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   Table of Contents - Current issue
Coverpage
July-August 2020
Volume 86 | Issue 4
Page Nos. 337-470

Online since Wednesday, June 10, 2020

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EDITORIAL  

Publishing in the time of pandemic: Editorial policy of a dermatology journal during COVID-19 p. 337
Saumya Panda
DOI:10.4103/ijdvl.IJDVL_704_20  PMID:32525104
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AWARD ARTICLE Top

Nail dermoscopy (onychoscopy) findings in the diagnosis of primary onychomycosis: A cross-sectional study p. 341
Manasa Narayan Kayarkatte, Archana Singal, Deepika Pandhi, Shukla Das, Sonal Sharma
DOI:10.4103/ijdvl.IJDVL_100_19  PMID:32415047
Background: Diagnosis of onychomycosis involves direct microscopic examination with potassium hydroxide, culture or histopathology with periodic acid–Schiff staining. Nail dermoscopy (onychoscopy) is a noninvasive, rapid and easily available diagnostic tool though its utility in onychomycosis remains unexplored. Objective: To describe the various onychoscopic patterns and compare its percentage positivity with that of standard potassium hydroxide examination, culture and histopathology in patients with a clinical diagnosis of onychomycosis. Methods: The study recruited 100 patients with a presumptive clinical diagnosis of onychomycosis. A detailed history, physical examination including that of nails and clinical photography was followed by onychoscopy with DermLite DL3. The nail clippings were sent for direct microscopic examination with potassium hydroxide, mycological culture and histopathology with periodic acid–Schiff stain. The patient was said to have onychomycosis if at least one of the three tests was positive. Results: Onychomycosis was confirmed by potassium hydroxide and/or culture and/or histopathology in 88 patients. Onychoscopic features were identified and their association with different clinical variants of onychomycosis was attempted. Percentage positivity for diagnosing onychomycosis in decreasing order was: direct microscopic examination with potassium hydroxide followed by spiked pattern, subungual hyperkeratosis, distal irregular termination on onychoscopy, histopathology, mycological culture and ruins aspect again observed on onychoscopy. Limitations: Small sample size. Conclusions: Many onychoscopic features are highly specific for different variants of onychomycosis so onychoscopy may serve as an important and quick adjunct to diagnose onychomycosis until other time-consuming investigations, such as culture and periodic acid–Schiff become available. Studies on a larger population will help arrive at a logistic conclusion.
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ORIGINAL ARTICLES Top

Nonsegmental vitiligo follows Blaschko's lines and embryonic pigmentary segments Highly accessed article p. 350
Nilendu Sarma
DOI:10.4103/ijdvl.IJDVL_790_18  PMID:31898641
Background: Pathogenic mechanism that determines the localization of vitiligo patches and thus a patterned distribution in patients with nonsegmental vitiligo has remained poorly elucidated. A distributional similarity of the vitiligo patches with Blaschko's lines has been documented in patients with segmental vitiligo, both isolated segmental vitiligo and mixed vitiligo but never in cases of nonsegmental vitiligo. Methods: Distribution of nonsegmental vitiligo patches on face and neck regions was assessed and compared with Blaschko's lines and also with embryonic pigmentary segments on the face. Results: This study has documented distributional similarity of the nonsegmental vitiligo patches on face and neck with Blaschko's lines and the “embryonic pigmentary segments” among 154 (58.6%) cases. Patches around the palpebral and other fissures like periorbital, perinasal, perioral, and periaural were more common. In addition to the vitiligo patches, the spared areas were also found to respect the embryonic segmental outlines and follow the Blaschko's lines. Conclusion: Distributional pattern of the individual nonsegmental vitiligo patches along the Blaschko's lines and embryonic pigmentary segments suggests that mosaicism might control the susceptibility to the disease process in a patterned manner. Limitation: No genetic testing could be performed to confirm the hypothesis. Evaluation of nonsegmental vitiligo was done only on the face and neck areas.
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Pigmented linear discoid lupus erythematosus following the lines of Blaschko: A retrospective study of a Chinese series p. 359
Wei Liu, Sergio Vano-Galvan, Jia-Wei Liu, Yue-Tong Qian, Kai Fang, Dong-Lai Ma
DOI:10.4103/ijdvl.IJDVL_341_19  PMID:32270767
Background: Linear cutaneous lupus erythematosus is a rare subtype of lupus erythematosus (LE) that develops linear lesions following the lines of Blaschko. Linear cutaneous lupus erythematosus may present as various subtypes of LE, including linear discoid lupus erythematosus. There are few reports about pigmentedlinear discoid lupus erythematosus in the literature. Aims: We aimed to summarize the clinical and pathological features of patients with pigmented linear discoid lupus erythematosus following the lines of Blaschko. Methods: Eighteen patients with pigmented linear discoid lupus erythematosus attending the outpatient department of the Dermatology, Peking Union Medical College Hospital, China, were enrolled in the study. We recorded clinical data including sex, age at onset, disease duration, location and distribution of the lesions, symptoms, trigger factors, antinuclear antibody (ANA) testing, therapy, and therapeutic responses. Histopathological features were also summarized. Results: All 18 patients presented with well-defined brownish pigmented linear or segmental macules or plaques, following the lines of Blaschko. All the lesions were located on the head or neck. Unilaterally distributed lesions were found in 94.4% of patients. Two patients showed low titers of ANA in a speckled pattern. No systemic involvement or progression to systemic LE was noted. The patients were clinically diagnosed as pigmented lichen planus (55.6%), pigmented linear discoid lupus erythematosus (33.3%), and linear morphea (11.1%) before histopathological examination. Limitations: The study was retrospective and direct immunofluorescence was not performed. Not all patients' information was available and 4 patients were lost to follow-up because their contact information was changed. Conclusion: Pigmented linear discoid lupus erythematosus mostly occurs on the head and neck. It manifests as brownish macules along the lines of Blaschko. Differentiation between pigmented linear discoid lupus erythematosus and other dermatoses that have a linear distribution can be difficult both clinically and pathologically, but histological details can help distinguish them.
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The bidirectional association between type 2 diabetes and psoriasis: Two retrospective cohort studies p. 366
Hsien-Yi Chiu, Chu-Ju Hung, Chih-Hsin Muo, Kang-Chih Fan, Fung-Chang Sung
DOI:10.4103/ijdvl.IJDVL_428_18  PMID:32031110
Background: Inflammation plays a crucial role in both type 2 diabetes mellitus (T2DM) and psoriasis pathogenesis; thus, a bidirectional association between them is likely suspected. Aims: We investigated the possible bidirectional association between T2DM and psoriasis. Methods: Using the Taiwan National Health Insurance Research Database, we conducted two retrospective cohort studies. The analysis of psoriasis onset in relation to T2DM status included 31,697 patients with diabetes and 126,788 nondiabetic control subjects (Analysis 1). The analysis of T2DM onset in relation to psoriasis status included 1,947 psoriatic patients and 7,788 nonpsoriatic control subjects (Analysis 2). The follow-up period was from 2000 to the date of the outcome of interest, date of death, or December 31, 2013. Cox proportional models were used to estimate the relative hazards. Results: In Analysis 1, Kaplan–Meier (KM)-based cumulative incidence of psoriasis was higher in the T2DM cohort than that in the non-T2DM cohort (1.2% vs. 0.7%). The covariate-adjusted hazard ratio (HR) was 1.40 [95% confidence interval (CI), 1.20–1.63] for patients with T2DM. Analysis 2 revealed KM-based cumulative T2DM incidences of 18.7% and 13.1% in psoriatic and nonpsoriatic subjects, respectively. The adjusted HR for incident T2DM was higher in patients with psoriasis (1.38; 95% CI, 1.20–1.58). Limitation: This article may not represent the population worldwide and patient selection bias may exist. Conclusion: Our results provide evidence for a bidirectional T2DM–psoriasis association. T2DM and psoriasis are common worldwide; thus, our findings have public health implications for the early identification and management of these comorbid diseases.
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Type D personality is associated with poor quality of life, social performance, and psychological impairment in patients with moderate to severe psoriasis: A cross-sectional study of 130 patients p. 375
Paula Aguayo-Carreras, Jose Carlos Ruiz-Carrascosa, Alejandro Molina-Leyva
DOI:10.4103/ijdvl.IJDVL_114_19  PMID:31857521
Background: Psoriasis is a systemic autoinflammatory disease that is related to an increased risk of organic and psychological comorbidities. Type D personality has been related to poor quality of life and worse physical and psychological outcomes in different diseases. Aims: The aim of this study is to explore whether type D personality is associated with an increased risk of presenting physical and/or psychological comorbidities, their relationship with the capacity of social adaptation, and health-related quality of life (HRQOL) in patients with psoriasis. Methods: This was a cross-sectional study. In all, 130 patients with moderate to severe psoriasis were included in this study. Participants completed the DS14 test and different validated questionnaires regarding quality of life and psychological morbidities. Results: Type D personality was present in 38.4% (50/130) of the participants of the study. Patients with psoriasis and type D personality presented a higher risk of depression and anxiety. We observed that type D personality was associated with a lower educational level. These patients also presented a worse HRQOL in different dimensions of the Short Form Health Survey-36 questionnaire, more sleep problems, poor social adaptation, and a higher frequency of sexual disturbances. Limitations: Due to the cross-sectional design of the study, we could not confirm causality. Selection of sample was not random. Diagnoses of physical comorbidity were collected through clinical interview of patients under active treatment, which may imply a classification bias. Conclusion: Type D personality could represent a frequent personality profile in patients with psoriasis that could identify subjects with poor coping abilities to the disease with poorer levels of quality of life, increased psychological comorbidities, and inadequate social adaptation mechanisms.
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CASE REPORT Top

Pseudoxanthomatous or xanthelasmoid mastocytosis: Reporting a rare entity Highly accessed article p. 382
Preema Sinha, Sunmeet Sandhu, Arijit Sen, Aradhana Sood
DOI:10.4103/ijdvl.IJDVL_633_17  PMID:30785120
Mastocytosis is a disease characterized by abnormal and pathologic increase in mast cells in the cutaneous tissue and extracutaneous organs such as the bone marrow, liver, spleen, lymph node and gastrointestinal tract. Cutaneous mastocytosis comprises of four major clinical variants: solitary and multiple mastocytomas, urticaria pigmentosa, diffuse cutaneous mastocytosis and telangiectasia macularis eruptiva perstans. Cutaneous mastocytosis of the xanthelasmoid type is a rare variant of diffuse mastocytosis. It is clinically characterized by the typical yellowish hue and is accompanied histologically by mast cells infiltrating far into the lower dermis. Here we report one such rare case.
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BRIEF REPORT Top

Macular hypopigmentation, hair loss and follicular spongiosis: A distinct clinicopathological entity Highly accessed article p. 386
Riti Bhatia, Vishal Gupta, Sudheer Arava, Sujay Khandpur, M Ramam
DOI:10.4103/ijdvl.IJDVL_679_17  PMID:30688218
Background: Hypopigmented macules are seen in a variety of disorders and the diagnosis rests on clinicopathological correlation. However, some cases are difficult to classify and pose a diagnostic challenge. Aim: To describe the clinical and histopathological features of patients with hypopigmented macules and follicular spongiosis on histopathology. Materials and Methods: We undertook a retrospective analysis of clinical and histopathological findings in 12 patients who presented with clinically nondiagnostic hypopigmented macules and showed follicular spongiosis on skin biopsy, at All India Institute of Medical Sciences, New Delhi, India between January 2015 and October 2016. The findings were compared with 12 patients with “unclassified” hypopigmented macules, who did not show follicular spongiosis on skin biopsy. Results: A total of 12 patients with hypopigmented macules showed spongiosis affecting the follicular epithelium on histopathology. There were eight men and four women, most in their second decade (mean age 19.1 ± 8.05 years), presenting with hypopigmented macules most commonly on the upper limbs, for a mean duration of 6.33 ± 5.10 months. Clinically evident lesional hair loss was seen in all patients, and follicular prominences in seven (58%) patients. Histological features suggestive of other diagnosis, namely leprosy, mycosis fungoides or sarcoidosis were not seen in any biopsy. Alcian blue stain revealed an minimal amount of mucin in one biopsy. Clinically apparent hair loss and follicular prominences were found to be statistically significantly associated with histological evidence of follicular spongiosis (P < 0.001 and 0.003, respectively). Limitations: Our study is limited by its retrospective design and small sample size. Conclusions: Patients with hypopigmented macules and follicular spongiosis on histopathology may represent a distinct clinicopathological entity that is associated with lesional hair loss and follicular prominences. It is probably a variant of an endogenous dermatitis similar to pityriasis alba.
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IMAGES IN CLINICAL PRACTICE Top

Insect tattoos Highly accessed article p. 392
Valeti Meghana, Hima Gopinath, Kaliaperumal Karthikeyan
DOI:10.4103/ijdvl.IJDVL_226_18  PMID:31290462
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QUIZ Top

Multiple ulcers in an immunocompromised patient Highly accessed article p. 394
Rajsmita Bhattacharjee, Debajyoti Chatterjee, Tarun Narang
DOI:10.4103/ijdvl.IJDVL_538_17  PMID:30516166
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LETTERS TO THE EDITOR - CASE LETTERS Top

Pityriasis lichenoides et varioliformis acuta following measles rubella vaccine p. 398
Veeranna Shastry, P. S. S. Ranugha, Vinutha Rangappa, P Sanjaykumar
DOI:10.4103/ijdvl.IJDVL_48_18  PMID:32474500
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A case of Bier spots with bilateral nevoid telangiectasia p. 400
Yuanbo Huang, Lichao Zhang, Zhongming Li, Mingye Bi
DOI:10.4103/ijdvl.IJDVL_781_19  PMID:32372762
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Papulonecrotic tuberculid with optic neuritis p. 404
Ying Wang, Sitong Li, Yanping Bai, Yong Cui, Zhancai Zheng
DOI:10.4103/ijdvl.IJDVL_817_19  PMID:32445311
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Cutaneous squamous cell carcinoma in a patient with Lynch syndrome p. 407
Sarah Alsukait, Zaid Almohsen, Sohail Alqarawi, Fahad Alsaif
DOI:10.4103/ijdvl.IJDVL_412_19  PMID:32436921
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Facial nodulocystic eruption induced by sorafenib in a patient with hepatocellular carcinoma p. 409
Carlos Duran-Vian, Cristina Gómez-Fernández, Iñigo Navarro-Fernández, Leandra Reguero del Cura, Lucia Alonso-Buznego, M Carmen González-Vela, Marcos A González-López
DOI:10.4103/ijdvl.IJDVL_864_18  PMID:32415051
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Actinic keratosis arising in an epidermal cyst p. 411
Eswari Loganathan, Kuo-Ming Chang, Yu-Hung Wu
DOI:10.4103/ijdvl.IJDVL_521_19  PMID:32461383
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Cutaneous protothecosis in an immunocompetent host p. 414
Aswath Rajan, Varadraj Vasant Pai, Pankaj Shukla
DOI:10.4103/ijdvl.IJDVL_920_18  PMID:32461385
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LETTERS TO THE EDITOR - OBSERVATION LETTERS Top

Morbihan disease: Look beyond facial lymphedema p. 418
Prince Yuvraj Singh, Sukriti Baveja, Deepak Vashisht, Manish Sharma, Prashant Sengupta
DOI:10.4103/ijdvl.IJDVL_1004_18  PMID:32496225
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Dermatoscopic features of incontinentia pigmenti p. 422
Anuradha Bishnoi, Sendhil M Kumaran, Keshavamurthy Vinay
DOI:10.4103/ijdvl.IJDVL_77_19  PMID:32394899
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Pagetoid dyskeratosis of hands: Report of two cases and the usefulness of dermoscopy p. 424
María Librada Porrino-Bustamante, Josefa Sánchez-López, Salvador Arias-Santiago, María Antonia Fernández-Pugnaire
DOI:10.4103/ijdvl.IJDVL_633_19  PMID:32445310
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Primary cutaneous marginal zone B-cell lymphoma with unusual manifestation and spontaneous regression p. 428
Xinyue Tang, Jiaoqing Tang, Weiping Liu, Lin Wang
DOI:10.4103/ijdvl.IJDVL_516_19  PMID:32415050
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Generalized facial pigmentation: An uncommon presentation of cutaneous lupus erythematosus p. 431
Alba Calleja Algarra, Raquel Aragón Miguel, Marta Prieto Barrios, Rafael Llamas Martín, Carlos Zarco Olivo, Maria Del Rosario Haro Ramos, Jose Luis Rodríguez Peralto, Pablo Luis Ortiz Romero, Concepcion Postigo Llorente
DOI:10.4103/ijdvl.IJDVL_603_18  PMID:32461382
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Dermoscopic features of a case of solitary reticulohistiocytoma p. 435
Biswanath Behera, Rashmi Kumari, Devinder Mohan Thappa, Debasis Gochhait
DOI:10.4103/ijdvl.IJDVL_916_18  PMID:32445312
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LETTERS TO THE EDITOR - STUDY LETTERS Top

Cutaneous syndecan-1 expression before and after phototherapy in psoriasis p. 439
Reham William Doss, Abdel-Aziz El-Rifaie, Aya Nagy Said, Laila A Rashed
DOI:10.4103/ijdvl.IJDVL_525_19  PMID:32496227
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A preliminary prospective non-randomized controlled trial to compare the efficacy of subcutaneous etanercept versus oral methotrexate in moderate-to-severe chronic plaque psoriasis and correlation of response with T helper (th) 1, th2, th17 and T regulatory cytokine patterns p. 441
Sujay Khandpur, Aashim Singh, Alok Kumar, Alpana Sharma
DOI:10.4103/ijdvl.IJDVL_443_19  PMID:32496226
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New Drugs and Clinical Trials Rules-2019: What academicians need to know p. 445
Sandeep Lahiry, Sayanta Thakur, Dwaipayan Sarathi Chakraborty
DOI:10.4103/ijdvl.IJDVL_790_19  PMID:32394898
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LETTERS TO THE EDITOR - THERAPY LETTERS Top

Subungual abscess treated by decompression using a CO2laser p. 449
Hanjae Lee, Je-Ho Mun
DOI:10.4103/ijdvl.IJDVL_392_19  PMID:32415049
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Alexandrite (755 nm) laser hair removal therapy reduces recurrence rate of pilonidal sinus after surgery p. 451
Harriet G Luijks, Hedwig A. L. Luiting-Welkenhuyzen, Ellen G. E. Greijmans, H Jorn Bovenschen
DOI:10.4103/ijdvl.IJDVL_97_19  PMID:32415052
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The rationale of ideal pulse duration and pulse interval in the treatment of steatocystoma multiplex using the carbon dioxide laser in a super-pulse mode as opposed to the ultra-pulse mode p. 454
Niharika Dixit, Kabir Sardana, Purnima Paliwal
DOI:10.4103/ijdvl.IJDVL_154_19  PMID:32362600
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“Verrucous vulva”: Meeting therapeutic challenges in massive condyloma acuminata with intralesional immunotherapy p. 456
Saurabh Singh
DOI:10.4103/ijdvl.IJDVL_535_19  PMID:32415053
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PEARLS Top

Polyethylene tube as an attachment to universal serial bus (USB) dermatoscope for preventing cross-infection p. 459
Deepak Jakhar, Chander Grover, Ishmeet Kaur
DOI:10.4103/ijdvl.IJDVL_376_19  PMID:32235100
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IMAGES IN CLINICAL PRACTICE Top

Calciphylaxis in a renal transplant patient p. 461
Alvaro March-Rodriguez, Rebeca Alcalá, Ramon M Pujol
DOI:10.4103/ijdvl.IJDVL_156_19  PMID:31650980
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QUIZ Top

Chronic paronychia with subungual purpura Highly accessed article p. 463
Balakrishnan Nirmal, Renu George, Mandeep Singh Bindra
DOI:10.4103/ijdvl.IJDVL_762_17  PMID:30829296
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OBITUARY Top

Professor Bhanushankar Verma p. 466
Terence J Ryan
DOI:10.4103/ijdvl.IJDVL_451_20  PMID:32436922
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BOOK REVIEW Top

Skin: Clinical Dermatology p. 468
M Ramam
DOI:10.4103/ijdvl.IJDVL_674_20  PMID:32525105
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NET STUDY Top

Expression of pigment epithelium-derived factor in psoriasis, verrucae, squamous cell carcinoma and normal skin: An immunohistochemical study p. 469
Abd Ellatif M Elbalshy, Asmaa M El-Refaie, Essam M Akl
DOI:10.4103/ijdvl.IJDVL_396_19  PMID:32372761
Background: Preservation of homeostasis status in the skin needs an equilibrium of keratinocyte proliferation, differentiation, necrosis and apoptosis. Disturbance of these regulatory mechanisms may lead to keratinocyte neoplastic and hyperproliferative diseases. Pigment epithelium-derived factor is a glycoprotein that is endogenously produced in different tissues and has a variety of biological effects in different diseases. Objective: To evaluate the keratinocyte expression of pigment epithelium-derived factor in normal skin and three epidermal hyperproliferative diseases, namely, psoriasis, verrucae and squamous cell carcinoma. Methods: This study included skin biopsy samples from 80 participants who were divided into four equal groups; each containing 20 samples. The first group included skin biopsies from normal skin, the second group from psoriatic lesions, the third group from verruca vulgaris and the fourth group from squamous cell carcinoma. All tissue samples were stained with hematoxylin and eosin stain and later immunohistochemically for pigment epithelium-derived factor expression. Results: Scores of pigment epithelium-derived factor expression were lower in squamous cell carcinoma and verruca and psoriasis than normal skin with a significant difference (P = 0.04). In addition, the pattern of pigment epithelium-derived factor expression was mainly cytoplasmic in normal skin with a significant difference with that seen in psoriasis, squamous cell carcinoma and verruca vulgaris (P = 0.001). Conclusion: Pigment epithelium-derived factor may play a role in keratinocyte differentiation.
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NET LETTERS Top

Multiple inguinal basal cell carcinomas in the setting of intertrigo p. 469
Alexander Brooks Aria, Lara E Rosenbaum, Michael R Migden
DOI:10.4103/ijdvl.IJDVL_769_18  PMID:31710000
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A case of disseminated histoplasmosis presenting with facial and laryngeal involvement p. 470
Prateek Sondhi, Sanjay Singh, Sujay Khandpur, Shipra Agarwal
DOI:10.4103/ijdvl.IJDVL_707_17  PMID:31650978
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A case of malignant syphilis complicated with myiasis in Northeast China p. 470
Yong-Zhi Ji, Li-Li Jia, Yang Li
DOI:10.4103/ijdvl.IJDVL_912_17  PMID:31929231
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