Subhra Dhar

Colocalization of vitiligo and psoriasis in a 9-year-old boy.

To the Editors: Information on reticulate pigmentary disorders is scant (1) and these disorders have not been adequately highlighted in standard dermatology texts. DowlingDegos disease (DDD), reticulate acropigmentation of Kitamura (RAPK), and acropigmentation of Dohi are some of the entities in this heterogeneous group (2). Cases reported in non-Japanese populations are of special interest (3,4). A substantial number of cases of DDD and RAPK have been reported from India (5-9). The first author has reported a series of cases from northern India (9). However, acropigmentation of Dohi is a rarely reported entity in India (10). To the best of our knowledge, so far only one case has been reported (9). We herein describe an additional case recently seen by us. A 12-year-old boy had 1 to 4 mm angulated, dark brown, frecklelike lesions symmetrically distributed over the dorsa of both hands and feet for the last 5 years. In addition, multiple 1 to 3 mm depigmented macules were interspersed in the same distribution. There was no atrophy over the macules or palmar pits or breaks in the epidermal ridge pattern. No other site was affected. None of his family members had a similar skin problem. He was diagnosed as acropigmentation of Dohi. Skin biopsy was refused by the patient. Acropigmentation of Dohi has mostly been reported in Japanese individuals (11). A combination of angulated, nonatrophic, dark brown, frecklelike macules over the dorsa of the hands without palmar pits establishes the diagnosis. Of 12 cases studied by Dohi (1920) and reported by Komaya (1 l), 10 were boys and 2 were girls. Our present patient also was a boy. However, the earlier case seen by the first author was a girl (9). Although this entity is known to be transmitted as an autosomal dominant trait (1 I), neither the boy’s parents nor his two sisters had a similar type of pigmentation. This can be explained on the basis of spontaneous mutation or incomplete penetrance. The girl reported earlier also had no affected family members (9).

Seven cases of histoplasmosis: Cutaneous and extracutaneous involvements

Seven cases of histoplasmosis have been reported, 6 males and one female. Their ages ranged from 40 to 78 years. Of 7 patients, 5 had skin lesions, 4 with palatal ulcer, one with papules and nodules. None of the patients were HIV positive. In all patients either cytology, or skin biopsy or both revealed Histoplasma. Culture was positive in two patients.

Diffuse cutaneous mastocytosis with bullous lesions and pulmonary involvement: A rare case

Mastocytosis is defined as a heterogeneous group of disorders characterized by an accumulation of mast cells in one or more organs, particularly in the skin, bone marrow, liver, spleen and lymph nodes. However here we describe an 11-month-old girl child presented with diffuse cutaneous mastocytosis with bullous lesion, having pulmonary involvement, which is very rare and there is no available case report from India.

Child with flagellate skin eruptions

An 8-year-old girl presented with asymptomatic skin lesions over the face, neck, trunk, and extremities for month. Two months before, she had developed an asymptomatic skin rash on both hands. There was no history of fever, oral ulcers, arthritis, photosensitivity, or any topical application, but there was history suggestive of proximal muscle weakness. Physical examination revealed proximal muscle strength grossly reduced. Cutaneous examination revealed erythematous to hyperpigmented linear flagellate macules or zebra stripelike macules distributed longitudinally on the face, neck, trunk, and upper limbs (Figures 1–3). Multiple erythematous to violaceous papules were present on the metacarpophalangeal joints. There was no dermatographism. Oral mucosa, nails, palms, and soles were normal. Other systemic examination was normal. Skin and muscle biopsy were assessed.

Cutaneous plasmacytosis: A rare entity with unique presentation

Primary cutaneous plasmacytosis is a rare cutaneous disorder with extensive cutaneous plaques/papules mainly on the trunk and face. Cases have mostly been documented from Japan. We present here a rare case of cutaneous plasmacytosis from India of Mongolian descent. This 50-year-old female from Mizoram had extensive maculo-papular violaceous plaques distributed on the face, axillae, trunk and lower extremities. Initial and repeat skin biopsy revealed dense perivascular and periadnexal mature plasma cells. She also had lymphadenopathy. Serum protein electrophoresis did not reveal any M band and the Bence Jones protein was negative in urine. The patient had multiple superficial lymph nodes and a biopsy from the cervical lymph node showed effacement of normal nodal architecture by sheets of plasma cells. Immuno histochemistry was done from both skin and lymph node biopsies. The kappa and lambda tight chains were not restricted; there by proving the polyclonal nature of the plasma cells. The novelty of the case lies in its classical clinical presentation with histopathological documentation.