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   Table of Contents - Current issue
Coverpage
November-December 2017
Volume 83 | Issue 6
Page Nos. 627-741

Online since Monday, October 16, 2017

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EDITORIAL  

Encouraging curricular research: A new agenda for IJDVL p. 627
Saumya Panda, Yogesh S Marfatia
DOI:10.4103/ijdvl.IJDVL_725_17  PMID:28984628
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VIEWPOINT Top

Vitiligo pathogenesis is interlinked with pigment homeostasis: A new concept Highly accessed article p. 630
Ratnam Attili, Sasi Kiran Attili
DOI:10.4103/ijdvl.IJDVL_900_16  PMID:28948944
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REVIEW ARTICLES Top

The nail as an investigative tool in medicine: What a dermatologist ought to know p. 635
Chander Grover, Shikha Bansal
DOI:10.4103/ijdvl.IJDVL_1050_16  PMID:28980535
The nail is an important skin appendage, but not many dermatologists are aware of the importance it receives outside our specialty. This article focuses on the nail in non-dermatological contexts. The nail is a keratinized matrix capable of continuous growth with the ability to incorporate various compounds within its structure. Therefore it can be used to monitor long-term consumption of drugs. It is also an excellent source of germ-line DNA for genetic analyses. With an increased undrstanding of nail physiology, there is now a better understanding of its connection to various pathologies as well. Nails, being peripherally placed, are easy to sample without significant discomfort to the patient, making them a valuable diagnostic tool. For this narrative review, we carried out a PubMed search using the key words “nail clipping,” “nail DNA,” “nail diabetes mellitus;” “nail clipping oncology,” and “nail forensics”. Retrieved articles were searched for information pertaining to non-dermatologic uses of nail for evaluation, which is presented in a narrative fashion. It is clear from recent literature that the nail is not just an inert skin appendage, but a dynamic window into the ever-changing metabolic and genetic milieu. We highlight the numerous roles of nail specimens, as well as point towards future research needed therein.
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Traction alopecia: A neglected entity in 2017 p. 644
Christiana Oyinlola Akingbola, Jui Vyas
DOI:10.4103/ijdvl.IJDVL_553_16  PMID:29035284
Traction alopecia was first described in 1904 but is still a cause of scarring hair loss in young women worldwide. It is unique in being initially a reversible then an irreversible (scarring) form of alopecia. Linked to tightly-pulled hairstyles, it is seen across all races. The pattern of hair loss depends on the style creating it but most commonly affects the frontotemporal hairline. There are some new examination findings associated with traction alopecia, which are traction folliculitis, the fringe sign and hair casts (pseudonits) on dermatoscopy. These may prove key in prompting early specialist referral. The mainstay of current treatment is cessation of the contributing hairstyles. Camouflage, anti-inflammatory or growth-stimulating topical preparations are second line treatments. In later stages of severe traction alopecia hair transplantation may be the only effective treatment. The evidence basis for medical intervention with topical agents is anecdotal at best. Furthermore, additional research is required to clarify the pathogenesis of this biphasic alopecia. Until then, prompt diagnosis and identification of causative hairstyles are focus of current dermatological practice.
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ORIGINAL ARTICLES Top

Clinical and serological characteristics of nail psoriasis in Indian patients: A cross-sectional study p. 650
Deepashree Daulatabad, Chander Grover, Bineeta Kashyap, Amit Kumar Dhawan, Archana Singal, Iqbal R Kaur
DOI:10.4103/ijdvl.IJDVL_795_16  PMID:28656915
Background: Nail involvement in psoriasis is common with a lifetime incidence of 80-90%. It may reflect severity of cutaneous involvement and predict joint disease. Yet it remains, poorly studied and evaluated especially in Indian psoriatic patients. Aim: The present study was undertaken to evaluate clinical and serological profile of nail involvement in psoriasis and to assess quality of life impairment associated with nail involvement in Indian patients. Methods: Consecutive patients with nail psoriasis were assessed for severity of cutaneous disease (psoriasis area severity index score) and nail disease (nail psoriasis severity index score). The impairment in quality of life attributable to nail disease was scored with nail psoriasis quality of life 10 score. All patients were also assessed for joint disease and tested for inflammatory and serological markers as erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor and anti-cyclic citrullinated peptide antibodies. Results: In our cohort of 38 patients with nail psoriasis, 9 had concomitant psoriatic arthritis. The mean psoriasis area severity index was 14.4 ± 9.6 (range = 0.4–34). The most commonly recorded psoriatic nail changes were pitting (97.4%), onycholysis (94.7%) and subungual hyperkeratosis (89.5%). The mean nail psoriasis severity index score was 83.2 ± 40.1 (range = 5–156) and mean nail psoriasis quality of life 10 was 1.1 ± 0.4. Erythrocyte sedimentation rate and C-reactive protein were raised in 22/38 (57.9%) and 15/38 (39.5%) patients, respectively; rheumatoid factor was positive in 5/38 (13.2%) and anti-cyclic citrullinated peptide antibody was raised in 4/38 (10.5%) patients. Limitations: Small sample size and lack of a control group. Conclusions: In Indian patients with nail psoriasis, severity of nail involvement was found to be poorly correlated with the extent of cutaneous disease. In addition the impact of nail disease on patient's quality of life was found to be minimal. This suggests the need for a quality of life questionnaire suited to the Indian population. Serological markers were raised overall in the study patients and more so in the patients with concomitant arthritis.
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Dermoscopy and patch testing in patients with lichen planus pigmentosus on face: A cross-sectional observational study in fifty Indian patients p. 656
Vinod Kumar Sharma, Vishal Gupta, Piyush Pahadiya, Kamal Kumar Vedi, Sudheer Arava, M Ramam
DOI:10.4103/ijdvl.IJDVL_469_16  PMID:29035285
Background: Lichen planus pigmentosus (LPP) is a common cause of facial melanosis in the dark-skinned population. At present, information on dermoscopy and patch testing in LPP is limited. Objectives: To describe dermoscopic findings and study the role of patch testing in patients with LPP on the face. Methods: Facial lesions of 50 patients with LPP were studied dermoscopically, followed by histological evaluation. Patch and photopatch tests with the Indian Standard Series and Scandinavian series, respectively, and patient's own cosmetics were performed on all patients. Results: The most common dermoscopic finding was dots and/or globules (43/50, 86%) in different patterns: hem-like (20.9%), arcuate (18.6%), incomplete reticular (39.5%), complete reticular (7%), and not otherwise specified (14%). Other patterns were exaggerated pseudoreticular pattern, accentuation of pigmentation around follicular openings, targetoid appearance, and obliteration of the pigmentary network. There were 26 relevant patch tests in 17 (34%) patients: para-phenylenediamine (n = 5), nickel (n = 3), colophony, perfume mix and fragrance mix (n = 2 each), thiuram mix and 3,3,4,5-tetrachlorosalicylanilide (n = 1 each), and patients' own products (n = 9). The only positive photopatch test was to fentichlor. No clinical or histological finding differed significantly based on patch test results. The only dermoscopic finding to be statistically associated with a positive patch test was the non-characteristic arrangement of dots/globules (P = 0.042). Limitations: Dermoscopic features were not correlated with clinical features or disease duration. Implications of patch testing on the management of LPP cannot be commented upon as ours was a cross-sectional study. Conclusions: The present study describes the dermoscopic findings of facial lesions in LPP. Our patch test results suggest a probable role of allergens in causing LPP on the face.
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Unusually high incidence of multifocal epithelial hyperplasia in children of the Nahuatl population of Mexico p. 663
Constantino Ledesma-Montes, Amilcar Mendez-Mendoza
DOI:10.4103/ijdvl.IJDVL_442_16  PMID:28799531
Background: Multifocal epithelial hyperplasia is an uncommon disease of the oral mucosa caused by the human papilloma virus. Aim: To study the clinical and pathological findings of multifocal epithelial hyperplasia detected during an oral examination of 343 Mexican Nahuatl children from a single primary school in El Paso de Cupilco, Mexico. Methods: A thorough oral examination was performed in all children and clinical data (age, gender, location and number of lesions) were documented and analyzed. Results: Multifocal epithelial hyperplasia was diagnosed in 110 of the 343 children (32.3%). The ages of the children varied from 5 to 15 years, and of these, 56.3% were girls. The lesions were asymptomatic, 0.2 to 3.0 cm in diameter, soft, round to oval, smooth surfaced, sessile papulonodules, similar in colour to that of the surrounding mucosa. The lesions were commonly seen on the buccal mucosa and tongue, and most affected children (85%) had less than 5 lesions. Children in the 7 to 10 years age group were most often affected. Limitations: Human papillomavirus typing was not done owing to a lack of facilities. Conclusions: There is a high incidence of multifocal epithelial hyperplasia in Nahuatl children with a predilection for females.
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Urocytological evaluation of pemphigus patients on long term cyclophosphamide therapy: A cross sectional study p. 667
Sujay Khandpur, Saurabh Singh, Saumyaranjan Mallick, Vinod Kumar Sharma, Venkat Iyer, Amlesh Seth, Mahesh Kumawat
DOI:10.4103/ijdvl.IJDVL_625_16  PMID:29035286
Background: Cyclophosphamide therapy is associated with several urological complications including urinary bladder malignancy. Data on urologic complications of chronic cyclophosphamide therapy for dermatologic conditions is not available. Objectives: To study the urocytological profile of pemphigus patients on long-term cyclophosphamide therapy. Materials and Methods: In a cross-sectional study, consecutive patients who had received cyclophosphamide therapy for pemphigus for more than 12 months were included. All patients were subjected to urinalysis including microscopy, culture, and urine cytology. Immunocytochemical staining for cytokeratin 20 (CK-20) on urine sediments and ELISA (enzyme-linked immunosorbent assay) for nuclear membrane protein-22 (NMP-22) were performed in all cases. In patients with urinary symptoms, microscopic hematuria, or those detected with abnormal urine sediment cytology, NMP-22, and CK-20 positivity, cystoscopy, and other relevant investigations were also done. Results: A total of 44 patients (43 of pemphigus vulgaris and one of pemphigus foliaceus) were recruited. Mean duration of cyclophosphamide intake was 2.9 ± 1.7 years (range 1–8 years) with a mean cumulative dose of 53 ± 28.4 g (range 6.5–141 g). Twenty-one cases (47.7%) each were asymptomatic and symptomatic with episodic urinary symptoms [of which two had urinary tract infection (UTI)] and two patients had gross hematuria. Urine cytology revealed mild urothelial nucleomegaly with hyperchromasia in four patients. However, CK-20 and NMP-22 were negative in all samples. Cystoscopy was performed in 21 cases and did not reveal any sign of bladder malignancy. Limitations: A relatively small sample size and lack of long-term follow-up were limitations. Conclusions: In our study, no serious urologic complications were found in pemphigus cases on chronic cyclophosphamide therapy.
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CASE REPORT Top

Cutaneous plasmacytosis: A rare entity with unique presentation p. 673
Subhra Dhar, Lalthleng Liani, Kamlakar Patole, Sandipan Dhar
DOI:10.4103/ijdvl.IJDVL_874_16  PMID:28799534
Primary cutaneous plasmacytosis is a rare cutaneous disorder with extensive cutaneous plaques/papules mainly on the trunk and face. Cases have mostly been documented from Japan. We present here a rare case of cutaneous plasmacytosis from India of Mongolian descent. This 50-year-old female from Mizoram had extensive maculo-papular violaceous plaques distributed on the face, axillae, trunk and lower extremities. Initial and repeat skin biopsy revealed dense perivascular and periadnexal mature plasma cells. She also had lymphadenopathy. Serum protein electrophoresis did not reveal any M band and the Bence Jones protein was negative in urine. The patient had multiple superficial lymph nodes and a biopsy from the cervical lymph node showed effacement of normal nodal architecture by sheets of plasma cells. Immuno histochemistry was done from both skin and lymph node biopsies. The kappa and lambda tight chains were not restricted; there by proving the polyclonal nature of the plasma cells. The novelty of the case lies in its classical clinical presentation with histopathological documentation.
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BRIEF REPORT Top

Cardio-pulmonary involvement in systemic sclerosis: A study at a tertiary care center p. 677
Geetakiran Arakkal, Sudha Rani Chintagunta, Vasavilatha Chandika, Sudha Vani Damarla, Srinivas Manchala, B Udaya Kumar
DOI:10.4103/0378-6323.198453  PMID:29035287
Background: Systemic sclerosis is a multisystem disorder characterized by microangiopathy, dysregulation of the immune system and massive deposition of collagen in the connective tissue of the skin, blood vessels and various internal organs. Although the mortality from renal crises has dropped significantly due to the use of angiotensin-converting enzyme inhibitors, cardiac and pulmonary involvement accounts for significant morbidity and mortality. We studied 28 patients with systemic sclerosis at Gandhi Medical College and Hospital, Hyderabad, over a period of two years for cardiopulmonary involvement. Aim: The aim of this study was to analyze the cardiopulmonary involvement in systemic sclerosis. Methods: All patients with systemic sclerosis attending the dermatology outpatient department were included in the study. The diagnosis of systemic sclerosis was made based on the American Rheumatology Association criteria, and was further confirmed by skin biopsy and serological investigations. X-ray chest, electrocardiogram, two-dimensional ECHO, high-resolution computed tomography chest, pulmonary function tests and bronchoalveolar lavage were done to evaluate cardiopulmonary involvement. Observations: Out of 28 patients, 17 had diffuse systemic sclerosis and 11 had limited systemic sclerosis. Mean duration of symptoms was 2.9 years. Abnormalities in chest X-ray were found in 16 patients. Pulmonary function tests showed a restrictive pattern in 23 patients. High-resolution computed tomography of the chest showed evidence of interstitial lung disease in 21 patients, while five patients each had pleural effusion and cardiomegaly. Bronchoalveolar lavage showed different cellular patterns such as neutrophilia, eosinophilia and lymphocytosis. Pulmonary arterial hypertension was observed in seven patients and isolated pulmonary arterial hypertension in two patients. Electrocardiogram abnormalities were found in twenty patients. Two-dimensional ECHO was abnormal in 17 patients with valvular abnormalities being the most common finding. Overall, pulmonary involvement was observed in 27 patients and cardiac involvement in 17 patients. Limitations: A small sample size was a limitation of this study. Diffusing capacity of lung for carbon monoxide, and right cardiac catheterization were not done, as these were not available at our centre. Conclusions: In our patients, pulmonary involvement was more common than cardiac involvement. Interstitial lung disease and cardiac involvement were more commonly seen in diffuse systemic sclerosis whereas pulmonary hypertension was more frequent in limited systemic sclerosis. Hence, it is important to screen the patients for cardiopulmonary involvement for early diagnosis and treatment and a better prognostic outcome.
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IMAGES IN CLINICAL PRACTICE Top

Trichorrhexis nodosa due to repetitive trivial trauma p. 683
Ameet L Dandale, Sujit J. S. Shanshanwal, Prasad R Wankhede, Rachita S Dhurat
DOI:10.4103/ijdvl.IJDVL_45_16  PMID:28656909
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LETTERS TO THE EDITOR - LETTER IN RESPONSE TO PUBLISHED ARTICLE Top

Nurture Indian dermatology innovations as man-maximum, machine-minimum research p. 684
SR Narahari, KS Prasanna
DOI:10.4103/ijdvl.IJDVL_26_17  PMID:28980536
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LETTERS TO THE EDITOR - CASE LETTERS Top

Extranodal natural killer/T cell lymphoma, nasal type presenting as recurrent facial cellulitis p. 687
Colin WX Tan, Hong Yi Tan, Ronald Goh Chin Hong, Shiu Ming Pang
DOI:10.4103/ijdvl.IJDVL_687_16  PMID:28984627
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Extranodal natural killer T-cell lymphoma mimicking cellulitis and venous thrombosis: A case report p. 689
Ruizhen Liu, Jianbo Chen, Guiying Zhang, Rong Xiao
DOI:10.4103/ijdvl.IJDVL_965_16  PMID:28984629
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Intradermal spindle cell/pleomorphic lipoma: Case report and review of the literature p. 692
Bing-Jun Shi, Xue Jiang, Yu-Juan Xiao, Su-Ping Wang, Jin Hao, Qing-Chun Diao
DOI:10.4103/ijdvl.IJDVL_156_16  PMID:28984623
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Facial multiple xanthogranuloma in an adult p. 696
Ankang Gu, Haixia Guo, Litao Zhang, Faku Ma
DOI:10.4103/ijdvl.IJDVL_663_16  PMID:28984624
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LETTERS TO THE EDITOR - STUDY LETTERS Top

Coping strategies and quality of life among patients with chronic psoriasis and eczema/dermatitis p. 699
Abdulrahman A. A. Amer, Xing-Hua Gao, Jiu-Hong Li, Ruiqun Qi, Yu-Jing Zhang, Hong-Duo Chen
DOI:10.4103/ijdvl.IJDVL_917_16  PMID:28980539
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LETTERS TO THE EDITOR - OBSERVATION LETTERS Top

Follicular psoriasis - dermoscopic features at a glance p. 702
Biswanath Behera, Debasis Gochhait, Raj Remya, MR Resmi, Rashmi Kumari, Devinder Mohan Thappa
DOI:10.4103/ijdvl.IJDVL_12_17  PMID:28984622
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Development of dysplastic nevus during radotinib therapy in patients with chronic myeloid leukemia p. 704
Yu Ri Woo, Jong Sic Kim, Dong Wook Kim, Hyun Jeong Park
DOI:10.4103/ijdvl.IJDVL_1030_16  PMID:28891531
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An outlandish association of Klinefelter syndrome p. 708
R Sivayogana, A Ramesh, V Sampath
DOI:10.4103/ijdvl.IJDVL_944_16  PMID:28936992
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LETTERS TO THE EDITOR - THERAPY LETTERS Top

Low-dose methotrexate combined with superficial X-ray in the treatment of folliculotropic mycosis fungoides: A case report p. 710
Yanan Jiang, Ruzeng Xue, Weijia Wang, Yongfeng Chen
DOI:10.4103/ijdvl.IJDVL_1077_16  PMID:28984625
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Treatment of drug-induced hypersensitivity syndrome with cyclosporine p. 713
Zhao-Xia Zhang, Bao-Qi Yang, Qing Yang, Mei Wu, Guang-Jin Wang
DOI:10.4103/ijdvl.IJDVL_1084_16  PMID:28984626
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Combination of A-T advancement flap and crescentic flap: A novel approach to repair surgical defect above the eyebrow p. 717
Snehal Desale, Chih-Jung Hsu
DOI:10.4103/ijdvl.IJDVL_6_17  PMID:28980538
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Blastomycosis-like pyoderma: Novel use of potassium iodide p. 720
Santhi Kiran Borra, Dincy C. V. Peter, Nirmal Balakrishnan, Susanne Pulimood, Mandeep Bhindra
DOI:10.4103/ijdvl.IJDVL_260_17  PMID:28980537
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Combination of two types of nail brace for the treatment of complicated ingrown toenails p. 722
Che-Wei Liu, Yu-Chen Huang
DOI:10.4103/ijdvl.IJDVL_908_16  PMID:28948945
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Successful treatment of total obliteration of vulva caused by inveterate vulvar lichen sclerosus p. 725
Sara Pinelli, Stefano Basile, Maria Giovanna Salerno
DOI:10.4103/ijdvl.IJDVL_114_17  PMID:28891532
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IMAGES IN CLINICAL PRACTICE Top

Pseudoainhum and autoamputation associated with lamellar ichthyosis p. 728
Biswanath Behera, Debasis Gochhait, Devinder Mohan Thappa
DOI:10.4103/ijdvl.IJDVL_56_17  PMID:28936990
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FOCUS Top

Intracutaneous pharmacokinetics of oral antifungals and their relevance in recalcitrant cutaneous dermatophytosis: Time to revisit basics p. 730
Kabir Sardana, Pooja Arora, Khushbu Mahajan
DOI:10.4103/ijdvl.IJDVL_1012_16  PMID:28936991
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HISTORY Top

Yellapragada SubbaRow – The unsung Indian biochemist behind methotrexate and other drugs p. 733
Ankit H Bharti, Yogesh S Marfatia
DOI:10.4103/ijdvl.IJDVL_1018_16  PMID:28948942
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QUIZ Top

A protruding nodule on the upper lip p. 736
Hyun Ji Kang, Sung Eun Chang, Mi Woo Lee, Woo Jin Lee
DOI:10.4103/ijdvl.IJDVL_564_16  PMID:28566561
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E-IJDVL - NET STUDY Top

Scanning electron microscopy study of hair shaft changes related to hardness of water p. 740
Lujain M Alahmmed, Ebtehal A Alibrahim, Abdullah F Alkhars, Mohammed N Almulhim, Sayed Ibrahim Ali, Feroze Kaliyadan
DOI:10.4103/ijdvl.IJDVL_1119_16  PMID:28799530
Introduction and Aims: Brittleness and breakage of hair is a common complaint in the geographical area of Saudi Arabia where we work. This area has a high level of hardness in normal tap water. We aimed to study and compare structural differences and relative deposition of calcium and magnesium salts on the hair shaft surface using scanning electron microscopy (SEM) between hair shaft samples from normal, healthy volunteers treated with hard and soft water. Methods: Hair samples obtained from 20 healthy volunteers were divided into two groups. One group was treated with hard water for 3 weeks and the second with soft water for the same duration. SEM was used to assess hair shaft surface damages and relative deposition of calcium and magnesium on the surface of the hair. Results: There was no statistically significant difference between the study and control group as far as surface changes under SEM were concerned. As far as the relative deposition of calcium and magnesium was concerned, there was no statistically significant difference in calcium deposition between the control and study samples (P = 0.28). On the other hand, magnesium deposition showed a significant difference between both groups (P = 0.001), with a higher level in samples washed with hard water. Conclusions: Hard water may be associated with increased deposits on the hair shaft surface, however, this does not necessarily translate into evident structural surface changes, as evidenced by SEM.
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E-IJDVL - NET LETTERS Top

Unilateral facial and upper truncal anhidrosis and absence of physiological flushing: A case of idiopathic harlequin syndrome p. 740
Crystal Zhen Yu Phuan, Hong Liang Tey
DOI:10.4103/ijdvl.IJDVL_767_16  PMID:28799533
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Tinea barbae presenting as kerion p. 741
Sanjay Singh, Prateek Sondhi, Savita Yadav, Firdaus Ali
DOI:10.4103/ijdvl.IJDVL_1104_16  PMID:29035288
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Low plasma zinc levels in androgenetic alopecia Highly accessed article p. 741
Kumpol Aiempanakit, Sawangpong Jandee, Kanokphorn Chiratikarnwong, Thavatchai Chuaprapaisilp, Sauvarat Auepemkiate
DOI:10.4103/ijdvl.IJDVL_680_16  PMID:28566562
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Online since 15th March '04
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