Hand eczema: correlation of morphologic patterns, atopy, contact sensitization and disease severity.

BACKGROUND: Hand eczema is a common distressing condition aggravated by a number of endogenous and exogenous factors. Various morphological forms of hand eczema have been described, but categorization into one of them is not always possible. AIMS: To study the morphological patterns of hand eczema, relationship of atopy with hand eczema, and the implications of contact sensitization with respect to severity and diagnosis of hand eczema. METHODS: Hundred consecutive patients of hand eczema attending the contact dermatitis clinic of the institute were recruited over a two year period from 2004-05. Objective assessment was done using hand eczema severity index (HECSI) and all the patients were patch tested using Indian standard series. RESULTS: Unspecified type of hand eczema with no definite morphologic picture was seen in 62% followed by pompholyx in 14%. Hand eczema severity was not found to be statistically associated with age, sex, and atopic status of the patient. Positive patch test to one or more allergen was present in 65% of patients. The most common allergens were potassium dichromate (25%), fragrance mix (16%), nickel sulphate (14%), and PPD (13%). There was no significant correlation between patch test positivity and hand eczema severity or atopic status of the patient. Among the morphological patterns pompholyx was strongly associated with an atopic status (P=0.004). CONCLUSIONS: Hand eczema was seen twice more commonly in men. Atopic and non-atopic patients of hand eczema had no difference in the severity of disease. Contact sensitivity to different allergens did not correlate with increased eczema severity.

Patterns of lower leg and foot eczema in South India.

BACKGROUND: The pattern of eczema is altered by geography, habits of people and environmental factors and regional variation in skin structure and function. AIMS: Our study was done to estimate frequency and patterns of lower leg and foot eczemas. METHODS: A total of 200 patients with various types of lower leg and foot eczemas were recruited over a period of 2 years. Demographic and clinical characteristics were noted. Suspected cases of allergic contact dermatitis were patch tested. RESULTS: The frequency of these eczemas was 2.5 per 1000 out patients. Mean age of patients was 40.49 years. Female to male ratio was 1.6:1. Sixty (30%) patients were farmers, sixty (30%) were housewives, forty (20%) were students, nineteen (9.5%) were daily laborers, nine had sedentary jobs and three were teachers. Most eczemas were bilateral (72%). Mean duration of eczema was 36.6 months. Most common type of eczema was lichen simplex chronicus (36%) followed by discoid eczema (18.5%), allergic contact dermatitis (14.5%) and stasis eczema (7.5%). Other eczemas noted were juvenile plantar dermatosis, cumulative irritant contact dermatitis, infected eczema, hyperkeratotic eczema, asteatotic eczema, pompholyx, infective eczema and unclassified endogenous eczema. Common sites of involvement were dorsa of feet (49.5%), followed by lateral aspect of lower leg (31%), medial aspect of lower leg (17.5%) and ankle (12%). CONCLUSION: Our study highlights lichen simplex chronicus as the most common eczema affecting the lower legs and feet.

Post-kala-azar dermal leishmaniasis in Nepal.

BACKGROUND: Post-kala-azar dermal leishmaniasis (PKDL) manifests as a skin eruption after healing of visceral leishmaniasis (VL), either spontaneously or as a result of treatment. This study was undertaken to describe the demographic, clinical, and histopathologic features of PKDL in Nepal. METHODS: Demographic, clinical, microbiologic, and histopathologic features and response to treatment were studied in 22 patients with PKDL from April 1998 to March 2000. RESULTS: PKDL accounted for 0.13% of all new dermatologic cases. There were 13 (59.1%) males and nine (40.9%) females. A past history of kala-azar was present in all but one patient. A family history of kala-azar was noted in eight (36.4%) patients. All patients presented with multiple types of lesion, except for two in whom only macular lesions were seen. Oral lesions in the form of nodules and plaques were seen in four patients. Generalized lymphadenopathy was present in five patients. Slit skin smears revealed Leishman-Donovan bodies (LDBs) in nine (40.9%) patients. In macular lesions, there was a sparse infiltrate of plasma cells, lymphocytes, or histiocytes in the upper dermis. There was a dense chronic inflammatory infiltrate comprising plasma cells, lymphocytes, histiocytes, and epithelioid cells in the entire dermis from papules, plaques, or nodules. Giemsa staining of biopsy specimens revealed LDBs in seven (38.9%) patients only. Fine needle aspiration from epitrochlear lymph nodes in two patients demonstrated LDBs. All patients responded well to treatment with minimal side-effects. CONCLUSIONS: This study emphasizes the need to be aware of the possibility of cases of PKDL in endemic regions of leprosy, as the conditions may be difficult to distinguish clinically and histopathologically.