Cutis verticis gyrata secondary to infiltrating ductal carcinoma breast

Cutis verticis gyrata is a long lasting and progressive condition in which there is hypertrophy and folding of the scalp skin. It typically affects the vertex and occipital region; however, it may involve the entire scalp. Classically, it has been divided into primary and secondary forms. Primary has been sub-divided into primary essential and non-essential. Secondary forms are commonly due to systemic diseases, inflammatory dermatoses, underlying nevoid abnormalities or trauma. The association between cutis verticis gyrata and malignancy is rare. It has been described in patients of leukemia, endocrine tumours and malignant melanoma. We present a case of cutis verticis gyrata in a patient of carcinoma breast

Frequency of HCV infection in different dermatological disorders

Hepatitis C Virus [HCV] has estimated affected nearly 3% of the world population. Studies in Pakistan have shown a somewhat higher prevalence. The objective of this study was to determine the frequency of hepatitis C virus infection in patients with dermatological disorders, known to be associated with HCV infection. This was a descriptive study, conducted at Departments of Dermatology, Military Hospital, Rawalpindi and PNS Shifa, Karachi from September 2003 to November 2005. There were 355 patients of the dermatologic disorders mentioned above. HCV status was determined by the presence of anti-HCV antibodies in the serum, by third generation ELISA. In this study 14% of lichen planus, 8% of generalised pruritus, 7.8% of urticaria, 8.7% of prurigo, and 50% of porphyria cutanea tarda patients had underlying HCV infection. None of the patients of leukocytoclastic vasculitis, erythema multiforme or erythema nodosum had anti-HCV antibodies. No patient of mixed cryoglobulinaemia or polyarteritis nodosa was seen during the study period. Patients of lichen planus, generalised pruritus, urticaria, prurigo, and porphyria cutanea tarda have increased frequency of HCV infection compared to normal population of our country. In contrast, none of the patients of leukocytoclastic vasculitis, erythema multiforme or erythema nodosum had HCV infection.

Risk factors associated with pre-senile cataract

To determine frequency of various risk factors associated with presenile cataract among patients schedule for cataract surgery. Study was conducted at Abbasi Shaheed Hospital and Karachi Medical Dental College between October 2007 and September 2009. Patients of cataract of age 30-55 years were selected. Presence of risk factors like diabetes mellitus, high myopia, occupational exposure to metal work, atopic dermatitis and smoking were noted. Visual acuity, anterior and posterior segments were examined and axial length was measured. Two hundred fifty four patients satisfying inclusion criteria were selected. These included 181 male [mean age 44.7 years] and 73 females [mean age 43.8 years]. Unilateral eye involvement was present in 108 patients while bilateral involvement was present in 146 patients. Risk factors frequency was diabetes [26%], high myopia [16.1%], smoking [15%], metallic exposure [3.1%], atopic dermatitis [2%] while 37.8% were idiopathic. Significant difference were found in frequency of risk factors [p=0.004] and mean age according to presence of risk factors [p=0.001]. While no significant association was found of age with risk factors [p=0.7] and gender [p=0.24]. Our study shows that idiopathy contributed to most of the cases of presenile cataract followed by diabetes mellitus, high myopia and smoking

Auricular angiolymphoid hyperplasia with eosinophilia

Angiolymphoid hyperplasia with eosinophilia is an uncommon, benign, angioproliferative cutaneous disorder. Previously, angiolymphoid hyperplasia with eosinophilia and Kimura's disease were regarded as identical conditions, however, recent work identifies them as separate entities. It is clinically manifested by solitary or multiple, red to brown firm papules and nodules, occurring in the head and neck region with a predilection for the peri-auricular area. It usually occurs during the early and mid-adult life. It is more common in Caucasians with equal gender involvement. We report this condition in a 32 years old adult Pakistani male having red-brown papules in left ear

Vitiligo appearing in striae distensae as a Koebner phenomenon

Koebner phenomenon, the appearance of preexisting skin lesions following trauma to previously uninvolved skin, has been seen frequently with vitiligo. The type of trauma leading to Koebner phenomenon can vary from scratching, surgical scars, radiotherapy, burns, irritation from drug use and laser therapy. Striae distensae are a form of injury to the skin and in this particular case resulted from rapid increase in body size at puberty and possibly the use of systemic steroids for the treatment of vitiligo. The appearance of vitiligo in striae distensae as a form of Koebner phenomenon has been reported rarely. We describe a 14-year-old boy with vitiligo for the past 2 years, which Koebnerized in the striae distensae

Secondary Syphilis mimicking palmoplantar pustular Psoriasis: an unusual clinical presentation

A 38 year old Pakistani man presented with multiple, red, raised, pustular and scaly asymptomatic lesions on the palms and soles of 3 months duration. His past medical history was unremarkable. On physical examination he had multiple, symmetrically distributed erythematous plaques with well-delineated margins surmounted by pustules and scales on the palms and soles. There was paronychia around the fingernails involving nearly all the digits of the hands. Detailed examination also revealed hyperkeratotic lesions in the beard area, skin coloured papules concentrated around the nostrils and the angles of the mouth. There were mucous patches on the tongue and inner aspect of lips. Anogenital examination showed perianal condylomas with no genital erosion, ulceration or old scar mark. His vital signs were within normal limits and systemic examination did not reveal any abnormality. Biopsy finding from a scaly, erythematous plaque was consistent with syphilis i.e. perivascular infiltrate of lymphocytes and plasma cells with endarteritis obliterans. The second specimen from a pustular lesion showed localized epidermal accumulation of numerous neutrophils, lymphocytes and karyorrhectic debris. There was some overlying hyperkeratosis and parakeratosis alongwith lengthening of rete ridges with dilated, tortuous dermal capillaries. This picture was consistent with pustular psoriasis. The patient`s venereal disease research laboratory [VDRL] test and trepenoma pallidus h aemogbulination [TPHA] were positive in titers of 1:16 and 1:320 respectively. She was found to have mucous patches in the mouth and had positive serology for syphilis. Both husband and wife were treated with injection Benzyl Penicillin 10 lacs I.0 i.v 6 hourly for 2 weeks and they responded well to treatment. They were advised 3 monthly follow-up in the first year and then at 18th and 24th months. Six months after treatment the patient was symptom-free with a positive VDRL in a low titre of 1:2

Recurrence rate of pterygium following surgical excision with intraoperative versus postoperative mitomycin-C

To compare the rate of recurrence and complications of pterygium following surgical excision by applying 0.02% mitomycin-C intraoperatively or using topical 0.02% mitomycin-C drops postoperatively. Randomized clinical trial. Baqai Medical University Hospital, Department of Ophthalmology, from January 2001 to July 2005. Eighty-four eyes of 65 patients, aged between 20-70 years, with primary pterygium were randomly allocated into two groups using random tables. Patients with bilateral disease were treated with an interval of 10-14 days and randomized separately. In group-I, 0.02% mitomycin-C was applied intraoperatively for 3 minutes after pterygium excision. Group-II received mitomycin-C 0.02% eye drops twice a day for 2 weeks after pterygium excision. Patients were followed-up for pterygium recurrence for one year. Variables were compared for significance, using Pearson chi-square test. In Group I, recurrence of pterygium was seen in 4 [10.0%] eyes and superficial punctate keratitis in 4 [9.5%] eyes, while 8 [19.0%] eyes developed avascularization of sclera at the pterygium excision site. In group II, 8 [20.51%] eyes had pterygium recurrence [p=0.38], 13 [31.0%] eyes had superficial punctate keratitis and tenon cyst was seen in one [2.4%] eye. One [2.4%] eye in each group developed scleral thinning. There was no significant difference in pterygium recurrence rate intraoperatively or postoperative application of 0.02% mitomycin-C. Complications were comparatively less following application of intraoperative 0.02% mitomycin-C for 3 minutes