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.

Acquired Cold Urticaria: An Under-reported Entity.

Acquired cold urticaria (ACU) is a subtype of physical urticaria which may be primary (idiopathic) or secondary to underlying infections or cryoproteins. In addition to complete history and thorough physical examination, the diagnosis is dependent on a positive cold stimulation time test (CSTT) which is the minimum time of cold contact stimulation required to induce an immediate coalescent wheal. Although idiopathic type is seen in 96% of the cases, it is important to rule out cryoprotein by an intricate yet simple test for cryoprecipitate. The identification of cold exposure as the likely trigger for urticaria is vital because systemic anaphylactic reactions are common in patients with cold urticaria, occurring in roughly 1 in 3 patients. In addition to preventive counseling and avoidance of critical cold exposure, H1-receptor antagonists form the first line of treatment. However resistant cases may require cyclosporine, danazol or omalizumab. No individual case reports of ACU appear in Indian literature. Therefore, the authors attempt to highlight the diagnostic work-up and therapeutic options for this not so uncommon cause of chronic urticaria.

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.

Two cases of scalp white piedra caused by Trichosporon ovoides.

White piedra is a superficial fungal infection of the hair shaft, caused by Trichosporon beigelii . We report two cases of white piedra presenting as brown palpable nodules along the hair shaft with a fragility of scalp hairs. T. beigelii was demonstrated in hair culture of both the patients and T. ovoides as a species was confirmed on carbohydrate assimilation test. The first patient responded to oral itraconazole and topical ketoconazole, with a decrease in the palpability of nodules and fragility of scalp hairs at the end of two months.

Male sex workers: are we ignoring a risk group in Mumbai, India?

BACKGROUND: Male sex workers (MSWs) have recently been recognized as an important risk group for sexually transmitted infections (STIs) including human immunodeficiency virus (HIV) infection. Although there are global studies on MSWs, few such studies describe the behavioral patterns and STIs among this population in India. METHODS: MSWs were evaluated at the Humsafar trust, a community based organization situated in suburban Mumbai, India. We report on the demographics, sexual behaviors, and STIs including HIV of these sex workers. RESULTS: Of the 75 MSWs, 24 were men and 51 were transgenders. The mean age of the group was 23.3 (+ 4.9) years. About 15% were married or lived with a permanent partner. Of these individuals, 85% reported sex work as a main source of income and 15% as an additional source. All the individuals reported anal sex (87% anal receptive sex and 13% anal insertive sex). About 13% of MSWs had never used a condom. The HIV prevalence was 33% (17% in men vs 41% in transgenders, P = 0.04). The STI prevalence was 60% (58% in men vs 61% in transgenders, P = 0.8). Syphilis was the most common STI (28%) in these MSWs. HIV was associated with being a transgender (41 vs 17%, P = 0.04), age > 26 years (57 vs 28%, P = 0.04), more than one year of sex work (38 vs 8%, P = 0.05), and income P = 0.02). CONCLUSIONS: The MSWs have high-risk behaviors, low consistent condom use, and high STI/HIV infections. These groups should be the focus of intensive public health interventions aimed at reduction of risky sexual practices, and STI/HIV prevention and care.

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.