Biomedical subjects
Publications and source records attributed to D M Thappa.
A new case with the typical features of progeria (Hutchinson-Gilford) occurred in India. Histopathology of the skin showed atrophic epidermis and diffuse fibrosis of dermis with loss of appendages. Roentgenographic findings were characteristic of progeria. The child also had a gangrenous ulcer over the left foot, a finding not highlighted in the literature.
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Two cases of longstanding rhinosporidiosis developed widespread asymptomatic nodular skin lesions. Cutaneous examination showed multiple, discrete, sessile and pedunculated, smooth and warty, friable nodular lesions of variable sizes and shapes. Histopathology of representative skin lesions showed hyperplastic epidermis with sporangia containing spores in the upper dermis diagnostic of rhinosporidiosis. Epidemiological data about rhinosporidiosis at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India, is presented. Possible modes of dissemination to the skin and differential diagnosis are discussed in relation to this rare manifestation of rhinosporidiosis.
Five hundred pregnant women attending obstetrics OPD were screened for the presence of pruritus. The patients with other dermatological causes of pruritus (other than specific dermatosis of pregnancy) were excluded from the study. The selected patients were further subjected to routine laboratory investigations including liver function tests and IIBs Ag detection. The prevalence of pruritus in pregnancy was found to be 4.6% (23 cases). Ten patients were found to have specific dermatoses of pregnancy, including four cases of pruritus gravidarum and four of pruritic urticarial papules and papules of pregnancy. The prevalence of pruritus gravidarum was 0.8% of pregnancies. All the patients with pruritus gravidarum were primigravidae and had no clinical overlap with other specific dermatoses of pregnancy, jaundice, or intrahepatic cholestasis. One case of perinatal death was recorded among the pruritus gravidarum cases. This study has been helpful in determining the prevalence and severity of pruritus gravidarum in South India.
An extremely rare case of primary extragenital donovanosis affecting the dorsa of right foot is reported. Clinical and histopathological features of the disease are described and the rarity, absence of genital lesions, and consequent difficulty in diagnosis are discussed.
Thirty-one patients with inherited palmoplantar keratodermas (PPKs) were screened from 59,490 cases who visiting the OPD of JIPMER, Pondicherry. The prevalence rate was 5.2 per 10,000 population (1:2000 approx.). PPKs were more common in males (25 patients) than females (6 patients); the overall male to female ratio was 4.2:1. The incidence was highest in the group from 0-10 years of life (67.7% of cases). Unna-Thost syndrome topped the list with 38.7% of cases and its prevalence 1:6000 (approx.), followed by Greither's disease (22.9%) and others-Vohwinkel (3 cases), idiopathic punctate (2 cases), ichthyosis vulgaris associated PPK (2 cases) etc. This study has for the first time reported the prevalence and patterns of hereditary PPKs in South India.
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A case of extensive verrucae vulgaris with cutaneous horns in a 32-year-old man is reported. Accompanying terminal phalangeal bone absorptive changes in the fingers of both hands, resulting from subungual warty lesions, are highlighted. The existing literature on the subject of cutaneous horn is briefly reviewed.
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A fourteen-year-old male with solitary neurilemmoma over his left cheek is described. Clinically, it was mistaken for molluscum contagiosum. The case is reported for its rarity and unique features.
Both serum studies by indirect immunofluorescence (IIF) tests and skin biopsy examination by direct immunofluorescence (DIF) were performed on 22 cases of pemphigus with clinically active lesions. Twenty cases had pemphigus vulgaris and two, pemphigus foliaceus. The majority of cases (70%) were between 21 and 60 years old; the mean age was 39.5 +/- 12.7 years. There was no sex predilection. DIF showed the positive fluorescence of intercellular cement substance (ICS) of the epidermis in all 22 cases (100%). IgG was positive in 77.2%, followed sequentially by C3C (50%), IgA (45.45%), and IgM (36.36%). Six cases (27.27%) also showed granular immunoglobulin and/or complement deposits at the dermoepidermal junction. IIF detected serum antiepithelial antibodies in 18 cases (81.81%) using human esophagus as substrate. Most of these cases (88.88%) showed IgG type of antibodies; the other 11.11% exhibited IgA and IgM in low concentrations. 1+ titer positivity was observed in 15 cases. This study demonstrates the value of DIF for a definitive diagnosis of pemphigus. However, it is also important to appreciate that immunofluorescence is not a substitute for histopathology, but rather complementary to it.
To ascertain whether skin tags (ST) are associated with a higher risk for diabetes mellitus (DM), 35 patients with ST were screened out of 5000 consecutive patients visiting our dermatology clinic. The study group ranged in age from 35 to 73 years, with a mean of 52.03. Twenty-six of the patients were men, and nine, women. The risk of getting ST was found to increase with age, but this risk decreased after the fifth decade. The neck was invariably involved, followed by the eyelids, axillae and groin. Of the cases, 62.8% (22 patients) had DM. Four new cases of DM were found among this group. All the diabetic patients in this study population had noninsulin dependent DM. The frequency of DM in ST patients was found to increase with age, however, it was statistically insignificant. No correlation was found between localisation, size, color, or number of ST and the presence of DM. The frequency with which ST had been found to co-exist with DM in this population is significant, and ST may serve as a marker for DM.
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Twenty patients with nodulocystic acne were randomly allocated to one of two treatment schedules: 1) Tetracycline 500 mg or 2) Tab. Gugulipid (equivalent to 25 mg guggulsterone). Both were taken twice daily for 3 months, and both produced a progressive reduction in the lesions in the majority of patients. With tetracycline, the percentage reduction in the inflammatory lesions was 65.2% as compared to 68% with gugulipid; on comparison, this difference was statistically insignificant (P > 0.05). Follow-up at 3 months showed a relapse in 4 cases on tetracyline and 2 cases on gugulipid. An interesting observation was that the patients with oily faces responded remarkably better to gugulipid.