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Squamous cell carcinoma (SCC) usually arises in skin damaged by actinic rays. Exposure to chemicals like coal tar, soot, arsenic and a variety of oils and distillation products is also implicated in its pathogenesis. It occasionally occurs in scars following inflammatory or degenerative processes. It is an end stage complication of a wide array of inflammatory skin conditions. SCC complicating chronic cutaneous lupus erythematosus (CCLE) in Indian patients is rarely reported. Here we report two such Indian patients with long standing CCLE in whom the diagnosis of CCLE and SCC was confirmed by histopathology.

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A 24-year-old female presented with a firm, hyperpigmented, and gradually enlarging, tender, solitary dermal nodule of non-traumatic origin over the right suprascapular region. The lesion was extending into the subcutaneous tissue. She was otherwise normal. There was no calcification on X-ray. Biopsy revealed numerous large pleomorphic fibroblasts in a mucoid ground substance diagnostic of nodular fasciitis. No recurrence was noticed after surgical excision. This case is reported because of its rarity in the Indian medical literature.

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BACKGROUND: A survey was undertaken in patients of sexually transmitted infections with the aim of exploring STD and HIV prevention opportunities. METHODS: A behavioral survey was conducted on 56 soldiers while being treated or followed up for a sexually transmitted disease. They were studied for their attitude and sexual activity patterns relevant to the transmission of STDs. In addition, the individual's outlook to sexual life and motivation factors was assessed. RESULTS: The study revealed that the source of infection of STD was equally divided between commercial sex worker (CSW) and casual sexual relationships. The majority did not use barrier contraceptives and knowledge about their protective role was insufficient. Access to health education was satisfactory; however, awareness levels for preventive action were still inadequate. Homosexuality was rare and most soldiers could stay without frequent sex. Alcohol was not found to be a significant co-factor. CONCLUSIONS: Heterosexual contact remains the main route of sexual contact. A wide variation in casual relationships and motivating factors was noted. Long abstinence and transit periods, traditionally considered major reasons for a soldier's indulgence in sex did not seem to play a major role. The role of sex parlors in the army was negated.

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BACKGROUND: Internal malignancies are accompanied by various skin changes which may be specific infiltrates or non-specific changes. This study is aimed at determining the frequency of such changes in malignant disease treatment center attendees in India. METHODS: A study of 300 confirmed cases of internal malignancy at a malignant disease treatment center was undertaken to evaluate these skin changes. Specific infiltrates were confirmed by histopathology. Statistical methods were employed to calculate significance in non-specific lesions by comparing with 300 controls not suffering from internal malignancy. RESULTS: Skin changes were present in 82 (27.3%). Cutaneous metastases were found in 19 (6.3%); non-contiguous in 5 (1.6%); contiguous in 14 (4.3%). Non-specific skin lesions numbered 74 (11.6%) in 52 patients. Statistically significant non-specific skin changes were acquired ichthyosis, herpes zoster and generalized pruritus. CONCLUSION: Metastases usually occurred late in internal malignancy (17, 5.6%) except in a case each of histiocytic lymphoma and non-Hodgkin's lymphoma (2, 0.7%) where the lesions preceded malignancy by 3 months and 1 month respectively. Contiguous nodules were a marker of relapse after surgery in 3 (1%).

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BACKGROUND: Steroids when left on the skin for longer duration may contribute to the side effects without any additional clinical benefit. The relationship between the duration of topical steroid contact with the skin and its effectiveness has not been established. The ability of the topical steroids to inhibit the size of histamine induced wheal was used to assess their relative efficacy. AIM: To determine whether half an hour contact and three hour contact of a topical steroid, clobetasol propionate, is equally effective in inhibiting the size of the histamine induced wheal. METHODS: On 30 volunteers, 4 squares were marked on flexor aspect of both forearms using a template. One fingertip unit of clobetasol propionate 0.05% was applied on all the areas. Half an hour later all areas of left forearm and last square of right forearm were wiped. Prick testing was done with histamine and size of wheal recorded after 15 minutes. Similarly steroid was wiped from the 1st, 2nd, 3rd square after 1 hr, 2 hr and 3 hrs on right forearm and the corresponding areas prick tested on both forearms. RESULTS: There was statistically significant wheal suppression at the end of 2 hrs and 3hrs as compared to half an hour. CONCLUSION: We conclude that half an hour application of clobetasol propionate is ineffective and that it is effective only after two hours of contact and hence short contact of half an hour will be less effective than relatively prolonged contact of 2 hours.

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BACKGROUND: Phenytoin, one of the most commonly used antiepileptic drug, is associated with a wide spectrum of adverse drug eruptions. It is metabolized by the hepatic microsomal enzymes. The intermediate metabolites are arene oxides which accumulate due to deficiency of the enzyme epoxide hydrolase. These are postulated to be associated with phenytoin induced hepatotoxicity and antiepileptic hypersensitivity syndrome. AIM: We tried to correlate the in vitro lymphocyte toxicity of arene oxide metabolites with phenytoin induced drug eruptions and hence develop it as a predictive test for the same. METHODS: Clinically diagnosed cases of phenytoin induced drug eruptions were selected in this hospital based study. Lymphocytes from the subjects and controls were exposed to the phenytoin metabolites generated by a murine hepatic microsomal system. The toxicity was assayed by trypan blue dye exclusion test. The results were analyzed by a linear orthogonal curve and were compared for the subject and control. RESULTS: The results showed increased toxicity to lymphocytes from the patients when compared to those from controls. The toxicity was directly proportional to the severity of the drug eruption. CONCLUSION: In vitro lymphocyte cytotoxicity to phenytoin metabolites tested in this animal system could possibly predict phenytoin induced drug eruptions.

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We describe a case of diffuse plane normolipemic xanthomatosis (DPNX) associated with Takayasu's disease and hyperhomocysteinemia. This report of an association of Takayasu's disease with hyperhomocysteinemia and DPNX is the only such report in literature. This report corroborates the study by Marcoval et al on 8 patients in 1988 where they highlighted that in every case of DPNX a possible concomitant condition should be always suspected and found out.

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The association of lichen planus (LP) with liver diseases is now well established. Recent reports suggest that the hepatitis viruses may play a central role in this association. Lichen planus following hepatitis B vaccination is much more unusual. A 19-year-old previously healthy male developed itchy violaceous papules and plaques over the upper extremities eight to ten days after the first injection of hepatitis B vaccine. He developed similar lesions over the upper trunk, neck and lower leg after the second and third injections. A skin biopsy showed a lichenoid tissue reaction. Direct immunofluorescence (DIF) showed multiple colloid bodies and a strong continuous ragged basement membrane zone (BMZ) band with fibrinogen. HbsAg by ELISA and anti-HCV antibodies were negative. The patient was treated with oral steroids and the lesions improved. LP is a pruritic inflammatory dermatosis of unknown origin. An increased prevalence of liver disease in patient with LP has been reported. Since the first case reported by Rebora in 1990, about 15 cases of LP occurring after hepatitis B vaccination have been reported in the literature irrespective of the type of vaccine used.

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Background: The titer of contact hypersensitivity (TCH) has been used to determine the degree of contact hypersensitivity in patients with contact dermatitis. The values have been found to vary in different individuals and also in the same individual at different times apparently due to the varying severity of the disease. We evaluated the correlation of TCH with disease severity and therapeutic response in patients of contact dermatitis caused by the plant Parthenium hysterophorus. Methods: Forty-two patients, 30 (71.4%) males and 12 (28.6%) females, aged between 30-75 years, having air-borne contact dermatitis to Parthenium hysterophorus for 0.5-20 years were included in the study. The disease severity and TCH at baseline were recorded in all the patients. They were treated with azathioprine and followed up every month for 4-69 months. The TCH was repeated every 3 months and the last recorded TCH value was taken for analysis in each patient. Results: The baseline clinical severity score (CSS) varied from 10-80 (mean ± SD: 35.47 ± 19.41) in these patients. It ranged from 10-30 in 22 (52.4%) patients, from 31-50 in 14 (33.3%) patients, and was more than 50 in 6 (14.3%) patients. The baseline TCH to Parthenium was undiluted (UD) in 2 (4.8%), 1:10 in 15 (35.7%), 1:100 in 20 (47.6%), and 1:1000 in 5 (11.9%) patients respectively. At the end of the study, the clinical severity of the disease decreased in most of the patients. The CSS came down to 0 in 31 patients, to 10-20, and to 50 in 4 patients each, but remained stable in three patients who had baseline CSS from 20-40. The overall mean CSS came down from 35.47 ± 19.41 to 4.76 ± 9.43 (p = 0.002). However, there was no significant change in the TCH levels over time (p = 0.153). The last TCH value was negative in 2 (4.8%) patients, undiluted in 5 (11.9%), 1:10 in 10 (23.8%), 1:100 in 18 (42.9%), and 1:1000 in 7 (16.7%) patients. There was no change in the TCH values in 16 (38.1%) patients while it increased or decreased by 1-2 dilutions in 12 (28.6%) patients each. Conclusions: We therefore conclude that the TCH does not correlate with the clinical severity of contact dermatitis or response to treatment.

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