INDIAN PEDIATRICS 982 VOLUME 50 __ OCTOBER 15, 2013 IMAGES Black Heel (Talon Noir) Associated with a Viral Exanthem A 6-year-old child was referred for a suspected viral exanthem associated with URTI. On examination the trunk showed a maculopapular rash while the sole showed multiple black “spots” which were present for 7 days. A diagnosis of Talon noir was confirmed by paring the lesion with a No 15 blade which removed the superficial layer of the stratum corneum, and revealed puncta of black pigment of extravasated red cells. This condition is normally seen as a post-traumatic intraepidermal hemorrhage seen most often in basketball players and is also known as “calcaneal petechiae”. The shearing forces rupture papillary dermal blood vessels, with subsequent leakage of blood into the epidermis. The major differentials include cutaneous melanoma, lentigines, traumatic tattoo, verruca vulgaris and corn. Melanoma, lentigines and traumatic tattoo cannot be removed by paring. Dermoscopy, if available can distinguish Talon noir from melanoma. Plantar warts are painful and bleed on paring while corn do not bleed. In our patient probably the viral infection predisposed to capillary fragility which in association with the normal shearing force on the sole led to the disorder. The child used to walk barefoot even before the viral exanthema without any history of a similar lesion in the past. Vitamin C 500 mg once a day lead to resolution within 7 days. The disorder can also resolve spontaneously. KABIR SARDANA AND *VIVEK SAGAR Department of Dermatology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India *Department of Dermatology, ESI Model hospital Sector -9A.Gurgaon, Haryana. [email protected] FIG. 1 Black macules with irregular margins on the sole Bronchoscopy and other Key investigations in Pediatric Respiratory Disorders: 2 nd Edition D VIJAYASEKARAN Kural Publications,Chennai, India. Pages: 222 Pages; Price: Rs. 1000/- . This book is a detailed manual on the methodology as well as indications and an atlas of the bronchoscopic findings, supplemented with 56 summaries of interesting and educative cases. The addition of chapters on chest CT and MRI, pulmonary functions, arterial blood gases would widen the learning BOOK K K K K R R R R REVIEW experience. The book is printed on good quality art paper and most pictures are very clear. Being a book of handy size it can be easily carried in the pocket. When I reviewed the first edition, my wish list for future included larger pictures and better editing. This continues to be on my list for the next edition too. Further, it would have been better if the author had put all the cases at the end after discussing the various investigations. This book is useful to both general pediatricians and pulmonary specialists working with children, in our settings. VARINDER SINGH Professor, Department of Pediatrics, Kalawati Saran Children’s Hospital, New Delhi 110 001, India, [email protected]

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Page 1: Bronchoscopy and other key investigations in pediatric respiratory disorders: 2nd Edition

INDIAN PEDIATRICS 982 VOLUME 50__OCTOBER 15, 2013

IMAGES

Black Heel (Talon Noir) Associatedwith a Viral Exanthem

A 6-year-old child was referred for a suspected viralexanthem associated with URTI. On examination thetrunk showed a maculopapular rash while the soleshowed multiple black “spots” which were present for 7days. A diagnosis of Talon noir was confirmed by paringthe lesion with a No 15 blade which removed thesuperficial layer of the stratum corneum, and revealedpuncta of black pigment of extravasated red cells.

This condition is normally seen as a post-traumaticintraepidermal hemorrhage seen most often in basketballplayers and is also known as “calcaneal petechiae”. Theshearing forces rupture papillary dermal blood vessels,with subsequent leakage of blood into the epidermis. Themajor differentials include cutaneous melanoma,lentigines, traumatic tattoo, verruca vulgaris and corn.Melanoma, lentigines and traumatic tattoo cannot beremoved by paring. Dermoscopy, if available candistinguish Talon noir from melanoma. Plantar warts arepainful and bleed on paring while corn do not bleed. Inour patient probably the viral infection predisposed tocapillary fragility which in association with the normalshearing force on the sole led to the disorder. The childused to walk barefoot even before the viral exanthemawithout any history of a similar lesion in the past.Vitamin C 500 mg once a day lead to resolution within 7days. The disorder can also resolve spontaneously.

KABIR SARDANA AND *VIVEK SAGARDepartment of Dermatology, Maulana Azad Medical

College and Lok Nayak Hospital, New Delhi, India*Department of Dermatology, ESI Model hospital

Sector -9A.Gurgaon, [email protected]

FIG. 1 Black macules with irregular margins on the sole

Bronchoscopy and other Keyinvestigations in PediatricRespiratory Disorders: 2nd

EditionD VIJAYASEKARANKural Publications,Chennai, India.Pages: 222 Pages; Price: Rs. 1000/-.This book is a detailed manual on the

methodology as well as indications and an atlas of thebronchoscopic findings, supplemented with 56summaries of interesting and educative cases. Theaddition of chapters on chest CT and MRI, pulmonaryfunctions, arterial blood gases would widen the learning

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experience. The book is printed on good quality art paperand most pictures are very clear. Being a book of handysize it can be easily carried in the pocket. When Ireviewed the first edition, my wish list for future includedlarger pictures and better editing. This continues to be onmy list for the next edition too. Further, it would havebeen better if the author had put all the cases at the endafter discussing the various investigations. This book isuseful to both general pediatricians and pulmonaryspecialists working with children, in our settings.

VARINDER SINGHProfessor, Department of Pediatrics,Kalawati Saran Children’s Hospital,

New Delhi 110 001, India, [email protected]