The role of DNA polymerase chain reaction, culture and histopathology in the diagnosis of cutaneous tuberculosis.

BACKGROUND: Cutaneous tuberculosis (TB) is re-emerging as a significant problem in India due to increased incidence of human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), other immunosuppressive states/factors like drugs, and emergence of multidrug resistance (MDR-TB). Proper diagnosis is warranted as there is varied clinical presentation and similarity with many other diseases. OBJECTIVE: To assess the sensitivities of DNA polymerase chain reaction (PCR), culture, and histopathology for the diagnosis of cutaneous TB in clinically suspected skin lesions. METHODS: Clinically suspected cases of cutaneous TB were enrolled in the study. Two skin punch biopsies were taken from each patient and sent for histopathology examination and DNA PCR with culture, respectively. RESULTS: Of the total 70 cases enrolled, 49 were detected as cutaneous TB by the above tests. The sensitivities of DNA PCR, culture, and histopathology were 24.5, 16.3, and 91.8%, respectively. CONCLUSION: DNA PCR and culture should be advised in cases of cutaneous TB with inconclusive histopathology. DNA PCR should be considered in preference over culture if facilities are available as it gives rapid results and has a higher sensitivity.

Ulcerative Pyoderma Gangrenosum and Leukocytoclastic Vasculitis in a Hypothyroid Woman: A Case Report.

BACKGROUND: Skin ulcers, especially of the lower extremities, encompass a myriad of causes that a clinician must analyze. Case Re- port. A 45-year-old hypothyroid woman presented with a 6-year history of recurrent widespread eruptions of rashes and ulcers on her skin. She was diagnosed to have pyoderma gangrenosum and leukocytoclastic vasculitis. She was successfully managed with a novel combination of azathioprine and methotrexate. CONCLUSION: Pyoderma gangrenosum is an unusual wounding disease that makes the diagnosis and manage- ment challenging. In addition, occurrence of these 2 distinct entities together and their association with preexisting hypothyroidism is new to the scienti c literature and hence discussed here.

A randomized comparative trial of two low-dose oral isotretinoin regimens in moderate to severe acne vulgaris.

BACKGROUND: Oral isotretinoin is highly effective in all forms and grades of acne, even in lower dosages (<0.5 mg/kg/day). There is a paucity of comparative data on the various low-dose regimens of oral isotretinoin in the Indian literature. OBJECTIVES: To assess and compare the efficacy and tolerability of two low-dose oral isotretinoin treatment regimens (20 mg daily and 20 mg alternate days) in moderate to severe acne vulgaris. MATERIALS AND METHODS: A total of 240 patients with moderate to severe acne vulgaris were selected and randomized into two groups and treated with a fixed dose of 20 mg of isotretinoin (Group A - daily and Group B - alternate days) for 24 weeks and followed up for 12 weeks post therapy. RESULTS: A total of 234 patients completed the study. At the end of therapy, decrease in the total acne loads up to 98.99% (Group A) and 97.69% (Group B) was achieved from the baseline (P < 0.01), excellent response was observed in 98.3% (Group A) and 93.96% (Group B) patients (P = 0.166). In the severe acne, Group A performed significantly better than Group B until the end of 36 weeks. While in the moderate acne, significant difference in the response between both groups was observed only up to 12 weeks. No serious side effect was observed. CONCLUSION: Both isotretinoin regimens were well tolerated and found to be an effective treatment for moderate to severe acne vulgaris. However, in moderate acne 20 mg alternate day regimen may be preferred. A 20 mg daily regimen is a better choice for severe acne in terms of response. LIMITATION: Small sample size and short follow-up period.

A Sporadic Case of Ichthyosis Curth Macklin: Rare Presentation of a Rare Disease.

Ichthyosis hystrix is a rare autosomal dominant genodermatosis, characterized by persistent spiny hyperkeratotic scales which cover a significant part of the skin surface. Based on the pattern of distribution, five clinical variants namely Brocq type, Lambert type, Curth-Macklin type, Rheydt type and Bδfverstedt type have been described. We report the case of an 11-year-old male child with spiny, hyperkeratotic scales all over the body since birth with sparing of scalp and central part of the face. Palmoplantar keratoderma was also present. These clinical features are suggestive of Ichthyosis Curth Macklin, which has been typically described in families. However, family history was negative in our patient. The case is being reported on account of rarity of the disease, that too with a very rare sporadic presentation.

Hand eczema.

Hand eczema is often a chronic, multifactorial disease. It is usually related to occupational or routine household activities. Exact etiology of the disease is difficult to determine. It may become severe enough and disabling to many of patients in course of time. An estimated 2-10% of population is likely to develop hand eczema at some point of time during life. It appears to be the most common occupational skin disease, comprising 9-35% of all occupational diseases and up to 80% or more of all occupational contact dermatitis. So, it becomes important to find the exact etiology and classification of the disease and to use the appropriate preventive and treatment measures. Despite its importance in the dermatological practice, very few Indian studies have been done till date to investigate the epidemiological trends, etiology, and treatment options for hand eczema. In this review, we tried to find the etiology, epidemiology, and available treatment modalities for chronic hand eczema patients.

Oral isotretinoin in different dose regimens for acne vulgaris: a randomized comparative trial.

BACKGROUND: Oral isotretinoin is recommended for severe nodulocystic acne in the doses of 1-2 mg/kg/day which is usually associated with higher incidence of adverse effects. To reduce the incidence of side-effects and to make it more cost-effective, the lower dose regimen of isotretinoin has been used. AIM: To compare the efficacy and tolerability of oral isotretinoin in daily, alternate, pulse and low-dose regimens in acne of all types and also to assess whether it can be used for mild and moderate acne also. METHODS: One hundred and twenty patients with acne were randomized into four different treatment regimens each consisting of 30 patients. Group A was prescribed isotretinoin 1 mg/kg/day, Group B 1 mg/kg alternate day, Group C 1 mg/kg/day for one week/four weeks and Group D 20 mg every alternate day for 16 weeks. Patients were further followed for eight weeks to see any relapse. Side-effects were also recorded. RESULTS: Though the daily high dose treatment Group A performed better initially at eight weeks, at the end of therapy at 16 weeks results were comparable in Group A , B and D. Patients with severe acne did better in Group A than in Group B, C and D. Patients with mild acne had almost similar results in all the groups while patients with moderate acne did better in Group A, B and D. Frequency and severity of treatment-related side-effects were significantly higher in treatment Group A as compared to Group B, C and D. CONCLUSION: We conclude that for severe acne either conventional high doses of isotretinoin may be used or we can give conventional high dose for initial eight weeks and later maintain on low doses. Use of isotretinoin should be considered in mild to moderate acne also, in low doses; 20 mg, alternate day seems to be an effective and safe treatment option in such cases.

Hutchinson-Gilford progeria syndrome.

Progeria is a rare genetic disorder characterized by premature aging, involving the skin, bones, heart, and blood vessels. We report a 4-year-old boy who presented with clinical manifestations of progeria. He had characteristic facies, prominent eyes, scalp and leg veins, senile look, loss of scalp hair, eyebrows and eyelashes, stunted growth, and sclerodermatous changes. The present case is reported due to its rarity.

Satellite repigmentation after punch grafting.

Punch grafting is an established treatment modality for management of localized, nonprogressive vitiligo resistant to conventional therapies.(1) In our set up, punch grafting is routinely carried out in focal vitiligo, segmental vitiligo and even in few cases of generalized vitiligo, especially when it is a serious cosmetic problem.(2) However, the procedure is adopted only when the disease is stable for a sufficient period. All patients are routinely kept on psoralen tablets and ultraviolet light exposure from sunlight (PUVA sol therapy) after 2-3 weeks of punch grafting. Interestingly, follow up of such patients revealed conspicuous repigmentation in surrounding ungrafted patches in four of the patients (out of 55 follow-up cases). Herein, this phenomenon has been aptly termed satellite repigmentation (SR). To the best of our knowledge, no other report documenting SR after punch grafting exists in the medical literature. We report the observations of these four patients.