Tj Jaisankar

Disseminated Cutaneous Rhinosporidiosis

Two cases of longstanding rhinosporidiosis developed widespread asymptomatic nodular skin lesions. Cutaneous examination showed multiple, discrete, sessile and pedunculated, smooth and warty, friable nodular lesions of variable sizes and shapes. Histopathology of representative skin lesions showed hyperplastic epidermis with sporangia containing spores in the upper dermis diagnostic of rhinosporidiosis. Epidemiological data about rhinosporidiosis at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India, is presented. Possible modes of dissemination to the skin and differential diagnosis are discussed in relation to this rare manifestation of rhinosporidiosis.

A clinical study of skin changes in pregnancy.

BACKGROUND During pregnancy profound immunologic, metabolic, endocrine and vascular changes occur, that are responsible for the changes of the skin and its appendages, both physiologic and pathologic. AIMS We undertook a clinical study to find out the frequency and pattern of skin changes in pregnant women. METHODS All consecutive pregnant women were included in the study. RESULTS A total of 607 pregnant women were included in this study. Of these, 303 (49.9%) pregnant women were primigravida and 304 (51.1%) were multigravida. Skin changes grouped into: physiological changes (all cases), specific dermatoses (22 cases) and other dermatoses affected by pregnancy (125 cases). Most common physiological changes were pigmentary alterations seen in 555 (91.4%) followed by striae seen in 484 (79.7%) cases. Of the various specific dermatoses of pregnancy, pruritic urticarial papules and plaques of pregnancy (PUPPP) was the most common disorder (14 cases) followed by pruritus gravidarum (5 cases). The most common dermatoses affected by pregnancy were candidal vaginitis (17 cases), acne vulgaris (15 cases), skin tags (15 cases), eczemas (14 cases). CONCLUSION This study brings into focus various skin changes during pregnancy in south India.

Retrospective analysis of Stevens-Johnson syndrome and toxic epidermal necrolysis over a period of 10 years

Background: Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN), are the acute emergencies in dermatology practice. Prompt diagnosis and management may reduce the morbidity and mortality in SJS/TEN patients. Early identification of the offending drug is necessary for early withdrawal and to prevent the recurrences of such a devastating illness. Aims To study the demography, offending agents, clinical and laboratory features, treatment, complications, morbidity and mortality of SJS/TEN in our hospital. Materials and Methods: In this retrospective study, we reviewed the medical records of SJS, TEN, SJS/TEN overlap of inpatients over a period of 10 years Results: Maximum number of SJS/TEN cases were in the age group of 11-30 years. Males predominated in the SJS group with a ratio of 1.63:1, whereas females predominated the TEN group with a ratio of 1:2.57.Nonsteroidal anti-inflammatory drugs (NSAIDs) were the commonest group of drugs among the SJS group in 5/21 patients (23.8%). Antimicrobials were the commonest group of drugs causing TEN in 11/25 patients (44%). Mucosal lesions preceded the onset of skin lesions in nearly 50%. Our study had one patient each of SJS/TEN due to amlodipine and Phyllanthus amarus, an Indian herb. The most common morbidity noted in our study was due to ocular sequelae and sepsis leading to acute renal failure respectively. Kaposis varicelliform eruption was found in three of our patients. Conclusion: Antimicrobials and NSAIDS are the common offending agents of SJS/TEN in our study.

Pebbling of the skin: a marker of Hunter's syndrome.

Abstract: A 9‐year‐old boy, the third child of nonconsanguinous parents, presented with asymptomatic, solid, raised skin lesions over the upper back. They first appeared at the age of 4 years. Gradually similar lesions appeared over the chest, neck, arms, and thighs. On examination, he had firm, hypopigmented to skin‐colored papules and nodules which coalesced to form ridges in a reticular pattern (pebbling of the skin) and were arranged bilaterally and symmetrically over the scapulae, pectoral region of the chest, and lateral aspects of the arms and thighs. They resembled sulci and gyri of the brain. He had normal intelligence, short stature, coarse facial features, thick lips, a large tongue, clear corneas, a protuberant abdomen with hepatosplenomegaly, and broad hands with clawlike contractures of the distal interphalangeal joints. Investigations revealed cardiomegaly and proximal tapering of metacarpal bones. Although peripheral blood smear and urine spot test for mucopolysaccharides were negative, histopathology of a representative skin lesion was compatible with the diagnosis of Hunters syndrome. The case is reported for its rarity and the typical skin lesions, the recognition of which may be helpful in diagnosis and genetic counseling.

High seroprevalence of HSV-1 and HSV-2 in STD clinic attendees and non-high risk controls: a case control study at a referral hospital in south India.

BACKGROUND In Asia, HSV seroprevalence studies are sparse and they have recorded lower prevalence of HSV infection, especially HSV-2. AIMS To ascertain the seroprevalence of HSV-1 and HSV-2 in patients attending a STD clinic in a referral hospital in south India and to compare it with a control group. METHODS The study included 135 consecutive STD cases having history of ulcerative or non-ulcerative STD in the present or in the past 5 years and 135 age and sex-matched controls. Diagnostic serology was done for HSV-1 and HSV-2 using type specific IgG by indirect immunoassay using ELISA. The results were analyzed utilizing Chi- square test. RESULTS Amongst 135 STD clinic cases, 106 cases were males and 29 cases were females with male to female ratio of 3.65:1. The mean age was 32.2 years (range 16-65 years). Among study group cases, 112 (82.9%) cases were co-infected with HSV-1 and HSV-2, 11 (8.1%) cases were seropositive for HSV-1 alone and 3 (2.2%) cases were seropositive for HSV-2 alone. In the control group, 112 (82.9%) cases were co-infected with HSV-1 and 2, 12 (9.6%) for HSV-1 alone and 1(0.8%) for HSV-2 alone. Correlation of HSV-1 and HSV-2 serology with various demographic and behavioral factors was statistically insignificant. CONCLUSIONS Seroprevalence of HSV-1 and HSV-2 in STD clinic cases and control group is high, similar to that recorded in sub-Saharan Africa. Thus, serological studies for HSV-1 and HSV-2 cannot be taken as a marker of sexual behavior in our set of population.

Spectrum of vaginal discharge in a tertiary care setting

Introduction: Vaginal discharge is one of the common reasons for gynecological consultation. Many of the causes of vaginitis have a disturbed vaginal microbial ecosystem associated with them. Effective treatment of vaginal discharge requires that the etiologic diagnosis be established and identifying the same offers a precious input to syndromic management and provides an additional strategy for human immunodeficiency virus prevention. The present study was thus carried out to determine the various causes of vaginal discharge in a tertiary care setting. Materials and Methods: A total of 400 women presenting with vaginal discharge of age between 20 and 50 years, irrespective of marital status were included in this study and women who had used antibiotics or vaginal medication in the previous 14 days and pregnant women were excluded. Results: Of the 400 women with vaginal discharge studied, a diagnosis was established in 303 women. Infectious causes of vaginal discharge were observed in 207 (51.75%) women. Among them, bacterial vaginosis was the most common cause seen in 105 (26.25%) women. The other infections observed were candidiasis alone (61, 15.25%), trichomoniasis alone (12, 3%), mixed infections (22, 5.5%) and mucopurulent cervicitis (7 of the 130 cases looked for, 8.46%). Among the non-infectious causes, 72 (18%) women had physiological vaginal discharge and 13 (3.3%) women had cervical in situ cancers/carcinoma cervix. Conclusion: The pattern of infectious causes of vaginal discharge observed in our study was comparable with the other studies in India. Our study emphasizes the need for including Papanicolaou smear in the algorithm for evaluation of vaginal discharge, as it helps establish the etiology of vaginal discharge reliably and provides a valuable opportunity to screen for cervical malignancies.

Spectrum of seborrheic keratoses in south Indians: A clinical and dermoscopic study

BACKGROUND Even though seborrheic keratoses (SK) have been well characterized clinically and histopathologically, data regarding clinical and dermoscopic correlation of different types of SK are inadequate. AIMS We carried out a study to establish any correlation between the clinical and dermoscopic appearance of SK and its variants. METHODS This was a descriptive study conducted in the Department of Dermatology, a tertiary care institute, from August 2008 to June 2010. Patients with SK were evaluated with respect to age, sex, age of onset, duration, site of lesions, number of lesions, and morphology. Dermoscopy was performed in all cases. RESULTS A total of 250 cases of SK were recruited. A male-to-female ratio was 1:1.04. The most common age group affected by SK was 60 years and above (40%). The most common clinical variant was common seborrheic keratosis (CSK) (60%). Comedo-like openings (CL) (80%), fissures and ridges (FR) (52%), and sharp demarcation (SD) (83%) were consistent finding on dermoscopy in CSK. Dermatosis papulosa nigra (DPN) and pedunculated seborrheic keratoses (PSK) had characteristic CL and FR in both of them. Fingerprint (FP) (55%) and network-like (NL) (88%) structures were commonly seen in flat SK. Stucco keratoses demonstrated SD (100%) and NL structures (100%). CONCLUSIONS The most common clinical variant of SK was CSK, followed by DPN, PSK, Flat SK, and stucco keratoses. Dermoscopic findings were consistent with those described in the literature.

Hypopigmentary disorders in children in South India

Background: Hypopigmentary disorders are common group of dermatoses in pediatric age group. Aim: To study the frequency and patterns of hypopigmentary disorders in children. Materials and Methods: This study was a descriptive clinical study spanning over a period of 23 months. A total of 113 children (61 boys and 52 girls) were included in this study. Results: The frequency of hypopigmentary disorders among children was 3.28 per 1000 children attending the dermatology out patient department. The mean age of the children was 7.2 years. The mean of age of onset was 7.36 years. Most common hypopigmentary disorder in our study was pityriasis alba (24.7%), followed by vitiligo (20.4%), leprosy (11.5%), nevus depigmentosus (10.18%), and tinea versicolor (6.2%). Others were hypomelanosis of Ito (5), post-inflammatory hypopigmentation (5), pityriasis rosea (4), steroid-induced hypopigmentation (4), lichen sclerosus et atrophicus (3), pityriasis lichenoides chronica (3), lichen striatus (2), oculocutaneous albinism (2), tuberous sclerosis complex (2), pigmentary mosaicism (1), and Griscelli syndrome (1). Conclusion: Pityriasis alba, vitiligo, leprosy, nevus depigmentosus and tinea versicolor are the five most common hypopigmentary disorders in children.

Parthenium dermatitis presenting as erythroderma.

Partheniumhysterophorus is amember of the Compositae family, which was accidentally introduced to India in 1956 in a wheat shipment from the USA. Since then, it has spread all over the country and has become the commonest cause of plant dermatitis in India (1). Erythroderma is a rare manifestation of parthenium dermatitis. In this study, we present four cases of erythroderma because of parthenium dermatitis seen over a period of 2 years.

Lichen simplex chronicus of anogenital region: A clinico-etiological study

BACKGROUND Lichen simplex chronicus (LSC) of the anogenital region, is a benign, extremely uncomfortable disease. AIMS As very little is known about the cause of anogenital LSC (AGLSC), we undertook this study to determine various clinico-etiological factors involved in it and to assess the frequency of AGLSC. METHODS This was a descriptive study, including 105 patients with AGLSC, who attended the Dermatology clinic in our institute from September 2007 to June 2009. Detailed history, physical examination, and relevant investigations were done. The collected data were tabulated and analyzed. RESULTS The frequency of AGLSC among patients presenting with anogenital pruritus was 2.54%. Primary AGLSC was more common than secondary AGLSC (69.5% vs. 30.5%). AGLSC manifested more commonly in males than in females (56.2% vs. 43.8%). The mean duration of the disease was 30.6 months. The common triggering factors for itching were sweating (41.9%), rubbing of thighs while walking for long distances (9.5%), and mental stress (5.7%). Pruritus of AGLSC was related to the intake of various food items in 37.1% of patients. In males, scrotum was the predominant site involved (89.8%), whereas in females, labia majora was the predominant site involved (78.2%). Nearly one-third of cases (30.5%) of AGLSC had some other dermatoses in the anogenital region. CONCLUSIONS Though psychological factors are thought to play an important role in disease causation and perpetuation among AGLSC patients, their significance could not be ascertained by us.