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   2012| July-August  | Volume 78 | Issue 4  
    Online since July 6, 2012

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Newer and upcoming therapies for melasma
Rashmi Sarkar, Shikha Chugh, Vijay K Garg
July-August 2012, 78(4):417-428
Melasma is one of the most common and distressing pigmentary disorders presenting to dermatology clinics. The precise cause of melasma remains unknown; however, there are many possible contributing factors. It is notably difficult to treat and has a tendency to relapse. The existing and most tried topical therapy is hydroquinone and the triple combination with tretinoin and corticosteroids, which is considered the gold standard for melasma. Besides that, azelaic acid, kojic acid, arbutin, ascorbic acid, glycolic acid and salicylic peels have also been tried with limited success. However, multiple novel topical agents are being investigated for their potential as hypopigmenting agents with unique mode of action. But, further trials are required to study their efficacy and safety before they can be further recommended. The article highlights these newer formulations and also briefly mentions about the newer chemical peels and the much hyped lasers in treating this difficult and frustrating condition.
  60,530 2,583 4
Pediculosis capitis: An update
Bhushan Madke, Uday Khopkar
July-August 2012, 78(4):429-438
Head louse infestation, or pediculosis capitis, caused by Pediculus humanus var. capitis, is a common health concern in pediatric age group. An itching of the scalp is the chief symptom, whereas presence of viable nits confirms the diagnosis of head louse infestation. Secondary bacterial infection with impetignization with cervical and occipital lymphadenopathy can complicate the clinical scenario with physician misdiagnosing pediculosis to a primary bacterial infection. Screening and treatment of all close contacts is necessary for an adequate management of pediculosis. Medical management of head louse infestation requires proper application of topical pediculicidal agents', chiefly permethrin lotion and wet combing with a fine toothcomb. Severe cases with high parasitic load justify the use of either oral cotrimoxazole or Ivermectin. Other described technique involves a single application of hot air for 30 minutes. Radical but culturally unacceptable method would be shaving of scalp in resistant cases. Environmental fogging with insecticides is neither necessary nor recommended.
  25,122 1,062 2
Efficacy and safety of a nano-emulsion gel formulation of adapalene 0.1% and clindamycin 1% combination in acne vulgaris: A randomized, open label, active-controlled, multicentric, phase IV clinical trial
Siva Prasad, Amiya Mukhopadhyay, Amit Kubavat, Amit Kelkar, Ajay Modi, Bhavesh Swarnkar, Bobby Bajaj, Maya Vedamurthy, Shafiq Sheikh, Ravindra Mittal
July-August 2012, 78(4):459-467
Background: Acne vulgaris is a very common skin disease with a significant detrimental effect on the quality of life of the patients. Aims: To assess the comparative efficacy and safety of a nano-emulsion gel formulation of adapalene and clindamycin combination with its conventional formulation in the treatment of acne vulgaris of the face. It was a prospective, randomized, open label, active-controlled, multicentric, clinical trial. Methods: Eligible patients suffering from acne vulgaris of the face were randomized to receive once-daily treatment with a nano-emulsion gel or conventional gel formulation of adapalene 0.1% and clindamycin (as phosphate) 1% combination for 12 weeks. Total, inflammatory and noninflammatory lesion counts, with grading of acne severity were carried out on a monthly basis. Safety assessments were done to determine the comparative local and systemic tolerability. Two-tailed significance testing was carried out with appropriate statistical tests, and P-values < 0.05 were considered as significant. Results: 209/212 patients enrolled in the study were eligible for efficacy and safety assessments in both nano-emulsion gel (118/119 patients) and conventional gel (91/93 patients) groups. Significantly better reductions in total (79.7% vs. 62.7%), inflammatory (88.7% vs. 71.4%) and noninflammatory (74.9% vs. 58.4%) lesions were reported with the nano-emulsion gel as compared to the conventional gel (P < 0.001 for all). Mean acne severity score also reduced significantly more with the nano-emulsion formulation (1.9 ± 0.9 vs. 1.4 ± 1.0; P < 0.001) than the comparator. Significantly lower incidence and lesser intensity of adverse events like local irritation (4.2% vs. 19.8%; P < 0.05) and erythema (0.8% vs. 9.9%; P < 0.05) were recorded with the nano-emulsion gel. Conclusions: The nano-emulsion gel formulation of adapalene and clindamycin combination appears to be more efficacious and better tolerated than the conventional formulation for the treatment of acne vulgaris in Indian patients. Further studies can elucidate the comparative treatment benefits of this nano-emulsion gel formulation.
  19,694 466 5
Granuloma annulare on the palms: A clinicopathological study of seven cases
Rameshwar Gutte, Dimple Kothari, Uday Khopkar
July-August 2012, 78(4):468-474
Background : Granuloma annulare (GA), a common dermatological condition of unknown etiology, affecting all ages. Involvement of the palms appears rare, posing a diagnostic challenge. This study was conducted to document various clinical and histopathological features of GA on the palms. Aims: To study clinical and histopathological variations in granuloma annulare on palms. Methods : A total 7 patients from our outpatient department with lesions of GA, exclusively on the palms, were studied over a period of 6 months from March 2011 to August 2011. Total of 8 biopsies were studied. In each patient, diagnosis was made on clinico-pathological correlation. Various clinical and histopathological features were analyzed. Results: An average age of onset was 47 years, male: female ratio was 1.33: 1, and average disease duration was 9 months. Pain was the most common symptom. Clinically, the most common presentation was pseudovesicles. Histologically, both classic palisading and interstitial pattern were seen. Perineural granulomas, perieccrine granulomas, elastophagocytosis were seen additionally. In 5 out of 7 patients, diagnosis was missed clinically. Conclusion: GA on palms poses a diagnostic challenge due to variable presentations. Histopathology is of vital importance for correct diagnosis and treatment. GA should be considered in differential diagnosis of papular lesions on palms.
  9,874 178 3
Ethics in research
Sanjay Singh
July-August 2012, 78(4):411-413
  9,084 262 1
Therapeutic plasma exchange as a crisis option in severe pemphigus vulgaris
P. S. S. Ranugha, Rashmi Kumari, Lakshmi B Kartha, Sreejith Parameswaran, Devinder Mohan Thappa
July-August 2012, 78(4):508-510
  8,587 178 -
Appraisal of transverse nasal groove: A study
Belagola D Sathyanarayana, Halevoor B Basavaraj, Kuchangi C Nischal, Mukunda R Swaroop, Puttagangu N Umashankar, Dhruv P Agrawal, Suchetha S Swamy, Sarda Okram
July-August 2012, 78(4):439-442
Background: Transverse nasal groove is a condition of cosmetic concern which awaits due recognition and has been widely described as a shallow groove that extends transversely over the dorsum of nose. However, we observed variations in the clinical presentations of this entity, hitherto undescribed in literature. Aims: We conducted a clinicoepidemiological study of transverse nasal lesions in patients attending our outpatient department. Methods: We conducted a prospective observational study. We screened all patients attending our out-patient department for presence of transverse nasal lesions, signs of any dermatosis and associated other skin conditions. Results: One hundred patients were recruited in the study. Females (80%) predominated over males. Most patients were of 15-45 years age group (70%). Majority of the transverse nasal lesions were classical transverse nasal groove (39%) and others included transverse nasal line (28%), strip (28%), ridge (4%) and loop (1%). Seborrhoeic diathesis was the most common condition associated with transverse nasal lesion. Conclusions: Occurrence of transverse nasal line, strip, ridge and loop, in addition to classical transverse nasal groove implies that latter is actually a subset of transverse nasal lesions. Common association of this entity with seborrheic dermatitis, seborrhea and dandruff raises a possibility of whether transverse nasal lesion is a manifestation of seborrheic diathesis.
  8,462 191 -
Citation Index and Impact factor
Anjana Nigam, Pramod K Nigam
July-August 2012, 78(4):511-516
  7,865 373 1
Palmar pits and epidermodysplasia verruciformis: A rare association
Piyush Kumar, Niharika Ranjan Lal, Ramesh Chandra Gharami
July-August 2012, 78(4):501-503
  7,455 107 -
Epidermal nevus syndrome associated with unusual neurological, ocular, and skeletal features
Reena Sharma, Archana Singal, Prashant Verma, Jolly Rohatgi, Sonal Sharma
July-August 2012, 78(4):480-483
Epidermal nevus syndrome (ENS) is a rare disease, the pathogenesis of which is largely elusive. We, hereby, report an exclusive case of a 20-year-old man with verrucous ENS presented with dark colored papules and plaques along the Blaschko's lines present over the head and neck area along with fleshy growth in both eyes since birth. Limb length discrepancy and kyphoscoliosis were remarkable. Skin biopsy was compatible with verrucous epidermal nevus while the biopsy of the ocular lesion confirmed complex choristoma. MRI brain revealed calcification in the right temporal lobe. Bilateral arachnoid cyst in the middle cranial fossa, scleral osteoma in the posterior part of the right eyeball, and deformed calvarium were evident on CECT skull and orbit. The present illustration emphasizes the importance of a punctilious work up of the case.
  7,333 191 2
Ultrasonographic assessment of skin structure according to age
Diana Crisan, Monica Lupsor, Andreea Boca, Maria Crisan, Radu Badea
July-August 2012, 78(4):519-519
Background: High-frequency ultrasound is a noninvasive tool that offers characteristic markers, quantifying the cutaneous changes of the physiological senescence process. Aims: The aim was to assess the changes in skin thickness, dermal density and echogenicity, as part of the ageing process, with different age intervals. Methods : The study was performed on 160 patients, aged 40.4 ± 21.2, divided into four age categories: <20, 21-40, 41-60, 61-80. Ultrasonographic images (Dermascan device) were taken from three sites: dorsal forearm (DF), medial arm (MA), zygomatic area (ZA). We assessed the thickness of epidermis and dermis (mm), number of low, medium, high echogenicity pixels, the ratio between the echogenicity of the upper and lower dermis (LEPs/LEPi), and SLEB (subepidermal low echogenicity band). The statistical analysis was performed using SPSS 15.00. A P value <0.05 was considered significant. Results: On all examined sites, it was found that the dermal thickness increases in the 21 to 40 year interval (P<0.0001). After the 21 to 40 year interval, the number of low echogenic pixels increases significantly, especially on photoexposed sites. High-echogenic pixels follow the same pattern on all examined sites: they increase in the 21 to 40 year interval and decrease in the 3rd and 4th age category. The LEPs/LEPi ratio increases significantly with age, at all sites (P<0.05), due to an increase of hypoechogenic pixels in the upper dermis. Conclusions: High-frequency ultrasound is a noninvasive "histological" tool that can assess the cutaneous structure and age-related changes. It offers imagistic markers, comparable to the histological parameters and also characteristic ultrasonographic markers. Histology remains the gold standard for the investigation of the integumentary system.
  7,326 184 9
Scleredema adultorum of Buschke: With unusual manifestations in a young female
Kavitha Mohanasundaram, Subramaniyan Kumarasamy, Ramesh Kumar, Chandran P Rajendran
July-August 2012, 78(4):503-505
  6,933 113 -
Quality of life among schoolchildren with acne: Results of a cross-sectional study
Slavenka Jankovic, Jelica Vukicevic, Sanja Djordjevic, Janko Jankovic, Jelena Marinkovic
July-August 2012, 78(4):454-458
Background: Acne is a common problem in adolescent children and has a considerable impact on their quality of life. Aims: The purpose of this study was to assess health-related quality of life (HRQoL) among Serbian adolescents with acne, using 2 questionnaires: The Children's Dermatology Life Quality Index (CDLQI) and the Cardiff Acne Disability Index (CADI) and to provide a cross validation of 2 scales. Methods: This cross-sectional study was conducted among the pupils of the secondary railway-technical school in Belgrade, Serbia. 478 pupils (aged 15 - 18 years) completed 2 HRQoL questionnaires: CDLQI and CADI. We used t-test for differences between mean values of CDLQI and CADI and Spearman's rho coefficient for correlation between 2 questionnaires. Results: Self-reported acne was present in 71.6% of pupils (64.3% boys and 35.7% girls). The overall mean CDLQI score (4.35 of max. 30) and the overall mean CADI score (3.57 of max. 15) were low, indicating a mild impairment of HRQoL among adolescants. There was good correlation between the 2 questionnaires (Spearman' rho = 0.66). Conclusion: The CADI and the CDLQI questionnaires represent simple and reliable instruments for the assesment of HRQoL among schoolchildren with acne. In this study, we identified 17% of boys and 18% of girls perceived their acne as a major problem. It is important to detect and treat such adolescents on time to reduce the psychosocial burden associated with acne.
  5,693 239 6
"Sines" of dermatology
Sudhir U. K. Nayak, Shrutakirthi D Shenoi
July-August 2012, 78(4):490-491
  5,050 746 -
Cream-yellow and firm nodule in finger pad
Li-qiang Zheng, Xiang-chun Han
July-August 2012, 78(4):522-522
  5,278 115 -
A pilot study for diagnosis of genital Chlamydia trachomatis infections by polymerase chain reaction among symptomatic Indian women
Seema Sood, Anjan Mukherjee, Manju Bala, Gita Satpathy, Neeraj Mahajan, Anjana Sharma, Arti Kapil, Vinod Kumar Sharma, Ravindra Mohan Pandey, Jyotish Chandra Samantaray
July-August 2012, 78(4):443-447
Background: Chlamydia trachomatis is the most common bacterial etiology of sexually transmitted infection. Aim : A pilot study was designed using PCR for amplification and detection of a specific 517 bp sequence of the common endogenous plasmid of C. trachomatis from clinical swab specimens obtained from symptomatic female patients attending STD clinics of AIIMS and Regional STD Teaching, Training & Research Center, Safdarjang Hospital, New Delhi. Methods: 97 patients were recruited in the study, and endocervical swabs were collected following standard procedures. The samples were analyzed by PCR and direct fluorescence antibody (DFA) for detection of C. trachomatis, and the sensitivity, specificity, PPV and NPV of PCR were calculated taking DFA as gold standard. Results: Out of 97 samples tested, 9 were positive for C. trachomatis by PCR. 1 PCR positive patient was negative by DFA although a total of 11 patients were positive by DFA. The sensitivity, specificity, PPV and NPV of PCR with reference to DFA was 72.73%, 98.84%, 88.89% and 96.59%, respectively. This PCR had high specificity and NPV for detection of C.trachomatis. Conclusions : In light of the introduction of enhanced syndromic approach, which involves the use of laboratory techniques (wherever possible) to confirm clinical diagnosis, a diagnostic PCR with high specificity and NPV is particularly valuable for determination of etiological diagnosis and hence contribute to judicious use of antimicrobials in the community.
  4,808 160 -
A new site of cutaneous pili migrans in a 6-month-old infant
Hui Xie, Ru-zhi Zhang, Wen-yuan Zhu
July-August 2012, 78(4):498-499
  4,500 65 1
Cutaneous epithelioid angiosarcoma: A rare aggressive neoplasm
Rajkumar D Mastiholimath, Akshay Bali, C Panduranga, Maitrayee Roy, Ramesh Chavan
July-August 2012, 78(4):494-496
  4,417 74 -
Multiple skin nodules over the scalp and trunk
Mohanan Sarita, Rashmi Kumari, Nachiappa Ganesh Rajesh, Devinder Mohan Thappa
July-August 2012, 78(4):517-518
  4,279 201 -
Neutrophilic figurate erythema recurring on the same site in a middle-aged healthy woman
Sudip Kumar Ghosh, Debabrata Bandyopadhyay, Susmit Haldar
July-August 2012, 78(4):505-508
  3,886 91 -
Bullous pilomatricoma: A stage in transition to secondary anetoderma?
Premanshu Bhushan, Syed N Hussain
July-August 2012, 78(4):484-487
Pilomatricoma is an uncommon hamartomatous tumor of the hair matrix. Bullous and anetodermic changes over pilomatricoma are rare. We report an 18-year-old male with an asymptomatic nodule with overlying cystic changes on the left arm of 6-month duration with clinical and histological features of both bullous and anetodermic modifications. We also reviewed the associated literature to conclude that there is sufficient overlap in these two entities. Both variants show a bullous or pseudobullous appearance clinically and loss of elastin, sparse collagen bundles separated by intense edema, and dilated lymphatics/blood vessels in the dermis overlying the tumor mass histologically. We therefore propose that bullous, pseudoampullary, anetodermic, and lymphangiectatic forms should be considered as synonymous or transitional to the ultimate scar-like anetodermic appearance.
  3,788 89 4
Mucous membrane pemphigoid with antibodies against β3 subunit of laminin-332: First report from India
Amrinder Jit Kanwar, Keshavamurthy Vinay, Hiroshi Koga, Takashi Hashimoto
July-August 2012, 78(4):475-479
Mucous membrane pemphigoid (MMP) is a chronic, recurrent, progressive, subepidermal blistering disorder, mainly affecting the mucous membranes. Anti-laminin 332 MMP is a distinct subset of MMP with antibodies, mainly targeted against α3 or γ2 subunit. Antibodies exclusively against β3 subunit are rarely seen. An internal malignancy is frequently associated with anti-laminin 332 MMP. This disorder usually responds poorly to treatment, requiring multidisciplinary approach. Herein, we describe the first case of anti-laminin-332 MMP from India, which showed antibodies exclusively to β3 subunit.
  3,762 100 2
Panniculitis associated with Sjögren's syndrome
Yu-Chen Huang, Ming-Hsiu Lin
July-August 2012, 78(4):491-493
  3,797 61 -
Topical photodynamic therapy with methylaminolevulinate for the treatment of actinic keratosis and reduction of photodamage in organ transplant recipients: A case-series of 16 patients
Ariel Hasson, Cristián Navarrete-Dechent, Claudia Nicklas, Claudia de la Cruz
July-August 2012, 78(4):448-453
Background: Organ transplant recipients (OTR) are at high risk of developing cutaneous neoplasms. Topical photodynamic therapy (PDT) has been used for the treatment of actinic keratosis (AK) in OTR. Aims: The objective was to evaluate the efficacy of PDT with methylaminolevulinate (MAL) in the treatment of facial AK in OTR. As a secondary objective, we wanted to evaluate the usefulness of topical PDT in the reduction of photodamage in OTR. Methods: A prospective, single center, single arm study was made. 16 OTR were included. Topical PDT was applied for 1 or 2 cycles depending on the patient's characteristics. An evaluation of AK was made at visits pre-treatment, at 12 weeks and at 24 weeks. Photodamage was measured with multispectral image technique (SkinCare®). Results: A complete response rate of 100% was achieved for AK in all patients; it persisted without change at 12 and 24 weeks of follow-up. 62.5% of patients improved their photodamage as measured by SkinCare®, but this result was not statistically significant (P = 0.12). All patients had high level of satisfaction at the end of the therapy. Conclusions: MAL-PDT is an effective therapy for the treatment of AK in OTRs. It can reduce photodamage in this group of patients, but these results were not statistically significant.
  3,753 84 5
Tuberous sclerosis in a patient with situs inversus totalis and polysplenia
Efstathios Rallis, Constantinos Giannopoulos, Chrysovalantis Korfitis, Nikolaos Kyriakos, Christos Liatsos
July-August 2012, 78(4):520-520
  3,395 43 1
Cutaneous adverse drug reactions: An 8-year retrospective study on hospitalized patients in Southern China
Fang Wang, Yu Li, Ying Mo, Chen Shen, Lu Yang, Xingqi Zhang
July-August 2012, 78(4):488-490
  3,265 129 2
Primary cutaneous angiosarcoma of the nose
Vidya Kharkar, Pinanky Jadhav, Viral Thakkar, Sunanda Mahajan, Uday Khopkar
July-August 2012, 78(4):496-497
  3,275 70 2
Acrosyringeal lichen planus of palm
Rameshwar M Gutte
July-August 2012, 78(4):521-521
  3,254 80 1
Pentazocine induced ulceration of the buttocks
Sushruta Kathuria, V Ramesh, Avninder Singh
July-August 2012, 78(4):521-521
  3,195 115 1
Computer Assisted Objective Structured Clinical Examination: A useful tool for dermatology undergraduate assessment
Chander Grover, Sambit Nath Bhattacharya, Deepika Pandhi, Archana Singal, Pradeep Kumar
July-August 2012, 78(4):519-519
Background: Dermatology is a minor subject in undergraduate medical curriculum in India. The dermatology clinical postings are generally poorly attended, and the clinical acumen of an average medical graduate in this specialty is quite low. Aims: To develop and implement Computer Assisted Objective Structured Clinical Examination (CA-OSCE) as a means of end of dermatology posting evaluation. Also, to assess its effectiveness in improving the motivation, attendance and learning of undergraduate students with respect to their visual recognition skills and problem solving ability. Methods: We designed and introduced CA-OSCE as a means of end of posting assessment. The average attendance and assessment scores of students undergoing CA-OSCE were compiled and compared using 'independent t test' with the scores of previous year's students who had undergone assessment with essay type questions. Results: The average attendance and average assessment scores for the candidates undergoing CA-OSCE were found to 83.36% and 77.47%, respectively as compared to 64.09% and 52.07%, respectively for previous years' students. The difference between the two groups was found to be statistically significant. Student acceptability of the technique was also high, and their subjective feedback was encouraging. Conclusion: CA-OSCE is a useful tool for assessment of dermatology undergraduates. It has the potential to drive them to attend regularly as well as to test their higher cognitive skills of analysis and problem solving.
  3,181 90 -
Porphyrias amongst patients with cutaneous photosensitivity in Kashmir: A seven year experience
Sabhiya Majid, Qazi M Ahmad, Iffat H Shah
July-August 2012, 78(4):520-520
  3,146 85 -
Unilateral segmental type II leiomyomatosis: A rare occurrence
Resham J Vasani
July-August 2012, 78(4):521-521
  2,967 59 -
Proceedings from "Clinical Dermatology Updates - Atopic Dermatitis", 3-4 March, 2012, Mumbai
Rashmi Sarkar
July-August 2012, 78(4):524-525
  2,789 208 -
Epithelioid blue nevus not associated with Carney complex in a Korean patient
Min Soo Jang, Dong Young Kang, Jong Bin Park, Sang Tae Kim, Kee Suck Suh
July-August 2012, 78(4):521-521
  2,920 44 2
The systematic effects of chitosan on fibroblasts derived from hypertrophic scars and keloids
Chuan Lv, Haiying Dai, Xin Xing, Jingde Zhang
July-August 2012, 78(4):520-520
  2,835 56 3
A case of disseminated cutaneous rhinosporidiosis presenting with multiple subcutaneous nodules and a warty growth
Rajesh Verma, Biju Vasudevan, Vijendran Pragasam, Prabal Deb, Vijay Langer, Sathyamoorthy Rajagopalan
July-August 2012, 78(4):520-520
  2,767 93 1
Evolution of verrucous hemangioma
Mirjana Popadic
July-August 2012, 78(4):520-520
  2,651 87 1
Unilateral psoriatic onychopachydermoperiostitis
Biju Vasudevan, Rajesh Verma, Vijendran Pragasam, Disha Dabbas
July-August 2012, 78(4):499-501
  2,633 80 -
Skin detoxification cycles
Ismael Vásquez-Moctezuma, Enrique Méndez-Bolaina, Dolores J Sánchez-González
July-August 2012, 78(4):414-416
  2,450 227 -
A sporadic case of oligosymptomatic ectrodactyly-ectodermal dysplasia-clefting syndrome
Adone Baroni, Vincenzo Piccolo, Rosa Di Maio, Teresa Russo
July-August 2012, 78(4):521-521
DOI:10.4103/0378-6323.98102  PMID:22772642
  2,600 57 -
Sexually Transmitted Infections
N Usman
July-August 2012, 78(4):523-523
  1,799 113 -
Online since 15th March '04
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