Subhav Kumar Agrawal

Pearly penile papules: a review

Lesions similar to PPP were described as early as 1700 by Littre. 8 Duhring reported similar lesions in 1888 and thought that they were nerve organs. 8 In 1909, Buschke demonstrated similar lesions in men and boys, and stated that similar structures had been observed in the newborn and even in the orangutan. 4 Later illustrations were reproduced by Dickinson 9 in his atlas. The term PPP was coined by Johnson and Baxter, 1

Topical tretinoin in Indian male with zosteriform porokeratosis.

International Journal of Dermatology 2003, 42 , 919–920 919 XXXX Topical tretinoin in Indian male with zosteriform porokeratosis A 28-year-old Indian male presented with the complaint of the gradual appearance, over the course of 1 year, of multiple asymptomatic skin lesions on the left shoulder and back. He gave a history of applying topical medicaments (the nature of which could not be ascertained) for 2 months without any relief. The patient was a young healthy adult with a normal general physical and systemic examination. Cutaneous examination revealed multiple annular plaques of variable size (3–10 mm in diameter) arranged in a zosteriform pattern on the dorsolateral aspect of the arm, shoulder and back extending to the medial border of the left scapula ( Fig. 1 ). Each lesion was reddish brown in color and had a conspicuous thread-like border with a mildly atrophic center ( Fig. 2 ). In a few places, annular lesions had coalesced to form large polycyclic plaques. Histopathological evaluation of a punch biopsy specimen taken from the edge of an annular lesion stained with hematoxyline and eosin showed a markedly hyperkeratotic epidermis with a conspicuous parakeratotic column suggestive of cornoid lamella. The granular layer was absent below the cornoid lamella and a mild lymphocytic infiltrate was present in the dermis below it. The patient was started on topical application of tretinoin (0.1%) gel every night. He responded dramatically, with complete resolution of lesions over the next 4 months, leaving mild residual pigmentation. At further follow-up after 2 months, the mild pigmentation persisted without the appearance of any new lesions.

Comparative efficacy of topical 1% butenafine and 1% clotrimazole in tinea cruris and tinea corporis: A randomized, double‐blind trial

Localized tinea cruris and tinea corporis can be treated by topical imidazoles (clotrimazole) or newer topical agents like butenafine, a benzylamine derivative with fungicidal activity. The therapeutic efficacy of these two agents was compared in this study. Eighty patients, diagnosed clinically to have tinea cruris or localized tinea corporis and confirmed on KOH examination, were randomly assigned to one of the two treatment groups in a double‐blind manner; butenafine once daily for 2 weeks or clotrimazole twice daily for 4 weeks. Follow‐up was done at 1, 2, 4 and 8 weeks. Clinical assessment score and KOH examination were performed at each visit. Butenafine recipients exhibited higher clinical cure as compared with clotrimazole recipients at the end of 1 week (26.5% vs 2.9%) as well as higher mycological cure (61.7% vs 17.6%). However, this difference was not statistically significant at 4 and 8 weeks of treatment.

Calcium Dobesilate (Cd) in Pigmented Purpuric Dermatosis (PPD): A Pilot Evaluation

Pigmented purpuric dermatosis (PPD) is a chronic disorder of unknown etiology. It is quite common, and no therapy is significantly effective. Calcium dobesilate (Cd) has been tried successfully in many vascular disorders. The aim of this study was to evaluate the usefulness and efficacy of Cd in PPD. Nine male patients (7 with Schambergs and 1 each with lichenoid dermatosis of Gougerot and Blum and lichen aureus) were given Cd 500 mg twice daily for two initial weeks and then 500 mg once daily for a total period of three months. All the patients were followed up for one year after cessation of therapy. The improvement was moderate in 11.11% and mild in 66.67% of cases; 22.22% did not show any improvement. New lesions stopped appearing in two weeks in all patients, and itching also improved in symptomatic cases without any significant side effects. Based upon the results of this pilot study we recommend Cd as the first line therapy for PPD.

Mondor's phlebitis of penis following recurrent candidal balanoposthitis

Since 1970, there have been 10 case reports/studies describing familial LP in 28 families. These case reports of familial LP occurring in two or more members of one family have described cutaneous or a combination of cutaneous and mucosal lesions. 2–8 The present case report describes a woman, her son, and grandson with mucosal LP and no cutaneous lesions. To my knowledge, a familial occurrence of mucosal LP in three successive generations has not been reported previously. A 65-year-old woman (Case 1) presented with complaints of soreness of the mouth of 10 years’ duration. She experienced discomfort and a burning sensation on consuming hot and spicy food. On examination, she had a violaceous plaque of 2.0 × 1.5 cm in size in the middle of the right half of the tongue (Fig. 1). She did not have cutaneous, nail, or scalp lesions. A clinical diagnosis of LP was confirmed on histopathology of the lesion, which showed characteristic parakeratosis, basal cell vacuolar degeneration, and a dense upper dermal infiltrate comprising predominantly lymphocytes. One year later, the 32year-old son (Case 2) of Case 1 presented with a moderately itchy, violaceous papule on the glans penis of 6 months’ duration and multiple painful violaceous lesions on the buccal mucosa bilaterally. Around the same time, the 11-year-old grandson (Case 3) of Case 1 and the son of Case 2 presented with an erythematous, painful lesion with a violaceous hue, measuring 1.0 × 1.5 cm in size, on the right half of the tongue (Fig. 1) of 2 months’ duration. Histopathology from the lesions was consistent with a clinical diagnosis of LP in Cases 2 and 3. All three patients were treated with topical betamethasone dipropionate 0.05% in gel formulation for a duration of 3–6 months. This treatment resulted in the resolution of the lesions with postinflammatory hyperpigmentation in all three cases. Other members of the family were also clinically examined, but none were found to have mucosal or cutaneous lesions of LP. The pedigree (Fig. 2) of this family suggests an autosomal dominant transmission, as mucosal LP manifested in one female and two males over three successive generations with each affected individual having an affected parent. In the earlier case reports of familial LP, only two generations were affected, and hence the pattern of inheritance could not be ascertained. The etiopathogenesis of LP remains obscure. Immunologic, infective, and genetic etiologies have been suggested. Copeman et al . 2 found an association of human leukocyte antigen (HLA)-B7 in familial cases, but not in patients with sporadic LP; however, no significant associations were found between HLA and LP in other studies. 8,9 A single case report described LP concurrently in monozygotic twin sisters, supporting a possible genetic predisposition. 10 The present report of mucosal LP in three successive generations also suggests a genetic predisposition to the disease.