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   Table of Contents - Current issue
Coverpage
November-December 2019
Volume 10 | Issue 6
Page Nos. 617-760

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REVIEW ARTICLE  

Vasculitis: A checklist to approach and treatment update for dermatologists Highly accessed article p. 617
Prabhakar M Sangolli, Dammaningala Venkataramaiah Lakshmi
DOI:10.4103/idoj.IDOJ_248_18  
Vasculitis poses a great diagnostic, investigative and therapeutic challenge to the treating physician. The classification of vasculitides itself still eludes universal acceptance. Comprehensive management comprises establishing the diagnosis of true vasculitis after ruling out vasculitis mimics, finding the etiology if feasible, assessing the caliber of the vessels involved, deciphering the pathological process of vessel damage, investigating for the existence and extent of systemic involvement and finally planning the therapy in the background of co-morbidities. Successful management also entails regular monitoring to foresee complications arising from the disease process itself as well as complications of immunosuppressive treatment. Although steroids remain first line drug, biologics are emerging as popular agents in the treatment of immune-mediated vasculitis. Triphasic treatment is the best plan of action comprising induction, maintenance of remission and treatment of relapses.
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ORIGINAL ARTICLES Top

Comparison of efficacy of two different concentrations of intralesional amphotericin B in the treatment of cutaneous leishmaniasis; A randomized controlled trial Highly accessed article p. 627
Pooja Goswami, BC Ghiya, Vineet Kumar, S Rekha, RD Mehta
DOI:10.4103/idoj.IDOJ_470_18  
Introduction: Cutaneous leishmaniasis is a vector borne disease caused by Leishmania major and Leishmania tropica. Bikaner is an endemic pocket for cutaneous leishmaniasis caused by Leishmania tropica. Materials and Methods: A prospective study was done to evaluate the efficacy of different concentrations of intralesional amphotericin B as a treatment modality for cutaneous leishmaniasis in Bikaner, Rajasthan, India from January 2016 to June 2017. Fifty patients were randomized into two groups, A and B. Twenty-five patients from group A, received intralesionl amphotericin B (2.5 mg/ml) 0.5 ml/cm2, weekly for 8 weeks. Another group of 25 patients were treated by intralesional amphotericin B (5.0 mg/ml) weekly for same period. The cases were followed-up for response, side effects, and recurrence of disease. Results: The results at the end of 8 weeks, showed complete response in 18 (72%) patients, partial response in 5 (20%) and 2 (8%) patients were non responders in group A. In group B, complete response was observed in 14 (56%), partial response in 7 (28%) patients and 4 (16%) patients did not show response. The difference was statistically insignificant (P > 0.05). No side effects were observed in both groups. Conclusion: The difference between the efficacy of 5 mg/ml and 2.5 mg/ml concentrations of Amphotericin B injections was found to be statistically insignificant. So, weekly injections of amphotericin B looks promising, however, larger sample size is required to assess the efficacy of both concentrations in the treatment of cutaneous leishmaniasis.
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Clinicoepidemiologic features of chronic spontaneous urticaria in patients with elevated plasma D-dimer levels versus those without it: A case–control cross-sectional study of 100 indian patients p. 632
Shailja Chauhan, Vikram K Mahajan, Karaninder S Mehta, Rajinder S Yadav, Pushpinder S Chauhan, Satya Bhushan, Vikas Sharma, Anuj Sharma, Dhaarna Wadhwa, Aditi Sharma
DOI:10.4103/idoj.IDOJ_505_18  
Background: Activated coagulation cascade is implicated in urticaria pathogenesis marked by high plasma D-dimer, a marker of fibrinolysis, levels correlating with high urticaria activity score (UAS) and poor therapeutic outcome. Methods: Quantitative plasma D-dimer levels and coagulation parameters in 100 (male:female ratio 1:3) Indian patients with chronic spontaneous urticaria and age- and gender-matched healthy controls were compared. The clinicoepidemiologic features of chronic urticaria were then compared among patients with normal (≤0.2 mg/L) and elevated (≥0.3 mg/L) plasma D-dimer levels. Results: Plasma D-dimer in 23% patients and 4% controls and prothrombin time and activated partial thromboplastin time in 63% and 5% patients, respectively, were significantly higher compared with 58% and 1% of controls, respectively. About 18 of 72 (25%) patients with high UAS of ≥16–42 were compared with 5 of 28 (17.8%) patients with UAS7 of ≤15. Patients with elevated plasma D-dimer levels had significantly more systemic symptoms (86.9% vs. 81.8%) compared with patients with normal plasma D-dimer levels. Conclusion: A subset of patients with chronic urticaria have elevated plasma D-dimer levels and exhibit higher UAS7 and systemic symptoms that may influence long-term prognosis and therapeutic choices. Small number of patients, a cross-sectional nature of study, lack of treatment outcome measures, information on self-medication, and unavailability of specific parameters for coagulation pathway activation remain few limitations of this study.
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Dermoscopic diagnosis of ashy dermatosis: A retrospective study p. 639
Ömer Faruk Elmas, Emine Müge Acar, Asuman Kilitçi
DOI:10.4103/idoj.IDOJ_517_18  
Aim: Ashy dermatosis (AD) is a cutaneous pigmentation disorder with unknown etiology characterized by ash-colored hyperpigmented macules. The diagnosis of Ashy dermatosis is primarily based on the clinical and histopathological findings. In this study, we aimed to identify the dermoscopic features of AD, which may facilitate the diagnosis by reducing the need for invasive procedures. Material and Methods: The study included the patients diagnosed with Ashy dermatosis. Demographic, clinical, dermoscopic and histopathological features of the lesions were reviewed and the findings observed were recorded. Results: A total of 60 lesions from 15 patients were included. The most common dermoscopic finding were irregular linear dots and globules, pinkish brown color was the predominant color of the background, and found to be associated with early lesions. Among the vascular structures observed, irregular linear vessels were the most prevalent. There were no significant differences in terms of dermoscopic structures according to age and localization of the lesions. Conclusion: Dermoscopy can serve as a noninvasive helpful tool for the diagnosis of Ashy dermatosis.
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Clinico-Dermoscopic pattern of beard alopecia areata: A cross-sectional study p. 644
Delanthimar Joshika Bhandary, Banavasi Shanmukha Girisha, Basanna Nagargund Mahadevappa
DOI:10.4103/idoj.IDOJ_508_18  
Background: Alopecia areata (AA) is an autoimmune condition affecting hair-bearing regions of the body. Few studies worldwide have focused exclusively on beard alopecia areata (BAA). Aims: To describe the clinical associations, comorbidities, and dermoscopy of BAA. Materials and Methods: Forty-six patients with BAA were recruited for this hospital-based cross-sectional study. Patients with disease onset of less than 1 month, patches showing extension, and appearance of new patches within the past 1 month were grouped under active disease. Dermoscopy was performed using handheld polarized dermoscope. Chi-square test was applied to know the various associations. P value <0.05 was considered statistically significant. STATA 11.2 was used for analysis of data. Results: The mean age was 31.07 ± 8.72 years. The majority (50%) belonged to 20–29 age group. Twenty-two (48%) patients had active disease. Fourteen (30.43%) patients had extra-beard manifestation of AA. Statistically significant association was noted between active disease and extra-beard manifestation (P = 0.034). Diabetes mellitus and hypertension were noted in one and three patients, respectively. Alcohol abuse was noted in six patients and smoking in five patients. Dermoscopic findings such as black dots, short vellus hair, tapering hair, nonfollicular white dots, regrowing hair, yellow dots, and black dots were similar to findings noted in AA. Uncommon findings such as peripilar sign, i-hair, perifollicular hemorrhage, and tulip hair were observed in BAA. Limitations: Small sample size, lack of follow-up. Conclusion: Trichoscopy of BAA may reveal newer nonfollicular findings, in addition to the follicular findings already described in literature for AA.
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Pediatric cutaneous emergencies and their outcome: Study from a Tertiary Care Center in South India p. 650
Dharshini Sathishkumar, Parthiban Udhayakumar, Debasis Das Adhikari, Renu George
Background: Skin problems are commonly encountered in the pediatric emergency department (PED). Although there are a few studies on the prevalence and spectrum of skin conditions in children attending the PED, only limited information is available on the outcome of the children with skin-related ailments requiring hospitalization. Aim: To study the clinical profile of skin manifestations in children presenting to the PED over a period of one year and assess the impact of skin lesions on the clinical outcome. Materials and Methods: All children <16 years of age attending the PED were screened and children with skin lesions were referred to the dermatologist for further evaluation, and those admitted were followed up until discharge. Children with skin lesions were categorized into seven subsets based on their diagnosis. Outcomes evaluated were duration of hospital stay, associated systemic inflammatory response syndrome (SIRS), and mortality. Results: Of the 24,324 patients screened, 203 (0.83%) had skin lesions, of whom 158 (77.83%) were discharged from the PED. Forty five (22.16%) patients required admission of whom 2 (0.99%) died. Inflammatory disorders were the most common, 102 (50.24%), followed by infections in 91 (44.82%) patients. Among the hospitalized patients, 25 (55.6%) had SIRS, which included infections in 14 (56%), vasculitis in 5 (20%), and urticaria in 3 (12%) patients. Two patients with SIRS died and the causes were purpura fulminans and febrile exanthem of probable viral etiology. Conclusion: Our study highlights the spectrum of pediatric cutaneous emergencies and their outcome. A subset of patients can present with severe skin ailments and SIRS in whom early diagnosis and prompt treatment can impact the outcome.
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Analysis of hypersensitivity in fragrance series by patch testing p. 657
Mohan Kumar Periyasamy, Shanmuga C Sekar, Reena Rai
DOI:10.4103/idoj.IDOJ_490_18  
Introduction: Allergic contact dermatitis (ACD) is an inflammatory disorder, which occurs as a result of repeated contact with an allergen. Fragrances are the products obtained naturally or produced synthetically. The purpose of this study is to detect the fragrance allergens producing ACD. Materials and Methods: This is an open-label prospective observational study. Patients of age above 18 years with history of using cosmetic products with dermatitis lesions over face, neck, axilla and hands were included. Patch testing was done with fragrance series by using the standard technique. The results were interpreted on day 2 and day 4 as recommended by International Contact Dermatitis Research Group criteria. Results: Totally 27 patients were included in this study. Of them, 12 were males and 15 were females; the mean age was 43 years. The mean duration of symptoms was 12.5 months. The most common site of involvement was hands. Housewives and office workers were the most commonly affected occupational groups. The most commonly used category of cosmetic product was talcum powders by 13 (48.1%) patients. In this study, 85.18% patients showed at least one fragrance antigen positivity. Fragrance mix II is the most frequent allergen in this study. Discussion: We conclude that the fragrance mix II is an important marker to find out fragrance allergy. Hand dermatitis is the most common presentation in patients with fragrance allergy. Perfumed talcum powders, soaps and perfumes are the leading sources of sensitization to fragrance allergens.
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Correlation of dermoscopic and histopathologic patterns in leprosy – A pilot study p. 663
Ajay Chopra, Debdeep Mitra, Reetu Agarwal, Neerja Saraswat, Krishna Talukdar, Abhay Solanki
DOI:10.4103/idoj.IDOJ_297_18  
Background: Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. It is diagnosed based on clinical features and confirmed on the histological findings and peripheral slit-skin smear staining. Dermoscopy is a handy, easily accessible tool to diagnose this granulomatous disease and classify patients based on the immunological and clinical response. Methods: A single spot observational analysis was conducted in a tertiary hospital in North India. Patients attending the leprosy clinic and admitted patients for institutional therapy on the day of the study were enrolled in the cohort. The clinical and histological findings were correlated with the characteristic dermoscopy findings. A total of 50 patients were included in the study. All patents included in the study were on multidrug therapy and anti-lepra reaction drugs for a duration of less than 6 months. Results: The dermoscopy findings correlated with the clinical and histological findings. Tuberculoid poles of leprosy classically showed loss of hair and skin pigment along with absence of white dots as sweat glands in dermoscopy. Lack of blood vessel changes ruled out any lepra reaction. Lepromatous pole of leprosy on the other hand showed characteristic xerosis and white scaling on dermoscopy in the background of hypotrichosis and hypopigmentation. Leprosy reactions were characterized by blood vessel changes and arborizing blood vessels were characteristic in erythema nodosum leprosum, and a diffuse erythema was a clue toward diagnosing type I lepra reaction. Interestingly, clofazimine-induced pigmentation was picked up characteristically on dermoscopy as a “honey comb pattern”. Conclusion: Dermoscopy is certainly a handy tool in aiding the diagnosis of leprosy, lepra reactions, and course of therapy. Characteristic patterns during the course of leprosy would certainly facilitate a quick and definitive diagnosis of patients suffering from leprosy. Also, patient drug compliance particularly to clofazimine can also be picked up objectively on dermoscopy.
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Clinicoepidemiological and patch test profile of patients attending the contact dermatitis clinic of a tertiary care hospital in North India: A 7-year retrospective study p. 669
Iffat Hassan, Saniya Akhtar, Sumaya Zeerak, Farhan Rasool, Parvaiz Anwar Rather, Yasmeen J Bhat, Insha Latif, Shagufta Rather, Syed Mubashir, Shazia Jeelani, Reeta Devi, Yakzata Bashir, Nahida Nabi, Samina Batool, Samia Aleem
DOI:10.4103/idoj.IDOJ_26_19  
Introduction: Allergic contact dermatitis (ACD) is a growing concern due to increased use of cosmetics and topical medications routinely and exposure to a large number of allergens on day-to-day basis. Patch testing is a reliable method for detecting the causative antigens in suspected cases. Aims and Objectives: To assess the demographic profile, pattern of ACD, and patch test profile of suspected cases of ACD attending contact dermatitis clinic of our department. Materials and Methods: It was a retrospective study in which all the data enrolled in the contact dermatitis clinic of our department over a 7-year period were analyzed. Patch testing was done using the Indian Standard Series of 20 antigens primarily, and other batteries were used depending on patient requirement and availability. Results: A total of 582 patients were enrolled in the contact dermatitis clinic over a period of 7 years. Hand eczema was the most common pattern seen in 268 cases followed by feet eczema, hand and foot eczema, facial eczema, forearm and leg eczema and photoallergic contact eczema. A total of 177 patients (30.4%) gave positive patch test results, with nickel sulfate being the most common allergen identified followed by potassium dichromate, cobalt sulfate, paraphenylenediamine, neomycin sulfate, and fragrance mix. Conclusion: Common allergens identified in our study were more or less similar to studies from other parts of India. However, due to the unique climate of the valley, the profile of parthenium sensitivity was low in our study when compared to the rest of the country.
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BRIEF REPORTS Top

Hyperhidrosis prevalence: A disease underreported by patients and underdiagnosed by physicians Highly accessed article p. 676
Surajsingh Wadhawa, Sudha Agrawal, Manoj Chaudhary, Sanjib Sharma
DOI:10.4103/idoj.IDOJ_55_19  
Background: Hyperhidrosis (HH) is a disorder characterized by excessive sweating beyond required for normal thermoregulation, as a result of the excessive functioning of the sudomotor sweat control system. HH is broadly classified into 2 categories: primary HH and secondary. Our aim was to study the prevalence of HH in patients attending dermatological outpatients. Methods: Randomly selected 832 attendees of dermatology outpatient department were requested to fill out a questionnaire for their presenting concerns to attend, the demography information (age, gender, and occupation), and presence of excessive visible sweating symptoms after the informed, written, and understood consent. This questionnaire was then evaluated by the researchers. And those who had a history of excessive sweating were evaluated in detail about HH by another questionnaire. Results: The overall prevalence of HH was 17.9% (149/832), whereas only self-reported prevalence was 10.2% (85/832) in the dermatology outpatients. Of 149 patients, 110 (73.8%) were of primary HH followed by 39 (26.2%) of secondary HH. Conclusion: This study showed a higher prevalence of HH in the attendees of dermatology outpatients of a tertiary care center but estimates that this disease affects a much larger proportion of individuals in the Nepalese population.
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Dermoscopy in the evaluation of pityriasis versicolor: A cross sectional study p. 682
Ishmeet Kaur, Deepak Jakhar, Archana Singal
DOI:10.4103/idoj.IDOJ_502_18  
Background: Pityriasis versicolor (PV) is a superficial mycosis caused by Malassezia yeast; a lipophilic fungus. Dermoscopy may be a value addition in the diagnosis of PV in some cases, where results of KOH (potassium hydroxide) examination are ambiguous. There is paucity of Indian data on dermoscopy of PV. Materials and Methods: Thirty consecutive patients diagnosed clinically with pityriasis versicolor were recruited in this pilot cross sectional study.Patients were subjected to KOH mount of the skin scrapings from the lesions which were positive in all the patients.Dermoscopy was performed in all using Universal Serial Bus (USB) dermoscope [Dinolite AMZT 73915, Edge 3] and features were recorded for analysis. Results: Hypopigmented variant was the most common type (80%). Dermoscopic analysis revealed altered pigmentary network as most common finding (100%) followed by scaling seen in 25 cases (83.33%). Folliculocentric pattern was appreciated in 20 cases (66.67%). A characteristic contrast halo ring around the primary altered pigmentation was observed in 20 cases (66.67%). Invasion of hair follicles by yeast was evident in 6 patients (20%). Conclusion: Dermoscopy with characteristic features such as folliculocentricity, contrast halo sign, and yeast invasion of hair follicles can be a very useful aid in contributing towards diagnosing pityriasis versicolor.
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CASE REPORTS Top

Ichthyosis follicularis, alopecia, and photophobia (IFAP) syndrome: A case report and review of cases reported from India p. 686
Anupama Bains, Deepak Vedant, Anurag Verma, Abhishek Bhardwaj, Aasma Nalwa
DOI:10.4103/idoj.IDOJ_19_19  
Ichthyosis follicularis, alopecia, and photophobia (IFAP) syndrome is characterized by the triad of follicular keratotic papules, total to subtotal alopecia, and photophobia. We hereby report a case of IFAP syndrome in a 1-year-old boy who presented with all these classical features along with hyperkeratotic plaques over knees, plantar keratoderma, and umbilical hernia. Also, literature review of cases reported from India is being presented.
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Reverse koebner phenomenon in bullous pemphigoid – A case report p. 692
Liza Mohapatra, Kallolinee Samal, Prasenjeet Mohanty, Siddhartha Dash
DOI:10.4103/idoj.IDOJ_512_18  
Reverse Koebner response is the nonappearance or disappearance of the lesions of particular dermatoses at the site of injury. Herein we report a case of the reverse Koebner phenomenon in bullous pemphigoid in a 35-year-old male patient with sparing of the waist area which could probably be because of the phenomenon of locus majoris resistentiae. The histopathology of the lesion showed subepidermal split with a mixed inflammatory infiltrate, which was composed of predominantly eosinophils, neutrophils, and lymphocytes, but the histopathology of the spared skin showed no abnormalities. However, the direct immunofluorescence from the perilesional area showed linear deposits of immunoglobulin G and C3 in the dermoepidermal junction, but there were no deposits in direct immunofluorescence from the spared skin. This case is being reported for its originality and one of its kind.
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Squamous cell carcinoma and lymph node metastasis with hypertrophic lichen planus in a 12 year old boy p. 695
Anju George, Renu George, Sunitha S Varghese, Ramesh B Telugu
DOI:10.4103/idoj.IDOJ_27_19  
Hypertrophic lichen planus (HLP) is a chronic variant of lichen planus with an estimated risk of 0.4% developing squamous cell carcinoma (SCC) in later years. We report the case of a 12-year- old boy with history of hypertrophic lichen planus since 4 years of age, with malignant transformation into squamous cell carcinoma along with lymph node metastasis.
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Atypical presentation of sweat dermatitis with review of literature p. 698
Rohini Soni, Archana J Lokhande, Paschal D'souza
DOI:10.4103/idoj.IDOJ_5_19  
Sweat dermatitis is a peculiar kind of irritant inflammatory dermatoses occurring due to prolonged exposure of retained sweat over the skin. It is commonly seen in hot and dry climates like tropics during summer months due to thermal stress. Typically, parchment paper or cellophane paper like scaling is seen over occluded areas of back, shoulder, and other areas. Here we have reported a varied presentation of sweat dermatitis in the form of its coexistence with miliaria rubra (impending to thermal burn). Further we have also observed co existing pityriasis versicolor and sweat dermatitis where the former has prevented the development of latter. Till date there is very little discussion on this condition, so we have tried to provide a concise review about sweat dermatitis along with its classical to atypical presentation with special emphasis on dermoscopy.
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Treatment of elephantiasis nostras verrucosa with CO2laser p. 704
Adrián De Quintana Sancho, Leandra Reguero Del Cura, Susana Armesto Alonso, Marcos Antonio González López
DOI:10.4103/idoj.IDOJ_484_18  
Elephantiasis nostras verrucosa (ENV) is the most severe form of chronic non-filarial lymphedema that leads to disfiguration of body parts. Multiple topical and surgical treatments have been typically used with high relapse rates and local complications. In this context, CO2 laser emerges as a new well-tolerated and effective treatment option. We report two cases of long-term evolution of elephantiasis nostras verrucosa recalcitrant to topical therapy and successfully treated with CO2 laser. Both of them were septuagenarians with personal history of obesity and suffered from lower extremities edema due to heart failure in one case, and due to chronic venous insufficiency in the other. We describe the procedure, the results and the advisable maintenance for preventing recurrence in this difficult to treat and chronic condition.
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Concurrent presentation of systemic lupus erythematosus in mother and daughter p. 707
Pravesh Yadav, Anuja Yadav, Keemi Dalal, Ram Chander
DOI:10.4103/idoj.IDOJ_9_19  
Systemic lupus erythematosus (SLE) is a connective tissue disorder with a high prevalence in certain races like Africans. It also has a female predilection. The pathogenesis of SLE is a complex interplay of genetic and environmental factors. Familial presentation of SLE has been well documented. We herein illustrate a scenario of SLE presenting in related females (mother and daughter) concurrently with similar clinical features and fulfilling the Systemic Lupus Collaborating Clinics criteria. Stress was identified as a common possible triggering factor.
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Clinicopathological and dermoscopic features in a case of linear and unilateral basaloid follicular hamartoma p. 710
Naziya Muhammed, Atul M Dongre, Uday S Khopkar
DOI:10.4103/idoj.IDOJ_45_19  
Linear and unilateral basaloid follicular hamartoma (BFH) is a rare disease that manifests with papules and plaques with distribution along lines of Blaschko. It runs a benign course but with the risk of basal cell carcinoma (BCC) in long term course. BCC can be differentiated from BFH with histopathology and immunohistochemistry. Dermoscopic features of BCC are well studied. Dermoscopic features of BFH are not yet described in literature in detail probably due to rarity of the disease. Here, we present a case of extensive linear and unilateral BFH with its clinicohistopathological and dermoscopic features. The lesions were extensive to involve scalp, face, neck, upper, and lower trunk. Dermoscopy revealed features similar to that of BCC including brown-grey globules and dots, in focus dots, brown linear and arciform structures, crown vessels, short fine telangiectasias, spoke wheel like structures without central dark point, white structureless areas with telangiectasias and keratotic plug. Other dermoscopic features of BCC like arborizing vessels, blue-grey ovoid nests, maple leaf-like areas, concentric structures, ulcerations, erosions and white streaks were absent in this case.
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Adult onset xantogranulomatous disease associated with vitiligo p. 714
Rashmi Sriram, Rajendra Okade, TA Sushma
DOI:10.4103/idoj.IDOJ_65_19  
Adult Onset Xanthogranulomatous Disease represents an umbrella term encompassing 4 distinct entities with partially overlapping clinicopathological features: adult-onset xanthogranuloma, adult-onset asthma with periocular xanthogranuloma, Erdheim-Chester disease, and necrobiotic xanthogranuloma. They are characterized by a predilection to affect the orbit and ocular adnexa and special histopathological features, in particular infiltrates comprising non-Langerhans-derived foamy histiocytes and Touton giant cells. The appearance of the eyelid lesions is virtually diagnostic, producing readily recognisable diffuse, yellow plaques. Affected patients should be investigated and reviewed regularly for systemic disease. We would like to present a case of 35-year-old male patient with Adult-onset xanthogranulomatous disease [AOXG] associated with vitiligo. This case is reported for its rarity.
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MUSINGS, OPINIONS, TIPS AND EXPERIENCES Top

A dermatologist's visit to the community: An intriguing perspective p. 717
Anuja Yadav, Pravesh Yadav, Ram Chander
DOI:10.4103/idoj.IDOJ_111_19  
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CONCISE COMMUNICATIONS Top

Goldenhar syndrome: A report of two cases p. 719
Ramesh Kumar Kushwaha, Arti Singh, Alpana Mohta, Suresh Kumar Jain
DOI:10.4103/idoj.IDOJ_491_18  
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Pustular vasculitis: Different names for same entity? p. 721
Shivani B Kaushik, Animesh A Upadhyay, Ethan Routt, Robert Phelps
DOI:10.4103/idoj.IDOJ_415_18  
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Reed's syndrome - A rare case of multiple cutaneous and uterine leiomyomatosis with renal cyst p. 724
Liza Mohapatra, Kallolinee Samal, Prasenjeet Mohanty, Siddhartha Dash
DOI:10.4103/idoj.IDOJ_511_18  
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LETTERS TO THE EDITOR Top

Pemphigus herpetiformis masquerading as tinea corporis p. 727
Taru Garg, Anuja Yadav, Ram Chander, Anita Nangia
DOI:10.4103/idoj.IDOJ_43_19  
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Ulcerative lupus vulgaris primarily involving the ear lobule p. 729
Mary Zothanpuii Chhangte, Binod Kumar Thakur, Shikha Verma, Biswajit Dey
DOI:10.4103/idoj.IDOJ_436_18  
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Ocular abnormalities in vitiligo patients: A cross-sectional study p. 731
Neel Prabha, Namrata Chhabra, Ankur Kumar Shrivastava, Ripu Daman Arora, VR Roja, Shrikant Kaushik, Nitin M Nagarkar
DOI:10.4103/idoj.IDOJ_361_18  
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A rare case of alternative medicine induced toxic epidermal necrolysis without mucosal involvement p. 735
Rajeshwari Dabas, Navya Donaparthi, Radhakrishnan Subramaniyan, Manasa Shettisara Janney
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Clinical implications of antifungal drug susceptibility testing of dermatophytes p. 737
Ananta Khurana, Kabir Sardana, Anuradha Chowdhary, Khushboo Sethia
DOI:10.4103/idoj.IDOJ_253_19  
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Tinea confined to tattoo sites - An example of Ruocco's immunocompromised district p. 739
Shyam B Verma
DOI:10.4103/idoj.IDOJ_343_19  
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DERMATOLOGY PEARLS Top

“Toggle test” in dermoscopy of papulo-squamous lesions: An essential step for holistic evaluation p. 741
Chander Grover, Deepak Jakhar
DOI:10.4103/idoj.IDOJ_132_19  
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SKINDIA QUIZ Top

SkIndia Quiz 54: The Mysterious nodule on the thigh p. 743
Divya Sachdev, Satyaki Ganguly, Namrata Chhabra
DOI:10.4103/idoj.IDOJ_243_18  
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RESEARCH SNIPPETS Top

P-Value demystified p. 745
Amrita Sil, Jayadev Betkerur, Nilay Kanti Das
DOI:10.4103/idoj.IDOJ_368_19  
Biomedical research relies on proving (or disproving) a research hypothesis, and P value becomes a cornerstone of “null hypothesis significance testing.” P value is the maximum probability of getting the observed outcome by chance. For a statistical test to achieve significance, the error by chance must be less than 5%. The pros are the P value that gives the strength of evidence against the null hypothesis. We can reject a null hypothesis depending on a small P value. However, the value of P is a function of sample size. When the sample size is large, the P value is destined to be small or “significant.” P value is condemned by one school of thought who claims that focusing more on P value undermines the generalizability and reproducibility of research. For such a situation, presently, the scientific world is inclined in knowing the effect size, confidence interval, and the descriptive statistics; thus, researchers need to highlight them along with the P value. In spite of all the criticism, it needs to be understood that P value carries paramount importance in “precise” understanding of the estimation of the difference calculated by “null hypothesis significance testing.” Choosing the correct test for assessing the significance of the difference is profoundly important. The choice can be arrived by asking oneself three questions, namely, the type of data, whether the data is paired or not, and on the number of study groups (two or more). It is worth mentioning that association between variables, agreement between assessments, time-trend cannot be arrived by calculating the P value alone but needs to highlight the correlation and regression coefficients, odds ratio, relative risk, etc.
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HISTORY Top

Pandit Kriparam Sarma: A brief account of an unsung and unmourned leprosy curer p. 751
Amiya K Mukhopadhyay
DOI:10.4103/idoj.IDOJ_171_19  
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THROUGH THE LENS Top

Retinal astrocytic hamartoma in tuberous sclerosis p. 753
Chitaranjan Mishra, Naresh Babu Kannan, Kim Ramasamy, Dhipak Arthur Balasubramanian
DOI:10.4103/idoj.IDOJ_23_19  
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Molluscum contagiosum in interdigital area of foot in a pregnant patient p. 755
Murat Ozturk, Rojda Aktar, Remzi Erten
DOI:10.4103/idoj.IDOJ_408_18  
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THROUGH THE DERMOSCOPE Top

Demystifying the stinking reddish brown stains through the dermoscope: Cydnidae pigmentation p. 757
Shital Poojary, Kavya Baddireddy
DOI:10.4103/idoj.IDOJ_346_18  
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Dermoscopy of chromoblastomycosis p. 759
Payal Chauhan, Rashmi Jindal, Nadia Shirazi
DOI:10.4103/idoj.IDOJ_213_18  
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