A 65-year-old woman presented with asymptomatic, bilateral, yellowish flattened plaques involved both inner canthi of three years duration. The fasting plasma levels of lipids were normal and there was no family history of xanthomatosis, hyperlipidemia or early ischemic heart disease.
Category Archives: Metabolic Disorders
Metabolic disorders
Pellagra
A 35-year-old alcoholic man presented with sunburn-like rash confined to the extensor surface of both forearms and the sides of the neck. Good and early response obtained on starting therapy with multivitamin supplement containing oral niacin.
Diabetic dermopathy
History
A 60-year-old diabetic man presented with asymptomatic, small, rounded, hyperpigmented atrophic lesions involved the shins of more than 15 years duration.
Necrobiosis lipoidica diabeticorum
History
A 45-y-o man with type II diabetes mellitus since 5 years presented with an irregular, large, shiny and waxy atrophic plaque with yellowish-brown hue and surface telangiectasia on the shin of more than three years duration. Many atrophic small rounded scars are seen in the middle part of the plaque due to previous ulcerations.
INH-induced pellagra
History
A very interesting case of pellagra localized to the exposed parts of the hands only. The patient was diagnosed as pulmonary tuberculosis and started anti-Tb therapy (Rifampicin+INH+ETB). Three months later she suffered well-circumscribed red scaly hyperpigmented rash on the back of both hands whereas other photosensitive areas were not affected. The rash had been diagnosed as eczematous and there was no response to topical corticosteroids for 6 weeks. On multivitamine supplemental therapy containing nicotinic acid 100 mg three times daily the rash improved dramatically within one week. The treating physician was asked to modify the anti-Tb therapy regarding INH which is the most probable cause of pellagroid rash.
Cretinism
History
A 3-year-old boy presented with mental retardation, short stature, alopecia, sparse hair (eyebrows), wide-set eyes, periorbital puffiness, wide broad nose, thick lower lip and dry cool and pale skin. Thyroid hormones levels were very low.
Idiopathic calcinosis cutis
History
A 25-year-old female presented with a unilateral, asymptomatic, hard, pinkish nodules extruding chalky whitish material. These nodules were confined to the extensor surface of one knee joint. She had no history of trauma, connective tissue disorder, bone disease or parathyroid dysfunction. Calcium and phosphorous levels were normal.
Calcinosis cutis
History
A 19-year-old female presented with many firm to hard white to skin-colored asymptomatic papules involving the fingertips and elbow extensors. Skin biopsy was typical of calcinosis cutis and on investigations she had elevated levels of calcium and parathyroid hormone.