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IMAGES IN MEDICINE
Year : 2019  |  Volume : 32  |  Issue : 6  |  Page : 378

Casal's necklace


1 Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication15-Dec-2020

Correspondence Address:
Sweta Subhadarshani
Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-258X.303626


How to cite this article:
Subhadarshani S, Sharma P, Khanna N. Casal's necklace. Natl Med J India 2019;32:378

How to cite this URL:
Subhadarshani S, Sharma P, Khanna N. Casal's necklace. Natl Med J India [serial online] 2019 [cited 2021 Oct 20];32:378. Available from: http://www.nmji.in/text.asp?2019/32/6/378/303626

An 18-year-old male presented with a 2-week history of hyperpigmented scaly plaque associated with mild burning and itching. There was characteristic involvement of the front and nape of the neck and lower half of the face in a sharply demarcated symmetrical manner [Figure 1]. In addition, the lesion extended to the anterior aspect of the chest resembling a ‘cravat’. He had associated photosensitivity but no history of diarrhoea or neurological symptoms. There was no history of antecedent drug use, alcohol abuse or topical application. The patient used to stay alone and had poor dietary habits. A skin biopsy showed irregular acanthosis, lymphocytic exocytosis and spongiosis along with focal basal cell vacuolar degeneration [Figure 2]. A diagnosis of pellagra was made, and he was started on oral nicotinamide 500 mg daily with which he started responding within 3 days and lesions cleared completely within a week [Figure 1].
Figure 1: (a) Sharply demarcated plaque on the neck; (b) clinical response after treatment with nicotinamide 500 mg daily for 1 week

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Figure 2: Histopathology (H and E, ×10) showing irregular acanthosis, lymphocytic exocytosis and spongiosis along with focal basal cell vacuolar degeneration

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Conflicts of interest. None declared



 
 
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