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   Table of Contents - Current issue
Coverpage
September-October 2019
Volume 85 | Issue 5
Page Nos. 441-568

Online since Friday, August 16, 2019

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REVIEW ARTICLES  

An update on prevalence, diagnosis, treatment and emerging issues of genital mycoplasma infection in Indian women: A narrative review p. 441
Deepti Tandon, Kiran Munne, Sanjay Chauhan, Anushree D Patil
DOI:10.4103/ijdvl.IJDVL_915_18  PMID:31389367
Despite adequate treatment of reproductive tract infection, there is persistence of symptoms in some patients. This raises the possibility of existence of other silent microbes with pathogenic potential. Apart from the common sexually transmitted organisms such as Chlamydia trachomatis and Neisseria gonorrhoeae, there are other silent and emerging pathogens, like genital mycoplasma, which have been associated with cervicitis, pelvic inflammatory disease, infertility, and pregnancy-related complications in women. Although these organisms were identified decades ago, they are still overlooked or ignored. There is a need to understand the role played by these organisms in Asian populations and their susceptibility to the standard line of treatment. Data on genital mycoplasma infections in Indian women is heterogeneous, with limited evidence of pathogenicity. Although known for their wide spectrum of reproductive morbidities in western counterparts, these microorganisms are yet to gain the attention of Indian clinicians and microbiologists. There is paucity of adequate information in India regarding these infections, so Indian literature was compiled to get an overview of these pathogens, their association with reproductive morbidities, and their response to treatment. Thus, there is a need to explore genital mycoplasma infections in Indian women, especially in the arena of antimicrobial resistance among genital mycoplasma, which has the potential to become a major problem. A literature search with keywords focusing on “genital mycoplasma”, “sexually transmitted infections India”, “sexually transmitted mycoplasma”, and “characteristic of mycoplasma” was carried out through computerized databases like PubMed, MEDLINE, Embase, and Google Scholar.
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Dermatoses due to Arabic cultural and traditional practices p. 448
Fatimah Mohammad Budair
DOI:10.4103/ijdvl.IJDVL_123_18  PMID:31389374
A number of social and cultural practices are prevalent in the Middle-East celebrating various occasions or to treat health conditions. These often result in dermatoses that are unfamiliar and confusing to dermatologists outside this region. This paper reviews skin manifestations emanating from traditional and ritual practices in Arab countries, particularly those from Saudi Arabia.
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ORIGINAL ARTICLES Top

A cross-sectional study of the histopathology and immunology of alopecia areata: Unearthing the role of the Janus kinase–signal transducer and activator of transcription pathway p. 455
Anuva Bansal, Vineet Relhan, Vijay Kumar Garg, Ravindra Kumar Saran
DOI:10.4103/ijdvl.IJDVL_738_17  PMID:31031313
Background: Alopecia areata is an autoimmune disease that occurs as a result of the loss of the inherent immune privilege of the hair follicle. It has been recently demonstrated that the interferon-γ/interleukin-15 feedback loop that signals via the Janus kinase–signal transducer and activator of transcription pathway is critical to the breakdown of this immune privilege. Aims: To evaluate the immunological distribution of CD4+ T-cells, CD8+ T-cells, phosphorylated signal transducer and activator of transcription 1 and study its relation with the clinical and histopathological findings of the disease. Materials and Methods: A total of 30 patients of alopecia areata were included in the study. Following a detailed history and clinical examination, a scalp biopsy was performed. Histopathology was studied and immunohistochemistry was done to demonstrate the positivity and distribution of CD4+ T-cells, CD8+ T-cells and phosphorylated signal transducer and activator of transcription 1. Results: The follicular count, number of anagen and terminal hair were found to be decreased, whereas the catagen, telogen and vellus hair were found to be increased in number. A peribulbar CD4+ T-cell infiltrate was seen in 70% cases, whereas a CD8+ T-cell infiltrate was seen in 83.3% cases. An intrabulbar CD4+ T-cell infiltrate was seen in 26.7% cases, whereas a CD8+ T-cell infiltrate was seen in 70% cases. Among the 25 hair follicles dermal papilla identified, 36.8% cases were found to be positive for phospho-signal transducer and activation of transcription-1. Limitations: The drawbacks of our study included a small sample size and the use of only vertical sectioning for the scalp biopsy samples. Conclusion: Phosphorylated signal transducer and activator of transcription 1 positivity as an indicator of signalling via the Janus kinase-1/2 pathway was seen in 36.8% of our cases highlighting the integral role of this pathway in the pathogenesis of alopecia areata.
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To determine irradiance of ultraviolet A in ambient sunlight and optimum exposure time for PUVAsol in a North Indian location p. 462
Akanksha Kaushik, Dipankar De, Sanjeev Handa, Ankit Mittal
DOI:10.4103/ijdvl.IJDVL_487_18  PMID:30757998
Background: Psoralen with ultraviolet A is an effective photochemotherapeutic modality. A subtype of this, PUVAsol, uses sunlight as the natural source of ultraviolet A. The amount of sunlight received and the consequent ultraviolet A exposure vary according to the month in the year, time of the day and geographical location of a place. Aim: The aim of this study is to determine irradiance of ultraviolet A in ambient sunlight and optimum exposure time for PUVAsol. Materials and Methods: This was an observational study carried out at Postgraduate Institute of Medical Education and Research, Chandigarh (30.7333°N, 76.7794°E), India using a photometer. Ultraviolet A irradiance was recorded at a fixed place at 10 AM, once weekly for a period of 12 months. Results: The irradiance of peak ultraviolet A was found to be 3.1 mW/cm2 in June 2016 while irradiance of 0.64 mW/cm2 was recorded in January 2017. The exposure time needed for therapeutic dose of 2 J/cm2 was 11 min 6 s in June 2016 while exposure time for achieving therapeutic dose of 2 J/cm2 was 52 min 5 s in January 2017. The duration of exposure was found to be significantly longer in the winter months. Limitation: The limitation of the study is not determining ultraviolet B radiation and infrared exposure. Other limitation of this study is that the irradiance was measured only at 10 am. This data cannot be used to determine irradiance at different time points in the day as the patient may expose himself/herself to sunlight anytime depending on his/her convenience. Conclusions: The study demonstrates the mean exposure time required for a given therapeutic dose of ultraviolet A in different months. The wide variation in ultraviolet A irradiance in natural sunlight over the year in different months also suggests that exposure times for PUVAsol should be based on the season and geographical location at the site of therapy and not based on uniform guidelines.
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Clinimetric analysis of recently applied quantitative tools in evaluation of vitiligo treatment p. 466
Nancy Wadea Mikhael, Hanan Hasan Sabry, Asmaa M El-Refaey, Rehab Mohammed Salem, Mahmoud Fawzi El-Gendy, Shaymaa Ahmed Farid
DOI:10.4103/ijdvl.IJDVL_63_17  PMID:30729924
Background: Vitiligo affects about 1% of the world's population, however, there is currently no universally used standardized measure to assess its response to treatment. Objective: To find the most effective technique for the quantitative assessment of therapeutic results in vitiligo patients. Materials and Methods: The study was performed in three stages: (1) Conducting an adapted Delphi survey to check current dermatologists' attitudes regarding the topic of study. (2) Conducting a pilot study that involves testing the selected digital image analysis software in the laboratory to validate future tasks. (3) The chief clinimetric study that implicates selecting actual vitiligo lesion models and evaluating them. Results: Regarding the surface area measuring techniques, the most accurate results were gained through the digital image analysis for surface area, followed by point-counting technique. The digital image analysis for color measurement was accurate and reliable in getting a percentage representation of color improvement within the vitiligo lesions, in response to therapy. Limitations: Many dermatologists lack understanding of basic concepts about imaging techniques. The study does not include a traditional assessment method such as vitiligo area scoring index. Conclusion: Our designated digital image analysis technique was able to efficiently assess the changes that occur both on surface area and the color of vitiligo lesions in response to therapy.
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Pulsed dye laser in the treatment of basal cell carcinoma: A single session versus two sessions – a randomized controlled trial p. 475
Naeim M Abd El-Naby, Nashwa Naeem El-Far, Hanan A Al-Shenawy, Sameh E Elshwadfy, Amira A Koura
DOI:10.4103/ijdvl.IJDVL_644_17  PMID:31062722
Background: Basal cell carcinoma is the most common form of skin cancer worldwide. It has a specialized microvasculature system that can be targeted by the pulsed dye laser using the theory of selective photothermolysis. Objective: To evaluate the efficacy and safety of single session versus two sessions of pulsed dye laser in the treatment of basal cell carcinoma. Methods: A total of 22 patients with basal cell carcinoma were collected in this randomized controlled trial. The patients were divided into two groups: Group I – 11 patients were treated by one session of pulsed dye laser, and Group II – 11 patients received two sessions of pulsed dye laser 2 weeks apart. The patients were assessed clinically and histopathologically after end of the treatment. Results: There was a significant improvement of basal cell carcinoma clinically and histopathologically. Maximal histological clearance rate was achieved in superficial basal cell carcinoma type, small-sized basal cell carcinoma <0.7 cm and in cases with strong inflammatory response after laser treatment. Treatment of basal cell carcinoma with two sessions of pulsed dye laser was more effective than one session treatment. Limitations: The small sample size of patients and the limited location of the lesions on the head compared with trunk and extremities. Also, the lack of adequate study power may prevent generalization of results. Conclusion: Pulsed dye laser proved to be a safe, effective and noninvasive modality for the treatment of basal cell carcinoma that can be used as a monotherapy in small-sized lesions. Also, it can be used to debulk large-sized lesions before surgery.
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CASE REPORT Top

Hemophagocytic lymphohistiocytosis: A rare, potentially fatal complication in subcutaneous panniculitis like T cell lymphoma p. 481
Chandra Sekhar Sirka, Swetalina Pradhan, Susama Patra, Somanath Padhi, Saroj Kumar DasMajumdar, Debjani Panda
DOI:10.4103/ijdvl.IJDVL_277_17  PMID:30289114
Subcutaneous panniculitis-like T cell lymphoma is a rare subtype of cutaneous lymphomas with distinct clinical, histological and immunophenotypic characteristics, as well as an indolent clinical course. Rarely, it may be complicated with hemophagocytic lymphohistiocytosis: a hyperinflammatory syndrome which, if not diagnosed early, carries a dismal outcome. In this article, we describe a case of subcutaneous panniculitis-like T cell lymphoma in a middle-aged female patient which was complicated with secondary hemophagocytic lymphohistiocytosis with a favorable outcome following etoposide-based therapy. The various histological mimics of subcutaneous panniculitis-like T cell lymphoma and the management options are also briefly discussed.
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BRIEF REPORT Top

A randomized controlled trial of topical benzoyl peroxide 2.5% gel with a low glycemic load diet versus topical benzoyl peroxide 2.5% gel with a normal diet in acne (grades 1-3) Highly accessed article p. 486
G Pavithra, Gatha M Upadya, MS Rukmini
DOI:10.4103/ijdvl.IJDVL_109_17  PMID:30264745
Background: The improvement in insulin resistance and acne lesions on low glycemic load diets in various studies suggests that diet plays a significant role in acne pathogenesis. Aims: To compare the efficacy of a low glycemic load diet plus topical benzoyl peroxide 2.5% gel with that of only topical benzoyl peroxide 2.5% gel in grades 1, 2 and 3 of acne vulgaris. Methods: In a randomized controlled trial, 84 patients with grades 1, 2 and 3 acne vulgaris were divided into two groups, to receive a low glycemic load diet and no dietary intervention respectively. Acne lesions (face) were scored and graded at baseline and 4, 8 and 12 weeks. Homeostasis model assessment of insulin resistance and body mass index were measured during the first and last visits. Statistical analysis was done with Statistical Package for the Social Sciences, version 17.0. Results: Both groups showed significant reduction in acne counts at 12 weeks (P = 0.931) with no statistically significant difference between the groups. The differences in body mass index and homeostasis model assessment of insulin resistance between the groups were statistically significant (P = 0.0001). Group 1 showed reductions in body mass index and homeostasis model assessment of insulin resistance values at the end of the study, whereas group 2 did not. Limitations: Application of mild topical cleanser in both the groups might have contributed to the improvement in epidermal barrier function, and topical application of 2.5% of benzoyl peroxide gel in both groups contributed to the improvement in acne counts. Conclusions: A low glycemic load diet did not result in any significant improvement in acne counts.
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IMAGES IN CLINICAL PRACTICE Top

"Melanocytic nevus", or is it? p. 491
Richa Pradeep Shindore, Prachi V Gole, Sunanda A Mahajan
DOI:10.4103/ijdvl.IJDVL_657_17  PMID:30058569
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LETTERS TO THE EDITOR - CASE LETTERS Top

Advanced type 1 hyperoxaluria presenting as livedo racemosa in a patient with end-stage renal disease p. 493
Ignacio Torres-Navarro, Victor Garcia-Bustos, Rafael Botella-Estrada, Nohelia Rojas-Ferrer, Pedro Moral-Moral
DOI:10.4103/ijdvl.IJDVL_1030_18  PMID:31397396
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Giant cell tumor of tendon sheath in children p. 496
Saba Mohammed Musaddique Ansari, Swagata Arvind Tambe, Chitra Shivanand Nayak
DOI:10.4103/ijdvl.IJDVL_471_18  PMID:31274471
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Verrucous dermatophytosis on photoexposed areas resembling pellagra in acquired immunodeficiency syndrome p. 499
Anuradha Bishnoi, Raihan Ashraf, Nirmalya Banerjee, Uma Nahar Saikia, Dipankar De
DOI:10.4103/ijdvl.IJDVL_3_19  PMID:31317873
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Posterior reversible encephalopathy syndrome and intracerebral hemorrhage in an adult patient with Henoch-Schönlein purpura p. 502
Jianjun Liu, Lina Zong, Jie Gao, Shichao Lu
DOI:10.4103/ijdvl.IJDVL_681_18  PMID:31368450
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Chromoblastomycosis with a sporotrichoid distribution p. 506
Arpita Nibedita Rout, Kananbala Sahu, Chandra Sekhar Sirka
DOI:10.4103/ijdvl.IJDVL_16_19  PMID:31368452
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Urticaria pigmentosa in monochorionic twins p. 509
Goknur Ozaydin Yavuz, Ibrahim Halil Yavuz, Serap Gunes Bilgili, Remzi Erten, Hulya Savas, Irfan Bayram
DOI:10.4103/ijdvl.IJDVL_163_18  PMID:31389368
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Atypical manifestations of disseminated cutaneous botryomycosis mimicking dermatitis herpetiformis in an immunocompetent adult woman p. 511
Rachita Misri, Shikha Khare, Meenakshi Batrani, HK Kar
DOI:10.4103/ijdvl.IJDVL_845_18  PMID:31368455
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Frontal fibrosing alopecia developing on vitiligo p. 514
Chen-Yu Wu, Chih-Yi Liu, You-Chen Serena Liu
DOI:10.4103/ijdvl.IJDVL_752_18  PMID:31322136
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A case of cutaneous Rosai-Dorfman disease presenting with auricular enlargement as the first manifestation p. 518
Lu Gan, Wei-Da Liu, Wan-Ting Yu, Jian-Fang Sun, Yi-Qun Jiang
DOI:10.4103/ijdvl.IJDVL_351_18  PMID:31290464
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Pigeon tick infestation in humans: A case from North India p. 523
Jasleen Kaur Sandhu
DOI:10.4103/ijdvl.IJDVL_136_19  PMID:31368454
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Macular presentation of primary cutaneous follicle center lymphoma with an intermittent clinical course p. 525
Isabel Abadías-Granado, Javier Sánchez-Bernal, Guillermo Muñoz-González, Mariano Ara-Martín
DOI:10.4103/ijdvl.IJDVL_486_18  PMID:31389373
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LETTERS TO THE EDITOR - STUDY LETTERS Top

Cyclosporine in treatment of progressive vitiligo: An open-label, single-arm interventional study p. 528
Atul Taneja, Asha Kumari, Kapil Vyas, Ashok Kumar Khare, Lalit Kumar Gupta, Asit Kumar Mittal
DOI:10.4103/ijdvl.IJDVL_656_18  PMID:31389371
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Interleukin-17-dressed neutrophil: Neutrophil does not produce but delivers interleukin-17 to lesional epidermis causing keratinocyte S100A expression p. 531
Kento Mizutani, Yoshiaki Matsushima, Koji Habe, Keiichi Yamanaka
DOI:10.4103/ijdvl.IJDVL_375_18  PMID:31389372
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Expression and correlation of interleukin-36γ, claudin-1 and claudin-7 in psoriasis p. 534
Yunlei Pan, Shunli Tang, Lina Xu, Siting Zheng, Jianjun Qiao, Hong Fang
DOI:10.4103/ijdvl.IJDVL_640_18  PMID:31322135
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Judicial precedents on medicolegal disputes arising from psoriasis treatment in South Korea p. 536
Soo Ick Cho, Suhwan Shin, Hanjae Lee, Seong Jin Jo
DOI:10.4103/ijdvl.IJDVL_110_19  PMID:31389366
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LETTERS TO THE EDITOR - OBSERVATION LETTERS Top

Leukemia cutis following herpes zoster infection: An unusual example of Wolf's isotopic response p. 539
Hui Ke, Xiao-Pan Gong, Hui-Chun Su, Wei Su, Bo Cheng
DOI:10.4103/ijdvl.IJDVL_363_18  PMID:31389376
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Impact factor: Does it really have an impact? p. 541
Sandeep Lahiry, Rajasree Sinha, Sayanta Thakur
DOI:10.4103/ijdvl.IJDVL_51_19  PMID:31347514
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Diagnostic role of dermatoscopy in porokeratotic adnexal ostial nevus p. 546
Nilendu Sarma, Sayantani Chakraborty
DOI:10.4103/ijdvl.IJDVL_776_18  PMID:31368451
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LETTERS TO THE EDITOR - THERAPY LETTER Top

Complete response of a locally advanced basosquamous carcinoma with vismodegib treatment p. 549
Antonio Sahuquillo-Torralba, Margarita Llavador-Ros, Javier Caballero-Daroqui, Rafael Botella-Estrada
DOI:10.4103/ijdvl.IJDVL_647_18  PMID:31389370
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IMAGES IN CLINICAL PRACTICE Top

Annular scaly plaque confined to presternal keloid treated with intralesional injections p. 553
Sanjay Singh, Vishal Gupta, Somesh Gupta
DOI:10.4103/ijdvl.IJDVL_915_17  PMID:30198492
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QUIZ Top

Solitary nodular lesion on forehead in a 56-year-old woman Highly accessed article p. 555
Charu Agarwal, Kanika Singh, Mukta Pujani, Pragya Verma, Varsha Chauhan
DOI:10.4103/ijdvl.IJDVL_1141_16  PMID:29582788
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RESIDENTS’ PAGE Top

Ten clinical clues for the diagnosis of frontal fibrosing alopecia Highly accessed article p. 559
Daniel Fernandes Melo, Taynara de Mattos Barreto, Elaine de Souza Albernaz, Natacha de Carvalho Haddad, Violeta Duarte Tortelly
DOI:10.4103/ijdvl.IJDVL_713_17  PMID:30073989
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BOOK REVIEW Top

IADVL's textbook on cutaneous adverse drug reactions p. 565
Sunil Dogra, Anuradha Bishnoi
DOI:10.4103/ijdvl.IJDVL_510_19  
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NET STUDY Top

Circulating levels of chemokines in patients with psoriasis vulgaris and their association with disease severity: A case–control study from North India p. 567
Neha Joshi, Tarun Narang, Sunil Dogra, Seema Chhabra
DOI:10.4103/ijdvl.IJDVL_392_18  PMID:31389369
Background: Psoriasis is a chronic inflammatory skin disease characterized by hyperproliferation and incomplete differentiation of epidermis, and accumulation of neutrophils and proinflammatory T cells in epidermis and dermis. Chemokines are believed to be the main players mediating the chemotaxis of leucocytes to the lesional site. Previous studies have established the role of various chemokine ligands and receptors at the lesional site in psoriasis. Aims: In this study, we have compared the serum levels of various chemokines, namely, inducible protein-10 (IP-10) (CXCL10), MCP-1 (CCL-2), monokine induced by gamma interferon (MIG) (CXCL-9), RANTES (CCL5), interleukin (IL)-8, and eotaxin in patients with chronic plaque psoriasis with that of healthy controls. We also studied whether the chemokine levels varied within different patient groups based on various clinical and demographic parameters, and if any of these chemokines correlated with disease activity. Methods: We studied 40 patients with chronic plaque psoriasis from a single center. Their clinical and demographic details were recorded in predesigned prforma. Patients with unstable forms of psoriasis like guttate, erythrodermic, or pustular psoriasis were excluded. The serum chemokine levels were measured by flow cytometry–based bead array set system. The serum levels of the patients were compared with that of 25 healthy controls. A subgroup analysis was also done to study the correlation of chemokine levels with age, sex, duration, and severity of disease. Results: We observed a significant decrease in serum level of all these chemokines in patients, when compared with that of healthy controls. We also found that MIG levels showed a positive correlation with disease severity based on Psoriasis Area and Severity Index. Limitations: The major limitation of the study is lack of data on the lesional chemokine levels compared to serum chemokines. Conclusion: The inflammatory process in psoriasis is orchestrated through chemokines. MIG is a potential serum biomarker for assessing disease severity.
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NET LETTERS Top

Chemical leukoderma due to hydroquinone: An unusual phenomenon p. 567
Anupam Das, Anupama Ghosh, Piyush Kumar
DOI:10.4103/ijdvl.IJDVL_209_17  PMID:30117459
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Keratoacanthoma-like cutaneous metastases in a case of squamous cell carcinoma of the tongue p. 568
Harshal Ranglani, Varadraj V Pai, Pankaj Shukla
DOI:10.4103/ijdvl.IJDVL_595_17  PMID:30381581
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Intralesional steroids in dermatophytosis: Quackery in India takes new route p. 568
Ankita Srivastava, Sakshi Agrawal
DOI:10.4103/ijdvl.IJDVL_684_17  PMID:30504531
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