Indirect immunofluorescence to demonstrate lichen planus specific antigen (LPSA) in lichen planus.

BACKGROUND: Current evidence suggests that lichen planus is an immunological disease. Cytotoxic CD8+ cells in the lesional epidermis recognize a unique antigen called lichen planus specific antigen. This antigen could be demonstrated by indirect immunofluorescence using the patient's serum and autologous lesional skin. AIM: To study indirect immunofluorescence pattern in lichen planus, among Indian patients. METHODS: Twenty-five consecutive patients with the clinical diagnosis of lichen planus were enrolled in the study. Direct immunofluorescence was done in all patients. Indirect immunofluorescence using lesional skin as substrate was done in all 25 patients and five patients with other dermatoses. RESULTS: A specific fluorescence pattern corresponding to the distribution of lichen planus specific antigen was observed in the stratum spinosum and granulosum in 22 (88%) patients. It was absent from other parts of the epidermis, dermis and in patients with other dermatoses. CONCLUSION: Indirect immunofluorescence is a useful adjuvant test in lichen planus, particularly in atypical cases.

Ichthyosis follicularis with alopecia and photophobia (IFAP) syndrome.

A 12-year-old boy born of a nonconsanguineous marriage presented with dry rough skin and photophobia since birth. His growth and developmental milestones were normal and there was no history of any neurological problem, hearing deficit or scarring around the hair follicles. Cutaneous examination revealed diffuse thinning of scalp hair with loss of eyebrows and eyelashes and a sandpapery texture of the skin all over the body, suggestive of ichthyosis follicularis with alopecia and photophobia syndrome.

Clinical profile of forefoot eczema: a study of 42 cases.

BACKGROUND: Forefoot eczema (FE) is characterized by dry fissured dermatitis of the plantar surface of the feet. AIM: To study the clinical profile of FE and the possible etiological factors. METHODS: Forty-two patients with FE were included in the study. A detailed history was recorded and examination done. Fungal scrapings and patch test with Indian Standard Series (ISS) were performed in all patients. RESULTS: The most common site affected was the plantar surface of the great toe in 16 (38.09%) patients. Hand involvement, with fissuring and soreness of the fingertips and palm, was seen in four patients (9.5%). Seven patients (16.6%) had a personal history of atopy whereas family history of atopy was present in six (14.2%). Seven patients (16.6%) reported aggravation of itching with plastic, rubber or leather footwear, and 13 (30.9%), with detergents and prolonged contact with water. Negative fungal scrapings in all patients ruled out a dermatophyte infection. Patch testing with ISS was performed in 19 patients and was positive in five. CONCLUSIONS: FE is a distinctive dermatosis of the second and third decade, predominantly in females, with a multifactorial etiology, possible factors being chronic irritation, atopy, footwear and seasonal influence.

Lichen amyloidosus: a study of clinical, histopathologic and immunofluorescence findings in 30 cases.

BACKGROUND: Lichen amyloidosus (LA) is a primary localized cutaneous amyloidosis characterized clinically by discrete hyperkeratotic hyperpigmented papules and histologically by deposition of amyloid material in previously normal skin without any evidence of visceral involvement. AIMS AND OBJECTIVES: The aim of this work was to study the etiology, clinical features, histopathology and direct immunofluorescence findings in LA. METHODS: A prospective study of 30 patients with clinical, histological and immunofluorescence findings suggestive of LA was undertaken. After a detailed history and clinical examination, two punch biopsies for histopathology and immunofluorescence were taken. RESULTS: Of the 30 patients, 19 (63.3%) were males and 11 (36.7%) were females with duration of LA ranging from 6-20 months. Pruritus was the presenting symptom in 27 (90%) patients. Shin was involved in 26 (86.7%) followed by arms in three (10%) and back in one (3.3%). Seventeen patients (56%) had used scrubs for more than 2 years. Histopathology, direct immunofluorescence and Congo red staining detected amyloid in all cases. CONCLUSIONS: LA commonly presents over the shins as pruritic discrete hyperpigmented papules. Familial predisposition and friction may have a pathogenic role. Histopathological examination is very useful in the detection of amyloid which may be supplemented with direct immunofluorescence and Congo red staining.

Co-existence of lepromatous leprosy and myasthenia gravis.

Various circulating autoantibodies are known to occur commonly in patients with lepromatous leprosy. However, the association with autoimmune diseases has rarely been reported. One such association of lepromatous leprosy with myasthenia gravis is being reported.

Ganglion cyst of the proximal tibiofibular joint causing foot drop-diagnostic problem of differentiating from neuritic leprosy.

A six-year old boy presented with pain around the knee joint and abnormal gait of one month duration. There was no history of hypopigmented anaesthetic patches, neuritis or family history of leprosy. Clinical examination revealed a localized cystic swelling of 1 x 1 cm in size in the region of left common peroneal nerve, with sensory loss on the lateral aspect of the left leg which was mistaken for a nerve abscess.

Extensive larva migrans.

Larva migrans is characterized by tortuous migratory lesions of the skin caused by larvae of nematodes. A 26-year-old fisherman presented to us with complaints of an itchy eruption on his back and arms of two months' duration. Clinical examination revealed multiple wavy serpentine tracts and fork like lesions with a raised absolute eosinophil count of 3800 cells/cmm. Biopsy was inconclusive. This case is reported to highlight the extensive involvement by larva migrans.

Minimal erythema response (MED) to solar simulated irradiation in normal Indian skin.

BACKGROUND: Phototesting is an essential tool in the investigation of photodermatoses. AIMS: The main aim was to study the cutaneous response to UVR in terms of minimal erythema dose (MED) to both UVA and UVB in normal Indian subjects with a solar simulator and to study the relationship of skin type to MED. METHODS: One hundred healthy volunteers not on any medication and without any history of photodermatoses were phototested using a solar simulator with whole spectrum irradiation (UVA, UVB and visible light) and only visible and UVA radiation. The tested areas were marked with gentian violet and readings were taken after 24 hrs. RESULTS: Of the 100 volunteers, 48% were males and 52% were females, with a mean age of 36.6 +/- 11.6 yrs. The most common skin type among Indians was type 5 (46%) followed by type 4 (41%). The mean MED for UVB was 61.5 +/- 17.25 J/cm2. The MED for UVA could not be determined as none of the patients showed any erythema after irradiation for 45 minutes. CONCLUSIONS: As the MED is found to be low in idiopathic acquired photodermatoses, the MED in the normal population could serve as a baseline data in the investigation.

Non-bullous variant of bullous pemphigoid: role of immunofluorescence in diagnosis.

An elderly lady presented with persistent and unexplained excoriated lesions on trunk and limbs of 4 years' duration. No vesicles or bullae ever developed during the course of the disease. Histopathology showed nonspecific dermatitis. The diagnosis of bullous pemphigoid was confirmed by immunofluorescence. The patient responded well to topical steroids and dapsone.

Hair loss in cancer chemotherapeutic patients.

The hair loss in 8 cancer patients aged between 18 and 60 years on chemotherapy was studied. All had diffuse moderate alopecia within 1 month of starting treatment. Of the 8, 3 had only telogen hairs and 3 had high dystrophic hair count. Both anagen and telogen effluvium are implicated.

Clinical study of cutaneous drug reactions in 80 patients.

Eighty patients (46 males, 34 females) with cutaneous drug eruption were studied. Maculopapular rash was the commonest reaction seen in 46 cases, others being purpuro in 7, acneiform in 6, SJS/ TEN in 5, FIDE in 5, EM in 3, exfoliative dermatitis in 2, AEGP in 2, pustular and eczematous reaction in one each. Majority of the patients were in 21-30 year age group, the youngest being 3 years and the oldest 76 years. The incriminated drugs were NSAIDS in 28, antipsychotics in 26, antibiotics in 24, antileprotics/antitubercular in 8, steroids in 5, antimitotics in 4 and cardiac drugs in 3 cases. Histopathological features were compatible with the clinical lesions in most of the cases. The commonest immunoreactant in direct immunofluorescence was C3 and fibrin.

Efficacy of antioxidants as an adjunct to photochemotherapy in vitiligo: a case study of 30 patients.

Low levels of antioxidant enzymes (catalase) have been demonstrated in the epidermis of vitiligo patients. Clinical trials with antioxidants as an adjunct to UVB phototherapy have shown encouraging results. The aim of this study was to determine the efficacy of oral antioxidants as an adjunct to photochemotherapy. Thirty patients of stable vitiligo, not on any treatment fort month were included in the study. Fifteen patients were treated with photochemotherapy alone and another 15 were treated with photochemotherapy and oral antiodixants (1 capsule od). Two index lesions were assessed in each patient, prior to treatment, 1 month and 3 months after treatment. Average area was calculated by Computer Aided Design. Patients were monitored for side effects to photochemotherapy and antioxidants. Percentage decrease in the area of index lesions was calculated after 3 months. No statistically significant difference was noted between the two regimes. No side effects specific to antioxidant therapy were observed. Antioxidants as an adjunct to photochemotherapy offer no distinct advantage and antioxidant therapy is free of adverse effects.

A fatal case of erythema necroticans.

Erythema nodosum leprosum (ENL) classically presents as tender, erythematous nodules over the face, arms and legs. Severe ENL can become vesicular or bullous and break-down and is termed erythema necroticans (Jopling & McDougall, 1996) and is treated with corticosteroids. The causes of death in a majority of leprosy patients are the same as in the general population, with the exception of renal damage in lepromatous leprosy. There is possible increased mortality from side-effects of antileprosy drugs, steroids, or other drugs used in reactions, from toxaemia in severe reactions, and from asphyxia due to glottic oedema (Jopling & McDougall, 1996). We report here a case of erythema necroticans, the cause of death being septicaemia, secondary to skin ulcers and urinary tract infection, precipitated by corticosteroids.

Evaluation and therapeutic outcome of palpable purpura.

Palpable purpura is the clinical hallmark of leukocytoclastic vasculitis. Its etiology can be varied but often is elusive. Henoch- Schonlein purpura (HSP) is a distinct subtype of hypersensitivity vasculitis of unknown cause occurring primarily in children. IgA deposits in vessels is thought to be diagnostic of HSP. This study is aimed to evaluate the etiology, clinical manifestations and therapeutic outcome in patients with palpable purpura and to assess the relevance of IgA deposits in these patients. Thirty-six patients with palpable purpura were evaluated by history and laboratory investigations including biopsy for histopathology and direct immunofluorescence . Twenty-four patients received treatment with dapsone, steroids or a combination. All patients were followed up at first and third month and then at 6 monthly intervals for a maximum of 2 years.