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2013| March-April | Volume 58 | Issue 2
Online since
March 5, 2013
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E–IJD®-STUDY
A comparative study of the efficacy of 4% hydroquinone vs 0.75% Kojic acid cream in the treatment of facial melasma
Rochelle C Monteiro, B Nanda Kishore, Ramesh M Bhat, D Sukumar, Jacintha Martis, H Kamath Ganesh
March-April 2013, 58(2):157-157
DOI
:10.4103/0019-5154.108070
PMID
:23716817
Background:
Melasma is a common acquired cause of facial hyperpigmentation seen predominantly among females with significant psychological and social impact. It is often recalcitrant to treatment. Several topical hypopigmenting agents have been used to combat melasma. Hydroquinone and Kojic Acid are well established monotherapeutic agents for treating melasma.
Objectives:
This study focuses mainly on the efficacy of once daily application of 4% Hydroquinone and 0.75% Kojic Acid cream (containing 0.75% Kojic acid and 2.5% vitamin C) so as to determine an effective modality of treatment for facial melasma.
Materials and Methods:
A total number of 60 patients with facial melasma attending the Out-patient department of Dermatology, Venerology and Leprosy, Fr. Muller Medical College Hospital, Mangalore from Oct 2008-April 2010 were studied. Patients were allocated alternately to group A and group B. Group A patients received 4% Hydroquinone cream and group B patient received a Kojic Acid cream (which contained 0.75% Kojic acid and 2.5% vitamin C) and were advised to apply topically once daily at night. Patients were followed up on 4
th
, 8
th
and 12
th
week. At each visit side effects were noted and clinical response to treatment was calculated using the MASI score.
Statistical Methods:
Chi square test, student '
t
' test.
Results:
At the 4
th
week post treatment evaluation, facial hyperpigmentation responded early to 4% Hydroquinone cream than to 0.75% Kojic Acid cream. At the end of 12 week treatment period, 4% Hydroquinone cream had an overall superiority to 0.75% Kojic Acid cream as a topical hypopigmenting agent.
Conclusion:
The results of the study show that 4% Hydroquinone cream is a better topical hypopigmenting agent with rapid rate of clinical improvement when compared to 0.75% Kojic Acid cream.
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REVIEW ARTICLE
Fixed-duration therapy in leprosy: Limitations and opportunities
Munisamy Malathi, Devinder Mohan Thappa
March-April 2013, 58(2):93-100
DOI
:10.4103/0019-5154.108029
PMID
:23716796
Leprosy has been considered a curable disease after the implementation of multidrug therapy (MDT), which has been proven to be safe and effective, by bringing about a significant change in the global and national scenario of leprosy by upgrading the control of leprosy to the next stage of eradication. Since its introduction, the MDT regimens for the treatment of leprosy have undergone several changes especially with regard to the duration of treatment. The advantages of shortened duration of treatment need to be balanced against the risk of relapse and a lot of controversies exist pertaining to this aspect. The fixed-duration (FD) therapy is not popular among academicians and private practitioners who prefer precise diagnosis and treatment with superior MDT regimens and for a longer duration. On the contrary, from a public health-care point of view, precise diagnosis and a longer treatment schedule are not cost effective and not feasible to be implemented in elimination programs. Hence, a fine balance needs to be maintained between achieving a cure for the patient and protecting the society at risk, and this review discusses the various limitations and opportunities of FD therapy with a note on the newer MDT regimens.
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CME ARTICLE
Update on cutaneous calciphylaxis
Uwe Wollina
March-April 2013, 58(2):87-92
DOI
:10.4103/0019-5154.108026
PMID
:23716795
Calciphylaxis is a devastating disorder with a mortality rate of 80% due to sepsis and organ failure. Hallmarks of this rare disease are arteriolar media calcification, thrombotic cutaneous ischemia, and necrotic ulcerations. Different mechanisms of vascular calcification can lead to calciphylaxis. Early diagnosis by deep cutaneous ulcer biopsy is most important for prognosis. Here, dermatologists play a significant role although treatment usually needs an interdisciplinary approach. Surgical procedures had been the cornerstone of treatment in the past including parathyroidectomy, but recently new medical treatments emerged aiming to normalize disturbances of minerals to reduce the serum concentration of sodium phosphate and to prevent precipitation and calcification. Multimodal therapy is warranted but only aggressive surgical debridement of cutaneous ulcers has shown significant outcome improvement.
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314
E–IJD®-CASE REPORTS
Is it lucio phenomenon or necrotic erythema nodosum leprosum?
PSS Ranugha, Laxmisha Chandrashekar, Rashmi Kumari, Devinder M Thappa, Bhawana Badhe
March-April 2013, 58(2):160-160
DOI
:10.4103/0019-5154.108087
PMID
:23716834
Lucio phenomenon (LP) or erythema necroticans is a relatively rare, peculiar reaction pattern occurring in untreated lepromatous (LL) or borderline lepromatous (BL) leprosy cases. A 38-year-old male, a cook by occupation, was referred to the dermatology clinic from otolaryngology department with blistering over both the hands and feet of 2 days duration. He had been admitted 1 week back with epistaxis and nasopharyngeal myiasis in otolaryngology department. He was started on systemic antibiotics gentamycin, crystalline penicillin, and metronidazole with nasal instillation of turpentine oil 2 drops 6 times a day. Two days later, he had developed edema with painless hemorrhagic blistering over the dorsum of left hand followed by involvement of the right hand, dorsa of both feet, and both the earlobes within a day. Histopathology of the blister showed sub-epidermal blister, with necrotizing leukocytoclastic vasculitis of papillary dermal vessels with thrombosis, numerous acid-fast bacilli in macrophages, and macrophage granulomas extending up to subcutis. In view of the absent fever or constitutional symptoms, and the classical angular infarcts and hemorrhagic blisters evolving into ulcers with angulated margins, we considered LP as the most likely diagnosis. The patient was started on a combination of WHO recommended multibacillary anti-leprosy therapy and prednisolone (40 mg/day).
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Porokeratoma: A different entity or a variant of verrucous (Hyperkeratotic) porokeratosis?
Ana Batalla, Elena Rosón, Carlos De la Torre
March-April 2013, 58(2):158-158
DOI
:10.4103/0019-5154.108073
PMID
:23716820
Porokeratoma (acanthoma with features of porokeratosis) is a recently described entity with a distinct pattern of cornoid lamellation and clinically different from typical porokeratosis. We present a case of multiple porokeratomas on the buttock of a 78-year-old man with paraplegia secondary to poliomyelitis and ankylosing spondylarthritis. We briefly review the characteristics and controversies of this new entity.
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E–IJD®-CORRESPONDENCE
Acrodermatitis continua of hallopeau evolving into generalised pustular psoriasis
Poovanur SS Ranugha, Rashmi Kumari, Devinder M Thappa
March-April 2013, 58(2):161-161
DOI
:10.4103/0019-5154.108096
PMID
:23716843
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81
ORIGINAL ARTICLES
Relapse after methylprednisolone oral minipulse therapy in childhood vitiligo: A 12-month follow-up study
Imran Majid, Saher Imran
March-April 2013, 58(2):113-116
DOI
:10.4103/0019-5154.108040
PMID
:23716799
Background:
Oral minipulse (OMP) therapy with methylprednisolone is presently one of the most common oral treatments used for progressive vitiligo in children. The treatment is usually given for a period of 6 months during which majority of patients are reported to go into remission. However, there are no follow-up studies to comment upon what happens to the disease after OMP therapy is withdrawn.
Aim of the study:
To document the incidence of relapse over a period of 1 year after OMP therapy is stopped in children with vitiligo.
Materials and Methods:
The study was conducted in 180 patients of childhood vitiligo (<15 years of age) who had been on OMP therapy with oral methylprednisolone for at least 6 months and who had achieved a complete remission of their disease during the treatment period. The enrolled patients were followed up for a period of 1 year and examined clinically for any sign of reactivation of their disease over either the old lesions or at any new area of the body.
Results:
Forty-two patients were lost and could not complete the follow-up period of 1 year. Out of the 138 patients available at the end of 1 year, relapse was observed in 48 patients (34.8%). Rest of 90 patients remained in remission over the follow-up period of 1 year. Relapse was more common in patients below 10 years of age (47.4%) as compared with older children (25.9%).
Conclusion:
Relapse after using methylprednisolone OMP therapy in children with vitiligo is quite common especially in younger age groups. Studies are needed to see whether these relapses could be avoided by giving the treatment for a period longer than 6 months.
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E-IJD®- REVIEW ARTICLE
Macrophage migration inhibitory factor as an incriminating agent in dermatological disorders
Nader Pazyar, Amir Feily, Reza Yaghoobi
March-April 2013, 58(2):157-157
DOI
:10.4103/0019-5154.108068
PMID
:23716815
Macrophage migration inhibitory factor (MIF) is a critical immunoregulatory pluripotent cytokine. It has been re-evaluated as a proinflammatory cytokine, pituitary hormone and glucocorticoid-induced immunoregulatory protein. MIF exists in human epidermis, especially in the basal layer and also is expressed constitutively by monocytes/macrophages, T cells, B cells, endocrine, and epithelial cells. In the field of dermatology, MIF is believed to be a detrimental factor in inflammatory dermatological diseases including atopic dermatitis (AD), psoriasis, vitiligo, pemphigus vulgaris, bullous pemphigoid (BP), alopecia areata (AA) as well as other conditions such as photoaging, and photocarcinigenesis. The objective of this review is to gather and summarize MIF related disorders in dermatology and present valuable information for readers and researchers.
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6
4,474
145
E–IJD®-CASE REPORTS
Leukocyte adhesion defect type 1 presenting with recurrent pyoderma gangrenosum
Neha Thakur, Ravitanya Sodani, Jagdish Chandra, Varinder Singh
March-April 2013, 58(2):158-158
DOI
:10.4103/0019-5154.108076
PMID
:23716823
Leukocyte adhesion deficiency 1 (LAD-1) is a rare autosomal recessive disorder of leukocyte function. LAD-1 affects about 1 per 10 million individuals and is characterized by recurrent bacterial and fungal infections and depressed inflammatory responses despite striking blood neutrophilia. Patients with the severe clinical form of LAD-1 express <0.3% of the normal amount of the β
2
-integrin molecules, whereas patients with the moderate phenotype may express 2-7%. Skin infection may progress to large chronic ulcers with polymicrobial infection, including anaerobic organisms. The ulcers heal slowly, require months of antibiotic treatment, and often require plastic surgical grafting. The diagnosis of LAD-1 is established most readily by flow cytometric measurements of surface CD11b in stimulated and unstimulated neutrophils using monoclonal antibodies directed against CD11b. Pyoderma gangrenosum (PG) is an uncommon condition characterized by recurrent sterile, inflammatory skin ulcers. Commonly, PG occurs in the context of inflammatory bowel disease or rheumatic, hematologic, or immunologic disorders. Here, we present a 5-year-old female with a long history of PG, which healed with atrophic scarring, who was ultimately diagnosed with leukocyte adhesion deficiency type 1 (LAD1). She had a good response to high-dose prednisone therapy (2 mg/kg) and was discharged after 3 weeks of admission but only to be re-admitted 3 weeks later with severe pneumonia. During hospital stay, she developed pneumothorax and pneumomediastinum and later succumbed to her illness.
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E–IJD®-RESIDENTS PAGE
Annular lesions in dermatology
Naveen Kikkeri Narayanasetty, Varadraj V Pai, Sharatchandra B Athanikar
March-April 2013, 58(2):157-157
DOI
:10.4103/0019-5154.108071
PMID
:23716818
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E–IJD®-STUDY
Evaluation of
Demodex folliculorum
as a risk factor for the diagnosis of rosacea in skin biopsies. Mexico's general hospital (1975-2010)
Jose M Ríos-Yuil, Patricia Mercadillo-Perez
March-April 2013, 58(2):157-157
DOI
:10.4103/0019-5154.108069
PMID
:23716816
Context:
Rosacea significantly affects the quality of life and its pathophysiology is not well understood. It has been suggested that the presence of
Demodex folliculorum
in the affected skin could be related to the development of rosacea.
Aims:
To study the risk for association between the presence of
D. folliculorum
in skin biopsies and the diagnosis of rosacea.
Settings and Design:
Analytical, observational, retrospective, case-control study.
Materials and Methods:
Skin biopsies of patients diagnosed clinically as rosacea and the same number of controls were studied. The controls were selected among the facial skin biopsies that were not diagnosed as rosacea. All the slides were analyzed for the presence of
D. folliculorum
and the density of the infestation was assessed.
Statistical Analysis Used:
Absolute/relative frequencies, mean, standard deviation, odds ratio (OR), Chi square and Independent Student
t
-test with Epi Info v. 3.4.3
.
Results:
D. folliculorum
was present in 80% of the skin biopsies of rosacea patients and in 30% of the controls. The risk of suffering rosacea was increased among persons infested with the mite (OR = 9.33 [95% confidence interval: 2.85-30.60];
P
= 0.0001). The mean infestation density among the cases was 1.908 for every 10 high-power fields while it was 0.718 among the controls (
P
< 0.005). There were no statistically significant differences among the groups with regard to sex and age.
Conclusions:
The presence of
D. folliculorum
in skin biopsies is associated with the diagnosis of rosacea. The infestation density was increased among the patients with rosacea.
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SYMPOSIUM
Evidence-based integrative dermatology
Saravu R Narahari, Kodimoole S Prasanna, Kandathu V Sushma
March-April 2013, 58(2):127-131
DOI
:10.4103/0019-5154.108046
PMID
:23716802
American recognition for medical pluralism arrived in 1991. The National Center for Complementary and Alternative Medicine was established under the National Institutes of Health in 1998. Following this, patients and researchers began exploring use of integrative medicine. Terence Ryan with Gerry Bodeker in Europe, Brian Berman in America, and the Indian council of Medical Research advocated traditional medicine and integrative medicine. The Institute of Applied Dermatology (IAD), Kerala has developed integrated allopathic (biomedical) and ayurvedic therapies to treat Lymphatic Filariasis, Lichen planus, and Vitiligo. Studies conducted at the IAD have created a framework for evidence-based and integrative dermatology (ID). This paper gives an overview of advances in ID with an example of Lichen Planus, which was examined jointly by dermatologists and Ayurveda doctors. The clinical presentation in these patients was listed in a
vikruthi
table of comparable biomedical terms. A
vikruthi
table was used for drug selection in ayurvedic dermatology. A total of 19 patients were treated with ayurvedic prescriptions to normalize the
vatha-kapha
for 3 months. All patients responded and no side effects were recorded. In spite of advancing knowledge on ID, several challenges remain for its use on difficult to treat chronic skin diseases. The formation of new integrative groups and financial support are essential for the growth of ID in India.
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145
E–IJD®-CASE REPORTS
CD30+ large cell transformation of mycosis fungoides during pregnancy
Farahnaz Fatemi Naeini, Jamshid Najafian, Mohammadali Nilforoushzadeh
March-April 2013, 58(2):160-160
DOI
:10.4103/0019-5154.108090
PMID
:23716837
Mycosis fungoides (MF) a cutaneous T-cell lymphoma, is a subgroup of non-Hodgkin's lymphomas, characterized by skin infiltration and occasionally systemic involvement. MF coincidence with pregnancy is rare. The effect of pregnancy on MF and the effect of this disease on pregnancy are still unknown. There are few case reports about pregnancy and its deleterious effect on the clinical course of MF. This case report is about a 30-years-old female with MF who became pregnant and after delivery developed CD30+ large cell transformation; this is the first report of large cell transformation of MF related to pregnancy.
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3,953
37
E–IJD®-CORRESPONDENCE
Methotrexate-induced toxic epidermal necrolysis in a child
Ajay Gogia, Subha Pathania, Prasenjit Das, Yogendra K Gupta, Sameer Bakhshi
March-April 2013, 58(2):161-161
DOI
:10.4103/0019-5154.108094
PMID
:23716841
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ORIGINAL ARTICLES
Incidence and care of environmental dermatoses in the high-altitude region of Ladakh, India
GK Singh, Manas Chatterjee, RS Grewal, Rajesh Verma
March-April 2013, 58(2):107-112
DOI
:10.4103/0019-5154.108038
PMID
:23716798
Background
: Low humidity, high-velocity wind, excessive ultraviolet (UV) exposure, and extreme cold temperature are the main causes of various types of environmental dermatoses in high altitudes.
Materials and Methods:
A retrospective study was carried out in patients visiting the lone dermatology department in Ladakh between July 2009 and June 2010. The aim was to identify the common environmental dermatoses in high altitudes so that they can be treated easily or prevented. The patients were divided into three demographic groups, namely, lowlanders, Ladakhis (native highlanders), and tourists. Data was analyzed in a tabulated fashion.
Results:
A total of 1,567 patients with skin ailments were seen, of whom 965 were lowlanders, 512 native Ladakhis, and 90 were tourists. The skin disorders due to UV rays, dry skin, and papular urticaria were common among all groups. The frequency of melasma (
n
= 42; 49.4%), chronic actinic dermatitis (CAD) (
n
= 18; 81.81% of total CAD cases), and actinic cheilitis (
n
= 3; 100%) was much higher among the native Ladakhis. The frequency of cold-related injuries was much lesser among Ladakhis (
n
= 1; 1.19%) than lowlanders (
n
= 70; 83.33%) and tourists (
n
= 13; 15.47%) (
P
< 0.05).
Conclusion:
Dryness of skin, tanning, acute or chronic sunburn, polymorphic light reaction, CAD, insect bite reactions, chilblain, and frostbite are common environmental dermatoses of high altitudes. Avoidance of frequent application of soap, application of adequate and suitable emollient, use of effective sunscreen, and wearing of protective clothing are important guidelines for skin care in this region.
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BASIC RESEARCH
The role of EGFR/ERK/ELK-1 MAP kinase pathway in the underlying damage to diabetic rat skin
Xinhong Ge, Zhiyun Shi, Nan Yu, Yaning Jiao, Li Jin, Jianzhong Zhang
March-April 2013, 58(2):101-106
DOI
:10.4103/0019-5154.108035
PMID
:23716797
Background:
Diabetes mellitus (DM) is a highly prevalent disease. Atrophy and spontaneous ulcers are the most common cutaneous manifestation of diabetic dermopathy (DD). Before spontaneous ulcers, we believe there is an underlying damage stage although the mechanism is unknown.
Aims:
To explore the expression of extracellular signal-regulated kinase1/2 (ERK1/2), its correlated upstream protein epidermal growth factor receptor (EGFR) and its downstream transcription factor E twenty-six (ETS)-like 1(ELK-1)in the damage of the diabetic rat skin, and to explore the role of ERK1/2 on the recessive damage to diabetic rat skin.
Materials and Methods:
Eighty Sprague-Dawley (SD) rats weighing 260-300 g were randomly divided into control and streptozotocin (STZ)-induced diabetes groups. After 0.5, 2, 4, and 8 weeks, the shaved skin specimens from the back of rats in both groups were collected to observe the histological characteristics of the skin, to measure the thickness of the epidermis and the dermis, and to observe the ultrastructure. Immunohistochemistry (IHC) and Western blot techniques were used to detect the expression and activation of ERK1/2, EGFR, ELK-1 in the skin of the rats. Results: There are ultrastructural changes in the DM skin. With the continuance of the diabetes course, the thicknesses of the epidermis and dermis decreased, and the expression of phospho-ERK1/2 (P-ERK1/2), EGFR, and ELK-1 was decreased gradually in the back skin of the diabetes rats. It was significantly lower in 4 and 8 week DM than that of the normal control (
P
< 0.05). The expression of P-EGFR and P-ERK1/2 in the back skin of the diabetes rats was positively correlated (
r
= 0.572
P
< 0.05), and the positive correlation was also obtained between P-ERK1/2 and P-ELK-1 (
r
= 0.715,
P
< 0.05). Conclusion: The phenomenon of recessive damage exists in the skin of diabetes rats, which probably may relate to the weakness of the signal transduction: P-EGFR → ERK1/2 → ELK-1.
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CASE REPORT
Multifocal fixed drug eruption with COX-2 inhibitor-celecoxib
Shikha Chugh, Rashmi Sarkar, Vijay K Garg, Avninder Singh, Chitralekha Keisham
March-April 2013, 58(2):142-144
DOI
:10.4103/0019-5154.108057
PMID
:23716804
Cyclooxygenase-2 (COX-2) inhibitors are rapidly becoming the first choice nonsteroidal anti-inflammatory drugs (NSAIDs) for various rheumatological and other painful conditions. However, they might not be as safe or free of side effects as they are considered to be. These COX-2inhibitors may cause a variety of dermatological and systemic side effects of which we should be aware to avoid their indiscriminate use. We hereby report a case of multifocal fixed drug eruption (FDE) with celecoxib which has not yet been reported in Indian settings.
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3
4,070
69
E–IJD®-CORRESPONDENCE
Facial necrotizing fasciitis disclosing systemic lupus erythematosus
Sunil Kumar, Vikram Kokate, Madhukar Patil, Shraddha Jain
March-April 2013, 58(2):163-163
DOI
:10.4103/0019-5154.108105
PMID
:23716852
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3,291
42
SYMPOSIUM
Collaboration culture in medicine
Saravu R Narahari
March-April 2013, 58(2):124-126
DOI
:10.4103/0019-5154.108042
PMID
:23716801
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3
3,412
69
E–IJD®-CASE REPORTS
Glomeruloid hemangioma in normal individuals
Jyoti Gupta, Rajat Kandhari, V Ramesh, Avninder Singh
March-April 2013, 58(2):160-160
DOI
:10.4103/0019-5154.108088
PMID
:23716835
Glomeruloid hemangioma is a rare, histologically distinctive, cutaneous, benign vascular tumor, originally described by Chan
et al.
Glomeruloid hemangioma appears specific to polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome (POEMS), and is usually, but not always, related to Castleman's disease. We herein report two cases with glomeruloid hemangioma, without any features of the POEMS syndrome. Glomeruloid hemangioma requires a high index of suspicion for diagnosis. It could rarely present as a solitary finding, without any evidence of an underlying POEMS syndrome.
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Cutaneous changes in fibrous hamartoma of infancy
Pilar F-Eire, Joaquin Gonzalez-Carrero Fojon
March-April 2013, 58(2):160-160
DOI
:10.4103/0019-5154.108089
PMID
:23716836
Only a few published case of fibrous hamartoma of infancy (FHI) have commented on the changes in the overlying skin. There are descriptions of individual cases with cutaneous hyperpigmentation, hypertrichosis and hyperhidrosis. It is interesting to describe our case because, to our knowledge, the altered pigmentation of the overlying skin, with hairs on the surface, and eccrine gland hyperplasia combined with abortive hair follicles has not been reported together in association with the FHI. We recommend that all the biopsies must be excisional including overlying skin, thus the epidermal and dermal adnexal changes can be assessed in the microscopic evaluation which could have relevant implications from clinical and embryological point of view.
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Disabling pansclerotic morphea of childhood with extracutaneous manifestations
Mahendra M Kura, Saurabh R Jindal
March-April 2013, 58(2):159-159
DOI
:10.4103/0019-5154.108079
PMID
:23716826
Disabling pansclerotic morphea (DPM) of childhood is a rare generalized type of localized scleroderma (LS) that is known to follow an aggressive course with pansclerotic lesions leading to severe joint contractures and consequent immobility. Mortality is due to complications of the disease such as bronchopneumonia, sepsis, or gangrene. There is no specific laboratory finding. Treatment protocols are still evolving for this severe recalcitrant disorder. Extracutaneous manifestations are rarely reported in DPM. We present the case of a 7-year-old girl with DPM with severe extracutaneous manifestations in the form of gastrointestinal and vascular disease, whose disease progressed rapidly. In spite of treatment with methotrexate, corticosteroids, and PUVA therapy, she ultimately succumbed to her illness due to sepsis.
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72
Adenoid type of basal cell carcinoma: Rare histopathological variant at an unusual location
Swagata A Tambe, Smita S Ghate, Hemangi R Jerajani
March-April 2013, 58(2):159-159
DOI
:10.4103/0019-5154.108080
PMID
:23716827
Basal Cell Carcinoma (BCC) is almost exclusively seen in head-neck region with rare involvement of trunk and extremities. The tumour is commonly seen on nose, eyelids, at the inner canthus of eyes and behind the ears. Adenoid type of BCC is one of the rare histopathological types of BCC which has not found to have any site predilection. We report two cases of BCC occurring at an unusual site i.e., lower back and both of them showed adenoid type of BCC on histopathology. Morphologically they were pigmented and ulcerative type of BCC respectively.
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2
5,500
82
Unilateral multi-segmental leiomyomas: A report of rare case
Chandramohan Kudligi, Binod K Khaitan, Pradeep Vittal Bhagwat, Dinesh Prasad Asati
March-April 2013, 58(2):160-160
DOI
:10.4103/0019-5154.108086
PMID
:23716833
A 30-year-old female presented to us with multiple tender erythematous papules and nodules. These lesions showed multi-segmental distribution along 5
th
cervical, 6
th
dorsal, and 1
st
sacral segments of right half of the body. Histopathological examination confirmed the clinical diagnosis of leiomyoma. Patient was started on nifedipine 10 mg thrice-daily with significant symptomatic improvement in 3 months. Though segmental distribution of leiomyoma is common, unilateral multi-segmental distribution has not been so far reported in the literature. Hence, the case is being reported for its rare presentation and the need for long-term follow-up in view of its association with aggressive renal carcinoma.
[ABSTRACT]
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2
3,414
42
E–IJD®-CORRESPONDENCE
Hypopigmented mycosis fungoides in a Chinese woman
Jiang-An Zhang, Jian-Bin Yu
March-April 2013, 58(2):161-161
DOI
:10.4103/0019-5154.108093
PMID
:23716840
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2
3,525
39
Bullous type II reaction in leprosy: A diagnostic dillemma
Bikash Ranjan Kar, Kanaklata Dash
March-April 2013, 58(2):162-162
DOI
:10.4103/0019-5154.108101
PMID
:23716848
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2
3,562
77
Steroid-resistant localized lymphomatoid papulosis treated with local bath-puva therapy
Enzo Errichetti, Angelo Piccirillo, Federico Ricciuti, Francesco Ricciuti
March-April 2013, 58(2):163-163
DOI
:10.4103/0019-5154.108109
PMID
:23716855
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2
3,671
24
SYMPOSIUM
Integrative medicine selects best practice from public health and biomedicine
Terence J Ryan
March-April 2013, 58(2):132-141
DOI
:10.4103/0019-5154.108049
PMID
:23716803
The meaning of terms Integrated and Integrative are described variously by an amalgam of latest scientific advances with ancient healing systems, of complementary medicine and biomedicine, and sexually transmitted infections and HIV/AIDS. It means seamless good quality care between hospital and primary care. They provoke approval mostly from patients and disapproval mostly from advocates of science and evidence-based medicine. The Institute of Applied Dermatology in Kasaragod, Kerala, India has championed a mix of Biomedicine, Yoga and herbals from Ayurvedic medicine, partly based on publications from the Department of Dermatology of the University of Oxford. In Oxford dermatology, acceptance of value of integrative medicine (IM) is demonstrated, especially in wound healing and the skin's blood supply. This has long featured in the university's research program. A variety of approaches to the practice of medicine are illustrated with reference to Osler, Garrod, and Doll. IM is believed to underlie contemporarily best practice. Particular emphasis is given to the control of heat, pain, redness, and swelling, all manifestations of inflammation, and the importance of emotion as a stimulus or inhibitor carried by neural pathways. These may explain some
unbelievable
Asian practices and one of the many roles of Yoga. The concept of Integrative is expanded to include care of the earth and nutrition, the hazards of climate change,
Gardens
for
Health,
do
(k) no (w)
harm
as a key to good practice.
[ABSTRACT]
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2
6,514
83
CORRESPONDENCE
Onychoheterotopia: A unique case
Kingshuk Chatterjee, Anita Chaudhuri, Gautam Chatterjee
March-April 2013, 58(2):150-151
DOI
:10.4103/0019-5154.108064
PMID
:23716811
[FULL TEXT]
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1
3,128
60
Multicentric squamous cell carcinoma arising on psoriatic plaque
Megha Gupta, Jayanta K Das, Asok Gangopadhyay
March-April 2013, 58(2):151-153
DOI
:10.4103/0019-5154.108065
PMID
:23716812
[FULL TEXT]
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1
4,310
35
Keloids in scleroderma-keloidal scleroderma: A unique entity
Sumit Sen, Tanusree Biswas, Gautam Banerje, Saugato Biswas
March-April 2013, 58(2):153-154
DOI
:10.4103/0019-5154.108066
PMID
:23716813
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1
5,571
49
A comment on: "Update on photoprotection"
Prasan R Bhandari
March-April 2013, 58(2):145-145
PMID
:23716805
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1
3,051
96
E–IJD®-CASE REPORTS
Angiolymphoid hyperplasia with eosinophilia with follicular mucinosis
Rameshwar Gutte, Bhavana Doshi, Uday Khopkar
March-April 2013, 58(2):159-159
DOI
:10.4103/0019-5154.108081
PMID
:23716828
Follicular mucinosis occurring along with angiolymphoid hyperplasia with eosinophils (ALHE) has been described in a 49-year-old male. The patient presented with pruritic hyperpigmented papules and nodules on the vertex and right parietal scalp. There was no any other complaint. Histopathological examination from one of the papule showed prominent blood vessels in the dermis lined by plump histiocytoid endothelial cells that were surrounded by a dense lymphoid infiltrate with numerous eosinophils; these findings are typical of angiolymphoid hyperplasia with eosinophilia. Features of follicular mucinosis were observed in the same section with 3 hyperplastic follicular infundibula containing pools of mucin in the infundibular epithelium. The concurrent occurrence of these 2 distinct histopathological patterns in the same biopsy specimen has been reported rarely.
[ABSTRACT]
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1
5,546
90
Chondroid syringoma: A case with unusual cytological findings
Kalyan Khan
March-April 2013, 58(2):157-157
DOI
:10.4103/0019-5154.108072
PMID
:23716819
Chondroid syringoma is a rare benign skin adnexal tumor, the cytological features of which have been published very rarely in the literature. A mucoid aspirate, abundant chondromyxoid matrix material, and epithelial components were suggested as diagnostic criteria. The reported case is one of chondroid syringoma confirmed by histopathology, the fine needle aspiration cytology of which yielded thin fluid-like material and microscopy revealed epithelial clusters with admixed smaller myoepithelial cells, background cyst macrophages, and only scanty chondromyxoid stromal elements. Including these cytological features of the present case among the diagnostic criteria for cytodiagnosis of chondroid syringomas might increase the chances of a definitive preoperative diagnosis and help in planning the extent of surgery.
[ABSTRACT]
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1
4,890
71
Nevus depigmentosus treated with suction blister grafting: Follow-up after 10 years
Bikash Ranjan Kar
March-April 2013, 58(2):158-158
DOI
:10.4103/0019-5154.108074
PMID
:23716821
Nevus depigmentosus is a congenital hypomelanotic condition for which no effective treatments are available. The hypopigmentation is permanent and enlarges in proportion with growth in the person. Here, I report a patient of nevus depigmentosus on whom we performed suction blister grafting and the resultant pigmentation was satisfactory even at a follow-up after 10 years.
[ABSTRACT]
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1
8,055
67
Rhino cerebral mucormycosis in systemic lupus erythematosus
Parimalam Kumar, C Zohra Begum, P Thirumaran, K Manoharan
March-April 2013, 58(2):158-158
DOI
:10.4103/0019-5154.108075
PMID
:23716822
Systemic lupus erythematosus (SLE) is a multisystem connective tissue disease. Patients with SLE develop cutaneous infections due to immune dysregulation and treatment with immunosuppressive agents. Deep fungal infections are rare in SLE but are important cause of morbidity. We report a case of successfully treated rhino cerebral mucormycosis (RCM) in a female patient with SLE.
[ABSTRACT]
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1
4,190
48
Infantile digital fibromatosis (inclusion body fibromatosis) observed in a baby without finger involvement
Avni Kaya, Sevil Ari Yuca, Kamuran Karaman, Remzi Erten, Murat Dogan, Mehmet Selcuk Bektas, Lokman Ustyol
March-April 2013, 58(2):160-160
DOI
:10.4103/0019-5154.108085
PMID
:23716832
A 9-day-old male baby was hospitalized after his birth due to some swells under the skin. The hard consistency nodules observed under the skin all over the body of the patient were of different size, and presented lesions, among which the biggest was 1 × 1 cm. No lesions were observed on the fingers. By superficial ultrasonography, multiple isoechoic hypoechoic lesions were observed among the muscle plan. In thoracolumbar magnetic resonance imaging, multiple massif lesions retaining peripheral contrast (the biggest was 1.7 × 1.4 cm large) had been observed under the skin muscle plans, between the muscles of the extremities. The biopsy was positive for smooth muscle actin, but negative for desmin, S100, and CD34. These findings were diagnosed as infantile digital fibromatosis (IDF) (inclusion body fibromatosis). The case was presented with an objective to illustrate and remind that IDF can be observed in babies without finger involvement.
[ABSTRACT]
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1
6,302
40
Perforating dermatosis in a patient receiving azathioprine
Emiliano Grillo, Sergio Vano-Galván, Carmen Moreno, Pedro Jaén
March-April 2013, 58(2):158-158
DOI
:10.4103/0019-5154.108077
PMID
:23716824
Azathioprine (AZA) is an imidazole derivative of mercaptopurine. It antagonizes purine metabolism, and it may inhibit synthesis of DNA, RNA, and proteins. The 6-thioguanine nucleotides appear to mediate the majority of AZAs immunosuppressive and toxic effects. While cutaneous adverse side-effects are not uncommon, perforating dermatosis has not been reported in association to AZA. We speculate that immunological disorders induced by AZA in susceptible individuals could be related to perforating dermatosis.
[ABSTRACT]
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1
3,679
47
Inflammatory linear verrucous epidermal nevus in perineum and vulva: A report of two rare cases
Falguni Nag, Arghyaprasun Ghosh, Trupti V Surana, Saugato Biswas, Anusree Gangopadhyay, Gobinda Chatterjee
March-April 2013, 58(2):158-158
DOI
:10.4103/0019-5154.108078
PMID
:23716825
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1
5,539
64
Subcutaneous pheohyphomycosis presenting as a innocuous pustule
Varadraj Vasant Pai, Kikkeri Narayanshetty Naveen, Keloji Hanumanthayya, Udupi Shastry Dinesh
March-April 2013, 58(2):159-159
DOI
:10.4103/0019-5154.108083
PMID
:23716830
Pheohyphomycosis is a rare heterogeneous group of mycotic infections caused by dematiaceous (phaeoid) fungi affecting the skin, subcutaneous tissue, and central nervous system. Herein, we report a case of 29-year-old man with innocuous pustule over the right index finger. Examination revealed a subcutaneous swelling with pustules over the surface. Biopsy revealed phaeoid fungi, and diagnosis of subcutaneous pheohyphomycosis was made.
[ABSTRACT]
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1
4,097
58
E–IJD®-CORRESPONDENCE
Monitoring the disease activity in pemphigus by direct immunofluorescence of plucked hair: A pilot study
Raghavendra Rao, Kavitha Dasari, Shrutakirthi D Shenoi, C Balachandran, P Dinesh
March-April 2013, 58(2):164-164
DOI
:10.4103/0019-5154.108111
PMID
:23716856
[FULL TEXT]
[PDF]
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[CITATIONS]
[PubMed]
1
3,188
95
A case of desmoplastic trichoepithelioma with ossification
Makoto Wada, Keiji Hanada, Fuminao Kanehisa, Jun Asai, Hideya Takenaka, Norito Katoh
March-April 2013, 58(2):164-164
DOI
:10.4103/0019-5154.108112
PMID
:23716857
[FULL TEXT]
[PDF]
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[EPub]
[CITATIONS]
[PubMed]
1
3,609
36
A case of sarcoidosis in a patient with systemic sclerosis
Taro Isohisa, Noriaki Nakai, Keiji Hanada, Hideya Takenaka, Norito Katoh
March-April 2013, 58(2):165-165
DOI
:10.4103/0019-5154.108119
PMID
:23716863
[FULL TEXT]
[PDF]
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[EPub]
[CITATIONS]
[PubMed]
1
2,639
33
Waterhouse-Friderichsen syndrome in an adult patient with meningococcal meningitis
Viral N Shah
March-April 2013, 58(2):161-161
DOI
:10.4103/0019-5154.108095
PMID
:23716842
[FULL TEXT]
[PDF]
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[CITATIONS]
[PubMed]
1
2,586
27
Congenital melanocytic nevus admixed with speckled lentiginous nevus
Nam-Ji Jeong, Seung-Bae Park, Young Lee, Young-Joon Seo, Jeung-Hoon Lee, Myung Im
March-April 2013, 58(2):161-161
DOI
:10.4103/0019-5154.108091
PMID
:23716838
[FULL TEXT]
[PDF]
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[PubMed]
1
3,644
44
Hyperkeratosis lenticularis perstans: Case report of a rare entity
Krina B Patel
March-April 2013, 58(2):161-161
DOI
:10.4103/0019-5154.108092
PMID
:23716839
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[PubMed]
1
7,898
59
CORRESPONDENCE
Authors' reply
Reena Rai, C Shanmuga Sekar, CR Srinivas
March-April 2013, 58(2):146-146
[FULL TEXT]
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1,801
31
Ballpoint pen as diagnostic tool
Viroj Wiwanitkit
March-April 2013, 58(2):146-146
DOI
:10.4103/0019-5154.108060
PMID
:23716807
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2,927
130
Author's reply
Kiran V Godse
March-April 2013, 58(2):146-147
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1,936
36
Positron emission tomography for staging and response assessment of mycosis fungoides in a child
Indranil Ghosh, M Ramam, Somesh Gupta, Manoj K Singh, Pramod K Julka, Punit Sharma, Sameer Bakhshi
March-April 2013, 58(2):147-148
DOI
:10.4103/0019-5154.108062
PMID
:23716809
[FULL TEXT]
[PDF]
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[PubMed]
-
2,991
38
Higher doses for heavy hives
Kiran Godse, Nidhisingh Tandon, Sharmila Patil, Nitin Nadkarni
March-April 2013, 58(2):149-150
DOI
:10.4103/0019-5154.108063
PMID
:23716810
[FULL TEXT]
[PDF]
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-
2,944
77
E-IJD®-QUIZ
A child in horse-riding stance
Arun C Inamadar, Aparna Palit, S Ragunatha
March-April 2013, 58(2):165-165
DOI
:10.4103/0019-5154.108120
PMID
:23716864
[FULL TEXT]
[PDF]
[Mobile Full text]
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[PubMed]
-
2,908
104
E–IJD®-CASE REPORTS
Unilateral multiple facial angiofibromas: A case report with brief review of literature
Rameshwar Gutte, Uday Khopkar
March-April 2013, 58(2):159-159
DOI
:10.4103/0019-5154.108084
PMID
:23716831
Tuberous sclerosis (TSC) is an autosomal dominant hereditary condition with many varied forms of clinical presentation. The most frequent cutaneous findings in TSC include multiple angiofibromas, hypopigmented macules, periungual fibromas, and shagreen patch. Rarely, unilateral multiple facial angiofibromas have been reported. We report a case of unilateral multiple facial angiofibromas without any other manifestations of TSC. Although rare, unilateral multiple facial angiofibromas may be a mosaic form of TSC.
[ABSTRACT]
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0
0
Hyperkeratotic warty skin lesion of foot caused by
Fusarium oxysporum
Ravinder Kaur, Megha Maheshwari
March-April 2013, 58(2):159-159
DOI
:10.4103/0019-5154.108082
PMID
:23716829
Fusarium
species are common soil-inhabiting organisms and plant pathogens. Human infections are usually precipitated by local or systemic predisposing factors, and disseminated infection is associated with impaired immune responses. Skin infections caused by
Fusarium
spp. include keratitis, onychomycosis, mycetoma, painful discrete erythematous nodules. Hyperkeratotic skin lesions caused by
Fusarium
spp. are, however, rarely reported. We report a case of hyperkeratotic verrucous warty skin lesion in the foot of a 50-year-old immunocompetent male, farmer by occupation.
[ABSTRACT]
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4,758
57
E–IJD®-CORRESPONDENCE
Panitumumab-induced acneiform rash in a patient with metastatic colon adenocarcinoma
Paulo Ricardo Saquete Martins-Filho, Simone Yuriko Kameo, Ana Carolina Mascarenhas-Oliveira, Nivaldo Farias Vieira, André Luis de Santana Peixoto
March-April 2013, 58(2):164-164
DOI
:10.4103/0019-5154.108113
PMID
:23716858
[FULL TEXT]
[PDF]
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3,661
36
Nasal involvement in hand and foot syndrome
Anil Mishra, Prashanna R Shrestha, RV Ramanna Rao, Ajay Kumar
March-April 2013, 58(2):164-164
DOI
:10.4103/0019-5154.108114
PMID
:23716859
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
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-
2,987
38
Simple scoring system for oral pemphigus vulgaris
Shamim Thorakkal
March-April 2013, 58(2):164-164
DOI
:10.4103/0019-5154.108115
PMID
:23716860
[FULL TEXT]
[PDF]
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-
7,236
105
Vitiligo vulgaris in a patient of progeria
Bikash Ranjan Kar, Jasmita Satapathy
March-April 2013, 58(2):164-164
DOI
:10.4103/0019-5154.108116
PMID
:23716861
[FULL TEXT]
[PDF]
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3,189
40
Primary cutaneous CD30+ anaplastic lymphoma: a case report and reappraisal
Sumit Sen, Anusree Gangopadhyay, Uttara Chatterjee, Abhas C Ray
March-April 2013, 58(2):165-165
DOI
:10.4103/0019-5154.108117
PMID
:23716862
[FULL TEXT]
[PDF]
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2,673
47
Importance of cutaneous findings in childhood scleromyositis in Indian scenario
Vandana Puri, Shilpi Agarwal, Taru Garg, Ram Chandar
March-April 2013, 58(2):162-162
DOI
:10.4103/0019-5154.108097
PMID
:23716844
[FULL TEXT]
[PDF]
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2,873
36
Irritant contact dermatitis to accidental exposure of cyanide
TS Rajashekar, Rajendra Okade
March-April 2013, 58(2):162-162
DOI
:10.4103/0019-5154.108098
PMID
:23716845
[FULL TEXT]
[PDF]
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3,827
44
Knowledge and attitude of truck and bus drivers about sedating anti-histamines and vehicular accidents
Kiran Godse, Sharmila Patil, Manjyot Gautam, Ameya Kalambe
March-April 2013, 58(2):162-162
DOI
:10.4103/0019-5154.108099
PMID
:23716846
[FULL TEXT]
[PDF]
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2,791
57
Can Darrier disease be localized bullous??!!
Ranjan C Raval, Shweta Gupta, Piyush Borkhatariya, Khyati C Patel
March-April 2013, 58(2):162-162
DOI
:10.4103/0019-5154.108100
PMID
:23716847
[FULL TEXT]
[PDF]
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4,215
39
Aplasia cutis and ipsilateral congenital melanocytic naevus: An unusual association
Anusree Gangopadhyay, Arghya Prasun Ghosh, Joydeep Singha, Chinmay Halder, Falguni Nag
March-April 2013, 58(2):163-163
DOI
:10.4103/0019-5154.108107
PMID
:23716853
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3,139
31
Perilesional urticaria in a varicella patient; another trigger?
Satyaki Ganguly, Lopamudra Ray
March-April 2013, 58(2):163-163
DOI
:10.4103/0019-5154.108108
PMID
:23716854
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[PDF]
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2,728
37
A case of multiple facial clear cell acanthomas successfully treated by cryotherapy
Mayumi Hatakeyama, Masahiro Oka, Atsushi Fukunaga, Makoto Kunisada, Yoko Funasaka, Chikako Nishigori
March-April 2013, 58(2):162-162
DOI
:10.4103/0019-5154.108122
PMID
:23716849
[FULL TEXT]
[PDF]
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3,468
37
A case of idiopathic unilateral circumscribed hyperhidrosis
Hari Kishan Kumar Yadalla, H Ambika, Simran Chawla
March-April 2013, 58(2):163-163
DOI
:10.4103/0019-5154.108102
PMID
:23716850
[FULL TEXT]
[PDF]
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3,341
45
Linear scleroderma with calcinosis and its successful treatment with surgical excision
Uma Shankar Agarwal, Raj Kumar Besarwal, Gauri Panse, Kalyani Bhola
March-April 2013, 58(2):163-163
DOI
:10.4103/0019-5154.108104
PMID
:23716851
[FULL TEXT]
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4,096
54
IJD® QUIZ
Widespread confluent, annular, and circinate patches and plaques in a 56-years-old woman
Mohammad Shahidi-Dadras, Somayeh Hejazi, Azin Ayatollahi, Mohammad Saeedi, Zahra Asadi-Kani
March-April 2013, 58(2):155-156
DOI
:10.4103/0019-5154.108067
PMID
:23716814
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5,468
142
THERAPEUTIC ROUND
Evaluation of efficacy, safety, and tolerability of fixed dose combination (FDC) of halometasone 0.05% and fusidic acid 2% w/w topical cream versus FDC of betamethasone valerate 0.12% and neomycin sulphate 0.5% w/w topical cream in the treatment of infected eczematous dermatosis in Indian subjects: A randomized open-label comparative phase III multi-centric trial
Dasiga Venkata Subrahmanya Pratap, Mariam Philip, Narayana T Rao, Hemangi R Jerajani, Sainath A Kumar, Maria Kuruvila, Latha S Moodahadu, Shilpi Dhawan
March-April 2013, 58(2):117-123
DOI
:10.4103/0019-5154.108041
PMID
:23716800
Aim:
To evaluate the efficacy and safety of fixed drug combination (FDC) halometasone 0.05% and fusidic acid 2% (group A)
vs
FDC betamethasone 0.12% and neomycin sulfate 0.5% cream (group B) in acute or chronic infected eczematous dermatosis, through a randomized open-label, comparative, multicentric study. Materials and Methods: A total of 152 patients were randomized to either Group A or Group B. EASI (Eczema Area and Severity Index), IGA (Investigator's global assessment), scale for severity of eczema, pruritus, and safety parameters were assessed at baseline, Day 5/Day 10, Day 10/20, and Day 20/Day 30 for acute/chronic cases. Skin swabs were tested at screening, Day 10, and end of the study. Results:
Staphylococcus aureus
was the frequently encountered causative agent. There was a significant reduction within the study groups in EASI, IGA scales for severity of eczema, pruritus at various visits, compared to baseline. At the end of study, 83.87% in group A and 65.71% in group B were culture negative. Cure rate was 54.28% and 50% in group A and B, respectively. Five adverse events were reported in five patients, of which three patients withdrew from the study. Conclusion: Halometasone 0.05% and Fusidic acid 2% cream is effective, safe, well tolerated with comparable efficacy to the comparator in the treatment of acute and chronic infected eczematous dermatosis.
[ABSTRACT]
[FULL TEXT]
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251
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© 2005 - Indian Journal of Dermatology | Published by Wolters Kluwer -
Medknow
Online since 25
th
November '05