Erythema Induratum of Bazin

Erythema Induratum of Bazin is a tuberculid, a condition occurring 'on the legs of female and in young and plump well nourished women. It is characterized by recurrent nodular and ulcerative lesions. Lesions are usually localized to the lower legs especially calf area, but can affect other areas. We are presenting a case of a 54-years-old lady with recurrent crops of nodules on legs. Mantoux test was positive. Histopathology revealed lobular panniculitis, epithelioid cells, lymphocytes and giant cells surrounding foci of caseous necrosis which was suggestive of erythema induratum. She was put on Antituberculous treatment

Granuloma formation in discoid lupuserythematosus: a novel microscopic feature

Lupus erythematosus is an autoimmune disease with marked pleotropism. If several systems are involved then the disease is named as systemic lupus erythematosus [SLE] and if skin is exclusively involved the term discoid lupus erythematosus [DLE] is used. One of the several histopathological features of DLE includes periappendageal inflammation. This may at times ; completely wipe out sebaceous glands forming sebaceous granulomas. To determine the frequency of sebaceous granulomas formation in discoid lupus erythematosus. In this prospective observational study was conducted at the Departments of Dermatology and Pathology, Pakistan Institute of Medical Sciences, Islamabad. 100 cases of DLE spanning over two years and with the age range of 3 years to 70 years were examined for the presence of sebaceous granuloma. Other features of DLE like hyperkeratosis, follicular plugging, epidermal atrophy, basal layer vacuolization, basement membrane deposits, pigmentary incontinence, perivascular inflammation, periappendageal inflammation, and collagen damage were also noted., Out of these 100 cases, 8 cases contained sebaceous granulomas. These granulomas were,, . composed of epithelioid cells, foreign body giant cells containing partially digested sebaceous material and a few lymphoctytes. Sebaceous granulomas formation was seen in 8% cases of DLE cases. This feature must be recognized both by dermatologists and pathologist so that diagnosis of DLE may not be distracted and erroneous diagnosis due to presence of granulomas may not be rendered

Response to treatment of cutaneous leishmaniasis with intralesional chloroquine vs intralesional meglumine antimoniate

In Pakistan, cutaneous leishmaniasis [CL] is mostly caused by Leishmania major. For simple lesions which are few in number and where there is no risk of disfigurement or joint mobility restriction, topical application or local treatment e.g. intralesional antimony compounds are valuable. To compare the effect of intralesional chloroquine with meglumine antimoniate in the treatment of CL. In this quasi experimental study, 60 patients of CL with 1 to 3 lesions and aged >3years were divided into 2 treatment groups to receive either intralesional chloroquine [treatment group] or meglumine antimoniate [control group]. Both drugs were used Ice per cm[2] of lesion, once weekly for 8 weeks [8 injections]. 8 more injections were given to those who showed partial response. Both treatments showed 100% response; however, greater number of injections was required with meglumine antimoniate [p<0.05]. Both drugs were well tolerated. Intralesional chloroquine appears to be an effective, safe and cheap alternative to meglumine antimoniate in the treatment of CL

Sebaceous granulomas: a novel feature of discoid lupus erythematosus

To determine the frequency of sebaceous granulomas formation in discoid lupus erythematosus, Retrospective observational study. Departments of Dermatology and Pathology, Pakistan Institute of Medical Sciences, Islamabad. 100 cases of Discoid Lupus Erythematosus [DLE] spanning over two years and with the age range of 3 years to 70 years were examined for the presence of Sebaceous Granuloma. Other features of DLE like hyperkeratosis, follicular plugging, epidermal atrophy, basal layer vacuolization, basement membrane deposits, pigmentary incontinence, perivascular inflammation, periappendigeal inflammation, and collagen damage were also noted. Lupus erythematosus is an immune complex, type Ill hypersensitivity disease where antibodies are formed against native Deoxyribose Nucleic Acid [DNA]. The immune compexes are deposited in various organs and various sites causing marked pleotropism. If several systems are involved then the disease is named Systemic Lupus Erythematosus [SLE] and if skin is exclusively involve the term Discoid Lupus Erythematosus [DLE] is used. One of the several features of DLE includes periappengeal inflammation. This may at times completely wipe out sebaceous glands forming sebaceous granulomas. Out of these 100 cases 8 cases contained sebaceous granulomas. These granulomas were composed of epithelioid cells, foreign body giant cells containing partially digested sebaceous material and a few lymphoctytes. Sebaceous granulomas formation was seen in 8% cases of discoid lupus erythematosus. This feature must be recognized both by dermatologists and pathologist so that diagnosis of DLE may not be distracted and erroneous diagnosis due to presence of granulomas may not be rendered

Comparison of fine needle aspiration with biopsy in the diagnosis of cutaneous leishmaniasis

Leishmaniasis is a zoonotic infection caused by the protozoa belonging to the genus Leishmania .Demonstration of Leishman-Donovan [LD] bodies on histopathological examination of biopsy specimen is considered to be the definitive diagnostic modality. This study was designed to assess the diagnostic value of fine needle aspiration and to compare it with full thickness biopsy. This was randomized, open label comparison study conducted in department of dermatology, Pakistan Institute of Medical Sciences, Islamabad from 1 [st] June 2007 to 31 [st] July 2007.15 patients, 15 years of age or older were enrolled in the study. Selection of patients was made on the basis of clinical features. Patients with the lesions having typical clinical features of cutaneous leishmaniasis-like erythematous crusted plaques or nodules were enrolled. Demographic characteristics including age, sex residential address site, size, shape and duration of lesions was noted Informed consent was taken. Procedure and its pros and cons were explained to the patient. Procedure was performed in the FNA room of pathology department under strict aseptic conditions. Local anaesthesia was not given as patients tolerated the pain well. Biopsy specimen was taken from the same lesion under local anaesthesia after doing FNA. Slides were processed and examined. The diagnosis was confirmed on the basis of finding giant cells or Leishman-Donovan bodies on FNA of the lesion. Out of 15 patients 12 patients had positive FNA and three patients had negative FNA report. While the biopsy specimen showed typical histopathological features of cutaneous leishmaniasis in 14 out of 15 patients and one turned out to be a case of ruptured inclusion cyst. So out of 3 negative cases of FNA one had ruptured inclusion cyst. The diagnostic rate was 80%for FNA and 93.3%for biopsy. Fine needle aspiration seems a reasonably good diagnostic modality for cutaneous leishmaniasis.Its sensitivity is comparable to that of full thickness biopsy

Eosinophilic granuloma: a rare presentation of Langerhans cell histiocytosis in a young female

Histiocytosis encompasses a group of diverse disorders that have in common, as a primary event, the accumulation and infiltration of monocytes, maerophages, and dendritic cells in the affected tissues. Langerhans cell histiocytosis [LCH] can be local and asymptomatie, as in isolated bone lesions, or it can involve multiple organs and systems with significant symptomatology and consequences. Thus, the clinical manifestations depend on the site of the lesions and organs and systems involved and theft functions. We report a case of a 35-year-old lady who presented with skin lesions in presternal area mimicking very closely to those of scrofuloderma [a form of skin tuberculosis]. She had been treated with antituberculous therapy thrice with no benefit. There was no evidence of systemic involvement. Diagnosis of LCH was confirmed on histopathological findings of skin lesion and markers. Patient was treated with oral methttrexate with resolution of lesions

Ivermectin in the treatment of scabies

Ivermectin is structurally similar to the macrolide antibiotics, but does not have antibacterial activity. It is, however, active against number of ecto- and endoparasites. It has been extensively employed in veterinary medicine, and in humans it is used to treat filarial diseases, principally onchocerciasis. A clinical trail was conducted for the first time in Pakistan to determine the efficacy of oral ivermectin in patients with scabies and its comparison with the most effective standard treatment available until now i.e. permethrin applied locally. This non randomized, open-label comparison study was conducted in department of dermatology, Pakistan Institute of Medical Sciences, Islamabad, from January, 2007 to March, 2007. 30 patients, 12 years of age or older were enrolled in the study. Diagnosis was made on the basis of clinical features, including history and clinical examination with typical lesions and sites of involvement. 15 patients received orally administered ivermectin, two doses of 200 micro g/kg body weight separated by one week. Remaining 15 patients received local treatment with permethrin 5%, according to the standard method, in which it is applied for 12 hours and was repeated after one week. Pretreatment complete physical examination was done along with necessary laboratory investigations in all cases. They were repeated after 2 weeks at the end of treatment to note any abnormality developing. Groups were almost matched in terms of age, sex and weight. The efficacy was evaluated by the relief of symptoms and disappearance of the lesions. All patients completed therapy without any complication. Patients recovered completely with relief of symptoms and complete healing of skin lesions. The cure rate was 100% in both groups, at the end of treatment period. Ivermectin seems to be a safe and effective alternative to permethrin. The striking advantage of ivermectin being its benefit of oral administration and low cost

Chloroquine in cutaneous leishmaniasis

Chloroquine is an antiprotozoal drug that has shown a favorable therapeutic index for cutaneous leishmaniasis. A clinical trial was conducted to determine the efficacy of oral chloroquine in patients with cutaneous leishmaniasis and its comparison with the most effective standard treatment, pentavalent antimony compounds. This non randomized, open-label comparison study was conducted in department of dermatology, Pakistan Institute of Medical Sciences, Islamabad, from August 2006 to January 2007. 30 patients, 12 years of age or older were enrolled in the study. Diagnosis was made on the basis of clinical features and histopathological examination. 15 patients received orally administered chloroquine 250mg tds for 20 days and remaining 15 patients received injectable pentavalent antimony 20mg/kg for 28 days. Pre-treatment complete physical examination was done along with necessary laboratory investigations in all cases. They were repeated after 2 weeks and then at the end of treatment to note any abnormality developing. Groups were almost matched in terms of age, duration of lesions and number of lesions. The efficacy was evaluated by the appearance of the lesion and healing with or without scar formation. Patients were followed up for 3 months. All patients completed the study without any complication. Lesions healed completely with only minimal scarring or post-inflammatory hyperpigmentation at the site of lesion. The cure rate at 3-month follow-up was 100% in group A [chloroquine] and 93% in group B [antimony compound] at the end of treatment period. Chloroquine seems to be a safe and effective alternative to antimony compounds. The striking advantage of chloroquine being its benefit of oral administration, and low cost along with easy availability which is of particular importance in underdeveloped countries like Pakistan

Tuberous sclerosis in a young adult

Tuberous sclerosis is a genetic disorder of hamartoma formation in many organs, characterized by angiofibroma, Shagreen patch, periungual fibroma, ash-leaf macule, although not invariably, seen in association with epilepsy and mental retardation. We document a case of tuberous sclerosis in a young adult without CNS manifestations