Leprosy: type 1 reaction precipitated by doxorubicin and cisplatin

Type 1 reaction [T1R] in leprosy is common and characterized by increased inflammation in skin lesions or nerve. Besides antileprotic therapy, T1Rs are associated with intercurrent infection, pregnancy and drugs. Also, T1Rs may be a presenting feature of leprosy. We report a case of T1R in leprosy presenting as drug reaction during cancer chemotherapy with doxorubicin and cisplatin. We propose to explain this unusual occurrence by highlighting the increased production and expression of TNF-alpha by these drugs. Thus, physicians using these drugs should keep this unusual adverse effect in mind

Large irritation fibroma of palate - a rare presentation

A 65-year-old lady presented with large, asymptomatic normal coloured pedunculated growth of 3.5 centimeter in length over hard palate since last two years. Patient had a history of betel leaf and nut ingestion with other irritant agents for several decades. All hematological investigations were within normal limit but radiographic imaging revealed soft tissue shadow. After excision, histopathological examination revealed bundles of spindle cells producing extensive collagen in both radiating and circular pattern in lower dermis with focal pseudoepitheliomatous hyperplasia in mucosal epithelium and chronic inflammatory infiltrates in submucosa. All these features were consistent with irritation fibroma with unusual size. It was located in palate which was very unusual location

introspection into the cutaneous manifestations of chronic arsenicosis as reported in a tertiary care centre in Kolkata

To study different patterns of skin manifestations of arsenicosis. A cross-sectional observational study was done on 110 patients of clinically suspected arsenicosis attending the dermatology outdoor of a tertiary care centre in eastern India over a period of one year. Cutaneous indicators like keratosis over palms and soles, melanosis and hypopigmentation over trunk in patients coming from endemic zones were included. Arsenic level estimation was done in drinking water, hair and nails. Systemic evaluation was done in symptomatic cases. Majority of the patients hailed from Nadia, North 24 Parganas and Murshidabad districts. Males and females presented equally. Skin pigmentation was present in almost all patients [95%]. Raindrop pigmentation was the commonest cutaneous manifestation [71%] followed by punctuate palmar keratosis [49%]. Bowen's disease was found in 21% patients whereas squamous cell carcinoma was the commonest cutaneous malignancy [5%]. Raindrop pigmentation was found more in males than females. Peak incidence was found in patients exposed to arsenic containing drinking water for a minimum of 5 years. There was strong correlation of severity of skin manifestations and level of arsenic in drinking water. The most common presentation of arsenicosis was raindrop pigmentation and it was found more in males. The incidence of cutaneous malignancy was 3% with premalignant Bowen's disease being quite high [21%]

Pyoderma gangrenosum in pregnancy: a case with unusual presentation

Pyoderma gangrenosum [PG] is an uncommon idiopathic chronic ulcerative condition, clinically characterized by initial small pustules which develop into ulcers with typical undermined borders with violaceous hue. In most cases, PG is associated with systemic diseases like inflammatory bowel disease, inflammatory polyarthritis and hematological disorders as paraproteinemia and leukemias. Diagnosis is difficult, mostly resting on the exclusion of other similar conditions, due to lack of pathognomonic histological features. We describe a case of PG in pregnancy not only for the rarity of the association, but also because of some unusual presenting features. We treated the patient by intralesional steroid injection and topical steroid application; the ulcers healed within a month

Dermatoses in pregnancy: Specific dermatoses vis-a-vis others, in a tertiary hospital in Kolkata

To document the frequency of specific and other dermatoses in pregnancy. Two hundred and twenty five consecutive pregnant patients irrespective of the duration of pregnancy and gravidity reporting to our skin OPD were enrolled in the study. Out of them, 218 patients who gave consent were included in the study. The specific dermatoses of pregnancy were subclassified into four main groups - atopic eruption of pregnancy [AEP], polymorphic eruption of pregnancy [syn. pruritic urticarial papules and plaques of pregnancy] [PEP], pemphigoid gestationis [PG], intrahepatic cholestasis of pregnancy [ICP]. 39 [68.4%] patients belonged to AEP, 14 [24.5%] to PEP, and 1 [1.8%] to PG and 3 [5.2%] to ICP. About half of the patients with AEP were found to have raised IgE level. Five STD patients were reported in the first trimester, 2 in second and 7 in third trimester. Patients reported with molluscum contagiosum [4], genital herpes [4], condyloma acuminata [3], primary chancre [1] and condyloma lata [1]. One patient with molluscum contagiosum was HIV positive. Among the non STD other dermatoses in pregnancy, scabies topped the list affecting in all trimesters. Fungal infections [tinea and pityriasis versicolor] was a close second. One case each of pompholyx, psoriasis, and leprosy reported to us. Early diagnosis of specific dermatosis of pregnancy may prevent harmful effect on mother and fetus