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   2012| January-February  | Volume 78 | Issue 1  
    Online since December 17, 2011

 
 
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SYMPOSIUM - VITILIGO
Melanocytorrhagy and apoptosis in vitiligo: Connecting jigsaw pieces
Ravinder Kumar, Davinder Parsad
January-February 2012, 78(1):19-23
DOI:10.4103/0378-6323.90942  PMID:22199056
Vitiligo 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.
  10 6,998 424
ORIGINAL ARTICLES
Non-cultured epidermal suspension in vitiligo: From laboratory to clinic
Yvon Gauthier, Laila Benzekri
January-February 2012, 78(1):59-63
DOI:10.4103/0378-6323.90947  PMID:22199061
Background: 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 37΀C 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.
  7 15,297 645
SYMPOSIUM - VITILIGO
Ultraviolet-based therapy for vitiligo: What's new?
Iltefat H Hamzavi, Henry W Lim, Zain U Syed
January-February 2012, 78(1):42-48
DOI:10.4103/0378-6323.90945  PMID:22199059
Vitiligo 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.
  7 9,618 586
ORIGINAL ARTICLES
Segmental vitiligo: A randomized controlled trial to evaluate efficacy and safety of 0.1% tacrolimus ointment vs 0.05% fluticasone propionate cream
Sushruta Kathuria, Binod K Khaitan, M Ramam, Vinod K Sharma
January-February 2012, 78(1):68-73
DOI:10.4103/0378-6323.90949  PMID:22199063
Background: 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.
  6 10,243 395
SYMPOSIUM - VITILIGO
Childhood vitiligo
Aparna Palit, Arun C Inamadar
January-February 2012, 78(1):30-41
DOI:10.4103/0378-6323.90944  PMID:22199058
Childhood 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.
  6 35,332 1,211
LETTERS TO THE EDITOR
Idiopathic acquired persistent true partial to total leukonychia
Shehnaz Z Arsiwala
January-February 2012, 78(1):107-108
DOI:10.4103/0378-6323.90962  PMID:22199074
  5 5,396 132
Bone marrow transplantation improves symptoms of congenital erythropoietic porphyria even when done post puberty
Saurabh Singh, Neena Khanna, Lalit Kumar
January-February 2012, 78(1):108-111
DOI:10.4103/0378-6323.90963  PMID:22199075
  5 4,909 141
Excellent response of infantile hemangioma associated with PHACES syndrome to propranolol
Saritha Mohanan, Laxman Besra, Laxmisha Chandrashekar, Devinder Mohan Thappa
January-February 2012, 78(1):114-115
DOI:10.4103/0378-6323.90966  PMID:22199078
  4 4,808 174
NET LETTERS
Giant linear syringocystadenoma papilliferum of the back
Manoranjan Kar, Jugal K Kar, Saswati Maiti
January-February 2012, 78(1):123-123
DOI:10.4103/0378-6323.90977  PMID:22199089
  4 4,299 131
SYMPOSIUM - VITILIGO
Depigmentation therapies in vitiligo
Divya Gupta, Rashmi Kumari, Devinder Mohan Thappa
January-February 2012, 78(1):49-58
DOI:10.4103/0378-6323.90946  PMID:22199060
Depigmentation 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.
  4 21,173 689
EDITORIALS
The intricacies of impact factor and mid-term review of editorship
M Malathi, Devinder Mohan Thappa
January-February 2012, 78(1):1-4
DOI:10.4103/0378-6323.90938  PMID:22199052
  3 3,963 236
LETTERS TO THE EDITOR
Epidermal inclusion cyst or giant milium of the nipple
Shalu Jain, Rashmi Sarkar, Vijay K Garg, Nita Khurana
January-February 2012, 78(1):103-105
DOI:10.4103/0378-6323.90960  PMID:22199072
  3 21,420 125
CASE REPORTS
Primary extramammary Paget's disease with extensive skeletal metastases
Indukooru Subrayalu Reddy, Meenakshi Swain, Swarnalata Gowrishankar, Dronamraju Butchi Narayana Murthy
January-February 2012, 78(1):89-92
DOI:10.4103/0378-6323.90954  PMID:22199067
Extramammary 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.
  2 9,309 127
NET LETTERS
Lymphangiectasia of the vulva, treatment with CO 2 laser
Myriam Ben Hamida, Dora Baccouche, Nadia El Fekih, Becima Fazaa, Ridha Kamoun
January-February 2012, 78(1):122-122
DOI:10.4103/0378-6323.90973  PMID:22199085
  2 6,858 130
CASE REPORTS
Granulomatous and eccrinotropic lymphomatoid papulosis
Nilam Jain, Rameshwar Gutte, Pinanky Jadhav, Uday Khopkar
January-February 2012, 78(1):82-84
DOI:10.4103/0378-6323.90951  PMID:22199065
Lymphomatoid 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.
  1 3,558 159
Neurocutaneous spectrum of multiple endocrine neoplasia-1
Shireen Furtado, Nandita Ghosal, Sunil V Furtado, Kanchan Gupta, Alangar S Hegde
January-February 2012, 78(1):93-96
DOI:10.4103/0378-6323.90956  PMID:22199068
Multiple 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.
  1 4,493 144
EDITORIALS
Measuring the severity of vitiligo
M Ramam, S Gaurang Krishna
January-February 2012, 78(1):5-7
DOI:10.4103/0378-6323.90939  PMID:22199053
  1 5,102 728
GUEST EDITORIAL
Vitiligo: Emerging paradigms
Davinder Parsad
January-February 2012, 78(1):17-18
DOI:10.4103/0378-6323.90941  PMID:22199055
  1 5,352 591
LETTERS TO THE EDITOR
A case of Parry-Romberg syndrome with congenital heart disease
Supriya P Deshmukh, Yugal K Sharma, Bharat B Dogra, Nitin C Chaudhari
January-February 2012, 78(1):105-106
DOI:10.4103/0378-6323.90961  PMID:22199073
  1 3,779 151
Can highly active antiretroviral therapy unmask leprosy? A case of type 1 lepra reaction in a HIV-seropositive patient
G Raghurama Rao, A Amareswar, S Sandhya
January-February 2012, 78(1):101-103
DOI:10.4103/0378-6323.90959  PMID:22199071
  1 4,259 138
NET CASES
A case of bacillary angiomatosis developed at a burn site
Ayse Albayrak, Yavuz Albayrak, Deniz Unal, Mustafa Atasoy, Muhammet H Uyanik
January-February 2012, 78(1):121-121
DOI:10.4103/0378-6323.90970  PMID:22199082
Bacillary 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.
  1 3,962 109
NET LETTERS
Erythema gyratum repens and rheumatoid arthritis: An unrecognized association?
Ada Lo Schiavo, Stefano Caccavale, Ida Orlando, Rosella Tirri
January-February 2012, 78(1):122-122
DOI:10.4103/0378-6323.90974  PMID:22199086
  1 4,620 126
ORIGINAL ARTICLES
The effect of H 1 and H 2 receptor antagonists on melanogenesis
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
January-February 2012, 78(1):64-67
DOI:10.4103/0378-6323.90948  PMID:22199062
Background: 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.
  1 4,326 258
SYMPOSIUM - VITILIGO
On the pathophysiology of vitiligo: Possible treatment options
Raymond E Boissy, Maria Lucia Dell'Anna, Mauro Picardo
January-February 2012, 78(1):24-29
DOI:10.4103/0378-6323.90943  PMID:22199057
Vitiligo 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.
  1 7,847 643
CASE REPORTS
Unilateral linear punctate palmoplantar keratoderma
Sudhanshu Sharma, Krishna Deb Barman, Vijay Kumar Garg, Shalu Jain
January-February 2012, 78(1):85-88
DOI:10.4103/0378-6323.90953  PMID:22199066
Punctate 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.
  - 7,075 193
IMAGES IN CLINICAL PRACTICE
Hyperhidrosis, vesicles, and papules over the nose: Granulosis rubra nasi
Sidharth Sonthalia, Archana Singal, Reena Sharma
January-February 2012, 78(1):97-98
DOI:10.4103/0378-6323.90957  PMID:22199069
  - 5,421 237
LETTERS TO THE EDITOR
Comparative study of dietary habits between acne patients and a healthy cohort
Claudia Salomone, Claudia Nicklas, Cristián Navarrete-Dechent, Katherine Droppelmann, María Luisa Pérez-Cotapos
January-February 2012, 78(1):99-101
DOI:10.4103/0378-6323.90958  PMID:22199070s
  - 3,667 262
Colocalization of mucosal vitiligo and oral pemphigus vulgaris
Dipankar De, Amrinder J Kanwar, Uma N Saikia, Rashmi Jindal
January-February 2012, 78(1):111-113
DOI:10.4103/0378-6323.90964  PMID:22199076
  - 3,871 119
Majocchi's granuloma over the face
Cuicui Liu, Lilla Landeck, Sui-Qing Cai, Min Zheng
January-February 2012, 78(1):113-114
DOI:10.4103/0378-6323.90965  PMID:22199077
  - 4,241 162
NET CASES
Acute hemorrhagic edema of infancy: A report of two cases
Atul Dongre, Vijay Adhe, Dimple Kothari, Suchitra Kardekar, Uday Khopkar
January-February 2012, 78(1):121-121
DOI:10.4103/0378-6323.90969  PMID:22199081
Acute 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.
  - 5,226 143
NET LETTERS
A new site of milia en plaque
Ru-Zhi Zhang, Wen-Yuan Zhu
January-February 2012, 78(1):122-122
DOI:10.4103/0378-6323.90975  PMID:22199087
  - 0 0
Zinc responsive acrodermatitis in nephrotic syndrome: A rare presentation
Afsha A Topal, Rachita S Dhurat, Chitra S Nayak
January-February 2012, 78(1):122-123
DOI:10.4103/0378-6323.90976  PMID:22199088
  - 3,800 131
Lymphangioma circumscriptum-like presentation of breast carcinoma
Dilek Bayramgürler, Evren Odyakmaz Demirsoy, Nurşah Doğan, Kürşat Yıldız, Zafer Utkan
January-February 2012, 78(1):121-121
DOI:10.4103/0378-6323.90971  PMID:22199083
  - 1,941 63
Coexistence of acquired hypertrichosis and scalp alopecia in a patient with infiltrating ductal carcinoma
Ru-Zhi Zhang, Wen-Yuan Zhu, Lei Zhou
January-February 2012, 78(1):122-122
DOI:10.4103/0378-6323.90972  PMID:22199084
  - 3,609 206
NET QUIZ
Asymptomatic nodule over the shin
Rameshwar Gutte, Gaurav Garg, Vidya Kharkar, Uday Khopkar
January-February 2012, 78(1):123-123
DOI:10.4103/0378-6323.90978  PMID:22199090
  - 4,504 252
ORIGINAL ARTICLES
Survey of dermatologists' phototherapy practices for vitiligo
Khalid M AlGhamdi, Huma Khurram, Alain Taïeb
January-February 2012, 78(1):74-81
DOI:10.4103/0378-6323.90950  PMID:22199064
Background: 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.
  - 9,842 295
QUIZ
A solitary facial tumor with erosion on an 81-year-old oriental woman
Wei-Chih Ko, Chih-Ming Hung, Tsen-Fang Tsai
January-February 2012, 78(1):119-120
DOI:10.4103/0378-6323.90968  PMID:22199080
  - 2,671 174
RESIDENT’S PAGE
In vivo antinuclear antibodies of the skin
Sandeep K Arora, Seema Chhabra
January-February 2012, 78(1):116-118
DOI:10.4103/0378-6323.90967  PMID:22199079
  - 4,562 919
REVIEW ARTICLE
Camouflage for patients with vitiligo
Feroze Kaliyadan, Ambika Kumar
January-February 2012, 78(1):8-15
DOI:10.4103/0378-6323.90940  PMID:22199054
Vitiligo 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.
  - 25,445 750
Online since 15th March '04
Published by Wolters Kluwer - Medknow