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   Table of Contents - Current issue
Coverpage
November-December 2018
Volume 9 | Issue 6
Page Nos. 367-483

Online since Monday, November 5, 2018

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EDITORIAL  

Rituximab in pemphigus: Road covered and challenges ahead Highly accessed article p. 367
Keshavamurthy Vinay, Sunil Dogra
DOI:10.4103/idoj.IDOJ_290_18  
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REVIEW ARTICLE Top

A compendium of intralesional therapies in nail disorders Highly accessed article p. 373
Chander Grover, Shikha Bansal
DOI:10.4103/idoj.IDOJ_280_18  
Nail unit is a complex skin appendage offering natural barrier to drug penetration by virtue of its unique anatomy. This is the reason why topical as well as oral therapies can be largely ineffective when dealing with nail diseases. Intralesional (injectable therapies) offer a practical solution in this scenario. This review aims to summarise the role of different injectable drugs in various nail unit disorders. Various types of intralesional therapies in the nail unit, their techniques of administration, appropriate drugs to be used and optimum treatment protocols are summarised.
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ORIGINAL ARTICLES Top

A clinico-epidemiological study of childhood herpes zoster p. 383
Barnali Mitra, Ajay Chopra, Krishna Talukdar, Neerja Saraswat, Debdeep Mitra, Joyjit Das
DOI:10.4103/idoj.IDOJ_107_18  
Herpes zoster (HZ) is a viral infection believed to be caused by the re activation of varicella zoster virus (VZV) or human herpes virus type 3 (HHV 3) that persists in the posterior nerve root ganglion. HZ is rarely reported in the pediatric age group with an intact immunity. Past infection with VZV and immunization with chickenpox vaccine are key markers in the onset of varicella zoster in children. Our aim was to study the clinicoepidemiological pattern of HZ infection in children aged less than 12 years and to start an early management to prevent long term complications. A prospective observational study over a total duration of 2 years was conducted in a tertiary hospital, and all children less than 12 years of age with diagnosed HZ were included in the study. A total of 39 children were diagnosed to have pediatric HZ infection during the study period. The children were followed up over 4 weeks post diagnosis and were treated with oral acyclovir therapy along with symptomatic management. All children had an uneventful benign course, and their siblings and close pediatric contacts were also screened for the development of HZ or chickenpox during the incubation period. All children were screened for an underlying immunodeficiency and two cases of HIV co infection were detected. HZ is a rare disease in childhood. Varicella in early childhood is a risk factor for HZ in both immunocompromised and immunocompetent children. The appearance of HZ in a young child does not always imply an underlying immunodeficiency or malignancy, but the children should be screened for immunodeficiency. In general, the prognosis is good in healthy children.
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A randomized double blind controlled study comparing the efficacy of intralesional MMR vaccine with normal saline in the treatment of cutaneous warts Highly accessed article p. 389
Chesta Agrawal, Kapil Vyas, Asit Mittal, Ashok K Khare, Lalit K Gupta
DOI:10.4103/idoj.IDOJ_111_18  
Background: Recently, with better understanding of the immunology of warts, immunotherapeutic approaches have emerged as an effective treatment option for the management of cutaneous warts. Intralesional immunotherapy with MMR vaccine is one such modality but there are still lack of enough placebo-controlled studies. Aim: To evaluate the efficacy of intralesional MMR in patients of extragenital warts in a double-blinded manner using normal saline as control. Patients and Methods: One hundred patients of extragenital cutaneous warts were randomly allocated into two groups, the interventional (MMR) group and control (normal saline) group. MMR vaccine was injected intralesionally in the patients belonging to interventional group, a similar volume of normal saline (NS) was injected in the control group. The outcome in terms of treatment response, adverse effects, and recurrences were evaluated and compared. Results: Eighteen of thirty (60%) patients in the interventional group achieved complete response as against 7 (23.3%) in the control group (P = 0.01). Distant warts cleared in 69.5% patients in the interventional groupcompared to none in the control group. Adverse effects seen in both groups were injection site pain and mild erythema. A total of 57.1% patients showed recurrences in the control group compared to 16.6% in the interventional group. Conclusion: Intralesional MMR vaccine is an effective treatment option in patients with multiple extragenital warts. It is suggested that it should be used as first-line therapy for multiple warts and a second-line therapy for warts recalcitrant to standard therapies.
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Narrow-band UVB phototherapy does not consistently improve quality of life in psoriasis patients: A prospective observational study from Eastern India p. 394
Shweta Arora, Bikash R Kar
DOI:10.4103/idoj.IDOJ_63_18  
Introduction: Psoriasis is a chronic inflammatory and proliferative condition of the skin which is well-known to impair the patients' quality of life (QoL). Of the various treatment modalities, narrowband UVB (NBUVB) phototherapy is one of the standard treatments for moderate to severe plaque psoriasis with minimal side-effects compared to other systemic therapies. Objectives: To study whether NBUVB phototherapy administration improves QoL in plaque-type psoriasis and to find the correlation between clinical severity of psoriasis and patients' QoL by using psoriasis area severity index (PASI), dermatology life quality index (DLQI), and psoriasis disability index (PDI) tools before and after NBUVB phototherapy. Materials and Methods: Thirty-seven patients with plaque psoriasis involving >10% of body surface area (BSA) underwent NBUVB phototherapy thrice weekly for 36 sessions. Clinical severity of psoriasis was assessed by PASI and impact of psoriasis on quality of life by DLQI and PDI. Assessment was done at the baseline, 18th, and 36th session. Results: After 36 sessions of NBUVB phototherapy, mean reduction in PASI was 79.6% which was statistically significant. On the other hand, DLQI and PDI did not show significant improvement and did not correlate with PASI. Conclusion: NBUVB phototherapy reduces clinical severity of psoriasis. However, clinical severity and QoL impairment is independent of one another. DLQI and PDI do not improve proportionate to clinical improvement.
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Factors affecting the duration of phase 1 of dexamethasone-immunosuppressant pulse therapy for pemphigus group of disorders: A 10-year retrospective study in a tertiary care center p. 405
Vidya Mundakkat, Rajiv Sridharan
DOI:10.4103/idoj.IDOJ_74_18  
Context: Dexamethasone-immunosuppressant pulse therapy introduced by Pasricha et al. in 1981 as a treatment for long-term remission in pemphigus group of disorders has gained wide acceptance in many places, especially India. Since the overall duration of treatment is determined by the duration of phase 1 of the regime, identification of factors that influence phase 1 may be particularly helpful in addressing patient's concerns and apprehensions before initiation of treatment so that compliance can be improved. Aims: To find out factors that affect the duration of phase 1 of dexamethasone-immunosuppressant pulse therapy. Subjects and Methods: A 10-year retrospective study from medical records of 37 patients was conducted. The severity of pemphigus was assessed using Kumar's scoring system. The mean duration of phase 1 compared between the variables and significance of association was found out using Student's t-test. Patients were further classified in to two groups: with phase 1 duration ≤6 months and >6 months. Chi-squared and Fisher's exact tests were done to find out factors which significantly contribute to prolonged induction phase. Results: A significant association was noticed between total severity score and mean duration of phase 1 (P = 0.031). Significant association was also noticed between prolonged induction phase of >6 months and oral mucosal severity score >2 (P = 0.017). Other patient factors, type of pulse therapy, and comorbidities had no effects on the duration of phase 1. Conclusions: Duration of phase 1 is expected to prolong if the total severity score is >3, and when oral severity score is >2 it is likely to be more than 6 months.
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Evaluating the unusual histological aspects of granuloma annulare: A study of 30 cases p. 409
Debajyoti Chatterjee, Manveen Kaur, R. P. S Punia, Mala Bhalla, Uma Handa
DOI:10.4103/idoj.IDOJ_75_18  
Background: Granuloma annulare (GA) is an uncommon dermatologic disorder that presents as annular, skin-colored to erythematous plaques. Histopathologically, it is characterized by palisaded histiocytic granulomas. A definitive diagnosis of GA is based on clinicopathologic correlation. Objective: The aim of this study was to study the histomorphologic spectrum of GA. Materials and Methods: A total of 30 cases reported as GA over 6 years (2012–2017) were retrieved. The detailed clinical profile and histomorphologic findings on the skin biospies were reviewed. Results: Majority of the cases (40%) presented in the 6th decade of life with a mean age of 48.3 ± 16.5 years and with a female predominance (77%). The lesions were localized in 22 cases (73%). Asymptomatic to erythematous, annular plaques was the most frequent presentation (60%). GA was not suspected clinically in two cases. Histopathologically, interstitial pattern of infiltrate was most common (44%), whereas granuloma formation and palisaded histiocytes were seen in 4 (13%) and 3 cases (10%), respectively. A mixed pattern was observed in 10 (33%) cases. Collagen degeneration was universal finding (100%) and presence of dermal mucin was noted in 24 cases (80%), both of which were important clues to the diagnosis of GA. Additional features such as presence of plasma cells, eosinophils, and vasculitis were noted in 10 (33%), 6 (20%), and 6 (20%) cases, respectively. Conclusion: The diagnosis of GA may be challenging owing to its diverse morphology. Acquaintance with the varied histomorphology of GA is of utmost importance to render a correct diagnosis and understand the pathogenesis.
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Pityriasis rosea: Clinical profile from Central India p. 414
Namrata Chhabra, Neel Prabha, Sandeep Kulkarni, Satyaki Ganguly
DOI:10.4103/idoj.IDOJ_12_18  
Background: Pityriasis rosea (PR) is a common, self-limiting dermatologic disorder. The information regarding the clinical profile of the disease in India is limited because of inadequate studies. Materials and Methods: A retrospective, record-based study on the clinical presentation of PR was conducted in a tertiary care center based in Central India. Data of all the patients presenting to our outpatient department from October 2014 to March 2015 with a clinical diagnosis of PR were analyzed. Results: The age of the patients ranged from 9 to 54 (mean-20.32) years. There was a male preponderance with a male-to-female ratio of 1.3:1. History of prodromal symptoms was present in 11 (27.5%) patients. Pruritus was a common symptom in 30 of 40 (75%) patients. Of 40 patients, 15 (35%) had herald patch. The morphology of skin lesions was typical in most of the patients (77.5%). Two (5%) patients had papular skin lesions, four (10%) patients had erythema multiforme-like skin lesions, and one patient each had papulovesicular, psoriasiform, and eczematous skin lesions. Conclusion: The clinical features of most of the cases were mostly in accordance with the classical pattern of PR, with few unusual features.
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Expression of vascular endothelial growth factor and microvessel density in psoriatic skin lesions p. 418
Priya T Rajan, TN Suresh, TS Rajashekar
DOI:10.4103/idoj.IDOJ_147_17  
Background: Psoriasis is a common chronic and immune-mediated skin disorder having a significant impact on the patient's quality of life. An analysis of the role of angiogenic vascular endothelial growth factor (VEGF) expression and microvessel density in psoriatic skin lesions may help in better understanding of the disease pathogenesis. The aim of this study was to examine the expression of vascular endothelial growth factor (VEGF) and microvessel density using CD34 antibodies in psoriatic skin lesions by immunohistochemical examination using normal skin of healthy individuals as controls. Materials and Methods: Patients with clinical diagnosis of plaque type of psoriasis (e.g., chronic plaque) (n = 49) were included in the study. 5-mm punch biopsies were taken from the psoriatic skin lesions in these patients. A total of 20 punch biopsies were taken from the control group comprising of 20 healthy volunteers. The biopsies were subjected to histopathological examination for confirmation of diagnosis and grading. Immunohistochemical evaluation was done for the expression of VEGF, and microvessel density was assessed using CD34 and compared with the controls. Results: An increased VEGF expression by keratinocytes (49.80% ± 21.16%) and microvessel density in the papillary dermis (15.302% ± 3.8061%) was observed in patients with psoriasis, which was significantly higher as compared to controls (P < 0.0001). A significant positive correlation was observed between VEGF expression by keratinocytes and the microvessel density in the dermis (r = 0.664, P = 0.01). No significant correlation was observedbetween the histopathological grade of psoriasis and microvessel density, or with the VEGF expression. Conclusion: VEGF expression ascertained to be a significant factor in the pathogenesis of psoriasis.
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BRIEF REPORTS Top

Prospective study of pulse therapy in childhood pemphigus disorders p. 422
Bhumesh Kumar Katakam, SB Kavitha, G Narsimha Rao Netha, M Shahana, T Satya Sri, D Sudha Vani
DOI:10.4103/idoj.IDOJ_9_18  
Background: Pemphigus disorders are a group of immunobullous diseases affecting skin and/or mucus membranes. Dexamethasone cyclophosphamide pulse (DCP)/dexamethasone only pulse (DOP) therapy has shown promising results in the management of pemphigus group of diseases in adults. Aim: To evaluate the outcome of pulse therapy (PT) in pediatric cases diagnosed with pemphigus vulgaris (PV). Materials and Methods: Prospective study of 12 pediatric cases of PV from 2010 to 2015 and treated with PT in Gandhi Hospital. The patients were treated with DOP therapy, with a dose of 50 mg of dexamethasone in 250 ml of 5% dextrose in pediatric patients below the age of 12 years and 100 mg of dexamethasone in 500 ml of 5% dextrose for above 12 years, for three consecutive days. No interpulse steroids or rituximab were given to any patients in our study. Results: Out of 12 cases, 10 were female and 2 were male children. Four cases were below the age of 12 years and 8 cases were above the age of 12 years. The lowest age was 11 years female and highest age was 16 years male child. Average duration of illness is between 4 and 6 months. Six cases completed three phases, four cases were in phase II cycle 7, and two cases were in phase IV. In majority of cases clinical improvement was observed between 2 and 4 pulses in phase I. No significant adverse effects were observed in any case except in two cases who developed headache, shivering, and nausea in first one to two pulses of phase I and managed conservatively. Conclusion: Our study shows that PT gives good response in the management of pemphigus in children, in terms of remission and side effects. There was no significant major adverse effect as observed in adults. In low-resource centers such as government institution, PT would be one option. Further studies and long-term follow-up are required to weigh the risks and benefits of PT in pediatric age group.
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A pilot analysis of morphometric assessment of itraconazole brands using dermoscopy and its relevance in the current scenario Highly accessed article p. 426
Kabir Sardana, Ananta Khurana, Ajeet Singh, RK Gautam
DOI:10.4103/idoj.IDOJ_339_17  
Background: Itraconazole (ITZ) is widely used for cutaneous and systemic mycoses. Its bioavailability is inconsistent and shows interindividual variations. The quality of ITZ pellets is an important factor determining its absorption profile and thereby the therapeutic effect. Analysis of morphometric characteristics is a surrogate method to determine the same. Pellet number and size are the most important parameters in this regard. Aim: We aimed to delineate few low-cost brands, the assessed variables of which fell within the formulated criteria. Materials and Methods: In all, 22 (100 mg) formulations of ITZ were included. The pellet number was calculated manually and pellet size was determined using a dermoscope with an inbuilt measurement tool. Furthermore, size variation with respect to the innovator US Food and Drug Administration (FDA)-approved brand was determined. Results: There is a large variation in pellet number and average pellet size among different brands. Pellet number ranged from 121 to 820 and average size from 959 to 1845 μm. Few brands had dummy pellets and loose powder within the capsule. Two brands within the price range of less than Rs. 20 per capsule fulfilled the three formulated criteria: of a good pellet count, small pellet size, and low size variation. Two other brands also satisfied these criteria but were priced between Rs. 20 and 30 per capsule. The innovator US FDA-approved brand had the highest number of pellets and minimum size variation but is the costliest of all assessed brands. Limitations of the Study: We cannot comment on inter-batch variation as ours was a one-point assessment. Advanced techniques such as scanning electron microscopy and drug release profile, which would have given further useful information on pellet quality, were beyond our scope. Conclusion: There is marked variation in the assessed characteristics of ITZ formulations. These morphometric characteristics may have a significant bearing on the quality of ITZ. And thus analysis of these can help clinicians make an informed decision in choosing an ITZ formulation to achieve optimal efficacy.
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Knowledge, attitudes and behavior regarding topical corticosteroids in a sample of pharmacy students: A cross sectional survey p. 432
Karalikkattil T Ashique, Feroze Kaliyadan, Shilpa Mohan, Shreya Vijayan, Dilip Chandrasekhar
DOI:10.4103/idoj.IDOJ_143_18  
Introduction and Background: The abuse and misuse of topical corticosteroids, especially over the face, is an increasing problem encountered by dermatologists in India. Lack of patient awareness and the ease of obtaining topical corticosteroids without a prescription are important underlying factors. As the first point of contact, the pharmacist has an important role in controlling topical corticosteroid abuse. Aims: This study aimed to evaluate the knowledge, attitudes, and behavior regarding topical corticosteroids in a sample of pharmacy students. Methods: A cross-sectional survey was carried out among pharmacy students using convenience sampling method. A total of 110 questionnaires were distributed, and 103 valid responses were obtained. Results: Majority of the students were conversant of the fact that different classes of topical corticosteroids effectuate different effects. Majority of the students concurred on points such as topical corticosteroids can have significant cutaneous adverse effects, the important role pharmacist plays in preventing topical steroid abuse, and the need to hold fast dispensing of topical corticosteroids on a prescription-only basis. However, a significant gap in knowledge related to specific side effects and awareness of different classes of topical corticosteroids was noted. Moreover, there was no statistical significant difference in terms of knowledge and awareness regarding topical corticosteroid use between postgraduate and undergraduate students. Conclusion: In our study, although several students were aware of the potential adverse effects of topical corticosteroids, there were gaps in the awareness about specific classes and adverse effects. Knowledge regarding the ethical and rational use of topical corticosteroids should be disseminated among pharmacy students, and the dermatologists should play a key role in this.
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CASE REPORTS Top

Cutaneous munchausen syndrome by proxy: A diagnostic challenge for dermatologist p. 435
Chandra S Sirka, Swetalina Pradhan, Debadatta Mohapatra, Biswa R Mishra
DOI:10.4103/idoj.IDOJ_28_18  
Munchausen syndrome by proxy (MSBP) is a rare psychiatric disorder of a caregiver (commonly mother) who induces injury or symptoms on victim because of his or her psychiatry illness. The victims are usually under 6 years of age who cannot complain regarding inflicted injury. Diagnosis is challenging to the physician. We came across a 15-month-old girl child, who had consulted various specialists for episodes of blister followed by erosions on body since 6 months of age. Dermatological examination revealed blisters and healed leaf-shaped scars of different sizes which were suggestive of scalds. Smell of different varieties of oils, dribbling of hot oil from body at various intervals, and mother being the first to notice appearance of new skin lesions in all past episodes lead to suspicion of cutaneous MSBP with mother being the culprit. The family members were counselled regarding nature and course of the condition, mother was started on psychotropics, and the child was rescued from mother along with symptomatic treatment of the skin lesions.
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The direct use of mobile phone and the occurrence of chondrodermatitis nodularis in the antihelix: An exemplificative case p. 438
Federica Di Berardino, Diego Zanetti
DOI:10.4103/idoj.IDOJ_57_18  
Chondrodermatitis nodularis helicis (CNH) is an idiopathic inflammatory painful condition of the ear characterized by a tender nodule located on the helix or antihelix. Even if various causes have been ascribed, such as a microvascular injury due to acute exposure to cold or trauma, pressure, or rubbing, etiopathogenesis still remains unknown. We describe the unusual case of a young female with a peculiar sequential onset of bilateral CNH in the antihelix region, possibly ascribed to the direct use of mobile phone without earphones.
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Dental infection mimicking dermatological lesion: Three case reports of cutaneous fistulae and sinus tracts on face p. 441
Anuj Chhabra, Nidhi Chhabra
DOI:10.4103/idoj.IDOJ_317_17  
Cutaneous odontogenic fistulae or sinus tracts are commonly misdiagnosed and incorrectly treated, leading to unnecessary and excessive medications attributing to patient agony. An understanding of cutaneous sinus tracts and their drainage will guide to more appropriate treatment. The following clinical case reports present three patients with cutaneous sinus tracts on chin and jaw line, secondary to chronic periapical dental infection, which was misdiagnosed initially as dermatological lesion and was submitted to inappropriate dermatological treatment and antimicrobial therapy. Diagnosis, etiopathogenesis, and treatment in relation to patient history, clinical findings, and radiographic imaging are elaborated.
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Lamotrigine-induced systemic lupus erythematosus: A diagnostic dilemma p. 445
Jaskaran Batra, Sukhjot Kaur, Sandeep Kaushal, Aminder Singh
DOI:10.4103/idoj.IDOJ_24_18  
Many drugs are known to cause systemic lupus erythematosus (SLE), however there are no well defined criteria for drug induced lupus erythematosus (DILE). We present a rare case of lamotrigine induced lupus presenting as acute syndrome of apoptotic pan epidermolysis (ASAP).
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Schopf–Schulz–Passarge syndrome p. 448
Kinjal D Rambhia, Vidya Kharkar, Sunanda Mahajan, Uday S Khopkar
DOI:10.4103/idoj.IDOJ_26_18  
Schopf–Schulz–Passarge syndrome (SSPS) is a rare type of ectodermal dysplasia that has autosomal recessive inheritance. It is characterized by palmoplantar keratoderma, hypodontia, hypotrichosis, nail dystrophy, and multiple periocular and eyelid apocrine hidrocystomas. A 36-year-old male presented with multiple eyelid and periocular apocrine hidrocystomas, ichthyosis, palmoplantar keratoderma, hypodontia, nail dystrophy, and thin scalp hair. Skin biopsy from a periocular lesion revealed cyst lined with smooth, thin epithelium, and few areas revealed foci of decapitation secretion consistent with apocrine hidrocystoma. The patient was diagnosed with SSPS.
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Diffuse cutaneous leishmaniasis in an immunocompromised patient resembling histoid Hansen's disease p. 452
Asha Kumari, Manisha Balai, Lalit K Gupta, Ashok K Khare, Asit K Mittal, Sharad Mehta
DOI:10.4103/idoj.IDOJ_34_18  
Cutaneous leishmaniasis is caused by protozoan parasites of the genus Leishmania. Atypical presentation and widespread progression of the lesions may be seen in patients with HIV disease and diffuse cutaneous leishmaniasis and HIV co-infection is emerging as a serious new threat. We report a case of diffuse cutaneous leishmaniasis in a HIV- infected patient resembling Histoid Hansen.
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CONCISE COMMUNICATION Top

Skin changes during pregnancy: A study from Northeast India p. 455
Kharkongor Larisa Dabette, Devi Th. Bijayanti, Bishurul N.A Hafi, Ranjit L Singh
DOI:10.4103/idoj.IDOJ_352_17  
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A case of multifocal tuberculosis involving skin and bone: An uncommon presentation p. 458
Banavasi Shanmukha Girisha, Vikram Shetty, S Teerthanath, Rajesh Venkataram, Preethi B Nayak
DOI:10.4103/idoj.IDOJ_7_18  
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LETTERS TO THE EDITOR Top

Periorbital ecchymosis secondary to severe coughing- A valsalva associated phenomenon p. 461
Isha Gupta, Surabhi Dayal
DOI:10.4103/idoj.IDOJ_41_18  
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Pseudo acne fulminans: An under recognized entity p. 462
Manju Meena, Asit Mittal, Ashok Kumar Khare, Lalit Kumar Gupta
DOI:10.4103/idoj.IDOJ_296_17  
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Secukinumab in generalized pustular psoriasis p. 464
Shraddha Madanagobalane
DOI:10.4103/idoj.IDOJ_93_18  
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SKINDIA QUIZ Top

SkinIndia Quiz 48: Blistering and mottled pigmentation in a young male Highly accessed article p. 467
Anupama Bains, Deepak Vedant, Abhishek Bhardwaj, Poonam Elhence
DOI:10.4103/idoj.IDOJ_245_17  
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THROUGH THE LENS Top

Exclusive facial actinic porokeratosis p. 469
Swetha K Hegde, Asha Panchagavi, Naveen Kikkeri Narayanasetty
DOI:10.4103/idoj.IDOJ_76_18  
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Vulvar extramammary Paget's disease secondary to urothelial carcinoma presenting with a small painful erosion of the vulva p. 471
Yu-Chen Chen, Cheng-Lin Wu, J Yu-Yun Lee
DOI:10.4103/idoj.IDOJ_98_18  
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THROUGH THE DERMOSCOPE Top

Dermoscopy of juvenile circumscribed pityriasis rubra pilaris p. 474
Pragya A Nair, Niral Sheth
DOI:10.4103/idoj.IDOJ_334_17  
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Dermoscopy of striae rubrae p. 477
Feroze Kaliyadan, Abhijeet Kumar Jha, Sidharth Sonthalia
DOI:10.4103/idoj.IDOJ_29_18  
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Brown shadow in lichen nitidus: A dermoscopic marker! p. 479
Subrato Malakar, Sushrut Save, Purva Mehta
DOI:10.4103/idoj.IDOJ_338_17  
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HISTORY Top

Teigne Tondante and Mahon brothers: Two laymen “physicians” of Hôpital Saint-Louis, Paris p. 481
Amiya Kumar Mukhopadhyay
DOI:10.4103/idoj.IDOJ_100_18  
In the early and mid-nineteenth century Europe, ringworm of the scalp was a vexing problem. It affected children in such numbers that the famous Hôpital Saint-Louis of Paris had a separate Tinea School. Before advent of radiation method of epilation, painful method of peeling was the mainstay of management. A family bearing title Mahon with no conventional medical training and qualification developed a secret method of epilation which was far superior to the existing method of treatment. Two brothers of this family, whose identity is obscure in the history of dermatology, were given the charge of treatment of such cases in various hospitals of France. Though they were not physician per se, their observations surprise us even today. Mahon the junior wrote a book on ringworm which is the first ever monograph on the subject. They also described favus of the nail and named ringworm of the scalp.
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