Siddhi Chikhalkar

Androgenetic alopecia: Quality-of-life and associated lifestyle patterns

Background: Androgenetic alopecia (AGA) is a condition, which is an important psychosocial problem. The hormonal variations causing AGA are known, but whether behavioral patterns and lifestyle influence the condition and which age groups they influence is uncertain and such factors have not been studied in detail. Objectives: To compare association of lifestyle patterns with androgenetic alopecia, prevalence of psychiatric symptoms and resulting quality-of-life (QoL) between two age groups of males with AGA. Materials and Methods: Male subjects in each of the two age groups attending the hair clinic diagnosed with AGA were administered a questionnaire on lifestyle patterns. HAIRDEX and symptom checklist-90 (SCL-90) to study the presence of psychosocial problems and QoL were used. The stress experienced by such patients was studied by a stressful life events scale. Results: Of the 37 patients studied, 23 were in younger age group (average age) and 14 were in the older age group (average age). No significant difference was found in lifestyle, as far as eating habits, physical activity, occupational activity and leisure time were concerned. However, the younger age group had a significantly better psychological health. (P=0.013). On assessing the QoL, self-assurance seemed better in younger age group (P=0.014), reflecting changing societal trends, causing better acceptance of hair loss. On the other subscales, emotions seemed to be more affected in the younger age group, while older patients had worse functioning, more symptoms and more sense of stigmatization. On assessing SCL-90, no significant psychopathological difference was found between both the groups; however the older patients appeared to have more psychological symptoms on almost all scales scoring highly on obsessive–compulsive, interpersonal sensitivity and depression subscales. No significant difference in stressful life events at the time of onset of alopecia was noticed although older patients scored higher on this scale. Family history was found to be significantly associated with the onset of alopecia (P=0.0448). Conclusions: We concluded that lifestyle factors and stressful life events are not significantly affected by the onset of AGA. Only heredity seems to be associated with hair loss. Quality-of-life is affected in both the age groups but younger patients seem to have better self-assurance as well as better psychological health.

Disseminated cutaneous with nasopharyngeal rhinosporidiosis: Light microscopy changes following dapsone therapy.

We report a case of disseminated cutaneous and nasopharyngeal rhinosporidiosis in a 48‐year‐old man. The patient complained of a 6‐month history of six subcutaneous skin‐coloured swellings on the body and a 5‐year history of a pea‐sized swelling on the inner aspect of the left lower eyelid. Histopathological examination from one of these lesions showed multiple globular cysts packed with endospores that were typical of rhinosporidiosis. We report this case because of its rarity and to describe the morphological effects of dapsone in promotion of a host inflammatory response to the organism.

Granulomatous mycosis fungoides with hypohidrosis mimicking lepromatous leprosy

Granulomatous mycosis fungoides (GMF) is a rare type of cutaneous T cell lymphoma. A 38-year-old married male presented with decreased sweating all over the body for last 8 years, progressive redness and scaling over body for 2 years and multiple noduloulcerative lesions over the body for 1 year. Cutaneous examination revealed generalized erythema and scaling with poikilodermatous changes over chest and upper back along with multiple noduloulcerative lesions. Skin biopsy from a nodular lesion revealed dense granulomatous infiltrate of atypical lymphocytes with epidermotropism and sparing of appendages. Diagnosis of GMF was made. Computed tomographic scan of thorax, abdomen and pelvis revealed axillary and inguinal lymphadenopathy. Immunohistochemistry revealed leukocyte common antigen and CD3 positivity suggestive of T cell origin. Patient was started on CHOP (Cyclophosphamide, Hydroxydaunorubicin, Oncovin and Prednisolone) regimen of chemotherapy with marked improvement after three cycles of chemotherapy. This case had some clinical resemblance to lepromatous leprosy.

“Pink glow”: A new sign for the diagnosis of glomus tumor on ultraviolet light dermoscopy

Glomus tumors are usually benign hamartomas, which are painful, small, and uncommon. They are usually subungal in location but may occur at other sites. A female patient presented to the outpatient department with painful swelling over the nail matrix of her right index finger. Here, we describe the use of a videodermosope having white light, polarized light, and ultraviolet (UV) light in the localization of glomus tumors that revealed a pinkish glow on UV light examination suggesting the vascular nature of the tumor. Thus, videodermoscopy can be used as an outpatient department procedure to confirm the diagnosis of glomus tumors.

Generalized lichen planus following tattooing with involvement of old hypertrophic scars: Is it 'Koebner recall?'

Sweet’s syndrome related to multiple myeloma is infrequent,[9] but bortezomib-related neutrophilic diseases have been previously described with typical lesions that usually appear between the first and the third cycle.[4-11] The presence of leucocytosis or fever may favor the diagnosis of myeloma associated-Sweet’s syndrome, but both findings were not present in our case unlike some other cases.[11] We were able to find only 2 previous cases of histiocytoid Sweet’s syndrome related to bortezomib.[4,12] The main differential diagnoses of histiocytoid Sweet’s syndrome include interstitial granuloma annulare and interstitial granulomatous dermatitis, both showing a denser, “bottom-heavy,” inflammatory infiltrate of histiocytes with large, pleomorphic nuclei that in some small foci are arranged in palisades surrounding degenerated basophilic collagen;[1] methotrexate-induced rheumatoid papules, which appears only in methotrexate-treated patients; and leukemia cutis that shows nodular dermal infiltrates of medium-sized, round to oval mononuclear cells that express lysozyme, myeloperoxidase, CD43, CD45, and CD68. Specific myeloma infiltration should be ruled out when evaluating presumed lesions of histiocytoid Sweet’s syndrome. A cytologic examination of peripheral blood should be performed and fluorescence in situ hybridization may be useful to detect underlying cytogenetic abnormalities in histiocytoid Sweet’s syndrome when there is an identifiable chromosomal abnormality.[13]

Successful treatment of multifocal cutaneous leishmaniasis with miltefosine

We report a 48-year-old immunocompetent male, resident of Central India, who presented with slowly progressive asymptomatic multiple red lesions on different parts of body. On enquiry, the patient gave history of travel to Middle East 6 months back. Examination showed 10 crusted erythematous indurated plaques and nodules over forearms, left leg, right index finger, left wrist and dorsa of both feet. Histopathological examination of tissue biopsy showed multiple intracellular as well as extracellular leishmania donovan bodies. Keeping in mind the higher rate of side effects to pentavalent antimony, we treated this patient with oral miltefosine 50 mg bid and the lesions showed complete resolution over 4 months of therapy.

Evaluation of utility of phenol in alopecia areata

Background: Alopecia areata (AA) is a common hair disorder of unknown etiology and prognosis with no definitive cure. Aims and Objective: (i) To study the efficacy and immunomodulatory action of 88% phenol on hair growth on test area in AA. (ii) To study various epidemiological factors in relation to AA. Materials and Methods: A total of 50 subjects presenting with nonscarring patchy hair loss on scalp were enrolled in this prospective open label study to receive 88% phenol at 3 weekly intervals in a tertiary care hospital. Efficacy was assessed using scoring system for density, pigmentation, and texture of growing hair. Results: Texture and pigmentation of hair growth was significantly improved at 9 week, while density of hair growth showed steady improvement, which was significant from 9 week onwards. About 78% of patients showed good to excellent response while none of them showed poor response. Conclusion: 88% phenol was found to be efficacious with all patients showing hair regrowth. 88% phenol can be considered as a treatment of choice for stable AA due to its ease of application, easy availability, and low cost.

Infantile systemic hyalinosis: A case report and review of literature.

We report a case of infantile systemic hyalinosis in a 3.5-month-old male child born out of consanguineous marriage. He presented with multiple brownish raised lesions over bony prominences. He had also developed difficulty in movement of limbs and as a result developed severe flexion joint contractures. There was history of similar complaints in elder sibling who died at the age of 5 months due to repeated episodes of pneumonia. Skin biopsy from one of the papulonodular lesions showed increased amount of amorphous hyaline matrix, which was Periodic Acid Schiff positive with scattered fibroblasts. Though classical, we report this case for its rarity in western India.

Zosteriform spiradenoma with spiradenocarcinoma: A rare entity

Eccrine spiradenoma (ES) is an uncommon well-differentiated benign tumor originating from the sweat glands. It usually occurs as a single lesion in adults. Multiple ES in a linear or zosteriform distribution are rare. Spiradenomacarcinoma is an extremely rare tumor, which develops in an existing benign spiradenoma of several years of duration. We report a case of a 23-year-old- female patient with multiple spiradenomas arranged in zosteriform pattern and malignant transformation occurred in one of the lesions over a period of 10 years.

Sebaceous carcinoma of scalp with proliferating trichilemmal cyst.

Sebaceous carcinoma is a rare neoplasm of the sebaceous gland. It is diagnosed mainly on histopathology and, clinically, it may mimic other neoplasms like squamous or basal cell carcinoma. We came across a patient presenting with a non-healing ulcer over the left temporo-parietal region of the scalp since 4 years and a single asymptomatic nodule over the occipital region since 3 years. Histopathology from an ulcer was pathognomonic of sebaceous carcinoma and that from a nodule was suggestive of proliferating trichilemmal cyst. The patient was screened for Muir Torre syndrome. We referred the patient to the oncologist for further management, where the patient was advised complete excision of the lesion.