Indian Journal of Dermatology
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   Table of Contents - Current issue
July-August 2021
Volume 66 | Issue 4
Page Nos. 331-448

Online since Friday, September 17, 2021

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The Difference in Expression of Autophagy-Related Proteins in Lesional and Perilesional Skin in Adult Patients with Active and Stable Generalized Vitiligo—A Cross-Sectional Pilot Study p. 331
Haiyan Yu, Xiaoxia Lin, Yaoyao Huang, Hao Cheng, Oliver Seifert
Background: Autophagy plays an important role in maintaining intracellular homeostasis and is essential for cell survival and cell death. Dysfunction of autophagy has been described in many autoimmune diseases but data on vitiligo are scarce. Aims: The aim of this pilot study was to investigate the expression of autophagy-related proteins in patients with vitiligo. Methods: Western blotting was used to analyze the expression of microtubule-associated protein light chain 3 (LC3II/I), autophagy-related gene 5 (Agt5), mammalian target of rapamycin (mTOR) and p62 in lesional and perilesional vitiligo skin from seven patients with active generalized vitiligo and nine patients with stable generalized vitiligo compared to control skin from six healthy subjects. Results: Our data showed increased expression of the autophagy marker LC3II/I and decreased p62 protein expression in lesional skin of active and stable vitiligo compared to control skin (P < 0.01). No significant difference in the expression of LC3II/I and p62 was found in perilesional skin of active vitiligo patients (P > 0.05) compared to control skin. Expression of LC3II/I in stable vitiligo lesional skin was higher and p62 expression was lower compared to active vitiligo lesional skin (P < 0.01). Decreased p62 expression was shown in perilesional skin of stable vitiligo patients (P < 0.05). Agt5 protein in lesional and perilesional skin of both active and stable vitiligo patients were increased (P < 0.01 and P< 0.05) compared to control skin. The expression of mTOR protein in lesional and perilesional skin of active and stable vitiligo patients was significantly lower than in control skin (P < 0.01). Conclusions: The present study indicates increased autophagy in lesional skin in vitiligo patients. Stable vitiligo lesional skin showed increased autophagy compared to active vitiligo lesional skin. Missing activation of autophagy in active vitiligo perilesional skin suggests disturbed autophagy to be associated with vitiligo.
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Patch Testing as a Corroborative and Diagnostic Tool in Patients Suspected of Contact Allergen Induced Facial Melanosis p. 337
Vedant M Ghuse, Shylaja Someshwar
Background: Hypermelanosis involving predominantly the face and neck is relatively common and often presents a complex diagnostic problem. Objective: To study the patterns of facial melanosis in Indian skin and assess the importance of patch testing as a corroborative tool in the diagnosis of facial melanosis. Subjects and Methods: A total of 50 patients who consented to the study and satisfied the inclusion and exclusion criteria were incorporated in the study. These patients were subjected to a detailed history, clinical, dermoscopic, and histopathological evaluation. Patch testing using the universal series, cosmetic series, and photopatch was done on those who satisfied the inclusion criteria. Suspected allergen "as is" patch testing was done in selected cases. Results: Facial melanosis as a result of contact dermatitis is a common entity and was seen in the age group of 18–70 years in both the sexes with male to female ratio of 6.5:2.5 indicating a male preponderance. The most common dermoscopic finding was the presence of reticular pigment network seen in 33 (66%) cases. Histopathology showed increased basal melanin in 56% and pigment incontinence in 26% of the cases. The commonest allergen in men was found to be potassium dichromate (15%), while in females it was nickel (20%). Photopatch test was done for all the patients and was positive in five cases (10%). Suspected allergen "as is" patch testing was negative in all the cases. Conclusions: Facial melanosis as a result of contact dermatitis can be confused with other acquired dermatological conditions causing hyperpigmentation. Therefore, a detailed history of contact with allergens has to be elicited, and if found relevant, has to be confirmed by patch testing.
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Immunohistochemical Analysis of Differences of Toll-Like Receptor 2, Mast Cells, and Neurofilaments between Granulomatous Rosacea and Non-Granulomatous Rosacea p. 343
Ye Ji Jang, Eun Hye Hong, Eun Joo Park, Kwang Joong Kim, Kwang Ho Kim
Background: Granulomatous rosacea is a distinct variant of rosacea because of its unique histopatholiogic findings. However, the pathogenesis of granulomatous rosacea has not yet been clearly demonstrated. Aims and Objectives: The aim of this study was to investigate the expression of toll-like receptor 2, mast cells, and neurofilaments in the granulomatous rosacea compared with the non-granulomatous rosacea. Materials and Methods: Biopsy specimens were obtained from 12 patients with erythematotelangiectatic rosacea, 11 patients with granulomatous rosacea, and 11 control patients. Biopsy tissue blocks were subjected to immunohistochemical staining using antibodies against toll-like receptor 2, mast cells, and neurofilaments. Results: In granulomatous rosacea, the expression of mast cells increased significantly, compared to the erythematotelangiectatic rosacea and the control group (P-value = 0.001 and 0.013, respectively). Additionally, the expression of toll-like receptor 2 in the granulomatous rosacea group was higher than that in the control group (P-value = 0.04). Conclusion: The results of this study suggest that the increased expression of mast cells may be a sign of chronic, later stage of granulomatous rosacea compared to the erythematotelangiectatic rosacea. The increased expression of toll-like receptor 2 suggests that cathelicidin-induced neuroimmune pathogenesis also contributes to the pathophysiology of granulomatous rosacea.
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Prevalence and Risk Factor of Occupational Skin Complaints among Male Tannery Workers of Kanpur, India p. 347
Gyan Chandra Kashyap, Shri Kant Singh, Bal Govind Chauhan
Background: Occupational skin illnesses are the second most common occupational health hazard following musculoskeletal disorders. Tannery workers have frequent and prolonged exposure to skin irritants and allergens and may have a higher risk of developing occupational dermatitis. Aims and Objectives: The aim of this study is to examine the extent of skin problems and their determinants among male tannery workers. Materials and Methods: The data for the present research was drawn from a cross-sectional household study of tannery and nontannery workers in the Jajmau area of Kanpur, Uttar Pradesh. A total of 284 tannery and 289 nontannery workers were interviewed using purposive sampling technique. Descriptive statistics and multivariate techniques have been used. Results: Tannery workers experienced itching hands or fingers with fissures (21%), scaling of hands or fingers with fissures (18%), red and swollen hands or fingers (11%), and vesicles on the hands or between the fingers (11%). The workers who had moderate/high dermal exposure to chemicals were 35(P < 0.001), and they were 31 (P < 0.001) times more likely to experience vesicles on scaling hands or fingers with fissures, and itching hands or fingers with fissures. The tannery workers engaged in wet finishing work were significantly 3.9 (P < 0.1) times more likely to experienced scaling on hands or fingers with fissures. Conclusion: The study acclaims the mechanization of tannery activities at workplaces, so that risk of skin complaints can be minimized among tannery workers. As the risk of skin complaints is very high with the dermal exposure to chemicals, personal protective equipment must be provided and their use should be included in the curriculum of the ternary workers.
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A Cross Sectional Survey for Dermatoses in Children and Adolescents Residing in Orphanages in Urban Tirunelveli, Tamil Nadu, India p. 352
Nirmaladevi Palanivel, Vijaikumar Manikka Govardhanan, Soundharyaa Savada Moorthi, A N. M. Maalik Babu, SM Kannan
Context: Skin diseases are a major cause of public concern among underprivileged people residing in orphanages. There is a need for community-based study for dermatoses in orphanages as the literature is scarce at the national and international levels. Aims: For profiling of various dermatoses to generate information on general health, nutritional status, and sanitation, and to educate about personal skin hygiene and care to inmates in urban child orphanages. Settings and Design: A cross-sectional study was conducted at 18 urban child orphanages in Tirunelveli city for 1 month. Methods and Material: A predesigned proforma was prepared and the demographic details regarding the inmates were obtained and they were screened under natural light for skin, hair, nail, and oral disorders as well as their built, nourishment, height, and weight were measured and recorded in tabulations. Statistical Analysis Used: Descriptive statistical analysis was followed for describing the prevalence of dermatoses and the age group affected which are explained in percentages and ratios. Results: Out of a total of 850 inmates, 93 (11%) were of 5–9 years and 757 (89%) were of 10–19 years. Among them, 330 (39%) were males and 520 (61%) were females. Overall, the inmates affected with dermatoses were 360 (42.4%) and infectious dermatoses were seen in 218 inmates (60.5%) and non-infectious dermatoses were seen in 142 inmates (39.5%). Adolescent females were more commonly affected and the commonest dermatoses observed were pediculosis capitis (13.6%) followed by acne vulgaris (8.1%) and in adolescent males, scabies (7.1%) was the commonest. No psychocutaneous disorders were encountered. Conclusions: Infections and infestations are common in orphanages due to a lack of awareness of personal hygiene and self-care practices. They should be given health education in order to reduce the disease burden in children living in orphanages which in turn decreases the disease burden at the community level.
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Utility of Immunofluorescence Antigen Mapping in Hereditary Epidermolysis Bullosa p. 360
Raghavendra Rao, Varsha M Shetty
Background: Epidermolysis bullosa (EB) is characterized by blisters and erosions on the trauma-prone areas of the body. It occurs as a result of mutation in the genes encoding structural proteins. Transmission electron microscopy (TEM) is considered the gold standard test in the laboratory diagnosis of EB. However, this test requires a lot of expertise and is not widely available. Immunofluorescence antigen mapping (IFM) is considered a suitable alternative with comparable sensitivity and specificity. However, there is paucity of studies analyzing the utility of IFM in the diagnosis of EB. Aims and Objectives: To study the utility of IFM in the laboratory diagnosis of EB. Materials and Methods: A cross-sectional study was conducted involving 179 biopsy specimens of patients with EB. IFM was carried out using a panel of monoclonal antibodies against K14, laminin 332, type IV collagen, and type VII collagen. Results: Diagnosis of EB simplex (EBS), junctional EB (JEB), and dystrophic EB (DEB) was made in 104, 28, and 26 biopsy specimens, respectively. The overall concordance rate was 41.3% with higher concordance rates in EBS. Conclusion: The present study is conducted to assess the efficacy of IFM in the diagnosis of EB with large sample size. Our study serves to establish IFM as an important tool in the diagnostic armamentarium of EB as the prognosis mainly rests on diagnosing the type of EB.
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The Study of Serum Level of Interleukin-2, Interleukin-6, and Tumor Necrosis Factor-alpha in Stable and Progressive Vitiligo Patients from Sina Hospital in Tabriz, Iran p. 366
Mohammad Reza Ranjkesh, Mahya Rahimi Partovi, Mehrdad Pashazadeh
Background: Vitiligo is an acquired depigmenting disorder characterized by the loss of functional melanocytes from the epidermis. Although the etiology of vitiligo is unknown, over the last few years, substantial data from clinical research have greatly supported the "Autoimmune theory." Vitiligo has two major forms: progressive and stable. As cytokines are important mediators of immunity, the most important of them are IL-2, IL-6, and tumor necrosis factor-α (TNF-α). Objectives: We aimed to study the serum level of IL-2, IL-6, and TNF-α in stable and progressive vitiligo and compared them to find a useful lab test to determine the form of vitiligo for diagnose and treatment. Materials and Methods: Serum IL-2, IL-6, and TNF-α were done by the indirect enzyme-linked immunosorbent assay (ELISA) in 40 cases of stable and progressive vitiligo. Results: Twenty patients had progressive vitiligo and 20 patients were stable vitiligo. In every group, there were seven male patients. Twenty-one patients had a positive family history of vitiligo and four patients had other autoimmune diseases. The average age and familial history between two groups and two genders were not meaningful. The mean serum TNF-α level was significantly higher in progressive than stable vitiligo. No significant difference was observed in the serum levels of IL-2, IL-6 between stable and progressive vitiligo. The mean serum IL-6 and TNF-α had higher levels in male patients. Conclusion: Analysis of TNF-α levels in every age or gender can show us the type of vitiligo, stable or progressive and we can choose the best form of treatment for patients.
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Comparative Effectiveness and Safety of Methotrexate Versus PUVA in Severe Chronic Stable Plaque Psoriasis p. 371
Saikat Banerjee, Suchibrata Das, Alok K Roy, Loknath Ghoshal
Background: Psoriasis is a chronic, inflammatory, immune-mediated, debilitating skin disease affecting approximately 2%–3% of the global population. Various treatment modalities are available for extensive psoriasis which include methotrexate, cyclosporine, retinoids, oral PUVA therapy, and biologic agents. Aims and Objectives: The aim of this study was to compare the effectiveness and safety of methotrexate vs. PUVA in severe chronic plaque psoriasis with BSA >20%. Materials and Methods: A randomized open-label clinical study was performed. Sixty patients with extensive stable plaque psoriasis were recruited in the study. Thirty patients received methotrexate at a dose of 0.4 mg/kg up to a maximum of 15 mg/week and the rest 30 were treated by PUVA, 8-methoxy psoralen tablet (20 mg) followed by UVA started at the dose of 1 j/cm2 thrice weekly with an increment of 20% dose every third sitting until 2.5 j/cm2 is reached. Both forms of treatment were continued for 10 weeks or until PASI 90 achieved, which-ever was earlier. Clinical examination, blood investigation, PASI scoring, and photograph were repeated in serial intervals during the study. At the end of study, the data were compiled, tabulated, and analyzed. Results: In the PUVA group, 90% achieved PASI-50 and 63.33% achieved PASI-90, in the methotrexate group all patients achieved both PASI-50 and PASI-90. Methotrexate acted significantly faster than PUVA in disease clearance. In the methotrexate group decreased platelet count in 13.33% patients, decreased hemoglobin (<10 gm/dl), elevated liver enzyme, each of these developed in 10% of patients. In the PUVA group, no serious side effects were observed. Conclusions:Methotrexate is more efficacious with lesser incidence of subjective complications and more incidence of laboratory complications compared to PUVA in extensive plaque psoriasis.
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Barriers for Antiretroviral Therapy Adherence and Viral Suppression in Members of the Key Population in Mumbai, India: Implications for Interventions p. 378
Shrikala Acharya, M Parthasarathy, Amol Palkar, Padmaja Keskar, Maninder Singh Setia
Background: Poor adherence to antiretroviral therapy (ART) is associated with poor virologic control and drug resistance in people living with HIV/AIDS. Some barriers to ART adherence are cost, lack of information, stigma, or dissatisfaction with health services. Aims and Objectives: To study the association between barriers for ART adherence and viral suppression, and explore the role of "missing ART dose" as a potential mediator in high-risk groups. Materials and Methods: Demographic, clinical, and behavioral data from 50 "virally suppressed" (viral load [VL] <1000 copies/ml) and 48 "not suppressed" (VL > 1000 copies/ml) individuals belonging to the key population in Mumbai were collected. Sociodemographic, behavioral, and other characteristics were compared, and mediation analysis was used to identify the mediator in the pathway to viral suppression. Results: Those who had missed their ART at least once in the past three months (37% versus 60%, P = 0.03) and stayed alone were less likely to be virally suppressed (31% versus 69%, P = 0.002). Individuals who had negative perception about ART (adjusted odds ratio [aOR]: 0.11, 95% confidence interval [CI]: 0.02, 0.47; P = 0.002), poor ART-related knowledge/behaviors (aOR: 0.14, 95% CI: 0.03, 0.60; P = 0.007), and poor pill taking practices (aOR: 0.10, 95% CI: 0.02, 0.61; P = 0.01) were significantly less likely to be virally suppressed. The mediation pathway "adherence theme > missed ART in the past three months > viral suppression" was significant in these themes. Conclusions: The factors associated with low viral suppression were knowledge/behaviors, perceptions about ART, and poor pill taking practices. Thus, it is important to provide correct information about ART, its effects, side effects, and potential limitations to marginalized population. Involving brothel keepers and Gurus (head of male-to-female transgendered people/Hijras clans), and technology enabled customized counseling sessions will be helpful.
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Extracorporeal Therapy in Dermatology p. 386
Sumit Sen, Olympia Rudra, Tirthankar Gayen
Extracorporeal therapy is a treatment modality where human blood undergoes favorable technical modifications and is reintroduced into the same patient. Since the last four decades this technique has been deployed in the management of difficult and refractory disorders in dermatology. Over a period of time newer techniques like immunoadsorption has emerged and opened new vistas in management of morbid dermatoses. In extracorporeal photopheresis a patient's leukocytes are separated and treated outside with Ultra Violet A in presence of 8-methoxypsoralen. Double filtration plasmapheresis and Immunoadsorption are techniques to remove offending immune complexes. They are safe and reduce the need of toxic medications that are conventionally used in recalcitrant skin diseases. In recent years immunoadsorption is emerging as first-line therapy in condition like immunobullous diseases. High cost is one of the important factors limiting their wider use in developing countries like India. Our review discusses different extracorporeal therapies, their applications, recommendations and guidelines based on various clinical trials.
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Mucormycosis: The Scathing Invader p. 393
Biju Vasudevan, Nandita Hazra, KP Shijith, Shekhar Neema, Senkadhir Vendhan
Mucormycosis is an invasive fungal infection that has been increasing in incidence over the years. Increase in the number of diabetics, malignancy patients, and use of immunosuppressants has mainly led to this gradual upward surge. Mucormycosis has various clinical forms, including rhino-orbito-cerebral, pulmonary, gastrointestinal, and cutaneous. Fungi belonging to Mucorales are thermotolerant and ubiquitous, found growing on organic substrates such as bread, decaying fruits and vegetables, crop debris in soil, compost, and animal excreta. During this second wave of the COVID-19 pandemic, the number of cases of mucormycosis has increased manifold in a short span of time. Associated comorbidity of diabetes mellitus, increased use of higher doses and prolonged duration of systemic corticosteroids, the glucogenic and prothrombotic propensity of the virus, hypoxic environment, COVID pneumonia, increased hospitalization, ICU admissions, and mechanical ventilation have all contributed toward this high rise in numbers. The rhin-orbito-cerebral form is the commonest manifestation of mucormycosis in COVID. Rhizopus oryzae, the main species causing mucormycosis, is identified by hyaline, sparsely-septate, broad, ribbon-like hyphae with irregular right-angle branching ribbon-like hyphae with rhizoids. For the early diagnosis of this infection, 10% KOH mount is very important. These fungi are very rapidly growing and thus can be differentiated from their main ally, Aspergillus. Treatment is mainly in the form of extensive surgical debridement along with liposomal amphotericin B. Posaconazole and isavuconazole are second-line agents, which can also be used for maintenance. Control of diabetes and COVID-19, along with judicious use of antibiotics and systemic corticosteroids, are equally important as management strategies in these pandemic times.
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Unusual Spurts of Rosacea Like Dermatoses, Posing a Diagnostic Dilemma During Covid-19 Pandemic: A Cross-Sectional, Observational Study From a Tertiary Care Centre p. 401
Gautam Kumar Singh, Barnali Mitra, Anuj Bhatnagar, Debdeep Mitra, Krishna Talukdar, Pankaj Das, Chetan Patil, Sunmeet Sandhu, Anwita Sinha, Teghveer Singh
Background: The gradual opening of healthcare system since second week of May 2020 following lockdown imposed due to corona virus pandemic saw spurts of cases of unexplained central facial dermatoses in subset of previously healthy people. The aim of the study was to find out the cause and establish the definitive diagnosis of unusual occurrence of facial dermatoses on previously healthy people so that an appropriate management can be offered to the patients. Materials and Methods: It was a cross-sectional, observational study carried during May 15 to July 15, 2020 at a tertiary dermatology center. All cases presented with erythema on face and papular or pustular lesions on central facial area of not more than 2 months of duration were included in the study. Results: Total 81 patients visited skin OPD with facial dermatoses of various types during this period, out of which 21 patients fulfilled the inclusion criteria. This was 0.72% (21/2900) of total skin OPD of the 2 months. All the patients had been using face masks during this period of symptoms due to the ongoing coronavirus situation. Dermatological examination revealed only erythema on the central area of face (n = 10), erythema and few papules (n = 3), erythmatous papules and pustules (n = 5), and erythematous papules, pustules, and telengiectasia (n = 3). All the skin biopsies showed predominantly epithelioid cells, noncaseating granuloma with a variable degree of infiltrate. Conclusion: There has been a definite change in the lifestyle due to the current Covid-19 pandemic. People are compulsorily using face masks to avoid the spread of Covid-19 infection. This change in behavior has brought out a surge of rosacea like lesions on the covered area of face. Partly, it can be explained by change in innate immunity due to excessive sweating and change in microenvironment of skin.
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Time from Injury to Tumor Onset in Patients with Angiolymphoid Hyperplasia with Eosinophilia: A Case Report and Literature Review p. 405
Yi-Liang Lin, Gong-Yau Chu
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Angiokeratoma of Fordyce on the Shaft of Penis with Underlying Venous Malformation p. 407
Barnita Saha, Isha Gupta, Kamal Aggarwal, Sant P Kataria
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Penile Rhinoscleroma Masquerading as Penile Malignancy: A Case of Mistaken Identity p. 409
Indrashis Podder, Ramesh Chandra Gharami
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A Case of Neutrophilic Eccrine Hidradenitis in a Patient with Crohn's Disease p. 411
Serap Maden, Didem Mullaaziz, Hanife Özkayalar
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Evaluation of Lichen Striatus by In vivo Reflectance Confocal Microscopy p. 413
Dai Hui, Jiang Hong-Yan, Xu Ai-E
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A Delayed-Onset Upper Lip Silicone Granuloma in a Patient Under Lung Cancer Chemotherapy p. 415
L Panariello, D Fattore, E Cinelli, MR Campanino, G Mansueto, G Fabbrocini
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A Case of Dermal Nerve Sheath Myxoma: A Different Tumor from Cellular Neurothekeoma p. 416
Huimin Meng, Cunhuo Jiang
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Erythema Elevatum Diutinum: Revisiting A Rare Entity in Pediatric Age Group p. 419
Faizan M Kalekhan, Spandana P Hegde, M Manjunath Shenoy, Amina Asfiya M. Iqbal
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A Pilot Study to Evaluate Dermoscopic Patterns in Eczema at Rural Based Tertiary Care Centre p. 421
Pragya A Nair, Namrata Bhavsar, Dhruv Patel
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Hereditary Distal Onycholysis: A New Affected Family p. 424
Fernando Garcia-Souto, Isabel Maria Coronel-Pérez, Sandra Cases-Mérida, Jeronimo Escudero-Ordoñez
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Papulonecrotic Tuberculid (PNT) Manifesting as Koebner Phenomenon; Hitherto Unreported Observation p. 425
Geetali Kharghoria, Archana Singal, Deepika Pandhi, Nadeem Tanveer
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A Rare Case of Primary Oral Malignant Melanoma of Mandibular Gingiva with an Update on Clinical Staging Highly accessed article p. 427
S Akhil, RB Vinod K, Shabil Mohamed Mustafa, Justin Mathew
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Gradual Spontaneous Fading of Giant Congenital Melanocytic Nevi of the Scalp and Trunk p. 430
María S Zegpi, Andrea Santos, Catalina Hasbún, Paula Majluf, Virginia Vergara, Alejandra Villarroel
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Adult-onset Eccrine Angiomatous Hamartoma: Report of a Rare Case p. 431
Reza Yaghoobi, Nader Pazyar, Emad Mostufi, Elnaz Hemmati
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Successful Treatment of Poikiloderma-Like Cutaneous Amyloidosis: A Case Report and Literature Review p. 434
Yi-Liang Lin, Gong-Yau Chu
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Becker's nevus of the scalp p. 437
Hyun-Min Seo, Se Kwang Park, Se Uk Oh, Ju Wang Jang, Tae Lim Kim, Hyung Kwon Park, Joung Soo Kim
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Inflammasome Related Mediators and Their Association with Disease Determinants in Chronic Plaque Psoriasis p. 438
Seema Chhabra, Tarun Narang, Frainey Bansal, Smrity Sahu, Sunil Dogra
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Effect of Hand Hygiene Practices in Healthcare Workers on Development of Hand Eczema during Coronavirus-19 Pandemic: A Cross Sectional Online Survey p. 440
Rashmi Jindal, Deepika Pandhi
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A Study of Cutaneous Adverse Drug Reactions and their Association with Autoimmune Diseases at a Tertiary Centre in South-West Rajasthan, India p. 445
Shweta Rana, Kalpana Gupta, Nidheesh Agarwal, Ahamed Noor Mqnsoon Ahamed
Background: Cutaneous adverse drug reactions (CADRs) comprise about 30% of all adverse drug reactions and observed in 2–3% of hospitalized patients by wide variety of offending agents. Aims: To study the clinical patterns, causative drugs and their association with autoimmune diseases in CADR patients. Materials and Methods: A total of 174 CADR patients who presented to the dermatology OPD over a period of 18 months (1 July 2015 to 31 Dec 2016) were considered for the study. Detailed history, clinical examination, hematological, and biochemical investigations were recorded. The venereal disease research laboratory test, HIV (ELISA), and histopathological examination were done wherever indicated. Results: The mean age of the patients with cutaneous drug eruptions was 40.2 years. Most of them (31.0%) were in the age group of 41–50 years. There were 93 (53.4%) males and 81 (46.5%) females with the M:F ratio of 1.5:1. The most common eruption observed was maculopapular rash in 33.3% followed by fixed drug eruption (17.2%) and lichenoid dermatitis' (11.5%). The drugs most commonly responsible for CADRs were antimicrobials (n = 68, 39%) with fixed dose combination of fluoroquinolones with nitroimidazoles (n = 42). We also noticed that a total of 42 patients out of 174 had comorbities in the form of diabetes (n = 27, 15.5%), hypothyroidism (n = 9, 5.1%), rheumatoid arthritis (n = 3, 1.7%), vitiligo (n = 2, 1.1%), and SLE (n = 1, 0.5%). Conclusion: Cutaneous ADR patterns and the drugs causing various reactions are changing every year, which may be because of the introduction of newer molecules and changing trends in the use of drugs. In our study, a significant relation of CADRs with autoimmune diseases (P value = 0.004) was also observed.
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Evaluation of Dermoscopic Patterns of Vesiculobullous Disorders p. 445
Namita D Narkhede, Balakrishna Nikham, Varsha Jamale, Asma Hussain, Mohan Kale
Background: Clinical diagnosis of vesiculobullous disorders (VBD) is not always straightforward. It is a challenge for a dermatologist to make the right diagnosis noninvasively in a short time. Objective: To evaluate dermoscopic patterns associated with vesiculobullous disorders. Methods: A total of 230 patients, irrespective of age and gender, with a history and clinical presentation suggestive of VBD (including primarily infectious, inflammatory, genetic, antibody-mediated, mechanical, environmental, metabolic, and drug-related) were recruited into the study. Patients with secondarily infected lesions were excluded. Dermoscopic examination along with Tzanck smear/skin biopsy smear test was performed on the most representative lesions. Data were compiled and statistically analyzed using SPSS version 21.0. Results: Lesions with erythematous (vascular) and yellowish (serum) translucent background with regular margins were seen in most of the VBD studied. Chickenpox (CP) and herpes zoster (HZ) lesions evolved with the progress of their clinical stages. Follicular and eccrine openings were commonly seen, but the pigmentation around them was specific to pemphigus vulgaris. A distorted pigment network was noted in bullous pemphigoid. White rosettes (keratin blockage) were characteristic of epidermolysis bullosa, Wickham striae (orthokeratosis) of lichen planus, and crumpled fabric appearance (flaccidity) of Hailey-Hailey disease. Globules/dots (microvesicles) of different colors were also seen in various VBD. Blue/black color usually corresponded to retained melanin. Conclusion: Some dermoscopic patterns are observed consistently with certain diseases, and these can be used for their diagnosis, complementary to histopathological examination.
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Epidemiological Trends and Clinicomycological Profile of Chronic Dermatophytosis: A Descriptive Study From South India p. 445
Remya Rajamohanan, Renu Raj, Janaki Chellam, Madhu Rengasamy
Background: Chronic dermatophytosis refers to persistent or recurrent episodes of dermatophytosis lasting for more than 1 year despite adequate treatment with topical and systemic antifungal agents. The rise in the number of these cases is alarming over the past 5 to 6 years, and a thorough knowledge about the reasons for chronicity of dermatophytosis may go a long way in the treatment and prevention of this infection. Aims and Objectives: The aim of this study was to investigate the epidemiology, various clinical types, and factors associated with chronicity in patients with chronic dermatophytosis, and to isolate the etiological agents and study the clinicomycological correlation. Materials and Methods: Detailed history and clinical details of all patients with chronic dermatophytosis who presented to our tertiary care center over a span of 1 year were recorded. Skin scrapings from these patients were subjected to potassium hydroxide mount and culture in modified Sabouraud's dextrose agar medium. Results: Sixty-four patients were enrolled in this study with a mean age of 44.5 years. The mean duration of infection was 3.14 years. Tinea corporis was the most common clinical type seen in 46 (71.9%) patients, affecting commonly the waist area in females and the back in males. Bronchial asthma was the most frequent systemic association affecting 20 (31.3%) patients followed by diabetes mellitus, which was present in 13 (20.3%) patients. About 34% patients had a history of long-term steroid use. Among the 28 isolates, Trichophyton mentagrophytes was the most frequent species isolated (46.4%), followed by Trichophyton rubrum (39.3%). Trichophyton tonsurans and Trichophyton verrucosum were isolated from two patients each. Conclusion: Extensive area of involvement, atopy, diabetes, and long-term use of systemic corticosteroids were associated with chronicity. Unlike in the yesteryears, T. mentagrophytes has emerged as the most common etiological agent of chronic dermatophytosis.
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Traction Alopecia: Clinical and Cultural Patterns p. 445
Khalifa E Sharquie, Robert A Schwartz, Wesal K Aljanabi, Camila K Janniger
Background: Traction alopecia is common and preventable but frequently overlooked disorder. Objective: To evaluate patients with traction alopecia. Patients and Methods: This study was conducted at the Dermatology Center, Medical City, Baghdad, Iraq, during the period from November 2005 to October 2019. Demographic features like age, gender, disease duration and special hair styling practices and accessories were recorded. Clinical patterns were studied. Results: Thirty female patients were included in this study. Their ages ranged from 6 to 47 years with mean age ± SD was 15.63 ± 9.806. Twenty-one (70%) were below the age of 16 years. No patient had tightly curled hair. All cases were asymptomatic apart from hair loss. The fringe sign was observed in 27 (90%) of cases. The response to therapy was poor. Conclusion: Traction alopecia is an important type of pressure-induced hair loss evident in children and adults with or without curly hair due mainly due to cultural hair styling practices with its frequency apparently increasing in recent years. The fringe sign is common and of diagnostic importance. It is a preventable form of hair loss which can be reversed if diagnosed early; otherwise, permanent scarring alopecia results. It represents a pressure phenomenon evident worldwide in both non-Sub-Saharan lineage and Sub-Saharan lineage individuals.
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Dermoscopic Evaluation of Longitudinal Melanonychia in Children: A Prospective Study p. 445
Mahshid Sadat Ansari, Hamidreza Mahmoudi, Ali Sadeghinia, Shadi Azizzadeh-Roodpishi, Alireza Ghanadan, Maryam Daneshpazhooh
Background: Longitudinal melanonychia (LM) is a worrisome sign in both children and adults. Nail apparatus melanoma (NAM) can be related to LM, but it is very rare in children. Dermoscopic signs of benign lesions in children can be similar to melanoma; therefore, it is important to review dermoscopy of LM in children to make the best decision in performing biopsy. Aims: Biopsy taking is very challenging in LM in children. Most lesions are benign in children. The aim of this study was to review dermoscopic signs of LM in children and compare them with adults. Materials and Methods: In this prospective study a total of 108 LM (35 children and 73 adults) were undergone dermoscopy of LM. Dermoscopic features were compared in children and adults; both for benign lesions proven by biopsy or follow up and melanomas diagnosed histopathologically. Results: Black background, black band color, band color diversity and pseudo-Hutchinson's sign were more frequent in children in comparison with benign adult melanonychia. Some children's dermoscopic features of LM such as broad band width, Band color diversity, Hutchinson's sign, gray band color, asymmetry of pattern, and regression were similar to melanoma, but we did not find any melanoma by biopsy and/or follow up among children. We also detected the newly described "zigzag" pattern in four children. Conclusion: Dermatologists should consider all dermoscopic features of a lesion, dermoscopic sign changes in follow-up, medical, and familial history of the patient in deciding to perform biopsy of LM in children.
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Evaluation of the Knowledge, Attitude and Practice of Patients on Immunosuppressive Drugs Towards COVID-19 Attending Dermatology Department- A Multicentric Cross-Section Study p. 446
Alpana Mohta, Achala Mohta, Radhe Shyam Nai, Aakanksha Arora, Aditi Aggrawal, Suresh Kumar Jain, Rajesh Dutt Mehta, Arti Singh
Background: The deadly COVID-19 (Coronavirus Disease 2019) or SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) was identified for the first time in December 2019 from Wuhan, China, and by the beginning of March 2020, it was declared a pandemic by the World Health Organization (WHO). Despite so many government regulations and awareness measures, there is still a lacuna between the gravity of illness and the knowledge of the average person toward it. Objective: We aimed at assessing the knowledge, attitude, and behavioral practice (KAP) of patients on immunosuppressive medication attending the dermatology department toward, COVID-19. Material and Methods: A self-designed printed/digital questionnaire consisting of 30 questions (Hindi and English) was supplied to patients being treated with any systemic immunosuppressives (for at least 3 weeks), for any dermatological ailment. The questionnaire consisted of 12 questions assessing the knowledge, 11 for attitude, and 7 for practices of patients toward COVID-19. Results: The study included 237 patients with a mean age of 44.57 ± 13.72 years. The correct knowledge toward COVID-19 was present in 126 (53.16%) patients with a mean score of 7.79 ± 3.08 out of 13. The mean attitude score was 8.35 ± 2.16 (out of 11) while the mean score of practice was 5.64 ± 2.03 (out of 8). Increased hygiene levels were seen in 220 (92.83%) patients. Sixty-six (27.85%) patients admitted to stopping their prescribed immunosuppressives by themselves during COVID-19 and a significant proportion agreed to the use of alternative medicines with questionable efficacy (n = 91; 38.39%). A significant difference in KAP was found across various strata of society like gender, age, socioeconomic status, literacy, and residence (P < 0.001). Limitations: Our study was limited by small sample size, absence of a control group with healthy individuals, and short duration of the study. Conclusions: Most of the participants had poor knowledge, a positive attitude, and good practices toward COVID-19. Proper counseling of patients and the use of telemedicine could help combat the gap in KAP without compromising the healthcare facilities needed for the management of such patients.
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Filarial Bursitis Complicating Leprosy Reaction p. 446
Ghanshyam K Verma, Saru Thakur, Gita R Tegta, Ajeet K Negi
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Bilateral Morphea en coup de sabre. A Rare Presentation p. 446
Pablo Vargas-Mora, Diego Orlandi, Ligia Aranibar, Claudia Morales
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Low-Dose Oral Retinoid Combined with Topical Therapy Successfully Treats Punctate Palmoplantar Keratoderma Lesions Misdiagnosed as Corns: A Case Report p. 446
Joon Woo Jung, Eun Hye Hong, Eun Joo Park, Kwang Joong Kim, Kwang Ho Kim
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Ulcerated Nodule over a Laproscopic Scar: An Unusual Presentation of Cutaneous Plasmacytoses? p. 447
Anupama Bains, Deepak Vedant, Poonam Elhence, Afroz Alam
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Human Papillomavirus Genotyping in Cutaneous Warts of Koreans by Sequencing p. 447
Kang Su Kim, Jae Seok Kim, Joon Ki Kim, Si Young Yang, Chul Woo Kim, Sang Seok Kim
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Immune-Mediated Necrotizing Myositis Presenting with Cutaneous Lesions p. 447
Bruno de Castro e Souza, Isaura A Fasciani, Bethania C C Swiczar, Rodrigo de H Mendonça, Neusa Y S Valente
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Umbilicated Papules as a Rare Manifestation of Borderline Lepromatous Leprosy p. 447
Piyush Kumar, Anupam Das, Priya Rajbansh, Mamta Yadav
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Penile Pyoderma Gangrenosum: A Mimicker to Know p. 447
Khallaayoune Mehdi, Palamino Hind, Meziane Mariame, Senouci Karima
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Unmasking Facial Tinea in the COVID-19 Era p. 448
Anil Abraham, Karalikkattil T Ashique
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