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The type of treatment prescribed by the dermatologist should not only be appropriate to the clinical form of psoriasis but also take into account the wishes of the child (if he or she is old enough to express them) and of the parents. The dermatologist, parents and child should work together to find the treatment which best suits the child. The benefits and risks of a treatment should be weighed even more carefully than for adults, especially as regards systemic treatments. Because of the toxicity of certain drugs, there are fewer treatments available for children than adults. Infantile psoriasis is commonly treated sequentially, with treatment altered every three months (it is treated the same way in adults). Lesions are less visible during summer because of exposure to the sun. Treatment should be recommenced when new eruptions appear, and continued until lesions turn white. Most importantly, the skin must be moisturised, usually by taking baths with emollients and using moisturising creams. Cortisone-based ointments are highly effective on psoriasis lesions [7]. The dermatologist may suggest a systemic treatment when the psoriasis is very widespread or severe and when it is having a significant impact on the patient’s life. Systemic treatments have significant side effects and their advantages and disadvantages should be carefully balanced with the child and his or her family. They are usually prescribed for a very short period of time and their use must be monitored. PUVA therapy is generally used only on children over 15 years as it leads to an increased risk of cancer. Retinoids are used for treating pustular and erythrodermic psoriasis and psoriatic rheumatism [8,9]. Children must be particularly carefully monitored to make sure that retinoids are not inhibiting their growth. Calcipotriene is very effective over the intertriginous areas where corticosteroids cant be prescribed [10]. Moreover the potent corticosteroids can be hazardous in children. Conclusions We conclude that calcipotriene can be a safe and effective therapy for psoriasis in early infancy. REFERENCES 1. Nyfors A, Lemholt K: Psoriasis in children. A short review and a survey of 245 cases. Br J Dermatol. 1975;92:437–42. 2. Farber EM, Mullen RH, Jacobs AH, Nall L: Infantile psoriasis: a follow-up study. Pediatr Dermatol. 1986;3:237–43. 3. Lerner MR, Lerner AB: Congenital psoriasis: report of three cases. Arch Dermatol. 1972;105:598–601. 4. Farber EM, Nall ML: The natural history of psoriasis in 5,600 patients. Dermatologica. 1974;148:1–18. 5. Lowe NJ: Psoriasis: Semin Dermatol. 1988;7:43–47. 6. Burton JL: Dietary fatty acids and inflammatory skin disease. Lancet. 1989;1:27–31. 7. Boxley JD, Dawber RP, Summerly R: Generalized pustular psoriasis on withdrawal of clobetasol propionate ointment. Br Med J. 1975;2:255–6. 8. Rosińska D, Wolska H, Jablonska S, Konca I: Etretinate in severe psoriasis of children. Pediatr Dermatol 1988;54:266–72. 9. Perlman SG: Psoriatic arthritis in children. Pediatr Dermatol. 1984;1:283–7. 10. Kragballe K, Gjertsen BT, De Hoop D, Karlsmark T, van de Kerkhof PC, Larkö O, et al: Double blind, right/left comparison of calcipotriol and betamethasone valerate in treatment of psoriasis vulgaris. Lancet. 1991;337:193–6. Copyright by Neerja Puri. 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 207
Case Report DOI: 10.7241/ourd.20132.50 OCULOCUTANEOUS ALBINISM COMPLICATED WITH AN ULCERATED PLAQUE Belliappa Pemmanda Raju, Umashankar Nagaraju, Leena Raveendra, Vivekananda, Priya Kootelu Sundar, Lokanatha Keshavalu Source of Support: Nil Competing Interests: None Department of Dermatology, Rajarajeswari Medical College and Hospital, Kambipura, Kengeri Hobli, Mysore Road, Bangalore – 560074, Karnataka, India Corresponding author: Ass. Prof. Belliappa Pemmanda Raju drbelliappa@gmail.com Our Dermatol Online. 2013; 4(2): 208-211 Date of submission: 01.02.2013 / acceptance: 03.03.2013 Abstract A 32-year-old male with a history of albinism and farmer by occupation presented with an ulcerated plaque on the right wrist. The patient had light eyes, hair, and skin. Physical examination showed extensive photodamage. A skin biopsy specimen from the plaque revealed a welldifferentiated squamous-cell carcinoma. Wide surgical excision was done. The most common types of oculocutaneous albinism (OCA), OCA 1 and OCA 2, are autosomal recessive disorders of pigmentation that commonly affect the skin, hair and eyes. Photodamage and skin cancers plague patients with albinism. Albinos face a myriad of social and medical issues. Importance of photoprotection, skin cancer surveillance and treatment has been stressed upon in this report. Key words: albinism; photoprotection; melanin; squamous cell carcinoma Cite this article: Belliappa Pemmanda Raju, Umashankar Nagaraju, Leena Raveendra, Vivekananda, Priya Kootelu Sundar, Lokanatha Keshavalu: Oculocutaneous albinism complicated with an ulcerated plaque. Our Dermatol Online. 2013; 4(2): 208-211. Introduction Albinism is a genetically inherited disorder characterized by hypopigmentation of the skin, hair and eyes due to a reduced or lack of cutaneous melanin pigment production [1]. Generally, there are two principal types of albinism, oculocutaneous, affecting the eyes, skin and hair, and ocular affecting the eyes only [1,2]. The mode of inheritance of albinism is thought to vary, depending on the type. The oculocutaneous type is considered autosomal recessive, and the ocular variant sex-linked [1-3]. Ocular problems faced by albinos are nystagmus, strabismus, photophobia, foveal hypoplasia and decreased visual acuity. The cutaneous problems seen with oculocutaneous albinism include sunburns, blisters, centro-facial lentiginosis, ephelides, solar elastosis, solar keratosis, basal cell carcinomas and squamous cell carcinomas. Squamous cell carcinoma has been reported to be the commonest skin malignancy seen in albinos [4,5]. Albinos are at an increased risk of developing skin malignancies due to the absence of melanin, which is a photo protective pigment, protecting the skin from the harmful effects of ultraviolet radiation [6]. Hence, a regular examination for early detection and treatment of these malignancies would increase their life expectancy to a great extent. We report here a case of oculocutaneous albinism with well-differentiated squamous cell carcinoma in a farmer and also review oculocutaneous albinism with emphasis on treatment and preventive aspects. Case Report A 32- year- old male, who was a known case of Oculocutaneous Albinism, presented with an ulcerated lesion over the right forearm. It started as a small wound which arised from normal looking skin and gradually increased to the present form over a period of six months. The patient was a farmer who had occupational sun exposure with no apparent photoprotection for the past fifteen years. History of photosensitivity and photophobia was present. He was born out of a non-consanguineous marriage. He had an elder sibling who was unaffected, but had an affected first-degree relative. On physical examination, generalized depigmented skin with white hairs, brownish freckles and telangiectasia were seen on his body (Fig. 1 - 3). Ocular Examination revealed photophobia, nystagmus and decreased visual acquity. Ulcerated plaque measuring 4cm x 3 cm with crusting with rolled out edges was seen on the right wrist (Fig. 4a, b). It was fixed to the underlying tissues. Regional lymphadenopathy was absent. General physical and systemic examination was normal. 208 © 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.
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Figure 1. Survival time of HIV/TB-
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Original Article DOI: 10.7241/ourd.
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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 60 and 61: Figure 1. a PAS positive accentuati
Page 62 and 63: The patient was put on melanocyl 0.
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 108 and 109: Figure 5. Alfred Guido Miescher (18
Page 112 and 113: Names of ''Lines'', in dermatology
Page 114 and 115: 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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