A cross sectional descriptive study of dermoscopic features of clinical variants of cutaneous tuberculosis.

Tuberculosis continues to be a major public health concern worldwide with almost 20-40% of the world's population being affected yearly. Cutaneous Tuberculosis (TB) is a rare and underdiagnosed entity that manifests in about 1-1.5% of extrapulmonary tuberculosis cases worldwide. Dermoscopy is a non-invasive tool which will be a useful aid to histopathology in the confirmation of the diagnosis alongside culture, and molecular techniques. This is a cross-sectional descriptive study that was conducted at a tertiary care center in Mumbai, India. A total of 31 patients were enrolled in this study; 14 males and 17 females. The mean duration of disease was 4.3 months and the average age was 31 years. There were 10 cases of lupus vulgaris, 7 scrofuloderma, 5 papulonecrotic tuberculid (PNT), 3 tuberculosis verrucosa cutis (TBVC), and 2 cases each of erythema induratum of Bazin, lichen scrofulosorum and resolved lupus vulgaris. All the lesions demonstrated orange yellow background suggestive of dermal granuloma. Other key dermoscopic features noted include yellowish-white scales, patulous follicles, white structureless areas, milia-like cysts, white streaks, pigment globules, hairpin and linear vessels. Newer findings such as the crown of vessels and perifollicular pallor in lichen scrofulosorum, and radiating white streaks in PNT were also noted. Dermoscopy of infective granulomas such as cutaneous tuberculosis is a less explored field of dermatology. Newer dermoscopic features of each clinical variant of cutaneous TB have been described.

A Six-Year Retrospective Analysis of Skin Biopsies in the Pediatric and Adolescent Population Performed at a Tertiary Health Care Center in India.

Background: Hesitancy to perform skin biopsies in children or adolescents may lead to delayed diagnosis or misdiagnosis and relatively, few studies analyzing pediatric skin biopsies exist. Aim and Objectives: This study aims to analyze the spectrum of skin diseases biopsied and demographic data of pediatric patients underwent skin biopsies at a tertiary health care center in India. Materials and Methods: Biopsy records over six years were analyzed, noting demographic data, disease duration, clinical differential diagnoses (CDD), final diagnosis after histopathology, disease categorization, and agreement between clinical and final diagnosis. The mean, range, and statistical significance of differences between proportions were calculated. Results: A total of 1308 biopsy records were analyzed. A male preponderance was noted (males - 55.1%; n = 721, females - 44.9%; n = 587). Most biopsies were performed in adolescents (12-18 years; 55.2%) followed by school-age children (5-12 years; 31.4%). Preponderant disease groups biopsied comprised papulosquamous (17.7%; n = 231) and infectious diseases (14.1%; n = 184). Leprosy was the most common infectious disease (37.5%; n = 69) with most patients belonging to borderline tuberculoid spectrum. The overall diagnostic agreement was 74.7%. No correlation of final diagnosis was noted with the number of CDD offered. In more than a fifth of cases, biopsy averted misdiagnosis. Conclusions: This study highlights the importance of skin biopsies in pediatric patients and the relatively high clinico-histopathologic agreement. Leprosy and papulosquamous diseases were preponderant in the pediatric dermatopathology caseload.

Acral involvement in lichen scrofulosorum: A diagnostic oddity with distinctive features on dermoscopy.

A commonly underdiagnosed harbinger of visceral tuberculosis, lichen scrofulosorum classically manifests as centripetally located erythematous to violaceous cutaneous papules. Perifollicular and perieccrine tuberculoid granulomas constitute the histologic hallmark. We report a case of lichen scrofulosorum with involvement of the acral areas which is unusual. Also, dermoscopy, which has not yet been widely utilized in this condition gave a novel insights into histopathology in this case.

A descriptive observational study on clinical and dermoscopic features of benign melanocytic neoplasms.

BACKGROUND: Benign melanocytic neoplasms have nests of melanocytic cells and show characteristic dermoscopic features. Clinical and dermoscopic features have not been studied previously in the Indian population. AIMS: To study the clinical, epidemiological and dermoscopic patterns of benign melanocytic neoplasms. METHODS: This was a descriptive, observational, single centre study. In 107 patients with melanocytic neoplasms, 167 lesions were clinically examined and studied under the dermoscope and histopathological examination was done when indicated. The lesions were broadly divided as acquired and congenital. Five main dermoscopic patterns were seen-globular, homogenous, reticular, parallel and streaks. If there were two of these patterns in a particular lesion, it was termed 'mixed pattern'. The presence of three or more patterns was called 'multicomponent pattern'. Various other features were also observed. RESULTS: The majority of patients belonged to the third decade with a female preponderance. History of increased UV exposure and family history was significant in acquired nevi. The dermoscopic pattern progressed from predominantly reticular in junctional nevi to predominantly globular in compound nevi and lesser pigment in intradermal nevi, with more vascular structures. The congenital melanocytic nevi showed additional features of comedo- like lesions, milia- like cysts, perifollicular pigmentary changes and increased colour variation. Even though colour variation was observed in both acquired and congenital lesions, no signs of dysplasia were seen on histopathology. LIMITATIONS: A larger sample size is required, with follow up of lesions. No parallel studies in brown skinned population were found for exact comparison. CONCLUSION: Benign melanocytic proliferations are often neglected in our country. This study will help in understanding the course, clinical features and dermoscopic patterns of various benign melanocytic neoplasms, and will be a step forward towards research in our population. To the best of our knowledge, this is the first study of its kind in India.

Schopf-Schulz-Passarge Syndrome.

Schopf-Schulz-Passarge syndrome (SSPS) is a rare type of ectodermal dysplasia that has autosomal recessive inheritance. It is characterized by palmoplantar keratoderma, hypodontia, hypotrichosis, nail dystrophy, and multiple periocular and eyelid apocrine hidrocystomas. A 36-year-old male presented with multiple eyelid and periocular apocrine hidrocystomas, ichthyosis, palmoplantar keratoderma, hypodontia, nail dystrophy, and thin scalp hair. Skin biopsy from a periocular lesion revealed cyst lined with smooth, thin epithelium, and few areas revealed foci of decapitation secretion consistent with apocrine hidrocystoma. The patient was diagnosed with SSPS.

Epidermotropic metastatic melanoma with perilesional depigmentation in an Indian male.

Melanoma is a rare form of cutaneous malignancy encountered in the dark skin population. Epidermotropic metastatic melanoma is a rare form of cutaneous metastatic melanoma which can mimic primary melanoma on histopathology. Hence its differentiation is of immense prognostic importance. The occurrence of rim of depigmentation around the primary cutaneous melanoma has previously been reported to portend a bad prognosis. The occurrence of vitiligo like lesions in patients with metastatic melanoma in comparison has a better prognosis. However the occurrence of depigmentation around the secondaries is rare and its importance is not well known. Hence we wish to report a case of epidermotropic metastatic melanoma with perilesional depigmentation in a 78 year old Indian male.

Granulomatous variant of giant centrifugal miliaria profunda.

Two infants presented with multiple asymptomatic papules and geographic and annular plaques over the extensor aspect of the upper and lower extremities and trunk. Skin biopsy of both lesions showed plugged and hyperplastic dilated acrosryingia and deep dermal ducts, along with granulomatous inflammatory reaction. These lesions showed self-healing with complete resolution. A previous report described similar clinical and histopathologic features and labeled it giant centrifugal miliaria profunda. Because of the large granulomatous plaques and deep infiltrate, we propose that it was a granulomatous variant of giant centrifugal miliaria profunda. We report these cases for their rarity and self-healing nature.

Epidermodysplasia verruciformis: an unusual malignant transformation.

Epidermodysplasia verruciformis (EV) is a rare, life-long heritable disease caused due to a unique susceptibility to human papilloma virus. The disseminated verrucous lesions and pityriasis versicolor-like lesions persist from early childhood and can transform into a cutaneous malignancy in a fourth of patients. Malignant transformation into syringoid eccrine carcinoma (SEC) has been reported only once so far. SEC is an extremely invasive, rare, locally destructive, slowly growing adnexal tumor. We hereby report the association of EV with SEC in a 29-year-old male.

Disseminated cutaneous histoplasmosis in an immunocompetent adult.

Histoplasmosis, a systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum var capsulatum and Histoplasma capsulatum var duboisii is endemic to many parts of the world. The clinical manifestations range from acute or chronic pulmonary infection to a progressive disseminated disease. After initial exposure to the fungus, the infection is self-limited and restricted to the lungs in 99% of healthy individuals. The remaining 1%, however, progress to either disseminated or chronic disease involving the lungs, liver, spleen, lymph nodes, bone marrow or rarely, the skin and mucous membranes. Mucocutaneous histoplasmosis is frequently reported in patients with acquired immune deficiency syndrome (AIDS), but it is rare in immunocompetent hosts. A 60-year-old male presented with asymptomatic swelling of the hard palate and crusted papules and nodules over the extremities, face and trunk. Clinically, the diagnoses of cutaneous cryptococcosis versus histoplasmosis was considered in this patient. A chest X-ray revealed hilar lymphadenopathy. Enzyme-linked immunosorbent assay (ELISA) for human immunodeficiency virus (HIV) was nonreactive. Skin biopsy revealed multiple tiny intracellular round yeast forms with a halo in the mid-dermis. Culture of the skin biopsy in Sabouraud's dextrose agar showed colonies of Histoplasma capsulatum. Despite an investigation including no evidence of underlying immunosuppression was found, he was started on IV amphotericin-B (0.5 mg/kg/day). However, the patient succumbed to his disease 2 days after presentation. We report a rare case of disseminated cutaneous histoplasmosis in an immunocompetent individual.

Successful treatment of multifocal cutaneous leishmaniasis with miltefosine.

We report a 48-year-old immunocompetent male, resident of Central India, who presented with slowly progressive asymptomatic multiple red lesions on different parts of body. On enquiry, the patient gave history of travel to Middle East 6 months back. Examination showed 10 crusted erythematous indurated plaques and nodules over forearms, left leg, right index finger, left wrist and dorsa of both feet. Histopathological examination of tissue biopsy showed multiple intracellular as well as extracellular leishmania donovan bodies. Keeping in mind the higher rate of side effects to pentavalent antimony, we treated this patient with oral miltefosine 50 mg bid and the lesions showed complete resolution over 4 months of therapy.

Childhood granulomatous periorificial dermatitis in children with extra-facial involvement.

Childhood granulomatous periorificial dermatitis (CGPD) is a self-limiting and well-recognized entity. A six-year-old male child, a known case of juvenile rheumatoid arthritis (JRA) presented with multiple red raised and yellowish lesions over the face, neck, trunk and upper extremities since one month with occasional itching. Cutaneous examination revealed multiple erythematous scaly papules of size up to 5 mm around the mouth, nose and periorbital areas, neck, trunk and upper extremities with few excoriations. Lesional skin biopsy was pathognomic of CGPD. We report a six-year-old Indian male child with extra-facial involvement and healing with small atrophic pigmented scars in a known case of JRA.