Shekhar Neema

Rare case of primary cutaneous mucormycosis of the hand caused by Rhizopus microsporus in an immunocompetent patient.

Primary cutaneous mucormycosis is a very uncommon manifestation occurring most often in diabetics or following trauma.

Livedoid vasculopathy: A review of pathogenesis and principles of management

Livedoid vasculopathy is a rare cutaneous disease manifesting as recurrent ulcers on the lower extremities. The ulceration results in atrophic, porcelain white scars termed as atrophie blanche. The pathogenesis is yet to be understood with the main mechanism being hypercoagulability and inflammation playing a secondary role. The important procoagulant factors include protein C and S deficiency, factor V Leiden mutation, antithrombin III deficiency, prothrombin gene mutation and hyperhomocysteinemia. Histopathology of livedoid vasculopathy is characterized by intraluminal thrombosis, proliferation of the endothelium and segmental hyalinization of dermal vessels. The treatment is multipronged with anti-thrombotic measures such as anti-platelet drugs, systemic anticoagulants and fibrinolytic therapy taking precedence over anti-inflammatory agents. Colchicine, hydroxychloroquine, vasodilators, intravenous immunoglobulin, folic acid, immunosuppressive therapy and supportive measures are also of some benefit. A multidisciplinary approach would go a long way in the management of these patients resulting in relief from pain and physical as well as psychological scarring.

A rare case of imatinib-induced erythroderma

Imatinib, a specific tyrosine kinase inhibitor is a newer anticancer agent, which has shown excellent efficacy in managing chronic myeloid leukemia. It is generally well tolerated with few side effects. Most commonly reported adverse events are maculopapular eruptions and periorbital edema. Severe adverse reactions are seen in 5% of patients. Exfoliative dermatitis has been very rarely reported with this drug. We report a case of a 52-year-old male who initially presented with a maculopapular rash and developed erythroderma on continuation of the drug.

A unique association of unilateral idiopathic calcinosis cutis with ipsilateral porokeratotic eccrine ostial and dermal duct nevus.

An 11‐year‐old boy presented with complaints of multiple skin‐colored hard lumps on the right side of his body and progressive deformity of the right leg of 7‐years duration. His parents had also noticed multiple asymptomatic pits over his right arm, palms, and soles since childhood. Examination revealed skin‐colored nontender nodules on the right half of his body and shortening of his right leg. The multiple hyperpigmented pits over the right arm, palm, and sole raised diagnostic difficulties, but histopathologic, radiologic, and biochemical investigations confirmed the features of idiopathic calcinosis cutis and porokeratotic eccrine ostial and dermal duct nevus. Unilateral idiopathic calcinosis cutis has not been previously reported in the literature, and the association with ipsilateral porokeratotic eccrine ostial and dermal duct nevus makes this case unique. Diagnostic difficulties and limited options for treatment make this case interesting academically.

Rare case of subcutaneous mycosis with intrathoracic extension due to Chaetomium strumarium

A 47‐year‐old man presented with a 10‐year history of multiple lumps over his left upper arm and shoulder and the adjoining left side of his chest and upper back. His medical history included diabetes mellitus type 2. The patient was a farmer and used to lift sacks of grains and fertilizers onto his shoulders as part of his work, although he did not recollect any history of specific trauma. Skin biopsy revealed granulomatous reaction with Splendore–Hoeppli phenomenon, while periodic‐acid–Schiff and Grocott–Gomori stains confirmed fungal elements. Sabouraud agar grew Chaetomium species, and lactophenol blue mount confirmed the fungus as Chaetomium strumarium. Radiography and computed tomography of the chest revealed intrathoracic extension of the mycetoma. The patient responded well to treatment with oral Itraconazole. Subcutaneous mycosis due to C. strumarium is rarely reported in the literature, and the intrathoracic extension makes it an even rarer entity.

Nano-silver dressing in toxic epidermal necrolysis

and systemic methotrexate were previously tried in that patient with no improvement.3 Iontophoresis utilizing methotrexate and cyclosporine A has been assessed in animal models and experimental studies but there have been only two reports that utilized iontophoresis with therapeutic drugs to manage psoriasis.4,5 The first was a case report where palmar psoriasis was successfully managed utilizing methotrexate iontophoresis and the second was a retrospective study of 31 patients where dexamethasone iontophoresis was used for treating nail psoriasis.6,7 Although there was a satisfactory improvement in psoriatic lesions, none of these reports mention the duration of remission.

Eyelash transplantation for the treatment of vitiligo associated eyelash leucotrichia

Background: Eyelash leucotrichia is cosmetically disfiguring condition and remains a therapeutic challenge in successful management of vitiligo. Aims: To study the efficacy of eyelash transplantation in management of eyelash leucotrichia associated with vitiligo. Materials and Methods: Fifteen patients with eyelash leucotrichia were treated with follicular unit transplantation. Improvement in leucotrichia was evaluated using objective assessment. Results: Out of fifteen patients, good to excellent response was seen in 13 patients (86.67%), fair in one patient (6.66%) and poor in one patient (6.66%). Conclusion: Eyelash transplantation is safe and effective method for eyelash leucotrichia.

First reported case of Aspergillus nidulans eumycetoma in a sporotrichoid distribution

Mycetomas are chronic subcutaneous infections caused by either fungi (eumycetomas) or bacteria (actinomycetomas). Eumycetoma is commonly seen in tropical and subtropical climates, usually in males working in occupations prone to trauma. Aspergillus spp. are an uncommon cause of mycetomas.

Through the lens: Cryoglobulinemia

© 2018 Indian Dermatology Online Journal | Published by Wolters Kluwer Medknow A 51‐year‐old lady presented with episodic discoloration of lower extremities associated with severe pain of 2 years’ duration. She was a nonsmoker, nondiabetic, and normotensive. On examination, she had gangrene involving the left great toe [Figure 1]. Evaluation revealed hepatitis C virus (HCV) RNA copies – 1.4 million copies/mL, genotype – 3, cryoglobulins – present, rheumatoid factor – positive and thrombocytopenia. Color Doppler involving lower limb vessels and two‐dimensional echocardiography were normal. Histopathology of the skin showed fibrinoid deposits and thrombus formation in dermal capillaries without active vasculitis. Diagnosis of HCV‐associated cryoglobulinemic vasculitis was made. She was treated with tablet sofosbuvir 400 mg and daclatasvir 60 mg once a day along with tablet prednisolone 40 mg once a day. She responded favorably to treatment, and review at 3 months showed resolution of skin lesions [Figure 2].

Dermoscopy of Pigmentary Disorders in Brown Skin

Dermoscopy is a noninvasive technique for the diagnosis, prognosis, and monitoring of pigmentary disorders in brown skin. It can be used for the diagnosis of various facial melanoses, which can avoid the need for biopsy in many cases. It can also help in early identification of the adverse effect of topical steroids and hydroquinone when they are used for the treatment of these disorders. Dermoscopy can also reliably differentiate vitiligo from other disorders of hypopigmentation. It can also help in assessing the stability of vitiligo before surgery.