Case Report Of Mucha-Habermann Disease

Pityriasis lichenoides et varioliformis acuta (PLEVA), also known as a Mucha-Habermann disease, is an uncommon, idiopathic, and acquired dermatosis. The disease is characterized by erythematous, scaly, papules, and polymorphic lesions which often progresses to hemorrhagic necrosis and heals with varioliform scarring. A febrile ulceronecrotic variant of PLEVA, also termed pityriasis lichenoides (PL) with ulceronecrosis and hyperthermia (PLUH) or febrile ulceronecrotic Mucha-Habermann disease (FUMHD), is a severe variant of PLEVA. The disease is characterized by the acute onset of large, more destructive, coalescent papules, leading to ulceronecrotic skin lesions associated with high fever and other systemic symptoms. In spite of the presence of multiple treatment modalities with variable success rate, the disease has poor prognosis. Here, we report the case of a 17-year-old male patient who presented with typical features of FUMHD and responded well to systemic administration of corticosteroid therapy.

Knowledge and Awareness Regarding Leprosy and its Treatment Among Leprosy Patients in a Tertiary Care Hospital

Background: Study was conducted to assess awareness of leprosy and its treatment among leprosy patients presenting at a tertiary care hospital in Lucknow (UP), India. Methods: The study was conducted by a qualified interviewer using a 12-point self-prepared questionnaire on 78 leprosy patients turning up at the Dermatology Out-Patient Department of  I.I.M.S & R and Hospital in Lucknow (UP) from January 2015 to June 2016. Results: Around 73% patients had heard about leprosy, while remaining 27% patients were either unaware or not sure. About 33% of the total 78 patients thought leprosy to be a type of infection, 21.7% said it was due to bad blood, 20.5% said it was exclusively a skin disease, 10% attributed it to supernatural phenomenon and rest of the 14%  patients were unsure about its cause. Nearly 43.5% patients believed that they got the disease by coming in direct contact with some infected individual and 25.6% patients believed it to be as a result of some alteration in the blood. About 56.4% patients believed that leprosy was a communicable disease. Only 30.7% patients were confident that leprosy was curable. Approximately 72% patients knew one or more sign/symptom of leprosy. Only 23% patients were well aware of multidrug therapy (MDT) for leprosy while even a further lower percentage had knowledge of its free availability at government hospitals or centres. More than 90% patients did not know about the duration of treatment. Only about 27% patients believed that allopathic medications would be best for curing leprosy while remaining 63% patients were either not sure or believed that alternate medicine (unani, homeopathy or auyurveda) could cure leprosy better. Literacy influenced the answer for many of the questions although in few areas it had less or no effect at all. Conclusion: Awareness of leprosy is still not adequate among the masses. Further steps are needed to ensure that basic knowledge of leprosy, its signs & symptoms, MDT and its availability is conveyed more to the general population by educating them at the grass root level through various literacy programme and other innovative ideas.

Exfoliative Dermatitis: A Clinico-etiological Study

Background: Exfoliative dermatitis or erythroderma is a symptom complex characterized by universal desquamation and erythema of the skin in response to various internal or external, known or unknown factors. Largely it is a secondary process and therefore it is mandatory to establish its etiopathology to facilitate the precise management. We attempted to establish the different causes of exfoliative dermatitis. Methods: We reviewed the clinical, laboratory and histopathological findings of 50 patients diagnosed with exfoliative dermatitis. Results: The frequency of exfoliative dermatitis was found to be 0.1 percent. The male-female ratio was 2.5:1 and majority of patients were in their 5th & 6th decade of life (mean age at diagnosis being 45.2 years). The total duration of disease ranged from 2 months to 1 year. The common causative factors were preexisting dermatomes (64%), followed by idiopathic (18%), drug induced (16%) and malignancy (2%). The most common dermatoses were psoriasis (24%) and eczema (24%). Carbamazepine (6%) and antitubercular drugs (6%) were the most frequent drugs which induced exfoliative dermatitis. Apart from scaling with erythema, pruritus and thickening of skin were found in all patients. Anemia was the most common finding (90%), followed by fever (42%), lymphadenopathy (38%) and edema (32%). The best Clinicopathological correlation was found in psoriasis and pemphigus foliaceous. Conclusions: This study outlined that the underlying etiologic factors of exfoliative dermatitis may show geographic variations. In this study preexisting dermatoses was most common cause of exfoliative dermatitis followed by idiopathic causes. Clinical features were identical irrespective of the etiology.

Phototherapy as an effective treatment for Majocchi's disease - Case report

Pigmented purpuric dermatoses are chronic and relapsing disorders characterized by a symmetrical rash of petechial and pigmentary macules, mainly confined to the lower limbs. Purpura annularis telangiectodes of Majocchi is a less common variant of Pigmented purpuric dermatoses characterized by punctate telangiectatic macules progressing to annular, hyperpigmented patches with central clearing and infrequent atrophy. A 12 year-old girl presented with asymptomatic round to oval reddish brown macules, present symmetrically over her lower and upper limbs for 3 years. Few lesions were annular in shape. Biopsy from the lesion was compatible with Pigmented purpuric dermatoses. On the basis of clinical and histopathological findings, a diagnosis of Purpura annularis telangiectodes of Majocchi was made. The patient began phototherapy thrice a week and showed excellent response.

Atypical varicella zoster as SJS-TEN overlap syndrome with involvement of palm and sole.

A 14-month-old boy presented with generalised vesicular eruption involving the face, trunk and extremities accompanied by high grade fever. He had associated redness and purulent discharge from both eyes. Examination revealed erosions on the tongue, soft palate and genitalia with haemorrhagic crusts on the lips and nasal orifices. All laboratory investigations were within normal limits except leucocytosis. Chest x-ray showed left middle zone pneumonitis. Treatment was by paracetamol, antibiotics and oral acyclovir. Desquamation started from the eighth day. Our purpose in reporting this case is to highlight the fact that varicella can be atypical with distal involvement and can present as SJS-TEN overlap syndrome.

Comparison of direct immunofluorescence and ELISA for the detection of Chlamydia trachomatis antigen in the patients of pelvic inflammatory disease.

Fifty female patients clinically diagnosed as pelvic inflammatory disease (PID) attending Gynaecology OPD of Smt. Sucheta Kriplani Hospital were studied for the presence of Chlamydial antigen by direct immunofluorescence (DFA) and Enzyme linked immunosorbant assay (ELISA) test. Out of fifty PID patients Chlamydia tracchomatis lipopolysaccharide antigen could be detected in 28% of cases by ELISA and Chlamydial outer membrane protein antigen could be detected in 32% of cases by DFA. Although in the present study DFA and ELISA compare well with each other, but DFA has been found to be more specific test as it detects outer membrane protein antigen of Chlamydia trachomatis.