Srinath M Kambil

Cutaneous lymphangiectasia of the vulva secondary to tuberculosis

Cutaneous lymphangiectasia, also called as acquired lymphangioma, is a benign cutaneous disorder involving the dermal and subcutaneous lymphatic channels. It can rarely occur on the vulva. We describe a 35-year-old woman who came with multiple raised lesions over the vulva and left upper thigh of 1 year duration. She gave history of getting treated for multiple swellings that developed over right side of the neck and inguinal regions on both sides three decades ago. On local genital examination, the patient had a large polypoidal growth involving both sides of the vulva, left upper thigh, and over pubic area. Multiple linear scars were present over the upper thighs and groin bilaterally. The patient underwent simple vulvectomy and left thigh growth excision. Histopathological examination of the vulvectomy specimen confirmed our diagnosis.

Role of C-reactive protein as a marker of disease severity and cardiovascular risk in patients with psoriasis

Background: There is a paucity of studies addressing the elevation of C-reactive protein (CRP) among psoriatic patients and the role of this marker in assessment of disease severity and association with cardiovascular diseases (CVDs). Objective: To assess the difference in CRP levels between psoriatic patients and healthy population and to determine their role in disease severity. Also to compare CRP levels in psoriatic patients with and without the metabolic syndrome. Materials and Methods: A total of hundred patients with chronic plaque psoriasis and an equal number of age- and gender-matched healthy controls were enrolled in the study over a period of one year. Serum CRP levels of both cases and controls were estimated. Metabolic syndrome was identified among psoriasis patients using National Cholesterol Education Programs Adult Panel III (ATP III) guidelines. Clinical activity of psoriasis was evaluated using Psoriasis Area and Severity Index Score. Results: Patients with psoriasis reported significantly higher levels of CRP than healthy controls (P value 0.001). Patients with severe disease had significantly higher levels of CRP (P value < 0.003). Elevated level of CRP was observed among psoriatic patients with the metabolic syndrome than patients without the metabolic syndrome and the difference was statistically significant (P value = 0.001). Conclusion: CRP may be considered as a useful marker of psoriasis severity that could be used to monitor psoriasis and its treatment. Elevated levels of CRP may be an independent risk factor for CVD in patients with psoriasis.

Clinical and epidemiological features of coryneform skin infections at a tertiary hospital

Background: Skin infections caused by coryneform bacteria are common dermatological conditions. However, to the best of our knowledge, no studies are available on the clinical characteristics and epidemiological features of this group of disorders as one entity from India and abroad. Aims: To study the clinical and epidemiological features of coryneform skin infections Methods: A total of 75 patients presenting with clinically distinctive lesions of pitted keratolysis, erythrasma and trichobacteriosis to our hospital were included in the study. Cases were interviewed with particular emphasis on epidemiological features and the various clinical findings were recorded. Investigations like Grams stain, Woods light examination, 10% KOH scrapings, were done in selected cases to ascertain the diagnosis. Results: Pitted keratolysis was more common in the age group of 31-40 years (40%) with a male preponderance (76.7%), most commonly affecting pressure bearing areas of the soles with malodour (86.7%) and frequent contact with water (58.3%) constituting the most important presenting symptom and provocating factor respectively. Erythrasma affected both male and female patients equally and was more commonly detected in patients with a BMI > 23kg/m2 (62.5%) and in diabetics (50%). All patients with trichobacteriosis presented with yellow coloured concretions in the axillae. Bromhidrosis (71.4%) and failure to regularly use an axillary deodorant (71.4%) were the most common presenting symptom and predisposing factor respectively. Conclusion: Coryneform skin infections are common dermatological conditions, though epidemiological data are fragmentary. Hyperhidrosis is a common predisposing factor to all three coryneform skin infections. Asymmetrical distribution of pits has been reported in our study. Diabetic status needs to be evaluated in all patients with erythrasma. Woods lamp examination forms an indispensible tool to diagnose erythrasma and trichobacteriosis.

Diffuse cutaneous leishmaniasis in coexistence with leprosy.

Cutaneous leishmaniasis and leprosy are diseases both caused by intracellular pathogens that represent a major health predicament even today. Both these diseases have some characteristics in common, such as the involvement of mucocutaneous tissue, a course with a chronic granulomatous response, a broad clinical spectrum in relation to the hosts immunity, and they often affect the poor population in tropical countries. Co‐infection of the two diseases, although known to occur, is rarely encountered and reported. Even though new cases of leprosy are diagnosed in the region of coastal Karnataka of India, cutaneous leishmaniasis is rarely reported. We hereby describe a patient who presented with concurrent leprosy and diffuse cutaneous leishmaniasis.

Target-like pigmentation after minipunch grafting in stable vitiligo

Surgical treatment for vitiligo has been ever evolving. Each surgical modality has its own benefits and limitations. Miniature punch grafting is the most extensively performed surgery, which gives good results in stable vitiligo. Herein we report an unusual type of repigmentation observed after minipunch grafting in a patient of stable vitiligo, which resembled target-like lesions with a “perigraft halo” surrounding individual grafts. Such pigment spread occurred despite the use of 0.5 mm larger graft from the donor site.

Granulomatous cheilitis with granulomatous vulvitis: a rare association.

Granulomatous cheilitis and granulomatous vulvitis are rare disorders characterized by painless swelling of lips and vulva, respectively. Histopathology of both conditions show non-caseating epithelioid cell granulomas in the dermis. Both disorders have been associated with Crohns disease rarely. Occurrence of the two conditions in the same patient is extremely infrequent. We hereby report, the association of granulomatous cheilitis with granulomatous vulvitis in a 30-year-old female.

Subcutaneous mycoses in coastal Karnataka in south India

Subcutaneous mycoses are chronic, localized infections of the skin and subcutaneous tissue which occur following traumatic implantation of the etiological agent. The causative organisms are soil saprophytes of regional epidemiology with varying ability to adapt to the tissue environment and elicit disease.

Granulomatous pyoderma gangrenosum of the genitalia in the absence of Crohn's disease.

Pyoderma gangrenosum (PG) is a rare ulcerative neutrophilic disorder of the skin. Atypical variants of PG such as vegetative PG, bullous PG, and pustular forms are described in literature. Occasionally, granulomatous reaction in dermis may be seen on histology when PG is associated with Crohn′s disease or in the vegetative variant of PG. We report a case of granulomatous PG involving the genitalia in a 43-year-old female without associated inflammatory bowel disease.

Benign cephalic histiocytosis

Benign cephalic histiocytosis was first described by Gianotti, Caputo, and Ermacora in 1971. There have been 56 cases of BCH reported in literature so far. A slight male preponderance (1.67:1) has been seen and in 50% of cases lesions start developing by 6 months of age.[1,2] BCH typically presents as yellow to red‐brown papules of 2–8 mm size located on the head, neck, and shoulders. Lesions may subsequently spread to involve trunk arms and legs, but spares the palms, soles, mucosa, eyes, and internal organs. Though single case reports of diabetes insipidus and insulin‐dependent diabetes mellitus associated with BCH have been reported, systemic involvement is not usually seen.[3,4] Histological examination shows circumscribed histiocytic infiltrate in the upper dermis, but foamy cells and touton giant cells are usually absent. Comma‐shaped or worm‐like bodies are seen in 5–30% of histiocytes on electron microscopy, but birbeck granules are absent in BCH.[5] Immunohistologically the lesional cells are positively for CD68, factor XIIIa, and fascin and negative for CD1a, S100, and langerin. BCH must be differentiated from histiocytic disorders like juvenile xanthogranuloma, GEH, LCH, and non histiocytic disorders like mastocytosis, plane warts, syringoma, and spitz nevi. Lesions of BCH spontaneously regress in an average of 50 months and may sometimes leave behind hyperpigmented macules or atrophic scars. No treatment is required and the benign nature of BCH should be explained to the parents of the child. Sir, Benign cephalic histiocytosis (BCH) is a rare, benign, nonlangerhan cell histiocytosis (LCH) seen in infants and young children. It presents as a self‐healing eruption of red‐brown papules on head and neck initially and lesions may subsequently spread to involve trunk, arms, and legs. Histological finding of CD68 and factor XIIIa positive histiocytes in the dermis helps to confirm the diagnosis.[1]

Immunobullous disorders: Clinical histopathological and immunofluorescence study of thirty-six cases

Background: Immunobullous disorders are characterized by antibody-mediated bullous lesions affecting the skin and mucosa. Accurate diagnosis of these disorders requires clinicopathological correlation along with immunofluorescence study. Aims and Objectives: To study the clinical, histopathological, and immunopathological features of immunobullous disorders and to analyse the utility of immunofluorescence in the diagnosis of these disorders. Materials and Methods: A total of 36 cases of immunobullous disorders observed over a span of 2 years in our institution were studied. Detailed clinical examination, histopathological examination and immunofluorescence study were done in all cases. Results: Out of 36 cases studied, 18 cases (50%) belonged to pemphigus group, 10 cases (27.78%) were bullous pemphigoid (BP), 5 cases (13.89%) were linear IgA disease (LAD), 2 cases (5.56%) were cicatricial pemphigoid (CP) and 1 case (2.77%) was lichen planus pemphigoides (LPP). Twenty-one patients (58.33%) were in the age group of 21-60 years, 9 patients (25%) were above 60 years and 6 patients (16.67%) were below 20 years. Histopathology of all cases of pemphigus vulgaris (PV) showed suprabasal bulla with acantholytic cells. Pemphigus foliaceus (PF) showed subcorneal bulla in all three cases. Immunofluorescence in all 15 cases of PV showed IgG deposition in intercellular substance (ICS) and C3 deposition in ICS in six cases. PF showed IgG deposition in ICS in all three cases. BP and CP showed deposition of IgG and C3 in a linear band at basement membrane zone (BMZ) in all cases. All cases of LAD showed linear IgA band at BMZ. Conclusion: In three cases (two cases of BP and 1 LAD), immunofluorescence was absolutely essential to come to a final diagnosis, while in two cases of CP immunofluorescence helped in confirming the clinical diagnosis as histopathological finding was nonspecific. In the remaining cases it helped in confirming the diagnosis suggested by clinical examination and light microscopy.