Ravindranath Brahmadeo Chavan; Vasudha A Belgaumkar; Nitika Deshmukh; Balakrishna Nikam; Vijay Deepak Joshi
Abstract
Proliferating trichilemmal tumors are rare, generally solitary, benign tumors arising from the hair’s outer root sheath with trichilemmal keratinization. These tumors are predominantly found on the head, neck, and face of elderly females; the inguinal region is a highly unusual site of involvement. ...
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Proliferating trichilemmal tumors are rare, generally solitary, benign tumors arising from the hair’s outer root sheath with trichilemmal keratinization. These tumors are predominantly found on the head, neck, and face of elderly females; the inguinal region is a highly unusual site of involvement. Malignant change in this tumor is rare, histologically mimicking squamous cell carcinoma. Metastatic malignant proliferating trichilemmal tumor requires a high index of suspicion for diagnosis and accurate histopathological reporting for timely intervention. Here, we report the case of a 65-yearold man presenting with nodular-ulcerative lesions in the groin, clinically confused with hidradenitis suppurativa and histologically with squamous cell carcinoma. He was finally diagnosed with an inoperable metastatic stage of malignant proliferating trichilemmal tumor and was treated with palliative care. This case highlights the innocuous clinical appearance of such lesions that might delay the management of this fulminant tumor.
Sunil Narayan Tolat; Anil Gosavi; Vasudha Belgaumkar; Ravindranath Chavan; Nitika Deshmukh; Sweta Tharewal; Nupur Warke
Abstract
Schnitzler’s syndrome is an autoinflammatory disorder presenting with wheals, monoclonal gammopathy, and signs of inflammation. A 55-year-old woman presented with reddish, moderately itchy wheals with intermittent fever and arthralgia for two years. Multiple erythematous, edematous plaques were ...
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Schnitzler’s syndrome is an autoinflammatory disorder presenting with wheals, monoclonal gammopathy, and signs of inflammation. A 55-year-old woman presented with reddish, moderately itchy wheals with intermittent fever and arthralgia for two years. Multiple erythematous, edematous plaques were noted all over the body. Dermographism was present. A diagnosis of chronic urticaria was considered and treated with antihistamines. The patient returned six weeks later with partial symptomatic relief. She was then investigated for the cause of chronic urticaria, and the following differentials were considered: systemic lupus erythematosus (SLE), dermatomyositis, urticarial vasculitis, and auto-inflammatory diseases. The patient was febrile, and her blood investigations revealed leukocytosis and a raised erythrocyte sedimentation rate along with IgM gammaglobulinemia and an M band on serum electrophoresis. Skin biopsy revealed a neutrophilic infiltrate in the dermis. Thus, based on the Strasbourg diagnostic criteria, a final diagnosis of Schnitzler syndrome was made. Urticarial rash is one of the most common complaints encountered by dermatologists. Other extremely uncommon diseases like autoinflammatory disorders (for example, Schnitzler syndrome) can mimic chronic urticaria. The appearance of the rash and associated symptoms should be carefully considered to identify these missed cases. Auto-inflammatory syndromes are severely debilitating, with little awareness among healthcare professionals. Thus, they are often recognized with a diagnostic delay of many years. Early diagnosis of such rare diseases is imperative for effective treatment and to prevent devastating long-term complications.
Anil Prakash Gosavi; Ravindranath Brahmadeo Chavan; Neelamkumari Bhatt; Nitika Deshmukh; Darshana Rajendra Kundale
Abstract
Bullous pemphigoid is the most common type of subepidermalautoimmune bullous disease. It usually affects older people;isolated cases among people younger than 65 have been reportedwith various presentations, usually more severe and active thanthose seen in the elderly. Toxic epidermal necrolysis (TEN) ...
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Bullous pemphigoid is the most common type of subepidermalautoimmune bullous disease. It usually affects older people;isolated cases among people younger than 65 have been reportedwith various presentations, usually more severe and active thanthose seen in the elderly. Toxic epidermal necrolysis (TEN) is apotentially life-threatening dermatologic disorder characterizedby widespread necrosis and bullous detachment of the epidermisand mucous membranes resulting in exfoliation and possiblesepsis. Various morphological variants of bullous pemphigoidhave been reported, with reports of the TEN-like variant ofbullous pemphigoid being scarce. In this study, we report a caseof bullous pemphigoid with TEN-like presentation in a middleagedfemale.
Anil Prakash Gosavi; Ravindranath Brahmadeo Chavan; Rahul Narendra Jaiswal; Vijay Deepak Joshi
Abstract
Methotrexate, an anti-psoriatic drug possessing immunoregulatory, antiproliferative, and anti-inflammatory properties,acts by blocking deoxyribonucleic acid and ribonucleic acid synthesis. It acts especially on rapidly dividing bone marrow cells and proliferating epithelia and mucosae. The toxicity of ...
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Methotrexate, an anti-psoriatic drug possessing immunoregulatory, antiproliferative, and anti-inflammatory properties,acts by blocking deoxyribonucleic acid and ribonucleic acid synthesis. It acts especially on rapidly dividing bone marrow cells and proliferating epithelia and mucosae. The toxicity of this double-edged sword occurs due to accidental excessive intake or daily dosing instead of weekly dosing. We report the case of a 31-year-old male with acute methotrexate toxicity presenting with ulcerations over pre-existing psoriatic plaques with foci of bleeding. Oral mucosal involvement in the form of buccal and palatal ulceration was present in the setting of sepsis, pancytopenia, and acute kidney injury. It is worth emphasizing the role of adequate prescription guidelines, patient education, stringent monitoring, early recognition of tell-tale signs of toxicity, timely leucovorin rescue, and the need for strict enforcement of regulations regarding the over-the-counter availability of such drugs, especially in developing countries.
Ravindranath B Chavan; Vasudha A Belgaumkar; Nitika S Deshmukh; Ranjitha Krishnegowda
Abstract
Papulosquamous disorders constitute one of the common pediatric dermatoses. They are a heterogeneous group consisting of psoriasis, eczema, pityriasis rubra pilaris, and other conditions, where the differential diagnoses are close to each other clinically. Moreover, the presentation of the same disease ...
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Papulosquamous disorders constitute one of the common pediatric dermatoses. They are a heterogeneous group consisting of psoriasis, eczema, pityriasis rubra pilaris, and other conditions, where the differential diagnoses are close to each other clinically. Moreover, the presentation of the same disease in children can differ from that occurring in adults. We report two infants with erythematous scaly papules and plaques diagnosed as two different disorders, albeit with a grossly similar appearance. Both these dermatoses are considered to be quite uncommon in infancy and can pose significant challenges in management. These disorders sometimes present with atypical variants, rendering it increasingly difficult to distinguish them. Some of these disorders tend to progress to erythroderma, and the infant may occasionally present directly in the erythrodermic stage, further compounding the conundrum. In such situations, identification of subtle clinical and histopathological clues allows accurate diagnosis, which is imperative for appropriate prognostication and treatment. This article illustrates the importance of histopathology and immunohistochemistry in aiding diagnosis and outlines the management of these disorders while emphasizing the importance of timely intervention in averting inadvertent complications in these young individuals.
Neelam Bhatt; Ravindranath B. Chavan; Vasudha A. Belgaumkar; Nitika S. Deshmukh
Abstract
Background: Linear skin eruptions are commonly encountered in dermatology practice. They may be the manifestations of various skin diseases resembling each other, leading to difficulty in diagnosis and treatment. This study aimed to document linear dermatoses and analyze them demographically, clinically, ...
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Background: Linear skin eruptions are commonly encountered in dermatology practice. They may be the manifestations of various skin diseases resembling each other, leading to difficulty in diagnosis and treatment. This study aimed to document linear dermatoses and analyze them demographically, clinically, and etiologically in order to facilitate diagnosis.Methods: A cross-sectional study was conducted on 100 patients presenting with linear skin eruptions to a tertiary care center’s dermatology outpatient/inpatient department over two years (2016 to 2018). These patients were evaluated and classified after clinico-etiological correlation into several subgroups of acquired and congenital linear skin eruptions.Results: The major etiological group encountered was acquired dermatoses (79%), followed by nevoid/congenital dermatoses (21%). Among acquired dermatoses, the majority belonged to the papulosquamous group (33%), mostly lichen striatus cases (21%). The significant group were ≤ 40 years and ≤ 20 years in the acquired and papulosquamous groups, respectively (P = 0.001). In nevoid/congenital dermatoses, linear verrucous epidermal nevus was the predominant group (10%). We also attempted to find correlations with variables like gender, duration of symptoms, and distribution; however, there was no statistically significant correlation. Among other causes, 56% had the Blaschkoid distribution (P = 0.007).Conclusion: This novel study attempted a comprehensive clinicoetiological compilation of linear skin eruptions by analyzing many variables and risk factors. It documents some uncommon dermatoses that occasionally present with linear configuration and need to be considered in the differential diagnoses.