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   Table of Contents - Current issue
Coverpage
January-February 2019
Volume 85 | Issue 1
Page Nos. 1-131

Online since Sunday, December 30, 2018

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VIEWPOINT  

Cosmetic dermatology: An integral part of current dermatology curriculum p. 1
Jasleen Kaur Sandhu
DOI:10.4103/ijdvl.IJDVL_290_18  PMID:30487345
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SYMPOSIUM - LASERS Top

Methods to overcome poor responses and challenges of laser hair removal in dark skin p. 3
Shehnaz Zulfikar Arsiwala, Imran M Majid
DOI:10.4103/ijdvl.IJDVL_1103_16  PMID:30027915
Conventional and advance technologies are available for laser hair removal. Complete and permanent hair reduction is not yet possible by treatment with lasers. Ideal patient for any conventional laser hair removal treatment is one who has thick, dark terminal hair, light skin and normal hormonal status. Factors that contribute to variable outcomes in laser hair removal can be broadly divided into patient related ones and the technology related ones. Skin type, hair color, thickness and density, degree of tan, hormonal dysfunction etc., constitute the patient related factors. The wavelength, fluence, spot size and pulse duration of the laser system are the technology related factors. There are some patients who respond variably, unpredictably or poorly to laser hair removal despite ensuring that indication for treatment is appropriate with adequate parameters of the laser system. This article reviews various patient related and technology related factors which lead to variable-to-poor outcomes in laser hair removal; and various challenges and limitations of laser hair removal technology in patients with dark skin types.
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Optimizing Q-switched lasers for melasma and acquired dermal melanoses p. 10
Sanjeev Jayanth Aurangabadkar
DOI:10.4103/ijdvl.IJDVL_1086_16  PMID:30027914
The Q-switched Nd:YAG laser is an established modality of treatment for epidermal and dermal pigmented lesions. The dual wavelengths of 1064nm and 532nm are suited for the darker skin tones encountered in India. Though this laser has become the one of choice for conditions such as nevus of Ota, Hori's nevus and tattoos, its role in the management of melasma and other acquired dermal melanoses is not clear. Despite several studies having been done on the Q-switched Nd:YAG laser in melasma, there is no consensus on the protocol or number of sessions required. Acquired dermal melanoses are heterogenous entities with the common features of pigment incontinence and dermal melanophages resulting in greyish macular hyperpigmentation. This article reviews the current literature on laser toning in melasma and the role of the Q-switched Nd:YAG laser in stubborn pigmentary disorders such as lichen planus pigmentosus. As the pathology is primarily dermal or mixed epidermal-dermal in these conditions, the longer wavelength of 1064nm is preferred due to its deeper penetration. Generally multiple sessions are needed for successful outcomes. Low fluence Q-switched Nd:YAG laser at 1064nm utilizing the multi-pass technique with a large spot size has been suggested as a modality to treat melasma. Varying degrees of success have been reported but recurrences are common on discontinuing laser therapy. Adverse effects such as mottled hypopigmentation have been reported following laser toning; these can be minimized by using larger spot sizes of 8 to 10mm with longer intervals (2 weeks) between sessions.
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Isotretinoin and dermatosurgical procedures p. 18
Venkataram Mysore, HM Omprakash, Gayatri Nagindas Khatri
DOI:10.4103/ijdvl.IJDVL_96_17  PMID:29998863
Several early reports suggested that performance of dermatosurgical procedures in patients on oral isotretinoin is associated with abnormal skin healing, keloid or hypertrophic scar formation. However, this association has been recently questioned in some studies. This review examines this issue, analyzes the studies published and concludes that the recommendation made earlier about the need to avoid dermatosurgical procedures in patients on isotretinoin is based on inadequate and insufficient evidence and hence needs revision. The review also suggests that recent studies on the subject establish that performing such procedures is safe.
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Complications of laser and light-based devices therapy in patients with skin of color p. 24
BS Chandrashekar, Chaithra Shenoy, C Madura
DOI:10.4103/ijdvl.IJDVL_88_17  PMID:30560814
Lasers and light-based devices are indispensable to an aesthetic dermatology practice. The growing popularity of lasers has been matched by a sharp increase in the incidence of complications. The Indian skin with its high melanin content is more prone to injury and careful setting of laser parameters, early detection of complications and immediate therapy are vital to avoiding permanent sequelae. We review the various complications that occur during laser procedures and their management.
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ORIGINAL ARTICLES Top

Autologous noncultured melanocyte-keratinocyte transplantation in stable vitiligo: A randomized comparative study of recipient site preparation by two techniques p. 32
Sumit Gupta, Vineet Relhan, Vijay Kumar Garg, Bijaylaxmi Sahoo
DOI:10.4103/ijdvl.IJDVL_1130_16  PMID:29998861
Background: Accurate preparation of recipient area is a critical step in melanocyte-keratinocyte transplantation procedure for vitiligo. It is an important potential step for adaptation in the quest to achieve better results and ablative lasers potentially offer excellent precision over margin and depth control in achieving that. Objective: To compare between the two techniques used for recipient site preparation: Er:YAG laser ablation and mechanical dermabrasion for melanocyte-keratinocyte transplantation procedure in terms of re-pigmentation achieved and adverse effects seen. Methods: A randomized comparative trial was performed among 32 patients of stable vitiligo undergoing melanocyte-keratinocyte transplantation procedure. In Group A (n = 15), recipient site preparation was done with Er:YAG laser, and in Group B (n = 17), it was done with a motorized dermabrader. Patients of both groups were objectively assessed for re-pigmentation at 1, 3 and 6 months. Results: A total of 253.696 cm2 of depigmented surface was operated upon and re-pigmentation of 125.359 cm2 (49.4%) was achieved. On comparison between two groups, no statistical difference was found with respect to total re-pigmentation achieved (Group A: 54.67% vs Group B: 48.841%, P = 0.663) and grades of re-pigmentation achieved (P = 0.796). Occurrence of adverse events was also statistically similar in both the groups. Conclusion: This study did not reveal any statistically different outcome (in terms of re-pigmentation and adverse effects) between the two methods of recipient site preparation – motorized dermabrasion and Er:YAG ablation. Limitations: This study is small and larger studies are needed to ascertain the benefit of Er:YAG for recipient site preparation. Future studies may also ascertain variables such as time taken to prepare the recipient area, nature of bleeding, postoperative healing, difficulties in specific area, cost of the procedure, patient comfort and ease of the surgeon, rather than comparing the re-pigmentation alone.
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A randomized, open-label, comparative study of oral tranexamic acid and tranexamic acid microinjections in patients with melasma p. 39
Vinod K Khurana, Rachita R Misri, Swati Agarwal, Akhilesh V Thole, Sachin Kumar, Tanu Anand
DOI:10.4103/ijdvl.IJDVL_801_16  PMID:30333359
Background: Melasma poses a great challenge as its treatment modalities are unsatisfactory. Treatment using tranexamic acid is a novel concept. Aim: This study aimed to compare the therapeutic efficacy and safety of oral tranexamic acid and tranexamic acid microinjections in patients with melasma. Methods: This is a prospective, randomized, open-label study with a sample size of 64, 32 in each treatment arm. Thirty-two patients were administered localized microinjections (4 mg/ml) of tranexamic acid monthly in 1 arm, while in the other arm, 32 were given oral tranexamic acid 250 mg twice a day. Patients were followed up for 3 consecutive months. Clinical photographs were taken at each visit, and a modified melasma area and severity index scoring was performed at the beginning and end of treatment. Results: Improvement in melasma area and severity index score in the oral group was 57.5% as compared to 43.5% in the intralesional group. All 32 patients in the oral group (100%) showed >50% improvement, out of which 8 showed >75% improvement. In the intralesional group, 17 (53%) patients had >50% improvement, of which 3 had >75% improvement. The remaining 15 patients in this group had <50% improvement. Thus, the oral group showed a more significant response as compared to the intralesional group. No major adverse effects were observed in both the groups. At 6-month follow-up, two patients (6.2%) in the oral group had recurrence as compared to three patients (9.4%) in the intralesional group. Limitations: A small sample size was one of the limitations in this study. The dose of tranexamic acid in microinjections and the frequency of injections could have been increased. Conclusion: Tranexamic acid provides rapid and sustained improvement in the treatment of melasma. It is easily available and affordable. Oral route is undoubtedly efficacious, but the results of microinjections, while encouraging, can probably be enhanced by either increasing the frequency of injections or increasing the concentration of the preparation.
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Safety and efficacy of autologous noncultured dermal cell suspension transplantation in the treatment of localized facial volume loss: A pilot study p. 44
Alok Kumar Sahoo, Savita Yadav, Vinod K Sharma, Anita Singh Parihar, Surabhi Vyas, Somesh Gupta
DOI:10.4103/ijdvl.IJDVL_760_17  PMID:30058570
Background: Available options for correction of facial volume loss, such as synthetic fillers, autologous fat and cultured fibroblasts, have limitations viz. temporary effect and high cost. Aim: To assess the use of a novel technique, autologous non-cultured dermal cell suspension transplantation, for correction of localized facial volume loss due to inflammatory pathologies. Methods: It was a pilot study conducted in the Dermatology Outpatient Department, All India Institute of Medical Sciences (AIIMS), New Delhi, India. Autologous non-cultured dermal cell suspension was transplanted in a total of 10 patients, out of which 5 had predominantly dermal loss and the rest had predominantly lipoatrophy. The donor tissue from the gluteal region was digested into a single cell suspension using collagenase-1 and injected into the recipient area. The outcome was assessed subjectively by patients and investigators and objectively using ultrasonography. Cell count, viability testing and measurement of mesenchymal stem cells were also done. Results: On assessment of patients, the median improvement in the predominantly dermal atrophy group at 3 and 6 months was 70% (range: 10–90%) and 80% (range: 0–90%), respectively, and in the predominantly lipoatrophy group, 0% (range: 0–40) and 0% (range: 0–50), respectively. Mean thickness of dermis + subcutis at the baseline was 1.835 mm (range: 0.89–6.04 mm), which increased to 2.912 mm (range: 0.88–7.07 mm, P = 0.03) at 6 months. Limitations: Our pilot study has some limitations such as small sample size and heterogeneity of the recruited patients. Conclusions: Autologous non-cultured dermal cell suspension transplantation appears to be safe and effective in localized facial dermal defects because of inflammatory pathologies, but not effective in deeper defects.
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Toenail concentrations of zinc, selenium and nickel in patients with chronic recurrent warts: A pilot two-group comparative study p. 51
Mohamed El-Komy, Vanessa Hafez, Rania Abdel Hay, Dina Mehaney, Iman Hafez
DOI:10.4103/ijdvl.IJDVL_861_17  PMID:30226475
Background: Normal immune functioning requires sufficient levels of trace elements including zinc and selenium, while elements such as nickel can be immunotoxic. Aim: To assess long-term abnormalities in zinc, selenium and nickel levels in patients with chronic recurrent warts. Methods: Toenail samples were taken from 28 patients with chronic recurrent warts and 30 apparently healthy matching controls were analysed. Toenail concentrations of zinc, selenium and nickel were measured using inductively-coupled plasma-optical emission spectroscopy. Results: Selenium levels were significantly higher in patients than in controls (P = 0.03). Levels of trace elements did not correlate with the number or duration of warts. Toenail nickel levels in all subjects were higher than globally reported values. Limitations: A small sample size and the absence of regional reference ranges for concentrations of trace elements in toenails. Conclusion: Zinc does not seem to be involved in the chronicity of warts, and it is unclear if selenium has a protective role against warts. Our finding of high concentrations of nickel in both patients and controls raises concerns about environmental exposure.
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CASE REPORTS Top

Successful treatment of metastatic extramammary Paget's disease with pemetrexed monotherapy systemically and 5-fluorouracil topically Highly accessed article p. 56
Kexu Chen, Hanlin Liang, Jiewen Peng, Yanfang Zheng
DOI:10.4103/ijdvl.IJDVL_171_17  PMID:29536970
Advanced extramammary Paget's disease does not have a standardized treatment guideline as its incidence is low and has been rarely reported in literature. Here we describe a case of metastatic extramammary Paget's disease successfully treated with topical 5-fluorouracil (5-FU) and systemic pemetrexed. The therapy was safe without any appreciable adverse effects like diarrhea, rash, neutropenia or fatigue; maintaining remission for more than 6 months. Thus, we propose 5-FU and pemetrexed as the first-line therapy for advanced extramammary Paget's disease, especially for aged patients with unresectable skin lesions.
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Localized unilateral basaloid follicular hamartoma along Blaschko's lines on face Highly accessed article p. 60
Sarina Jain, Uday Khopkar, Jagdish Sakhiya
DOI:10.4103/ijdvl.IJDVL_466_17  PMID:29491193
Basaloid follicular hamartoma (BFH) is a rare hamartoma of hair follicle. Clinical presentations may vary but are united by the same histopathological features in the form of folliculocentric basaloid or squamoid cell proliferation in the superficial dermis, which represents malformed and distorted hair follicles. It is important to recognize this entity as its simulant is basal cell carcinoma, a low-grade malignancy. Here, we report a case of localized unilateral BFH in a Blaschkoid distribution on the face of a 14-year-old female.
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BRIEF REPORTS Top

A study of serum vascular endothelial growth factor in infantile hemangiomas Highly accessed article p. 65
Sanjeev Paria, Vibhu Mendiratta, Ram Chander, Anju Jain, Saurabh Mittal
DOI:10.4103/ijdvl.IJDVL_996_16  PMID:29469063
Background: Though infantile hemangiomas are the most common benign tumor of infancy, their etiopathogenesis is not fully understood. Some studies report a diagnostic role for vascular endothelial growth factor (VEGF), but such studies are lacking from India. Aims: To study the clinicoepidemiological profile of infantile hemangiomas, to estimate and compare the serum levels of VEGF in infantile hemangiomas and controls, and to determine correlations between serum levels of VEGF and growth characteristics of infantile hemangiomas. Methods: A hospital-based, cross-sectional study was carried out on 30 clinically diagnosed cases of infantile hemangioma and 30 controls presenting with other disorders. VEGF levels were recorded for both cases and controls by the sandwich enzyme-linked immunosorbent assay (ELISA) technique. Results were analyzed using SPSS version 20.0, and their significance determined using appropriate tests. Results: Mean serum VEGF level in the cases was 216.8 ± 49.2 pg/ml while in the control group it was 115.1 ± 43.1 pg/ml (P < 0.0001). There were no statistically significant correlations between serum VEGF levels and sex or size, phase of growth, morphological variants or ulceration of lesions. Limitations: Our sample was not large enough to draw clinically applicable conclusions. An adequate sample size could not be achieved because of low incidence of the disease, and resource and time constraints. Conclusions: The mean value of serum VEGF in the study group was significantly higher than that in the control group, suggesting that serum VEGF can serve as a diagnostic marker of infantile hemangiomas. Mean serum VEGF was higher in proliferative lesions than in involuting lesions, indicating that it may also be useful as a prognostic serological marker in cases of infantile hemangioma.
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Four novel mutations of ADAR1 in Chinese patients with dyschromatosis symmetrica hereditaria Highly accessed article p. 69
Wei Hu, Xian Shi, Hongwen Li, Luzhu Chen, Tingmei Wang, Yingying Dong, Yanhong Zhang, Man Hu, Xiaoli Liu, Caie Zhang, Dongxian Liu, Yunhua Deng
DOI:10.4103/ijdvl.IJDVL_66_17  PMID:29536976
Background: Novel mutations in adenosine deaminase acting on RNA 1 gene (ADAR1) are responsible for dyschromatosis symmetrica hereditaria (DSH). DSH patients display a mixture of hyperpigmented and hypopigmented macules on the dorsal aspects of the extremities, and freckle-like macules on the face. Aims: To provide new evidence for further study of the etiopathogenisis of DSH. Methods: Genomic DNA was extracted and used as a template for the polymerase chain reaction (PCR) amplification of all 15 coding exons as well as intron-exon boundaries of ADAR1. The PCR products were sequenced directly. Results: We identified eight mutations of ADAR1 in four Chinese pedigrees and four individual patients, which were c.2722G>T, p.(Asp908Tyr), c.1657delA, p.(Ser553fs), c.2563_2564delCT, p.(Leu855fs), c.526T>G, p.(Leu176Val) as well as four previously reported mutations c. 3363_3364insT, p.(Lys1122fs), c. 2865_2866delGT, p.(Val955fs), c.1630C>T, p.(Arg544X), and c.2894C>T, p.(Pro965Leu). In silico analysis predicted that all the mutations reported were pathogenic. Limitations: We did not study how ADAR1 played its role in DSH. So, the exact pathogenic mechanism of ADAR1 in DSH patients wasn't clarified in this study. Conclusion: We found four novel ADAR1 mutations in this study. Our results enlarge the database on ADAR1 mutations associated with DSH.
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IMAGES IN CLINICAL PRACTICE Top

A case of cutaneous horn arising in verrucous epidermal nevus Highly accessed article p. 74
Anupama Bains, Neha Bagga, Deepak Vedant, Abhishek Bhardwaj, Aasma Nalwa
DOI:10.4103/ijdvl.IJDVL_435_17  PMID:29536972
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QUIZ Top

Asymptomatic erythematous plaques on the left arm and trunk p. 76
JiHong Lim, Yuri Woo, Miri Kim, Hyun Jeong Park
DOI:10.4103/ijdvl.IJDVL_1150_16  PMID:30058566
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LETTERS TO THE EDITOR - LETTERS IN RESPONSE TO PREVIOUSLY PUBLISHED ARTICLES Top

Intramatricial injections for nail psoriasis: An open-label comparative study of triamcinolone, methotrexate, and cyclosporine p. 81
Surya Ravindran, Sebastian Criton
DOI:10.4103/ijdvl.IJDVL_632_18  PMID:30457124
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Author's reply p. 82
BB Mahajan
DOI:10.4103/ijdvl.IJDVL_888_18  PMID:30504532
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End of the road for terbinafine? Think of compliance to treatment p. 83
Noureddine Litaiem, Manel Karray, Sabrine Bouhlel, Takwa Bacha, Faten Zeglaoui
DOI:10.4103/ijdvl.IJDVL_844_18  PMID:30460930
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Author's reply p. 84
Sanjay Singh
DOI:10.4103/ijdvl.IJDVL_927_18  PMID:30516169
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Everything is in the name: Macular hyperpigmentation of uncertain etiology or acquired dermal macular hyperpigmentation of varied etiologies? p. 85
Anuradha Bishnoi, Keshavamurthy Vinay, Sendhil Muthu Kumaran, Davinder Parsad
DOI:10.4103/ijdvl.IJDVL_373_18  PMID:30460929
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Authors' reply p. 87
Vishal Gupta, Vinod K Sharma
DOI:10.4103/ijdvl.IJDVL_843_18  PMID:30516169
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LETTERS TO THE EDITOR - CASE LETTERS Top

Lethal melanoma in a two-year-old child with multiple congenital melanocytic nevi p. 89
Fei Gao, Guiye Niu, Bin Zhang, Linlin Xin
DOI:10.4103/ijdvl.IJDVL_938_17  PMID:30560815
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Unilateral distribution of cutaneous metastasis in a case of colon carcinoma p. 93
Carlos Duran Vian, Iosune Vilanova-Urdániz, Gema Pérez Paredes, M Carmen González-Vela, Marcos A González-López
DOI:10.4103/ijdvl.IJDVL_665_17  PMID:30504536
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LETTERS TO THE EDITOR - OBSERVATION LETTERS Top

Eruptive squamous cell carcinomas associated with programmed cell death protein-1 inhibitor therapy p. 97
Jack Lee, Darren J Guffey, Mary-Margaret B Noland, Mark A Russell
DOI:10.4103/ijdvl.IJDVL_147_18  PMID:30539800
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Stevens–Johnson syndrome-like reaction without mucosal lesions associated with cyclophosphamide p. 101
Yang Lo, Chun-An Yao
DOI:10.4103/ijdvl.IJDVL_903_17  PMID:30504533
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Surrogate advertisement of a super-potent corticosteroid-containing cream: An alarming development and a cautionary tale of its consequences p. 104
Abir Saraswat, Rajetha Damisetty
DOI:10.4103/ijdvl.IJDVL_22_18  PMID:30504534
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LETTERS TO THE EDITOR - THERAPY LETTER Top

Successful treatment of red ear syndrome with botulinum toxin type A p. 107
Maria Castellanos-Gonzalez, Fernando De Manueles, María García Martos, Maria Agustina Segurado Rodríguez
DOI:10.4103/ijdvl.IJDVL_111_18  PMID:30487346
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IMAGES IN CLINICAL PRACTICE Top

Eccrine syringofibroadenomatosis over the dorsa of both feet p. 109
Hak Tae Kim, Young Jae Kim, Chong Hyun Won
DOI:10.4103/ijdvl.IJDVL_537_17  PMID:29697067
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QUIZ Top

A solitary nodule on the posterior pinna p. 111
Ki Min Sohn, Young Jun Woo, Jung Eun Kim, Hoon Kang
DOI:10.4103/ijdvl.IJDVL_273_17  PMID:29376510
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PEARLS Top

Ensuring precise beard and eyebrow shaping with laser: Innovative use of tongue depressor p. 114
Seema Satyapal Singh, Minal Patwardhan Andrade
DOI:10.4103/ijdvl.IJDVL_115_18  PMID:30539799
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RESIDENTSí PAGE Top

Dermatoses with “collarette of skin” p. 116
Keshavmurthy A Adya, Arun C Inamadar, Aparna Palit
DOI:10.4103/ijdvl.IJDVL_623_17  PMID:29770789
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HISTORY Top

A historical note on the evolution of “ringworm” p. 125
Amiya Kumar Mukhopadhyay
DOI:10.4103/ijdvl.IJDVL_56_18  PMID:30409924
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NET STUDY Top

Falknor's needling method as a potential immunotherapy in palmo-plantar warts p. 129
Pramila Kumari, Devendra Yadav, Anita Vijay, Suresh Kumar Jain, Mukesh Kumar, Ramesh Kumar, Asha Nyati
DOI:10.4103/ijdvl.IJDVL_809_17  PMID:30467272
Background and Aim: Treatment of palmoplantar warts is a challenge for dermatologists. We aimed to study the efficacy and safety of Falknor's needling method in palmoplantar warts. Methods: In an open, nonrandomized study, the index wart of eligible patients was punctured several times with a 26-gauge needle to produce a “beefy” red wound. Patients were followed up to 6 months. Results: Out of 82 patients, complete resolution occurred in 58 (70.7%) and partial response in 5 (6.1%) patients. Nine (10.9%) patients developed secondary infection. Limitations: Small sample size, No comparison group. Conclusion: Falknor's needling method provides a high rate of complete resolution after a single treatment session. It is easy to perform and is cost effective.
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NET QUIZ Top

Painful leg rash p. 129
Adeline Mei-Yen Yong, Yee-Leng Teoh, Yong-Kwang Tay
DOI:10.4103/ijdvl.IJDVL_388_18  PMID:30504535
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NET LETTERS Top

An unusual early onset of lentigo maligna in the fourth decade of life p. 129
Eftychia Platsidaki, Nikolaos Kostopoulos, Kanellos Gesakis, Dorothea Polydorou, Efthymia Agiasofitou
DOI:10.4103/ijdvl.IJDVL_125_17  PMID:29327697
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Partial unilateral lentiginosis with ipsilateral ocular involvement and seizures p. 130
Vishal Gupta, Neha Taneja, Binod K Khaitan, Manish Singh
DOI:10.4103/ijdvl.IJDVL_1025_16  PMID:29176249
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Bloom syndrome sans characteristic facial features in a Mestizo patient- a diagnostic challenge p. 130
Sonia Chavez-Alvarez, Alejandra Villarreal-Martinez, Ma Del Roble Velasco-Campos, Isabel Moreno-Vega, Laura Elia Martinez-de-Villarreal, Maira Herz-Ruelas, Jorge Ocampo-Candiani, Luis Daniel Campos-Acevedo
DOI:10.4103/ijdvl.IJDVL_787_16  PMID:29794356
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IJDVL Awards 2018 p. 131
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