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2020| January-February | Volume 86 | Issue 1
Online since
December 20, 2019
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REVIEW ARTICLES
Future therapies in melasma: What lies ahead?
Rashmi Sarkar, Anuva Bansal, Pallavi Ailawadi
January-February 2020, 86(1):8-17
DOI
:10.4103/ijdvl.IJDVL_633_18
PMID
:31793496
Melasma is a common, acquired, symmetrical hypermelanosis. It negatively impacts the patient's quality of life and responds poorly to treatment. Although earlier classified as epidermal and dermal, melasma is now thought to be a complex interaction between epidermal melanocytes, keratinocytes, dermal fibroblasts, mast cells, and vascular endothelial cells. Factors influencing melasma may include inflammation, reactive oxygen species, ultraviolet radiation, genetic factors, and hormones. With a better understanding of the pathogenesis of melasma and the realization that targeting melanin synthesis alone is not very effective, treatments focussing on newly implicated factors have been developed. These include agents targeting hyperactive melanocytes, melanosomal transfer to keratinocytes, defective skin barrier, the mast cells, vasculature, and estrogen receptors as well as drugs with anti-inflammatory and antioxidant activity. Many of these newer agents are botanicals with multimodal mechanisms of action that offer a better safety profile when compared with the conventional drugs. There has also been a focus on oral agents such as tranexamic acid, flutamide, and ascorbic acid. It has been suggested that the “triple therapy of the future” may be a combination of hydroquinone, an antiestrogen and a vascular endothelial growth factor inhibitor, as the “ideal” skin-lightening agent.
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15,783
888
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BRIEF REPORT
Clinico-epidemiological features of chronic urticaria in children: A retrospective analysis of 296 children from a tertiary care institute in Northern India
Muthu Sendhil Kumaran, Rahul Mahajan, Nupur Goyal, Davinder Parsad
January-February 2020, 86(1):50-54
DOI
:10.4103/ijdvl.IJDVL_573_17
PMID
:30264742
Background:
Urticaria is a common dermatosis affecting approximately 25% of the population. Childhood chronic urticaria is frequently encountered, however, epidemiologic data on pediatric urticaria are limited.
Aim:
The objective of this study was to study the clinico-epidemiological profile of children with chronic urticaria.
Methods:
A retrospective study including children less than 14 years with chronic urticaria was conducted from January 2010 to December 2015. Detailed history, clinical examination, investigation results, treatment taken, and follow-up details were recorded on a prefixed proforma. As per the practice of the urticaria clinic, the children were investigated only in case of inadequate therapeutic response or had features of atopy/autoimmune disorders.
Results:
Two hundred and ninety-six children (166 boys, 130 girls; mean age, 11.3 years) with chronic urticaria were included in the study. Urticaria was spontaneous in onset in 57.1% (169) children; precipitating factors were reported in 42.9% children, most common being physical factors, food allergy, drug intake and infections. Investigations were done in 48 (16.2%) patients; Antinuclear antibody was negative in all patients, raised serum IgE in 20/48 (41.6%), positive autologous serum skin test in 32/48 (66.6%) and raised anti-TPO titre in 10/48 (20.8%) children. A diagnosis of chronic spontaneous urticaria was made in 245 (82.77%) children, chronic dermographic urticaria in 35 (11.82%), cholinergic urticaria and drug-induced urticaria in 5 (1.69%) each, aquagenic urticaria in 4 (1.35%) and cold-induced urticaria in 2 (0.68%) children. Two hundred and fifteen (72.6%) children responded to nonsedating antihistamines alone, 61 (20.6%) required addition of a sedating antihistamine, 7 (0.02%) required addition of montelukast, 3 (0.01%) ranitidine and 10 (20.8%) required a short course of oral corticosteroids to control acute flare. None of the patients required any long-term immunomodulatory or immunosuppressive agent. The mean duration of treatment required was 3 to 12 months.
Limitations:
The main limitation is the study being retrospective in nature with associated drawbacks of data loss. In addition, we did not use objective scoring system such as urticaria severity score and not all children were extensively investigated.
Conclusions:
Chronic spontaneous urticaria is the most common type of chronic urticaria in children. Majority of these children can be managed conservatively with long-term antihistamines.
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REVIEW ARTICLES
Risk of tuberculosis with anti-tumor necrosis factor-alpha therapy in patients with psoriasis and psoriatic arthritis in Indian population
Soumajyoti Sarkar, Saumya Panda, Byungsoo Kim, Smriti K Raychaudhuri, Asutosh Ghosh, Siba P Raychaudhuri
January-February 2020, 86(1):1-7
DOI
:10.4103/ijdvl.IJDVL_791_18
PMID
:31719235
Anti-tumor necrosis factor-alpha (TNF-α) immunotherapy has revolutionized the treatment of inflammatory diseases, such as psoriasis and psoriatic arthritis. However, a major concern is that patients receiving this therapy have an increased risk of infection, particularly of reactivation of latent tuberculosis (TB). There were an estimated 10.4 million new cases of tuberculosis in 2016, worldwide, and India has one of the largest TB case burden with an estimated incidence of 2.79 million cases of TB in the same year. Anti-TNF agents like etanercept and infliximab are available in India approved for psoriasis and psoriatic arthritis. But long-term use of these agents possesses a risk of reactivation of latent TB. In this review article, we assessed the risk of TB with anti-TNF therapy especially in patients with psoriasis and psoriatic arthritis in India. At the end of the article, we have also suggested a recommendation for screening of latent tuberculosis and its management, before starting anti-TNF-α therapy.
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ORIGINAL ARTICLES
Effectiveness and safety analysis of rituximab in 146 Indian pemphigus patients: A retrospective single-center review of up to 68 months follow-up
Dipankar De, Anuradha Bishnoi, Sanjeev Handa, Tanmay Mahapatra, Rahul Mahajan
January-February 2020, 86(1):39-44
DOI
:10.4103/ijdvl.IJDVL_848_17
PMID
:31089006
Background:
Rituximab is being increasingly used for the treatment of pemphigus. Data derived from single-center studies following a uniform treatment protocol are limited. Effect of demography and disease type on treatment response is poorly characterized.
Objective:
Our aim was to assess the effectiveness of biosimilar rituximab in pemphigus patients who had received rituximab as per rheumatoid arthritis protocol (2 doses, 1g each, infused 14 days apart).
Methods:
It was a retrospective review of 146 eligible patients to assess the proportion of patients achieving complete remission off treatment, time to achieve complete remission off treatment, proportion of patients who relapsed after achieving complete remission off treatment, time taken to relapse, duration and total cumulative dose of corticosteroids administered after rituximab. Additionally, we tried to find whether a correlation existed between age, gender, total duration of illness before rituximab and pemphigus disease type with the above-mentioned outcome measures.
Results:
Of 146 patients, 107 (73.3%) attained complete remission off treatment. Mean interval between first dose rituximab administration and complete remission off treatment was 6.6 ± 3.4months. Complete remission off treatment was sustained for a mean duration of 9.1 ± 8.5 months before relapse. Over a mean follow-up duration of 24.9 ± 17.1 months (median 23, maximum 68 months), 75 of 107 patients (76.5%) who had achieved complete remission after first cycle of rituximab relapsed. A mean total cumulative dose of 3496 ± 2496 mg prednisolone was prescribed over a mean duration of 7.2 ± 4.7 months after first cycle of rituximab. Time taken to achieve remission was significantly longer in pemphigus foliaceus and these patients required significantly higher cumulative dose of prednisolone over a longer duration after rituximab. No deaths and long-term complications were recorded.
Limitations:
Only clinical parameters were assessed. Immunological parameters including B-cell counts and enzyme-linked immunosorbent assay for anti-desmoglein antibody titers were not carried out.
Conclusion:
This study reinforces the beneficial role of rituximab in pemphigus. Pemphigus foliaceus patients required a higher total cumulative dose of prednisolone over a longer time to achieve remission and the remission lasted longer than that in pemphigus vulgaris.
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Nailfold capillaroscopy with USB dermatoscope: A cross-sectional study in healthy adults
Deepak Jakhar, Chander Grover, Archana Singal
January-February 2020, 86(1):33-38
DOI
:10.4103/ijdvl.IJDVL_240_18
PMID
:31290463
Background:
Nailfold capillaroscopy (NFC) is a convenient method for studying capillary morphology in the proximal nailfold (PNF) and is used for the evaluation of connective tissue and other diseases affecting the microvasculature. However, capillary density and morphological patterns in healthy individuals are largely unknown and this compromises the evaluation of the microvasculature in disease states.
Objective:
To describe and quantify the morphological characteristics of nailfold capillaries in healthy adult Indians.
Methods:
A USB 2.0 dermatoscope (Dinolite AM413ZT) with polarizing light was used to study nailfold capillary characteristics in 50 consecutive healthy adult individuals. NFC was performed on all 10 fingers. Images were assessed for both quantitative and qualitative features.
Results:
The mean capillary density in healthy Indian adults was 7.63 ± 1.12 capillary/mm. Tortuosity (22%), meandering capillaries (14%) and microhemorrhages (14%) were frequently seen in these individuals.
Limitation:
The small sample size limited a conclusive determination of statistically significant differences in NFC findings with respect to gender and age.
Conclusion:
NFC with a USB dermatoscope is a useful technique for studying the PNF capillaries. The normal PNF capillary density in healthy Indian adults was 7.63 ± 1.12 capillary/mm. Capillary alterations such as tortuosity, meandering capillaries and microhemorrhages are seen in a significant number of healthy individuals.
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2,558
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A retrospective study: Clinicopathological and immunohistochemical analysis of 54 cases of tufted angioma
Xin Su, Yu Liu, Yanghe Liu, Cuiling Ma
January-February 2020, 86(1):24-32
DOI
:10.4103/ijdvl.IJDVL_777_18
PMID
:31397400
Background:
Tufted angioma is a rare benign lesion with vascular proliferation.
Aim:
To retrospectively analyze the clinicopathological manifestations and immunohistochemical features of tufted angioma.
Methods:
Clinical and histopathological features of tufted angioma (
n
= 54) were evaluated and analyzed retrospectively in the Department of Dermatology, Xijing Hospital from 2003 to 2014.
Results:
Clinically, tufted angioma usually presented as erythematous plaques and papules on the head and neck (
n
= 11), trunk (
n
= 21) and extremities (
n
= 22), mainly in children (
n
= 48), without gender difference (24 males and 30 females). A total of 45 cases showed solitary lesions and nine cases showed multiple lesions. Common symptoms included pain (
n
= 11), tenderness (
n
= 7), itching (
n
= 1), hypertrichosis (
n
= 7), hyperhidrosis (
n
= 6) and Kasabach–Merritt phenomenon (
n
= 1). Histopathologically, typical tufted angioma (
n
= 37) showed proliferation of endothelial cells in a so-called cannonball pattern, while in the early (
n
= 4) and regressed (
n
= 13) stages the tufted appearance was not prominent. The proliferated endothelial cells were diffusely positive for CD31 and Wilms tumor 1, focally positive for D2-40 and Prox1, and negative for Glut-1.
Limitations:
Our research was confined to patients of Chinese origin and our sample size was limited.
Conclusions:
Tufted angioma is a rare vascular neoplasm with diverse clinical manifestations and unique pathological features. It should be recognized as a vascular tumor with lymphatic differentiation. We emphasize the importance of considering tufted angioma in the differential diagnoses of any congenital or acquired vascular tumor.
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IMAGES IN CLINICAL PRACTICE
Giant pilomatricoma on the upper back
Deepak Jakhar, Chander Grover, Sonal Sharma
January-February 2020, 86(1):55-56
DOI
:10.4103/ijdvl.IJDVL_352_18
PMID
:30719991
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1,700
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CASE REPORT
Cutaneous plasmacytosis with mast cell infiltration
Sarina Jain, Rohit V Hede, Uday S Khopkar
January-February 2020, 86(1):91-95
DOI
:10.4103/ijdvl.IJDVL_716_17
PMID
:30073990
Cutaneous plasmacytosis is a rare disorder of uncertain etiology, described mainly in patients of Japanese descent. Clinically, it is characterized by multiple pigmented papules and plaques distributed primarily on the trunk. Histopathologically, it is marked by a dense dermal plasma cell infiltrate. Here, we describe a case of cutaneous plasmacytosis in a 55-year-old Indian male who presented with hyperpigmented plaques on the body. Histopathological examination revealed dense superficial and deep perivascular and periappendageal infiltrate composed mainly of plasma cells, lymphoid follicles with reactive germinal centres, perineural distribution of plasma cells, mast cell infiltration and increased dermal small blood vessels. Immunohistochemical analysis confirmed the polyclonal nature of the plasma cells. Laboratory investigations were within normal limits, except for the presence of polyclonal hypergammaglobulinemia without any M band. There was no evidence of autoimmune disease or any infection. There was no systemic involvement in this patient. The patient was diagnosed as cutaneous plasmacytosis and advised long-term follow-up. Peculiar histopathological finding in this case of cutaneous plasmacytosis was the presence of abundant mast cells in the dermis.
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1,726
48
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IMAGES IN CLINICAL PRACTICE
Masturbation-induced painless hemorrhagic bulla on scarring penile lichen planus
Anurag Verma, Saurabh Singh, Aasma Nalwa
January-February 2020, 86(1):96-97
DOI
:10.4103/ijdvl.IJDVL_134_18
PMID
:30665993
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1,670
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ORIGINAL ARTICLES
Serum prolidase and oxidative stress levels in patients with recurrent aphthous stomatitis: a prospective, controlled study
Adnan Ekinci, Emre Demir, Halil Ekinci
January-February 2020, 86(1):18-23
DOI
:10.4103/ijdvl.IJDVL_20_18
PMID
:31249217
Background:
Recurrent aphthous stomatitis is a common disease characterized by single or multiple, self-healing, well-circumscribed, periodic ulcers occurring in the oral cavity. Although the relationship between recurrent aphthous stomatitis and oxidative stress has been extensively reviewed in the past, its relationship with prolidase enzyme levels has not been previously investigated.
Aim:
The aim of this study is to investigate plasma antioxidant status and prolidase enzyme levels in patients with recurrent aphthous stomatitis.
Methods:
The serum total oxidant status, total antioxidant status, oxidative stress index, prolidase and paraoxonase levels of 34 recurrent aphthous stomatitis patients (mean age 35.1) and 34 healthy controls (mean age 37.7) were compared in this study.
Results:
Total oxidant status was significantly higher in the recurrent aphthous stomatitis group (
P
< 0.005). The mean total oxidant status value was 5.19 mmol/L in the recurrent aphthous stomatitis group, while it was 2.90 mmol/L in the control group. Oxidative stress index was significantly higher in the recurrent aphthous stomatitis group (
P
= 0.016*). The mean oxidative stress index level was 0.28 AU in the recurrent aphthous stomatitis group, while it was 0.18 AU in the control group. When control and patient groups were compared, there was no significant difference between groups with regard to the total antioxidant status (
P
= 0.343). The total antioxidant status levels were 1.09 and 1.14 mmol/L in control and patient groups, respectively. There was no statistically significant difference between PON1 levels of recurrent aphthous stomatitis and control groups (
P
= 0.218). Mean PON1 levels were 326 U/L in the recurrent aphthous stomatitis group and 381 U/L in the control group. Prolidase levels were not significantly different between recurrent aphthous stomatitis and control groups (
P
= 0.955). The mean prolidase level was 219.79 U/L in the recurrent aphthous stomatitis group and 219.26 U/L in the control group.
Limitations:
The limitation of this study is the small size of both patient and control groups and exclusion of pediatric patients., Similar studies performed in pediatric patient populations with a comparison to adults may be useful in providing meaningful results.
Conclusions:
We detected that the total oxidant status and oxidative stress index was higher in patients with recurrent aphthous stomatitis as compared to healthy controls. We could not demonstrate a significant difference in total antioxidant status, PON1 and prolidase values.
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1,551
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NET LETTERS
Lichenoid skin lesions: A rare manifestation in secondary syphilis
Daniela Armijo, Fernando Valenzuela, Jonathan Stevens, Claudia Morales
January-February 2020, 86(1):105-105
DOI
:10.4103/ijdvl.IJDVL_200_18
PMID
:30785122
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1,515
45
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LETTERS TO THE EDITOR - CASE LETTERS
Multiple minute digitate hyperkeratosis, familial type: A rare entity
Siva Rami Reddy Karumuri, Santoshi Latha Surampally, V Sindhuri Reddy, Naresh Babu Thambisetti
January-February 2020, 86(1):63-65
DOI
:10.4103/ijdvl.IJDVL_400_18
PMID
:31793494
[FULL TEXT]
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1,434
54
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LETTERS TO THE EDITOR - OBSERVATION LETTERS
Exacerbation of systemic lupus erythematosus in a patient with concomitant chronic plaque psoriasis treated with ustekinumab
Siew Wen Goh, Adawiyah Jamil, Norazirah Md Nor, Rizna Abd Cader, Syahrul Sazliyana Shaharir
January-February 2020, 86(1):68-70
DOI
:10.4103/ijdvl.IJDVL_961_18
PMID
:31823905
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1,395
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CASE REPORT
Identification of atypical dermal leishmaniasis resolved by restriction fragment length polymorphism
Srija Moulik, Ritika Sengupta, Aishwarya Dighal, Bikash Sardar, Bibhuti Saha, Nilay Kanti Das, Mitali Chatterjee
January-February 2020, 86(1):45-49
DOI
:10.4103/ijdvl.IJDVL_14_18
PMID
:30264743
This case report series alerts to the atypical manifestations of dermal leishmaniasis in an area endemic for post kala-azar dermal leishmaniasis, the sequel to visceral leishmaniasis. We have reported two cases with multiple skin lesions, wherein the rK39 strip test, polymerase chain reaction and parasite load confirmed the presence of
Leishmania
parasites. The causative parasite was identified as
Leishmania major
by restriction fragment length polymorphism of the ribosomal DNA Internal Transcribed Spacer-1, overruling the clinical suspicion of post kala-azar dermal leishmaniasis. The third case presented with fever and extensive hypopigmented patches in the upper extremities; parasites were identified in blood and skin by polymerase chain reaction and typed by restriction fragment length polymorphism as
Leishmania donovani
, establishing this as a case of visceral leishmaniasis concomitant with dermal leishmaniasis, secondary to dissemination of viscerotropic
L. donovani
. The present case series emphasizes the importance of molecular tools to identify the
Leishmania
species in order to ensure appropriate treatment.
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1,307
65
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QUIZ
Annular scaly plaques in a girl
Pooja Parulkar, Swagata Arvind Tambe, Chitra Shivanand Nayak
January-February 2020, 86(1):98-100
DOI
:10.4103/ijdvl.IJDVL_346_17
PMID
:29974887
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1,258
109
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LETTERS TO THE EDITOR - OBSERVATION LETTERS
Bullous pemphigoid triggered by rabies vaccine
Anuradha Jindal, Sudhir U. K. Nayak, Shrutakirthi D Shenoi, Raghavendra Rao, Vidya Monappa
January-February 2020, 86(1):66-68
DOI
:10.4103/ijdvl.IJDVL_666_18
PMID
:31823906
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1,244
61
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Can a test-dose of methotrexate cause methotrexate-induced epidermal necrosis?
Gabriela Fortes Escobar, André Cartell, Caroline Kullmann Ribeiro, Maiby De Bastiani
January-February 2020, 86(1):70-72
DOI
:10.4103/ijdvl.IJDVL_889_18
PMID
:31823907
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1,181
74
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LETTERS TO THE EDITOR - STUDY LETTERS
Familial pityriasis rubra pilaris in a Chinese family caused by a novel mutation in CARD14 gene
Tieqiang Wu, Santasree Banerjee, Jianlian Deng, Jing Wu, Hui Huang, Heping Zheng, Huiqing Pan, Yiming Wang, Zhiyu Peng, Xiaofang Sun
January-February 2020, 86(1):81-84
DOI
:10.4103/ijdvl.IJDVL_9_18
PMID
:31755479
[FULL TEXT]
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1,160
27
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Two novel mutations of
NF1
gene identified in Chinese patients with severe neurofibromatosis type 1
Yuxin Zheng, Guiying Qiu, Huatuo Dai, Chengyao Zhu, Dan Xue, Yunqing Ren
January-February 2020, 86(1):76-81
DOI
:10.4103/ijdvl.IJDVL_1037_18
PMID
:31868168
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1,148
19
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PEARLS
Diagnosis and treatment response monitoring of scabies with reflectance confocal microscopy: A diagnostic pearl
Xavier Fustà-Novell, Daniel Morgado-Carrasco, Beatriz Alejo, José Riera-Monroig, Susana Puig
January-February 2020, 86(1):101-103
DOI
:10.4103/ijdvl.IJDVL_482_18
PMID
:31793492
[FULL TEXT]
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1,064
55
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LETTERS TO THE EDITOR - CASE LETTERS
Persistent papular varicella in an immunocompetent male
Anza Khader, Kunnummel Muhammed, Sarita Sasidharan Pillai, Chettithodi Sivasankaran Bindhu, Reena Mariyath, Pardeep Mann
January-February 2020, 86(1):59-62
DOI
:10.4103/ijdvl.IJDVL_877_17
PMID
:31823901
[FULL TEXT]
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1,044
63
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LETTERS TO THE EDITOR - STUDY LETTERS
Novel and recurrent mutations in GJB3 and GJB4 cause erythrokeratodermia variabilis et progressiva
Shangzhi Dai, Huijun Wang, Zhimiao Lin
January-February 2020, 86(1):87-90
DOI
:10.4103/ijdvl.IJDVL_926_18
PMID
:31793497
[FULL TEXT]
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1,093
13
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IJDVL AWARDS 2019
IJDVL Awards 2019
January-February 2020, 86(1):106-106
DOI
:10.4103/0378-6323.272678
PMID
:31823904
[FULL TEXT]
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[PubMed]
1,024
79
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BOOK REVIEW
Clinical dermatology through case studies
Sujay Khandpur
January-February 2020, 86(1):104-104
DOI
:10.4103/ijdvl.IJDVL_826_19
PMID
:31793493
[FULL TEXT]
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[PubMed]
1,040
57
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NET LETTERS
Hand, foot and mouth disease caused by Coxsackie viruses A6 and A16 in Assam, Northeast India: A need for surveillance
Biswajyoti Borkakoty, Mandakini Das, Aniruddha Jakharia, Chandrakanta Bhattacharya, Chandrajyoti Bora, Pranjal Jyoti Baruah, Dipankar Biswas
January-February 2020, 86(1):105-105
DOI
:10.4103/ijdvl.IJDVL_576_17
PMID
:30860171
[FULL TEXT]
[PDF]
[Mobile Full text]
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[PubMed]
1,040
45
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Aleukemic leukemia cutis mimicking urticaria pigmentosa in a patient of T-cell acute lymphoblastic leukemia
Sanjay Singh, Neha Taneja, Subuhi Kaul, Sudheer Arava, Neetu Bhari
January-February 2020, 86(1):105-105
DOI
:10.4103/ijdvl.IJDVL_355_18
PMID
:31397398
[FULL TEXT]
[PDF]
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[PubMed]
1,051
26
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LETTERS TO THE EDITOR - CASE LETTERS
A newborn with an oral mass: Non-neural granular cell tumor
Muzeyyen Muge Savas, Itir Ebru Zemheri
January-February 2020, 86(1):57-59
DOI
:10.4103/ijdvl.IJDVL_460_18
PMID
:31793495
[FULL TEXT]
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1,047
27
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LETTERS TO THE EDITOR - OBSERVATION LETTERS
A case of multiple eruptive dermatofibromas in a Chinese man with chronic inactive hepatitis B infection
Conghui Li, Wenju Wang, Liwen Zhang, Lei Xu
January-February 2020, 86(1):72-75
DOI
:10.4103/ijdvl.IJDVL_306_19
PMID
:31823900
[FULL TEXT]
[PDF]
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[PubMed]
998
24
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LETTERS TO THE EDITOR - STUDY LETTERS
Assessment of the role of spleen tyrosine kinase and zeta-chain-associated 70-kDa protein (tyrosine) kinase in the pathogenesis of psoriasis
Hesham A Zaher, Heba I Gawdat, Rehab A Hegazy, Faisal N Mohammed, Aya M Alorbani, Nahed A Ibrahim, Khadiga Sayed Sayed
January-February 2020, 86(1):85-87
DOI
:10.4103/ijdvl.IJDVL_2_19
PMID
:31709999
[FULL TEXT]
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