Sole, An Uncommon Location of Borderline Tuberculoid Hansen’s Disease

Leprosy a chronic granulomatous infection, frequently affects areas with relatively low temperature and which are trauma prone. Areas like scalp, palms and soles, groins, genitalia, axillae, eyelids, and perineum, have been described as “immune” to development of leprosy. But clinic-pathological and bacteriological evidence of involvement of these so-called “immune zones” has rarely been documented. Palmoplantar involvement is uncommon in leprosy and could be easily misdiagnosed. We report here a case of 65-year-old male who had a single, well defined, round, 5*5 cm, dull erythematous to hyperpigmented plaque with central clearing over medial aspect of left foot extension as single, erythematous, roundish 2*2cm, plaque with central clearing over medial aspect of left foot just below ankle, for 3 months. There was decreased sensation to hot and cold temperature and to fine touch and pain over the lesions. Sensory examination elsewhere on the body was normal. There was no motor loss, no thickened nerves, no deformities, trophic ulcers or evidence of reaction. Histopathology of sole lesion suggested borderline tuberculoid Hansen’s disease. Stain for AFB was negative. Slit skin smear was negative. Good response to MDT was seen at end of 4 months. Such presentation needs to be kept mind for diagnosis of leprosy for instituting timely and appropriate treatment

Flatfish (Pleuronectiformes) species richness and depth distribution in the Gulf of Nicoya, Golfo Dulce, and two adjacent areas on the Pacific coast of Costa Rica

Introduction: Information on the number of flatfish species and their depth distributions is scarce for the Eastern Tropical Pacific. Historical data is important to evaluate changes in ecosystems due to local, regional and global stressors. Objective: To provide information on the presence, depth distributions and lengths of flatfish species collected by trawl nets. Methods: Fish studies were conducted by trawling at four sites along the Pacific coast of Costa Rica by the survey vessels Skimmer (1979-1980), Nishin Maru (1987-1988) and Victor Hensen (1993-1994). The published lists of species were consulted, museum specimens were accessed, and an updated list of flatfish species assembled. Results: A total of 36 species were found over a depth range of 8-359 m. The family Paralichthyidae included 13 species followed by the Cynoglossidae with 12 species, Achiridae with six and Bothidae with five. Thirty-five species were collected at depths from 10-235 m in the Gulf of Nicoya and Golfo Dulce. Monolene asadeae was collected offshore at a depth range of 254-359 m. The Gulf of Nicoya estuary yielded 27 species during the Skimmer expedition over a depth range of 8-60 m, while 31 species were found during the V. Hensen survey at depths from 10-228 m. The V. Hensen survey in Golfo Dulce (20-235 m) collected 19 species, and 17 species in Coronado Bay (21-187 m). Off the Nicoya Peninsula (56-359 m) 13 species were collected by the Nishin Maru shrimp trawler. A total of 21 species (58 %) were found at depths greater than 100 m which were probably exposed to low oxygen concentrations. During the V. Hensen survey Symphurus chabanaudi and S. elongatus were collected more frequently in the Gulf of Nicoya, while S. leei was collected more frequently in Golfo Dulce. Cluster analyses based on presence-absence data for the Gulf of Nicoya and Golfo Dulce revealed low station similarity indicating possible habitat partitioning among species. The size (Total length) of 33 species measured from both the Gulf of Nicoya and Golfo Dulce ranged from 8 cm (Syacium cf longidorsale, Trinectes xanthurus) to 50 cm (S. ovale). Only 12 species were found with lengths over 20 cm. Data on flatfish landings by the semi-industrial fishing fleet for the period 2000-2016 indicates that this group represents less than 1 % of the total landings (shrimp and bycatch), with a minimum of 365 kg in 2001 and a maximum of 13 414 kg in 2013. Conclusions: The number of flatfish species of the Pacific coast of Costa Rica appears relatively high but comparable to the numbers found in other tropical regions. A reduced fishing impact on the populations together with this updated list of flatfish provide a good baseline for a new survey of fish populations. Both are important for a future updating of the trophic models available the Gulf of Nicoya and Golfo and their use as tools for better management of the ecosystems.

Introducción: Es escasa la información sobre el número de especies y la distribución batimétrica de los lenguados del Pacífico Este Tropical. Esos datos son importantes para evaluar cambios en los ecosistemas debidos a tensores locales, regionales y globales. Objetivo: Proveer información de la presencia, distribución batimétrica y longitudes de especies de lenguados recolectados por red de arrastre. Métodos: Evaluaciones de los peces mediante redes de arrastre fueron conducidas en cuatro sitios a lo largo de la costa del Pacífico de Costa Rica por los buques de investigación Skimmer (1979-1980), Nishin Maru (1987-1988) y Victor Hensen (1993-1994).Se consultó las listas publicadas de especies, se revisó ejemplares depositados en el museo y se integró una lista actualizada de especies de lenguados. Resultados: Un total de 36 especies de lenguados fueron encontrados en un ámbito de profundidad de 8 a 359 m. La familia Paralichthyidae incluyó 13 especies seguida por los Cynoglossidae con 12 especies, Achiridae tuvo seis y Bothidae cinco especies. Treinta y cinco especies fueron recolectadas entre 10 y 235 m en el Golfo de Nicoya y Golfo Dulce. Monolene asadeae fue recolectada aguas afuera en un ámbito de profundidad de 254-359 m. El Golfo de Nicoya produjo 27 especies durante la expedición del Skimmer y en un ámbito de profundidad de 8 a 60 m, mientras que 31 especies fueron encontradas durante el muestreo del V. Hensen en profundidades entre los 10 y 228 m. El muestreo del V. Hensen en el Golfo Dulce (20 a 235 m) produjo 19 especies y 17 en Bahía de Coronado (21-187 m). Afuera de la península de Nicoya (56-359 m) 13 especies fueron recolectadas por el camaronero Nishin Maru. Un total de 21 especies (58 %) fueron encontradas a profundidades mayores de 100 m y posiblemente expuestas a las bajas concentraciones de oxígeno. Durante el muestreo del V. Hensen, Symphurus chabanaudi y S. elongatus fueron capturados más frecuentemente en el Golfo de Nicoya, mientras S. leei lo fue en Golfo Dulce. El tamaño (Longitud Total) de 33 especies medidas en ambos Golfo de Nicoya y Golfo Dulce oscilaron entre 8 cm (Syacium cf longidorsale, Trinectes xanthurus) y 50 cm (S. ovale). Solo 12 especies fueron encontradas con longitudes mayores de 20 cm. Datos de desembarcos de lenguados por la flota semi-industrial para el periodo 2000-2016 indican que este grupo representa menos del 1 % de los desembarcos totales (camarones y fauna acompañante), con un mínimo de 365 kg en 2001 y un máximo de 13 414 kg en 2013. Conclusiones: Los análisis de conglomerados basados en datos de presencia-ausencia para el Golfo de Nicoya y Golfo Dulce revelaron baja similitud de estaciones indicando partición del hábitat entre las especies. La diversidad de la fauna de lenguados de la costa del Pacífico de Costa Rica aparece relativamente alta pero comparable con la encontrada en otras regiones tropicales. El número de buques arrastreros ha disminuido significativamente en el Pacífico de Costa Rica después del 2014. Esta reducción del impacto en las poblaciones y la lista actualizada de lenguados proveen una buena base para un nuevo estudio de las poblaciones de peces. Ambas son importantes para una futura actualización de los modelos tróficos disponibles para el Golfo de Nicoya y Golfo Dulce y su utilidad como herramientas para un mejor manejo de los ecosistemas.

Gyrate Erythema like Manifestation - An Unusual Presentation of Borderline Lepromatous Hansen's Disease

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. Once considered a taboo, it is still misdiagnosed and underdiagnosed. Leprosy can present in innumerable diverse ways which can be confused with many treatable and non-treatable, infectious and noninfectious disorders. Though leprosy is eliminated from India in 2005, still many new cases are being reported day by day. Here we found a very rare manifestation of borderline lepromatous leprosy presented with erythematous figurate bands over trunk, proximal extremities and erythematous patches over palms and soles.

Psoriasis pustulosa palmar unilateral: A propósito de un caso / Unilateral palmar pustular psoriasis: A clinical case

La psoriasis pustulosa palmoplantar (PPP) es una enfermedad inflamatoria crónica y recurrente, caracterizada por la presencia de pústulas estériles, sobre una base eritematosa en palmas y plantas. Es de gran importancia, debido a que ocasiona tanto limitación funcional como disminución en la calidad de vida, siendo en la mayoría de los casos refractaria al tratamiento. Se presenta un caso de PPP, donde fueron necesarias aplicar terapias combinadas: tópica y sistémica (esteroides de alta potencia y ciclosporina), con evolución satisfactoria en cuatro semanas de tratamiento. Se realizó una revisión exhaustiva en los motores de búsqueda como: Latindex.org, Scielo.org y Google académico, de las publicaciones más representativas hasta la actualidad y las palabras clave, a través de la web de Medical Subject Headings.

Palmoplantar Pustular Psoriasis (PPP) is a chronic and recurrent inflammatory disease, characterized by the presence of sterile pustules on an erythematous base in palms and soles. It is important because it causes both functional limitation decreasing quality of life. In most cases refractory to treatment. We present a case of PPP with topical and systemic combined therapy (high potency corticoids and cyclosporine) with satisfactory outcomes at four weeks of treatment. An exhaustive review in search engines as Scholar Google, Latindex and Scielo was made for the last 30 years and key words in Medical Subject Headings.

Comparative study of oral methotrexate and acitretin in the treatment of palmoplantar psoriasis.

Background: Psoriasis is chronic inflammatory skin condition. Palmoplantar psoriasis is a type where lesions are present on the palms and soles. This type affects patient’s quality of life and is difficult to treat. Topical modes of treatment are not so effective and produce inadequate response. Systemic drugs are necessary in the treatment of moderate to severe disease. The objective was to compare the efficacy of oral methotrexate and acitretin in treatment of moderate to severe palmoplantar psoriasis and there side effects. Methods: 50 patients with palmoplantar psoriasis were randomized into 2 groups. Patients in group I received oral methotrexate and patients in group II received acitretin for 3 months. Baseline grading was done with Modified Psoriasis Area Severity Index (MPASI) score. MPASI score was assessed monthly. Scores at the beginning and at the end of 3 months of treatment were compared. Quality of life was assessed using a questionnaire. Results: MPASI score in group I was 57.15 ± 17.17 at baseline and 14.50 ± 13.55 at the end of 3rd month. The difference in scores before and after treatment was statistically significant. MPASI score in group II was 57.76 ± 18.60 at baseline and 21.30 ± 8.168 at the end of 3rd month. Intragroup analysis showed statistically significant difference before and after treatment. There was significant improvement in the quality of life after treatment. Conclusion: Oral methotrexate reduces the lesions faster than acitretin. Both oral methotrexate and acitretin are highly effective in treating palmoplantar psoriasis and in improving patient’s quality of life.

Effects of soles with different hardness on human lower extremity kinematics during walking / 医用生物力学

Objective To evaluate effects of soles with different hardness on kinematic parameters of human lower extremity during walking by conducting kinematic analysis on subjects walking with soles of different hardness. Methods Subjects were required to wear 3 kinds of shoes with soles of different hardness and walk on the treadmill at the speed of 6 km/h. Vicon infrared camera system was used to capture the motions of subjects during walking, and kinematic parameters such as heel height, toe height, knee angle and ankle angle were collected for experimental analysis. Results Compared with the other shoes, the gait cycle was increased when subjects wearing soft-soled shoes, with the smallest angel of the forward pendulum of crus. The forward pendulum of thigh was the smallest and the back pendulum was the largest when subjects wearing medium-hardness shoes. The forward pendulum of thigh was the largest and the back pendulum was the smallest when subjects wearing hard-soled shoes. The time of swing phase was relatively stable. Conclusions Soft-soled shoes are more suitable for slow walking during a short period, while medium-hardness shoes have the smallest impact on lower extremity kinematics during walking for a long period, and hard-soled shoes are suitable for fast walking during a short period.

Cardiac Myxoma Diagnosed by Signs of Purpuric Macules on Both Palms and Soles

Cardiac myxoma, the most prevalent primary cardiac tumor, is rare. The clinical features of this tumor are principally intracardiac obstruction, extracardiac embolism, and general symptoms including fever, myalgia, arthralgia. Although cutaneous manifestations in patients with cardiac myxoma are frequent, in rare cases, cutaneous signs have been clues to the correct diagnosis. We report a 42-year-old male who presented with recurrent multiple purpuric patches on both palms and soles for 4 months. Histopathological finding showed a myxomatous embolus in the arteriole in the lower dermis. Echocardiogram demonstrated the presence of a left atrial myxoma with a provisional diagnosis of left atrial myxoma. In our patient, skin examinations and histopathological finding led us to the diagnosis of cardiac myxoma.

Hyperkeratotic pitted plaques on the palms and soles.

Lichen planus (LP) and lichen nitidus (LN) present with varied morphology on the palms and soles. We present four unusual cases of palmoplantar LP and LN manifesting as hyperkeratotic plaques with pits. The diagnosis was confirmed histologically. Subtle features like presence of violaceous border suggests LP and plugs within the pits suggest LN.

Nevos melanocíticos palmoplantares: correlación dermatoscópica e histopatológica / Melanocytic nevi in palms and soles: dermatoscopy and histopathogic correlation

Introducción. El nevo se define como malformación circuscripta de los tegumentos, disembrioplásicos o hereditarios, transitorios o permanentes. Su importancia radica en su conocida relación casual con el melanoma. Un porcentaje de los melanomas proviene de nevos melanocíticos preexistentes. Por este motivo es importante distinguir aquellos que tienen alto riesgo de modificarse. La dermatoscopía es una técnica no invasiva, especialmente útil en la distinción de lesiones pigmentadas melanocíticas y no melanocíticas y, dentro de las primeras, entre nevos y melanoma. La piel volar presenta características especiales que producen imágenes dermatoscópicas peculiares. Objetivos, Descripción de los patrones dermatoscópicos acrales y frecuencia de presentación, correlación dermatoscópica e histopatológica de los nevos palmoplantares. Evaluar la concordancia dermatoscópica entre el investigador y un observador independiente. Material y métodos. Estudio observacional, prospectivo, transversal y analítico de pacientes con diagnóstico clínico de nevos melanocíticos palmoplantares. Se realizó en el hospital Privado de Córdoba entre mayo 2006 y abril 2007. Variables a estudiar: edad, sexo, antecedentes personales, fototipo, localización, patrón dermatoscópico y patrón histológico. Todos los pacientes fueron observados por el investigador y un observador independiente. Se realizó dermatoscopía y cirugía de todos los nevos. Resultados. En 74 pacientes, promedio de edad 32 años, con fototipo principal el II, se detectaron 83 nevos melanocíticos acrales. El patrón dermatoscópico más frecuente fue el paralelo del surco, y el patrón histológico fue el compuesto. La concordancia dermatoscópica fue excelente, calculada con el valor Kappa. Conclusión. Los patrones dermatoscópicos hallados en nuestro estudio coinciden con la literatura consultada.

Introduction.Nevus is defi ned as a circumscribed malformation, whichcan be dysembryoplastic or hereditary, temporary or permanent, of the teguments. Nevi are important given their well-known causal relationship with melanoma, a percentage of which results from preexisting melanocytic nevi. The refore, it is important to distinguish nevi which run the risk of undergoing a change. Dermoscopy is a non-invasive technique particularly useful to distinguish pigmented melanocytic lesions, which can be nevior melanomas, and pigmented non-melanocytic lesions. Volar skin exhib-its special dermoscopic features which produce particular images. Objectives. To describe the acral dermoscopic patterns, the frequency with which they occur and the dermoscopic and histopathologic correlation of nevi of the palms and soles, and to assess the dermatoscopic agreement between the investigator and an independent observer.Material and Methods. Observational, prospective, transverse and analytical study of patients with the clinical diagnosis of melanocytic nevi of the palms and soles. The study was conducted at Hospital Privado, in Córdoba, from May 2006 through April 2007. The variables to be studied were age, sex, personal history, phototype, location and dermoscopic and histologic patterns. All the patients were observed by the investigator as well as an independent observer, and dermoscopy and surgery were performed in all nevi. Results. 83 acral melanocytic nevi were detected in 74 patients with amean age of 32 and phototype II. The most frequent dermoscopic pat-tern was the parallel furrow pattern and the most frequent histologic pattern was the compound one. The dermoscopic agreement, calculated with Kappa values, was excellent. Conclusion.The dermoscopic patterns found in our study is consistedwith the literature reviewed.

A Case of Basal Cell Nevus Syndrome with Symmetric Basal Cell Carcinomas on Neck

Basal cell nevus syndrome is an autosomal dominant disorder characterized by developmental and skeletal anomalies, palmo-plantar pits, odontogenic keratocysts, ectopic calcification, and occurrence of various types of tumors including basal cell carcinoma. Within our country, 9 cases at dentistry and 3 cases at dermatology were reported. The patient was a 66-year-old woman. Chief complaint was multiple dark brownish colored papules which were symmetrically distributed around the neck. Excision and biopsy were done under general anesthesia and the wound was healed without complication. Histological examination of the lesion revealed 'basal cell carcinoma'. During the evaluation of metastasis of basal cell carcinoma, at PNS CT we found odontogenic keratocyst on the left alveolar process of maxilla by accident. Physical examination revealed pits of the palm and sole. These are consistent with the major diagnostic criteria for basal cell nevus syndrome. Hereby we report one case of basal cell nevus syndrome.

A Case of Nevoid Basal Cell Carcinoma Syndrome with Multiple, Symmetrically Distributed Basal Cell Carcinomas / 대한피부과학회지

Nevoid basal cell carcinoma syndrome is a rare inherited disorder characterized by multiple cutaneous basal cell carcinoma, pits of the palms and soles, cysts of the jaws, and ectopic calcification of cranial membranes. The patient was a 66 year old female. She complained of multiple, symmetrically distributed black-colored papules on the both sides of the neck. On physical examination, multiple pits were detected in the palms and soles. The histopathologic findings of the papules showed variable shaped and sized tumor nests composed of basaloma cells. On PNS CT for search of metastasis of the cancer, odontogenic keratocyst was detected at the Lt. alveolar process of maxilla by accident. We diagnosed her nevoid basal cell carcinoma syndrome and the lesions on both sides of the neck were removed completely.

Clinical study of pigmemted Nevi on the palms,soles,and genitalia in Korean / 대한피부과학회지

BACKGROUND: There are reviews with regard to the treatment of pigmented nevi present on the palms, soles, and genitalia. One advocated that pigmented nevi on thesa locations should be prophylactically removed to avoid their tuture development into malignant melanoma, while the other believes that this is not practicable. OBJECTIVE: Our purpose was to determine the incidence rates and clinical characteristics and to discuss the management of pigrnented nevi, developed on these areas of the Korean men. METHOD: We examined 1,537 Korean men, between 19 and 21 rears old, to evaluate the pigmented nevi on their palms, soles, and genitalia. RESULTS: Atleast 1 pigmented nevus appeared in 314(20.4%) men on the palms, 189(12.3%) on the soles, and 117(7.6%) on the genitalia. The sizes(mean diameter) of nevi on genitalia, soles, and palms were 4.5mm, 3.1mm, and 2.3mm respectively. The color of the nevi was darkest on the penile shaft(4.3 point) and then glans penis(3.9 points), soles(3.2 points), palms(2.5 points) in decreasing orders of the points. Most of the nevi was consistent with type 1 by Levers clinical classification and their incidence were 357 on palms, 211 on soles, and 128 on genitalia. Among the 21 nevi of type 2, 13 nevi appeared on the soles, and noine of type 3 and type 5 were found. The distribution of the nevi on the palms was of a rather uniform and scattered pattern, whereas, on the soles, they were distinctly concentrated in the midfoot. Tkie nevi on the glans penis appeared larger and more irregular in outline than those on the penile shaft. CONCLUSION: The plantar nevi were larger, darker, and had greater incidence of elevated type compared with the palmar nevi. From this observation, particular attenticn should be paid to the presence of pigmented nevi on the soles.

A Case of PUVA Lentigo / 대한피부과학회지

Generalized distinct hyperpigrnented macules developed at 2. 7 years after starting photochemotherapy(psoralen and UVA) in a 66-year-old psoriatic male patient. The histopathologic feature of this macule was characterized as a lentiginous p roliferation. The significance and long term course of PUVA lentigo are still unknown. So, we will further monitor this patient continually for melanocytic dysplasias, including melanoma.