Patrick Yesudian

Malignant Transformation of Hypertrophic Lichen Planus

A 50-year-old South Indian man presented with an ukerative growth on the middle of the left leg of 6 months duration. The patient had had itchy lesions on all the extremities for 5 years but had not sought any treatment. Examination revealed a large patch of vitiligo that extended from the left knee to the ankle. Pigmented papules and nodules, some of which had depigmented summits, were scattered irregularly over both legs. On the left leg there was a large hypertrophic and verrucous plaque. An ulcerated growth about 8 cm in diameter with everted edges was present over the middle of the left leg (Fig. 1). On his upper extremities, the patient had typical lichen planus papules. The lymph nodes in the left inguinal region were enlarged and hard. Biopsy specimens were taken from a papule on the right forearm and from the edge of the ulcer. The former showed the typical findings of lichen planus. Microscopic examination of the latter showed irregular atypical squamous cell hyperpiasia with many mitotic figures in the epidermis. A mononuclear infiltrate was present in the upper dermis. The specimen thus showed a poorly differentiated squamous cell carcinoma. The patieni refused a regional node biopsy and died 6 months later at home. No autopsy was done.

Genetic tylosis with malignancy: a study of a South Indian pedigree

Tylosis at birth was found as an autosomal dominant inheritance in twenty‐two members of a family spanning over five generations. Of those affected three of the fourth generation tylotics developed squamous carcinoma of the tylotic skin and one of these died of carcinoma of the oesophagus. It is possible that there is a genetic association between the state of the oesophagus and the tylosis of the palms and soles which predisposes both sites towards the development of squamous carcinoma.

Periumbilical Pseudoxanthoma Elasticum with Transepidermal Elimination

A 45-yecir-olcl multiparous, gravidd 5, ihin wonuin of complexion atttndecl nur skin clinic in March 1981 tor <in asymptomatic periunibilrcal cutaneous lesion of b months duration. Her family history was not significant. There was no history of gastrointestinal or cardiovascular symptoms, Dermatologic examination revealed hyperpigmentation with soft and slightly elevated papules being smooth in the periumbilical region. In most of the areas they coalesced lo form a reticulated pla îue of 1 6 x 8 cm in size, A few discrete keratolic lesions were present in Ihe upper part of the lesion (Fig, I). Systemic examination showed nn abnormalities. Her peripheral pulses were normal. Blood pressure in the upper extremities was 110/80 mmHg. Blood pressure in the lower extremities was higher than that of upper extremities—130/90 mmHg on the right side and 150/96 mmHg on the lefl side. Routint lilood, urine and stool examinations showed anemia wilh a raised ESR, glycosuria, and ankyloslomiasis, respectively. Blood VDRL was nonreactive. Hfr ECCi and ECHO cardiogram were normal. X-rays of the abdomen, pelvis, and extremities did not show soft tissue or vascular calcifkalion. Her chest X-ray showed parenchymal lesions in the mid and upper zones of the right lung, Mantoux test was positive (18 mm). Barium studies showed no gastrointestinal abnormalities. Post-prandial blood giLKOso level was i68 mg/dl, Other biochemical investigations ol blood urea, serum calcium, serum [ihosphorotJs, serum cholesterol, and serum alkaline phosphatase levels were within normal limits, Ophlhalmologic examination showed no angioid streak*̂ .

Hail the Dermato-Trichologist!

Established and ever growing evidences of inter disciplinary bonding of Trichology with Dermatology, Endocrinology, Immunology, Obstetrics and Gynecology, psychiatry, surgery and every specialty of medicine and surgery anchors the physician in every Dermatologist to play a pivotal role in diagnosing and treating hair disorders positively and passionately. The quintessential Dermatologist practicing ethical trichology should therefore and hence forth be called as Dermato‐Trichologist.

Lithium in trichology: a double edged weapon.

A very useful drug for the treatment and the prophylaxis of the latter is lithium. Though first discovered in 1818 by Johan August Arfvedson [Figure 1], it was used in clinical medicine only in 1843 by Alexander Ure for treating uric acid bladder stones. William Hammonds [Figure 2] was the first to use the drug in 1873 for the treatment of maniac episodes. In larger than pharmacological doses it did cause a few deaths and hence, like thalidomide it was consigned to the realms of medical history. However, after intense research, the drug was approved in 1970 for the treatment and prophylaxis of bipolar illness.

Hair Today, Gone Tomorrow

Hi Alice, I recently shaved the lower part of my pubic hair. I am a female. My husband and I both like the results, but I am a bit self-conscious about going to the doctor for a pap smear. Do you have any info on the prevalence of this practice and the response to it by doctors? Please let me know. I have delayed scheduling a much needed pap smear for fear of embarrassment. Thanks, Curious Read more [3]

Proceedings of the 7(th) World Congress of Hair Research.

The venue was the Edinburgh International Centre. At the opening ceremony, mementoes were presented to the various hair research societies around the globe, including The Hair Research Society of India (THRSI), which I accepted as its founder president. True to Scottish tradition, this was followed by the whisky tasting session wherein famous scotch whiskies were served for tasting and appreciation by connoisseurs.

Mind the hair

Pulling out one’s hairs can be a manifestation of anger, sorrow, or frustration. The two biblical priests, Ezra and Nehemiah, reacted in different ways when they found the children of Israel taking pagan wives for themselves. While the former pulled out his own scalp and beard hairs which can be a very painful procedure, the latter Nehemiah wisely pulled out the hairs of the people of Israel standing around him to show his anger.

Malignant atrophic papulosis (Degos' syndrome): First case report from India

SIR, Malignant atrophic papulosis (Degos syndrome) has recently been reviewed by Black (1976) and Degos (1979). A case of Degos syndrome in a female of 43 years, the first Indian case, is reported here. She had typical slin lesions with porcelain white atrophic centres and a well-defined erythematous edge (Fig. i). Unusually, numerous skin lesions, about 370, were present involving even the palms and soles. Dilated bulbar conjunctival vessels were also present. Skin biopsy of both an early and a late lesion showed the characteristic wedge-shaped hyalinization of collagen at the centre. Alcian blue stain showed deposits of mucin in the dermis. PAS stain revealed tliickening of the wall of the blood vessels. Lesions in palms and soles differ from the lesions elsewhere by the absence of porcelain white atrophic centres and by the presence of acanthosis instead of an atrophic epidermis overlying the central hyalinization of collagen. Palmar dermatoglyphics showed the sites of lesions in the palms, fingers and wrist areas (Fig. 2). Finger tip pattern study showed ulnar loop pattern (L) in all the fingers ot the right palm and in the left little finger. A central pocket loop (L̂ ; in the left ring finger, radial loop (L/) in the left middle finger, tented arch (A) in the left index finger and a whorl (W) pattern in the left thumb were present. A small loop (I) pattern was present in the I.1 of the right palm and I4 of the left palm. TFRC (total finger ridge count) was 157 (raised). The position of axial triadius was t. The atd angle was 40° in the right palm and 38° in the left palm. White lines were also present.