A rare presentation of pseudoepitheliomatous keratotic and micaceous balanitis with malignant transformation.

Pseudoepitheliomatous keratotic and micaceous balanitis (PKMB) is a rare nonvenereal penile condition with a risk of malignant transformation. We report a case of PKMB in a 45-year-old male who presented with multiple keratotic growths over his glans penis after circumcision for long-standing phimosis. Histopathology revealed pseudoepitheliomatous hyperplasia and atypical cells. He was successfully treated with wide local excision.

A clinical and mycological study of dermatophytic infections.

BACKGROUND: Dermatophytoses refer to superficial fungal infection of keratinized tissues caused by keratinophilic dermatophytes. According to observations worldwide, dermatophytoses are the most common of the superficial fungal infections. It is common in tropics and may present in epidemic proportions in areas with high rates of humidity. Although common, the precise size of the problem defies measurement. AIMS: The present study was undertaken to assess the clinical profile of dermatophytic infection and to identify the species of fungi that are prevalent in this region. MATERIALS AND METHODS: A total of 100 patients clinically suspected for dermatophytoses were selected for the study. Direct microscopy in 10% potassium hydroxide (KOH) and culture was done in each case. RESULTS: Out of 100 patients, the maximum were seen in the age groups of 16-30 years. Tinea corporis was the most common clinical type (44.3%) followed by tinea cruris (38.2%). Overall positivity by culture was 39% and by direct microscopy 96%. CONCLUSION: Trichophyton rubrum was the predominant species isolated (67.5%) in all clinical types followed by Trichophyton mentagrophytes. Culturing the fungus may identify the species, but it is not essential for the diagnosis as it is not a sensitive test.

Safety and efficacy of low-dose isotretinoin in the treatment of moderate to severe acne vulgaris.

BACKGROUND: Isotretinoin is indicated for moderate to severe cases of acne which are unresponsive to conventional therapy. The classical recommended dose is 0.5 to 1.0 mg/kg/day. As the side effects are dose related, low-dose isotretinoin therapy for acne is an attractive option; however, but little data exists on the safety and efficacy of this strategy. MATERIALS AND METHODS: In this prospective, non-comparative study, 50 participants, both male and female, having moderate to severe acne vulgaris were enrolled and treated with isotretinoin at a dose of 20 mg/day (approximately 0.3-0.4 mg/kg/day), for a period of 3 months. Participants were evaluated by means of clinical and laboratory investigations before starting isotretinoin. Investigations were repeated at the end of the first and third months following completion of treatment, and participants were followed up for 6 months to look for any relapse. RESULTS: At the end of the treatment, very good results were observed in 90% of participants. Cheilitis was the most common among the side effects observed and was seen in 98% of the participants. One participant developed vitiligo as a side effect, which is a new finding, and has not reported in literature before. Elevated serum lipid levels were observed in 6% of the participants, and relapse occurred in 4% of the participants over a 6 month follow up period. CONCLUSION: Three months of treatment with low-dose isotretinoin (20 mg/day) was found to be effective in the treatment of moderate to severe acne vulgaris, with a low incidence of serious side effects. This dose also was more economical than the higher doses.

The clinical spectrum and antibiotic sensitivity patterns of staphylococcal pyodermas in the community and hospital.

CONTEXT: The uncontrolled use of antibiotics has resulted in a relentless spread of multiresistant strains of Staphylococcus aureus. There are studies conducted in medical colleges in Chandigarh, Chennai, Mumbai and Vellore comparing pyodermas in the community and hospital setting based on clinical and bacteriological parameters. AIMS: This study, conducted over 1½ years from March 2009 to August 2010, aimed at analyzing the clinical spectrum and antibiotic sensitivity pattern of community and hospital-associated (HA) staphylococcal pyoderma. It also assessed the prevalence of methicillin-resistant S. aureus (MRSA) in the community and hospital cohort settings. SUBJECTS AND METHODS: The study comprised of 200 cases of staphylococcal pyodermas, derived from the community (150 cases) and hospital (50 cases). Patients were evaluated based on their clinical presentation; antibiotic susceptibility was tested using the Kirby-Bauer disk diffusion method. STATISTICAL ANALYSIS USED: Statistical significance between individual attributes between the community and HA staphylococcal pyoderma groups was analyzed using Chi-square test and mean differences using student's t-test. RESULTS: Factors associated with community-associated (CA) pyodermas were young age (P = 0.0021), primary pyodermas, and involvement of extremities, while those with HA pyodermas were middle age, secondary pyodermas, and significantly increased body surface involvement (P = 0.041). Incidence of CA-MRSA was 11.3%, while that of HA-MRSA was 18%. CONCLUSIONS: A high level of resistance to first-line drugs such as penicillin, ciprofloxacin and cotrimoxazole was observed, more so in the hospital strain than in the community strain. S. aureus demonstrated good susceptibility to cephalosporins. Though the two strains of MRSA differed clinically, they showed 100% sensitivity to vancomycin and linezolid.

Clinico-etiological study of 30 erythroderma cases from tertiary center in South India.

BACKGROUND: Erythroderma is a morphological reaction pattern of skin having many underlying causes and finding the etiology helps in the proper management of erythroderma cases. AIM: To evaluate the clinical profile, etiology of erythroderma and to correlate clinical diagnosis with histopathology. MATERIALS AND METHODS: This study was performed at the department of dermatology, Father Muller Medical College and Hospital, Mangalore, South India. We studied 30 consecutive cases of erythroderma with respect to the epidemiological, clinical and histological data. Clinico-histological correlation was analyzed for etiology of erythroderma. RESULTS: The mean age of onset was 52.3 years with a male to female ratio of 14:1. In addition to erythroderma, other co-existent features included pruritus, fever, lymphadenopathy, and edema. Of the pre-existing dermatoses, psoriasis was the most common (33.3%) disease followed by eczema (20%), atopic dermatitis (6.6%), pityriasis rubra pilaris (3.3%) and drug-induced erythroderma (16.6%). In 16.6% of cases, etiology could not be ascertained. Clinico-histopathological correlation could be established in 73.3% of cases. CONCLUSION: Clinical features were identical irrespective of etiology. Detailed clinico-histopathological examination helps to establish the etiology of erythroderma.

Multiple nodules on the face and trunk in metastatic adenocarcinoma of unknown primary origin.

Metastatic cancer of unknown primary (CUP) may unexpectedly manifest on the skin and subcutaneous tissue, prompting the patient to first visit a dermatologist. We describe an interesting case of cutaneous metastases from poorly differentiated adenocarcinoma of an unknown primary site in a 57-year-old man. The CUP had an unusually long period of indolence between presentation as a solitary axillary lymph node metastasis and rapid cutaneous dissemination. The possible causes of such a presentation are reviewed, and the management is briefly discussed. Diagnosis of unusual cutaneous manifestations of occult systemic malignancies could pose a diagnostic challenge to dermatologists.

Mucocutaneous manifestations of chikungunya Fever: a study from an epidemic in coastal karnataka.

BACKGROUND: Chikungunya fever (CF) epidemic has recently re-emerged in India affecting large population. Mucocutaneous manifestations are an important clinical feature of the disease. We have reviewed mucocutaneous manifestations of the disease during a recent epidemic in coastal Karnataka. PATIENTS AND METHODS: Seventy-five "suspect cases" of CF with dermatological manifestations were examined. RESULTS: WE CATEGORIZED THE MUCOCUTANEOUS MANIFESTATION INTO SIX GROUPS: 1. skin rash, 2. apthae like ulcers, 3. pigmentary changes, 4. desquamation, 5. exacerbation of the existing dermatoses, 6. miscellaneous. Skin rashes were the most commonly observed skin changes followed by apthae like ulcers and pigmentary changes. Desquamation of the skin over the face is a new manifestation observed by us. CONCLUSION: wide spectrum of mucocutaneous manifestations is observed in CF. We have provided a classification for these manifestations, which may help in better recognition and uniform recording in future.

Pyoderma gangrenosum: an Indian perspective.

BACKGROUND: Pyoderma gangrenosum (PG) is an uncommon, idiopathic, neutrophilic skin disease sometimes associated with systemic diseases. To our knowledge, there have been no case series of PG reported from India. AIM: To study the clinical features, associated systemic diseases and treatment methods in our case series. METHODS: In total, 18 cases of PG diagnosed at our institution in Mangalore were evaluated in a prospective study. RESULTS: Ulcerative PG was the most common variant, seen in all except one case. Paediatric patients constituted less than a quarter (27.77%) of the patients. Systemic diseases were associated with the disease in over half of the patients (55.55%). The pathergy test was positive in seven patients (38.88%), and all but one had associated systemic disease. Corticosteroids were mainly used for management. CONCLUSIONS: PG is a rare disease in India, but paediatric PG cases were relatively common. Ulcerative PG was the commonest type, and over half of the patients had associated systemic diseases. There were a significant number of patients with associated systemic disease who had a positive pathergy test.

Leprosy scenario in southern part of Dakshina Kannada district, Karnataka, after 16 years of control work.

This article examines the changes that occurred in epidemiological indices over a period of 16 years following the introduction of MDT in Ullal town, south of Mangalore city, having a population of 130,000. The analysis indicates that new case-detection rates and prevalence rates showed a declining trend due to shorter duration of treatment with MDT. There was a ten-fold reduction in the prevalence rate during the first 6 years, from 23 in 1987 (230 cases) to 2.76 per 10,000 (29 cases) at the end of 16 years. The number of nmultibacillary cases among the newly detected cases showed a downtrend (from 28 cases in 1987 to 5 in 2001). The number of newly detected cases presenting with single lesion also showed a declining trend.

Giant lesions in histoid leprosy--an unusual presentation.

A forty-year-old man presented with multiple, asymptomatic, raised lesions of one-year duration. Well-defined, non-tender papules and nodules were seen on the normal looking skin. Few giant lesions were seen over the lower legs and feet. Diffuse infiltration of the face and ears was present. Bilateral ulnar, radial cutaneous, sural and right superficial peroneal nerves were thickened. Slit-skin smear from a nodule had a BI of 6+. Biopsy showed features of histoid leprosy. The lesions had developed de novo, without previous dapsone monotherapy.

A clinical study of vitiligo.

A clinical study of one hundred patients having vitiligo revealed the incidence among new patients to be 1.84%. The male/female ratio was 1:1.22. Family history of vitiligo was available in 8% of our patients. The different morphological pattern consisted of vitiligo vulgaris (39 cases), focal vitiligo (27 cases), acrofacial vitiligo (18 cases), lip-tip vitiligo (7 cases), lip vitiligo (5 cases), segmental vitiligo (3 cases) and universal vitiligo (1 case). Associated diseases include atopic dermatitis (2 cases), Hansen's disease (2 cases), alopecia areata (1 case), halo naevus (1 case), chronic urticaria (1 case), lichen planus (1 case), diabetes mellitus (9 cases), hypertension (4 cases), hypothyroidism (2 cases), epilepsy (1 case) and IHD (1 case).