Nails in systemic disease.

Nail abnormalities secondary to systemic disease could be classified as nail abnormalities associated with systemic disease, disease of specific organ system or associated with syndromes and genodermatoses. Because nail findings are easily observable and yield valuable information, careful examination of nails could be an important diagnostic tool for a dermatologist. A brief review of the common and not so common nail changes in systemic illness is presented.

Immune zones in leprosy.

Leprosy affects mainly those areas of skin which have a relatively lower temperature and are more exposed to trauma. Certain zones like scalp, palms and soles, genitalia, groins, axillae, eyelids, transverse band of skin over lumboscaral area, midline of back and perineum have been described to be immune to the development of lesions in leprosy. But clinical, histological and bacteriological evidence of involvement of these so called immune zones though infrequent have been documented. Hence, these immune zones should be termed as relatively immune, rather than absolutely immune zones of leprosy.

Affection of immune zones in leprosy: a clinico-epidemiological study.

The study was undertaken to evaluate the prevalence of involvement of immune zones in leprosy and to assess the clinico-epidemiological characteristics of the disease in patients presenting with immune zone involvement. 200 leprosy cases were included in this study and detailed history, clinical examination, slit-skin smears and skin biopsies were carried out on all patients. Those cases presenting with immune zone involvement were further evaluated for clinical and epidemiological characteristics of disease process. Immune zone involvement was detected in 7% of cases with male preponderance in the study. Majority of patients (85.5%) had borderline tuberculoid leprosy and midline of back was the commonest site of involvement (50% of cases). Morphologically, macular lesions were the commonest presentation (85.68%) of immune zone involvement. The study heightens the clinical awareness of the possibility of occurrence of leprous lesions on uncommon and unusual sites, which should be termed as relatively immune, rather than absolutely immune zones of leprosy.

CD-3 positive extranodal T-cell lymphoma of nasal type with skin involvement.

A 40-year-old previously healthy lady presented with nasal obstruction and localized plaques over the right arm. She developed complete nasal obstruction due to a mass in the right nasal cavity and skin lesions that ulcerated to present as ecthyma gangrenosum like lesions. Patient's condition deteriorated fast and she developed icterus with fatal outcome within 4 weeks of developing skin lesions. Nasal and skin biopsy revealed angiocentric T-cell lymphoma, which on immuno-phenotyping revealed CD-3 positive; and CD-20, CD-30, ALK and EMA negativity. She was seronegative for HIV. Final diagnosis of CD-3 positive extranodal T-cell lymphoma of nasal type was made. Extranodal T-cell lymphomas are very aggressive NHLs with poor prognosis. Prognosis depends on histology, stage of the disease and sites of involvement. NK/T cell lymphoma of nasal type is common with EBV association. Skin involvement is rare and is also an indicator of poor prognosis.

Stigma experience in skin disorders: an Indian perspective.

Dermatologic disorders generally have a major impact on patients' daily activities, psychologic and emotional state, and social relationships. The intensity of impact of skin disease on an individual person is extremely variable, however, and depends on natural history of the disorder; the patient's demographic characteristics, personality, character, and value; the patient's life situation; and the attitudes of society. Social stigma toward dermatologic disorders in the Indian society is quite widespread, especially toward leprosy. Dermatologists are expected to consider quality of life issues along with social aspects, nature of disorder, efficacy, and tolerability of various therapeutic options to optimize relief and comfort to their patient.

A comparative evaluation of skin and nerve histopathology in single skin lesion leprosy.

BACKGROUND: In spite of leprosy being a disease of nerves, ROM therapy for single skin lesion leprosy was based on clinical trials without much evidence-based studies of nerve pathology. The present study was undertaken to compare the histology of skin and nerve in single skin lesion leprosy, and to assess the scientific rationale and justification of single dose ROM therapy. METHODS: Twenty-seven untreated patients with single skin lesion without significantly thickened peripheral nerves were selected. Skin and nearby pure cutaneous nerve biopsies were studied under both H&E and Fite's stain. RESULTS: All the skin biopsies were negative for AFB and clinico-pathological correlation was positive in 51.85% of skin biopsy specimens. Histopathological diagnosis of leprosy was evident in 55.5% of clinically normal looking nerves, with AFB positivity in 29.6% of nerve biopsy specimens. Correlation between clinical diagnosis and nerve histopathology was poor (26%). CONCLUSIONS: Single skin lesion without thickened peripheral nerves as criteria for single dose ROM therapy is not logical, since the histological diagnosis of leprosy in normal looking nerves with presence of AFB is revealed in this study. Pure cutaneous nerve biopsy is a simple outpatient procedure, without complications. This study emphasizes the need to consider nerve pathology as an important tool for further therapeutic recommendations, than just clinical trials and skin pathology alone. Though single dose ROM therapy has been withdrawn recently, the principle holds good for any future therapeutic recommendations.

Nail changes and disorders among the elderly.

Nail disorders are frequent among the geriatric population. This is due in part to the impaired circulation and in particular, susceptibility of the senile nail to fungal infections, faulty biomechanics, neoplasms, concurrent dermatological or systemic diseases, and related treatments. With aging, the rate of growth, color, contour, surface, thickness, chemical composition and histology of the nail unit change. Age associated disorders include brittle nails, trachyonychia, onychauxis, pachyonychia, onychogryphosis, onychophosis, onychoclavus, onychocryptosis, onycholysis, infections, infestations, splinter hemorrhages, subungual hematoma, subungual exostosis and malignancies. Awareness of the symptoms, signs and treatment options for these changes and disorders will enable us to assess and manage the conditions involving the nails of this large and growing segment of the population in a better way.