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   2014| July-August  | Volume 80 | Issue 4  
    Online since July 18, 2014

 
 
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CASE REPORTS
Trichosporon inkin and Trichosporon mucoides as unusual causes of white piedra of scalp hair
Uma Tendolkar, Alka Shinde, Sujata Baveja, Rachita Dhurat, Meghana Phiske
July-August 2014, 80(4):324-327
DOI:10.4103/0378-6323.136896  PMID:25035357
White piedra of scalp hair is considered a rare entity. We report three cases of this disorder all of whom presented with nodules on the hair. Potassium hydroxide preparations of the hair revealed clustered arthrospores and mature, easily detachable nodules. Cultures grew Trichosporon inkin in 2 patients and Trichosporon mucoides in one patient. Both these fungi are unusual causes of white piedra.
  2 5,287 100
LETTERS TO THE EDITOR
Panniculitis-polyarthritis-pancreatitis syndrome
Subhash Kashyap, Vinay Shanker, Sandhya Kumari, Lokesh Rana
July-August 2014, 80(4):352-354
DOI:10.4103/0378-6323.136926  PMID:25035369
  2 2,337 115
Narrow-band ultraviolet B home phototherapy in vitiligo
Xiaofeng Shan, Changliang Wang, Hongqing Tian, Baoqi Yang, Furen Zhang
July-August 2014, 80(4):336-338
DOI:10.4103/0378-6323.136907  PMID:25035361
  2 2,544 155
Bullous pemphigoid induced by topical PUVASOL
Najeeba Riyaz, Naazneen Nasir, Valiaveetil Bindu, Sarita Sasidharanpillai
July-August 2014, 80(4):363-364
DOI:10.4103/0378-6323.136936  PMID:25035374
  2 1,454 99
Multiple reactive keratoacanthomas in a patient with hypertrophic lichen planus treated with cyclosporine: Successful treatment with acitretin
Maria Letizia Musumeci, Francesco Lacarrubba, Raffaele Gibilisco, Giuseppe Micali
July-August 2014, 80(4):374-376
DOI:10.4103/0378-6323.136984  PMID:25035380
  2 2,214 81
ORIGINAL ARTICLES
Intermediate doses of rituximab used as adjuvant therapy in refractory pemphigus
Pradnya J Londhe, Yogesh Kalyanpad, Uday S Khopkar
July-August 2014, 80(4):300-305
DOI:10.4103/0378-6323.136832  PMID:25035353
Background: Rituximab, a monoclonal anti-CD20 antibody, has been used with encouraging results in pemphigus. We describe herein refractory cases of pemphigus vulgaris (n = 23) and pemphigus foliaceus (n = 1) treated with rituximab in addition to steroids and immunosuppressants. Aims: To assess the response to treatment, the duration of clinical remission, serology of the response and adverse effects of rituximab in pemphigus patients. Methods: We recorded observations of 24 patients with pemphigus having either refractory disease in spite of high dose of steroids and immunosuppressants, corticosteroid-dependent disease, strong contraindications to corticosteroids, or severe disease. The patients were treated with infusions of one injection per week for three consecutive weeks of 375 mg of rituximab per m 2 of body-surface area. One similar infusion was repeated after 3 months of 3 rd dose. We observed the clinical outcome after 6 months of 3 rd dose of rituximab and looked for complete healing of cutaneous and mucosal lesions (complete remission). Observations: After follow-up of 7-24 months, five patients showed only partial improvement while 19 of 24 patients had a complete remission 3 months after rituximab. Of these 19 patients, 12 patients achieved complete remission and are off all systemic therapy, and the rest are continuing with no or low dose of steroids with immunosuppressants. Two patients relapsed after initial improvement; one was given moderate dose of oral steroids and immunosuppressant and the other was given repeat single dose of rituximab to control relapse. Conclusion: Rituximab is able to induce a prolonged clinical remission in pemphigus after a single course of four infusions. The high cost and limited knowledge of long term adverse effects are limitations to the use of this biologic agent.
  2 3,781 418
CASE REPORTS
Lyme disease in Haryana, India
Vijayeeta Jairath, Manu Sehrawat, Nidhi Jindal, VK Jain, Parul Aggarwal
July-August 2014, 80(4):320-323
DOI:10.4103/0378-6323.136894  PMID:25035356
Lyme disease is a multiorgan animal-borne disease caused by the spirochete Borrelia burgdorferi. This case series highlights its presence in Haryana, a nonendemic zone. The first case was a 27-year-old housewife who presented with an annular erythematous patch with a central papule following an insect bite on the left upper arm. The second case was a 32-year-old farmer who gave a history of insect bite on the right arm followed by the development of an erythematous patch with a central blister. The third case, a 17-year-old boy presented with a history of tick bite over right thigh and a typical bull's eye lesion with central ulceration. These cases were managed with oral doxycycline 100 mg twice daily for 14 days. The fourth case was a 7-year-old boy with typical erythema migrans on the right check and neck while the fifth case, a 30-year-old housewife, presented with an erythematous patch with a central papule on the right buttock. These patients were treated with oral amoxycillin 25 mg/kg, thrice daily for 14 days. All patients showed IgM antibodies to B. burgdorferi. Treatment led to clearance of lesions in all the patients. Lyme borreliosis was diagnosed in these patients based on the history of established exposure to tick bites, presence of classic signs and symptoms, serology and the response to treatment.
  1 14,787 342
EDITORIAL
Treatment of pemphigus: An Indian perspective
Amrinder J Kanwar, Keshavamurthy Vinay
July-August 2014, 80(4):285-288
DOI:10.4103/0378-6323.136828  PMID:25035350
  1 7,875 826
LETTERS TO THE EDITOR
Seroprevalence of syphilis and biologically false positive cases in a tertiary care center
Supriya Sanjay Tankhiwale, Sonal Rahul Naikwade
July-August 2014, 80(4):340-341
DOI:10.4103/0378-6323.136911  PMID:25035363
  1 2,110 127
Hidradenitis suppurativa treated with carbon dioxide laser followed by split skin thickness graft
Karthika Natarajan, CR Srinivas, Maria Thomas, M Aruchamy, S Rajesh Kumar
July-August 2014, 80(4):376-378
DOI:10.4103/0378-6323.136987  PMID:25035381
  1 3,432 90
Primary mucinous carcinoma of skin with psammoma bodies
Debarshi Saha, Urmila N Khadilkar, Radha R Pai, Ashwani Kumar
July-August 2014, 80(4):367-369
DOI:10.4103/0378-6323.136952  PMID:25035376
  1 1,473 57
Primary melanoma in rare locations: Clinical and dermatoscopic features
Grazyna Kaminska-Winciorek, Jacek Calik, Jerzy Wydmanski, Robert A Schwartz, Rafal Czajkowski
July-August 2014, 80(4):369-371
DOI:10.4103/0378-6323.136976  PMID:25035377
  1 1,945 85
Dermoscopy in tungiasis
Alvaro Abarzua, Karina Cataldo, Sergio Alvarez
July-August 2014, 80(4):371-373
DOI:10.4103/0378-6323.136980  PMID:25035378
  1 2,327 65
EMPACT syndrome
Uma Rajan, Sarita Sasidharanpillai, Anza Khader, Manju Mohan
July-August 2014, 80(4):354-356
DOI:10.4103/0378-6323.136927  PMID:25035370
  1 2,044 179
Muir-Torre syndrome
Ashutosh Kansal, Shruti Aggarwal, Divya Gupta
July-August 2014, 80(4):356-358
DOI:10.4103/0378-6323.136928  PMID:25035371
  1 1,932 121
BOOK REVIEW
Clinical Synopsis and Color Atlas of Skin Tumors
AS Kumar
July-August 2014, 80(4):383-383
  - 772 87
CASE REPORTS
Paraneoplastic autoimmune multiorgan syndrome (paraneoplastic pemphigus) with unusual manifestations and without detectable autoantibodies
Jimena Sanz-Bueno, Daniella Cullen, Carlos Zarco, Francisco Vanaclocha
July-August 2014, 80(4):328-330
DOI:10.4103/0378-6323.136898  PMID:25035358
We describe a patient with paraneoplastic autoimmune multiorgan syndrome (PAMS) secondary to a lymphoblastic T- cell lymphoma who presented with a lichenoid dermatitis and vitiligo, later developing bronchiolitis obliterans and autoimmune hepatitis. Notably, he had no detectable autoantibodies. The development of vitiligo and autoimmune hepatic involvement probably indicate a role for cytotoxic T- cell lymphocytes in the pathogenesis of this syndrome.
  - 3,374 160
Cutaneous Paecilomyces lilacinus infections in immunocompromised and immunocompetent patients
Shahindokht Bassiri-Jahromi
July-August 2014, 80(4):331-334
DOI:10.4103/0378-6323.136903  PMID:25035359
Paecilomyces is a genus of saprophytic fungus that has been associated, in rare instances, with human disease. We report two cases in which Paecilomyces lilacinus was isolated from cutaneous and subcutaneous lesions in an immunocompromised and an immunocompetent host. The first case was a subcutaneous infection due to P. lilacinus in a patient with a renal transplant and diabetes mellitus. The second case was an immunocompetent young woman who developed a cutaneous infection, with no identified predisposing factors. A biopsy from each patient provided an initial diagnosis of fungal elements in the tissues under examination and multiple positive fungal cultures were obtained from the tissue biopsy samples. Both microscopic and macroscopic examinations of the biopsy revealed the presence of P. lilacinus. Each of the two cases was successfully treated with oral ketoconazole (200 mg/day) and itraconazole. We also review previously reported cases in which the clinical history and response to therapy were noted.
  - 1,782 85
COMMENTARY
A new patch test unit
Sanjeev Handa
July-August 2014, 80(4):289-290
DOI:10.4103/0378-6323.136829  
  - 2,462 265
EDITORIAL
How do I look?
M Ramam
July-August 2014, 80(4):283-284
DOI:10.4103/0378-6323.136827  PMID:25035349
  - 1,944 220
IMAGES IN CLINICAL PRACTICE
Pediatric tuberous xanthomas
Yugal K Sharma, Aayush Gupta, Nitin D Chaudhari
July-August 2014, 80(4):335-335
DOI:10.4103/0378-6323.136904  PMID:25035360
  - 1,871 159
LETTERS TO THE EDITOR
Isospora induced diarrhea in a pemphigus vulgaris patient
Aparna R Sahu, Avani H Koticha, Sunil S Kuyare, Uday S Khopkar
July-August 2014, 80(4):342-343
DOI:10.4103/0378-6323.136912  PMID:25035364
  - 1,384 61
Isolated oral mucosal leishmaniasis
Nishat Hussain Ahmed, Anjan Mukherjee, Jyotish Chander Samantaray, Hemanta Kumar Kar
July-August 2014, 80(4):343-345
DOI:10.4103/0378-6323.136915  PMID:25035365
  - 2,010 74
Progressive symmetric erythrokeratoderma with dermatophytosis
Fan Wu, Jun Chen, Zong-hui Li, Zhi-li Hu, Lin Deng, Hong Sang
July-August 2014, 80(4):345-347
DOI:10.4103/0378-6323.136917  PMID:25035366
  - 2,378 78
Multiple morphological presentations of skin tuberculosis in a patient
Neelakantababu Rasineni, P Venkata Ramana, Sridevi Kota, Ramesh Kumar Gandikota
July-August 2014, 80(4):347-349
DOI:10.4103/0378-6323.136921  PMID:25035367
  - 2,133 151
Severely disfiguring multiple familial trichoepitheliomas with basal cell carcinoma
Mohammad Ali Mapar, Nastaran Ranjbari, Nasim Afshar, Iman Karimzadeh, Amin Karimzadeh
July-August 2014, 80(4):349-352
DOI:10.4103/0378-6323.136924  PMID:25035368
  - 2,058 86
Adult T cell leukemia-lymphoma
Najeeba Riyaz, Ettappurath N Abdul Latheef, Sarita Sasidharanpillai, Saleem Rahima, Valiaveetil Bindu, Ahmedali Nermin
July-August 2014, 80(4):358-361
DOI:10.4103/0378-6323.136930  PMID:25035372
  - 2,393 67
Persistent skin donor site erythema: A simple physiological phenomenon
Sidharth Sonthalia, Rahul Arora, Rashmi Sarkar
July-August 2014, 80(4):361-362
DOI:10.4103/0378-6323.136933  PMID:25035373
  - 1,427 65
Bullous pemphigoid in a female with hypogonadotrophic hypogonadism
Varadraj V Pai, Pankaj Shukla, Rakhi Godge
July-August 2014, 80(4):364-367
DOI:10.4103/0378-6323.136937  PMID:25035375
  - 2,091 49
Changing trends in leprosy among patients attending a tertiary care institution
Sarita Sasidharanpillai, Olasseri K Reena Mariyath, Najeeba Riyaz, Manikoth P Binitha, Biju George, Anisha K Janardhanan, Neethu Haridas
July-August 2014, 80(4):338-340
DOI:10.4103/0378-6323.136909  PMID:25035362
  - 1,770 154
Calcipotriol and adapalene therapy for disseminated superficial actinic porokeratosis
Yoshitaka Nakamura, Michiya Yamaguchi, Akiko Nakamura, Masahiko Muto
July-August 2014, 80(4):373-374
DOI:10.4103/0378-6323.136981  PMID:25035379
  - 4,135 101
Electrochemotherapy for a locally advanced basal cell carcinoma on the forehead
Alessandro Gatti, Giuseppe Stinco, Nicola di Meo, Cecilia Noal, Vincezo Maione, Giusto Trevisan
July-August 2014, 80(4):378-380
DOI:10.4103/0378-6323.136989  PMID:25035382
  - 1,643 55
NET LETTERS
Borderline tuberculoid leprosy with scrofuloderma: An uncommon association
Sneha Ghunawat, Shivani Bansal, Bijaylaxmi Sahoo, Vijay Kumar Garg
July-August 2014, 80(4):381-381
DOI:10.4103/0378-6323.136995  PMID:25035384
  - 1,616 92
Zoster ophthalmicus with dissemination in a six year old immunocompetent child
Subhash Kashyap, Vinay Shanker
July-August 2014, 80(4):382-382
DOI:10.4103/0378-6323.136997  PMID:25035385
  - 1,709 75
NET STUDY
The molecular fingerprint of human papillomavirus infection and its effect on the Langerhans cell population in squamous cell carcinomas of the genital skin
Jose M Rios-Yuil, Norma E Herrera-Gonzalez, Jose L Aguilar-Faisal, Eleazar Lara-Padilla, Patricia Mercadillo-Perez, Luis M Moreno-Lopez, Alejandro K Marquez-Ramirez, Azael Saldana-Patino, Ivan Rubio-Gayosso
July-August 2014, 80(4):381-381
DOI:10.4103/0378-6323.136992  PMID:25035383
Background: Information is scarce about the presence of molecular alterations related to human papillomavirus (HPV) infection in squamous cell carcinomas of the genital skin and about the effect of this infection in the number of Langerhans cells present in these tumors. Aims: To determine the presence of HPV in genital skin squamous cell carcinomas and to see the relationship between HPV infection and changes in the expression of Ki-67 antigen (Ki-67), p53 protein (p53), retinoblastoma protein (pRb) and E-cadherin and to alterations in Langerhans cell density, if any. Methods: A descriptive, comparative, retrospective and cross-sectional study was performed with all the cases diagnosed as squamous cell carcinomas of the genital skin at the Dermatopathology Service from 2001 to 2011. The diagnosis was verified by histopathological examination. The presence of HPV was examined using chromogenic in situ hybridization, and protein expression was studied via immunohistochemical analysis. Results: The 34 cases studied were verified as squamous cell carcinomas and 44.1% were HPV positive. The degree of expression of pRb was 17.50% ±14.11% (mean ± SD) in HPV-positive cases and 29.74% ±20.38% in HPV-negative cases (P = 0.0236). The degree of expression of Ki-67 was 47.67% ±30.64% in HPV-positive cases and 29.87% ±15.95% in HPV-negative cases (P = 0.0273). Conclusion: HPV infection was related to lower pRb expression and higher Ki-67 expression in comparison with HPV negative samples. We could not find a relationship between HPV infection and the degree of expression of p53 and E-cadherin or with Langerhans cell density.
  - 2,293 60
ORIGINAL ARTICLES
Clinical features of primary cicatricial alopecia in Chinese patients
Shiling Qi, Ying Zhao, Xiaoting Zhang, Shuifeng Li, Hui Cao, Xingqi Zhang
July-August 2014, 80(4):306-312
DOI:10.4103/0378-6323.136833  PMID:25035354
Background: There have been few reports on primary cicatricial alopecias (PCR) especially from Asia (PCA). Aims: To study the clinical, pathological and dermoscopic characteristics of PCA among Chinese patients. Methods: A retrospective analysis of the clinical data of 59 patients with PCA was conducted and the dermoscopic, pathological, treatment and prognosis characteristics analyzed. Fisher's Chi-square exact test, Kruskal-Wallis and Spearman rank correlation test were performed. Results: The ratio of neutrophilic to lymphocytic cicatricial alopecias was about 1.3:1 in this group. The most frequent disorder was folliculitis decalvans. Follicular openings were absent on dermoscopy in all cases except alopecia mucinosa. Patulous follicular openings were characterisitc of alopecia mucinosa. After treatment, an increase in short vellus hairs was the earliest feature, while telangiectasia, epidermal scale, follicular hyperkeratosis, pustules and hair diameter diversity gradually decreased or even disappeared. Improvement in the areas of hair loss after treatment was seen more often in discoid lupus erythematosus, folliculitis decalvans and dissecting cellulitis than in patients with classic pseudopelade of Brocq. Nine patients (13.6%) relapsed after cessation of therapy. Female patients needed longer treatment times. Long duration, large areas of hair loss and shorter treatment courses were the major factors in relapses. Conclusions: Dermatoscopy provides a rapid, practical and useful aid for the diagnosis of PCA and also to assess disease activity. Patulous follicular openings are a specific dermoscopic sign of alopecia mucinosa. Lichen planopilaris is less common in China than in the West.
  - 4,237 175
Comparison of acquired bilateral nevus of Ota-like macules in men and women
Woo Jin Lee, Ga-Young Lee, Kwang Hee Won, Chong Hyun Won, Mi Woo Lee, Jee Ho Choi, Sung Eun Chang
July-August 2014, 80(4):313-319
DOI:10.4103/0378-6323.136893  PMID:25035355
Background: The clinical and histopathological characteristics of acquired bilateral nevus of Ota-like macules in men are poorly documented due to its rarity. Aims: To compare the clinical and histopathological characteristics of acquired bilateral nevus of Ota-like macules in men with the condition in women. Methods: We studied 11 men and 62 women, all with a clinical diagnosis of acquired bilateral nevus of Ota-like macules. Biopsies were taken from 5 men and 10 women and their clinical and histopathological features were compared. Results: The most frequently affected site in men was the forehead [8 (73%) out of 11 patients]. Lesions on the forehead were more common in men than women (P = 0.001). In contrast to women, there was no apparent tendency of the lesions to become more blue with age in men. Concurrent melasma was observed in 14 (23%) out of 62 women, but not in men. Extra-facial acquired dermal melanocytosis was noted in 2 (18%) out of 11 men and in none of the 62 women. Conclusion: Significant differences were noted between men and women in the appearance of concurrent pigmentary lesions and the distribution of lesions. Extra-facial acquired dermal melanocytosis was noted in men.
  - 2,716 151
A new occlusive patch test system comparable to IQ and Finn chambers
Shaziya Z Sajun Merchant, Ashlesha D Vaidya, Anjali Salvi, Rajiv S Joshi, Rashmikant B Mohile
July-August 2014, 80(4):291-295
DOI:10.4103/0378-6323.136830  PMID:25035351
Background: A good patch test system should have good adhesion and contact, and minimal leakage; Finn and IQ patch test system have these properties but are expensive. Aims: To develop a new cost-effective occlusive patch test system that had good contact with the skin and was non-irritant. Methods: The system (designated Chamber X) was fabricated using a semi-permeable tape and a flexible virgin plastic chamber. Chamber X was developed by (i) selecting adhesive tape based on its non irritancy and adhesive potential (ii) testing plastic chamber material for its skin irritancy (iii) testing the assembled system against Finn, IQ and locally available chambers for irritancy, contact, leakage and occlusivity. Results: Chamber X showed better occlusion than IQ, Finn and locally available chambers and was comparable to, (P > 0.05) IQ and Finn in terms of irritancy, contact and leakage. Conclusions: The results demonstrate that the Chamber X offers a cost effective patch test system comparable to IQ and Finn chambers in terms of safety, adhesion, leakage and occlusivity.
  - 3,179 166
Factors affecting the duration of phase I of dexamethasone - cyclophosphamide pulse therapy
Chitra S Nayak, Somshukla Ray, Anil Thombre, Mahim Jain
July-August 2014, 80(4):296-299
DOI:10.4103/0378-6323.136831  PMID:25035352
Background: The introduction of dexamethasone-cyclophosphamide pulse (DCP) therapy for the pemphigus group of disorders by Pasricha has revolutionized the therapy for pemphigus. There are very few studies regarding factors affecting duration of phase I of the DCP. Aims: Our purpose was to study the relationship between various factors and duration of the phase I. Methods: A retrospective study of 98 patients of pemphigus on Dexamethasone Pulse therapy was conducted. Patients were classified according to duration of Phase 1 as those with phase I less than 6 months and those more than 6 months and analyzed for variable factors affecting duration of phase I. Results: Disease severity in pemphigus significantly prolonged the duration of phase I of DCP. Longer duration was also observed in patients on concurrent oral steroid therapy (both statistically significant). Conclusion: The findings from our study help us to address patient expectations and apprehensions regarding duration of therapy. A detailed understanding of the various patient and disease related factors responsible for affecting Phase I duration will help in better management of the patient, and the disease.
  - 2,217 377
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