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   Table of Contents - Current issue
Coverpage
May-June 2016
Volume 82 | Issue 3
Page Nos. 249-366

Online since Wednesday, April 06, 2016

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EDITORIAL  

Vitamin D, bone health and congenital ichthyosis Highly accessed article p. 249
Gomathy Sethuraman, Raman K Marwaha
DOI:10.4103/0378-6323.179750  PMID:27088925
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REVIEW ARTICLES Top

Pure neuritic leprosy: Current status and relevance Highly accessed article p. 252
P Narasimha Rao, Sujai Suneetha
DOI:10.4103/0378-6323.179086  PMID:27088926
Pure neuritic leprosy has always been an enigma due to its clinical and management ambiguities. Although only the Indian Association of Leprologist's classification recognizes 'pure neuritic leprosy' as a distinct sub group of leprosy, cases nonetheless are reported from various countries of Asia, Africa, South America and Europe, indicating its global relevance. It is important to maintain pure neuritic leprosy as a subgroup as it constitutes a good percentage of leprosy cases reported from India, which contributes to more than half of global leprosy numbers. Unfortunately, a high proportion of these patients present with Grade 2 disability at the time of initial reporting itself due to the early nerve involvement. Although skin lesions are absent by definition, when skin biopsies were performed from the skin along the distribution of the affected nerve, a proportion of patients demonstrated leprosy pathology, revealing sub-clinical skin involvement. In addition on follow-up, skin lesions are noted to develop in up to 20% of pure neuritic leprosy cases, indicating its progression to manifest cutaneous disease. Over the decades, the confirmation of diagnosis of pure neuritic leprosy has been subjective, however, with the arrival and use of high-resolution ultrasonography (HRUS) for nerve imaging, we have a tool not only to objectively measure and record the nerve thickening but also to assess the morphological alterations in the nerve including echo texture, fascicular pattern and vascularity. Management of pure neuritic leprosy requires multidrug therapy along with appropriate dose of systemic corticosteroids, for both acute and silent neuritis. Measures for pain relief, self-care of limbs and physiotherapy are important to prevent as well as manage disabilities in this group of patients.
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Glutathione as a skin whitening agent: Facts, myths, evidence and controversies Highly accessed article p. 262
Sidharth Sonthalia, Deepashree Daulatabad, Rashmi Sarkar
DOI:10.4103/0378-6323.179088  PMID:27088927
Glutathione is a low molecular weight thiol-tripeptide that plays a prominent role in maintaining intracellular redox balance. In addition to its remarkable antioxidant properties, the discovery of its antimelanogenic properties has led to its promotion as a skin-lightening agent. It is widely used for this indication in some ethnic populations. However, there is a dichotomy between evidence to support its efficacy and safety. The hype around its depigmentary properties may be a marketing gimmick of pharma-cosmeceutical companies. This review focuses on the various aspects of glutathione: its metabolism, mechanism of action and the scientific evidence to evaluate its efficacy as a systemic skin-lightening agent. Glutathione is present intracellularly in its reduced form and plays an important role in various physiological functions. Its skin-lightening effects result from direct as well as indirect inhibition of the tyrosinase enzyme and switching from eumelanin to phaeomelanin production. It is available in oral, parenteral and topical forms. Although the use of intravenous glutathione injections is popular, there is no evidence to prove its efficacy. In fact, the adverse effects caused by intravenous glutathione have led the Food and Drug Administration of Philippines to issue a public warning condemning its use for off-label indications such as skin lightening. Currently, there are three randomized controlled trials that support the skin-lightening effect and good safety profile of topical and oral glutathione. However, key questions such as the duration of treatment, longevity of skin-lightening effect and maintenance protocols remain unanswered. More randomized, double-blind, placebo-controlled trials with larger sample size, long-term follow-up and well-defined efficacy outcomes are warranted to establish the relevance of this molecule in disorders of hyperpigmentation and skin lightening.
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ORIGINAL ARTICLES Top

Predisposing factors and histopathological variants of cutaneous squamous cell carcinoma: Experience from a North Indian teaching hospital p. 273
Geeti Khullar, Uma Nahar Saikia, Dipankar De, Sanjeev Handa, Bishan Das Radotra
DOI:10.4103/0378-6323.168936  PMID:27088928
Background: Squamous and basal cell carcinomas together constitute the majority of non-melanoma skin cancers. These malignancies are infrequent in Indians as compared to the white skinned population. Literature on squamous cell carcinoma in dark skin is limited. Aim: To analyze the risk factors and to characterize the histopathological subtypes of cutaneous squamous cell carcinoma in Indian patients in an area, non-endemic for arsenicosis. Methods: A retrospective analysis of data from January 2003 to August 2013 was performed to evaluate the predisposing factors and histopathological types of cutaneous squamous cell carcinoma at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh. Demographic and disease characteristics such as age, gender and predisposing factors, particularly premalignant dermatoses were recorded and histopathology slides were reviewed. Results: Of the 13,426 skin biopsy specimens received during the 10-year period, there were 82 (0.6%) cases of squamous cell carcinoma and 170 (1.7%) of basal cell carcinoma. The mean age at diagnosis of cutaneous squamous cell carcinoma was 53.7 years and the male to female ratio was 2:1. The most common site of involvement was the lower limbs in 34 (41.5%) patients. Marjolin's ulcer was present in 36 (43.9%) cases. No predisposing factor was identified in 35 (42.7%) patients. Histopathologically, the tumors were classified most commonly as squamous cell carcinoma not otherwise specified in 33 (40.2%) cases. Limitations: This was a retrospective study and details of occupation and interval between the precursor lesions and development of tumor were not recorded. Immunohistochemistry for human papilloma virus and p53 tumor suppressor protein were not performed as these tests were not available. Conclusion: Cutaneous squamous cell carcinoma is uncommon in Indian patients and a high index of suspicion is necessary when a rapidly enlarging nodule, verrucous fungating plaque or an ulcer with everted margins develops in long standing scars and other predisposing dermatologic conditions. Histopathological examination is mandatory to confirm the diagnosis and identify the subtype and this has prognostic implications.
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Assessment of intralesional injection of botulinum toxin type A injection for hypertrophic scars p. 279
Alhasan M Elhefnawy
DOI:10.4103/0378-6323.173586  PMID:27088929
Background: Hypertrophic scars are dermal fibroproliferative disorders that typically develop after a skin injury heals. They can cause physical, psychological, and cosmetic problems. The management of such scars remains a matter of debate due to lack of effective treatment methods and the inability to prevent recurrences. Recent reports have demonstrated that botulinum toxin type A improves wound healing so it may play a role in treating hypertrophic scars. Aims: We assessed the effectiveness of intralesional botulinum toxin type A injection for treating hypertrophic scars. Methods: This prospective clinical study included twenty patients with hypertrophic scars. Intralesional injection of botulinum toxin type A was given once a month for three months with a follow-up period of six months. Each lesion was injected until slight blanching occurred. Therapeutic satisfaction of the patient and physician were recorded. Lesions were assessed for erythema, itching and pliability. Each item was assessed on a 5-point scale. Results: Therapeutic satisfaction was recorded as 'good' in 14 patients and 'excellent' in the remaining six. The mean erythema score decreased from 3.2 to 1.0, the mean pliability score from 3.3 to 0.8 and the mean itching score from 2.7 to 0.7. All of these were statistically significant. Limitations: A larger sample size and longer follow-up period would have given a better evaluation but was not feasible due to the high expenses involved. Conclusion: Botulinum toxin type A is a novel and promising therapy for hypertrophic scars with few side effects.
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Local antimicrobial, protease and cytokine defense systems in psoriatic skin p. 284
Elga Sidhom, Mara Pilmane, Janis Kisis
DOI:10.4103/0378-6323.171652  PMID:27088930
Background: Psoriasis vulgaris is an inflammatory skin condition characterized by dramatic biochemical and immunological changes. Aims: The aim of the study was to evaluate antimicrobial response, tissue degeneration reactions and distribution of inflammatory cytokines in untreated psoriatic skin as well as the correlations between these factors and influence on the course of the disease. Methods: We evaluated skin samples obtained from routine punch biopsies in 40 patients with psoriasis vulgaris. All tissue specimens were examined by hematoxylin and eosin staining and immunohistochemistry for human beta defensin 2 (HBD-2), matrix metalloproteinase 2 (MMP-2), tumor necrosis factor-alpha (TNF-alpha), interleukin 6 (IL-6) and IL-8. The staining intensity was semi-quantitatively graded. Results: Numerous keratinocytes, fibroblasts and macrophages expressed HBD-2 while the number of MMP-2-positive macrophages, fibroblasts and epitheliocytes varied. TNF-alpha-positive cells varied from a few to numerous in each microscopic field. IL-6-positive cells varied from a few to abundant and IL-8-positive cells from numerous to abundant in each field. Limitations: This study had a rather small patient number. Conclusions: Psoriatic skin shows a strong correlative increase in skin antimicrobial proteins and enzymes mediating tissue degeneration suggesting that the skin maintains compensatory mechanisms during persistent remodeling. While individual notable decrease in antimicrobial proteins was observed in some tissue samples, generally the increased human beta defensin associated with psoriasis is likely to be due to an altered immune status. TNF-alpha, IL-6 and IL-8 are common cytokines expressed in psoriatic skin plaques to maintain the inflammatory cycle. HBD-2, MMP-2 and TNF-alpha positively correlate with the severity of psoriasis. Meanwhile, the expression of IL-8 significantly decreases with clinically more severe psoriasis, perhaps making these factors candidate prognostic factors for psoriatic inflammation.
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BRIEF REPORT Top

Quality of life in acne vulgaris: Relationship to clinical severity and demographic data p. 292
Aayush Gupta, Yugal Kishor Sharma, Kedar Nath Dash, Nitin Dinkar Chaudhari, Sumit Jethani
DOI:10.4103/0378-6323.173593  PMID:27088931
Background: Acne vulgaris is known to impair many aspects of quality of life. However, the correlation of this impairment with clinical severity remains equivocal despite various school, community and hospital-based studies. Aim: A hospital-based study was undertaken to measure the impairment of quality of life of patients of acne vulgaris and correlate it with the severity of lesions. Methods: This was a cross-sectional, questionnaire-based study in a cohort of 100 patients of acne vulgaris attending the outpatient department of our referral hospital. A physician measured the severity of lesions using the global acne grading system, and patients assessed quality of life by completing a questionnaire (Cardiff acne disability index). A correlation of these two was done; some additional correlations were brought out through demographic data collected from the patients. Results: There was no correlation between the severity of acne vulgaris and an impaired quality of life. Patients who consumed alcohol and/or smoked cigarettes were found to have an impaired quality of life. While the severity of acne progressively lessened in older patients, the impact on quality of life increased. Limitations: The sample size was small and there was a lack of guaranteed reliability on the self-reported quality of life. Conclusion: The severity of acne vulgaris does not correlate with impairment in quality of life.
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CASE REPORT Top

Phacomatosis pigmentovascularis: Report of four new cases p. 298
Arti Nanda, Hamad K Al-Abdulrazzaq, Yousif K. R Habeeb, Mohamed Zakkiriah, Faisal Alghadhfan, Rana Al-Noun, Hejab Al-Ajmi
DOI:10.4103/0378-6323.178905  PMID:27088932
Phacomatosis pigmentovascularis is a rare group of syndromes characterized by the co-existence of a vascular nevus and a pigmentary nevus with or without extracutaneous systemic involvement. The existing classifications of phacomatosis pigmentovascularis are based on phenotypic characteristics. We report four new cases of phacomatosis pigmentovascularis, three with phacomatosis cesioflammea demonstrating phenotypic variability, and one with phacomatosis cesiomarmorata. Extracutaneous manifestations were observed in three patients (75%) that included central nervous system involvement in three, bilateral congenital glaucoma in two, and cardiovascular system involvement in one. The molecular basis of phacomatosis pigmentovascularis is yet to be elucidated. Whether the various subtypes of phacomatosis pigmentovascularis are separate molecular entities or phenotypic variants of the same disease needs to be settled.
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IMAGES IN CLINICAL PRACTICE Top

Minoxidil-induced hypertrichosis in a 4-year-old child Highly accessed article p. 304
Shyam B Verma
DOI:10.4103/0378-6323.174406  PMID:27088933
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LETTERS TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES Top

Misinterpretation of ATP2C1 gene mutations p. 306
Massimo Micaroni
DOI:10.4103/0378-6323.175922  PMID:27088934
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LETTERS TO THE EDITOR - STUDY LETTERS Top

Cognitive behavior therapy for psychosocial stress in vitiligo p. 308
Aditi Jha, Manju Mehta, Binod K Khaitan, Vinod K Sharma, M Ramam
DOI:10.4103/0378-6323.175925  PMID:27088935
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Psoriasis and thyroid profile: Analysis of the U.S. National Health and Nutrition Examination Survey database p. 310
Yi Chun Lai, Yik Weng Yew
DOI:10.4103/0378-6323.174382  PMID:27088936
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Relationship between sleep quality and facial sebum levels in women with acne vulgaris p. 313
Özlem Bilgiç, Ayhan Bilgiç, Hilmi Cevdet Altinyazar
DOI:10.4103/0378-6323.174408  
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Nail changes in psoriatic children p. 314
Marjorie Uber, Kerstin Taniguchi Abagge, Renata Robl, Vânia Oliveira Carvalho, Leide Parolin Marinoni
DOI:10.4103/0378-6323.174380  PMID:27088938
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Skin conditions in veterinarians and veterinary workers: A worksite-based study p. 317
Sumaya Zeerak, Iffat Hassan, Farhan Rasool, Yasmeen J Bhat
DOI:10.4103/0378-6323.174409  PMID:27088939
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LETTERS TO THE EDITOR - OBSERVATION LETTERS Top

Bullous hemorrhagic dermatosis probably associated with enoxaparin p. 319
Laura Miguel-Gomez, Pablo Fonda-Pascual, Rosario Carrillo-Gijon, Ernesto Muñoz-Zato
DOI:10.4103/0378-6323.175915  PMID:27088940
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Basal cell carcinoma overlying vitiligo attributable to phototherapy p. 320
Neetu Bhari, Kanika Sahni, Kaushal K Verma, Neena Khanna, Sudheer Arava, Somesh Gupta
DOI:10.4103/0378-6323.175929  PMID:27088941
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Azathioprine-associated anagen effluvium p. 322
Sidharth Sonthalia, Deepashree Daulatabad
DOI:10.4103/0378-6323.174411  PMID:27088942
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Drug reaction with eosinophilia and systemic symptoms due to lercanidipine p. 324
Raoudha Slim, Neila Fathallah, Sofiene Larif, Chaker Ben Salem
DOI:10.4103/0378-6323.175914  PMID:27088943
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Safety of ustekinumab in severe psoriasis with chronic hepatitis B p. 326
Anelise Rocha Raymundo, Ana Paula Berreta Facin, Caio César Silva de Castro, Adriane Reichert Faria
DOI:10.4103/0378-6323.174393  PMID:27088944
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LETTERS TO THE EDITOR - CASE LETTERS Top

Neurofollicular hamartoma p. 329
Ebru Zemheri, Pinar Engin, Seyma Ozkanli, Ilkin Zindanci, Tulay Zenginkinet, Ayse Serap Karadag
DOI:10.4103/0378-6323.175921  PMID:27088945
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Verrucous oral focal mucinosis p. 330
Kinjal Deepak Rambhia, Uday Sharadchandra Khopkar
DOI:10.4103/0378-6323.174384  PMID:27088946
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Palmoplantar keratoderma unveiling renal cell carcinoma: A novel paraneoplastic presentation p. 333
KK Kamalakannan, P Arunprasath, Padmavathy Lanka, Srivenkateswaran Kothandapany
DOI:10.4103/0378-6323.174410  PMID:27088947
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Blaschko-linear angioma serpiginosum p. 335
Dipti Das, Chitra S Nayak, Swagata A Tambe
DOI:10.4103/0378-6323.175916  PMID:27088948
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Facial solar porokeratosis p. 337
Ami Ramnik Dedhia, Shylaja J Someshwar, Hemangi Rajeev Jerajani
DOI:10.4103/0378-6323.174391  PMID:27088949
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Choroidal melanoma in phacomatosis pigmentovascularis cesioflflammea p. 339
Hui Zhou, Jiande Han, Renxiang Mao, Mukai Chen
DOI:10.4103/0378-6323.174387  PMID:27088950
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LETTERS TO THE EDITOR - THERAPY LETTERS Top

Intralesional mumps, measles and rubella vaccine in the treatment of cutaneous warts p. 343
Poonam Saini, Asit Mittal, Lalit K Gupta, Ashok K Khare, Sharad Mehta
DOI:10.4103/0378-6323.175920  PMID:27088951
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Effective treatment of severe nail psoriasis using topical calcipotriol with betamethasone dipropionate gel p. 345
Eugene Sern-Ting Tan, Hazel Hwee-Boon Oon
DOI:10.4103/0378-6323.174389  PMID:27088952
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Lack of efficacy of liposomal glucantime in the treatment of cutaneous leishmaniasis p. 347
Vahid Mashayehki Ghoyonlo, Mahmoud Reza Jafari, Mohammad Javad Yazdanpanah, Habiballah Esmaili, Soleiman Noori, Bita Kiafar
DOI:10.4103/0378-6323.175918  PMID:27088953
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IMAGES IN CLINICAL PRACTICE Top

Acquired ectopic hypertrichosis of the tongue Highly accessed article p. 350
KT Ashique
DOI:10.4103/0378-6323.173589  PMID:27088954
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HISTORY Top

The forgotten hair transplantation experiment (1897) of Dr. Menahem Hodara (1869 − 1926) p. 352
Halil Tekiner, Marianna Karamanou
DOI:10.4103/0378-6323.179089  PMID:27088955
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QUIZ Top

Asymptomatic angiomatous lesions on the face and limbs of an adult woman p. 356
Carmen María Alcántara-Reifs, Rafael Salido-Vallejo, Gloria Garnacho-Saucedo, Antonio Rizo-Barrios, Antonio Vélez García-Nieto
DOI:10.4103/0378-6323.179093  PMID:27088956
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E-IJDVL - NET STUDIES Top

Clinical, demographic and immunopathological spectrum of subepidermal autoimmune bullous diseases at a tertiary center: A 1-year audit p. 358
Dipankar De, Geeti Khullar, Sanjeev Handa, Uma Nahar Saikia, Bishan Das Radotra, Biman Saikia, Ranjana W Minz
DOI:10.4103/0378-6323.175928  PMID:27088957
Background: The subepidermal autoimmune bullous diseases are a subset of immunobullous diseases encountered less frequently in the Indian population. There is a paucity of data on the prevalence, demographic and clinicopathological spectrum of various subepidermal autoimmune bullous diseases from India. Aim: To determine the demographic and clinicopathological profile of subepidermal autoimmune bullous diseases in Indian patients, presenting to the Immunobullous Disease Clinic of Postgraduate Institute of Medical Education and Research, Chandigarh. Methods: Patients seen from November 2013 to November 2014 who fulfilled the preset diagnostic criteria of subepidermal autoimmune bullous diseases were identified from case records. Data regarding demographic characteristics, clinical profile, immunopathological findings and treatment were collected from the predesigned proforma. Results: Of 268 cases of autoimmune bullous diseases registered, 50 (18.7%) were subepidermal autoimmune bullous diseases. Bullous pemphigoid was most frequently seen in 20 (40%) cases, followed by dermatitis herpetiformis in 14 (28%), mucous membrane pemphigoid in 6 (12%), chronic bullous dermatosis of childhood / linear immunoglobulin A bullous dermatosis in 5 (10%), lichen planus pemphigoides in 3 (6%), pemphigoid gestationis and epidermolysis bullosa acquisita in 1 (2%) case each. None of the patients had bullous systemic lupus erythematosus. Limitations: We could not perform direct and indirect immunofluorescence using salt-split skin as a substrate and immunoblotting due to non-availability of these facilities. Therefore, misclassification of subepidermal autoimmune bullous diseases in some cases cannot be confidently excluded. Conclusion: Subepidermal autoimmune bullous diseases are not uncommon in Indian patients. Bullous pemphigoid contributes maximally to the burden of subepidermal autoimmune bullous diseases in India, similar to that in the West, although the proportion is lower and disease onset is earlier. Dermatitis herpetiformis was observed to have a higher prevalence in our population, compared to that in the West and the Far East countries. The prevalence of other subepidermal autoimmune bullous diseases is relatively low. Detailed immunofluorescence and immunoblotting studies on larger patient numbers would help better characterize the pattern of subepidermal autoimmune bullous diseases and their features in Indian patients.
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Pemphigus in North-Western Yemen: A therapeutic study of 75 cases p. 359
Mishri Lal Khatri
DOI:10.4103/0378-6323.175917  PMID:27088959
Background: The incidence of pemphigus, though not documented, seems to be quite high in Yemen. There is no universal consensus on the treatment of this disease. Aims: The aim was to evaluate the efficacy and side effects of different therapeutic regimens used in patients of pemphigus in North-Western Yemen. Patients and Methods: Seventy-five Yemeni patients (39 males and 36 females) were included. Diagnosis was based on clinical features, histopathology and the Tzanck test. Results of treatment with these different therapeutic regimens were compared: (1) dexamethasone-cyclophosphamide pulse (DCP), (2) dexamethasone pulse with oral azathioprine, (3) oral prednisolone with azathioprine, (4) oral prednisolone with oral cyclophosphamide, and (5) prednisolone monotherapy. Results: Pemphigus vulgaris (PV) was diagnosed in 46 patients, pemphigus foliaceus (PF) in 23, pemphigus vegetans (PVEG) in 5 and pemphigus herpetiformis (PH) in one. Among the 16 patients who received regular DCP therapy, 13 were in remission for 6 months to 11 years without medications (phase 4). Remission without pharmacotherapy could not be achieved with the other regimens and steroid-induced side-effects appeared to be more than with DCP. Limitations: Immunofluorescence was not available to confirm the diagnosis of pemphigus. Randomization was not done. Conclusion: The DCP regimen seemed to be superior to the other regimens used.
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E-IJDVL - NET LETTER Top

Becker's nevus among siblings p. 359
Varadraj V Pai, Pankaj Shukla, Mayur Bhobe
DOI:10.4103/0378-6323.175912  PMID:27088958
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RESIDENTS CORNER Top

Viva questions from the IJDVL p. 360
Vishalakshi Viswanath, Resham Vasani
PMID:27088960
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Online since 15th March '04
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