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   Table of Contents - Current issue
July-September 2019
Volume 20 | Issue 3
Page Nos. 191-287

Online since Friday, June 28, 2019

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Childhood psoriasis: Disease spectrum, comorbidities, and challenges Highly accessed article p. 191
Soumajyoti Sarkar, Sandipan Dhar, Siba P Raychaudhuri
Psoriasis is a chronic, inflammatory, papulosquamous disorder with a variable clinical spectrum. Although it affects population of all age groups, the significance and negative impact of childhood psoriasis is often neglected worldwide. In nearly one-third of the psoriatic population, psoriasis appears during the childhood. In this article, we have focused on different issues and challenges faced during the management of childhood psoriasis. In addition to the varied clinical spectrum and associated comorbidities, in this article, we have given emphasis on the following real needs for childhood psoriasis: (i) psychological and social effects on the affected children, (ii) impact on their family members, and (iii) early diagnosis and management of psoriasis on children with psoriasis. We have concluded the article with the “concept of total care,” which is a third dimension for the management of psoriasis.
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Childhood acanthosis nigricans Highly accessed article p. 199
Anupam Das, Priyankar Misra, Saumya Panda
Acanthosis nigricans (AN) is a frequently encountered dermatological condition seen commonly in middle aged or elderly, but in the recent times, there has been an increase in the childhood cases, especially in the adolescent age group. AN clinically manifested as dark, velvety, and thickened skin, symmetrically distributed over the neck, axillae, other flexural regions of the body and face. Facial AN, a somewhat recent entity that has been described and significant association with obesity, hyperinsulinemia, and metabolic syndrome, has been established. AN was once considered a rare paraneoplastic dermatosis but is now frequently observed in obese adolescents. Obesity in adolescence is a public health priority because it usually tracks into adulthood, resulting in enormous medical and social costs. This underscores the importance of early identification and intervention. The purpose of this narrative review is to provide a comprehensive overview of AN in childhood, including history, definition, classification, its clinical significance, management challenges, and the direction of future research.
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Contact dermatitis in pediatric age group: Indian scenario p. 205
Yasmeen Jabeen Bhat, Saniya Akhtar, Iffat Hassan
Contact dermatitis was previously considered to be rare in children except some forms of irritant contact dermatitis which were seen commonly in children. However, nowadays, there are an increasing number of cases of allergic contact dermatitis (ACD) being reported in children due to increased exposure to a variety of allergens at an earlier age. Various predisposing factors which influence the occurrence of contact dermatitis include age, sex, atopy, and presence of any concomitant skin disease. Nickel has been identified as leading cause of ACD in children. Other common allergens reported are cobalt, fragrance mix, rubber, lanolin, thiomersal, neomycin, gold, mercapto mix, balsam of Peru, and colophony. Clinical presentation in children is similar to that in adults with eczema of the hands, feet, wrists, face, forehead, scalp, eyelids, earlobes, neck, axilla, trunk, thighs, and anogenital area being seen. Disseminated lesions can as well be seen. When ACD is suspected, patch testing is the gold standard diagnostic procedure. However, patch testing in children differs from adults as some technical difficulties are encountered in children due to their smaller test area and frequent movements. However, the general opinion stands that children can be patch tested with the same methods and patch test concentrations as adults. For the prevention of recurrence, allergen elimination should be the aim of treatment; however, in many cases, it is not possible to completely eliminate the allergen from the patients environment. Topical steroids and calcineurin inhibitors form the mainstay of treatment in most cases.
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Clinical spectrum of dermatological disorders in children referred from pediatrics department p. 212
Taru Garg, Riaz Ahmed, Srikanta Basu, Ram Chander
Background: Worldwide, limited studies have been done to study the spectrum of dermatological referrals in children. Aims and Objectives: The aim of this study was to analyze the spectrum of dermatological disorders in children referred from pediatrics department. Materials and Methods: It was a hospital-based observational study. Five hundred twenty-five children of either sex or age ≤18 years, in whom, parents had given written informed consent, and referred to Dermatology from Pediatric medicine department were included in this study. The diagnosis was made based on clinical features supported by necessary investigations. Working hours were considered as routine and emergency. Nelson' severity scoring system was used to classify children as sick. Results: Most of the children were referred during routine hours (85.7%), maximally from inpatient department (46%) followed by outpatient department (37%). Most common diagnosis was viral infections (21.2%), closely followed by eczematous disorders (17.6%) and disorders due to arthropods (17.1%). Majority of patients were not sick (83.61%). Pediatricians did not suggest any diagnosis in 70.85% of referrals followed by doubtful diagnosis in 26.85% and definitive diagnosis in 2.28% of patients. Conclusion: Majority of referrals were done during routine hours in nonsick patients. As many common easily treatable dermatoses were observed in all the referrals reiterating the fact that these referrals should be sought as early as possible to prevent unnecessary delays in the diagnosis and patient management. Furthermore, a robust dermatological training should be provided to undergraduates and interns to better equip the nondermatologists to diagnose common dermatological disorders.
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Dermoscopy of congenital dermatoses in pediatric age group: An observational study Highly accessed article p. 219
Prachi Chetankumar Gajjar, Hita Hemant Mehta, Mehul Gosai
Objective: To study dermoscopic (DS) patterns of various congenital dermatologic conditions affecting pediatric age group. Background: DS helps to fill gap between histopathology and gross examination, especially in children as they are noncooperative for invasive procedure. It also helps in early detection of malignant change. Methodology: One hundred and forty-nine children with congenital dermatoses were enrolled in a study conducted from August 2017 to January 2018 in dermatology outpatient department (OPD). After proper history and examination, DS images were captured using DermLite DL IV and stored for analysis. Results: One hundred and forty-nine DS images of 22 congenital dermatoses were studied including 80 males and 69 females. Homogenous pattern (80%) was the most common pattern observed in melanocytic nevi (26). Mongolian spots (25) had greenish hue (100%) on DS. Hemangioma (13) and port wine stains (5) showed cherry red vacuoles and red dots against a pink background, respectively. Criss-cross, rhomboid, and lamellate pattern of scales were observed in DS of congenital ichthyosis (8). We also analyzed DS features of bullous and perforating disorders, syndromes, few rare miscellaneous conditions, and hair disorders. Conclusions: DS is a non-invasive diagnostic tool which enables visualization of deeper structures of the skin which are not seen with naked eyes. Melanocytic nevus, if disorganized, indicates increased risk for melanoma in situ. Pattern of scales on DS helps to classify ichthyosis. Regular brown dots suggest wart-like infection in epidermodysplasia verruciformis. DS of monilethrix and short anagen syndrome helps in differentiating from other hairs shaft disorders. Although time consuming, DS is easy to perform, especially in children and it aids to confirm the diagnosis.
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Halo Nevi in children: A separate entity or a sign of vitiligo? p. 227
N A Bishurul Hafi, Romita Bachaspatimayum, Ronibala Soraisham, N CP Muhammed
Background: Halo nevi (HN) can present either singly or along with vitiligo. Whether they are different entities, remains debatable. Objectives: The objective of the study is to compare clinicoepidemiologic and laboratory factors associated with HN, HN with vitiligo and vitiligo alone, in children. Methodology: A total of 205 children <18 years who presented to the outpatient department were sampled purposively to three groups: (a) HN without vitiligo, (b) HN with vitiligo, and (c) Vitiligo without HN. Results: There were seven patients in Group A, 11 in Group B, and 187 in Group C. A statistically significant difference was noted between Group B and C in the age of onset (0.004) as well as the age of presentation (0.031). Even though the disease process had started in head-and-neck region in more than half of the patients in each group, HN was present mostly on trunk (90.9%) in Group B and in 28.6% in Group A. No statistically significant difference was noted in associated disorders, personal or family history of autoimmune disorders, koebnerization, leukotrichia, or laboratory tests. Conclusions: Our study, particularly done among pediatric population, has failed to demonstrate much significant differences between HN and vitiligo, except in the age of presentation as well as the age of onset. It further gives proof to substantiate the hypothesis that HN can be a part of clinical spectra of vitiligo.
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Evaluation of efficacy and safety of intralesional Measles-Mumps-Rubella virus vaccine for the treatment of common warts in children and adolescents p. 231
Vikram K Mahajan, Pushpinder Singh Chauhan, Aditi Sharma, Karaninder Singh Mehta, Ritu Rawat, Vikas Sharma
Background: No single treatment for warts has proven 100% efficacy and most therapeutic modalities remain unsatisfactory. Immunotherapy with Measles-Mumps-Rubella (MMR) vaccine remains underevaluated, especially in children. Objective: To evaluate the efficacy and safety of intralesional MMR vaccine in the treatment of common warts in children. Materials and Methods: Fifty-five (36 boys and 19 girls) children aged 5–18 (mean ± standard deviation 12.8 ± 3.88) years with common warts received 0.25 ml of MMR vaccine injected intralesionally in the largest wart. The dose was repeated at 2-week interval until complete clearance or for a maximum of 5 doses. Thereafter, they were followed up once a month for 24-week study period. The response was evaluated as complete clearance (complete disappearance of the wart(s) including distant ones and appearance of normal skin), partial clearance (≤99% reduction in size and number including distant ones and few residual warts still visible), good response (some reduction in size only including that of distant ones but no decrease in number of warts), or poor response (no change in size and number). Results: Only 46 patients completed the study and 27 (58.7%) of them had complete clearance of warts, 9 (19.6%) showed partial clearance and 10 (21.3%) patients showed no response. In 15 of 27 patients complete clearance was achieved after 5 doses, 7 had complete clearance after 4 doses and 2 patients each showed complete clearance after 2 and 3 doses, respectively. Conclusion: Intralesional MMR vaccine immunotherapy appears promising, effective, and safe treatment for common warts in children with the advantage of single-lesion infiltration, and resolution without scarring or pigmentary changes commonly seen with destructive therapies. However, better designed larger controlled studies are warranted.
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A girl with alopecia and skeletal deformities: Satoyoshi syndrome with review of literature p. 236
Vishalakshi S Pandit, K Udaya
Satoyoshi syndrome is a rare disease characterized by alopecia, recurrent muscle spasms, diarrhea, and skeletal abnormalities. It is a multisystem disorder of suspected autoimmune etiology. We report a 12-year-old-girl presented with loss of hair from the scalp for 7 years. She had a history of muscle spasms of lower limbs, which used to last for a few minutes; the attacks of spasms were intermittent in nature and involved thigh and calf muscles. She had genu valgum deformity of the right knee and knock-knee gait. Central nervous system examination showed no abnormality. Her laboratory investigations including routine screening and endocrine evaluations were within normal limits, except for microcytic hypochromic anemia. Ultrasonography (USG) abdomen revealed relatively small uterus. X-ray of the right knee showed deformed shape of the epiphysis and dense metaphyseal band of bones. Histopathological examination (HPE) scalp showed noncicatricial alopecia with the absence of functional follicles and dermal lymphocytic infiltration. On the basis of clinical investigations, blood investigations, USG, and radiological findings, diagnosis of SS was made. SS is a sporadic disease with the mean age of onset of the disease being 10 years, but a few adult cases have also been reported. The usual initial symptoms are alopecia and painful muscle spasms. Treatment with oral corticosteroids has shown good response. The case is being presented to create awareness not only among dermatologists but also among pediatricians and orthopedicians about the multisystem involvement and long-term-associated complications and to emphasize the need of early diagnosis and treatment.
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Eruptive collagenoma: A rare entity in pediatric age p. 240
Pratiksha Sonkusale, Sonia Jain, Abhay Deshmukh
Eruptive collagenoma is a rare acquired connective tissue nevus predominantly composed of collagen, with elusive incidence and etiopathogenesis. Many cases are reported in young adults, but there is a dearth of literature in children. Herein, we report a rare case of eruptive collagenoma in a 5-year-old child who presented with multiple asymptomatic papules, plaques, and nodules over the back and face with no systemic involvement. There was no positive family history or history of consanguineous marriage, and diagnosis was confirmed histopathologically. We report this case due to its rarity in Indian literature in pediatric population with facial involvement.
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Rothmund–Thomson syndrome presenting with bullous eruption: A rare case report p. 243
Akshat Tamta, Jitendra Singh Bist, Gunjan Gupta, Sumeet Pal Saini, Anant Kumar Singh
Rothmund–Thomson syndrome is a rare, autosomal recessive genodermatosis characterized by an early-onset poikiloderma, skeletal abnormalities, short stature, premature aging, and increased susceptibility to malignancy. We report a case of a 1-year-old male child with bullous lesions and pigmentary changes over the face and extremities. Strict photoprotection and careful surveillance for malignancy forms the mainstay of treatment. The case is being reported due to its rarity and the diagnostic dilemmas associated with it.
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Secondary syphilis in a preadolescent boy p. 246
R Nisha, Banu Priya, V Mahalakshmi, S Murugan
The problem of sexual abuse in children seems to be more common today. We report a case of acquired syphilis in an 11year old boy with painless lesion in penile region along with flat topped whitish plaque lesion in the perianal area. Serological test for syphilis was positive in the affected child. Both the parents and other siblings were negative for syphilis. Acquired syphilis in children is usually due to sexual abuse. Hence syphilitic lesions in preadolescent children should raise the suspicion of possible sexual abuse.
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A rare case of onychomycosis due to Aspergillus species in a neonate p. 249
Kuldeep Verma, Gita Ram Tegta, Ghanshyam Verma, Santwana Verma
Onychomycosis is a common condition affecting 5.5% of the population worldwide and represents 20%–40% of all onychopathies and about 30% of cutaneous mycotic infections. It is common in elderly, uncommon in children, and rare in neonates. Onychomycosis is caused by dermatophytes, nondermatophytic molds (NDM), and yeasts. Onychomycosis due to NDM is even rarer in neonates. Here, we report a case of a 3-week-old neonate who was diagnosed as a case of onychomycosis due to Aspergillus species. The neonate was started on topical antifungal amorolfine 5% and improved in 8 weeks.
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Ascher syndrome p. 252
Ajitesh Prakash Varshney, Pratik Gahalaut, Nitin Mishra, Madhur Kant Rastogi
The triad of blepharochalasis, double lip, and nontoxic thyroid enlargement characterizes Ascher syndrome. We describe the case of a 16-year-old female who presented with progressive laxity and swelling of the skin associated with recurrent progressive episodes of painless swelling of the eyelids with increase in the size of the upper lip and diffuse swelling over the neck. We discuss this case for rarity of its presentation in the Indian population.
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Conradi–Hunermann syndrome: A rare case of chondrodysplasia punctata p. 255
Rajkumar Motiram Meshram, Akhilesh A Dandale, Lakshmikant A Rohadkar, Ravi N Chirag
Conradi–Hunermann syndrome is a common form of chondrodysplasia punctata, inherited as X-linked dominant disorder of cholesterol metabolism due to mutation of emopamil-binding protein gene resulting in a spectrum of skeletal, cutaneous, and ocular abnormalities. One-day-old premature, cesarean-delivered female neonate admitted with xerotic, featherlike yellow-to-white hyperkeratotic scale all over the body with craniofacial defect, coarse hair, patches of cicatricial alopecia, and absent eyebrows. Baby had rhizomelic shortening of proximal limb, clinodactyly, club foot, talipes equinovarus, and bilateral congenital cataract. Radiological skeletal survey revealed punctate stippled calcification involving left femoral head epiphysis, bilateral tarsal bones, vertebral bodies of multiple thoracolumbar vertebrae, and sternum. Serum level of 8-dehydrocholesterol was elevated. Diagnosis of rare disease can be made on clinical suspicion and radiological survey in resource-limited setting.
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A rare case of toxic epidermolysis necrolysis in early infancy: Successfully treated with intravenous immunoglobulin p. 258
Bharti Bhandari, Ragini Singh, Mritunjay Kumar, Aditya Saun
Toxic epidermal necrolysis (TEN) is a potentially life-threatening dermatological disorder characterized by widespread erythema, necrosis, and bullous detachment of the epidermis and mucous membranes, resulting in exfoliation and possible sepsis and/or death. TEN is a disease of both children and adults, but TEN in early infancy is a rare event; in literature, only few cases in infants aged <6 months have been reported so far. We reported a case of a 6-week-old infant who developed TEN after some local off-label medication for abdominal colic. After intravenous immunoglobulin treatment, the infant showed dramatic improvement without any complications.
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Hyperpigmented patches following blaschko lines: Two probable cases of linear atrophoderma of moulin with subtle atrophy and a critical review of the subject p. 261
Tasleem Arif, Mohammad Adil, Marwa Sami, Noora Saeed
Linear atrophoderma of Moulin (LAM) is a rare clinical entity characterized by hyperpigmented, depressed band-like skin lesions following blaschko lines (BL). Since its first description by Moulin et al., several authors have presented cases with variable clinical and histopathological features and have diagnosed them as LAM. Whether all those cases represented classical LAM as described by Moulin et al. or they represented a related dermatosis; depends on whether we confine the diagnosis of LAM as presented by Moulin et al. or consider it to be a spectrum where lesions may have overlapping clinical and histopathological findings. Some dermatoses that follow BL and have overlapping clinical and histopathological findings include LAM, idiopathic atrophoderma of Pasini and Pierini and Blaschkolinear morphea. Thus, it becomes difficult for a physician to diagnose these conditions when their typical clinical and histopathological findings are not present, especially when they present in early stages of evolution. Here in, we present two cases of LAM where the visible clinical atrophy is mild in one and not appreciable in the other. Whether our cases are the genuine cases of LAM or represent a stage of LAM or fall in the spectrum of LAM depends on how we expand the definition of LAM. We believe that whenever there is an encounter with hyperpigmented lesions in a blaschkoid pattern, a long-term follow-up is needed with serial biopsies to make a final definitive diagnosis.
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A rare phenomenon of twin spotting: Phacomatosis pigmentokeratotica p. 267
Vaishali Wankhade, Vrutika Hasmukh Shah, Rajesh P Singh, Jayesh Mukhi
Phacomatosis pigmentokeratotica is a rare form of cutaneous mosaicism characterized by epidermal nevus usually nevus sebaceous, papular speckled lentiginous nevus, and extracutaneous anomalies. This type of twin-spot phenomenon (didymosis) is due to postzygotic crossing-over resulting in two homozygous daughter cells, representing the stem cells of the two distinct types of nevi and leading to additional extracutaneous defects. We report a case of this rare syndrome in a 4-year-old male child associated with skeletal anomalies.
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Disseminated juvenile xanthogranulomas with systemic involvement: A rare presentation p. 271
Preeti K Sheth, Resham Vasani, Deepak Parikh, Manish Shah, Rajesh Jadhav
Juvenile xanthogranuloma is a self-healing non-Langerhans cell histiocytosis. It primarily manifests with cutaneous lesions which may have systemic associations. We report a case of a 6-month-old child who presented with multiple orangish papules and nodules all over the body with eye and liver involvement, which is a rare entity. The diagnosis was confirmed with dermoscopy and histopathological assessment, including immunohistochemical study. He responded to medical line of therapy.
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Anti-U1-ribonucleoprotein positive and anti-Ro and anti-La negative neonatal lupus erythematosus p. 276
Angoori Gnaneshwar Rao, Vangali Srikanth Reddy, Karnam Aparna, Ruhi Haqqani, Kranthi Jagadevapuram, Sneha Gupta, Kousar Fathima, M Tejal, Divyaparimala Muppirala
Neonatal lupus erythematosus (LE) is associated with anti-Ro and/or anti-La antibodies. Herein, we present a 2-month-old female baby born to an LE mother in evolution. The baby was positive for U1-ribonucleoprotein antibodies and negative for anti-Ro and anti-La antibodies and was not having any systemic involvement.
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Facial lichen striatus p. 279
Khalid Al Aboud, Faisal Alfelate
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Pyoderma gangrenosum: Misdiagnosis leading to mismanagement p. 280
Uddhao S Zambare, Swagata A Tambe, Chitra S Nayak
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Palmoplantar keratoderma in a classical case of christ-siemens-touraine syndrome: A rare association p. 282
Prince Yuvraj Singh, Aradhana Sood, Preema Sinha, Saikat Bhattacharjee
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Nicolau syndrome in a neonate p. 284
Fatima Tuz Zahra, Syed Suhail Amin, Mohammad Adil, Mahtab Alam
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Vohwinkel's syndrome in three siblings – A case report p. 285
Sonam Sharda, Vijay Paliwal, Pulkit Chaturvedi, Cheetar Mal Kuldeep
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