Acquired acromelanosis due to phenytoin.
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Biomedical subjects
Publications and source records attributed to A J Kanwar.
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Although most patients are overinvestigated, the history may offer clues to food-additive reactivity or urticarial vasculitis. In addition, the history may point to physical urticarias triggered, for instance, by pressure or heat. Recent evidence implicates histamine-releasing autoantibodies in at least 25% of patients with chronic idiopathic disease.
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Six patients with Melkersson-Rosenthal syndrome (M-R syndrome) were presented. Their ages varied from 20 to 60 years; age at onset was between 15 and 50 years. In all 6 patients, swelling started first over the lower lip. Associated facial palsy, facial edema, and scrotal tongue were found in three, four and one patients, respectively. Lip biopsies from 5 patients failed to show any granuloma. Intralesional corticosteroids produced mild regression of labial swelling in two patients after 6 injections. In one patient, near total reduction of labial swelling and facial edema was achieved after 5 months of clofazimine treatment. However, there was no improvement of facial palsy. To the best of our knowledge, this is the largest series of M-R syndrome reported from India.
A 4-year-old boy had a rare fixed drug eruption due to amoxicillin and confined to the tongue. Avoidance of the drug resulted in complete clearance within three months.
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Reticulate pigmentary disorders are rare in India. Only 15 cases of reticulate acropigmentation of Kitamura (RAPK) and 9 cases of Dowling-Degos disease (DDD) have been reported previously. To the best of our knowledge, there has been no earlier report of acropigmentation of Dohi. We herein describe 10 patients with various reticulate pigmentary abnormalities: 6 with RAPK, 2 with DDD, 1 with RAPK-DDD overlap, and 1 with acropigmentation of Dohi. Palmar pits and/or breaks in epidermal ridge pattern were absent in 2 of 6 patients with RAPK. A 23-year-old male patient had RAPK-DDD overlap. Periorbital pigmentation and pigmentation over the mucosal surface of the prepuce and corona of the glans penis were some unique features observed in this patient. His sister and mother had RAPK and DDD, respectively. We concluded that RAPK and DDD are varying manifestations of a single entity. Their presence in other family members probably depends on the degree of penetrance.
The records of 10 patients who died with pemphigus have been examined for factors affecting and contributing to death. Early initiation of therapy, the age at onset of the disease, and the mode of administration of corticosteroids, conventional or in pulse form, did not affect the survival. The cutaneous involvement was extensive in all 10 patients; it ranged between 30-80%. Septicemia was the commonest event preceding death; in 4 cases, it was due to Staphylococcus aureus.
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