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   Table of Contents - Current issue
Coverpage
July-August 2015
Volume 81 | Issue 4
Page Nos. 341-442

Online since Friday, July 03, 2015

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EDITORIAL  

Ahead of print: Reducing time to publication for accepted manuscripts p. 341
M Ramam
DOI:10.4103/0378-6323.159927  PMID:26144848
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REVIEW ARTICLE Top

Vitamin D and skin diseases: A review Highly accessed article p. 344
Bhawna Wadhwa, Vineet Relhan, Khushbu Goel, Atul M Kochhar, Vijay Kumar Garg
DOI:10.4103/0378-6323.159928  PMID:26144849
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ORIGINAL ARTICLES Top

A randomized controlled trial to compare cure and relapse rate of paucibacillary multidrug therapy with monthly rifampicin, ofloxacin, and minocycline among paucibacillary leprosy patients in Agra District, India p. 356
Anil Kumar, Anita Girdhar, Bhuvneswar Kumar Girdhar
DOI:10.4103/0378-6323.159929  PMID:26144850
Objectives: To study cure rate and relapse rate of standard World Health Organization paucibacillary multidrug therapy (PB-MDT) with monthly rifampicin, ofloxacin, and minocycline for six months (ROM-6) among paucibacillary leprosy patients. Methods: A total of 268 patients, detected during active search in Agra district during 2001-2004, who had paucibacillary (PB) leprosy having 1-5 skin lesions and/or one nerve thickening/tenderness, were allocated, using random number tables, to two treatment groups; PB-MDT and ROM-6. On the first day of the month, dose of PB-MDT and of the ROM were given under supervision for 6 months. After completion of drug therapy, patients were followed every 6 months for first 5 years and later annually for next 3 years for monitoring disease status, cure rates, reactions and relapses. Cηi σθuαρε test was used to compare relapse rates. Results: The cure rate at 2 years was 99% in ROM-6 and 97.0% in PB-MDT group, of those who completed treatment and the difference was statistically not significant. At 5 years, only 88 patients in PB-MDT group and 90 patients in ROM-6 group could be followed; all were observed to be cured. However, during the period of 5-8 years, 3 of 67 patients in PB-MDT group and 1 of 73 in ROM-6 group were observed to have relapsed. In all, 10 relapses were noted (3 in ROM-6 and 7 in PB-MDT group) giving a relapse rate of 1.10/100 person years in PB-MDT and 0.435/100 person years in ROM groups (P = 0.053 ; statistically not significant). Of the 10 relapses, 5 occurred within 5 years (3 in PB-MDT group and 2 in ROM-6), 4 during 5-8 years (3 in PB-MDT and 1 in ROM-6), and 1 occurred in MDT group after 8 years. Limitation: A number of patients were lost to follow up after release from treatment and thus actual number of relapses in the study could not be assessed. Additionally, diagnosis was purely clinical and histology could not be done for reasons related to functional difficulties in the field. Conclusion: The study shows that PB-MDT and ROM-6 have almost similar acceptability, cure rate and relapse rate.
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Comparative efficacy of continuous and pulse dose terbinafine regimes in toenail dermatophytosis: A randomized double-blind trial p. 363
Pravesh Yadav, Archana Singal, Deepika Pandhi, Shukla Das
DOI:10.4103/0378-6323.158634  PMID:26087080
Introduction: Dermatophytes are the most frequently implicated agents in toenail onychomycosis and oral terbinafine has shown the best cure rates in this condition. The pharmacokinetics of terbinafine favors its efficacy in pulse dosing. Objectives: To compare the efficacy of terbinafine in continuous and pulse dosing schedules in the treatment of toenail dermatophytosis. Methods: Seventy-six patients of potassium hydroxide (KOH) and culture positive dermatophyte toenail onychomycosis were randomly allocated to two treatment groups receiving either continuous terbinafine 250 mg daily for 12 weeks or 3 pulses of terbinafine (each of 500mg daily for a week) repeated every 4 weeks. Patients were followed up at 4, 8 and12 weeks during treatment and post-treatment at 24 weeks. At each visit, a KOH mount and culture were performed. In each patient, improvement in a target nail was assessed using a clinical score; total scores for all nails and global assessments by physician and patient were also recorded. Mycological, clinical and complete cure rates, clinical effectivity and treatment failure rates were then compared. Results: The declines in target nail and total scores from baseline were significant at each follow-up visit in both the treatment groups. However, the inter-group difference was statistically insignificant. The same was true for global assessment indices, clinical effectivity as well as clinical, mycological, and complete cure rates. Limitations: The short follow-up in our study may have led to lower cure rates being recorded. Conclusion: Terbinafine in pulse dosing is as effective as continuous dosing in the treatment of dermatophyte toenail onychomycosis.
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The reservoir effect of topical steroids in vitiliginous skin: A cross-sectional study p. 370
Satyendra Kumar Singh, Farzeen Nasir
DOI:10.4103/0378-6323.159933  PMID:26144851
Background: Prolonged and frequent use of topical steroids may lead to decrease in efficacy as well as many local adverse effects. Stratum corneum has a unique property of reservoir effect. Aims: To study the reservoir effect of topical steroids in a steroid-responsive condition which may enable a decrease in the dosing frequency of topical steroids. Methods: A cross-sectional study design was used. Patients with at least three vitiliginous patches of more than 2 cm 2 present over the trunk or limbs were included. Exclusion criteria were topical or systemic corticosteroid use within the previous 4 weeks, antihistamine use within the previous 7 days, history of any allergy in the past and immunosuppression. Clobetasol propionate cream was applied on the first vitiliginous area (site A) and fluticasone propionate ointment was applied on the second vitiliginous area (site B). The third vitiliginous area, site C (control site) was left without applying any medication. Histamine-induced wheal suppression test was performed on each site, at the same time of the day, on every consecutive day following steroid application, until the values obtained at sites A and B approached those obtained at site C. SPSS software for Windows, version 16.0 was used for statistical analysis. The mean and standard deviation of the various studied parameters were calculated for various treatment groups and compared using analysis of variance (ANOVA) test. Results: Forty patients were included in the study. The average wheal volumes and average erythema sizes at sites A and B were significantly smaller than the corresponding values at site C for up to 5 days after applying medication (P < 0.001). Limitations: The presence of a cutaneous reservoir of topical steroid was confirmed based on its suppressive effect on the wheal and flare response to histamine. It is not certain that the concentration that suppresses histamine-induced wheal and flare is sufficient for therapeutic efficacy in vitiligo. Conclusion: The reservoir effect of topical clobetasol propionate and fluticasone propionate persisted for 5 days in vitiliginous skin. Hence, it may be possible to reduce the frequency of topical steroid application in vitiligo.
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BRIEF REPORTS Top

Performance of a commercially available plant allergen series in the assessment of suspected occupational contact dermatitis to plants in north Indian patients p. 376
Dipankar De, Geeti Khullar, Sanjeev Handa
DOI:10.4103/0378-6323.156199  PMID:25937142
Background: Parthenium hysterophorus is the leading cause of phytogenic allergic contact dermatitis in India. The Indian Standard Series currently supplied by Systopic Laboratories Ltd and manufactured by Chemotechnique Diagnostics ® contains parthenolide as the only allergen representing plant allergens. Aim: The study was conducted to assess the performance of the Chemotechnique plant series (PL-1000), consisting of 14 allergens, in patients with clinically suspected occupational contact dermatitis to plant allergens. Methods: Ninety patients were patch tested with the Chemotechnique plant series from 2011 to 2013. Demographic details, clinical diagnosis and patch test results were recorded in the contact dermatitis clinic proforma. Results: Of 90 patients, 24 (26.7%) showed positive reactions to one or more allergens in the plant series. Positive patch tests were elicited most commonly by sesquiterpene lactone mix in 19 (78.6%) patients, followed by parthenolide in 14 (57.1%), Achillea millefolium in 10 (42.9%) and others in decreasing order. Conclusion: The plant allergen series prepared by Chemotechnique Diagnostics is possibly not optimal for diagnosing suspected allergic contact dermatitis to plants in north Indians. Sesquiterpene lactone mix should replace parthenolide as the plant allergen in the Indian Standard Series until relevant native plant extracts are commercially available for patch testing.
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CASE REPORTS Top

Cutaneous tuberculosis due to multidrug-resistant tubercle bacilli and difficulties in clinical diagnosis p. 380
V Ramesh, Manas K Sen, G Sethuraman, Paschal D'Souza
DOI:10.4103/0378-6323.157447  PMID:25994882
This report describes 6 HIV-negative patients including 5 children with scrofuloderma and an adult with lupus vulgaris, out of a total of 303 cases of cutaneous tuberculosis seen during a 4½-year period, who showed a positive tuberculin test and granulomatous histopathology, but failed to respond to first-line antitubercular therapy. They were suspected to have multidrug-resistant infection as no other cause could be ascertained. Tissue aspirate or biopsy was sent for histopathology and culture. Mycobacterium tuberculosis was isolated from the aspirate in three patients and sputum in one with associated pulmonary tuberculosis. Drug susceptibility tests showed that all isolates were resistant to rifampicin and isoniazid, and one each additionally to streptomycin and ethambutol, respectively. In two, culture was unsuccessful. All were administered second-line antitubercular drugs. Clinical improvement was appreciable within 2 months as weight gain, and regression of ulcers, swellings and plaques. Two completed the recommended 24 months of therapy. Multidrug-resistant cutaneous tuberculosis should be suspected in patients with no response to first-line drugs, with clinical deterioration, and where other causes of treatment failure are not forthcoming. Owing to poor isolation rates on culture and low sensitivity of molecular tests, in such cases, a trial of second-line anti-tubercular drugs may be justified for a reasonable period of 2 months. Where facilities permit, culture and drug sensitivity tests should be done before starting treatment. Culture positivity is better from aspirated material.
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A novel H1 mutation in keratin 6a in an infant with pachyonychia congenita p. 385
Shuanghong Luo, Qiuhong Luo, Haixia Zhang, Chaomin Wan
DOI:10.4103/0378-6323.158651  PMID:26087092
Pachyonychia congenita (PC) is a rare genetic disorder which is inherited in an autosomal dominant pattern. We report a sporadic novel H1 mutation in the KRT6A gene (c. 428G>A/p.Ser143Asn) in a Chinese infant patient. The mutation is concurrent with a single-nucleotide polymorphism and resulted in a serine for asparagine substitution in H1 subdomain of KRT6A chain next to the rod domain. The infant showed the classic symptoms of pachyonychia congenita. Conclusion: The heterozygous missense mutation c. 428G > A/p.Ser143Asn in KRT6A exon 1 may cause severe disease.
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IMAGES IN CLINICAL PRACTICE Top

Cutaneous cholesterol embolization syndrome p. 388
Naohiko Imai, Ryo Zamami, Kenjiro Kimura
DOI:10.4103/0378-6323.158664  PMID:26087104
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LETTERS TO THE EDITOR Top

Jellyfish dermatitis p. 389
Karthika Sivaprakasam
DOI:10.4103/0378-6323.156198  PMID:25937141
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Endonyx onychomycosis caused by Trichophyton tonsurans p. 390
Sumanas Bunyaratavej, Supapat Bunyaratavej, Chanai Muanprasart, Lalita Matthapan, Supenya Varothai, Chinmanut Tangjaturonrusamee, Penvadee Pattanaprichakul
DOI:10.4103/0378-6323.157460  PMID:25994895
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Cutaneous leishmaniasis mimicking verrucous carcinoma: A case with an unusual clinical course p. 392
Andac Salman, Ayse Deniz Yucelten, Dilek Seckin, Tulin Ergun, Zeynep Demircay
DOI:10.4103/0378-6323.157462  PMID:25994897
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Vascular patterns in cutaneous leishmaniasis: A videodermatoscopic study p. 394
Filomena Caltagirone, Giuseppe Pistone, Mario Arico, Fabrizio Vitale, Daniele Sorbello, Daniele Rizzo, Maria Rita Bongiorno
DOI:10.4103/0378-6323.159939  PMID:26144852
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Bacillary angiomatosis presenting as a digital ulcer p. 398
JoŃo VÝtor Pina Alves, Diogo Miguel Martins Matos, Constanša Maria Veiga Furtado, Elvira Augusta Felgueira Leonardo Fernandes Bßrtolo
DOI:10.4103/0378-6323.157450  PMID:25994885
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Primary localized cutaneous nodular amyloidosis with bullous lesions p. 400
Tutyana Sanusi, Yanqiu Li, Yue Qian, Changzheng Huang
DOI:10.4103/0378-6323.157459  PMID:25994894
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Coexistence of multiple variants of porokeratosis p. 402
Hao Guo, Xing-Hua Gao, Hong-Duo Chen, Jiu-Hong Li
DOI:10.4103/0378-6323.157463  PMID:25994898
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Fuchs syndrome or erythema multiforme major, uncommon or underdiagnosed? p. 403
Sonia Mangal, Tarun Narang, Uma Nahar Saikia, Muthu Sendhil Kumaran
DOI:10.4103/0378-6323.158640  PMID:26087085
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Symmetrical drug-related intertriginous and flexural exanthema due to codeine p. 405
Gamze Erfan, Mehmet Emin Yanik, Sule Kaya, Kaan Tasolar, Meltem Oznur, Mustafa Kulac
DOI:10.4103/0378-6323.158665  PMID:26087105
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Fatal outcome of DRESS syndrome associated with esomeprazole p. 407
Ahmed Za´em, Ons Charfi, Talel Badri, Sihem Elaidli
DOI:10.4103/0378-6323.158636  PMID:26087082
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Genetic study in a suspected case of Schöpf-Schulz-Passarge syndrome p. 408
Alejandro Vilas-Sueiro, Benigno Monteagudo, Daniel Gonzßlez-Vilas, Ana Varela-Veiga, Cristina De las Heras
DOI:10.4103/0378-6323.158657  PMID:26087098
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Nevus lipomatosus superficialis associated with deep penetrating nevus p. 410
Hee Joo Kim, Min Geol Lee
DOI:10.4103/0378-6323.157458  PMID:25994893
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Maffucci syndrome in an eight-year-old girl p. 412
Sharlene Helene H Chua, Ma. Lorna F Frez
DOI:10.4103/0378-6323.157451  PMID:25994886
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Nevoid basal cell carcinoma syndrome (Gorlin-Goltz syndrome) p. 414
Senda Majdoub, Houneida Zaghouani, Yasser Ben Cheikh, Mouna Laadhari, Habib Amara, Dajla Abassi, Chakib Kraeim
DOI:10.4103/0378-6323.159945  PMID:26144853
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Linear arrangement of neutrophils along the basal layer in a case of bullous pemphigoid p. 416
Yang Min, Gao Xiao-Man, Chang Jian-Min
DOI:10.4103/0378-6323.158654  PMID:26087095
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Proliferating trichilemmal cyst with nodal enlargement mimicking metastatic squamous cell carcinoma p. 418
Kiran Preet Malhotra, Saumya Shukla, Ashish Singhal, Nuzhat Husain
DOI:10.4103/0378-6323.157461  PMID:25994896
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Granular cell basal cell carcinoma: A rare variant p. 420
Martin Tichy, Martin Tichy Sen
DOI:10.4103/0378-6323.158652  PMID:26087093
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Breast carcinoma arising in ectopic breast tissue presenting as an enlarging axillary nodule p. 422
Marina Shuster, Julie Y Tse, Gideon P Smith
DOI:10.4103/0378-6323.158655  PMID:26087096
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Extensive inflammatory skin metastasis from ovarian carcinoma: Carcinoma erysipeloides p. 425
Sunil K Kothiwala, Mayuri Meena, Anshul Maheshwari, Arpita Jindal
DOI:10.4103/0378-6323.158662  PMID:26087103
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The effects of normobaric oxygen therapy on patients with periorbital darkening: An open, uncontrolled trial p. 427
Wedad Z Mostafa, Dina M Kadry, Esraa F Mohamed
DOI:10.4103/0378-6323.159946  PMID:26144854
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IMAGES IN CLINICAL PRACTICE Top

Cheilitis glandularis p. 430
Piyush Kumar, Rajesh Kumar Mandal
DOI:10.4103/0378-6323.157455  PMID:25994890
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QUIZ Top

Multiple asymptomatic papules on the glans penis p. 431
Cunjian Zhou, Zhifang Zhai, Xichuan Yang, Zhu Shen
DOI:10.4103/0378-6323.158661  PMID:26087102
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E-IJDVL - NET STUDY Top

Dermatological adverse reactions to cancer chemotherapy p. 434
Rachel A Pavey, Srinath M Kambil, Ramesh M Bhat
DOI:10.4103/0378-6323.159950  PMID:26144855
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E-IJDVL - NET LETTERS Top

Multifocal scrofuloderma overlying tuberculous dactylitis in an immunocompetent child p. 434
Yasmeen J Bhat, Asif Nazir Baba, Peerzada Sajad, Iffat Hassan, Sheema Sheikh, Saima Naaz
DOI:10.4103/0378-6323.156193  PMID:25937138
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Serpentine supravenous hyperpigmentation induced by docetaxel p. 434
Anupam Das, Dhiraj Kumar, Swosti Mohanty, Ashim Kumar Mondal, Satyendra N Chowdhury, Debabrata Bandyopadhyay
DOI:10.4103/0378-6323.156191  PMID:25937137
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Pityriasis rubra pilaris mixed type III/IV successfully treated with narrow band-ultraviolet B p. 435
AF Massa, P Vasconcelos, L Soares de Almeida, P Filipe
DOI:10.4103/0378-6323.156196  PMID:25937140
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Diaper dermatitis with psoriasiform id eruptions p. 435
Pradeep Balasubramanian, Soumya Jagadeesan, Jacob Thomas, Vinitha Varghese Panicker, Gopikrishnan Anjanayen
DOI:10.4103/0378-6323.156194  PMID:25937139
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RESIDENTS CORNER Top

Viva questions from the IJDVL p. 436
Vishalakshi Viswanath, Resham Vasani
DOI:10.4103/0378-6323.159948  PMID:26144856
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ANNOUNCEMENT Top

Announcement p. 442
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Online since 15th March '04
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