Presentation Of Dermatoses Research Articles

More Than Meets the Eye: Localized Bullous Eruption After Transfusion

Sweet syndrome, also known as acute febrile neutrophilic dermatosis, is a neutrophilic dermatosis characterized by the presence of painful erythematous plaques and nodules with a sterile neutrophilic infiltrate on histology. However, the clinical manifestations of sweet syndrome can vary widely. Additionally, Sweet syndrome is often associated with underlying systemic diseases. In this case report, we present the case of a 72-year-old female who developed bullous sweet syndrome with oral involvement following a blood transfusion. Serology revealed an elevated pANCA level and systemic manifestations consistent with granulomatosis with polyangiitis. There have been approximately 50 reported cases of concurrent neutrophilic dermatoses occurring with ANCA-associated vasculitis. Relapse is common in these patients, with all reported cases involving the ears, nose, and throat (ENT) region. Ultimately, the concomitant presentation of ANCA-associated vasculitis and neutrophilic dermatoses is rare. Dermatologists should be aware that testing for ANCA in cases of neutrophilic dermatoses is appropriate, and if positive, close monitoring for signs of systemic vasculitis is warranted.

Diagnostic difficulties in pediatric annular dermatoses.

The polymorphic presentation of annular dermatoses in the pediatric population renders them adiagnostic challenge to the clinician. They include various distinct disease entities that can be vaguely categorized according to the age of onset. Herein, we report on ayoung girl with clinical characteristics of Wells' syndrome, while histological findings favored the diagnosis of annular erythema of infancy (AEI). Although morphological and histological similarities do exist, AEI and eosinophilic annular erythema (EAE) of childhood are considered as distinct entities in the literature. Wells' syndrome (WS) is an eosinophilic dermatosis and histologically characterized by eosinophilic dermal infiltration with the hallmark feature of "flame figures." Based on this case, we discuss and review the differential diagnoses of annular dermatoses in children.

A study on the clinical profile of dermatoses induced by topical corticosteroids

<p class="abstract"><strong>Background:</strong> Topical corticosteroids (TC), commonly used for a wide range of skin disorders, are associated with many side effects with their overuse, abuse and over-the-counter use as a cosmetic. This article aims to study clinical presentation of various dermatoses induced by abuse of TC in order to bring awareness among patients and practitioners to use topical corticosteroids with utmost caution.</p><p class="abstract"><strong>Methods:</strong> This study was conducted at DVL department of a tertiary care teaching hospital over 23 consecutive months. A total of 200 consecutive patients of all ages and both genders with topical steroid induced dermatoses were included in the study. A detailed clinical evaluation was undertaken, data was then recorded and analysed.</p><p class="abstract"><strong>Results:</strong> Majority of the patients were females (56%). Most common age group was 20-29 years (42%). Majority used TC as a remedy for dermatophytosis (38%), followed by use as a fairness/cosmetic cream (20%). Most of patients (29.5%) used TC for 6 months duration. Most commonly used TC formulation was 0.05% clobetasol propionate (37.5%). Majority patients (62%) did not have a valid prescription of which 47% used TC on Quacks’s advice. The most common side effects encountered were tinea incognito (33%), steroid-induced acne (20.5%), hyperpigmentation (14.5%), and hypopigmentation in 22 (11%).</p><p class="abstract"><strong>Conclusions:</strong> Present study highlights irrational prescription of TC by non-dermatologists for dermatophytosis which are very common in this particular study region and emphasizes the need to educate patients about serious adverse effects of TC abuse.</p>

A clinical study on non venereal genital dermatoses in adult males at a tertiary care center

Introduction: Non-venereal genital dermatoses tend to be confused with venereal diseases, which cause concern to patients and diagnostic dilemma to physicians. A comprehensive understanding of their pattern of presentation, etiology and treatment options is therefore essential to effectively manage the condition and also allay the associated anxiety. This study was to determine the clinico- etiological and epidemiological pattern of presentation of non-venereal dermatoses in male genitalia; Materials and Methods: This was a hospital based descriptive study of 200 male patients over the age of 18years with non-venereal dermatoses of external genitalia attending DVL OPD of KIMS, Amalapuram. Patients having any venereal disease were excluded. A detailed history was taken and a thorough examination of the genitalia, skin and mucosae was done. Gram’s stain, KOH mount, Tzanck smear, patch test, skin biopsy were done as and when required to establish the diagnosis. Results: The overall prevalence of non-venereal genital dermatoses during the study period was 30.8 per 10,000 male patients. A total of 28 different conditions were identified of which the most common was scabies which accounted for 38% followed by candidiasis and vitiligo 12% each, pearly penile papules (10.5%). Certain interesting cases like verrucous carcinoma, lupus valgaris, Behcet’s disease, Erythroplasia of Queyrat, Lymphangiectasia with ramhorn penis and Acrochordon over prepuce were encountered. The data was tabulated and analysed using SPSS version22. Conclusion: Knowledge about the prevalence, etiology of various non- venereal genital dermatoses will be helpful to arrive at adiagnosis and create awareness among patients. Keywords: Non-venereal dermatoses, Male genitalia, Pattern.

Pattern of pediatric dermatoses and seasonal variations in a tertiary referral center in central India

Background: Skin diseases in the pediatric population are common worldwide, including rural and urban areas. There is a variation in the pattern and presentation of dermatoses, with eczemas being the most common skin disorder in developed countries and infestations in the developing countries. To study pattern, age-gender wise distribution and seasonal variations of various pediatric dermatoses.Methods: All children in the age group of 1-12 years of either sex were recruited in the dermatology outpatient department from November 2014 to October 2016.Results: Infections and Infestations were the most common dermatoses (46.3%), followed by dermatitis and eczema (20.24%). Among, the most common types of infections and infestations were scabies (33.49%), followed by viral (30.4%), and bacterial (23.3%) infections. Impetigo (P<0.001), furunculosis (P=0.025), molluscumcontagiosum (P<0.001), hand foot mouth disease (P=0.004) and atopic dermatitis (P=0.003) were significantly higher in the age group of 1 4 years. We also found a significant association between the seasonal variation and the bacterial infections, pediculosis and varicella.Conclusion: In our study, skin infections and infestations outnumbered other pediatric dermatoses. These are potentially controllable and hence strategies that target infections and infestations may be a key to an efficient child health care program.

Pemphigoid Gestationis in a 15 Year Old Pregnant Patient, A Case Report and Literature Review

Pemphigoid gestationis, previously known as herpes gestationis, is a rare autoimmune bullous disease that manifests in pregnancy. Upon presentation, patients complain of intense pruritis, urticarial plaques, vesicles and bullae that primarily affect the peri-umbilical area before spreading to involve the rest of the body. The accurate diagnosis of pemphigoid gestationis is made histopathologically on biopsies, based on the presence of sub-epidermal vesicles, as well as direct visualization of linear deposition of C3 at the basement membrane zone by using immunofluorescence staining on those biopsies. The mainstay treatment of the disease remains corticosteroids. Prompt recognition and provision of the appropriate management allow a reduction in both maternal morbidity as well as fetal adverse perinatal outcomes. Pathologic skin dermatoses and diseases of pregnancy are rare and have different presentations, treatment and prognoses. This literature review includes an up to date comparison on the presentation, diagnosis and treatment of dermatoses in pregnancy, in order to help with the discrimination. A case of pemphigoid gestationis in a 15 year old woman is described. This is the youngest reported age of presentation of pemphigoid gestationis, raising the question of whether maternal age is a factor that can affect the course and the severity of the disease.

Spectrum of Pediatric Dermatoses in The Pediatric Outpatient Clinic of a Rural Teaching Hospital

Introduction: Skin diseases in the pediatric population are common all over the world including rural and urban areas. There is variation in the pattern and presentation of Dermatoses, with eczemas being the most common skin disorder in developountries and infections and infestations in the developing countries. Aims and Objectives: i) To study the spectrum of various dermatoses in infants and children attending pediatric outpatient clinic. ii) To study the pattern of common Dermatological conditions affecting the pediatric population of different age groups. Material &amp; Methods: It was an observational retrospective database study of the spectrum of various dermatoses in infants and children attending pediatric outpatient clinic over past 6 months from July 2016 to December 2016. We included all patients coming with skin disorders to the pediatrics outpatient department. Results: The entire data was entered and cleaned in MS Excel before its statistical analysis. Among 2078 pediatric skin patients attending the Dermatology OPD, 597 cases were Infectious and 1481 cases were Non infectious. Males outnumbered the females. The distribution of diagnosis of dermatoses differs significantly between male and female cases studied (P-value&lt;0.001). Three most common spectrums of dermatoses were pityriasisinfections (17.5%), Atopic dermatitis (11.4%) and Tinea infections (10.5%). Tinea infections were found to be highest (36.7%) and next common was scabies (24.5%) in Infectious variety followed by Chicken –pox / Varicella (7.7%). Conclusion: Over all fungal infections, Atopic Dermatitis and Pytiriasis were commonest which commonly occurred in adolescents and teen age groups which could be attributed to hormonal changes, excessive sweating, and bad hygiene.

Lichenoid Dermatitis of the Vulva: Diagnosis and Differential Diagnosis for the Gynecologic Pathologist.

Inflammatory processes affecting the vulva may present a unique challenge due to location specific changes. Different factors are behind the intricacy in the presentation of vulvar dermatoses. First, the vulva is lined by different epithelia (hair-bearing keratinized epithelium, modified mucosa, and mucosa). Furthermore, among other factors, this organ is exposed to friction, occlusion, and trauma. Lastly, as there is a tendency to look for health care advice at an advanced stage of the disease, the lesion may be modified by secondary changes due to self-treatment. This article describes the clinical presentation and pathologic features of vulvar dermatoses with a lichenoid pattern and highlights practical points for their diagnoses.

A study of dermatoses in patients attending pediatric OPD in a tertiary care hospital of Gandhinagar, Gujarat, India

Background: Skin diseases in paediatric population are common all over the world. There is a wide variation in the presentation of Dermatoses in various studies. The variation among dermatoses can possibly be due to region of study, prevalent environmental factors, type of population studied, and hygiene and nutritional status and environmental factors. The objective of this study was to study prevalence, pattern of presentation and aetiologies of various dermatoses in paediatrics.Methods: A prospective, observational, single center study involving 500 patients of Dermatoses was carried out in a pediatric outpatient department. Detailed history, clinical presentation and other relevant parameter were recorded in a case record form and analyzed.Results: Majority of patients with dermatoses (39.40%) belong to age group of 6 - 16 years with male preponderance. Etiological analysis showed infections and infestations were most common dermatoses. Bacterial infection (184, 36.80%) was most common followed by viral (87, 17.40%), parasitic (51, 10.20%) and fungal (25, 5.00%) infection. Dermatitis was present in 30.6% patients. Diaper dermatitis (19 patients) was the commonest dermatitis present in infants while eczema and urticaria were the commonest dermatitis in school going children. Pyoderma was the commonest dermatoses in this study, present in 111 patients (22.20%) followed by varicella (14.40%), impetigo (12.80%); scabies (10.20%), eczema (10.20%) and urticaria (7.60%).Conclusions: Dermatoses in children are a wide spread problem which are responsible for significant morbidity in children. The high incidence of infections and infestations are possibly due to poverty, overcrowding, undernutrition, poor hygiene and lack of health education. Skin of the young children is more prone to develop skin disease.

Pattern of pediatric dermatoses in Northeast India

Background: The prevalence of pediatric skin diseases varies worldwide. Pediatric dermatoses require a separate view from adult dermatoses as there are important differences in clinical presentation, treatment, and prognosis. Aims and Objectives: To study the clinical and etiological presentation of dermatoses in the pediatric population in Northeast India. Materials and Methods: The study was carried out at a tertiary care center in Northeast region for 18 months (from December 2012 to May 2014). Cases under the age of 12 years were selected based on purposive sampling method. Results: Infections (36.25%) were the most common cause of skin diseases in the study group comprising 400 patients. Eczematous diseases (14.5%), pigmentary disorders (14.25%), and infestations (13.25%) were the other common causes. Varicella (6%), impetigo contagiosum (5%), and candidiasis (4.5%) were the most common viral, bacterial, and fungal diseases, respectively. Scabies (12.25%) was the most common individual disease in the present study. The prevalence of hand, foot, and mouth disease was high constituting 4% of the study group. Dyshidrotic eczema (6.5%), pityriasis alba (7.5%), and vitiligo (3.5%) were also common. Miliarial dermatitis and polymorphic light eruption also contributed significantly (5.25%) reflecting the typical pattern of the tropical skin diseases. Atopic dermatitis, genetic disorders, and nutritional deficiency disorders had a very low prevalence. Conclusion: The study finding that the majority of the diseases could be grouped into fewer than 8 disease categories may help in more accurate diagnosis. Significant proportions of the dermatoses are infections followed by eczematous and pigmentary diseases. Age, sex, locality, the income of the parents, family history, and season of presentation have an influential role in the pattern of distribution of the pediatric skin diseases.

Lichen planus and other lichenoid dermatoses: Kids are not just little people

Lichenoid dermatoses, a group of inflammatory skin conditions with characteristic clinical and histopathologic findings, range from common to rare. Classic lichen planus typically presents as pruritic, polygonal, violaceous flat-topped papules and plaques; many variants in morphology and location also exist. Other lichenoid dermatoses share similar clinical presentations and histopathologic findings. These include lichenoid drug eruption, lichen planus-like keratosis, lichen striatus, lichen nitidus, and keratosis lichenoides chronica. Epidemiologic characteristics vary among each lichenoid disorder. While classic lichen planus is considered a disease of adults, other lichenoid dermatoses may be more common in younger populations. The literature contains an array of reports on the variations in presentation and successful management of lichen planus and lichenoid dermatoses among diverse populations. Familiarity with the characteristics of each lichenoid dermatosis, rare or common within each patient population, is key to accomplishing timely recognition and effective management.

Differential diagnosis of anal eczema

Dermatologic disorders often show involvement of the (peri)anal skin. However, diagnosis of (peri)anal dermatoses is often difficult even for experienced dermatologists due to delayed clinical presentation or prior treatment with over-the-counter medications. The distinct anatomical conditions of the (peri)anal region results in atypical clinical presentation of common dermatoses. Typical symptoms include pruritus, burning, bleeding and pain. Careful history of symptoms, stool, hygiene, sexual practice as well as thorough inspection of the entire body and proctological examination are crucial to make the correct diagnosis. In case of atypical presentation or uncertainty a biopsy needs to be obtained to ensure correct diagnosis and treatment.

Management of difficult uncommon dermatoses in HIV/AIDS clinical setting: A case series

Skin disease may provide the first suspicion of diagnosis of HIV infection. Infection with HIV has great impact on skin diseases. In the context of HIV, the clinical presentation of dermatoses assumes either a classic or an uncommon form. Herein, we report six dermatological cases in the setting of HIV, with varied presentation and outcome after treatment. Knowledge of changing disease pattern with HIV may help the clinician to identify dermatoses and act in appropriate manner in the case management to support the patient.

Unusual Presentation of Obesity-associated Dermatoses: Acanthosis Nigricans Involving Both Auricles

Acanthosis nigricans is prevalent in the general population and is the most common dermatological manifestation of obesity. It is typically observed in the flexural areas such as the neck, axillae, and groin. Herein we report an interesting case of extensive acanthosis nigricans involving the neck, axillae, groin, and, uncommonly, the sulci of both auricles in an otherwise healthy but obese 23-year-old patient.

Nevoid hyperkeratosis of the nipple and areola: A distinct entity

Although nevoid hyperkeratosis of the nipple and areola was initially described in 1923, there are only case reports or reviews about it; no large series have been documented to date. The clinical features of the reported cases in the literature are not uniform, and it is questioned whether nevoid hyperkeratosis of the nipple and areola is a distinct clinicopathologic entity or a clinical presentation of various dermatoses. We describe 7 cases with hyperkeratotic nevoid lesions localized on the nipple and areola with different clinical features. None of them had any other associated dermatologic or systemic disease. Histopathologic examination was performed in 6 patients. Four of them had common histopathologic features suggesting a distinct entity, namely, nevoid hyperkeratosis of the nipple and areola; 2 of them had histopathologic features consistent with seborrheic keratosis. Seborrheic keratosis presents as sharply demarcated papules or plaques, whereas nevoid hyperkeratosis of the nipple or areola presents as a plaque diffusely involving the nipple or the areola. (J Am Acad Dermatol 2002;46:414-8.)

Skin diseases in patients with AIDS: study in 55 cases in Uberlândia, MG, Brazil

Fifty-five patients with acquired immunodeficiency syndrome (AIDS) seen at the Dermatology outpatient clinic and who had mucocutaneous diseases were studied. These diseases, some of them opportunistic, are common but difficult to diagnose given the atypical features of the lesions. The aim of this study was to analyse the frequency and clinical presentation of dermatoses related to Aids seen at the Dermatology outpatient clinic. Fifty-five patients with Aids and mucocutaneous lesions were examined from 1995 to 1997 in a cross-sectional study carried out at the Dermatology outpatient clinic of the Universidade Federal de Uberlândia (Minas Gerais, Brazil). Biopsies and cultures were undertaken for laboratory diagnosis. One hundred sixteen dermatoses were diagnosed. Fungal infections (78%) were the commonest among them, followed by viral infections (40%), papulosquamous disorders (27%), papular eruptions (18%), adverse drug reactions (10%), tumors (9%) and a variety of others (7%). The majority of the patients (67%) had more than one type of skin disorder. In agreement with previous literature data fungal and viral infections were confirmed as the most frequent skin disorders in HIV-positive patients. Dermatological examination, laboratory tests and skin biopsy for histopathological study are necessary for appropriate diagnostic investigation of HIV-related mucocutaneous diseases considering that atypical presentation occurs in a large proportion of the patients.