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   Table of Contents - Current issue
Coverpage
September-October 2018
Volume 9 | Issue 5
Page Nos. 293-366

Online since Tuesday, September 4, 2018

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REVIEW ARTICLE  

Systemic drug-induced chronic paronychia and periungual pyogenic granuloma Highly accessed article p. 293
Uwe Wollina
DOI:10.4103/idoj.IDOJ_133_18  
Paronychia is a painful inflammatory disorder of the nail fold. Periungual pyogenic granuloma – a benign vascular tumor of the capillaries – can develop as a complication of paronychia. We report both, paronychia and periungual pyogenic granuloma, as possible adverse events during systemic drug-therapy. The following groups of systemic drugs have been considered: taxanes, epidermal growth factor-receptor (EGFR) inhibitors, EGFR tyrosine kinase inhibitors, tyrosine kinase inhibitors, inhibitors of MEK/ERK, BRAF inhibitors, CD20 antagonists, vascular endothelial growth factor inhibitors, and retinoids. Recommendations for prevention and treatment are given. Since paronychia is a painful inflammatory disorder that has a negative impact on daily activities, early recognition and adequate treatment improve adhesion to treatment and quality of life.
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ORIGINAL ARTICLES Top

A study of cutaneous adverse drug reactions in a tertiary care center in Punjab p. 299
Niharika Jha, Emy Alexander, Bimal Kanish, Dinesh K Badyal
DOI:10.4103/idoj.IDOJ_81_18  
Context: Cutaneous adverse drug eruptions are the most common adverse reactions attributed to drugs in which any type of skin reaction can be mimicked, induced, or aggravated. Aims: To study the pattern of various types of cutaneous adverse drug reactions (CADRs), to find out the causative drug(s) involved and to determine the response to treatment and outcome in patients with CADRs. Patients and Methods: This prospective study was done in the department of dermatology. Patients with suspected drug rash, of either sex and all age groups were included in the study. Statistical Analysis: Frequencies and proportions were calculated using Chi-square test and t-test as the tests of significance. Data was analyzed using SPSS version 21. Results: A total of 258 patients were enrolled in the study. The most common CADR observed in the study was exanthematous drug eruption in 42.63% patients followed by drug induced urticaria in 21.32% patients. Antimicrobials were the most common offending drugs in 64.73% of patients, followed by non-steroidal anti-inflammatory drugs (NSAIDs) in 15.50% patients. In the study, 12 patients (4.65%) were found to have severe cutaneous adverse drug reactions (SCADRs). Stevens–Johnson syndrome (SJS) - Toxic epidermal necrolysis (TEN) was the most common SCADR (50%) and antituberculous drugs were the most common causative group of drugs causing SCADRs. Conclusion: The most common CADR observed in the study was exanthematous drug eruption and antimicrobials were the most common causative drugs.
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Prevalence of metabolic syndrome in patients with lichen planus: A cross-sectional study from a tertiary care center p. 304
Hashim Hashba, Joy Bifi, Anoop Thyvalappil, Rajiv Sridharan, Ajayakumar Sreenivasan, Pretty Mathew
DOI:10.4103/idoj.IDOJ_27_18  
Background: There have been reports of association between lichen planus (LP) and metabolic syndrome and its various parameters. Aims and Objectives: To determine the prevalence of metabolic syndrome in patients with LP and to determine the association between the morphologic types of LP and metabolic syndrome. Materials and Methods: In this cross-sectional study conducted over a period of 1 year, 70 clinically diagnosed patients with LP were included and evaluated for metabolic syndrome based on the modified National Cholesterol Education Program: Adult Treatment Panel III guidelines. Data were analyzed using Statistical Package for the Social Sciences version 17 software, and inferential statistical tools such as t-test for continuous data and Chi-square test for categorical data were used. Results: A 35.7% prevalence of metabolic syndrome was found in patients with LP. The average duration of LP was found to be higher in patients with metabolic syndrome. There was a higher prevalence of central obesity, increased fasting blood sugar, and low high-density lipoprotein-cholesterolin patients with LP. Conclusion: Metabolic syndrome was seen in 25 patients (35.7%) with LP. It is important to advise our patients to adopt healthy lifestyle choices to help prevent comorbidities and improve the general health of population. As this study was a cross-sectional study, the directionality of the association between LP and metabolic syndrome could not be assessed. Lack of controls and a small sample size are other limitations of our study.
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Impact of palmoplantar dermatoses on quality of life p. 309
Rochit Singhal, Nilofar G Diwan, Pragya A Nair
DOI:10.4103/idoj.IDOJ_347_17  
Background: Palmoplantar dermatoses are commonly found in dermatological practice. Quality of life (QOL) is severely impaired if these areas are affected. Early and appropriate management of palmoplantar dermatoses help in improving patient's QOL. Aim: To assess the impact of palmoplantar dermatoses on QOL. Materials and Methods: Patients with palmoplantar dermatoses with or without other body part involvement were enrolled in the study. QOL was assessed by Dermatology Life Quality Index (DLQI) questionnaire for >16 years of age and by Children's Dermatology Life Quality Index (CDLQI) questionnaire for 5–16 years of age. Results: Two hundred and two patients participated, of which 108 (53.46%) were males and 94 (46.53%) were females. The commonest age group affected was 17–40 years (42.57%). Housewives 61 (30.2%) and laborers 53 (26.2%) were most common occupational group affected. The mean DLQI and CDLQI scores were 7.68 and 7.46, respectively. Fifty-seven (28.21%) patients had palmoplantar psoriasis (PPP), 35 (17.32%) had palmoplantar keratoderma (PPK), and 26 (12.87%) had hand eczema (HE) with mean DLQI scores 8.60, 8.53, 8.60, and CDLQI scores 8.40, 8.28, and 8.26, respectively. In both DLQI and CDLQI, questions on symptoms and feelings scored maximum. Gender, age, occupation, duration, progress, and type of dermatosis did not show statistically significant association with DLQI. However, chronic recalcitrant dermatoses such as PPP, PPK, and HE showed significant impairment in QOL in relation to occupation and duration of disease. Limitation: Severity of various palmoplantar dermatoses was not graded and therefore relation between severity of various dermatoses and QOL was not established. Conclusion: Majority of patients with palmoplantar dermatoses especially those having chronic course had significant impairment in their QOL.
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Coexistence of fungal infections in psoriatic nails and their correlation with severity of nail psoriasis p. 314
Suteeraporn Chaowattanapanit, Penvadee Pattanaprichakul, Charussri Leeyaphan, Onjuta Chaiwanon, Panitta Sitthinamsuwan, Waritch Kobwanthanakun, Suchanan Hanamornroongruang, Sumanas Bunyaratavej
DOI:10.4103/idoj.IDOJ_192_17  
Background: Nail involvement in psoriasis is often complicated by concomitant fungal infections. The aim of this study was to investigate the prevalence of fungal infections in nail psoriasis and correlate it with the severity of nail psoriasis. Materials and Methods: This retrospective study included patients with nail psoriasis aged ≥18 years with at least one fingernail and one toenail involvement who were treated at Siriraj Hospital from September 2012 to January 2014. Severity of nail psoriasis was assesed by Nail Psoriasis Area Severity Index (NAPSI) score. The nail clippings from the the least and most severely involved psoriatic fingernails and toenails were cultured to determine the presence of coexisting fungal infections and isolate the fungal species. Results: Sixty-two patients (33 males, 29 females) fulfilling the inclusion criteria were included in the study. The mean age at the time of presentation was 51.3 years mention SD. The most common nail change consistent with psoriasis was onycholysis, followed by subungual hyperkeratosis. The most commonly isolated fungi in the most severely affected fingernails were Candida spp. (41.9%) manifesting as paronychia in 5 patients (19.2%). The most commonly isolated fungi in the most severely affected toenails were nondermatophytes (NDMs) other than candida (32.3%). Dermatophytes were not detected from any of the psoriatic nails. The fungal species isolated from the most severely affected fingernails were significantly different than the isolated fungal species in the most severely affected toenails (P = 0.026). Fungal organisms were identified in 32.3% of the most severely affected fingernails and in 27.4% of the most severely affected toenails. The overall rate of isolation of fungus was significantly significantly higher in severely affected nails than in the least affected nails (P < 0.005). Conclusion: A high rate of concomitant fungal infections, especially yeasts and NDMs, was found in psoriatic nail patients. The rate of isolation of fungal species was higher in severely involved psoriatic nails than mildly involved ones. The spectrum of fungal species isolated from the the severely involved toenails and fingernails were also different from each other. These organisms may be true pathogens that cause onychomycosis or their presence may reflect colonization, contamination, or concurrent infection.
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BRIEF REPORT Top

The prevalence of psychiatric comorbidity in patients with prurigo nodularis p. 318
Lovee Dhawan, Shubh M Singh, A Avasthi, M Sendhil Kumaran, Tarun Narang
DOI:10.4103/idoj.IDOJ_324_17  
Background: Prurigo nodularis (PN) is a chronic, recalcitrant itchy dermatosis. It is supposed to be associated with psychological factors, but research in this area is scarce. Objectives: To study the prevalence and determinants of psychiatric morbidity, and the phenomenology of itch in PN. Materials and Methods: This study was carried out in the outpatient service of the Department of Dermatology. Purposive sampling was used to recruit 50 patients each with PN, chronic urticaria (CU), and vitiligo (V). A one-time cross-sectional assessment was carried out on the participants. Psychiatric morbidity was assessed using Mini-International Neuropsychiatric Interview and Patient Health Questionnaire-9. Results: The three groups were comparable on socio-demographic parameters. The prevalence of any psychiatric disorder (current or lifetime) was 48%, 42%, and 58% in the PN, CU, and V groups, respectively (P = 0.27). Limitations: The limitations of this study include the small sample size and the purposive, non-blind nature of assessments. Conclusion: Our study suggests that there is significant psychiatric morbidity in PN which is comparable to that seen in CU and V.
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MUSINGS, OPINIONS, TIPS AND EXPERIENCES Top

Innovative use of felt-tip pen applicator for uniform spread of linkage fluid during dermatoscopy p. 322
Deepak Jakhar, Chander Grover
DOI:10.4103/idoj.IDOJ_58_18  
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CASE REPORTS Top

Caruncular oncocytoma: Report of two cases with review of literature p. 324
Suvradeep Mitra, Khushboo Lath, Ramanuj Samanta, Uma N Saikia
DOI:10.4103/idoj.IDOJ_241_17  
Caruncular lesions are uncommon and could be related to hair follicles, sebaceous glands, sweat glands, and accessory lacrimal gland harbored in caruncle. As the lesions of caruncle are diverse, the clinical diagnosis is difficult. Majority of the caruncular lesions are benign although rare malignant lesions have also been reported. Caruncular oncocytoma (CO) is a rare ocular neoplasm with an incidence of <3%, as per the Western literature. However, only two cases of ocular oncocytoma are reported in the Indian literature. Here, we report two more cases of CO from India with their histochemical and ultrastructural characteristics.
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Methotrexate cutaneous toxicity following a single dose of 10 mg in a case of chronic plaque psoriasis: A possible idiosyncratic reaction p. 328
Aastha Gupta, Kabir Sardana, Minakshi Bhardwaj, Ajeet Singh
DOI:10.4103/idoj.IDOJ_316_17  
Low-dose methotrexate is a well-tolerated and inexpensive systemic immunosuppressive agent used commonly in dermatology. However, several adverse events such as pancytopenia, pneumonitis, mucositis, and cutaneous ulcerations may develop during acute toxicity with dose-dependent or idiosyncratic mechanisms. Risk factors for methotrexate toxicity include advanced age, hypoalbuminemia, renal dysfunction, and concomitant drugs increasing the level of methotrexate in the body. We present a case of methotrexate toxicity presenting with classical features along with mucocutaneous side-effects, such as ulceration of psoriatic plaques and acral erythema, following a single dose of methotrexate.
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Imatinib-induced IgA pemphigus: Subcorneal pustular dermatosis type p. 331
Aradhana Sood, Preema Sinha, Deep K Raman, Anwita Sinha
DOI:10.4103/idoj.IDOJ_331_17  
Imatinib mesylate, a tyrosine kinase inhibitor, is commonly used in the treatment of chronic myeloid leukemia. IgA pemphigus is a rare bullous dermatosis caused by IgA autoantibodies. Clinical manifestations include localized or generalized itchy blisters and pustules. Drug-induced IgA pemphigus has been rarely reported in the literature till date. Here, we report one such rare case caused by imatinib which responded poorly to oral prednisolone but showed excellent response to tablet dapsone.
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Appearance of verruca over linear verrucous epidermal nevus – an example of locus minoris resistentiae: A report of three cases p. 334
P. S. S Ranugha, Jayadev B Betkerur, S Veeranna, Vijaya Basavaraj
DOI:10.4103/idoj.IDOJ_337_17  
Locus minoris resistentiae (LMR) is a site of the body that offers lesser resistance than the rest of the body to the onset of disease. It can be congenital or acquired. Areas of cutaneous mosaicism such as epidermal nevi can act as congenital LMR, leading to the development of inflammatory skin conditions or skin tumors on these. The occurrence of an infectious condition such as warts over nevi is rare. We report three cases of verrucous epidermal nevi (VENs) with the development of verrruca overlying the nevus later in life. The three patients had VEN on forehead, preauricular, and presternal area, respectively, since birth, with development of a warty lesion overlying these a few months before presenting to us. Skin biopsy and histopathological examination of the linear verrucous lesion were suggestive of VEN with hyperkeratosis, thickened epidermis, and papillomatosis. There was no evidence of epidermolytic hyperkeratosis or increased sebaceous glands in the dermis. Biopsy of the new warty lesion showed findings of verruca in all the patients. With the above findings, a diagnosis of verruca superimposed on linear VEN was made in all the three cases. The warts were removed by electrofulguration. Several acquired skin disorders, including inflammatory dermatoses, adnexal disorders, and neoplasms, have been shown to occur superimposed on epidermal or sebaceous nevus. Ours is probably the first ever description of a wart occurring on VEN.
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CONCISE COMMUNICATION Top

Sjogren–larsson syndrome: A rare case report p. 338
Vrutika Shah, Kinjal Rambhia, Jayesh Mukhi, Rajesh P Singh
DOI:10.4103/idoj.IDOJ_33_18  
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LETTERS TO THE EDITOR Top

Prevalence and association of dermatological manifestations with fanconi anemia: A retrospective study p. 341
Pallavi Shukla, Seema Korgaonkar, Lily Kerketta, Babu R Vundinti
DOI:10.4103/idoj.IDOJ_368_17  
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Dermoscopic features of cutaneous collagenous vasculopathy: A report of rare disorder p. 342
Daksha Vasava, Hita Mehta
DOI:10.4103/idoj.IDOJ_114_17  
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Lues maligna in an immunocompetent female p. 344
Swetalina Pradhan, Chandra S Sirka, Maitreyee Panda, Manas Baisakh
DOI:10.4103/idoj.IDOJ_277_17  
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Tubular apocrine adenoma on vulva: An unusual location p. 346
Sarina Jain, Kausar Valiulla, Atul M Dongre, Balasaheb V Malkar
DOI:10.4103/idoj.IDOJ_343_17  
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A rare case of neurofibromatosis type i with coexistent wilson disease p. 348
Tulika Rai, Vijay Kumar, Najuma Subba
DOI:10.4103/idoj.IDOJ_344_17  
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Unilateral facial telangiectasia macularis eruptiva perstansmimicking as rosacea p. 351
Preema Sinha, Anwita Sinha, Deep K Raman, Aradhana Sood
DOI:10.4103/idoj.IDOJ_313_17  
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Giant shagreen patch in tuberous sclerosis complex p. 353
V Kuntoji, PV Bhagwat, C Kudligi
DOI:10.4103/idoj.IDOJ_272_17  
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SKINDIA QUIZ Top

SkinIndia Quiz 47: Linear pitted plaque over the foot Highly accessed article p. 356
Sanjay Singh, Suman Patra, Sudheer Arava, Neetu Bhari
DOI:10.4103/idoj.IDOJ_207_17  
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THROUGH THE LENS Top

Cutaneous larva migrans in an infant p. 359
Farzana Ansari, Lalit K Gupta, Ashok K Khare, Manisha Balai, Asit Mittal, Sharad Mehta
DOI:10.4103/idoj.IDOJ_269_17  
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THROUGH THE DERMOSCOPE Top

Onychoscopy of nail involvement in lichen striatus p. 360
Deepak Jakhar, Ishmeet Kaur
DOI:10.4103/idoj.IDOJ_299_17  
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“Hair building” fibers through the dermoscope p. 362
Feroze Kaliyadan, Kaberi Feroze
DOI:10.4103/idoj.IDOJ_325_17  
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A case of Kyrle's disease with dermatoscopic findings p. 364
Pragya Nair, Kira Pariath
DOI:10.4103/idoj.IDOJ_327_17  
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