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Primary anetoderma is a rare idiopathic disease of the skin, characterized by circumscribed areas of loose skin, and loss of elastic fibers upon histopathologic examination. Two forms are traditionally distinguished, primary and secondary. Primary anetoderma occurs when there is no underlying associated skin disease, whereas the latter refers to an abnormal repair mechanism of preexisting skin lesions. We are reporting a case of primary anetoderma with lesions present all over the body, including the scalp, palms and soles, the sites that are not known to be involved in this condition.

Introduction: Palmoplantar lesions of lichen planus (LP) are uncommon and may not always have classical clinical features of LP. A variety of morphological types has been described in literature. Aim and Objectives: The aim was to study and classify the clinical variants into distinct easily recognisable categories for quick recognition and early treatment initiation. Methods: All patients diagnosed with LP over a period of 5 years were evaluated for palmoplantar lesions in our hospital. The clinical and histopathological features of the palmoplantar lesions were then studied. Results: Out of 424 patients of LP, 55 (12.9%) had palmoplantar lesions. Histopathology was consistent or at least compatible with LP in 44/55 patients. For the purpose of assessment, only patients with histopathology consistent with LP were included (n = 44) in the study. Just over half of the patients were male, with most patients (43.2%) having had LP lesions elsewhere for 6 months before palmoplantar lesions were noticed. Soles were more frequently involved than palms. The sites most often involved were the centre of the palms (45.2%), and the instep of the soles (63.9%). The predominant morphological presentation was psoriasiform (47.7%). One patient had ulcerative lesions of LP on both his soles which is a very rare variant. Notably, nearly half of the patients (20/44) had mucosal (mostly oral) lesions characteristic of LP. This was significant as typical oral lesions of LP help in identifying palmoplantar lesions that do not have classical lichenoid morphology. Conclusion: LP lesions on palms and soles need to be identified keeping a high index of suspicion and differentiated from other papulosquamous conditions so that specific treatment can be initiated early.

Background: Palmoplantar lesions in lichen planus (LP) are uncommon. In such cases, diagnosis is usually missed. This study was conducted to document various clinical and histopathological features of palmoplantar LP. Materials And Methods: A total of 18 patients from our outpatient department with lesions of LP, either predominantly or exclusively on palms and/or soles were studied. Patients with history of drug intake in recent past and patients with classical acute widespread LP with a few lesions on palms or soles were excluded. In each patient, diagnosis was made on clinicopathological correlation. Various clinical and histopathological features were analyzed. Results: Average age of onset was 38 years. Male: female ratio was 1:0.6 and average disease duration was 11 months. Exclusive palm or sole involvement was seen in 4/18 patients. Itching was the most common symptom. Clinically the most common variant was hypertrophic. Histologically presence of parakeratosis, spongiosis, lack of melanophages, and lack of hypergranulosis in some cases was seen in addition to classical features of LP. In 3 out of 4 patients with exclusive palmoplantar involvement diagnosis of LP was missed clinically. Conclusion: Involvement of palms and soles in LP poses a diagnostic challenge due to variable presentations. Histopathology is of vital importance for correct diagnosis and treatment.

Two adult patients from a village of district Bhilwara, Rajasthan, consulted Skin Department of R. N. T. Medical College and Hospital, Udaipur, with complaints of thickening of the palms and soles and pigmentation of skin with a nonhealing ulcer on the palm. They also had complaints of loss of appetite, abdominal pain, nausea, vomiting, and loose motion. On examination, there were multiple 2–3 mm, keratotic papules on the palms, and soles on the background of diffuse keratoderma. Two irregular nonhealing ulcers were present on the hands which on excisional biopsy revealed squamous cell carcinoma. A generalized mottled pigmentation was present over the trunk and proximal parts of extremities. The clinical presentation was suggestive of arsenicosis. There was history of similar ailment in some of the fellow villagers as well. With the help of health authorities, a survey was conducted in the village and it was found that eight more villagers were suffering from similar kind of illness. The common source of arsenic was explored and found to be increased in drinking water that was taken out through hand pump. The level of arsenic in drinking water was significantly above the WHO safe limit for arsenic.

Palmo-plantar keratodermas (PPKD) are a diverse group of acquired and hereditary disorders, characterized by excessive thickening of the skin of palms and soles. Here, we report a case of Type I or Buschke-Fischer-Brauer variant of punctate palmo-plantar keratoderma, in a 66-year-old gentleman. The association of our case with Hodgkin's lymphoma along with linear configuration of lesions on the palms evoked the current report.

A 22 year old female presented with asymptomatic papules, pustules and crusted lesions appearing in crops over the extensor aspect of both upper and lower limbs, palms and soles and sun exposed part of the back. She also had hypopigmented atrophic scars over the extremities and hyperpigmented macules on palms and soles. She had not responded to topical antibiotic creams and broad spectrum antibiotics in the past. VDRL test was non-reactive and the results of skin biopsy and Mantoux test were suggestive of papulonecrotic tuberculid. She was treated with antitubercular therapy and appearance of new lesions stopped within 4 days.

Rowell's syndrome (RS) is recognized since 1963 as a presentation of lupus erythematosus (LE) with erythema multiforme-like lesions and characteristic immunological changes. Antiphospholipid syndrome (APS) encompasses antibodies to phospholipids/phospholipid-binding cofactor proteins and/or circulating lupus anticoagulant with clinical manifestations of thrombosis such as recurrent spontaneous abortions, etc. A 32-year-old female with primary infertility since marriage (7 years) and sequential appearance, for the past 6 months, of various lupus-specific cutaneous lesions, “targetoid” lesions on palms, musculoskeletal, ocular and auditory (sensorineural hearing loss [SNHL]) complaints with positive serological profile for SMD-1, SS-A/Ro, SS-B/La, U1-snRNP, Ku, antiphospholipid and anticardiolipin antibodies, and histopathologically confirmed LE is presented as a case of concurrent overlap syndrome, RS and APS, primary infertility, and SNHL. A brief review of RS including analysis of data of cases reported from India hereto vis-a-vis that of cases worldwide up to 2012 has also been done.

Background: Scalp psoriasis and psoriasis limited to palms and/or soles have been referred to as difficult to control psoriasis. Contact allergy has long been suspected to aggravate existing lesions and cause resistance to therapy in these psoriasis variants. Objectives: The objective of the study was to assess common contact allergens in patients with palmoplantar and scalp psoriasis and the impact of their avoidance on dermatology life quality index (DLQI). Materials and Methods: A total of 54 patients with palmoplantar and scalp psoriasis were patch tested with Indian Standard Series. The patch test results were read on day 2 and day 4. DLQI was calculated before patch testing and at 1 month and 3 month in patch test positive patients after instructing allergen avoidance. Results: Sixteen out of fifty-four patients (29.62%) showed positive patch test reactions. Metal antigens like nickel and cobalt were the most common sensitizers identified. Statistically significant improvement in DLQI was observed at 1 month and at 3 month of allergen avoidance. Conclusion: Patch testing is a useful test to determine the triggering or aggravating antigens in patients with palmoplantar and scalp psoriasis and subsequent allergen avoidance should be stressed on.

Leprosy affects mainly those areas of skin which have a relatively lower temperature and are more exposed to trauma. Certain zones like scalp, palms and soles, genitalia, groins, axillae, eyelids, transverse band of skin over lumboscaral area, midline of back and perineum have been described to be immune to the development of lesions in leprosy. But clinical, histological and bacteriological evidence of involvement of these so called immune zones though infrequent have been documented. Hence, these immune zones should be termed as relatively immune, rather than absolutely immune zones of leprosy.

Hand and foot syndrome (HFS) is a well-known complication of chemotherapeutic drugs given in a dose-dense manner. Our patient was a 52-year-old female with metastatic breast carcinoma on salvage chemotherapy regimen with docetaxel at a dose of 60 mg/m(2). The patient had grade 3 HFS characterized by symmetrical, tender, and erythematous skin lesions over the palms and soles associated with dysesthesia necessitating interruption of treatment. She developed this syndrome at a much lower dose than previously described due to her altered hepatic function. An insight regarding this unique distressing side-effect and assessment of various contributing factors would help us identify and treat the patient at the earliest.

We describe two cases of neurofibromatosis type I with innumerable pigmented macules involving whole integument including palms and soles with only occasional neurofibromas and seek to differentiate the condition from other genodermatoses with pigmentary anomalies.

Circumscribed palmar or plantar hypokeratosis is a rare benign epidermal malformation of the skin. Clinically it shows asymptomatic, well-circumscribed, and depressed erythema persisting for many years on the palms or soles. Its main histopathologic feature shows a characteristic epidermal depression with an abrupt decrement in the thickness of the stratum corneum, with a sharp stair between normal and involved skin. We describe a case of a 68-year-old woman who presented with an erythematous, asymptomatic, well-circumscribed, depressed patch, on the right thenar eminence which had been present for years.

Reticulate hyperpigmentary disorders are a group of rare genetic pigmentary abnormalities which includes reticulate acropigmentation of Kitamura (RAPK), Dowling-Degos disease (DD), reticulate acropigmentation of Dohi (RAPD), Haber′s syndrome, and Galli-Galli disease. A 25-year-old male presented with asymptomatic dark-colored lesions on his hands and feet with light-colored skin lesions involving the trunk since three years. Dermatological examination revealed hyperpigmented macules in a reticulate pattern involving the dorsa of the hands and feet, front and sides of the neck, axillae, periorbital region, and groin. Multiple pits were present over both palms, with breaks in dermatoglyphics. He also had multiple nonacne facial scars predominantly on the nose and malar areas. The patient had overlapping features of RAPK and DDD. In addition, he also had hypopigmented macules and acneiform facial scars. Such an overlap of features of reticulate pigmentation has not been previously reported in the literature.

Background : 'Holi' is an annual spring festival celebrated all over India. The central ritual of Holi involves throwing of colors on one another. Playing with toxic industrial dyes often results in various dermatological complaints in a significant number of people immediately following the celebration. Aims : To describe patterns of various skin manifestations directly or indirectly related to the use of different colors in the celebration of Holi. Methods : Observational clinical study on consecutive patients presenting to a teaching hospital in Kolkata, India. Results : Forty-two patients with a mean age of 24.2 years were studied. Itching was the commonest symptom (25, 59.5%), followed by burning sensation, pain, oozing, and scaling. Eleven patients' symptoms were attributed to activities related to preparation of colors and the removal of colors from the skin surface. Eczematous lesions were the most common pattern (24, 57.1%) followed by erosions, xerosis and scaling, erythema, urticaria, acute nail-fold inflammation, and abrasions. Thirteen (30.9%) patients reported aggravation of preexisting dermatoses (acne, eczema, and paronychia). Secondary pyoderma occurred in 3 (7.1%). Face was the commonest site affected (24, 57.1%), followed by dorsum of the hands, scalp, forearm, palms, arms, and trunk. Ocular complaints in the form of redness, watering, and grittiness occurred in 7 (16.7%) patients. Conclusion : Various forms of cutaneous manifestations, often associated with ocular complaints, occur commonly due to Holi colors. Public awareness and regulatory actions are needed to avoid these preventable conditions.

Background : ′Holi′ is an annual spring festival celebrated all over India. The central ritual of Holi involves throwing of colors on one another. Playing with toxic industrial dyes often results in various dermatological complaints in a significant number of people immediately following the celebration. Aims : To describe patterns of various skin manifestations directly or indirectly related to the use of different colors in the celebration of Holi. Methods : Observational clinical study on consecutive patients presenting to a teaching hospital in Kolkata, India. Results : Forty-two patients with a mean age of 24.2 years were studied. Itching was the commonest symptom (25, 59.5%), followed by burning sensation, pain, oozing, and scaling. Eleven patients′ symptoms were attributed to activities related to preparation of colors and the removal of colors from the skin surface. Eczematous lesions were the most common pattern (24, 57.1%) followed by erosions, xerosis and scaling, erythema, urticaria, acute nail-fold inflammation, and abrasions. Thirteen (30.9%) patients reported aggravation of preexisting dermatoses (acne, eczema, and paronychia). Secondary pyoderma occurred in 3 (7.1%). Face was the commonest site affected (24, 57.1%), followed by dorsum of the hands, scalp, forearm, palms, arms, and trunk. Ocular complaints in the form of redness, watering, and grittiness occurred in 7 (16.7%) patients. Conclusion : Various forms of cutaneous manifestations, often associated with ocular complaints, occur commonly due to Holi colors. Public awareness and regulatory actions are needed to avoid these preventable conditions.

Olmsted syndrome is a rare disorder characterized by the combination of periorificial, keratotic plaques and bilateral palmoplantar keratoderma. New associated features are being reported. Olmsted syndrome is particularly rare in a female patient, and we report such a case in a six year-old Indian girl, who presented with keratoderma of her soles since birth and on her palms since the age of two years along with perioral and perinasal hyperkeratosis. She had sparse, light brown, thin hair. Although the psychomotor development of the child was normal until 18 months of age, the keratoderma plaques had restricted the child′s mobility after that stage.

A total of 80 atopic dermatitis cases were studied. The incidence was 4.2 per 1000 among OPD patients. The overall crude M : F ratio was 1.4:1 which after standardization was 0.9:1, 32.5% had the disease for the first time, 48.75% of patients had observed itching preceding rash, 26% of patients gave history of food allergy. The incidence of personal history of atopy and family history of atopy was 56.25% and 63.75% respectively. Facial involvement was common in infant and flexural involvement in adolescent and adult. Vesiculation, papules, erythema were common in all. Lichenification was seen in chronic cases, 18% of the patients had ichtyosis vulgaris and 93% of infantile, 55% of childhood and 57% of adult cases had xerotic skin. Hyperlinear palms were seen in 38% and keratosis pilaris in 34%. Dennie-Morgan line was seen in 50% of the cases. White dermographism was demonstrated in 50% of 66 cases tested. Secondary cutaneous infections were common.

A 45 year old male presented with dry skin, facial puffiness, weight gain, constipation and lethargy for five months. He had been diagnosed as thyrotoxicosis fifteen years back and improved after oral antithyroid drugs. General examination revealed bradycardia, obesity, hoarseness, proptosis and acropachy. Dermatological examination revealed pretibal as well as generalised myxoedema with cold, hyperpigmented and xerotic skin. Hair was thin, coarse and brittle and nails brittle. Face appeared puffy, expressionless and eyelids wrinkled and drooping. Palms, soles had a yellowish hue. The neck revealed a diffusely enlarged thyroid. Hormone profile revealed reduced T3, T4 and raised TSH. Thyroperoxidase antibody was positive. ECG showed low voltage sinus bradycardia. X-ray hands substantiated thyroid acropachy. Skin biopsy confirmed pretibial myxoedema. He was diagnosed as Graves disease with past hyperthyroidism and present hypothyroid state and managed with oral thyroxine with improvement. The pretibial myxoedema was successfully managed with intralesional and topical steroids.

Bullous SLE has a distinctive clinical, histopathologic and immunopathologic features that together constitute a unique bullous disease phenotype. We report a 33 year old female presenting with multiple tense vesicles and bullae on normal and erythematous skin over the body and oral erosions. Palms and extremities showed typical target lesions. She had consumed NSAIDs intermittently for joint pains. She was diagnosed as bullous erythema multiforme and started on oral prednisolone but lesions failed to heal. Patient recollected a history of low grade fever and a photosensitive rash in the past. Investigations revealed positive ANA with a peripheral pattern. A skin biopsy of a vesicle showed a subepidemal blisher. Perilesional direct immunofluorescence studies showed a linear deposition of IgG, IgA and fibrin along the basement membrane zone and perivascular deposition of IgG. Lapus band test showed a linear deposition of IgG, C3, IgM and fibrin at BMZ clinching the diagnosis of bullous lupus erythematosus.

A pigmented variant of lichen planus (LP) was first reported from India in 1974 by Bhutani et al. who coined the term LP pigmentosus (LPP) to give a descriptive nomenclature to it. LP has a number of variants, one of which is LPP. This disease has also later been reported from the Middle East, Latin America, Korea, and Japan, especially in people with darker skin. It has an insidious onset. Initially, small, black or brown macules appear on sun-exposed areas. They later merge to form large hyperpigmented patches. The disease principally affects the sun-exposed areas of the body such as the face, trunk, and upper extremities. The oral mucosa may rarely be involved. However, the palms, soles, and nails are not affected. Histologically, the epidermis is atrophic along with vacuolar degeneration of basal cell layer. The dermis exhibits incontinence of pigment with scattered melanophages and a sparse follicular or perivascular infiltrate. There is a considerable similarity in histopathological findings between LPP and erythema dyschromicum perstans. However, there are immunologic and clinical differences between the two. These observations have led to a controversy regarding the identity of the two entities. While some dermatologists consider them to be the same, others have opined that the two should be considered as distinctly different diseases. A number of associations such as hepatitis C virus infection, frontal fibrosing alopecia, acrokeratosis of Bazex and nephrotic syndrome have been reported with LPP. A rare variant, LPP inversus, with similar clinical and histopathological findings was reported in 2001. As opposed to LPP, this variant occurs in covered intertriginous locations such as groins and axillae and mostly affects white-skinned persons.

The treatment of vitiligo involving the mucosae, acral areas, palms and soles is an arduous challenge. No definite treatment guideline exists for these patients. The preliminary results of evaluation of four different treatment regimens in these patients are presented. Forty patients were alternatively assigned to 4 regimens comprising of PUVASOL: PUVASOL with levamisole: topical corticosteroids and topical corticosteroids with levamisole. All the four regimens gave comparable results. PUVASOL and topical corticosteroids used alone or in combination with levamisole are all equally effective in treating the so called â€difficult to treat or resistant†sites in vitiligo with cosmetically acceptable results (25.50% pigmentation) after 6 months of therapy.

A 55 year old HIV negative, controlled diabetic, male suffering from recurrent oropharyngeal ulcer for last 4 years, has recently developed papules and nodules predominantly on face and a few on upper trunk, arms and macrochilia for about last 3 months. Some papules resembled molluscum contagiosum. His palms showed significant erythema. Multiple ulcerative nodules were visible on tongue and buccal mucosa. Histopathology revealed intracellular yeast of Histoplasma capsulatum by PAS stain. The patient had no involvement of internal organs. He never traveled to endemic area but had exposure to a domestic ‘moina†bird for last 6 years. The subject responded well to oral itraconazole 400 mg daily for 8 weeks followed by a maintenance therapy with 200 mg daily for another 8 weeks.

This study was undertaken to identify occupation related skin problems among hotel workers. One thousand three hindered and ninety employees of a chain of vegetarian hotels were examined. Of the 273 people working in the kitchen, 206 (75.4%) had dermatosis related to work. The Kitchen workers were classified according to the type of work they routinely performed. Forty eight out of the 63 (76.1%) cooks who were involved in stirring had callosity at sites of contact with ladle and 28 of the40 (70%) cooks who were involved in frying had pigmentation and scars due to contact with hot oil and water. All the onion peelers had staining and fissuring of the palmer aspect of the fingers. Thirty two of the 46(69.5%) vegetable cutters had callosity on the palm at areas of contact with knife. Poori markers had pigmentation and callosity of knuckles due to pressing the dough with their knuckles. Nine of the 12 (66%) rice cleaners had chapping of nails. Seven of the 12 (58.3%) paratha markers had erythema of palm due to contact with hot tava. Tandoori experts had singing of hair over right forearm. Two workers (0.73%) had pigmentation of the face probably due to prolonged exposure to heat. Two of the16 (12.5%) grinders had paronychia and onychomycosis due to constant contact with water and dough. Nine of the 15 (60%) coconut graters had callosities of the palms. We conclude the minor occupational dermatosis is prevalent among kitchen workers employed in hotels

A 62 year old male agricultural labourer presented with itchy pigmented lesions involving mainly upper and lower limbs of 6 months duration. On physical examination he had macular and popular hyperpigmented violaceous lesions associated with Koebner phenomenon. Palms and soles demonstrated diffuse as well as macular type of huperpigmentation. Histopathological examination of forearm lesion showed basal cell liquefactive degeneration with melanin incontinence suggestive of healing lichen planus. The case is reported for the unusual palmoplantar lesion seen in our case.

Sir, Lichen nitidus was first described by Pinkus in 1901. It is an uncommon, chronic, papulosquamous eruption characterized by multiple, 1–2 mm, flesh-colored, shiny, dome-shaped papules. Although asymptomatic, it may sometimes be associated with pruritus.1 It classically involves the genitalia, upper extremities, chest and abdomen; in rare instances, it may become generalized.2 There appears to be no obvious racial or sex predilection; however, majority of cases are found in children and young adults. We present a young girl with a 4-year history of unremitting generalized lichen nitidus. A 10-year-old girl presented with a 4-year history of an asymptomatic eruption that first appeared over the hands and upper extremities and gradually spread to involve the lower limbs and trunk. The patient was otherwise healthy, and there was no intake of any prior medications or a similar family history. Clinical examination revealed numerous 1–2 mm shiny and skin-colored papules over the hands, forearms, feet, legs and abdomen, particularly around the umbilicus with multiple foci of koebnerization apparent on the forearms (Figs. ​(Figs.11–4). The face, oral mucosa, nails, palms, soles and anogenital area were not involved. Biopsy findings from one of the papules showed a focal granulomatous lymphohistiocytic infiltrate in the papillary dermis immediately subjacent to the epidermis clutched by the elongated rete pegs, thereby producing a “claw clutching a ball” picture. This confirmed the clinical diagnosis of lichen nitidus (Fig. 5). The patient was initially started on potent topical cortiscosteroids and was provided with the option of NB-UVB twice weekly; subsequently, she was lost for follow-up. Fig. 1 Skin-colored shiny papules on hands Fig. 4 Foci of koebnerization on forearm Fig. 2 Shiny papules on knees Fig. 3 Shiny papules on abdomen Generalized lichen nitidus is quite rare in children.3 In addition, several other uncommon variants that have been described include confluent, vesicular, hemorrhagic, familial, palmar and plantar, follicular, perforating and linear forms. Clinical instances of oral and nail involvement have also been reported in literature.4 The controversy regarding the etiology of lichen nitidus and its possible relationship to lichen planus is still unresolved. Some authors suggest that lichen nitidus represents a variant of lichen planus.5 Since lichen nitidus is usually asymptomatic and resolves without any sequelae, no treatment is required in most cases. However, the clinical course of generalized lichen nitidus is unpredictable with most patients experiencing spontaneous resolution several years after the onset of disease. Systemic and topical corticosteroids, dinitrochlorobenzene, diphenylcyclopropenone immunotherapy, astemizole, itraconazole, isoniazid, psoralen and ultraviolet A (PUVA) and narrow band ultraviolet B (NB-UVB) phototherapy have all been tried in its treatment, with PUVA, NB-UVB and astemizole being especially useful for generalized forms.6

Olmsted syndrome is a rare disorder characterized by the combination of periorificial, keratotic plaques and bilateral palmoplantar keratoderma. New associated features are being reported. Olmsted syndrome is particularly rare in a female patient, and we report such a case in a six year-old Indian girl, who presented with keratoderma of her soles since birth and on her palms since the age of two years along with perioral and perinasal hyperkeratosis. She had sparse, light brown, thin hair. Although the psychomotor development of the child was normal until 18 months of age, the keratoderma plaques had restricted the child's mobility after that stage.

A 60 year old male presented with complaints of raised skin lesions over the suprapubic area which spontaneously fell off, only to recur. On examination, there were multiple verrucous, homy papules over suprapubic area. Dowling sign was positive and a clinical diagnosis of verruca vulgaris was made. But a biopsy from the lesion showed features of keratoacanthoma. Patient also had firm, discrete papules with crateriform depressions along the medical margin of palms, which can be grouped under marginal keratodermas.

Toxic epidermal necrolysis (TEN) is a severe mucocutaneous reaction pattern characterized by fever, systemic toxicity, tenderness, erythema and wide-spread exfoliation. A retrospective analysis from January 1990 to December 1996 was undertaken to see the changing trends and outcome of this disorder in a third world country. A total of eleven cases were found. Their mean age was 33.09 years and male to female ratio was 2.6:1. Various drugs implicated were paracetamol (2 cases), co-trimoxazole (2 cases), aspirin (1 case), thiacetazone (1 case), streptomycin (1 case), etc. On an average, the patients developed TEN at the interval of 4.68 days following the drug intake. Fever was presenting symptom in all cases and burning sensation preceded it in 6 of them. Percentage area. Involved ranged from 40% to 90%. Other target areas involved in order of decreasing frequency were oral mucosa (9 cases) genitalia (8 cases), eye (5 cases), palms and soles (3 cases). Oral prednisolonoe therapy was started in all cases in the range of 20 to 80 mg. According to the severity, extent of lesion and body weight. Epithelisation of denuded areas took an average of 10.6 days. Complications in the form of secondary infection (3 cases), septicaemia and death (1 case) and symblepheron formation (1 case) were noted.

Mal de meleda (MdM), a rare autosomal recessive genodermatosis is characterized by erythema and hyperkeratosis of the palms and soles with a sharp demarcation and that progress with age (progrediens) and extend to the dorsal aspects of the hands and feet (transgrediens). It has been associated with various conditions albeit rarely with congenial cataract. Ocular lens and the skin have the same embryological origins. We hereby present this novel case report of Mal de meleda in association with congenital posterior subcapsular cataract which to the best of our knowledge has not been reported from India before.

Aquagenic keratoderma (AK) is a rare acquired skin condition characterized by recurrent and transient white papules and plaques associated with a burning sensation, pain, pruritus and/or hyperhidrosis on the palms and more rarely, soles triggered by sweat or contact with water. Often AK cause significant discomfort, thus requiring an appropriate therapy. Topical aluminum-based products are the most commonly used medications, but they are not always effective. We report a case of AK unresponsive to topical 20% of aluminum chloride successfully treated with tap water iontophoresis.

Gorlin-Goltz syndrome or nevoid basal cell carcinoma syndrome is characterized by multiple basocellular epitheliomas, keratocysts in the jaws, bifid ribs, palmar and/or plantar pits and ectopic calcifications of the falx cerebri. We describe a case of Gorlin-Goltz syndrome illustrating the importance of a thorough examination including the examination of palms and soles and detailed investigations in a patient having lesions suggestive of basal cell carcinoma and multiple naevi.

Aquagenic syringeal acrokeratoderma is a rare, transient, and usually bilaterally symmetric, palmoplantar keratoderma. Patients complain of tingling and pain in the hands starting a few minutes after exposure to water and lasting for 20-30 minutes after removal. Clinically, there is marked wrinkling with edematous white papules on the palms or, less often, the soles. We present the case of a 21-year-old woman who used spironolactone for polycystic ovary syndrome and had similar clinical features 2 weeks later, after withdrawing the drug.

A 20 year old male presented with fever associated with eruption of papules, plaques and vesiculobullous lesions on the chest, back, extremities, palms, soles, and genital mucosa of 20 days duration. Histopathological examination revealed epidermal clefts, edema and vacuolar degeneration of keratinocytes, basal cell degeneration, and dermal perivascular lymphocytic infiltrate. On the basis of clinical features and histology, a diagnosis of febrile ulceronecrotic Mucha-Habermann disease (FUMHD) was made. Treatment with doxycycline (100 mg BD for 4 weeks) and oral prednisolone 60 mg/day tapered to 25 mg in 4 weeks led to initial response that was followed by a relapse on tapering steroid. Addition of methotrexate (7.5 mg increased to 15 mg in 2 weeks) led to a dramatic response.

Eccrine angiomatous hamartoma (EAH) is a very rare benign neoplastic condition characterized by hamartomatous proliferation of eccrine glands and accompanying blood vessels and lymphatics. These lesions are more often present at birth or appear during early infancy and childhood and present as solitary nodule or plaque with occasional pain and sweating. They are generally present on the extremities, mostly the palms and soles. We report here a case of EAH in a 20-year-old female who presented with a solitary angiomatous plaque close to the lower eyelid of the right eye with occasional pain and sweating for its rarity.

A 63-year-old male agriculturist presented with a spontaneously appearing bullous eruption localized to the axillae and groins, with intense pruritus of 3 weeks duration. He was also a known hypertensive, diagnosed with renal failure on treatment with ACE inhibitors and amlodepin since 1 year. On examination there were tense vesicles and bullae associated with crusting and erosions in the axillae (Fig. 1), upper medial aspect of arms and groins bilaterally (Fig. 2). The rest of the skin including the mucous membranes, palms, soles, genitalia were normal. Histopathology revealed subepidermal blisters, direct immunofluorescence assay of perilesional skin showed linear deposits of IgG and C3 along the basement membrane zone and the indirect immunofluorescence demonstrated antibasement membrane antibodies bound to the epidermal side of the salt split normal human skin thus confirming our diagnosis of localized bullous pemphigoid. Patient was accordingly started on prednisolone 60 mg daily in tapering doses which resulted in complete healing of the erosions within a month. Fig. 1 Tense vesicles and bullae in the axilla Fig. 2 Tense vesicles and bullae in the groins Localized bullous pemphigoid (LBP) is a rare autoimmune subepidermal blistering disease of the elderly characterized by chronic intermittent eruptions affecting only a restricted area of the body. Though it accounts for 16% to 29% of all cases of bullous pemphigoid, the true incidence may be greater as it is often misdiagnosed and is highly responsive to topical steroids. LBP has got similar clinical, histopathological and immunofluorescence features to generalized bullous pemphigoid.1 Three types have been identified which include: 1) mucous membrane pemphigoid or cicatricial pemphigoid 2) localized scarring pemphigoid or Brunsting Perry pemphigoid affecting the head and neck 3) localized non scarring pemphigoid usually seen over the pretibial region, vulva, breast and the soles. The diagnosis of this last entity tends to be delayed because it can mimic other localized vesicobullous diseases and dyshidrotic eczema.2 While the pathogenesis of generalized bullous pemphigoid is well elucidated, it is unknown why patients with LBP have limited disease. The pathogenesis most likely could be similar to that of generalized bullous pemphigoid because patients in both the groups recognize the same BP antigens.3 LBP has been documented following radiotherapy,4 PUVA therapy, trauma,5 sunexposure,6 split skin grafting for burns,7 around peristomal lesions8 and several authors have thus postulated that these local factors might play a role in the induction of lesions in immunologically susceptible individuals. In a study on the distribution of bullous pemphigoid antigens in normal human skin the greatest expression was seen in the skin obtained from the flexor aspect of arms, legs and thighs9 which probably explains the predominant flexural localization of lesions in our case. Whether the ACE inhibitors contributed in triggering the bullous eruption here is not clear as the patient had been taking the above medications for almost a year. Nevertheless this case emphasizes the need to follow-up such patients regularly as they are at risk of developing a generalized eruption later in life.

Lichen planus (LP) is a common idiopathic inflammatory disorder that affects the flexor aspect of the wrists, the legs, and the oral and genital mucosa. Depending upon the site of involvement, LP can be divided into mucosal, nail, scalp, or palmoplantar types. Palmoplantar LP can pose a diagnostic problem to the clinician as it resembles common dermatoses like psoriasis, verruca, corn, calluses, lichenoid drug eruption, and papular syphilide of secondary syphilis. In this case report, we describe a 4-year-old male child who presented with highly pruritic erythematous to violaceous hyperkeratotic papules and plaques on his palms and soles. Typical LP papules were noted on the upper back. Histopathology of the papular lesion showed features of LP. Dermatoscopy of a papule from the back showed the characteristic Wickham striae. We report this rare involvement of palm and soles in a case of childhood LP.

Lichen planus (LP) is a chronic inflammatory skin disease characterized by polygonal, violaceous papules commonly involving flexural areas of the wrists, legs, and oral and genital mucous membranes. This report describes a patient who presented with asymptomatic black colored patches on both palms simulating Tinea nigra, a superficial fungal infection. She was previously diagnosed as allergic contact dermatitis and was being treated with potent topical steroid i.e. clobetasol propionate 0.05% and white soft paraffin. Dermatoscopy of the lesion showed brownish pigmentation along ridges of the dermatoglyphics. A biopsy from the lesional skin showed findings of lichen planus. Our case highlights the potential diagnostic confusion that can occur with unusual variants of palmoplantar lichen planus and importance of histopathology in diagnosis of such unusual lesions.

Tinea nigra is a rare superficial fungal infection of the skin affecting mainly the palms. So far, mostly isolated case reports have appeared in the Indian literature. Five cases in a single family are being reported here. The response to treatment is also highlighted.

Leprosy affects mainly those areas of skin which have a relatively lower temperature and are more exposed to trauma. Certain zones like scalp, palms and soles, genitalia, groins, axillae, eyelids, transverse band of skin over lumboscaral area, midline of back and perineum have been described to be immune to the development of lesions in leprosy. But clinical, histological and bacteriological evidence of involvement of these so called immune zones though infrequent have been documented. Hence, these immune zones should be termed as relatively immune, rather than absolutely immune zones of leprosy.

Carotenemia is characterized by an abnormal yellowish orange pigmentation of the skin, predominantly seen on the palms and soles. Although it may be associated with several diseases such as diabetes, hypothyroidism and anorexia nervosa, it is caused by excessive intake of carotene-rich food such as oranges and carrots in most cases. The condition is harmless, but it can lead to a mistaken diagnosis of jaundice. Herein, an interesting case of carotenemia is described in a 32-year-old female secondary to increased ingestion of oral sweet potatoes and oranges.

Sir, While inspecting the hands of the mother of a child with scabies, we had noticed multiple calluses on the fingers of her right hand. One of them was located over the dorsolateral surface of middle phalanx of the middle finger and was of size 1.2 × 0.9 cm (Fig. 1). The other callus was located on the dorsomedial surface of the ring finger measuring 0.8 × 0.7 cm. She also had a curvilinear band of thickening on the palmar aspect of the metacarpophalangeal joint of her right thumb culminating in a callus of size 1.2 × 1 cm on the lateral side (Fig. 2). The lesions had been present for nearly 6 years, initially small, increasing in size over the years. There was no history of fluid or pus-filled lesions, contact with cattle or similar lesions on the fingers of her left hand or toes. She, along with many of the women folk in her hamlet is engaged in making straps for slippers, with each one of them producing on an average 250 pairs of straps per day. The special scissors used for this purpose has two round “eyes,” and it is held with the base of the thumb placed in one eye, while both the middle and ring finger are placed in the other (Fig. 3). This enables them to exert adequate pressure to cut through the rubber mould. Although varying in size, calluses at the same sites were noted in all the professionals we had seen during the house visit. The calluses are asymptomatic, but for their cosmetic appearance. Fig. 1 Calluses on the dorsum of middle and ring finger Fig. 2 Curvilinear band of thickening at the base of thumb Fig. 3 Scissors, as held by slipper-strap makers Scissors-induced calluses have a pattern that almost defines the occupation. They are bound to occur in hairdressers, tailors/dressmakers and gardeners, but have also been reported to occur with beedi rollers and glove makers.1,2 The site of occurrence of the callus depends on how the scissors are held, while its size depends on the frequency and duration of usage. The morphology of the calluses also depend on the size and weight of the scissors used, the target to be cut and the techniques used for prevention or treatment, including self paring. Hairdressers use scissors with two small round eyes3 held by the ring finger and thumb and hence develop calluses predominantly on the medial and posterior surface of middle of the ring finger and on the medial and lateral surface of the base of the thumb of the dominant hand. Scissors used by tailors and dress makers are usually heavy and have one oval and one round eye.3 The round eye is held by the thumb, while all the other four fingers are placed inside the oval eye for good maneuverability. This explains the occurrence of calluses on the lateral portion of the base of the thumb, lateral aspect of the lower portion of the index finger and middle of the medial portion of the little finger consistently as they are the sites of maximum contact and friction. On prolonged usage, calluses can also form on knuckles of other fingers of the dominant hand.1 Beedi rollers also use scissors with two round but larger eyes and have been reported to have calluses on the sides and dorsa of fingers, especially right middle and index fingers.2 Gardeners use a variant of scissors called shears and can develop calluses on the palms. Glove-makers use knives in addition to scissors and develop callosities and deformities of hands and fingers.1 Calluses in slipper-strap makers are unique in a way that there are two well-defined calluses on two adjacent fingers, the middle and ring finger and on the thumb, a pattern caused by the specific way they hold the scissors and cannot be attributed to any other profession. Also, these calluses start appearing earlier, within 1 or 2 months and are related to the pressure against a firmer target. Use of rubber cushioning at the rims of the eyes of the scissors, use of plastic or lightweight scissors, regular sharpening of scissors and lesser work timings are some prevention methods. Regular use of emollients and keratolytics are treatment options.4 With increasing automation and mechanization, these occupational marks are bound to decrease, but identification of such occupational trauma and appropriate healthcare advice will help decrease the incidence of these calluses, avoid formation of large disabling calluses, prevent complications like fissuring or infection and improve work efficiency.

A 45 year old male presented with dry skin, facial puffiness, weight gain, constipation and lethargy for five months. He had been diagnosed as thyrotoxicosis fifteen years back and improved after oral antithyroid drugs. General examination revealed bradycardia, obesity, hoarseness, proptosis and acropachy. Dermatological examination revealed pretibal as well as generalised myxoedema with cold, hyperpigmented and xerotic skin. Hair was thin, coarse and brittle and nails brittle. Face appeared puffy, expressionless and eyelids wrinkled and drooping. Palms, soles had a yellowish hue. The neck revealed a diffusely enlarged thyroid. Hormone profile revealed reduced T3, T4 and raised TSH. Thyroperoxidase antibody was positive. ECG showed low voltage sinus bradycardia. X-ray hands substantiated thyroid acropachy. Skin biopsy confirmed pretibial myxoedema. He was diagnosed as Graves disease with past hyperthyroidism and present hypothyroid state and managed with oral thyroxine with improvement. The pretibial myxoedema was successfully managed with intralesional and topical steroids.

Case report of a 25 year old female who developed yellowish discolouration of palms and soles 2 days after MTP operation is described here.