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   2006| July-August  | Volume 72 | Issue 4  
 
 
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RESIDENT’S PAGE
Scoring systems in dermatology
Urmila Bhor, Sushil Pande
July-August 2006, 72(4):315-321
DOI:10.4103/0378-6323.26722  PMID:16880586
  55,573 2,989 18
REVIEW ARTICLES
Biologic therapy in psoriasis
Alka Dogra, Silonie Sachdeva
July-August 2006, 72(4):256-265
DOI:10.4103/0378-6323.26712  PMID:16880570
  17,468 1,860 4
EDITORIAL
Etiopathogenesis of seborrheic dermatitis
RG Valia
July-August 2006, 72(4):253-255
DOI:10.4103/0378-6323.26711  PMID:16880569
  16,560 1,033 5
BRIEF REPORT
Severe cutaneous adverse drug reaction to leflunomide: A report of five cases
Veeranna Shastri, Jyayadev Betkerur, PA Kushalappa, TG Savita, G Parthasarathi
July-August 2006, 72(4):286-289
DOI:10.4103/0378-6323.26725  PMID:16880575
Medications used to treat human ailments are known to cause cutaneous reactions which may vary in their severity. Leflunomide, an immunomodulating agent recently introduced to treat rheumatoid arthritis, is reported to cause severe cutaneous reactions. We are reporting five such cases. All our patients were started on leflunomide for rheumatoid arthritis, 4-6 weeks before the onset of cutaneous reaction and were admitted to the hospital with the common complaints of fever, skin rash and generalized weakness. All of them had characteristic pattern of events such as delayed onset of reaction, widespread and long lasting skin rash and internal organ involvement. These features suggest a possibility of drug hypersensitivity syndrome to leflunomide. Careful dosing and periodic monitoring of patients treated with leflunomide for possible adverse drug reaction is recommended.
  14,329 473 13
ORIGINAL ARTICLE
The efficacy of 1% metronidazole gel in facial seborrheic dermatitis: A double blind study
Amir H Siadat, Fariba Iraji, Zabiholahe Shahmoradi, Shahla Enshaieh, Azam Taheri
July-August 2006, 72(4):266-269
DOI:10.4103/0378-6323.26745  PMID:16880571
Background: Seborrheic dermatitis is a common, chronic inflammatory disease of the skin, characterized by erythematous plaques that are covered with yellow, greasy, scales and may or may not be associated with itching. Although a few studies have suggested use of topical metronidazole for the treatment of seborrheic dermatitis, there is no general consensus about it. Aims: To evaluate the efficacy of 1% metronidazole gel and its vehicle alone, in the treatment of seborrheic dermatitis. Methods: This was a double-blind, prospective, clinical trial. Fifty six patients with seborrheic dermatitis were randomly allocated to either apply 1% metronidazole gel or placebo to their facial lesions, twice daily for 8 weeks. All the patients were evaluated and scored every 2 weeks for 8 weeks. The results were analyzed statistically. Results: A total of 56 patients entered this study and 53 patients completed the treatment course. There was no significant difference in terms of demographic data and lesions severity score. There were statistically significant differences in the reduction of mean severity scores between the 2 groups at the second, fourth, sixth and eighth weeks of treatment ( p < 0.05). Metronidazole gel significantly decreased mean of seborrheic dermatitis severity score from the 2nd visit ( p <0.001). Conclusion: Metronidazole gel is an effective treatment for facial seborrheic dermatitis.
  13,495 413 11
NET CASE
Waardenburg syndrome
Sunita Tagra, Amrita Kaur Talwar, Rattan Lal Singh Walia, Puneet Sidhu
July-August 2006, 72(4):326-326
DOI:10.4103/0378-6323.26718  PMID:16880590
Waardenburg syndrome is a rare inherited and genetically heterogenous disorder of neural crest cell development. Four distinct subtypes showing marked interfamilial and intrafamilial variability have been described. We report a girl showing constellation of congenital hearing impairment with 110 dB and 105 dB loss in right and left ear respectively, hypoplastic blue iridis, white forelock, dystopia canthorum and broad nasal root. Other affected relatives of the family, with variable features of the syndrome, have been depicted in the pedigree.
  10,620 418 7
ORIGINAL ARTICLE
HIV and tuberculosis: Partners in crime
Janak K Maniar, Ratnakar R Kamath, Sundhiya Mandalia, Keyur Shah, Alok Maniar
July-August 2006, 72(4):276-282
DOI:10.4103/0378-6323.26723  PMID:16880573
Background: Tuberculosis is the commonest infection detected in HIV-infected individuals worldwide. Aim: The aim of this study is to describe the clinical, bacteriologic and radiological spectrum of tuberculosis (TB) in the setting of human immunodeficiency virus (HIV) infection in a tertiary care centre in Mumbai. Methods: A total of 8640 HIV-infected individuals were screened for tuberculosis routinely from January 1998 to December 2003, using clinical examination, chest X-ray and abdominal ultrasonography, sputum smears for acid-fast bacilli (AFB) and culture on Lowenstein-Jensen medium. Results: TB was detected in 8078 (93.5%) patients of whom 3393 (42%) had pulmonary, 3514 (43.5%) had extrapulmonary TB and 1171 (14.5%) had disseminated disease. One thousand two hundred thirty eight patients (36.5%) showed AFB in sputum, while 1154 (34%) showed growth on culture medium and 4174 had radiographic involvement. In 781 (67%) individuals disseminated disease coexisted with pulmonary involvement. All 8078 coinfected patients were treated with anti-TB therapy (ATT), of whom 6422 patients (79.5%) showed one or more adverse events. Gastritis was the commonest complaint followed by hepatitis and skin rashes. ATT resistance was detected in 482 individuals. Conclusion: Tuberculosis is the commonest opportunistic infection (OI) in HIV positive patients in India, showing a higher prevalence of extrapulmonary and disseminated TB and adverse events due to ATT. Early recognition of concurrent OIs and their adequate treatment and prophylaxis is essential.
  9,411 473 17
CASE REPORTS
Unilateral nevoid hyperkeratosis of the nipple: A report of two cases
Veeranna Shastry, Jayadev Betkerur, PA Kushalappa
July-August 2006, 72(4):303-305
DOI:10.4103/0378-6323.26730  PMID:16880580
Nevoid hyperkeratosis of the nipple and areola is an unusual condition. Two female patients aged 31 and 18 years presented with chronic unilateral warty lesions of the nipple. One patient had difficulty in breastfeeding from the affected side. A skin biopsy showed acanthosis, hyperkeratosis, papillomatosis, and lymphocytic infiltrate in the dermis. There was no significant improvement with topical tretinoin cream in both the patients.
  9,591 230 4
Cutaneous tuberculosis and phlyctenular keratoconjunctivitis: A forgotten association
Archana Singal, Puneet Aggarwal, Deepika Pandhi, Jolly Rohatgi
July-August 2006, 72(4):290-292
DOI:10.4103/0378-6323.26726  PMID:16880576
Cutaneous tuberculosis may be associated with concurrent systemic foci in the body such as lung, lymph node, bone or CNS. Phlyctenular keratoconjunctivitis (PKC) is a manifestation of immunological response to a variety of antigens in the eye, tubercular focus (evident or occult) being the commonest in India. Reports in the existing literature have shown lungs and lymph nodes to be the predominant underlying focus associated with PKC, whereas cutaneous tuberculosis has seldom been found in this situation. We report this forgotten association in two children with cutaneous tuberculosis, one each with lupus vulgaris and scrofuloderma, who also had PKC. Interestingly, one of the cases also had simultaneous lichen scrofulosorum, which is also an immunological response to tubercular antigen and manifests in the skin, thus showing immunological manifestation in two different organ systems along with cutaneous focus of tuberculosis.
  9,478 311 15
FOCUS
Journal impact factor
Garehatty Rudrappa Kanthraj
July-August 2006, 72(4):322-325
DOI:10.4103/0378-6323.26721  PMID:16880587
  8,394 407 5
LETTER TO EDITOR
Oral montelukast monotherapy is ineffective in chronic idiopathic urticaria: A comparison with oral cetirizine
Kiran V Godse
July-August 2006, 72(4):312-314
DOI:10.4103/0378-6323.26735  PMID:16880585
  7,887 388 21
Fixed drug eruption and generalised erythema following etoricoxib
Mary Augustine, Pooja Sharma, John Stephen, Elizabeth Jayaseelan
July-August 2006, 72(4):307-309
DOI:10.4103/0378-6323.26732  PMID:16880582
  7,824 239 12
CASE REPORTS
Rhinoentomophthoromycosis
Mathew M Thomas, Sumangala M Bai, Chitra Jayaprakash, P Jose, Rejee Ebenezer
July-August 2006, 72(4):296-299
DOI:10.4103/0378-6323.26728  PMID:16880578
A sixty year old patient presented with a slowly progressive swelling of the nose, of one year duration, suggesting a clinical diagnosis of subcutaneous zygomycosis. On investigation, the tissue fungal culture grew Conidiobolus coronatus , confirming the diagnosis as rhinoentomophthoromycosis. He was treated with a combination of oral fluconazole and oral potassium iodide for a total period of 5 months. His symptoms subsided completely. Serial CT scanning of paranasal sinuses showed the gradual resolution of the swelling, in response to the treatment. Early detection of the disease and combination therapy gave rapid and good results. This is the first case of its kind to be reported from Kerala, the southern state of India.
  7,377 284 14
ORIGINAL ARTICLE
Study of histamine wheal suppression by dexamethasone with and without iontophoresis
Sreerekha , Reena Rai, Sundaram V Shanmuga, Karthick , S Prabhu, CR Srinivas, Anil C Mathew
July-August 2006, 72(4):283-285
DOI:10.4103/0378-6323.26724  PMID:16880574
Background: Iontophoresis increases the penetration of drugs into the skin by electric current. The ability of topical steroids to reduce the size of the histamine wheal was used to assess the efficacy of topical dexamethasone delivered with and without iontophoresis. Aim: To determine the wheal suppressing ability of dexamethasone delivered with and without iontophoresis. Methods: A template with three squares of 3 x 3 cm was placed on both forearms of 20 volunteers and the edges marked. A gauze piece soaked in 2 ml of dexamethasone solution was placed on the flexor aspect of the left forearm and the electrode, an aluminum foil was placed on it and connected to the negative pole (since dexamethasone is negatively charged). An electric current was passed for 15 minutes. Similarly, on the right forearm, a dexamethasone soaked gauze piece was placed without iontophoresis. Histamine wheal suppression was assessed at the end of 30 min, 1 hr and 2 hrs, on both sides. Statistical analysis was done using an independent t-test. Results: There was a statistically significant difference in wheal suppression at 30 min ( p =0.006) on the left hand where iontophoresis was used. Conclusion: Our experiment showed that topical dexamethasone with iontophoresis has the maximum effect at the end of 30 minutes and is more effective than dexamethasone without iontophoresis.
  6,381 198 3
LETTER TO EDITOR
Sunscreen application: Not less, not more
CR Srinivas, Surendranath Lal, M Thirumoorthy, Shanmuga V Sundaram, Prabhu S Karthick
July-August 2006, 72(4):306-307
DOI:10.4103/0378-6323.26731  PMID:16880581
  6,124 343 2
Occupational marks in a coconut tree climber
Rashmi Kumari, Devinder M Thappa, KN Shivaswamy
July-August 2006, 72(4):311-312
DOI:10.4103/0378-6323.26734  PMID:16880584
  5,899 135 3
CASE REPORTS
Tuberous sclerosis complex associated with dyschromatosis universalis hereditaria
MP Binitha, Daisy Thomas, LK Asha
July-August 2006, 72(4):300-302
DOI:10.4103/0378-6323.26729  PMID:16880579
Tuberous sclerosis is an autosomal dominant disease due to mutations in two genetic loci, characterized by hamartoma formation in the skin, nervous system, heart, kidney, and other organs. Dyschromatosis universalis hereditaria is an autosomal dominant genodermatosis, characterized by small hyperpigmented and hypopigmented macules, uniformly distributed over the entire body. The face is rarely involved, and the palms, soles, and mucous membranes are usually spared. We report a case of tuberous sclerosis with dyschromatosis universalis hereditaria, with hyperpigmented and hypopigmented macules affecting the palms, soles, and oral mucosa. To our knowledge, this is the first reported case of such an association.
  5,818 187 5
Anetoderma occurring after hepatitis B vaccination
Marta Teixeira, Rosario Alves, Aurea Canelhas, Manuela Selores
July-August 2006, 72(4):293-295
DOI:10.4103/0378-6323.26727  PMID:16880577
Anetoderma is an elastolytic disorder of unknown origin. To our knowledge, anetoderma secondary to hepatitis B immunization has been described only once in the literature, in two siblings vaccinated at the same time. We describe, what we believe to be an additional case of such a rare disorder in a 21-year-old man. He presented with white spots and papules on his neck, upper limbs, and trunk, that had developed gradually within the last 6 years without any symptoms. The initial lesions were red macules, which gradually enlarged in size and number, becoming pale. Biopsy of a sack-like lesion revealed normal epidermis, and a discrete mononuclear infiltrate throughout the dermis. Association of anetoderma with hepatitis B vaccination is speculated here, as suggested by history of vaccination two weeks prior to the onset of skin eruption, and ruling out other possible causes of anetoderma.
  5,574 149 1
LETTER TO EDITOR
Isolated scalp collagenoma mimicking cutis verticis gyrata
Chandrashekar Laxmisha, Devinder Mohan Thappa, S Jayanthi
July-August 2006, 72(4):309-311
DOI:10.4103/0378-6323.26733  PMID:16880583
  4,619 155 5
NET LETTER
Localized non-epidermolytic keratoderma
R Chhetia, DK Jena, ML Dash, MK Ram
July-August 2006, 72(4):326-326
DOI:10.4103/0378-6323.26719  PMID:16880589
  4,111 106 -
QUIZ
Solitary painful red macule over left knee
Binod K Khaitan, Jasleen Kaur, Anup K Das
July-August 2006, 72(4):327-328
DOI:10.4103/0378-6323.26716  PMID:16880591
  3,862 141 -
BOOK REVIEW
Basic methods of medical research
SR Suryawanshi
July-August 2006, 72(4):329-329
  3,838 145 -
OBITUARY
Obituary: Dr. (Mrs) Bindu Nair
SC Bose
July-August 2006, 72(4):330-330
  3,391 72 -
NET QUIZ
Linear nodulo-ulcerative lesions in a child
H Hanumanthappa, S Rashmi
July-August 2006, 72(4):326-326
DOI:10.4103/0378-6323.26720  PMID:16880588
  3,264 120 -
ORIGINAL ARTICLE
Refining criteria for diagnosis of cutaneous infections caused by herpes viruses through correlation of morphology with molecular pathology
Almut Böer, Nina Herder, Norbert Blödorn-Schlicht, Volker Steinkraus, Thomas M Falk
July-August 2006, 72(4):270-275
DOI:10.4103/0378-6323.26717  PMID:16880572
BACKGROUND: Infections of the skin by herpes viruses do not always present themselves in typical fashion. Early diagnosis, however, is crucial for appropriate treatment. Polymerase chain reaction (PCR) allows diagnosis and differential diagnosis of herpes virus infections, but the method is not yet available in large parts of the world, where diagnosis is made based on morphology alone. AIM: To refine criteria for the diagnosis of herpes virus infections of the skin by way of correlation of clinical and histopathologic findings with results of PCR studies. METHODS: We studied 75 clinically diagnosed patients of "zoster," "varicella," and "herpes simplex", to correlate clinical and histopathological findings with results of PCR studies on paraffin embedded biopsy specimens. RESULTS: Clinical suspicion of infection by herpes viruses was confirmed by histopathology in 37% of the cases and by PCR studies in 65% of the cases. Zoster was frequently misdiagnosed as infection with herpes simplex viruses (30%). When diagnostic signs of herpes virus infection were encountered histopathologically, PCR confirmed the diagnosis in 94%. By way of correlation with results of PCR studies, initial lesions of herpes virus infections could be identified to have a distinctive histopathological pattern. Herpetic folliculitis appeared to be a rather common finding in zoster, it occurring in 28% of the cases. CONCLUSION: We conclude that correlation of clinical and histopathological features with results of PCR studies on one and the same paraffin embedded specimen permits identification of characteristic morphologic patterns and helps to refine criteria for diagnosis both clinically and histopathologically.
  2,629 184 3
Online since 15th March '04
Published by Wolters Kluwer - Medknow