Rashmi Jindal

Contact sensitization in venous eczema : Preliminary results of patch testing with Indian standard series and topical medicaments

BACKGROUND AND AIMS Elimination of allergens/topical medications causing contact dermatitis in venous eczema, which poses a significant problem in its chronicity and treatment, provides the basis for better therapeutic outcome. Our objective was to determine the pattern of contact sensitization in venous eczema patients in Himachal Pradesh (India). METHODS Thirty-four patients (M:F, 31:3) and 10 controls (M:F, 6:4) were patch tested with Indian standard series and 10 commonly used topical medicaments. RESULTS Positive patch test results were seen in 50% (M:F, 16:1) of the patients. Common allergens were Fragrance mix (15%), p-phenylendiamine (15%), nickel (9%), wool alcohol (9%), chinoform (9%), balsum of Peru (5%), cobalt chloride (5%), potassium dichromate (3%), epoxy resin (3%), thiuram mix (3%) and formaldehyde (3%). Only sisomycin and miconazole among the topical medications elicited a positive patch test reaction in 3 and 5% patients, respectively. Neomycin contact sensitivity was not seen in any of the patients. One patient who had exacerbation of venous eczema following accidental application of topical diclofenac showed a positive patch test reaction to it. CONCLUSIONS Patch test should be used to identify the topical agents that may be responsible for perpetuation or aggravation of eczema, especially in patients who do not improve despite adequate treatment of other underlying cause(s).

Hand eczema: Correlation of morphologic patterns, atopy, contact sensitization and disease severity

BACKGROUND Hand eczema is a common distressing condition aggravated by a number of endogenous and exogenous factors. Various morphological forms of hand eczema have been described, but categorization into one of them is not always possible. AIMS To study the morphological patterns of hand eczema, relationship of atopy with hand eczema, and the implications of contact sensitization with respect to severity and diagnosis of hand eczema. METHODS Hundred consecutive patients of hand eczema attending the contact dermatitis clinic of the institute were recruited over a two year period from 2004-05. Objective assessment was done using hand eczema severity index (HECSI) and all the patients were patch tested using Indian standard series. RESULTS Unspecified type of hand eczema with no definite morphologic picture was seen in 62% followed by pompholyx in 14%. Hand eczema severity was not found to be statistically associated with age, sex, and atopic status of the patient. Positive patch test to one or more allergen was present in 65% of patients. The most common allergens were potassium dichromate (25%), fragrance mix (16%), nickel sulphate (14%), and PPD (13%). There was no significant correlation between patch test positivity and hand eczema severity or atopic status of the patient. Among the morphological patterns pompholyx was strongly associated with an atopic status (P=0.004). CONCLUSIONS Hand eczema was seen twice more commonly in men. Atopic and non-atopic patients of hand eczema had no difference in the severity of disease. Contact sensitivity to different allergens did not correlate with increased eczema severity.

Cutaneous Manifestations of Common Liver Diseases

Skin functions as a window to our overall health and a number of systemic diseases result in various cutaneous changes. Knowledge of these manifestations helps in suspecting an underlying systemic illness. Cutaneous abnormalities are quite common in patients with liver diseases and this article aims to focus on these dermatoses. Cutaneous manifestations seen in patients with liver disease though common are nonspecific. They can also be seen in patients without liver diseases and generally do not indicate about a specific underlying hepatic disorder. The presence of a constellation of signs and symptoms is more useful in pointing toward an underlying hepatobiliary condition. The commonest symptom in patients with liver disease is pruritus which is often protracted and disabling. Other common features include spider angiomas, palmar erythema, paper money skin, xanthelasmas, pigmentary changes, and nutritional deficiencies. In this article, first the common cutaneous manifestations that may be associated with liver disorders are discussed and then common liver diseases with their specific cutaneous findings are discussed. Cutaneous abnormalities may be the first clue to the underlying liver disease. Identifying them is crucial for early diagnosis and better management.

HIRSUTISM: CLINICO-INVESTIGATIVE PROFILE OF 50 INDIAN PATIENTS

Background: Despite worldwide prevalence of hirsutism studies on hirsutism in Indian patients are not many. Aims: This retrospective study was carried out to assess the clinico-investigative profile of patients presenting with hirsutism. Materials and Methods: Medical records of 82 hirsutism patients diagnosed consecutively during July 2005 to October 2007 were analyzed. Results: The complete data of 50 patients aged between 13 and 47 years were available. Fifty percent patients were aged 20 to 30 years. The average F-G score was 10.3 ± 2.46. Associated signs of hyperandrogenism were acne (64%), oligomenorrhea or menstrual irregularities (36%), androgenetic alopecia (16%), acanthosis nigricans (6%) and seborrhea (4%). Polycystic ovaries were detected in 30% patients and 22% patients had elevated serum free testosterone levels. Family history of hirsutism was present in 18% patients. Conclusion: Hirsutism in Indian patients is not uncommon. Adolescent patients appear to be more concerned about hirsutism as compared to those in the older age group who were more often worried of late onset acne. All patients, however, were more concerned for facial hair than those on other body areas signifying that facial hair need to be given higher than current value in F-G score.

Skin Disorders Among Geriatric Population at a Tertiary Care Center in Uttarakhand

INTRODUCTION Ageing results in decline of normal functioning in all organ systems including skin. This predisposes the elderly persons to develop various skin ailments. A thorough knowledge of different diseases prevalent in this population in different geographic regions help the health care providers in better health care policy making. AIM This study was planned to know the common dermatological diseases prevalent in Uttarakhand region of India. MATERIALS AND METHODS Hospital out patients records maintained in Department of Dermatology, Venereology & Leprosy were analysed and information regarding age, sex and diagnosis of patients were recorded. Descriptive statistics for prevalence of skin diseases in patients presenting to hospital were calculated. RESULTS Out of the total 29,422 patients seen in dermatology department from August 2012 to 2014, 4.7% (1,380) were aged 60 years and above. Male to female ratio was 2:1. Erythemato-squamous disorders taken collectively constituted the major skin disorder seen in 38.9% patients. This was followed by infections and infestations (29.9%), senile pruritus (9.0%) and age related skin changes (3.7%). Benign neoplasms were seen in 1.1% patients followed by cutaneous malignancies in 0.8% and precancerous lesions in 0.4%. Fungal infections were the most common infections seen in 18% patients. CONCLUSION This study strengthens the opinion that infections, senile pruritus and eczema-dermatitis are the major dermatological disorders in elderly population.

Sarcoidosis associated systemic sclerosis: More than chance occurrence

were the most commonly encountered fungi in an analysis of 44 cases of mycotic embolization of the peripheral vessels. Early detection of fungal vegetation in the heart and aorta is difficult, because infection may be indolent in its early stages with nonspecific symptoms such as low-grade fever, malaise and anemia. Previously, only 43% of cases of mycotic embolization of the peripheral vessels showed positive blood cultures. More specifically, 83% of cases of candidal infections, but only 7% of cases of Aspergillus infection, had positive blood cultures. Aspergillus fumigates and Aspergillus flavus are the most commonly involved species in invasive mold infections. Unfortunately, however, we could not verify Aspergillus vegetation by molecular detection in our patient’s ascending aorta because the tissue samples were not viable following a long period of formaldehyde fixation. Mycotic infections of the heart or aorta are relatively uncommon but may be increasing in frequency. Therefore, patients presenting with unilateral cutaneous septic vasculitis who have undergone open-heart surgery with a prosthetic aortic graft should be evaluated for fungal vegetation and peripheral embolization.

Primary cutaneous anaplastic large cell lymphoma in a child simulating primary cutaneous Hodgkin’s disease.

Sir, The spectrum of CD30+ lymphoproliferative disorders includes a variety of T-cell lymphomas with lymphomatoid papulosis and anaplastic large-cell lymphoma at two ends of the spectrum. Anaplastic CD30+ large-cell lymphoma is the second most common, constituting 9% of all cutaneous lymphomas. It is a large T-cell lymphoma consisting of cells with an anaplastic, pleomorphic or immunoblastic cytomorphology and is also characterized by expression of the CD30 (Ki-1) antigen by >75% of the tumor cells.[1] It primarily involves lymph nodes and also has frequent cutaneous and extra-cutaneous involvement (nodal, systemic). It affects both children and adults and carries a poor prognosis. Primary cutaneous anaplastic large-cell lymphoma is currently considered an infrequent but distinct entity.

A 15-year-old boy with silvery white hair, hepatosplenomegaly, and pancytopenia

Dermatologic consultation was sought for a 15-year-old boy admitted to the Department of Pediatrics for recurrent episodes of fever of unknown origin. He had demonstrated silvery white hair over the scalp and eyebrows since birth, as well as progressively increasing speckled hypopigmentation of the face, hands, and feet (Fig. 1). The patient had been born of a first-degree consanguineous marriage and was the lone survivor of three sibFigure 2 Histopathology shows enlarged hyperpigmented melanocytes in the basal layer of the epidermis. (Hematoxylin and eosin stain; original magnification 910)

Intertriginous drug eruption: report of a case and proposed pathogenetic mechanism

Correspondence Intertriginous drug eruption: report of a case and proposed pathogenetic mechanism The clinical appearance of a drug eruption does not help in determining the offending drug or the pathogenetic mechanism involved. Routine laboratory investigations, intradermal or patch testing, drug re-challenge, and other in vitro tests either have limited diagnostic value or are open to misinterpretation. 1

Pigmented Pre-malignant and Malignant Lesions of Skin with Special Reference to Atypical Presentations.

BACKGROUND Cutaneous melanocytic proliferations are diverse both morphologically as well as in their behavioural patterns. Both dermatologists and pathologists regularly encounter diagnostic dilemmas while interpreting such lesions. AIM To study all cutaneous premalignant and malignant lesions with respect to their clinical features and histopathological findings. MATERIALS AND METHODS A retrospective study was done in the Department of Pathology over a period of 10 years (2004-14) on all the clinically pigmented lesions that were biopsied or excised. Out of these only premalignant and malignant melanocytic lesions were analysed with respect to their important clinical and histologic features. Immunohistochemistry was carried out using HMB-45 and S-100 where indicated. RESULTS A total of 338 skin cancers were reported, out of these 27, 7.9% were cutaneous malignant melanoma. Premalignant lesions were 33. The mean age for premalignant lesions and melanomas was 43 years and 50.7 years respectively with a male predominance in both groups. The sole of foot/ankle was the most common site of involvement by melanoma (n=8,29.6%) while sun exposed sites like face and scalp were common sites for development of premalignant lesions like dysplastic nevi, lentigo simplex, pigmented seborrheic keratosis and Bowens disease. One case presented as post-traumatic scar tissue which turned out to be desmoplastic melanoma. One case of amelanotic melanoma presented as recurrent painful penile ulcers. Both cases were confirmed on Immunohistochemistry. CONCLUSION All pigmented lesions should be regarded as tumours of uncertain malignant potential and treated with complete excision if possible with long term follow up.