Abstract Angina bullosa hemorrhagica (ABH) is a rare, benign condition characterized by the sudden appearance of blood-filled blisters in the oral cavity, typically in the absence of systemic, hematological, or mucocutaneous disorders. These lesions often arise spontaneously or following minor trauma and tend to rupture quickly, healing without scarring. We report the case of a 74-year-old female who presented with well-defined hemorrhagic blisters in the oral mucosa. The lesions developed abruptly, ruptured spontaneously, and resolved without intervention. Clinical examination and history revealed no evidence of underlying systemic disease, coagulopathy, or dermatological condition. The diagnosis of ABH was made based on characteristic clinical features and exclusion of other causes of oral bullous lesions. This case highlights the importance of recognizing ABH to avoid unnecessary diagnostic procedures and to differentiate it from other serious conditions such as autoimmune mucocutaneous disorders and bleeding diatheses. Increased awareness among clinicians can aid in prompt diagnosis and appropriate patient reassurance.

We report a 5-year-old girl with Blaschkoid lichen planus, a rare variant with linear distribution along Blaschko's lines. This case highlights the importance of recognizing this entity due to its distinct etiology and a more favorable outcome. This variant is crucial for proper diagnosis and patient reassurance regarding its self-limited course and favorable prognosis compared to classic linear lichen planus.

ABSTRACT Concurrent occurrence of blaschkoid lichen planus pigmentosus (LPP) and lichen planopilaris (LPp) in a pediatric patient is exceedingly rare. We present a case of a 13-year-old female with blaschkoid LPP and LPp. The patient exhibited hyperpigmented lesions in a reticular pattern on the face, trunk, and extremities, along with alopecic patches on the scalp. Histopathological examination confirmed the diagnosis. This case highlights the importance of considering LPp as a differential diagnosis for scarring alopecia in pediatric patients, even in atypical presentations.

Background:Methotrexate is a widely used immunosuppressant with good efficacy and cost-effectiveness. However, one of the drawbacks of methotrexate has been toxicity due to accidental overdose. During the COVID pandemic, there was an alarming increase in the number of patients with methotrexate toxicity which prompted us to do this study. Objective:To evaluate the clinical features and contributing factors in patients presenting with methotrexate toxicity. Materials and Methods:A detailed evaluation of the clinical features, laboratory indices, contributing factors, and outcomes of the patients presenting with methotrexate toxicity was analyzed. Results:A total of 19 cases were seen during the study period. All of the patients had oral mucositis and several developed cutaneous ulcerations. Laboratory abnormalities included cytopenia, transaminitis, and renal impairment. While sixteen patients recovered successfully, three people died as a result of delays in medical assistance. In addition to comorbidities, pandemic-induced restrictions played a major role in patients accidentally overdosing with methotrexate. Conclusion:This study highlights the fact that even low-dose methotrexate taken incorrectly can result in a lethal outcome, which is preventable.

Neonatal hemochromatosis (NH) is a rare disease characterized by diffuse hyperpigmentation of skin and mucosae along with jaundice, seizures, and anasarca. Most cases of NH are due to gestational alloimmune liver disease (GALD). We report a case of an 18-day-old neonate who presented with diffuse hyperpigmentation of skin, seizures, and liver dysfunction. Diagnosis of neonatal hemochromatosis was made based on iron deposits found in minor salivary glands on histopathology. The patient was treated with exchange transfusion and IVIG; however, the neonate succumbed to the illness. This case highlights the challenges of NH diagnosis and the importance of considering NH in neonates with diffuse hyperpigmentation and liver dysfunction. Targeted biopsies like minor-salivary gland biopsy with Prussian blue stain can be crucial for definitive diagnosis and potentially improved outcomes.

Oral-facial-digital syndromes (OFDSs) are a rare heterogeneous group of genetic disorders characterized by a spectrum of craniofacial, oral, and digital anomalies. A 3-month-old female patient presented with facial milia, cleft lip and palate, nodule over the tongue, and syndactyly of digits and was diagnosed with OFDS type 1, a subtype of the syndrome, based on distinctive oral, facial, and digital features. This case report adds to our understanding of this rare condition and emphasizes the significance of the dermatologist’s and oral clinician’s roles in the multidisciplinary approach needed for early diagnosis, treatment, and follow-up in OFDS cases.

Vitamin K deficiency is a common entity in infancy characterized by bleeding from various sites, intracranial bleeding being the most commonly reported feature. Nodular purpura is an uncommon manifestation of vitamin K deficiency in infancy with a few reported cases in literature. We present four cases of infants presenting with nodular purpura as a manifestation of late-onset vitamin K deficiency bleeding (VKDB). All four children presented with asymptomatic bluish-gray nodules, along with symptoms of hepatic dysfunction. Coagulation profile was deranged in all four children and symptoms improved with the administration of parenteral Vitamin K. The case series details the clinical course, treatment response, and follow-up for each patient. To conclude, nodular purpura can be a rare presentation of late-onset VKDB. "Warning bleeds" of VKDB are known to precede dangerous intracranial bleeds. Late-onset VKDB cannot be prevented by routine neonatal vitamin K prophylaxis and requires repeated vitamin K treatments. The case series is an attempt to highlight the unusual manifestation of a bleeding disorder that can be easily prevented by early intervention.

Hyaline fibromatosis syndrome (HFS) is a rare deposition disorder, wherein the skin and internal organs have unusual amounts of amorphous hyaline material. HFS can present as a milder form called Juvenile Hyaline Fibromatosis or severe Infantile Systemic Hyalinosis (ISH). Skin changes common to both the entities are skin thickening, perianal nodules, facial papules, gingival hyperplasia, hyperpigmented plaques over flexural joints and massive subcutaneous scalp tumours. Conspicuous involvement of the joints in the form of joint contractures affects patient morbidity. Furthermore, ISH involves the gastrointestinal tract characterised by protein-losing enteropathy and malabsorption. This contributes to the high mortality seen in ISH. We describe a 2-year-old male patient with grade 2 HFS who succumbed to a lower respiratory tract infection, a manifestation not typically observed in moderate HFS cases.

Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are some of the less common cutaneous adverse drug reactions with significant mortality. Objectives: This study was undertaken with the objective of studying the demographics and clinical profile of SJS/TEN and identifying parameters associated with mortality. Materials and Methods: All patients with SJS/TEN over 10 years (2010–2020) were included in the study. Data obtained from in-patient and out-patient records were analysed. Results: A total of 82 patients with SJS/TEN were admitted to our centre over a period of 10 years. Patients with SJS were significantly younger than those with TEN, with a male: female ratio >1 in SJS and <1 in TEN. The most commonly implicated drugs were antiepileptics (n = 29, 35.4%), antibiotics (n = 20, 24.4%). and Non-steroidal antiinflammatory drugs (NSAIDs) (n = 7, 8.5%). The mortality rate in the TEN group was 16% (n = 8). Certain factors such as cutaneous lesions preceding mucosal lesions at onset, high mean Body surface area (BSA) of denudation and a transfer to intensive care unit (ICU) more than 7 days after admission were significantly associated with higher mortality. There was no difference between survivors and deaths in terms of delay in hospitalisation, total disease duration, implicated drug, delay in initiation of therapy, the onset of re-epithelialisation, Severity-of-illness score for TEN (SCORTEN) and total duration of hospital stay. Conclusion: Factors significantly associated with increased mortality in TEN were cutaneous onset of lesions, mean BSA of involvement and transfer to the intensive care unit (ICU) beyond day 7 of admission.

Introduction: Bullous systemic lupus erythematosus (BSLE) is a rare blistering disorder seen in the background of systemic lupus erythematosus (SLE). It can either be a presenting feature or manifest later in an established case of SLE often accompanied by lupus nephritis. Case Report: We report a case of a 12-year-old girl in whom the presenting feature of SLE was BSLE, along with hemolytic anemia. Discussion: Bullous SLE should be considered in the differential diagnosis in children presenting with vesiculobullous lesions even in the absence of established SLE

Introduction: Morphea is a rare fibrosing disorder of the skin and underlying tissues. Deep morphea involves the deep dermis, subcutis, fascia, muscle, and bone. The above structures may be involved independently or in combination. Case report: We describe a case of deep morphea presenting as muscle weakness, independent of skin lesions, in a child with generalized morphea. Discussion: Muscle weakness, even in the absence of overlying or progressive skin sclerosis, can be deep morphea, especially when segmental and associated with atrophy.

Human immunodeficiency virus (HIV) infection in children is becoming a common occurrence. Worldwide, limited studies have been done on the mucocutaneous manifestations in HIV‐positive children. The aim of our study was to analyze the spectrum of mucocutaneous manifestations of pediatric HIV infection and correlate to degree of immunosuppression.

331 Indian Journal of Dermatology, Venereology and Leprology | Volume 84 | Issue 3 | May-June 2018 Isolation of group A Coxsackie virus. Can Med Assoc J 1958;79:615‐21. 13. Ghosh SK, Bandyopadhyay D, Ghosh A, Dutta A, Biswas S, Mandal RK, et al. Mucocutaneous features of hand, foot, and mouth disease: A reappraisal from an outbreak in the city of Kolkata. Indian J Dermatol Venereol Leprol 2010;76:564‐6. 14. Thumjaa A. Case series of hand foot mouth disease in children. Int J Contemp Pediatr 2014;1:14‐6. 15. Kumar KB, Kiran AG, Kumar BU. Hand, foot and mouth disease in children: A clinico epidemiological study. Indian J Paediatr Dermatol 2016;17:7‐12. 16. Sarma N. Relapse of hand foot and mouth disease: Are we at more risk? Indian J Dermatol 2013;58:78‐9. 17. Yan X, Zhang ZZ, Yang ZH, Zhu CM, Hu YG, Liu QB, et al. Clinical and etiological characteristics of atypical hand‐foot‐and‐mouth disease in children from Chongqing, China: A retrospective study. Biomed Res Int 2015;2015:802046. How to cite this article: Sabitha S, Sasidharanpillai S, Sanjay RE, Binitha MP, Riyaz N, Muhammed K, et al. Clinical profile and virology analysis of hand, foot and mouth disease cases from North Kerala, India in 2015–2016: A tertiary care hospital-based cross-sectional study. Indian J Dermatol Venereol Leprol 2018;84:328-31.

BACKGROUND:Dermatological emergencies in children are not uncommon. Worldwide, limited studies have been done to study the spectrum of such emergencies. The aim of our study was to analyze the spectrum of dermatological emergencies in the pediatric age group. MATERIALS AND METHODS:Over a period of 18 months, ninety consecutive patients under 18 years of age presenting with cutaneous in addition to emergency disorders as assessed by the Nelson's severity scoring system were recruited. RESULTS:The most common emergency was primary cutaneous infections (40%), followed by adverse cutaneous drug reactions (13.33%). Staphylococcal scalded skin syndrome was the most frequent infection, and the most common adverse cutaneous drug reaction was Stevens-Johnson syndrome and toxic epidermal necrolysis. Other emergencies included purpura fulminans (12.22%), congenital dermatoses (11.11%), vasculitis (8.90%), angioedema (6.67%), collagen vascular diseases (2.22%), serum sickness (2.22%), post-varicella cerebellitis (1.11%), post-infected scabies glomerulonephritis (1.11%), and Langerhans cell histiocytosis (1.11%). These emergencies presented in equal numbers to the outpatient department of dermatology or pediatrics and to the emergency department. CONCLUSION:Our study recommends the use of standard scoring systems such as the Nelson's score to assess sick children. The appropriateness of this scale or other scales for the assessment of dermatological emergencies needs to be established. Over half of our cases were initially assessed by pediatricians and emergency personnel, highlighting the importance of spreading awareness about cutaneous emergencies and providing them with access to a dermatologist's services.

3 0 9 (celecoxib and valdecoxib) could possibly cross react with sulfonamides. The sulfonamide-type reactions (erythema multiforme, Stevens Johnson syndrome, toxic epidermal necrolysis (TEN) and maculopapular rash) were found to be twice as common with celecoxib as with rofecoxib. The pathogenesis of these reactions is likely to be the same as for sulfonamide induced reactions – T cell mediated type IV hypersensitivity reaction. However, Shapiro et al in their study on the safety of celecoxib in 28 patients with a history of sulfonamide allergy found cross reactivity between celecoxib and sulfonamides to be low.