Calcification of the skin occurs in four main forms namely dystrophic, metastatic, iatrogenic and idiopathic. Idiopathic calcinosis cutis of the penis is exceedingly rare as only five cases have been reported till date to the best of our knowledge. Herein, we present another case of this rare entity in a 29-year old man and discuss its probable pathogenic origin.

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Acne is a manifestation of hormonal overstimulation of the pilosebaceous units of genetically susceptible individuals. Endogenous reproductive and growth hormones, exogenous reproductive hormones, insulin and endogenous insulin-like growth hormone-1, sourced from and stimulated by dairy and high glycemic load foods, all appear to contribute to this overstimulation. A postulated molecular mechanism linking food and acne is reported and integrated into the clinical picture.

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Indian children often present with atypical forms of pityriasis rosea (PR). We describe a female infant with acrally located eruptions consistent with a clinical diagnosis of PR. This is an extremely rare presentation of the disease.

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Faun tail nevus is a posterior midline cutaneous lesion of importance to dermatologists as it could be a cutaneous marker for its underlying spine and spinal cord anomaly. We report a 13-year-old girl with excessive hair growth over the lumbosacral region since birth. There was associated spinal anomaly with no neurological manifestation affecting the lower spinal cord. The diagnosis was made on clinical basis. The patient reported for cosmetic disability. This case is reported for its clinical importance.

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Although carbamazepine is the most common cause of Stevens Johnson syndrome (SJS) a new antiepileptic drug, oxcarbazepine which is structurally related to carbamazepine, has also been rarely shown to induce SJS. Here we report a case with SJS, which was induced by oxcarbazepine.

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The skin is constantly on the move and at a temperature below 37ºC. The epidermis is a factory, and its blood supply and lymphatic drainage, as well as adipose tissue, are much dependent on movement and influenced by cooling. Neither histopathology (still pictures) nor in vitro studies at 37ºC reflect the true picture. Recent publications neglect older literature exploring these issues.

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Hematohidrosis is a rare clinical condition of sweating blood. A 13-year-old boy was presented to the department of dermatology with a history of spontaneous bleeding from skin since January 2007. During examination, it disappeared as soon as it was mopped leaving behind no sign of trauma only to reappear within a few seconds. This confirms that it was sweating of blood and not bleeding. Bleeding time, clotting time and prothrombin time was normal. Patient was diagnosed with hematohidrosis clinically by exclusion, confirmed by benzidine test, biochemical and microscopic examination of fluid. At present, no treatment is available for this condition. Etiology is unknown till date. Stress may be a precipitating factor.

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An interesting episode of Papillon-Lefevre syndrome in a 25-year-old female with diffuse palmoplantar keratoderma, periodontitis and pseudoainhum of the toes is reported for academic interest. Her skin lesions improved with topical keratolytics and oral retinoid (acitretin) whereas periodontic problems showed significant improvement with systemic antibiotics and proper implementation of oral hygienic measures. She is undergoing oral rehabilitation with orthodontic surgical procedures.

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Aims: To evaluate the effect of nonablative superpulsed radiofrequency used for skin tightening and improvement of skin folds in Indian patients. Settings and Design: One hundred patients in the age group of 35-65 years with laxity of skin over face and neck were taken up for study using superpulse radiofrequency. Methods and Materials: Superpulsed radiofrequency is a biterminal, monopolar device which delivers current at the frequency of 1.75 MHz. In this study, current was delivered to the tissue with a capacitive electrode with a diameter of 25 mm. Power of 100-120 W, frequency of 18 Hz and pulse width of 50 ms was used. Statistical Analysis Used: Chi-square test, nonparametric Friedman test. Results: Evaluation was done by two independent observers on the basis of comparative photographs taken before treatment and then monthly after treatment for up to 6 months. A quartile grading scale was used. Patient satisfaction scores matched the clinical improvements observed. Ninety four patients completed a 6 month follow up. The age groups taken were 31-40 years, 41-50 years, 51-60 years, and >60 years and various areas were studied. The difference in improvement in all areas except glabellar folds across all age groups was found to be statistically significant. Conclusions: Nonablative face lift with a superpulsed radiofrequency machine is a safe, convenient and quick office procedure with excellent cosmetic results. It is noninvasive and there is no downtime. It can be used in all skin types and is safe on Indian skin. Longterm studies of effect of nonablative radiofrequency treatment on Indian skin is required.

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We report a case of infantile systemic hyalinosis in a 3.5-month-old male child born out of consanguineous marriage. He presented with multiple brownish raised lesions over bony prominences. He had also developed difficulty in movement of limbs and as a result developed severe flexion joint contractures. There was history of similar complaints in elder sibling who died at the age of 5 months due to repeated episodes of pneumonia. Skin biopsy from one of the papulonodular lesions showed increased amount of amorphous hyaline matrix, which was Periodic Acid Schiff positive with scattered fibroblasts. Though classical, we report this case for its rarity in western India.

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Syphilis in pregnancy still remains a challenge despite the availability of adequate diagnostic tests for serological screening and penicillin therapy. We report a case of 2 month old female infant who presented with runny nose, papulosquamous lesions over both palms and soles and perianal erosions since 1 month after birth. Cutaneous examination revealed moist eroded areas in the perianal region and fine scaly lesions over palms and soles. Radiograph of both upper limbs and limbs revealed early periosteal changes in lower end of humerus and lower end of tibia. Diagnosis of early pre-natal syphilis was confirmed by Child's Serum Rapid Plasma Reagin Antibody test [S.RPR] being positive with 1:64 dilution while that of mother was 1:8.

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Background: In this study, 76 male patients aged between 18 and 61 years affected with Tinea cruris attending the outpatient department of NRS Medical College during a 1-year period were selected. Materials and Methods: The patients were divided into two groups as Regimen I (n 37) and Regimen II (n 39) who were treated with Terbinafine (gr I) cream and Butenafine (gr II) cream, respectively. Results: The predominant pathogen was found to be Trichophyton rubrum in 99% of cases. Mycological cure, overall cure and effective treatment were evaluated on 7, 14 and 42 days. Conclusions: From the study, it was found that Butenafine produced the quickest result and primary efficacy end points were much higher with Butenafine cream than that of Terbinafine cream and this difference was statistically significant (P < 0.01).

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We are reporting a 62 year old male, who over a period of 1 year, developed a symmetric eruption of hundreds of brownish papules, with spontaneous regression of some lesions. The clinical and histopathological findings were compatible with the diagnosis of generalized eruptive histiocytoma.

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Darier-White disease (keratosis follicularis) is a rare disorder of keratinization involving the epidermis, mucous membranes, and nails. It is said to occur as a result of mutation in the ATP2A2 gene located on chromosome 12q23-24.1. In this article we present the case of two brothers with exacerbations of Darier-White disease who responded very well to systemic retinoids without any side effects within 2 weeks of commencing treatment.

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Nephrogenic systemic fibrosis (NSF) is a relatively new fibrosing disorder which has caught the attention of various specialities in the past decade. NSF is an extremely disabling and often painful condition, affecting up to 13% of the individuals with chronic kidney disease. The administration of a gadolinium chelate contrast agent has been reported to induce the development of NSF, particularly in patients who have acute or chronic renal disease with a glomerular filtration rate (GFR) lower than 30-mL/min/1.73 m ² and in those with acute renal insufficiency. Mass spectroscopy studies have demonstrated particles of gadolinium in the lesional tissue. The exact pathogenesis of this curious sclerosing condition is unknown. The role of the aberrant targeting of 'circulating fibrocytes' to the peripheral tissues and viscera has been hypothesized. NSF has distinct clinicopathological features in the setting of renal failure and needs to be looked upon as a new entity on the block. The condition is characterized by irregular indurated plaques, with amoeba-like projections and islands of sparing, chiefly on the trunk and extremities. Flexion contractures of fingers, knees, and elbow joints are known to occur in advanced cases of NSF. The course is frequently associated with painful episodes and loss of ambulation. Histopathology shows haphazard arrangement of thickened bundles of collagen, varying amount of mucin, and increased population of fibroblast-like cells in the dermis. Immunohistochemistry shows increased deposition of type-I procollagen and CD 34+ cells having fibroblastic activity. The condition is refractory to treatment with corticosteroids and immunosuppressive agents. Various modalities of therapy such as UVA1 phototherapy, imatinib mesylate, photodynamic therapy, plasmapheresis, extracorporeal photochemotherapy, and high-dose intravenous immunoglobulin have shown a moderate degree of improvement in skin thickness scores. A prudent option is restoration of renal function to normalcy via renal transplantation but to date the outcome of renal transplantation is unknown.

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Psoriatic arthritis (PsA) is a psoriasis-associated inflammatory disease of the joints and enthuses. The occurrence of PsA is linked to the complex interplay of gene environment, and immune system. Genetic factors have long been recognized to play an important role in PsA. Genes within the major histocompatibility complex (MHC) region have been shown to be associated with PsA. These include genes coded in the HLA region, (especially Class I antigens) and non-HLA genes (i.e., MHC class I chain-related antigen A, MICA, and TNF-α genes). Association studies in PsA have also identified a number of genes outside MHC region, including interleukin-1 (IL-1) gene cluster, killer-cell immunoglobulin-like receptors (KIRs), and IL-23R genes. Established systemic treatments for moderate-severe psoriasis and PsA may be potentially dangerous and usually time consuming for the patient and often expensive for the National Health Systems. Tests which could predict which subset of psoriatic patients could develop the most severe forms of the disease (i.e., PsA) or will respond to well-established (UVB irradiation) or other systemic treatments are now required. The goal of genetic test screening is to rapidly and safely identify subjects for preventive or early treatment or extended surveillance prior to the onset of signs and symptoms. Genetic tests today represent a reliable investigation procedure which could rapidly and consistently improve the diagnostic ability of the dermatologist and contribute to the early and correct treatment of the different subsets of PsA.

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