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Images In Medicine
2019:32:6;378-378
doi: 10.4103/0970-258X.303626
PMID: 33380641

Casal's necklace

Sweta Subhadarshani1 , Pooja Sharma2 , Neena Khanna1
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

Corresponding Author:
Sweta Subhadarshani
Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi
India
shweta.aiims07@gmail.com
Published: 15-Dec-2020
How to cite this article:
Subhadarshani S, Sharma P, Khanna N. Casal's necklace. Natl Med J India 2019;32:378
Copyright: (C)2019 The National Medical Journal of India

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

Conflicts of interest. None declared


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