Clinical Profile of Patients with Lichenoid Drug Eruption: A Observational Study.

Background: Lichenoid drug eruption (LDE) is an uncommon cutaneous adverse drug reaction, where a variety of drugs used in day-to-day clinical practice have been implicated. Objective: To describe the clinico-demographic characteristics of patients with LDE and to identify the most likely drugs involved. Methods: In this prospective, observational study, consecutive patients with LDE presenting to the dermatology department of a tertiary teaching hospital were included. The clinico-demographic profile of patients with LDE and implicated drugs was noted. Treatment of drug reaction along with outcome was also documented. Naranjo adverse drug reaction probability scale was used for causality assessment of the drug reactions. A thorough literature review on LDE was also undertaken due to the paucity of existing literature. Results: A total of 15 patients (11 males and 4 females) with LDE were evaluated. Their age ranged from 37 to 61 years, with a mean of 51.53 ± 7.59 years. Anti-hypertensive medications (40%) were the most common culprit agent, followed by antitubercular drugs (33.4%), anti-diabetic agents (13.3%), and others (13.3%). The latent period (time from drug initiation to the appearance of a cutaneous eruption) varied from 15 days to 6 months (mean 2.2 months). Cutaneous involvement was generalized in 73.4% and photo-distributed lesions in 26.6%. Drug provocation test was done to identify the culprit drug. According to the Naranjo adverse drug reaction probability scale, one-third of LDEs were "definite," whereas two-thirds were designated as "probable." Conclusion: LDE is more common in the elderly population. The latent period is comparatively longer in LDE than in other common drug reactions. Prompt recognition and withdrawal of suspected drug are essential to minimize disease morbidity.

Acrocyanosis: an overview.

INTRODUCTION: It is a functional peripheral vascular disorder characterized by bluish discoloration of skin and mucous membrane due to diminished oxyhemoglobin. It may be due to central or local tissue oxygenation defects. It is a painful episodic disorder, where trophic changes and ulceration are very rare except in necrotizing variant. By definition, it refers to persistent abnormally deep blue or cyanotic discoloration of skin over extremities (hand and feet most commonly) due to decreased oxyhemoglobin. ETIOLOGY: It can be both primary and secondary to psychiatric, neurologic, autoimmune, infective, metabolic and other causes. The existing hypothesis suggests the prevailing role of vasospastic reaction over possible blood rheology impairment.[1] As per the current line of thinking, it is due to chronic vasospasm of small cutaneous arteries, and arterioles along with compensatory dilatation in the capillary and post capillary venules causes cyanosis and sweating. CLINICAL FEATURES: Acrocyanosis is an uncommon condition. It usually presents with coolness and violaceous dusky discolorations of hands and less frequently the feet. Other peripheral part like ear, nose, lips and nipple can also be affected.[2] The changes may be transient after cold exposure but frequently persist during winter and even in summer. MANAGEMENT: There is no standard and curative medical or surgical treatment of acrocyanosis. In mild cases, it is unnecessary to give any drug treatment. Life style modification, dietary and hygiene counseling, avoidance of cold and reassurance that the bluish skin discoloration does not indicate any serious illness is all that is necessary.

Zinc and skin: a brief summary.

Zinc is an essential trace element that is an integral component of many metallo-enzymes in the body and thus serves many biological functions. The clinical presentation of zinc deficiency varies and depends on serum zinc level. Whereas a significantly low serum zinc level results in clinical features similar to acrodermatitis enteropathica, mild hypozincemia presents with a less characteristic appearance; hence it may be underdiagnosed. Recognition of various cutaneous lesions is required for suspecting and identifying cases of zinc deficiency. Although many laboratory tests are useful, therapeutic response in suspected cases remains the gold standard of diagnosis. Serum zinc estimation alone is not very reliable because disease activity may not necessarily correlate with serum zinc level. Zinc supplementation results in a rapid response and the skin lesions heal without permanent sequelae. However, pigmentary alterations may persist longer. Predisposing factors should be identified and corrected. This brief review summarizes the identification and management of clinical zinc deficiency.

Remittent idiopathic necrotizing acrocyanosis - a rare entity.

Remittent idiopathic necrotizing acrocyanosis is a very rare condition characterized by persistent systemic cyanotic or erythrocyanotic discoloration of hands and feet. It is associated with pain, tenderness of fingers and toes and may present as ulceration or gangrene of extremities. It is aggravated with cold exposure but persists even in summer. Acrocyanosis is not due to any systemic disease; peripheral arteriolar constriction with secondary vasodilatation due to disordered vascular tone of unknown etiology has been postulated. It responds to peripheral vasodilator drug but usually needs continuous long term therapy along with avoidance of cold exposure. We report the case of a 53-year-old male farmer with remittent necrotizing acrocyanosis.

Familial childhood systemic lupus erythematosus: report of 2 cases.

Systemic lupus erythematosus is a multisystem organ inflammation due to damage of cells and tissues by pathogenic auto-antibodies and immune complexes. The most important factor for the causation of familial systemic lupus erythematosus is genetic on which environmental factor usually coexists. Two brothers of 7 and 3 years of age having childhood systemic lupus erythematosus are reported here because of low incidence and familial occurrence. Both the children fulfilled the American Rheumatology Association (ARA) criterion of systemic lupus erythematosus though anti-dsDNA was negative in both and antinuclear factor was positive only in the younger child. Systemic lupus erythematosus begins in childhood in 20% of adult patients and usually after the age of 8 years but here onset was even at an earlier age. The treatment of the both the siblings included administration of steroids and cyclophosphamide.

Epidermolytic hyperkeratosis with a rare digital contracture.

A sixteen year-old male patient with no history of consanguinity in the family, reported with patchy, thickened lichenified plaques over the whole body. Some areas had normal skin while some were Blaschkoid lesions. The child had delayed milestones along with hypogonadism. Digital contracture with palmoplantar keratoderma was present. Histopathology showed characteristic vacuolar degeneration of the upper epidermis and suprabasilar keratinocytes with hyperkeratosis.