Shaurya Rohatgi

Fixed drug eruption to cetirizine: An unusual villain

A 21‐year‐old male patient presented to department of dermatology with chief complaints of itchy dark‐colored lesion over his left lower leg since 2 months. On examination there was single localized, scaly, hyperpigmented, and eczematous plaque. Diagnosis of nummular eczema was made and patient was advised topical steroid with emollients and oral cetirizine 10 mg per day to control pruritus. The following day, patient came back with multiple itchy dark color lesions associated with burning sensation over trunk, upper extremities, and buttocks. Lesions were multiple, well circumscribed, round, hyperpigmented patches with surrounding erythema [Figures 1a and b]. Patient gave the history of developing these lesions immediately 1 h after taking cetirizine. Oral cavity and genitals were not involved. Patient denied any history of oral cetirizine intake and similar complaints in the past. Patient was told to stop taking cetirizine and continue with emollients. Provisional diagnosis of FDE to cetirizine and erythema multiforme was made. Use of the Naranjo Adverse Drug Reaction (ADR) Probability Scale[1] indicated a probable relationship between this cutaneous adverse effect and cetirizine therapy in this patient. Histopathological examination revealed epidermal hyperplasia, spongiosis, interface vacuolar changes, pigmentary incontinence, and lymphocytes within basal layer. The dermis showed eosinophilic and neutrophilic perivascular infiltrate and extravasated red Address for correspondence: Dr. Kenit P. Ardeshna, Department of Dermatology, Venereology and Leprosy, MGM Medical College, Navi Mumbai, Maharashtra, India. E‐mail: kenitpatel@gmail.com

Alopecia Areata: An Update

Alopecia areata (AA) is a very common autoimmune disease that leads to unpredictable, relapsing patchy hair loss. Its chronic pathophysiology is still not fully understood. Hair follicles are not destroyed permanently due to which the potential for regrowth of hair is retained for many years, and is possibly lifelong. Clinical presentation varies from small alopecia patches most commonly on the scalp to full body involvement. Characteristic “swarm of bees” appearance on histopathology is confirmatory in acute cases. A variety of therapeutic options are available, but search for new modalities continues as there is a high relapse rate and a number of side effects associated with the available treatment options.

A case of psoriasis vulgaris aggravated with atorvastatin, aided by concomitant cyclosporine

1. Kumar R, Bumb RA, Ansari NA, Mehta RD, Salotra P. Cutaneous leishmaniasis caused by Leishmania tropica in Bikaner, India: Parasite identification and characterization using molecular and immunologic tools. Am J Trop Med Hyg 2007;76:896-901. 2. Sharma NL, Mahajan VK, Kanga A, Sood A, Katoch VM, Mauricio I, et al. Localized cutaneous leishmaniasis due to Leishmania donovani and Leishmania tropica: Preliminary findings of the study of 161 new cases from a new endemic focus in Himachal Pradesh, India. Am J Trop Med Hyg 2005;72:819-24. 3. Paramsothy Y, Lawrence CM. ‘Tin-tack’ sign in localized pemphigus foliaceus. Br J Dermatol 1987;116:127-9. 4. Cowley NC, Lawrence CM. ‘Tin-tack’ sign in seborrhoeic dermatitis. Br J Dermatol 1991;124:393-4. 5. Thomas RJ, Smith NP, Spittle MF. The ‘tin-tack’ sign in post-irradiation scalp skin scales. Br J Dermatol 1992;126:90. 6. Baba M, Uzun S, Acar MA, Gümürdülü D, Memisoglu HR. ‘Tin-tack’ sign in a patient with cutaneous B-cell lymphoma. J Eur Acad Dermatol Venereol 2001;15:360-1. 7. Cox NH, Tapson JS, Farr PM. Lichen planus associated with captopril: A further disorder demonstrating the ‘tin-tack’ sign. Br J Dermatol 1989;120:319-21.

Syphilis incognito: Resurgence of the covert devil

How to cite this article: Sookaromdee P, Wiwanitkit V. Anti‐human immunodeficiency virus serology status and pre‐ and post‐test counseling: A note. Indian J Sex Transm Dis 2016;37:89‐90. This is an open access article distributed under the terms of the Creative Commons Attribution‐NonCommercial‐ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‐commercially, as long as the author is credited and the new creations are licensed under the identical terms. the cases with seronegativity. Of interest, those with seronegativity and within window period usually get no posttest counseling. It is needed to find a method to increase the coverage of posttest counseling.[2]

Immunotherapy or not? The mystery deepens

Sir, This is with reference to the study by Saoji et al. on immunotherapy of warts with purified protein derivative (PPD).[1] Although it is a carefully executed study; in our view, the use of the term “immunotherapy” is an inappropriate description for the method employed by the authors. We understand that they achieved good clearance rates using the methods described in the report but injecting PPD into multiple lesions defies the true meaning of immunotherapy.

Successful treatment of recurrent dermatophytosis with isotretinoin and itraconazole.

1. London VA, Kim GH, Fairley JA, Woodley DT. Successful treatment of bullous pemphigoid with omalizumab. Arch Dermatol 2012;148:1241-3. 2. Yu KK, Crew AB, Messingham KA, Fairley JA, Woodley DT. Omalizumab therapy for bullous pemphigoid. J Am Acad Dermatol 2014;71:468-74. 3. Fairley JA, Baum CL, Brandt DS, Messingham KA. Pathogenicity of IgE in autoimmunity: Successful treatment of bullous pemphigoid with omalizumab. J Allergy Clin Immunol 2009;123:704-5. 4. Yalcin AD, Genc GE, Celik B, Gumuslu S. Anti-IgE monoclonal antibody (omalizumab) is effective in treating bullous pemphigoid and its effects on soluble CD200. Clin Lab 2014;60:523-4. 5. Corren J, Casale TB, Lanier B, Buhl R, Holgate S, Jimenez P. Safety and tolerability of omalizumab. Clin Exp Allergy 2009;39:788-97. How to cite this article: Gönül M, Keseroglu HO, Ergin C, Özcan I, Erdem Ö. Bullous pemphigoid successfully treated with omalizumab. Indian J Dermatol Venereol Leprol 2016;82:577-9. Received: August, 2015. Accepted: December, 2015. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.