Shuchi Bansal

Chemical peels for melasma in dark-skinned patients

Melasma is a common disorder of hyperpigmentation, which has a severe impact on the quality of life. Inspite of tremendous research, the treatment remains frustrating both to the patient and the treating physician. Dark skin types (Fitzpatrick types IV to VI) are especially difficult to treat owing to the increased risk of post-inflammatory hyperpigmentation (PIH). The treatment ranges from a variety of easily applied topical therapies to agents like lasers and chemical peels. Peels are a well-known modality of treatment for melasma, having shown promising results in many clinical trials. However, in darker races, the choice of the peeling agent becomes relatively limited; so, there is the need for priming agents and additional maintenance peels. Although a number of new agents have come up, there is little published evidence supporting their use in day-to -day practice. The traditional glycolic peels prove to be the best both in terms of safety as well as efficacy. Lactic acid peels being relatively inexpensive and having shown equally good results in a few studies, definitely need further experimentation. We also recommend the use of a new peeling agent, the easy phytic solution, which does not require neutralisation unlike the traditional alpha-hydroxy peels. The choice of peeling agent, the peel concentration as well as the frequency and duration of peels are all important to achieve optimum results.

A clinicotherapeutic analysis of Stevens–Johnson syndrome and toxic epidermal necrolysis with an emphasis on the predictive value and accuracy of SCORe of Toxic Epidermal Necrolysis

The SCORTEN scale (SCORe of Toxic Epidermal Necrolysis) is widely used to predict mortality in patients with Stevens–Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). Although it is largely a useful tool, the predictive ability of the scale is variable, and modifications to the existing scale have been suggested. In addition, there is controversy regarding the roles of active therapy and conservative management.

Epidermolysis bullosa: Where do we stand?

Epidermolysis bullosa, a genetically determined skin fragility disorder can severely incapacitate the life of the afflicted patient. Although the clinical features are multiple and varied, treatment still remains a major challenge. There have been major changes in the classification of the disease recently. Although there is still a long way to go, good nursing care, and gene therapy could possibly significantly alleviate the suffering of the patients in the future.

Postkala-azar dermal leishmaniasis coexisting with borderline tuberculoid leprosy.

follow-up no difference was noted in the noninflammatory lesions, whereas the count of inflammatory lesions had decreased on average by 66% (range 56–81%). All 16 patients completed the trial. To conclude, we believe that the use of MAL reduced to 4% concentration, together with application of low doses of light, may be useful for controlling the side-effects of PDT in acne and have the same efficacy as the higher concentration but with lower costs. Nevertheless, controlled studies are needed on a larger number of patients in order to determine the most effective therapy capable of balancing good efficacy with reduced side-effects.

Concurrent hand-foot skin reaction and hair depigmentation with sunitinib: Report of a case and literature review of kinase inhibitors and blocking antibodies

Kinase inhibitors have revolutionized cancer therapy by becoming the first-line agents for advanced solid malignancies replacing the traditional chemotherapeutic agents. Cutaneous side-effects with these drugs are common, but owing to their infrequent use in Indian patients, our current knowledge of toxicity is scanty and primarily based on the western literature. Cutaneous reactions can adversely affect patients’ quality of life (QoL) and can lead to dose modifications and treatment interruptions. The report discusses concurrent hand-foot skin reaction (HFSR) and hair depigmentation in an Indian patient being treated with sunitinib for advanced renal cell carcinoma. The pathogenesis and treatment strategies for this characteristic phenomenon and other cutaneous toxicities of kinase inhibitors have also been reviewed.

Periocular lupus vulgaris secondary to lacrimal sac tuberculosis: a rare presentation with emphasis on magnetic resonance imaging in localizing the primary focus of infection.

425 Indian Journal of Dermatology, Venereology, and Leprology | May-June 2013 | Vol 79 | Issue 3 and have a propensity to develop many different types of tumors.[2] To the best of our knowledge, there are twenty four published cases of NF1‐associated glomus tumors.[3‐5] The loss of neurofibromin function in NF1 patients is crucial for the pathogenesis of glomus tumors, and glomus tumors are thought to be part of the NF1 phenotype.[3] On the other hand, sporadic glomus tumors are almost always solitary,[1] whereas 10 (42%) patients among the reported NF1‐associated glomus tumor cases had multiple glomus tumors, as observed in our case. Multiple occurrences may be a characteristic feature of NF1‐associated glomus tumors.

Acquired port-wine stain in an adult male: First reported case from India with review of literature

Port-wine stains (PWSs) are congenital vascular lesions caused by progressive ectasia of blood vessels located in the vascular plexus of the dermis. Acquired PWSs develop later in life but are identical in morphology and histology to the congenital PWSs. Less than 75 cases of acquired PWSs have been reported in the published literature, of which there has not been a single report from India so far. Various factors have been proposed for its pathogenesis like trauma, actinic exposure, drugs, tumors, and herpes zoster infection. We report an acquired port-wine stain in a 41-year-old male. The causative factors, treatment, and previous reports of this uncommon entity have also been reviewed.

Solitary eccrine syringofibroadenoma with nail involvement: A rare entity

Eccrine syringofibroadenoma (ESFA) is a rare, benign tumor of eccrine sweat gland origin that usually presents as a nodule on the extremities of an elderly person. It can also present as an ulcerative plaque, verrucous lesion, papular or nodular lesion or as palmoplantar keratoderma. Although the clinical features are variable, histology is characteristic in the form of anastomosing strands, cords and columns of epithelial cells embedded in a fibrovascular stroma. We report the case of a 62-year-old male with a nodular lesion on the extremity that caused secondary involvement of the nail in the form of complete nail dystrophy. The histology showed features consistent with ESFA. Nail involvement by ESFA is a rare presentation and is rarely described in the literature.

A rare presentation of mammary Paget's disease involving the entire breast in the absence of any underlying ductal malignancy.

Pagets disease of the breast is an uncommon form of breast cancer presenting as an eczematous eruption over the nipple and/or areola. The diagnosis remains elusive with varied presentations, mimicking many benign skin diseases, the awareness of which is indispensable for diagnosis and minimizing morbidity. Most of the cases have an associated malignancy of the underlying breast tissue. There have been very few reports wherein the disease has occurred independent of any underlying malignancy. Since, the initial presentation is limited to skin; it is the dermatologist who plays a key role in making a diagnosis, thus, facilitating proper management. We report a rare presentation of mammary Pagets disease with a wide cutaneous spread probably attributed to a significantly delayed diagnosis without any associated underlying malignancy.