: Basal cell carcinoma arising at the site of venipuncture. Cutis 1985;36:297–298.

An observational study of cutaneous manifestations in diabetes mellitus in a tertiary care Hospital of Eastern India.

Background: Diabetes mellitus and its impact on the human body have been extensively dissected over the years. However, skin which is the largest organ in the body, has received minimum attention. Therefore, this study was designed to analyze the prevalence and pattern of skin disorders among diabetic patients from Eastern region of India. Materials and Methods: This is an observational study, conducted in the General Medicine and Endocrinology departments of a Medical College and Hospital in Eastern India. The data were collected prospectively and systematically in a pre-established proforma designed by us, where clinical findings along with investigations were recorded. Results: Six hundred and eighty (680) diabetic patients were examined, there were (64.8%) male and (35.1%) were female, of them 95.3% were Type 2 diabetics while 4.7% were Type 1. Five hundred and three patients (503) out of six hundred and eighty. i.e. 73.9% were found to have skin lesions. Thirteen (13) (41%) Type1 diabetics demonstrated skin lesions commonest being diabetic xerosis, infections and diabetic hand. Among Type2 diabetics 490(75.61%) showed skin lesions. Here infections, xerosis, hair loss beneath the knees, diabetic dermopathy were the most frequent. Majority of patients (67%) had combination of more than one type of skin lesion. There was statistically significant correlation of skin lesions with duration of diabetes, however similar correlation could not be demonstrated regarding metabolic control. Conclusion: Involvement of skin is inevitable and multifarious in diabetes mellitus. Higher prevalence is seen in Type 2 diabetic population. The duration of diabetes is positively correlated with lesions and infective dermatologic manifestations were associated with higher HbA1C values.

Familial disseminated plaque type porokeratosis with multiple horns and squamous cell carcinoma involving anal skin

Porokeratosis is a disorder of keratinization showing a well-defined lesion with a hyperkeratotic ridge on the border that contains the coronoid lamella. We report familial (autosomal dominant with reduced penetrance) disseminated plaque type (Mibellis type) porokeratosis in a father and son. In the father, there were multiple horns and a large squamous cell carcinoma in a large lesion over the perianal region that reached up to the squamo-columnar junction of the anal mucosa and even invaded the anal sphincteric muscles. Disseminated lesions of the Mibellis type, development of horns, and malignancy in this unusual location have not been previously reported.