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   Table of Contents - Current issue
Coverpage
September-October 2017
Volume 83 | Issue 5
Page Nos. 519-626

Online since Tuesday, August 8, 2017

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EDITORIAL  

Image manipulation and image plagiarism – what's fine and what's not? p. 519
Feroze Kaliyadan
DOI:10.4103/ijdvl.IJDVL_521_17  PMID:28749382
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VIEWPOINT Top

Chemical environmental factors: Can they affect acne? p. 522
Maria Mazioti
DOI:10.4103/ijdvl.IJDVL_736_16  PMID:28707651
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REVIEW ARTICLES Top

Occupational dermatoses: An Asian perspective p. 525
Riti Bhatia, Vinod Kumar Sharma
DOI:10.4103/ijdvl.IJDVL_1041_15  PMID:28485305
Occupational dermatoses contribute to a significant portion of work-related diseases, especially in Asia, where a major portion of the workforce is in the unorganized sector. This review article is focussed on the frequency and pattern of occupational skin diseases reported across Asian countries and type of allergens implicated in different occupations. The literature was searched systematically using key words 'occupational dermatoses,' 'occupational skin disease' and name of each Asian country. Ninty five full-text articles were considered relevant and evaluated. Some of the dermatoses seen in industrial workers in Asian countries are similar to those in Western countries, including dermatoses due to chromate in construction and electroplating workers, epoxy resin, and chromate in painters, wood dust in workers in the furniture industry, azo dyes in textile workers and formaldehyde and chromates in those working in the leather and dyeing industries, dermatoses in domestic workers, chefs and health-care workers. Dermatoses in workers engaged in agriculture, beedi (tiny cigars) manufacture, agarbatti (incense sticks) production, fish processing, carpet weaving, sanitation and those working in coffee plantations and coal mines appear to be unique to Asian countries. Recognition of clinical patterns and geographic variations in occupational skin diseases will provide an impetus to further strengthen future research in these areas, as well as improving their management.
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Onychoscopy: A practical guide Highly accessed article p. 536
Chander Grover, Deepak Jakhar
DOI:10.4103/ijdvl.IJDVL_242_16  PMID:28485306
Onychoscopy refers to the examination of the nail unit using a dermoscope. Since the advent of dermoscopy, attempts have been made to use it for the diagnosis of nail disorders, most commonly pigmented lesions. As of now, onychoscopy has carved out a distinct niche for itself in the diagnostic work up of nail disorders. The nail is capable of mounting only a limited number of reaction patterns to the large number of disorders affecting it. Therefore, simple visual inspection may not be helpful in diagnosing many conditions reliably. Even a nail biopsy may not give a definitive answer every time. Onychoscopy is thus a valuable aid not only in enhancing visible nail features but also in revealing cryptic features of diagnostic value. This review aims to summarize the current level of knowledge about onychoscopic features of various diseases of the nail unit. It also aims to offer practical tips on how to conduct onychoscopy. For the purpose of review, a PubMed search about the indications and results of onychoscopy was done using the keywords “onychoscopy,” “nail fold capillaroscopy,” “dermoscopy nail” and “dermatoscopy nail.” All the articles were retrieved and classified into case reports, reviews and clinical studies. The final data was then analyzed and presented in a narrative fashion.
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ORIGINAL ARTICLES Top

Epidermolysis bullosa acquisita and anti-p200 pemphigoid as major subepidermal autoimmune bullous diseases diagnosed by floor binding on indirect immunofluorescence microscopy using human salt-split skin p. 550
Nupur Goyal, Raghavendra Rao, Shrutakirthi D Shenoi, Sathish Pai, Pramod Kumar, Balbir S Bhogal, Enno Schmidt, Detlef Zillikens
DOI:10.4103/ijdvl.IJDVL_678_16  PMID:28749386
Background: Subepidermal autoimmune bullous diseases are a diverse group of diseases with overlapping clinical and immunopathological features. Indirect immunofluorescence microscopy on artificially split skin helps to classify these conditions into those with staining on the epidermal side of the split (“roof-binding”) and those with staining on the dermal side (“floor-binding”). Epidermolysis bullosa acquisita is the prototype of “floor-binding” subepidermal autoimmune bullous diseases. However, not all floor-binding sera are associated with epidermolysis bullosa acquisita. Aim: The aim of this study was to evaluate the clinical and immunological profile of patients with floor-binding subepidermal autoimmune bullous disease by indirect immunofluorescence microscopy and to identify the target antigens in them. Methods: Ten patients who showed a floor-binding pattern were studied with regard to their clinical and immunopathological characteristics. Target antigens were identified by modified indirect immunofluorescence microscopy using recessive dystrophic epidermolysis bullosa skin, enzyme linked immunosorbent assay, and immunoblotting. Results: Diagnosis of epidermolysis bullosa acquisita was confirmed in six patients. Three patients with an inflammatory subepidermal autoimmune bullous disease mimicking bullous pemphigoid reacted with a 200 kDa protein on immunoblotting with dermal extract, as is characteristic of anti-p200 pemphigoid. One serum showed both roof and floor binding, and reacted with the BP180 antigen. Limitation: We could not perform serration pattern analysis in our patients. Conclusion: In this study, we report three cases of anti-p200 pemphigoid from India. These cases, though indistinguishable clinically from bullous pemphigoid, revealed a floor-binding pattern on indirect immunofluorescence using salt-split skin.
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Receptor for advanced glycation end products is overexpressed in psoriatic plaques independent of disease severity p. 556
Ozkay Ozgor, Gulsen Akoglu, Nuran Sungu, Eda Karaismailoglu, Akin Aktas
DOI:10.4103/ijdvl.IJDVL_718_16  PMID:28707649
Background: Enhanced expression and excitation of the receptor for advanced glycation end products is considered to play a role in the regulation of many pro-inflammatory genes involved in the pathogenesis of psoriasis. Aim: We investigated the expression of receptor for advanced glycation end product in various cell types, in lesional and peri-lesional skin of patients with psoriasis, and its correlation with disease severity. Methods: Paraffin-embedded punch biopsy tissue taken from psoriatic plaques and peri-lesional normal appearing skin tissue of twenty patients with psoriasis, and normal skin samples of eleven healthy participants, were enrolled in the study. The sections were stained immunohistochemically with anti-receptor for advanced glycation end product antibody. The intensity of receptor for advanced glycation end product expression was assessed semi-quantitatively on epidermal cells, microvascular endothelium, dermal fibroblasts and inflammatory cells. They were graded as follows: 0 (no staining), 1 (weak), 2 (moderate) and 3 (strong) intensity. Results: Receptor for advanced glycation end product expression on epidermis, microvascular endothelium, inflammatory cells and fibroblasts in the psoriatic plaques was more intense than perilesional and normal tissue (all P < 0.05). It did not correlate with disease severity. Limitations: The main limitation of our study is that this was a semi-quantitative assessment, detected immunohistochemically in skin biopsies. Conclusion: Receptor for advanced glycation end product expression may have an important role in psoriasis pathogenesis, independent of disease severity.
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Effectiveness and safety of levocetirizine 10 mg versus a combination of levocetirizine 5 mg and montelukast 10 mg in chronic urticaria resistant to levocetirizine 5 mg: A double-blind, randomized, controlled trial Highly accessed article p. 561
Tushar Kanti Sarkar, Amrita Sil, Santasmita Pal, Chinmoy Ghosh, Nilay Kanti Das
DOI:10.4103/ijdvl.IJDVL_551_16  PMID:28656910
Background: Chronic urticaria is a vexing problem for patients and treating physicians alike. The EAACI/GA[2]LEN/EDF/WAO guidelines advocate an increased antihistamine dosage up to four times the standard, before adding leukotriene receptor antagonists. Patients are frequently intolerant of these higher dosages. We conducted this study to determine whether the addition of leukotriene receptor antagonists to the standard antihistamine dose was comparable to higher dosages of antihistamines alone, in terms of efficacy, safety and quality of life changes. We compared levocetirizine 10 mg (double dose of standard) versus a combination of levocetirizine 5 mg and montelukast 10 mg in cases of chronic urticaria not responding to single daily dose of 5 mg levocetirizine. Methods: A single-center, double-blind, randomized, active-controlled, parallel group phase IV trial (CTRI/2014/12/005261) was conducted on 120 patients of chronic urticaria of either sex not responding to 5 mg levocetirizine. Patients were randomized into receiving either levocetirizine 10 mg or levocetirizine 5 mg + montelukast 10 mg for 4 weeks. Primary outcome measures were Urticaria Activity Score (UAS) and Urticaria Total Severity Score (TSS). Routine hematological and biochemical tests and treatment-emergent adverse events were monitored for safety. Results: Fifty-two patients on levocetirizine 10 mg group and 51 patients on levocetirizine 5 mg + montelukast 10 mg group were analyzed. UAS and TSS reduced significantly in both treatment groups and reduction of score were comparable in between the groups (P = 0.628, P = 0.824, respectively). Among adverse effects, sedation was noted significantly more (P = 0.013) in levocetirizine 10 mg group. Quality of life was significantly improved in levocetirizine 5 mg + montelukast 10 mg group (P = 0.031). Limitations: The limitation of the study was that the follow-up period was 4 weeks. Conclusion: EAACI/GA[2]LEN/EDF/WAO guidelines need to be more flexible in allowing usage of montelukast before escalation of anti-histamine dosage.
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Methotrexate iontophoresis versus coal tar ointment in palmoplantar psoriasis: A pilot study p. 569
K Haseena, Sandhya George, Najeeba Riyaz, Sarita Sasidharanpillai, Paul V Puthussery
DOI:10.4103/ijdvl.IJDVL_185_16  PMID:28731017
Background: Palmoplantar psoriasis is often disabling and refractory to conventional therapy. Systemic drugs are indicated in its severe form, but side effects are a concern with their use. Methotrexate is one such systemic drug which is effective and cheap. To reduce systemic toxicity, methotrexate has been tried topically but results have been inconsistent due to poor drug penetration into the skin by passive diffusion. Iontophoresis may enhance its absorption and efficacy. Aim: To evaluate the efficacy and safety of topical methotrexate iontophoresis in comparison with coal tar ointment in the treatment of palmoplantar psoriasis. Methods: Thirty-one patients with palmar and/or plantar psoriasis were selected for the study and 28 patients completed it. The side having more severe involvement was treated while the other palm/sole served as a control. Iontophoresis using methotrexate solution was carried out on the study palm/sole with the injectable preparation of methotrexate (50 mg/2 ml) once a week for the first 4 weeks and subsequently every two weeks, for a total of six sittings. The control palm/sole was treated with coal tar ointment on other days. Erythema, scaling, induration and fissuring scores were noted in both groups before and after treatment. Results: Both study and control groups showed decreases in scores but the reduction was more in the study group, the difference being statistically significant. Limitations: Drawbacks of our study include the small sample size and the lack of follow-up. The study and control arms were not exactly matched and the study was not blinded. Conclusion: Methotrexate iontophoresis was safe and more effective than coal tar ointmentin palmoplantarpsoriasis.
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CASE REPORT Top

Syringocystadenocarcinoma papilliferum with coexisting trichoblastoma: A case report with review of literature p. 574
Rajeshwari K Muthusamy, Sangita S Mehta
DOI:10.4103/ijdvl.IJDVL_755_16  PMID:28656914
We present a unique case of syringocystadenoma with malignant transformation into syringocystadenocarcinoma papilliferum and coexisting trichoblastoma arising de novo in a scalp swelling of long duration in a 78-year-old woman. Syringocystadenocarcinoma papilliferum was described by the World Health Organization as an extremely rare malignant adnexal tumor of apocrine origin with varied histology with some cases reported in literature.
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BRIEF REPORT Top

Adult Henoch–Schönlein purpura: Clinical and histopathological predictors of systemic disease and profound renal disease p. 577
Ruoxi Cao, Sandra Lau, Virlynn Tan, Hong Liang Tey
DOI:10.4103/ijdvl.IJDVL_571_16  PMID:28485308
Background: A major challenge in the management of adult Henoch–Schönlein purpura is the difficulty in assessing the risk of systemic involvement. There is currently a paucity of data in this area. Aims: This study sought to determine specific clinical and histopathological features associated with systemic involvement in adult Henoch–Schönlein purpura. Methods: We reviewed the records of 99 adult Henoch–Schönlein purpura patients who presented at the National Skin Centre, Singapore, between January 2008 and May 2015. Results: Renal involvement was found in 56 (56.6%) patients, joint involvement in 21 (21.2%) and gastrointestinal involvement in 13 (13.1%). Age > 30 years was an independent predictor of renal involvement with an adjusted odds ratio of 2.97 (95% confidence interval, 1.08–8.16; P = 0.04). Risk factors for significant renal involvement necessitating nephrology referral were further evaluated: the odds were approximately 60% higher for every 10-year increase in age (95% confidence interval, 1.02–2.57; P = 0.04) and patients with cutaneous bullae and/or necrosis had an almost six times higher risk (95% confidence interval, 1.43–25.00; P = 0.01). Limitations: This study was limited by its retrospective design. We also lacked long-term data to examine how clinical and histopathological characteristics correlated with long-term disease outcomes. Conclusions: Adult Henoch–Schönlein purpura patients older than 30 years have a threefold increased risk of renal involvement. The risk of profound renal disease necessitating nephrology referral rose significantly with age and the presence of cutaneous bullae and/or necrosis.
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IMAGES IN CLINICAL PRACTICE Top

Capecitabine-induced acral and mucosal hyperpigmentation p. 583
Parul Verma
DOI:10.4103/ijdvl.IJDVL_594_16  PMID:28656912
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LETTERS TO THE EDITOR - CASE LETTERS Top

Cutaneous malakoplakia: Interesting case report and review of literature p. 584
Mukta S Tulpule, Pravin R Bharatia, Avinash M Pradhan, Yashwant V Tawade
DOI:10.4103/ijdvl.IJDVL_145_17  PMID:28749381
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Disseminated discoid lupus erythematosus with a linear lesion on the forearm and hand: A rare presentation and review of literature p. 586
Abhijit Saha, Joly Seth, Swetalina Pradhan, Somsuvra Dattaroy
DOI:10.4103/ijdvl.IJDVL_725_16  PMID:28707650
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Unilateral striate-punctate keratoderma: An extremely rare presentation of punctate keratoderma p. 589
Tasleem Arif, Mohammad Adil, Syed Suhail Amin, Noora Saeed
DOI:10.4103/ijdvl.IJDVL_1004_16  PMID:28731014
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Palmoplantar aquagenic urticaria: A case report p. 592
Prachi Rakesh Srivastava, Anand Kumar Vaggu, Suhasini Kasoju, Jaideep Khare
DOI:10.4103/ijdvl.IJDVL_577_16  PMID:28731018
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A noncancerous variant of xeroderma pigmentosum type D associated with novel heterozygous missense ERCC2 gene mutation p. 594
Shyama Choudhary, Manish Parakh, Kiran Suthar, Poonam Parakh, Satyendra Khichar
DOI:10.4103/ijdvl.IJDVL_485_16  PMID:28749383
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Partial dysautonomia: An interesting presentation p. 596
Subuhi Kaul, Chander Grover, Gopal K Das
DOI:10.4103/ijdvl.IJDVL_541_16  PMID:28749384
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LETTERS TO THE EDITOR - STUDY LETTER Top

Cholinergic urticaria: Clinicoepidemiological paradigms from a tertiary care center in North India p. 599
Muthu Sendhil Kumaran, Amanjot Kaur Arora, Davinder Parsad
DOI:10.4103/ijdvl.IJDVL_735_16  PMID:28731013
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LETTERS TO THE EDITOR - OBSERVATION LETTERS Top

Livedo reticularis after intra-articular hyaluronic acid injection p. 602
Sara Leite de Azevedo Campos, Ana Brasileiro, Alexandre João, Maria João Paiva Lopes
DOI:10.4103/ijdvl.IJDVL_720_16  PMID:28731012
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Wickham's striae-like appearance in a case of nodular Kaposi's sarcoma: A dermoscopic pitfall p. 604
Biswanath Behera, Raj Remya, Laxmisha Chandrashekar, Devinder Mohan Thappa, Debasis Gochhait, Biswajit Dey
DOI:10.4103/ijdvl.IJDVL_973_16  PMID:28731021
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Dermatomyositis revealing both a metastatic linitis plastica and hepatitis C virus infection p. 606
Imane Alouani, Nadia Fihmi, Nada Zizi, Siham Dikhaye
DOI:10.4103/ijdvl.IJDVL_697_16  PMID:28731019
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Demodex folliculorum associated Bacillus pumilus in lesional areas in rosacea p. 610
Alin Laurentiu Tatu, Marius Anton Ionescu, Violeta Corina Cristea
DOI:10.4103/ijdvl.IJDVL_921_16  PMID:28749385
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Vitiligo developing in congenital segmental speckled lentiginous nevus: Another example of immunocompromised cutaneous district due to immunological assault on aberrant melanocytes? p. 612
Anup Kumar Tiwary, Piyush Kumar
DOI:10.4103/ijdvl.IJDVL_1055_16  PMID:28731015
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LETTERS TO THE EDITOR - THERAPY LETTERS Top

Hidradenitis suppurativa unresponsive to canakinumab treatment: A case report p. 615
Burak Tekin, Andac Salman, Tulin Ergun
DOI:10.4103/ijdvl.IJDVL_147_16  PMID:28731016
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Long-term result of hair transplantation for therapy resistant alopecia areata of eyebrows p. 618
Ekrem Civas, Berna Aksoy, Firat Ozer, Muhitdin Eski
DOI:10.4103/ijdvl.IJDVL_913_16  PMID:28731020
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IMAGES IN CLINICAL PRACTICE Top

Subungual osteochondroma p. 620
Sewon Hwang, Miri Kim, Hyun Jeong Park
DOI:10.4103/ijdvl.IJDVL_931_16  PMID:28474643
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QUIZ Top

Reticulate erythema with ulceration p. 622
Rajsmita Bhattacharjee, Keshavamurthy Vinay, Dipankar De, Anindita Sinha, Uma Nahar Saikia
DOI:10.4103/ijdvl.IJDVL_634_16  PMID:28485309
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E-IJDVL - NET STUDY Top

Retrospective study on the characteristics and treatment of late-onset vitiligo p. 625
Yan Ling Kong, Vanessa Hui Ling Ching, Sai Yee Chuah, Tien Guan Thng
DOI:10.4103/ijdvl.IJDVL_650_16  PMID:28656913
Background: Late-onset vitiligo, defined as being aged 50 years and above at the point of clinical onset, remains poorly characterized till now. Aim: This study aims to describe the clinical characteristics and treatment response of patients with late-onset vitiligo. Methods: We retrospectively reviewed the case records of all patients diagnosed with late-onset vitiligo, from January 1, 2010 to December 31, 2014. Information obtained included patient demographics, characteristics of vitiligo and treatment responses. Results: Of the 3128 patients diagnosed with vitiligo over the 5-year period, 461 (14.7%) had late-onset disease. The study had more females (n = 260, 56.4%) than males, with an average onset age of 59.4 ± 7.4 years. Majority of patients were Chinese (n = 308, 66.8%) and 45 (9.8%) patients had an associated autoimmune disease. Focal vitiligo, defined as the localized presence of depigmented patches, was most common (n = 209, 45.3%). Treatment response was evaluated in 359 patients, of which 216 received monotherapy (topical creams: n = 210, 97.2%; phototherapy: n = 6, 2.8%) and 143 received both modalities. Fifty six (15.6%) patients received oral steroids. Patients who were treated with both topical creams and phototherapy yielded better clinical responses compared to those on monotherapy (P < 0.001) with 56.6% (n = 81) of them achieving good epidermal repigmentation, defined as >50% return of pigmentation compared to baseline (vs. n = 66, 30.6% in the monotherapy group). The choice of phototherapy (targeted, narrowband ultraviolet B or psoralen + ultraviolet A) did not significantly affect clinical response (P = 0.774). Limitations: This study is limited by its retrospective nature, the nonstandardized documentation resulting in the inability to determine disease progression and associated metabolic comorbidities and also by the gradual loss to follow-up of patients. Conclusion: Late-onset vitiligo is not uncommon and tends to be of the focal vitiligo subtype. Nonsegmented vitiligo is more prevalent than segmental vitiligo. Combination therapy with topical medications and phototherapy is superior to monotherapy.
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E-IJDVL - NET LETTERS Top

Erythroderma: A clinicopathological study of 370 cases from a tertiary care center in Kerala p. 625
Rani Mathew, V Sreedevan
DOI:10.4103/0378-6323.198434  PMID:28791968
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Angiosarcoma of the gingiva: Metastasis from a primary tumor of the scalp p. 626
Jingmei Yang, Kai Mei, Chenzhou Wu, Yafei Wu, Yi Xu
DOI:10.4103/0378-6323.193608  PMID:27852985
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Penile rhinosporidiosis: An unusual presentation and review of literature p. 626
Joly Seth, Abhijit Saha, Ashim Kumar Mondal, Kaushik Shome, Asit Baran Samanta, Ayush Bindal
DOI:10.4103/0378-6323.199583  PMID:28195081
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