Parimalam Kumar

Ulcerated infantile haemangioma of leg successfully treated with propranolol

Infantile haemangioma (IH) frequently requires no intervention. Eighty percent of IHs are focal and solitary. Fifteen percent of cutaneous haemangiomas occur on the extremities. A large size or a specific location or both may carry complications such as ulceration which is one of the main complications, and active treatment is usually required to manage pain, potential scarring, and occasionally, bleeding and infection. Oral propanolol is used in the treatment of IH and is found to be an effective treatment for complicated IH, replacing systemic corticosteroids as first-line therapy. Recommendations for instituting treatment with propranolol in infants differ among different specialties and academic centres. We report an infant with ulcerated IH of leg who responded dramatically to treatment with propranolol in 4 months.

Trigeminal trophic syndrome

Trigeminal trophic syndrome (TTS) is a rare cause of facial ulceration, consequent to damage to the trigeminal nerve or its central sensory connections. We reporta case of TTS in a 48-year-old woman with Bells palsy following herpes zoster infection. The patient was treated and counseled. There hasnot been any recurrence for 1 year and the patient is being followed-up. The diagnosis of TTS should be suspected when there is unilateral facial ulceration, especially involving the ala nasi associated with sensory impairment.

The scope of teledermatology in India

Telemedicine describes the application of information and communication technologies in the entire range of functions that involve the health sector. Several medical and surgical specialties utilize tele-consultation. Dermatology is the best clinical specialty in the use of communications technology because of its inherently visual nature in both diagnosis and follow-up, which makes it easily applicable to virtual medicine. Teledermatology embraces great potential for revolutionizing the delivery of dermatologic services to remote and distant locations by means of telecommunications and information technology. It encompasses consultations between a patient (and the primary healthcare provider) and a dermatologist for diagnosis and management advice. Teledermatology also covers dermatological education for health professionals and for consumers. Teleconsultations reduce time and increase the chances of access to one or more consultants as the patient or referring doctor desires, irrespective of the distance between the two. Its usefulness in the field of surgery and aesthetic surgery is immeasurable as there are only a few experts in the field of aesthetic surgery available currently in comparison to the dermatology population and the ever growing awareness and demand of the patients towards aesthetics. As the field of teledermatology is advancing in leaps and bounds the day is not far off when an aesthetic surgeon will be able to perform his skill from his own office on a patient in a distant locality with the help of a qualified and trained assistant. By adopting high-tech medical communication, high-performance computers, high-resolution cameras, and fiber-optic equipments the entire world shrinks!

Erosive adenomatosis of the nipple masquerading as Paget's disease

Erosive adenomatosis of the nipple (EAN) is a rare, benign neoplasm of breast lactiferous ducts. Peak incidence is in the fifth decade in women. Clinically, it is mistaken for eczema during early stages and Pagets disease at later stages. We present a young lady with EAN who was advised mastectomy. It is important for dermatologists to be familiar with this entity to avoid topical steroid abuse and unwarranted breast removal. This case is presented for awareness and importance of correct and early diagnosis.

Rhino cerebral mucormycosis in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a multisystem connective tissue disease. Patients with SLE develop cutaneous infections due to immune dysregulation and treatment with immunosuppressive agents. Deep fungal infections are rare in SLE but are important cause of morbidity. We report a case of successfully treated rhino cerebral mucormycosis (RCM) in a female patient with SLE.

Comorbid conditions in psoriasis - Higher frequency in females: A prospective study.

Aim: To study the association of obesity, diabetes, hypertension, and abnormal lipid profile in women above 40 years of age with psoriasis. Materials and Methods: Two hundred consecutive female patients with psoriasis attending private clinics were included. Complete general, systemic, and dermatological examinations were performed. Blood pressure, blood sugar, and lipid profile were recorded in all patients and the findings analyzed. Results: Of 200 patients, 45 were obese. Eighty-eight patients had diabetes mellitus and 29 had dyslipidemia of whom 13 and 18, respectively, were detected at the time of enrolment. All 25 patients with systemic hypertension were on treatment. A total of 177 (88.5%) patients had one or more comorbid conditions. This frequency is much higher when compared to other Indian studies where the sample included patients of both sexes.

Histology of psoriatic erythroderma in infants: analytical study of eight cases.

Background: Erythroderma in infants is a rare condition of varied etiology. Psoriasis is now emerging as the most common cause of erythroderma in infants. Early diagnosis of the etiological cause much depends upon the histological confirmation, which is essential for an early and appropriate treatment. Aim: It was aimed to study the histological findings in psoriatic erythroderma in infants. Materials and Methods: A total of 8 infants up to 1 year of age presenting with erythroderma, clinically suspected to be of psoriatic etiology attending private clinic were included. After detailed history taking and astute clinical exam, all of them were biopsied. In case 6, with a positive family history of psoriasis and asthma in parents, biopsy was taken from two sites. The histological findings of all nine biopsies were studied and analyzed. Results: Histology of all eight children showed psoriasi form pattern with acanthosis (AC) and dilated papillary capillaries (PC). Spongiform (SF) pattern was seen in the second biopsy (6b) of child with features of both psoriasis and atopy. SF pustule of Kogoj or Munros abscess was not seen in any of them. Conclusion: Regular AC and PC dilatation were the consistent histological findings observed in infants with erythrodermic psoriasis. These were the early findings observed in younger infants. Co-existence of psoriasis with atopic dermatitis may indicate a common pathogenic mechanism or an immunogenetic spin-off.

Type A woolly hair nevus

We present a 5-year-old girl with Type A woolly hair nevus. This is a rare non-hereditary focal condition characterized by unruly and tightly coiled hair. It may be associated with epidermal or melanocytic nevus. Children with woolly hair must be examined completely and monitored regularly to rule out cardiofaciocutaneous and Noonan syndrome.

Pseudoxanthoma elasticum with periumbilical perforation in a Nullipara

Pseudoxanthoma elasticum (PXE) is an inherited multisystem disorder that primarily affects the skin and is characterized by progressive calcification and degeneration of the elastic fibers. PXE has recently been found to be caused by mutations in the ATP-binding cassette transporter C6 (ABCC6) or the multidrug resistance–associated protein 6 (MRP6) genes. Perforating PXE is a rare presentation that is usually seen in the periumbilical area in obese multiparous black women; it has distinct clinical and histopathological features and there may or may not be systemic manifestations. We report an unusual case of PXE in a nulliparous woman, with perforation in the periumbilical area and without any systemic involvement.