Granuloma multiforme: A report from India.

Granuloma multiforme (GM) is a reactive skin disorder of unknown etiology, characterized clinically by confluent annular lesions and histologically by focal necrobiosis and histiocytic granulomas. GM is significant because of its clinical resemblance to tuberculoid leprosy, with which it can be confused. Here, we report a case of granuloma multiforme from India in a 70-year-old male farmer, with multiple asymptomatic large annular rings of papules over the back and thighs on photodistributed sites. Histopathology helps to clinch the diagnosis and differentiate from similar clinical and histologic mimics such as granuloma annulare, tuberculoid leprosy, actinic granuloma and annular sarcoid. Nevertheless, a very high degree of suspicion is required to diagnose GM.

Patterns of lower leg and foot eczema in south India.

BACKGROUND: The pattern of eczema is altered by geography, habits of people and environmental factors and regional variation in skin structure and function. AIMS: Our study was done to estimate frequency and patterns of lower leg and foot eczemas. METHODS: A total of 200 patients with various types of lower leg and foot eczemas were recruited over a period of 2 years. Demographic and clinical characteristics were noted. Suspected cases of allergic contact dermatitis were patch tested. RESULTS: The frequency of these eczemas was 2.5 per 1000 out patients. Mean age of patients was 40.49 years. Female to male ratio was 1.6:1. Sixty (30%) patients were farmers, sixty (30%) were housewives, forty (20%) were students, nineteen (9.5%) were daily laborers, nine had sedentary jobs and three were teachers. Most eczemas were bilateral (72%). Mean duration of eczema was 36.6 months. Most common type of eczema was lichen simplex chronicus (36%) followed by discoid eczema (18.5%), allergic contact dermatitis (14.5%) and stasis eczema (7.5%). Other eczemas noted were juvenile plantar dermatosis, cumulative irritant contact dermatitis, infected eczema, hyperkeratotic eczema, asteatotic eczema, pompholyx, infective eczema and unclassified endogenous eczema. Common sites of involvement were dorsa of feet (49.5%), followed by lateral aspect of lower leg (31%), medial aspect of lower leg (17.5%) and ankle (12%). CONCLUSION: Our study highlights lichen simplex chronicus as the most common eczema affecting the lower legs and feet.