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   2014| December  | Volume 5 | Issue 6  
    Online since December 5, 2014

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Nerve conduction studies in early tuberculoid leprosy
Deepak Vashisht, Arjun Lal Das, Sanjeev S Vaishampayan, Surbhi Vashisht, Rajneesh Joshi
December 2014, 5(6):71-75
Context: Hansen's disease is a chronic illness; besides involving skin and peripheral nerves, it affects multiple organs. Nerve involvement is always present in leprosy, and it may be present much before the patient manifests clinically. Aims: To assess nerve conduction parameters in thickened and contralateral non-thickened nerves in early tuberculoid leprosy Materials and Methods: Fifty new untreated male patients with tuberculoid and borderline tuberculoid leprosy in the age group of 15-50 years with thickened peripheral nerves on one side were included in the study. Nerve conduction studies consisting of sensory and motor velocity (NCV), distal latencies, and amplitude were carried out on thickened ulnar, common peroneal, and posterior tibial nerves and contralateral normal nerves. Statistical Analysis Used: Mean values along with coefficient of variation were obtained for various parameters. These were compared with normal values of the control population. P value was used to verify statistical significance. Results: Nerve conduction parameters were deranged in most of the thickened nerves. Sensory parameters were affected early in the disease process. Conclusion: Additional parameters are required to assess nerve damage in early cases, where it is more in slow conducting fibers (average velocity fibers). Change in conduction velocity may not be marked; this calls for the measurement of fast fibers separately because potentials recorded are mainly from myelinated fibers.
  2,823 9,213 1
Trichostasis spinulosa: An overlooked entity
Kikkeri Narayanasetty Naveen, Suraj R Shetty
December 2014, 5(6):132-133
  9,849 403 5
Autologous serum skin test as an indicator of chronic autoimmune urticaria in a tertiary care hospital in South India
Adaikalampillai Ganapathy Vikramkumar, Sheela Kuruvila, Satyaki Ganguly
December 2014, 5(6):87-91
Background: Autologous serum skin test (ASST) is a simple in-vivo clinical test for the detection of basophil histamine releasing activity and to diagnose chronic autoimmune urticaria (CAU) among chronic spontaneous urticaria (CSU) patients. Diagnosing these patients is also important as they may need high doses of antihistamines and systemic corticosteroids during acute exacerbations. Aims and Objectives: The aim of this study is to study the prevalence of CAU among cases of CSU by using ASST. Materials and Methods: This was a cross-sectional study done among 48 patients presenting with CSU. Detailed history, physical examination and routine investigations were recorded for all patients. ASST was done on all the 48 patients. Results: Of the 48 patients included in the study, 20 patients (41.6%) were ASST positive, while the remaining 28 (58%) were ASST negative. The median duration of disease in both ASST positive and negative patients was 1 year. ASST positivity was higher (66.6%) among patients with a history of round shaped weals, though not statistically significant. ASST positivity was seen in 5 (71.4%) out of seven patients with systemic involvement, which was again not statistically significant. Conclusion: Our study did not show any significant difference between patients with and without antibodies regarding mean age and sex distribution, clinical morphology of individual weals, duration, severity, systemic symptoms, angioedema, atopy, and association with other autoimmune conditions.
  7,537 1,291 2
Cutaneous adverse drug reactions in Indian population: A systematic review
Tejas K Patel, Sejal H Thakkar, DC Sharma
December 2014, 5(6):76-86
Background: Epidemiological data is limited for cutaneous adverse drug reactions (CADRs) in India. Most of the Indian studies have small sample size and are of limited duration. Aims: The aim of this study is to analyze CADRs with reference to the causative drugs and their clinical characteristics in Indian population. Materials and Methods: As per selection criteria, electronic databases were searched for publications describing CADRs from January-1995 to April-2013 by two independent investigators. Data of the causative drugs and clinical characteristics were extracted and summarized by absolute numbers, percentages, ranges, and means as presented by the authors. The subgroup analysis of causative drugs was performed for causality assessment, severe or nonsevere reactions and occurrence of common CADRs. Studies showing "definite" and "probable" categories of causality analysis were labeled as "definite and probable causality (DPC) studies". The other included studies were labeled as "non-DPC studies". Results: Of 8337 retrieved references, 18 prospective studies were selected for analysis. The pooled incidence was 9.22/1000 total among outpatient and inpatient cases. Commonly observed reactions were maculopapular rash (32.39%), fixed drug eruptions (FDEs) (20.13%), urticaria (17.49%) and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) (6.84%). The major causative drug groups were antimicrobials (45.46%), nonsteroidal anti-inflammatory drugs (NSAIDs) (20.87%) and anti-epileptic drugs (14.57%). Commonly implicated drugs were sulfa (13.32%), β-lactams (8.96%) and carbamazepine (6.65%). High frequency of CADRs is observed with anti-epileptic drugs in DPC studies only. Carbamazepine, phenytoin and fluoroquinolones had higher severe to nonsevere cutaneous reaction ratio than other drugs. Antimicrobials were the main causative drugs for maculopapular rash, FDEs and SJS/TEN, and NSAIDs for the urticaria. The mortality for overall CADRs, SJS/TEN, and exfoliative dermatitis were 1.71%, 16.39%, and 3.57%, respectively. "Definitely preventable", "probably preventable" and "not preventable" categories CADRs were 15.64%, 63.14%, and 34.64%, respectively. Conclusion: Antimicrobials, NSAIDs and antiepileptic are common causative agents of CADRs in India. Antiepileptic agents show high rates of severe cutaneous reactions.
  5,488 3,312 14
Response to oral acitretin in lichen amyloidosis
Resham J Vasani
December 2014, 5(6):92-94
We report the therapeutically challenging case of a patient with severe and extensive lichen amyloidosis (LA) who responded to oral acitretin and topical corticosteroids. Colloid milia and terra firma-forme dermatoses were noted post healing of the lesions of LA. There has been no recurrence of lesions post 8 months of follow-up. We recommend that acitretin should be used more often in severe and recalcitrant cases of LA.
  7,851 662 -
Favre-Racouchot syndrome
Sidharth Sonthalia, Rahul Arora, Namrata Chhabra, Uday Khopkar
December 2014, 5(6):128-129
  6,351 356 2
Acral acanthosis nigricans (acral acanthotic anomaly)
Vikas Anand, Anupam Das, Piyush Kumar, Rajesh Kumar, Shahid Hassan
December 2014, 5(6):140-141
  6,019 313 3
Herpes iris of Bateman
Piyush Kumar, Vikas Anand, Shahid Hassan
December 2014, 5(6):138-139
  4,117 387 1
Infantile perianal (perineal) pyramidal protrusion
Şule Güngör, Sinan Güngör
December 2014, 5(6):142-143
  3,145 50 -
Generalized benign acanthosis nigricans in an infant
Dipti Das, Anupam Das, Dhiraj Kumar, Ramesh C Gharami
December 2014, 5(6):116-118
The generalized form of acanthosis nigricans, especially in infants, is extremely rare. Herein we report a 1-year-old female child who developed generalized acanthosis nigricans without any evidence of internal malignancy or endocrine disorder. This case is being reported for its rarity.
  2,898 251 1
Lipoid proteinosis (Urbach-Wiethe disease) in two siblings
Rekha Thaddanee, Ajeet Kumar Khilnani, Purna Pandya, Mayank Chaturvedi
December 2014, 5(6):95-97
Lipoid proteinosis is a very rare autosomal recessive disorder characterized by deposition of hyaline material in the skin and the upper aerodigestive tract. Hoarseness of voice occurs very early in life and airway obstruction may occur. Characteristic skin lesions include multiple brown atrophic scars over face and distal extremities, beaded papules over the margins of the eyelids and verrucous nodules over the friction bearing areas (elbows, knees). The overall prognosis is good. There is no definitive treatment.
  2,492 454 1
Vesiculobullous viral exanthem due to chikungunya in an infant
Nidhi Singh, Laxmisha Chandrashekar, Deepthi Konda, Devinder Mohan Thappa, Bheemanathi Hanuman Srinivas, Rahul Dhodapkar
December 2014, 5(6):119-120
  2,226 302 -
Angiokeratoma circumscriptum naeviforme with soft tissue hypertrophy and deep venous malformation: A variant of Klippel-Trenaunay syndrome?
Vaishali Wankhade, Rajesh Singh, Venus Sadhwani, Purnima Kodate, Amit Disawal
December 2014, 5(6):109-112
Klippel-Trenaunay syndrome (KTS) is a cutaneous capillary malformation on a limb in association with soft tissue swelling with or without bony hypertrophy and atypical varicosity. The capillary malformation associated with KTS is port wine stain. Angiokeratoma circumscriptum naeviforme (ACN) is a congenital variant of angiokeratoma commonly present on the lower limb as a hyperkeratotic plaque. ACN is rarely associated with KTS. We report a case of ACN with soft tissue hypertrophy and deep venous malformation (possibly a variant of Klippel-Trenaunay) in a 4-year-old male child.
  2,127 292 3
The co-occurrence of lichen sclerosus et atrophicus and celiac disease
Ayse Serap Karadag, Mukaddes Kavala, Emin Ozlu, İlkin Zindancı, Seyma Ozkanlı, Zafer Turkoglu, Ebru Zemheri
December 2014, 5(6):106-108
A 53-year-old female patient was admitted to our clinic for generalized hypo/hyper-pigmented, partially firm and sclerotic plaques with undefined borders. As the skin biopsy taken from the lesion was compatible with lichen sclerosus et atrophicus (LSA), the patient was treated with ultraviolet A1 (UVA1) treatment. Upon follow-up, she developed abdominal pain and diarrhea. Further investigation (including endoscopic and laboratory tests) showed signs consistent with celiac disease. After 30 sessions of UVA1 treatment, the skin lesions partially regressed. We present this case because the co-occurrence of LSA and celiac disease is very rare.
  2,116 277 5
Caffeine as a cause of urticaria-angioedema
Linda Tognetti, Francesco Murdaca, Michele Fimiani
December 2014, 5(6):113-115
We report the case of a young woman presenting with recurrent urticaria. The episodes occurred both in and out of the workplace. On three occasions it presented as urticaria-angioedema, requiring emergency care on one occassion. A thorough clinical history along with serological and allergological tests allowed a diagnosis of caffeine-induced urticaria-angioedema. We advised the patient to follow a caffeine-free diet and to avoid all caffeine or methylxanthine-containing drugs. After two years of caffeine abstinence, she had not experienced any further episodes of urticaria-angioedema. Only a few cases of caffeine-induced urticaria and/or anaphylaxis have been reported till date, with varying outcomes in allergologic investigations. Moreover, several cases are probably undiagnosed or misdiagnosed as idiopathic urticaria or as occupational allergy. We speculate that hypersensitivity to caffeine rather than autoimmine reaction may be the probable cause of urticaria. Caffeine should considered as a potential urticaria-inducing agent and should be included in the allergological test series.
  2,014 280 1
Imatinib causing drug rash with eosinophilia and systemic symptoms: A rare cutaneous reaction
Meet Kumar, Prakas Kumar Mandal, Tuphan K Dolai, Maitreyee Bhattacharrya
December 2014, 5(6):120-122
  1,921 249 1
Fractional-targeted phototherapy
Sekar C Shanmuga, CR Srinivas
December 2014, 5(6):104-105
Targeted ultraviolet B phototherapy is used in the treatment for localized variants of psoriasis. We present two cases in which we compared the efficacy of lite spot and lite brush in the treatment of psoriasis and vitiligo.
  1,822 325 -
Linear verrucous hemangioma
Pooja Nupur, Sushil Satish Savant, Piyush Kumar, Shahid Hassan
December 2014, 5(6):136-137
  1,878 204 1
Childhood lichen planus pemphigoides triggered by chickenpox
TS Mohanarao, Gummalla Ajay Kumar, Kavya Chennamsetty, T Priyadarshini
December 2014, 5(6):98-100
Lichen planus pemphigoides (LPP) is a rare autoimmune bullous disorder that is rarer in children characterized by bullae on lichen planus like papules and the normal looking skin. Clinical, histopathological and direct immunoflourescence evaluation is important for the diagnosis of this entity. We report a case of LPP in a 5-year-old girl child probably triggered by an episode of preceding varicella. Diagnosis was confirmed by histopathology and immunofluorescence examination. Histological findings were typical of lichen planus from the biopsy taken from a violaceous to erythematous papule and characteristic of bullous pemphigoid in the biopsy taken from a bullous lesion with evidence of immunoglobulin G and C3 deposition along the basement membrane zone on direct immunofluorescence.
  1,813 258 1
Post-kala-Azar dermal leishmaniasis: A diagnostic dilemma in a nonendemic area
Prachi Bhandare, Pankaj Shukla, Mayur Bhobe, Varadraj V Pai
December 2014, 5(6):122-124
  1,764 266 -
Strawberry-shaped lesion on the chest: cutaneous rhinosporidiosis
KT Ashique, Muhamed Sajid, U Anjit
December 2014, 5(6):125-127
Rhinosporidiosis is a chronic granulomatous condition caused by the pathogen Rhinosporidium seeberi which frequently involves the nasopharynx and occasionally affects the skin. The disease has been reported from across the globe but the highest incidence has been from south India and Sri Lanka. This disease is commonly seen in adult men and the possible mode of transmission to humans is thought to be by direct contact with spores through dust, infected clothing, fingers, and swimming in stagnant water. The classical presentation is mucosal and here we present a case which presented as a growth on the chest wall. And we stress the need to keep a high index of suspicion in such cases in endemic areas
  1,779 222 1
Classic porokeratosis of Mibelli
Nidhi Singh, Laxmisha Chandrashekar, Nava Kumar, Rakhee Kar, Devinder Mohan Thappa
December 2014, 5(6):130-131
  1,511 300 1
Localized bullous pemphigoid on sites of radiotherapy and lymphedema in the same patient
Manikoth P Binitha, Veeravalli V Vishnu, Sukumarakurup Sreekanth, OK Reena Mariyath
December 2014, 5(6):101-103
Bullous pemphigoid (BP) is a blistering disorder due to autoantibodies to the epidermal basement membrane zone. The triggering factor could be localized damage to the skin by physical or chemical agents. We report a case of a 68-year-old woman with a three year history of oral lesions of BP following radiotherapy for carcinoma of the hypopharynx, and a three month history of BP over lymphedematous sites on the right hand and right lower limb. Localized BP induced by radiotherapy or lymphedema is rare; both factors working simultaneously in the same patient is even rarer.
  1,558 240 6
Ganesh Avhad, Priyanka Ghuge
December 2014, 5(6):134-135
  1,520 258 -
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