Treatment of actinomycetoma foot--our experience with ten patients.

BACKGROUND: Mycetoma is a chronic granulomatous inflammation of the subcutaneous tissue and usually results due to traumatic implantation of soil organisms. Mycetoma can be eumycotic or acinomycotic in origin. Actinomycetoma is susceptible to a large number of chemotherapeutic agents, but the response is variable and affected by various factors such as extent of involvement, duration of disease, presence or absence of bony involvement and drugs used for treatment. AIMS AND OBJECTIVES: To describe our experience of various treatment regimens used for actinomycetoma. MATERIAL AND METHODS: It was a prospective, open label study of actinomycetoma. Ten patients who were diagnosed clinically as mycetoma were included in this study. All patients were completely evaluated and investigated including skin biopsy, Gram staining of grains and discharge, Ziehl-Nielson stain, KOH preparation, fungal and bacterial cultures and CT scan/Magnetic resonance imaging (MRI), if required. Patients were treated with different treatment regimens, for example, Ramam regimen, modified Ramam regimen, Welsh regimen and its modification. RESULTS: Ten patients (eight males, two females) age ranging from 9 to 55 years (mean 29.6 years) were included in this study. Six patients were successfully treated with Ramam regimen, three patients were treated with our modified Welsh regimen (one of these three patients (case 7) initially failed to respond to Ramam regimen), and one patient was treated with modified Ramam regimen. CONCLUSION: Ramam regimen was found to be quite effective in treating patients of actinomycetoma with only minimal bony involvement, while Welsh regimen and its modification should be used in case of severe disease due to amikacin being more sensitive than gentamicin in treating resistant organisms. Intensive phase of Modified Welsh regimen can be extended to five cycles in case of extensive bony involvement.

Contact vitiligo: etiology and treatment.

Fifty patients of contact vitiligo were studied. Etiological agents of contact vitiligo were identified by clinical history, distribution of lesions and patch testing with suspected material. All patients were advised to avoid the suspected agent and treated with PUVASOL and topical steroid. Out of 50 patients (Male 8%, Female 92% age 14-60 years)., etiological agent of contact vitiligo was found to be sticking bindi alone in 24 (48%), while bindi along with other etiological agents were found to be purse, foot wear, plastic watch strap, lipstick and tooth paste in 14 (28%) cases. 14 (28%) patients also had disseminated lesions of vitiligo along with contact vitiligo. Positive reaction with patch testing was observed in 18 (36%) while depigmentation was seen in 4 (8%) cases. We observed that response of treatment was better in patients with shorter duration of disease while poor response was seen in patients with longer duration of disease.

Angiokeratoma of tongue.

An 8-year-old male child who presented with lesions of angiokeratoma on tongue is described.

Silicone gel sheet dressings for prevention of post-minigraft cobblestoning in vitiligo.

Punch grafting was performed in 15 patients using punches varying in size from 2 to 3 mm in diameter. Silicone gel sheets were used as a post-operative dressing. Removal of the dressings after 7 days revealed no lifting of grafts in 13 patients. A minimally raised surface seen in two patients flattened after 6 to 8 weeks of continuous use of the dressing. At two months of follow-up, no cobblestoning or any other untoward effect was evident. Firm pressure provided by silicone gel sheets probably prevents cobblestoning by counteracting forces which tend to lift the grafts. Additionally, the sheets act as a brace preventing graft dislocation, provide a sterile atmosphere underneath the grafts, facilitate periodic observation due to their transparency, and are easily removed at the time of follow-up.

Malignant acanthosis nigricans in a 2 year old child with Wilm's Tumour.

Case report of a 2-year-old male child who developed acanthosis nigricans lesions of sudden onset and rapid spread is described. The child was diagnosed as having Wilm's tumour and the lesions of acanthosis nigricans subsided with resection of the tumour.

Congenital familial acral vitiligo.

A 22-year-old female presented with vitiliginous lesions on her hands and feet since birth. Similar lesions at similar sites were present in 4 other family members. The trait appeared to have autosomal dominant inheritance with variable penetrance.

Severe bullous fixed drug eruption due to metronidazole mimicking a localized form of toxic epidermal necrolysis.

A 55-year-old diabetic male who had severe bullous fixed drug eruption mimicking a localized form of toxic epidermal necrolysis 8 hours after taking metronidazole is presented.

Continual skin peeling syndrome.

Two cases of continual skin peeling syndrome (CSPS) are presented.

Acrochordon, diabetes and associations.

A study of clinical profile of acrochordons was carried out in 100 patients. Their association with diabetes mellitus and other disorders was studied. Acrochordons were found to be closely associated with pseudo-acanthosis nigricans, seborrhoeic keratosis, obesity and non-insulin dependent diabetes mellitus.

Naevus comedonicus associated with epidermoid cyst.

Naevus comedonicus associated with epidermoid cyst is a rare association. Two such case reports are presented.

Hypopigmented lesions in early leprosy--a clinical and histological study.

26 Patients of leprosy presenting with hypopigmented lesions were divided on morphological grounds into 3 Sub groups, Group I (9 patients) with well-defined single patch with moderate to complete sensory loss; Group II (8 patients) with single ill-defined lesion having partial sensory loss; and Group III (9 patients) having multiple hypo-pigmented patches with mild to moderate sensory loss. Epidermal atrophy was a conspicuous histological finding in all groups. Only patients in Group I showed epitheloid cells in dermal infiltrate with erosion of epidermis in one case. This group may be labelled as maculoanesthetic leprosy. Patients in Group II and III showed mononuclear cell infiltrate in dermis, around neurovascular bundles and appendages. They were histologically consistent with indeterminate leprosy. Follow-up biopsy after six to eight months of treatment showed healing of the lesion of reduction in the infiltrate in most cases.

Summer Variant of Autosmal Dominant Ichthyosis Vulgaris.

Eleven cases of mild autosomal dominant ichthyosis vulgaris (ADIV) were seen who presented with asymptomatic, brownish-black hyper keratotic lesions' over the flexure surfaces of wrists, dorsum of hands, knees and ankles for 1-2 months during peak summer months. The lesions disappeared with the onset of monsoon. All these cases had typical lesions of ADIV during winter months. This paradoxical phenomenon of ichthyosis alternating with hyperkeratotic pigmented lesions in the same individual during different seasons remains unexplained. Treatment with 20% urea cream and oral vitamin A had no effect on the course of the disease.

Ultrastructural study of epidermal Langherhans cells in leprosy.

ATPase staining and ultrastructural study of skin biopsies from six patients of leprosy (2TT, 4LL) and three normal subjects was carried out to study Langherhans Cells (LC). ATPase staining showed normal counts of LCs in tuberculoid patients, while significant reduction was observed in lepromatous cases. Electron microscopy revealed morphological changes in LL cases in the form of dense matrix and indistinct cristae of mitochondria; decreased number of lysosomes and rough endoplasmic reticulum; and numerous vacuoles in cytoplasm. TT cases showed normal morphology. Possible role of Langerhans Cells in pathogenesis of leprosy is discussed.