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   Table of Contents - Current issue
Coverpage
July-August 2017
Volume 83 | Issue 4
Page Nos. 415-517

Online since Monday, June 5, 2017

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REVIEW ARTICLES  

Effects of air pollution on the skin: A review Highly accessed article p. 415
Poonam Puri, Shashi Kumar Nandar, Sushruta Kathuria, V Ramesh
DOI:10.4103/0378-6323.199579  PMID:28195077
The increase in air pollution over the years has had major effects on the human skin. Various air pollutants such as ultraviolet radiation, polycyclic aromatic hydrocarbons, volatile organic compounds, oxides, particulate matter, ozone and cigarette smoke affect the skin as it is the outermost barrier. Air pollutants damage the skin by inducing oxidative stress. Although human skin acts as a biological shield against pro-oxidative chemicals and physical air pollutants, prolonged or repetitive exposure to high levels of these pollutants may have profound negative effects on the skin. Exposure to ultraviolet radiation has been associated with extrinsic skin aging and skin cancers. Cigarette smoke contributes to premature aging and an increase in the incidence of psoriasis, acne and skin cancers. It is also implicated in allergic skin conditions such as atopic dermatitis and eczema. Polyaromatic hydrocarbons are associated with extrinsic skin aging, pigmentation, cancers and acneiform eruptions. Volatile organic compounds have been associated with atopic dermatitis. Given the increasing levels of air pollution and its detrimental effects on the skin, it is advisable to use strategies to decrease air pollution.
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Paederus dermatitis Highly accessed article p. 424
Kaliaperumal Karthikeyan, Annapurna Kumar
DOI:10.4103/0378-6323.198441  PMID:28584222
Paederus dermatitis is an irritant dermatitis caused by pederin, a toxin produced by the rove beetle (Paederus). The disease occurs worldwide, but it is often not recognized as a history of contact with the insect is frequently absent. It is commonly seen in the rainy season. Crushing the insect releases pederin, resulting in the characteristic linear lesions with a burning sensation that heal with hyperpigmentation. Treatment comprises immediate washing of the area to eliminate the toxin and topical application of a topical steroid-antibiotic combination. Preventive measures may include reducing the insect population in the surroundings, avoiding contact of insects with the skin, minimizing the lesions after contact. Awareness of the etiology and clinical manifestations makes it easier to suspect this condition even in the absence of a history of exposure to the insect. We present a comprehensive review of the etiopathogenesis, pathology, clinical features, treatment and prevention of Paederus dermatitis and also review the biology of the insect and its behavior.
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ORIGINAL ARTICLES Top

Expression of the receptor for advanced glycation end products in acquired reactive perforating collagenosis p. 432
Gulsen Akoglu, Nuran Sungu, Eda Karaismailoglu, Akin Aktas
DOI:10.4103/ijdvl.IJDVL_113_16  PMID:28474638
Background: Acquired reactive perforating collagenosis (ARPC) is a rare skin disorder characterized by transepidermal elimination of dermal collagen. There is little data regarding the pathogenesis of ARPC. The receptor for advanced glycation end products (RAGE) is a multiligand transmembrane receptor that plays an important role in inflammatory responses and may be involved in the pathogenesis of ARPC. Aim: To explore the expression of RAGE in ARPC. Methods: Paraffin-embedded punch biopsy specimens of 41 patients with ARPC and of 11 healthy controls with normal skin were obtained from the Department Of Pathology. Clinical data of all patients were reviewed from the medical files. All specimens were stained immunohistochemically with antibody to RAGE (Anti-RAGE). The intensity of RAGE expression was assessed semi-quantitatively on epidermal cells, microvascular endothelium, dermal fibroblasts and inflammatory cells and graded as 0 (no staining), 1 (weak), 2 (moderate) and 3 (strong). The patients were divided into diabetic and nondiabetic groups for analysis. Results: RAGE expression in microvascular endothelium, inflammatory cells and fibroblasts of patients with ARPC was more intense than normal tissues of healthy participants (P values are 0.005, 0.017 and <0.001, respectively). The grade of RAGE expression was comparable in diabetic and nondiabetic patients (all P > 0.05). Limitations: Our method of assessment of RAGE expression was semi-quantitative. Conclusion: We observed an overexpression of RAGE in lesional samples of patients with ARPC which was independent of the presence of diabetes.
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Clinico-mycological study of dermatophytic infections and their sensitivity to antifungal drugs in a tertiary care center p. 436
Soniya Mahajan, Ragini Tilak, Satyendra K Kaushal, Rabindra N Mishra, Shyam S Pandey
DOI:10.4103/ijdvl.IJDVL_519_16  PMID:28540871
Background: Worldwide, dermatophytic infections are running a chronic course either due to ineffective treatment or emerging drug resistance. In the past three decades, there has been an increase in incidence and non-responsiveness to conventional antifungals, which suggests that there is a need of antifungal sensitivity testing. Aims: This study was aimed at identifying clinico-mycological pattern of dermatophytic infections in patients attending thedermatology outpatient department of a tertiary care hospital, and to obtain the sensitivity pattern of isolates against six commonly used oral antifungals (fluconazole, terbinafine, itraconazole, ketoconazole, griseofulvin and voriconazole). Methods: Patients with suspected dermatophytoses attending the outpatient department of Sir Sunderlal Hospital, Varanasi, were enrolled in the study. A detailed history, clinical examination and sample collection for mycological examinations was done. In vitro antifungal sensitivity testing was done on species isolated from culture as per the Clinical and Laboratory Standard Institute M38-A standards, with broth microdilution method. Results: There were 256 patients recruited in the study, with a male: female ratio of 3:1. The most commonly affected age group was 20–40 years (52.4%). Tinea corporis et cruris was the most common type observed (27.2%). Potassium hydroxide positivity was seen in 211 samples (79.6%) and culture positivity was found in 139 samples (52.4%). The most common species identified was Trichophyton mentagrophytes (75.9%). Sensitivity testing was done on fifty isolates of T. mentagrophytes. Minimum inhibitory concentrations of itraconazole, ketoconazole, terbinafine and voriconazole were comparable, while griseofulvin showed the highest minimum inhibitory concentration. Itraconazole was found to be the most effective drug, followed by ketoconazole, terbinafine and fluconazole. Griseofulvin was the least effective drug among the tested antifungals. Limitations: This is a hospital-based study, and may not reflect the true pattern in the community. Sensitivity pattern of only one species T. mentagrophytes was carried out. Conclusion: Inadequate and irregular use of antifungal drugs has led to the emergence of resistant strains, which cause poor treatment outcomes. Thus, it is very important to test for antifungal sensitivity to check for resistance to antifungals.
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Atorvastatin as adjunctive therapy for chronic plaque type psoriasis versus betamethasone valerate alone: A randomized, double-blind, placebo-controlled trial p. 441
Sharlene Helene H. Chua, Giselle Marie S. Tioleco, Carmela Augusta F. Dayrit, Winlove P Mojica, Belen L Dofitas, Lorna F Frez
DOI:10.4103/ijdvl.IJDVL_425_16  PMID:28540870
Background: Psoriasis is a T helper 1 cell-mediated chronic inflammation. Statins have been found to have anti-inflammatory and immunomodulatory effects targeting T helper 1 cells and thus, are being investigated as treatments for psoriasis. Aims: To investigate the efficacy and safety of atorvastatin as adjunctive treatment for mild to moderate chronic plaque psoriasis; and the impact of atorvastatin on quality of life. The study also aimed to correlate the beneficial effects of atorvastatin with its lipid-lowering effects. Methods: Twenty-eight (19–65 year old) mild-moderate chronic plaque psoriasis patients were randomly assigned to two groups (treatment group: atorvastatin 40 mg OD; control group: placebo OD) and followed up for 6 months. All were allowed to use betamethasone valerate 0.1% ointment twice a day for a maximum of 3 weeks continuous application with 1-week rest periods in between. Primary outcome measures were the mean percentage reduction in Psoriasis Area and Severity Index (PASI) scores and percentage of patients achieving PASI-50. Results: Fourteen patients (treatment: 6, control: 8) completed the trial. Mean reductions in PASI scores between the treatment (2.15 ± 2.17) and control (1.69 ± 2.36) groups were not statistically significant (P = 0.636). Intention-to-treat analysis of PASI-50 showed increased risk of treatment failure with atorvastatin as adjunct but estimates were not significant. Changes in Dermatology Life Quality Index (DLQI) scores (P = 0.214) and high-sensitivity C-reactive protein (P = 0.884) were likewise not statistically significant. Reductions in PASI scores were not linearly correlated with reductions in total cholesterol (P = 0.924), triglycerides (P = 0.274), low-density lipoprotein-cholesterol (P = 0.636), high-density lipoprotein-cholesterol (P = 0.584), or high-sensitivity C-reactive protein levels (P = 0.906). Adverse effects in the treatment group were transient elevated transaminases (n = 1) and mild myalgia (n = 1). Limitations: A 50% dropout rate was experienced. This remarkably high dropout rate decreases the robustness of the study results. Conclusions: Although atorvastatin exhibited earlier percentage reduction in PASI scores, it was not able to produce an additional benefit compared to psoriatic patients applying steroid alone.
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Computer assisted Objective structured clinical examination versus Objective structured clinical examination in assessment of Dermatology undergraduate students p. 448
Richa Chaudhary, Chander Grover, SN Bhattacharya, Arun Sharma
DOI:10.4103/ijdvl.IJDVL_587_16  PMID:28540874
Background: The assessment of dermatology undergraduates is being done through computer assisted objective structured clinical examination at our institution for the last 4 years. We attempted to compare objective structured clinical examination (OSCE) and computer assisted objective structured clinical examination (CA-OSCE) as assessment tools. Aim: To assess the relative effectiveness of CA-OSCE and OSCE as assessment tools for undergraduate dermatology trainees. Methods: Students underwent CA-OSCE as well as OSCE-based evaluation of equal weightage as an end of posting assessment. The attendance as well as the marks in both the examination formats were meticulously recorded and statistically analyzed using SPSS version 20.0. Intercooled Stata V9.0 was used to assess the reliability and internal consistency of the examinations conducted. Feedback from both students and examiners was also recorded. Results: The mean attendance for the study group was 77% ± 12.0%. The average score on CA- OSCE and OSCE was 47.4% ± 19.8% and 53.5% ± 18%, respectively. These scores showed a mutually positive correlation, with Spearman's coefficient being 0.593. Spearman's rank correlation coefficient between attendance scores and assessment score was 0.485 for OSCE and 0.451 for CA-OSCE. The Cronbach's alpha coefficient for all the tests ranged from 0.76 to 0.87 indicating high reliability. Limitations: The comparison was based on a single batch of 139 students. Such an evaluation on more students in larger number of batches over successive years could help throw more light on the subject. Conclusions: Computer assisted objective structured clinical examination was found to be a valid, reliable and effective format for dermatology assessment, being rated as the preferred format by examiners.
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CASE REPORT Top

Primary cutaneous extranodal natural killer/T-cell lymphoma presenting as bilateral erythematous patches on the arms p. 453
Ik Jun Moon, Hyun Ji Kang, Mi Woo Lee, Woo Jin Lee
DOI:10.4103/ijdvl.IJDVL_264_16  PMID:28474639
Natural killer/T-cell lymphoma is a rare, Epstein–Barr virus-associated type of cytotoxic lymphoma thatpresents mainly in the nasal cavity and its vicinity. Very few cases of primary cutaneous extranodal natural killer/T-cell lymphoma have been reported till date. All the previously reported cases of primary cutaneous extranodalnatural killer/T-cell lymphoma presented as lesions resembling cellulitis, subcutaneous nodules or ulcers. We report a rare case which presented as erythematous and purpuric round patches on the arms and was finally diagnosed as primary cutaneous extranodalnatural killer/T-cell lymphoma, following a skin biopsy. The atypical patchy lesions presented a diagnostic challenge. We herein describe this clinically novel atypical patch-like presentation of primary cutaneous extranodalnatural killer/T-cell lymphoma together with the key histopathologic features and highlights of the previously reported cases.
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BRIEF REPORT Top

Bullous pemphigoid and antecedent neurological diseases: An association with dementia p. 457
Crystal Zhen Yu Phuan, Yik Weng Yew, Hong Liang Tey
DOI:10.4103/0378-6323.198451  PMID:28584223
Background: Bullous pemphigoid is the most common subepidermal immunobullous disorder. Studies have reported the association between bullous pemphigoid and various neurological diseases. Aims: The aim of this study was to evaluate whether bullous pemphigoid is associated with pre-existent neurological diseases and whether specific diseases exhibit this association. Methods: All dermatology inpatients from January 2010 to May 2015 were analyzed. Bullous pemphigoid cases were identified based on clinical features and consistent histopathologic and direct immunofluorescence findings. Patients with other autoimmune bullous skin disorders were excluded. An equal number of inpatients with other skin conditions were selected randomly as age- and sex- matched controls. Results: Out of 3015 inpatients, 103 cases of bullous pemphigoid and 103 age- and sex-matched controls were included. Seventy six patients with bullous pemphigoid had a history of at least one neurological disease. After adjusting for age, gender, race, functional status and neuro-psychiatric medications, patients with bullous pemphigoid were found to be approximately thrice as likely to have a history of at least one neurological disease than were controls (odds ratio: 2.88; 95% confidence interval: 1.32–6.26; P = 0.008). Amongst the pre-existing neurological diseases, only dementia was statistically more prevalent in bullous pemphigoid cases compared to controls (adjusted odds ratio: 2.61; 95% confidence interval: 1.19–5.75; P = 0.017). Parkinson disease and psychiatric disorders demonstrated a higher adjusted risk among bullous pemphigoid patients but the difference was not statistically significant. Limitations: The limitations were potential referral and selection bias, as the patients were inpatients. There is a possible misclassification as the diagnosis of neurological diseases was performed using medical records. The duration from the diagnosis of neurological diseases to bullous pemphigoid could not be accurately determined as it was a retrospective review of records and most neurological diseases have a prolonged course. Conclusions: Pre-existent neurological disease, specifically dementia, was found to be associated with bullous pemphigoid.
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IMAGES IN CLINICAL PRACTICE Top

Matting of body hair p. 462
Manikoth Payyanadan Binitha, Anza Khader, Sharanya Padma
DOI:10.4103/0378-6323.204201  PMID:28397713
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LETTERS TO THE EDITOR - CASE LETTERS Top

Cutis laxa-like pseudoxanthoma elasticum with osteoma cutis p. 464
Cem Leblebici, Tuğba Falay, Sibel Zırtıloğlu, Cuyan Demirkesen
DOI:10.4103/ijdvl.IJDVL_690_16  PMID:28540877
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Actinomycotic osteomyelitis p. 468
Yashwant Ingle, Roopa Madalli, Mamatha G. S. Reddy, Supriya Kheur, Manjusha Ingle
DOI:10.4103/ijdvl.IJDVL_685_16  PMID:28540876
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Unilateral angiokeratoma of the scrotum (Fordyce's type) associated with a contralateral varicocele p. 470
Marcos A González-López, Germana Consuegra, Marina Lacalle, M Carmen González-Vela
DOI:10.4103/ijdvl.IJDVL_850_14  PMID:28540880
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Bilateral subungual epidermoid inclusions of big toes p. 472
Piyush Kumar, Archana Singal, Sushil S Savant, Niharika Ranjan Lal
DOI:10.4103/ijdvl.IJDVL_773_16  PMID:28513484
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A case of dermatomyositis with underlying unusual malignancy p. 473
Taru Garg, Sarita Sanke, Ram Chander, Mahima Agarwal, Kiran Agarwal, Ashok Kumar
DOI:10.4103/ijdvl.IJDVL_365_16  PMID:28513483
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Ectodermal dysplasia-skin fragility syndrome with a new mutation p. 476
Emine Tugba Alatas, Asude Kara, Murat Kara, Gursoy Dogan, Onur Baysal
DOI:10.4103/ijdvl.IJDVL_411_16  PMID:28540868
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LETTERS TO THE EDITOR - OBSERVATION LETTERS Top

Palmoplantar hyperhidrosis: A paradoxical presentation of acquired idiopathic generalized hypohidrosis p. 480
Yan Ling Kong, Hong Liang Tey
DOI:10.4103/ijdvl.IJDVL_543_16  PMID:28540873
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Chromoblastomycosis caused by Cladophialophora carrionii p. 482
Jiaoqing Tang, Kaiwen Zhuang, Xin Ran, Yaling Dai, Yuping Ran
DOI:10.4103/ijdvl.IJDVL_707_16  PMID:28540878
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Generalized lichen planus developing at the healed sites of erythema multiforme in a human immunodeficiency virus-seropositive patient p. 485
Biswanath Behera, Rashmi Kumari, Debasis Gochhait, Devinder Mohan Thappa
DOI:10.4103/ijdvl.IJDVL_268_16  PMID:28540867
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Upper genital tract infection due to Ureaplasma urealyticum: Etiological or syndromic management? p. 489
Tanvi Dev, Neha Taneja, Deepak Juyal, Benu Dhawan, Somesh Gupta
DOI:10.4103/ijdvl.IJDVL_497_16  PMID:28474641
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LETTERS TO THE EDITOR - STUDY LETTERS Top

Clinical characteristics of pruritus in scabies p. 492
Kihyuk Shin, Hyunju Jin, Hyang-Suk You, Jeong-Min Kim, Woo-Haing Shim, Gun-Wook Kim, Hoon-Soo Kim, Hyun-Chang Ko, Moon-Bum Kim, Byung-Soo Kim
DOI:10.4103/ijdvl.IJDVL_1136_16  PMID:28540869
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Dexamethasone-cyclophosphamide pulse therapy in systemic sclerosis: A retrospective study from a tertiary care hospital p. 494
Devraj Dogra, Naina Dogra, Gunjan Gupta, Sabha Mushtaq
DOI:10.4103/ijdvl.IJDVL_527_16  PMID:28540872
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High B-cell-activating factor levels in endemic Tunisian pemphigus p. 496
Kaouthar Mejri, Maryam Kallel Sellami, Ines Rania Zaraa, Lilia Laadhar, Houria Lahmar, Mourad Mokni, Insaf Mokhtar, Bacima Fezza, Mondher Zitouni, Sondes Makni
DOI:10.4103/ijdvl.IJDVL_96_16  PMID:28540881
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A study on various Neisseria gonorrhoeae phenotypes circulating in Tripura p. 499
Jhinuk Basu Mullick, Tapan Majumdar, Raunak Bir, Samrat Hore, Samir Kumar Sil
DOI:10.4103/ijdvl.IJDVL_607_16  PMID:28540875
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The enigma of lamivudine rash: Experience on re-challenge from an anti retroviral treatment center in South India p. 502
PC Amrutha, TP Rakesh, Ajithkumar Kidangazhiyathmana, Sebin Cheeran Chakkunny, Bharath Bhushan Rewari, Andrews Mekkattukunnel Andrews
DOI:10.4103/ijdvl.IJDVL_463_16  PMID:28474640
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LETTERS TO THE EDITOR - THERAPY LETTERS Top

Gabapentin for the management of vismodegib-induced muscle cramps p. 505
Ercan Çaliskan, İlker Taşçı, Semai Bek
DOI:10.4103/ijdvl.IJDVL_762_16  PMID:28540879
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Trichosporon inkin causing subcutaneous sinus tract: Successfully treated by oral and ultrasound-guided intralesional itraconazole therapy p. 506
Xu Xiaoxi, Dai Yaling, Zhuang Kaiwen, Ran Xin, Sushmita Pradhan, Ran Yuping
DOI:10.4103/ijdvl.IJDVL_1017_16  PMID:28513482
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IMAGES IN CLINICAL PRACTICE Top

Pigmented fungiform papillae in mother and daughter p. 510
Hima Gopinath, Gatha M Upadya
DOI:10.4103/ijdvl.IJDVL_826_16  PMID:28440229
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HISTORY Top

Acantholysis or the Auspitz sign? A revelation of the life of Carl Heinrich Auspitz p. 512
Shahajah Shareef, Faizah Shareef, Emily Tongdee, Mercedes Florez-White
DOI:10.4103/ijdvl.IJDVL_785_16  PMID:28513485
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QUIZ Top

Multiple asymptomatic hard papules on cheeks in an elderly woman p. 513
Ram Chander, Taru Garg, Sarita Sanke, Kiran Agarwal, Aruna Chhikara
DOI:10.4103/ijdvl.IJDVL_432_16  PMID:28440231
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E-IJDVL - NET LETTERS Top

Pityriasis rosea along Blaschko's lines: A rare variant p. 516
Vijay Zawar, Antonio Chuh
DOI:10.4103/0378-6323.193618  PMID:27852994
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Disseminated molluscum contagiosum following chemotherapy: A therapeutic challenge p. 516
Vellayani T Ajithkumar, Sarita Sasidharanpillai, Kunnummal Muhammed, Meethale P Sreejayan, Muhammedkutty Simin, Febin Ashraf, Nimmi John, Thunoli Dhanyasree
DOI:10.4103/0378-6323.193619  PMID:27852995
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Lichen nitidus presenting with trachyonychia p. 516
Hulya Albayrak, Mehmet Emin Yanık, Gamze Erfan, Meltem Oznur, Mustafa Kulac
DOI:10.4103/0378-6323.196316  PMID:28004647
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ERRATA Top

Erratum: Ectodermal dysplasia skin fragility syndrome with a new mutation p. 517

DOI:10.4103/0378-6323.207545  PMID:28584224
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