Letters to the Editor cysticercus itself, which appears as an oval or round after masturbation for the last three months. These well-defined cystic lesion with an eccentric echogenic lesions persisted for 4–6 h after which they gradually scolex in it. The fourth ultrasound appearance is disappeared on their own accord within 24 h. that of calcified cysticercosis.[2,3] These appearances on high-resolution sonography are pathognomonic Dermographism is the most common mechanical of cysticercosis, and a definitive diagnosis can be type of physical urticaria, affecting 2–5% of the made with greater confidence and patient can be population. [2,3] Stroking of the skin with a tongue blade managed conservatively. Therefore, with the help elicits linear wheals within a few minutes. Individual of non-invasive high-resolution sonography such hives may last 30 min to 2 h.[4] In one case series, subcutaneous and intramuscular cysticerci can be dermographism could be exacerbated by hot water, accurately diagnosed without need of invasive biopsy emotion, exercise or cold exposure.[5] or fine needle aspiration cytology (FNAC). Further, the diagnosis of sonography findings can be confirmed Delayed-pressure urticaria can occur after application with therapeutic response as was also done in our of pressure to the skin. It most commonly affects the cases.[4] palms, soles and buttocks and can be disabling. It can be diagnosed by hanging a 15-lb weight across By this report, we want to make the dermatologists and the shoulder while walking for 20 min.[6] Author has surgeons aware of high-resolution sonography as an devised a simple test to diagnose delayed pressure important non-invasive tool for the proper diagnosis urticaria.[7] and management of subcutaneous/intramuscular swellings. In a study vitiligo and chronic urticaria groups experienced significantly more difficulties in sexual AAmitmit MMittal,ittal, SSanjeevanjeev GGuptaupta1, SSunitaunita GGuptaupta2, arousal and higher failure in attaining and maintaining VVinodinod MehtaMehta the lubrication-swelling response of sexual excitement Departments of Radiodiagnosis, 1Dermatology and 2Medicine, MM until the completion of sexual act than did controls. Institute of Medical Sciences and Research, Mullana, Ambala, India This study demonstrated that chronic skin diseases such as vitiligo and chronic urticaria have negative AAddressddress forfor correspondence:correspondence: Dr. Amit Mittal, H. No. E-3, MM [8] Medical College Residential Campus, Mullana, Ambala - 133203, impacts on sexual life. Ghiya et al. report a patient Haryana, India. E-mail: [email protected] who found masturbation to be more satisfying than

DDOI:OI: 10.4103/0378-6323.55404 - PPMID:MID: ***** normal vaginal intercourse points toward difficulties in sexual arousal.[1] RREFERENCESEFERENCES Sites that have reacted to pressure have been found 1. Singrodia S, Joshi RG, Solanki RB, Rawal RC. Subcutaneous refractory to an additional pressure stimulus for at nodules preceding convulsions due to neural cysticercosis. [9] Indian J Dermatol Venereol Leprol 2008;74:385-6. least 24–48 h. This could be tested in the patient 2. Vijayaraghavan SB. Sonographic appearances in cysticercosis. by asking him to reproduce lesions within 24–48 h. J Ultrasound Med 2004;23:423-7. 3. Mittal A, Das D, Iyer N, Nagaraj J, Gupta M. Masseter Authors report lesions appearing within 1–5 min is cysticercosis- a rare case diagnosed on sonography. atypical for delayed pressure urticaria (DPU); however, Dentomaxillofac Radiol 2008;37:113-6. lesions lasting for 4–6 h fits in to signs of DPU. Authors 4. Gupta S, Jain VK, Sen J, Gupta S, Arora B. Subcutaneous cysticercosis involving the eyelid: sonographic diagnosis. J have not performed simple tests to diagnose physical Dermatol 2000;27:35-9. urticaria. Lesions lasting for 4–6 h after masturbation suggest that it could be manifestation of delayed pressure urticaria. Authors also mention that the urticaria probably arises due to unusual and unnatural UUrticariarticaria aandnd masturbationmasturbation friction and pressure during masturbation as compared to natural vaginal intercourse. Similar friction and pressure should induce redness and swelling at other Sir, places of the body. Emotions could also play a part We read with interest an article by Ghiya et al. on in eliciting these lesions. We feel that this could be a masturbation and urticaria.[1] Authors describe a manifestation of delayed pressure urticaria and tests 30-year-old, married male with a history of recurrent for delayed pressure urticaria could help to find cause itching, redness and swelling on the penis 1–5 min of this unusual presentation.

516 Indian J Dermatol Venereol Leprol | September-October 2009 | Vol 75 | Issue 5 Letters to the Editor

KK.. VV.. GGodseodse grouped into 20 groups and the frequency of cases Shree Skin Centre, 22, L Market, Sector 8, Nerul, Navi in each group was studied. Descriptive statistics was Mumbai-400706, India used to analyze the data.

AAddressddress forfor correspondence:correspondence: Dr. K. V. Godse, Shree Skin Centre, 22, L market, Sector 8, Nerul, Navi Mumbai-400706, India. There were 24 631 patients which constituted 10.55% E-mail: [email protected] of the total out patient attendance of the hospital

DDOI:OI: 10.4103/0378-6323.55405 - PPMID:MID: **** (24 631/233 404). Excluding those who had repeat visits, 14 047 new diagnoses were made including RREFERENCESEFERENCES multiple diagnoses in some patients. Table 1 provides the summary of group wise break-up of diagnoses. 1. Ghiya BC, Mehta RD, Bumb RA. Masturbation: Can it be urticarogenic?. Indian J Dermatol Venereol Leprol 2008;74:384- Infections constituted the largest single group of 5. diseases accounting for 4943 (35.19%) new diagnoses. 2. Orfan NA, Kolski GB, Physical urticarias. Ann Allergy Fungal (2633; 18.74%), bacterial (947; 6.74%), parasitic 1993;71:205-12. 3. Kirby JD, Matthews CN, James J., The incidence and other (606; 4.31%) and viral (565; 4.02%) infections were the aspects of factitious wealing (dermographism). Br J Dermatol important subgroups among infections. Leprosy was the 1971;85:331-5. presenting disease in 104 (0.74%) patients and Sexually 4. Kaplan A.P., Clinical practice: Chronic urticaria and angioedema. N Engl J Med 2002;346:175-9. Transmitted Infections (STIs) in 88 (0.63%). Among the 5. Mathews CN, Kirby JD, James J, Warin RP. Dermographism: non-infective diseases, eczema was the most common reduction in wheal sizeby chlorpheniramine and hydroxyzine. Br J Dermatolol 1973;88:279-82. (3067; 21.83%). Papulosquamous diseases (1738; 6. Ryan TJ, Shim-Young N, Turk JL, Delayed pressure urticaria. Br 12.37%) were the next common group, out of which J Dermatol 1968;80:485-90. psoriasis contributed to 1089 cases (7.75%). Acne 7. Godse KV. Diagnosis of delayed pressure urticaria. Indian J Dermatol Venereol Leprol 2006;72:155-6. vulgaris contributed to 575 (4.09%) and pigmentary 8. Sukan M. The problems in sexual functions of vitiligo and diseases including vitiligo to 665 (4.73%) cases. chronic urticaria patients. J Sex Marital Ther 2007;33:55-64. Urticaria (485; 3.45%), hair diseases (219; 1.56%), nail 9. Estes SA, Yung CW. Delayed pressure urticaria: an investigation of some parameters of lesions induction. J Am Acad Dermatol diseases (157; 1.12%), neoplasia (182; 1.3%), cutaneous 1981;5:25. manifestations of systemic diseases (115; 0.82%), adverse drug reactions (82; 0.58%) and vesiculobullous diseases (59; 0.42%) contributed to the rest of cases. PPatternattern ooff sskinkin ddiseasesiseases aamongmong As this is a hospital-based study, the data obtained ppatientsatients aattendingttending a tertiarytertiary ccareare cannot be considered to be representative of the prevalence of the diseases in general population. tteachingeaching hospitalhospital inin KeralaKerala However, the finding that 10.55% of outpatients visit to this multispecialty tertiary care teaching hospital Sir, was for skin diseases is an indirect indicator of the Thrissur Medical College is a tertiary care teaching burden of skin diseases in the population. hospital in the public sector located in the central part of the South Indian state of Kerala. Knowledge of A PubMed search did not provide any comparable the pattern of diseases in this center is thought to be studies from India. Infection was the most common [1–3] important for caregivers, teachers and administrators group of diseases in most of the similar studies. to identify their priorities. So a study was planned Only one among them showed a higher prevalence of [1] with the aim to identify the pattern of diseases among infections than in our series. One study from Saudi patients who attended the outpatient section of the Department of Dermatology and Venereology. Table 1: Group wise break-up of diagnoses Disease Number of cases The outpatient (OP) registers of Department of Infections 4943 (35.19%) Dermatology and Venereology of Thrissur Medical Eczema 3067 (21.83%) College of the year 2007 were analyzed retrospectively. Papulosquamous diseases 1738 (12.37%) All cases were diagnosed by consultants having Post- Pigmentary diseases 665 (4.73%) graduate qualification in Dermatology and Venereology. Acne vulgaris 575 (4.09%) Diagnosis was primarily clinical, supported by Others 3251 (23.14%) relevant investigations. Various skin diseases were Total 14047

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