Shahbaz A. Janjua

Keratosis Follicularis Spinulosa Decalvans Associated with Acne Keloidalis Nuchae and Tufted Hair Folliculitis

Keratosis follicularis spinulosa decalvans is a rare, X-linked disorder characterized by scarring alopecia of the scalp and eyebrows in the setting of widespread keratosis pilaris. Less frequent associations are ocular abnormalities and palmoplantar keratoderma. Acne keloidalis nuchae has previously been described in one patient with keratosis follicularis spinulosa decalvans. We report another case of keratosis follicularis spinulosa decalvans with acne keloidalis nuchae and tufted hair folliculitis, thus further establishing this association.

Dermatologic, periodontal, and skeletal manifestations of Haim-Munk syndrome in two siblings

Haim-Munk syndrome is an extremely rare autosomal recessive disorder of keratinization characterized clinically by palmoplantar hyperkeratosis, severe early onset periodontitis, onychogryphosis, pes planus, arachnodactyly, and acro-osteolysis. Recently, germline mutations in the lysosomal protease cathepsin C gene have been identified as the underlying genetic defect in Haim-Munk syndrome and in the clinically related disorders, Papillon-Lefèvre syndrome and prepubertal periodontitis.

Trichostasis spinulosa: possible association with prolonged topical application of clobetasol propionate 0.05% cream

A 20‐year‐old woman of south Asian descent was concerned about her dark complexion, predominantly affecting the exposed areas of her body, including the face, neck, upper chest, and extremities. She tried multiple over‐the‐counter products, including topical hydroquinone, kojic acid, and various herbal formulations, without success. Three years previous to her presentation, she was given clobetasol propionate 0.05% cream by a friend, which she applied to the face, neck, upper chest, and arms.

Intertriginous eruption induced by terbinafine: a review of baboon syndrome.

A 60-year-old otherwise healthy man presented with a 1-week history of a mildly stinging erythematous eruption involving the buttocks and the flexural areas, including the axillae and the groins. His past medical history was significant for a recently diagnosed tinea pedis for which he was prescribed terbinafine HCl 125 mg tablets twice a day for 2 weeks about 10 days prior. On the third day of initiating treatment with terbinafine, a flexural rash was noted affecting the axillae. Despite the rash, he continued taking the medication for another few days, but as the rash worsened and progressed to involve the groins and upper inner thighs, he consulted his GP who immediately stopped the patient’s medication and referred him to a dermatologist. Physical examination revealed an erythematous eruption symmetrically involving the axillae, sides of the trunk, midsternal groove, antecubital fossae, groins, and the perianal and gluteal areas. It appeared as large welldemarcated dusky red patches with central confluence (Fig. 1). Superficial peripheral desquamation was also noted particularly around the axillae (Fig. 1). There were no raised or advancing margins at the periphery, and the superficial scrapings from the multiple affected sites showed no fungal elements on microscopy of the potassium hydroxide-treated samples. He was otherwise well, and there was no recent history of any upper respiratory tract infection, pharyngitis, or fever. He had not taken any other medications recently except terbinafine. According to his previous medical record, he had not been prescribed topical and/or oral terbinafine before. There was no personal and/or family history of atopic diatheses or any other drug hypersensitivity. His routine blood and urinalyses were unremarkable. Antistreptolysin titer was also within normal limits. Patch tests, carried out with terbinafine HCl, prepared in petrolatum and water as a vehicle, at different concentrations (5, 10, and 30% according to the guidelines of the International Contact Dermatitis Research Group) remained negative after 48 and 72 hours. Histopathologic examination of the biopsy from the affected sites showed a mixed, predominantly mononuclear perivascular infiltrate in the dermis. After clinicopathologic correlation, a diagnosis of drugrelated baboon syndrome (BS) or symmetrical drugrelated intertriginous and flexural exanthema (SDRIFE) was made. A drug provocation test was refused by the patient. He was treated with saline compresses and mild topical steroids. The eruption appeared to have cleared with desquamation when the patient was seen at the follow-up examination after 1 week.

Teledermatology in Pakistan

Pakistan like other developing countries is facing problems in addressing the issues of availability of health care services to its growing population, which is concentrated in the villages and remote areas. On the contrary, telecommunication connectivity all over the country improved remarkably in the last decade. In this scenario, telemedicine can be utilized to provide health care to the remote and underserved areas. Telemedicine has also played a major role in bridging the gap between primary and tertiary health care facilities during disaster relief operations. Dermatology is undoubtedly the most suitable specialty for telemedicine. Therefore, teledermatology has been an integral part of various telemedicine projects and networks in Pakistan. However, to meet the challenge of integrating teledermatology into the current health care system of the country, major issues need to be addressed.