Necrobiosis lipoidica: A clinicopathological study in the Indian scenario.

CONTEXT: Necrobiosis lipoidica (NL) is a chronic granulomatous dermatitis that is commonly associated with diabetes mellitus. Most of the current knowledge about this entity is from western literature. AIMS: This study evaluates the clinicohistological features of NL in an Indian scenario. MATERIALS AND METHODS: We retrospectively reviewed clinical features, associated comorbidities, and biopsies of all patients with NL over a period of one year. RESULTS: Five cases of NL were seen during the duration of the study. The preliminary clinical diagnosis ranged from sarcoidosis to tinea incognito. The commonest clinical presentation in the Indian scenario was of asymptomatic erythematous to skin-colored plaques and nodules on the shins with or without central atrophy. The most common site of involvement was the shin (3 of 5 patients). NL was associated with Diabetes mellitus in only two cases, both of whom were male patients. On histology, various patterns of inflammation were seen including the palisading, interstitial, and mixed granulomatous infiltrates. One patient had sarcoidal granulomas in association with an interstitial pattern. Features seen consistently in all cases include perivascular lymphoplasmacytic infiltrates, interstitial lymphocytic infiltrates, and fibroplasia. Interstitial mucin deposition was not observed in any of the biopsies. CONCLUSION: The diagnosis of NL was missed in most cases due to the rarity of the disease, absence of concomitant diabetes, and atypical presentations. Histology was a useful tool in clinching the diagnosis.

Keratosis pilaris revisited: is it more than just a follicular keratosis?

BACKGROUND: Keratosis pilaris (KP) is characterized by keratinous plugs in the follicular orifices and varying degrees of perifollicular erythema. The most accepted theory of its pathogenesis proposes defective keratinization of the follicular epithelium resulting in a keratotic infundibular plug. We decided to test this hypothesis by doing dermoscopy of patients diagnosed clinically as keratosis pilaris. MATERIALS AND METHODS: Patients with a clinical diagnosis of KP seen between September 2011 and December 2011 were included in the study. A clinical history was obtained and examination and dermoscopic evaluation were performed on the lesions of KP. RESULTS: The age of the patients ranged from 6-38 years. Sixteen patients had history of atopy. Nine had concomitant ichthyosis vulgaris. All the 25 patients were found to have coiled hair shafts within the affected follicular infundibula. The hair shafts were extracted with the help of a sterile needle and were found to retain their coiled nature. Perifollicular erythema was seen in 11 patients; perifollicular scaling in 9. CONCLUSION: Based on our observations and previously documented histological data of KP, we infer that KP may not be a disorder of keratinization, but caused by the circular hair shaft which ruptures the follicular epithelium leading to inflammation and abnormal follicular keratinization.

Luetic aortopathy: Revisited.

We report a case of 38-year-old male, who presented with a large pulsatile swelling on the left side of the anterior chest wall of 4 months' duration with a gradual increase in size. He gave history of sexual promiscuity in the form of unprotected sexual intercourse prior to his marriage in his early 20s. He also gave a history of ulceration on coronal sulcus of glans penis 20 years back with painless right inguinal mass. His blood serology was strongly positive for syphilis and hepatitis B surface antigen (HBsAg); however, serology for retroviral infection was negative. Computed tomography-angiography confirmed the pulsatile swelling as aneurysm of the arch of and ascending aorta. In view of the history, positive serology, and imaging studies, we concluded the aortic aneurysm to be of syphilitic origin. We report this case due to its extreme rarity in the present antibiotic era.