Premanshu Bhushan

The Spectrum of Skin Disease Among Indian Children

Abstract:  Skin diseases in children are encountered frequently and their characterization is essential for the preparation of academic, research and health plans. A retrospective study was designed to evaluate the epidemiologic features of pediatric dermatoses in India. The setting was a tertiary care referral center in India (Kalawati Saran Children’s Hospital, New Delhi) during January 1997 to December 2003. A total of 30,078 children less than 12 years of age with 32,341 new dermatoses were recorded, with a male to female ratio of 1.07:1. Most of the disease was seen in the 1‐ to 5‐year age group (44.94%). The most common skin diseases were infections and infestations (47.15%) consisting of bacterial infections (58.09%) and scabies (21.54%), followed by eczemas (26.95%), infantile seborrheic dermatitis, scabies, and pityriasis alba. Other unique dermatoses in our settings were papular uticaria (3.59%), miliaria (5.46%), postinflammatory pigmentary abnormalities (1.68%), and nutritional deficiency dermatoses (0.45%). A majority of patients were diagnosed clinically and special diagnostic tests were conducted in 2.6% of patients. The most common diagnostic test used was KOH mount (59.2%), followed by skin biopsy (39%). Nearly 90% of patients were seen without any referral and in the remaining, a majority were referred by pediatricians (75%). A majority of patients were diagnosed to have infection followed by dermatitis in our setting.

Efficacy of fixed low-dose isotretinoin (20 mg, alternate days) with topical clindamycin gel in moderately severe acne vulgaris

Background  In view of the potentially serious side‐effects of standard isotretinoin (0.5–1.0 mg/kg per day) therapy for acne, we studied the safety and efficacy of low‐fixed dose isotretinoin plus topical 1%clindamycin gel in the treatment of moderate grade of acne.

Diagnosing multibacillary leprosy : A comparative evaluation of diagnostic accuracy of slit-skin smear, bacterial index of granuloma and WHO operational classification

BACKGROUND In view of the relatively poor performance of skin smears WHO adopted a purely clinical operational classification, however the poor specificity of operational classification leads to overdiagnosis and unwarranted overtreatment while the poor sensitivity leads to underdiagnosis of multibacillary (MB) cases with inadequate treatment. Bacilli are more frequently and abundantly demonstrated in tissue sections. AIMS AND METHODS We compared WHO classification, slit-skin smears (SSS) and demonstration of bacilli in biopsies (bacterial index of granuloma or BIG) with regards to their efficacy in correctly identifying multibacillary cases. The tests were done on 141 patients and were evaluated for their ability to diagnose true MB leprosy using detailed statistical analysis. RESULTS A total of 76 patients were truly MB with either positive smears, BIG positivity or with a typical histology of BB, BL or LL. Amongst these 76 true-MB patients, WHO operational classification correctly identified multibacillary status in 56 (73.68%), and SSS in 43 (56.58%), while BIG correctly identified 65 (85.53%) true-MB cases. CONCLUSION BIG was most sensitive and effective of the three methods especially in paucilesional patients. We suggest adding estimation of bacterial index of granuloma in the diagnostic workup of paucilesional patients.

DPT vaccine‐induced lipoatrophy: an observational study

Introduction  Diphtheria Pertussis Tetanus (DPT) vaccine is universally used in infants and children. It is generally safe and well tolerated. Local reactions such as erythema, induration, palpable nodules, and injection site abscess are well known. Injection site lipoatrophy has not been reported earlier.

Bullous pilomatricoma: a stage in transition to secondary anetoderma?

Pilomatricoma is an uncommon hamartomatous tumor of the hair matrix. Bullous and anetodermic changes over pilomatricoma are rare. We report an 18-year-old male with an asymptomatic nodule with overlying cystic changes on the left arm of 6-month duration with clinical and histological features of both bullous and anetodermic modifications. We also reviewed the associated literature to conclude that there is sufficient overlap in these two entities. Both variants show a bullous or pseudobullous appearance clinically and loss of elastin, sparse collagen bundles separated by intense edema, and dilated lymphatics/blood vessels in the dermis overlying the tumor mass histologically. We therefore propose that bullous, pseudoampullary, anetodermic, and lymphangiectatic forms should be considered as synonymous or transitional to the ultimate scar-like anetodermic appearance.

Multiple reddish papules in the bathing trunk distribution

A 20‐year‐old boy presented with multiple, discrete, 2‐4 mm sized, red‐purple papules on the arms, trunk, penis, scrotum and legs, becoming confluent around the umbilicus [Figure 1]. The papules started appearing 3 years ago on his thighs and occasionally bled on trauma, without any other symptoms. The patient had episodic burning pain in both hands and feet, heat intolerance and decreased sweating. There was no history of abdominal pain, bone pain, edema of the feet, auditory or neurological complaints or significant drug intake. No other family member had similar features. Systemic and ophthalmic evaluations revealed no abnormalities.

Porokeratotic eccrine ostial and dermal duct nevus: A report of three cases.

Sir, Porokeratotic eccrine ostial and dermal duct nevus is a rare non-hereditary eccrine hamartoma. This disorder of keratinization usually occurs at birth or in early childhood but may sometimes present in adults. It generally involves acral areas, especially palms and soles and is characterized by multiple punctate pits or keratotic papules and plaques with comedo-like plugs in a linear distribution.[1] The histopathological hallmark of porokeratotic eccrine ostial and dermal duct nevus is the presence of a cornoid lamella with subjacent acrosyringium.

Angioma serpiginosum: A case series of 4 patients

Angioma serpiginosum is clinically characterized by multiple copper to red-colored grouped macules that are arranged in serpiginous or gyrate patterns. Histologically, it is characterized by dilatation and proliferation of vessels in the papillary dermis.[1] The occurrence of angioma serpiginosum on the upper limb is rare while we were unable to find previous reports of its occurrence on the face and neck.

Key messages from a rare case of annular sarcoidosis of scalp

Sarcoidosis, a multisystem disease of obscure etiology, is characterized by the formation of noncaseating epithelioid cell granulomas in several organs or tissues. The diagnosis of sarcoidosis requires a compatible clinical picture, histologic demonstration of noncaseating granulomas, and exclusion of other diseases capable of producing similar histology or clinical features. The lung is the most commonly affected organ, but the skin is frequently involved. Sarcoidosis occurs worldwide and affects all ages and races with female predominance. Scalp involvement is decidedly rare among the myriad cutaneous manifestations of sarcoidosis. Alopecia is common in sarcoidosis and is generally scarring in nature. Annular sarcoidosis is a rare morphology and annular sarcoid of scalp is seldom reported. Herein we present a case of annular scalp sarcoid with systemic involvement and without alopecia.

Giant bilateral Becker's nevus appearing as gladiator arm armor.

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