Skin Deep - A Dermatology Blog

Notalgia Paresthetica

2008-09-10T07:07:00.000+04:00

This patient presented to me with this pigmented itchy patch over the right infra scapular region. He had a neurological disorder with paresthesia extending to right finger tips. There is a report of successful treatment of this condition with Botulinum Toxin Type A. [Arch Dermatol. 2007; 143(8):980-982.]

Pitted keratolysis

2008-06-21T00:32:00.000+04:00

Pitted keratolysis is caused by a cutaneous infection with Corynebacterium and Actinomyces. It is often associated with hyperhidrosis. It is common in this part of the world because of occlusive footwear. Twice daily application of erythromycin or clindamycin is effective.

Speckled lentiginous nevus

2008-05-09T11:34:00.000+04:00

Speckled lentiginous nevus is a patch of hyperpigmentation representing a localized defect in neural crest melanoblasts. Several black or brown macules are seen within a patch of brown hyperpigmentation. Some consider this a variant of Congenital melanocytic naevus.

DermaMan: A dermatology calculator for PDAs

2008-01-06T22:44:00.000+04:00

I have recently made a simple application to bring basic dermatology related calculations to hand held devices in Java. It includes modules for frequently used dermatological calculations like PASI, MASI, SCORAD and for PUVA and Botox (R) related calculations.

DermaMan is a freeware which can be downloaded from http://www.gulfdoctor.net/derm/dermaman.htm if you are accessing from a PC and http://www.gulfdoctor.net/mobile/derm.htm if you are accessing from your hand held device for over-the-air installation. All modules are packaged as a single JAR file. Specific instructions for installation depend on your device and are usually available from the manufacturer’s user-guide. General instructions are available from the web pages mentioned above.

A more detailed description of the software is in print in the ‘Resident’s corner’ section of IJDVL, March-2008 issue. Please read the disclaimer before you download the software. Use this thread for support, bug report and feature requests.

Fixed Drug Eruptions (FDE)

2007-12-02T17:24:00.000+04:00

Hands, feet, and genitalia are the most common locations for Fixed Drug Eruptions (FDE) and lesions recur in the same area when the offending drug is given.

Hansens Disease (Leprosy)

2007-09-13T21:15:00.001+04:00

First Hansen’s I have seen after coming here. The treatment was hindered by the non availability of Dapsone and clofazamine. With the emergence of latest bactericidal drugs it is not much of a problem any more.

Sclerotic patch

2007-08-02T22:19:00.000+04:00

This 35 year old Asian male patient presented with this unilateral hyperpigmented sclerotic patch over the face for 20 years. What is your diagnosis?

Periorificial crusting and acral desquamation

2007-06-02T08:56:00.001+04:00

This poorly nourished 2-year-old girl developed asymptomatic erythema and crusting of the periorificial areas of the face over last one month. Desquamation of the distal phalanges of the fingers and the toes was also noted. Please take a look at the images and share your comments regarding the differential diagnosis.

2007-05-16T21:48:00.000+04:00

Pityriasis rosea is a skin disease characterized by sharply defined pruritic red patches covered by fine scales mostly affecting young adults. Typical lesions usually affect the trunk in a Christmas-tree pattern and it usually resolves spontaneously after 6 weeks. This patient reported with classic presentation of pityriasis rosea except for the unusual associated palmar lesions. A VDRL test was suggested but the patient refused.

2007-03-16T22:40:00.000+04:00

This is a query I recently received.

"The spots (they all have a hair coming out of the middle) pretty much stay there permanently. They have been around months but got real bad a month ago. Putting isotretinoin cream on made it much worse giving massive whiteheads and cysts. After stopping it reverted to how it is now. The area is pretty dry, a little scaly, itchy and quite red. It started in the left corner of my mouth (where I once had a massive cyst) and little spots started popping up and were especially visible if you pulled the skin. There are now plenty all over my chin, particularly in the crevice in the middle. Sometimes there are whiteheads but these are more like scabs. I get quite a lot of big spots on the corners of my mouth (esp. the left). I saw a derm a month ago. He said it was acne and put me on oral isotretinoin (my 4th dose). Its done nothing so far. I have read about perioral dermatitis and have started using a non SLS toothpaste but no effect so far. I also have no spots above the lip. The photographed regions are the only affected. My derm prescribed topical steroid, I read these can make things worse. I was on Azathioprine (autoimmune hepatitis) for 2 years till a month ago. I havent had oral steroids for AIH in 9 months. I did get an outbreak of folliculitis in the pubic region about 5 months ago. This was quickly resolved with antibiotics. Could this be a similar thing although it looks and feels different? "

A recurrent vesicular eruption

2007-01-26T16:34:00.000+04:00

This 4-year-old boy had a recurrent vesicular eruption on the sun exposed areas for three years. The eruption would heal with varioliform scarring. The boy's father and one of the siblings had similar problem since early childhood. What would be the ddx?

Hyper pigmentation in neonate

2006-12-13T21:59:00.000+04:00

This 17 days old baby girl developed such mottled hyper pigmentation on face and rest of the body since last 2 days. There is no h/o prior rash. There is h/o fever on day 5 after birth for which baby was admitted by pediatrician and she received 5 days course of ampicillin, Inj.Gentamycin and Inj.Ceftrioxone. It was normal delivery but at 36th week of gestation. Except for pigmentation she was otherwise normal.

Acute generalised exanthematous pustulosis (AGEP)

2006-12-02T18:56:00.000+04:00

This patient presented to me with sudden onset of widespread non follicular pustules over his body. He did not give personal or family history of psoriasis. My diagnosis was Acute generalised exanthematous pustulosis (AGEP). AGEP is a condition characterised by sudden onset of non-follicular aseptic pustules all over the body. Among drug-induced skin eruptions, AGEP is remarkable by its short time to onset after the administration of the suspected drug (less than 24 hours) and the great predominance (80%) of antibiotics as causative agents. Though it is generally easy to elicit a drug history in AGEP, I did not succeed. After 2 days patient called me and told that he remembered taking an Ayurvedic concoction called arishtam on the previous day of erruption. A literature search showed that, after drug reactions, the most common causes of AGEP are acute infections with enteroviruses, and hypersensitivity to mercury. Without taking sides, let me refer you to this article here:
http://faculty.washington.edu/chudler/ayur.html

Progressive Palmo Plantar Keratoderma of Greither

2006-11-21T12:10:00.000+04:00

Today an old patient of mine came with his brother who had severe palmo plantar keratoderma since childhood which worsened after coming to Gulf. The most striking feature was the transgrediens. They said several members of their family have this problem. With my broken Hindi, I managed to elicit sufficient history to draw a crude pedigree chart. Based on the livid transgrediens, I came to a diagnosis of Progressive PPK (Greither disease or PPK of Sybert). I started him on 50% urea and 0.05% tretinoin. Before leaving my old patient (A in the chart) asked me about the chances of this condition developing in his children. What is your answer?

Polymorphous Light Eruption (PLE / PMLE)

2006-11-16T10:24:00.000+04:00

Differentiation of PLE on pigmented skin from Actinic LP can be tricky without a biopsy as the second condition is also fairly common in India and Gulf. On fair skin PLE is described as ‘pink or red raised spots’ [ http://dermnetnz.org/reactions/pmle.html ] but the pink hue is never appreciable on pigmented skin. PLE is generally pruritic and involves photo exposed areas, often sparing the face as in the above case. Actinic LP is non-pruritic and commonly involves the face as the case posted below (http://www.gulfdoctor.net/blog/2006/01/diagnosis.html ).

Follicular Lesions

2006-11-06T17:39:00.000+04:00

A 36 year old male patient with these unilateral follicular lesions of 4 months duration over the shin. What is your diagnosis?

Ichthyosis Linearis Circumflexa (ILC) of Netherton Syndrome (NS)

2006-10-30T22:49:00.000+04:00

This 4 year old female patient presented with history of congenital erythroderma (without Colloidal membrane), which was evident during the first weeks of life and severe pruritic dermatosis. History of hair loss was given though it was not severe when she presented to me. Though lesions where predominantly ichthyosiform with a predilection for extremities, she also had eczematous peri-oral lesions characteristic of NS. However flexural lichenification was not prominent. ILC is a characteristic serpiginous migratory annular/polycyclic rash with double-edged scale.

More on the genomic and molecular aspects of this disease in my Applied - Bimatics (http://gulfdoctor.net/bioblog/2006/02/plasmin.html) Blog.

Lupus Vulgaris

2006-10-25T22:14:00.000+04:00

This 18 yr girl was brought for asymptomatic lesion on left elbow since last 3 months.It was a small papule to begin with, then grew slowly but steadily to attain present size. There is spontaneous healing with atrophy in the upper half .Secondary infection at the lower border is since last 5 days,Another small lesion inferior to the main lesion is post traumatic ecthyma (since 10 days.)There is no h/o injury prior to the main lesion.She also developed slightly tender matted epitrochlear lymphadenopathy 1month after the onset of the lesion.She had taken Anti tubercular treatment for 9 months(1 yr back )for pulmonary Kochs.Her father also had pulmonary Kochs.

Nodulocystic Acne

2006-10-23T19:41:00.000+04:00

Nodulocystic acne is a severe form of acne affecting the face, chest and back characterised by multiple inflamed and uninflamed nodules and frequently, scars. It is more common in males. Acne conglobata is an uncommon form of nodulocystic acne in which there are interconnecting abscesses and sinuses. Nodulocystic acne may very rarely be a manifestation of a genetic disorder, PAPA syndrome (Pyogenic Arthritis, Pyoderma gangrenosum and Acne. Autosomal Dominant). This patient was treated with isotretinoin, but lesions recurred after few months of stoping therapy.

Forehead Lesions

2006-10-01T20:18:00.000+04:00

A 30 year old male patient with these hyperpigmented hyperkeratotic lesions over the forehead since 2 years. What is your diagnosis?

Geographic tongue

2006-09-28T19:16:00.000+04:00

Geographic tongue is a relatively common benign condition which may cause significant psychological morbidity. Though often asymptomatic, some may complain of burning sensation or irritation with hot or spicy food as in this patient. He also had a median fissure which is a frequent association. He also gave history of recurrent oral ulcers.

Hyperpigmented Patches.

2006-09-04T12:44:00.000+04:00

This 25 year old male welder presented to me with well demarcated asymptomatic hyperpigmented spots over the face, neck, back and extremities since 4-6 months. What is your diagnosis?

Chronic Folliculitis of Legs (CFL / DCPA)

2006-08-24T19:11:00.000+04:00

Chronic folliculitis of legs, though not uncommon in India, is not frequently seen in the same expatriate population in Gulf. This is a case I saw few days back. However he complained that lesions appeared only when he is in gulf and disappeared completely while in India! PUVA and Co-Trimoxazole have found to be useful in reducing recurrence. Co-Trimoxazole retains high sensitivity in this region probably because of decreased use.

Tumid lesion on the nose with scarring alopecia.

2006-08-13T09:54:00.000+04:00

36 year old male patient presented with this tumid lesion on the nose since few months. On examination he also had this violaceous patch of scarring alopecia which he had not noticed. He also complained of similar lesions on his earlobe which spontaneously disappeared. No other significant history could be elicited and he did not have similar lesions elsewhere. What is your diagnosis?

Hyperpigmented Lesions.

2006-08-01T18:32:00.000+04:00

A 6 year old girl with these grouped hyperpigmented lesions since 2 years. What is your diagnosis?