- New Delhi, Delhi, India
Premanshu Bhushan
University of Delhi, Dermatology, Faculty Member
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A 20‐year‐old boy presented with multiple, discrete, 2‐4 mm sized, red‐purple papules on the arms, trunk, penis, scrotum and legs, becoming confluent around the umbilicus [Figure 1]. The papules started appearing 3 years ago on his thighs... more
A 20‐year‐old boy presented with multiple, discrete, 2‐4 mm sized, red‐purple papules on the arms, trunk, penis, scrotum and legs, becoming confluent around the umbilicus [Figure 1]. The papules started appearing 3 years ago on his thighs and occasionally bled on trauma, without any other symptoms. The patient had episodic burning pain in both hands and feet, heat intolerance and decreased sweating. There was no history of abdominal pain, bone pain, edema of the feet, auditory or neurological complaints or significant drug intake. No other family member had similar features. Systemic and ophthalmic evaluations revealed no abnormalities.
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adalimumab was stopped. The patient was commenced on ustekinumab 45 mg every 12 weeks, following an initial loading dose of 45 mg and another 45 mg at month 1. Her skin rapidly cleared after 4 weeks, and CsA was discontinued. Her skin... more
adalimumab was stopped. The patient was commenced on ustekinumab 45 mg every 12 weeks, following an initial loading dose of 45 mg and another 45 mg at month 1. Her skin rapidly cleared after 4 weeks, and CsA was discontinued. Her skin remains clear 2.5 years later on ustekinumab 45 mg every 12 weeks. There are multiple reports of ustekinumab triggering pustular psoriasis, and there is only one previously published case report of GPP being successfully treated with ustekinumab; this was a 47-year-old man with plaque psoriasis that decompensated into pustular psoriasis. Although anti-tumour necrosis factor agents (anti-TNFs) are used to treat GPP, there are reports of these drugs actually triggering GPP. In conclusion, we report a case of a patient with GPP that was refractory to methotrexate therapy and required discontinuation of acitretin and CsA because of adverse effects. Although the patient’s disease was initially controlled on adalimumab, it subsequently flared despite the addition of CsA to adalimumab therapy. The patient had a rapid and sustained response to ustekinumab therapy, and her skin has remained clear on a maintenance dose of ustekinumab. Our case highlights that ustekinumab can be a useful drug to treat this condition and should be considered in patients refractory to other systemic agents.
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Background Hand eczema is a common distressing condition aggravated by a number of endogenous and exogenous factors. Various morphological patterns of hand eczema have been described. Aims To study the morphological patterns of hand... more
Background Hand eczema is a common distressing condition aggravated by a number of endogenous and exogenous factors. Various morphological patterns of hand eczema have been described. Aims To study the morphological patterns of hand eczema and identification of contact sensitizers of hand eczema by patch test. Methods Hundred consecutive patients of hand eczema attending the outpatient department of the institute were recruited over a period of one year from 2013-2014. All the patients were patch tested using Indian standard series. Results Pompholyx was the most common morphological pattern seen in 25% of patients followed by hyperkeratotic palmar eczema in 22%. Positive patch test to one or more allergen was present in 61% of patients. Nickel sulphate was found to be the most common allergens seen in 16%. This was followed by potassium dichromate, parthenium, fragrance mix in 11%, 8%, 8% respectively. The females (57%) were out-numbered by males (43%) with sex ratio of 1.32:1. Hou...
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The bullous variant of Darier's disease is a rare type and the exact nosological position relative to Hailey Hailey disease has been doubtful. We report a case of bullous Darier's disease with histological picture suggestive of... more
The bullous variant of Darier's disease is a rare type and the exact nosological position relative to Hailey Hailey disease has been doubtful. We report a case of bullous Darier's disease with histological picture suggestive of Hailey-Hailey disease. We have also reviewed and summarized the differences between Darier's disease and Hailey-Hailey disease.
Research Interests: Medicine, Biopsy, Humans, Female, Differential Diagnosis, and 3 moreSkin, Middle Aged, and Darier Disease
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Nevus depigmentosus (ND) is classically defined as a congenital nonprogressive hypopigmented macule, stable in size and distribution. There have been many reports of colocalization of ND and lentigines. We describe development of multiple... more
Nevus depigmentosus (ND) is classically defined as a congenital nonprogressive hypopigmented macule, stable in size and distribution. There have been many reports of colocalization of ND and lentigines. We describe development of multiple lentigines over ND in a 9-year-old girl along with hypoplasia of the underlying breast. The case is being reported to highlight the phenotypic manifestation of reverse mutation and the coincidental breast hypoplasia that has not been reported before.
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... 45 Page 4. Moreno et al. Fig. 4. (jomma-likc delbr-rnity, dilatation and cpi-ihclial bypc-rplasia in a dermal eccrine duct (II&IC, XlOO). aspect of tbe middle left liftb finger (Fig. 5). No otber members of bis family have a... more
... 45 Page 4. Moreno et al. Fig. 4. (jomma-likc delbr-rnity, dilatation and cpi-ihclial bypc-rplasia in a dermal eccrine duct (II&IC, XlOO). aspect of tbe middle left liftb finger (Fig. 5). No otber members of bis family have a similar condi-tion. ...
Angioma serpiginosum is clinically characterized by multiple copper to red-colored grouped macules that are arranged in serpiginous or gyrate patterns. Histologically, it is characterized by dilatation and proliferation of vessels in the... more
Angioma serpiginosum is clinically characterized by multiple copper to red-colored grouped macules that are arranged in serpiginous or gyrate patterns. Histologically, it is characterized by dilatation and proliferation of vessels in the papillary dermis.[1] The occurrence of angioma serpiginosum on the upper limb is rare while we were unable to find previous reports of its occurrence on the face and neck.
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A 20‐year‐old boy presented with multiple, discrete, 2‐4 mm sized, red‐purple papules on the arms, trunk, penis, scrotum and legs, becoming confluent around the umbilicus [Figure 1]. The papules started appearing 3 years ago on his thighs... more
A 20‐year‐old boy presented with multiple, discrete, 2‐4 mm sized, red‐purple papules on the arms, trunk, penis, scrotum and legs, becoming confluent around the umbilicus [Figure 1]. The papules started appearing 3 years ago on his thighs and occasionally bled on trauma, without any other symptoms. The patient had episodic burning pain in both hands and feet, heat intolerance and decreased sweating. There was no history of abdominal pain, bone pain, edema of the feet, auditory or neurological complaints or significant drug intake. No other family member had similar features. Systemic and ophthalmic evaluations revealed no abnormalities.
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The bullous variant of Darier's disease is a rare type and the exact nosological position relative to Hailey Hailey disease has been doubtful. We report a case of bullous Darier's disease with histological picture suggestive of... more
The bullous variant of Darier's disease is a rare type and the exact nosological position relative to Hailey Hailey disease has been doubtful. We report a case of bullous Darier's disease with histological picture suggestive of Hailey-Hailey disease. We have also reviewed and summarized the differences between Darier's disease and Hailey-Hailey disease.
Research Interests: Medicine, Biopsy, Humans, Female, Differential Diagnosis, and 3 moreSkin, Middle Aged, and Darier Disease
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We present a case of infantile herpes zoster without clinical evidence of varicella infection in the mother or apparent exposure in the child; our patient's diagnosis was confirmed by serology and by Tzanck smear. We briefly review... more
We present a case of infantile herpes zoster without clinical evidence of varicella infection in the mother or apparent exposure in the child; our patient's diagnosis was confirmed by serology and by Tzanck smear. We briefly review the etiopathogenesis factors of this condition. We emphasize the benign course and spontaneous uneventful resolution.
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Research Interests: Medicine, Humans, Leprosy, Male, Prednisolone, and 3 moreAdult, Combination drug therapy, and Glucocorticoids
Nevus depigmentosus (ND) is classically defined as a congenital nonprogressive hypopigmented macule, stable in size and distribution. There have been many reports of colocalization of ND and lentigines. We describe development of multiple... more
Nevus depigmentosus (ND) is classically defined as a congenital nonprogressive hypopigmented macule, stable in size and distribution. There have been many reports of colocalization of ND and lentigines. We describe development of multiple lentigines over ND in a 9-year-old girl along with hypoplasia of the underlying breast. The case is being reported to highlight the phenotypic manifestation of reverse mutation and the coincidental breast hypoplasia that has not been reported before.
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Research Interests: Dermatology and Medicine
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We present a case of infantile herpes zoster without clinical evidence of varicella infection in the mother or apparent exposure in the child; our patient's diagnosis was confirmed by serology and by Tzanck smear. We briefly review... more
We present a case of infantile herpes zoster without clinical evidence of varicella infection in the mother or apparent exposure in the child; our patient's diagnosis was confirmed by serology and by Tzanck smear. We briefly review the etiopathogenesis factors of this condition. We emphasize the benign course and spontaneous uneventful resolution.
Research Interests:
Research Interests: Medicine, Humans, Leprosy, Male, Prednisolone, and 3 moreAdult, Combination drug therapy, and Glucocorticoids
True fl agellation/mechanical Flagellation has been used in various religions for penance or punishment.[1] Whipping has also been used to “discipline” children, but in the modern context flagellate marks on children should arouse a... more
True fl agellation/mechanical Flagellation has been used in various religions for penance or punishment.[1] Whipping has also been used to “discipline” children, but in the modern context flagellate marks on children should arouse a suspicion of child abuse.[2] In adults, these could be suggestive of partner/spouse abuse or torture. Sadomasochistic behavior involves voluntary whipping of oneself or the partner for sexual gratification.[3] Artefactual whiplash marks may be produced for tangible or intangible gains in malingering and other psychiatric illnesses.
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Pilomatricoma is an uncommon hamartomatous tumor of the hair matrix. Bullous and anetodermic changes over pilomatricoma are rare. We report an 18-year-old male with an asymptomatic nodule with overlying cystic changes on the left arm of... more
Pilomatricoma is an uncommon hamartomatous tumor of the hair matrix. Bullous and anetodermic changes over pilomatricoma are rare. We report an 18-year-old male with an asymptomatic nodule with overlying cystic changes on the left arm of 6-month duration with clinical and histological features of both bullous and anetodermic modifications. We also reviewed the associated literature to conclude that there is sufficient overlap in these two entities. Both variants show a bullous or pseudobullous appearance clinically and loss of elastin, sparse collagen bundles separated by intense edema, and dilated lymphatics/blood vessels in the dermis overlying the tumor mass histologically. We therefore propose that bullous, pseudoampullary, anetodermic, and lymphangiectatic forms should be considered as synonymous or transitional to the ultimate scar-like anetodermic appearance.
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Granuloma annulare (GA) is a noninfectious necrobiotic granuloma, which can present as localized or generalized patterns. We present a case of generalized GA with multiple large open comedones over the lesions in a woman with... more
Granuloma annulare (GA) is a noninfectious necrobiotic granuloma, which can present as localized or generalized patterns. We present a case of generalized GA with multiple large open comedones over the lesions in a woman with hypothyroidism and diabetes mellitus. GA is associated with collagen and elastic-fibre damage, which may lead to loss of follicular support and resultant open comedone formation, analogous to solar elastosis or senile comedones. The rapid recovery of our patient after treatment with of oral hypoglycaemics supports the role of insulin resistance as a predisposing factor for GA.
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Nevus depigmentosus (ND) is classically defined as a congenital nonprogressive hypopigmented macule, stable in size and distribution. There have been many reports of colocalization of ND and lentigines. We describe development of multiple... more
Nevus depigmentosus (ND) is classically defined as a congenital nonprogressive hypopigmented macule, stable in size and distribution. There have been many reports of colocalization of ND and lentigines. We describe development of multiple lentigines over ...
Research Interests:
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The bullous variant of Darier's disease is a rare type and the exact nosological position relative to Hailey Hailey disease has been doubtful. We report a case of bullous Darier's disease with histological picture suggestive of... more
The bullous variant of Darier's disease is a rare type and the exact nosological position relative to Hailey Hailey disease has been doubtful. We report a case of bullous Darier's disease with histological picture suggestive of Hailey-Hailey disease. We have also reviewed and ...