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EDITORIALS |
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The intricacies of impact factor and mid-term review of editorship |
p. 1 |
M Malathi, Devinder Mohan Thappa DOI:10.4103/0378-6323.90938 PMID:22199052 |
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Measuring the severity of vitiligo |
p. 5 |
M Ramam, S Gaurang Krishna DOI:10.4103/0378-6323.90939 PMID:22199053 |
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REVIEW ARTICLE |
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Camouflage for patients with vitiligo  |
p. 8 |
Feroze Kaliyadan, Ambika Kumar DOI:10.4103/0378-6323.90940 PMID:22199054Vitiligo is known to be associated with social stigma and a decreased quality of life, especially when lesions are located over the face. While there are numerous treatment options for vitiligo, most of these need a long time to produce good cosmetic results. Camouflaging the skin lesions can be a useful option in such patients. The proper use of camouflage has been shown to improve the quality of life in patients with vitiligo. In this article, we discuss the different camouflage options available in vitiligo - products and techniques with their relative advantages and disadvantages. |
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GUEST EDITORIAL |
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Vitiligo: Emerging paradigms |
p. 17 |
Davinder Parsad DOI:10.4103/0378-6323.90941 PMID:22199055 |
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SYMPOSIUM - VITILIGO |
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Melanocytorrhagy and apoptosis in vitiligo: Connecting jigsaw pieces |
p. 19 |
Ravinder Kumar, Davinder Parsad DOI:10.4103/0378-6323.90942 PMID:22199056Vitiligo is an acquired depigmenting disorder characterized by a chronic and progressive loss of melanocytes from the epidermis and follicular reservoir. The mechanism of melanocyte disappearance has never been clearly understood. This review discussed the data supporting the theory of melanocytorrhagy and apoptosis as one of the primary defects underlying melanocyte loss. Theory of melanocytorrhagy proposes that non-segmental vitiligo is a primary melanocytorrhagic disorder with altered melanocyte responses to friction and possibly other types of stress, inducing their detachment and subsequent transepidermal loss. Melanocytes detachment induces apoptosis whereas adherence to basement membrane suppresses apoptosis. The study of apoptosis, mechanisms of its induction, and the ways to block apoptosis is one possible way to find both the causes of depigmentation and medications to prevent its progression. |
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On the pathophysiology of vitiligo: Possible treatment options |
p. 24 |
Raymond E Boissy, Maria Lucia Dell'Anna, Mauro Picardo DOI:10.4103/0378-6323.90943 PMID:22199057Vitiligo is an acquired depigmenting disorder usually classified as non-segmental and segmental types with a higher incidence of the non-segmental ones. The cause of non-segmental vitiligo is still unknown. Currently, it is a dogma that there are several genes affecting the immune system and the pigment system that predisposes someone to develop vitiligo. A precipitating factor must then ellicit an interaction between the immune system and the melanocyte, resulting in destruction of the melanocyte population in discrete areas of the skin. Starting from the overlapping but distinct pathomechanisms, treatment should be finalized to the cellular targets and possibly related to the disease phase. |
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Childhood vitiligo  |
p. 30 |
Aparna Palit, Arun C Inamadar DOI:10.4103/0378-6323.90944 PMID:22199058Childhood vitiligo is often encountered in dermatological practice. When present in infancy or early childhood, various nevoid and hereditary disorders are to be differentiated. In many cases, familial aggregation of the disease is seen and other autoimmune disorders may be associated. Segmental presentation is more common, and limited body surface area involvement is usual in this age group. Children with vitiligo often suffer from anxiety and depression because of their unusual appearance. Management of vitiligo in children is difficult as therapeutic options are restricted when compared to that in adult patients. Selection of treatment should be careful in these patients with the aim to achieve best results with minimal side effects as well as relieving patients' and parents' anxiety. |
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Ultraviolet-based therapy for vitiligo: What's new? |
p. 42 |
Iltefat H Hamzavi, Henry W Lim, Zain U Syed DOI:10.4103/0378-6323.90945 PMID:22199059Vitiligo is an ancient disease in which depigmented and hypopigmented macules appear on the skin. It is a disfiguring condition that may lead to severe psychological trauma. Among the many treatment modalities available for use in vitiligo, those using light therapy, and in particular ultraviolet (UV) light, are some of the most effective treatments. UV-based therapy includes phototherapy (narrowband UVB), photochemotherapy (psoralens with UVA), and targeted phototherapy (excimer laser and excimer lamp). It is important for any practitioner of UV-based therapy to understand the efficacy of each treatment type, as well as their respective adverse effects. In order to take full advantage of UV-based therapy, location, dosing, and photoadaptation must also be taken into account. This review discusses the various UV-based therapeutic options, adjuvant therapies, optimal dosing guidelines, appropriate patient selection, future treatment options, and recommendations based upon the current evidence and the authors' experience with vitiligo. |
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Depigmentation therapies in vitiligo  |
p. 49 |
Divya Gupta, Rashmi Kumari, Devinder Mohan Thappa DOI:10.4103/0378-6323.90946 PMID:22199060Depigmentation therapy in vitiligo is an option in those with extensive vitiligo who have failed to respond to medical therapy and have obvious cosmetic disfigurement due to intervening patchy pigmented areas. Various aspects of this therapy such as the cost, treatment time, course, permanency of depigmentation, side effects, and the possibility of repigmentation should first be discussed with the patient. At present, there is no ideal depigmenting therapy available, but many agents in the market have been in use for many years. Monobenzyl ether of hydroquinone (MBEH) is the mainstay and Food and Drug Administration (FDA) approved in USA but takes many months to depigment and is associated with local side effects and risk of repigmentation. Other agents which are also used are 4-methoxy phenol and 88% phenol. Physical therapies for depigmentation include Q-switched ruby and alexandrite lasers and cryotherapy. Second-line agents which can be explored for depigmentation include imatinib mesylate, imiquimod, and diphencyprone. Many possible experimental agents are being explored like various phenol derivatives, melanoma vaccines, interferon gamma, busulfan, etc. A major lacuna still exists in this area and a lot more research is desirable to give satisfactory cosmesis to these patients with extensive vitiligo. |
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ORIGINAL ARTICLES |
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Non-cultured epidermal suspension in vitiligo: From laboratory to clinic  |
p. 59 |
Yvon Gauthier, Laila Benzekri DOI:10.4103/0378-6323.90947 PMID:22199061Background: Medical treatments are ineffective in many patients and surgical methods have therefore been developed. Objective: A review of autologous non-cultured melanocyte grafting techniques is proposed to obtain a successful repigmentation of vitiligo macules. Methods: Initially in 1992, we had developed a simplified grafting method which was carried out in the following two steps: production of blisters on the depigmented lesions by freezing with liquid nitrogen and injection in each blister of a non-cultured suspension of epidermal cells. The cellular suspension was obtained from samples of skin of the hair scalp after trypsinization. This very simple technique could be used at the dermatologist's clinic. Since 1998 (Olsson MJ, Juhlin L), quite comparable but improved and more sophisticated techniques have been proposed for the surgical treatment of vitiligo. These techniques require a laboratory set up to perform the melanocyte transplantation. The donor zone was usually taken on the gluteal region. The time of trypsinization was reduced to 60 minutes at 37C and the centrifuged cellular suspension added with hyaluronic acid (Van Geel) was directly applied on a dermabraded or laser abraded vitiligo lesions. Results: Whatever the technique chosen, repigmentation was evident within 25 to 30 days. Coalescence of the pigmented areas was spontaneously observed or obtained after UVB radiation. It is obvious that the complete repigmentation occurred more rapidly with the recent techniques compared with the initial method, but the efficiency was quite similar. Conclusion: The use of non-cultured epidermal suspension appears to be an effective, safe, and simple method for treating patients with achromic areas lacking melanocytes. |
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The effect of H 1 and H 2 receptor antagonists on melanogenesis |
p. 64 |
Tag S Anbar, Wiete Westerhof, Nafisa A Badawy, Amal T Abdel-Rahman, Talal A Abd El-Raheem, Saadea R Sayed, Azza H Ali, Hossam Salem DOI:10.4103/0378-6323.90948 PMID:22199062Background: Histamine was found to stimulate melanogenesis in cultured human melanocytes specifically mediated by histamine H 2 receptors via protein kinase A activation. Based on this finding, the effect of topically applied H 2 antagonist on UVB-irradiated Guinea pigs' skin was examined and found to be suppressive on the post-irradiation melanogenesis. Aims: In this study, we tried to explore the role of topically applied H 1 and H 2 receptor antagonists, in inhibition of UVB-induced melanization. Methods: The effect of topically applied H 1 and H 2 receptor antagonists in inhibition of melanization was done clinically and histochemically using Fontana Masson and DOPA reactions compared with placebo. Results: The post-irradiation pigmentation was found to be brownish/black instead of the original light brown color. This color change occurred below the shaved orange-red fur suggesting a switch of melanogenesis from pheomelanin to eumelanin. The induced pigmentation was suppressed by topically applied H 2 antagonist while both H 1 antagonist and vehicle had no effect. The microscopic examination showed that the keratinocytes in the H 2 antagonist-treated areas contained few melanosomes while the nearby dendrites are full of them. Conclusion: H 2 antagonists' inhibition of UVB-induced pigmentation is not only due to suppression of melanization but also due to a specific action on melanosomes' transfer. |
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Segmental vitiligo: A randomized controlled trial to evaluate efficacy and safety of 0.1% tacrolimus ointment vs 0.05% fluticasone propionate cream |
p. 68 |
Sushruta Kathuria, Binod K Khaitan, M Ramam, Vinod K Sharma DOI:10.4103/0378-6323.90949 PMID:22199063Background: Segmental vitiligo is a small subset of vitiligo which responds very well to surgical therapy, but the role of medical treatment is not very well defined. Aim: To compare the efficacy and safety of 0.1% tacrolimus ointment versus 0.05% fluticasone propionate cream in patients of segmental vitiligo. Methods: A randomized control trial was conducted in a tertiary care hospital on 60 consecutive patients with segmental vitiligo. Patients with segmental vitiligo exclusively or along with focal vitiligo, untreated or had not taken any topical treatment in previous 1 month or systemic treatment in previous 2 months, from May 2005 to January 2007, were block randomized into two groups. Children <5 years, pregnant and lactating women, and patients with known hypersensitivity to either drug and with associated multiple lesions of vitiligo were excluded. Group A (n = 29) patients were treated with tacrolimus 0.1% ointment twice daily and group B (n = 31) patients were treated with 0.05% of fluticasone cream once daily for 6 months. Response and side effects were recorded clinically and by photographic comparison. Results: Nineteen patients treated with tacrolimus and 21 patients treated with fluticasone completed the treatment with median repigmentation of 15% and 5%, respectively, at 6 months (P = 0.38). Transient side effects limited to the application site were observed. Conclusions: Both tacrolimus and fluticasone propionate produce variable but overall unsatisfactory repigmentation in segmental vitiligo. |
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Survey of dermatologists' phototherapy practices for vitiligo |
p. 74 |
Khalid M AlGhamdi, Huma Khurram, Alain Taïeb DOI:10.4103/0378-6323.90950 PMID:22199064Background: The details of phototherapy practices for vitiligo have been rarely studied. Objective: To explore the details of phototherapy practices for vitiligo among dermatologists. Methods: A self-administered questionnaire about the details of phototherapy practices for vitiligo was distributed to all dermatologists attending a national general dermatology conference in Riyadh, Saudi Arabia, in 2008. Results: Questionnaires were returned by 121 of 140 participants (response rate = 86.4%). The mean age of the respondents was 39.34 9.7 years, and 65% were males. One hundred eight of 110 (98.2%) respondents provided phototherapy to their vitiligo patients. The mean number of vitiligo patients who underwent phototherapy each week per dermatologist's office was 18 2.26. Narrowband ultraviolet B (NB-UVB) was the most common modality chosen to treat generalized vitiligo (84%). Excimer laser was the most common modality used to treat focal and segmental vitiligo (53% and 39%, respectively). Sixty-eight percent of dermatologists administered a fixed starting dose of NB-UVB to all patients, whereas 31% used the minimal erythema dose as a guide. Fifty percent reported that NB-UVB resulted in better color matching with the surrounding skin. Thirty-seven percent favored NB-UVB over psoralen + ultraviolet A for a faster response, and 31% preferred NB-UVB for a pigmentation that is more durable. Forty-seven percent (50/106) of the respondents limited the number of phototherapy sessions to reduce the risks of skin cancer. However, no respondent reported any skin cancer incidence in phototherapy-treated vitiligo patients. Conclusion: There is a need for phototherapy guidelines for the treatment of vitiligo in patients with skin of color. |
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CASE REPORTS |
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Granulomatous and eccrinotropic lymphomatoid papulosis |
p. 82 |
Nilam Jain, Rameshwar Gutte, Pinanky Jadhav, Uday Khopkar DOI:10.4103/0378-6323.90951 PMID:22199065Lymphomatoid papulosis has been classically described as a chronic, recurrent and self-healing papulonecrotic or papulonodular skin eruption, which is clinically benign and histopathologically malignant. The histologic characteristics of lymphomatoid papulosis are suggestive of a cluster of differentiation 30+ (CD30+) malignant lymphoma, and it is best regarded as a low grade cutaneous T cell lymphoma (CTCL). We hereby report a case of granulomatous and eccrinotropic lymphomatoid papulosis in a 40- year-old male. There was no systemic involvement. The patient was treated with low dose oral methotrexate with good response. |
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Unilateral linear punctate palmoplantar keratoderma |
p. 85 |
Sudhanshu Sharma, Krishna Deb Barman, Vijay Kumar Garg, Shalu Jain DOI:10.4103/0378-6323.90953 PMID:22199066Punctate palmoplantar keratoderma (Brauer-Buschke-Fischer syndrome) is a rare entity. Among punctate keratoderma, the linear presentation is much rarer, and exact incidence is not known. Unilateral linear punctate palmoplantar keratoderma is not yet reported in the literature. Here we report a case 12-year-old child presented with asymptomatic linear punctate plaque on the left sole and hand; histology revealed hyperkeratotic epidermis without columns of parakeratosis or cornoid lamella. |
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Primary extramammary Paget's disease with extensive skeletal metastases |
p. 89 |
Indukooru Subrayalu Reddy, Meenakshi Swain, Swarnalata Gowrishankar, Dronamraju Butchi Narayana Murthy DOI:10.4103/0378-6323.90954 PMID:22199067Extramammary Paget's disease (EMPD) is an uncommon malignancy that is most commonly seen in the vulval area in postmenopausal women. Pruritus is the predominant symptom. The clinical presentation can be so nonspecific that it can be misdiagnosed as an inflammatory or infective condition. We report an elderly male patient with EMPD over the pubic area, which remained asymptomatic for 5 years; he presented with severe low backache of 5 months' duration. Skin biopsy and immunohistochemistry showed the typical epidermal changes and deep dermal invasion. Positron emission tomography scan revealed involvement of regional lymph nodes as well as extensive skeletal metastases. |
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Neurocutaneous spectrum of multiple endocrine neoplasia-1 |
p. 93 |
Shireen Furtado, Nandita Ghosal, Sunil V Furtado, Kanchan Gupta, Alangar S Hegde DOI:10.4103/0378-6323.90956 PMID:22199068Multiple endocrine neoplasia type I or Wermer syndrome is characterized by primary hyperparathyroidism, enteropancreatic endocrine tumor, and a pituitary pathology. A 35-year-old male presented with visual field defects, hyperprolactinemia, and hypogonadism. He also had multiple infraumbilical skin-colored nodules. A syndromal association of Wermer syndrome was derived using the dermal, pituitary, parathyroid, and gastrointestinal hormonal manifestations of the tumor. The radiological and histological findings of lesion which underwent biopsy are discussed. The presence of collagenomas, lipomas, and hypopigmented macules in a patient with neuroendocrine symptoms should raise the suspicion of an underlying multiple endocrine neoplasia. |
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IMAGES IN CLINICAL PRACTICE |
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Hyperhidrosis, vesicles, and papules over the nose: Granulosis rubra nasi |
p. 97 |
Sidharth Sonthalia, Archana Singal, Reena Sharma DOI:10.4103/0378-6323.90957 PMID:22199069 |
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LETTERS TO THE EDITOR |
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Comparative study of dietary habits between acne patients and a healthy cohort |
p. 99 |
Claudia Salomone, Claudia Nicklas, Cristián Navarrete-Dechent, Katherine Droppelmann, María Luisa Pérez-Cotapos DOI:10.4103/0378-6323.90958 PMID:22199070s |
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Can highly active antiretroviral therapy unmask leprosy? A case of type 1 lepra reaction in a HIV-seropositive patient |
p. 101 |
G Raghurama Rao, A Amareswar, S Sandhya DOI:10.4103/0378-6323.90959 PMID:22199071 |
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Epidermal inclusion cyst or giant milium of the nipple  |
p. 103 |
Shalu Jain, Rashmi Sarkar, Vijay K Garg, Nita Khurana DOI:10.4103/0378-6323.90960 PMID:22199072 |
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A case of Parry-Romberg syndrome with congenital heart disease |
p. 105 |
Supriya P Deshmukh, Yugal K Sharma, Bharat B Dogra, Nitin C Chaudhari DOI:10.4103/0378-6323.90961 PMID:22199073 |
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Idiopathic acquired persistent true partial to total leukonychia |
p. 107 |
Shehnaz Z Arsiwala DOI:10.4103/0378-6323.90962 PMID:22199074 |
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Bone marrow transplantation improves symptoms of congenital erythropoietic porphyria even when done post puberty |
p. 108 |
Saurabh Singh, Neena Khanna, Lalit Kumar DOI:10.4103/0378-6323.90963 PMID:22199075 |
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Colocalization of mucosal vitiligo and oral pemphigus vulgaris |
p. 111 |
Dipankar De, Amrinder J Kanwar, Uma N Saikia, Rashmi Jindal DOI:10.4103/0378-6323.90964 PMID:22199076 |
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Majocchi's granuloma over the face |
p. 113 |
Cuicui Liu, Lilla Landeck, Sui-Qing Cai, Min Zheng DOI:10.4103/0378-6323.90965 PMID:22199077 |
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Excellent response of infantile hemangioma associated with PHACES syndrome to propranolol |
p. 114 |
Saritha Mohanan, Laxman Besra, Laxmisha Chandrashekar, Devinder Mohan Thappa DOI:10.4103/0378-6323.90966 PMID:22199078 |
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RESIDENT’S PAGE |
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In vivo antinuclear antibodies of the skin |
p. 116 |
Sandeep K Arora, Seema Chhabra DOI:10.4103/0378-6323.90967 PMID:22199079 |
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QUIZ |
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A solitary facial tumor with erosion on an 81-year-old oriental woman |
p. 119 |
Wei-Chih Ko, Chih-Ming Hung, Tsen-Fang Tsai DOI:10.4103/0378-6323.90968 PMID:22199080 |
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NET CASES |
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Acute hemorrhagic edema of infancy: A report of two cases |
p. 121 |
Atul Dongre, Vijay Adhe, Dimple Kothari, Suchitra Kardekar, Uday Khopkar DOI:10.4103/0378-6323.90969 PMID:22199081Acute hemorrhagic edema of infancy is one of the clinical forms of leukocytoclastic vasculitis seen in children. The condition runs a benign course. We report two male children who presented with upper respiratory tract infection followed by limb swelling and purpuric and ecchymotic lesions on the skin. Skin biopsy revealed leukocytoclastic vasculitis in both patients. In both cases, the lesions resolved completely without any sequelae. |
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A case of bacillary angiomatosis developed at a burn site |
p. 121 |
Ayse Albayrak, Yavuz Albayrak, Deniz Unal, Mustafa Atasoy, Muhammet H Uyanik DOI:10.4103/0378-6323.90970 PMID:22199082Bacillary Angiomatosis (BA) is frequently seen in patients with human immunodeficiency virus (HIV)-induced immunodeficiency. Our patient was a case that developed granuloma-like lesions in the area of a burn, 8 days after being burnt on the upper right arm by scalding water. No indication of immune deficiency was observed and no history of direct contact with cats was evident. By the sixth day of the patient's admission to our clinic, some of the lesions had reached a diameter of 2.5 cm. An excision biopsy was carried out from the lesions present on the patient. Electron microscopy revealed solitary bacilli located close to the capillary wall. Oral erythromycin treatment was implemented at 250 mg, 4 times a day for 2.5 months. Within this period of treatment, the lesions regressed completely, and a complete cure was achieved. This case demonstrates that BA must be considered in the differential diagnosis of both HIV-infected and immunocompetent patients. |
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NET LETTERS |
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Lymphangioma circumscriptum-like presentation of breast carcinoma |
p. 121 |
Dilek Bayramgürler, Evren Odyakmaz Demirsoy, Nurşah Doğan, Kürşat Yıldız, Zafer Utkan DOI:10.4103/0378-6323.90971 PMID:22199083 |
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Coexistence of acquired hypertrichosis and scalp alopecia in a patient with infiltrating ductal carcinoma |
p. 122 |
Ru-Zhi Zhang, Wen-Yuan Zhu, Lei Zhou DOI:10.4103/0378-6323.90972 PMID:22199084 |
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Lymphangiectasia of the vulva, treatment with CO 2 laser |
p. 122 |
Myriam Ben Hamida, Dora Baccouche, Nadia El Fekih, Becima Fazaa, Ridha Kamoun DOI:10.4103/0378-6323.90973 PMID:22199085 |
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Erythema gyratum repens and rheumatoid arthritis: An unrecognized association? |
p. 122 |
Ada Lo Schiavo, Stefano Caccavale, Ida Orlando, Rosella Tirri DOI:10.4103/0378-6323.90974 PMID:22199086 |
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A new site of milia en plaque |
p. 122 |
Ru-Zhi Zhang, Wen-Yuan Zhu DOI:10.4103/0378-6323.90975 PMID:22199087 |
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Zinc responsive acrodermatitis in nephrotic syndrome: A rare presentation |
p. 122 |
Afsha A Topal, Rachita S Dhurat, Chitra S Nayak DOI:10.4103/0378-6323.90976 PMID:22199088 |
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Giant linear syringocystadenoma papilliferum of the back |
p. 123 |
Manoranjan Kar, Jugal K Kar, Saswati Maiti DOI:10.4103/0378-6323.90977 PMID:22199089 |
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Asymptomatic nodule over the shin |
p. 123 |
Rameshwar Gutte, Gaurav Garg, Vidya Kharkar, Uday Khopkar DOI:10.4103/0378-6323.90978 PMID:22199090 |
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