Dermatofibrosarcoma protuberans in a patient with alopecia areata univerisalis

Dermatofibrosarcoma protuberans [DFSP] is an uncommon locally infiltrative, low grade soft tissue sarcoma. Alopecia areata universalis is a severe form of non-scarring alopecia involving the whole body. We are reporting a rare case where both of these occured in the same patient

Mangement of neuropathic pain

Neuropathic pain is a condition in which pain persists even after the removal of the noxious stimulus. The common etiologies are diabetic polyneuropathy, post-herpetic neuralgia, radiculopathy, cancer pain and HIV neuropathy. The management of neuropathic pain starts with the history and physical examination. This helps in differentiating between nociceptive and neuropathic pain. Electromyography and Nerve Conduction [EMG-NC] studies are also used to establish the etiology. The management differs between localized and generalized etiologies. Localized pain such as post-herpetic neuralgia can be treated with topical lidocaine whereas the generalized neuropathic pain in diabetic polyneuropathy requires systemic drugs. Pharmacological therapy involves medications such as antidepressants, antiepileptics and opioids. Nonpharmacological therapy involves use of physiotherapy, Transcutaneous Electrical Nerve Stimulation [TENS] and psychological therapy. Patients who do not respond to these measures are referred to specialized pain clinics. Pain interventionists use nerve blocks, epidural blocks and spinal cord stimulation to decrease pain intensity. Neuropathic pain is a complex problem presenting to family practice and established algorithms will help in accurate diagnosis and effective management. This will also help in establishing an effective referral system to the pain clinics

Post polio syndrome: Case report and review of literature

Post-polio syndrome is a constellation of symptoms, such as generalized fatigue, muscle pain and respiratory insufficiency, which occur many years after the acute episode of poliomyelitis. This syndrome is believed to occur primarily because of overburdened motor units which lead to metabolic stress. Diagnosis is essentially clinical. In managing patients with post-polio syndrome, a multi-disciplinary approach needs to be adopted. The role of non-fatiguing exercises in improving the strength of the muscles and alleviating pain without damaging motor units has been supported by a number of studies. Other salient features of management include weight loss, use of supportive devices at joints and using positive pressure ventilation for those with respiratory insufficiency