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Background: In our hospital setup located in the tropical zone, during each summer, we frequently come across a unique eczematous dermatosis among elderly females that typically occur in summer. Aims and Objectives: We carried out this study with the objective of studying the demographic and clinical features of this dermatosis. Materials and Methods: In this hospital-based descriptive study, we enrolled twenty consecutive patients presenting with typical features of the dermatosis of interest, such as itchy eczematous scaly papule and plaques distributed predominantly over flexures, self-limiting in nature, and with summer exacerbation. Detailed history, clinical examination, and laboratory investigations were carried out. Results: All were females with a mean age of 52.35±15.74 years. Mean age at onset of the disease was 50.80±15.77 years. The onset and exacerbation of lesions typically occurred during summer. The mean duration of the disease was 17.75±15.80 months. The typical lesions were multiple well-defined erythematous scaly papules and plaques bilaterally symmetrically distributed predominantly over the flexures. All biopsies showed spongiotic dermatitis picture and direct immunofluorescence was negative in all of them. Conclusion: This unique dermatosis which occurs in elderly females has not been widely reported. With clinical features and results of various investigations, it would be appropriate to call it “summer-associated dermatitis.”

Keratoacanthoma (KA) is a rapidly evolving tumor, composed of keratinizing squamous cells originating in pilosebaceous follicles and resolving spontaneously if left untreated. It is relatively uncommon in dark-skinned and occurs in middle aged individuals. Males are three times more affected than females. It presents as firm, rounded, flesh-colored or reddish papule; with a rapid growth phase followed by spontaneous healing over three months. Two types of KA exist i.e., solitary and multiple. There are three rare clinical variants of solitary KA, namely giant KA, keratoacanthoma centrifugum marginatum (KCM) and subungual KA. In KCM, lesions are large, reaching upto 20cms. There is peripheral extension with raised, rolled border and atrophy in the center. There is no tendency toward spontaneous involution. The most common locations are dorsa of hands and legs, lesions on scalp being rare. A rare case of KCM occurring on scalp which is an unusual site is reported.

A venous lake, sometimes referred to as senile hemangioma of the lips is usually a solitary, non-indurated, soft, compressible, blue papule occurring due to dilatation of venules. It is commonly found on sun-exposed surfaces of the face and ears. We describe a 46 year-old male who presented with this clinical picture on the lower lip.

Sir, Scleromyxedema is a rare disorder of unknown cause, with fewer than 150 reported cases in literature. It usually affects middle-aged adults of 30–50 years and is clinically characterized by a widespread symmetric eruption of 2–3 mm firm, waxy, dome-shaped papules, commonly over the hands, forearms, head and neck region, upper trunk, and thighs. The characteristic is the arrangement of papules in a striking linear array with the surrounding skin being sclerodermoid.[1] We report a case of scleromyxedema who considerably improved with a trial of steroid oral minipulse and methotrexate. A 43-year-old male farmer presented with a skin colored eruption on his body of 6 months duration. Initially, the lesions began as grouped skin-colored papules on his hands associated with mild pruritus and subsequently spread to the face, neck, shoulders, upper extremities, and the abdomen. There was no history of any systemic symptoms and his past medical and family history was noncontributory. On examination, facial and ear lobe infiltration was noted with prominent forehead creases. The skin of the forehead, neck, upper trunk, and arms was bound down and exhibited numerous 1–2 mm grouped skin colored papules [Figures 1 and 2]. Our patient was thoroughly investigated and results of his complete blood cell count, urinalysis, liver and renal parameters, thyroid profile, ECG, chest X-ray, ultrasound abdomen, and sugars were normal. ELISA for HIV was negative. Immunoglobulin profile showed elevated serum IgG 1797 (mg/dl) (normal 1200–1480 mg/dl), whereas IgA, IgM were normal. Biopsy features from the papule on the forearm showed features that are characteristic of scleromyxedema with special stains demonstrating mucin in the dermis. Figure 1 Infiltrated forehead skin with papules in a linear array Figure 2 Skin-colored papules on the neck and back In the literature, the terms lichen myxedematosus(LM), papular mucinosis, and scleromyxedema have often been used indiscriminately as synonyms, but most reported cases of LM without indication of the subtype appear infact to be cases of scleromyxedema. Actually, LM includes three distinct clinicopathologic subsets: A generalized papular and sclerodermoid form called as scleromyxedema with systemic even lethal manifestations, a localized papular form that does not run a disabling course and an atypical or intermediate form (not meeting the criteria for either scleromyxedema or the localised papular forms).[2] Patients of scleromyxedema may have a number of extracutaneous manifestations pertaining to the cardiovascular, pulmonary, gastrointestinal, rheumatologic, and central nervous systems. A paraproteinemia typically an IgGλ is observed in more than 80% patients. Microscopically, scleromyxedema is characterized by a triad of a diffuse deposit of mucin in the upper and mid reticular dermis, an increase in collagen deposition, and a marked proliferation of irregular arranged fibroblasts. The exact pathophysiologic mechanism that triggers excess mucin production by fibroblasts in scleromyxedema is unclear. Although this can be attributed to paraproteins according to previous studies, all patients of papular mucinosis do not have an identifiable paraprotein, which suggest the role of other cytokines as proliferative signals.[3] The treatment of scleromyxedema remains a therapeutic challenge to the treating physician and despite anecdotal reports of success with various agents, no satisfactory treatments are currently available.[4] Our patient was diagnosed as scleromyxedema clinically on the basis of a generalized papular and sclerodermoid eruption and histologically by the presence of mucin deposition fibrosis and fibroblast proliferation with a normal thyroid function. Extensive screening did not reveal any internal malignancy and although our patient had increased gamma globulin levels, we could not investigate this further due to financial constraints to support our diagnosis further. He was commenced on minipulse therapy with oral betamethasone six tablets to be taken twice weekly with weekly methotrexate 10 mgs. After 3 months of regular treatment, patient reported 75% reduction in the cutaneous induration. There were no other systemic complaints. Patient is currently on regular treatment and is doing well.

Palisaded encapsulated neuroma (PEN) is an infrequent benign cutaneous neural tumor, which usually presents as solitary, asymptomatic, papule or nodule, often localized on the faces, around the orifices, in middle age with no sex preponderance. Rarely, it can be multiple. Both solitary and multiple lesions are not associated with neurofibromatosis or multiple endocrine neoplasica syndrome type 2B (MEN 2B). We hereby report, a rare case of multiple cutaneous PEN in a 30-year-old female who presented with multiple asymptomatic soft-to-firm papules and nodules in a dermatomal distribution on the face along the supply of the ophthalmic division of the trigeminal nerve with no signs of neurofibromatosis or MEN 2B.

A 26‑year‑old sexually active male presented to us with multiple, grouped, mildly itchy, tiny elevated lesions on the penis for 6 months. The lesions were static since their onset, without any increase in size and number. The patient has been married for last 2 Disease Research Laboratory (VDRL) and Human years and has been in a monogamous relationship since then. Before presenting to us, the patient was treated for viral warts with topical podophyllin, but the lesions did not resolve. Cutaneous examination revealed small, flesh‑colored, shiny, papules of around 2‑3 mm in diameter on the shaft of the penisFigure 1]. Inguinal [lymph nodes and rest of the muco‑cutaneous and systemic examinations were unremarkable. Complete hemogram and serum biochemistry panel did not reveal any abnormality. Besides, serology for Venereal Immunodeficiency Virus (HIV) were non‑reactive. The findings of histological examination of a papule are shown in Figures 2a‑b.

Trichoepitheliomas (TEs) are benign cutaneous tumors that occur either as solitary non-familial or multiple familial. We report a case of multiple familial trichoepithelioma (MFT) in a 55-year-old female patient and her son who came with complaints of single ulcerated mass involving the left nasolabial fold and cheek. She had multiple papules and nodules all over the face and neck since 25 years. Histopathological examination of an ulcerated lesion revealed features of basal cell carcinoma (BCC) with squamous differentiation, which was confirmed by immunohistochemistry. A skin biopsy obtained from the papule on neck showed features of TE. However, whether BCC developed independently or by transformation from TE was uncertain. Her 36-year-old son presented with similar lesions on the face and a skin biopsy showed features of TE. Though malignant transformation of TE is quite rare, awareness of the potential for evolution of carcinoma in patients with MFT is important for management of these patients.

Cutaneous larva migrans or creeping eruptions is a cutaneous dermatosis caused by hookworm larvae, Ancylostoma braziliense. A 2-month-old female child presented with a progressive rash over the left buttock of 4 days duration. Cutaneous examination showed an urticarial papule progressing to erythematous, tortuous, thread-like tract extending a few centimeters from papule over the left gluteal region. A clinical diagnosis of cutaneous larva migrans was considered. Treatment with albendazole led to complete resolution, confirming the diagnosis. This is to the best of our knowledge, the youngest age at which this condition is being reported.

Cirsoid aneurysm is a small vascular proliferation characterized by small to medium-sized channels with features of arteries and veins, that present as small, blue or red asymptomatic papule. We report a case of a crisoid aneurysm on the forhead of an HIV patient that suggested a Kaposi sarcoma as a differential diagnosis.

Lichen planus (LP) is a common idiopathic inflammatory disorder that affects the flexor aspect of the wrists, the legs, and the oral and genital mucosa. Depending upon the site of involvement, LP can be divided into mucosal, nail, scalp, or palmoplantar types. Palmoplantar LP can pose a diagnostic problem to the clinician as it resembles common dermatoses like psoriasis, verruca, corn, calluses, lichenoid drug eruption, and papular syphilide of secondary syphilis. In this case report, we describe a 4-year-old male child who presented with highly pruritic erythematous to violaceous hyperkeratotic papules and plaques on his palms and soles. Typical LP papules were noted on the upper back. Histopathology of the papular lesion showed features of LP. Dermatoscopy of a papule from the back showed the characteristic Wickham striae. We report this rare involvement of palm and soles in a case of childhood LP.

Follicular mucinosis occurring along with angiolymphoid hyperplasia with eosinophils (ALHE) has been described in a 49-year-old male. The patient presented with pruritic hyperpigmented papules and nodules on the vertex and right parietal scalp. There was no any other complaint. Histopathological examination from one of the papule showed prominent blood vessels in the dermis lined by plump histiocytoid endothelial cells that were surrounded by a dense lymphoid infiltrate with numerous eosinophils; these findings are typical of angiolymphoid hyperplasia with eosinophilia. Features of follicular mucinosis were observed in the same section with 3 hyperplastic follicular infundibula containing pools of mucin in the infundibular epithelium. The concurrent occurrence of these 2 distinct histopathological patterns in the same biopsy specimen has been reported rarely.

Merkel cell carcinoma (MCC) is an uncommon aggressive neuroendocrine tumor of the skin that classically presents on chronic sun-damaged skin as a skin-colored, red or violaceous, firm and nontender papule or nodule with a smooth and shiny surface. Ulcerations can be observed very seldom and only in very advanced lesions. We present a unique case of a MCC presenting with two unusual clinical features: The Telangiectatic surface and the pedunculated aspect.

A 38-year-old lady, housewife by profession presented with mildly pruritic polymorphic lesions on various parts of her body. The lesions appeared as smooth, violaceous and round papules. Histopathological examination showed classical features of cutaneous sarcoidosis. She had no systemic involvement. Cutaneous sarcoidosis has many morphological presentations and often mimics other dermatologic diseases. Treatment options are reviewed.