Epidermodysplasia verruciformis (EDV) is a rare, inherited disorder that is characterized by an increased susceptibility to infection with specific human papilloma viruses (HPV) and a greater propensity for developing malignant skin tumors. A 26 years old Nepalese male patient presented with complaints of multiple asymptomatic raised warty lesions on bilateral hands and multiple light colored flat to raised lesions present over the neck, trunk, bilateral extremities sparing the face and genitals.A skin biopsy was performed which revealed hyperkeratosis, focal parakeratosis, acanthosis, keratinocytes were swollen and irregularly shaped, had abundant basophilic cytoplasm and contained numerous round basophilic keratohyaline granules. Nuclei were large, round and empty with marginal distribution of chromatin, some were pyknotic. Epidermodysplasiaverruciformis is a rare inherited disorder spread by HPV. It is characterized by hypopigmented or hyperpigmented macular lesions, pityriasis versicolor-like lesions and an early tendency to develop skin malignancies. The management of EDV includes early diagnosis, sun protection, life-long observation for the malignant transformation and therapeutic modalities like acitretin, imiquimod, topical retinoids, cryotherapy, etc.
Introduction: Tinea capitis is a common dermatophyte infection of the scalp and hair shaft, most commonly observed in children. Trichoscopy is nonivasive tool which helps in early diagnosis and prompt treatment of tinea capitis. Objectives: This study was carried out with the aim to describe the trichoscopic features of tinea capitis and to find out its different clinical variants with the aid of trichoscopy. Materials and Methods: This is a hospital based cross sectional descriptive study conducted from 1st January 2019 to 31st December 2019. All patients clinically diagnosed with tinea capitis were included in the study. Result: A total of 50 patients with tinea capitis were recruited. The most common age group was found to be 6-10 years (52%) and 27 patients (54%) were female. Majority of the population were students, i.e. 46 patients (92 %). Family history was positive in 38% of cases. The clinical variants seen were black dots in 20 patients (40%), followed by gray patch in 15 patients (30%), kerion in 8 patients (16%) and combined type (both gray patch and black dots) in 4 patients (8%). The most common trichoscopic feature were black dots in 40 (80%), followed by comma hairs in 38 (76%), corkscrew hairs in 33 (66%), and broken hairs in 24 (48%). Conclusion: This study highlighted that the use of trichoscopy as non-invasive tool helped in diagnosing the cases of tinea capitis without the use of wood’s lamp and laboratory investigations.
Mycosis fungoides is the most common primary cutaneous T-cell lymphoma and is recognized as one of the rare malignant skin neoplasms. Hypopigmented mycosis fungoides is a variant of mycosis fungoides, described in dark-skinned individual and Asian patients. We report a case of 32 years old Nepalese female who had presented with multiple asymptomatic hypopigmented macules over the bilateral arms, thighs, abdomen, back of trunk and buttocks. Skin biopsy revealed few atypical cells (small/medium-sized, cerebriform nuclei with halo) confined to epidermis with epidermotropism. Immunohistochemistry showed CD3, CD4, CD5 and CD8 positivity. The patient was managed with topical steroids, oral methotrexate and phototherapy, and she is on regular follow up. As the disease has an indolent clinical course, long term follow up is necessary.
Schwannomas/ neurilemmomas are benign tumors of nerve sheath arising from Schwann cells that form myelin sheath around peripheral nerves. They are usually solitary, slow growing and encapsulated lesions. Head and neck are the common sites. We report a case of a 38 years old Nepalese female who had presented with a solitary asymptomatic, slow growing nodule on the left side of the chin for the last three years. Dermoscopy of the lesion revealed arborizing vessels with brownish pigmentation overlying a whitish to pinkish background. Complete excision of the lesion was performed. Histopathological evaluation of the lesion revealed schwannoma. Though schwannomas are a rare diagnosis, they should be considered as a differential diagnosis of any unilateral, asymptomatic, slow growing nodule in the head and neck region. Dermoscopy is a useful tool which helps to differentiate schwannoma from other lesions. Histopathology is the gold standard for diagnosis and the treatment of choice is surgical excision.
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