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   2011| May-June  | Volume 77 | Issue 3  
    Online since April 19, 2011

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Phenomena in dermatology
Bhushan Madke, Bhavana Doshi, Sushil Pande, Uday Khopkar
May-June 2011, 77(3):264-275
DOI:10.4103/0378-6323.79695  PMID:21508564
For a better understanding of various dermatoses, it is imperative for any physician practising dermatology to have a good theoretical knowledge of the underlying pathophysiologic processes involved in various systemic diseases involving the skin. For an easy grasp over this topic, we have discussed the various phenomena under three broad categories, like (a) clinical - Meyerson, Meirowsky, pathergy, Renbok, (b) laboratory - LE cell, prozone and (c) histopathology - Splendore-Hoeppli.
  62,831 4,025 5
Multiple brownish papules on the penile shaft
Huang Ching-Fu, Wang Wei-Ming, Wu Bai-Yao
May-June 2011, 77(3):404-404
DOI:10.4103/0378-6323.79747  PMID:21508599
  29,940 142 2
Fractional lasers in dermatology - Current status and recommendations
Apratim Goel, DS Krupashankar, Sanjeev Aurangabadkar, KC Nischal, HM Omprakash, Venkataram Mysore
May-June 2011, 77(3):369-379
DOI:10.4103/0378-6323.79732  PMID:21508586
Introduction: Fractional laser technology is a new emerging technology to improve scars, fine lines, dyspigmentation, striae and wrinkles. The technique is easy, safe to use and has been used effectively for several clinical and cosmetic indications in Indian skin. Devices: Different fractional laser machines, with different wavelengths, both ablative and non-ablative, are now available in India. A detailed understanding of the device being used is recommended. Indications: Common indications include resurfacing for acne, chickenpox and surgical scars, periorbital and perioral wrinkles, photoageing changes, facial dyschromias. The use of fractional lasers in stretch marks, melasma and other pigmentary conditions, dermatological conditions such as granuloma annulare has been reported. But further data are needed before adopting them for routine use in such conditions. Physician qualification: Any qualified dermatologist may administer fractional laser treatment. He/ she should possess a Master's degree or diploma in dermatology and should have had specific hands-on training in lasers, either during postgraduation or later at a facility which routinely performs laser procedures under a competent dermatologist or plastic surgeon with experience and training in using lasers. Since parameters may vary with different systems, specific training tailored towards the concerned device at either the manufacturer's facility or at another center using the machine is recommended. Facility: Fractional lasers can be used in the dermatologist's minor procedure room for the above indications. Preoperative counseling and Informed consent: Detailed counseling with respect to the treatment, desired effects and possible postoperative complications should be provided to the patient. The patient should be provided brochures to study and also adequate opportunity to seek information. A detailed consent form needs to be completed by the patient. Consent form should include information on the machine, possible postoperative course expected and postoperative complications. Preoperative photography should be carried out in all cases of resurfacing. A close-up front and 45-degree lateral photographs of both sides must be taken. Laser parameters: There are different machines based on different technologies available. Choice parameters depend on the type of machine, location and type of lesion, and skin color. Physician needs to be familiar with these requirements before using the machine. Anesthesia: Fractional laser treatment can be carried out under topical anesthesia with eutectic mixture of lidocaine and prilocaine. Some machines can be used without any anesthesia or only with topical cooling or cryospray. But for maximal patient comfort, a topical anesthetic prior to the procedure is recommended. Postoperative care: Proper postoperative care is important in avoiding complications. Post-treatment edema and redness settle in a few hours to a few days. A sunscreen is mandatory, and emollients may be prescribed for the dryness and peeling that could occur.
  25,217 1,267 4
Intralesional immunotherapy for the management of warts
Laxmisha Chandrashekar
May-June 2011, 77(3):261-263
DOI:10.4103/0378-6323.79694  PMID:21508563
  23,831 1,320 7
Lasers for vascular lesions: Standard guidelines of care
CR Srinivas, M Kumaresan
May-June 2011, 77(3):349-368
DOI:10.4103/0378-6323.79728  PMID:21508585
Introduction: Lasers are a good therapeutic tool for congenital and acquired vascular lesions. Technological advances in lasers have reduced the adverse effects and increased the efficacy. Machines: Among the various lasers used for treating vascular lesions, pulsed dye laser (PDL) has the best efficacy and safety data. The other machines that are widely available are Nd:YAG laser and intense pulse light (IPL). Rationale and scope of guideline: Much variation exists in different machines and techniques, and therefore, establishing standard guidelines has limitations. The guidelines recommended here indicate minimum standards of care for lasers on vascular lesions based on current evidence. Physician Qualification: Laser may be administered by a dermatologist, who has received adequate background training in lasers during post-graduation or later at a center that provides education and training in lasers, or in focused workshops, which provide such trainings. He/she should have adequate knowledge of the lesions being treated, machines, parameters, cooling systems, and aftercare. Facility: The procedure may be performed in the physician's minor procedure room with adequate laser safety measures. Indications: PWS, hemangioma, facial telangiectasia, rosacea, spider angioma, pyogenic granuloma, venous lakes, leg veins. Contraindications: Absolute: Active local infection, photo-aggravated skin diseases, and medical conditions. Relative: Unstable vitiligo, psoriasis, keloid and keloidal tendencies, patient on isotretinoin, patient who is not cooperative or has unrealistic expectation. Patient Selection: Patient selection should be done after detailed counseling with respect to the course of lesions, different treatment options, possible results, cost, need for multiple treatments, and possible postoperative complications. Treatment Sessions: The number of treatments per lesion varies from 2 to 12 or more at 6-8 week intervals. All lesions may not clear completely even after multiple sessions in many cases. Hence, a realistic expectation and proper counseling is very important. Laser parameters: Laser parameters vary with area, type of lesion, skin color, depth of the lesion, and machine used. A test spot may be performed to determine individual specifications. Complications: Pain, edema, purpura, bleeding, scarring, postinflammatory hyperpigmentation/hypopigmentation, and atrophy changes.
  23,995 767 9
Isolated Crohn's disease of the vulva
Nina A Madnani, Devendra Desai, Nisha Gandhi, Kaleem J Khan
May-June 2011, 77(3):342-344
DOI:10.4103/0378-6323.79724  PMID:21508582
  19,626 109 1
Congenital cutis laxa with rectal and uterovaginal prolapse
Sanjiv V Choudhary, Shazia Bisati, Sankha Koley
May-June 2011, 77(3):321-324
DOI:10.4103/0378-6323.79706  PMID:21508572
A two-month-old female infant born of a consanguineous marriage, presented with loose, wrinkled and inelastic skin over the neck, axillae, trunk, inguinal region and thighs with slow elastic recoil. Patient also had systemic manifestations in the form of bilateral apical lobe consolidation of lung, bilateral inguinal hernia, rectal and uterovaginal prolapse. Histopathological examination of skin biopsy with special stain for elastic tissue revealed absence of dermal elastic tissue. Genital abnormalities in patients with congenital cutis laxa have been reported rarely. But rectal and uterovaginal prolapse have not been reported at an early age of two months. In the absence of mutational screening, with history and clinical findings our case is likely to be Type I autosomal recessive form of congenital cutis laxa.
  17,041 120 1
Keratosis follicularis spinulosa decalvans in a female
Fiona F Sequeira, Elizabeth Jayaseelan
May-June 2011, 77(3):325-327
DOI:10.4103/0378-6323.79708  PMID:21508573
Keratosis follicularis spinulosa decalvans (KFSD), is a rare follicular syndrome associated with widespread keratosis pilaris and progressive scarring alopecia. This genodermatoses often starts at infancy or early childhood with an X-linked mode of inheritance. Males are predominantly affected and females frequently show no disease or only a mild form. We describe this not so common entity of KFSD in a nine year old female child.
  13,916 241 -
Linear and whorled nevoid hypermelanosis in three successive generations
Arun Kumar Metta, S Ramachandra, Nayeem Sadath, Shilpa Manupati
May-June 2011, 77(3):403-403
DOI:10.4103/0378-6323.79742  PMID:21508598
  13,682 197 -
Proximal nail fold-lunula double punch technique: A less invasive method for sampling nail matrix without nail avulsion
Jung Eun Kim, Hyo Sang Ahn, Min Seok Cheon, Kyung Jin Lee, Baik Kee Cho, Hyun Jeong Park
May-June 2011, 77(3):346-348
DOI:10.4103/0378-6323.79727  PMID:21508584
  11,903 104 1
Newer insights in teledermatology practice
Garehatty Rudrappa Kanthraj
May-June 2011, 77(3):276-287
DOI:10.4103/0378-6323.79696  PMID:21508565
The study and practice of dermatology care using interactive audio, visual, and data communications from a distance is called teledermatology. A teledermatology practice (TP) provides teleconsultation as well tele-education. Initially, dermatologists used videoconference. Convenience, cost-effectiveness and easy application of the practice made "store and forward" to emerge as a basic teledermatology tool. The advent of newer technologies like third generation (3G) and fourth generation (4G) mobile teledermatology (MT) and dermatologists' interest to adopt tertiary TP to pool expert (second) opinion to address difficult-to-manage cases (DMCs) has resulted in a rapid change in TP. Online discussion groups (ODGs), author-based second opinion teledermatology (AST), or a combination of both are the types of tertiary TP. This article analyzes the feasibility studies and provides latest insight into TP with a revised classification to plan and allocate budget and apply appropriate technology. Using the acronym CAP-HAT, which represents five important factors like case, approach, purpose, health care professionals, and technology, one can frame a TP. Store-and-forward teledermatology (SAFT) is used to address routine cases (spotters). Chronic cases need frequent follow-up care. Leg ulcer and localized vitiligo need MT while psoriasis and leprosy require SAFT. Pigmented skin lesions require MT for triage and combination of teledermoscopy, telepathology, and teledermatology for diagnosis. A self-practising dermatologist and national health care system dermatologist use SAFT for routine cases and a combination of ASTwith an ODG to address a DMC. A TP alone or in combination with face-to-face consultation delivers quality care.
  11,456 407 8
Nonablative lasers and nonlaser systems in dermatology: Current status
Mukta Sachdev, Sunaina Hameed, Venkataram Mysore
May-June 2011, 77(3):380-388
DOI:10.4103/0378-6323.79733  PMID:21508587
Nonablative lasers and nonlaser systems are newer systems used for skin rejuvenation, tightening, body sculpting, and scar remodeling. Devices: Different technologies such as lasers, Intense Pulsed Light (IPL), and radiofrequency have been introduced. Most nonablative laser systems emit light within the infrared portion of the electromagnetic spectrum (1000-1500nm). At these wavelengths, absorption by superficial water containing tissue is relatively weak, thereby effecting deeper tissue penetration. A detailed understanding of the device being used is recommended. Indications: Nonablative technology have been used for several indications such as skin tightening, periorbital tissue tightening, treatment of nasolabial lines and jowl, body sculpting/remodeling, cellulite reduction, scar revision and remodeling and for the treatment of photodamaged skin. Facility: Nonablative laser and light modalities can be carried out in a physician treatment room or hospital setting or a nursing home with a small operation theater. Preoperative counseling and informed consent: The dermatologic consultation should include detailed assessment of the patient's skin condition and skin type. An informed consent is mandatory to protect the rights of the patient as well as the practitioner. All patients must have carefully taken preoperative and postoperative pictures. Choice of the device and parameters: Depends on the indication, the area to be treated, the acceptable downtime for the desired correction, and to an extent the skin color. Anesthesia: These lasers are mostly pain-free and tolerated well by patients but may require topical anesthesia. In most cases, topical cooling and numbing using icepacks is sufficient, even in an apprehensive patient. Postoperative care: The nonablative lasers, light sources and radiofrequency systems are safe, even in darker skin types, and postoperative care is minimal. Proper postoperative care is important in avoiding complications. Post-treatment edema and redness settle in a few hours to a few days. Postoperative sun avoidance and use of sunscreen is mandatory.
  10,991 586 3
Bacterial contamination of the hands of doctors: A study in the medicine and dermatology wards
Rudrajit Paul, Nilay Kanti Das, Rina Dutta, Ramtanu Bandyopadhyay, Amit Kumar Banerjee
May-June 2011, 77(3):307-313
DOI:10.4103/0378-6323.79700  PMID:21508569
Background: Doctors' hands are a common source of bacterial contamination. Often, these organisms are found to be virulent species with multidrug-resistance patterns. These are the sources of nosocomial infections in many patients. Aims: The present study was undertaken to find out the prevalence of bacterial contamination in the hands of doctors in the Medicine and Dermatology wards of a tertiary care hospital. Methods: The hands of 44 doctors were swabbed and cultured at entry to ward and at exit. Then, tap water and alcohol swab wash techniques were used and further swabs were done at each step. Thus, each doctor was sampled four-times for the study. The antibiotic-sensitivity pattern of the organisms was determined by the disc-diffusion method. Results: There was a significant contamination of the doctors' hands at entry (59.1%) and at exit (90.9%). Overall, Staphylococcus was the predominant organism (59% at entry and 85% at exit); coagulase-negative ones were more prevalent at entry (32%) and coagulase-positive ones were more prevalent at exit (54%). There was no difference in the hand contamination rates of junior and senior doctors. Also, the contamination rates were similar in the Medicine and Dermatology wards. Among the Gram negative organisms, Escherichia coli (4.5%), Pseudomonas (4.5%), Enterococci (13.6%) and Klebsiella (9%) were the main ones isolated. Gram negative organisms were significantly more prevalent at exit (P = 0.009) compared with their numbers at entry. Hand washing techniques reduced the contamination rates significantly, 76% with tap water wash and further 16.5% with alcohol swab. The removal rate for both groups of organisms was similar. Also, coagulase-positive and -negative Staphylococci showed equal rates of removal with hand washing (P = 0.9793). The organisms were found to be resistant to most of the commonly used antibiotics; the beta-lactam group was especially largely resistant both for Gram positive and Gram negative bacteria. Both cheaper ones like cloxacillin (50-100%) and very costly ones like cefepime (100%) were equally vulnerable to resistance. Even newer antibiotics like linezolid and vancomycin showed a significant resistance to Staphylococcus. In Gram negative organisms, drugs like ceftazidime and gentamicin showed 100% resistance. Conclusion: This study shows the high level of contamination of doctors' hands. It emphasizes the need for proper hygienic measures in day to day practice in hospitals to reduce the level of nosocomial infections. Also, it shows that most of the commonly used antibiotics will be ineffective in nosocomial infections.
  9,971 214 1
Two uncommon cases of idiopathic atrophoderma of pasini and pierini: Multiple and giant
Zhang Ru-Zhi, Zhu Wen-Yuan
May-June 2011, 77(3):402-402
DOI:10.4103/0378-6323.79739  PMID:21508593
We report a 39-year-old Chinese man presenting with approximately 200 atrophic brownish patches for 10 years, whose clinical manifestation and pathological features were consistent with the findings of idiopathic atrophoderma of Pasini and Pierini. Another described case was a 62-year-old woman who had a gradually increasing asymptomatic hyperpigmented and depressed patch on her right lumbosacral region over a period of 7 years. At the time of consultation, the size of the lesion was approximately 27 Χ 23 cm.
  9,945 119 1
Congenital generalized lipodystrophy of Berardinelli-Seip type: A rare case
Sujay Khandpur, Amrendra Kumar, Rajesh Khadgawat
May-June 2011, 77(3):402-402
DOI:10.4103/0378-6323.79740  PMID:21508592
Congenital generalized lipodystrophy of Berardinelli-Seip type is a rare autosomal recessive disorder characterized by nearly complete absence of adipose tissue and a consequent generalized muscular appearance, which is recognized easily at birth. The condition is associated with various dermatological and systemic manifestations. We report a case of this form of lipodystrophy. The patient had several cutaneous manifestations, including severe acanthosis nigricans, generalized hyperpigmentation, curly scalp hair, prominent subcutaneous veins, and enlarged clitoris. She also had associated celiac disease.
  9,277 137 -
Pattern and prevalence of physiological cutaneous changes in pregnancy: A study of 2000 antenatal women
Shagufta P Rathore, Shashi Gupta, Vipin Gupta
May-June 2011, 77(3):402-402
DOI:10.4103/0378-6323.79741  PMID:21508591
  8,407 253 1
Directly observed treatment short course and cutaneous tuberculosis: Our experience
G Raghu Rama Rao, Sridevi , Betsy Lakshmy Narayan, A Amareswar, S Sandhya
May-June 2011, 77(3):330-332
DOI:10.4103/0378-6323.79713  PMID:21508575
  7,956 190 -
A measurement of the stigma among vitiligo and psoriasis patients in India
Rajan Pichaimuthu, Premkumar Ramaswamy, Kar Bikash, Richard Joseph
May-June 2011, 77(3):300-306
DOI:10.4103/0378-6323.79699  PMID:21508568
Background and Aim: The aim is to measure and to compare the level of social participation experienced by vitiligo and psoriasis patients in their domestic and social life in an Indian context. Methods: A cross-sectional comparative study with a sample of 150 cases each of psoriasis and vitiligo, a total of 300 subjects. A detailed clinical assessment of these two conditions, including the extent of lesions on the affected body parts, socioeconomic status and participation levels in social and domestic lives, was done. Results: The result showed that, 17.3% of vitiligo patients participated minimally in domestic and social life, whereas 28% of psoriasis patients had this problem (P=0.027). Extreme participation restriction was observed only among psoriasis patients (2.7%). Psoriasis patients also faced significantly more restrictions in a number of day-to-day life situations such as, less confidence in learning and applying knowledge, difficulties in meaningfully participating in major life areas like, work, education and employment, and also in community, social and civic life (all three domains P<0.0001), to vitiligo patients. Conclusion: Both psoriasis and vitiligo patients suffered moderate to severe restriction while participating in their domestic and social life. Of these two groups, psoriasis patients faced significantly more restrictions in a number of day-to-day life situations. The Indian population of this study was predominantly dark-skinned and hypo-pigmentation as seen in vitiligo is much more noticeable than psoriatic red patches. However, the results showed that the component of hypo or hyperpigmentation of the skin is not the only factor leading to participation restrictions.
  7,685 297 4
Phenol application to distal nail matrix for the treatment of nail thickening
Ercan Caliskan, Mustafa Tunca, Hakan Erbil, Ahmet Akar
May-June 2011, 77(3):344-346
DOI:10.4103/0378-6323.79725  PMID:21508583
  7,102 100 1
Change in spectrum of dermatophytes isolated from superficial mycoses cases: First report from Central India
Sanjeev Sahai, Devesh Mishra
May-June 2011, 77(3):335-336
DOI:10.4103/0378-6323.79718  PMID:21508578
  6,588 343 3
The impact of the latest classification system of benign vulvar diseases on the management of women with chronic vulvar pruritus
Kiymet Handan Kelekci, Fulya Adamhasan, Servet Gencdal, Hamide Sayar, Sefa Kelekci
May-June 2011, 77(3):294-299
DOI:10.4103/0378-6323.79698  PMID:21508567
Background: The management of women with chronic benign vulvar dermatoses has been one of the most difficult and challenging aspects of women's healthcare for a long time. Aim: Our aim was to compare the ability to approach the specific diagnosis of nonneoplastic and noninfectious vulva diseases, between the new classification system and the old classification system. Methods: One hundred women with chronic vulvar pruritus were included in the study. After detailed examination of the vulva, all visible lesions were biopsied, with normal skin included. All specimens was sent for dermatopathology and examined simultaneously under a binocular microscope by two pathologists. Specific diagnosis if possible and histopathological findings were classified according to both the 1987 and 2006 International Society for the Study of Vulvar Diseases (ISSVD) classifications. The ratios that were able to be approached on the specific diagnosis, with the aid the two classification systems, were compared. Results: Specific clinical diagnosis by both pathological and after using clinicopathological correlation was possible in 69 out of 91 patients (75.8%) according to the 1987 ISSVD classification, and in 81 out of 91 patients (89.0%) according to the ISSVD 2006 classification system. The difference in the clinical diagnosis ratios between the two classification systems was statistically significant ( P < 0.05). In a subgroup of women without specific diagnosis at the time of pathological examination, clinical diagnosis was made in 28 out of 50 women (56%) after using the clinicopathological correlation according to the ISSVD 1987 classification, whereas, specific diagnosis was made in 39 out of 49 (79.6%) women after using the clinicopathological correlation according to the ISSVD 2006 classification. The difference was statistically significant in terms of the ratio of the ability to achieve a specific diagnosis ( P < 0.01). Conclusion: ISSVD 2006 classification of nonneoplastic and noninfectious vulvar disease is more useful than the former classification, in terms of approaching the specific diagnosis of vulvar dermatoses.
  6,701 129 -
Rapid response to acitretin, combined with cryotherapy, for extensive and recalcitrant verruca vulgaris on the scalp
Feroze Kaliyadan, AD Dharmaratnam
May-June 2011, 77(3):338-340
DOI:10.4103/0378-6323.79721  PMID:21508580
  6,373 129 -
Evaluation of hypothalamic-pituitary-adrenal axis in patients with atopic dermatitis
Nutan , AJ Kanwar, A Bhansali, D Parsad
May-June 2011, 77(3):288-293
DOI:10.4103/0378-6323.79697  PMID:21508566
Background: Most of the research on atopic dermatitis (AD) has focused on the pathophysiological role of the immune system in AD, and the role of endocrine signals in the pathology of AD has not been explored. Current research has shown a link between the neuroendocrine and immune functions. Aim: The aim was to measure the serum basal cortisol levels and cortisol levels following a low-dose ACTH stimulation test in patients with AD before and after treatment with corticosteroids. Methods: Three groups of patients with AD were evaluated: mild, moderate, and severe. Basal cortisol levels following an ACTH stimulation test were measured before and after treatment with topical steroids when an improvement in the disease activity by 75% as determined by the SCORAD index was observed. Results: Eighteen patients of the severe group at baseline showed an impaired hypothalamic-pituitary-adrenal (HPA) axis with cortisol levels <250 nmol/l during their first visit. A total of 13 of 18 patients regained their HPA axis activity when the baseline cortisol was measured after using topical corticosteroids which resulted in 75% improvement in the disease activity. Conclusions: The disease activity rather than the use of topical costicosteroids is responsible for the low basal levels in patients with severe AD.
  5,972 184 -
Get set, write
Bhushan Madke, Uday Khopkar
May-June 2011, 77(3):392-398
DOI:10.4103/0378-6323.79735  PMID:21508589
  5,547 501 -
Paraneoplastic multicentric reticulohistiocytosis: A clinicopathologic challenge
Rajalakshmi Tirumalae, Pritilata Rout, Elizabeth Jayaseelan, Arun Shet, Shanthala Devi, Karuna Ramesh Kumar
May-June 2011, 77(3):318-320
DOI:10.4103/0378-6323.79704  PMID:21508571
Multicentric Reticulohistiocytosis (MRH) is a rare, systemic non-Langerhans cell histiocytosis (non-LCH) with prominent joint and skin manifestations. It is mostly self limiting. However, 15-30% of the cases are associated with malignancy and carry a poor prognosis. We report the case of a 42-year-old man who presented with multiple reddish-brown papules that on biopsy showed aggregates of oncocytic histiocytes with several multinucleate giant cells. Immunostains were positive for CD 68, CD 45 and were negative for S-100, CD1a. An impression of multicentric reticulohistiocytosis (MRH) was made, with the recommendation to screen for malignancy. Electron microscopy of the skin lesions showed features consistent with non-Langerhans cell histiocytosis. The patient was later diagnosed with acute myeloid leukemia at a follow-up visit several months later. Thus, it appears prudent to screen and follow-up adults with MRH, to identify an underlying malignant condition.
  5,789 131 2
Foam sclerotherapy in various vascular and lymphatic malformations
GR Ratnavel
May-June 2011, 77(3):336-338
DOI:10.4103/0378-6323.79719  PMID:21508579
  5,714 164 -
Disfiguring morphology of tuberous sclerosis
Sujay Khandpur, Sandeep Gupta
May-June 2011, 77(3):403-404
DOI:10.4103/0378-6323.79746  PMID:21508594
  5,773 87 -
Social aspects of syphilis based on the history of its terminology
Antonis A Kousoulis, Nikolaos Stavrianeas, Marianna Karamanou, George Androutsos
May-June 2011, 77(3):389-391
DOI:10.4103/0378-6323.79734  PMID:21508588
  5,241 182 -
Basal cell carcinoma in the North Indian population: Clinicopathologic review and immunohistochemical analysis
Purnima Malhotra, Avninder Singh, V Ramesh
May-June 2011, 77(3):328-330
DOI:10.4103/0378-6323.79710  PMID:21508574
  5,205 165 1
Solitary lateral lower lip sinus: A rare congenital anomaly
Prashant K Palwade
May-June 2011, 77(3):403-403
DOI:10.4103/0378-6323.79744  PMID:21508596
  5,065 52 -
Primary cutaneous follicle center lymphoma in the setting of chronic lymphocytic leukemia
S Konda, A Beckford, MF Demierre, M Mahalingam
May-June 2011, 77(3):314-317
DOI:10.4103/0378-6323.79702  PMID:21508570
Primary cutaneous malignancies arising in association with chronic lymphocytic leukemia (CLL) are notable for their atypical clinical and histological presentation. We report a 69-year-old man with a 17-year history of CLL who presented for evaluation of a well-defined red to violaceous nodule with a central depressed scar on the left lower extremity. Microscopic examination of a punch biopsy revealed an infiltrate of predominantly small lymphocytes with scattered large, atypical epithelioid cells. Immunohistochemical stains revealed diffuse positive staining of the lesional cells with CD20+ and bcl-6+ and focal positive staining with bcl-2+ (negative CD10 and CD23), findings which, in conjunction with the histology, were most compatible with a diagnosis of primary cutaneous follicle center lymphoma (PCFCL). A review of the clinical charts revealed several prior biopsies with varied diagnoses. In light of the most recent biopsy findings, all previous biopsies were re-reviewed and interpreted as PCFCL arising in the setting of CLL. Features contributing to the diagnostic conundrum in this case included an atypical clinical and histological presentation, lack of pertinent clinical history and multiple presentations at different institutions.
  4,541 82 -
Food allergen-free diet in severe atopic dermatitis related to food allergy
Guillet Marie-Helene, Vasileios Anyfantakis, Gerard Guillet
May-June 2011, 77(3):332-333
DOI:10.4103/0378-6323.79715  PMID:21508576
  4,345 111 1
A case of giant sebaceous carcinoma localized in the breast area of a male patient
Antonio Ascari-Raccagni, Adina Dondas, Franco Padovani, Carlo Milandri, Maria Giovanna Righini, Giusto Trevisan
May-June 2011, 77(3):403-403
DOI:10.4103/0378-6323.79745  PMID:21508595
  4,210 54 -
Multiple grouped nodules around the right ear in a young male
Lalit Kumar Gupta, NK Bansal
May-June 2011, 77(3):399-401
DOI:10.4103/0378-6323.79738  PMID:21508590
  4,058 164 1
Quality of life in psoriasis patients in KwaZulu Natal, South Africa
Preetha Hariram, Anisa Mosam, Jamila Aboobaker, Tonya Esterhuizen
May-June 2011, 77(3):333-334
DOI:10.4103/0378-6323.79716  PMID:21508577
  3,871 108 2
Zosteriform cutaneous metastasis of renal cell carcinoma
Didem Dincer, Mustafa Tunca, Ahmet Akar, Bulent Kurt
May-June 2011, 77(3):340-342
DOI:10.4103/0378-6323.79723  PMID:21508581
  3,898 62 -
Multifocal extra-ocular sebaceous carcinoma
Ishwara P Bhat, J Madhukara, J Elizabeth, Usha Kini, A Anuradha
May-June 2011, 77(3):403-403
DOI:10.4103/0378-6323.79743  PMID:21508597
  3,683 83 2
Vitiligo-Leukoderma-Textbook and Atlas
Davinder Parsad
May-June 2011, 77(3):405-405
  3,331 102 -
Online since 15th March '04
Published by Wolters Kluwer - Medknow