Summary Pyoderma gangrenosum (PG) of the breast is a rare rapidly progressive neutrophilic dermatosis, which usually co-exists with severe underlying systemic conditions. A woman presented with a non-healing ulcer over her right breast with characteristic sparing of nipple-areola complex (Bork-Baykal phenomenon). It was diagnosed as pyoderma gangrenosum on the basis of clinico-pathological correlation and managed successfully with systemic corticosteroids and anti-inflammatory drugs along with wound care. The diagnosis and treatment of PG is challenging particularly at unusual sites given the paucity of robust clinical evidence and lack of consensus opinion regarding specific management guidelines. It is imperative that PG is considered as a clinical diagnosis in any patient with enlarging, sterile, necrotic lesions unresponsive to appropriate antibiotics. Early recognition of PG at rare locations can prevent devastating sequelae such as over-zealous surgical debridement and deep tissue infections associated with a chronic open wound leading to severe cosmetic morbidity.
Pyoderma Gangrenosum

Summary Halo nevi (HN) are benign skin lesion that represent melanocytic nevi in which an inflammatory infiltrate develops, resulting in zone of depigmentation around nevus. Although Sutton originally described the lesion in 1916 as leukoderma acquista centrifugum, the lesions were noted earlier as evidenced in the painting by Matthias Grunwald cica 1512-1516. The prevalence of HNs in the general population is 1%, and HNs usually appear in childhood or early adulthood. Up to 26% of patients with HN have vitiligo, but in very few instances is there an association of HN around congenital melanocytic nevi (CMN) and vitiligo. The exact mechanisms responsible for the development of vitiligo and HN and its resolution are unknown. One of the most accepted hypotheses considers that both phenomena are a result of a self-limited immunologic response to pigmented cells, either in the “normal” skin or within the melanocytic lesion. Hereby we present a rare case report of a girl with halo CMN and infraorbital vitiligo. The halo CMN was excised which was followed by spontaneous improvement of vitiligo.
Vitiligo ; Nevus, Halo

Overlap syndrome is a term used to describe a condition wherein a patient has features of more than one classic inflammatory rheumatic disease like systemic lupus erythematosus, polymyositis, scleroderma and rheumatoid arthritis. Individuals with an overlap syndrome may, but need not meet, complete diagnostic criteria for one or more than one classic rheumatic disease. Mixed connective tissue disease is a specific subset of overlap syndrome wherein patients have antibodies to the U1 small nuclear ribonuclear protein (anti- U1RNP) and clinical features like hand edema, synovitis, Raynaud phenomenon, acrosclerosis and biologically or histologically proven myositis. We came across an interesting case showing clinical features of both Systemic Sclerosis and Discoid Lupus erythematosus (DLE). On complete evaluation, a final diagnosis of Diffuse Systemic Sclerosis - DLE overlap was made on the basis of histopathopathological and serological findings. Patient was started accordingly on systemic and topical medications and responded well.