Letters to the Editor 3. 4. 5. 6.
Herridge CF. Norwegian scabies (crusted scabies). Br Med J 1963;1:239‑40. Clayton R, Farrow S. Norwegian scabies following topical steroid therapy. Postgrad Med J 1975;51:657‑9. Macmillan AL. Unusual features of scabies associated with topical fluorinated steroids. Br J Dermatol 1972;87:496‑7. Millard LG. Norwegian scabies developing during treatment with fluorinated steroid therapy. Acta Derm Venereol 1977;57:86‑8.
Collodion baby with polydactyly Sir, The term collodion baby is used to describe the transient appearance of a collodion membrane at birth and in the neonatal period of a baby. At birth, the typical collodion baby has characteristic clinical picture with a parchment like taut membrane covering the whole body, that cracks within 48 h and desquamates in large lamellae after a few days leaving an almost normal appearing skin that shows some scaling on the trunk. The eyelids and sometimes the lips, are tethered and everted (ectropion and eclabion), the pinnae may be flattened and the nostrils obstructed.[1] Collodion baby associated with polydactyly is an exceedingly rare entity. A 5‑day‑old baby boy, born of a consanguineous marriage after an uneventful full term pregnancy presented with a glistening membrane that totally wrapped his body. The membrane had begun to crack on the second day. The baby boy was second in birth order. His older sister aged 5 years was also born as a collodion baby. Though not available for clinical examination, she was healthy, with only mild scaling on the trunk and limbs. On physical examination, the child’s weight was 2500 g, height was 47 cm and head circumference 34 cm. He had a shiny membrane resembling oiled skin [Figure 1]. The membrane showed numerous fissures in the groins, axillae, neck, wrists, ankles, cubital, and popliteal
Figure 1: Thick taught parchment-like membrane wrapping the baby showing desiccation at a few places
54
Access this article online Quick Response Code: Website: www.idoj.in DOI: 10.4103/2229-5178.148951
fossae. In addition, severe ectropion, eclabium and flattening of ears and nose, claw like hands, and limitation of joint movements were noted. He also had postaxial polydactyly (hexadactyly) of both hands and feet [Figures 2 and 3]. The polydactyly was type A in both hands and feet. Routine laboratory investigations revealed no abnormality. Collodion baby is a rare congenital disorder with incidence of 1 in 300,000 live births.[2] The condition is usually a manifestation of congenital ichthyosiform erythroderma or lamellar icthyosis.[3] Up to 20% of collodion babies subsequently have normal or near‑normal skin, known as self‑healing collodion baby or “lamellar ichthyosis of the newborn.”[4] Polydactyly can be classified into preaxial, involving the thumb or great toe and postaxial, affecting the fifth digit; and central,
Figure 2: Hexadatyly of both hands Indian Dermatology Online Journal - January-February 2015 - Volume 6 - Issue 1
Letters to the Editor Address for correspondence: Prof. Iffat Hassan, Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India. E‑mail: [email protected]
REFERENCES 1.
2. Figure 3: Poydactyly of both feet
involving the three central digits. Postaxial polydactyly has further been classified into types A and B. In type A postaxial polydactyly the extra digit is well formed and articulates with the fifth or an extra digit. In postaxial polydactyly type B, the extra digit is frequently in the form of a skin tag.[4,5] We report the present case considering the rarity of reports describing the association of a collodion baby with polydactyly.
Iffat Hassan, Atiya Yaseen, Kaisar Ahmed1 Departments of Dermatology, Sexually Transmitted Diseases and Leprosy, and 1Paediatrics, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India
Scalp swelling: An unusual presentation of small cell lung carcinoma Sir, Some external features serve as warning signs for lung cancer. Scalp metastasis is a rare cutaneous manifestation of advanced stage of lung cancer. Though scalp metastasis from non small cell carcinoma has been reported previously, this presentation with small cell lung carcinoma (SCLC) has not been reported.[1] A 34‑year‑old male patient presented to the emergency department with complaints of low grade fever associated with productive cough and weight loss since last three months. He also complained of a painless progressive swelling over the right temporoparietal scalp region for last 1½ months. He had dyspnea on exertion for five days and hemoptysis for three days. Two months a ago, local practitioner had prescribed antitubercular therapy for his productive cough and weight loss with no response. He was a chronic smoker since last 20 years, consuming two packs of cigarettes per Indian Dermatology Online Journal - January-February 2015 - Volume 6 - Issue 1
3.
4.
5.
Nancy BE, Lawrence MS. Congenital and hereditary disorders of the skin. In: Schaffers Diseases of Newborn (Taeusch, Ballard, Avery, eds), 6th edn. USA: W B Saunders; 1991. p. 973‑84. Dhaded SM, Havaldar PV, Siddibhavi BM, Patil VD, M.Collodion baby. Indian J Dermatol Venereol Leprol 1992;58:393‑4. Ventruto V, Theo G, Celona A, Fioretti G, Pagano L, Stabile M, et al. A and B postaxial polydactyly in two members of the same family. Clin Genet 1980;18:342‑7. Raghunath M, Hennies HC, Ahvazi B, Vogel M, Reis A, Steinert PM, et al. Self‑healing collodion baby: A dynamic phenotype explained by a particular transglutaminase‑1 mutation. J Invest Dermatol 2003;120:224‑8. Temtamy S, McKusick VA. The genetics of hand malformations with particular emphasison genetic factors. Birth Defects 1969;14:364‑423.
Access this article online Quick Response Code: Website: www.idoj.in DOI: 10.4103/2229-5178.148953
day. On examination, he had a suffused face, distended neck veins and engorged veins over both arms and chest. There was no significant lymphadenopathy. Scalp examination revealed a 7.2 cm × 4.3 cm, solitary, nontender, irregular, firm, but mobile growth in the right temporoparietal region [Figure 1]. On chest examination, there was decreased air entry on the right side. Routine blood investigations were normal. Chest radiographs (CXRs) showed opacity in the right hilar and perihilar regions, which had increased in size over three months [Figure 2a and b]. Pleural fluid examination showed proteins 3.6 g/dl and glucose 88 mg/dl with total 10 leukocytes/µL. Pleural fluid was negative for adenosine deaminase. Contract‑enhanced computed tomography (CECT) chest revealed a well‑defined heterogeneous enhancing soft tissue mass of 71 mm × 68 mm size in the right hilar and perihilar regions attenuating the right main bronchus; medially the mass was abutting the ascending aorta and engulfing the right main pulmonary artery. There was a gross pleural effusion of the right side. On fine‑needle aspiration cytology (FNAC) of the scalp swelling, May–Grünwald–Giemsa [Figure 3] and Papanicolaou (PAP) [Figure 4] stained smears revealed high cellularity with dispersed small to medium sized cells, showing
55
Copyright of Indian Dermatology Online Journal is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Herridge CF. Norwegian scabies (crusted scabies). Br Med J 1963;1:239‑40. Clayton R, Farrow S. Norwegian scabies following topical steroid therapy. Postgrad Med J 1975;51:657‑9. Macmillan AL. Unusual features of scabies associated with topical fluorinated steroids. Br J Dermatol 1972;87:496‑7. Millard LG. Norwegian scabies developing during treatment with fluorinated steroid therapy. Acta Derm Venereol 1977;57:86‑8.
Collodion baby with polydactyly Sir, The term collodion baby is used to describe the transient appearance of a collodion membrane at birth and in the neonatal period of a baby. At birth, the typical collodion baby has characteristic clinical picture with a parchment like taut membrane covering the whole body, that cracks within 48 h and desquamates in large lamellae after a few days leaving an almost normal appearing skin that shows some scaling on the trunk. The eyelids and sometimes the lips, are tethered and everted (ectropion and eclabion), the pinnae may be flattened and the nostrils obstructed.[1] Collodion baby associated with polydactyly is an exceedingly rare entity. A 5‑day‑old baby boy, born of a consanguineous marriage after an uneventful full term pregnancy presented with a glistening membrane that totally wrapped his body. The membrane had begun to crack on the second day. The baby boy was second in birth order. His older sister aged 5 years was also born as a collodion baby. Though not available for clinical examination, she was healthy, with only mild scaling on the trunk and limbs. On physical examination, the child’s weight was 2500 g, height was 47 cm and head circumference 34 cm. He had a shiny membrane resembling oiled skin [Figure 1]. The membrane showed numerous fissures in the groins, axillae, neck, wrists, ankles, cubital, and popliteal
Figure 1: Thick taught parchment-like membrane wrapping the baby showing desiccation at a few places
54
Access this article online Quick Response Code: Website: www.idoj.in DOI: 10.4103/2229-5178.148951
fossae. In addition, severe ectropion, eclabium and flattening of ears and nose, claw like hands, and limitation of joint movements were noted. He also had postaxial polydactyly (hexadactyly) of both hands and feet [Figures 2 and 3]. The polydactyly was type A in both hands and feet. Routine laboratory investigations revealed no abnormality. Collodion baby is a rare congenital disorder with incidence of 1 in 300,000 live births.[2] The condition is usually a manifestation of congenital ichthyosiform erythroderma or lamellar icthyosis.[3] Up to 20% of collodion babies subsequently have normal or near‑normal skin, known as self‑healing collodion baby or “lamellar ichthyosis of the newborn.”[4] Polydactyly can be classified into preaxial, involving the thumb or great toe and postaxial, affecting the fifth digit; and central,
Figure 2: Hexadatyly of both hands Indian Dermatology Online Journal - January-February 2015 - Volume 6 - Issue 1
Letters to the Editor Address for correspondence: Prof. Iffat Hassan, Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India. E‑mail: [email protected]
REFERENCES 1.
2. Figure 3: Poydactyly of both feet
involving the three central digits. Postaxial polydactyly has further been classified into types A and B. In type A postaxial polydactyly the extra digit is well formed and articulates with the fifth or an extra digit. In postaxial polydactyly type B, the extra digit is frequently in the form of a skin tag.[4,5] We report the present case considering the rarity of reports describing the association of a collodion baby with polydactyly.
Iffat Hassan, Atiya Yaseen, Kaisar Ahmed1 Departments of Dermatology, Sexually Transmitted Diseases and Leprosy, and 1Paediatrics, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India
Scalp swelling: An unusual presentation of small cell lung carcinoma Sir, Some external features serve as warning signs for lung cancer. Scalp metastasis is a rare cutaneous manifestation of advanced stage of lung cancer. Though scalp metastasis from non small cell carcinoma has been reported previously, this presentation with small cell lung carcinoma (SCLC) has not been reported.[1] A 34‑year‑old male patient presented to the emergency department with complaints of low grade fever associated with productive cough and weight loss since last three months. He also complained of a painless progressive swelling over the right temporoparietal scalp region for last 1½ months. He had dyspnea on exertion for five days and hemoptysis for three days. Two months a ago, local practitioner had prescribed antitubercular therapy for his productive cough and weight loss with no response. He was a chronic smoker since last 20 years, consuming two packs of cigarettes per Indian Dermatology Online Journal - January-February 2015 - Volume 6 - Issue 1
3.
4.
5.
Nancy BE, Lawrence MS. Congenital and hereditary disorders of the skin. In: Schaffers Diseases of Newborn (Taeusch, Ballard, Avery, eds), 6th edn. USA: W B Saunders; 1991. p. 973‑84. Dhaded SM, Havaldar PV, Siddibhavi BM, Patil VD, M.Collodion baby. Indian J Dermatol Venereol Leprol 1992;58:393‑4. Ventruto V, Theo G, Celona A, Fioretti G, Pagano L, Stabile M, et al. A and B postaxial polydactyly in two members of the same family. Clin Genet 1980;18:342‑7. Raghunath M, Hennies HC, Ahvazi B, Vogel M, Reis A, Steinert PM, et al. Self‑healing collodion baby: A dynamic phenotype explained by a particular transglutaminase‑1 mutation. J Invest Dermatol 2003;120:224‑8. Temtamy S, McKusick VA. The genetics of hand malformations with particular emphasison genetic factors. Birth Defects 1969;14:364‑423.
Access this article online Quick Response Code: Website: www.idoj.in DOI: 10.4103/2229-5178.148953
day. On examination, he had a suffused face, distended neck veins and engorged veins over both arms and chest. There was no significant lymphadenopathy. Scalp examination revealed a 7.2 cm × 4.3 cm, solitary, nontender, irregular, firm, but mobile growth in the right temporoparietal region [Figure 1]. On chest examination, there was decreased air entry on the right side. Routine blood investigations were normal. Chest radiographs (CXRs) showed opacity in the right hilar and perihilar regions, which had increased in size over three months [Figure 2a and b]. Pleural fluid examination showed proteins 3.6 g/dl and glucose 88 mg/dl with total 10 leukocytes/µL. Pleural fluid was negative for adenosine deaminase. Contract‑enhanced computed tomography (CECT) chest revealed a well‑defined heterogeneous enhancing soft tissue mass of 71 mm × 68 mm size in the right hilar and perihilar regions attenuating the right main bronchus; medially the mass was abutting the ascending aorta and engulfing the right main pulmonary artery. There was a gross pleural effusion of the right side. On fine‑needle aspiration cytology (FNAC) of the scalp swelling, May–Grünwald–Giemsa [Figure 3] and Papanicolaou (PAP) [Figure 4] stained smears revealed high cellularity with dispersed small to medium sized cells, showing
55
Copyright of Indian Dermatology Online Journal is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
