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   Table of Contents - Current issue
Coverpage
January-February 2015
Volume 81 | Issue 1
Page Nos. 1-105

Online since Tuesday, January 06, 2015

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EDITORIALS  

Awards, images, instructions Highly accessed article p. 1
M Ramam
DOI:10.4103/0378-6323.148554  PMID:25566887
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Hello, limitations! The paradoxical power of limits in scientific writing Highly accessed article p. 4
Sanjay Singh
DOI:10.4103/0378-6323.148555  PMID:25566888
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Current status of genodermatoses: An Indian perspective p. 7
Deepika Pandhi
DOI:10.4103/0378-6323.148556  PMID:25566889
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THERAPEUTIC GUIDELINES - IADVL Top

Phototherapy for atopic dermatitis Highly accessed article p. 10
Sunil Dogra, Rahul Mahajan
DOI:10.4103/0378-6323.148557  PMID:25566890
Background: The aim of these guidelines is to review the available published literature regarding the effectiveness of phototherapy and photochemotherapy in atopic dermatitis and put forward recommendations regarding their use in atopic dermatitis. Materials and Methods: A literature search was performed to collect data from PubMed, EMBASE, and the Cochrane Library published till March 2014. Keywords used were "phototherapy", "photochemotherapy", "NB-UVB", "BBUVB", "PUVA", "UVA1", "atopic dermatitis", and "atopic eczema". Systematic reviews, meta-analysis, national guidelines, randomized controlled trials, prospective open label studies, and retrospective case series in English literature mentioning use of above-mentioned keywords were reviewed. Results: Six hundred and eighty eight studies were evaluated, 38 of which fulfilled the criteria for inclusion in the guidelines. Conclusions and Recommendations: Both UV1 and narrow-band UVB are effective in significantly decreasing the eczema severity although UV1 may be preferred in acute flares and narrow-band UVB in chronic eczema, especially in adults (Level of evidence 1+, Grade of recommendation A). Among various doses of UVA1, medium dose UVA1 may be preferred over others as its efficacy is similar to high dose and better than low dose UVA1 phototherapy. Narrow-band UVB is preferred to broad-band UVB (Level of evidence 1+, Grade of recommendation A). Medium-dose UVA1 is similar in efficacy to narrow-band UVB (Level of evidence 1+, Grade of recommendation A). In children, despite its efficacy, narrow-band UVB phototherapy should be used only as a second line therapy due to its potential for long-term adverse effects (Level of evidence 2+, Grade of recommendation B).
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ORIGINAL ARTICLES Top

Clinical profile and mutation analysis of xeroderma pigmentosum in Indian patients p. 16
Parag M Tamhankar, Shruti V Iyer, Shyla Ravindran, Neerja Gupta, Madhulika Kabra, Chitra Nayak, Mahendra Kura, Swapnil Sanghavi, Rajesh Joshi, Vasundhara Sridhar Chennuri, Uday Khopkar
DOI:10.4103/0378-6323.148559  PMID:25566891
Background: Xeroderma pigmentosum (XP) is an autosomal recessive genetic disorder characterized by cutaneous and ocular photosensitivity and an increased risk of developing cutaneous neoplasms. Progressive neurological abnormalities develop in a quarter of XP patients. Aim: To study the clinical profile and perform a mutation analysis in Indian patients with xeroderma pigmentosum. Methods: Ten families with 13 patients with XP were referred to our clinic over 2 years. The genes XPA, XPB and XPC were sequentially analyzed till a pathogenic mutation was identified. Results: Homozygous mutations in the XPA gene were seen in patients with moderate to severe mental retardation (6/10 families) but not in those without neurological features. Two unrelated families with a common family name and belonging to the same community from Maharashtra were found to have an identical mutation in the XPA gene, namely c.335_338delTTATinsCATAAGAAA (p.F112SfsX2). Testing of the XPC gene in two families with four affected children led to the identification of the novel mutations c.1243C>T or p.R415X and c.1677C>A or p.Y559X. In two families, mutations could not be identified in XPA, XPB and XPC genes. Limitation: The sample size is small. Conclusion: Indian patients who have neurological abnormalities associated with XP should be screened for mutations in the XPA gene.
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Analysis of twenty pediatric cases of tuberous sclerosis complex: Are we doing enough? p. 23
Jyoti Nath, Abhishek Dubey, Raj Pavan
DOI:10.4103/0378-6323.148560  PMID:25566892
Background: Tuberous sclerosis complex (TSC) is a neuro-cutaneous disease characterized by hamartoma formation in various organs particularly the skin, brain, eye, kidney, heart and lungs. Patients usually have multisystem involvement and thus present to different medical specialties with varied complaints while the true nature of the disease and the hidden manifestations may remain unattended. A im: To assess the frequency and characteristics of various cutaneous and systemic manifestations in TSC and the total impact on different system in a cohort of pediatric patients. Methods: The study included 20 patients fulfilling the diagnostic criteria for TSC from dermatology, pediatrics, and neurology department. Detailed history, examination, and investigations such as chest X-ray, electrocardiography (ECG), ultrasonography (USG) abdomen, echocardiography, fundoscopy, computed tomography (CT) scan of brain and abdomen were done. Results: Dermatological manifestations included ash leaf macules, angiofibromas, shagreen patch, and fibrous plaque. Systemic findings observed were subependymal calcified nodules, subependymal giant cell astrocytoma, cortical tubers, renal cysts, angiomyolipomas, lung cyst, retinal hamartomas, mental deficits and epilepsy. Limitations: Wechsler's Intelligence Scale for Children would have been more appropriate for assessing the intelligence. Dental check-up was not done in our group of patients. Conclusion: Our study highlights the wide variety of cutaneous and systemic manifestations of TSC. The study emphasizes the need for comprehensive multidisciplinary treatment and periodic follow-up which are necessary for appropriate management of this multisystem disorder. Counseling regarding education and rehabilitation of the patients and genetic counseling of parents are important.
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Histopathological characteristics of post kala-azar dermal leishmaniasis: A series of 88 patients p. 29
Avninder Singh, V Ramesh, M Ramam
DOI:10.4103/0378-6323.148562  PMID:25566893
Background: Post kala azar dermal leishmaniasis (PKDL) is a sequel to visceral leishmaniasis or kala azar seen predominantly in the Indian subcontinent and Africa. Histopathological descriptions of the condition are limited. Methods: Biopsies of 88 skin and 16 mucosal lesions were evaluated for histopathological findings on formalin-fixed, paraffin-embedded tissues. Results: There were 71 (80.7%) males and 17 (19.3%) females with a mean age of 24.8 and 28.5 years, respectively. A past history of kala azar was present in 64 (72.7%) patients and post kala azar dermal leishmaniasis developed a mean of 6.2 years after visceral leishmaniasis. Of the biopsies studied, the clinical lesions were macular in 14 (15.9%), papulo-nodular in 32 (36.3%) and showed both macules and papulo-nodules in 42 (47.8%). Follicular plugging was a common epidermal finding. A clear Grenz zone was frequently noted. The dermal infiltrates were arranged mainly in three patterns: superficial perivascular infiltrates in 16 (18.1%), perivascular and perifollicular infiltrates in 24 (27.3%) and diffuse infiltrates in 41 (46.6%) biopsies. Leishman-Donovan (LD) bodies were noted in 13 (44.9%) of 69 cases on slit-skin smear and in 25 (28.4%) of 88 biopsies. In 16 patients, where both skin and mucosal biopsies were available, LD bodies were identified in 10 (62.5%) mucosal biopsies as compared to 3 (18.7%) skin biopsies. Limitations: The retrospective nature of the study and the lack of controls were limitations. Conclusion: The various histomorphological patterns of post kala azar dermal leishmaniasis are a useful clue to the diagnosis even when LD bodies have not been detected. This study also suggests that LD bodies are more frequently seen in mucosal biopsies in comparison to cutaneous biopsies.
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BRIEF REPORT Top

Monthly rifampicin, ofloxacin, and minocycline therapy for generalized and localized granuloma annulare p. 35
Shilpa Garg, Sukriti Baveja
DOI:10.4103/0378-6323.148564  PMID:25566894
Background: The localized form of granuloma annulare is usually self-limiting, resolving within 2 years. Generalized granuloma annulare, on the other hand, runs a protracted course, with spontaneous resolution being rare. It is also characterized by a later age of onset, an increased incidence of diabetes mellitus, poor response to therapy, and an increased prevalence of HLA Bw35. Objective: To assess the efficacy of monthly pulsed rifampicin, ofloxacin, and minocycline (ROM) therapy in the management of granuloma annulare. Methods : Six biopsy proven patients of granuloma annulare were included in the study, five of the generalized variety, and one localized. Three of these patients were resistant to standard modalities of treatment. All six patients were treated with pulses of once monthly ROM till complete resolution of all lesions. Results were analyzed in terms of complete resolution of lesions and side effects. Presence of comorbid conditions was noted. Result: All six patients were successfully treated with 4-8 pulses of monthly ROM. None of the patients reported any adverse effects. Limitations: Small sample size and the lack of a control group are limitations. Conclusion: Treatment with pulses of once monthly ROM caused complete resolution of lesions in both localized and generalized granuloma annulare, even in cases recalcitrant to conventional therapy. There were no side effects in any of the patients. Larger trials are needed to substantiate the efficacy of monthly ROM in granuloma annulare.
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CASE REPORTS Top

Epidermolysis bullosa pruriginosa: A case with a novel mutation and co-existent lichen amyloidosus p. 40
Qiping Chen, Joyce Siong-See Lee, Hong Liang Tey
DOI:10.4103/0378-6323.148565  PMID:25566895
Epidermolysis bullosa pruriginosa is a rare variant of dystrophic epidermolysis bullosa characterized by severely pruritic and cicatricial lesions localized to the extensor extremities. We report a Singaporean Chinese male with epidermolysis bullosa pruriginosa with an underlying novel mutation in the COL7A1 gene. A heterozygous acceptor splice site mutation IVS67-1G>T probably led to in-frame skipping of exon 68 (36-basepairs), resulting in a loss of 12 amino acids. Among his three children, only the youngest son, who had bilateral big toenail thickening, possessed the same mutation. His skin biopsy one decade ago revealed association of focal amyloidosis; a recent skin biopsy showed more established features of lichen amyloidosis. It is debatable whether the cutaneous amyloidosis was a secondary or primary phenomenon. Our report highlights that the diagnosis of epidermolysis bullosa pruriginosa may be obscured when cutaneous amyloidosis is coexistent.
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Drug Eruptions Induced by Allopurinol Associated with HLA-B*5801 p. 43
Meihua Zeng, Min Zhang, Fang Liu, Wenliang Yan, Qingtao Kong, Hong Sang
DOI:10.4103/0378-6323.148566  PMID:25566896
Allopurinol, a drug commonly used for treating gout and hyperuricemia, is a frequent cause of drug eruptions. Recent investigations suggest that HLA-B*5801 allele is a very strong marker for allopurinol-induced cutaneous adverse drug reactions (cADRs). In this article we report two cases of allopurinol-induced drug eruptions in patients carrying the HLA-B*5801 allele and review the literature on the association between HLA-B*5801 and allopurinol-induced cADRs based on a MEDLINE and PubMed search
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Familial angiokeratoma corporis diffusum without identified enzyme defect p. 46
Ying-Yi Lu, Chun-Ching Lu, Chieh-Shan Wu, Chieh-Hsin Wu
DOI:10.4103/0378-6323.148568  PMID:25566897
Angiokeratoma corporis diffusum is the cutaneous hallmark of several rare inherited lysosomal diseases associated with specific enzyme deficiencies in the metabolism of glycoproteins, most notably Fabry disease. These defects result in many systemic manifestations. Here, we report a rare familial case of angiokeratoma corporis diffusum that developed at puberty with no major systemic manifestations and no underlying enzyme defect or gene mutation. Familial angiokeratoma corporis diffusum without identified enzyme defect appears to be a distinct clinical entity with a benign course.
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IMAGES IN CLINICAL PRACTICE Top

Aggressive calciphylaxis in end-stage renal disease after a failed kidney allograft p. 50
Charat Thongprayoon, Wisit Cheungpasitporn, Jackrapong Bruminhent
DOI:10.4103/0378-6323.148569  PMID:25566898
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RESIDENT’S PAGE Top

Interferons p. 51
Bharat Bhushan Mahajan, Sandeep Kaur
DOI:10.4103/0378-6323.148570  PMID:25566899
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LETTERS TO THE EDITOR Top

The efficacy of macrolides and acyclovir in pityriasis rosea p. 56
Francesco Drago, Giulia Ciccarese, Alfredo Rebora, Aurora Parodi
DOI:10.4103/0378-6323.148572  PMID:25566900
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Author's Response - The efficacy of azithromycin in pityriasis rosea: A randomized, double-blind, placebo-controlled trial p. 57
Deepika Pandhi, Prashant Verma, Archana Singal, Reena Sharma
DOI:10.4103/0378-6323.148573  PMID:25566901
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Cutaneous mercury granuloma following accidental occupational exposure p. 57
Anisha George, Kanwardeep Singh Kwatra, Sirish Chandra
DOI:10.4103/0378-6323.148574  PMID:25566902
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Subcutaneous human dirofilariasis p. 59
Sreekanth Sukumarakurup, Binitha Manikoth Payyanadan, Reena Mariyath, Minu Nagesh, Anitha Puduvail Moorkoth, Devarajan Ellezhuthil
DOI:10.4103/0378-6323.148576  PMID:25566903
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Elastosis linearis rubra nasi: A new clinical entity in the spectrum of localized nodular elastosis p. 62
Shyam Bhanu Verma, Rajiv S Joshi
DOI:10.4103/0378-6323.148577  PMID:25566904
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Reactive eccrine syringofibroadenoma on a leprous foot p. 64
Debabrata Bandyopadhyay, Sarbani Chattopadhyay, Simanti Saha
DOI:10.4103/0378-6323.148578  PMID:25566905
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Hyperpigmentation along Blaschko lines p. 66
Krishna Deb Barman, Sumit Sethi, Vijay K Garg, Neeta Khurana
DOI:10.4103/0378-6323.148580  PMID:25566906
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Erosive adenomatosis of the nipple in a man p. 68
Xiaoping Gu, Guangping Wang, Ruibin Wu, Hong Jia
DOI:10.4103/0378-6323.148581  PMID:25566907
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Acrodermatitis enteropathica in an infant with normal zinc levels p. 70
Malcolm Pinto, M Ramesh Bhat, Sukumar Dandekeri, Srinath M Kambil
DOI:10.4103/0378-6323.148583  PMID:25566908
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Blaschkoid mastocytosis p. 72
Sharad Mehta, Vaishali Masatkar, Ashok K Khare, Asit Mittal, Lalit K Gupta
DOI:10.4103/0378-6323.148584  PMID:25566909
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Enalapril induced normocomplementemic urticarial vasculitis p. 73
Savita Koregol, Varna Naidu, Sudhakar Rao, BS Ankad
DOI:10.4103/0378-6323.148586  PMID:25566910
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Congenital self-healing Langerhans cell histiocytosis in a male neonate p. 75
Qi Tan, Li Qiang Gan, Hua Wang
DOI:10.4103/0378-6323.148587  PMID:25566911
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Pilomatricoma with a bullous appearance p. 77
Hua-Li Cao, Ji-Su Chen, Jian-Liang Yan, Jian-You Wang
DOI:10.4103/0378-6323.148588  PMID:25566912
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Giant eccrine spiradenoma mimicking a malignant tumor p. 79
Satyabrata Tripathy, Laxmikanta Mishra, Manas Baisakh, Nachiketa Mohapatra, Sarala Das
DOI:10.4103/0378-6323.148590  PMID:25566913
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Allergic contact dermatitis due to clotrimazole with cross-reaction to miconazole p. 80
C Abhinav, Vikram K Mahajan, Karaninder S Mehta, Pushpinder S Chauhan
DOI:10.4103/0378-6323.148592  PMID:25566914
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Allergic contact dermatitis to Parthenium hysterophorus mimicking actinic prurigo p. 82
Saurabh Singh, Sujay Khandpur, Vinod Kumar Sharma
DOI:10.4103/0378-6323.148594  PMID:25566915
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Does contact allergy to benzocaine cause orodynia? p. 84
Arshdeep , Dipankar De, Sanjeev Handa
DOI:10.4103/0378-6323.148596  PMID:25566916
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Fox-Fordyce disease: A report of 2 cases responding to topical clindamycin p. 87
Anisha George, Anuradha Bhatia, Emy Thomas
DOI:10.4103/0378-6323.148597  PMID:25566917
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Hailey-Hailey disease with skin lesions at unusual sites and a good response to acitretin p. 88
Biju Vasudevan, Rajesh Verma, Sonia Badwal, Shekar Neema, Debdeep Mitra, T Sethumadhavan
DOI:10.4103/0378-6323.148600  PMID:25566918
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Lack of effectiveness of keratin dressings in epidermolysis bullosa p. 91
Hacer Altun Sürücü, Yavuz Yesilova, Enver Turan, Mustafa Aksoy, Osman Tanrikulu, Naime Eroglu
DOI:10.4103/0378-6323.148602  PMID:25566919
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QUIZ Top

A nose for trouble p. 93
Giuseppe Fumo, Federico Patta, Carla Milo, Luca Pilloni, Laura Atzori
DOI:10.4103/0378-6323.148604  PMID:25566920
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E-IJDVL - NET STUDY Top

Intravenous methylprednisolone pulse therapy in severe alopecia areata p. 95
Simona C Senila, Sorina A Danescu, Loredana Ungureanu, Elisabeta Candrea, Rodica M Cosgarea
DOI:10.4103/0378-6323.148608  PMID:25566921
Background: Severe, extensive, therapy resistant alopecia areata represents a clinical challenge. Systemic corticosteroids are a therapeutic tool that still needs to be evaluated. Aim: The purpose of this study was to assess the efficacy and safety of methylprednisolone pulse therapy in alopecia areata and to find prognostic factors for a favourable outcome. Methods: A total of 32 patients with severe multifocal alopecia areata (more than 40% scalp hair loss), alopecia totalis, and alopecia universalis were treated with infusions of 500 mg methylprednisolone for 3 days every month for 3 consecutive months. The end point of the study was 12 months. Results: Of 32 patients, 26 (81.3%) reported a clinical response. Four patients (12.5%) showed complete hair regrowth, 6 patients (18.8%) showed >50% hair regrowth, ten (31.3%) had <50% hair regrowth, 6 (18.75%) were non responders, and another 6 patients (18.8%) had relapse after an initial regrowth. Multivariate analysis revealed that patients reporting at the first episode and those with multifocal disease had the best results. Conclusion: Methylprednisolone infusions represent a possible therapeutic option for patients with multifocal alopecia areata and those presenting with the first episode of the disease.
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E-IJDVL - NET LETTERS Top

Giant facial cutaneous tuberculosis p. 95
Karina S.Y. Ng How Tseung, Jing Jun Zhao, Yan Ru Jia, Uma Keyal, Anil Kumar Bhatta
DOI:10.4103/0378-6323.148610  PMID:25566922
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Insect bite reaction and HIV infection p. 95
S Pradeep Nair
DOI:10.4103/0378-6323.148612  PMID:25566923
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Acute generalized exanthematous pustulosis in a child probably induced by terbinafine p. 95
Sedef Bayata, Aylin Türel Ermertcan, Mehmet Ates, Peyker Temiz
DOI:10.4103/0378-6323.148614  PMID:25566924
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Recurrent Spitz nevus with multiple satellite lesions on perineum p. 96
J Chen, QT Kong, M Zhang, H Sang
DOI:10.4103/0378-6323.148616  PMID:25566925
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Secondary comedones after waxing p. 96
Jignesh Babulal Vaishnani
DOI:10.4103/0378-6323.148617  PMID:25566926
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RESIDENTS CORNER Top

Viva questions from the IJDVL p. 97
Vishalakshi Viswanath, Resham Vasani
DOI:10.4103/0378-6323.148618  
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IADVL ANNOUNCEMENTS Top

IADVL Announcements p. 105
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Online since 15th March '04
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