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2020| May-June | Volume 86 | Issue 3
Online since
April 9, 2020
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ORIGINAL ARTICLES
A cross-sectional study of spontaneous repigmentation in vitiligo
Neha Taneja, V Sreenivas, Kanika Sahni, Vishal Gupta, M Ramam
May-June 2020, 86(3):240-250
DOI
:10.4103/ijdvl.IJDVL_409_18
PMID
:31793491
Background:
Spontaneous regression is well documented in several chronic skin diseases such as psoriasis, alopecia areata, and atopic dermatitis. However, information on vitiligo is scarce.
Aims:
We studied the frequency, extent, and factors affecting spontaneous repigmentation in vitiligo.
Methods:
A cross-sectional descriptive study was undertaken in 167 patients with vitiligo with an emphasis on history of spontaneous repigmentation. Where available, photographs documenting spontaneous repigmentation were also obtained. Repigmentation was defined as spontaneous if it occurred when the patient was off treatment for at least 3 consecutive months.
Results:
Spontaneous repigmentation occurred in 36 (21.5%) patients with complete repigmentation in 6 (3.6%) patients. The extent varied from 0.5% to 100% (mean, 35.4 ± 37.9%) of vitiliginous skin. It occurred after 3 months to 47 years (mean, 8.7 ± 9.5 years) of onset of vitiligo and persisted for 2 months to 27 years (mean, 4.4 ± 6.2 years). Diffuse repigmentation was the most common pattern observed in 20 (55.6%) patients and there was a good color match in 26 (72.2%) patients. Likelihood of spontaneous repigmentation was 3.5 times greater in patients with more than 3 years of stable disease (
P
= 0.001).
Limitations:
The chief limitation was the dependence on patient recall for the data, except when documented by images.
Conclusion:
Spontaneous repigmentation occurs in one-fifth of patients with vitiligo. In some patients, the repigmentation is clinically significant and long-lasting. Considering its frequency and extent, spontaneous repigmentation should be taken into account both when evaluating novel interventions and counselling patients about the course of the disease.
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Identification of clinical and immunological factors associated with clinical relapse of pemphigus vulgaris in remission
Ankur Guliani, Dipankar De, Sanjeev Handa, Rahul Mahajan, Naresh Sachdeva, Bishan Dass Radotra, Kamal Kishore
May-June 2020, 86(3):233-239
DOI
:10.4103/ijdvl.IJDVL_89_19
PMID
:31898637
Background:
Pemphigus vulgaris is a potentially fatal autoimmune epidermal blistering disease with a chronic and relapsing course. It is difficult to predict clinical relapse. Identification of clinical and immunological factors that are associated with early clinical relapse in a prospective study design may help in planning treatment for better maintenance of clinical remission.
Aim:
The aim of our study was to identify clinical and immunological factors associated with clinical relapse within 9 months of study inclusion in patients with pemphigus vulgaris in clinical remission.
Methods:
Forty consecutive consenting patients who had been diagnosed to have pemphigus vulgaris and were in clinical remission on minimal therapy or off therapy were included. The patients were followed up every 3 months until 9 months. Clinical factors considered relevant were recorded at the beginning of the study. Immunological factors such as CD19+ B-cell count and CD19+CD27+ memory B cells/plasma cell count in peripheral blood were assessed at baseline [anti-desmoglein (Dsg) 1 and 3 titers were first assessed at 3 months, not at baseline] and repeated every 3 months, until 9 months or clinical relapse whichever was earlier. Direct immunofluorescence (DIF) of skin biopsy specimen was performed at study initiation and again at the time of clinical relapse or study completion, whichever occurred earlier. All patients completed the study.
Results:
Of 40 patients, 11 (27.5%) experienced relapse as per definition, while 29 (72.5%) remained in complete remission. Clinical relapse during study duration was significantly more common in those who had onset of disease in oral mucosa [odds ratio (OR), 10.71; 95% confidence interval (CI) 1.21–94.86,
P
= 0.02], pruritus (OR 8.4; 95% CI 1.76–40.02,
P
= 0.01), and extensive cutaneous involvement during previous disease activity (OR 7.36; 95% CI 1.34–40.55,
P
= 0.03) and also pruritus during remission (
P
= 0.004). Immunological factors found to be significantly associated with early clinical relapse were raised CD19+ B-cell count at baseline (OR 7.84; 95% CI 1.39 – 53.41,
P
= 0.01), immunoglobulin G (OR 4.85; 95% CI 1.09–23.44,
P
= 0.04), and C3 (OR 20.33; 95% CI 3.02–199.5,
P
< 0.001) positivity in the intercellular space of the epidermis on DIF at study onset and rising anti-Dsg 3 antibody titers (OR 19.96; 95% CI 1.85- 310.9,
P
= 0.03).
Limitations:
Limited sample size, short follow-up duration, and inability to perform anti-Dsg enzyme linked immunosorbent assay for all the patients at all the time points of assessment are limitations of this study.
Conclusion:
Immunological relapse can be determined before clinical relapse, so that treatment can be restarted/modified and clinical remission can be maintained.
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3,775
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CASE REPORT
Scleredema of Buschke associated with lichen sclerosus: Three cases
Michela Venturi, Katerina Damevska, Caterina Ferreli, Anna Luisa Pinna, Laura Atzori, Gorgi Gocev, Franco Rongioletti
May-June 2020, 86(3):272-277
DOI
:10.4103/ijdvl.IJDVL_288_17
PMID
:30289118
Scleredema adultorum of Buschke is a rare fibromucinous, scleroderma-like connective tissue disease most commonly found in a post-infectious setting or linked to hematological disorders or diabetes. Lichen sclerosus et atrophicus is an autoimmune condition only in 2.5% of cases localized exclusively at an extragenital site, occurring in up to 34% of patients in association with other autoimmune diseases such as vitiligo, thyroid disorders, alopecia areata, lichen planus, morphea, pernicious anemia and systemic lupus erythematosus. In particular, a stronger link with an autoimmune background in lichen sclerosus et atrophicus has been observed in women who showed higher prevalence for autoimmune conditions and circulating autoantibodies. Literature reveals a genetic susceptibility linked to specific HLA types. We report three patients who developed lichen sclerosus et atrophicus superimposed on skin involved by scleredema adultorum of Buschke. Although the association of lichen sclerosus et atrophicus with scleredema adultorum of Buschke could be coincidental, both diseases could be considered part of the spectrum of sclerodermoid disorders with common underlying pathogenetic mechanisms; which could explain the sequential or simultaneous occurrence of both lesions in our patients.
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3,080
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ORIGINAL ARTICLES
Effectiveness and safety of autologous platelet-rich plasma therapy with total contact casting versus total contact casting alone in treatment of trophic ulcer in leprosy: An observer-blind, randomized controlled trial
Supratim Saha, Aparesh Chandra Patra, Srinivas P Gowda, Nasiruddin Mondal, Sufiur Rahaman, S. K. Sahriar Ahmed, Sujit Debbarma, Khune Prateek Kumar Vitthal, Somenath Sarkar, Amrita Sil, Nilay Kanti Das
May-June 2020, 86(3):262-271
DOI
:10.4103/ijdvl.IJDVL_571_18
PMID
:31997794
Background:
Trophic ulcers secondary to leprosy pose a great stigma to patients and remain a challenge to the treating dermatologists. Platelet-rich plasma (PRP) introduces growth factors directly into the wound and aids in rapid healing. The role of PRP in the treatment of trophic ulcers in leprosy patients has not yet been established by randomized controlled trials.
Aims:
To study the effectiveness and safety of autologous PRP therapy with total contact casting versus total contact casting alone in the treatment of trophic ulcers in leprosy.
Methods:
In an observer-blind, randomized (1:1) controlled study, 118 patients were enrolled. PRP was prepared by the manual double-spin method (1600 rpm for 10 min followed by 4000 rpm for 10 min). After wound bed preparation, activated PRP was injected intra- and perilesionally, and platelet-poor plasma gel was applied over the ulcer bed. Occlusive dressings and total contact casting were then applied in Group A, and only total contact casting was applied in Group B. The same procedure was repeated every 2 weeks for 8 weeks.
Results:
In all, 56 patients were analyzable in Group A and 52 in Group B. The surface area of the ulcer decreased significantly from first follow-up onward in both the groups (
P
< 0.001 in both the groups). Intergroup comparison showed that the reduction in the surface area of the ulcer was significantly more in Group A than in Group B from the first follow-up onward (
P
= 0.038) and the difference was maintained till the fifth follow-up (
P
< 0.001). At the end of the study, 91.10 ± 9.65% ulcer surface area reduction had occurred in Group A, whereas it was 79.77 ± 17.91% in Group B (
P
< 0.001). Trophic ulcers healed completely more often in paucibacillary leprosy patients (
P
< 0.001) and in those with a lower initial surface area of the ulcer (
P
< 0.001).
Limitation:
Short duration of treatment (8 weeks).
Conclusion:
PRP combined with total contact casting accelerates the healing of trophic ulcers of leprosy and is more effective than total contact casting alone. Complete remission is more likely to occur when the duration and surface area of ulcer are less and in the paucibacillary spectrum.
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2,398
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BRIEF REPORT
Clinical and pathological characterization of oral mucosal 'lichen planus-like lesions' in patients with pemphigus vulgaris: An observational study
Dipankar De, Amanjot Kaur Arora, Sanjeev Handa, Debajyoti Chatterjee, Uma Nahar Saikia, Bishan Dass Radotra, Kamal Kishore, Geeti Khullar
May-June 2020, 86(3):278-283
DOI
:10.4103/ijdvl.IJDVL_129_18
PMID
:31031312
Background:
Lichen planus-like lesions on oral mucosa occasionally occur in Indian patients with pemphigus vulgaris. Its significance, both clinical and pathological, is yet to be elucidated.
Aims and Objectives:
To study the clinical and pathological characteristics of clinically apparent oral mucosal lichen planus-like lesions in pemphigus patients and to assess their relation with pemphigus disease activity.
Materials and Methods:
A total of 32 patients with pemphigus vulgaris who had oral lichen planus-like lesions were included and classified as 'cases,' and eight diagnosed cases of pemphigus vulgaris without lichenoid 'hue' were included as controls. The biopsy specimens were subjected to routine histopathologic examination, immunohistochemistry with FasL, and caspase-3 and direct immunofluorescence.
Results:
On histopathologic examination, the diagnosis of pemphigus vulgaris, lichen planus, 'overlap' and 'nonspecific' were rendered in 19 (59.4%), 4 (12.5%), 5 (15.6%) and 4 (12.5%) cases, respectively. On immunohistochemistry, FasL was positive in epithelial cells in 16 (50%) cases and 4 (12.5%) controls (
P
= 0.066). Caspase-3 stained positively in 18 (56.2%) cases and 20 (62.5%) controls (
P
= 0.77). Direct immunofluorescence was positive in 77.8% (21/27) of the cases.
Limitations:
Relatively small number of controls is the limitation of this study.
Conclusion:
Lichen planus-like lesions in pemphigus should not be labeled as inactive disease or postinflammatory hyperpigmentation. Apoptosis followed by pigment incontinence seems to explain such lesions with 'lichen planus-like appearance' in oral pemphigus vulgaris. Active pemphigus smoulders in a majority of these lesions.
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2,371
435
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ORIGINAL ARTICLES
A descriptive observational study on clinical and dermoscopic features of benign melanocytic neoplasms
Nitya Sarala Nirmala Malladi, Siddhi Bhalchandra Chikhalkar, Uday Khopkar, Vidya Kharkar
May-June 2020, 86(3):251-261
DOI
:10.4103/ijdvl.IJDVL_184_17
PMID
:31997793
Background:
Benign melanocytic neoplasms have nests of melanocytic cells and show characteristic dermoscopic features. Clinical and dermoscopic features have not been studied previously in the Indian population.
Aims:
To study the clinical, epidemiological and dermoscopic patterns of benign melanocytic neoplasms.
Methods:
This was a descriptive, observational, single centre study. In 107 patients with melanocytic neoplasms, 167 lesions were clinically examined and studied under the dermoscope and histopathological examination was done when indicated. The lesions were broadly divided as acquired and congenital. Five main dermoscopic patterns were seen–globular, homogenous, reticular, parallel and streaks. If there were two of these patterns in a particular lesion, it was termed 'mixed pattern'. The presence of three or more patterns was called 'multicomponent pattern'. Various other features were also observed.
Results:
The majority of patients belonged to the third decade with a female preponderance. History of increased UV exposure and family history was significant in acquired nevi. The dermoscopic pattern progressed from predominantly reticular in junctional nevi to predominantly globular in compound nevi and lesser pigment in intradermal nevi, with more vascular structures. The congenital melanocytic nevi showed additional features of comedo- like lesions, milia- like cysts, perifollicular pigmentary changes and increased colour variation. Even though colour variation was observed in both acquired and congenital lesions, no signs of dysplasia were seen on histopathology.
Limitations:
A larger sample size is required, with follow up of lesions. No parallel studies in brown skinned population were found for exact comparison.
Conclusion:
Benign melanocytic proliferations are often neglected in our country. This study will help in understanding the course, clinical features and dermoscopic patterns of various benign melanocytic neoplasms, and will be a step forward towards research in our population. To the best of our knowledge, this is the first study of its kind in India.
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2,222
389
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QUIZ
A case of red ears
Yang Sun, Sam Shiyao Yang, Lucinda Siyun Tan
May-June 2020, 86(3):325-328
DOI
:10.4103/ijdvl.IJDVL_828_17
PMID
:30319137
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2,090
442
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IMAGES IN CLINICAL PRACTICE
Oral compound nevus: an unusual presentation
Srilekha Pulivarthi, G Ramlal, P Divya Shree
May-June 2020, 86(3):284-285
DOI
:10.4103/ijdvl.IJDVL_676_18
PMID
:30860168
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1,695
387
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NET LETTERS
Recurrent purpura: A clue to Sjögren's syndrome
Lu Gan, Hao Chen, Jian-Fang Sun
May-June 2020, 86(3):335-335
DOI
:10.4103/ijdvl.IJDVL_7_18
PMID
:31736466
[FULL TEXT]
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1,564
365
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Neurocutaneous melanosis is not always a benign disease
Suzy Abd El Mabood, Yahya Wahba, Sohier Yahia, Mohammed M Sarhan, Ahmed K Mansour, Aldesia Provenzano, Hoda S Elmahdi, Ahmad Darwish
May-June 2020, 86(3):335-335
DOI
:10.4103/ijdvl.IJDVL_456_18
PMID
:31512584
[FULL TEXT]
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1,545
352
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Acrokeratosis paraneoplastica (Bazex syndrome) with bullous lesions
C Duran-Vian, C Gómez, I Navarro, L Reguero, L Alonso, MC González-Vela, MA González-López
May-June 2020, 86(3):335-335
DOI
:10.4103/ijdvl.IJDVL_288_18
PMID
:31339109
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1,473
352
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LETTERS TO THE EDITOR - CASE LETTERS
Concomitant trichotillomania, trichotemnomania and skin picking disorder in a woman
Mohammad Adil, Syed Suhail Amin, Mohd Mohtashim, Divya Agrawal
May-June 2020, 86(3):286-289
DOI
:10.4103/ijdvl.IJDVL_236_19
PMID
:32108615
[FULL TEXT]
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1,295
295
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IMAGES IN CLINICAL PRACTICE
Solitary hard plaque on scalp with pustules: An unusual case of secondary osteoma cutis
Suman Patra, Snehal Agarwal, Vinod K Sharma, M Ramam
May-June 2020, 86(3):329-330
DOI
:10.4103/ijdvl.IJDVL_682_18
PMID
:31608898
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1,228
346
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LETTERS TO THE EDITOR - STUDY LETTERS
Narrow-band ultraviolet B comb as an effective home-based phototherapy device for limited or localized non-segmental vitiligo: A pilot, open-label, single-arm clinical study
Sujay Khandpur, Riti Bhatia, Ajeet Singh Bhadoria
May-June 2020, 86(3):298-301
DOI
:10.4103/ijdvl.IJDVL_476_19
PMID
:32068191
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1,144
333
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LETTERS TO THE EDITOR - CASE LETTERS
Alopecia areata in a girl: A conundrum of endocrinopathies
Vernika Tyagi, Aashima Dabas, Sangeeta Yadav, Atul Mohan Kochhar
May-June 2020, 86(3):295-297
DOI
:10.4103/ijdvl.IJDVL_22_19
PMID
:32068194
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1,137
333
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LETTERS TO THE EDITOR - STUDY LETTERS
Assessment of
in vitro
antifungal susceptibility pattern of dermatophytes isolated from patients with onychomycosis attending a tertiary care hospital of East Delhi
Shukla Das, Shyama Datt, Sajad Ahmad Dar, Sambit Nath Bhattacharya, Deepika Pandhi, Chhavi Gupta, Naseem Akhter
May-June 2020, 86(3):301-304
DOI
:10.4103/ijdvl.IJDVL_173_18
PMID
:32056978
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1,016
347
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LETTERS TO THE EDITOR - OBSERVATION LETTERS
Linear granuloma annulare localized to the finger
Ankang Gu, Junmei Liang, Litao Zhang, Yin Xiao
May-June 2020, 86(3):314-316
DOI
:10.4103/ijdvl.IJDVL_24_18
PMID
:32209755
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1,112
134
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Generalized hypertrichosis in an infant after treatment with propranolol for infantile hemangioma
Roberto Mendez-Gallart, María García-Palacios, Jorge Cortizo-Vazquez, Adolfo Bautista-Casasnovas
May-June 2020, 86(3):311-313
DOI
:10.4103/ijdvl.IJDVL_245_18
PMID
:32242868
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1,156
86
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LETTERS TO THE EDITOR - CASE LETTERS
Recurrent spontaneous forehead ecchymoses with headache: A distinctly curious phenomenon
Vishal Gupta, Snehal Agrawal, GN Abhishek, Shipra Agarwal, Kanika Sahni
May-June 2020, 86(3):289-291
DOI
:10.4103/ijdvl.IJDVL_515_19
PMID
:32242866
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1,057
95
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PEARLS
Urea occlusion prior to single session fractional CO
2
laser as a treatment in onychomycosis
Sandeep Arora, Eeshaan Ranjan
May-June 2020, 86(3):331-333
DOI
:10.4103/ijdvl.IJDVL_742_19
PMID
:32245937
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996
123
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LETTERS TO THE EDITOR - OBSERVATION LETTERS
A novel loci of the HR gene in Marie - Unna hereditary hypotrichosis using whole-exome sequencing
Minho Lee, Gunhee Lee, Yeun-Jun Chung, Min Ji Kang, Dong Soo Yu, Young Bok Lee
May-June 2020, 86(3):321-324
DOI
:10.4103/ijdvl.IJDVL_511_19
PMID
:32235101
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889
60
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Follicular lichen planus pigmentosus in blaschkoid pattern: Superimposed segmental mosaicism
Manju Daroach, Ankur Guliani, Vinay Keshavmurthy, Vikarn Vishwajeet, Uma Nahar Saikia, Muthu Sendhil Kumaran
May-June 2020, 86(3):305-307
DOI
:10.4103/ijdvl.IJDVL_680_18
PMID
:32242870
[FULL TEXT]
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851
73
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LETTERS TO THE EDITOR - CASE LETTERS
Pulmonary tuberculosis in association with Erasmus syndrome
Reena Kumari Sharma, Mudita Gupta, Anjna Kumari Sharma
May-June 2020, 86(3):292-295
DOI
:10.4103/ijdvl.IJDVL_187_18
PMID
:32245936
[FULL TEXT]
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779
121
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LETTERS TO THE EDITOR - OBSERVATION LETTERS
Blaschkoid hypermelanosis in a patient with ring 18 chromosome
Eduardo Varas-Meis, Sonsoles Delgado-Vicente, Paula Fernández-Canga, Manuel Ángel Rodríguez Prieto
May-June 2020, 86(3):316-318
DOI
:10.4103/ijdvl.IJDVL_282_18
PMID
:32209754
[FULL TEXT]
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729
119
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A case of metastatic malignant melanoma in congenital systemic dermal melanocytosis
Won-Oh Kim, Young-Wook Ryoo, Sung-Ae Kim
May-June 2020, 86(3):308-311
DOI
:10.4103/ijdvl.IJDVL_747_19
PMID
:32235102
[FULL TEXT]
[PDF]
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744
63
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Novel ATP2A2 mutation in a large Chinese pedigree with extensive Darier's disease
Wei Zhang, Cheng Wang, Birong Guo, Jianfang Sun
May-June 2020, 86(3):318-321
DOI
:10.4103/ijdvl.IJDVL_953_18
PMID
:32242872
[FULL TEXT]
[PDF]
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711
56
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OBITUARY
Dr. B K Girdhar - Journey of a Divine Soul
AK Bajaj
May-June 2020, 86(3):334-334
DOI
:10.4103/ijdvl.IJDVL_253_20
PMID
:32245938
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
648
103
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