Lucio Phenomenon: An Unusual Case of Skin Necrosis.

Introduction: Lucio leprosy is a non-nodular diffuse type of lepromatous leprosy first described by Lucio and Alvarado. Lucio phenomenon is a rare vasculonecrotic reaction characterized by cutaneous necrosis with minimal constitutional features. Case Presentation: We describe an unusual case of a 53-year-old man from Central India who had blisters, ulcers, and widespread erosions on his foot, forearms, and arms. The diagnosis of lepromatous leprosy with the Lucio phenomenon was established after thorough evaluation by clinical findings, histopathological findings, and slit-skin smear examination. Conclusion: Lucio phenomenon is an uncommon cause of cutaneous infarction and necrosis. Primary care physicians should keep a high index of suspicion in patients with cutaneous necrosis and minimal constitution features. Since leprosy is a relatively curable disease, primary care physicians should think of a rare form of lepromatous leprosy presenting with cutaneous necrosis, especially in non-endemic zones.

Efficacy of salicylic acid peel in dermatophytosis.

BACKGROUND: Treatment of dermatophytosis is becoming costlier and challenging. AIMS AND OBJECTIVES: To study the efficacy of salicylic acid peel in dermatophytosis. METHODS: Twenty-five patients (20 males and 5 females) having dermatophytosis with positive potassium hydroxide (KOH) mounts were enrolled in the study. Salicylic acid 30% was applied over the lesions weekly for 4 weeks, thereafter patients were followed up weekly for 4 weeks. RESULTS: Of the 25 patients, 22 (88%) patients showed clinical and microbiological cure 1 week after the last application, while the remaining 3 patients were nonresponders. Nine (41%) patients of the 22 responders showed recurrences indicating that 4 weeks' treatment is not sufficient in some patients to eradicate fungus and may require longer treatment. LIMITATIONS: A relatively small sample size and lack of long-term follow-up are the shortcomings of our study. CONCLUSION: Salicylic acid peel is a cheap and useful option in the treatment of dermatophytic infection.

Angiolymphoid hyperplasia with arterial ectasia and arteriovenous malformation: Response to intra-arterial embolization.

Angiolymphoid hyperplasia with eosinophilia is a rare disease characterized by vascular proliferation of unknown origin. The lesions are mostly seen in the head and neck region and are characterized by papules or nodules. A 20-year-old man presented with a 1 year history of reddish papulo-nodular lesions overlying a pulsatile swelling on the left auricular area. Histopathology was suggestive of angiolymphoid hyperplasia with eosinophilia. B-mode ultrasonography, color Doppler and angiography revealed arterial ectasia and arteriovenous malformation of the left auricular artery. Such malformations have been reported previously, in association with angiolymphoid hyperplasia with eosinophilia. The cutaneous lesions responded well to transarterial embolization of the nidus.

Immunotherapy using purified protein derivative in the treatment of warts: An open uncontrolled trial.

BACKGROUND: Warts are known to clear spontaneously with the development of cell-mediated immunity (CMI) to the virus. Purified protein derivative (PPD) of tuberculin bacilli has been used as a non-specific stimulant of CMI to achieve this outcome. AIM: To study the effect of PPD in the treatment of warts. METHODS: Patients with difficult-to-treat warts were selected for immunotherapy. Each patient received 2.5 TU of PPD intralesionally in a few warts. A total of four sessions were given at 2 weekly intervals and patients were followed up for 6 months after the last dose. RESULTS: Sixty-one patients were recruited of which 55 completed 6 months follow up and were available for analysis. Of these, 25 had verruca vulgaris, 18 had verruca plana and 12 had plantar warts. Forty two (76%) patients showed complete clearance after four sessions while the remaining 13 (24%) patients were non-responders. One patient developed a recurrence after total clearance during the follow-up period. Adverse effects were erythema, edema and pain at the site of injections. LIMITATIONS: As this was an uncontrolled trial, there is no comparison with a non-intervention group. Also, a Mantoux test was not done due to practical difficulties. CONCLUSION: Immunotherapy with PPD is helpful in the treatment of cutaneous warts.

Primary systemic amyloidosis: three different presentations.

Primary systemic amyloidosis is a rare disease. We report three cases of primary systemic amyloidosis, one case with multiple myeloma and two cases without any hematological abnormality. Purpuric lesions were the only presenting symptoms of the patient with multiple myeloma and only on investigation, myeloma was detected. Bone marrow biopsy and serum and urine electrophoresis were normal in remaining two cases. These two patients presented with typical waxy lesions on face. Cutis verticis gyrata was present in one case and carpal tunnel syndrome was seen in other case as an additional diagnostic clue. Macroglossia was present in all three cases. Diagnosis was confirmed in all three cases by biopsy using haematoxylin and eosin staining and Congo red staining. Polarized microscopy was not done because of unavailability.

Hand, foot and mouth disease in Nagpur.

Hand, foot and mouth disease (HFMD) is a viral infection of children caused by Coxsackie virus-A16, a type of enterovirus closely related with the virus that causes herpangina. Although seen worldwide, it is not common in India. Hand, foot and mouth disease is sporadically reported from India as a mild illness. This report describes four cases of HFMD from Nagpur, Central India, seen between September 2005 and April 2006. All patients presented with a mild febrile prodrome followed by the appearance of aphthous-like oral ulcers and vesicular lesions on the hands and feet. All cases were clinically diagnosed. Coxsackie virus A16 was isolated from the serum of one of the patients. All the patients were in the age group of 3-5 years from different schools. It was a mild illness and all the four patients recovered without any complication. There were no secondary cases in the families.

Premature ovarian failure due to cyclophosphamide: a report of four cases in dermatology practice.

Immunosuppressant drugs like cyclophosphamide are used in the treatment of a variety of skin disorders. Though it is a very useful drug, it has some serious side-effects. Prolonged amenorrhea due to premature ovarian failure leading to infertility is one of the serious side-effects of cyclophosphamide. Four cases of cyclophosphamide-induced premature ovarian failure are presented. Two patients of scleroderma, one patient of pemphigus and one patient of hypersensitivity vasculitis developed amenorrhea due to premature ovarian failure leading to infertility after receiving cyclophosphamide 50 mg o.d. for eight months to one year. The ages of these patients ranged from 28-38 years. All these patients had good improvement of their disease with cyclophosphamide. These patients did not experience any other side-effects and their routine blood and urine tests were normal. There were no spontaneous menses during the follow-up period of one to two years. Because of the serious risk of developing premature ovarian failure, cyclophosphamide should be avoided in those patients where the family is not complete.

Herpes labials and genitalis in a hiv positive patient.

A 22-year-old man who was HIV positive, presented with recurrent oral and genital losions simultaneously.