Pigmented Purpuric Dermatoses.

Pigmented purpuric dermatoses (PPD) are a group of histopathologically similar conditions that are primarily differentiated based on morphology. The basic pathological finding is a lymphocytic perivascular infiltrate with hemorrhage limited to the papillary dermis without fibrinoid necrosis of the vessels. The etiology is unknown; they run a chronic course and are fairly resistant to treatment. We present this review for the physicians to kindle interest in this not-so-uncommon entity.

Leprosy Scenario at a Tertiary-level Hospital in Navi Mumbai: A Four-year Retrospective Study.

Introduction: India was among the last few countries in the world to achieve leprosy elimination in 2005. However, wide variations in prevalence rates continue to exist across the states and regions in the country. Aims: The purpose of the study is to determine the current clinical profile of leprosy from a tertiary-level hospital in Navi Mumbai. Materials and methods: A retrospective study was done to determine the epidemiological and clinical profile of leprosy patients in a tertiary care center, MGM Medical College & Hospital, Navi Mumbai (September 2011 to August 2015). Data regarding demographic details, clinical features, investigations, treatment, and complications were analyzed. Results: In total, 207 patients were registered over a 4-year period, with male:female ratio of 2.4:1 and children (≤ 14 years) constituting 7.2%. As per Ridley Jopling classification, borderline tuberculoid leprosy was the most frequent morphologic type, seen in 45.8%, followed by borderline lepromatous (28%), lepromatous leprosy (10.1%), and other forms in 11.5%. Multibacillary leprosy was the most common clinical type (81.1%). About 32.8% patients presented in reaction (type I in 22.7% and type II in 10.1%). World Health Organization (WHO) grade 2 deformities were diagnosed in 32.8%, with claw hand being the most common paralytic deformity (18.8%). Conclusion: The study shows that despite statistical elimination, multibacillary disease, leprosy reactions, and deformities are commonly seen as presenting manifestations. Large population of migrant workers in Navi Mumbai could be a possible contributing factor towards these findings. It highlights the need to sustain and provide high-quality leprosy services to all patients through general health services, including good referral system. Investigations, such as slit skin smear and biopsy must be carried out for all newly diagnosed patients.

Peeling Palmar Skin.

A 20-year-old male presented with asymptomatic peeling of palmar skin of 1 month duration ( Fig. 1). He gave history of similar episodes since 3 years, all of which occurred during the winter season and subsided without treatment in a period of 2 to 3 months. He also complained of excessive sweating over palms. There was no personal or family history of atopy. Cutaneous examination revealed exfoliation of skin over the volar aspect of the palms and fingers. Soles were spared. Palmar hyperhidrosis was also noted. Onset in adulthood, absence of itching and/ or fluid-filled blisters, and negative KOH mount excluded dyshidrotic eczema, acral peeling skin syndrome, epidermolysis bullosa simplex, and dermatophytid and convened the diagnosis of keratolysis exfoliativa. Keratolysis exfoliativa is characterized by annular erythema with an air-filled blister arising in the center, followed by superficial collarette and lamellar peeling of glabrous palmoplantar skin. Synonyms include dyshidrosis lamellosa sicca and lamellar dyshidrosis. Emollients, urea, and lactic acid may be used; however, treatment is not necessary as the condition is asymptomatic.

Favre-Racouchot Syndrome with Predominant Nose Involvement.

Favre-Racouchot syndrome (FRS) is a dermatological condition predominantly affecting individuals with an excessive sunexposure. We report a case seen in an elderly male with a predominant involvement of the nose.

Cutaneous Adverse Drug Reactions.

Cutaneous adverse drug reaction is one of the most common manifestations of drug allergy. As the knowledge of the morphology of drug induced cutaneous lesions helps in the early identification of even a serious drug reaction, it is mandatory for the treating physician to pick up early signs of these reactions followed by a prompt withdrawal of the suspected drug. The paper discusses the clinical presentation and management of these including severe cutaneous adverse drug reactions. It emphasizes on need of a great amount of skill for its identification and management.

Clinical and demographic trends in a sexually transmitted infection clinic in Mumbai (1994-2006): An epidemiologic analysis.

Background: People presenting to sexually transmitted infections (STIs) clinics represent an important risk group for HIV infection; prevention strategies will depend on the clinical attendance. Aims: The demographic and clinical changes in clinic attendees in Mumbai, as well as the factors associated with HIV infection in this clinic over a 13-year period, were assessed. Methods: STI clinic data in 3417 individuals (1994 to 2006) were analyzed: clinical presentation, types of STIs, and serology over the 13-year period. We used a logistic regression model to assess socio-demographic and clinical associations with HIV infection. Results: The clinic evaluated 689 patients in 1994 and the number had dropped to 97 in 2006. In 1994, the majority of STIs seen in the clinic were bacterial (53%, 95% confidence interval [CI] 50% to 57%); however, this proportion had dropped in 2006 (28%, 95% CI: 19% to 38%). There was a proportional increase in viral STIs during the same time period. Although women attending the clinic were younger than men, they were more likely to be married. The overall seropositivity for HIV was 28%. Viral STIs were more likely to be associated with HIV than bacterial infections (odds ratio: 1.5, 95% CI: 1.2 to 1.9). Conclusions: Viral infections were the most common STIs in recent years in a tertiary care center in Mumbai. HIV prevalence was high in this population. Thus, these clinical data suggest that STI patients were and continue to be an important group for HIV prevention in the country.

The effects of a daily facial lotion containing vitamins B3 and E and provitamin B5 on the facial skin of Indian women: A randomized, double-blind trial.

Background : The B vitamins niacinamide and panthenol have been shown to reduce many signs of skin aging, including hyperpigmentation and redness. Aims : To measure the facial skin effects in Indian women of the daily use of a lotion containing niacinamide, panthenol, and tocopherol acetate using quantitative image analysis. Methods : Adult women 30-60 years of age with epidermal hyperpigmentation were recruited in Mumbai and randomly assigned to apply a test or control lotion to the face daily for 10 weeks. Effects on skin tone were measured using an image capturing system and associated software. Skin texture was assessed by expert graders. Barrier function was evaluated by transepithelial water loss measurements. Subjects and evaluators were blinded to the product assignment. Results : Of 246 women randomized to treatment, 207 (84%) completed the study. Women who used the test lotion experienced significantly reduced appearance of hyperpigmentation, improved skin tone evenness, appearance of lightening of skin, and positive effects on skin texture. Improvements versus control were seen as early as 6 weeks. The test lotion was well tolerated. The most common adverse event was a transient, mild burning sensation. Conclusions : Daily use of a facial lotion containing niacinamide, panthenol, and tocopheryl acetate improved skin tone and texture and was well tolerated in Indian women with facial signs of aging.

Childhood sclerodermatomyositis with generalized morphea.

Systemic sclerosis (SS) and dermatomyositis (DM) are both multisystem disorders and share some common clinical features. We report here an 11 year-old girl whose disease showed a changing clinical pattern from juvenile systemic sclerosis (JSS) to slowly progressing juvenile dermatomyositis (JDM) and had associated generalized morphea. Serological studies revealed antinuclear antibodies (ANA) with a speckled pattern. Topoisomerase-I (Scl-70), U1 RNP (ribonucleoprotein), anti-Ro, anti-La and anti Jo-1 antibody tests were negative. Electromyography (EMG) was suggestive of primary muscle disease and histopathological findings indicated scleroderma. The patient fulfilled the American College Rheumatology (ACR) diagnostic criteria for JSS as well as Bohan and Peter criteria for JDM separately and hence, was diagnosed to have sclerodermatomyositis (SDM). Mixed connective tissue disease (MCTD) and antisynthetase antibody syndrome (ASS) which share same clinical features with SS and DM were excluded by immunological studies.