Journal of Pakistan Association of Dermatologists 2013;2 (3):348-352.

consistent with . We prescribed Correspondence Address clobetasol-salicylic acid 6% ointment to the Dr. Tulika Rai, Department of and Venereology, I.M.S, patient along with levocetirizine. After two B.H.U. Varanasi-221005, U.P. India months of treatment, the thickness has subsided E-mail: [email protected] and the itching has stopped. Xeroderma Some consider nevoid psoriasis to be either pigmentosum synonymous with inflammatory linear verrucous epidermal nevus (ILVEN) or an invasion of pre- associated with unusual existing epidermal nevus by psoriasis due to squamous cell koebnerisation. 1,2,3 In linear psoriasis and nevoid carcinoma-report of two psoriasis, lesions are clinically and histologically similar in appearance but the former is present cases as linear configuration, the latter is distributed in specific band like zones of the skin (the lines of Sir, (XP) is a rare Blaschko). 4 Nevoid psoriasis probably reflects autosomal recessive disease characterized by mosaicism for a gene responsible for psoriasis. photosensitivity, pigmentary changes, premature In our patient, there was no seasonal variation skin ageing, neoplasia and abnormal DNA the size of the lesion, no psoriasiform scaling repair. There may be neurological abnormalities was present but Auspitz sign was positive. There in some cases. Malignant tumors may develop as was no response with the application of mid- early as third or fourth year. We report two cases potent topical steroids alone but there was of XP associated with squamous cell carcinoma response to application of clobetasol-salicylic (SCC). acid ointment. The lesion clinically looked like ILVEN but histopathology was consistent with A 35-year-old housewife, born of second degree psoriasis. We are reporting the case because of consanguineous marriage, presented with history its rarity. of photosensitive skin disorder since early childhood associated with photophobia, blurring References of vision and history of painless mass over the inner side of the right eye since one year. Her 1. Bondi EE. Psoriasis overlying an epidermal general physical examination and systemic nevus. Arch Dermatol. 1979; 115 :624-5. examination were unremarkable. Cutaneous

2. Bolognia JL, Orlow SJ, Glick SA. Lines of examination revealed poikilodermatous changes Blaschko. J Am Acad Dermatol . 1994; 31 :157-90. involving almost entire skin surface. 3. Goujon C, Pierini AM, Thivolet J. Does Examination of her right eye revealed a reddish, linear psoriasis exist? Ann Dermatol non-ulcerated, firm to hard mass, fixed to the Venereol . 1981; 108 :643-50. 4. Atherton DJ, Kahana M, Russel Jones R. underlying structures, arising from the medial Naevoid psoriasis. Br J Dermatol . aspect of bulbar conjunctiva measuring five 1989; 120 :837-41. centimeters (Figure 1 ) in diameter. It was Satyendra Kumar Singh, Tulika Rai associated with foul smelling yellowish purulent Department of Dermatology and Venereology, I.M.S, discharge. Cornea of the left eye was opaque. B.H.U. Varanasi-221005, UP, India There was complete loss of vision in the right

eye and the visual acuity in the left eye was

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6/36. There was no lymph node enlargement. Routine investigations were normal. Histopathological examination of the biopsy revealed moderately differentiated SCC ( Figure 2).

Our second case, a thirty year old, housewife, borne of second degree consanguineous marriage, presented to us with history of photosensitive disorder and photophobia since early childhood and a mass over the inner aspect of the left cheek extending to the nose and left eye since six months. Patient complained of difficulty in opening the left eye. Her general Figure 1 Mass in the right eye and corneal opacity in physical examination and systemic examinations the left eye (case 1). were normal. Cutaneous examination revealed poikilodermatous changes over most of the body surface. There was a hard, fixed, brownish to skin coloured, verrucous plaque, measuring 10x8 cm, extending from right side of the upper part of the nose to maxillary prominence on the left cheek horizontally and midpoint of the nose to the left eye brow vertically ( Figure 3 ). There was no ulcer over the surface of the mass. The margin was smooth and not rolled out. There was no tenderness or bleeding on touch. There was no lymph node enlargement. Figure 2 Photomicrograph showing moderately Histopathological examination of the biopsy differentiated squamous cell carcinoma. revealed well differentiated SCC.

The mass was excised in both of our patients and they were advised sunscreen, avoidance of sunlight exposure and wearing protective clothing and goggles. They were put on capsules 1mg/kg/day after proper counseling.

Photophobia is the earliest symptom of XP which is due to keratitis, exposure keratitis, vascularization, ulceration, nodular dystrophy Figure 3 Mass over the left cheek and nose (case 2). and uveitis.2 In a Turkish case series, nine out of 12 patients had SCC.3 In another study, 33.9% of 120 patients with XP had SCC and ocular

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tumors were seen in 25.8% of patients.4 Our first Associate Professor, Department of Skin & STD, patient had SCC arising from the bulbar Karnataka Institute of Medical Sciences, Hubli, Karnataka, India conjunctiva which must be very rare. In a case E-mail: [email protected] report, a seven year old boy with XP and a large Phone: 09880084769, 09986155070 SCC of the cheek received a combination of isotretinoin (1 mg/kg/day) and chemotherapy for Trichostasis spinulosa: a period of 3 months and showed complete case report remission of the tumor.5 We resorted to surgical treatment in our cases because there were no A 46-year-old female patient presented to our secondaries and initiated isotretinoin therapy clinic for itching and ulcers under her breast. On (1mg/kg/day) for prevention of development of dermatological examination, there were two fresh tumors. Our patients did not have erythematous, papulonodular lesions 1 cm metastasis probably because they presented to us diameter under the breast and multiple, slightly early in the course of the malignancies. raised and slightly pigmented follicular lesions (Figure 1 ). Otherwise her medical and family References history was unremarkable. Systemic examination was normal. Her hemogram, , 1. Harper JI. Genetics and genodermatoses. In: creatinine and urine tests were normal. ESR was Champion RH, Burton JL, Burns DA, Breathnach SM, editors. Rook’s Textbook 26mm/hour and CRP 0.79mg/dl. Fasting blood th of Dermatology, 6 edn. London: Blackwell glucose (155mg/dl), AST (54 U/L), ALT (94 Science; 1998. P.407-11. U/L) levels were raised. She was diagnosed as a 2. Pathy S, Naik KK, Suman B et al . Squamous cell carcinoma of the face with case of trichostasis spinulosa along with xeroderma pigmentosa - a case report. pyoderma. Indian J Med Paediatr Oncol . 2005; 26 :47-9. 3. Gul U, Kilic A, Gonul M et al . Xeroderma pigmentosum: a Turkish case series. Int J Since the patient had no complaints in terms of Dermatol . 2007; 46 :1125-8. trichostasis spinulosa lesions, treatment was not 4. Moussaid L, Benchikhi H, Boukind EH et advised. Local treatment was started for al . Cutaneous tumors during xeroderma pigmentosum in Morocco: study of 120 pyoderma. patients. Ann Dermatol Venereol . 2004; 131 :29-33. 5. Saade M, Debahy ESN, Houjeily S. Clinical remission of xeroderma pigmentosum- associated squamous cell carcinoma with isotretinoin and chemotherapy: case report. J Chemother. 1999; 11 :313-7.

Pradeep Vittal Bhagwat*, Chandramohan Kudligi*, BM Shashikumar**, Mohan Eshwara Rao Shendre*, B Suphala*

*Department of Skin & STD, Karnataka Institute of Medical Sciences, Hubli, Karnataka **Department of Skin & STD, Mandya Institute of Medical Sciences, Mandya, Karnataka Figure 1 Multiple skin-coloured papules and two ulcerated papulonodules under the left breast. Address for correspondence Dr. PV Bhagwat,

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