Rothmund-thomson syndrome: more than just a cosmetic concern

Rothmund-Thomson syndrome is a rare autosomal recessive poikilodermatous disorder with various inconsistent features. Clinical features of two siblings are described, which raised only just cosmetic concerns for the parents. The parents were counseled and advised regular follow-up for early detection of complications including malignancies and to protect the children from sun exposure by using broad spectrum sun screens and physical barriers.

Recurrent cutaneous leishmaniasis presenting as sporotrichoid abscesses: a rare presentation near Afghanistan border

Cutaneous leishmaniasis caused by Leishmania tropica and Leishmania major is endemic in Pakistan and is the second most prevalent vector-borne disease in the country (after malaria). We report a case of non-ulcerating, sporotrichoid cutaneous leishmaniasis that recurred 2 years after successful treatment of two typical leishmaniasis ulcers. The patient came from Kohat, a border town in the northwestern region of Pakistan about 50 miles east of Afghanistan. It is important for physicians to be familiar with unusual presentations of this common condition.

Knowledge, attitude and practice regarding dandruff among soldiers

OBJECTIVE

To assess the knowledge, attitude and practice regarding dandruff among soldiers.

DESIGN

Cross-sectional study.

PLACE AND DURATION OF STUDY

Departments of Dermatology at Combined Military Hospitals, Abbottabad, Malir and Gujranwala from January 2006 to March 2006.

PATIENTS AND METHODS

Serving male soldiers posted at Abbottabad, Malir and Gujranwala Cantonments were included in the study. Convenience sampling was used to distribute the questionnaire. All soldiers included in the study were asked or assisted by the trained staff to fill the close-ended questionnaire in Urdu, which included information about demographic profile and questions relevant to the objectives of the study. The ethical requirements for the study were fulfilled. SPSS-10 was used for data management.

RESULTS

A total of 800 serving male soldiers were surveyed. Five hundred and twenty-one soldiers (65.1%) answered yes to dandruff, whereas 279 (34.9%) replied in negative. Dandruff was considered a disease by 433 (83.1%) respondents. Hair fall (n=392, 75.2%) and scalp itching (n=380, 72.9%) were the common symptoms and 330 (63.3%) respondents were embarrassed by dandruff. Bad water (n=93, 17.8%), winter (n=40, 07.6%) and lack of sleep (n=30, 05.7%) were considered the most common causes of dandruff. Majority of the individuals (n=487, 93.4%) used different hair oils and household remedies for the treatment of dandruff. One hundred and fourteen (21.9%) and 50 (09.6%) participants consulted doctors and traditional healers respectively for their dandruff. Advertisements in electronic or print media and wall hoardings etc. influenced 213 (40.9%) respondents to use various anti-dandruff shampoos, hair tonics and oils.

CONCLUSION

Dandruff is a common problem and there is a need for education programmes and formulation of a policy regarding the positive role of media on health matters.

Epidemiology of erythema ab igne at a moderately cold weather station

Erythema ab igne is a localized red brown reticular pigmentation, resulting from chronic, repetitive exposure to sub maximal heat, insufficient to cause burn. A study was carried out at the dermatology outpatient department of Combined Military Hospital, Abbottabad during January-April 2005 with the purpose to see frequency of erythema ab igne. Fourteen patients were identified, interviewed and examined in detail. Nine were females, eight of them housewives, and five were males. Age of the patients ranged from 9 to 60 years with a mean of 36.5 +/- 14.8 years. Body Mass Index (BMI) of the patients ranged from 13.5 to 33.5, six of them were in the BMI range of between 25.1 and 30. Nine patients belonged to rural areas. Erythema ab igne was not associated with thyroid disease or any other systemic or psychiatric illness.

Paederus dermatitis in Sierra Leone

Paederus dermatitis, a type of irritant contact dermatitis attributed to a Staphylinid beetle, is prevalent in most parts of the world. We studied 50 cases of Paederus dermatitis at the United Nations Hospital at Koidu Sierra Leone (West Africa), over a period of 6 months from Oct 2003 to Mar 2004. The objectives of the study were to determine clinical patterns of dermatitis and its response to topical steroids, with and without antibiotics. Patients with a definite history of contact with the insect were included in the study. Amongst these, 14 of the more severe cases were treated with oral prednisolone or intralesional triamcinolone acetonide. The remainder of the 36 patients were divided in two equal groups A and B. Patients in Group A were treated with topical diflucortolone valerate 0.001 percent and oral cetirizine hydrochloride; patients in group B were given oral ciprofloxacin in addition. In 50 patients studied, 43 (86%) were males and 7 (14%) were females. The neck was the most common site involved followed by face. Healing time ranged from 14 to 28 days and lesions in all the patients healed with residual dyschromia. Healing time was shorter in Group B patients in comparison with those in Group A. Paederus dermatitis in Sierra Leone is a relatively severe form of this dermatitis. The better response to a combination of topical steroids and oral antibiotics may indicate concurrent bacterial infection.

Progressive symmetrical erythrokeratoderma with perioral involvement

Erythrokeratodermas are inherited or sporadic disorders of keratinization, with many variants. Progressive symmetrical erythrokeratoderma presents as large, erythematous or hyperpigmented, hyperkeratotic, fixed symmetrical plaques over various parts of the body along with many other inconsistent features. Periorificial keratotic lesions have very rarely been reported in progressive symmetrical erythrokeratodermas. We report a 9 years old boy with progressive symmetrical erythrokeratoderma having perioral involvement besides fixed hyperpigmented, keratotic plaques. He was started with oral etretinate but he stopped the treatment due to no-response after two weeks and is presently using topical keratolytics without marked improvement.

Chilblains at Abbottabad, a moderately cold weather station

BACKGROUND

Chilblains are quite often seen in various parts, in particular cold weather areas of Pakistan. Unfortunately, no studies have so far been carried out in Pakistan, to determine epidemiological aspects of chilblains. The objective of this study was to see the epidemiological patterns of chilblains at a moderately cold weather station.

METHODS

The study was conducted at Dermatology out patient department of Combined Military Hospital, Abbottabad from 1 Dec 2004 to 31 Mar 2005. All the patients fulfilling clinical criteria for the diagnosis of chilblains were registered. Every patient was interviewed in detail followed by thorough physical examination. Complete Blood Count, Urine Routine Examination and Anti Nuclear Factor were carried out in only those patients, having the disease of more than 3 years duration. A pre-designed proforma was filled separately for each patient.

RESULTS

Out of 111 patients, 67 (60.4%) males and 44 (39.6%) females were registered with the diagnosis of chilblains. Fifty nine (53.2%) patients were locals and 52 (46.8%) were non locals. Out door workers were 75 (67.6%). Onset in majority of the patients (42.3%) was in the age group 11-20 years. Family history of chilblains was present in 25 (22.5%) patients and 8 patients (7.2%) were smokers. The disease of longer duration was more common in females and locals.

CONCLUSION

At moderately cold weather areas, out door workers and young adolescents are more likely to develop Chilblains. The disease of longer duration is more common among females and local residents. On the other hand, first episode or the disease of shorter duration is more common among non locals at moderately cold weather stations because of poor acclimatization and inadequate protection.

Exuberant ulcerated lesions of secondary syphilis on the palms--an unusual presentation

Ulcerated lesions in secondary syphilis are rare. Exuberant tissue is seen in condylomas of syphilis, which occur in flexural and occluded areas of the body and not in open areas such as palms. We report a case of secondary syphilis that presented with ulcerated exuberant lesions on palms, which on initial examination gave an impression of lesions of Orf and Milker's Nodule.

Secondary syphilis clinically mimicking pseudolymphoma of the face

Syphilis has been given titles such as the great imitator, the great mimic, and the great masquerader. It may lack pathognomonic signs and often presents similar to many other dermatological conditions. We present a case of a young woman who developed asymptomatic papulonodular lesions on the forehead; the lesions were clinically similar to pseudolymphoma but it was determined that she had secondary syphilis exhibiting prozone phenomenon. She also had alopecia of eyebrows. Both the alopecia as well as nodular lesions clinically resembling pseudolymphoma responded to and completely recovered with antisyphilitic treatment.

Rickets in xeroderma pigmentosum

Xeroderma pigmentosum patients are advised to strictly avoid sun exposure to prevent ultraviolet-induced DNA damage. We describe a 2 1/2 years old boy having xeroderma pigmentosum, who also developed rickets. He was given one injection of vitamin D along with dietary vitamin D supplements to which he responded. He is being followed- up regularly in outdoor clinic with the advice to the parents to continue dietary vitamin D supplements and to avoid sun exposure.

Simultaneous onset of herpes zoster in a father and son

The Varicella Zoster virus persists in sensory nerve ganglion cells after chicken pox and gets reactivated to cause herpes zoster after variable periods of time as a result of waning of specific cellular immunity. Susceptible contacts of herpes zoster can develop chicken pox and very rarely herpes zoster. We report an interesting case of a father and his son who developed herpes zoster simultaneously without any obvious common predisposition and discuss the possible underlying mechanism.

Cutaneous pseudolymphoma due to topical application of 4% hydroquinone cream for melasma

Cutaneous pseudolymphoma is an aggregate of mature or abnormal looking lymphocytes in the dermis, which clinically and /or histologically simulates lymphoma but has a benign course and outcome. Systemic drugs, especially anti-epileptics, are an important cause of cutaneous pseudolymphomas. Pseudolymphoma of the skin, secondary to topical drug application, is very rare. We report a case of cutaneous pseudolymphoma induced by local application of 4% hydroquinone cream to melasma over the cheeks.

Recurrence of herpes zoster in an immunocompetent adult male

Repeated and disseminated eruptions herpes zoster are frequently detected in immunocompromised patients, but are rare in immuno-competent individuals. We report a case of recurrent herpes zoster in a young healthy male, who redeveloped herpes zoster in a different dermatome after one year.

Unilateral psoriasis along Blaschko lines

Atypical forms and unusual localizations of psoriasis are quite frequently seen. However, psoriasis arranged unilaterally along Blaschko Lines is extremely rare. We report a case of an adult male, who presented with unilateral psoriasis arranged in Blaschko Lines on left side of the body.