Vitiligo, an autoimmune disorder characterized by localized and/or generalized depigmentation of the skin and/or mucous membranes, is a well-recognized entity. The imperatives of its epidemiology both in rural India and in global reckoning have been highlighted frequently. Its morphology is striking and is characterized by asymptomatic ivory/chalky white macule(s) that may be frequently surrounded by a prominent pigmented border, the 'trichrome vitiligo'. However vitiligo may have morphological variations in the form of: trichrome, quadri-chrome, penta-chrome, blue and inflammatory vitiligo. Its current topographical classification into segmental, zosteriform and nonsegmental, areata, vulgaris, acrofacialis and mucosal represent its well acclaimed presentations. Its adult and childhood onset is well appreciated as also its presentation in males and females. Occasionally, it may be possible to identify triggering factors. Vitiligo may be associated with cutaneous, ocular and systemic disorders, the details of which are discussed in this article.
Cutaneous tuberculosis incidence was recorded as 0.15%. Of the 42 patients, 23 had scrofuloderma, 17 lupus vulgaris, and 2 tuberculosis verrucosa cutis. Both men and women were affected by the disease in the second and third decades. Its duration was variable. An affirmative family history was elicited in five scrofuloderma patients. The clinical expression largely conformed to the ritual text. Variation in Mantoux test positivity was unremarkable. The disparity in the demonstration of bacilli in the smear and tissue sections was, however, quite apparent in scrofuloderma. The correlation of different parameters indicates a continuous spectrum, formed at one end by lupus vulgaris, and at another by scrofuloderma. A moderate to strongly positive Mantoux text, enormous lymphocytes in the granuloma, absence of tubercle bacilli, negative culture, and an apparently normal immunoprofile were features of lupus vulgaris; whereas scrofuloderma had a moderately positive Mantoux test, lesser number of lymphocytes in the granuloma, large number of bacilli in tissue smear and/or tissue section, raised levels of immunoglobulins, and a grossly lowered C3 levels. The other variants probably occupy a position in between.
Ever since its inception, acrodermatitis continua of Hallopeau, has been recognized as an uncommon clinical entity which has been sparingly reported from across the globe. The attempt to have cumulative information on prevalent nomenclature, definition, reminiscences, and clinical overtures has brought differential diagnosis and diagnosis in sharp focus, the highlights of which are outlined. Hence, it was considered important to review the evolution of treatment options available thus far including use of biologics.
Paraneoplastic pemphigus is the term used for an exclusive subset of pemphigus. The clinical lesions may resemble pemphigus, pemphigoid, erythema multiforme, graft-vs.-host disease, or lichen planus. A common denominator in all patients is the concomitant occurrence of either occult or confirmed systemic neoplasm. It is imperative to confirm the diagnosis through microscopy, where intraepidermal suprabasal cleavage, epidermal acantholysis, dyskeratotic keratinocytes and vacuolar changes in the basal epidermis, interfacial dermatitis, and epidermal exocytosis can be seen. Furthermore, the deposition of immunoglobulin G (IgG) and complement in the epidermal intercellular spaces, detected by direct and/or indirect immunofluorescence, is equally crucial for confirming the diagnosis.
The study of different aspects, namely clinical, bacteriological, histopathological and immunological, of 23 cases of histoid leprosy were quite revealing. The salient features included the occurrence of histoid lesions in a proportion of untreated leprosy patients in addition to those on dapsone treatment for a variable periods of time, a high bacteriological index in spite of infrequent formation of globi, high morphological indices and the immunological status of these patients. Cell‐mediated immunity, which was deficient in relation to healthy controls, appeared to be augmented when compared with active lepromatous (LL) patients. A few contributory factors to the development of such a situation are discussed.
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