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   Table of Contents - Current issue
Coverpage
July-August 2016
Volume 82 | Issue 4
Page Nos. 367-474

Online since Monday, June 06, 2016

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EDITORIAL  

Image quality for publication p. 367
Feroze Kaliyadan
DOI:10.4103/0378-6323.182968  PMID:27279293
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REVIEW ARTICLE Top

Topical corticosteroids in dermatology Highly accessed article p. 371
Aayushi B Mehta, Nitin J Nadkarni, Sharmila P Patil, Kiran V Godse, Manjyot Gautam, Shweta Agarwal
DOI:10.4103/0378-6323.178903  PMID:27279294
Since their introduction, topical corticosteroids have become indispensable in the treatment of various dermatoses. Hydrocortisone was the first compound. Modifications in the basic structure generated in vivo activity and thus different topically active compounds were discovered. Apart from the Stoughton vasoconstrictor assay, various other methods are used for potency assessment of topical corticosteroids. Topical corticosteroides are classified based upon potency and action of these molecules. Mechanism of action at the cellular level and indications of topical corticosteroid use have been discussed. Various adverse effects often occur as an extension of their activity combined with inappropriate usage. Tachyphylaxis and contact allergy are potential problems in clinical practice. Newer compounds with improved risk-benefit ratio are available.
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ORIGINAL ARTICLES Top

Anatomical segmentations in all forms of vitiligo: A new dimension to the etiopathogenesis p. 379
Venkata Ratnam Attili, Sasi Kiran Attili
DOI:10.4103/0378-6323.181463  PMID:27279295
Background: We have reported segmented lesions in acral vitiligo as well as in generalized vitiligo and thereby proposed somatic mosaicism as a predisposing feature in all forms of vitiligo. This study is a further attempt to characterize and understand such segmented lesions by screening a large series of patients. Methods: We searched our electronic archives (from 2002 to 2014) and identified/reviewed the photos of 615 vitiligo patients inclusive of all clinical types. Over 3500 photographs were screened for patterns that were repeatedly seen in two or more patients and a composite picture of these were marked on a body map. Results: Similar unilateral/bilateral segmented lesions were identified among all forms of vitiligo during relatively stable phases of the disease. These appeared to be related to small and large anatomical divisions of the body. In rapidly evolving disease on the trunk, the lesions conformed to Blaschkoid patterns. Several instances of stable mirror image lesions, symmetric incremental progressions and regressions were also recorded. Limitations: These are observations of a retrospective, single-center review which need to be substantiated further in larger prospective studies. Conclusion: Similar unilateral/bilateral segmented patterns delineating major/minor anatomical divisions of the body may indicate a preexisting developmental defect (such as mosaicism).
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Clinical efficacy of rituximab in the treatment of pemphigus: A retrospective study p. 389
Vinod Kumar Sharma, Neetu Bhari, Somesh Gupta, Kanika Sahni, Neena Khanna, M Ramam, G Sethuraman
DOI:10.4103/0378-6323.174379  PMID:27279296
Background: Pulsed corticosteroids have been used successfully for the management of pemphigus. However, prolonged use of glucocorticoids may be associated with adverse effects and some patients show a poor response to conventional therapy. Biologics have shown a promising role in such cases; however, there is limited data from the Indian subcontinent. Objective: The primary objective was to assess the efficacy and adverse effects of rituximab in pemphigus. The secondary objective was to measure the cumulative doses of corticosteroids required for these patients. Methods: We undertook a retrospective review of records of 25 pemphigus patients (pemphigus vulgaris: 21, pemphigus foliaceus: 4) who had received rituximab infusion (rheumatoid arthritis protocol in 21 patients, modified in 4). Oral prednisolone was administered in dosages up to 0.5 mg/kg of body weight and tapered over the next 3–4 months according to the disease activity. However, other immunosuppressive agents such as cyclophosphamide and azathioprine were continued for one year after clinical remission was achieved. Results: Complete remission was observed in 22 (88%) patients. The mean time to disease control and complete remission was 1.10 and 4.36 months, respectively. Four (16%) patients experienced relapse after a mean duration of 11.75 months. The mean total dose of oral steroids administered was equivalent to 3535.64 mg of prednisolone. Exacerbation of disease was noted in two patients after the first dose of rituximab and infectious complications, pneumonia and cellulitis, developed in one patient each. Limitations: A small sample size, the retrospective nature of the study and unavailability of follow-up anti-desmoglein autoantibodies levels were limitations. Conclusion: Rituximab is an effective agent in the treatment of pemphigus. The use of rituximab enabled use of a lower initial dose of oral prednisolone in pemphigus and hence reduced its total cumulative dose. Severe side effects were rare.
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Keratoderma-like T cell dyscrasia: A report of 13 cases and its distinction from mycosis fungoides palmaris et plantaris p. 395
Cynthia M Magro, Giang Huong Nguyen
DOI:10.4103/0378-6323.181502  PMID:27279297
Background: Atypical epitheliotropic T cell lymphocytic infiltrates are commonly encountered in routine and consultative dermatopathology practices and typically do not represent mycosis fungoides. Other conditions can mimic certain light microscopic and phenotypic findings encountered in mycosis fungoides, comprising a diverse spectrum of conditions including the lymphomatoid drug reaction, collagen vascular disease, viral hypersensitivity reactions and cutaneous T cell dyscrasia. Aims: To examine biopsies obtained from cutaneous T cell dyscrasia localized to the palms and soles and to evaluate whether it exhibits a morphologic and pathogenetic continuum with mycosis fungoides plantaris et palmaris. Methods: We examined 13 biopsies showing an epidermotropic superficial lymphocytic infiltrate from thirteen patients who presented with a palmar and/or plantar keratoderma without other sites of cutaneous involvement. Conventional light microscopy, immunophenotyping and clonality studies were carried out. The clinical features were recorded. Results: Biopsies showed a variably dense, superficial, angiocentric CD4 or CD8 dominant lymphocytic infiltrate accompanied by a non-destructive pattern of epidermotropism. Low-grade cerebriform atypia along with variable diminution in the expression of CD7 and CD62L was noted. In three cases, statins were suspected to be the cause. Due to lack of familiarity with the entity, treatment interventions were inconsistent and not aggressively pursued. There was no evidence of disease progression to mycosis fungoides in any case. Limitations: The limitations of this study include the lack of long-term follow up and information on the nature of the therapeutic interventions and responses to treatment. Conclusion: The spectrum of cutaneous lymphoid dyscrasias should be expanded to include cases manifesting as palmo-plantar keratoderma. These cases are to be distinguished from mycosis fungoides palmaris et plantaris. As with other forms of cutaneous lymphoid dyscrasia, the lesions tend to be persistent. The course however, is indolent in most cases.
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BRIEF REPORT Top

Metabolic syndrome in androgenic alopecia p. 404
Hima Gopinath, Gatha M Upadya
DOI:10.4103/0378-6323.174421  PMID:27279298
Background: Androgenic alopecia has been associated with an increased risk of coronary heart disease in various studies. The relationship between androgenic alopecia and metabolic syndrome, a known risk factor for atherosclerotic cardiovascular disease, is still poorly understood. Aim: To study the association between metabolic syndrome and early-onset androgenic alopecia. Methods: A hospital-based analytical cross-sectional study was done on men in the age group of 18–55 years. Eighty five clinically diagnosed cases with early-onset (<35 years) androgenic alopecia of Norwood grade III or above, and 85 controls without androgenic alopecia were included. Data collected included anthropometric measurements, arterial blood pressure and history of chronic diseases. Fasting blood and lipid profile were determined. Metabolic syndrome was diagnosed as per the new International Diabetes Federation criteria. Chi-square and Student's t-test were used for statistical analysis using Statistical Package for the Social Sciences (SPSS) version 17.00. Results: Metabolic syndrome was seen in 19 (22.4%) patients with androgenic alopecia and 8 (9.4%) controls (P = 0.021). Abdominal obesity, hypertension and lowered high-density lipoprotein were significantly higher in patients with androgenic alopecia versus their respective controls. Limitations: The limitations of our study include small sample size in subgroups and the lack of evidence of a temporal relationship between metabolic syndrome and androgenic alopecia. Conclusion: A higher prevalence of metabolic syndrome is seen in men with early-onset androgenic alopecia. Early screening for metabolic syndrome and its components is beneficial in patients with early-onset androgenic alopecia.
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CASE REPORTS Top

Imatinib induced melasma-like pigmentation: Report of five cases and review of literature p. 409
Sneha Ghunawat, Rashmi Sarkar, Vijay Kumar Garg
DOI:10.4103/0378-6323.182387  PMID:27279299
Imatinib mesylate is a cytotoxic agent that targets tyrosine kinase. Common side effects of this drug include nausea, edema and maculopapular rash. Hypopigmentation is a commonly reported side effect of this drug while hyperpigmentation has rarely been described. We describe five cases of melasma-like pigmentation induced by this anti-cancer drug. Four of the patients were diagnosed with gastrointestinal stromal tumor while one had chronic myeloid leukemia. Patients received imatinib mesylate in a dose of 400 mg daily. Over an average period of 3 months, well defined hyperpigmented macules appeared over the convexities of the face. One of the patients also developed similar pigmentation on the forearm. Other causes of hyperpigmentation were excluded in each patient.
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Angiolymphoid hyperplasia with arterial ectasia and arteriovenous malformation: Response to intra-arterial embolization p. 413
Nitin R Lade, Pankaj Banode, Neha Dhope, Prithvi Tharafdar, Vikrant Saoji
DOI:10.4103/0378-6323.181202  PMID:27279300
Angiolymphoid hyperplasia with eosinophilia is a rare disease characterized by vascular proliferation of unknown origin. The lesions are mostly seen in the head and neck region and are characterized by papules or nodules. A 20-year-old man presented with a 1 year history of reddish papulo-nodular lesions overlying a pulsatile swelling on the left auricular area. Histopathology was suggestive of angiolymphoid hyperplasia with eosinophilia. B-mode ultrasonography, color Doppler and angiography revealed arterial ectasia and arteriovenous malformation of the left auricular artery. Such malformations have been reported previously, in association with angiolymphoid hyperplasia with eosinophilia. The cutaneous lesions responded well to transarterial embolization of the nidus.
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IMAGES IN CLINICAL PRACTICE Top

Post-traumatic ectopic nail p. 416
Binod Kumar Thakur, Shikha Verma, Ankit Jitani
DOI:10.4103/0378-6323.171644  PMID:27279301
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LETTERS TO THE EDITOR - LETTERS IN RESPONSE TO PREVIOUSLY PUBLISHED ARTICLES Top

Immunotherapy or not? The mystery deepens p. 417
Shaurya Rohatgi, Amit Shivaji Kerure, Satish Udare, Hemangi Rajiv Jerajani
DOI:10.4103/0378-6323.182970  PMID:27279302
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Authors' reply p. 418
Vikrant Saoji, Nitin Lade
DOI:10.4103/0378-6323.182971  PMID:27279303
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LETTERS TO THE EDITOR - STUDY LETTERS Top

Intralesional immunotherapy with tuberculin purified protein derivative for verruca: A study from a teaching hospital in South India p. 420
Amit Shivaji Kerure, Amiya Kumar Nath, P Oudeacoumar
DOI:10.4103/0378-6323.175910  PMID:27279304
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Total contact casting in the treatment of nonhealing plantar ulcers in anesthetic foot p. 422
Siddharth Rai, Anil Kumar Gupta, Dileep Kumar, Ashok Kumar Aggarwal, Vijai Prakash Sharma
DOI:10.4103/0378-6323.181460  PMID:27279305
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LETTERS TO THE EDITOR - OBSERVATION LETTERS Top

Multifocal tuberculous gummas and bilateral scrofuloderma followed by papulonecrotic tuberculids developing during anti-tubercular therapy p. 424
Kinjal Deepak Rambhia, Vidya Kharkar, Sunanda Mahajan, Uday Sharadchandra Khopkar
DOI:10.4103/0378-6323.181207  PMID:27279306
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Uncommon presentations of lupus miliaris disseminatus faciei p. 426
Keshavamurthy Vinay, Rahul Mahajan, Uma Nahar Saikia, Dipankar De, Sanjeev Handa
DOI:10.4103/0378-6323.175913  PMID:27279307
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A novel missense mutation of the ATP2C1 gene in a Chinese patient with papular acantholytic dermatosis of the anogenital area p. 429
Xuemin Xiao, LiHong Chen, Baoxi Wang, Chengrang Li
DOI:10.4103/0378-6323.181206  PMID:27279308
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Spontaneous sublingual hematoma due to warfarin: An emergency presenting to the dermatologist p. 432
Sudip Kumar Ghosh, Biswajit Majumder, Megha Agarwal, Olympia Rudra
DOI:10.4103/0378-6323.181469  PMID:27279309
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Sebaceous cell carcinoma developing in epidermodysplasia verruciformis p. 433
Sindhura Bala Naga Kambhampati, Keshavamurthy Vinay, Dipankar De, Sanjeev Handa, Balan Louis Gaspar, Uma Nahar Saikia
DOI:10.4103/0378-6323.175909  PMID:27279310
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Down-regulation of peroxin synthesis by silencing RNA (siRNA): A novel hypothesis for treatment of leishmaniasis p. 436
Masoud Keighobadi, Saeed Emami, Abbas Khonakdar Tarsi, Mahdi Fakhar
DOI:10.4103/0378-6323.181473  PMID:27279311
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LETTERS TO THE EDITOR - CASE LETTERS Top

Lionfish envenomation: Relapses controlled by intralesional triamcinolone p. 438
Lianne Thomas, Sriramulu Tharakaram
DOI:10.4103/0378-6323.181472  PMID:27279312
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Juvenile IgA pemphigus: A case report and review of literature p. 439
Kanagala Chowdary Neethu, Raghavendra Rao, C Balachandran, Sathish Pai
DOI:10.4103/0378-6323.181467  PMID:27279313
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Multiple glomeruloid hemangiomas without POEMS syndrome p. 442
Vishal Gupta, Ajay Rai, Asit Ranjan Mridha, Vinod Kumar Sharma
DOI:10.4103/0378-6323.181461  PMID:27279314
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Congenital absence of skin and an absent twin p. 444
Sivaprakasam Karthika, Govindan Balaji
DOI:10.4103/0378-6323.181204  PMID:27279315
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An asymptomatic inguinal swelling: Lymphatic filariasis p. 446
Amit Kumar Dhawan, Kavita Bisherwal, Chander Grover, Sonal Sharma
DOI:10.4103/0378-6323.174367  PMID:27279316
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Painful calcifying aponeurotic fibroma p. 449
Geeti Khullar, Dipankar De, Satyaswarup Tripathy, Mahesh Prakash, Uma Nahar Saikia, Sanjeev Handa
DOI:10.4103/0378-6323.181503  PMID:27279317
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Two cases of D-penicillamine-induced elastosis perforans serpiginosa p. 452
Jun Liang, Duoqin Wang, Jinhua Xu, Lianjun Chen
DOI:10.4103/0378-6323.178907  PMID:27279318
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Two cases of axillary chromoblastomycosis p. 455
Sowmyashree Krishna, Manjunath M Shenoy, Malcolm Pinto, Varsha Saxena
DOI:10.4103/0378-6323.174415  PMID:27279319
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LETTERS TO THE EDITOR - THERAPY LETTERS Top

Angiolymphoid hyperplasia with eosinophilia treated with surgical excision and electrocoagulation forceps p. 457
Yun-Wei Su, Xin-Feng Wu
DOI:10.4103/0378-6323.181203  PMID:27279320
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Severe recalcitrant psoriasis treated with itolizumab, a novel anti-CD6 monoclonal antibody p. 459
Aayush Gupta, Yugal Kishor Sharma, Kirti Deo, Preeti Kothari
DOI:10.4103/0378-6323.181466  PMID:27279321
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IMAGES IN CLINICAL PRACTICE Top

Reticulate pigmentation in non-bullous ichthyosiform erythroderma p. 462
Geeti Khullar, Dipankar De, Sanjeev Handa
DOI:10.4103/0378-6323.171639  PMID:27279322
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QUIZ Top

Yellowish-white papules in a cobblestone pattern on the neck p. 464
Elena Conde-Montero, Eva Chavarría Mur, Teresa Rivera García, Pablo de la Cueva Dobao
DOI:10.4103/0378-6323.181504  PMID:27279323
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E-IJDVL - NET LETTERS Top

Localized contact dermatitis from Ferula assa-foetida oleo-gum-resin essential oil, a traditional topical preparation for stomach ache and flatulence p. 467
Therdpong Tempark, Susheera Chatproedprai, Siriwan Wananukul
DOI:10.4103/0378-6323.182969  PMID:27279325
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Annular lichenoid dermatitis of youth in a 15-year-old boy: Topical tacrolimus as a treatment option p. 467
Pelin Kuteyla Ülkümen, Emek Kocatürk, Sule Güngör, Nurhan Erzurumluoglu
DOI:10.4103/0378-6323.181501  PMID:27279324
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RESIDENTS CORNER Top

Viva questions from the IJDVL p. 468
Vishalakshi Viswanath, Resham Vasani
DOI:10.4103/0378-6323.183531  PMID:27279326
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BOOK REVIEW Top

Illustrated Synopsis of Dermatology and Sexually Transmitted Diseases p. 474
Asit Mittal
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Online since 15th March '04
Published by Wolters Kluwer - Medknow