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   Table of Contents - Current issue
Coverpage
May-June 2017
Volume 83 | Issue 3
Page Nos. 281-414

Online since Monday, April 24, 2017

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EDITORIAL  

The menace of dermatophytosis in India: The evidence that we need p. 281
Saumya Panda, Shyam Verma
DOI:10.4103/ijdvl.IJDVL_224_17  
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VIEW POINT Top

Seborrheic melanosis: An entity worthy of mention in dermatological literature p. 285
Shyam B Verma, Resham J Vasani, Laxmisha Chandrashekar, Mary Thomas
DOI:10.4103/0378-6323.203248  
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REVIEW ARTICLES Top

Autophagy: A brief overview in perspective of dermatology Highly accessed article p. 290
Rahul Nagar
DOI:10.4103/0378-6323.196320  PMID:28004651
Autophagy, literally meaning “self-eating,” is an intracellular catabolic process of delivering cytosol and/or its specific content to the lysosomes for degradation.The resulting macromolecular constituents are recycled and utilized again by the cells. Basal level autophagy plays an important role in cellular homeostasis through the elimination of the old or damaged organelles, as well as aggregated intracellular proteins. Autophagy refers to sequestration of intact organelles along with a portion of cytosol, into a double-or multi-membrane structure known as phagophore, which elongates, and after closure, forms a vesicular structure known as the autophagosome. Subsequently, the mature autophagosome fuses with a lysosome, thereby forming a single membrane structure, an autolysosome. Autophagy plays a critical role in inflammation, autoimmunity and cellular differentiation. Skin serves as the first line of defense against a variety of environmental insults and autophagy is thought to be a form of an endogenous defense mechanism against such environmental derangements. Autophagy has been linked with keratinocyte differentiation and melanocyte survival, as well as with the pathogenesis of diverse skin disorders including systemic lupus erythematosus, systemic sclerosis, psoriasis, vitiligo, infectious skin diseases and cancer. Autophagy has been one of the most studied phenomena in cell biology and pathophysiology, and given its broad clinical implications, has become a major target for drug discovery. The last decade has seen a substantial upsurge in autophagy-related research and publications; still, the dermatology literature appears to be less initiated. Autophagy will probably change our understanding of dermatological disorders/medicines. Hence, a basic knowledge of autophagy is a prerequisite to understand the developments in the field of autophagy-related research.
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Update on etiopathogenesis and treatment of Acne Highly accessed article p. 298
Yasmeen Jabeen Bhat, Insha Latief, Iffat Hassan
DOI:10.4103/0378-6323.199581  PMID:28195079
Acne, the most common skin disease, is a disorder of pilosebaceous units that affects adolescents mainly and adults occasionally. The pathogenesis is multifactorial. Besides genetic predisposition, other major factors include the action of androgens, pro-inflammatory lipids acting as ligands of peroxisome proliferator-activated receptors in the sebocytes, toll-like receptor-2 acting on keratinocytes, recognition of pathogen-associated molecular patterns, cytokines, chemokines, inflammasomes, neuroendocrine regulatory mechanisms, diet and other pro-inflammatory targets implicated in the activation of immune detection and response. Most of these factors converge on mammalian target of rapamycin complex1 (mTORC1) activation which is further enhanced by the nutrient signaling of Western diet. This multitude of pathogenic factors has led to a new armamentarium of drugs for the treatment of acne. Topical anti-androgens, insulin-like growth factor-1 inhibitors, peroxisome proliferator-activated receptor-modulators, acetylcholine inhibitors, topical retinoic acid metabolism-blocking agents, vitamin D analogues, antimicrobial peptides, interleukin-1α and interleukin-1β blockers and immunotherapy are some of the novel treatment options.
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ORIGINAL ARTICLES Top

Digital volumetric measurement of cutaneous leishmaniasis lesions: Blur estimation method p. 307
Ahmad Reza Taheri, Saeid Alikhani, Ameneh Sazgarnia, Maryam Salehi, Sadegh Vahabi Amlashi
DOI:10.4103/ijdvl.IJDVL_134_16  
Background: Cutaneous leishmaniasis is a common parasitic infestation in Iran. With recent advantages in digital imaging, we have devised a novel non-contact objective method of measuring lesions. Aim: The aim of the study was to design a software system that analyzes images of cutaneous leishmaniasis lesions, objectively assess and monitor volume. Methods: A photographic technique along with an image processing algorithm was applied to extract a three-dimensional map of the lesion from a simple two-dimensional picture. This method recovers depth on the basis of blur estimation. A macro lens with a low depth of field was used to blur the objects out of focus. To assess and compare the results, a polymer mold of the corresponding lesion was made and filled with liquid. The volume of liquid corresponded to the volume of the lesion. A total of thirty-seven patients were enrolled, and 48 lesions were analyzed. Results: The mean volume measured by image processing was 159 μl (range: 8–685 μl), in comparison to an average of 170 μl (range: 6–800 μl) obtained from the molds. This was not significantly different. Statistical analysis by the Pearson correlation test showed a 'very good fit' correlation between these measured volumes (P < 0.001, r = 0.938). Limitation: The location and height of lesions were two important limitations in implementing this technique. If the lesion location is in the curvature region of body or the lesion height is less than 1 mm or more than 1 cm, this method will lose precision and accuracy. Conclusion: Image processing with blur estimation technique is an accurate and precise method to measure the volume of lesions in cutaneous leishmaniasis.
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Effectiveness, safety and tolerability of cyclosporine versus supportive treatment in Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis: A record-based study p. 312
Swosti Mohanty, Anupam Das, Anupama Ghosh, Amrita Sil, Ramesh Chandra Gharami, Debabrata Bandyopadhyay, Nilay Kanti Das
DOI:10.4103/ijdvl.IJDVL_201_16  
Background: Toxic epidermal necrolysis and Stevens–Johnson syndrome comprise life-threatening, drug-induced mucocutaneous disease spectrum. Interest in cyclosporine, a calcineurin inhibitor that can block the function of T-cells, has increased with the discovery of the importance of granulysin in apoptosis in toxic epidermal necrolysis. In our hospital, cyclosporine is given to Stevens–Johnson syndrome/toxic epidermal necrolysis patients as an adjunctive therapy. Aims: This study is an observational, record-based study comparing the effectiveness and safety of patients receiving cyclosporine versus only supportive therapy. Methodology: Medical records as bed-head tickets and laboratory investigation reports of Stevens–Johnson syndrome/toxic epidermal necrolysis patients admitted in the hospital over a period of 1 year were collected. Data regarding clinico-demographic profile, suspected drug causing Stevens–Johnson's syndrome/toxic epidermal necrolysis, SCORTEN, body surface area involved, treatment received and outcome were obtained. Results: Twenty-eight patients were analyzed. Nineteen belonged to the cyclosporine group (supportive treatment + cyclosporine), nine to supportive treatment only group. Among the suspected drugs, antiepileptics formed the major group (28.6%). Five patients in the supportive only group and one in the cyclosporine group died. Time for stabilization and reepithelialization and duration of recovery were significantly lower in the cyclosporine group (P < 0.001, P= 0.007, P= 0.01, respectively). The standardized mortality ratio was 0.32 in cyclosporine group which is nearly 3.3 times lower than the only supportive treatment. Limitations: As it was a record-based study, certain confounding factors (serum blood urea nitrogen) could not be adjusted. Conclusion: Cyclosporine (5 mg/kg/day) for 10 days from onset of Stevens–Johnson syndrome/toxic epidermal necrolysis may decrease the risk of dying, may provide faster healing of lesions and might lead to early discharge from hospital.
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Low-dose rituximab as an adjuvant therapy in pemphigus p. 317
Jaya Gupta, Ranjan C Raval, Arti N Shah, Rekha B Solanki, Dhara D Patel, Kaksha B Shah, Ami D Badheka, Keyur B Shah, Neetish K Aggarwal, Vaaruni Ravishankar
DOI:10.4103/ijdvl.IJDVL_1078_14  
Background: Pemphigus is a chronic autoimmune blistering disease where systemic steroids and immunosuppressants are the mainstay of therapy, but long-term treatment with these agents is associated with many side effects. Rituximab, a chimeric monoclonal anti-CD20 antibody, in low doses has shown efficacy as an adjuvant to reduce the dose of steroids. Aim: To study the clinical efficacy and safety of low-dose rituximab as an adjuvant therapy in pemphigus. Methods: Fifty patients with extensive pemphigus were selected, who either had recalcitrant pemphigus, were steroid dependent, had relapsed after pulse therapy, had anti-desmoglein levels >20, had contraindications to conventional treatment or wanted to avoid conventional treatment and its side effects. Two doses of rituximab (500 mg) were given 2 weeks apart and patients were regularly followed up every 2 weeks for 3 months and then monthly upto 2 years. Complete blood counts, liver function tests, renal function tests, skin biopsy, direct immunofluorescence and desmoglein levels were checked before and after rituximab administration. Pre-rituximab chest X-ray and electrocardiograph were also obtained. Results: At 3 months, 41 (82%) patients showed complete remission. Nine (18%) patients had partial remission. After 6–12 months, 20 (40% of enrolled patients) continued to be in remission and were off all systemic therapy and the remaining 19 (38%) were continuing to take low doses of steroids with or without other adjuvant immunosuppressants and 2 (4%) had to be given another 2 doses of rituximab and subsequently could be managed with low-dose steroids. Of the 9 patients in partial remission at 3 months, after 6–12 months 5 (10% of the total) were completely off treatment and went into complete remission and 4 (8%) were on additional treatment out of which 2 (4%) had to be given 2 additional doses of rituximab and were in partial remission with low-dose therapy at the end of 12 months. One patient developed urticaria as a side effect. Another developed herpes zoster. Conclusion: Our results show that low-dose rituximab is a well-tolerated and beneficial adjuvant therapy in recalcitrant pemphigus which helps reduce both the severity of disease as well as the dose of steroids and immunosuppressants.
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Clinico-epidemiological study of tinea incognito with microbiological correlation p. 326
Bornali Dutta, Elmy Samsul Rasul, Bobita Boro
DOI:10.4103/ijdvl.IJDVL_297_16  
Background: Tinea incognito is a dermatophytic infection with a clinical presentation that is modified due to previous treatment with topical or systemic steroids, as well as topical immunomodulators. It tends to mimic other dermatological conditions. Aims: To evaluate the various clinical manifestations, sites, predisposing factors and causative agents of tinea incognito. Methods: A prospective observational study was done on one hundred clinically suspected cases of tinea incognito, with a history of topical or systemic steroid use for a period of at least six weeks. They were subject to direct microscopy and fungal culture, and re-evaluated at the end of the third and sixth week. Results: Eczema-like conditions were the most common clinical manifestation, followed by inflammatory, autoimmune and infective conditions. The face was the most commonly affected site. Direct microscopy was positive in 85% of cases, and fungal culture was positive in 63% of cases. Trichophyton rubrum was the most common species isolated. Pharmacists were responsible for 78% of tinea incognito cases, and betamethasone dipropionate was the most common drug used. Limitations: As this was a hospital outpatient-based study, cases with severe systemic problems could have attended other departments. Cases involving the hair and nails were negligible. Conclusions: Tinea incognito is a commonly encountered, yet poorly reported entity in the study population. An increased level of awareness and vigilance on the sale of steroid containing compounds will help control this dermatological condition.
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CASE REPORT Top

Successful treatment of Rosai–Dorfman disease using in situ photoimmunotherapy p. 332
Meng Li, Lei Shi, Min Luo, Jia Chen, Bo Wang, Fuhe Zhang, Uma Keyal, Anil Kumar Bhatta, Wei R Chen, Xiuli Wang
DOI:10.4103/ijdvl.IJDVL_356_16  
Rosai–Dorfman disease is difficult to cure. In situ photoimmunotherapy combines local photothermal therapy with immunoadjuvant. In the present case report, a 39-year-old Chinese man with Rosai–Dorfman disease lesions below the left nostril and left preauricular region was treated with in situ photoimmunotherapy. The patient was treated with daily application of topical imiquimod (5%) and laser irradiations every 2 weeks for 8 weeks. After three cycles of treatment, the lesions improved markedly without adverse effects. Our results showed that in situ photoimmunotherapy can be used as an effective treatment for Rosai–Dorfman disease.
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BRIEF REPORT Top

Clinical characteristics of acquired ungual fibrokeratoma p. 337
Sewon Hwang, Miri Kim, Baik Kee Cho, Hyun Jeong Park
DOI:10.4103/0378-6323.193611  PMID:27852988
Background: Acquired ungual fibrokeratomas are uncommon fibrous tissue tumors located in the ungual area. Though there are many reports of this entity, only some reports have reviewed the clinical features of the tumor. Aims: The aim of this study was to clarify the clinical characteristics of acquired ungual fibrokeratomas. Methods: We reviewed twenty patients who were treated surgically at our clinic from 2003 to 2014 for acquired ungual fibrokeratomas confirmed on histopathological examination. Our study was conducted by retrospective analysis of charts, clinical pictures and patient records. Cases of tuberous sclerosis were not included. Results: Acquired ungual fibrokeratomas occurred on toenails in 16 (80%) patients and on fingernails in 4 (20%) patients. Periungual lesions were noted in 15 (75%) patients followed by intraungual lesions in 4 (20%) patients and subungual lesions in 1 (5%) patient. A longitudinal groove was observed in 80% of patients. Surgical resection was performed in all cases for both medical and cosmetic reasons. After excision, recurrence occurred in three cases. Limitations: This was a retrospective study of a limited number of patients. Conclusions: Acquired ungual fibrokeratomas occurred more commonly on toenails than on fingernails and were located in the periungual area in most patients. A longitudinal groove in the nail plate was a frequent finding. Surgical resection led to medical and cosmetic improvement with a recurrence in 3 (15%) patients.
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IMAGES IN CLINICAL PRACTICE Top

Tinea pseudoimbricata Highly accessed article p. 344
Shyam Verma
DOI:10.4103/0378-6323.187686  PMID:27506504
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LETTERS TO THE EDITOR - CASE LETTERS Top

Subcutaneous Saksenaea vasiformis infection presenting as disfiguring facial plaques p. 346
Jantakan Nitinawarat, Opass Putcharoen, Ariya Chindamporn, Pawinee Rerknimitr
DOI:10.4103/ijdvl.IJDVL_637_16  
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Post-lower segment cesarean section wound infection with Mycobacterium abscessus p. 349
Chinnu Sasikumar, Unnati Desai, Jyotsna M Joshi
DOI:10.4103/ijdvl.IJDVL_693_16  
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Myiasis in a neglected case of generalized erythrodermic pemphigus foliaceus p. 350
Priyanka Patil, Uddhao Zambare, Swagata Tambe, Rashmi Aderao, Chitra Nayak
DOI:10.4103/ijdvl.IJDVL_503_16  
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Carcinoma erysipeloides due to primary cutaneous squamous cell carcinoma p. 353
Suchismita Paul, Elizabeth Yim, Xiaolong Zhou, Erin Wei, Jeong Hee Cho-Vega, Clara Milikowski, Francisco Kerdel
DOI:10.4103/ijdvl.IJDVL_1078_15  
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Extrafacial lupus miliaris disseminatus faciei: A rare entity p. 354
Yogesh Namdev Kalyanpad, Atul Madhusudan Dongre, Prachi Vinayak Gole, Uday Sharadchandra Khopkar
DOI:10.4103/0378-6323.203584  
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Penile tuberculosis: A case report p. 357
Sema Aytekin, Fatih Göktay, Şirin Yasar, Zeynep Altan Ferhatoǧlu, Pembegül Güneş
DOI:10.4103/ijdvl.IJDVL_301_16  
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Massive retiform hemangioendothelioma that expresses D2-40 p. 360
Yang Tan, Yudong Hu, Jinjin Wu, Qionghui Cheng, Xia Lei
DOI:10.4103/ijdvl.IJDVL_373_16  
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Squamous cell carcinoma in long-standing chromoblastomycosis p. 363
Prasenjeet Mohanty, K Vivekanandh, Liza Mohapatra, Gaurav Dash
DOI:10.4103/0378-6323.201339  PMID:28272060
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Rare case of herpes zoster ophthalmicus with orbital myositis, oculomotor nerve palsy and anterior uveitis p. 365
Mansha Daswani, Nidhi Bhosale, Virna M Shah
DOI:10.4103/0378-6323.199582  PMID:28195080
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Verrucous eccrine angiomatous hamartoma p. 367
Prashant Verma, M Kaur, V Narula, V Ramesh, A Singh, AK Saxena
DOI:10.4103/0378-6323.197391  PMID:28071609
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Unilateral monomorphic hypopigmented macules: A variant of Darier disease p. 369
Jagdish Sakhiya, Neha C Virmani, Yugal K Sharma, Uday Khopkar, Shamsudheen Karuthedath Vellarikkal
DOI:10.4103/0378-6323.199580  PMID:28195078
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LETTERS TO THE EDITOR - OBSERVATION LETTERS Top

Human herpesvirus-8 and human cytomegalovirus infections in Bowen's disease: Is there any association? p. 372
Fahimeh Abdollahimajd, Hamideh Moravvej, Arian Rashidi, Saeed Aref, Zahra Safaei-Naraghi
DOI:10.4103/ijdvl.IJDVL_179_16  
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Leaving a mark: Multiple geometric areas of alopecia p. 373
Hima Gopinath, Maria Kuruvila, Ramadas Naik, Suja Sreedharan
DOI:10.4103/ijdvl.IJDVL_234_16  
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Ipsilateral facial paralysis and steroid acne p. 376
Berna Aksoy
DOI:10.4103/ijdvl.IJDVL_363_16  
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Ipsilateral facial paralysis and steroid acne p. 376
Berna Aksoy
DOI:10.4103/ijdvl.IJDVL_363_16  
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Clear cell papulosis: A case report and its possible association with epidermal immature dendritic cells p. 379
Jae Hwa Kim, Kyung Eun Jung, Dae Won Koo, Joong Sun Lee
DOI:10.4103/ijdvl.IJDVL_1231_15  
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Strongyloides stercoralis hyperinfection: An often missed but potentially fatal cause of anemia and hypoalbuminemia in leprosy patients on long-term steroid therapy p. 381
Vishal Gupta, Saurabh Bhatia, Asit Ranjan Mridha, Prasenjit Das, Neena Khanna
DOI:10.4103/ijdvl.IJDVL_347_16  
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Dermatoscopic evaluation of three cases of nevus lipomatosus cutaneous superficialis p. 383
Keshavamurthy Vinay, Gitesh U Sawatkar, Uma Nahar Saikia, Muthu Sendhil Kumaran
DOI:10.4103/ijdvl.IJDVL_677_16  
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LETTERS TO THE EDITOR - STUDY LETTER Top

Treatment of primary palmar hyperhidrosis using glycopyrrolate iontophoresis: Intensity of electrical current used, efficacy and side effects p. 387
Mabel Qi He Leow, Hong Liang Tey
DOI:10.4103/0378-6323.201338  PMID:28272059
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LETTERS TO THE EDITOR - THERAPY LETTERS Top

A combination of oral azathioprine and methotrexate in difficult to treat dermatoses p. 389
Puneet Agarwal, Uma Shankar Agarwal, Ram Singh Meena, Priyanka Sharma
DOI:10.4103/ijdvl.IJDVL_487_16  
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Response of superimposed linear psoriasis to ustekinumab: A case report p. 392
Hao-Jui Weng, Tsen-Fang Tsai
DOI:10.4103/0378-6323.203080  
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IMAGES IN CLINICAL PRACTICE Top

Scrotal lymphangiectasia following scrofuloderma p. 397
Debabrata Bandyopadhyay
DOI:10.4103/0378-6323.201340  PMID:28272061
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RESIDENTS PAGE Top

Beta-blockers in dermatology p. 399
Neel Prabha, Namrata Chhabra, Ripudaman Arora
DOI:10.4103/ijdvl.IJDVL_220_16  
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QUIZ Top

Unusual targetoid nodule on the back p. 408
Isidora García-Huidobro, Alvaro Ábarzúa-Araya, Camila Downey, Sergio González
DOI:10.4103/0378-6323.190874  PMID:27647358
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E-IJDVL - NET STUDY Top

Immunotherapy in viral warts with intradermal Bacillus Calmette–Guerin vaccine versus intradermal tuberculin purified protein derivative: A double-blind, randomized controlled trial comparing effectiveness and safety in a tertiary care center in Eastern India p. 411
Indrashis Podder, Sabari Bhattacharya, Vivek Mishra, Tushar Kanti Sarkar, Somodyuti Chandra, Amrita Sil, Santasmita Pal, Dhiraj Kumar, Abanti Saha, Koushik Shome, Debabrata Bandyopadhyay, Nilay Kanti Das
DOI:10.4103/0378-6323.193623  PMID:27852999
Background: Current therapeutic modalities for viral warts are mostly ablative and are limited by high recurrence rates besides being unsuitable for numerous lesions. Immunotherapy has the potential to overcome these limitations. Aims: The aim of this study was to compare the effectiveness and safety of Bacillus Calmette–Guerin vaccine versus tuberculin purified protein derivative in the immunotherapy of warts. Methods: Patients received three doses of 0.1 ml of Bacillus Calmette–Guerin vaccine or tuberculin purified protein derivative intradermally over the deltoid region at 4-weekly intervals. They were followed-up for another month. Number of warts, complete cure rates and quality of life were assessed. Results: A total of 60 patients were included. Complete clearance was noted in 16 (48.5%) out of 33 patients in the Bacillus Calmette–Guerin group and in 5 (18.5%) out of 27 in the tuberculin purified protein derivative group (P = 0.121). The number of lesions reduced statistically significantly from baseline in both the groups (P < 0.001) from the first follow-up visit onward (P < 0.05). The reduction was statistically significantly more in the Bacillus Calmette–Guerin group than in the tuberculin purified protein derivative group from the second follow-up onward. Dermatologic life quality index improved statistically significantly with both treatments. Adverse events (pain during injection, abscess formation and scarring at injection site) were more frequent with Bacillus Calmette–Guerin. No recurrence was seen after lesions cleared. Limitations: Patients were not followed up for more than 4 weeks after treatment. We could not estimate the cytokine levels or the peripheral blood mononuclear cell proliferation in response to Bacillus Calmette–Guerin/tuberculin purified protein derivative injections. Conclusion: Both intradermal Bacillus Calmette–Guerin and tuberculin purified protein derivative hold promise in the treatment of viral warts. Bacillus Calmette–Guerin may be more effective, though it had more adverse events in our study.
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E-IJDVL - NET LETTERS Top

Postsurgical pyoderma gangrenosum successfully treated with cyclosporine p. 412
Biswanath Behera, Laxmisha Chandrashekar, Devinder Mohan Thappa, Bheemanathi Hanuman Srinivas, Parth Pratim Pasayat, Ishita Laroiya
DOI:10.4103/0378-6323.193616  PMID:27852992
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A study of the efficacy of platelet-rich plasma in the treatment of androgenetic alopecia in males Highly accessed article p. 412
Shruti Gupta, TN Revathi, S Sacchidanand, HV Nataraj
DOI:10.4103/0378-6323.191128  PMID:27679404
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Giant, mutilating facial lupus vulgaris due to long-term misdiagnosis Highly accessed article p. 412
Li Xue, Wei Li, Xiaoyan Lv, Li Li
DOI:10.4103/0378-6323.186481  PMID:27451925
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OBITUARY Top

Prof. K. Siddappa (1931–2017) p. 413
Arun C Inamadar
DOI:10.4103/ijdvl.IJDVL_301_17  
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Erratum: Digital volumetric measurement of cutaneous leishmaniasis lesions: Blur estimation method p. 414

DOI:10.4103/0378-6323.205029  
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Erratum: Clinical characteristics of acquired ungual fibrokeratoma p. 414
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DOI:10.4103/0378-6323.205030  
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