Department of Dermatology

Rajiv Gandhi Medical College and Shivaji Maharaj Hospital, Kalwa, Thane.400605

Sunday, 27 June 2010

1) Bleomycin as a therapeutic modality in recurrent warts - Dr.  Bharti  Patel

Background:- IL Bleomycin has been used for the treatment of wart since 1970 but not commonly in recent practice.

Aims:-  To assess the efficacy of IL Bleomycin, side effects, total treatment duration , interval between 2 sittings, total units of Bleomycin used & recurrence rate assessed after 6 week of complete clearance.

Methods:- Randomized uncontrolled study in recurrent wart with study population of 10, all above 12 years. IL Bleomycin (0.1% solution with concurrent anesthesia) was given for maximum 4 treatments 3 weeks apart & maximum 5 warts and maximum 2 IU of Bleomycin given in one sitting. Patients had their warts measured at base line and with each return visit including a post treatment follow-up 6 weeks apart from last treatment taken

Result:-  Out of 10, six patients with periungual warts and two with palmar warts responded in average 1.5 sittings. Average total number of sitting needed was 2.2 with average 4.8 IU of Bleomycin. Common s/e was post inflammatory hyperpigmentaion.  Clearance rates in context of number of patients & number of warts were 90% & 95% respectively.

Conclusion:- IL Bleomycin injection is effective for recurrent warts & high beneficial in periungual & palmar warts. Further evaluation with a larger sample size & comparison with other modalities is needed.

2) Diagnostic & Therapeutic dilemma - Dr Shweta Nakhawa

a) A 45yr old male loom worker presented with discolored & erythematous pruritic lesion on both extremities & trunk since 4yrs. He had h/o of tingling & numbnes, generalized malaise, single episode of fever, joint pain, photosensitivity & finger scarring pt was treated with systemic steroid with partial relief. Hematological & immunological investigations were positive (ANA+ve at 2 occasion ). Biopsy was s/o UCTD. presently patient  is on antimalarials with intermittent recurrence of lesions literature on UCTD & MCTD will be reviewed.

b) A 45yr old farmer presented with sudden onset hypoaesthetic eschar with impending ulceration since 15 days ,skin colored lesion of 1 yr duration. he had h/o tingling & numbness& thickened peripheral nerves were felt on examination slit skin smears were positive average BI-2.2,MI-80%. Biopsy was confirmatory of blh with ulcerative type 1 reaction (lazzarine). Pt was treated with MDT –Mb along with high dose steroids with good response. Literature on lazzarine leprosywill be reviewed.

     3.  Diagnostic challenges - Dr Amishi Parekh

   Three female patients aged 32, 39 and 27 respectively, presented with facial lesions in periorificial       distribution in form of scaly plaques and papules with  I week, 3 months and 4 years duration,  respectively. Flushing and contact eitiology was seen in one case and scarring was seen in another. Histopathology of two showed perivascular and perifollicular non-caseating epithelioid cell granulomas and one showing caseating  epithelioid cell granulomas. All were treated with tetracyclins with moderate response. Granulomatous rosacea was Considered in one  case and Lupus milliaris desseminatus faciei in the other two cases. Clinical and histopathological differences in this two conditions would be discussed along with concept of newer terminologies(F.I.GU.R.E)

4. SPOTS

1. Angiofibroma

2. Verrucous hemangioma

3. Angiokeratoma circumscriptum (2 cases)

4. Capillary hemangioma

5. Nevus flammeus

6. Dowling Dego’s disease

7. Hidrotic ectodermal dysplasia

8. Hailey-Hailey disease

9. Unna-Thost syndrome

10. Keratosis punctata of the palmar creases

11. Basal cell carcinoma

12. Seborrheic keratosis

13. Bowen’s disease

14. Nodular metastasis from Breast carcinoma.

5) Vitiligo: Beyond the clinical frontiers

Background: Vitiligo varies in its epidemiological patterns on a regional basis and also affects the patient’s Quality of Life. There is limited data about these  aspects in the Indian scenario.

Objectives:

1. To determine the clinico-epidemiological characteristics concerned with the disease

2. To evaluate the impact of vitiligo and its clinical correlation with the overall Quality of Life (QoL).

3. To evaluate the impact of phototherapy and its clinical correlation with the QoL.

Materials and methods: A single-observer, cross-sectional study, conducted on sixty clinically diagnosed vitiligo cases, aimed to reveal the correlation between demographic parameters and DLQI scores.  Relevant clinico-epidemiological parameters were recorded and the impact on QoL measured using the Dermatology Life Quality Index (DLQI).

Results: Males constituted 41.67%(n=25) and females 58.33%(n=35) of the total sample with a positive family history in 15%(n=9). Hypertension 6.67%(n=4), diabetes 5%(n=3) and acne 5%(n=3) were found to be the leading concomitant diseases. Vitiligo vulgaris with 58.33%(n=35) cases was predominant. The overall mean DLQI score was 7.87. Among new cases, married females had significantly higher mean score(12.25) compared to males(8.14) [p<0.05]. Patients with generalized vitiligo had significantly higher mean score(7.92) compared to localized variety(5.22) [p<0.05], the significance being attributable exclusively to male patients. The mean score of new cases(8.94) was significantly higher than those on phototherapy(6.95) [p<0.05]. At least eleven months of treatment were required to produce progressively significant decline in mean scores.

Conclusion: The assessment of clinico-epidemiological profile reiterated the fact that vitiligo has varied epidemiological characteristics. Vitiligo has a definite negative impact on patient’s QoL as demonstrated by DLQI scores. Hence cost-effective intervention strategies need to deal with both clinical and psychosocial problems. Phototherapy proves promising in this regard.

6.Kaposi sarcoma.- Dr. Bharti Patel

40 year male, from Nepal presented with h/o bleeding from oral & nasal cavity since 15 days and lump on neck & raised skin coloured to black horny papules & nodules with cephalocaudal progression since 3 months. He was k/c/o GI tuberculosis on AKT since 3 months. The significant investigation findings included HIV negative, raised ESR & markedly raised LDH levels. The histopathology was of skin biopsy & FNAC from nasal lesion was suggestive of Kaposi’s sarcoma & IHC study showed CD34 weakly positive and CD31 negative. However tissue HHV 8 was negative. Literature on Kaposi’s sarcoma in non-seropositive patients will be reviewed.

7)  Unusual swellings -  Dr Shweta Nakhawa

a) A 13yr old female presented with asymptomatic fleshy mass on right elbow since 6yrs which gradually increased in size over 2 past 2yrs . biopsy was s/onevus lipomatosus ,a rare benign skin malformation at an atypical site .

b) A 72 yr old female presented with progressive erythematous plaque on right forearm since 7months with prior history of trauma. Biopsy from nodular & ulcerated lesion showed cutaneous horn & squamous cell carcinoma .

c) A 60yr female presented with progressive hyperpigmented plaques on breast since 6months .clinical diagnosis of keloid or hypertrophic scar was considered, biopsy was s/o dermatomyofibroma ,is a rare fibrous tumour more commonly seen in young females over axlla & shoulder.

8)  Spots – Dr. Kinjal Mistry

1. Solitary mastocytoma

2. Urticaria pigmentosa

3. Isotopic phenomenon in a case of psoriasis

4. Scleredema

5. Localised morphea

6. Morphea profundus

7. Lymphangioma circumscriptum

8. Eruptive milia

9. Lamellar desquamation

10. Granuloma annulare

11. Psuedoxanthoma elasticum with elastolytic GA

12.  Erythema chronicum migrans