and other aspects of factitious wealing (dermographism). Br J Dermatol 1971;85:331-5. 4. Kaplan A.P., Clinical practice: Chronic urticaria and angioedema. N Engl J Med 2002;346:175-9. 5. Mathews CN, Kirby JD, James J, Warin RP. Dermographism: reduction in wheal sizeby chlorpheniramine and hydroxyzine. Br J Dermatolol 1973;88:279-82. 6. Ryan TJ, Shim-Young N, Turk JL, Delayed pressure urticaria. Br J Dermatol 1968;80:485-90. 7. Godse KV. Diagnosis of delayed pressure urticaria. Indian J Dermatol Venereol Leprol 2006;72:155-6. 8. Sukan M. The problems in sexual functions of vitiligo and chronic urticaria patients. J Sex Marital Ther 2007;33:55-64. 9. Estes SA, Yung CW. Delayed pressure urticaria: an investigation of some parameters of lesions induction. J Am Acad Dermatol 1981;5:25.

Hypothyroidism is a common and well recognized cause of diffuse hair loss. Zinc and other trace elements such as copper and selenium are required for the synthesis of thyroid hormones, and deficiency of these can result in hypothyroidism. Conversely, thyroid hormones are essential for the absorption of zinc, and hence hypothyroidism can result in acquired zinc deficiency. The hair loss attributed to hypothyroidism may not improve with thyroxine unless zinc supplements are added, as demonstrated in our case.

Background:Adult T-cell leukemia/lymphoma (ATL) is caused by human T-cell lymphotropic virus type-1 (HTLV-1). India is considered as a nonendemic region for HTLV-1. Recent upsurge of cases have been noted in southern parts of India.Aims and objectives:The objective was to describe skin manifestations in various types of ATL.Materials and Methods:Clinical examination, blood investigations, skin biopsies, lymph node biopsies, and immunohistochemistry were performed in five patients. Flow cytometry was performed in two cases.Results:Serological testing was positive for HTLV-1 in all patients. All patients presented with skin lesions. Rare presentations of molluscum contagiosum like papules, purpuric macules and plaques, hypopigmented macules and verrucous papules were seen. Dermatophytic infections occurred in two patients. Mucosal lesion was seen in one patient. Histological features include dermal lymphoid infiltrate with or without epidermotropism. Presence of epidermotropism did not correlate with the severity of disease. All patients except one succumbed to illness within few months to 1 year period.Conclusions:ATL manifest in myriad presentations and skin lesions are often the earliest manifestation. Cutaneous manifestations of ATL vary from subtle hypopigmented macules to florid nodular lesions, and HTLV-1 screening need to be carried out in all doubtful cases.

In the present patient, parenteral antibiotics and daily steroids, colchicine, and oral minocycline had failed to halt the progression of ulcers. However, dexamethasone pulse therapy resulted in complete healing without sequelae and also proved cost-effective.

Lichen planus (LP) is a chronic inflammatory disorder that most commonly affects middle-aged individuals. LP involves the skin and/or mucous membranes, including oral, vulvovaginal, esophageal, laryngeal, and conjunctival mucosa. Linear LP, a rare distinct variant of LP, is characterised by pruritic eruption of lichenoid and violaceous papules in a linear distribution. We report an unusual presentation of linear LP in a 14-year-old child that extended from the left anterior nares to upper lip and into the oral mucosa up to the upper gum margin.