“…. Trench foot appeared in the winter of 1914, characterized by pedal swelling, numbness, and pain. It was quickly recognized by military-medical authorities. There was little debate over whether it was frostbite or new condition, and it was quickly accepted as a specific disease. The major etiologies proposed were exposure, diet, and infection. The opinion emerged that it was caused by circulatory changes in the foot caused by cold, wet, and pressure. Predisposing factors included dietary inadequacy and fatigue. A number of labels were first given to the disease. However, the name “trench foot” was eventually officially sanctioned. Trench foot became a serious problem for the Allies, leading to 75 000 casualties in the British and 2000 in the American forces. Therapy for trench foot involved a number of conventional, tried-and-tested, and conservative methods. Some more innovative techniques were used. Amputation was only used as a last resort. Prevention involved general measures to improve the trench environment; modification of the footwear worn by the men; and the provision of greases to protect them from moisture. The medical reaction to this condition seems to have been relatively effective. The causation was identified, and prophylactic measures were introduced to fit this model; these seem to have been successful in reducing the prevalence of the condition by 1917-18…”

Purple Hair Sign

Hair becomes purplish brown when the scalp is treated with chrysarobin and then washed with an alkali soap [16].

Pseudo-acanthosis Nigricans Sign

Pseudo-acanthosis is a type of acanthosis nigricans that is seen in obese persons and is reversible on weight reduction [17].

Pseudo-acne Sign

Acneiform red papules along transverse nasal crease in preadolescent individuals. They are basically keratin granulomas derived from ruptured and inflamed milia. Due to their clinical similarity to acne, they have been named pseudo-acne [18].

Pseudo-ainhum Sign

Ainhum is the autoamputation of a digit, due to development of constricting bands around bilateral fifth toes, seen in underdeveloped countries of Africa (Fig. 3). In the remainder of the world, constricting bands that mimic ainhum are termed pseudo-ainhum. Causes of pseudo-ainhum are amniotic bands, constrictions associated with keratotic disorders, infections, and trauma [19].

Pseudo-bubo Sign

Seen in Donovanosis. Sub-cutaneous swellings in inguinal areas, which may break down to form typical granulomas, are known as pseudo-bubos since there is no lymphadenitis on microscopic examination [20].

Pseudo-chancre Redux Sign

This term is used to describe a solitary gumma of the penis at the site of the original chancre [21].

Pseudo-cowpox Sign

Milker’s nodule is otherwise known as pseudo-cowpox. It is a paravaccinia (parapox) virus infection seen in individuals in close contact with cattle, like milkers, veterinarians, and workers in meat industry. Cutaneous lesions can be one or several papulovesicles to bluish nodules, which may rupture to form ulcers with eschar. Cowpox is caused by the cowpox virus (orthopox) [22].

Pseudo-Darier Sign

When firmly stroked, fasciculation of the skin causes the appearance of goosebumps or cobblestones from the stimulation of aberrant arrector pili muscles – Smooth muscle hamartoma.

Pseudo-eccrine Chromhidrosis Sign

This refers to the development of colored sweat when surface compounds or molecules mix with sweat to produce pigment e.g. the formation of blue sweat in copper workers. Extrinsic dyes, paints, fungi, and chromogenic bacteria are other causes of pseudo-eccrine chromhidrosis [23].

Pseudo-elephantiasis Sign

Pseudo-elephantiasis is a condition, caused due to inflammation, edema or obstruction of lymphatics, triggered by non-filarial infections like donovanosis, lymphogranuloma venereum, syphilis, tuberculosis [24].

Pseudo-folliculitis Sign

Inflammatory papules resulting from re-entry of sharp tips of cut hair into the skin. Pseudo-folliculitis usually affects the beard area, when it is known as pseudo-folliculitis barbae [25].

Pseudo gall Sign

Eliminate certain parasitic pruritus such as scabies, difficult to diagnose in patients with strict hygiene, in the absence of specific signs (pseudo-bladder and groove), possibly by a testing treatment (Vulvar and anal pruritus) [26].

Pseudo-granuloma Inguinale Sign

It is a clinical variant of chancroid resembling granuloma inguinale (Donovanosis). Selective culture media isolates Hemophilus ducreyi from the penile ulcer, which clinically looks like granuloma inguinale [20].

Pseudo-Hutchinson’s Sign

Discoloration of the eponychium: Congenical nevus of the nail apparatus. (Fig. 4) [27].

Pseudo sign of Lesar Trelat

Inflammation of seborrheic keratosis caused by cytarabine: A pseudo sign of Leser-Trelat. A Leser-Trelat sign refers to multiple eruptive seborrheic keratosis, in the context of an internal malignancy [20].

Pseudo-monilethrix Sign

It is a hair shaft abnormality, where the hair shaft shows irregular, flattened, expanded areas that have an indented appearance, unlike monilethrix where the hair shafts have beaded appearance because of alternate zones of spindle-like thickening and thinning, placed at a regular intervals [28].

Pseudo-mycosis Sign

Botryomycosis is otherwise known as pseudo-mycosis. Cutaneous botryomycosis resembles a fungal infection but is actually a chronic, inflammatory response to bacterial infection. Staphylococcus aureus is the most commonly implicated bacteria, followed by Pseudomonas aeruginosa [29].

Pseudo-Nikolskiy Sign

The method and mechanism of elicitation is the same as for Nikolskiy sign but and can be elicited only on the involved or erythematous areas. The underlying mechanism here is the necrosis of epidermal cells and not acantholysis as in true Nikolskiy sign. This sign is positive in Stevens-Johnson syndrome, toxic epidermal necrolysis and in some cases of burns and bullous ichthyosiform erythroderma [20].

Pseudo-nits Sign

Peipilar keratin casts or hair casts or pseudo-nits are thin, elongated, firm, cylindrical concretions that encircle the hair shafts and can be easily dislodged, unlike true nits, which are oval, glistening, translucent, whitish lidded capsule attached to the side of the hair shaft by a firm chitinous sheath [20].

Pseudo-ochronosis Sign

Bluish-black macular pigmentation seen on the upper extremities of jewelry workers. Histopathologically, it is seen as localized argyria. The pigmentation simulates the typical pigmentation seen in endogenous ochronosis (alkaptonuria) [30].

Pseudo-paralysis of Parrot Sign

Originally described by Parrot, this pseudo-paralysis represents decreased movement of the extremity secondary to painful syphilitic periostitis [20].

Pseudo-pseudoxanthoma Elasticum

It is a penicillamine-induced degenerative dermatosis, histopathologically characterized by abnormal elastic fibers in the dermis. Clinically, the patient develops multiple small yellowish papules on both sides of neck mimicking pseudo-xanthoma elasticum, after long term therapy with D-penicillamine [31].

Pseudo-rheumatoid Nodule Sign

Sub-cutaneous granuloma annulare is otherwise known as pseudo-rheumatoid nodule, because of their clinical resemblance to rheumatoid nodule. Lesions are nodular and predominantly occur on the scalp and pretibial regions [32].

Pseudo-scleroderma Sign

Pseudo-scleroderma refers to sclerosis of skin in conditions other than morphea or systemic sclerosis. This is seen in eosinophilic fasciitis, dermatomyositis, systemic lupus erythematosus, porphyria cutanea tarda, phenylketonuria or paraproteinemia [33].

Pseudo-syndactyly Sign

Pseudo-syndactyly is seen in dystrophic epidermolysis bullosa, autosomal-recessive forms, where repeated blistering with progressive scarring causes fusion of adjacent fingers and toes, thus giving rise to pseudo-syndactyly. True syndactyly is a congenital malformation, where there is failure of differentiation, in which the fingers fail to separate into individual appendages [34].

Pseudo-verrucous Papules Sign or Pseudo-verrucous Papules Nodules Sign

Pseudo-verrucous papules and nodules occur in the diaper and perineal areas in patients, of any age, with a predisposition to prolonged wetness. Children who wear diapers due to chronic urinary incontinence are prone to this type of dermatitis [35].

Pseudo-xanthoma Elasticum Sign

Pseudo-xanthoma elasticum is an inherited disorder characterized by generalized fragmentation and progressive mineralization of the elastic fibers in various tissues, involving the dermis (in flexural sites), eye (angioid streak and retinal defects), and cardiovascular system (hypertension and vascular disease). Cutaneous lesions are small, yellowish papules occur in a linear or reticular pattern, commonly involving areas like the sides of neck, axillae, groins, and perineum [36].

Punshi’s Sign

In young women and girls having from vitiligo the original white color of vitiligo macules turns to red-pink during menstruation and after the menstruation, it turns to the original colour [37]. Sign described in 1970.

Satish Kashiram Punshi

Dermatologist from India (Fig. 5). He was born in the year 1939. He is a well known writer, a thinker, philosopher, a social worker and a dermatologist of international repute, all rolled up in one. He is one of the most famous author of medical books on the topic Leucoderma. He is one who is pioneer for introducing placental extract therapy in Vitiligo (Leucoderma) and winner of prestigious International Lions award for Leprosy eradication. Dr. S. K. Punshi’s work on Leucoderma is quoted in various books and Journals of Dermatology. He completed his Medical Dgree M.B.B.S. from the Indore and went on to get D.D.V. from Mumbai, his academic qualification also includes F.I.M.S., F.D.S. (London). Though being engaged with writing of Medical books and serving the patients of skin diseases, he being awoken soul always find time to spend for the social works and thinks about the development of deprived section of society. During his long illustrated social life at Amravati city Dr. Punshi is active with many social organizations like Amravati Junior Chamber [Ex. Vice President], Loins Club of Amravati Central [Ex. President] along with being the life member of Red Cross Society, Sangit Kala Upasak Mandal, Cancer relief society, Vivekananda Ashram Society and many more. He also attended many national and international conferences and at few he was the Guest Speaker. In the Sindhi literature, Dr.Punshi is the famous personality for being the Author of Biography of Famous sindhi Saint Bhagat Kanwar Ram and spiritual master Sant Satramdas Sahib Ji. His many articles are published in Hindvasi (Sindhi), Illustrated weekly of India, Hindustan, Times of India, Hitvada and Nagpur times etc. Divine knowledge (A scientific approach to the study of Geeta), Biography of Dr. A. V. Mudliyar, Sindh darshan and Saint Kashiram- Roohani Rahbar are the some of other books written by him.

Dr. Punshi with all his achievements remains simple, solumn, sober, without much pomp and show and fanfare. He believes in God says “All is God’s will; man is just an instrument in the hands of God”.

He has more of Humanistic and Holistic approach to life”. He is a humble servant of humanity. He has lived his life for the cause and service of others. Nothing did for the self accept suffering.

Author Medical Books: 1. Vitiligo – Diagnosis and treatment; 2. Vitiligo and placental extract; 3. Vitiligo – quarterly medical review; 4. A Hand books of Scabies; 5. A Hand books of Leprosy; 6. Dermatology for general practitioners; 7. Colour Atlas of Vitiligo (Jaypee Brothers); 8. Diagnosis & Management of Dermatology made easy. (Jaypee Brothers).

Awards: 1. All India Award by skin institute Delhi in 1977 for research on use of placental extract in Leucoderma; 2. ‘ Ambady Oration’ award I 1986; 3. International Lions award for Leprosy eradication; 4. Lifetime achievement award I.A.D.V.L- Maharashtra state 2010; 5. Saint Kanwaram award; 6. Proffesor Hasanand memorial award.

“One who works in devotion, who is a pure soul, and who controls his mind and senses is dear to everyone, and everyone is dear to him. Though always working, such a man is never entangled.”

Pup-tent Sign

It is seen in nail lichen planus, in which the nail splits and elevates longitudinally with downward angle of lateral nail edge [38,39].

Puumala Sign

Rapid fever, kidney failure, severe back pain, and bleeding rash which progresses to death in 15 percent of victims. Caused by a zoonotic hantaviral infectious process known as hemorrhagic fever with renal syndrome disease [40].