Eczema herpeticum

Eczema herpeticum, also known as Kaposi's varicelliform eruption, represents widespread cutaneous HSV in patients with pre-existing skin disorders. Atopic Dermatitis is by far the most common underlying skin condition. Other skin conditions that predispose patients to this primary HSV infection include: Darier disease, pemphigus foliaceous and icthyosis vulgaris. The differential diagnosis may include widespread impetigo. The diagnosis is made by history and the clinical presentation. Tzanck preparation is a useful confirmatory test, and viral culture may also be helpful.
Eczema herpeticum is treated with oral acyclovir 200 mg 5 times daily. Burow's soaks 2 or 3 times daily may be useful for vesicular areas. Early and aggressive therapy of secondary infection is necessary. Infants with high fever, poor oral intake, and evidence of secondary infection, may require inpatient management with intravenous acyclovir or antibiotic coverage. How often do you see eczema herpeticum in your practice? Can you appreciate an underlying skin condition in all such cases? View images

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Polymorphous light eruption

Polymorphous light eruption(PMLE) is an abnormal, recurrent, delayed reactions to sunlight, ranging from erythematous papules, papulovesicles, and plaques to erythema multiforme like lesions on sunlight-exposed surfaces. Only one clinical form is consistently manifested in any one patient, but combined morphologies may also result.. PMLE affects females 2-3 times more often than males. The eruption typically occurs in spring typically at the onset of a vacation in a sunny place or at a high altitude and disappears without scarring by the time the patient returns home. I have seen good response to oral beta carotene, antihistamines and topical steroids. How do you manages such cases in your practice? View images

Epidermodysplasia verruciformis

Epidermodysplasia verruciformis is a rare, lifelong disorder of autosomal recessive inheritance. It is characterized by chronic infection with human papillomavirus that manifests as widespread skin eruptions of flat-to-papillomatous, wartlike lesions and reddish brown pigmented plaques on the trunk, the hands, the upper and lower extremities, and the face. The lesions have a potential to transform into malignant carcinomas during the fourth and fifth decades of life. What would be the appropriate treament for the widespread lesions as seen in this case. View images

Palmoplantar psoriasis

Psoriasis is a chronic and unpredictable disease that has a negative impact on patients' quality of life. Palmoplantar psoriasis can add to this negative impact as it directly affects activities of daily living. I have had good results with oral acitretin; what is your experience with oral retinoids? View images

Palmoplantar keratoderma, sclerodactyly and nail dystrophy

Scleroatrophic syndrome of Huriez is a rare congenital genodermatosis of autosomal dominant inheritance, characterized by scleroatrophy of the hands and feet, nail hypoplasia, palmoplantar keratoderma and hypohidrosis. This 16-year-old boy was born with mild PPK that slowly progressed and worsened alongwith the development of sclerodactyly and nail dystrophy. The development of aggressive squamous cell carcinoma of the affected skin is distinctive feature of the syndrome, occurring in >15% of affected individuals. SCC in Huriez syndrome is characterized by early onset, mostly in the third to fourth decade of life, and by early metastasis. What treatment modalities do you suggest for the severe keratoderma associated with this condition? View images

Welcome note

We are so glad to announce the launch of Pakistan Society of Teledermatology. The membership is open to all the Pakistani dermatologists working in the country or abroad. As a new tool in medicine, teledermatology holds promise for the future dermatologic care. New horizons are still to be discovered. Lets discover them together. Best regards, Shahbaz