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This article discusses a case of arsenical keratosis with unusual lung involvement. Arsenical keratosis is a skin condition characterized by hyperpigmentation and hypopigmentation, as well as yellowish hyperkeratotic papules and plaques. It is caused by long-term ingestion of arsenic above the safe limit. In this case, a 65-year-old male shopkeeper from West Bengal presented with multiple lesions on his palms and trunk. Further examination revealed lung involvement, and a diagnosis of arsenical keratosis with basal cell carcinoma and lung malignancy was made. The patient was referred for further treatment. The article emphasizes the importance of extensive evaluation in cases of chronic arsenic exposure to rule out internal organ involvement. [Extracted from the article]

Background: Tuberculosis (TB) has been one of the most challenging infectious diseases globally. Cutaneous tuberculosis (CTB) accounts for 0.5–2% of extrapulmonary TB and is often missed owing to its varying morphology and paucibacillary nature. Methods: In this retrospective analytical study, we share our 22‐year experience to describe the clinicoepidemiological features and treatment response of CTB in 1458 Indian patients. In each patient, detailed history was followed by clinical examination, hematological and biochemical investigations, Mantoux testing, chest x‐ray, and other specialized investigations to detect coexisting systemic foci. Clinical diagnosis of CTB was confirmed on histopathology/cytology and response to standard antitubercular treatment (ATT). All details were recorded on a predesigned proforma. Results: Of 1458 eligible patients, 803 were children. The mean disease duration was 15.3 months. Lupus vulgaris (40.4%) was the most common clinical variant, followed by scrofuloderma (32.7%) and lichen scrofulosorum (15.2%). Other variants included tuberculosis verrucosa cutis, gumma, tuberculids, and inoculation TB. Multiple clinical variants were observed in 3.6% of patients. A total of 41.4% of patients had coexistent systemic foci; in lymph nodes (50.4%), lungs (35.6%), bone (10.3%), and abdomen (5.8%). TB foci were also observed at uncommon locations like the eye, central nervous system, and genital organs. Treatment response to ATT was favorable in 99.2%. Interpretation: The burden of CTB still persists in developing countries. The diagnosis is often missed due to the wide spectrum of clinical and histological presentations. Awareness among clinicians of varying aspects of CTB is of paramount importance for early diagnosis and management and will significantly prevent morbidity and disease complications. [ABSTRACT FROM AUTHOR]

Leprosy is a chronic infectious granulomatous disease caused by Mycobacterium leprae, primarily affecting the skin and the peripheral nerves. Variable involvement of internal organs and mucosa has been reported with incidence ranging from 19% to 60%, more commonly seen in lepromatous spectrum of leprosy (LL and BL). We report a case of borderline tuberculoid (BT) leprosy presenting with oral mucosal lesions involving the gingival mucosa and lower lip. [ABSTRACT FROM AUTHOR]

Background: Lichen scrofulosorum (LS) represents immunologic reaction to the Mycobacterium tuberculosis antigen and presents with subtle, asymptomatic, grouped follicular papules over the trunk and shows good therapeutic response to antitubercular drugs. Objective: To study the clinical and epidemiological characteristics of patients diagnosed with LS. Materials and Methods: A single‐center retrospective review of patients diagnosed with LS from 1997 to 2018 was conducted. The data pertained to clinico‐epidemiological profile, BCG vaccination, Mantoux positivity, laboratory investigations, coexistent focus of tuberculosis, and response to antitubercular treatment (ATT). Results: LS cases constituted 15.2% (221/1458) of all the patients diagnosed with cutaneous tuberculosis (CTB). Of these, 156 (70.5%) were pediatric patients. All patients presented with multiple follicular and perifollicular grouped papules. The trunk was the most common site involved (98.6%), followed by lower limb (25.33%), upper limb (15.83%), face (5%), and external genitalia (3.6%). Evidence of BCG vaccination and Mantoux test positivity was observed in 52.03 and 83.2%, respectively. Coexistent TB focus was detected in 134 (60.6%) patients in lymph nodes, lungs, abdomen, and unusual sites such as intracranial, endometrium, and eye. Twenty‐eight patients (12.66%) had coexistent other clinical forms of CTB. Clinical diagnosis of LS was confirmed on histology that revealed chiefly periappendageal epithelioid cell granuloma. Response to ATT was good with complete resolution of lesion in 8–12 weeks. Conclusion: LS appears to be an underdiagnosed entity. Subtle and asymptomatic lesions of LS are often missed, thereby necessitating a high index of suspicion and appropriate evaluation of the underlying TB focus. [ABSTRACT FROM AUTHOR]

A 23-year-old male developed right hemifacial atrophy following marphea profunda. Facial asymmetry due to residual atrophy was treated with autologous fat harvested from buttocks with marked cosmetic improvement.

Byline: Amit. Dhawan, Kavita. Bisherwal, Vijay. Gandhi, Archana. Singal, Sonal. Sharma Sir, An 18-year-old man presented to the dermatology outpatient department with complaints of a raised skin lesion for 4 [...]

Background: Psoriasis is a multisystem disorder associated with various systemic diseases such as cardiovascular diseases, diabetes mellitus and metabolic syndrome. Renal involvement in patients with psoriasis is sparsely studied and its association is still unclear. Aim: The aim of this article was to study causal attributable renal involvement in patients with psoriasis and factors affecting the same. Methods: Fifty patients with documented psoriasis were recruited after excluding any secondary causes of renal disease. They were subjected to routine investigations along with hs-CRP and specific investigations for kidney function including urine albumin creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). The eGFR and ACR of the patients were compared with 50 age- and sex-matched controls. Association with any disease-related factors such as severity and duration were assessed. Renal biopsy was planned in patient with ACR >500 mg/g creatinine. Results: The mean eGFR (IQR) (ml/min/1.73 m2) of the case group was found to be 80.00 (71.00–95.75) and in the control group was 88.00 (75.25–99.00). This difference was not significant (P = 0.206). However, in the age group of > 30 years, the eGFR of disease group (78.50 ± 17.94) was significantly lower than that in the control group (88.96 ± 17.01, P = 0.023).The mean urine ACR (mg/g) in the disease group was found to be 13.359 ± 26.01 while that in the control group was found to be 5.66 (3.40–8.08), and the difference was not found to be clinically significant. Four patients with psoriasis had microalbuminuria as opposed to none of the controls. Conclusion: Subclinical albuminuria was found in 8 per cent of patients with psoriasis. Glomerular dysfunction with statistically significant reduction in eGFR was seen in psoriasis in age group of more than 30 years and those who had a long-standing disease. The renal involvement had positive correlation with hs-CRP indicating the role of inflammatory milieu. Further large-scale cohort studies would help assess this aspect in further details. Limitation of the Study: Sample size was small. Large-scale studies would be required to further substantiate these observations. [ABSTRACT FROM AUTHOR]

Byline: Vijay. Gandhi, Prashant. Verma, Pravesh. Yadav Sir, A 35-year-old, married man, carpenter by occupation, presented to our outpatient department with recurrent eruptions of acne-like lesions over face and painful [...]

Byline: Vijay. Gandhi, Prashant. Verma, Geetanjali. Naik Ochronosis is a rare disease characterized by speckled and diffuse pigmentation symmetrically over the face, neck, and photo-exposed areas. It is characterized histologically [...]

Byline: Pradeep. Kumar, Vijay. Gandhi Sir, Pseudoainhum is a condition characterized by the development of an acquired constricting ring most commonly around a digit. It has been described in association [...]

Systemic pulse corticosteroid therapy is used widely in the treatment of pemphigus vulgaris. Dural venous sinus thrombosis as a complication of pulse therapy has not been reported in the literature. A middle-aged female with pemphigus vulgaris was started on monthly pulse dexamethasone therapy with daily azathioprine as an adjuvant. After two pulse therapies, she developed throbbing headache, which on further evaluation was determined to be due to dural venous thrombosis. Other causes of dural venous thrombosis were excluded. Pulse therapy was stopped and other medications were started. The headache subsided within two weeks of stopping pulse therapy. Corticosteroids may play the role of a procoagulant in producing cerebral venous sinus thrombosis. Herein, we report a rare case of dural venous sinus thrombosis due to pulse steroid therapy in pemphigus vulgaris. [ABSTRACT FROM AUTHOR]

Byline: Vijay. Gandhi, Puneet. Aggarwal, Jyoti. Dhawan, Usha. Singh, S. Bhattacharya A four-year-old girl was brought to the dermatology outpatient department with scaling all over the body since birth. She [...]

Byline: Vijay. Gandhi, Amit. Vij, S. Bhattacharya Sir, Apocrine chromhidrosis is characterized by secretion of colored apocrine sweat. The color results from lipofuscin pigment in apocrine secretions. The colors vary [...]

Anogenital warts, also known as condylomata acuminata caused by human papillomavirus constitute the most common sexually transmitted infection. Rarely, the disease may evolve into a huge cauliflower-like growth called giant condyloma acuminatum or Buschke–Löwenstein tumor (BLT). In contrast with normal anogenital warts, BLT displays local invasion, lack of spontaneous resolution, posttreatment recurrence, and potential for malignant transformation. Although radical excision with split-thickness skin grafting is considered its first-line treatment, it is not always feasible. While many other treatments have shown variable success and recurrence rates, topical imiquimod 5%, a popular evidence-based therapy for warts has also been reported as an efficacious treatment for BLT. We present a case of penile BLT where the patient refused surgery but recovered completely with no recurrence at five years following 16 weeks' therapy with topical 5% imiquimod. Excepting a single reported case, this might be another case where BLT resolved with imiquimod as a standalone therapy. We also present a succinct review of past cases of BLT treated with imiquimod. [ABSTRACT FROM AUTHOR]

Sir, It was truly enlightening and educative reading the editorial on dexamethasone pulse therapy in dermatology (1) and the associated viewpoint by Prof. Pasricha (2) who is widely regarded as [...]

We report a case of incontinentia pigmenti in a 3-day-old male neonate presenting with multiple vesicular and hyperkeratotic papular crusted lesions over the right leg and trunk in a blaschkoid pattern since birth, with characteristic histopathological findings. A good clinical acumen is required for diagnosing a rare disorder in the absence of genetic analysis and karyotyping. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Aquagenic syringeal acrokeratoderma" published in the previous issue of the journal.

The article presents a case study of a 67‑year‑old female presented with painful red swelling around bilateral great toenails with no history of prior trauma, and the patient underwent incision/drainage and multiple courses of antibiotics with only transient relief. The article discusses clinical diagnosis of erlotinib‑induced acute paronychia with reactive capillary proliferation in the form of pyogenic granuloma was made.

The article presents a case study of a 17-year-old girl who presented with dusky cyanosis of both feet with painful symmetrical swelling of feet and toes for one week. She has a history of high-grade fever associated with chills and rigours. She was diagnosed with symmetrical peripheral gangrene (SPG) due to Pseudomonas septicaemia. She was treated with antibiotics, supportive management with intravenous fluids, low-molecular weight heparin and sildenafil citrate.

A letter to the editor is presented by Prashant Verma, Vijay Gandhi, and Geetanjali Naik related to the successful treatment of Eccrine hidrocystomas (EHs) with the use of topical Botulinum Toxin (Boxtlak-BL).

Presents the response from the author to the letter of the editor about the treatment of Schamberg's disease with pentoxifylline.

Mastocytosis is characterized by the proliferation of neoplastic mast cells in various organs, which can have either cutaneous or systemic presentation. Solitary cutaneous mastocytomas are most commonly seen in the pediatric age group but rarely present in adults. Histopathology of cutaneous mastocytoma is well described in the literature but only a few studies are available describing the cytomorphological features. We present a case of a 19-year-old female who presented with a 6-month history of a right supraclavicular single, 0.5 × 0.5 cm, well-defined, reddish-brown round nodule. The fine needle aspiration cytology (FNAC) smears were highly cellular showing monomorphic cells, predominantly dispersed singly and occasionally in small clusters. The cells were round to oval, with moderate cytoplasm containing coarse metachromatic granules. Toluidine blue stain and CD117 immunocytochemical stain confirmed the presence of mast cell granules. Based on the cytomorphology, staining, clinical history, and examination, a diagnosis of solitary cutaneous mastocytoma was rendered. FNAC plays a pivotal role in diagnosing mast cell tumors and even obviates the need for tissue biopsy in selected cases., (© 2024 Wiley Periodicals LLC.)

Pigmented purpuric dermatosis (PPD) is a chronic disorder of unknown etiology. It is quite common, and no therapy is significantly effective. Calcium dobesilate (Cd) has been tried successfully in many vascular disorders. The aim of this study was to evaluate the usefulness and efficacy of Cd in PPD. Nine male patients (7 with Schamberg's and 1 each with lichenoid dermatosis of Gougerot and Blum and lichen aureus) were given Cd 500 mg twice daily for two initial weeks and then 500 mg once daily for a total period of three months. All the patients were followed up for one year after cessation of therapy. The improvement was moderate in 11.11% and mild in 66.67% of cases; 22.22% did not show any improvement. New lesions stopped appearing in two weeks in all patients, and itching also improved in symptomatic cases without any significant side effects. Based upon the results of this pilot study we recommend Cd as the first line therapy for PPD.