Papillon-Lefevre syndrome and Haim Munk syndrome are palmoplantar keratodermas associated with premature periodontal destruction. The additional findings of Haim Munk Syndrome include onychogryphosis, arachnodactyly, acral osteolysis and pes planus. Both are associated with mutations in the lysosomal protease cathepsin C. We describe a patient with phenotype for Haim Munk Syndrome and genetic analysis revealed a homozygous point mutation in exon 1 of the gene encoding cathepsin C.

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A 35-year-old female presented with scaly annular and pigmented lesions all over the body of 2 years duration. Her clinical features, histopathology, immunofluorescence findings and positive ANA and anti-Ro antibodies were suggestive of subacute cutaneous lupus erythematosus-lichen planus. We report this case because of its clinical rarity.

Background:Keloids are abnormal wound responses characterised by excessive deposition of collagen and glycoprotein. They are both aesthetically and symptomatically distressing for most of the patients. There are reports of keloid management with pulsed dye laser (PDL), fractional carbon dioxide (CO2) laser and neodymium-doped yttrium aluminium garnet (Nd:YAG) laser individually and also in combination of CO2 with PDL and CO2 with Nd:YAG. Here, we discuss a combination of all the 3 lasers as a therapy for keloids.Aim:This study aims to assess the efficacy of fractional CO2 laser, long pulse Nd:YAG laser and PDL in the management of keloids.Materials and Methods:Fifteen patients with keloids were treated by fractional CO2 laser, followed by PDL and long pulse Nd:YAG laser at monthly intervals. Four patients discontinued the study and were lost for follow-up. Photographs were taken at the beginning of the treatment and at the end of five sessions. Clinical improvement was analysed based on a visual analogue scale graded by three blinded observers after assessing the clinical photographs for the improvement in size, colour and aesthetic impression.Results:Of the 11 patients, one patient had excellent improvement, one patient had good improvement, four patients had moderate improvement, two patients had mild improvement and three had no improvement.Conclusion:Lasers may have a synergistic effect when combined with other modalities of treatment but cannot be used as monotherapy in the treatment of keloids.

Background: Port Wine Stain (PWS) is only partially and superficially treated with the Pulsed dye laser (PDL) because of its limited depth of penetration. The 1064-nm long pulsed Nd:YAG laser has greater depth of penetration and is used to treat deeper vessels. The dual sequential wavelength laser (DSWL) which combines PDL/Nd:YAG (595/1064 nm) can be more effective for the treatment of deeper, nodular portwine stains due to its synergistic effect. The purpose of this study is to evaluate the efficacy and safety of DSWL in the treatment of portwine stains after five treatment sessions. Materials and Methods: A total of 11 patients with PWS lesions on the head and neck, who were treated with DSWL for at least five sittings at monthly interval were included in this study. The assessment of the therapeutic response and grading of improvement was done with a scale of 0 to 4 by comparing the photographs taken before treatment and after 5 sittings of laser treatment. Results: Out of the 11 patients, 5 patients (45.45%) had more than 70% improvement. Six out of eleven patients (54.54%) had 40 to 70% improvement at the end of five sittings with no adverse effects including purpura. Conclusion: Dual Sequential Wavelength Laser is a good modality of treatment for portwine stains. It has enhanced penetration and effective clearance of thicker, nodular, recalcitrant lesions of PWS. DSWL is safe and efficacious and it can be recommended as a therapeutic modality for portwine stains.