A comparison of systemic photochemotherapy with 8-methoxypsoralen (8-MOP) and with trimethylpsoralen (TMP) in vitiligo.

Oral 8-MOP and TMP were compared in the PUVA therapy for vitiligo. Group A (25 cases) was initiated on 0.3 mg/kg of 8-MOP with 1/2 Joule/cm2 of UVA and weekly increments of 1/2 Joule/ cm2 and Group B was started on 0.6 mg/kg of TMP with 1 Joule/cm2 of UVA and weekly increments of 1 Joule/cm2. Therapy was given thrice a week. Repigmentation was evaluated by using a 0-6 scale. At the end of 60 sittings, on acceptable cosmetic response was seen over the face, neck and upper extremities in both groups, while trunk and lower extremities showed lesser response. 8-MOP gave earlier response, needing a lower cumulative UVA dose i.e. 75 J/cm2 as compared to TMP i.e. 106 J/cm2. Phototoxicity was seen more often with 8-MOP. In conclusion, in Indians, 8-MOP is the drug of choice in PUVA therapy of vitiligo provided precautions against phototoxicity are adequate.

Proteus syndrome.

A 2½-year-old male child born of a nonconsanguineous marriage with high parental age presented with macrodactyly, dysmorphic features, large disfiguring lipomas, small fibromas, a linear verrucous epidermal naevus and lymphangioma circumscriptum. X-ray of hand revealed macrodystrophia lipomatosa progressiva. A lipoma and lymphangioma circumscriptum were confirmed by histopathology. The cosmetically disfiguring lipomas were excised. This is the first case report from India with the characteristic macrodactyly. This could possibly be the first case of report of a mutational disorder following intake of carbimazole during pregnancy.

Disseminate and persistent infundibulo-folliculitis.

An 18-year-old girl presented with a persistent skin eruption of 6 years duration. She had skin-coloured follicular papules involving the trunk, proximal extremities, neck and face. Histopathology revealed spongiosis of the follicular infundibulum and infiltration with lymphocytes and neutrophils. Treatment with oral vitamin A and topical retinoic acid was ineffective.

Cutaneous vasculitis with peripheral neuropathy.

a 40-year-old male patient presented with cutaneous vasculitis affecting both lower legs without any evidence of systemic involvement and a bilateral sensory neuropathy affecting both lateral popliteal nerves. Treatment with oral prednisolone resulted in healing of the cutaneous lesions but the sensory loss persisted.

Comparison of topical methenamine, glutaraldehyde and tap water Iontophoresis for palmoplantar hyperhidrosis.

Sixty patients with palmo-plantar hyperhidrosis were studied to compare the efficacy and safety of topical methenamine in the treatment of palmo-plantar hyperhidrosis with established therapies like glutaraldehyde and tap water iontophoresis. Patients were randomly allocated to 3 treatment groups: topical Methenamine (10%) solution, topical Glutaraldehyde (5% for palms and 10% for soles) and tap water iontophoresis. Hyperhidrosis was graded into 4 grades. The total duration of therapy was 4 weeks for all the 3 groups. Patients were followed up weekly for 4 weeks and 2 weeks after completion of therapy. Response to therapy was evaluated by the change in the grade of hyperhidrosis. Side-effects like irritation and pigmentation were looked for at every follow up. Wilcoxon's rank sum test was used for comparison between changes in grading of 2 groups. It showed that methenamine is superior to tap water iontophoresis and acts faster than glutaraldehyde. Fewer side effects were noted with mether amine.