November 27, 2018Ikram Ullah khanCase Studies - Best dermatologist in Islamabad Prof. Dr. Ikram Ullah Khan

Exploring Grover’s Disease: Prof. Dr. Ikram Ullah Khan Delves into the Uncharted

Diving into the realm of dermatology, Grover’s disease emerges as a subject of fascination and exploration. Prof. Dr. Ikram Ullah Khan, a prominent figure in the field, has recently brought to attention a rare Grover’s disease case, unravelling its distinct characteristics. Collaborating with Kiren Mohsin, this noteworthy case study has found its place in the esteemed ‘Journal of Pakistan Association of Dermatologists 2007; 17: 56-58.’

Unfolding the Case: A Novel Discovery Comes to Light

At the heart of this study lies a 26-year-old man who sought medical consultation at the dermatology OPD due to recurring, self-healing, and intensely itchy rash. This rash, exacerbated during the summer months, affected his trunk, back, and arms for the past three years. Upon thorough examination, the patient appeared as a robust young male with papules and vesicles dispersed across his trunk, back, and arms.

Deciphering the Diagnostic Pathway

Navigating the road to diagnose this enigmatic condition was a complex endeavor. The patient’s baseline laboratory investigations yielded normal results. However, a skin biopsy provided a clearer perspective. The biopsy unveiled hyperkeratosis within the epidermis, accompanied by intraepidermal clefts. Notably, acantholytic cells resided within these clefts, exhibiting a pattern reminiscent of Darier disease. Moreover, a dermal inflammatory infiltrate was identified. This comprehensive analysis culminated in the identification of Grover’s disease as the definitive diagnosis.

Unveiling the Intricacies of Grover’s Disease: Shedding Light on the Unknown

Grover’s disease, often referred to as transient and persistent acantholytic dermatosis, has proven to be a multifaceted entity. Characterized by pruritic papules and vesicles predominantly located on the chest, back, and thighs of older men, the disease has maintained an air of mystery. While its precise cause remains elusive, various triggers have been identified. These include sweat, fever, heat, sunlight, and genetic predisposition. Histologically, the disease manifests as focal acantholytic dyskeratosis, adding depth to its intriguing nature.

Unraveling Potential Causes: A Comprehensive Approach

Though the exact etiology of Grover’s disease remains elusive, potential causes have been hypothesized. Factors such as sweat, fever, heat, and sunlight, coupled with genetic predisposition, might contribute to this dermatological anomaly. Interestingly, some reports have even suggested occlusion of eccrine ducts, with sweat contents and acantholytic cells playing key roles in this narrative.

A Diverse Spectrum: Associations and Differential Diagnoses Explored

Prof. Dr. Khan’s study has demonstrated that Grover’s disease does not exist in isolation. It has exhibited associations with internal malignancies and various other conditions. In a landscape teeming with differential diagnoses, the disease bears similarities to dermatitis herpetiformis, folliculitis, arthropod reactions, and more. Precise differentiation is crucial for accurate diagnosis.

Navigating Treatment: Insights for Effective Management

For milder cases, symptom management through pruritus relief and topical steroids has proven to be beneficial. Alongside these measures, substances like calcipotriol, retinoids, and PUVA have showcased their utility. Recognizing and identifying Grover’s disease early on is pivotal for successful management.

An Unveiled Journey: Prof. Dr. Ikram Ullah Khan’s Pioneering Contribution

Through his groundbreaking case study, Prof. Dr. Ikram Ullah Khan has illuminated the path to understanding Grover’s disease. Collaborating with Kiren Mohsin, his meticulous analysis has paved the way for future explorations into this enigmatic condition. As the medical community delves deeper, Grover’s disease may gradually unveil its secrets, offering relief and insights to those grappling with its complexities.

In essence, Grover’s disease continues to captivate the dermatology world as experts like Prof. Dr. Ikram Ullah Khan and Kiren Mohsin unlock its mysteries, one case at a time. With each discovery, the veil over this intriguing condition lifts, shedding light on its intricacies and potential avenues of treatment.

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November 27, 2018Ikram Ullah khanCase Studies - Best dermatologist in Islamabad Prof. Dr. Ikram Ullah Khan

The study conducted by Dr. Ikramullah Khan and Rifat Yasmin aimed to evaluate the diagnostic value of fine needle aspiration (FNA) and compare it with full thickness biopsy in diagnosing cutaneous leishmaniasis (CL). They conducted the study at the Department of Dermatology at Pakistan Institute of Medical Sciences, Islamabad, from June 1st, 2007 to July 31st, 2007.

Background and Introduction:

Protozoal species and subspecies of the genus Leishmania cause leishmaniasis, a major health concern in tropical and subtropical regions. Certain areas of Pakistan are endemic for cutaneous leishmaniasis (CL). The disease’s clinical diagnosis can be challenging due to disease mimics, making pathological confirmation essential before treatment initiation. The gold standard diagnostic method involves histopathological examination of biopsy specimens to demonstrate Leishman-Donovan (LD) bodies. However, this approach has limitations, particularly when biopsy is impractical due to factors like location or scarring risk.

Methods:

The study enrolled 15 patients aged 15 years or older, primarily from Islamabad and Azad Kashmir, who exhibited clinical features indicative of cutaneous leishmaniasis. The researchers performed fine needle aspiration (FNA) in aseptic conditions without local anesthesia, followed by a full thickness biopsy from the same lesion. The diagnosis relied on identifying giant cells or Leishman-Donovan bodies through FNA. They then compared the sensitivity of FNA with that of biopsy.

Results:

Among the 15 patients, 12 (80%) had positive FNA results, while 3 (20%) tested negative. Biopsy specimens from 14 out of 15 patients (93.3%) exhibited typical histopathological features of cutaneous leishmaniasis. However, one case turned out to be a ruptured inclusion cyst. Among the negative FNA cases, one was identified as a ruptured inclusion cyst. The diagnostic rate for FNA stood at 80%, compared to 93.3% for biopsy.

Conclusion:

The researchers concluded that fine needle aspiration (FNA) serves as a reasonably good diagnostic modality for cutaneous leishmaniasis. FNA’s advantages lie in its simplicity, patient acceptance, lack of scarring risk, cost-effectiveness, and swift results. This proves especially beneficial in areas where expert pathologists are scarce. Furthermore, FNA’s sensitivity is comparable to that of full thickness biopsy.

Limitations:

• The study’s sample size is small, comprising only 15 patients.
• The study lacks discussion on the follow-up period and treatment outcomes.
• Factors such as lesion location and size could influence the comparison between FNA and biopsy.
• The study lacks long-term data on FNA’s reliability in diagnosing CL.
• The conclusions are based on a single study site and specific timeframe.
• Potential variations in diagnostic expertise among different pathologists were not considered.

To comprehensively assess FNA’s reliability in diagnosing cutaneous leishmaniasis, larger-scale studies involving multiple centers and longer follow-up periods are warranted.

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November 27, 2018Ikram Ullah khanCase Studies - Best dermatologist in Islamabad Prof. Dr. Ikram Ullah Khan

Case Report Eosinophilic Pustular Folliculitis of Ofuji in an Immunocompetent (Non-HIV) Pakistani Patient

Prof. Dr. Ikram-Ullah Khan, Saima Rafiq Dermatology Department, Pakistan Institute of Medical Sciences, Islamabad : Eosinophilic Pustular Folliculitis Case Report

Abstract

Eosinophilic pustular folliculitis is a rare condition characterized by recurrent, pruritic papulopustules and plaques that expand peripherally. It primarily affects hair-bearing areas such as the face, chest, back, and upper arms. Although more than 90% of reported cases are from Japan, we present a case of eosinophilic pustular folliculitis in a young immunocompetent Pakistani male. Diagnosis was based on both clinical presentation and histological findings.

Introduction

Eosinophilic pustular folliculitis (EPF) is an idiopathic papulopustular follicular eruption primarily found on the upper trunk, face, neck, and proximal extremities. It can also affect palms and soles. It is more prevalent in immunocompromised individuals and those with HIV. The classic variant is most common in the second to fourth decades of life, while infantile EPF is usually congenital. While the histopathological hallmark is perifollicular eosinophilic infiltrate, the underlying pathophysiology remains unclear. Treatment options include prednisolone, dapsone, minocycline, and other agents.

Case Report

A 23-year-old man presented with erythematous pruritic plaques and pustules on his face, neck, ears, trunk, arms, and palms. The lesions started as discrete papules and pustules on his trunk, which then coalesced into plaques. Peripheral eosinophilia was noted. Skin biopsy confirmed the diagnosis of eosinophilic pustular folliculitis. The patient was treated with prednisolone and dapsone, leading to improvement within 20 days.

Discussion

Eosinophilic pustular folliculitis is characterized by its papulopustular eruption on the upper trunk and extremities. There are three variants of this disease: classic, HIV-associated, and infantile. It is more common in immunocompromised and HIV patients, with the histopathological hallmark being perifollicular eosinophilic infiltrate. Although it can be clinically mistaken for other conditions, its histology is distinctive. Treatment includes various options such as indomethacin, isotretinoin, and dapsone. Our patient showed improvement with dapsone and topical steroids.

References:

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2. Ramdial PK, Morax N, Dlora NC, Aboobakar J. HIV-associated eosinophilic folliculitis. Am J Dermatopathol Acad 1999; 21: 241-6.
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8. Ishiguro N, Shishido E, Okamoto R et al. Ofuji’s disease. J Am Acad Dermatol 2002; 46: 827-33.
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