Paraviral exanthems.

INTRODUCTION: Paraviral exanthems are skin diseases suspected to be caused by viruses, with a single virus-exanthem relationship not universally accepted. Although most paraviral exanthems are self-remitting, accurate diagnoses are important as some patients might develop complications. Some of the differential diagnoses might cause serious complications, and some paraviral exanthems might lead to complications for at-risk groups such as pregnant women. Moreover, some paraviral exanthems might be symptomatic such as the development of severe pruritus, with relief of such being crucial in the plan of management. Patients and carers of patients should also be counselled regarding the aetiologies, clinical features, and prognoses of the exanthems concerned. AREAS COVERED: We covered the clinical manifestations and managements of pityriasis rosea, pityriasis lichenoides, and Gianotti-Crosti syndrome. Expert Commentary: Most patients with pityriasis rosea do not need any active intervention. Symptomatic relief of the pruritus would be adequate. For patients with pityriasis rosea that are serious, extensive, or causing severe impacts of their quality of life, oral acyclovir could be considered. For pityriasis lichenoides, managements would be depending on the type of the exanthem such as the acute form (pityriasis lichenoides et varioliformis acuta, also known as Mucha Habermann disease) the chronic form (pityriasis lichenoides chronic Juliusberg's disease), and the febrile ulceronecrotic Mucha-Habermann disease, which is a complication of the acute form. The management of Gianotti-Crosti syndrome is mainly symptomatic. The need for long-term follow-up for chronic complications of the underlying viral infections is still controversial.

Liquid Nitrogen Cryotherapy in Recalcitrant Alopecia Areata: A Study of 11 Patients.

CONTEXT: Recalcitrant alopecia areata (AA) is not uncommon in clinical practice. In certain patients, treatment failures are known with almost every conventional therapy either singly or in combination. AIMS: To study the efficacy of liquid nitrogen (LN) cryotherapy in patients with recalcitrant AA. SUBJECTS AND METHODS: We present series of eleven patients of recalcitrant AA, who consulted us after getting no response to various modalities of treatment for 6 months. We treated them with LN cryotherapy every 2 weeks till significant hair regrowth or maximum five sittings (at 0, 2, 4, 6, and 8 weeks) whichever was earlier. Inclusion and exclusion criteria were applied. Each patient was counseled and a written consent was taken. Every session consisted of dual freeze and thaw cycles of 15 s each with a cryo unit spray. Two months of follow-up after last treatment was done to observe sustained re-growth of hair. STATISTICAL ANALYSIS USED: The clinical response was evaluated by using regrowth scale at 4(th), 8(th), and 16(th) week. RESULTS: 11 patients were recruited, one patient dropped due to inability to attend follow-ups. Remaining ten patients completed the treatment and follow-up. Out of 10 patients, five patients (50%) showed an excellent response, three (30%) had a satisfactory response, one (10%) had a fair response, and one patient (10%) had a poor response. No serious adverse effects were seen. Sustained hair regrowth was seen in 80% of patients at the 16(th) week. CONCLUSIONS: LN cryotherapy may be worth trying treatment in the management of recalcitrant AA.

Plasma cell vulvitis.

Plasma cell vulvitis is a very rare inflammatory disorder of vulva, characterized by a bright-red mucosal lesion of significant chronicity, which may be symptomatic. Very few case studies of this condition are reported in literature. We describe one such classical patient, who presented with slight dyspareunia. The diagnosis was confirmed on histopathological examination. It is important for clinicians to accurately diagnose this alarming condition in time.

Exogenous Ochronosis.

Exogenous ochronosis (EO) is a cutaneous disorder characterized by blue-black pigmentation resulting as a complication of long-term application of skin-lightening creams containing hydroquinone but may also occur due to topical contact with phenol or resorcinol in dark-skinned individuals. It can also occur following the use of systemic antimalarials such as quinine. EO is clinically and histologically similar to its endogenous counterpart viz., alkaptonuria, which, however, exhibits systemic effects and is an inherited disorder. Dermoscopy and in vivo skin reflectance confocal microscopy are noninvasive in vivo diagnostic tools. It is very difficult to treat EO, a cosmetically disfiguring and troubling disorder with disappointing treatment options.

Treatment of Postinflammatory Pigmentation Due to Acne with Q-Switched Neodymium-Doped Yttrium Aluminum Garnet In 78 Indian Cases.

BACKGROUND: Postinflammatory hyperpigmentation (PIH) is a common sequela seen in the Indian population following affliction by acne. It is psychologically extremely disturbing for the patients and can severely affect the quality of life. Very few therapeutic modalities have proved to be really efficacious in this condition. AIMS: The aim was to review our experience with 1,064-nm Q-switched neodymium-doped yttrium aluminum garnet (QSNY) laser in the treatment of PIH. MATERIALS AND METHODS: Seventy-eight patients with postacne hyperpigmentation were included in the study. They were treated with six sessions at two weekly intervals using a 1,064-nm QSNY laser. Patient and physician scores were assessed at 1 month and 3 months after the last treatment. Clinical photographs also were reviewed to determine the efficacy. Adverse effects were noted. RESULTS: Seventy percent of the patients reported significant improvement in hyperpigmentation as compared to the baseline. The majority of the adverse events were limited to mild, brief erythema. CONCLUSION: The 1,064-nm QSNY laser is an effective modality for the treatment of PIH caused by acne.

Giant pilomatricoma (pilomatrixoma) following an intramuscular injection.

We describe a young Indian male patient who developed a large solitary tumor following an intramuscular injection at the same location. The tumor was histologically proven to be a pilomatricoma. It was treated by surgical excision and there was no recurrence until one year after the operation. An alarming phenomenon following intramuscular injection is presented here for its novelty.

Matting of hair following use of a new herbal shampoo.

An Indian woman had irreversible entanglement (matting) of scalp hair following the use of a new shampoo. Previous shampoos used were well tolerated. Unaccustomed shampoo is the most likely cause, but the piling of long hair on the top of the head while shampooing and the repeated friction of combing of wet hair might both have facilitated the process of matting.