Confluent and Reticulate Papillomatosis: A Retrospective Study from southern India.

BACKGROUND: Confluent and reticulate papillomatosis (CRP) is an uncommon benign, acquired keratinization disorder. Studies on this disorder are lacking except for a few case reports and there is a paucity of Indian literature on the condition. OBJECTIVES/METHODS: To study and describe the various morphological patterns and histopathological findings, as well as assess the response to treatment of 30 patients diagnosed with CRP. RESULTS: Thirtypatients with a diagnosis of confluent and reticulate papillomatosis were included in the study. The male to female ratio was 1:1.5. Mean age at onset of skin eruptions was 27.3 years and mean duration of skin eruptions was 8.2 months. Most of the patients (60%) were asymptomatic. The majority (66.7%) had lesions distributed over upper trunk. Two-thirds of patients had typical brown macules in confluent and reticulate pattern. KOH mount was done in 24 cases and was positive in three cases (12.5%) for yeast-like hyphae. Biopsy demonstrated variable degrees of hyperkeratosis, papillomatosis, and moderate acanthosis. Thirteen out of eighteenpatients on minocycline showed complete clearance within 3 weeks andthreepatients had more than 50% improvement at the end of 3 weeks. Doxycycline showed satisfactory response but results were less satisfactory with azithromycin. CONCLUSION: CRP is an uncommon condition. There is a paucity of large studies in Indian literature. The present study highlightssuch a large cohort of cases. Prevalence of CRP was more in female in contrast to western studies. Association of CRP with hyperthyroidism was described in many studies but the present study highlights the association with hypothyroidism. Morphological variants like shiny atrophic lesions, verrucous lesions, and involvement of atypical sites like forearm have been described. Role of minocycline in the management of chronic and recurrent cases has been reinforced.

Hypersensitive Reaction to Tattoos: A Growing Menace in Rural India.

BACKGROUND: Increased enthusiasm toward newer fashion trends among rural India along with the lack of government regulation has led to increased tattoo reactions. OBJECTIVE: The objective of this study is to describe various clinical manifestations of hypersensitive reactions to tattoo ink reported at a tertiary care hospital in Mandya district. MATERIALS AND METHODS: An observational study was carried out over a period of 1 year from June 2014 to May 2015 at Mandya Institute of Medical Sciences, Mandya. All the patients reporting with allergic reaction due to tattooing were included in the present study after obtaining informed consent. Transient acute inflammatory reaction, infections, and skin diseases localized on tattooed area were excluded from this study. A detailed history regarding the onset, duration and color used for tattooing were collected. Cutaneous examination and biopsy was to done to know the type of reaction. RESULTS: Fifty cutaneous allergic reactions were diagnosed among 39 patients. Mean age of subjects was 22 years and mean duration before the appearance of lesion was 7 months. Common colors associated with reactions were red (53.9%), black (33.3%), green (5.1%), and multicolor (7.7%). Itching was the predominant symptom. Skin lesions mainly consisted of lichenoid papules and plaques, eczematous lesions, and verrucous lesions. Lichenoid histopathology reaction was the most common tissue allergic reaction. CONCLUSION: Increasing popularity of tattooing among young people has predisposed to parallel increase in adverse reactions. Red pigment is most common cause of allergic reaction in the present study, and lichenoid reaction is the most common reaction.

Triamcinolone Impregnated Nasal Pack in Endoscopic Sinus Surgery: Our Experience.

The selection of an effective packing method to prevent postoperative complications and recurrence following Endoscopic Sinus Surgery remains ambiguous at present. This study was conducted to evaluate the efficacy of Triamcinolone impregnated nasal pack in Endoscopic Sinus Surgery, in the prevention of postoperative crusting, edema, infection and recurrence. This study was an interventional randomized placebo-controlled study, conducted at a tertiary care centre in South India between February 2015 and May 2016, after getting approval from Institute Ethical Committee. 75 patients with bilateral chronic rhinosinusitis undergoing Endoscopic Sinus Surgery were selected for the study. After surgery, each patient was randomized to receive Polyvinyl Acetal (Merocel) nasal pack soaked with Triamcinolone to one side, while the contralateral side was packed with Merocel soaked with saline. Incidence of postoperative crusting, edema, polypoidal change and mucosal discharge was evaluated using the Endoscopic Staging System at 1st and 2nd weeks and at 1st and 3rd months of surgery. A significant reduction in mucosal edema was observed in the test group at all stages of follow up (p values <0.05). Incidence of crusting was found to be significantly lower in the test group (p values <0.05) except at 3 months (p value >0.05). However, there was no significant difference in the occurrence of polypoidal change and mucosal discharge between the groups. Triamcinolone impregnated nasal pack is an effective method to reduce the incidence of early postoperative complications following Endoscopic Sinus Surgery.

Gingival pigmentation reduction: a novel therapeutic modality.

AIM: The objective of the present clinical study was to compare the effectiveness of radiofrequency de-epithelialization and conventional (slicing) method in reducing gingival pigmentation on long term basis by split mouth design. MATERIALS AND METHODS: A total of 28 maxillary gingival units from 4 subjects aged between 15-30 years were considered for this clincal study and the selected gingival units were made plaque free and clinically healthy before subjectiing these sites to one of the procedures. The selected sites were abraded by either the conventional (slicing) method (14 gingival units of 21, 22, 23, 24) or by radiofrequency (14 gingival units of 11, 12, 13, 14). After the procedure periodontal dressing was applied to protect the operated area. After 1 week periodontal dressing was removed and the area was irrigated with saline. Follow up examination was done on 30(th), 60(th) and 90(th) days to evaluate the recurrence of pigmentation, if any. RESULTS: It was obsereved that, sites operated with conventional (slicing) method, showed higher mean pigmentation than the sites treated with the radioablation during the follow up period of 90 days. CONCLUSION: When used judiciously, radiofrequency can be clinically valuable, safe and effective method to reduce pigmentation of gingiva.

A study of cutaneous manifestations in HIV infected persons.

Skin is one of the major target organs during all stages of HIV. The present study is conducted to know the dermatological manifestations among 181 HIV positive patients over a period of 17 months ie, from 01-03-2006 to 31-08-2007 at Mandya Institute of Medical Sciences, Mandya. Of these 181 patients, skin diseases were seen in 82 patients (45.3%), 41 patients had only one dermatological disease, 25 had two, 10 had three and 6 patients had more than four diseases. It was observed that a total of 45.3% patients among the study group developed mucocutaneous manifestations. Therefore early recognition of mucocutaneous lesions will help in early diagnosis and better management of HIV/AIDS patients.

Cutaneous sarcoidosis - a great masquerader: a report of three interesting cases.

It is a known fact that cutaneous sarcoidosis is a great imitator in dermatology. We report three cases of cutaneous sarcoidosis without systemic involvement and with varied dermatologic presentation with regard to age and morphology. Lesions mimicked various common dermatologic conditions, causing great confusion for the diagnosis and posing problems for management. Awareness of these varied morphologic presentations is essential for the early diagnosis and management of the master mimicker - cutaneous sarcoidosis.

Affection of immune zones in leprosy: a clinico-epidemiological study.

The study was undertaken to evaluate the prevalence of involvement of immune zones in leprosy and to assess the clinico-epidemiological characteristics of the disease in patients presenting with immune zone involvement. 200 leprosy cases were included in this study and detailed history, clinical examination, slit-skin smears and skin biopsies were carried out on all patients. Those cases presenting with immune zone involvement were further evaluated for clinical and epidemiological characteristics of disease process. Immune zone involvement was detected in 7% of cases with male preponderance in the study. Majority of patients (85.5%) had borderline tuberculoid leprosy and midline of back was the commonest site of involvement (50% of cases). Morphologically, macular lesions were the commonest presentation (85.68%) of immune zone involvement. The study heightens the clinical awareness of the possibility of occurrence of leprous lesions on uncommon and unusual sites, which should be termed as relatively immune, rather than absolutely immune zones of leprosy.