Mucosal lichen planus simultaneously involving oral mucosa, conjunctiva and larynx.

Lichen planus is an autoimmune disease that typically involves skin and the mucosa of the mouth and genitalia. The involvement of conjunctival and laryngeal is rare. A young patient presented with hoarseness of voice, oral ulcerative lesions and symblephron. Mucosal biopsies (buccal mucosa and supraglottic area) revealed the diagnosis of lichen planus and he was managed accordingly. Although oral lichen planus is frequently reported but simultaneous involvement of oral, ocular and laryngeal mucosa has not been reported earlier.

Efficacy of rifampicin in eradication of carrier state of Staphylococcus aureus in anterior nares with recurrent furunculosis.

OBJECTIVE: To compare the frequency of detection of Staphylococcus aureus carrier state in anterior nares of the patients suffering from recurrent furunculosis with the normal population and to determine the efficacy of rifampicin in eradication of the carrier state. DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: Skin Department of Combined Military Hospital, Peshawar and Multan, from March 2004 to December 2005. PATIENTS AND METHODS: The study consisted of 80 individuals. They were placed in two groups. Group I comprised of 40 patients suffering from recurrent furuncles and group II included 40 healthy adults, kept as controls. Nasal swab was taken from the individuals belonging to both the groups, when they first reported to skin OPD. The patients who were suffering from furuncles were treated with co-amoxiclav 375 or 625 mg three times a day. The patients in whom S. aureus carrier state was detected were again divided into two groups. Group 1 was prescribed rifampicin 450-600 mg daily (depending on the body weight) for 10 days, while the group 2 was not offered any treatment. After this course, a second nasal swab was taken and submitted for cultures. RESULTS: Among the 40 patients belonging to group I, S. aureus carrier state was detected in 23 (57.5%), while in group II the carrier state was found in 8 (20%) individuals (p<0.001). Among the 13 patients who received rifampicin, 10 got cured of carrier state, while in 3 patients nasal swab was still positive after a course of rifampicin. In 10 patients, who were not offered any treatment, the nasal swabs remained positive (p<0.001). These patients were followed-up in skin OPD for another 3 months, and did not develop any recurrence of the infection. CONCLUSION: Nasal swab for detection of S. aureus carrier state should be done in all patients of recurrent furunculosis. If the nasal swab culture is positive, then as the infection gets cured, the patients should receive a course of rifampicin for 10 days. This may eradicate the carrier state in majority of cases and prevent the recurrence of the infection.

Clinicopathological spectrum of mycosis fungoides type cutaneous T-cell lymphoma.

OBJECTIVE: To determine the clinical, histological, and immunophenotypic characteristics of mycosis fungoides type cutaneous T-cell lymphoma. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: This study was conducted from January 2000 to December 2004 at the Department of Dermatology, Military Hospital and the Department of Dermatopathology, Armed Forces Institute of Pathology, Rawalpindi. MATERIALS AND METHODS: The medical case records of patients with mycosis fungoides diagnosed during the period of study were surveyed. Data was collected pertaining to patient s characteristics, clinical descriptions, histopathological features, immunophenotypic analysis and stage of disease at the time of diagnosis. RESULTS: A total of 33 cases of mycosis fungoides were diagnosed between the years 2000 and 2004. There were 24 male and 9 female patients with male to female ratio of 2.6:1 The age ranged from 24 to 68 years and the duration of disease prior to diagnosis varied between 2 to 36 months. The number of skin biopsies performed for definite diagnosis ranged from 01 to 5. The various clinical presentations recorded in these patients were hypopigmented patches in 7 (21.3%), infiltrated papules and plaques in 6 (18.2%), erythroderma in 5 (15.2%), psoriasiform lesions in 3 (9%), and nodular lesions in 3 (9%) patients. There were 2 (6%) cases respectively of noduloulcerative, ichthyosiform and poikilodermatous lesions, and 1(3%) case each of follicular, morphoea-like and purpuric skin lesions. The predominant histological features were lymphocytic infiltrate in the upper dermis, epidermotropism, haloed lymphocytes in epidermis, Pautrier s microabscesses, and interface dermatitis. The immunohistochemical studies (n=12) showed predominantly T helper cell immunophenotype (CD3+, CD45RO+) in 11(92%) cases and T suppressor cell immunophenotype (CD3+, CD8+) in 1(8%) patient. CONCLUSION: The mycosis fungoides type cutaneous T-cell lymphoma has a wide clinicopathological spectrum. In a clinically non-specific dermatosis, a high index of suspicion and a regular follow-up may eventually lead to the definite diagnosis.