A case of oculocutaneous sarcoidosis.

Purpose: To present a case of extrapulmonary sarcoidosis presenting with ocular and cutaneous involvement. Observations: We report a 54-year-male who presented with bilateral redness of eyes, photophobia, and diminished vision for a week. The best corrected visual acuity in the right eye was 6/60 and the left eye was counting fingers close to face (CFCF). He also had multiple brown plaques on the nape of the neck, chest, back, and arms. Furthermore, he was on multiple antipsychotic drugs for schizophrenia for 3 years. Uveitis investigation workup revealed raised serum angiotensin converting enzyme (ACE), negative Mantoux, and other serological tests. The patient was treated for acute anterior uveitis secondary to sarcoidosis. Clinical improvement was seen after a few days following treatment. The patient presented a year later with multiple yellowish conjunctival nodules in the superior bulbar conjunctiva associated with hyperemia. A biopsy of the plaque like skin lesions was done, which suggested cutaneous sarcoidosis. Involvement of the skin and the eyes raised suspicion that the persistent psychotic episodes despite multiple antipsychotic drugs could be attributed to neurosarcoidosis. However, magnetic Resonance Imaging (MRI) of the brain and orbit showed normal findings. After treatment with corticosteroids and immunosuppressives (methotrexate), the conjunctival nodules as well as skin lesions drastically improved, and the psychosis also responded well to clozapine. Conclusion: A high index of suspicion is needed in cases presenting with granulomatous uveitis with multisystem involvement. Long-term follow-up is crucial to monitor the disease progression and adverse effects of medications.

Porokeratosis of gluteal region: A case report.

Genitogluteal porokeratosis is a rare localized disorder of keratinization. Due to the rarity of the case and non-specific keratotic lesion, it is often misdiagnosed until a histological examination is performed. Treatment of this condition can be challenging, which comprises various topical and systemic drugs, lasers, cryotherapy, phototherapy, and also surgical intervention. Regular follow-up is necessary in the view of this disorder being a premalignant condition.

Skin Prick Test Positivity in Chronic Urticaria.

BACKGROUND: Skin prick tests identify allergens for chronic urticaria. The objective of this study was to determine skin prick test positivity in patients with chronic urticaria visiting skin outpatient department in one of the tertiary referral centre of Nepal. METHODS: This was a hospital based cross-sectional study conducted at Department of Dermatology and Venereology, Tribhuvan University Teaching Hospital. All patients of chronic urticaria aged more than 16 years were taken into study and were prick tested with seven groups of 21 allergens, taking normal saline as negative control and histamine as positive control as per the standard protocol by the Global Allergy and Asthma European Network. Frequency of positivity to each allergen was assessed. RESULTS: Out of 62 patients of chronic urticaria enrolled in the study, 52% were females and 48% were males. Overall, 71% were positive for at least one allergen. The most common allergens which tested positive included Dermatophagoides farinae (50%), Cotton dust (17.7%), Mosquito (16%), hay dust (14.5%), Cladosporium herbarum (14.5%), Candida albicans (12.9%), Parthenium hysterophorus (9.6%), House fly (9.6%), Soya bean (9.6%) and fish sardine (8%). Out of all these patients, 55% patients showed positivity to more than one allergens. CONCLUSIONS: A significant proportion of cases with chronic urticaria demonstrated sensitivity to various allergens. Skin prick test can be considered as important diagnostic procedure in cases of chronic urticaria in our population.

Fine needle aspiration cytology as a preliminary diagnostic tool in chondroid syringoma: a case report and review.

We report a case of chondroid syringoma (CS) in a 44-year-old male. He presented with a firm asymptomatic nodule in his left upper lip of 2-year duration. The initial clue to the diagnosis was made on fine needle aspiration cytology (FNAC), and a final diagnosis was based on histopathological examination. The case highlights the importance of FNAC in providing clues to the diagnosis of suspected cases of chondroid syringoma before performing large excisions and repair, which would require more skill and time. We have also reviewed the cytological findings of all the cases of benign CS reported until the current date.

Morphoea profunda presenting with atrophic skin lesions in a 26 year old female: a case report.

Morphoea Profunda is a rare variant of Morphoea that presents clinically as a solitary fibrotic plaque. Morphoea Profunda presenting with atrophic lesions has rarely been reported in literature. We report the case of a 26 year old Nepalese lady who presented to us with multiple non-inflammatory atrophic lesions on her body without significant skin induration, pigmentation and texture change. The findings on histopathology confirmed a diagnosis of Morphoea Profunda. Hence, Morphoea Profunda should be considered in the differential diagnosis of anyone presenting with asymptomatic atrophy of the skin.