Neurofibromatosis I with unusual hypopigmentation masquerading as leprosy.

A case of Neurofibromatosis I (NFI) occurring in association with symmetrical peripheral nerve enlargement and multiple hypopigmented macules strikingly limited to the neurofibromas, with normal to minimally reduced sensations, evoking a strong clinical suspicion of co-existent lepromatous leprosy, is being reported. Leprosy was ruled out by microbiological, histopathological and electrophysiological studies. The case is interesting in view of the hypopigmented macules overlying the neurofibromas, which is an unreported feature of NFI.

Childhood leprosy in eastern Nepal: a hospital-based study.

A hospital-based retrospective study on childhood leprosy was carried out at B.R. Koirala Institute of Health Sciences, Dharan, covering the period April 1998-April 2002. 20 (4.45%) leprosy patients were detected in children aged 6-14 years. The male:female ratio was 4:1. History of contact was found in 10% of the patients. The commonest type of leprosy was borderline tuberculoid leprosy (550%), followed by borderline lepromatous leprosy (301%). Most of the patients had more than one lesion. Nerve involvement and grade 2 deformity were noted in 55% and 20% of the patients respectively. Slit skin smear was positive in 30% of patients.

Long term topical application of lactic acid/lactate lotion as a preventive treatment for acne vulgaris.

In an open clinical study, efficacy of 5% aqueous solution of lactate for preventing acne was evaluated in 22 patients. Lactate lotion was used topically all over the face twice a day and continued like a cosmetic for 1 year. Systematic antibiotics were given for periods of 4 weeks whenever the disease was severe. The effect of the treatment was evaluated by counting the number of comedones, inflammatory lesions and cysts separately once a month and recording them graphically. The greatest reduction in the lesion counts was achieved in 8-24 weeks for the inflammatory lesions and 8-30 weeks for the comedones. At the end of 1 year 90-100% reduction of the inflammatory lesions was achieved in 40.9% patients and non-inflammatory lesions in 22.7% patients. The remaining patients showed 50-90% reduction, while 2 patients showed less than 50% reduction in the non-inflammatory lesions. Thus, most of the patients showed significant reduction in the lesion counts. Aggravations were associated with the hot and the rainy season and required concomitant treatment with oral antibiotics.

Primary cutaneous amyloidosis involving the external ears along with the classical sites.

A 26-year-old woman had multiple itchy persistent gradually progressive papular lesions on the forearms and shins for 10 and 4 years respectively. She also noticed similar lesions on both the ears for 4 years. There were no systemic symptoms. Cutaneous examination revealed multiple 2-3 mm discrete firm hyperpigmented papules on the extensors of forearms, shins and earlobes. Skin biopsy from all sites demonstrated deposits of amyloid in the papillary dermis. The patient was treated with cyclophosphamide 50 mg daily orally. There was more than 50% improvement in her lesions.

Azathioprine as a therapeutic modality for the treatment of severe adult atopic dermatitis.

Atopic dermatitis is a difficult disease to treat. A few reports suggest that azathioprine may be effective in the treatment of atopic dermatitis. We therefore, evaluated the role of azathioprine in adult atopic dermatitis not adequately controlled with conventional therapy. Four patients of adult atopic dermatitis were treated with azathioprine 50 mg twice daily orally for 3-4 months. All the patients had complete remission after therapy. There were no significant side effects. Therefore, azathioprine can be considered a better and safer alternative drug in recalcitrant adult atopic dermatitis.

Multiple lichen striatus--an unusual presentation.

A 2-year-old mare child presented with multiple hypopigmented, flat topped papules with a bilateral distribution along the lines of Blaschko. A 7-year-old girl presented with multiple hypopigmented macules arranged linearly along the left upper and lower limb and also on the back along the lines of Blaschko. Three discrete lines in three distinct anatomical areas in a case of lichen striatus do not appear to have been described.

Extensive facial angiofibromas in tuberous sclerosis treated with carbon dioxide laserbrasion.

Facial angiofibromas in systemic sclerosis cause significant cosmetic disfigurement and emotional distress. The treatment of these lesions have been a challenge because of the multiplicity of the lesions and the presence of the lesions at anatomically difficult sites. Four female patients between 12-22 years in age with extensive angiofibromas on face, nasolabial folds and chin for 2-10 years were treated with carbon dioxide (CO2) laser. The lesions in all patients were vaporized with the indigenously developed CO2 laser. All the patients were evaluated at 1 and 2 weeks and then every month for 6 months to assess the overall response to treatment and side effects. All the patients responded to the treatment and had an improvement of 50-80%. Transient erythema and hypopigmentation were seen in all the patients while post laser hyperpigmentation was seen in 2 patients. There were no other significant side effects. CO2 laser seems to be a good therapeutic tool for the treatment of extensive facial angiofibromas with good, cosmetically acceptable results even in dark (brown) skin patients with negligible side effects and minimal recurrences.

Lichen planus treated with betamethasone oral mini-pulse therapy.

Ten Patients, 6 males and 4 females between 7-60 years of age having lichen planus for I month to 2 years were treated with betamethasone 5mg orally on two consecutive days in a week for 3 months. There was excellent (75-100%) response in 6 (60%) patients and good (50-75%) in 4 (40%) patients. None of the patients had significant side effects of the therapy and there were no treat-ment failures. Betamethasone on two consecutive days in a week as oral mini pulse therapy may be a safe, effective and a better therapeutic alternative for the treatment of lichen planus.

Failure of pentoxifylline to affect air- borne contact dermatitis caused by parthenium.

Twelve patients, 9 males and 3 females between 22 to 65 years in age having air-borne contact dermatitis (ABCD) for 6 months to 12 years were included in this study. The diagnosis in each patient was confirmed by patch tests. Six of these patients (group I) were treated with pentoxifylline 400 mg three times a day orally in addition to topical clobetasol propionate and oral betamethasone 1.0 to 2.0 mg per day for 5 to 10 weeks. The other 6 patients (group II) were given the same treatment for the same duration but without pentoxifylline. The response to the treatment in both the groups was almost the same. The patients treated with pentoxifylline did not have any added benefit. There were no significant side effects of the therapy in either of the groups.

Lepromatous leprosy presenting as a swelling in the neck.

A 25-year-old electrician presented with gradually, asymptomatic swelling on left of the neck since 2 years. The swelling which was initially diagnosed as cervical lymphadenitis by the internist represented the enlarged left great auricular nerve. Cutaneous examination revealed an ill-defined, hypoaesthetic macule with minimal atrophy on the pinna of the left ear. The histopathology of the nerve showed a lepromatous neuritis with bacteriological index (BI) of 5+.

Disseminated malignant melanoma.

A 25-year-old man had multiple asymptomatic, nodular lesions on the trunk, extremities and the face for 3 months. He also had left facial palsy with severe headache and vomiting. There were no other systemic or constitutional symptoms. Skin biopsy from a nodular lesion showed features of malignant melanoma, confirmed by Fontana Masson and S-100 protein staining. A diagnosis of disseminated malignant melanoma was made and the patient was treated symptomatically. The patient died in 4 months.

Olmsted syndrome.

A 20-year-old Sikh man had palmoplantar keratoderma, flexion deformity of digits, universal alopecia, keratotic plaques at the angles of mouth, gluteal cleft, knees and dorsal aspects of the metacarpophalangeal joints of the hand; features of Olmsted syndrome. He had normal nails, teeth, oral mucosa and normal joint movements. Treatment with acitretin, 25mg/day for three and a half months, followed by 25mg once daily alternating with 50mg once daily for 3 months resulted in significant improvement.

Azathioprine as a corticosteroid-sparing agent in air-borne contact dermatitis.

Two patients having air-borne contact dermatitis (ABCD) caused by Parthenium hysterophorus.for 10 and 15 years respectively and without having had complete remissions in spite of oral betamethasone in a dose of 2-3 mg per day, experienced complete relief while taking 50-100 mg azathioprine for 5 and 12 weeks without having to take systemic corticosteroids. There were no side effects of azathioprine. With further experience and standardization of the treatment schedule, it may be possible to use azathioprine as a corticosteroid-sparing agent to reduce the side effects of corticosteroids in patients having ABCD.

Tuberculosis verrucosa cutis of the scrotum.

A 13-year-old boy had asymptomatic slowly progressive warty growth on the scrotum for 4 years. Examination revealed a 4 cm x 2 cm keratotic, nontender, indurated plaque on the right side of the scrotum. Histopathological examination of the lesion showed epithelioid cell granuloma with giant cells and lymphocytes in the dermis. Mantoux test was 15 mm x 20 mm. A diagnosis of tuberculosis verrucosa cutis of the scrotum was made. Six months of therapy with INH 150 mg and rifampicin 300 mg daily resulted in complete clearance of the lesion.

Air-borne contact dermatitis caused exclusively by xanthium strumarium.

Most cases having air-borne contact dermatitis (ABCD) in India are considered to be caused by Parthenium hysterophorus. In some cases however, other plants have also been noticed to give positive patch test reactions. We are reporting two cases presenting as ABCD who showed positive patch tests with Xanthium strumarium while the patch tests with Parthenium hysterophorus were negative. It is therefore necessary to realise that every case of ABCD is not caused by Parthenium, and patch testing with Parthenium alone can lead to serious mistakes.

Psychiatric morbidity in displaced leprosy patients.

One hundred confirmed leprosy patients, all of them migrated from elsewhere, were examined for psychiatric co-morbidity. Forty-six of them were from an 'ashram' and the others were from a slum area. 76% of the patients were found to be having psychiatric illness. Of these, 55% were having neurotic depression and 21% had anxiety neurosis. Single, unemployed, socio-economically backward and patients with physical deformities were suffering significantly more often with psychiatric symptoms. Psychiatric morbidity was found to be more frequent in the patients staying in slum than in those in the 'ashram' where they had some security.

Effect of rehabilitation on the prevalence of psychiatric morbidity among leprosy patients.

A hundred patients with leprosy were studied; forty six patients were rehabilitated and staying in an ashram while the remaining fifty four were not rehabilitated and staying in slum areas. A11 the patients were administered Goldberg's General Health Questionnaire (GHQ) and those who scored more than 12 on the GHQ were administered Indian Psychiatric Interview Schedule (IPIS). The diagnosis of psychiatric illness was made according to ICD-9. Psychiatric morbidity was present in 76% of patients, with a statistically significant difference between the non rehabilitated group (85%) and rehabilitated groups (68%). It was noted that even rehabilitated patients expressed very high psychiatric symptomatology. Neurotic depression was present in about 67% of non rehabilitated and 41% of rehabilitated patients. Anxiety neurosis was reported in approximately 18% of non rehabilitated and 24% of rehabilitated patients. No other psychiatric illness was found.