Lethal midline granuloma.

Lethal midline granuloma is a relatively rare disease characterized by destruction and mutilation of the nose and other structures of respiratory passages. The nonspecificity of symptoms obscures the correct diagnosis and is responsible for the delay in treatment which can be detrimental as this grave disease calls for urgent intervention. We present a case report of this disease in a 35 year old male who gave a short two month history of the clinical symptoms.

Tinea capitis in the form of concentric rings in an HIV positive adult on antiretroviral treatment.

Dermatophyte infection may present in the form of concentric rings caused by Trichophyton concentricum, known as Tinea Imbricata. In immunosuppressed patients, there are reports of lesions in the form of concentric rings caused by dermatophytes other than Trichophyton concentricum too, mostly by Trichophyton tonsurans, known as Tinea indesiciva or Tinea pseudoimbricata. We report a case of tinea capitis in a HIV-positive adult woman on antiretroviral therapy, who presented with concentric rings of papules and pustules with slight scaling on the scalp along with diffuse thinning of hair. Both Potassium hydroxide mount and culture showed the presence of Dermatophytes. Tinea capitis is considered rare in adults, but new cases are being reported in immunocompromised as well as in immunocompetent patients. The pertinent features of this case are: HIV-positive adult female on antiretroviral therapy, presenting with tinea capitis in the form of concentric rings; culture from the lesion grew Microsporum audouinii; responding to oral Terbinafine.

Atrophic sarcoidosis: an unusual presentation of cutaneous sarcoidosis.

A 66-year-old woman presented with asymptomatic skin-colored to hypopigmented scaly plaques over the extremities, reportedly of 12 years' duration. The lesions started as well-defined erythematous scaly papules over the forearms, gradually followed by the appearance of similar lesions over both legs and dorsum of feet. During this period, the lesions increased in size, with peripheral extension and central clearing, leading to the present morphology. She is a known patient with coronary artery disease currently on treatment. There is history of exertional dyspnea, which has been related to her cardiologic ailment. She is not a known diabetic and has no other significant medical history.

Some unusual type 2 reactions in leprosy.

BACKGROUND: Type 2 reactions with lepromatous leprosy (LL) not occurring during multi-drug therapy (MDT) have been reported. METHODS: Three patients have been described, each representing a prototype, the first presenting as bullous erythema nodosum leprosum (ENL), second with ENL erupting after treatment for co-existing pulmonary tuberculosis and resembling immune reconstitution inflammatory syndrome, and a third patient with recurrent Sweets-syndrome like presentation who had taken incomplete MDT in the past for leprosy. In all, the diagnosis was established by demonstration of acid-fast bacilli (AFB) on slit-skin smears (SSS) and histopathology. RESULTS & CONCLUSION: The fact that reactions can occur in patients with clinically inapparent LL, who are more likely to present in general hospitals, has been reemphasized to enhance awareness among physicians. First presentation of leprosy as ENL is probably precipitated by common antibiotics taken for other illnesses. Since reactional episodes can occur before, during and after MDT for leprosy and the clinical picture is not specific to any of them, it is important to ascertain the status of anti-leprosy therapy during these episodes and treat them accordingly.

Glomus tumour of the nail bed treated with the 'trap door' technique: a report of two patients.

Glomus tumours of the nail bed are an excruciatingly painful condition. The treatment of choice for these is surgical excision. However, since most cases are treated by surgeons, the usual method of treatment is total nail avulsion and excision. We have treated two patients of this rare presentation with a nail plate-conserving surgical method called the 'trap door' technique with excellent results. We hereby present a step-by-step pictorial guide to the method.

Chanarin-Dorfman syndrome with eccrine gland vacuolation: a case report.

Chanarin-Dorfman syndrome is a rare congenital disorder of lipid metabolism characterized by ichthyosis, leukocytic vacuolation (Jordan's anomaly), and variable involvement of the liver and neuromuscular system, with about 40 cases described worldwide to date. We report one more case of this rare syndrome, with certain peculiarities, namely vacuolation in eccrine glands, in a young male adult.

Pimecrolimus, yet another intriguing topical immunomodulator.

Pimecrolimus, yet another intriguing local immunomodulator, has been approved for use in atopic dermatitis in individuals of more then 2 years of age. However, its indications are now being extended to include a variety of inflammatory dermatoses, which are identified in the current article with a proviso that their use should be considered only as an alternative when conventional modalities have failed.