Objectives To study constitutional and behavioral risk factors for chilblains in patients at Abbottabad and Sialkot, Pakistan. Methods One hundred patients and matched controls completed a single-page, close-ended questionnaire which included demographic data and questions related to possible constitutional and behavioral risk factors for chilblains. Computer program SPSS-10 was used to manage and analyze the data. Risk factors were identified statistically by determining odds ratios and 95% confidence intervals using multivariate analysis. Results There were an equal number of male and female respondents in each group. Age of the patients and controls ranged from 2 to 80 years with a mean of 24.51 ± 16.02. Twenty-six patients and 3 controls had a positive family history for chilblains (odds ratio = 9.33); 42 patients and 14 controls reported a history of constipation (odds ratio = 2.69); 32 patients and 8 controls had a history of either numbness or tingling of fingers or toes (odds ratio = 2.93); 55 patients and 45 controls led sedentary lifestyles (odds ratio = 1.27); 85 patients and 58 controls consumed a low number of cups of tea daily (odds ratio = 3.20); 65 patients and 29 controls frequently washed their hands and/or feet (odds ratio = 4.93); and 56 patients and 33 controls had occasional sun exposure during winter months (odds ratio = 2.08). Conclusion Significant risk factors for the development of chilblains for people at Abbottabad and Sialkot included a history of chilblains in first-degree relatives, numbness and tingling sensations of fingers or toes, frequent hand or feet washing, and lower tea consumption during winter months.

Penile strangulation by hair coil is an uncommon, under-recognized condition with a spectrum of potential complications including urethral transection and partial or complete penile amputation. Early recognition and treatment can greatly reduce the incidence of these devastating complications. We report a 5-year-old, circumcised boy with penile edema and erosions secondary to a hair wrapped around the coronal sulcus. Prompt diagnosis and removal of the hair led to rapid resolution without surgical repair. We also analyze the possible underlying causes which can lead to strangulation of the penis with a hair.

Asymmetrical periflexural exanthem is a rare clinical condition, seen almost exclusively in children. Very few adult cases have been reported in the literature. We report a case of this rare eruption in an adult man showing characteristic clinical and histological features. Interestingly, this patient also exhibited a pseudoisomorphic Köebner response. Although an infective aetiology of viral origin has been suggested for this localized eruption, the aetiology remains unknown. We are of the opinion that the pseudoisomorphic Köebner response in this patient may support the inoculation hypothesis in the pathogenesis of this disorder.

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months. No cause could be found despite multiple investigations. There was poor response to medication. The child was referred to dermatology for the evaluation of a rash that had developed over the past 1 month. According to her mother, the rash appeared as erythematous papules in crops and then resolved with scars. Examination revealed multiple painful erythematous papules scattered over the limbs in different stages of evolution (Figure 1). Some were raised whereas others were umblicated in the center with a necrotic base. Healed lesions appeared as whitish, porcelain-like macular scars (Figure 2). Systemic examination was normal. Her complete blood count, renal functions, liver functions, abdominal sonography and barium meal follow-through, and coagulation profile including the international normalized ratio and serum antinuclear antibody revealed no abnormality. Skin biopsy showed a thin epidermis with hyperkeratosis overlying a necrobiotic dermal collagen with sparse inflammatory infiltrate. The blood vessels were dilated with swelling of endothelial cells and luminal thrombosis. Scattered mucin deposits were also seen. Based on historical features, characteristic skin lesions, and a supportive histology, the patient was diagnosed with Degos disease. Aspirin (3 mg/kg) and dipyridamole (5 mg/kg) were prescribed. Within 48 hours, the patient improved. Irritability reduced significantly. Active lesions started healing. Abdominal pain improved but vomiting continued although frequency was reduced significantly. At the time of reporting, the patient is still admitted in our pediatric