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   2015| March-April  | Volume 81 | Issue 2  
    Online since March 2, 2015

 
 
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LETTERS TO THE EDITOR
Systemic anaplastic large cell lymphoma with secondary cutaneous involvement
Amit S Murkute, Dhananjay K Damle, Bhavana R Doshi, Vasudha A Belgaumkar
March-April 2015, 81(2):208-210
DOI:10.4103/0378-6323.152306  PMID:25751352
  1 3,048 98
Nilotinib-induced psoriasis in a patient of chronic myeloid leukemia responding to methotrexate
Sukhjot Kaur, Amanjot Kaur Arora, Jagdev S Sekhon, Neena Sood
March-April 2015, 81(2):216-218
DOI:10.4103/0378-6323.152311  PMID:25751356
  1 3,357 105
ORIGINAL ARTICLES
Relapse in psoriasis with two different tapering regimens of methotrexate: A randomized open-label controlled study
Satyendra Kumar Singh, Tulika Rai
March-April 2015, 81(2):144-147
DOI:10.4103/0378-6323.152175  PMID:25751329
Background : Systemic therapy with methotrexate is a very useful modality in psoriasis, but relapses can occur soon after stopping it. Aim : To compare the relapse rates in psoriasis with two different tapering regimens of methotrexate after control is achieved. Methods : This was a randomized open-label controlled study, and patients of chronic plaque psoriasis with psoriasis area and severity index (PASI) >10 were included. Methotrexate 0.3 mg/kg weekly was given and the PASI calculated every 2 weeks. After achieving a 75% reduction in the PASI (PASI-75), patients were assigned randomly in to one of three groups. In the half-dose group, the dose of methotrexate was reduced to half and given weekly; in the 2-weekly group, the same dose was given at 2-week intervals; in the control group, methotrexate was stopped. Patients were followed up for 12 weeks. Results : Out of 141 registered patients, 81 were included: 27 in the half-dose group, 28 in the 2-weekly group, and 26 in the control group. After further exclusions due to adverse effects and loss to follow-up, the results were analysed for 16, 17 and 19 patients respectively in the 3 groups. There was statistically a highly significant difference in relapse rates between the half-dose and control groups (P < 0.001), and a significant difference between the 2-weekly and control groups (P = 0.001). Relapse rates in the half-dose and 2-weekly groups did not show a significant difference (P = 0.680). Limitation: Many (35.8%) patients were excluded and only 52 (64.2%) completed the study. Conclusion: There appears to be no significant difference in the frequency of relapse in psoriasis whether methotrexate is tapered by halving the weekly dose or by doubling the interval between two doses, and both methods led to fewer relapses than abrupt cessation of the drug.
  1 5,967 458
REVIEW ARTICLE
Patient-assisted teledermatology practice: What is it? When, where, and how it is applied?
Garehatty Rudrappa Kanthraj
March-April 2015, 81(2):136-143
DOI:10.4103/0378-6323.152172  PMID:25751328
Recent teledermatology practice has been focused on different models made possible by robust advances in information technology leading to consistent interaction between the patient and health care professionals. Patient-assisted teledermatology practice also called patient-enabled teledermatology or home based teledermatology is one such novel model. There is a lack of scientific literature and substantive reviews on patient-assisted teledermatology practice. The present article reviews several studies and surveys on patient-assisted teledermatology practice and outlines its advantages and barriers to clinical utility and analyses the potentiality of this concept. Incorporating patient-assisted teledermatology practice as a novel model in the revised classification of teledermatology practice is proposed. In patient-assisted teledermatology, the patient can upload his/her clinical images as a first contact with the dermatologist or an initial face-to-face examination can be followed by teledermatology consultations. The latter method is well suited to chronic diseases such as psoriasis, vitiligo, and leg ulcers, which may need frequent follow-up entailing significant costs and time, particularly in the elderly. Teledermatology may also be used by the treating dermatologist to seek expert opinion for difficult cases. Studies have demonstrated the importance and usability of the concept of patient-assisted teledermatology practice. Various teledermatology care models are available and the appropriate model should be chosen depending on whether the clinical situation is that of easily diagnosed cases ("spotters"), chronic cases or doubtful cases and difficult-to-manage cases.
  1 5,474 357
THERAPEUTIC GUIDELINES - IADVL
Phototherapy for mycosis fungoides
Sunil Dogra, Rahul Mahajan
March-April 2015, 81(2):124-135
DOI:10.4103/0378-6323.152169  PMID:25751327
Background: Both phototherapy and photochemotherapy have been used in all stages of mycosis fungoides since they improve the symptoms and have a favourable adverse effect profile. Materials and Methods: We performed an extensive search of published literature using keywords like "phototherapy", "photochemotherapy", "NBUVB", "PUVA", "UVA1", "mycosis fungoides", and "Sezary syndrome", and included systematic reviews, meta-analysis, national guidelines, randomized controlled trials (RCTs), prospective open label studies, and retrospective case series. These were then arranged according to their levels of evidence. Results: Five hundred and forty three studies were evaluated, of which 107 fulfilled the criteria for inclusion in the guidelines. Conclusions and Recommendations: Photochemotherapy in the form of psoralens with ultraviolet A (PUVA) is a safe, effective, and well tolerated first line therapy for the management of early stage mycosis fungoides (MF), that is, stage IA, IB, and IIA (Level of evidence 1+, Grade of recommendation B). The evidence for phototherapy in the form of narrow-band UVB (NB-UVB) is less robust (Level of evidence 2++, Grade of recommendation B) but may be considered at least as effective as PUVA in the treatment of early-stage MF as an initial therapy. In patients with patches and thin plaques, NB-UVB should be preferentially used. PUVA may be reserved for patients with thick plaques and those who relapse after initial NB-UVB therapy. For inducing remission, three treatment sessions per week of PUVA phototherapy or three sessions per week of NB-UVB phototherapy may be advised till the patient achieves complete remission. In cases of relapse, patients may be started again on PUVA monotherapy or PUVA may be combined with adjuvants like methotrexate and interferon (Level of evidence 2+, Grade of recommendation B). Patients with early-stage MF show good response to combination treatments like PUVA with methotrexate, bexarotene or interferon-α-2b. However, whether these combinations hold a significant advantage over monotherapy is inconclusive. For late stage MF, the above-mentioned combination therapy may be used as first-line treatment (Level of evidence 3, Grade of recommendation C). Currently, there is no consensus regarding maintenance therapy with phototherapy once remission is achieved. Maintenance therapy should not be employed for PUVA routinely and may be reserved for patients who experience an early relapse after an initial course of phototherapy (Level of evidence 2+, Grade of recommendation B). Bath-water PUVA may be tried as an alternative to oral PUVA in case the latter cannot be administered as the former may show similar efficacy (Level of evidence 2-, Grade of recommendation C). In pediatric MF and in hypopigmented MF, both NB-UVB and PUVA may be tried (Level of evidence 3, Grade of recommendation D).
  1 7,953 391
BRIEF REPORT
Report of rpoB mutation in clinically suspected cases of drug resistant leprosy: A study from Eastern India
Abu Hena Hasanoor Reja, Nibir Biswas, Supratik Biswas, Mallika Lavania, Vedithi Sundeep Chaitanya, Surajita Banerjee, Prasanta Sinha Maha Patra, Umesh Dutta Gupta, Pradip Kumar Patra, Utpal Sengupta, Basudev Bhattacharya
March-April 2015, 81(2):155-161
DOI:10.4103/0378-6323.152185  PMID:25751332
Background: The current strategy for leprosy control depends mainly on early case detection and providing the recommended multidrug therapy (MDT) dosage. Understanding the molecular mechanisms of drug resistance to each of these drugs is essential in providing effective treatment and preventing the spread of resistant strains in the community. The progress of molecular biology research provides a very efficient opportunity for the diagnosis of drug resistance by in vitro method. Aim: We aimed to investigate the point mutations within the rpoB gene region of the Mycobacterium leprae genome, which are responsible for resistance to rifampicin, in order to determine the emergence of drug resistance in leprosy in the Kolkata region of West Bengal. Methods: A total of 50 patients with a relapse of leprosy were enrolled in the study. Skin smears were obtained for estimation of bacillary index and biopsies were obtained in 70% alcohol for extraction of DNA. The extracted DNA was amplified by M. leprae-polymerase chain reaction (PCR) targeting rpoB gene region. Every single nucleotide base in the sequence is aligned to reference sequence and identity gaps were determined by NCBI - BLAST. Later in-silico analysis was done to identify the changes in the translated protein sequences. Results: A mutation at the base pair position 2275405 where G is replaced by C in the M. leprae genome, which corresponds to the coding region of rpoB gene (279 bp - 2275228 to2275506), was observed in two patients. This missense mutation in CAC codon brings about a glutamic acid to histidine change in the amino acid sequence of RNA polymerase beta subunit at the position 442 (Glu442His), a region specific for rifampicin interaction, which might be responsible for unresponsiveness to rifampicin by manifesting a stable bacteriological index in these 2 patients even after completion of 24 months of multibacillary multi-drug therapy (MB-MDT). Limitations: The major limitations of multiple-primer PCR amplification refractory mutation system (MARS) assay is that it capable of detecting mutation at codon 425 and cannot distinguish any silent amino acid changes. Conclusion: The study indicates the existence of rifampicin drug resistance in Eastern India.
  - 4,464 219
CASE REPORTS
Frontal fibrosing alopecia and lichen planopilaris in HLA-identical mother and daughter
María Mercedes Otero Rivas, Sara Calleja Antolín, Pedro Sánchez Sambucety, Elia Samaniego González, José María García Ruíz de Morales, Manuel Ángel Rodríguez Prieto
March-April 2015, 81(2):162-165
DOI:10.4103/0378-6323.152284  PMID:25751333
Frontal fibrosing alopecia (FFA) is a lymphocyte-mediated scarring alopecia thought to be a variant of lichen planopilaris (LPP). We present a 67-year-old woman with frontal fibrosing alopecia whose daughter was diagnosed to have lichen planopilaris. Both patients had identical human leukocyte antigen (HLA) D types, supporting a phenotypical relationship between the two clinical entities. Interestingly, our patient also had of autoimmune chronic atrophic gastritis, a previously unreported association.
  - 6,220 174
Psoriasis in autoimmune polyendocrine syndrome type I: A possible complication or a non-endocrine minor component?
Shital Amin Poojary, Nikita Lodha, Nikita Gupta
March-April 2015, 81(2):166-169
DOI:10.4103/0378-6323.152285  PMID:25751334
Introduction: Autoimmune polyendocrine syndrome type I (APS I) is an autosomal recessive systemic autoimmune disorder, affecting primarily endocrine glands, in which chronic mucocutaneous candidiasis is an early and prominent manifestation. We describe the rare occurrence of unstable psoriasis (with onset of pustular lesions) in a case of APS I without mucocutaneous candidiasis. A patient presenting with unstable psoriasis (with onset of pustular lesions) was detected to have persistent hypocalcemia which led to the diagnosis of hypoparathyroidism. Subsequently he was found to have hypergonadotrophic hypogonadism, primary adrenal insufficiency (compensated), and coeliac disease, thus confirming the diagnosis of APS I. Psoriasis is very rarely reported in APS I, possibly due to the protective effect of antibodies to Th17 cytokines, which are responsible for the occurrence of candidiasis in this syndrome. However, psoriasis could occur in APS I patients without mucocutaneous candidiasis, who lack these antibodies. In our patient, possible factors aggravating psoriasis include hypocalcemia due to hypoparathyroidism as well as coeliac disease via anti-tissue transglutaminase antibodies. However, defining psoriasis as a possible minor component of APS I would require further studies of the autoimmune regulator (AIRE) gene functions.
  - 3,866 105
Spontaneous regression in an ulcerated CK7 positive Merkel cell carcinoma
Anza Khader, Sandhya George, Swapna Balakrishnan, Karumathil Puthiaveetil Aravindan
March-April 2015, 81(2):170-173
DOI:10.4103/0378-6323.152286  PMID:25751335
Merkel cell carcinoma is an aggressive and frequently lethal tumor of the elderly, associated with sun exposure and immunosuppression which is less common in the dark-skinned. We report the case of a 40-year-old woman who presented with multiple slowly progressive, mildly itchy ulcerated plaques of size ranging from 2 × 3 cm to 5 × 7 cm on the left knee of 1 year duration. Skin biopsy showed diffuse dermal infiltration by small round cells with molding of cells and lymphocyte infiltration. The cells stained positive for cytokeratin (CK) 20, CK7, neuron-specific enolase, and chromogranin. The skin lesions underwent spontaneous regression within 1 month of skin biopsy and have not recurred during the past 2 years. The immune mechanisms triggered by biopsy possibly explain the spontaneous regression.
  - 3,794 88
E-IJDVL - NET LETTERS
Association of type 2 lepra reaction with filariasis and malaria
Satyendra Kumar Singh, Taniya Sharma, Gopal Nath, Tej Bali Singh, Manoj Kumar Shrivastava
March-April 2015, 81(2):224-224
DOI:10.4103/0378-6323.152318  PMID:25751359
  - 3,089 100
Ulceronodular syphilis as the first manifestation of HIV infection
Romina Andino Navarrete, Cristián Vera Kellet, Juan Manriquez
March-April 2015, 81(2):224-224
DOI:10.4103/0378-6323.152320  PMID:25751360
  - 4,038 101
Black dot tinea capitis caused by trichophyton rubrum in an adult female presenting with cicatricial alopecia
Chitralekha Keisham, Rashmi Sarkar, Nita Khurana, Nivedita Ghosh, Vijay Kumar Garg, Raj Kumar Manoj
March-April 2015, 81(2):224-224
DOI:10.4103/0378-6323.152323  PMID:25751361
  - 5,161 114
White fibrous papulosis of the neck
Rajat Kandhari, Sanjiv Kandhari, Sudhir Jain
March-April 2015, 81(2):224-224
DOI:10.4103/0378-6323.152325  PMID:25751362
  - 5,633 128
Evaluation of blood and urinary mercury in pemphigus vulgaris and pemphigus foliaceus patients and its comparison with control group
Shafagh Nikpour, Mohammad Javad Yazdanpanah, Reza Afshari, Masoud Maleki, Majid Ghayour-Mobarhan, Mohammad Taghi Shakeri, Zahra Maghami, Mohsen Sadrneshin, Zohre Seidi
March-April 2015, 81(2):225-225
DOI:10.4103/0378-6323.152329  PMID:25751363
  - 3,362 93
EDITORIAL
IJDVL International Awards
M Ramam
March-April 2015, 81(2):113-114
DOI:10.4103/0378-6323.152167  PMID:25751325
  - 3,675 188
GUEST EDITORIAL
Designing a research protocol in clinical dermatology: Common errors and how to avoid them
Saumya Panda
March-April 2015, 81(2):115-123
DOI:10.4103/0378-6323.152168  PMID:25751326
  - 5,135 336
IADVL ANNOUNCEMENT
IADVL Announcement

March-April 2015, 81(2):232-232
  - 2,606 89
IMAGES IN CLINICAL PRACTICE
Hemorrhagic acne in immune thrombocytopenia
Manjot Marwah, Vivek Sharma, Gurjot Marwah
March-April 2015, 81(2):174-174
DOI:10.4103/0378-6323.152287  PMID:25751336
  - 3,375 133
LETTERS TO THE EDITOR
Syphilis among sexually transmitted infections clinic attendees in a tertiary care institution: A retrospective data analysis
Bhushan Kumar
March-April 2015, 81(2):179-179
DOI:10.4103/0378-6323.152289  PMID:25751338
  - 3,161 106
Author's reply: Significance of seropositivity for syphilis in asymptomatic individuals
Sarita Sasidharanpillai, Valiaveetil Bindu, Najeeba Riyaz, Pentam V Beegum Sherjeena, Saleem Rahima, Nirmal Chandrasekhar
March-April 2015, 81(2):179-181
DOI:10.4103/0378-6323.152290  PMID:25751339
  - 3,673 198
The pH of skin cleansers for acne
Nakaraj Pluetrattanabha, Kanokvalai Kulthanan, Piyavadee Nuchkull, Supenya Varothai
March-April 2015, 81(2):181-185
DOI:10.4103/0378-6323.152291  PMID:25751340
  - 4,962 268
A curious case of hourly attacks of disabling episodic spontaneous hypothermia with hyperhidrosis
Sharad Mehta, Tarun Ralot, Vaishali Masatkar, Nidheesh Agarwal, Atul Rana
March-April 2015, 81(2):185-186
DOI:10.4103/0378-6323.152292  PMID:25751341
  - 3,567 120
Unilateral pruritus following stroke
Satyaki Ganguly, C Vijay Krishna, Nisha V Parmar, Sheela Kuruvila, Dilip S Phansalkar
March-April 2015, 81(2):186-188
DOI:10.4103/0378-6323.152294  PMID:25751342
  - 3,399 97
Severe abdominal wall defect leading to dehiscence in focal dermal hypoplasia (Goltz syndrome)
Nilendu Sarma, Sayantani Chakraborty, Subhamoy Neogi, Sushila Hansda
March-April 2015, 81(2):188-190
DOI:10.4103/0378-6323.152295  PMID:25751343
  - 3,335 86
Rothmund - Thomson syndrome with bronchiectasis: An uncommon phenotype?
Vikram K Mahajan, Vikas Sharma, Pushpinder S Chauhan, Karaninder S Mehta, Rashmi Raina
March-April 2015, 81(2):190-192
DOI:10.4103/0378-6323.152297  PMID:25751344
  - 3,370 131
A recurrent R936X mutation of CYLD gene in a Chinese family with multiple familial trichoepithelioma
Qi-Guo Zhang, Yan-Hua Liang
March-April 2015, 81(2):192-194
DOI:10.4103/0378-6323.152298  PMID:25751345
  - 3,154 65
Annular epidermolytic ichthyosis: A rare phenotypic variant of bullous congenital ichthyosiform erythroderma
Aditi Jha, Jitender Taneja, V Ramesh, Avninder Singh
March-April 2015, 81(2):194-197
DOI:10.4103/0378-6323.152299  PMID:25751346
  - 4,228 112
Precocious puberty in a 3-year-old child with systematized verrucous epidermal nevus
Taru Garg, Ram Chander, Niti Gaur, Kanika Sahni
March-April 2015, 81(2):197-198
DOI:10.4103/0378-6323.152301  PMID:25751347
  - 3,687 110
Eruptive blue nevi
Katarina Kesty, Omid Zargari
March-April 2015, 81(2):198-201
DOI:10.4103/0378-6323.152302  PMID:25751348
  - 5,292 109
Churg-Strauss syndrome with asymptomatic pulmonary emboli
Chau Yee Ng, Rosaline Chung-Yee Hui, Tseng-tong Kuo, Chun-Yu Cheng, Jennifer Wu
March-April 2015, 81(2):201-203
DOI:10.4103/0378-6323.152303  PMID:25751349
  - 3,550 105
Sweet's syndrome associated with chronic neutrophilic leukemia
Sukhjot Kaur, Amit Bery, Bhavna Garg, Neena Sood
March-April 2015, 81(2):203-206
DOI:10.4103/0378-6323.152304  PMID:25751350
  - 3,606 114
Squamous cell carcinoma mimicking lupus vulgaris
Surendra Kumar, Swati Gondane, Neena Kasliwal
March-April 2015, 81(2):206-208
DOI:10.4103/0378-6323.152305  PMID:25751351
  - 3,056 105
Aminolevulinic acid photodynamic therapy for bowenoid papulosis
Yin-hua Wu, Jian-jun Qiao, Juan Bai, Hong Fang
March-April 2015, 81(2):219-220
DOI:10.4103/0378-6323.152313  PMID:25751357
  - 4,784 82
Metastatic porocarcinoma
G Raghurama Rao, Rajiv Joshi, KA Seetharam, A Amareswar, M Sridevi
March-April 2015, 81(2):210-213
DOI:10.4103/0378-6323.152307  PMID:25751353
  - 3,282 132
Papular mucinosis associated with monoclonal gammopathy of unknown significance
Sarvesh S Thatte, Atul M Dongre, Siddhi B Chikhalkar, Uday S Khopkar
March-April 2015, 81(2):213-214
DOI:10.4103/0378-6323.152308  PMID:25751354
  - 4,325 89
Recalling the recall phenomenon
Sharmila Patil, Nitin Nadkarni, Snehal Shende
March-April 2015, 81(2):214-216
DOI:10.4103/0378-6323.152310  PMID:25751355
  - 3,497 186
OBITUARY
Prof. Dr. B. Narasimha Rao
G Raghu Rama Rao
March-April 2015, 81(2):231-231
  - 3,621 90
ORIGINAL ARTICLES
Screening for depressive disorders in outpatients with mild to moderate psoriasis: A study from North India
Shubh Mohan Singh, Tarun Narang, Sunil Dogra, Anant Kumar Verma, Sunil Gupta, Sanjeev Handa
March-April 2015, 81(2):148-150
DOI:10.4103/0378-6323.152178  PMID:25751330
Background: Psoriasis and depressive disorders commonly occur together. Depressive disorders have an impact on the quality of life and the outcome of psoriasis. Aims: The aim of this study was to test the feasibility of using a modification of the Hindi translation of the Patient Health Questionnaire-9 (PHQ-9) as a verbal, clinician administered, short screening questionnaire for detecting depressive disorders. Materials and Methods: One hundred and four out-patients with psoriasis were recruited in the study. In the first stage of the study, socio-demographic data, Psoriasis Area Severity Index (PASI) score, and Dermatological Quality of Life (DLQI) score were recorded. The modified questionnaire was administered by the dermatologist. In the second stage, psychiatric diagnoses were confirmed using the Mini International Neuropsychiatric Interview. Results: The prevalence of depressive disorders was 39.4%. Receiver operating curve (ROC) analysis showed that the questionnaire had a good discriminant ability in detecting depressive disorders (area under curve: 0.81, SE = 0.04, 95% confidence interval = 0.72-0.89). Limitations: The sample size is small and more studies are needed with the screening questions in different languages to validate the findings of the study. Conclusion: The questionnaire can be a useful screening instrument for detecting depressive disorders in patients with psoriasis.
  - 3,954 181
Topical photodynamic therapy in the treatment of basal cell carcinoma in Singaporean Chinese patients
Hui-Yi Chia, Shui-Lyn Claire Koh, Thiam-Seng Colin Theng, Wei-Sheng Chong
March-April 2015, 81(2):151-154
DOI:10.4103/0378-6323.152180  PMID:25751331
Background: Topical photodynamic therapy has been used for the treatment of superficial and nodular basal cell carcinomas, with varying cure rates. Aims: This study aims to evaluate the effectiveness of topical photodynamic therapy in the treatment of superficial and nodular basal cell carcinomas in Asian patients treated at the National Skin Centre, Singapore. Materials and Methods: A retrospective analysis of Asian patients with histologically confirmed basal cell carcinomas and treated with photodynamic therapy was performed. Results: Eight Chinese patients, with an equal gender distribution and mean age of 83.4 years were included. Five of eight basal cell carcinomas were superficial while the remaining three were nodular. The basal cell carcinomas were located in the head and neck in seven patients. The overall clearance rate at 3 months was 87.5% while the clearance rate for superficial and nodular basal cell carcinomas was 100% and 66.6% respectively at 3 months. At 12 months, the overall clearance rate was 85. 7%. Limitations: This is a retrospective analysis with small patient numbers. Conclusions: In this small series of eight Asian patients, topical photodynamic therapy has been shown to be effective and generally well-tolerated in the treatment of basal cell carcinomas, particularly of the superficial subtype. However, larger studies are needed to evaluate its overall efficacy in Asian patients.
  - 3,482 125
QUIZ
An asymptomatic swelling on the neck
Swagata Tambe, Shylaja Someshwar, Ami Dedhia, Raviraj Jadhav, Kalpana Bhatt, Hemangi Jerajani
March-April 2015, 81(2):221-223
DOI:10.4103/0378-6323.152314  PMID:25751358
  - 3,461 176
RESIDENT’S PAGE
Skin substitutes in dermatology
Sudha Anish
March-April 2015, 81(2):175-178
DOI:10.4103/0378-6323.152288  PMID:25751337
  - 6,215 890
RESIDENTS CORNER
Viva questions from the IJDVL
Vishalakshi Viswanath, Resham Vasani
March-April 2015, 81(2):226-230
DOI:10.4103/0378-6323.152315  
  - 9,965 1,177
Online since 15th March '04
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