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   Table of Contents - Current issue
Coverpage
November-December 2019
Volume 85 | Issue 6
Page Nos. 569-682

Online since Friday, October 11, 2019

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ORIGINAL ARTICLES  

Oral isotretinoin for treating mucocutaneous human papillomavirus infections: A systematic review and meta-analysis Highly accessed article p. 569
Ting-Hua Yang, Tsai-Hsien Lee, Yu-Chen Huang
DOI:10.4103/ijdvl.IJDVL_269_18  PMID:31274470
Introduction: Some viral warts are refractory to treatment, some others tend to recur. Oral isotretinoin is useful against warts to varying degrees. Objective: To determine the efficacy of oral isotretinoin for treating mucocutaneous human papillomavirus infections. Methods: A systematic review and meta-analysis of studies published from the date of inception of the databases to December 30, 2017 were conducted. Randomized controlled trials or case series with ≥10 patients with mucocutaneous human papillomavirus infection who had received oral isotretinoin treatment were analyzed. The meta-analysis estimated the pooled odds ratio and pooled response rate. Results: The review included eight studies. Trials of oral isotretinoin versus placebo treatment revealed that isotretinoin effectively treated mucocutaneous human papillomavirus infections (odds ratio: 43.8, 95% confidence interval: 9.7–198.8). The pooled estimate of the complete response rate of oral isotretinoin to mucocutaneous human papillomavirus was 67.7% (95% confidence interval: 49.5–81.7%). Another pooled estimation revealed that 83.9% (95% confidence interval: 59.7–94.9%) of patients exhibited at least 50% lesion clearance, whereas 12.3% with complete response experienced recurrence. Limitations: This meta-analysis had a small sample size and high inter-study heterogeneity. Conclusion: Oral isotretinoin is superior to placebo for treating mucocutaneous human papillomavirus infections, particularly plane warts. The recurrence rate and risk of severe side effects are low.
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Evaluation of anti-gal enzyme-linked immunosorbent assay for the diagnosis of Indian post-kala-azar dermal leishmaniasis p. 578
Souvik Datta, Manab Ghosh, Somenath Sarkar, Bibhuti Saha, Sumi Mukhopadhyay
DOI:10.4103/ijdvl.IJDVL_485_18  PMID:31397399
Background: Elimination of kala azar from India is challenging as there are potential reservoirs of Leishmania donovani in patients with post-kala-azar dermal leishmaniasis (PKDL). The vast repertoire of carbohydrate moieties on L. donovani is known to elicit specific and strong humoral responses in patients with kala azar. Aim: The present study was undertaken to evaluate the diagnostic performances of anti-gal antibodies using enzyme-linked immunosorbent assay for successful serological diagnosis of PKDL in Indian patients and to differentiate cases of past cured visceral leishmaniasis infections. Methods: We developed Gal enzyme-linked immunosorbent assay to measure specific anti-gal IgG isotype in the sera of 71 Indian patients with PKDL. The diagnostic efficacy of the newly developed assay was evaluated for precision, sensitivity and accuracy. Results: Gal2 enzyme-linked immunosorbent assay revealed three-fold increased anti-gal titers in 71 patients with active PKDL compared to controls. Subclass enzyme-linked immunosorbent assay analysis further revealed enhanced IgG2 and IgG3 anti-gal titers in patients with PKDL compared to control subjects. The rank order for specificity and sensitivity for IgG subclasses was IgG3>IgG2>IgG4>IgG1. The area under the curve values of 0.98 and 0.99 were obtained for IgG and IgG3 Gal2 enzyme-linked immunosorbent assays respectively. Overall sensitivity and specificity were 95.7% (95% CI: 88.1–99.1) and 98.1% (95% confidence interval: 90.1–99.9), and 98.5% (95% CI: 92.4–99.9) and 98.1% (95% CI: 90.1–99.9), respectively. Intra-assay coefficient of variation was 1.5% and inter-assay coefficient of variation was 11.7%. Limitations: The Gal2 enzyme-linked immunosorbent assay needs to be further investigated in mass surveys. Conclusion: Taken together, anti-gal titers detected through Gal2 enzyme-linked immunosorbent assay can serve as an effective diagnostic tool in disease elimination setting and help in better case management in endemic districts.
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Second to fourth digit ratio in female patients with acne vulgaris: Could it be a predictor of androgen receptor status? p. 590
Azza Gaber Antar Farag, Mohamed Ahmed Shoiab, Rehab Samaka, Asmaa Gaber Abdou, Nada Farag Elnaidany, Asmhan Omar M. Mansour
DOI:10.4103/ijdvl.IJDVL_35_18  PMID:31249215
Background: Second to fourth digit (2D:4D) ratio is the ratio of index to ring fingers length. It reflects prenatal androgen exposure and sensitivity. Androgens are important in the pathogenesis of acne vulgaris, This ratio may therefore be of significance in determining the expression of androgen receptors. Aim: To investigate the relationship between second to fourth digit ratio and androgen receptor expression in female patients with acne vulgaris and to assess its association with clinical aspects of acne vulgaris. Methods: Females patients (n = 352) with different degrees of acne vulgaris severity and 168 age-matched females were enrolled. Right, left and total second to fourth digit ratios were calculated. Biopsies from all participants were processed for androgen receptor expression by immunohistochemical method. Results: Right, left and total second to fourth digit ratios were significantly lower in acne vulgaris patients than controls (P < 0.001 for all), and each of them had a significant negative correlation with duration of acne vulgaris (P < 0.001; P = 0.013; P < 0.001, respectively). Androgen receptors were detected in epidermal keratinocytes, hair follicles, sebaceous glands and fibroblasts. Right second to fourth digit ratio showed a negative correlation with androgen receptor H score of keratinocytes (r = −0.28;P = 0.02), hair follicles (r = −0.22; P = 0.05) and fibroblasts (r= −0.37;P = 0.001), while left second to fourth digit ratio demonstrated negative correlation with androgen receptor H score of sebocytes (r = −0.397; P < 0.000) only. Limitations: Lack of follow-up and absence of male participants were the main limitations of this study. Conclusion: A masculine second to fourth digit ratio in female patients could anticipate acne vulgaris development, its duration and severity. Moreover, this ratio is associated with an upregulation of cutaneous androgen receptors. Taken together, second to fourth digit ratio could help in designing plans for treatment of acne vulgaris.
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Lichenoid pseudovesicular papular eruption on nose: A papular facial dermatosis probably related to actinic lichen nitidus or micropapular polymorphous light eruption p. 597
Saurabh Singh, Ashok Singh, Saumyaranjan Mallick, Sudheer Arava, M Ramam
DOI:10.4103/ijdvl.IJDVL_347_18  PMID:31293275
Background: Facial papules are a feature of several clinical conditions and may present both diagnostic and therapeutic challenges. Aim: To describe a grouped papular eruption on the nose and adjoining cheeks that has not been well characterized previously. Materials and Methods: A series of consecutive patients with a papular eruption predominantly involving nose and cheeks were evaluated, treated and followed up prospectively at tertiary care centers. Demographic details, clinical features, histopathology and response to treatment were recorded. Results: There were five men and six women (mean age 29.9 ± 6.9 years) who had disease for a mean duration of 17.3 ± 11.1 months. All patients presented with a predominantly asymptomatic eruption of monomorphic, pseudovesicular, grouped, skin colored to slightly erythematous papules prominently involving the tip of nose, nasal alae, philtrum and the adjoining cheeks. A total of 15 biopsies from 11 patients were analyzed and the predominant finding was a dense, focal lymphoid infiltrate restricted to the upper dermis with basal cell damage and atrophy of the overlying epidermis. The eruption ran a chronic course from several months to years. Limitations: Direct immunofluorescence could not be performed except in one case. Immunohistochemical stains for CD4 and CD8 could not be done owing to nonavailability. Phototesting was undertaken in one patient only. Conclusion: Small grouped papules on the nose and adjoining skin with a lichenoid histopathology appear to represent a distinct clinicopathological entity. It may be related to actinic lichen nitidus/micropapular variant of polymorphous light eruption.
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CASE REPORT Top

Vacuum sealing drainage: A novel treatment method for primary cutaneous Mycobacterium intracellulare infection p. 605
Mei Chen, Haijing Yang, Fei Wang, Hongsheng Wang
DOI:10.4103/ijdvl.IJDVL_873_17  PMID:29974888
The incidence of primary cutaneous Mycobacterium intracellulare infection is very low. We report a case of primary cutaneous M. intracellulare infection which presented as painful erythematous swelling of the right upper limb without systemic involvement. A novel technique of vacuum sealing drainage was successfully implemented after antimycobacterial treatment proved ineffective at the end of 3 months. Our technique also revealed some additional practical advantages.
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BRIEF REPORT Top

Chitosan-based biocompatible dressing for treatment of recalcitrant lesions of cutaneous leishmaniasis: A pilot clinical study p. 609
Fahimeh Abdollahimajd, Hamideh Moravvej, Sahar Dadkhahfar, Hamid Mahdavi, Mehdi Mohebali, Hamid Mirzadeh
DOI:10.4103/ijdvl.IJDVL_189_18  PMID:30785121
Background: Chitosan has a biocompatible, biodegradable and nontoxic nature. The effectiveness of nano-chitosan films in the treatment of cutaneous leishmaniasis has been confirmed previously in susceptible laboratory animals. Aims: The aim of this study is to evaluate the safety and efficacy of a chitosan-based biocompatible dressing in patients with cutaneous leishmaniasis who were either nonresponsive to or had medical contraindications for conventional treatments. Materials and Methods: A total of 10 eligible patients were included in this single arm, single center study. The sterile chitosan film was immersed in saline serum and was cautiously extended over the wound to avoid air occlusion. Sterile Vaseline gauze was then applied and the film was kept on the wound site for 7 days and was repeated every week until the healing was completed. Complete clinical response was defined as complete re-epithelialization of the skin lesion as well as microscopic negative results for amastigote forms of Leishmania sp. Results: All patients showed either significant (30%) or complete (70%) improvement after 8 weeks of therapy and at 16 weeks post treatment all cases were completely cured. It was well tolerated and there were no product-related adverse events such as allergic reaction or infection. Moreover, no recurrences were observed in any patients after 6 months follow-up. Limitations: The lack of a control group, relatively small sample size and failure to evaluate the histological and molecular effects of chitosan were the limitations of this study. Conclusion: Our findings confirmed that chitosan can be safely and effectively used for the treatment of cutaneous leishmaniasis. We were unable to find any previous clinical study in evaluating the efficacy of chitosan for cutaneous leishmaniasis on human subjects. Further studies are recommended to design a randomized, double-blinded clinical trial with more volunteers who infected with different species of Leishmania and various clinical forms of cutaneous leishmaniasis.
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IMAGES IN CLINICAL PRACTICE Top

Entomodermoscopy: A tool for hunting bed bug p. 615
Deepak Jakhar, Ishmeet Kaur
DOI:10.4103/ijdvl.IJDVL_791_17  PMID:30117460
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LETTERS TO THE EDITOR - LETTERS IN RESPONSE TO PREVIOUSLY PUBLISHED ARTICLES Top

Errata: Review article: Hidradenitis suppurativa: A systematic review and meta-analysis of therapeutic interventions p. 617
Ankita Agrawal, Yugal Kishor Sharma
DOI:10.4103/ijdvl.IJDVL_453_19  PMID:31512583
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LETTERS TO THE EDITOR - CASE LETTERS Top

A rare case of phakomatosis pigmentovascularis type IIb associated with inverse Klippel–Trenaunay syndrome and Sturge–Weber syndrome p. 618
Lian Liu, Jiayu Sun, Yunlong Pan, Xian Jiang
DOI:10.4103/ijdvl.IJDVL_55_19  PMID:31571612
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Unilateral vancomycin-induced linear IgA bullous dermatosis p. 621
Kamar Belhareth, Yosra Soua, Aymen Hraeich, Nadia Ben Fredj, Sriha Badreddine, Hichem Belhaj Ali, Jameleddine Zili
DOI:10.4103/ijdvl.IJDVL_899_18  PMID:31571615
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Sorafenib-induced grade III hand–foot skin reaction with ulcerative dermatitis on scrotum, penis, and earlobe p. 623
Chandra Sekhar Sirka, Kananbala Sahu, Swetalina Pradhan, Arpita Nibedita Rout
DOI:10.4103/ijdvl.IJDVL_67_19  PMID:31584016
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Adult-onset Still's disease presenting as blotchy and flagellate pigmentation p. 626
Suman Patra, Neetu Bhari, Pratik Mohta, Sanjay Singh, M Ramam, Shipra Agarwal
DOI:10.4103/ijdvl.IJDVL_513_18  PMID:31571611
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LETTERS TO THE EDITOR - OBSERVATION LETTERS Top

Dermoscopic findings of Spitz nevus on acral volar skin p. 629
Sara Estefania Montenegro Jaramillo, Gwanghyun Jo, Claudia Christin Darmawan, Cheol Lee, Je-Ho Mun
DOI:10.4103/ijdvl.IJDVL_728_18  PMID:31571613
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Co-occurrence of lichen striatus in twins p. 632
Tapaswini Tripathy, Bhabani S. T. P. Singh, Bikash Ranjan Kar
DOI:10.4103/ijdvl.IJDVL_978_18  PMID:31571609
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Blue vitiligo: A dermoscopic perspective p. 634
Balachandra S Ankad, Balakrishna P Nikam, Priyanka S Jaju
DOI:10.4103/ijdvl.IJDVL_809_18  PMID:31571614
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LETTERS TO THE EDITOR - STUDY LETTERS Top

Early clinical and histological changes induced by microneedling in facial melasma: A pilot study p. 638
Daniel Pinho Cassiano, Ana Cláudia Cavalcante Espósito, Karime Marques Hassun, Emerson Vasconcelos de Andrade Lima, Ediléia Bagatin, Hélio Amante Miot
DOI:10.4103/ijdvl.IJDVL_44_19  PMID:31607716
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A portable fluorescence spectrometer as a noninvasive diagnostic tool in dermatology: A cross-sectional observational study p. 641
Shital Poojary, Saurabh Jaiswal, Akshat Wahi, Aparajita Sahoo, Forum Shah, Geetanjali Rathod, Anshuman J Das
DOI:10.4103/ijdvl.IJDVL_440_18  PMID:31571616
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Scabicidal effect of heat on the in vitro survival of scabies mites and their eggs: Optimal temperature and exposure time p. 647
Charussri Leeyaphan, Nakaraj Pluetrattanabha, Pichaya Limphoka, Sumanas Bunyaratavej
DOI:10.4103/ijdvl.IJDVL_198_19  PMID:31552836
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Application of a “fish mouth flap” combined with an orbicularis oculi myocutaneous flap after surgical removal of basal cell carcinoma in the facial buccal region p. 649
Siqi Fu, Adriana C Panayi, Qianjin Lu, Hai Long
DOI:10.4103/ijdvl.IJDVL_1003_18  PMID:31571610
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Aberrant expression of bradykinin b2 receptor in the epidermis of patients with psoriasis vulgaris p. 653
Haibo Liu, Min Zhang, Xiaoping Dong, Fang Liu, Hong Sang
DOI:10.4103/ijdvl.IJDVL_741_18  PMID:31552837
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LETTERS TO THE EDITOR - THERAPY LETTER Top

Is cyclosporine a good option for the treatment of subcutaneous panniculitis-like T-cell lymphoma associated with hemophagocytic syndrome? p. 656
Raquel Aragón-Miguel, Alba Calleja-Algarra, Virginia Velasco-Tamariz, María Garrido, Pablo Ortiz-Romero, Lidia Maroñas-Jiménez
DOI:10.4103/ijdvl.IJDVL_747_18  PMID:31571617
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CASE REPORT Top

A case of febrile ulceronecrotic Mucha-Habermann disease with comorbidities p. 660
Dhanashree Santosh Bhide, Mukta Shriram Tulpule, Suresh V Pethe
DOI:10.4103/ijdvl.IJDVL_552_17  PMID:30860167
Febrile ulceronecrotic Mucha-Habermann disease is a very rare and severe variant of pityriasis lichenoides et varioliformis acuta. Adult cases are difficult to diagnose as in the early course they can mimic erythema multiforme or lymphomatoid papulosis. We report a case of a 38-year-old woman who presented with 90% body surface area involvement, fever, diarrhea, malaise and associated comorbidities. She was treated with systemic steroids and methotrexate but suffered a fatal outcome. So far, a total of 65 cases are reported in the literature.
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IMAGES IN CLINICAL PRACTICE Top

Dermoscopy: An easy way to solve the diagnostic puzzle in pityriasis versicolor p. 664
Naveen Thomas, Subrata Malakar
DOI:10.4103/ijdvl.IJDVL_816_16  PMID:30117461
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QUIZ Top

An erythematous plaque on the leg of a female p. 666
Anuradha Bishnoi, Sanjeev Handa, Vikarn Vishwajeet, Uma Nahar Saikia, Baljinder Singh, Bhagwant Rai Mittal, Gaurav Prakash, Pankaj Malhotra
DOI:10.4103/ijdvl.IJDVL_497_17  PMID:30073981
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RESIDENTS’ PAGE Top

Wonder drug for worms: A review of three decades of ivermectin use in dermatology Highly accessed article p. 674
Saravanan Gowtham, Kaliaperumal Karthikeyan
DOI:10.4103/ijdvl.IJDVL_840_18  PMID:31552839
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HISTORY Top

Human lice: Spectators and actors of the history of humanity through the ages p. 679
Gianluca Nazzaro, Giovanni Genovese, Stefano Veraldi
DOI:10.4103/ijdvl.IJDVL_797_18  PMID:31552838
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NET STUDY Top

Utility of trichoscopy to diagnose early female pattern hair loss in resource-poor setting: A cross-sectional study p. 681
Rahul Nagar, Radha Dhudshia
DOI:10.4103/ijdvl.IJDVL_826_18  PMID:31584017
Background: Trichoscopy is a reliable instrument for diagnosis and for tracking therapy-related changes in female pattern hair loss (FPHL). Videodermoscopic diagnosis of FPHL has been established, which requires fine measurements of hair-related parameters; the method requires an expensive equipment/digital program. Aim: To determine whether a low-cost, simple USB dermoscope can ascertain the hair-related changes in early FPHL. Methods: An age-matched, cross-sectional study was performed over 3 years on subjects with less than 6-month history of hair loss and without an obvious broadening of midline hair parting. Trichoscopic analysis of the frontal and occipital scalp of the study subjects were performed, using a USB-connected dermoscope. The subjects were analyzed for the presence of microscopic hair changes in the form of anisotrichosis, vellus-like hair, single hair follicle unit, peri-pilar sign and yellow dots. Results: A total of 230 cases and 230 controls were analyzed. The dermoscopic hair changes were found to be significantly associated with the frontal scalp zone of cases. Limitations: Histopathological evaluation of the cases was not done. Conclusion: Microscopic changes recorded with the help of a simple USB dermoscope are helpful in establishing a diagnosis of FPHL even in early disease.
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NET LETTERS Top

Complete form of pachydermoperiostosis with cutis verticis gyrata resulting from the SLCO2A1 gene mutation p. 681
Xiaoxue Li, Dan Hao, Jesse Li-Ling, Xian Jiang
DOI:10.4103/ijdvl.IJDVL_911_17  PMID:30880718
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PLA2R antibody positive membranous glomerulonephropathy associated with psoriasis vulgaris p. 682
Sandeep Arora, Anantharam Jairam, S Radhakrishnan, Niyor Das, Mahesha Vankalakunti
DOI:10.4103/ijdvl.IJDVL_298_18  PMID:30757997
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High dynamic range conversion and contrast adjustment to improve quality of dermoscopy imaging in vitiligo: A pilot study p. 682
Feroze Kaliyadan, Karalikkattil T Ashique
DOI:10.4103/ijdvl.IJDVL_316_18  PMID:30516168
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