Riti Bhatia

Photo-patch and patch tests in patients with dermatitis over the photo-exposed areas: A study of 101 cases from a tertiary care centre in India

Many patients with dermatitis over photo‐exposed body areas are positive to many contact allergens and have a pre‐existing allergic contact dermatitis.

Handheld narrow band ultraviolet B comb as home phototherapy device for localised vitiligo: Dosimetry and calibration

Sir, Phototherapy is an established therapeutic modality for vitiligo with high repigmentation rates and good safety profile. Narrowband‐UVB (NB‐UVB) involves the use of UV‐lamps with peak emission at 311 nm. The efficacy of NB‐UVB in vitiligo was first demonstrated by Westerhof and Nieuwboer‐Krobotova in 1997, and since then, several clinical studies have demonstrated its effectiveness in both generalized and localized vitiligo.1,2 NB‐UVB therapy is currently being administered in whole body chambers which are usually available in tertiary care hospitals. This is an expensive equipment, requires regular hospital visits, and is inconvenient for patients travelling long distance for therapy, in addition to resulting in loss of wages for the patients and their attendants. To overcome these significant disadvantages of whole body cabinets, home‐based NB‐UVB therapy is the need of the hour; such devices are being used in both vitiligo and psoriasis with encouraging results.3,4 In addition, unnecessary exposure to uninvolved body sites in whole body cabinets would be circumvented by targeted home phototherapy devices. A home‐based phototherapy unit that has been found as effective in psoriasis as the outpatient NB‐UVB chamber, in a comparative trial, consists of 2 Philips TL‐9 W/01 lamps and delivers NB‐UVB at irradiance of 10 mW/cm2, over a 9 × 7 cm area for the treatment of localized lesions.4 Several other studies have also documented the safety of home phototherapy.5

Hypopigmented macules and papules following the lines of Blaschko: a novel variant of Darier's disease

lar to those visible in its male counterpart, including brown/ brown–gray dots arranged in linear fashion, albeit they are usually more scattered compared to VIN, and blue–black structureless areas. The male lesions may also show glomeruloid vessels, but they are more diffuse and scattered than those visible in VIN. In conclusion, our case confirms that VIN usually shows focally distributed glomerular vessels, bluish areas, scales, and blue/brown dots arranged in a linear distribution, all typical features of pigmented Bowen’s disease, and emphasizes that the pigment arrangement may be dermoscopically heterogeneous, with a possible similarity to the male genital and cutaneous counterpart. Anyhow, further studies are needed to characterize better the dermoscopy of VIN.

Penile 'tuberculid': could it be sexually acquired primary inoculation tuberculosis?

with 5-FU. However, a cutaneous reaction progressively developed 6 weeks after capecitabine monotherapy and she was referred to our clinic for further evaluation. Multiple erythematous annular patches were observed on the face, forearms and dorsum of both hands (Fig. 1a,d). Histopathological findings from the forearm lesions showed vacuolar degeneration of the epidermal basal layer and lymphocytic infiltration in the periappendages (Fig. 2a,b). Mucin deposition in the dermis was also observed (Fig. 2c). Laboratory tests showed an increased titre of antinuclear antibodies (>1 : 320) and anti-Ro antibodies (>1 : 200). No other abnormalities were observed in the blood tests. The clinical, histopathological and laboratory findings were compatible with drug-induced SCLE and capecitabine was suspected to be the offending drug on the basis of her medical history. Her skin lesions improved after the withdrawal of capecitabine and the administration of systemic corticosteroids. The patient preferred continuation of capecitabine because of the inconvenience of repeated intravenous 5-FU injections; however, her skin lesions aggravated after the readministration of capecitabine (Fig. 1b,e). Her chemotherapy regimen was then changed to intravenous injection of 5-FU. No further skin lesions were noted during 4 months of chemotherapy with 5-FU (Fig. 1c,f). Since Weger et al. first reported SCLE induced by 5-FU and exacerbated by capecitabine in 2008, seven cases of SCLE associated with capecitabine have been reported. Although the exact pathomechanism of capecitabine-induced SCLE and its correlation with 5-FU are not yet fully elucidated, some authors suggested that 5-FU, a metabolite of capecitabine, might play an important role. However, there has been only one reported case of SCLE induced by 5-FU alone, and there have been no reports on the consequences of readministration of 5-FU after the development of capecitabine-induced SCLE. In our case, the drug-induced SCLE could have been caused by capecitabine itself, or by derivatives from the conversion of capecitabine to 5-FU, but not by 5-FU itself, because her cutaneous lesions never aggravated after the readministration of 5-FU. We also suggest that the pathomechanism of SCLE induced by 5-FU could be different from that caused by capecitabine. SCLE induced by 5-FU might be aggravated after the administration of capecitabine because capecitabine is converted to 5FU. However, SCLE induced by capecitabine may not be aggravated by 5-FU administration, as in our case. In conclusion, this is the first reported case of SCLE induced by capecitabine that was not aggravated after the readministration of 5-FU. Further studies are needed to determine the pathomechanism of SCLE induced by capecitabine or 5-FU.

Clinical profile and quality of life of patients with occupational contact dermatitis from New Delhi, India

Data regarding occupational contact dermatitis (OCD) and its effect on quality of life (QOL) in India are limited.

Dermatopathology Clues in Pigmentary Disorders

Pigmentary disorders are a group of diseases characterized by a reduction, increase or alteration of pigment in the skin. On biopsy, hypopigmented lesions typically show a reduction of melanin in basal epidermal cells with an accompanying reduction in the number of melanocytes in some conditions. Hyperpigmented lesions show an increase in basal layer melanin with some melanophages in the upper dermis. However, these findings are shared by many different disorders and are not of much diagnostic value.

Chlamydia trachomatis proctitis masquerading as carcinoma rectum: First case report from India

While proctitis is caused both by infectious and noninfectious causes, infectious causes are acquired typically sexually. Chlamydia trachomatis, which is the most frequent bacterial pathogen causing sexually transmitted infections worldwide, is one of the causative agents of proctitis. We report a case history of a bisexual male who presented to us with rectal bleeding. The colonoscopy showed a nodular ulcerated lesion in the rectum suggestive of rectal malignancy, but biopsies from rectal mass did not reveal malignancy. A rectal biopsy was positive for C. trachomatis by polymerase chain reaction assay, and a diagnosis of C. trachomatis proctitis was made. Considering the invasive anorectal disease and patients sexual history, he was treated with prolonged doxycycline therapy as per Centres for Disease Control and Preventions treatment recommendation for lymphogranuloma venereum. A high index of clinical suspicion along with appropriate microbiological testing can clinch the diagnosis of C. trachomatis infection.

Oral involvement in disseminated superficial porokeratosis

Indian Journal of Dermatology, Venereology, and Leprology | March-April 2017 | Vol 83 | Issue 2 244 Sir, Porokeratosis is a clonal disorder of keratinization that clinically manifests as centrifugally expanding, annular plaque(s) with a thready, ridge‐like margin (often with a furrow), which histopathologically shows pathognomonic cornoid lamella.1,2 We report a clinically typical lesion of porokeratosis in the buccal mucosa of a patient with disseminated superficial porokeratosis.