DESMOPLASTIC TRICHOEPITHELIOMA AND MULTIPLE EPIDERMAL CYSTS

A 22-year-old peanut vendor presented with an asympto-matic annular plaque of 2 years duration on his face. It began as a small, firm papule and gradually increased in size and extent. His occupation involved long hours of ex-posure to sunshine, but there was no associated burning sensation or irritation.
Dermatologic examination revealed an oval, annular plaque over the right temple, about 4 cm × 3 cm. The rim was studded with miliary white papules 1 to 2 mm in size, and the center was depressed (Fig. 1). It had an indurated feel and was freely mobile over the underlying structures. Clinically, a differential diagnosis of colloid milium, granu-loma annulare, or annular elastolytic granuloma was enter-tained. In addition, numerous milia were scattered over the cheeks. He also had multiple, well-defined, firm, white scro-tal swellings, 1 to 3 cm in size. Systemic examination did not reveal any abnormality.
Skin biopsies of the plaque and a scrotal cyst were per-formed, and the sections stained with hematoxylin and eosin. The annular plaque, showed mild hyperplasia of the epidermis, numerous keratin cysts, islands of basophilic cells in the dermis, and abundant fibrous tissue compress-ing the tumor cells into narrow strands (Fig. 2). Tumor stro-mal retraction was conspicuous by its absence. A diagnosis of desmoplastic trichoepithelioma was made.
The scrotal nodule revealed an epidermal cyst lined by stratified squamous epithelium and containing laminated keratin (Fig. 3). The patient was referred to the department of plastic surgery, where the plaque was excised in toto, and the defect repaired.     

Cutaneous infection by Cryptococcus laurentii

Crypiococcus laurentil was isolated twice from cutaneous granulomas in the leg and foot of a 40-yearold man. Histologically the cells of C. laurentii were found in groups in the dermis and also inside giant cells. There was cpithelioid cell infiltration in the dermis and subcutis. An atypical mycobacterium was isolated in addition to C. laurentii. Therapy with anti-tuberculous drugs after an initial amphotericin B infusion was found to be satisfactory.     

METRONIDAZOLE IN THE TREATMENT OF TROPICAL PHAGEDENIC ULCERS

In an uncontrolled preliminary trial, metronidazole administered orally to 30 patients was effective in resoving tropical phagedenic ulcers within a period of one to two weeks. The efficacy of this drug indicates the important role played by fusospirochetes in causing tropical ulcers.     

Genetic tylosis with malignancy: a study of a South Indian pedigree

Tylosis at birth was found as an autosomal dominant inheritance in twenty-two members of a family spanning over five generations. Of those affected three of the fourth generation tylotics developed squamous carcinoma of the tylotic skin and one of these died of carcinoma of the oesophagus. It is possible that there is a genetic association between the state of the oesophagus and the tylosis of the palms and soles which predisposes both sites towards the development of squamous carcinoma.     

FRICTION AMYLOIDOSIS: A VARIANT OR AN ETIOLOGIC FACTOR IN AMYLOIDOSIS CUTIS?

Background. During a study of cutaneous annyloidosis, it was noticed that a significant number of patients gave a history of friction of some kind or other, which when analyzed could be clearly related to their cutaneous pigmentation. A common feature in all these patients was the relative lack of itching when compared with others who did not give a history of friction. Methods. We studied the role of friction in 65 patients with amyloidosis cutis and found that in 20 patients, frictional factors could be attributed to their cutaneous condition, and these latter were taken up for further study. Results. Histologic examination of the affected area of skin showed amyloid deposits, which could be detected by light microscopy with hematoxylin and eosin stained sections and confirmed by special stains. Conclusions. The role of friction in the causation of lesions that resemble amyloidosis cutis morphologically is discussed.     

Ichthyosis with unusual hair shaft abnormalities in siblings

An autosomal recessive disorder characterized by lamellar ichthyosis, an unusual structural defect of the scalp hairs and amino aciduria occurred in two siblings in a south Indian family in Madras. In addition the female sibling was physically and mentally retarded. The disorder differs from typical Netherton's syndrome in several ways. The hair abnormality specific for this disorder appears to be splitting of the shaft. The possible mechanism of production of the split hairs is discussed.     

Behaviour of the private sector in the health market of Bombay

In Bombay, the private sector plays a major role in providingmedical care to all strata of society and these services arewell utilized by everyone. Of late there have been criticismsabout the quality of private medical care and there is a needfor a proper policy on the development and regulation of privatesector health services. This paper contributes to this by unravellingthe inadequacies in the medical infrastructure and manpower,and highlighting the unethical medical practice rampant in privatepractice. The paper also assesses the existing regulatory mechanismsand their inability to control the quality of private sectormedical care. After exposing the behaviour of the private sector,the paper suggests a holistic policy approach to increase andstrengthen the public sector health services in poor areas,to develop norms to maintain quality in medical infrastructureand manpower, and to discipline unethical professional behaviour.     

An unusual presentation of Trichophyton violaceum infection

A case with encapsulated Tricophyton violaceum abscesses in the skin is recorded. Defective cell mediated immunity was shown in the patient and in his two cousins. This defect combined with malnutrition, hypoadrenalism and griseofulvin resistance gave unusual lesions and chronicity. A probable genetic factor for the defective cell mediated immunity is postulated.     

Cerebriform tongue—a clinical sign in pemphigus vegetans

Ten cases of pemphigus vegetans of Neumann type are reported. Six of these showed clinically distinctive changes in the tongue for which the term cerebriform tongue is proposed. Histological examination of the tongue showed typical features of pemphigus vegetans.