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   Table of Contents - Current issue
Coverpage
September-October 2015
Volume 81 | Issue 5
Page Nos. 447-556

Online since Friday, August 28, 2015

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EDITORIAL  

Making the transition from thesis to published paper: A supervisor's note to her student p. 447
Navjeevan Singh
DOI:10.4103/0378-6323.163694  
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REVIEW ARTICLES Top

Therapeutic potential of biosimilars in dermatology p. 451
Vishal Gupta, Binod K Khaitan
DOI:10.4103/0378-6323.163706  
The introduction of biologic therapy has revolutionized the treatment of many chronic diseases, including several dermatological disorders. Biological agents promise to satisfy medical needs previously unmet by conventional medicines. Unfortunately, these agents are expensive and out of reach for the majority of patients who need them. Biosimilars are copies of the innovator biological agents and represent an important advance in the field of biological therapeutics. Although they are similar to the original biologic, differences in terms of structure, efficacy, safety and immunogenicity remain a concern. Thus, biosimilars cannot be regarded as bio-generics. Awareness of the key differences between a biosimilar and its reference biological agent is essential for optimal treatment and safety of patients. The increasing availability of biosimilars provides patients and doctors with less expensive alternatives and increases the accessibility of biologic therapy to needy patients. In this review, we discuss the concept of biosimilars, the need for appropriate regulatory pathways and their current status in dermatology.
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Recent advances in topical formulation carriers of antifungal agents p. 457
Eman Ahmed Bseiso, Maha Nasr, Omaima Sammour, Nabaweya A Abd El Gawad
DOI:10.4103/0378-6323.162328  PMID:26261140
Fungal infections are amongst the most commonly encountered diseases affecting the skin. Treatment approaches include both topical and oral antifungal agents. The topical route is generally preferred due to the possible side effects of oral medication. Advances in the field of formulation may soon render outdated conventional products such as creams, ointments and gels. Several carrier systems loaded with antifungal drugs have demonstrated promising results in the treatment of skin fungal infections. Examples of these newer carriers include micelles, lipidic systems such as solid lipid nanoparticles and nanostructured lipid carriers, microemulsions and vesicular systems such as liposomes, niosomes, transfersomes, ethosomes, and penetration enhancer vesicles.
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ORIGINAL ARTICLES Top

Comprehensive lipid tetrad index, atherogenic index and lipid peroxidation: Surrogate markers for increased cardiovascular risk in psoriasis p. 464
S Sunitha, Medha Rajappa, Devinder Mohan Thappa, Laxmisha Chandrashekar, Malathi Munisamy, G Revathy, M Priyadarssini
DOI:10.4103/0378-6323.163734  
Background and Objectives: Recently, the concept of "psoriatic march" has come to the fore, in which chronic cutaneous inflammation in psoriasis leads to systemic inflammation which, in conjunction with increased oxidative stress, triggers a cascade of events resulting in increased cardiovascular risk in patients with severe psoriasis. We, therefore, decided to study the levels of some biochemical cardiovascular risk markers: lipid peroxidation (malondialdehyde), lipoprotein (a), lipid indices and atherogenic index, in patients with psoriasis and their association with disease severity. Methods: Fortyfive patients with psoriasis and 45 age and gender-matched healthy controls were included in this cross-sectional study. Disease severity was assessed by the Psoriasis Area Severity Index (PASI). Serum malondialdehyde, lipoprotein (a) and fasting lipid profile were estimated in all study subjects. Lipoprotein ratios were computed using standard formulae. Atherogenic index was calculated as ratio of lipoprotein (a)/high-density lipoprotein. Results: In psoriasis, we observed significantly higher levels of malondialdehyde, total cholesterol, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, lipoprotein (a), lipid ratios, atherogenic index and comprehensive lipid tetrad index, compared to controls. These levels were directly proportional to disease severity. Serum levels of malondialdehyde correlated positively with serum lipoprotein (a), comprehensive lipid tetrad index and atherogenic index. Limitations: Different morphological types of psoriasis were not included and follow-up post-therapy was not done. A larger sample size would have validated the results further. Conclusion: Our results indicate that psoriasis, especially the severe variants, are associated with increased oxidative stress and dyslipidemia, which correlate positively with atherogenic index and hence, an increased cardiovascular risk.
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Controlled trial comparing the efficacy of 88% phenol versus 10% sodium hydroxide for chemical matricectomy in the management of ingrown toenail p. 472
Chander Grover, Ananta Khurana, Sambit Nath Bhattacharya, Arun Sharma
DOI:10.4103/0378-6323.163787  
Background: Partial nail avulsion with lateral chemical matricectomy is the treatment of choice for ingrown toenails. Phenol (88%) is the most widely used chemical agent but prolonged postoperative drainage and collateral damage are common. Sodiumhydroxide (NaOH) 10% has fewer side-effects. Methods: Adult, consenting patients with ingrown toenails were alternately allocated into two treatment groups in the order of their joining the study, to receive either 88% phenol (Group 1, n = 26) or 10% NaOH (Group 0, n = 23) chemical matricectomy. The patients as well as the statistician were blinded to the agent being used. Post-procedure follow-up evaluated median duration of pain, discharge, and healing along with recurrence, if any, in both the groups. The group wise data was statistically analyzed. Results: Both the groups responded well to treatment with the median duration of postoperative pain being 7.92 days in Group 0 and 16.25 days in Group 1 (P < 0.202). Postoperative discharge continued for a median period of 15.42 days (Group 0) and 18.13 days (Group 1) (P < 0.203). The tissue condition normalized in 7.50 days (Group 0) and 15.63 days (Group 1) (P < 0.007). Limitations: Limited postsurgical follow up of 6 months is a limitation of the study. Conclusion: Chemical matricectomy using NaOH is as efficacious as phenolisation, with the advantage of faster tissue normalization.
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Role of dental restoration materials in oral mucosal lichenoid lesions p. 478
Rajneesh Sharma, Sanjeev Handa, Dipankar De, Bishan Dass Radotra, Vidya Rattan
DOI:10.4103/0378-6323.162341  PMID:26261149
Background: Dental restorative materials containing silver-mercury compounds have been known to induce oral lichenoid lesions. Objectives: To determine the frequency of contact allergy to dental restoration materials in patients with oral lichenoid lesions and to study the effect of removal of the materials on the lesions. Results: Forty-five patients were recruited in three groups of 15 each: Group A (lesions in close contact with dental materials), Group B (lesions extending 1 cm beyond the area of contact) and Group C (no topographic relationship). Thirty controls were recruited in two groups of 15 individuals each: Group D (oral lichenoid lesions but no dental material) and Group E (dental material but no oral lichenoid lesions). Patch tests were positive in 20 (44.5%) patients. Mercury was the most common allergen to elicit a positive reaction in eight patients, followed by nickel (7), palladium (5), potassium dichromate (3), balsam of Peru, gold sodium thiosulphate 2 and tinuvin (2) and eugenol (1), cobalt chloride (1) and carvone (1). Seven patients elicited positive response to more than one allergen. In 13 of 20 patients who consented to removal of the dental material, complete healing was observed in 6 (30%), marked improvement in 7 (35%) and no improvement in 7 (35%) patients. Relief of symptoms was usually observed 3 months after removal. Limitations: Limited number of study subjects and short follow up after removal/replacement of dental restoration materials are the main limitations of this study. Conclusion: Contact allergy to amalgam is an important etiologic factor in oral lichenoid lesions and removal of restorative material should be offered to patients who have lesions in close proximity to the dental material.
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BRIEF REPORT Top

Evaluation of role of Candida in patients with chronic paronychia p. 485
Rakesh Kumar Bahunuthula, Devinder Mohan Thappa, Rashmi Kumari, Rakesh Singh, Malathi Munisamy, Subash Chandra Parija
DOI:10.4103/0378-6323.158635  PMID:26087081
Background: Chronic paronychia, earlier considered to be an infection due to Candida, is currently being considered as a dermatitis of the nail fold. Irritant, allergic and protein contact dermatitis are the suggested major pathogenic mechanisms. Hypersensitivity to Candida is more likely to be the etiology, rather than the infection itself. Aims: To assess the clinico-etiological profiles of patients with chronic paronychia and to determine the role of contact sensitization and hypersensitivity to Candida. Methods: All consecutive patients of chronic paronychia attending the dermatology outpatient department (OPD) were assessed for risk factors, number of nails affected, clinical presentation and presence of fungus, patch tested for contact allergy and prick tested for hypersensitivity to Candida allergen. Results: A total of 80 patients of chronic paronychia were recruited into our study. There was female preponderance (66 patients, 82.5%), with the most common group affected being housewives (47 patients, 58.8%). Frequent washing of hands (64 patients, 80%) was the most common risk factor. Fungal culture was positive in 56.1% (41 patients), the predominant species cultured was Candida albicans (15 patients, 36.5%). Patch testing with Indian standard series was positive in 27.1% patients (19 out of 70 patients tested), with nickel being the most common allergen. Prick test with Candida allergen was positive in 47.6% patients (31 out of 65 patients tested). Limitations: Prick test and patch test provide indirect evidence of hypersensitivity, with inherent limitations. Conclusion: Our study shows that chronic paronychia is probably a form of hand dermatitis associated with prolonged wet work, and that there is a higher incidence of contact sensitization and Candida hypersensitivity in these patients.
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CASE REPORTS Top

Disseminated cutaneous phaeohyphomycosis due to Cladophialophora bantiana p. 491
Anza Khader, Betsy Ambooken, Manikoth Payyanadan Binitha, Saji Francis, Ashokan K Kuttiyil, Deepthi Nalini Sureshan
DOI:10.4103/0378-6323.162333  PMID:26261143
Cladophialophora bantiana is a neurotropic dematiaceous fungus which only rarely affects the skin. We report a case of disseminated cutaneous phaeohyphomycosis caused by Cladophialophora bantiana in an immunocompromised female who presented with multiple pyogenic granuloma-like nodules, dermatophytosis-like plaque, and subcutaneous cysts on the upper and lower extremities without systemic involvement. Biopsy revealed black yeasts resembling sclerotic bodies and culture yielded irregular, velvety, grey colonies with black reverse. Excisionof the nodules and treatment with oral itraconazole 100 mg twice daily resulted in complete clinical resolution within two months, following which itraconazole was administered for another 4 months.
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Cutaneous annular lesions as the first sign of transformation of follicular lymphoma into diffuse large B-cell lymphoma p. 495
Irene Palacios-Álvarez, Concepción Román-Curto, Alejandro Martín García-Sancho, Ángel Santos-Briz, Juan Carlos Santos-Durán, Emilia Fernández-López
DOI:10.4103/0378-6323.158660  PMID:26087101
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma with diverse clinical, pathological and genetic features. An 80-year-old woman was diagnosed with a stage IV-X-A (Ann Arbor staging system) low grade systemic follicular lymphoma (FL). Four months after the diagnosis, she developed asymptomatic, indurated, annular erythematous plaques with centrifugal growth on the abdomen, arms and neck. The skin biopsy revealed a dermal infiltration compatible with diffuse large B-cell lymphoma. Light chain restriction by flow cytometry was demonstrated. The variable, diverse and joining genes of immunoglobulin G heavy chains were sequenced and cloned, and showed the same pattern for both the initial follicular lymphoma and the skin infiltration. Translocation t (14;18) was present in both samples. Based on these findings, a diagnosis of transformation of follicular lymphoma into diffuse large B cell lymphoma was made. Although other hematological disorders such as primary cutaneous diffuse large B cell lymphoma, mycosis fungoides and the cutaneous infiltration of chronic juvenile myeloid leukemia can present as annular lesions, we were unable to find any previous reports of these as a manifestation of cutaneous infiltration by systemic non-Hodgkin lymphoma.
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IMAGES IN CLINICAL PRACTICE Top

Extensive facial and vulval syringomas in a young woman p. 498
Tarang Goyal, Anupam Varshney, Neha Malik
DOI:10.4103/0378-6323.157453  PMID:25994888
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LETTERS TO THE EDITOR - STUDY LETTERS Top

Failure to detect Mycobacterium lepromatosis as a cause of leprosy in 85 Chinesepatients p. 499
Yan Zhang, Yong hu Sun, Chuan Wang, Dan Liu, Mingfei Chen, Xi'an Fu, Guizhi Zhou, Hong Liu, Furen Zhang
DOI:10.4103/0378-6323.162326  PMID:26261139
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Clinical and epidemiological profile of sexually transmitted infections in a tertiary care centre in Kerala: A 1-year observational study p. 500
Puravoor Jayasree, Manikoth P Binitha, Riyaz Najeeba, George Biju
DOI:10.4103/0378-6323.158646  PMID:26087090
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LETTERS TO THE EDITOR - OBSERVATION LETTERS Top

Pseudo-lipomatosis cutis: A singular dermal artifact p. 504
Rajiv Joshi
DOI:10.4103/0378-6323.162336  PMID:26261144
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Palatal ecchymosis associated with irrumation p. 505
Kavitha Muthu, Sathya Kannan, Senthilkumar Muthusamy, Preena Sidhu
DOI:10.4103/0378-6323.162343  PMID:26261150
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Matchbox sign: Look before you label! p. 507
Premanshu Bhushan, Sarvesh S Thatte, Kashish Kalra
DOI:10.4103/0378-6323.162321  PMID:26261135
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Pemphigus vegetans localized to unusual sites p. 509
Geeti Khullar, Dipankar De, Tarun Narang, Uma Nahar Saikia, Sanjeev Handa
DOI:10.4103/0378-6323.162317  PMID:26261132
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Extrafacial rosacea with predominant scalp involvement p. 511
Laura Miguel-Gomez, Pablo Fonda-Pascual, Sergio Vano-Galvan, Rosario Carrillo-Gijon, Ernesto Muñoz-Zato
DOI:10.4103/0378-6323.162340  PMID:26261148
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LETTERS TO THE EDITOR - CASE LETTERS Top

Fingertip eczema to pooja flowers: Allergic contact dermatitis to Tabernaemontana divaricata and Tecoma stans p. 514
Chembolli Lakshmi
DOI:10.4103/0378-6323.162337  PMID:26261145
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Tattoo inoculation lupus vulgaris in two brothers p. 516
Amit Kumar Dhawan, Deepika Pandhi, Neelam Wadhwa, Archana Singal
DOI:10.4103/0378-6323.158658  PMID:26087099
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Unilateral cutaneous vasculitis: An uncommon presentation and a possible explanation p. 518
Burak Tekin, Andac Salman, Serhan Tuglular, Derya Guler, Gulsen Ozen, Haner Direskeneli, Fatma Gulcicek Ayranci, Leyla Cinel, Tulin Ergun
DOI:10.4103/0378-6323.162319  PMID:26261133
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Dermato-neuro syndrome associated with scleromyxedema p. 519
Bedriye Karaman, Ayse Guler, Ilgen Ertam, Nese Celebisoy
DOI:10.4103/0378-6323.162344  PMID:26261151
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Black grain eumycetoma of the breast misdiagnosed as fibroadenoma p. 521
Sunil K Kothiwala, Saroj Purohit, Mayuri Meena, Arpita Jindal
DOI:10.4103/0378-6323.162329  PMID:26261141
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Scrotal elephantiasis secondary to recalcitrant hidradenitis suppurativa p. 524
Pedro T de Vasconcelos, João Décio-Ferreira, Paulo L Filipe
DOI:10.4103/0378-6323.158656  PMID:26087097
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Pemphigus foliaceus occurring with adenocarcinoma of prostate p. 525
Meenakshi Wadhokar, Yugal K Sharma, Kirti Deo, Archana Buch, Aayush Gupta
DOI:10.4103/0378-6323.162332  PMID:26261142
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Tuberous sclerosis presenting with late onset seizures and scrotal angiofibromas p. 527
Rahul Ray, Kirti Jangid, Biju Vasudevan, Jandhyala Sridhar, Aarti Trehan, Rohan Kodgule
DOI:10.4103/0378-6323.162324  PMID:26261138
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Papular elastorrhexis p. 529
Ruzeng Xue, Liyan Yuan, Huaiqiu Huang
DOI:10.4103/0378-6323.162339  PMID:26261147
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Trichilemmal carcinoma in a young adult p. 531
Noo Ri Lee, Seung Joon Oh, Mi Ryung Roh
DOI:10.4103/0378-6323.158644  PMID:26087088
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Melanoma arising from the epidermis overlying an acquired intradermal nevus on the forehead p. 533
Noriaki Nakai, Norito Katoh
DOI:10.4103/0378-6323.158653  PMID:26087094
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Peripheral T-cell lymphoma, not otherwise specified with prominent cutaneous involvement p. 535
Ben Jacob Friedman, Chauncey A McHargue, Michael D Nauss
DOI:10.4103/0378-6323.162315  PMID:26261131
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Cetirizine-induced urticaria masquerading as multiple drug intolerance syndrome p. 537
Saurabh Singh, Pawan Kumar, Vinod K Sharma
DOI:10.4103/0378-6323.162338  PMID:26261146
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LETTERS TO THE EDITOR - THERAPY LETTER Top

Topical mTOR (mechanistic target of rapamycin) inhibitor therapy in facial angiofibroma p. 540
Debopam Samanta
DOI:10.4103/0378-6323.163800  
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IMAGES IN CLINICAL PRACTICE Top

Constricting band following incomplete condom removal p. 542
Joginder Kumar, V Ramesh
DOI:10.4103/0378-6323.157452  PMID:25994887
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QUIZ Top

Purplish plaques on the leg of a 12-year-old boy p. 543
Rajesh Kumar Mandal, Sudip Kumar Ghosh, Abhijit Dutta
DOI:10.4103/0378-6323.163806  
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BOOK REVIEW Top

Color atlas and synopsis of pediatric dermatology p. 545
AJ Kanwar
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E-IJDVL - NET STUDIES Top

Cutaneous adverse events of epidermal growth factor receptor inhibitors: A retrospective review of 99 cases p. 547
Kumutnart Chanprapaph, Padcha Pongcharoen, Vasanop Vachiramon
DOI:10.4103/0378-6323.157448  PMID:25994883
Background: Previous reports regarding the cutaneous adverse events of epidermal growth factor receptor inhibitors are mostly limited to small case reports and case series, mainly involving Caucasian patients. Aims: We describe the trends in the clinical presentation of Asian patients who had cutaneous adverse events induced by epidermal growth factor receptor inhibitors and to explore the relationship between skin adverse events and tumor response. Methods: From 2006 to 2010, medical records of Thai patients with non-small cell lung cancer receiving epidermal growth factor receptor inhibitors were retrieved and analyzed. Results: In all, 99 patients were reviewed and analyzed. Erlotinib and gefitinib were commenced in 75 (75.8%) and 24 (24.2%) patients, respectively. Cutaneous adverse events occurred in 43 (57.3%) patients receiving erlotinib and in 15 (62.5%) patients receiving gefitinib. The most common adverse event was xerosis (52.5%). Less common adverse events included papulo-pustular eruption (27.3%), erythematous maculopapular rash (11.1%), mucositis (6.7%), paronychia (5.1%), and trichomegaly (2%). Elderly patients had a higher occurrence of xerosis. The presence of cutaneous adverse events was significantly higher in subjects who had a tumor response. Limitations: The limitations of study include its retrospective nature, and the initial screening of cutaneous adverse events was done by non-dermatologists. Conclusions: Cutaneous adverse events due to epidermal growth factor receptor inhibitors are not uncommon in the Asian population. We found a positive correlation between the occurrences of cutaneou adverse events and tumor response supporting the view that they are surrogate markers for therapeutic response.
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Efficacy and safety of 0.1% kinetin cream in the treatment of photoaging skin Highly accessed article p. 547
Rungsima Wanitphakdeedecha, Walailak Meeprathom, Woraphong Manuskiatti
DOI:10.4103/0378-6323.157446  PMID:25994881
Background: Kinetin is a plant-derived compound, which is reported to possess antiaging properties. It has been used in a topical cream to manage facial photo-damage and aging. Although studies elsewhere have shown its benefits, not many studies of the effects of kinetin in Asian skin are available. Objectives: To assess the efficacy and tolerability of 0.1% kinetin cream in the treatment of facial photo-aging. Methods: The study was designed to be open-label and single-blinded, without a control group. One hundred Thai female and male subjects with mild, moderate or severe facial photo-damage were enrolled. They were asked to apply 0.1% kinetin cream twice daily for 12 weeks and follow up at 4, 8, and 12 weeks. Subjective patient self-assessment and physician assessment of facial skin photo-damage were accompanied by digital photographic analysis using the VISIA® (Canfield Scientific Inc, Fairfield, NJ) imaging system. Results: At baseline, most patients reported moderate skin changes related to photo-damage, skin texture, skin color and wrinkles. After 12 weeks, physician and patient assessments showed slight but statistically significant improvements in overall skin condition, skin texture, color, and wrinkles. Findings were similar with the digital photographic system analysis, especially in relation to skin color. Facial ultraviolet spots and redness also showed statistically significant improvements after 12 weeks. The treatment was generally well tolerated. Limitations: The study was designed to be pragmatic and hence no randomization was carried out; there were also no intrapatient or interpatient control observations, and no comparison arm. Conclusion: Kinetin (0.1%) cream was found to slightly improve cutaneous facial photo-damage after 12 weeks of use in a group of Thai patients.
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E-IJDVL - NET LETTERS Top

Chemokine receptors CCR5 and CCR2 genes in HIV positive, HIV exposed seronegative and in HIV unexposed individuals: A study from Mumbai p. 548
Deepali V Chaudhari, Shilpa C Kerkar, Vijay Chavan, Preeti R Mehta, Jayanti Mania-Pramanik
DOI:10.4103/0378-6323.158642  PMID:26087087
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Persistent pruritic rash: A rare manifestation and possible poor prognostic sign in adult onset Still's disease p. 548
Najeeba Riyaz, Neeraj Manikath, Sarita Sasidharanpillai, Aparna Govindan, Hena Davul, Mengassery R Rini
DOI:10.4103/0378-6323.158659  PMID:26087100
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Atypical clinical presentation of molluscum contagiosum in an epidermal cyst p. 548
Han Mi Jung, Won Joon Choi, Ki Min Sohn, Jung Eun Kim, Hoon Kang
DOI:10.4103/0378-6323.158648  PMID:26087091
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Pyoderma gangrenosum in successive pregnancies p. 548
Chintagunta Sudha Rani, Arakkal Geeta Kiran, Damarla Sudha Vani, Enubothula Nirmala Devi
DOI:10.4103/0378-6323.158638  PMID:26087084
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Infantile hemangioma associated with PHACES syndrome showing a dramatic response to oral propranolol p. 549
Bhukya Amar Singh, Yaramati Sri Harsha, Bellum Siva Nagi Reddy
DOI:10.4103/0378-6323.158641  PMID:26087086
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DOI:10.4103/0378-6323.157449  PMID:25994884
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IADVL Invites Application for Editor IJDVL (2017-19) p. 556
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