Ram Krishan Gautam

Oral ulcer as an unusual feature of visceral leishmaniasis in an AIDS patient.

Leishmaniasis, a globally prevalent parasitic disease, occurs in three forms, viz, visceral, cutaneous and mucocutaneous. It is transmitted by female Phlebotomus sandflies. Human immunodeficiency virus (HIV) infection is increasing worldwide and several reports indicate a rising trend of VL / HIV co-infection, modifying the traditional anthroponotic pattern of VL transmission. India is one of the countries having the largest burden of leishmaniasis; nevertheless, there are very few HIV / leishmania co-infection cases reported so far. We report a 35-year-old homemaker infected with the human immunodeficiency virus; she presented with an oral ulcer. The investigations carried out on her revealed that she was afflicted by visceral leishmaniasis and the oral ulceration was a part of the same. This is only the second such case from the Indian subcontinent and more significantly from a non-endemic area.

Simultaneous Occurrence of Disseminated Superficial Actinic Porokeratosis (dsap), Linear, and Punctate Porokeratosis

8. Bonnekoh B, Kulin A. Squamous cell carcinoma from lichen ruber liypertrophicus—case report and review of literature. Z Hautkrankh 1986; 61:394-402. 9. Yesudian P, Rao NR. Malignant transformation of hypertrophic lichen planus. Int J Dermatol 1985; 24:177-178. 10. Ruocco V, Satriano RA, Rosa GD, et al. Malignancy in lichen planus. Int J Dermatol 1989; 28:542-544. 11. Fulling HJ. Gancer development in oral lichen planus; a follow-up study of 327 patients. Arch Dermatol 1973; 108:667. 12. Kaplan B, Barnes L. Oral lichen planus and squamous cell carcinoma; case report and update of literature. Arch Otolaryngol 1985; 111:543-547. 13. Grofty GP, Suw PD, Winkelmann RK. Ulcerative lichen planus. Arch Dermatol 1980; 116:1252-1256. Figure 1. Numerous skin-colored, slightly bluish, superficial, and relatively indistinct ringlike lesions.

Isolated Collagenoma : A Case Report with a Review of Connective Tissue Nevi of the Collagen Type

A 22‐year‐old male had had five skin colored tumorous growths on the mid‐palm, ring and little fingers of the right hand for the last 15 years. Histopathological examination with hematoxylin and eosin and special stains confirmed the diagnosis of connective tissue nevi of collagen type. There were no associated cutaneous or systemic findings; thus the case was designated as isolated collagenoma. A review of connective tissue nevi of the collagen type is presented.

Localized Darier's disease and its nosologic status.

A 12-year-old girl was referred from the department of pediatrics, with an infected and crusted lesion on the medial aspect of the left thigh. The eruption was noticed by parents as a small red area, when the girl was 1 day old. The pustular lesions appeared on this red area after 1 week. Thereafter, similar lesions erupted at the same site every year with the onset of summer. These lesions were reported to subside every time within 2-3 weeks of the application of various medicaments. She was a product of normal vaginal delivery after an uncomplicated pregnancy. There were no birth defects. Similar eruptions were not reported in her two siblings or her parents at the time of delivery. The examination of the skin revealed an erythematous, slightly raised plaque, measuring approximately 6 x 3 cm and occupying the left thigh. The plaque was covered with a multilayered, yellowish crust (Fig. 1). There were a few pustules besides a few follicular and nonfollicular keratotic papules with greasy scales. There was very prominent epidermal atrophy, particularly in an area of hypopigmentation, forming the lower part of the plaque. The mucous membranes and nails were unremarkable. The systemic examination was essentially normal. The investigations revealed a normal hemogram, blood urea, blood sugar, serum electrolytes, and urine examination. The roentgenograms of the chest and left thigh were also normal. The patient was treated with 1% topical framycetin. There was some improvement after 2 weeks of therapy. Sections of the biopsy from a keratotic papule stained with hematoxylin and eosin showed dyskeratosis in the form of corps ronds at the granular layer and in the upper part of the stratum malpighii (Fig. 2). There were prominent suprabasal clefts with focal acantholysis. In addition, there was hyperkeratosis of the epidermis and a mild subepidermal infiltrate, consisting predominantly of mononuclear cells.

Linear syringocystadenoma papilliferum: A case report with review of literature

We report a rare case of syringocystadenoma papilliferum (SCAP) presenting as multiple papulonodules in a linear pattern over right lower abdomen which has been reported only once before.

Comparison of Q-switched Nd:YAG laser alone versus its combination with ultrapulse CO2 laser for the treatment of black tattoo

ABSTRACT Background: Q-switched lasers are conventionally used for the treatment of black tattoo. However, they require multiple sittings, and the response may be slow due to competing epidermal pigment in dark skin. Objective: To compare the efficacy of Q-switched Nd:YAG laser alone with its combination with ultrapulse CO2 for the removal of black tattoo. Materials and methods: Sixty patients with black tattoo were randomized into two groups viz., group A and group B. Group A was treated with QS Nd:YAG laser (1064 nm) alone, and group B received combination of ablative ultrapulse CO2 followed by fixed-dose QS Nd:YAG laser (1064 nm), at 6-week interval for a maximum of 6 sittings. After each sitting, 3 independent physicians noted percentage of improvement that was evaluated using visual analogue scale (VAS) and grading system for tattoo ink lightening (TIL). Results: Combination laser (group B) showed statistically significant improvement in mean VAS score in the last 2 noted visits as compared to 1st session (p < 0.007, p < 0.001) and TIL mean score in last three noted visits as compared to 1st session (p < 0.008, p < 0.020, and p < 0.004). There was no statistically significant difference in the side effect profile of both the groups. Conclusion: For refractory professional tattoos, combination of ultrapulse CO2 laser and QS Nd:YAG laser is superior to QS Nd:YAG laser alone.

Bilateral lichen striatus: A case report with review of literature

Lichen striatus is a self-limiting dermatosis presenting with sudden eruption of lichenoid papules along the lines of Blaschko. A 5-year-old girl presented with asymptomatic hypopigmented linear lesions over both upper limbs. The histopathological examination revealed spongiosis, vacuolar alteration of the basal layer and lymphocytic exocytosis with a mild-to-moderate perivascular mononuclear infiltrate in the dermis. Lichen striatus was diagnosed based upon the characteristic clinical and histopathological findings. The pathogenetic mechanism of bilateral lichen striatus is unknown at present, however, a somatic mutation in two different clones of cells can be a possibility.

A clinical approach to diagnose patients with localized telangiectasia

Telangiectasia, or dilated blood vessels, may represent a benign condition or a marker of a much more serious internal or cutaneous malignancy (e.g. mycosis fungoides). They can be generalized or localized in distribution. ‘Localized telangiectasia? can be macular or papular. Macular ones can be further divided into two major categories: primary and secondary. They can occur on their own (primary), after skin injury (e.g. sun damage, post‐radiation therapy, after prolonged topical steroid application), or may arise due to an underlying condition (secondary). While telangiectases can spring from a multitude of possible causes, the location of the lesions, in combination with a careful history and exmination, often helps in elucidating the correct diagnosis. A patient with localized telangiectasia as a manifestation of malignancy may be difficult to diagnose, however the diagnosis is one of exclusion, and a thorough evaluation should be performed before diagnosing this condition. This article reviews possible conditions to consider in these patients and suggests an approach to their evaluation.

Langerhans cell disease of the eyelids masquerading as blepharochalasis.

Langerhans cell disease (LCD) occurring as an isolated tumor of the eyelids has been described infrequently. Moreover, none of the reported cases had associated systemic involvement. We present an unusual case of LCD of the eyelids masquerading as blepharochalasis with central diabetes insipidus (CDI).

An unusual case of noma caused by Klebsiella pnuemoniae and its management

Noma or cancrum oris is an orofacial gangrene causing progressive mutilating destruction of the infected tissues. It mainly affects malnourished children with poor oral hygiene and concurrent debilitating systemic illnesses. It is a polymicrobial infection and borrelia vincentii and fusobacterium are the most important pathogens known. We present a case of a boy aged 2.5 years with noma where klebsiella was grown and was the initial cause of failure of empiric therapy.