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   Table of Contents - Current issue
Coverpage
March-April 2014
Volume 80 | Issue 2
Page Nos. 103-196

Online since Wednesday, March 26, 2014

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EDITORIAL  

Streamlining advertisements: Editorial perspective p. 103
Uday Khopkar
DOI:10.4103/0378-6323.129373  PMID:24685843
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VIEW POINT Top

Advertisements in medical journals p. 104
Vinay Kulkarni
DOI:10.4103/0378-6323.129376  PMID:24685844
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REVIEW ARTICLE Top

Understanding itch: An update on mediators and mechanisms of pruritus Highly accessed article p. 106
Iffat Hassan, Mir Laieq Ishtiyaq Haji
DOI:10.4103/0378-6323.129377  PMID:24685845
Pruritus is the most common symptom secondary to skin diseases. Advances in the fields of neurobiology, immunology and physiology have made it possible for us to understand and unravel the deeper pathophysiological basis of pruritus. This review aims to update our current understanding of the mechanisms and mediators of pruritus. Special attention is paid to endogenous itch mediators particularly newly identified ones like endovanilloids, opioids, neurotrophins, cannabinoids, proteases and cytokines. Various theories explaining the peripheral encoding of itch are reviewed. Multiple neural pathways including the central itch pathways as well as supraspinal processing of itch and brain areas involved in pruritus are highlighted. Apart from peripheral itch mediators, spinal neural receptors are also involved in control of itch and should form part of the development of a novel antipruritic strategy. Further studies are required to fill the lacunae in our current understanding of the pathophysiology of pruritus.
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ORIGINAL ARTICLES Top

Drug advertisements in two dermatology journals: A critical comparison of IJDVL and JAAD p. 115
Pratik Gahalaut, Sandhya Chauhan, Nitin Mishra, Madhurkant Rastogi, Richa Thakur
DOI:10.4103/0378-6323.129381  PMID:24685846
Background: Though drug promotion regulations exist worldwide, low quality of journal drug advertising is a global issue. Medical journals are regarded as a leading source of information for new drugs. They may also modulate prescribing behavior of physicians without their knowledge. A comparative analysis of advertisements from different countries may provide insights regarding strengths and weaknesses of different regulating systems. Aims: Prescription drug advertisements from the Indian Journal of Dermatology, Venereology, and Leprology (IJDVL) and Journal of American Academy of Dermatology (JAAD) were compared to check their compliance with criteria of World Health Organization (WHO) and International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). Methods: All the prescription drug advertisements of at least one page length appearing in all the issues of IJDVL and JAAD from January 2012 till December 2012 were included in this study. The contents of both advertisements were compared for compliance regarding different criteria of ethical codes for drug advertising of WHO and IFPMA. Statistical analysis was done using Fisher's exact test. Results: Compared to IJDVL, more advertisements in JAAD complied with WHO and IFPMA codes. On the whole, advertisements in IJDVL had significantly less information regarding the approved usage, dosage, abbreviated prescribing information (API), summary of scientific information, safety information regarding the drug, and references to the scientific literature to support various claims. However, JAAD had more advertisements with multiple claims than IJDVL, and many advertisements interspersed between scientific articles while IJDVL had none. Conclusion: The complex issue of ethical drug advertising in dermatology journals requires constant review and discussion. Dermatologists should be cautious in assessing any advertisement or claim even if it seems evidence-based. The results from our study highlight the need for a global, proactive and effective regulatory system to ensure ethical medicinal drug advertising in medical journals.
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A randomized placebo-controlled double-blind pilot study of methotrexate in the treatment of H1 antihistamine-resistant chronic spontaneous urticaria p. 122
Vinod K Sharma, Saurabh Singh, M Ramam, Mahesh Kumawat, Rakesh Kumar
DOI:10.4103/0378-6323.129382  PMID:24685847
Background: Chronic urticaria not responsive to antihistamines is a difficult disease to manage. Methotrexate has been used in difficult chronic urticarias with some benefit. Objective: To evaluate the efficacy of methotrexate in the treatment of chronic spontaneous urticaria poorly responsive to H1 antihistaminics. Methods: In a randomized double-blind trial at the Department of Dermatology and Venereology of a tertiary care centre, 29 patients with chronic spontaneous urticaria not responding well to H1 antihistaminics were recruited. Patients were randomly allocated to receive either a weekly dose of oral methotrexate 15 mg or placebo (calcium carbonate) for a total duration of 12 weeks, after which treatment was stopped and patients were followed up for relapse of urticaria. Each group also received levocetrizine 5 mg once daily for symptom control. Primary outcome measured was a reduction by >2/3 rd of baseline urticaria scores after 12 week therapy. Secondary outcome was a reduction in antihistamine requirement after stopping therapy. Results: Fourteen patients were randomized to the methotrexate group and fifteen patients to the placebo group. Out of 17 patients who completed therapy, the primary outcome was achieved by 3.5 ± 1.9 (out of 10) patients in the methotrexate group and by 3.67 ± 1.03 (out of 7) patients in the placebo group (P > 0.05). Ten patients followed up, after stopping therapy, for a mean period of 3.5 ± 2.4 months; 3 remained in remission and 7 had relapsed. One patient had uncontrollable nausea and vomiting after taking methotrexate and was withdrawn from the study. The placebo group did not experience any side effects. Conclusions: Methotrexate 15 mg weekly for 3 months did not provide any additional benefit over H1 antihistamines in this study but an adequately powered study with longer follow up is required to assess its utility.
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Extramammary Paget's disease: Analysis of 17 Chinese cases p. 129
Yuqing Qi, Jianzhong Hu, Chenwei Sun, Junyan Zhang, Quanzhong Liu
DOI:10.4103/0378-6323.129385  PMID:24685848
Background/Objective: Extramammary Paget's Disease (EMPD) seems to be more common in Caucasians than Chinese. We report the clinical manifestations, management, and prognostic characteristics in 17 Chinese patients. Methods: Medical records and biopsies of 17 patients who had been treated at a large university hospital in China between March 2005 and January 2012 were reviewed. Results: Of the 17 patients, 14 were men. They had lesions on the scrotum and the penis. Of the three women, two had vulvar and one had inguinal lesions. All patients underwent Mohs micrographic surgery (MMS). Three men had metastasis to the inguinal lymph nodes and underwent an extensive local excision with inguinal lymphadenectomy. Eight patients who had positive excision margins received additional radiation therapy. The mean follow-up duration was 54 months (4-85 months). One patient had two recurrences. Three had metastasis to the inguinal lymph node. One had metastasis to the bone and concomitant prostate cancer. Two patients died of the disease. Conclusion: A striking difference in presentation of EMPD in Chinese compared with Caucasians is the male predominance and location on the penis and scrotum. Mohs micrographic surgery followed by radiotherapy is an effective treatment. Long-term follow-up suggests that the disease has a good prognosis when it does not metastasise.
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Validation of a computer based objective structured clinical examination in the assessment of undergraduate dermatology courses p. 134
Feroze Kaliyadan, Abdul Sattar Khan, Joel Kuruvilla, Kaberi Feroze
DOI:10.4103/0378-6323.129386  PMID:24685849
Many teaching centers have now adopted objective structured clinical examination (OSCE) as an assessment method for undergraduate dermatology courses. A modification of the standard OSCE in dermatology is computer based or electronic OSCE (eOSCE). We attempted to validate the use of a computer-based OSCE in dermatology in a group of fifth year medical students. The scores of the students in the computer-based OSCE showed a strong positive correlation with the scores on the clinical presentation (Pearson's co-efficient - 0.923, P value <0.000, significant at the 0.01 level) and a good correlation with overall scores of the student (Pearson's co-efficient - 0.728, P value <0.000, significant at the 0.01 level), indicating that this is a reliable method for assessment in dermatology. Generally, the students' feedback regarding the methods was positive.
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CASE REPORTS Top

Extensive disseminated cysticercosis p. 137
Sujay Khandpur, Sunil Kumar Kothiwala, Binamra Basnet, Rattan Nangia, HA Venkatesh, Raju Sharma
DOI:10.4103/0378-6323.129389  PMID:24685850
Cysticercosis, especially neurocysticercosis, is a major public health problem in India. We report an unusual case of disseminated cysticercosis with extensive infiltration of the skin, central nervous system, skeletal muscles, eye, lung, and heart. A patient with extensive cutaneous cysticercosis must be thoroughly investigated for widespread internal organ involvement.
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Tumor of follicular infundibulum: An unsuspected cause of macular hypopigmentation p. 141
Asha Kubba, Meenakshi Batrani, Atul Taneja, Vivek Jain
DOI:10.4103/0378-6323.129391  PMID:24685851
We present three cases of a rare eruptive variant of tumor of follicular infundibulum. Two patients presented with hypopigmented macules. The clinical differential diagnoses considered in these two cases were vitiligo, lichen sclerosus et atrophicus, and idiopathic guttate hypomelanosis. In the third case, the lesions were hypopigmented flat topped maculo-papules diagnosed clinically as verruca plana. In all three cases, the histopathological features of plate like growth of pale keratinocytes connected to the epidermis and peritumoral condensation of elastic fibers were diagnostic. Although no satisfactory treatment is available, the exclusion of other clinical differential diagnosis particularly vitiligo with its psychosocial implications underscores the importance of skin biopsy.
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Old world leishmaniasis presenting as a nasal mass p. 145
Mahdi Bakhshaee, Shahaboddin Shabani, Mehdi Farzadnia, Seyed Aliakbar Shamsian, Pouran Layegh
DOI:10.4103/0378-6323.129393  PMID:24685852
Mucosal leishmaniasis is a major problem in Latin America but has been rarely noticed in our region. Although there have been a few reports of mucosal involvement especially in the oral cavity from Southwest Iran, yet none have been presented from the Northeast where Leishmania tropica is the major concern. We report a patient with endonasal leishmaniasis due to L. tropica, an extremely rare entity in immunocompetent patients in our region. He presented with a mass in the left nasal vestibule causing a sense of obstruction on the same side, accompanied by occasional rhinorrhea and mild epistaxis. This case exemplifies the need for considering leishmaniasis as a differential diagnosis for nasal obstruction in this endemic area.
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IMAGES IN CLINICAL PRACTICE Top

Mucosal carotenoderma p. 148
Feroze Kaliyadan
DOI:10.4103/0378-6323.129396  PMID:24685853
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RESIDENT’S PAGE Top

Flagellate dermatoses Highly accessed article p. 149
Premanshu Bhushan, Prateek Manjul, Vinisha Baliyan
DOI:10.4103/0378-6323.129397  PMID:24685854
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LETTERS TO THE EDITOR Top

Polycystic ovarian disease: Still an enigma! p. 153
Sidharth Sonthalia, Jyotirmaya Bharti
DOI:10.4103/0378-6323.129398  PMID:24685855
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Polycystic ovarian syndrome: A review p. 154
Nina Madnani, Kaleem Khan, Phulrenu Chauhan, Parmar
DOI:10.4103/0378-6323.129399  PMID:24685856
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Delleman syndrome or Haberland syndrome? p. 155
Shivcharan Lal Chandravanshi, Sujata Lakhtakia
DOI:10.4103/0378-6323.129400  PMID:24685857
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Multibacillary leprosy: Follow up observations on 19 patients treated with 12 monthly doses of rifampicin, ofloxacin and minocycline therapy in Agra p. 156
Anil Kumar, Bhavneswar Kumar Girdhar
DOI:10.4103/0378-6323.129401  PMID:24685858
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Occupational contact dermatitis among construction workers: Results of a pilot study p. 159
Vikas Sharma, Vikram K Mahajan, Karaninder S Mehta, Pushpinder S Chauhan
DOI:10.4103/0378-6323.129402  PMID:24685859
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Syphilis among sexually transmitted infections clinic attendees in a tertiary care institution: A retrospective data analysis p. 161
Sarita Sasidharanpillai, Valiaveetil Bindu, Najeeba Riyaz, Pentam V Beegum Sherjeena, Saleem Rahima, Nirmal Chandrasekhar
DOI:10.4103/0378-6323.129403  PMID:24685860
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Piebaldism with non-intertriginous freckles: What does it mean? p. 163
Nilendu Sarma, Sayantani Chakraborty, Dulal Chandra Bhanja, Sneha Ranjan Bhattachraya
DOI:10.4103/0378-6323.129404  PMID:24685861
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Scrub typhus in a child: Looking behind the ear and beyond p. 165
Chandrasekaran Venkatesh, Russelian Arulraj, Palanisamy Soundararajan, Sadagopan Srinivasan
DOI:10.4103/0378-6323.129406  PMID:24685862
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Dermatomyositis and nasopharyngeal carcinoma in an Indian patient p. 167
Vishal Gupta, Divya Seshadri, Maneesh Kumar Vijay, Puja Sahai, Somesh Gupta
DOI:10.4103/0378-6323.129408  PMID:24685863
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Epithelioid sarcoma of the extremities p. 168
Fatma Akpinar, Emine Dervis, Cuyan Demirkesen, Ali Cem Akpinar, Selma Sonmez Ergun
DOI:10.4103/0378-6323.129409  PMID:24685864
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Periocular granuloma annulare in a child p. 171
Sahana M Srinivas, Moupia Goswami, Madhavi Naik
DOI:10.4103/0378-6323.129410  PMID:24685865
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Distinctive manifestations of cutaneous intraneural perineurioma of fingers, compared with typical intraneural perineurioma p. 172
Szu-Ying Chin, Yu-Chien Kao, Chia-Fen Yang, Woan-Ruoh Lee
DOI:10.4103/0378-6323.129412  PMID:24685866
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Mondor's disease p. 173
Saikat Bhattacharjee, Preema Sinha, Raju Augustine George, Mihir Gupta
DOI:10.4103/0378-6323.129413  PMID:24685867
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Treatment of multifocal epithelial hyperplasia with imiquimod p. 175
Behrooz Barikbin, Zohreh Tehranchinia, Nikoo Mozafari
DOI:10.4103/0378-6323.129415  PMID:24685868
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Central retinal artery occlusion and cerebral inrfaction following forehead injection with a corticosteroid suspension for vitiligo Highly accessed article p. 177
Ou-gen Liu, Li Chunming, Wang Juanjuan, Xiong Xiaoyan
DOI:10.4103/0378-6323.129416  PMID:24685869
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Disseminated molluscum contagiosum in a patient on methotrexate therapy for psoriasis p. 179
Shivani Bansal, Vineet Relhan, Esha Roy, Vijay Kumar Garg, Nita Khurana
DOI:10.4103/0378-6323.129418  PMID:24685870
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Lindane toxicity following accidental oral ingestion p. 181
Sujatha Ramabhatta, GR Sunilkumar, C Somashekhar
DOI:10.4103/0378-6323.129419  PMID:24685871
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Interstitial granulomatous drug reaction due to febuxostat p. 182
Laura Atzori, Luca Pilloni, Anna Luisa Pinna
DOI:10.4103/0378-6323.129420  PMID:24685872
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Adult variant of self-healing papular mucinosis in a patient treated with interferon α2a p. 184
Daniel González Fernández, Blanca Vivanco Allende, Narciso Pérez Oliva
DOI:10.4103/0378-6323.129421  PMID:24685873
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Severe eosinophilia during anti-tumor necrosis factor-alpha therapy for psoriatic arthritis p. 187
Giacomo Maria Guidelli, Sara Tenti, Antonella Fioravanti
DOI:10.4103/0378-6323.129422  PMID:24685874
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Unilateral Blaschkoid Darier's disease over the forehead p. 189
Ashok Krishnarao Ghorpade
DOI:10.4103/0378-6323.129423  PMID:24685875
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QUIZ Top

Multiple cutaneous nodules in a patient with rheumatoid arthritis p. 191
Wen-Hui Chen, Chien-Ping Chiang, Bai-Yao Wu
DOI:10.4103/0378-6323.129424  PMID:24685876
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NET LETTERS Top

Clinico-mycological study of dermatophytes in a tertiary care centre in northwest India p. 194
US Agarwal, Jitendra Saran, Puneet Agarwal
DOI:10.4103/0378-6323.129434  PMID:24685877
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Retrospective analysis of fixed drug eruptions among patients attending a tertiary care center in Southern India p. 194
Varadraj Vasant Pai, Naveen Narayanshetty Kikkeri, SB Athanikar, Pankaj Shukla, Prasana Bhandari, Vijetha Rai
DOI:10.4103/0378-6323.129435  PMID:24685878
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Effects of low-level light therapy on facial corticosteroid addiction dermatitis: A retrospective analysis of 170 Asian patients p. 194
Qi Luan, Ling Liu, Qiangmei Wei, Bin Liu
DOI:10.4103/0378-6323.129436  PMID:24685879
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Nevus lipomatosus cutaneus superficialis associated with nevus sebaceous of Jadassohn p. 194
Enver Turan, Yavuz Yesilova, Derya Uçmak, Gül Türkçü, Özgür Ilhan Çelik, Mehmet Salih Gürel
DOI:10.4103/0378-6323.129437  PMID:24685880
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Bullous pemphigoid after femur fracture surgery: A mere coincidence? p. 195
Rong Zeng, Hao Chen, Yiqun Jiang, Min Li
DOI:10.4103/0378-6323.129438  PMID:24685881
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Successful treatment of multiple facial basal cell carcinomas with imiquimod in a patient with chronic renal failure p. 195
Sedef Bayata, Aylin Türel Ermertcan, Gülsüm Gençoglan, Görkem Eskiizmir, Peyker Temiz
DOI:10.4103/0378-6323.129439  PMID:24685882
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BOOK REVIEW Top

Pigmentary disorders: A comprehensive compendium p. 196
Venkataram Mysore
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