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Figure 1. a PAS positive accentuation in a hair follicle outer root sheath (dark pink staining; blue arrow) and in the follicular papilla border area (green arrow) (400x). b. H&E staining, showing a mild inflammatory infiltrate around an eccrine gland coil and a neurovascular package (blue arrows) (100x). c. PAS positive accentuation around a dermal blood vessel and nerve (200x). d and e. DIF using FITC conjugated anti-human IgM antibody, and demonstrating positive staining against superficial, thin nerves entering the epidermis and in the upper dermal neurovascular plexus (green staining; white arrows). f. Positive DIF staining against a sebaceous gland, utilizing FITC conjugated anti-human fibrinogen antibody (green-yellow staining; white arrow). g. Positive DIF staining against a deep dermal blood vessel, utilizing FITC conjugated anti-human lambda light chains antibody (green staining; white arrow). h. Positive DIF staining with FITC conjugated anti-human IgD antibodies against the upper and central epidermal stratum spinosum layer in an anti-nuclear and/or perinuclear keratinocytic staining pattern (white arrows). i. Positive DIF FITC conjugated anti-human lambda light chains staining, in an epidermal stratum spinosum perinuclear and pericytoplasmic pattern (white arrow). Copyright by Ana Maria Abreu Velez, et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. © Our Dermatol Online 2.2013 201
Case Report DOI: 10.7241/ourd.20132.48 STRICT ANATOMICAL CO EXISTENCE AND COLOCALIZATION OF VITILIGO AND PSORIASIS – A RARE ENTITY Neerja Puri, Asha Puri Source of Support: Nil Competing Interests: None Department of Dermatology and Venereology, Punjab Health Systems Corporation, Ferozepur, Punjab, India Corresponding author: Dr. Neerja Puri neerjaashu@rediffmail.com Our Dermatol Online. 2013; 4(2): 202-204 Date of submission: 04.01.2012 / acceptance: 06.02.2013 Abstract The coexistence of psoriasis and vitiligo is rare. We describe a case report of a 58 year old female patient who developed typical psoraiatic plaques covering completely or partly the vitiliginous areas of her skin. Her psoriasis was strictly limited to the vitiliginous patches with no involvement of the normal skin. Strict anatomical coexistence of both diseases is extremely rare and suggests a casual mechanism, possibly due to a koebner phenomenon but genetic and environmental factors may also be involved. Key words: autoimmune; colocalization; koebner phenomenon; patch; psoriasis; vitiligo Cite this article: Neerja Puri, Asha Puri: Strict anatomical co existence and colocalization of vitiligo and psoriasis – a rare entity. Our Dermatol Online. 2013; 4(2): 202-204. Introduction The occurrence of psoriasis in patients with vitiligo has not been often described [1-3]. Vitiligo and psoriasis are common conditions with a prevalence of approximately 1% and 3% respectively [4,5] and may be present in the same person. Patients with vitiligo and psoriasis may have the koebner phenomenon [3]. In 1982, Koransky and Roenig described the association of vitiligo and psoriasis to be rare [6,7]. The increased incidence of presumably autoimmune diseases in patients with vitiligo and psoriasis is an evidence of the autoimmune origin of these two conditions [8]. Case Report A 58 year female reported to the department of dermatology with depigmented patch over axilla, neck, breast and groins, arms, forearm, elbows, hands, fingers, legs & thighs since 6 years. Patient noticed erythematous plaques with thick scaling over extensors and scalp since 2 years. Cutaneous examination revealed well defined and erythematous papules and plaques with silvery scales over arm, forearm, elbows, hands (Fig. 1), fingers, legs and thighs. There was mild pruritis present over lesions. There was cohabitation of psoriatic lesions over vitiligo patches. The PASI score of the patient was 12. Auspitz sign was positive. A clinical diagnosis of coexistent vitiligo and psoriasis was made. On cutaneous examination, there were present thick plaque on the wrist over a depigmented patch measuring 8cm x 6cm in diameter. The plaque had thick silvery scaling. The depigmented patches were present over the tips of fingers, over central part of buttocks (10cm x 8cm) measuring 10cm x 8cm, over both axilla (right axilla 7cm x 6cm and left axilla 8cm x 5cm) and groins and breast (right breast 5cm x 3cm and left breast 4cm x 4cm). The nail showed pitting, beaus lines and longitudinal striations. All the investigations of the patient were within normal limits except the ESR which was 48 mm 1 st hour. A clinical diagnosis of psoriasis in association with vitiligo was made. Two skin biopsies of the patient were taken from the localized lesion. The skin biopsy taken from left elbow showed neutrophilic crust and parakeratosis. Epidermis showed loss of granular layer and elongation of rete ridges with suprapapillary thinning of the epidermis (Fig. 2). Dilated capillaries and papillary dermal oedema were seen. Lymphohistiocytic infiltrate was noted. So, the biopsy from left elbow was consistent with psoriasis. The second biopsy was taken at the site of depigmented patch over the left elbow. The histopathological findings were as follows: Architecturally normal epidermis showed intact basal layer. Mild lymphohistiocytic infiltrate was present in the papillary dermis. There was an absenceof melanocytes in the basal cell layer confirmed by special staining (Fig. 3). There was inflammation at the dermoepidermal junction. The clinical features were consistent with colocalized vitiligo and psoriasis. 202 © Our Dermatol Online 2.2013 www.odermatol.com
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Volume 4, Number 2, April 2013 ISSN
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Editorial Board: Abdel-Naser Mohame
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CONTENTS E d i t o r i a l O r i g
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Original Article DOI: 10.7241/ourd.
Page 10 and 11: Figure 1. Survival time of HIV/TB-
Page 12 and 13: Original Article DOI: 10.7241/ourd.
Page 14 and 15: Figure 3. A. melanocytic naevus on
Page 16 and 17: Original Article DOI: 10.7241/ourd.
Page 18 and 19: 82% of the children belonged to the
Page 20 and 21: Comment to the article DOI: 10.7241
Page 22 and 23: The skin around body openings such
Page 24 and 25: Figure 1. Finger nail dystrophy in
Page 28 and 29: Similar type of rash was also prese
Page 30 and 31: 13. Mastaglia FL, Ojeda VJ: Inflamm
Page 32 and 33: Figure 1. Atrophic areas on left up
Page 34 and 35: 5. Brocard A, Quereux G, Moyse D, D
Page 36 and 37: Figure 1. Macroglossia Figure 2. Ma
Page 38 and 39: Case Report DOI: 10.7241/ourd.20132
Page 40 and 41: Figure 4a, b. Skin biopsy shows hyp
Page 46 and 47: Discussion Poikiloderma of Civatte
Page 52 and 53: Case Report A 56 year old Caucasian
Page 54 and 55: Using a battery of neurotoxic agent
Page 56 and 57: Figure 1. Multiple lesions on the u
Page 62 and 63: The patient was put on melanocyl 0.
Page 66 and 67: The type of treatment prescribed by
Page 68 and 69: On the basis of these clinical find
Page 70 and 71: Surgery has been reported to be the
Page 72 and 73: Figure 1. Histological section show
Page 76 and 77: Discussion The breast location of t
Page 78 and 79: Figure 2. The epithelial nests show
Page 82 and 83: Discussion SCACP is one of the cuta
Page 84 and 85: Figure 1. Tumor of the nasal colume
Page 86 and 87: Figure 2. Vesicles and crusts aroun
Page 88 and 89: Outbreaks have occurred recently in
Page 90 and 91: Clasificación En base al epitelio
Page 92 and 93: - Microcefalia, hipoplasia mediofac
Page 94 and 95: Caso Nº 3: · Niña, edad desconoc
Page 96 and 97: Clinical Images DOI: 10.7241/ourd.2
Page 98 and 99: Figure 7. Fixed cutaneous sporotric
Page 100 and 101: Letter to the Editor DOI: 10.7241/o
Page 102 and 103: Historical Article DOI: 10.7241/our
Page 104 and 105: Figure 6. Henri Mondor (1885-1962).
Page 106 and 107: Historical Article DOI: 10.7241/our
Page 108 and 109: Figure 5. Alfred Guido Miescher (18
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Historical Article DOI: 10.7241/our
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Names of ''Lines'', in dermatology
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Figure 1. Erik Adolf von Willebrand
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THOMAS INMAN English physician, 182
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There are three type of tinea capit
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Our Dermatology Online www.odermato
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