Neurocristic Hamartoma With Lymph Node Involvement: A Diagnostic Dilemma.

Neurocristic hamartoma (NH) is a rare dermal melanocytic lesion that is formed due to the aberrant development of neural crest-derived melanocytes during their course of migration through the dermis at the time of embryogenesis. Here, we describe a case of NH in a 6-year-old boy who clinically presented with diffuse plaque-type blue nevus on his scalp with a contiguous extension into the cervical region and lymph node involvement. A subcutaneous nodule displaying a marked histological heterogeneity with lymph node involvement is a very unusual and diagnostically challenging presentation of NH. The importance of an accurate diagnosis of NH lies in the fact that malignant transformation can rarely occur within these lesions over an unpredictable time course and remain undetected, rendering clinical management difficult. Although our child had a benign course after a follow-up of 5 years despite lymph node involvement, the possible risk of development of malignant melanoma in such a lesion warrants long-term surveillance. This case report highlights the unusual clinical presentation and histopathological features of this rare entity along with a relevant review of the literature. The present case also underscores the concept that sentinel lymph node involvement in certain melanocytic lesions in children must not be mistaken for malignant melanoma.

Back pain, lower limb immobility and ulcers as indicators of abdominal aorta occlusion below the origin of renal arteries, Leriche syndrome.

A 33-year-old female, presented with fever, lower limb ulcers and severe backache. The present history evolved four weeks after the complaints of claudication of buttocks, thighs and calves. Lower limb arterial pulsations were not detectable. Colour Doppler and Computed Tomograph (CT) Angiography revealed blockage of abdominal aorta below the origin of renal arteries. The cause of the fever, lower limb ulcers and cruciate backache could be related to this occlusion. This obstruction which was first described by Leriche and is not known to endow with such perplex symptomatology and that too, to a dermatologist with acute febrile illness, severe backache and lower limb ulcers.

Linear syringocystadenoma papilliferum: a case report with review of literature.

We report a rare case of syringocystadenoma papilliferum (SCAP) presenting as multiple papulonodules in a linear pattern over right lower abdomen which has been reported only once before.

Granuloma faciale with extrafacial involvement and response to tacrolimus.

Granuloma faciale (GF) is a chronic condition characterized by red-brown plaques with follicular accentuation present usually on the face. We present a case of 35-year-old female with 5 year history of plaques over cheek and extra facial sites consistent with GF and its response to topical tacrolimus. This case supports previous reports of successful treatment of GF with topical tacrolimus.

A comparative study on efficacy of high and low fluence Q-switched Nd:YAG laser and glycolic acid peel in melasma.

BACKGROUND: Melasma is acquired symmetric hypermelanosis characterized by light-to-deep brown pigmentation over cheeks, forehead, upper lip, and nose. Treatment of this condition is difficult and associated with high recurrence rates. With the advent of newer therapies, there is interest in the use of glycolic acid peels and Q-switched Nd:YAG laser (QSNYL) in high and low fluence for this disorder. AIMS: To compare the therapeutic efficacy of low fluence QSNYL, high fluence QSNYL, and glycolic acid peel in melasma in three study groups of 25 patients each. METHODS: Seventy-five Indian patients diagnosed as melasma were included. These patients were randomly divided in three groups (Group A = 25 patients of melasma treated with low-fluence QSNYL at weekly intervals, Group B = 25 patients of melasma treated with glycolic acid peel at 2 weeks intervals, Group C = 25 patients of melasma treated with high-fluence QSNYL at 2 weeks intervals). Study period and follow-up period was of 12 weeks each. Out of the 75 patients included, 21 patients in Group A, 19 patients in Group B, and 20 patients in Group C completed the study. Response to treatment was assessed using melasma area and severity index score. RESULTS: Significant improvement was recorded in all the three groups. The improvement was statistically highly significant in Group A as compared to Group C (P<0.005), significant in Group A as compared to Group B (P<0.05), and also in Group B when compared to Group C (P<0.05). Low-fluence QSNYL was associated with least side effects. CONCLUSIONS: This study shows the efficacy of low-fluence QSNYL and glycolic acid peel in melasma. These could be an effective treatment options compared to conventional methods for the treatment of melasma.

1064 nm Q switched Nd: YAG laser treatment of nevus of Ota: an Indian open label prospective study of 50 patients.

BACKGROUND: Nevus of Ota is very common in Asians. Estimated male to female ratio is 1:4.8. Patients seek treatment early in life due to psychological trauma and cosmetic disfigurement. The creation of high power, short pulse Q switched lasers has recently provided tools for considerable therapeutic advances in the treatment of dermal pigmented lesions. AIMS: To determine the efficacy and side-effect profile of Q switched Nd:YAG Laser (QSNYL) in fifty Indian patients. METHODS: Fifty patients of nevus of Ota underwent multiple treatments (average 5 sessions) at monthly intervals carried out over a period of 2 years with QSNYL (Med-lite C6). Of the 50 patients, 2 were males; and the rest were females. Skin types treated included phototype IV and V. The response after subsequent treatments was documented through serial photographs that were taken before and after every treatment session. Response to the treatment was graded based on quartile grading scale. RESULTS: Near total improvement was seen in 8%, marked improvement in 22%, moderate improvement in 38% and 32% patients reported less than 25% clearing of the lesion. All patients reported some improvement. Transient postinflammatory hyperpigmentation was observed in 4 (8%) patients, which cleared with use of sunscreens and bleaching agents within 2 months. No textural change or scarring was observed in any patient. CONCLUSIONS: QSNYL is an easy-to-perform and effective treatment in cases of nevus of Ota in Indian patients with few side effects.

Nevoid hypertrichosis: case report with review of the literature.

Nevoid hypertrichosis is a rare entity characterized by circumscribed patches of terminal hair. It is associated with many cutaneous and extra-cutaneous abnormalities. In our case, a single circumscribed patch of terminal hair growth was present without any underlying or associated cutaneous or systemic abnormalities.

A case of angiokeratoma circumscriptum of the tongue: response with carbon dioxide and pulsed dye laser.

Solitary angiokeratoma circumscriptum (AC) of the tongue is a rare entity. We present a case of solitary AC over the ventral surface of the tongue present for 3 years. The patient was treated with a combination of carbon dioxide (CO(2)) and pulsed dye laser (PDL). There was more than 75% improvement in the lesion after treating with alternate sessions of CO(2) and PDL.