Hyperkeratotic flexural erythema responding to amoxicillin-clavulanic acid therapy: Report of four cases.

Hyperkeratotic eruptions in the flexures, especially in the inguinal region, often pose a diagnostic and therapeutic dilemma. Inguinal keratotic eruptions may be caused by various infections, inflammatory dermatoses, vesico-bullous dermatoses, nutrient deficiencies, medication allergies and other miscellaneous causes such as granular parakeratosis. We hereby report four patients who presented with idiopathic hyperkeratotic erythematous eruptions with a migratory nature involving the inguinal region and occasionally showing the histopathologic features of granular parakeratosis. All four patients showed a dramatic therapeutic response to amoxicillin-clavulanic acid combination. We suggest that 'granular parakeratosis' should be considered as a histopathologic feature rather than the diagnosis. We would prefer to label our cases as 'Hyperkeratotic Flexural Erythema'. We recommend that detailed study of skin microbiome may help identify a possible alteration in skin microbiome contributing to the pathogenesis. We briefly review strategies on characterising the skin microbiome and the latest knowledge surrounding how alterations to the skin microbial populations can contribute to some diseases.

A global consensus statement on ashy dermatosis, erythema dyschromicum perstans, lichen planus pigmentosus, idiopathic eruptive macular pigmentation, and Riehl's melanosis.

Ashy dermatosis (AD), lichen planus pigmentosus (LPP), erythema dyschromicum perstans (EDP), and idiopathic eruptive macular pigmentation are several acquired macular hyperpigmentation disorders of uncertain etiology described in literature. Most of the published studies on these disorders are not exactly comparable, as there are no clear definitions and different regions in the world describe similar conditions under different names. A consensus on the terminology of various morphologies of acquired macular pigmentation of uncertain etiology was a long-felt need. Several meetings of pigmentary disorders experts were held to address this problem. A consensus was reached after several meetings and collation of e-mailed questionnaire responses and e-mail communications among the authors of publications on the above conditions. This was achieved by a global consensus forum on AD, LPP, and EDP, established after the 22nd International Pigment Cell Conference held in Singapore in 2014. Thirty-nine experts representing 18 countries participated in the deliberations. The main focus of the deliberations was terminology of the conditions; as such, we present here the consensus statement of the forum and briefly review the available literature on the subject. We have not attempted to discuss treatment modalities in detail.

Macular pigmentation of uncertain aetiology revisited: two case reports and a proposed algorithm for clinical classification.

Ashy dermatosis, erythema dyschromicum perstans, lichen planus pigmentosus and idiopathic eruptive macular pigmentation are various types of acquired macular hyperpigmentation disorders of the skin described in literature. However, a global consensus on the definitions of these entities is lacking. We report two cases of acquired macular (hyper)pigmentation of uncertain aetiology diagnosed as ashy dermatosis and attempt to clarify the various confusing nosologies based on existing literature. We infer that acquired small and large macular pigmentation of uncertain aetiology should be considered separate from that associated with lichen planus. We also propose a diagnostic algorithm for patients with acquired macular hyperpigmentation.

Chromoblastomycosis in Kerala, India.

BACKGROUND: We are reporting 35 new cases of Chromoblastomycosis from Central Kerala. A majority of the cases from India are reported from the Sub Himalayan belt and South India. The disease scenario in India and abroad is briefly reviewed. AIMS: To study chromoblastomycosis in Central Kerala including the demographic and clinico- investigative profile. METHODS: This report is a retrospective record analysis of 35 cases of chromoblastomycosis who presented to the Dermatology Outpatient department of our tertiary center from January 2003 to July 2010 after obtaining Institutional Review Board approval. RESULTS: The disease was found to be more common among male agriculturists. The majority of cases were from the central districts of Kerala in and around the Western Ghats. The lower extremity (60%) was more affected with 40% of the subjects remembering a prior history of trauma. Sclerotic bodies were demonstrable in scrapings from black dots in 42.8%. The characteristic mixed mycotic granuloma was demonstrable in 77.1% of cases. The most common species isolated was Fonsecaea pedrosoi. CONCLUSIONS: Chromoblastomycosis is very common in Central Kerala. The disease mainly affects male agriculturists especially those employed in rubber plantations. The most common organism is F. pedrosoi.