U. N. Saikia

Histoid leprosy: a retrospective study of 40 cases from India.

Background  Rare variants of leprosy pose a diagnostic challenge even to astute clinicians and histoid leprosy is one such form of disease with unique clinical and histopathological features. There are very few large series on this entity, mainly reported from India.

Clinical and treatment characteristics determining therapeutic outcome in patients undergoing autologous non-cultured outer root sheath hair follicle cell suspension for treatment of stable vitiligo

Autologous non‐cultured outer root sheath hair follicle cell suspension (NCORSHFS) is a recently described novel cellular graft technique for the treatment of stable vitiligo. There is lack of data about various factors determining the repigmentation rate in vitiligo patients undergoing this novel surgical therapy.

Generalized eruptive lentiginosis induced by chemotherapy

Lentigines are characterized by brown macules developing due to increased proliferation of melanocytes in the dermoepidermal junction. Many drugs, including immunosuppressants and immunomodulators, have been shown to cause generalized lentiginosis. We describe a case of lentiginosis induced by cancer chemotherapy, an extremely rare occurrence.

Kikuchi's disease with skin lesions in a patient with SLE.

© 2005 European Academy of Dermatology and Venereology JEADV (2005) 19, 763–784 2 De Jong A. Sexually transmitted diseases in sexually abused children. Sex Transm Dis 1986; 13: 123–126. 3 Hammerschlag MR. Sexually transmitted diseases in sexually abused children: medical and legal implications. Sex Transm Infect 1998; 74: 167–174. 4 Ingram DL, Everett VD, Lyna PR, White ST, Rockwell LA. Epidemiology of adult sexually transmitted disease agents in children being evaluated for sexual abuse. Pediatr Infect Dis J 1992; 11: 945–950. 5 Atabaki S, Paradise JE. The medical evaluation of the sexually abused child: lessons from a decade of research. Pediatrics 1999; 104: 178–186. 6 Gutman LT, Herman-Giddens ME, Phelps WC. Transmission of human genital papilloma virus disease: comparison of data from adults to children. Pediatrics 1993; 91: 31–38. 7 Moscicki AB. Genital HPV infections in children and adolescents. Obstet Gynecol Clin North Am 1996; 23: 675–697. 8 Cason J, Kaye JN, Jewers RJ et al. Perinatal infection and persistence of human papilloma virus types 16 and 18 in infants. J Med Virol 1995; 47: 209–218. 9 Schwarcz SK, Whittington WL. Sexual assault and sexually transmitted diseases: detection and management in adults and children. Rev Infect Dis 1990; 12: S682–S689. 10 Patel RR. Child sexual abuse: psychosocial aspects. Indian J Psychiatry 1997; 39 (Suppl.): 56. 11 Virani P. Bitter Chocolate: Child Sexual Abuse in India. Penguin Books, New Delhi, 2000.

Involvement of flexures in an adolescent patient with dermatomyositis: extension of inverse Gottron papules?

A 16-year-old presented with a 6-month history of poikilodermatous changes on the shoulders, upper back, upper arms and ‘V’ area of the chest, associated with progressive proximal muscle weakness and photosensitivity. Physical examination of the patient’s hands revealed atrophic nontender lichenoid papules with scaling on both the dorsal and ventral aspects of the interphalangeal joints (Fig. 1a). Interestingly, a few erythematous to violaceous, scaly plaques were present on the flexural aspects of the wrists, bilateral cubital fossae, axillae, popliteal fossae and abdominal folds. There was associated pigmentary change in the form of depigmentation in the popliteal fossa (Fig. 1b–d). No dilated capillaries were seen in the nail folds. Muscle power was reduced in both knee and arm extensors. Histological examination of a skin biopsy from the palmar papules showed hyperkeratosis, focal basal cell vacuolization, mild perivascular lymphocytic infiltrate and melanin incontinence (Fig. 2a), while a biopsy from the cubital fossa demonstrated hyperkeratosis, epidermal atrophy, necrotic keratinocytes, extensive basal cell vacuolization, and moderate perivascular and interstitial lymphocytic infiltrate (Fig. 2b). Direct immunofluorescence examination was negative. The findings were consistent with dermatomyositis. Levels of muscle enzymes were raised and electromyography showed myopathic changes. Chest examination and high-resolution computed tomography did not show evidence of interstitial lung disease. Atrophic lichenoid papules on the dorsal aspect of interphalangeal joints, elbows and knees are referred to as Gottron papules (GP) of dermatomyositis, and represent a pathognomonic finding. Hand examination is important in patients with dermatomyositis, as it can reveal GP, mechanic’s hands and nail-fold abnormalities. Our patient had GP on his hands and elbows. Rarely, similar papules may be present over the palmar aspect of the interphalangeal joints, known as inverse GP. The presence of inverse GPs has been shown to correlate with the presence of interstitial lung disease and myositis-specific antibodies. When associated with antimelanoma differentiation-associated antigen-5 antibody, these papules are erythematous and tender, whereas when associated with antitranscriptional intermediary factor-c antibody, they are nontender and nonerythematous. Our patient did not have positive anti-Mi-2 or anti-Jo-1 antibodies. The rest of the myositis-specific antibody panel could not be performed because of the lack of facilities. Antinuclear antibody titre was raised at 1 : 160. Dermatomyositis chiefly involves the extensor aspects of the extremities, notably the extensors of the hands, elbows and knees. The index patient exemplifies unique findings in the form of flexural involvement in addition to characteristic extensor involvement. Although palmar papules have been previously described as inverse GP, those extending to other flexures (with sparing of the intervening skin) are unique and have not been described previously in the literature. In addition, the histopathological findings of the flexural lesions were characteristic, revealing interphase dermatitis consistent with dermatomyositis. The patient is currently receiving prednisolone and methotrexate for his disease, and is under continuing follow-up. There is substantial improvement in the muscle weakness. The lesions on the axillae and cubital fossae have resolved with pigmentary changes suggestive of poikiloderma. Inverse GP are still persistent. The patient is still receiving tapering doses of prednisolone and methotrexate. It is important to identify novel cutaneous manifestations associated with rare disorders as Correspondence: Professor Davinder Parsad, Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India E-mail: parsad@me.com

Hypopigmented patches on a young man.

ours the fifth reported case. A study by Pincus et al. provides histological evidence that BCCs develop directly from TEs. The unique histology in our case, in which the majority of BCCs occurred within the background of a TB/TE, supports this association. Further, to our knowledge, we are the first to report the presence of multiple steatocystomas and infundibular follicular cysts in BSS. Although these may indeed be coincidental findings, the extent of tumour burden suggests a possible genetic predisposition. Thus, the missense mutation identified in this family may have broader effects in folliculosebaceous differentiation. Our study expands the database of CYLD germline mutations. Physicians should be aware of the potential for BCC development in the setting of a classically benign and very heterogeneous clinical presentation. Long-term follow-up of the family members will be crucial to monitor the development of malignancies.

Pemphigus vegetans presenting as a verrucous plaque on the finger

1 Vaira F, Nazzaro G, Pesapane F, Veraldi S. ‘Dumbo’ ear. Clin Exp Dermatol 2014; 39: 667–8. 2 Berman JD, Gallalee JV. In vitro antileishmanial activity of inhibitors of steroid biosynthesis and combinations of antileishmanial agents. J Parasitol 1987; 73: 671–3. 3 Alrajhi AA, Ibrahim EA, De Vol EB et al. Fluconazole for the treatment of cutaneous leishmaniasis caused by Leishmania major. N Engl J Med 2002; 346: 891–5. 4 Emad M, Hayati F, Fallahzadeh MK, Namazi MR. Superior efficacy of oral fluconazole 400 mg daily versus oral fluconazole 200 mg daily in the treatment of cutaneous Leishmania major infection: a randomized clinical trial. J Am Acad Dermatol 2011; 64: 606–8. 5 SousaAQ, FrutuosoMS,Moraes EA et al.High-dose oral fluconazole therapy effective for cutaneous leishmaniasis due to Leishmania (Vianna) braziliensis.Clin Infect Dis2011;53: 693–5.

Lipomatous neurofibromas with giant pigmented lesion

Neurofibroma is the most common benign neural tumour. Among the large number of histopathological variants reported, lipomatous neurofibroma is exceedingly infrequent, and shows the presence of intratumoral adipocytes admixed with spindle cells in the dermis. We present a case of a 37‐year‐old man with lipomatous neurofibromas associated with a giant garment‐like pigmented lesion involving his lower trunk and right thigh.

Dermoscopy in disseminated sporotrichosis

We read with interest the article by Slawinska et al1 on dermoscopic features of disseminated cryptococcosis. We would like to highlight the dermatoscopic features of disseminated sporotrichosis and discuss the similarities in the dermatoscopic features of various deep mycosis and cutaneous leishmaniasis. A 41-year-old male, resident of the Kashmir valley, presented for the evaluation of multiple ulcerated skin lesions since past 3 years. This article is protected by copyright. All rights reserved.

Lichen planus pigmentosus: a retrospective clinico-epidemiologic study with emphasis on the rare follicular variant.

Y.-A. Chen, C.-C. Yang, S.-W. Ting, J.Y.-Y. Lee, W. Chen* Department of Dermatology, Cathay General Hospital, Taipei, Taiwan, Department of Dermatology, Cathay General Hospital, Hsinchu, Taiwan, Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Department of Dermatology, Chang Gung Memorial Hospital, Taipei, Taiwan, Department of Dermatology and Allergy, Technische Universit€ at M€ unchen, Munich, Germany *Correspondence: W. Chen. E-mail: wenchieh.chen@lrz.tum.de Y.-A. Chen and C.-C. Yang contributed equally to this work.