anza khader | Government Medical College, Haldwani (original) (raw)

Papers by anza khader

Research paper thumbnail of CD30+ primary cutaneous tumoral adult T-cell leukemia/lymphoma successfully treated with zidovudine and interferon

Journal of Skin and Sexually Transmitted Diseases

Adult T-cell leukemia/lymphoma (ATL) is an aggressive neoplasia of mature peripheral T lymphocyte... more Adult T-cell leukemia/lymphoma (ATL) is an aggressive neoplasia of mature peripheral T lymphocytes associated with human T-cell lymphotropic virus type 1 (HTLV-1). The primary cutaneous tumoral (PCT) type of adult T-cell leukemia/lymphoma presents as nodules and tumors without internal organ involvement, but with a bad prognosis. Here, we report a middle aged woman, who manifested a nodular lesion on the right leg. Histopathology showed moderately dense, lymphoid infiltrate of atypical, medium sized cells in the dermis and subcutaneous tissue. The cells were positive for CD3, CD4, CD30, and CD25, and negative for CD8, CD20, and anaplastic lymphoma kinase. The biopsy specimen showed a Ki-67 proliferation index of 90%. Serological testing for HTLV-1 was positive. The patient was diagnosed to have CD30+ PCT type ATL and was treated initially with localized radiation. The lesion regressed, however, there was a recurrence of the disease, which was treated with low dose interferon-alfa (I...

Research paper thumbnail of Acrochordon as a marker of metabolic syndrome – A cross-sectional study from South India

Journal of Skin and Sexually Transmitted Diseases

Objectives: To determine the association of acrochordons with metabolic syndrome and its componen... more Objectives: To determine the association of acrochordons with metabolic syndrome and its components. Materials and Methods: A cross-sectional study was conducted in 100 patients with acrochordon and 100 age- and gender-matched controls who attended the dermatology outpatient department of a tertiary care center in South India from January 2017 to December 2017. A detailed dermatological examination was carried out in cases with respect to distribution, number, color, and morphology of acrochordons. Blood pressure (BP), pulse rate, waist circumference, height, weight, and body mass index were recorded in all cases and controls. Fasting lipid profile, fasting blood sugar, liver function test, and renal function test were done in all study participants. A diagnosis of metabolic syndrome was made based on the International Diabetes Federation metabolic syndrome worldwide definition specified for the Asian population. Statistical analysis was done using Pearson’s Chi-square test. Results...

Research paper thumbnail of Effect of monthly cyclophosphamide pulses on skin sclerosis in systemic sclerosis

Indian Journal of Dermatology, Venereology and Leprology, 2021

Research paper thumbnail of Drug reaction with eosinophilia and systemic symptoms within one week of exposure to the drug

Journal of the American Academy of Dermatology, 2020

Research paper thumbnail of Acquired Cutaneous Lymphangiectasia of the Scrotum Secondary to Filarial Lymphoedema

Kerala Medical Journal, 2015

A middle-aged man developed acquired cutaneous lymphangiectasis of the scrotum secondary to filar... more A middle-aged man developed acquired cutaneous lymphangiectasis of the scrotum secondary to filarial lymphedema. He had distressing copious watery discharge, which was completely relieved by carbon dioxide laser therapy Keywords: Acquired cutaneous lymphangiectasia, Scrotum, Filariasis

Research paper thumbnail of Benign Cephalic Histiocytosis with Unique Dermoscopic Pattern

Indian Journal of Paediatric Dermatology, 2021

Research paper thumbnail of Histopathology of skin lesions of leprosy before and after fixed duration treatment

Leprosy Review, 2017

Objectives: To study and compare the histopathological features of skin lesions of leprosy before... more Objectives: To study and compare the histopathological features of skin lesions of leprosy before and after fixed duration treatment. Design: Prospective study. The first 30 newly diagnosed leprosy patients from July 2012 who successfully completed fixed duration treatment from our tertiary care institution, and who were willing for a post-treatment skin biopsy were included in this study after obtaining written informed consent. Only those who underwent a pre-treatment biopsy were enrolled in the study. Histological features of preand post-treatment biopsies of the skin lesions of leprosy were studied and compared. Results: The patients who showed an increase or only a slight reduction in granulomas post-treatment compared to the pre-treatment status had clinical and/or histological evidence of lepra reaction at the completion of treatment or had lepra reaction during FDT which was not managed with steroids. Two patients whose pretreatment biopsy revealed only inflammatory infiltrate manifested granulomas in the post-treatment biopsy. 18/30 developed dermal fibrosis after treatment, which was more common in those with considerable post-treatment reduction in inflammation. Five patients showed post-treatment restoration of the reduced basement membrane pigmentation that was noted in the pre-treatment biopsy. Conclusions: Persistence or increase in granulomas after treatment was not a bad prognostic sign. More prospective studies with a larger sample size analyzing the histological resolution achieved by FDT may improve our knowledge of leprosy.

Research paper thumbnail of Disseminated cutaneous rhinosporidiosis

Journal of Skin and Sexually Transmitted Diseases, 2020

Research paper thumbnail of Interface dermatitis as an indicator of hepatic involvement in drug reaction with eosinophilia and systemic symptoms ( DRESS )

Journal of Cutaneous Pathology, 2020

Background: There are conflicting reports on the association between interface dermatitis and hep... more Background: There are conflicting reports on the association between interface dermatitis and hepatic involvement in DRESS. Methods: A cross-sectional analysis of the clinical and the histopathology features of DRESS was performed to study the association between the histopathology of the skin rash and hepatic involvement. Results: The clinical and the histopathology findings were evaluated in forty cases of DRESS. Thirty patients (75%) had a hepatic involvement. Thirty (75%) biopsy specimens showed a combination of different inflammatory patterns. The interface dermatitis was noted in 24 specimens (60%). Twenty-one patients with the interface dermatitis had a hepatic involvement (P = 0.04). Conclusions: The skin rash of DRESS often shows the coexistence of different inflammatory patterns. The interface dermatitis showed a statistically significant association with the hepatic involvement in DRESS.

Research paper thumbnail of Drug reaction with eosinophilia and systemic symptoms within 1 week of exposure to the drug

Journal of the American Academy of Dermatology, 2020

Research paper thumbnail of Persistent papular varicella in an immunocompetent male

Indian Journal of Dermatology, Venereology and Leprology, 2020

59 Indian Journal of Dermatology, Venereology and Leprology | Volume 86 | Issue 1 | January-Febru... more 59 Indian Journal of Dermatology, Venereology and Leprology | Volume 86 | Issue 1 | January-February 2020 Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Research paper thumbnail of Histological evaluation of acquired dermal macular hyperpigmentation

Indian Dermatology Online Journal, 2019

Context: An umbrella term, acquired dermal macular hyperpigmentation (ADMH), has been proposed to... more Context: An umbrella term, acquired dermal macular hyperpigmentation (ADMH), has been proposed to denote conditions including ashy dermatosis, erythema dyschromicum perstans, lichen planus pigmentosus, and idiopathic macular eruptive pigmentation. Aims: To classify the patients manifesting ADMH on the basis of histology. Settings and Design: In this retrospective, cross-sectional study, histology specimens of patients of ADMH, who underwent skin biopsy in our institution from 1.1 2015 to 31.12.2017, were included after obtaining ethical clearance. Materials and Methods: The histology specimens of patients of ADMH were reviewed by the pathologist and classified. Clinical features of individual patient were collected from previous records and the data analyzed. Statistical Analysis Used: Pearson's Chi-square test was used to determine significance of association between age of onset and duration of pigmentation with histology type. Results: Three patterns of histology were identified in the study group (17 males and 13 females). Type 1: Basal cell degeneration and moderate to dense inflammation (12 patients, 40%), type 2: Significant pigment incontinence and sparse inflammation without basal cell degeneration, (12 patients, 40%), and type 3: sparse inflammation without basal cell degeneration or significant pigment incontinence (six patients, 20%). Statistically significant association was noted between age of onset of pigmentation and histology type (P value, 0.02). Limitations: Main limitation was the small sample size. Conclusions: Prospective studies evaluating the clinical progression and dermoscopy features and analyzing serial biopsies of ADMH patients may confirm whether the histology patterns observed represent different stages of same disease process or are different entities.

Research paper thumbnail of Aetiological and Clinical Profile of Acute Myeloid Leukaemia in a Tertiary Care Hospital

Journal of Evolution of Medical and Dental Sciences, 2018

BACKGROUND Acute myeloid leukaemia (AML) is a group of neoplastic disorders characterised by the ... more BACKGROUND Acute myeloid leukaemia (AML) is a group of neoplastic disorders characterised by the proliferation and accumulation of immature haematopoietic cells in the bone marrow and blood. It is the most common type of leukaemia among adults. The underlying pathophysiology in AML consists of a maturational arrest of bone marrow cells in the early stages of development. Aims and Objectives-To look for the possible aetiological factors in patients with Acute Myeloid Leukaemia and to study the clinical profile and to determine any prognostic factors with the help of clinical parameters and basic investigations. MATERIALS AND METHODS All patients above 12 years of age with acute myeloid leukaemia admitted in haematology unit of Department of Medicine between July 2009 and June 2013 were included in the study. The diagnosis of AML with subtypes was established based on clinical features, peripheral smear and bone marrow findings. RESULTS There were 100 patients (47 males, 53 females). Amongst aetiological factors, cigarette smoking was most commonly seen. Easy fatigability was the commonest presenting symptom, followed by fever, anorexia, weight loss and bleeding. The most common clinical finding was pallor followed by wet purpura, generalised lymphadenopathy and gum hypertrophy. The mean haemoglobin value was 7.35 gm% and platelet count was 56,740 cells/ mm 3. WBC count varied between 600 cells/mm 3 and 2,61,000 cells/mm 3. Among the subtypes of AML, most common leukaemia was AML M2 followed by AML M3. CONCLUSION Easy fatigability and malaise were the most common presentations in AML. Environmental factors like anti-cancer drug exposure, chemical exposure, smoking, proximity to mobile towers, high tension electric lines and dietary factors like poor intake of vegetables and fruits may have an influence on aetiopathogenesis of AML. Very high WBC count, bleeding manifestations and platelet count at presentation < 20,000/mm 3 all had a poor outcome. AML M2 was the most common subtype followed by AML M4, the prognosis was best in AML M2 and M3.

Research paper thumbnail of Predictors of disease severity in drug reaction with eosinophilia and systemic symptoms

Indian journal of dermatology, venereology and leprology, Jan 23, 2018

Drug reaction with eosinophilia and systemic symptoms is an outcome of a complex interaction betw... more Drug reaction with eosinophilia and systemic symptoms is an outcome of a complex interaction between specific drugs, certain herpesviruse types and the immune system of the affected individual and is characterized by an unpredictable course and recurrent flares even after withdrawal of the offending drug and administration of systemic steroids. To identify the predictors of disease severity in drug reaction with eosinophilia and systemic symptoms. After obtaining ethical clearance from the institutional ethics committee and a written informed consent from individual study participant, the first hundred patients who required inpatient care in Government Medical College, Kozhikode with drug reaction with eosinophilia and systemic symptoms from January 1 2011 were included in this study aimed to identify the predictors of disease severity in drug reaction with eosinophilia and systemic symptoms. Male-to-female ratio of the study group was 0.8:1. The presence of atypical cells in periph...

Research paper thumbnail of Neurolymphomatosis in primary cutaneous CD4+ pleomorphic small/medium-sized T-cell lymphoma mimicking Hansen's disease

Indian Journal of Dermatology, 2017

Neurolymphomatosis (NL) refers to nerve infiltration by neurotropic neoplastic cells in the setti... more Neurolymphomatosis (NL) refers to nerve infiltration by neurotropic neoplastic cells in the setting of a known or an unknown hematological malignancy. It typically presents as painful or painless peripheral mononeuropathy, mononeuritis multiplex, polyneuropathy, polyradiculopathy, or cranial neuropathy. A 32-year-old male presented with a hyperpigmented hypoesthetic plaque over the anterolateral aspect of the right leg with thickening of the right common peroneal nerve and foot drop clinically diagnosed as Hansen's disease. Biopsy taken from skin showed infiltrates of pleomorphic small and medium sized lymphocytes in the dermis and subcutis. On immunohistochemistry, the cells were positive for CD3, CD4 and negative for CD8, CD20, and CD30. Ultrasonography-guided fine-needle aspiration of the thickened nerve showed infiltrates of atypical lymphoid cells. Based on these findings, a diagnosis of NL in primary cutaneous CD4+ pleomorphic small/medium-sized T-cell lymphoma was made. The disease responded to systemic chemotherapy and localized radiotherapy with no evidence of relapse during 3 years follow-up. NL in primary cutaneous CD4+ pleomorphic small/medium-sized T-cell lymphoma presenting with manifestations redolent of Hansen's disease is not described in available literature. This case also demonstrates the utility of fine needle aspiration of nerve, a minimally invasive procedure in the diagnosis of NL.

Research paper thumbnail of Matting of body hair

Indian Journal of Dermatology, Venereology and Leprology, 2017

‘Matting of hair’ is a rare condition, characterized by knotting and rolling together of multiple... more ‘Matting of hair’ is a rare condition, characterized by knotting and rolling together of multiple hair shafts due to friction, most commonly when the hair is wet. This condition is similar to wool felting, where compacting of contiguous fibres occurs when exposed to friction and compression in the liquid medium. Matting of body hair has been rarely reported in Asians, as they are shorter, straighter and thinner than in Caucasians and Africans.

Research paper thumbnail of A clinicopathological analysis of primary cutaneous lymphomas: A 6-year observational study at a tertiary care center of south India

Indian Journal of Dermatology, 2016

Little data are available concerning clinical and pathological patterns of cutaneous lymphomas in... more Little data are available concerning clinical and pathological patterns of cutaneous lymphomas in India. To analyze the clinical and histopathological characteristics of cutaneous lymphomas in Indian patients. This is a single-center, prospective, observational study carried out from January 1, 2010, to December 31, 2015. The patients underwent clinical examination, human T-cell lymphotropic virus-1 (HTLV-1) screening, skin biopsy with hematoxylin and eosin and immunohistochemistry staining. Among 35 cases, 33 (94.3%) were T-cell, and 2 (5.7%) were B-cell lymphomas. The mean age was 52.66, and the male to female ratio was 2.5:1. The most common types of T-cell lymphomas included mycosis fungoides (MF) (57.1%) followed by adult T-cell lymphoma/leukemia (ATL) (17.1%). Primary cutaneous peripheral T-cell lymphoma not otherwise specified was diagnosed in 17.1% and anaplastic large cell lymphoma in 2.9%. The morphological types of MF included polymorphic, poikilodermatous, folliculotropic, hypopigmented, hyperpigmented, mixed, and purpuric. Skin manifestations of ATL included ulcerated plaques and erythroderma. Epidermotropism was very marked in ATL (83.3%) than in MF (70%). Larger Pautrier&amp;amp;amp;amp;#39;s microabscess was noted in ATL compared to smaller ones in MF. Markedly dense, diffuse infiltrate of atypical cells was noted in ATL in contrast to mild to moderate nodular or perivascular infiltrate in MF. ATL had an extremely poor prognosis. Identification of DNA integration of HTLV-1 by Southern blot could not be analyzed, and the number of cases studied is limited. The study showed unique patterns of subtypes of cutaneous lymphomas in our country. Variations in the clinical pattern and histopathological analysis will help to differentiate T-cell lymphoma types which have prognostic implications.

Research paper thumbnail of Pyodermatitis-pyostomatitis vegetans with penile ulceration complicated by acute glomerulonephritis

Indian Journal of Dermatology, 2016

Research paper thumbnail of Disseminated cutaneous phaeohyphomycosis due to Cladophialophora bantiana

Indian Journal of Dermatology, Venereology, and Leprology, 2015

Cladophialophora bantiana is a neurotropic dematiaceous fungus which only rarely affects the skin... more Cladophialophora bantiana is a neurotropic dematiaceous fungus which only rarely affects the skin. We report a case of disseminated cutaneous phaeohyphomycosis caused by Cladophialophora bantiana in an immunocompromised female who presented with multiple pyogenic granuloma-like nodules, dermatophytosis-like plaque, and subcutaneous cysts on the upper and lower extremities without systemic involvement. Biopsy revealed black yeasts resembling sclerotic bodies and culture yielded irregular, velvety, grey colonies with black reverse. Excisionof the nodules and treatment with oral itraconazole 100 mg twice daily resulted in complete clinical resolution within two months, following which itraconazole was administered for another 4 months.

Research paper thumbnail of Multifaceted adult T-cell leukemia/lymphoma in India: A case series

Indian Journal of Dermatology, 2015

Adult T-cell leukemia/lymphoma (ATL) is caused by human T-cell lymphotropic virus type-1 (HTLV-1)... more Adult T-cell leukemia/lymphoma (ATL) is caused by human T-cell lymphotropic virus type-1 (HTLV-1). India is considered as a nonendemic region for HTLV-1. Recent upsurge of cases have been noted in southern parts of India. The objective was to describe skin manifestations in various types of ATL. Clinical examination, blood investigations, skin biopsies, lymph node biopsies, and immunohistochemistry were performed in five patients. Flow cytometry was performed in two cases. Serological testing was positive for HTLV-1 in all patients. All patients presented with skin lesions. Rare presentations of molluscum contagiosum like papules, purpuric macules and plaques, hypopigmented macules and verrucous papules were seen. Dermatophytic infections occurred in two patients. Mucosal lesion was seen in one patient. Histological features include dermal lymphoid infiltrate with or without epidermotropism. Presence of epidermotropism did not correlate with the severity of disease. All patients except one succumbed to illness within few months to 1 year period. ATL manifest in myriad presentations and skin lesions are often the earliest manifestation. Cutaneous manifestations of ATL vary from subtle hypopigmented macules to florid nodular lesions, and HTLV-1 screening need to be carried out in all doubtful cases.

Research paper thumbnail of CD30+ primary cutaneous tumoral adult T-cell leukemia/lymphoma successfully treated with zidovudine and interferon

Journal of Skin and Sexually Transmitted Diseases

Adult T-cell leukemia/lymphoma (ATL) is an aggressive neoplasia of mature peripheral T lymphocyte... more Adult T-cell leukemia/lymphoma (ATL) is an aggressive neoplasia of mature peripheral T lymphocytes associated with human T-cell lymphotropic virus type 1 (HTLV-1). The primary cutaneous tumoral (PCT) type of adult T-cell leukemia/lymphoma presents as nodules and tumors without internal organ involvement, but with a bad prognosis. Here, we report a middle aged woman, who manifested a nodular lesion on the right leg. Histopathology showed moderately dense, lymphoid infiltrate of atypical, medium sized cells in the dermis and subcutaneous tissue. The cells were positive for CD3, CD4, CD30, and CD25, and negative for CD8, CD20, and anaplastic lymphoma kinase. The biopsy specimen showed a Ki-67 proliferation index of 90%. Serological testing for HTLV-1 was positive. The patient was diagnosed to have CD30+ PCT type ATL and was treated initially with localized radiation. The lesion regressed, however, there was a recurrence of the disease, which was treated with low dose interferon-alfa (I...

Research paper thumbnail of Acrochordon as a marker of metabolic syndrome – A cross-sectional study from South India

Journal of Skin and Sexually Transmitted Diseases

Objectives: To determine the association of acrochordons with metabolic syndrome and its componen... more Objectives: To determine the association of acrochordons with metabolic syndrome and its components. Materials and Methods: A cross-sectional study was conducted in 100 patients with acrochordon and 100 age- and gender-matched controls who attended the dermatology outpatient department of a tertiary care center in South India from January 2017 to December 2017. A detailed dermatological examination was carried out in cases with respect to distribution, number, color, and morphology of acrochordons. Blood pressure (BP), pulse rate, waist circumference, height, weight, and body mass index were recorded in all cases and controls. Fasting lipid profile, fasting blood sugar, liver function test, and renal function test were done in all study participants. A diagnosis of metabolic syndrome was made based on the International Diabetes Federation metabolic syndrome worldwide definition specified for the Asian population. Statistical analysis was done using Pearson’s Chi-square test. Results...

Research paper thumbnail of Effect of monthly cyclophosphamide pulses on skin sclerosis in systemic sclerosis

Indian Journal of Dermatology, Venereology and Leprology, 2021

Research paper thumbnail of Drug reaction with eosinophilia and systemic symptoms within one week of exposure to the drug

Journal of the American Academy of Dermatology, 2020

Research paper thumbnail of Acquired Cutaneous Lymphangiectasia of the Scrotum Secondary to Filarial Lymphoedema

Kerala Medical Journal, 2015

A middle-aged man developed acquired cutaneous lymphangiectasis of the scrotum secondary to filar... more A middle-aged man developed acquired cutaneous lymphangiectasis of the scrotum secondary to filarial lymphedema. He had distressing copious watery discharge, which was completely relieved by carbon dioxide laser therapy Keywords: Acquired cutaneous lymphangiectasia, Scrotum, Filariasis

Research paper thumbnail of Benign Cephalic Histiocytosis with Unique Dermoscopic Pattern

Indian Journal of Paediatric Dermatology, 2021

Research paper thumbnail of Histopathology of skin lesions of leprosy before and after fixed duration treatment

Leprosy Review, 2017

Objectives: To study and compare the histopathological features of skin lesions of leprosy before... more Objectives: To study and compare the histopathological features of skin lesions of leprosy before and after fixed duration treatment. Design: Prospective study. The first 30 newly diagnosed leprosy patients from July 2012 who successfully completed fixed duration treatment from our tertiary care institution, and who were willing for a post-treatment skin biopsy were included in this study after obtaining written informed consent. Only those who underwent a pre-treatment biopsy were enrolled in the study. Histological features of preand post-treatment biopsies of the skin lesions of leprosy were studied and compared. Results: The patients who showed an increase or only a slight reduction in granulomas post-treatment compared to the pre-treatment status had clinical and/or histological evidence of lepra reaction at the completion of treatment or had lepra reaction during FDT which was not managed with steroids. Two patients whose pretreatment biopsy revealed only inflammatory infiltrate manifested granulomas in the post-treatment biopsy. 18/30 developed dermal fibrosis after treatment, which was more common in those with considerable post-treatment reduction in inflammation. Five patients showed post-treatment restoration of the reduced basement membrane pigmentation that was noted in the pre-treatment biopsy. Conclusions: Persistence or increase in granulomas after treatment was not a bad prognostic sign. More prospective studies with a larger sample size analyzing the histological resolution achieved by FDT may improve our knowledge of leprosy.

Research paper thumbnail of Disseminated cutaneous rhinosporidiosis

Journal of Skin and Sexually Transmitted Diseases, 2020

Research paper thumbnail of Interface dermatitis as an indicator of hepatic involvement in drug reaction with eosinophilia and systemic symptoms ( DRESS )

Journal of Cutaneous Pathology, 2020

Background: There are conflicting reports on the association between interface dermatitis and hep... more Background: There are conflicting reports on the association between interface dermatitis and hepatic involvement in DRESS. Methods: A cross-sectional analysis of the clinical and the histopathology features of DRESS was performed to study the association between the histopathology of the skin rash and hepatic involvement. Results: The clinical and the histopathology findings were evaluated in forty cases of DRESS. Thirty patients (75%) had a hepatic involvement. Thirty (75%) biopsy specimens showed a combination of different inflammatory patterns. The interface dermatitis was noted in 24 specimens (60%). Twenty-one patients with the interface dermatitis had a hepatic involvement (P = 0.04). Conclusions: The skin rash of DRESS often shows the coexistence of different inflammatory patterns. The interface dermatitis showed a statistically significant association with the hepatic involvement in DRESS.

Research paper thumbnail of Drug reaction with eosinophilia and systemic symptoms within 1 week of exposure to the drug

Journal of the American Academy of Dermatology, 2020

Research paper thumbnail of Persistent papular varicella in an immunocompetent male

Indian Journal of Dermatology, Venereology and Leprology, 2020

59 Indian Journal of Dermatology, Venereology and Leprology | Volume 86 | Issue 1 | January-Febru... more 59 Indian Journal of Dermatology, Venereology and Leprology | Volume 86 | Issue 1 | January-February 2020 Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Research paper thumbnail of Histological evaluation of acquired dermal macular hyperpigmentation

Indian Dermatology Online Journal, 2019

Context: An umbrella term, acquired dermal macular hyperpigmentation (ADMH), has been proposed to... more Context: An umbrella term, acquired dermal macular hyperpigmentation (ADMH), has been proposed to denote conditions including ashy dermatosis, erythema dyschromicum perstans, lichen planus pigmentosus, and idiopathic macular eruptive pigmentation. Aims: To classify the patients manifesting ADMH on the basis of histology. Settings and Design: In this retrospective, cross-sectional study, histology specimens of patients of ADMH, who underwent skin biopsy in our institution from 1.1 2015 to 31.12.2017, were included after obtaining ethical clearance. Materials and Methods: The histology specimens of patients of ADMH were reviewed by the pathologist and classified. Clinical features of individual patient were collected from previous records and the data analyzed. Statistical Analysis Used: Pearson's Chi-square test was used to determine significance of association between age of onset and duration of pigmentation with histology type. Results: Three patterns of histology were identified in the study group (17 males and 13 females). Type 1: Basal cell degeneration and moderate to dense inflammation (12 patients, 40%), type 2: Significant pigment incontinence and sparse inflammation without basal cell degeneration, (12 patients, 40%), and type 3: sparse inflammation without basal cell degeneration or significant pigment incontinence (six patients, 20%). Statistically significant association was noted between age of onset of pigmentation and histology type (P value, 0.02). Limitations: Main limitation was the small sample size. Conclusions: Prospective studies evaluating the clinical progression and dermoscopy features and analyzing serial biopsies of ADMH patients may confirm whether the histology patterns observed represent different stages of same disease process or are different entities.

Research paper thumbnail of Aetiological and Clinical Profile of Acute Myeloid Leukaemia in a Tertiary Care Hospital

Journal of Evolution of Medical and Dental Sciences, 2018

BACKGROUND Acute myeloid leukaemia (AML) is a group of neoplastic disorders characterised by the ... more BACKGROUND Acute myeloid leukaemia (AML) is a group of neoplastic disorders characterised by the proliferation and accumulation of immature haematopoietic cells in the bone marrow and blood. It is the most common type of leukaemia among adults. The underlying pathophysiology in AML consists of a maturational arrest of bone marrow cells in the early stages of development. Aims and Objectives-To look for the possible aetiological factors in patients with Acute Myeloid Leukaemia and to study the clinical profile and to determine any prognostic factors with the help of clinical parameters and basic investigations. MATERIALS AND METHODS All patients above 12 years of age with acute myeloid leukaemia admitted in haematology unit of Department of Medicine between July 2009 and June 2013 were included in the study. The diagnosis of AML with subtypes was established based on clinical features, peripheral smear and bone marrow findings. RESULTS There were 100 patients (47 males, 53 females). Amongst aetiological factors, cigarette smoking was most commonly seen. Easy fatigability was the commonest presenting symptom, followed by fever, anorexia, weight loss and bleeding. The most common clinical finding was pallor followed by wet purpura, generalised lymphadenopathy and gum hypertrophy. The mean haemoglobin value was 7.35 gm% and platelet count was 56,740 cells/ mm 3. WBC count varied between 600 cells/mm 3 and 2,61,000 cells/mm 3. Among the subtypes of AML, most common leukaemia was AML M2 followed by AML M3. CONCLUSION Easy fatigability and malaise were the most common presentations in AML. Environmental factors like anti-cancer drug exposure, chemical exposure, smoking, proximity to mobile towers, high tension electric lines and dietary factors like poor intake of vegetables and fruits may have an influence on aetiopathogenesis of AML. Very high WBC count, bleeding manifestations and platelet count at presentation < 20,000/mm 3 all had a poor outcome. AML M2 was the most common subtype followed by AML M4, the prognosis was best in AML M2 and M3.

Research paper thumbnail of Predictors of disease severity in drug reaction with eosinophilia and systemic symptoms

Indian journal of dermatology, venereology and leprology, Jan 23, 2018

Drug reaction with eosinophilia and systemic symptoms is an outcome of a complex interaction betw... more Drug reaction with eosinophilia and systemic symptoms is an outcome of a complex interaction between specific drugs, certain herpesviruse types and the immune system of the affected individual and is characterized by an unpredictable course and recurrent flares even after withdrawal of the offending drug and administration of systemic steroids. To identify the predictors of disease severity in drug reaction with eosinophilia and systemic symptoms. After obtaining ethical clearance from the institutional ethics committee and a written informed consent from individual study participant, the first hundred patients who required inpatient care in Government Medical College, Kozhikode with drug reaction with eosinophilia and systemic symptoms from January 1 2011 were included in this study aimed to identify the predictors of disease severity in drug reaction with eosinophilia and systemic symptoms. Male-to-female ratio of the study group was 0.8:1. The presence of atypical cells in periph...

Research paper thumbnail of Neurolymphomatosis in primary cutaneous CD4+ pleomorphic small/medium-sized T-cell lymphoma mimicking Hansen's disease

Indian Journal of Dermatology, 2017

Neurolymphomatosis (NL) refers to nerve infiltration by neurotropic neoplastic cells in the setti... more Neurolymphomatosis (NL) refers to nerve infiltration by neurotropic neoplastic cells in the setting of a known or an unknown hematological malignancy. It typically presents as painful or painless peripheral mononeuropathy, mononeuritis multiplex, polyneuropathy, polyradiculopathy, or cranial neuropathy. A 32-year-old male presented with a hyperpigmented hypoesthetic plaque over the anterolateral aspect of the right leg with thickening of the right common peroneal nerve and foot drop clinically diagnosed as Hansen's disease. Biopsy taken from skin showed infiltrates of pleomorphic small and medium sized lymphocytes in the dermis and subcutis. On immunohistochemistry, the cells were positive for CD3, CD4 and negative for CD8, CD20, and CD30. Ultrasonography-guided fine-needle aspiration of the thickened nerve showed infiltrates of atypical lymphoid cells. Based on these findings, a diagnosis of NL in primary cutaneous CD4+ pleomorphic small/medium-sized T-cell lymphoma was made. The disease responded to systemic chemotherapy and localized radiotherapy with no evidence of relapse during 3 years follow-up. NL in primary cutaneous CD4+ pleomorphic small/medium-sized T-cell lymphoma presenting with manifestations redolent of Hansen's disease is not described in available literature. This case also demonstrates the utility of fine needle aspiration of nerve, a minimally invasive procedure in the diagnosis of NL.

Research paper thumbnail of Matting of body hair

Indian Journal of Dermatology, Venereology and Leprology, 2017

‘Matting of hair’ is a rare condition, characterized by knotting and rolling together of multiple... more ‘Matting of hair’ is a rare condition, characterized by knotting and rolling together of multiple hair shafts due to friction, most commonly when the hair is wet. This condition is similar to wool felting, where compacting of contiguous fibres occurs when exposed to friction and compression in the liquid medium. Matting of body hair has been rarely reported in Asians, as they are shorter, straighter and thinner than in Caucasians and Africans.

Research paper thumbnail of A clinicopathological analysis of primary cutaneous lymphomas: A 6-year observational study at a tertiary care center of south India

Indian Journal of Dermatology, 2016

Little data are available concerning clinical and pathological patterns of cutaneous lymphomas in... more Little data are available concerning clinical and pathological patterns of cutaneous lymphomas in India. To analyze the clinical and histopathological characteristics of cutaneous lymphomas in Indian patients. This is a single-center, prospective, observational study carried out from January 1, 2010, to December 31, 2015. The patients underwent clinical examination, human T-cell lymphotropic virus-1 (HTLV-1) screening, skin biopsy with hematoxylin and eosin and immunohistochemistry staining. Among 35 cases, 33 (94.3%) were T-cell, and 2 (5.7%) were B-cell lymphomas. The mean age was 52.66, and the male to female ratio was 2.5:1. The most common types of T-cell lymphomas included mycosis fungoides (MF) (57.1%) followed by adult T-cell lymphoma/leukemia (ATL) (17.1%). Primary cutaneous peripheral T-cell lymphoma not otherwise specified was diagnosed in 17.1% and anaplastic large cell lymphoma in 2.9%. The morphological types of MF included polymorphic, poikilodermatous, folliculotropic, hypopigmented, hyperpigmented, mixed, and purpuric. Skin manifestations of ATL included ulcerated plaques and erythroderma. Epidermotropism was very marked in ATL (83.3%) than in MF (70%). Larger Pautrier&amp;amp;amp;amp;#39;s microabscess was noted in ATL compared to smaller ones in MF. Markedly dense, diffuse infiltrate of atypical cells was noted in ATL in contrast to mild to moderate nodular or perivascular infiltrate in MF. ATL had an extremely poor prognosis. Identification of DNA integration of HTLV-1 by Southern blot could not be analyzed, and the number of cases studied is limited. The study showed unique patterns of subtypes of cutaneous lymphomas in our country. Variations in the clinical pattern and histopathological analysis will help to differentiate T-cell lymphoma types which have prognostic implications.

Research paper thumbnail of Pyodermatitis-pyostomatitis vegetans with penile ulceration complicated by acute glomerulonephritis

Indian Journal of Dermatology, 2016

Research paper thumbnail of Disseminated cutaneous phaeohyphomycosis due to Cladophialophora bantiana

Indian Journal of Dermatology, Venereology, and Leprology, 2015

Cladophialophora bantiana is a neurotropic dematiaceous fungus which only rarely affects the skin... more Cladophialophora bantiana is a neurotropic dematiaceous fungus which only rarely affects the skin. We report a case of disseminated cutaneous phaeohyphomycosis caused by Cladophialophora bantiana in an immunocompromised female who presented with multiple pyogenic granuloma-like nodules, dermatophytosis-like plaque, and subcutaneous cysts on the upper and lower extremities without systemic involvement. Biopsy revealed black yeasts resembling sclerotic bodies and culture yielded irregular, velvety, grey colonies with black reverse. Excisionof the nodules and treatment with oral itraconazole 100 mg twice daily resulted in complete clinical resolution within two months, following which itraconazole was administered for another 4 months.

Research paper thumbnail of Multifaceted adult T-cell leukemia/lymphoma in India: A case series

Indian Journal of Dermatology, 2015

Adult T-cell leukemia/lymphoma (ATL) is caused by human T-cell lymphotropic virus type-1 (HTLV-1)... more Adult T-cell leukemia/lymphoma (ATL) is caused by human T-cell lymphotropic virus type-1 (HTLV-1). India is considered as a nonendemic region for HTLV-1. Recent upsurge of cases have been noted in southern parts of India. The objective was to describe skin manifestations in various types of ATL. Clinical examination, blood investigations, skin biopsies, lymph node biopsies, and immunohistochemistry were performed in five patients. Flow cytometry was performed in two cases. Serological testing was positive for HTLV-1 in all patients. All patients presented with skin lesions. Rare presentations of molluscum contagiosum like papules, purpuric macules and plaques, hypopigmented macules and verrucous papules were seen. Dermatophytic infections occurred in two patients. Mucosal lesion was seen in one patient. Histological features include dermal lymphoid infiltrate with or without epidermotropism. Presence of epidermotropism did not correlate with the severity of disease. All patients except one succumbed to illness within few months to 1 year period. ATL manifest in myriad presentations and skin lesions are often the earliest manifestation. Cutaneous manifestations of ATL vary from subtle hypopigmented macules to florid nodular lesions, and HTLV-1 screening need to be carried out in all doubtful cases.