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  Citation statistics : Table of Contents
   2007| November-December  | Volume 73 | Issue 6  
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Onychomycosis: Clinico-mycologic study of 130 patients from Himachal Pradesh, India
Mudita Gupta, Nand Lal Sharma, Anil K Kanga, Vikram K Mahajan, Gita Ram Tegta
November-December 2007, 73(6):389-392
DOI:10.4103/0378-6323.37055  PMID:18032856
Background: Onychomycosis is a common nail infection caused by dermatophytes, yeast or other nondermatophyte molds and has diverse clinical presentations. Although common in this part of the country, no significant clinico-mycologic data is available. Objectives: This study was carried out to document the clinico-mycologic pattern of onychomycosis in Himachal Pradesh (India). Methods: All consecutive patients of onychomycosis diagnosed clinically during March 2005 to February 2006 were studied for clinical forms, number of nails involved and severity of infection. The clippings from the most severely affected nails were subjected to potassium hydroxide (KOH) mounts for direct microscopy and fungal culture on Sabouraud's dextrose agar. Results: These 130 patients (M:F 98:32) were between 8-76 years of age (mean 41.35 ± 14.98 years). The prevalence of onychomycosis was higher among farmers and office workers (20% each). Finger or toe nails were exclusively involved in 56.9 and 32.3% patients respectively while these were involved concurrently in the rest of the 10.8% patients. Distal and lateral subungual onychomycosis seen in 73.1% of the specimens was the most common clinical type. KOH- and culture-positivity were recorded in 59.2 and 37.6% cases respectively. Dermatophytes and yeast (Candida albicans) were isolated in 40.8% each of the cultured nail specimens while nondermatophytic molds (NDM) were cultured in 18.6% of the samples. Various dermatophytes cultured were Trichophyton rubrum (32.6%), T. mentagrophytes (6.1%) and T. verrucosum (2.1%) respectively. Aspergillus spp. (6.1%) was the most commonly isolated NDM while other detected molds were Acremonium spp., Fusarium spp,, Scopulariopsis spp., Curvularia spp. and Penicillium marneffei. Peripheral vascular disorders (7.69%), occupational trauma (13.8%), close association with animals (60.78%) and a family history of onychomycosis (26.15%) were a few of the predisposing factors identified. Conclusion: Onychomycosis is not uncommon in this part of the country and has similar clinico-mycologic profiles in the different cases detected.
  25 11,174 771
A clinical and mycological study of onychomycosis in HIV infection
Amar Surjushe, Ratnakar Kamath, Chetan Oberai, Dattatray Saple, Minal Thakre, Sujata Dharmshale, Aruna Gohil
November-December 2007, 73(6):397-401
DOI:10.4103/0378-6323.37057  PMID:18032858
Background: Onychomycosis is one of the early manifestations of HIV infection with a prevalence of 15-40%. Multiple nail involvement, isolation of both common and rare species, and resistance to treatment are the characteristics of onychomycosis in HIV. Aim: To study the epidemiology, clinical manifestations of onychomycosis in HIV-infected individuals and to identify the various causative fungi microbiologically. Methods: A total of 250 HIV infected patients, diagnosed by ELISA, were screened for nail involvement; of which 60 patients i.e., 40 males and 20 females, who had clinically suspected untreated fungal infection were included in this study. Results: Of the 60 respondents, 34 (56.66%) were from the 31-40 years age group. Amongst the 40 males, there were 20 manual laborers and 14 farmers; while 18 of 20 females were housewives. Toenail involvement was seen in 38 patients (63.33%), fingernail in 12 patients (20%) while 10 (16.66%) patients had involvement of both. Twenty eight (46.66%) patients gave history of some trauma, 6 (10%) had diabetes mellitus, and only 1 patient (1.66%) had history of peripheral vascular disease. Nineteen (31.66%) patients had associated tinea pedis, 5 (8.33%) had tinea manuum, 10 (16.66%) had tinea corporis and 7 (11.66%) had tinea cruris. Twenty one (35%) respondents had distal and lateral superficial onychomycosis (DLSO), 5 (8.33%) had proximal subungual onychomycosis (PSO), 1 (1.66%) had superficial white onychomycosis (SWO), while 33 (55%) had total dystrophic onychomycosis (TDO). Fungal elements were demonstrated by KOH mount in 49 patients (81.66%) and growth was seen in 32 (53.33%) cultures. Dermatophytes were isolated in 13 (21.66%) and nondermatophytic molds (NDM) in 19 (31.66%). Out of the 13 positive dermatophyte cultures, Trichophyton rubrum was isolated on 11 and Trichophyton mentagrophytes on 2 cultures. Of the 19 non-dermatophytic cultures, Aspergillus niger was isolated on 3 and Candida spp. on 12 while Cladosporium spp., Scytalidium hyalinum, Penicillium spp., and Gymnoascus dankaliensis on 1 each. Conclusions: Total dystrophic onychomycosis was the most common clinical type and NDM were the predominant causative organisms.
  21 12,452 809
An open randomized comparative study to test the efficacy and safety of oral terbinafine pulse as a monotherapy and in combination with topical ciclopirox olamine 8% or topical amorolfine hydrochloride 5% in the treatment of onychomycosis
Amit Jaiswal, RP Sharma, AP Garg
November-December 2007, 73(6):393-396
DOI:10.4103/0378-6323.37056  PMID:18032857
Background: Onychomycosis is a fungal infection of nails caused by dermatophytes, yeasts and molds. Aims: To study the efficacy and safety of oral terbinafine pulse as a monotherapy and in combination with topical ciclopirox olamine 8% or topical amorolfine hydrochloride 5% in onychomycosis. Methods: A clinical comparative study was undertaken on 96 Patients of onychomycosis during the period between August 2005 to July 2006. Forty-eight patients were randomly assigned in group A to receive oral terbinafine 250 mg, one tablet twice daily for seven days every month (pulse therapy); 24 patients in group B to receive oral terbinafine pulse therapy plus topical ciclopirox olamine 8% to be applied once daily at night on all affected nails; and 24 patients in group C to receive oral terbinafine pulse therapy plus topical amorolfine hydrochloride 5% to be applied once weekly at night on all the affected nails. The treatment was continued for four months. The patients were evaluated at four weekly intervals till sixteen weeks and then at 24 and 36 weeks. Results: We observed clinical cure in 71.73, 82.60 and 73.91% patients in groups A, B and C, respectively; Mycological cure rates against dematophytes were 88.9, 88.9 and 85.7 in groups A, B and C, respectively. The yeast mycological cure rates were 66.7, 100 and 50 in groups A, B and C, respectively. In the case of nondermatophytes, the overall response was poor: one out of two cases (50%) responded in group A, while one case each in group B and group C did not respond at all. Conclusion: Terbinafine pulse therapy is effective and safe alternative in treatment of onychomycosis due to dermatophytes; and combination therapy with topical ciclopirox or amorolfine do not show any significant difference in efficacy in comparison to monotherapy with oral terbinafine.
  17 10,603 957
Idiopathic eruptive macular pigmentation with papillomatosis: Report of nine cases
Rajiv Joshi
November-December 2007, 73(6):402-405
DOI:10.4103/0378-6323.37058  PMID:18032859
Nine patients, seven males and two females aged 6-14 years, presented with extensive, asymptomatic, brown-black macules and mildly elevated, pigmented lesions of a few months' duration. The sites affected were the face, trunk and proximal extremities. The skin lesions were discrete and individual lesions were less than 2 cm in size. The clinical diagnoses rendered by the referring physicians were lichen planus pigmentosus, urticaria pigmentosa, erythema dyschromicum perstans and postinflammatory hyperpigmentation. Histology in all nine cases showed papillomatosis of the dermis with prominent pigmentation of the basal layer (pigmented papillomatosis) without any significant dermal inflammation. Two cases had spores of Pityrosporum ovale in the thickened horny layer, one of which also had, in addition, bacterial colonies in the stratum corneum. The pigmentation resolved on its own over several months. This presentation is similar to the previously described idiopathic eruptive macular pigmentation with the additional histological finding of papillomatosis that is being described for the first time and may be nosologically related to acanthosis nigricans and confluent and reticulate papillomatosis.
  13 9,916 607
Imiquimod-induced vitiligo-like depigmentation
Engin Senel, Deniz Seckin
November-December 2007, 73(6):423-423
DOI:10.4103/0378-6323.37065  PMID:18032867
  13 5,416 299
Current treatment of onychomycosis
Devinder Mohan Thappa
November-December 2007, 73(6):373-376
DOI:10.4103/0378-6323.37052  PMID:18032853
  7 26,051 1,770
Ectodermal dysplasia with alopecia, onychodysplasia, hypohidrosis, keratoderma, abnormal teeth and deafness
Maryam Akhyani, Katrin Kiavash
November-December 2007, 73(6):409-411
DOI:10.4103/0378-6323.37060  PMID:18032861
The ectodermal dysplasias are a heterogeneous group of disorders with primary defect in hair, teeth, nail and sweat gland function. Numerous types have been described and several classifications exist. Here, we present a patient with ectodermal dysplasia with alopecia, dysplastic nails, hypohidrosis, sensorineural deafness, palmoplantar keratoderma, abnormal teeth and dry skin. To our knowledge, combination of all these features in ectodermal dysplasia has not been reported in the past. The etiology is unknown, but consanguinity of parents points to an autosomal recessive inheritance.
  6 9,557 441
Collaborative writing: Tools and tips
Bell Raj Eapen
November-December 2007, 73(6):439-441
DOI:10.4103/0378-6323.37078  PMID:18032878
Majority of technical writing is done by groups of experts and various web based applications have made this collaboration easy. Email exchange of word processor documents with tracked changes used to be the standard technique for collaborative writing. However web based tools like Google docs and Spreadsheets have made the process fast and efficient. Various versioning tools and synchronous editors are available for those who need additional functionality. Having a group leader who decides the scheduling, communication and conflict resolving protocols is important for successful collaboration.
  6 8,137 250
A clinico-epidemiological study of dermatophytoses in Northeast India
Smita Sarma, AK Borthakur
November-December 2007, 73(6):427-428
DOI:10.4103/0378-6323.37068  PMID:18032869
  6 4,563 475
Malassezia furfur onychomycosis in an immunosuppressed liver transplant recipient
Ilgen Ertam, Derya Aytimur, Sibel Alper
November-December 2007, 73(6):425-426
DOI:10.4103/0378-6323.37067  PMID:18032868
  5 5,098 298
Epidermodysplasia verruciformis associated with isolated IgM deficiency
Ulker Gul, Secil Soylu, Rana Yavuzer
November-December 2007, 73(6):420-422
DOI:10.4103/0378-6323.37064  PMID:18032865
A 20 year-old man presented to our clinic with multiple warts on both hands and tumoral lesions on his face but otherwise healthy. On dermatological examination, numerous brown-black papular lesions, changing from 2 to 5 cm in diameter were found on his face along with multiple, flesh-coloured, flat-topped papules on the dorsa of his hands. A tumoral lesion, approximately 3 cm in diameter on the right side of his forehead and desquamated erythematous macules were also observed on the trunk. Laboratory investigations showed that serum immunoglobulin M (IgM) level was decreased. The histopathological examination of verrucous lesions on the hands was consistent with epidermodysplasia verruciformis and the histopathological diagnosis of the tumoral lesion was squamous cell carcinoma.
  4 5,117 273
Diphenylcyclopropenone immunotherapy in ophiasis
Gurcharan Singh, Rajendra Okade, Chandra Naik, CD Dayanand
November-December 2007, 73(6):432-433
DOI:10.4103/0378-6323.37072  PMID:18032873
  4 7,299 391
Nodular secondary syphilis mimicking cutaneous lymphoreticular process
BK Brar, Vivek Mehta, Rakesh Tilak Raj
November-December 2007, 73(6):437-438
DOI:10.4103/0378-6323.37077  PMID:18032877
  4 5,081 253
Reducing the allergenic hexavalent chromium in leather to hypoallergenic trivalent chromium for prevention of leather dermatitis
CR Srinivas, V Shanmuga Sundaram, K Selvaraj
November-December 2007, 73(6):428-429
DOI:10.4103/0378-6323.37069  PMID:18032870
  4 5,058 228
Nicolau's syndrome following diclofenac administration: A report of two cases
S Chidambara Murthy, Karjigi Siddalingappa, T Suresh
November-December 2007, 73(6):429-431
DOI:10.4103/0378-6323.37070  PMID:18032871
  4 6,201 355
Microcannular tumescent liposuction
Venkataram Jayashree, Venkataram Mysore
November-December 2007, 73(6):377-383
DOI:10.4103/0378-6323.37053  PMID:18032854
Liposuction is a commonly performed procedure to remove localized deposits of fat. Liposuction under general anesthesia is associated with significant morbidity and risk of mortality. Dermatologic surgeons have made significant contributions in this field. Tumescent liposuction using microcannuale under local anesthesia, as practised by dermatologic surgeons is safe and effective. This article describes the procedure of microcannular tumescent liposuction.
  4 10,241 642
Acquired Blaschkoid dermatitis
P Mercy, A Ghorpade, MN Das, A Soud, S Puttoo, D Sharma, A Jain
November-December 2007, 73(6):415-416
DOI:10.4103/0378-6323.37062  PMID:18032863
Acquired Blaschkoid dermatitis characterised by unilateral relapsing inflammatory disease along the lines of Blaschko. A 40-year-old Indian male presented with unilateral erythematous, itchy grouped papules on the left side of the chest, abdomen, back and left arm of 15 days duration. The eruption stopped abruptly at the midline of the torso, completely sparing the right side of the body. The lesions were arranged in whorls and streaks corresponding to the lines of Blaschko. Skin biopsy showed hyperkeratosis and features suggestive of sub-acute spongiotic dermatitis with lymphocytic infiltrate around the blood vessels in the dermis. Patient was diagnosed as a case of Blaschkoid dermatitis. To the best of our knowledge, this is the first case of this condition being reported from India.
  3 7,085 378
Annular tufted angioma
Nilendu Sarma, Sudip Das, Aloke Kumar Roy
November-December 2007, 73(6):435-436
DOI:10.4103/0378-6323.37076  PMID:18032876
  3 3,623 208
Comparison of the mouse foot pad test with a Buddemeyer type radiorespirometric assay in detecting viable Mycobacterium leprae in human lesional biopsies
Vinay P Agrawal, Vanaja P Shetty
November-December 2007, 73(6):384-388
DOI:10.4103/0378-6323.37054  PMID:18032855
Aim : This study assesses the utility of a Buddemeyer type radiorespirometric (RR) assay in detecting viable Mycobacterium leprae in clinical samples taking the mouse foot pad (MFP) test as gold standard. Methods : A total of 131 skin biopsy specimens comprising of 56 untreated, smear-positive, borderline lepromatous and lepromatous leprosy (BL-LL) and 75 untreated, smear-negative, borderline tuberculoid and mid-borderline (BT-BB) specimens were processed by both the methods. The cut-off value (in counts per minute, cpm) for test samples in the RR assay was determined using nonleprous (normal) skin biopsy specimens. Results : In the untreated BL-LL and BT-BB groups, 86 and 56% of the cases tested positive in the RR assay respectively, which was comparable to the results of the MFP test (80 and 45% respectively). The overall concordance between the two tests was 74.79%, whereas the sensitivity and specificity were 75 and 74.3% respectively. A Kappa value of 0.459 indicated a fairly good agreement between the two methods. There was no linear relationship observed between the bacteriological index (BI) and the morphological index (MI) with the counts per minute (cpm) output. Conclusion : The results indicate the ability of this RR assay to detect viability; however a comparison with another sensitive method would further validate the assay system.
  3 5,285 280
An observation of leprosy situation in Surat district from 2001 to 2006
Rajesh K Chudasama, Naresh Godara, VS Tripathi, Mahendra Patel
November-December 2007, 73(6):434-435
DOI:10.4103/0378-6323.37075  PMID:18032875
  2 3,215 224
Pseudoxanthoma elasticum and cerebral ischemic stroke
Sudhir Kumar
November-December 2007, 73(6):433-434
DOI:10.4103/0378-6323.37073  PMID:18032874
  2 3,332 225
Squamous cell carcinoma of the thumb nail bed
Manohar Arumugam
November-December 2007, 73(6):445-445
Squamous cell carcinoma arising from the nail bed is not common. This condition can be easily misdiagnosed, especially if there is preceding trauma. We present here a case of squamous cell carcinoma of the right thumb in a 70 year-old man. The distal phalanx and part of the proximal phalanx were also involved. We performed a disarticulation of the metacarpophalangeal joint of the right thumb. The wound healed well. If an early diagnosis is made, then Moh's micrographic surgery or wide local excision with the use of a local flap could be advocated. In late stages, amputation or disarticulation is the treatment of choice.
  2 17,446 227
Silvery hair with bronze-tan in a child: A case of Elejalde disease
Arun C Inamadar, Aparna Palit
November-December 2007, 73(6):417-419
DOI:10.4103/0378-6323.37063  PMID:18032864
A 5-year-old boy was admitted for severe neurological impairment including hypotonia and loss of consciousness without preceding febrile illness. On examination, he had silver colored hair and bronze-tan over photo-exposed body parts. He was born of consanguineous parents and three of his elder siblings, who died in early childhood, had similar colored hair. Complete blood count and serum immunoglobulin levels were within normal limits. Peripheral blood smear did not show any cytoplasmic granules in neutrophils. Cerebro-spinal fluid examination did not reveal any abnormality. Light microscopic examination of the hair revealed irregular clumping of the melanin throughout the shafts. The patient died on the second day following admission. A clinical diagnosis of Elejalde disease was made. The clinical and genetic overlapping of the three silvery-hair syndromes has been discussed.
  1 6,134 325
Successful use of imiquimod 5% cream in Bowen's disease
Smitha Prabhu, Raghavendra Rao, H Sripathi, Sunaina Hameed, Ranjini Kuduva
November-December 2007, 73(6):423-425
DOI:10.4103/0378-6323.37066  PMID:18032866
  1 3,830 283
Group discussion: Prepare, learn, teach and assess
Garehatty Rudrappa Kanthraj
November-December 2007, 73(6):442-444
DOI:10.4103/0378-6323.37079  PMID:18032879
  1 4,764 361
Tuberous sclerosis with portal vein thrombosis, protein C and S deficiency
Biju Vasudevan, M.P.S Sawhney, S Radhakrishnan, G Shilpa
November-December 2007, 73(6):412-414
DOI:10.4103/0378-6323.37061  PMID:18032862
A 29-year-old lady with a bad obstetric history and portal vein thrombosis, presented to the Skin OPD for facial lesions. On examination, angiofibromas on face, shagreen patch and periungual fibromas were observed. She also had dental pits and a retinal hamartoma. Investigations revealed hamartomas in the brain and kidney. Hematological work-up showed protein C and S deficiency with Factor V Leiden positivity. Except for the cutaneous symptoms, the patient did not have any clinical manifestations in other organs affected by tuberous sclerosis. A similar association of tuberous sclerosis with protein C deficiency has been reported in only one case in literature.
  - 7,574 257
Costello syndrome
J Madhukara, M Sendhil Kumaran
November-December 2007, 73(6):406-408
DOI:10.4103/0378-6323.37059  PMID:18032860
Costello syndrome is a rare, distinctive, multiple congenital anomaly syndrome, characterized by soft, loose skin with deep palmar and plantar creases, loose joints, distinctive coarse facial features and skeletal and cardiac abnormalities. The affected patients have a predisposition to develop malignancy, developmental delays and mental retardation. Recently, a 7-year-old male child born to normal nonconsanguineous parents presented to us with abnormal facial features, arrhythmia, mitral valve dysfunction and growth retardation. His cutaneous examination revealed lax and pigmented skin over hands and feet with deep creases, acanthosis nigricans and short curly hairs. Its differentiation from other syndromes with similar clinical features is discussed in this article.
  - 8,618 437
Supernumerary digits associated with pachyonychia congenita type I
Saurabh Agarwal, Krishna Gopal
November-December 2007, 73(6):431-432
DOI:10.4103/0378-6323.37071  PMID:18032872
  - 3,723 201
Authors' reply
G Nanda Kumar, KV Ragi, S Pradeep Nair
November-December 2007, 73(6):434-434
  - 2,472 132
Management of ear rim keloid with carbon dioxide laser
DS Krupa Shankar, Vipul Gupta
November-December 2007, 73(6):445-445
  - 5,409 197
Symmetrical erythematous annular and scaly patches
Najeeba Riyaz, Uma Rajan, KB Anuradha
November-December 2007, 73(6):446-446
  - 5,813 240
Malignancy in dermatomyositis: A Bayesian Belief Network approach
Bell Raj Eapen
November-December 2007, 73(6):445-445
Background: Dermatomyositis (DMS) is an inflammatory disease affecting the muscle and the skin and is known to be associated with a definite risk of malignancy. Extensive malignancy screening may not be cost-effective in all patients. Several predictive factors have been postulated in DMS. Aims: This study attempts to build a Bayesian Belief Network model based on data available from literature to assign a numerical risk to each patient by taking the predictive factors into consideration. Methods: Relevant frequency data was collected from literature reports of dermatomyositis cases for four independent factors: age over 40, male sex, elevated erythrocyte sedimentation rate (ESR) and cutaneous necrosis. The model had 'malignancy risk' as the single decision variable. All evidence nodes had only two outcomes. The model was constructed using the GeNIe modeling environment and the user interface was implemented using VisualBasic.NET. Results: Four studies provided data for 151 DMS patients out of which 44 patients had malignancy. The constructed model had one decision node and four evidence nodes. The software to calculate the numerical risk is available for download from http://www.gulfdoctor.net/derm/dmbbn.htm. Conclusion: Bayesian Belief networks (BBN) can be used in situations like this where predictive factors are clearly associated with uncertainty. However, the present model may still be inaccurate because of the lack of reliable data and extensive testing.
  - 5,982 239
Scaly erythematous plaque on the chest
Vandana Mehta Rai, C Balachandran, Sudha Bhat, V Geetha
November-December 2007, 73(6):447-448
DOI:10.4103/0378-6323.37084  PMID:18032880
  - 4,162 233
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