Ramesh Chander Sharma

Chromoblastomycosis in India

Background Four patients with chromoblastomycosis are presented. An additional 30 infected Indian patients are reviewed.

Twelve-year clinico-therapeutic experience in pemphigus: a retrospective study of 54 cases.

Background  Pemphigus, a common immunobullous disease of skin and mucous membranes affecting both sexes of all ages, was almost fatal before the advent of corticosteroids. Better strategies to avoid their side‐effects and recent introduction of adjuvant therapy has further improved its prognosis. As the treatment remains need‐based and patient‐specific, different regimens and strategies have evolved, each with its own merits and demerits.

Cutaneous sporotrichosis in Himachal Pradesh, India

During the period 1990–2002 in Himachal Pradesh, India, 103 new patients with cutaneous sporotrichosis were detected. Lymphocutaneous and fixed cutaneous varieties were the most common and seen in 49% and 43% respectively. Chronic non‐specific inflammation without granuloma formation was seen in 46% skin biopsy specimens, 29% showed acute or chronic inflammation and tuberculoid granuloma formation was seen in 25%. In 32% of cases Sporothrix schenckii growth was seen on Sabouraud glucose agar. A saturated solution of potassium iodide was used as first‐line treatment and in 93% patients healing of lesions occurred in 4–32 weeks (average 8.7 weeks) without significant side‐effects. Itraconazole, used in 12 patients, was highly effective in recommended doses. Rapid healing was seen with higher than previously used doses of fluconazole in one patient who also had unusual exacerbation of lesional inflammation with saturated solution of potassium iodide.

Trichotillomania and trichophagia leading to trichobezoar.

A 14‐year‐old female presented with the complaints of loss of hair, scalp pruritus, and pain in the abdomen. On careful work‐up, she was found to have trichotillomania as well as trichophagia. Investigations also revealed a trichobezoar which completely filled the stomach. Hemogram showed moderate hypochromic anemia. Her detailed psychiatric profile showed a few additional features like obsessive hand washing, knuckle cracking, nose picking and body rocking. Her trichobezoar was removed surgically, and she had an uneventful post‐operative recovery. She is being maintained on fluoxetine and is doing well. The role of a multi‐disciplinary approach to trichotillomania patients is highlighted.

Cutaneous sarcoidosis: clinical profile of 23 Indian patients.

BACKGROUND Sarcoidosis is a multisystem disease of undetermined etiology. Indian studies on cutaneous sarcoidosis are not many and mainly comprise case reports. AIMS This retrospective study was carried out to assess the clinical profile of sarcoidosis patients presenting with cutaneous lesions. METHODS All histopathologically proven cases of cutaneous sarcoidosis seen consecutively between 1999 and 2004 were studied. Their age, sex, presenting features, evolution of disease and laboratory parameters were analyzed. RESULTS A total of 23 patients (F:M 15:8) between 31 to 78 years (mean 44.3 years) of age had the mean duration of skin lesions of 1.4 years. Six patients had one to four lesions; two patients each had scar sarcoidosis and angiolupoid and one patient each had recurrent erythema nodosum, leg lymphedema and subcutaneous sarcoidosis. Others showed combination of papules, nodules, plaques and psoriasiform lesions. Peripheral lymph nodes were involved in two patients. Among 10 patients of pulmonary involvement, three had become symptomatic four months to four years after the cutaneous lesions. Routine laboratory investigations including serum calcium estimation were normal in all cases. Serum angiotensin-converting enzyme levels were raised in 3 out of 6 patients. Asymptomatic lytic lesions of digital bones were detected in hand X-ray of one patient. CONCLUSION Skin lesions of sarcoidosis are like the tip of an iceberg indicating more changes in other organs. The symptomatology and abnormal laboratory results do not necessarily correlate with the severity of cutaneous involvement in general.

Subcutaneous pheohyphomycosis in India – a case report and review

Background Pheohyphomycosis is a rare infection caused by dematiaceous fungi, affecting the skin and subcutis, paranasal sinuses, or central nervous system.

Trichomegaly of the Eyelashes in Dermatomyositis

Trichomegaly or lengthening of the eyelashes, found to be familial or associated with drug therapy, has also been described in patients with phenylketonuria [1], following treatment with leukocyte A interferon [2], in the setting of kala azar (Pitalugo’s sign) or chronic diseases such as liver diseases or malnutrition [3] and more recently in HIV infection [4]. Localized hypertrichosis has been reported to occur rarely with dermatomyositis [5] but not trichomegaly of the eyelashes. Because of its extreme rarity, a case of trichomegaly of the eyelashes associated with dermatomyositis is reported. A 20-year-old, unmarried, HIV-negative female patient presented with a periorbital purplish red heliotropic rash, difficulty in climbing stairs, combing hair, pain and tenderness of proximal skeletal muscles, occasional malaise and low-grade fever of 6 months duration. No photosensitivity or Raynaud’s phenomenon was associated. She had diffuse scaling and dryness of the skin, prominent nail fold capillaries and diffuse loss of scalp hair. She, as well as other members of her family had also observed an increased length of her eyelashes (fig. 1) after about 4 months of her illness. There was no history of ingestion of drugs like corticosteroids, penicillamine, streptomycin, psoralens, cyclosporin A, minoxidil or of any use of lanosterol eye drops, known to cause hypertrichosis. Significant alterations in her investigations were: ESR 75 mm in the 1st hour, increased serum CPK and LDH to 272 and 405 U/l, respectively; a muscle biopsy showed an inflammatory reaction. Other investigations were normal. With the diagnosis of idiopathic type II dermatomyositis, she was treated with 80 mg (2 mg/kg body weight) prednisolone daily. After an initial improvement of her symptoms, she was lost to follow-up. Dermatomyositis, a collagen vascular disease, has characteristic skin changes associated with muscle weakness and inflammation, particularly involving those of the shoulder girdle and pelvic girdle. Apart from the typical heliotropic rash, Gottron’s papules, widespread dermatitis with or without photo exacerbation, Raynaud’s phenomenon, poikiloderma, erythema of the scalp with diffuse alopecia and a wide variety of lesions have been observed [6], and the majority of them were seen in the present case. Although the disease is often associated with alopecia, localized hypertrichosis has also been observed rarely [7]. Hypertrichosis of the elbows, infrapatellar and temporal regions has been reported with local inflammation as the possible explanation for this curious phenomenon [5]. Association of trichomegaly or lengthening of the eyelashes in dermatomyositis has not been documented in the literature. A prolonged anagen phase or prolactinemia have been cited as the probable reasons for this feature in HIV infection [4, 8]. However, the exact mechanism remains unknown. In the absence of any other Fig. 1. Dermatomyositis patient having trichomegaly of the eyelashes.

Sweet's syndrome from an Indian perspective: a report of four cases and review of the literature.

Background  Sweets syndrome or acute febrile neutrophilic dermatosis is not frequently reported from India. Four patients fulfilling clinico‐pathologic criteria for Sweets syndrome seen during May–August 2002 prompted us to review reports on Indian patients from the indexed literature.

Parthenium dermatitis: is it a systemic contact dermatitis or an airborne contact dermatitis?

We describe here a Parthenium hysterophorus patch‐test‐positive patient with widespread dermatitis of non‐airborne contact dermatitis pattern, improving while staying in Shimla (a parthenium‐free area) and rapidly worsening while visiting his native place, where there was exuberant parthenium growth. After recovery, inhalation of fresh plant material from a polythene bag resulted in exacerbation of dermatitis and pruritus within 8–10 hr, without any respiratory symptoms. The possible pathomechanism of such a phenomenon is discussed.

Self-limiting acrodermatitis enteropathica. A follow-up study of three interrelated families.

ABSTRACT A variant of acrodermatitis enteropathica is described that has its onset before weaning and clears when the child starts its normal solid diet. A pedigree with three interrelated families is reported where 10 children were afflicted with this variant. They had symptoms of hypozincemia for a brief period during infancy. At the time of this study, they were symptom‐free and their serum zinc levels were found to be within normal limits. The term “self‐limiting acrodermatitis enteropathica” is proposed for the variant. In one lactating mother, the mammary zinc secretion was determined and was found to be deficient and unresponsive to oral zinc supplements. The possible mode of inheritance is also discussed.