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   2013| July-September  | Volume 4 | Issue 3  
    Online since July 24, 2013

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Erosive adenomatosis of the nipple masquerading as Paget's disease
Parimalam K Kumar, Jayakar Thomas
July-September 2013, 4(3):239-240
DOI:10.4103/2229-5178.115534  PMID:23984247
Erosive adenomatosis of the nipple (EAN) is a rare, benign neoplasm of breast lactiferous ducts. Peak incidence is in the fifth decade in women. Clinically, it is mistaken for eczema during early stages and Paget's disease at later stages. We present a young lady with EAN who was advised mastectomy. It is important for dermatologists to be familiar with this entity to avoid topical steroid abuse and unwarranted breast removal. This case is presented for awareness and importance of correct and early diagnosis.
  7,454 311 2
Adult onset atopic dermatitis: Under-recognized or under-reported?
Amrinder Jit Kanwar, Tarun Narang
July-September 2013, 4(3):167-171
DOI:10.4103/2229-5178.115508  PMID:23984225
  6,128 794 8
Achieving hemostasis in dermatology-Part II: Topical hemostatic agents
Jaimie B Glick, Ravneet R Kaur, Daniel Siegel
July-September 2013, 4(3):172-176
DOI:10.4103/2229-5178.115509  PMID:23984226
Bleeding is a common occurrence during any dermatologic surgery that disrupts blood vessels. The complications of excess bleeding can include delayed wound healing, hematoma formation, infection, dehiscence, and necrosis. In part one of this review, we discussed the pre-operative, intra-operative, and post-operative management of patients undergoing dermatologic surgery. In Part two, we discuss traditional and new topical hemostatic agents used to achieve hemostasis in dermatological procedures and surgery. We will evaluate the caustic and non-caustic hemostatic agents as well as hemostatic dressings. The mechanisms of action, side effect profile, and advantages and disadvantages of the topical hemostatic agents are provided. Sources for this article were found searching the English literature in PubMed for the time period 1940 to March 2012. A thorough bibliography search was also performed and key references examined.
  5,153 722 10
Pachyonychia congenita: A rare genodermatosis
Puneet Agarwal, Mahendra K Chhaperwal, Apurva Singh, Arvind Verma, Manisha Nijhawan, Kishore Singh, Dinesh Mathur
July-September 2013, 4(3):225-227
DOI:10.4103/2229-5178.115527  PMID:23984242
Pachyonychia congenita (PC) is a rare genodermatosis with only 450 cases reported since 1906. It is of two types, type I due to mutation in genes 6a and 16, and 6b and 17 in type II with an autosomal dominant inheritance in both types. A 22 yr old female patient presented in our OPD with hypertrophy of finger and toe nails, palmoplantar keratoderma, oral punctuate leukokeratosis, hyperhidrosis in palms and soles with maceration and malodour since childhood. She had a positive family history with father and grandfather affected but less severely. Microscopy and culture of nail clippings and scrapping were done to rule out fungal infection. On biopsy acanthotic epidermis, parakeratosis, orthokeratosis were seen. No evidence of any associated malignancy was found after thorough workup. She was diagnosed as PC Type 1. She was put on topical steroids and orally on acetretin 25 mg OD. Paring of the nails was done too reduce the thickness of nails & to provide symptomatic relief. She was on a regular treatment for 3-4 months and showed some improvement in the form of reduced palmoplantar hyperkeratosis and reduced oral punctate keratosis but was later lost on followup. She showed no adverse effect to therapy during this period. This case is being reported because of its rarity.
  5,228 452 -
Granulosis rubra nasi
Cynthia Sargunam, Jayakar Thomas, N Ashwak Ahmed
July-September 2013, 4(3):208-209
DOI:10.4103/2229-5178.115519  PMID:23984236
Granulosis rubra nasi is a rare disorder of the eccrine glands, inherited as an autosomal dominant trait. It is clinically characterized by hyperhidrosis of the central part of the face, most conspicuous on the tip of the nose, followed by appearance of diffuse erythema over the nose, cheeks, chin, and upper lip. It is commonly seen in childhood, but can also occur in adults. This is a case report of a 27-year-old male patient who presented with excessive sweating over the nose. Physical examination of the nose revealed erythema and multiple telangiectatic vesicles. Biopsy findings supported the diagnosis of granulosis rubra nasi. This case is being reported for its rarity since to the best of our knowledge, it has not been reported in Indian subjects so far.
  5,072 345 2
A rare case of malignant chondroid syringoma of scalp
Rajesh Malik, Agamya Saxena, Namita Kamath
July-September 2013, 4(3):236-238
DOI:10.4103/2229-5178.115533  PMID:23984246
Chondroid syringoma represents the cutaneous counterpart of mixed tumor (pleomorphic adenoma) of salivary glands, therefore it is also termed "mixed tumour of the skin." It is generally accepted that there are both eccrine and apocrine variants of mixed tumors of skin. Malignant chondroid syringoma is a malignant eccrine neoplasm that is very rarely encountered in radio-pathological and clinical practice. Unlike the benign variety which occurs most often on the head and neck, malignant chondroid syringomas are most often found on the trunk and extremities. The usual presentation is that of an asymptomatic slow-growing mass in the region of head or neck. We present here a case report of histopathologically proven malignant chondroid syringoma of scalp in occipital region, with dural invasion. Malignant chondroid syringomas clinically appear as very large nodules and they metastasize at a very high rate. The treatment of these malignancies is surgical excision.
  4,208 336 8
Dowling-Degos disease and hidradenitis suppurativa: Co occurrence or association?
Sanjiv V Choudhary, Divya Jain, Piyush Agrawal, Adarshlata Singh
July-September 2013, 4(3):191-194
DOI:10.4103/2229-5178.115514  PMID:23984231
A 44 year old female patient presented with multiple, painful, relapsing, nodules, plaques with sinuses discharging pus and scars in apocrine gland bearing region since past 17 years. These lesions were clinically and histopathologically suggestive of hidradenitis suppurativa. Our patient was not aware about the flexural pigmentary lesions, comedones and pitted scars which were also clinically and histopathologically suggestive of Dowling-Degos disease. We are reporting a rare interesting association of Dowling Degos disease and hidradenitis suppurativa which is not reported in Indian literature till date.
  3,946 291 6
Facial plexiform neurofibromatosis: A surgical challenge
Bharat B Dogra, Karamvir Singh Rana
July-September 2013, 4(3):195-198
DOI:10.4103/2229-5178.115515  PMID:23984232
Plexiform neurofibromatosis is a relatively common but potentially devastating manifestation of neurofibromatosis type 1 (NF1). It produces very hideous deformity if the face is involved. Surgical management remains the mainstay of therapy, but in the head and neck region it is limited by the infiltrating nature of these tumors, inherent operative morbidity and high rate of regrowth. We present two cases of facial neurofibromatosis managed in our hospital. The first patient presented with overhanging mass of skin folds on the right side of her face, completely obliterating her right eye. The other patient was a young male having a huge, unsightly swelling over the right cheek, resulting in pulled down right eyelids and right pinna. Physical examination revealed the presence of café au lait macules, freckling in the axillary region and multiple neurofibromas over the trunk. Reconstructive surgical procedure in the form of subtotal excision of tumor mass followed by re draping of the facial skin was performed in both cases. There was evidence of regrowth of the tumor on review after 6 months.
  3,572 378 2
A rare case of woolly hair with unusual associations
Biju Vasudevan, Rajesh Verma, Vijendran Pragasam, Ambresh Badad
July-September 2013, 4(3):222-224
DOI:10.4103/2229-5178.115524  PMID:23984241
Woolly hair is a congenital abnormality of scalp hair manifesting as short, kinked hair, which may also involve the hair over the other parts of the body. Keratosis pilaris has been a well known association of woolly hair, and can also be a part of the Naxos or Carvajal syndromes. We herein present a case of woolly hair with associated keratosis pilaris, canaliform dystrophy of nails, increased interdental spaces and recurrent bullous impetigo. Although keratosis pilaris and teeth abnormalities have been reported as isolated associations with woolly hair, such a combination of findings as seen in our patient has not been reported before.
  3,504 276 3
Symmetrical peripheral gangrene associated with peripartum cardiomyopathy
Ajay Jaryal, Sujeet Raina, Surender Thakur, Tushar Sontakke
July-September 2013, 4(3):228-230
DOI:10.4103/2229-5178.115528  PMID:23984243
Symmetrical peripheral gangrene (SPG) is a rare clinical entity. It was first described in late 19 th century and since then has been reported with array of medical conditions mainly those complicated with shock, sepsis, and disseminated intravascular coagulation (DIC). Here in, we describe a parturient with peripartum cardiomyopathy (PPCM) and SPG. Clinicians should be aware of this entity as early recognition can help in reducing morbidity and mortality.
  3,496 257 2
Ingenol mebutate: A novel topical drug for actinic keratosis
Suruchi Aditya, Sanjeev Gupta
July-September 2013, 4(3):246-249
DOI:10.4103/2229-5178.115538  PMID:23984250
The global incidence of non-melanoma skin cancer is rising. Significant morbidity leading to unacceptable cosmetic outcomes and/or functional impairment is a major concern. Search for non-surgical, non-invasive and tissue-sparing treatment modalities has led to development of new therapeutic agents. Actinic keratoses (AK) are one part of a continuous spectrum of benign sun damage to squamous cell carcinoma (SCC). Although it is not possible to predict which AK might progress to SCC, the presence of AK is a biomarker of risk for patients and must be treated to avoid possible morbidity and mortality. Ingenol mebutate is a novel topical drug from the latex sap of a plant-Euphorbia peplus that acts by chemoablative and immunostimulatory properties. Clinical studies have proven it to be safe and efficacious, leading to FDA approval of this chemotherapeutic agent for field therapy of AK in 2012. Current topical agents for field therapy of AK must be applied for weeks, whereas ingenol needs to be applied for three days. Ingenol offers a new therapeutic option that is convenient, safe, effective, acceptable and well-tolerated.
  2,741 493 9
Extensive and invasive lymphangioma circumscriptum in a young female: A rare case report and review of the literature
Mohan H Kudur, Manjunath Hulmani
July-September 2013, 4(3):199-201
DOI:10.4103/2229-5178.115516  PMID:23984233
Lymphatic malformations, or lymphangiomas, are benign proliferations of lymphatics, classified as superficial lymphangioma circumscriptum (LC) and deep (cavernous lymphangioma). LC, as the name suggests, is a well-circumscribed lesion but, rarely, extensive and invasive forms can also be seen. Surgical excision is the main modality of treatment. We report a case of extensive and invasive type of LC where surgical excision is difficult and recurrence is the rule.
  2,802 348 2
Primary cutaneous leiomyosarcoma: A rare malignant neoplasm
Akshay Bali, Ranjit Kangle, Maitrayee Roy, Bhagyashree Hungund
July-September 2013, 4(3):188-190
DOI:10.4103/2229-5178.115513  PMID:23984230
Primary cutaneous leiomyosarcoma (PCL) is an exceedingly uncommon malignant superficial soft tissue sarcoma with a predilection for middle-aged to elderly male. Morphologic differential diagnosis includes a host of other malignant spindle cell neoplasms, thereby necessitating the use of a panel of immunohistochemical markers to arrive at a definitive diagnosis. We report a case of PCL arising in the right leg of a 70-year-old male.
  2,796 349 1
Cavernous lymphangioma: Two case reports
Cynthia Sargunam, Jayakar Thomas, PK Raneesha
July-September 2013, 4(3):210-212
DOI:10.4103/2229-5178.115520  PMID:23984237
Lymphangiomas are congenital malformation of the lymphatic system that involve the skin and subcutaneous tissues. We are reporting two cases of cavernous lymphangioma. These cases are presented for their rarity.
  2,270 255 -
To evaluate the efficacy and safety of "RV2427B" cream in Irritant dermatitis care
Ramesh M Bhat, Rajeev Chavda, Virginie Ribet
July-September 2013, 4(3):180-184
DOI:10.4103/2229-5178.115511  PMID:23984228
Background: The treatment of various irritant dermatitis involves the elimination of the casual or favoring factor, the control of aggravating factors, and administration of topical agents. Even though corticosteroids are extensively used in these conditions to reduce the inflammation, it can also result in undesirable side effects. Hence, there is a need for a non steroidal topical agent to be used in these conditions. Aims: To evaluate the efficacy and tolerance of repairing cream "RV 2427B" in children and adults in irritant dermatitis care. Materials and Methods: In this phase III open labeled, multicenter, non-controlled, non-randomized trial, irritant dermatitis in children and adults either due to diaper rash, pityriasis alba and irritant dermatitis (eczema), perioral dermatitis, perleche or intertrigo were administered; repairing cream RV 2427 B containing a) 4 % zinc oxide, b) 2.5 % dry colloidal oat extract, (c) 0.5 % oat oil, (d) 0.2% copper sulfate, and (e) 0.1 % zinc sulfate to be applied twice-daily in the affected area. The subjects were evaluated on day 7 and day 21 for both efficacy and tolerance and last visit for cosmetic acceptability. The trial was conducted in accordance with the good clinical practices (GCP) after obtaining ethical clearance from respective Institutional Review Boards. Statistical evaluation was by variance analysis and student test for the quantitative variables, chi-square test for the qualitative variables. Results: Of the 136 enrolled subjects, 95 completed the study. After 21 days of treatment, 84% of the subjects assessed by the investigator and 76% by the self-assessment for the cream found effective. Investigational product was considered to be safe after 7 and 21 days of use. Conclusion: Repairing cream "RV 2427 B" is effective and safe in the management of irritant dermatitis.
  2,100 419 -
A case report of focal dermal hypoplasia-Goltz syndrome
Sheela Bharani, Sejal Thakkar
July-September 2013, 4(3):241-243
DOI:10.4103/2229-5178.115535  PMID:23984248
Goltz syndrome is a rare multisystem disorder with cutaneous, ocular, dental and skeletal abnormalities. Other mesoectodermal abnormalities are also present. Its hallmark is thinning of the dermis resulting subcutaneous fat herniation. The present case is a 5 year old girl having linear skin atrophy with fat herniation, skeletal abnormalities in the form of polysyndactyly, facial asymmetry, squint with coloboma iris, deformed pinna, abnormal dentition, umbilical hernia along with osteopathia striata of long bones which is consistent with Goltz syndrome. We are presenting this case due to its rarity.
  2,006 277 1
Phacomatosis cesioflammea with Klippel Trenaunay syndrome: A rare association
Anubhav Garg, Lalit K Gupta, AK Khare, CM Kuldeep, Asit Mittal, Sharad Mehta
July-September 2013, 4(3):216-218
DOI:10.4103/2229-5178.115522  PMID:23984239
A 30-year-old Indian male presented with bilateral Nevus of Ota, extensive nevus flammeus over the trunk and left lower limb with soft tissue hypertrophy and varicosities affecting the left lower limb. He was otherwise in good general health. A diagnosis of Phacomatosis cesioflammea or Phacomatosis pigmentovasularis Type II with Klippel Trenaunay syndrome was made. The case is being reported on account of its rarity.
  1,966 250 -
SkIndia Quiz 10 - Papulonodular lesions in a Human Immunodeficiency Virus-positive patient
Lalit Kumar Gupta, Sonakshi Pargi, Ashok Kumar Khare, Asit Mittal, Sharad Mehta, CM Kuldeep
July-September 2013, 4(3):257-258
DOI:10.4103/2229-5178.110655  PMID:23984256
  1,969 240 -
Speckled lentiginous nevus syndrome with median nerve paresis: A rare syndrome with a new association
Vibhu Mendiratta, Masarat Jabeen, Meenu Barara, Manish Varshney
July-September 2013, 4(3):234-235
DOI:10.4103/2229-5178.115530  PMID:23984245
Speckled lentiginous nevus (SLN) represents a mosaic phenotype which consists of café au lait macule superimposed by melanocytic nevi. Recently, SLN syndrome has been characterized where ipsilateral neurological abnormalities have been reported in association with SLN with papular type of melanocytic nevi only. This case describes the presence of ipsilateral thenar muscle atrophy with median nerve paresis in nevus spilus which had melanocytic nevi of the macular type alone, thus delineating a new association in SLN syndrome, hitherto unreported.
  1,965 239 3
Eruptive vellus hair cyst presenting as asymptomatic follicular papules on extremities
Swapna Khatu, Resham Vasani, Shital Amin
July-September 2013, 4(3):213-215
DOI:10.4103/2229-5178.115521  PMID:23984238
Eruptive vellus hair cysts were first described in 1977. They usually appear as yellow to reddish-brown papules on the chest. Usual onset is between ages 17 and 24 years, but they may be congenital. Some believe that they may be inherited as an autosomal dominant disorder. Histologically the cyst has a stratified squamous epithelium and it contains laminated keratin and vellus hairs. They are felt to be caused by an abnormality at the infundibular level of the vellus hair. We present this because of this patient's unusual distribution of eruptive vellus hair cysts.
  1,826 242 1
Necrolytic migratory ulceration
Jaheersha Pakran, Najeeba Riyaz
July-September 2013, 4(3):205-207
DOI:10.4103/2229-5178.115518  PMID:23984235
Endocrine tumors of the gastroenteropancreatic system associated with specific skin manifestations are rare. We report a 53-year-old female who presented with migratory annular and arcuate ulcers on her limbs. Histopathology was similar to necrolytic erythema family which includes necrolytic migratory erythema (NME). Though initial CT scans were normal, follow up scans revealed multiple mass lesions in the tail of pancreas. Her skin lesions responded to oral zinc sulphate and monthly injections of octreotide. Prior to planned FNAC from the mass lesion, patient developed altered sensorium and succumbed to the disease. This case report seems to differ from NME clinically, due to unique finding of deep migrating ulcers which heal with scarring. 'Necrolytic migratory ulceration' thus appears to be a new paraneoplastic manifestation, secondary to pancreatic malignancy.
  1,831 236 1
Hit hard and early: Can the march of psoriasis be halted?
Sridhar Jandhyala
July-September 2013, 4(3):177-179
DOI:10.4103/2229-5178.115510  PMID:23984227
Psoriasis is increasingly considered a systemic disease with comorbidities. There is sufficient evidence that systemic inflammation lies at the heart of these developments. Considering the chronic nature of psoriasis and its comorbidities, timely manipulation of systemic inflammation could avert both mortality and morbidity. Data from retrospective studies suggest that aggressive treatment of psoriasis with traditional systemic agents and/or biologic drugs improves health outcomes. To maximize treatment outcomes, severe psoriasis needs to be managed as a systemic disease with likely comorbidities.
  1,578 426 1
Herpes zoster in infancy
Lalit Kumar Gupta, Ashok Kumar Khare, Asit Mittal, CM Kuldeep
July-September 2013, 4(3):252-254
DOI:10.4103/2229-5178.115541  PMID:23984253
  1,630 281 -
Cutaneous metastasis from carcinoma of lung
Smita Pathak, Sneha R Joshi, Janice Jaison, Dipak Kendre
July-September 2013, 4(3):185-187
DOI:10.4103/2229-5178.115512  PMID:23984229
A 65-year-old male with a history of smoking since 30 years presented with breathlessness, hemoptysis, multiple swellings all over the body, and weakness in September 2010 at our hospital. Clinically, a diagnosis of chronic obstructive pulmonary disease (COPD) with cutaneous lymphoma or soft tissue tumor was made. Chest X-ray (CXR) and computed tomography (CT) scan revealed a neoplastic lesion in the right lung with secondary cavitation. Biopsy of the cutaneous nodules showed metastatic deposits from squamous cell carcinoma. Metastatic skin cancer is a relatively rare complication of internal malignancy. The clinical features of metastatic skin disease vary enormously. They may present as erysipeloid, sclerodermoid, alopecia neoplastica or in an inflammatory or bullous form or as multiple nodules as in our case. A high index of suspicion for metastatic deposits is required in an elderly male patient who is a known case of lung cancer or even one who is a chronic smoker and presents with such cutaneous lesions.
  1,500 329 3
Multiple keratoacanthomas developing in healing plaques of Psoriasis
Vineet Relhan, Surabhi Sinha, Nita Khurana, Vijay K Garg
July-September 2013, 4(3):202-204
DOI:10.4103/2229-5178.115517  PMID:23984234
A 22 year old male psoriatic patient presented with multiple reddish scaly plaques all over body. After hematological and biochemical investigations the patient was started on oral methotrexate 15 mg weekly. PASI score at the start of treatment was 26.2. After 3 months PASI dropped to 11.5, the dose of methotrexate was tapered to 7.5mg weekly and the patient was maintained on this dose and kept under monthly follow up. Four months later, the patient presented with reddish to hyperpigmented raised firm nodules having a central crater over the healing plaques of psoriasis. Few lesions showed self resolution over a period of 6-12 weeks. Histopathology of the lesion confirmed it to be Keratoacanthoma. We believe the most likely etiologic factors for the multiple KAs in our patient could be a genetic susceptibility stimulated by multiple causes.
  1,580 223 -
A baby with photosensitivity and red teeth
Ashim Kumar Mondal, Piyush Kumar, Ramesh Chandra Gharami
July-September 2013, 4(3):260-261
DOI:10.4103/2229-5178.115546  PMID:23984258
  1,587 196 -
Verrucous trichoadenoma - presenting as discharging sinus on face
Swati Arora, Jasleen Kaur, Harjot Kaur
July-September 2013, 4(3):251-252
DOI:10.4103/2229-5178.115540  PMID:23984252
  1,543 213 -
Porokeratosis of Mibelli: Giant variant
Ganesh Avhad, Hemangi Jerajani
July-September 2013, 4(3):262-263
DOI:10.4103/2229-5178.115547  PMID:23984259
  1,410 286 1
Acute generalized exanthematous pustulosis: A rare side effect of a common over-the-counter drug, Acetylsalicylic acid
Amit Bahuguna
July-September 2013, 4(3):231-233
DOI:10.4103/2229-5178.115529  PMID:23984244
Acute generalized exanthematous pustulosis is an uncommon cutaneous reaction characterized by sudden onset of generalized non-follicular aseptic pustules. It is most often secondary to drugs but causes as varied from viral infection to insect bites are reported. A case report of a 48-year-old male who developed pustular eruptions after taking acetylsalicylic acid is reported here. Clinicians need to be aware of this entity when dealing with pustular rash as this rare side effect of a very common drug is both, easy to miss and easy to manage.
  1,417 251 1
A clinical study of the spectrum of vitiligo in children versus adults and its associations
Preeti Prakash, Devinder Mohan Thappa
July-September 2013, 4(3):250-251
DOI:10.4103/2229-5178.115539  PMID:23984251
  1,346 309 -
A case of zosteriform Darier's disease with seasonal recurrence
Lalit K Gupta, Anubhav Garg, Ashok Kumar Khare, Asit Mittal
July-September 2013, 4(3):219-221
DOI:10.4103/2229-5178.115523  PMID:23984240
Darier's disease is an uncommon genodermatosis characterized by keratotic papules in seborrheic distribution. The disease can rarely present in unilateral zosteriform pattern, as a mosaic form following the Blaschko's line. We present a 35-year-old woman with zosteriform pattern of Darier's disease over right infra mammary region. The lesions occurred strictly during summers. Histologically, suprabasal acantholysis with abundant dyskeratotic cells were seen.
  1,391 222 1
Dermpath Quiz
Johanna Durda, Viktoryia Kazlouskaya, Elen Blochin, Ciara A Maguire, Dirk Elston
July-September 2013, 4(3):244-245
DOI:10.4103/2229-5178.115536  PMID:23984249
  1,239 334 2
Prayer sign
Sujeet Raina, Ajay Jaryal, Tushar Sonnatakke
July-September 2013, 4(3):259-259
DOI:10.4103/2229-5178.115545  PMID:23984257
  1,089 278 -
Radiotherapy induced keobernisation of vitiligo
Meghana Phiske
July-September 2013, 4(3):254-255
DOI:10.4103/2229-5178.115542  PMID:23984254
  921 190 -
Cutaneous angiomyolipoma
AS Ammanagi, VD Dombale, VV Shindholimath
July-September 2013, 4(3):255-256
  660 187 -
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