Rameshwar Gutte

Bullous scabies in an adult: A case report with review of literature

Scabies is an infestation caused by Sarcoptes scabiei, characterized by polymorphous lesions that may include burrows, papules, nodules, excoriation, and crusts. Vesicular and bullous lesions are rather rare. Bullous scabies is regarded as a distinct subtype of scabies, closely resembling bullous pemphigoid. Here, we report a case of bullous scabies in an adult male and review the literature.

Cutaneous larva migrans (creeping eruption)

Indian Dermatology Online Journal June 2011 Volume 2 Issue 1 Address for correspondence: Dr. Uday Khopkar, Department of Dermatology, Seth G.S. Medical College and King Edward Memorial Hospital, Parel, Mumbai 400 012, India. E-mail: drkhopkar@gmail.com Department of Dermatology, Seth G.S. Medical College and King Edward Memorial Hospital, Mumbai, India Cutaneous larva migrans (creeping eruption)

Granulomatous mycosis fungoides with hypohidrosis mimicking lepromatous leprosy

Granulomatous mycosis fungoides (GMF) is a rare type of cutaneous T cell lymphoma. A 38-year-old married male presented with decreased sweating all over the body for last 8 years, progressive redness and scaling over body for 2 years and multiple noduloulcerative lesions over the body for 1 year. Cutaneous examination revealed generalized erythema and scaling with poikilodermatous changes over chest and upper back along with multiple noduloulcerative lesions. Skin biopsy from a nodular lesion revealed dense granulomatous infiltrate of atypical lymphocytes with epidermotropism and sparing of appendages. Diagnosis of GMF was made. Computed tomographic scan of thorax, abdomen and pelvis revealed axillary and inguinal lymphadenopathy. Immunohistochemistry revealed leukocyte common antigen and CD3 positivity suggestive of T cell origin. Patient was started on CHOP (Cyclophosphamide, Hydroxydaunorubicin, Oncovin and Prednisolone) regimen of chemotherapy with marked improvement after three cycles of chemotherapy. This case had some clinical resemblance to lepromatous leprosy.

Granulomatous and eccrinotropic lymphomatoid papulosis

Lymphomatoid papulosis has been classically described as a chronic, recurrent and self-healing papulonecrotic or papulonodular skin eruption, which is clinically benign and histopathologically malignant. The histologic characteristics of lymphomatoid papulosis are suggestive of a cluster of differentiation 30+ (CD30+) malignant lymphoma, and it is best regarded as a low grade cutaneous T cell lymphoma (CTCL). We hereby report a case of granulomatous and eccrinotropic lymphomatoid papulosis in a 40- year-old male. There was no systemic involvement. The patient was treated with low dose oral methotrexate with good response.

Granuloma annulare on the palms: A clinicopathological study of seven cases

BACKGROUND Granuloma annulare (GA), a common dermatological condition of unknown etiology, affecting all ages. Involvement of the palms appears rare, posing a diagnostic challenge. This study was conducted to document various clinical and histopathological features of GA on the palms. AIMS To study clinical and histopathological variations in granuloma annulare on palms. METHODS A total 7 patients from our outpatient department with lesions of GA, exclusively on the palms, were studied over a period of 6 months from March 2011 to August 2011. Total of 8 biopsies were studied. In each patient, diagnosis was made on clinico-pathological correlation. Various clinical and histopathological features were analyzed. RESULTS An average age of onset was 47 years, male: female ratio was 1.33: 1, and average disease duration was 9 months. Pain was the most common symptom. Clinically, the most common presentation was pseudovesicles. Histologically, both classic palisading and interstitial pattern were seen. Perineural granulomas, perieccrine granulomas, elastophagocytosis were seen additionally. In 5 out of 7 patients, diagnosis was missed clinically. CONCLUSION GA on palms poses a diagnostic challenge due to variable presentations. Histopathology is of vital importance for correct diagnosis and treatment. GA should be considered in differential diagnosis of papular lesions on palms.

Trichorrhexis nodosa with nail dystrophy: diagnosis by dermoscopy.

A 25-year-old male, born of non-consanguineous marriage presented with complaints of sparse and thin hairs over scalp and dystrophy of nails since childhood. This case highlights the association of trichorrhexis nodosa with nail dystrophy and the use of trichoscopy as a noninvasive method for diagnosis of hair disorders.

Predominant palmoplantar lichen planus: A diagnostic challenge

Background: Palmoplantar lesions in lichen planus (LP) are uncommon. In such cases, diagnosis is usually missed. This study was conducted to document various clinical and histopathological features of palmoplantar LP. Materials And Methods: A total of 18 patients from our outpatient department with lesions of LP, either predominantly or exclusively on palms and/or soles were studied. Patients with history of drug intake in recent past and patients with classical acute widespread LP with a few lesions on palms or soles were excluded. In each patient, diagnosis was made on clinicopathological correlation. Various clinical and histopathological features were analyzed. Results: Average age of onset was 38 years. Male: female ratio was 1:0.6 and average disease duration was 11 months. Exclusive palm or sole involvement was seen in 4/18 patients. Itching was the most common symptom. Clinically the most common variant was hypertrophic. Histologically presence of parakeratosis, spongiosis, lack of melanophages, and lack of hypergranulosis in some cases was seen in addition to classical features of LP. In 3 out of 4 patients with exclusive palmoplantar involvement diagnosis of LP was missed clinically. Conclusion: Involvement of palms and soles in LP poses a diagnostic challenge due to variable presentations. Histopathology is of vital importance for correct diagnosis and treatment.

Angiolymphoid hyperplasia with eosinophilia with follicular mucinosis.

Follicular mucinosis occurring along with angiolymphoid hyperplasia with eosinophils (ALHE) has been described in a 49-year-old male. The patient presented with pruritic hyperpigmented papules and nodules on the vertex and right parietal scalp. There was no any other complaint. Histopathological examination from one of the papule showed prominent blood vessels in the dermis lined by plump histiocytoid endothelial cells that were surrounded by a dense lymphoid infiltrate with numerous eosinophils; these findings are typical of angiolymphoid hyperplasia with eosinophilia. Features of follicular mucinosis were observed in the same section with 3 hyperplastic follicular infundibula containing pools of mucin in the infundibular epithelium. The concurrent occurrence of these 2 distinct histopathological patterns in the same biopsy specimen has been reported rarely.

Fibroepithelioma of Pinkus: A distinctive variant of trichoblastic carcinoma

How to cite this article: Gutte RM. Fibroepithelioma of Pinkus: A distinctive variant of trichoblastic carcinoma. Indian J Dermatol Venereol Leprol 2013;79:725. Received: January, 2013. Accepted: April, 2013. Source of Support: Nil. Confl ict of Interest: None declared. Sir, Fibroepithelioma of Pinkus (FEP) was initially described in 1953 by Pinkus, as premalignant fibroepithelial tumor of the skin.[1] Since then, FEP has been considered to be an unusual variant of basal cell carcinoma (BCC). However, some studies suggested that FEP is actually a variant of trichoblastoma and its classification still remains controversial.[2] Some consider it benign counterpart of BCC, while others think it a malignant neoplasm.[3]

Pseudolymphomatous folliculitis: a distinctive cutaneous lymphoid hyperplasia.

Pseudolymphomatous folliculitis (PLF) was first described in 1986 as a distinct variant of pseudolymphoma, characterized by a dense lymphoid infiltrate and accompanied by hyperplastic hair follicles. Here in we report a case of PLF presenting as an erythematous plaque with pustules and satellite lesions on forehead in an otherwise healthy adult male patient.