Paraneoplastic Addisonian pigmentation and acquired ichthyosis as presenting features of multiple myeloma

Black brown hyperpigmentation of the mucosae, sunexposed skin, palmar creases and frictional sites [Addisonian pigmentation] is characteristic of Addison disease. However, it can also occur as a paraneoplastic manifestation of tumours like bronchogenic carcinoma. Acquired ichthyosis starts later in life and can also be a paraneoplastic presentation.We report a unique combination of paraneoplastic Addisonian pigmentation and acquired ichthyosis as presenting features in a patient with undiagnosed multiple myeloma. To the best of our knowledge this combination of paraneoplastic dermatosis has not been documented before in multiple myeloma. It is concluded that the presence of more than one suspicious dermatosis may be an indicator of being paraneoplastic requiring necessary work-up

Late onset erythropoietic porphyria [gunther's disease]

Congenital erythropoietic porphyria [CEP] or Gunther's disease is inherited disorder of porphyrin heme synthetic pathway that usually presents early in life. A very rare form of this disease has its onset in later years of life, called late onset erythropoietic porphyria [late onset EP]. Fourteen cases of late onset EP have been reported to-date. We report another case of this rare entity in a 40 years old male with associated findings of haemolysis and thrombocytopenia

Comparison of clinical and sonographical findings of Achilles tendon involvement in newly diagnosed and established cases of psoriasis

To compare the clinical and sonographical findings of Achilles tendon involvement in newly diagnosed [disease duration <6 months] and established psoriatic patients [disease duration >5years]. This cross-sectional, comparative study was carried out in Departments of Dermatology and Radiology, Military Hospital, Rawalpindi, over a period of six months. 70 patients of psoriasis were divided into two groups comprising 35 patients in each. Group I patients were newly diagnosed cases while group II included the established psoriatic patients. All patients with clinical and histological evidence of psoriasis were included. Patients with history of osteoarthritis, rheumatoid arthritis or foot trauma were excluded. Detailed history and complete clinical examination was carried out as per pro forma. The condition was considered symptomatic when there was tendon swelling, pain, tenderness or functional impairment. Ultrasound of Achilles tendon was done, keeping patient in prone position by using Pro Sound SSD 5500 Toshiba ultrasonographic machine with high frequency probe [7.5MHz] to assess findings of Achilles tendon in psoriatic patients. Fibrillar tendon structures, tendon thickness, peritenon, and bursae were evaluated. On clinical assessment 1 [2.8%] patient in group I and 5 [14.3%] patients in group II had Achilles tendon involvement. On ultrasonographic assessment, 3 [8.5%] patients in group I and 15 [42.8%] patients in group II showed involvement of Achilles tendon [p <0.05]. Achilles tendon involvement occurs in significant number of patients with long standing psoriasis as compared to newly diagnosed cases. It also revealed that enthesitis progresses with the duration of disease

Miltefosine in treatment of old world cutaneous leishmaniasis in Pakistan

To evaluate the efficacy of miltefosine in the treatment of cutaneous leishmaniasis Uncontrolled, open label, quasi-experimental study Place and Duration of Study: The study was carried out in Military Hospital Rawalpindi and five other Army Hospitals from Jan 2006 to Aug 2006. This study was dome to investigate the efficacy of treatment of cutaneous leishmaniasis patients with oral miltefosine in doses of 2.5 mg/kg/day at 6 centers in Pakistan. The study was conducted among 90 hospitalized adult cutaneous leishmaniasis patients. All patients completed the full 28-days treatment course. The study revealed excellent response in 32[28.8%], good in 38[34.4%], fair in 17[15.3%] and poor in 3[2.7%] patients. Treatment-related adverse events were transient rise in ALT [95%], followed by myalgia [33%], arthralgia [15%], nausea vomiting [12%], bad oral taste [2%], testicular pain [4%], cough [2%], conjunctivitis [2%] and fever [1%]. All theses side effects were transient and settled on discontinuation of medication. Compliance was good The use of oral miltefosine in doses of 2.5 mg/kg/day is effective and well tolerated in old world cutaneous leishmaniasis

Depression in adult dermatology outpatients

To determine the frequency of depression in adult male dermatology outpatients. Cross-sectional study. Combined Military Hospital, Bahawalpur, from January to March 2007. A consecutive sample was screened for depression by using Urdu version of General Health Questionnaire-12 [GHQ-12]. The final diagnosis of depression was based on criteria of International Classification of Diseases-10. Out of the 114 adult males with dermatological disorders, 39 [34.11%] had depression. The frequency and percentage of depression in dermatological conditions was 6 [100%] in psychocutaneous disorders, 2 [66.6%] in urticaria, 3 [66.6%] in pruritis, 7 [57.5%] in acne vulgaris, 4 [50%] in psoriasis, 4 [44.4%] in vitiligo, 3 [37.5%] in melasma, 1 [33.3%] each in hyperhidrosis and alopecia areata, and 9 [20.4%] in eczema. It was not recorded in leprosy and chronic fungal infections. Depression was frequently in adult males with dermatological disorders especially psychocutaneous disorders, urticaria, pruritis, acne vulgaris and psoriasis. Depressive symptoms should be specifically explored even at busy dermatology outdoors for early recognition and timely appropriate psychiatric referral

clinical study of papular urticaria

To determine the clinical features and demographic profile of the patients having papular urticaria. A case-series. Dermatology Department of Combined Military Hospital, Abbottabad from January to December 2006. Individuals of all age groups and either gender either suspected of or having definite history of insect bite were included in the study. A specially-designed proforma was filled for each patient separately. The proforma included demographic features, information regarding clothing and sleeping habits, personal or family history of atopy and clinical patterns of the lesions. Computer programme SPSS 10 was used to manage and analyze the data. Out of 280 patients, 201 [71.8%] were children upto 12 years of age, 178 [63.6%] were males, 91[32.5%] had atopy, 194 [69.3%] were non-locals, 212 [75.7%] came from urban/pen-urban areas and 173 [61.8%] presented during May-August. Lesions were present over exposed parts of the body in 36 [12.9%], arranged in groups in 152 [54.3%] and were papular urticaria in 185 [66.1%] patients. Children, adult males, non-locals and those belonging to urban/peri-urban areas are more vulnerable to papular urticaria in a particular region. Papular and urticarial lesions arranged in groups over both exposed as well as covered body parts of a single patient is the most common clinical pattern

Narrow band ultraviolet - B radiation therapy in patients of vitiligo

To determine the efficacy of Narrow Band Ultra Violet B [NB-UVB] therapy to induce repigmentation in vitiligo patients with skin Fitzpatrick phototype IV. Descriptive study. Department of Dermatology, PNS Shifa Karachi, from April 2004 to October 2005. Thirty-five patients were included in the study during a period of eighteen months starting from 23rd April 2004. Each patient had thrice weekly exposure to NB-UVB therapy on nonconsecutive days for a maximum period of one year. Results were evaluated clinically and by comparing digital photographs taken before, during and at the completion of treatment. Improvement was objectively assessed by grading it into four groups depending on percentage of re-pigmentation in the affected areas. Out of the 35 patients, two dropped out and 33 completed the course of therapy successfully. The extent of vitiligo varied from 5% to 40% of body surface area. At the end of one year 9 [27.3%] patients had grade 4 recovery [> 75% repigmentation], 15 [45.4%] had grade 3 recovery [50-75% repigmentation] and the rest had grade 2 recovery [25-50% repigmentation]. No significant side effects were observed during the study period. Narrow-band UVB is a safe and effective treatment option for patients with Vitiligo

Localized lesions in secondary syphilis

The clinical manifestations of secondary syphilis are variable and can mimic many skin diseases, mostly being generalized and symmetrical in distribution. Localized lesions of secondary syphilis are rarely seen in dermatology clinics. We report an unusual presentation wherein a patient had localized lesions over face and soles only. There is a need for increased awareness on the part of physicians to recognize new patterns of syphilitic infection, together with a willingness to consider the diagnosis of syphilis in patients with unusual clinical features

Role of calcium supplement and exercise in management of women having Osteopenia and Osteoporosis

To measure the effects of calcium supplements and exercise on bone mineral density in women between 35-70 years. Quasi experimental study. The study was conducted in the department of gynecology Combined Military Hospital Abbotabad, from July 2004 to June 2006. Based upon bone mineral densities T score 39 patients were assigned to group A [osteopenic] and 20 patients to group B [osteoprotic]. Both groups were subdivided into I and II groups. The cases in group-IA and group-IIA were given calcium Ossonate 800 mg in two divided doses. Whereas, the cases in group-IB and group-IIB were advised to take dietary calcium in the form of two glasses milk [300 mg calcium/glass] and one hour brisk walk daily. Better improvement in bone mass density was noted in group I-B patients as compared to other groups. In osteopenia a combination of dietary supplementation and brisk walk is beneficial in maintaining or improving bone mineral density. In osteoporosis, the more severe form of the disease, simple calcium supplements or dietary calcium supplementation with exercise are not helpful

Simultaneous onset of herpes zoster in a father and son

The Varicella Zoster virus persists in sensory nerve ganglion cells after chicken pox and gets reactivated to cause herpes zoster after variable periods of time as a result of waning of specific cellular immunity. Susceptible contacts of herpes zoster can develop chicken pox and very rarely herpes zoster. We report an interesting case of a father and his son who developed herpes zoster simultaneously without any obvious common predisposition and discuss the possible underlying mechanism

Exuberant ulcerated lesions of secondary syphilis on the palms - an unusual presentation

Ulcerated lesions in secondary syphilis are rare. Exuberant tissue is seen in condylomas of syphilis, which occur in flexural and occluded areas of the body and not in open areas such as palms. We report a case of secondary syphilis that presented with ulcerated exuberant lesions on palms, which on initial examination gave an impression of lesions of Orf and Milker's Nodule

Cutaneous pseudolymphoma due to topical application of 4% hydroquinone cream for melasma

Cutaneous pseudolymphoma is an aggregate of mature or abnormal looking lymphocytes in the dermis, which clinically and /or histologically simulates lymphoma but has a benign course and outcome. Systemic drugs, especially anti-epileptics, are an important cause of cutaneous pseudolymphomas. Pseudolymphoma of the skin, secondary to topical drug application, is very rare. We report a case of cutaneous pseudolymphoma induced by local application of 4% hydroquinone cream to melasma over the cheeks

Reticulated multifocal fixed drug eruption due to mefenamic acid - a new morphological pattern

Fixed drug eruption is a heterogeneous pattern of cutaneous reaction to certain drugs. Different morphological patterns of fixed drug eruption can occur. We describe a new morphology of fixed drug eruption showing a reticulated pattern as a result of ingestion of mefenamic acid and discuss the possible mechanism underlying such an appearance

Mastocytoses

Mastocytoses are an important group of dermatoses characterized by histological infiltrates predominantly rich in mast cells. The present review focuses on the salient clinical, diagnostic and therapeutic features of different entities included in this group

Cutis marmorata telangiectatica congenita

A case of cutis marmorata telangiectatica congenita [CMTC] is reported. A young girl had an unusual presentation with sclerosis in the skin lesions, senile features, hypoplasia of the mandible, transverse nail dystrophy, and transverse toe defects resembling Adams-Oliver syndrome. These associated abnormalities are very rare and some have not been documented before with CMTC. The possible relationship of CMTC with Adams-Oliver syndrome is also discussed

Histiocytoses

Histiocytoses are an important group of dermatoses characterized by histological infiltrates predominantly rich in cells of monocyte-macrophage origin. The present review focuses on the salient clinical, diagnostic and therapeutic features of different entities included in this group

Comparison of various diagnostic modalities in tinea pedis

To compare the accuracy of various wet mounts in relationship to culture positivity of Tinea Pedis. Design: A cross sectional study of 151 clinically suspected cases of tinea pedis. Place and Duration of Study: The study was conducted at the department of dermatology, PNS Shifa hospital, Karachi, from April 1999 to February 2000. Subjects and Skin scrapings were obtained from the affected areas and divided into six equal parts. The five parts were subjected to wet mounts for direct microscopy, the sixth part to culture on Sabouraud's medium. The results were recorded according to a simple protocol and subjected to biostatistical evaluation. The comparative biostatistical diagnostic yield of these wet mounts in relation to culture positivity rate, in terms of their accuracy were: 39% [10% potassium hydroxide mount], 40.3% [potassium hydroxide/dimethyl sulphoxide mount], 27.1% [potassium hydroxide/Parker's ink mount], 35.7% [potassium hydroxide/methylene blue mount] and 60.9% [potassium hydroxide/lactophenol cotton blue mount]. The traditional use of 10-20% KOH mounts, as an initial step in the diagnosis, should be abandoned because of the low diagnostic yield and be replaced by a mixture of KOH/lactophenol cotton blue mounts for the maximum diagnostic yield