Shricharith Shetty

Autologous platelet-rich fibrin in treatment of scleroderma ulcer

Dear Editors, Systemic sclerosis (SSc) is a generalized disorder of connective tissue in which there is thickening of dermal collagen bundles, and fibrosis and vascular abnormalities in internal organs. Skin ulcers in SSc are often painful, slow healing and unresponsive to traditional treatments, with greater impact on the patient’s quality of life. The standard approach for skin ulcers is often ineffective. Here we report a case of SSc with chronic painful refractory skin ulcer, showing good improvement with platelet-rich fibrin (PRF) therapy. The procedure involves drawing of blood that is collected into test tubes without an anticoagulant followed by centrifuging instantaneously at 2700 rpm for 12 minutes. The resultant product consists of three layers (Figure 1A), out of which intermediate level clot is then removed from the tube (Figure 1B) and gently squeezed to obtain the PRF membrane. The PRF obtained is then applied over the cleaned ulcer and covered by an occlusive dressing. The primary dressing is left in place for 7 days and changed at weekly intervals. Care should be taken not to disturb the wound bed unless there is concern about possible infection. A 46-year-old woman, suffering from diffuse cutaneous SSc for 12 years, presented with 3 cm× 3 cm non-healing painful skin ulcer over the left great toe (Figure 2A). She had history of ulcers at the tip of hand digits and over both elbows, all of which had healed with previous treatments except for the ulcer over the left great toe which was persisting for more than a year. She was on oral pentoxifylline, aspirin, proton pump inhibitor and antibiotics along with regular dressings for the ulcers.

Linear alopecia areata

Alopecia areata (AA) over scalp is known to present in various shapes and extents of hair loss. Typically it presents as circumscribed patches of alopecia with underlying skin remaining normal. We describe a rare variant of AA presenting in linear band-like form. Only four cases of linear alopecia have been reported in medical literature till today, all four being diagnosed as lupus erythematosus profundus.

Acantholytic Variant of Bowen's Disease with Micro-invasive Squamous Cell Carcinoma: A Case Report of a Unique Variant.

Bowens disease is generally regarded as premalignant dermatoses. The disease affects both skin and the mucosa and has the potential to progress to invasive squamous cell carcinoma. There are descriptions of several histological variants of Bowens disease like psoriasiform, atrophic, pagetoid, etc. Acantholysis of anaplastic keratinocytes with bullae/cleft formation is described in premalignant condition like actinic keratosis and adenoid variant of squamous cell carcinoma, but there is lack of report describing this phenomena in Bowens disease. We present a case of unusual acantholytic variant of Bowens disease with focus of micro-invasive carcinoma.

Aesthetic correction of smoker's lip using 1064 nm Q-switched neodymium-doped yttrium aluminium garnet laser

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Orange web space in a patient with pulmonary tuberculosis

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Granular IgM deposition at basement membrane zone in an infant with diffuse cutaneous mastocytosis

Diffuse Cutaneous mastocytosis (DCM) occurs due to abnormal accumulation of mast cells in the skin. We report an 8-month-old infant presented papulovesicular lesions, predominantly on the trunk. Skin biopsy revealed subepidermal bulla, interspersed with mast cells, eosinophils and neutrophils. Direct immunofluorescence microscopy of perilesional skin revealed nonspecific deposition of IgM in granular pattern along the dermoepidermal junction.

Curious case of raccoon eye under general anaesthesia

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Parthenium Dermatitis With Deck-Chair Sign

Study concept and design: Diven, Allred, Reed. Acquisition, analysis, or interpretation of data: Bartenstein, Diven, Reed. Drafting of the manuscript: Bartenstein, Diven, Allred. Critical revision of the manuscript for important intellectual content: Bartenstein, Diven, Reed. Statistical analysis: Bartenstein, Reed. Administrative, technical, or material support: Reed. Study supervision: Diven, Reed.