Shikha Verma

Clinical, Trichoscopic, and Histopathological Features of Primary Cicatricial Alopecias: A Retrospective Observational Study at a Tertiary Care Centre of North East India.

Background: The primary cicatricial alopecias (PCAs) are a rare group of diseases where hair follicle is the primary target of destruction. There are a few studies on histopathological and trichoscopic features of PCA. Aims: To study the clinical, trichoscopic, and histopathological characteristics of PCAs of the scalp and to find out the concordance between trichoscopic and histopathological diagnosis. Materials and Methods: We retrospectively analyzed the clinical, trichoscopic, and histopathological features of 24 PCA patients. Fishers Chi-square exact test was done to find the significant trichoscopic and histopathological features. Cohens kappa coefficient was used to determine the agreement between histopathological and trichoscopic diagnosis. Results: A total of 24 patients of PCA were seen with a male: female ratio of 2:1. There were 10 (41.7%) patients of discoid lupus erythematosus (DLE), 5 (20.8%) of lichen planopilaris (LPP), 3 (12.5%) of dissecting cellulitis of scalp, and 2 (8.3%) each of pseudopelade of brocq, folliculitis decalvans, and frontal fibrosing alopecia. The important histopathological findings of DLE were follicular plugging, vacuolar changes in the basal layer, necrotic keratinocytes, and superficial and deep perifollicular and perivascular lymphocytic infiltrate. Histopathology of LPP showed vacuolar changes in the basal layer and lichenoid infiltrate involving the infundibulum and isthmus. Trichoscopy of DLE showed follicular plugging, yellow dots, and thick arborizing blood vessels. The peripilar cast was important finding in LPP. The characteristic yellow dot with three-dimensional structure was noted in dissecting cellulitis of the scalp. The Cohens kappa agreement was 0.89 between histopathological and trichoscopic diagnosis. Conclusion: The diagnosis of PCA is challenging because of overlapping features clinically and histopathologically. Trichoscopy may provide quick and reliable diagnosis and obviate the necessity of scalp biopsy in busy clinics.

Extensive tonsure pattern trichotillomania-trichoscopy and histopathology aid to the diagnosis.

Trichotillomania manifests as a compulsive desire to pull out own hair. The clinical presentation of trichotillomania is usually characteristic, with varying length hair distributed within areas of alopecia on otherwise normal scalp. In severe forms, tonsure pattern of baldness results, involving the entire scalp sparing the hair at the margins. Extensive tonsure pattern trichotillomania is rare and difficult to differentiate from other nonscarring alopecias on clinical grounds alone. Trichoscopy and histopathology of scalp play a corroborative role in definitive diagnosis. We hereby report two cases of extensive tonsure pattern trichotillomania, with special reference to their trichoscopic and histopathological features.

Lichenoid drug reaction to isoniazid presenting as exfoliative dermatitis in a patient with acquired immunodeficiency syndrome.

Human immunodeficiency virus-infected patients are at increased risk of drug reactions because of immune dysregulation and multiple drug intake. Lichenoid drug reactions to isoniazid have been reported previously in the literature. However, for lichenoid drug reaction to isoniazid to be so extensive to present as exfoliative dermatitis is rare. We report here a rare case of lichenoid drug reaction to isoniazid presenting as exfoliative dermatitis in a patient with acquired immunodeficiency syndrome.

Subungual Glomus Tumour Excision with Transungual Approach with Partial Proximal Nail Avulsion.

The general and systemic physical examination was within normal limit. On local examination, there was a violaceous spot on the lunula and longitudinal ridging on the nail plate [Figure 1a]. The love test (applying pressure to the suspected area with a pinhead, which elicits exquisite localised pain) was positive. The posterior‐anterior and lateral view of X‐ray left hand was normal [Figure 1c]. Magnetic resonance imaging of the left thumb revealed T1 hypointense, T2/T2‐FS hyperintense spherical mass showing intense enhancement on the post‐contrast study of distal phalanx suggestive of glomus tumour [Figure 1d].

Tattoo Practices in North-East India: A Hospital-based Cross-sectional Study.

Background: Tattooing has become increasingly popular, particularly among young people. However, little is known about the tattoo practices in North-East India. Objectives: The primary objective of this study was to know the reasons and motivations of tattoo application and tattoo removal in individuals asking for tattoo removal. The secondary objective was to identify the demography, methods and safety of tattoo practices in these tattooed individuals. Materials and Methods: A hospital-based cross-sectional study was carried out in 212 consecutive individuals seeking tattoo removal. Chi-square and Fishers exact tests were performed for intergroup comparisons. Results: There were 178 (84%) males and 34 (16%) females. The mean ± standard deviation (SD) age of individuals seeking tattoo removal was 21.8 ± 4 years. The mean ± SD age of doing tattoo was 15.8 ± 3 years. Most individuals possessed an amateur tattoo (94.3%), 4.2% a professional one and 1.4% had a combination. Sewing needle was the most common instrument used for making tattoos in 51.4%. The individuals made their tattoos in an unsterile manner in 49.1%. The most common reason for doing tattoo was for fashion in 87.7%. The participants wanted tattoo removal to qualify for jobs, especially in armed forces in 49.5% and due to regret in 21.7%. Black was the most preferred colour in 37.3% followed by green in 28.3%. The fabric ink was the choice of ink in maximum number of individuals, i.e. 93.9%. Limitations: It was a hospital-based study done only on individuals seeking tattoo removal. It needs caution to generalise the findings in population. In addition, there may be recall bias in the participants. Conclusion: The tattoo was done mostly below 18 years of age in a crude unsterile way. The individuals had poor risk perceptions about various infections and complications of tattooing. There is an urgent need to caution and educate the youngsters and school-going children about safe tattooing and consequences of tattooing.

Pyogenic granuloma with onychomadesis following plaster cast immobilization.

A healthy 14-year-old boy presented with a red nodule on the left thumb for 3 weeks and loss of proximal nail plate of the left index finger for 4 weeks. The patient had developed left distal radio-ulnar joint dislocation following trauma around 3 months back for which a plaster cast was applied from above the elbow up to the metacarpophalangeal joint for 3 weeks. During this period there was no pain, paresthesia or sudomotor change of the fingers of the left hand. One and a half months after the plaster cast was removed, he noticed bleeding from the proximal nail fold of the left index finger and thumb following trivial trauma. It was associated with increased sweating on the cuticular area of these digits. Within a few days, he observed protrusion of red nodules from the proximal nail fold of both left index finger and thumb. The patient was able to pull off the nodule on the index finger; however, he could not remove the thumb lesion. On examination, there was a well-defined erythematous fleshy, transversely elongated nodule on the left thumb involving the proximal nail fold. There was onychomadesis of both left index finger and thumb [Figure 1]. There was no history of local trauma, drug intake or infection prior to development of the nodule. The routine blood investigations were within normal limits. ELISA for antibodies to human immunodeficiency virus was nonreactive. The nerve conduction and electromyographic tests were normal. The lesion was removed by curettage [Figure 2] under local anesthesia and sent for histopathological examination which showed features of pyogenic granuloma [Figure 3]. A final diagnosis of pyogenic granuloma with onychomadesis following plaster cast immobilization was made.

Post-traumatic ectopic nail.

416 A 38-year-old woman presented with a keratotic lesion on the left thumb for 1 year. Six months before the lesion was noted, she had sustained a cut on the medial-third of the distal nail of left thumb extending to the base of the distal phalanx. Examination revealed a 1 cm × 0.5 cm, keratotic, nail-like lesion [Figure 1a]. There was a longitudinal split on the medial third of the left thumb and the scar of the previous cut injury on the distal phalanx. The lesion was excised under distal digital block [Figure 1b]. Histopathological examination revealed nail plate and nail matrix confirming the diagnosis of ectopic nail.

Eccrine angiomatous hamartoma: multiple, symmetrical swellings on forearms of a 10-year-old girl

Editor Eccrine angiomatous hamartoma (EAH) is a rare benign tumour, of eccrine glands and blood vessels. It typically presents during childhood as a solitary slowly growing, bluish-purple nodule or plaque on the distal extremities, and may be associated with pain, hyperhidrosis, and/or hypertrichosis. EAH usually presents as a single plaque or nodule and rarely, multiple lesions may be observed. We herby report a rare case of EAH presenting as multiple painful lesions on both forearms and right hand in a 10year-old girl. A 10-year-old girl presented in Dermatology Out Patient Department with multiple, mildly painful, dusky, raised lesions on both forearms and dorsum of right hand. The first lesion appeared on dorsum of right hand 4 years back in the form of a small, mildly painful nodule. Gradually, new similar lesions appeared on both forearms which slowly increased in size. There was history of increased sweating over the lesions. Her developmental milestones were normal and past medical history was insignificant. There was no history of similar skin lesions in family members. General and systemic physical examinations revealed no abnormality. Cutaneous examination revealed multiple, dusky, mildly tender, firm, nodules, of various sizes ranging 2–4 cm with normal surface distributed symmetrically on both forearms and dorsum of right hand (Fig. 1). The nodules were better felt than seen. Histopathology from nodule on dorsal aspect of right hand showed nests of normal appearing eccrine glands, numerous thin-walled blood vessels and lipomatous tissue in deep dermis (Fig. 2). Routine blood investigations like haemogram, liver and renal function tests were within normal limits. Based on the clinical and histopathological features, diagnosis of EAH was made. The patient was advised for regular follow-up. EAH was first described by Lotzbeck in 1859 and termed as EAH by Hyman and colleagues in 1968. EAH usually presents as a solitary lesion on acral skin, although rare cases with multiple lesions have been described. EAH may be painful and may demonstrate hyperhidrosis due to the presence of the eccrine component. Our case was unique as she had multiple lesions symmetrically distributed on both forearms and dorsum of right hand and there was history of both pain and hyperhidrosis. EAH is characterized histopathologically by dermal proliferation of well-differentiated eccrine secretory and ductal elements closely associated with thin-walled angiomatous channels. Other components, particularly hair follicles, fat or mucin deposition may also be closely associated with the eccrine angiomatous complexes. The histopathology in our case demonstrated increased number of eccrine structures intermingled with numerous thinwalled capillaries and lipomatous tissue in the deep dermis. Carcinoembryonic antigen and S-100 protein, which are commonly found in the eccrine sweat apparatus, are found to be diminished in EAH. However, immunohistochemistry could not be performed in our case. Aetiology of EAH remains unknown. A pathophysiological theory to explain EAH involves a biochemical fault in the interactions between the differentiating epithelium and subjacent mesenchyme that gives rise to an abnormal proliferation of adenexal and vascular structures. As most of the lesions of EAH are located on forearm, some authors suggested that there may be a phylogenetic relationship between EAH and the antebrachial organ of the ringtailed lemur. As EAH is a clinicopathological diagnosis, familiarity with this condition is important for its proper diagnosis. Simple excision is usually curative.

Plica “Neuropathica” in an 11‐Month‐Old Boy

Plica neuropathica is an acquired, irreversible tangling and matting of scalp hair presenting as discrete masses. Many cases are reported in the literature, but it has never been reported in an infant. Herein we report the first case of plica neuropathica in an 11‐month‐old.

Perforating pilomatricoma in a 62-year-old female: a rare case report.

Pilomatricoma presents as a single, slow-growing, painless, superficial mass arising from the hair matrix cells, over the hair-bearing areas of the body, especially the head and neck. Perforating pilomatricoma is a rare variant of pilomatricoma presenting as crusted or ulcerated nodule. Here, we report a case of 62-year-old female presenting with rapidly growing noduloulcerative lesion on the left cheek, which on histopathology showed perforating pilomatricoma.