Atypical Morphology of a Typical Mycobacterial Infection.

A-24-year-old woman reported with asymptomatic facial lesions present for 6 months. Examination revealed two closely located nodules which were firm, nontender, slightly erythematosus with crusting over the left cheek (Figure 1A). There was no regional lymphadenopathy, and the systemic examination was within normal limits. The differential diagnosis included cutaneous leishmaniasis, keratoacanthoma, and basal cell carcinoma. Tissue smear from nodules failed to reveal Leishmania donovan bodies. The histopathologic examination revealed nonca-seating epithelioid granulomas with lymphocyte cuffing in the dermis (Figures 2A and 2B). Special staining performed with Ziehl-Neelsen and Periodic acid-Schiff (PAS) stains was negative. Tissue cultures for bacteria, mycobacteria, and fungi were also negative; however Mantoux test (MT) performed for latent tuberculosis was strongly positive. Sputum for acid fast bacilli was negative, and serology for human immuno-deficiency virus (HIV)-1 and HIV-2 was nonreactive. A chest x-ray and ultrasound of the abdomen did not reveal any abnormality. Although the morphology of skin lesions did not favor classic lupus vulgaris (LV), considering the endemicity of tuberculosis in India, positive results of Mantoux test, and a dermal epithelioid granuloma, the patient was prescribed antitubercular therapy (ATT), comprising isoniazid, rifampicin, ethambutol, and pyrazinamide. Dramatic response was observed after 2 months, and complete healing with residual scarring took place in next 4 months (Figure 1B).

Update in the Uses of Chalazion Clamp in Dermatological Procedure Revisited.

Chalazion clamp has a distal tip with a flat oval plate; other side has a ring-like structure and forceps-like handle. Handle has a thumbscrew, which can be tightened and released so as to achieve the required pressure. Available in various sizes. Used mainly in ophthalmological procedures primarily. Used in dermatology by modifying its technique and creating an adequate hemostasis in various diagnostic and interventional procedures. In the previous article chalazion clamp was used for preparing SSS for ear lobule, so this article revisited the uses of chalazion clamp in dermatology and extended use in the preparation of adequate blanching while preparing SSS from the peripheral tissue site.

An old entity, a new trigger: Post COVID-19 vaccine pityriasis rubra pilaris.

BACKGROUND: Pityriasis rubra pilaris (PRP) is a rare, acquired, chronic papulosquamous dermatosis which can occur in all ages. PRP can be associated with infection, autoimmunity, drugs and malignancies, and can be idiopathic. OBJECTIVE: PRP following vaccination has been rarely described in the literature. To the best of our knowledge, we report the first case of PRP two weeks following COVID-19 vaccination (Covishield). CASE REPORT: A 72-year-old male presented to the outpatient dermatology department at All India Institute of Medical Sciences - Bhopal with minimally pruritic superficial plaques since one week. The patient was vaccinated against COVID-19 with Covishield two weeks earlier. The lesions developed as erythematous scaly follicular papules and plaques over axilla that rapidly spread to the trunk in the following weeks and involved palms and soles as well as thickening and fissuring. The clinical features suggested PRP. The histopathology showed epidermal acanthosis with hypergranulosis alternating with parakeratosis and orthokeratosis with broad rete ridges with follicular plugging. The patient had started taking topical corticosteroids and emollients, which proved effective. There was no recurrence after receiving a second dose on follow-up. CONCLUSION: In patients presenting with new onset PRP in this COVID-19 era, the possibility of vaccine as a trigger should be taken into consideration, and further dosing should be carefully monitored in view of possible recurrence.

Nonisomorphic and Nonisotopic Multidermatomal Discoid Lupus Erythematosus - A Rare Subtype of Cutaneous Lupus Erythematosus.

Discoid lupus erythematosus (DLE) is the most common variant of chronic cutaneous lupus erythematosus. Several cases of Blaschko-linear lupus erythematosus, which is regarded as a distinct subtype of lupus erythematosus, have been reported across the globe. Dermatomal involvement in DLE is rare and that too has been reported in patients of systemic lupus erythematosus at site of healed herpes zoster either as an isomorphic or isotopic phenomenon. Here, we report a case of DLE on account of its unusual morphology, de novo multidermatomal configuration, without previous episode of herpes zoster or trauma.