Pigmented Purpuric Dermatoses.

Pigmented purpuric dermatoses (PPD) are a group of histopathologically similar conditions that are primarily differentiated based on morphology. The basic pathological finding is a lymphocytic perivascular infiltrate with hemorrhage limited to the papillary dermis without fibrinoid necrosis of the vessels. The etiology is unknown; they run a chronic course and are fairly resistant to treatment. We present this review for the physicians to kindle interest in this not-so-uncommon entity.

Leprosy Scenario at a Tertiary-level Hospital in Navi Mumbai: A Four-year Retrospective Study.

Introduction: India was among the last few countries in the world to achieve leprosy elimination in 2005. However, wide variations in prevalence rates continue to exist across the states and regions in the country. Aims: The purpose of the study is to determine the current clinical profile of leprosy from a tertiary-level hospital in Navi Mumbai. Materials and methods: A retrospective study was done to determine the epidemiological and clinical profile of leprosy patients in a tertiary care center, MGM Medical College & Hospital, Navi Mumbai (September 2011 to August 2015). Data regarding demographic details, clinical features, investigations, treatment, and complications were analyzed. Results: In total, 207 patients were registered over a 4-year period, with male:female ratio of 2.4:1 and children (≤ 14 years) constituting 7.2%. As per Ridley Jopling classification, borderline tuberculoid leprosy was the most frequent morphologic type, seen in 45.8%, followed by borderline lepromatous (28%), lepromatous leprosy (10.1%), and other forms in 11.5%. Multibacillary leprosy was the most common clinical type (81.1%). About 32.8% patients presented in reaction (type I in 22.7% and type II in 10.1%). World Health Organization (WHO) grade 2 deformities were diagnosed in 32.8%, with claw hand being the most common paralytic deformity (18.8%). Conclusion: The study shows that despite statistical elimination, multibacillary disease, leprosy reactions, and deformities are commonly seen as presenting manifestations. Large population of migrant workers in Navi Mumbai could be a possible contributing factor towards these findings. It highlights the need to sustain and provide high-quality leprosy services to all patients through general health services, including good referral system. Investigations, such as slit skin smear and biopsy must be carried out for all newly diagnosed patients.

Peeling Palmar Skin.

A 20-year-old male presented with asymptomatic peeling of palmar skin of 1 month duration ( Fig. 1). He gave history of similar episodes since 3 years, all of which occurred during the winter season and subsided without treatment in a period of 2 to 3 months. He also complained of excessive sweating over palms. There was no personal or family history of atopy. Cutaneous examination revealed exfoliation of skin over the volar aspect of the palms and fingers. Soles were spared. Palmar hyperhidrosis was also noted. Onset in adulthood, absence of itching and/ or fluid-filled blisters, and negative KOH mount excluded dyshidrotic eczema, acral peeling skin syndrome, epidermolysis bullosa simplex, and dermatophytid and convened the diagnosis of keratolysis exfoliativa. Keratolysis exfoliativa is characterized by annular erythema with an air-filled blister arising in the center, followed by superficial collarette and lamellar peeling of glabrous palmoplantar skin. Synonyms include dyshidrosis lamellosa sicca and lamellar dyshidrosis. Emollients, urea, and lactic acid may be used; however, treatment is not necessary as the condition is asymptomatic.

Acquired Cold Urticaria: An Under-reported Entity.

Acquired cold urticaria (ACU) is a subtype of physical urticaria which may be primary (idiopathic) or secondary to underlying infections or cryoproteins. In addition to complete history and thorough physical examination, the diagnosis is dependent on a positive cold stimulation time test (CSTT) which is the minimum time of cold contact stimulation required to induce an immediate coalescent wheal. Although idiopathic type is seen in 96% of the cases, it is important to rule out cryoprotein by an intricate yet simple test for cryoprecipitate. The identification of cold exposure as the likely trigger for urticaria is vital because systemic anaphylactic reactions are common in patients with cold urticaria, occurring in roughly 1 in 3 patients. In addition to preventive counseling and avoidance of critical cold exposure, H1-receptor antagonists form the first line of treatment. However resistant cases may require cyclosporine, danazol or omalizumab. No individual case reports of ACU appear in Indian literature. Therefore, the authors attempt to highlight the diagnostic work-up and therapeutic options for this not so uncommon cause of chronic urticaria.

Non-mycosis Peripheral T-Cell non-Hodgkin Lymphoma involving the Skin.

A 64 years old male presented with reddish lesions all over the body of 1 month duration, high grade fever with evening rise of temperature and chills. No lymphadenopathy or hepatosplenomegaly were noted. Multiple infiltrated erythematous and hyperpigmented patches and plaques were present on the face, trunk and extremities along with few oral erosions. Histopathology from skin showed features of mycosis fungoides (MF). A further workup with Immunohistochemistry was suggestive of peri pheral T-cell lymphoma, not otherwise specified diag nosis (PTCLNOS). We report a case of PTCLNOS in a man mimicking MF clinically and histopathologically.

Metabolic and Cardiovascular Comorbidities in Psoriasis: Revisited.

There is increasing awareness that psoriasis, as a disease, is more than ‘skin deep’ and associated with comorbidities that potentially increase morbidity and mortality, and lower quality of life. The consistency of association and the diversity of comorbidities reported in psoriasis warrants it to be labeled as a complex syndrome. Merely finding an association between psoriasis and comorbidities is not going to suffice until this evidence is put into clinical practice. The pathogenesis of psoriasis and its comorbidities is complex but several studies have revealed certain mechanisms and factors which are common to both. These shared pathogenic mechanisms solve the mystery to this comorbid association, especially with metabolic syndrome and cardiovascular disease. Studying these pathogenic links may reveal certain parameters which can be utilized as potential biomarkers in the presumptive screening of patients for the presence of comorbidities. These shared pathogenic mechanisms hold the key toward establishing a novel biomarker which can monitor both the disease severity and the associated comorbidity. Psoriasis patients with comorbidities also incur more healthcare costs, than those without comorbidities. Cardiovascular comorbidity in psoriasis incurs the greatest increase in healthcare resource use. Early detection of cardiovascular and other comorbid conditions in psoriasis can possibly reduce the morbidity, mortality, and economic burden associated with the disease. We attempt to review the pathogenic links between psoriasis and its metabolic and cardiovascular comorbidities.