A Cross-Sectional Study to Correlate Disease Severity in Bullous Pemphigoid Patients with Serum Levels of Autoantibodies Against BP180 and BP230.

CONTEXT: Enzyme-linked immunosorbent assay (ELISA) for BP 180 and 230 antibodies is commonly done in patients with bullous pemphigoid. We could not find much data regarding the usefulness of this test to predict the disease severity in Indian population. AIMS: We studied the correlation of IgG anti BP180 and anti BP230 antibody titer with disease severity and clinical features in bullous pemphigoid. SETTINGS AND DESIGN: This cross-sectional study was conducted at a tertiary care center in western India. MATERIALS AND METHODS: Forty-two clinically diagnosed treatment-naive cases of bullous pemphigoid were enrolled and investigated with skin punch biopsy, IgG anti BP180, and anti BP230 ELISA, direct immunofluorescence, and indirect immunofluorescence tests. Disease severity was assessed by calculating modified Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) score. Thirty patients with a final diagnosis of bullous pemphigoid were included in the statistical analysis. Pearson's correlation coefficient (r) was used to study correlation. RESULTS: The mean ABSIS skin score was 32.81 when both tests were negative, 42.13 when only BP230 was positive, 76.28 when only BP180 was positive, and 78.16 when both were positive. Pearson's correlation coefficient (r) for BP180 and ABSIS skin score was 0.6 (P value: 0.0005), and for BP230 was -0.055 (P value: 0.600). CONCLUSIONS: BP antibody titers correlate partially with disease severity. Anti-BP180 antibody is associated with more severe disease. Anti-BP230 antibody titer does not correlate with disease severity.

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.

Clinicopathological and Dermoscopic Features in a Case of Linear and Unilateral Basaloid Follicular Hamartoma.

Linear and unilateral basaloid follicular hamartoma (BFH) is a rare disease that manifests with papules and plaques with distribution along lines of Blaschko. It runs a benign course but with the risk of basal cell carcinoma (BCC) in long term course. BCC can be differentiated from BFH with histopathology and immunohistochemistry. Dermoscopic features of BCC are well studied. Dermoscopic features of BFH are not yet described in literature in detail probably due to rarity of the disease. Here, we present a case of extensive linear and unilateral BFH with its clinicohistopathological and dermoscopic features. The lesions were extensive to involve scalp, face, neck, upper, and lower trunk. Dermoscopy revealed features similar to that of BCC including brown-grey globules and dots, in focus dots, brown linear and arciform structures, crown vessels, short fine telangiectasias, spoke wheel like structures without central dark point, white structureless areas with telangiectasias and keratotic plug. Other dermoscopic features of BCC like arborizing vessels, blue-grey ovoid nests, maple leaf-like areas, concentric structures, ulcerations, erosions and white streaks were absent in this case.

Granulomatous Variant of Giant Centrifugal Miliaria Profunda in a Hypothyroid Infant: A Case Report.

The miliarias are a clinically heterogeneous group of diseases which occur when the free flow of eccrine sweat to the skin surface is impeded. Miliaria profunda is a variant with obstruction of the duct at or below the level of dermoepidermal junction. The giant centrifugal variant of miliaria profunda has been described in the past at the sites of occlusive tapes and in febrile patients. Thyroid hormone has a regulatory effect on the skin and its appendages and an association of hypothyroidism with this variant of miliaria profunda has not been described in the past. We report a case of giant centrifugal miliaria profunda in an infant with congenital hypothyroidism.

Localized unilateral basaloid follicular hamartoma along Blaschko's lines on face.

Basaloid follicular hamartoma (BFH) is a rare hamartoma of hair follicle. Clinical presentations may vary but are united by the same histopathological features in the form of folliculocentric basaloid or squamoid cell proliferation in the superficial dermis, which represents malformed and distorted hair follicles. It is important to recognize this entity as its simulant is basal cell carcinoma, a low-grade malignancy. Here, we report a case of localized unilateral BFH in a Blaschkoid distribution on the face of a 14-year-old female.

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.

A Case of Progressive Evolution of Multiple Woolly Hair Nevi in a Child.

Woolly hair nevus is a rarely acquired disorder of the scalp hair with well-circumscribed patch of curly and unruly hairs which are smaller in diameter than normal surrounding hair. We report a case of progressively evolving multiple woolly hair nevi in a 10-year-old child. Trichoscopy of unruly hairs showed abnormal kinking of hair shafts. Varying diameters of a single hair shaft, damaged cuticle, and trichorrhexis nodosa-like features were observed on hair microscopy. Histopathology showed abnormal bending of hair follicle above the hair bulb and irregularities of inner root sheath near the bulb at the bending. Most of the reported cases of woolly hair nevi had one or two stable patches, but this case presented with four patches which were progressively evolving.

Prevalence and Burden Related to Genital Warts in India.

The prevalence of genital warts (GW) and self-reported human papillomavirus (HPV) as well as disease-related psychosocial impact among male and female patients aged 18-60 years in India were assessed. GW prevalence was estimated using a 2-week daily log of patients examined from June 7-September 22, 2011 by 200 participating physicians in 6 regions of India. Psychosocial impact was estimated using one-time, self-administered surveys, including HPV Impact Profile (HIP), Cuestionario Específico para Condiloma Acuminado ([Spanish] CECA; "Specific questionnaire for Condylomata Acuminata") and EuroQol-5 Dimension survey. T-tests or Mann-Whitney U-tests were used for continuous comparisons and Chi-square or Fisher exact tests were applied for categorical comparisons. Overall GW prevalence in India was estimated at 1.07% (95% confidence interval = 0.97-1.17) and was higher among men than women. Regional prevalence ranged from high in Delhi (2.17%) to low in Bangalore (0.40%). Patients aged 25-29 years had the highest GW prevalence (1.42%). GW patients were most often newly diagnosed (74.07%). Among those with existing GW, 56.24% were recurrent, and 43.76% were resistant. According to total HIP scores, 55.4% of male GW patients and 20.0% of those without GW reported moderate psychological impact (p < 0.0001). HIP scores among women revealed that patients with abnormal Papanicolaou (Pap) test results (34.3%), precancerous lesions (46.2%), external GW (48.0%), and those without HPV-related disease (18.5%) reported moderate psychological impact (p = 0.0089) (Psychosocial impact results are reported in the Supplementary Data ). Estimated national GW prevalence, diagnosis, and treatment costs in India were higher for men than for women. GW in men and HPV infection in women had a negative psychosocial impact on well-being and health-related quality of life (HRQoL) scores, especially among women diagnosed with GW and precancerous lesions compared to those with other selected HPV-related diseases. Despite its limitations, this study provides an estimation of GW data in India not previously available.

Multiple acquired smooth muscle hamartomas with thick-walled blood vessels on scalp.

Smooth muscle hamartoma (SMH) is a benign hamartomatous condition that consists of a dermal proliferation of smooth muscle cells. We hereby report a case of multiple, acquired SMHs on scalp. A 25-year-old male had a 6-year history of multiple, asymptomatic, hyperpigmented plaques on the scalp which were progressively increasing in number and size. Histopathological examination revealed large thick-walled blood vessels, in addition to the haphazardly arranged discrete smooth muscle bundles in the reticular dermis. This case of SMH is unusual in being acquired, having multiple lesions, involving scalp, and having thick-walled blood vessels apart from arrector pili muscle bundles. It emphasizes the wide spectrum of clinical and histopathological variations that may be associated with acquired SMH.

Fibroepithelioma of Pinkus in continuity with nodular basal cell carcinoma: A rare presentation.

Fibroepithelioma of Pinkus and nodular basal cell carcinoma (BCC) are different morphological variants of BCC. It is very rare to see both the variants together in a single lesion. Here we report a case of a 56-year-old female who presented with a nodule on the trunk, which on biopsy showed features of both nodular BCC and fibroepithelioma of Pinkus.

Cutaneous tuberculosis with a difference: Documenting transfollicular elimination of granulomas.

A patient presented with a an asymptomatic brown to erythematous, scaly indurated solitary plaque on his elbow. The lesion was diagnosed as lupus vulgaris on the basis of clinical features and biopsy findings. The histopathology further revealed a granuloma within the follicular infundibulum, which was possibly being expelled out. The phenomenon of transepidermal elimination has been described previously in many conditions, including cutaneous tuberculosis; however, transfollicular elimination of the granuloma has not been reported. We report this unusual phenomenon as a possible mode of elimination of the granuloma.