Clinical evaluation of patients patch tested with plant series: a prospective study.

BACKGROUND: Plants are ubiquitous in nature and are essential for human life, though some do have detrimental effects. In India, there are various indigenous and foreign plants that are well known to cause dermatitis, Parthenium hysterophorus being the foremost. AIMS OF THE STUDY: To study the clinical features of patients presenting with plant dermatitis and evaluate plant allergen series patch test results. MATERIALS AND METHODS: 50 patients with suspected plant dermatitis were evaluated regarding evolution of dermatitis, precipitating factors and contact with various plants. 31 patients (62%) complained of photo sensitivity and 24 (48%) had involvement of sun-exposed areas. Our provisional diagnoses included allergic contact dermatitis in 16, air borne contact dermatitis in 9, phytophotodermatitis in 7, photodermatitis in 6, airborne contact dermatitis to other causes in 4, phytodermatitis in 3. Patients were patch tested with Indian standard series of allergens as well as plant allergen series consisting of common allergenic plants of local flora in and around Manipal and also with plants strongly suspected by the patient. 35 tested positive with maximum positives (26 patients, i.e., 52%) to Parthenium hysterophorus (Compositae). RESULTS: The result of patch testing was correlated with the history and clinical examination and relevance established. CONCLUSIONS: Majority of the patients with clinically suspected plant dermatitis belonged to 3(rd) or 4(th) decade and Parthenium was the leading plant allergen Sensitization to Leguminosae plants and Hopea ponga, seen in 9 cases, have not been reported earlier in literature.

Erythema nodosum leprosum as the presenting feature in multibacillary leprosy.

Leprosy is an ancient disease that has survived into the modern ages despite an intense effort to eliminate it worldwide. Here we report a case of a 32-year-old woman who had recurrent painful nodules of six months duration. Because of a lack of lesions suggestive of leprosy, she was initially diagnosed to have cutaneous vasculitis and erythema nodosum. However, because of the persistent nature of her condition she was later detected to have leprosy and erythema nodosum leprosum (ENL) with the aid of simple diagnostic tests.

Indirect immunofluorescence to demonstrate lichen planus specific antigen (LPSA) in lichen planus.

BACKGROUND: Current evidence suggests that lichen planus is an immunological disease. Cytotoxic CD8+ cells in the lesional epidermis recognize a unique antigen called lichen planus specific antigen. This antigen could be demonstrated by indirect immunofluorescence using the patient's serum and autologous lesional skin. AIM: To study indirect immunofluorescence pattern in lichen planus, among Indian patients. METHODS: Twenty-five consecutive patients with the clinical diagnosis of lichen planus were enrolled in the study. Direct immunofluorescence was done in all patients. Indirect immunofluorescence using lesional skin as substrate was done in all 25 patients and five patients with other dermatoses. RESULTS: A specific fluorescence pattern corresponding to the distribution of lichen planus specific antigen was observed in the stratum spinosum and granulosum in 22 (88%) patients. It was absent from other parts of the epidermis, dermis and in patients with other dermatoses. CONCLUSION: Indirect immunofluorescence is a useful adjuvant test in lichen planus, particularly in atypical cases.

Ichthyosis follicularis with alopecia and photophobia (IFAP) syndrome.

A 12-year-old boy born of a nonconsanguineous marriage presented with dry rough skin and photophobia since birth. His growth and developmental milestones were normal and there was no history of any neurological problem, hearing deficit or scarring around the hair follicles. Cutaneous examination revealed diffuse thinning of scalp hair with loss of eyebrows and eyelashes and a sandpapery texture of the skin all over the body, suggestive of ichthyosis follicularis with alopecia and photophobia syndrome.

Role of slit skin smear examination in cutaneous T-cell lymphomas and other chronic dermatoses.

The purpose of this study was to evaluate the utility of slit-skin smear examination in the diagnosis of various chronic dermatoses. The study included 24 patients with chronic dermatoses who presented to the skin outpatient department. Ten patients had idiopathic erythroderma, seven were diagnosed with airborne contact dermatitis, four had cutaneous T-cell lymphoma, two had chronic actinic dermatoses, and a single patient had panniculitis. Slit skin smears were obtained from all patients, stained with Leishman stain, and examined under microscope. Out of 24 patients, all four cases of cutaneous T-cell lymphoma showed abnormal cells suggestive of lymphomatous infiltration, two patients with airborne contact dermatitis showed reactive lymphocytes, and two idiopathic erythroderma cases showed numerous eosinophils in the smear. Slit skin smear examination is a simple rapid, decisive test in the diagnosis of cutaneous T-cell lymphoma. It is a useful screening test, especially in Sezary syndrome and diseases with specific skin infiltrate.

Mandibular resorption in progressive systemic sclerosis: a report of three cases.

Progressive systemic sclerosis is a generalized collagen disorder, which is characterized by fibrosis that involves skin, muscles and other organ systems like the gastrointestinal tract, lungs, heart and kidneys. Its oral manifestations include features like restricted mouth opening, widening of periodontal ligament space, pseudoankylosis, malocclusion and mandibular resorption. Mandibular resorption in systemic sclerosis is relatively uncommon and is reported only in 10% of cases. The purpose of reporting these three cases is to highlight the importance of screening all patients with advanced systemic sclerosis with panoramic radiographs. Panoramic radiographs are essential for early detection of resorption in the mandible to prevent possible consequences like pathological fractures, osteomyelitis and neuropathies.

Co-existence of lepromatous leprosy and myasthenia gravis.

Various circulating autoantibodies are known to occur commonly in patients with lepromatous leprosy. However, the association with autoimmune diseases has rarely been reported. One such association of lepromatous leprosy with myasthenia gravis is being reported.

Ganglion cyst of the proximal tibiofibular joint causing foot drop-diagnostic problem of differentiating from neuritic leprosy.

A six-year old boy presented with pain around the knee joint and abnormal gait of one month duration. There was no history of hypopigmented anaesthetic patches, neuritis or family history of leprosy. Clinical examination revealed a localized cystic swelling of 1 x 1 cm in size in the region of left common peroneal nerve, with sensory loss on the lateral aspect of the left leg which was mistaken for a nerve abscess.

Tuberculous gluteal abscess coexisting with scrofuloderma and tubercular lymphadenitis.

A 23-year-old man presented with diffuse swelling of the left buttock with overlying skin lesions associated with seropurulent discharge. There was no past history of tuberculosis. Routine investigations were normal and smears of the discharge for bacteria, fungi, and AFB were negative. However, culture of skin biopsy showed Mycobacterium tuberculosis. Skin and lymph node biopsy showed granulomatous inflammation suggestive of tuberculosis. Administration of antitubucular therapy led to complete resolution of the lesions within 12 months.

Ichthyosis follicularis with congenital atrichia, nail dystrophy and palmoplantar keratoderma. Variant of IFAP syndrome or a new entity?

A 23-year-old man was seen for dry, rough skin and alopecia present since birth. There was no history of impaired sweating, photophobia, or lacrimation. Examination revealed generalized cutaneous thorn-like projections with nonscarring alopecia, twenty-nail dystrophy, and palmoplantar keratoderma.

Lichen amyloidosus: a study of clinical, histopathologic and immunofluorescence findings in 30 cases.

BACKGROUND: Lichen amyloidosus (LA) is a primary localized cutaneous amyloidosis characterized clinically by discrete hyperkeratotic hyperpigmented papules and histologically by deposition of amyloid material in previously normal skin without any evidence of visceral involvement. AIMS AND OBJECTIVES: The aim of this work was to study the etiology, clinical features, histopathology and direct immunofluorescence findings in LA. METHODS: A prospective study of 30 patients with clinical, histological and immunofluorescence findings suggestive of LA was undertaken. After a detailed history and clinical examination, two punch biopsies for histopathology and immunofluorescence were taken. RESULTS: Of the 30 patients, 19 (63.3%) were males and 11 (36.7%) were females with duration of LA ranging from 6-20 months. Pruritus was the presenting symptom in 27 (90%) patients. Shin was involved in 26 (86.7%) followed by arms in three (10%) and back in one (3.3%). Seventeen patients (56%) had used scrubs for more than 2 years. Histopathology, direct immunofluorescence and Congo red staining detected amyloid in all cases. CONCLUSIONS: LA commonly presents over the shins as pruritic discrete hyperpigmented papules. Familial predisposition and friction may have a pathogenic role. Histopathological examination is very useful in the detection of amyloid which may be supplemented with direct immunofluorescence and Congo red staining.

Clinical profile of forefoot eczema: a study of 42 cases.

BACKGROUND: Forefoot eczema (FE) is characterized by dry fissured dermatitis of the plantar surface of the feet. AIM: To study the clinical profile of FE and the possible etiological factors. METHODS: Forty-two patients with FE were included in the study. A detailed history was recorded and examination done. Fungal scrapings and patch test with Indian Standard Series (ISS) were performed in all patients. RESULTS: The most common site affected was the plantar surface of the great toe in 16 (38.09%) patients. Hand involvement, with fissuring and soreness of the fingertips and palm, was seen in four patients (9.5%). Seven patients (16.6%) had a personal history of atopy whereas family history of atopy was present in six (14.2%). Seven patients (16.6%) reported aggravation of itching with plastic, rubber or leather footwear, and 13 (30.9%), with detergents and prolonged contact with water. Negative fungal scrapings in all patients ruled out a dermatophyte infection. Patch testing with ISS was performed in 19 patients and was positive in five. CONCLUSIONS: FE is a distinctive dermatosis of the second and third decade, predominantly in females, with a multifactorial etiology, possible factors being chronic irritation, atopy, footwear and seasonal influence.

Minimal erythema response (MED) to solar simulated irradiation in normal Indian skin.

BACKGROUND: Phototesting is an essential tool in the investigation of photodermatoses. AIMS: The main aim was to study the cutaneous response to UVR in terms of minimal erythema dose (MED) to both UVA and UVB in normal Indian subjects with a solar simulator and to study the relationship of skin type to MED. METHODS: One hundred healthy volunteers not on any medication and without any history of photodermatoses were phototested using a solar simulator with whole spectrum irradiation (UVA, UVB and visible light) and only visible and UVA radiation. The tested areas were marked with gentian violet and readings were taken after 24 hrs. RESULTS: Of the 100 volunteers, 48% were males and 52% were females, with a mean age of 36.6 +/- 11.6 yrs. The most common skin type among Indians was type 5 (46%) followed by type 4 (41%). The mean MED for UVB was 61.5 +/- 17.25 J/cm2. The MED for UVA could not be determined as none of the patients showed any erythema after irradiation for 45 minutes. CONCLUSIONS: As the MED is found to be low in idiopathic acquired photodermatoses, the MED in the normal population could serve as a baseline data in the investigation.

Extensive larva migrans.

Larva migrans is characterized by tortuous migratory lesions of the skin caused by larvae of nematodes. A 26-year-old fisherman presented to us with complaints of an itchy eruption on his back and arms of two months' duration. Clinical examination revealed multiple wavy serpentine tracts and fork like lesions with a raised absolute eosinophil count of 3800 cells/cmm. Biopsy was inconclusive. This case is reported to highlight the extensive involvement by larva migrans.