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   Table of Contents - Current issue
Coverpage
September-October 2014
Volume 80 | Issue 5
Page Nos. 387-484

Online since Saturday, September 06, 2014

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COMMENTARY  

Not too dark, not too light, the quest for skin, that's just right p. 387
Amit G Pandya
DOI:10.4103/0378-6323.140283  PMID:25201835
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PERSPECTIVE Top

Limitations of histopathology in diagnosis and management of patients with leprosy Highly accessed article p. 389
Rajiv Joshi
DOI:10.4103/0378-6323.140286  PMID:25201836
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VIEWPOINT Top

Lasers for treating striae: An emergent need for better evidence Highly accessed article p. 392
Kabir Sardana
DOI:10.4103/0378-6323.140288  PMID:25201837
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ORIGINAL ARTICLES Top

Skin complexion and pigmentary disorders in facial skin of 1204 women in 4 Indian cities p. 395
Virginie Hourblin, Stephanie Nouveau, Nita Roy, Olivier de Lacharriere
DOI:10.4103/0378-6323.140290  PMID:25201838
Background: The color of Indian skin shows great diversity and pigmentary disorders are a major concern of Indian women. Despite great variations in climate, diet, and social parameters within India, studies of the range of skin types have been rather scarce. Aims: This study was aimed at characterizing the color of Indian skin in various geographical locations, its characteristics in terms of overall skin complexion and pigmentary disorders, and the impact of age on these features. Methods: An extensive descriptive study, including skin color parameters (objective measurements and evaluations by dermatologists, clinically or from photographs) was carried out involving 1,204 female volunteers of different ages living in four different Indian cities. Results: Important differences in skin complexion according to the geographical location were observed. Age seemed to have little impact on complexion. Hyperpigmented spots were frequent and were noted at early stages and many lentigines were found. Melasma affected about 30% of middle-aged women, but many other ill defined, pigmented macules were also observed. Additionally, we found pigmented lip corners associated with marionette lines, and linear nasal pigmentation. Conclusions: Indian skin color is diverse and pigmentary disorders are common. Skin complexion is not greatly affected by age. Some hyperpigmented disorders occur at early stages and increase with age, contributing to overall unevenness of facial color.
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Evaluation of key histologic variables in skin biopsies of patients of borderline leprosy with type 1 lepra reaction p. 402
Nivedita Patnaik, Sarla Agarwal, Sonal Sharma, Satendra Sharma, Deepika Pandhi
DOI:10.4103/0378-6323.140293  PMID:25201839
Background: Leprosy remains an important health problem mainly in the African and South-East Asia regions. Type 1 reaction is an immune-mediated phenomenon known to complicate at least 30% of patients of leprosy. Diagnosing type 1 reaction correctly is important for timely institution of therapy to prevent and treat neuropathy-associated disability and morbidity. There is paucity of literature on definitive criteria for histologic diagnosis of type 1 reaction. This study was conducted to determine the key histologic variables for diagnosing type 1 reaction. Methods: This was a prospective study recruiting 104 patients with borderline leprosy. Three pathologists blinded to the clinical diagnosis independently assessed the cases. The agreement between each histological variable and clinical diagnosis was then calculated by using Cohen's kappa (Κ) coefficient. Results: Histological diagnosis of type 1 reaction was given to 27 (67.5%) of 40 clinically diagnosed cases of type 1reaction cases. Histological variables chosen as key variables for histological diagnosis of type 1 reaction were presence of giant cells, dermal edema, intragranuloma edema, granuloma fraction 31-50%, and presence of medium to large giant cells. Conclusion: This study has shown that T1R are still underdiagnosed histologically in comparison with clinical assessments. The key variables for diagnosing type 1 reaction were proposed.
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Evaluation of an ablative and non-ablative laser procedure in the treatment of striae distensae p. 409
Sule Gungor, Tulay Sayilgan, Gonca Gokdemir, Deniz Ozcan
DOI:10.4103/0378-6323.140296  PMID:25201840
Background: Striae distensae or stretch marks are atrophic linear dermal scars with epidermal atrophy. There are many therapeutic options for management, but no consistently effective modality is available yet. Objective: We compared the efficacy of 1064 nm long pulse (LP) Nd: YAG laser and 2940 nm variable square pulse (VSP) erbium: YAG laser in the treatment of striae distensae. Methods: Twenty female volunteers (Fitzpatrick skin types II-V) aged between 20 and 40 years with striae (3 patients with the rubra type and 17 with the alba type) were enrolled in the study. The duration of striae ranged from 4 months to 12 years. Lesions were located on the abdomen in all patients except one patient who had striae on the arms and two patients with striae in the lumbar region. Treatments were randomly allocated to both sides of the body in each patient, one side being treated with VSP erbium: YAG laser and the opposite side with LP Nd: YAG laser. All subjects were treated monthly for a total of three treatments. Two 3-mm punch biopsies were obtained from six subjects, both of the same striae, one before the first treatment and one 4 weeks after the last session. Results: Response was evaluated clinically by photographic comparison and was found to be poor in 17 subjects, both on the LP Nd: YAG laser treated side and VSP erbium YAG laser treated side. All these patients had mature lesions (striae distensae alba). Three subjects had a moderate response on both sides; these patients' striae were immature (striae distensae rubra). Histologically, elastic fibers were slightly increased in post-treatment samples compared with pretreatment skin biopsies. Conclusion: We observed no satisfactory clinical improvement in striae distensae alba lesions although histopathological changes were seen. We suggest that variable square pulse Er: YAG and long pulse Nd: YAG lasers are not useful in the treatment of striae distensae alba.
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Clinicopathologic assessment of Candida colonization of oral leukoplakia p. 413
Reena Sarkar, GP Rathod
DOI:10.4103/0378-6323.140299  PMID:25201841
Background: Leukoplakia is the most common premalignant lesion of the oral mucosa. We studied the colonization of Candida in oral leukoplakia using direct microscopy, culture and histopathology to determine if there is a statistical correlation between Candida invasion and the clinical appearance and presence of epithelial dysplasia in leukoplakia. Methods: Samples were collected from 40 patients with oral leukoplakia and 21 controls. The swabs collected were used to inoculate Sabouraud's dextrose agar slant and for direct microscopy with Gram's stain. Culture growths were subjected to germ tube and corn meal agar tests to differentiate between Candida albicans and non-albicans groups. Biopsies were also done in all patients for histopathological confirmation; Gomori's methanamine silver stain was used to identify fungal invasion of lesional epithelium. Results and Conclusions: Nineteen cases of leukoplakia showed Candida on direct smears, compared to 3 controls. Eighteen cases and one control showed growth of Candida on culture. Non-homogenous leukoplakia showed a higher positivity rate on microscopy and culture than homogenous lesions. All these correlations were statistically significant. Forty percent of leukoplakia cases were simultaneously positive for Candida on direct microscopy, culture and histopathologic evaluation. No significant difference was found between non-dysplastic and distinctly dysplastic lesions with respect to Candida detection on microscopy or culture.
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CASE REPORTS Top

Intralesional radiofrequency ablation for nodular angiolymphoid hyperplasia on forehead: A minimally invasive approach p. 419
Saurabh Singh, Madhukar Dayal, Ritika Walia, Sudheer Arava, Raju Sharma, Somesh Gupta
DOI:10.4103/0378-6323.140300  PMID:25201842
Angiolymphoid hyperplasia with eosinophilia (ALHE) is an idiopathic acquired condition characterized by erythematous papulo-nodular lesions with a predilection for the head and neck. The lesions are cosmetically disfiguring, resistant to most medical and surgical therapies and tend to recur. We report the novel use of radiofrequency equipment in the management of nodular ALHE on forehead of a 53-year-old man. Intra-lesional radiofrequency ablation was done using a modified 18 gauge intravenous cannula and three sittings over a period of four years yielded cosmetically acceptable results with no recurrence and minimal side effects.
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Use of rituximab in pemphigus patients with chronic viral hepatitis: Report of three cases p. 422
Amrinder J Kanwar, Keshavamurthy Vinay, Kara Heelan, Scott Walsh, Neil H Shear, Radha K Dhiman
DOI:10.4103/0378-6323.140301  PMID:25201843
Use of rituximab in patients with chronic viral hepatitis can worsen pre-existing hepatitis or reactivate occult infection. There are no reports of use of rituximab in pemphigus patients with co-existing viral hepatitis. Herein, we report three pemphigus patients with co-existing chronic viral hepatitis (hepatitis C (n = 2), hepatitis B (n = 1)), who were treated successfully with rituximab under close supervision and concurrent antiviral drug administration. There was no derangement of the liver function tests or increase in viral load in any of the patients. By incorporating good collaboration with a hepatologist and close follow-up, such patients can be managed successfully with biologic therapies when the conventional treatment modalities have failed.
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Hand and foot syndrome secondary to capecitabine p. 427
Hina Shaikh Lal
DOI:10.4103/0378-6323.140302  PMID:25201844
A 55-year-old woman on treatment with capecitabine and paclitaxel for breast carcinoma presented with history of a tingling sensation in her hands and feet with a progressive burning sensation. She also noted discomfort, minimal pain and stiffness while holding objects. On examination, there was patchy hyperpigmentation of both the palms and soles, and the dorsa of hands and feet. This was accompanied by a thickening of the skin more over the knuckles and toes. In addition there was a moist desquamation around the toes and over the palmar creases and a bluish discoloration of the lunulae of both thumbnails. She was diagnosed with hand and foot syndrome and started on pyridoxine and emollients. The finding of keratoderma noted in our patient is not seen commonly in hand and foot syndrome.
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IMAGES IN CLINICAL PRACTICE Top

Mutilating basal cell carcinoma p. 431
Sarabjit Kaur, Nidhi Jindal, VK Jain
DOI:10.4103/0378-6323.140303  PMID:25201845
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RESIDENTíS PAGE Top

Appearances in clinical dermatology  Highly accessed article p. 432
Bhushan Madke, Bhavana Doshi Chougule, Sumit Kar, Uday Khopkar
DOI:10.4103/0378-6323.140304  PMID:25201846
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LETTERS TO THE EDITOR Top

Pattern of pediatric dermatoses in Kashmir valley: A study from a tertiary care center p. 448
Iffat Hassan, Kaisar Ahmad, Atiya Yaseen
DOI:10.4103/0378-6323.140308  PMID:25201847
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Onset of psoriasis triggered by Mantoux test p. 451
Deepshikha Khanna, Archana Singal, Ruchika Gupta
DOI:10.4103/0378-6323.140309  PMID:25201848
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Acquired cutis laxa of face with multiple myeloma p. 454
Tulika A Yadav, Atul M Dongre, Uday S Khopkar
DOI:10.4103/0378-6323.140310  PMID:25201849
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Obesity-associated lymphedematous mucinosis p. 456
Ayse Serap Karadag, Emin Ozlu, Seyma Ozkanli
DOI:10.4103/0378-6323.140311  PMID:25201850
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Bilateral madarosis due to papular mucinosis p. 458
Vani Vasanth, Chandrashekar Byalakere Shivanna, Venkataram Mysore
DOI:10.4103/0378-6323.140312  PMID:25201851
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Congenital lip pits without associated anomalies p. 459
R Shobana, Sanath Aithal, S Srikanth
DOI:10.4103/0378-6323.140314  PMID:25201852
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Multiple cutaneous horns due to discoid lupus erythematosus p. 461
Joyeeta Chowdhury, Piyush Kumar, Ramesh Chandra Gharami
DOI:10.4103/0378-6323.140315  PMID:25201853
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Langerhans cell histiocytosis with widespread ulcers and masses on the palate p. 462
Jiajia Liu, Dongjuan Liu, Yu Zhou, Qianming Chen, Xin Zeng, Xin Jin
DOI:10.4103/0378-6323.140317  PMID:25201854
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Multiple ungual fibromas as an only cutaneous manifestation of tuberous sclerosis complex p. 464
Ezgi Unlu, Ilknur Balta, Serhan Unlu
DOI:10.4103/0378-6323.140318  PMID:25201855
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Granuloma annulare-like palisading as a histological reaction to a tattoo p. 465
Subhash Kashyap, Vinay Shanker, Uday Khopkar
DOI:10.4103/0378-6323.140321  PMID:25201856
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Combined planar and eruptive xanthoma in a patient with type lla hyperlipoproteinemia p. 467
Varadraj V Pai, Pankaj Shukla, Mayur Bhobe
DOI:10.4103/0378-6323.140323  PMID:25201857
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Unilateral asymmetrical double Becker's naevus p. 470
Prafull Mehta, Ramesh Kumar, Suresh Kumar Jain, Naresh N Rai
DOI:10.4103/0378-6323.140325  PMID:25201858
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Craniotomy incision site tumor implantation in a patient with metastatic breast carcinoma p. 471
Kanwaljeet Garg, Ribhav Pasricha, Hitesh Kumar Gurjar, Aanchal Kakkar, Bhawani Shankar Sharma
DOI:10.4103/0378-6323.140328  PMID:25201859
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Classic form of nevus lipomatosis cutaneous superficialis of vulva p. 473
Nidhi Singh, Rashmi Kumari, Devinder Mohan Thappa, Rakhee Kar, Sivashankari Kulandaisamy
DOI:10.4103/0378-6323.140330  PMID:25201860
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Annular elastolytic giant cell granuloma treated with topical pimecrolimus p. 475
Enzo Errichetti, Giuseppe Stinco, Claudio Avellini, Pasquale Patrone
DOI:10.4103/0378-6323.140331  PMID:25201861
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Refractory subacute cutaneous lupus erythematous responding to a single course of belimumab: A new anti-BLyS human monoclonal antibody p. 477
Husein Husein-ElAhmed, Jose Luis Callejas-Rubio, Raquel Rios-Fernandez, Norberto Ortego-Centeno
DOI:10.4103/0378-6323.140335  PMID:25201862
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Nevus sebaceous treated with fractional carbon dioxide laser followed by pulsed dye laser p. 478
Hae Eul Lee, Seung Bae Park, Jeung Hoon Lee, Myung Im
DOI:10.4103/0378-6323.140336  PMID:25201863
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QUIZ Top

Solitary asymptomatic papule on cheek p. 481
Piyush Kumar, Asma Parveen, Anupam Das, Tanumay Raychaudhury, Indu Arun
DOI:10.4103/0378-6323.140343  PMID:25201864
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NET LETTERS Top

Evaluation of serum neuropeptide levels in patients with chronic urticaria p. 483
Pinar Yuksel Basak, Ijlal Erturan, Ozlem Yuksel, Oya Oylum Kazanoglu, Huseyin Vural
DOI:10.4103/0378-6323.140345  PMID:25201865
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Concurrent lichen scrofulosorum and papulonecrotic tuberculid in a patient with tubercular lymphadenitis p. 483
Pravesh Yadav, Vibhu Mendiratta, Nikita , Ram Chander
DOI:10.4103/0378-6323.140347  PMID:25201866
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Hypohidrotic ectodermal dysplasia in association with milia  Highly accessed article p. 483
Sharad Mehta, Nidheesh Agarwal, Ashok Kumar Khare, CM Kuldeep, Asit Mittal, Lalit Kumar Gupta
DOI:10.4103/0378-6323.140348  PMID:25201867
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CHILD syndrome p. 483
GD Heda, Vinayashree Valivade, Prakash Sanghavi, Ram M Kukreja, Yoganand J Phulari
DOI:10.4103/0378-6323.140350  PMID:25201868
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Acquired smooth muscle hamartoma p. 483
Satish A Adulkar, Atul M Dongre, Sarvesh S Thatte, Uday S Khopkar
DOI:10.4103/0378-6323.140351  PMID:25201869
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Capillary malformation associated with multiple accessory tragi p. 484
Pravesh Yadav, Vibhu Mendiratta, Saurabh Mittal, Ram Chander
DOI:10.4103/0378-6323.140352  PMID:25201870
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Tufted hair folliculitis associated with Melkersson-Rosenthal syndrome and hidradenitis suppurativa p. 484
Sule Gungor, Tulin Yuksel, Ilteris Topal
DOI:10.4103/0378-6323.140354  PMID:25201871
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Nicolau syndrome following sclerotherapy for pyogenic granuloma p. 484
Balakrishnan Nirmal, Smitha S Segu, Sarvajnamurthy A Sacchidanand, Pushkar Deshpande
DOI:10.4103/0378-6323.140356  PMID:25201872
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