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  Citation statistics : Table of Contents
   2010| July-August  | Volume 76 | Issue 4  
    Online since July 21, 2010

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Childhood psoriasis
Sunil Dogra, Inderjeet Kaur
July-August 2010, 76(4):357-365
DOI:10.4103/0378-6323.66580  PMID:20657115
Psoriasis is a common dermatosis in children with about one third of all patients having onset of disease in the first or second decade of life. A chronic disfiguring skin disease, such as psoriasis, in childhood is likely to have profound emotional and psychological effects, and hence requires special attention. Psoriasis in children has been reported to differ from that among adults being more frequently pruritic; plaque lesions are relatively thinner, softer, and less scaly; face and flexural involvement is common and guttate type is the characteristic presentation. Whether onset in childhood predicts a more severe form of psoriasis is a matter of controversy, it may cause significant morbidity particularly if it keeps relapsing. Most children have mild form of psoriasis which can be generally treated effectively with topical agents such as emollients, coal tar, corticosteroids, dithranol, calcipotriol etc. according to age and the sites affected. Narrow band UVB is the preferred form of phototherapy in children for moderate to severe disease or in patients not responding to topical therapy alone. Systemic therapies are reserved for more severe and extensive cases that cannot be controlled with topical treatment and/or phototherapy such as severe plaque type, unstable forms like erythrodermic and generalized pustular psoriasis and psoriatic arthritis. There are no controlled trials of systemic therapies in this age group, most experience being with retinoids and methotrexate with favorable results. Cyclosporine can be used as a short-term intermittent crisis management drug. There is an early promising experience with the use of biologics (etanercept and infliximab) in childhood psoriasis. Systemic treatments as well as phototherapy have limited use in children due to cumulative dose effects of drugs, low acceptance, and risk of gonadal toxicity. More evidence-based data is needed about the effectiveness and long-term safety of topical, phototherapy and systemic therapies in children.
  11 21,634 1,526
Skin manifestations of child abuse
Aylin Turel Ermertcan, Pelin Ertan
July-August 2010, 76(4):317-326
DOI:10.4103/0378-6323.66572  PMID:20657110
Child abuse is a major public health problem all over the world. There are four major types of abuse: physical abuse, sexual abuse, emotional abuse and neglect. The most common manifestations of child abuse are cutaneous and their recognition; and differential diagnosis is of great importance. Clinicians, especially dermatologists, should be alert about the skin lesions of child abuse. In the diagnosis and management of child abuse, a multidisciplinary approach with ethical and legal procedures is necessary. In this manuscript, cutaneous manifestations of physical, sexual, emotional abuse and neglect are reviewed and discussed.
  7 16,904 807
Tophi as first manifestation of gout
Sankha Koley, Atul Salodkar, Sanjiv Choudhary, Arvind Bhake, Kailash Singhania, Manoj Choudhury
July-August 2010, 76(4):393-396
DOI:10.4103/0378-6323.66593  PMID:20657121
Chronic tophaceous gout classically occurs after 10 years or more of recurrent polyarticular gout. However, tophi can also occur as first sign of the disorder. Here we report a 20-year-old male presenting with multiple subcutaneous nodules on bilateral feet and toes, left palm, right elbow, helix of left ear since last one and half year prior to any other manifestation of gout. He was having mild intermittent arthritis since last six months. Fine Needle Aspiration Cytology of one tophus showed monosodium urate crystals, which are pathognomonic for gout. His serum uric acid was normal and ultrasound revealed bilateral nephrocalcinosis. So far as we know, this is the first case report from India, demonstrating tophi as the initial clinical presentation of gout.
  6 9,021 206
Comparative study of trichloroacetic acid versus glycolic acid chemical peels in the treatment of melasma
Rashmi Kumari, Devinder Mohan Thappa
July-August 2010, 76(4):447-447
DOI:10.4103/0378-6323.66602  PMID:20657143
Background: Melasma is a common cause of facial hyperpigmentation with significant cosmetic deformity. Many modalities of treatment are available, but none is satisfactory. Aim: This study was designed to compare the therapeutic response of melasma in Indian women to glycolic acid (GA 20-35%) versus trichloroacetic acid (TCA 10-20%) for chemical peeling. Methods: Forty nonpregnant female patients with a minimum melasma area and severity index (MASI) of 10 were recruited in the study. After a detailed history and clinical examination under natural light, MASI was calculated and color photographs were taken of all the patients. The patients were advised to carry out a prepeel program of daily application of 12% GA cream or 0.1% tretinoin at night for 2 weeks. They were then treated with graded concentrations of 20-35% GA facial peel every 15 days in GA group and 10-20% TCA in the second group. Results: Objective response to treatment evaluated by reduction in MASI scoring after 12 weeks was by 79% reduction (from 26.6 to 5.6) in GA group and by 73% reduction in TCA group (from 29.1 to 8.2) but this difference was not significant. Patients with epidermal-type melasma showed a better response to treatment than those with mixed-type melasma (P < 0.05). Subjective response, as graded by the patient, showed good or very good response in 75% in GA group and 65% in TCA group. No relation of treatment response to age and duration of melasma could be established in this study. Conclusions: A prepeel program of daily application of 12% GA cream at night for 2 weeks, followed by graded increase in GA and TCA concentrations proved to be an equally effective treatment modality for epidermal and mixed melasma. There are hardly any major side effects, and regular use of sunscreens prevents chances of postpeel hyperpigmentation. GA peel is associated with fewer side effects than TCA and has the added advantage of facial rejuvenation.
  5 15,911 666
Lichen planus in children
Amrinder J Kanwar, Dipankar De
July-August 2010, 76(4):366-372
DOI:10.4103/0378-6323.66581  PMID:20657116
Lichen planus in children is considered to be rare overall, though it does not appear to be so in Indian subcontinent. Most of the large studies on lichen planus in children have been undertaken in India. We review here the epidemiology, pathogenesis, clinical features, diagnosis, management and prognosis pertaining to lichen planus in children with emphasis on studies published from India.
  5 23,067 865
Cutaneous metastases in 42 patients with cancer
Esther Una Cidon
July-August 2010, 76(4):409-412
DOI:10.4103/0378-6323.66584  PMID:20657126
  4 3,442 88
Benign familial pemphigus (Hailey-Hailey disease) responsive to low dose cyclosporine
Arti Nanda, Fatima Khawaja, Rafat Harbi, Mousmee Nanda, Richard Dvorak, Qasem A Alsaleh
July-August 2010, 76(4):422-424
DOI:10.4103/0378-6323.66597  PMID:20657133
  4 6,289 139
Zosteriform cutaneous metastases: A case report and brief review of literature
Raghavendra Rao, C Balachandran, Lakshmi Rao
July-August 2010, 76(4):447-447
DOI:10.4103/0378-6323.66605  PMID:20657142
A 56-year-old woman presented with painful erythematous, papulo-nodular lesions on the left side of the trunk in a dermatomal distribution of two-weeks duration. She had earlier undergone surgery for breast carcinoma and was receiving palliative chemo-radiotherapy, when seen by us. A diagnosis of zosteriform cutaneous metastases was made and biopsy was done from the representative lesion which showed chords and sheets of malignant cells. Majority of these cases in the past have been misdiagnosed as herpes zoster and were treated with antiviral drugs. Metastatic diseases should be considered in the differential diagnosis of zosteriform rash in elderly.
  4 5,557 135
Lupus erythematosus profundus
T Narayana Rao, Kamal Ahmed, K Venkatachalam
July-August 2010, 76(4):448-448
DOI:10.4103/0378-6323.66612  PMID:20657144
  4 5,552 163
Patient-reported multiple drug reactions: Clinical profile and results of challenge testing
M Ramam, Radhakrishna Bhat, Sonal Jindal, Uttam Kumar, Vinod K Sharma, Rajesh Sagar, Rakesh K Chadda
July-August 2010, 76(4):382-386
DOI:10.4103/0378-6323.66587  PMID:20657119
Background: Some patients report hypersensitivity reactions to many drugs making it difficult to prescribe medications when they fall ill. Aim: To describe the clinical profile of multiple drug hypersensitivity and the results of challenge testing in a large teaching hospital.Methods: We performed a five-year retrospective review of the records of patients who complained of reactions to two or more unrelated drugs and avoided medication because of a fear of developing reactions. Oral challenge testing was carried out in hospital with drugs suspected by the patient to cause reactions and/or commonly prescribed medications. A positive reaction was diagnosed when symptoms and signs resembled previously experienced episodes and there was no such reaction with placebo. Results: Twenty three patients (aged 14-65 years; 19 females) underwent challenge testing. Their complaints had been present for 1-30 years, with 2-40 drug reaction episodes reported. Antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) were most commonly implicated, and urticaria/angioedema were the most often reported manifestations. The patients underwent 3-27 challenges with 1-24 drugs. Three had positive challenge reactions with various NSAIDs, 13 developed symptoms and signs that were judged not to be true reactions, and 7 had no reactions. None of our patients qualified for a diagnosis of true multiple drug hypersensitivity. Conclusion: Patients who believe they are allergic to multiple, pharmacologically unrelated drugs are usually mistaken. Challenge testing is a reliable way of demonstrating this and providing patients with a list of safe drugs.
  4 5,571 238
Liposomal zinc phthalocyanine as a potential agent for photodynamic therapy of leishmaniasis
Ameneh Sazgarnia, Mohammad Hossein Bahreyni -Toosi, Pouran Layegh, Omid Rajabi, Rahman Movahhed Ghodsinia
July-August 2010, 76(4):417-418
DOI:10.4103/0378-6323.66591  PMID:20657130
  3 4,052 95
Discoid lupus erythematosus of the eyelid
Jelica S Vukicevic, Danica J Milobratovic
July-August 2010, 76(4):418-420
DOI:10.4103/0378-6323.66592  PMID:20657131
  3 4,845 114
Mortimer's Malady revisited: A case of polymorphic cutaneous and systemic sarcoidosis
Deepika Pandhi, Sidharth Sonthalia, Archana Singal
July-August 2010, 76(4):448-448
DOI:10.4103/0378-6323.66606  PMID:20657147
Sarcoidosis is a systemic disorder with prominent cutaneous component. Skin lesions are of diverse morphology, of which few are specific for the disease. We describe a 30-year-old woman with polymorphic skin lesions including papules, plaques, and nodules, as well as uncommon variants like eyelid papules, palmar and digital nodules, tattoo sarcoid, as well as scar sarcoid. The patient also had stage II pulmonary sarcoidosis, and articular as well as reticulo-endothelial system involvement manifested by enlarged mediastinal and abdominal lymph nodes and hepatosplenomegaly. The presentation of polymorphic skin lesions with involvement of multiple extra-cutaneous systems is uncommon in a single patient.
  3 5,756 125
Multicentric reticulohistiocytosis
Arvind Kaul, Sunil N Tolat, Vasudha Belgaumkar, Chandrakant B Mhaske
July-August 2010, 76(4):404-407
DOI:10.4103/0378-6323.66598  PMID:20657124
A 50-year-old male presented with fever, joint pain and skin lesions since eight months. Examination showed multiple papules and nodules with periarticular predisposition. Swelling of knees and elbows with flexion deformity of distal interphalangeal joints was present. Investigations revealed anemia and raised ESR. Histopathology was pathognomonic of multicentric reticulohistiocytosis. Patient was treated with bisphosphonates along with systemic steroids and methotrexate to which he responded well.
  2 5,351 179
Moulages in dermatology-venereology
Rajiv Joshi
July-August 2010, 76(4):434-438
DOI:10.4103/0378-6323.66579  PMID:20657139
  2 4,796 175
Ulcerative subcutaneous zygomycosis: Development of hypothyroidism induced by potassium iodide (Wolff-Chaikoff effect)
Bhushan Madke, Siddhi Chikhalkar, Sunanda Mahajan, Vidya Kharkar, Uday Khopkar
July-August 2010, 76(4):431-433
DOI:10.4103/0378-6323.66604  PMID:20657138
  2 4,904 129
Naevoid Blaschkoid psoriasis
Ashok Krishnarao Ghorpade
July-August 2010, 76(4):449-449
DOI:10.4103/0378-6323.66613  PMID:20657149
  2 3,936 147
Serum vitamin B12, folate, ferritin and iron levels in Turkish patients with vitiligo
Muzeyyen Gonul, Seray Kulcu Cakmak, Secil Soylu, Arzu Kilic, Ulker Gul
July-August 2010, 76(4):448-448
DOI:10.4103/0378-6323.66611  PMID:20657145
  2 7,501 198
Neonatal dermatological emergencies
S Ragunatha, Arun C Inamadar
July-August 2010, 76(4):328-340
DOI:10.4103/0378-6323.66575  PMID:20657112
The neonates are unique in several ways in comparison with older children and adults which render them highly susceptible to severe, sometimes life threatening dermatological disorders. The neonatal dermatological emergencies are a diagnostic and therapeutic challenge. A wide range of dermatoses such as infections, genodermatoses, metabolic disorders and vascular tumors may require emergency care. The clinical presentation also varies from generalized involvement of skin to localized disease with or without systemic symptoms. Irrespective of the etiology and clinical presentation, these disorders are associated with significant morbidity and mortality. With the availability of effective drugs and monitoring facilities, and awareness of need for immediate care, there has been a significant decline in the fatality rate associated with neonatal dermatological emergencies. Knowledge of clinical presentations, rapid diagnostic methods, emergency care and monitoring of progress of the disease helps in comprehensive multidisciplinary care of neonates with these disorders.
  2 15,328 1,041
Persistent nodular contact dermatitis to gold: Case report of two cases
Vandana Mehta, C Balachandran
July-August 2010, 76(4):397-399
DOI:10.4103/0378-6323.66594  PMID:20657122
Metallic gold has long been regarded as a relatively safe and inert material when in contact with the skin and mucosal membranes, with only sporadic reports of allergic contact dermatitis. We report two cases, where persistent nodules developed at sites of gold piercing with gold jewelry with positive patch test reactions to gold.
  1 4,265 114
Nephrogenic systemic fibrosis following hair-dye ingestion induced acute renal failure
IS Reddy, VK Somani, G Swarnalata, Sanjay Maitra
July-August 2010, 76(4):400-403
DOI:10.4103/0378-6323.66596  PMID:20657123
We report a patient who developed acute renal failure following the ingestion of a hair-dye with a suicidal intent. He was managed by hemodialysis and other symptomatic measures. He developed generalized seizures and underwent MRI scan of the brain using gadolinium containing contrast material followed by development of bilateral and symmetrical thickening and induration of the skin over the extremities and verrucous papules and plaques over the lower back. Skin biopsy and immunohistochemistry showed typical features of nephrogenic fibrosing dermopathy as well as deposits of calcium. Successful management of renal failure resulted in clearing of all skin lesions except a small bony hard plate like area overt the left leg, the biopsy of which showed features of osseous metaplasia.
  1 5,525 177
Erythema elevatum diutinum with verrucous carcinoma: A rare association
Seema R Nair, Vishalakshi Viswanath, Amey D Sonavane, Aditi C Doshi, Mrunal G Parab, Raghunandan G Torsekar
July-August 2010, 76(4):420-422
DOI:10.4103/0378-6323.66595  PMID:20657132
  1 3,564 83
Granuloma faciale with extra-facial involvement
D. V. S. Pratap, Srinivas Putta, G Manmohan, S Aruna, M Geethika
July-August 2010, 76(4):424-426
DOI:10.4103/0378-6323.66599  PMID:20657134
  1 4,681 114
Linear IgA bullous dermatosis of childhood: Response to thalidomide
Nina A Madnani, Kaleem J Khan
July-August 2010, 76(4):427-429
DOI:10.4103/0378-6323.66601  PMID:20657136
  1 5,341 104
Pseudoxanthoma elasticum: Description of a late onset case
Francesco Baglieri, Giovanni Scuderi
July-August 2010, 76(4):448-448
DOI:10.4103/0378-6323.66608  PMID:20657146
Pseudoxanthoma elasticum (PXE) is a genetic multisystem disorder characterized by ectopic mineralization of connective tissues with primary manifestations in the skin, retina and cardiovascular system, and a phenotypic spectrum highly variable.This article presents the case of a 46-year-old male patient with sporadic late-onset PXE, without severe systemic complications.
  1 4,804 144
Punctate keratotic papules and plaques over palm
H Sripathi, Mohan H Kudur, Smitha Prabhu, Sathish B Pai
July-August 2010, 76(4):449-449
DOI:10.4103/0378-6323.66614  PMID:20657148
  1 5,174 202
Clinical and demographic trends in a sexually transmitted infection clinic in Mumbai (1994-2006): An epidemiologic analysis
Maninder S Setia, Hemangi R Jerajani, Paul Brassard, Jean-Francois Boivin
July-August 2010, 76(4):387-392
DOI:10.4103/0378-6323.66590  PMID:20657120
Background: People presenting to sexually transmitted infections (STIs) clinics represent an important risk group for HIV infection; prevention strategies will depend on the clinical attendance. Aims: The demographic and clinical changes in clinic attendees in Mumbai, as well as the factors associated with HIV infection in this clinic over a 13-year period, were assessed. Methods: STI clinic data in 3417 individuals (1994 to 2006) were analyzed: clinical presentation, types of STIs, and serology over the 13-year period. We used a logistic regression model to assess socio-demographic and clinical associations with HIV infection. Results: The clinic evaluated 689 patients in 1994 and the number had dropped to 97 in 2006. In 1994, the majority of STIs seen in the clinic were bacterial (53%, 95% confidence interval [CI] 50% to 57%); however, this proportion had dropped in 2006 (28%, 95% CI: 19% to 38%). There was a proportional increase in viral STIs during the same time period. Although women attending the clinic were younger than men, they were more likely to be married. The overall seropositivity for HIV was 28%. Viral STIs were more likely to be associated with HIV than bacterial infections (odds ratio: 1.5, 95% CI: 1.2 to 1.9). Conclusions: Viral infections were the most common STIs in recent years in a tertiary care center in Mumbai. HIV prevalence was high in this population. Thus, these clinical data suggest that STI patients were and continue to be an important group for HIV prevention in the country.
  1 5,712 240
A skin tumor in a young girl
Muzeyyen Gonul, Seray Kulcu Cakmak, Ulker Gul, Ozge Han, Ulker Karagece
July-August 2010, 76(4):445-446
DOI:10.4103/0378-6323.66573  PMID:20657141
  1 3,890 142
Acyclovir versus valacyclovir
R Rajalakshmi, Rashmi Kumari, Devinder Mohan Thappa
July-August 2010, 76(4):439-444
DOI:10.4103/0378-6323.66577  PMID:20657140
  1 19,229 934
Erythroderma in children
Rashmi Sarkar, Vijay Kumar Garg
July-August 2010, 76(4):341-347
DOI:10.4103/0378-6323.66576  PMID:20657113
Although erythroderma is a well-recognized entity in the adult age groups and has been studied by various authors, there is a paucity of studies on erythroderma in the pediatric age group. It poses a greater challenge to the dermatologist and pediatrician because of its potential life threatening nature. In a study conducted by us in a large Indian hospital to delineate the causes of neonatal and infantile erythroderma, the causes identified were infections (40%), ichthyosiform erythroderma (25%), atopic dermatitis (15%), infantile seborrheic dermatitis (10%) and unidentified (10%). In another study of childhood erythroderma, etiologically, drugs (29%) showed the highest incidence, followed equally (18%) by genodermatoses, psoriasis and staphylococcal scalded skin syndrome (SSSS). The management of childhood erythroderma is mainly supportive with correction of the hematologic, biochemical and metabolic imbalance if required. In this review, the causes of childhood erythroderma, the clinical features useful to the diagnosis and management are discussed.
  1 17,826 1,226
Pediatric dermatology
Deepak Parikh
July-August 2010, 76(4):327-327
DOI:10.4103/0378-6323.66574  PMID:20657111
  - 5,610 416
Prescribing and dispensing of isotretinoin: A survey
Shraddha R Anwikar, Mitali S Bandekar, Uday Khopkar, Nilima A Kshirsagar
July-August 2010, 76(4):412-413
DOI:10.4103/0378-6323.66586  PMID:20657127
  - 3,480 152
Comparison of commercial histamine release test and autologous serum skin test in the diagnosis of autoimmune urticaria
KV Godse, NJ Nadkarni, G Jani
July-August 2010, 76(4):413-415
DOI:10.4103/0378-6323.66588  PMID:20657128
  - 4,054 169
Moist exposed burn ointment: Role of alternative therapy in the management of partial-thickness burns
Sanjay Saraf
July-August 2010, 76(4):415-417
DOI:10.4103/0378-6323.66589  PMID:20657129
  - 12,108 95
Use of a wood's lamp as a Ultra-Violet light source to improve the speed and quality of suction blister harvesting
Feroze Kaliyadan, S Venkitakrishnan, Jayasree Manoj
July-August 2010, 76(4):429-431
DOI:10.4103/0378-6323.66603  PMID:20657137
  - 4,466 106
Drug hypersensitivity syndrome with lithium
KB Shreedhar, J Madhukara, J Jessy, SM Manohari, K Srinivasan
July-August 2010, 76(4):426-427
DOI:10.4103/0378-6323.66600  PMID:20657135
  - 5,056 100
Response of patients with nerve function impairment in leprosy to low dose steroid administration: An outpatient based study
Varadraj V Pai, BK Girdhar, K Hanumanthayya, RS Tophakhane
July-August 2010, 76(4):408-409
DOI:10.4103/0378-6323.66582  PMID:20657125
  - 2,836 95
Diagnostic significance of colloid body deposition in direct immunofluorescence
Leena Chularojanamontri, Papapit Tuchinda, Daranporn Triwongwaranat, Sumruay Pinkaew, Kanokvalai Kulthanan
July-August 2010, 76(4):373-377
DOI:10.4103/0378-6323.66583  PMID:20657117
Background: Colloid bodies (CB) in direct immunofluorescence (DIF) studies are usually found in interface dermatitis. Furthermore, CB can be found in various skin diseases and even in normal skin. Aim: To evaluate the diagnostic value of CB deposits in DIF studies. Methods: From 1996-2007, data from 502 patients where DIF studies showed immunoreactants at CB were enrolled. The definite diagnoses of these patients were based on clinical, histopathological and immunofluorescent findings. The results of DIF studies were analyzed. Results: Immunoreactants at CB were detected in 44.4%, 43.8%, 4.2%, 3.8%, and 2.2% of interface dermatitis, vasculitis, autoimmune vesiculobullous disease, panniculitis, and scleroderma/morphea, respectively. The most common immunoreactant deposit of all diseases was Immunoglobulin M (IgM). Brighter intensity and higher quantity of CB was detected frequently in the group with interface dermatitis. Conclusions: Immunoreactant deposits at CB alone can be found in various diseases but a strong intensity and high quantity favor the diagnosis of interface dermatitis. CB plus dermoepidermal junction (DEJ) deposits are more common in interface dermatitis than any other disease. Between lichen planus (LP) and discoid lupus erythematosus (DLE), CB alone is more common in LP; whereas, CB plus DEJ and superficial blood vessel (SBV) is more common in DLE. The most common pattern in both diseases is CB plus DEJ. The quantity and intensity of CB in LP is higher than in DLE.
  - 13,015 318
Pigmentary demarcation lines on the face in Saudi women
Abdullah Al-Samary, Saad Al Mohizea, Ghada Bin-Saif, Amal Al-Balbeesi
July-August 2010, 76(4):378-381
DOI:10.4103/0378-6323.66585  PMID:20657118
Background: Pigmentary demarcation lines (PDL) are physiological abrupt transition lines between hyperpigmented skin and lighter areas. Recent evidence suggests that they involve the face. Aims: To survey facial PDL in Saudi females referred to general dermatology clinics for various complaints and determine any associated risks. Methods: Screening for facial lines was done in general dermatology clinics over a year. Whenever a patient was found to have facial PDL, a detailed questionnaire and examination were undertaken. Results: Out of 1033 patients screened, 144 patients (14%) were found to have at least one of the facial PDLs. The median age of onset was 16 years. The most common line was F with 76 patients (53%). Family history was positive in 51 patients (35%). Conclusion: Facial PDL is a common and chronic pigmentary problem in Saudi women. It should be recognized and differentiated from other similar diseases like melasma. A significant proportion of patients have a milder presentation.
  - 6,122 274
Scleroderma in children: Emerging management issues
Saumya Panda
July-August 2010, 76(4):348-356
DOI:10.4103/0378-6323.66578  PMID:20657114
Scleroderma is a set of rare connective tissue diseases of unknown etiology. It is characterized by thickening and hardening of the skin. Scleroderma is divided into two main subgroups: systemic and localized. The systemic form, also known as systemic sclerosis, involves diffuse skin involvement associated with fibrotic changes in internal organs. Juvenile localized scleroderma is a more common entity and is usually confined to a specific region of the body with no internal organ involvement. Therapeutics are divided into three main subgroups for juvenile systemic sclerosis: antifibrotics, anti-inflammatories, and vasodilators. For localized disease, anti-inflammatories, vitamin D analogues, and UV irradiation have been investigated. The rarity of scleroderma in children and the self-limiting nature of the disease together make randomized controlled trials very difficult. Therefore, most data on therapeutic modalities for this condition have to be extrapolated from studies conducted on adults. International cooperation, following a standardized operation protocol, is needed to validate these and future interventions such as autologous stem cell transplant and cytokine-directed therapies.
  - 9,757 567
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