Sukumar Dandekeri

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.

Acquired bilateral nevus of ota-like macules with Mucosal involvement: A new variant of Hori's nevus

Acquired bilateral nevus of Ota-like macules (ABNOM) or Horis nevus, a rare form of acquired dermal melanocytoses, presents as bilateral facial blue-gray macules without ocular or mucosal involvement. This condition is mostly found in women of Asian descent and usually appears in the fourth or fifth decade of life. Pathogenesis is unknown, though few theories have been proposed. Effective treatment has been found to be achieved with pigment-specific lasers. Herein, we report a case of Horis nevus with mucosal involvement. A 42-year-old male patient, presented to us with blue-gray discoloration on either side of his face, both eyes, and in the mouth since the age of one year. Histopathological examination showed clusters and singly dispersed pigmented melanocytes within the upper and mid-dermis regions. Special staining of melanocytes using Masson-Fontana stain was positive. Diagnosis of Horis nevus was made by correlating clinical and histopathological findings. Patient was informed of his treatment options, but refused treatment. A similar case of Horis nevus with mucosal involvement has not been reported so far.

Epidemiological and investigative study of premature graying of hair in higher secondary and pre-university school children

Background: Hair pigmentation is one of the most conspicuous phenotypes in humans ranging from black, brown, and blonde to red. Premature graying of hair occurs more commonly without any underlying pathology but is said to be inherited in autosomal dominant pattern. Premature graying has been shown to be associated with a few of the autoimmune disorders. A role for environmental factors and nutritional deficiencies has also been postulated. However, to date the exact etiology of premature graying has not been established. Aim: The objective of our study was to conduct an epidemiological and investigative study of premature graying of hair in higher secondary and pre-university school children of the semi-urban area. Materials and Methods: A total of 35 cases and controls were investigated for various parameter such as Hemoglobin, total iron binding capacity, serum ferritin (S. Ferritin), serum calcium (S. Ca), serum iron (S. Iron), vitamin B12, and vitamin D3 after taking informed consent. Epidemiological and investigations correlation was established using the Chi-square and Mann Whitney test and P < 0.05 values were considered significant. Result: Among the various laboratory parameters S. Ca, S. Ferritin and vitamin D3 were low in patients with premature graying of hair. There was significant high number of vitamin D3 deficient and insufficient among the cases compared to the controls. Conclusion: According to our study S. Ca, S. Ferritin, vitamin D3 may play a role in premature graying of hair in our society.

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.

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]

Histoid leprosy in the era of elimination

Histoid leprosy is a variant of Lepromatous leprosy believed to occur due to a mutant strain of leprosy bacillus called as Histoid Bacillus. It was first described by Wade in 1960 in patients from Phillipines. It occurs in patients relapsing after Dapsone monotherapy, in the presence of Dapsone resistance or at times denovo, presenting with lesions mainly over bony prominences. Herein, we present a case of a 37 year old male who presented with skin coloured raised lesions mainly over the trunk, chest, neck and ears in contrast to its usual site of presentation, associated with tingling sensation over the hands and feet. A histopathological examination of the skin lesion was ordered which revealed sheets of histiocytes and lepra bacilli on hematoxylin and eosin and acid fast staining. On correlating the clinical and histopathological findings we came to a diagnosis of Histoid leprosy. The patient was promptly treated with MB-MDT and followed up.