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2015| May-June | Volume 6 | Issue 3
Online since
May 6, 2015
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ORIGINAL ARTICLES
Role of direct immunofluorescence in dermatological disorders
Vijaya V Mysorekar, TK Sumathy, AL Shyam Prasad
May-June 2015, 6(3):172-180
DOI
:10.4103/2229-5178.156386
PMID
:26009711
Background:
Direct immunofluorescence (DIF) test for tissue-bound autoantibodies, has been found to be of value in the diagnosis of several dermatological disorders. The location and pattern of deposition of immunoreactants helps in classifying various immune-mediated diseases.
Aims and Objectives:
The aim of this study was to analyze the concordance between the clinical, histopathological and DIF diagnosis in bullous and nonbullous lesions of the skin, and thus determine the impact of immunofluorescence on diagnosis.
Materials and Methods:
A total of 215 skin biopsies performed in suspected immune-mediated vesiculobullous disease, vasculitis or dermatosis, were studied. Histopathological examination was done along with DIF study for deposits of immunoglobulin G(IgG), IgA, IgM, and C3.
Results:
Direct immunofluorescence was positive in 103/215 cases. There was very good concordance between the clinical, histological and DIF results (observed agreement = 93.4%,
κ
=0.90, with 95% confidence interval = 0.86-0.94). The overall sensitivity of DIF in immune-mediated skin disorders was 98.0%. DIF was positive in 52/53 cases (98.1%) in the pemphigus group and 24/25 (96.0%) bullous pemphigoid cases. None of the clinically suspected cases of dermatitis herpetiformis showed DIF positivity. A positive lupus band test was seen in 9/9 (100%) cases of lupus erythematosus. DIF was positive in 10/10 (100%) clinically suspected cases of Henoch-Schönlein purpura. In 110 cases, negative DIF results helped to rule out immune-mediated vesiculobullous disorders, lupus erythematosus and vasculitis, and the final diagnosis was made on the basis of the clinical features and/or histopathology.
Conclusion:
Direct immunofluorescence is a useful supplement for the accurate diagnosis of immune-mediated dermatological disorders, and helps to classify various autoimmune bullous disorders. When the clinical features/histopathology are inconclusive, the diagnosis often can be made on the basis of the DIF findings alone. A combination of the clinical features, histopathology and DIF usually gives the best results.
[ABSTRACT]
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3,120
752
5
REVIEW ARTICLES
Light-based therapies in acne treatment
Susan Pei, Arun C Inamadar, Keshavmurthy A Adya, Maria M Tsoukas
May-June 2015, 6(3):145-157
DOI
:10.4103/2229-5178.156379
PMID
:26009707
The use of light and laser in the treatment of acne is increasing as these modalities are safe, effective, and associated with no or minimal complications when used appropriately. These light and laser sources are also being used in combination with pharmacological and/or physical measures to synergize their effects and optimize the therapeutic outcome. This review focuses on optical devices used in treating acne and serves to delineate the current application of various methods, including their utility and efficacy.
[ABSTRACT]
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2,830
831
9
Clinical photography in dermatology using smartphones: An overview
KT Ashique, Feroze Kaliyadan, Sanjeev J Aurangabadkar
May-June 2015, 6(3):158-163
DOI
:10.4103/2229-5178.156381
PMID
:26009708
The smartphone is one of the biggest revolutions in the era of information technology. Its built in camera offers several advantages. Dermatologists, who handle a specialty that is inherently visual, are most benefited by this handy technology. Here in this article, we attempt to provide an overview of smartphone photography in clinical dermatology in order to help the dermatologist to get the best out of the available camera for clinical imaging and storage
[ABSTRACT]
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2,660
512
3
ORIGINAL ARTICLES
Acyclovir in pityriasis rosea: An observer-blind, randomized controlled trial of effectiveness, safety and tolerability
Anupam Das, Amrita Sil, Nilay Kanti Das, Kunal Roy, Amal Kanti Das, Debabrata Bandyopadhyay
May-June 2015, 6(3):181-184
DOI
:10.4103/2229-5178.156389
PMID
:26009712
Background:
Pityriasis rosea (PR) is an acute inflammatory dermatosis. The association of human herpes virus 6 and 7 suggests the utility of use of antiviral agents in this disease.
Aims
and
Objectives:
To evaluate the effectiveness and safety of acyclovir in the treatment of PR.
Methods:
An observer-blind, randomized (1:1), parallel group, add-on trial was conducted on 24 adult patients with PR. Subjects of both Group A and B received the standard of care in the form of cetirizine 10 mg OD and calamine. Group A in addition received acyclovir 400 mg tablets thrice daily for 7 days. Both groups were followed up for four consecutive weeks for assessment of effectiveness and adverse events.
Results:
Group A complained of significantly fewer new lesions than Group B (
P
= 0.046). A complete response was obtained in all patients of Group A and 83% patients of Group B at the end of the follow up period. There was significant reduction in both lesional score and pruritus at second week follow-up in Group A and third week follow-up in Group B (
P
< 0.05). Minor adverse effects were observed in both treatment arms.
Conclusion:
Acyclovir offered rapid resolution of clinical severity of PR from second week onwards without significantly increased adverse events as compared to supportive therapy alone.
[ABSTRACT]
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2,337
570
2
Dermoscopic evaluation of idiopathic guttate hypomelanosis: A preliminary observation
Balachandra S Ankad, Savitha L Beergouder
May-June 2015, 6(3):164-167
DOI
:10.4103/2229-5178.156383
PMID
:26009709
Background:
Depigmented skin lesions are of great concern in the society, especially in the Indian subcontinent. These comprise many infective and inflammatory conditions that cause apprehension and anxiety among patients due to the social stigma attached to these conditions. Idiopathic guttate hypomelanosis (IGH) appears similar to many depigmented lesions and differentiation of IGH from these conditions is difficult clinically as well as histopathologically.
Methods:
Clinically suspected IGH were included in the study. All IGH lesions were confirmed by histopathology. Clinical data and dermoscopic patterns were analyzed and presented in proportions and percentages.
Results:
Thirty patients were included in the study with 16 females and 14 males. Dermoscopy showed amoeboid, feathery, petaloid and nebuloid patterns in 12, 7, 6 and 1 patients respectively. Four patients had combination of these patterns.
Conclusion:
Dermoscopy of IGH revealed consistent patterns. Hence, we propose these patterns were specific to IGH and help clinician to differentiate many depigmented skin lesions from IGH in clinical practice. However, histopathology must be done for confirmation of diagnosis. Further studies on dermoscopy of IGH with histopathology correlation are proposed.
[ABSTRACT]
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4
A study of cutaneous adverse drug reactions at a tertiary center in Jammu, India
Rohini Sharma, Devraj Dogra, Naina Dogra
May-June 2015, 6(3):168-171
DOI
:10.4103/2229-5178.156384
PMID
:26009710
Aim:
The aim was to study various morphological patterns of cutaneous adverse drug reactions (CADRs) and identify the culprit drug or drugs by establishing a causal link using Naranjo adverse drug reaction probability scale.
Materials and Methods:
The study was carried out between November 2010 and November 2011 at the Department of Dermatology, Government Medical College, Jammu. A total of 150 patients with CADR reporting to the dermatology department or referred from other departments were evaluated. Detailed history, clinical examination, hematological, and biochemical investigations were recorded. The venereal disease research laboratory test, HIV (ELISA), and histopathological examination were done wherever indicated.
Results:
A total of 150 patients were evaluated after applying the inclusion and exclusion criteria. The mean age of the patients with CADRs was 33.26 years. A majority of patients (30.6%) were in the age group of 21-30 years. The male to female ratio was 1.7:1.2. The most common CADRs were fixed drug eruption in 33.3% of patients followed by urticaria in 17.3%, and maculopapular rash in 13.3%. The most common classes of drugs implicated were antimicrobials in 40% of patients followed by nonsteroidal antiinflammatory drugs in 35.3%. The Naranjo adverse drug reaction probability scale indicated probable association of 77.3%, highly probable association of 12.6%, and 1% possible association with the implicated drugs.
Conclusion:
The pattern of CADRs and the drugs causing them is remarkably different in our population. Knowledge of these drug reactions, their causative drugs, and prognostic indicators is essential for the clinician.
[ABSTRACT]
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1,870
413
1
THROUGH THE LENS
Dermoscopic patterns in lichen sclerosus: A report of three cases
Balachandra S Ankad, Savitha L Beergouder
May-June 2015, 6(3):237-240
DOI
:10.4103/2229-5178.156450
PMID
:26009734
[FULL TEXT]
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1,706
223
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LETTERS TO THE EDITOR
Adrenocorticotropic hormone test and estimation of a safe dose for high potency steroids in vitiligo
Beuy Joob, Viroj Wiwanitkit
May-June 2015, 6(3):227-227
DOI
:10.4103/2229-5178.156434
PMID
:26009728
[FULL TEXT]
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1,728
126
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RESIDENTS’ AREA
Newly described signs in dermatology
Bhushan Madke, Sumit Kar, Nidhi Yadav
May-June 2015, 6(3):220-221
DOI
:10.4103/2229-5178.156424
PMID
:26009724
Authors have attempted to discuss recently described "signs" in the field of dermatology.
[ABSTRACT]
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1,198
477
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LETTERS TO THE EDITOR
"Reversed pigmentary network pattern" in evolving lesions of vitiligo
Sarvesh S Thatte, Atul M Dongre, Uday S Khopkar
May-June 2015, 6(3):222-223
DOI
:10.4103/2229-5178.156427
PMID
:26009725
[FULL TEXT]
[PDF]
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1,253
199
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ORIGINAL ARTICLES
Azathioprine in autologous serum skin test positive chronic urticaria: A case-control study in a tertiary care hospital of eastern India
Dulal Chandra Bhanja, Loknath Ghoshal, Sudip Das, Suchibrata Das, Alok Kumar Roy
May-June 2015, 6(3):185-188
DOI
:10.4103/2229-5178.156391
PMID
:26009713
Context:
Urticaria, also referred to as hives or wheals is a common and distinctive reaction pattern characterized by spontaneous eruption of wheals. About 30-50% of patients categorized as idiopathic urticaria have autoimmune urticaria, needing immunosuppressive agents. Immunosuppressive agents are either too costly or have serious side effects. Azathioprine seems to address both these issues, being less costly.
Aims:
The aim was to evaluate the role of azathioprine in autologous serum skin test (ASST) positive chronic urticaria (CU).
Settings and Design:
A single-blind randomized control trial of ASST positive patients of CU.
Materials and Methods:
Patients with positive ASST were allotted into two treatment groups, named group A and group B. Patients in group A were administered azathioprine (50 mg/day) for a period of 8 weeks and followed up till 36 weeks, while patients in group B were given placebo pills. All patients were directed to take levocetirizine (5 mg) on as and when basis, in addition. Urticaria was assessed by total severity score.
Statistical Analysis Used:
MedCalc statistical software (v 12.5 for Windows) to calculate
P
values in independent samples by
t
-test, Mann-Whitney test, Friedmann test, and ANOVA.
Results:
Administration of azathioprine in group A resulted in a significant diminution of the intensity of the disease as well as in the requirement of rescue antihistamine (positive primary and secondary outcome).
Conclusion:
Azathioprine not only had immunomodulatory properties during the treatment period, but also had lasting therapeutic effect as well. There were some gastrointestinal side effects in the initial stages but no incidence of hematological or biochemical disturbances.
[ABSTRACT]
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1,162
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4
CASES FROM ACKERMAN ACADEMY
Tumor with the features of both squamous cell carcinoma and melanoma (melanocarcinoma)
Elise Kochoumian, Viktoryia Kazlouskaya, Aaron Mangold, Karan Lal, Sandra Maia-Cohen, Dirk M Elston
May-June 2015, 6(3):217-219
DOI
:10.4103/2229-5178.156422
PMID
:26009723
Combined tumors of malignant melanoma (MM) and squamous cell carcinoma (SCC) are extremely rare and have unknown biological potential. Different theories of their development, including collision and dual/divergent differentiation, are proposed. Although some observations suggest an indolent course for such tumors, a case of MM metastasis was reported in a patient who initially presented with a combined MM-SCC tumor. Re-excisions of such tumors may show MM
in situ
and should be treated accordingly. Herein we present another case of a combined MM-SCC tumor in a 78 male patient with lentigo maligna seen after complete re-excision of the tumor.
[ABSTRACT]
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1,165
176
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CASE REPORTS
Ineffectiveness of tumor necrosis factor-α blockers and ustekinumab in a case of type IV pityriasis rubra pilaris
Vito Di Lernia, Elena Ficarelli, Magda Zanelli
May-June 2015, 6(3):207-209
DOI
:10.4103/2229-5178.156410
PMID
:26009720
Treatment of pityriasis rubra pilaris (PRP) may be difficult since no standardized therapeutic approach has been established. Recently, tumor necrosis factor-α (TNF-α) blockers have been demonstrated to be favorable in the management of recalcitrant PRP. The authors report a case of a patient who presented a type IV PRP or circumscribed, juvenile type. Such a condition follows an unpredictable course, presenting with diffuse, palmoplantar keratoderma and sharply-demarcated areas of follicular hyperkeratosis on the elbows and knees. Treatment with all available TNF-α inhibitors and ustekinumab did not prove to be helpful. The authors suggest that circumscribed variants of PRP could respond to therapy in ways different from classical PRP.
[ABSTRACT]
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1,106
182
4
THROUGH THE LENS
Bilateral asymmetrical herpes zoster
Shailesh M Kantaria
May-June 2015, 6(3):236-236
DOI
:10.4103/2229-5178.156448
PMID
:26009733
[FULL TEXT]
[PDF]
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[PubMed]
1,081
136
1
CASE REPORTS
Cutaneous metastasis in anorectal adenocarcinoma
Krishnendra Varma, Ujjwal Kumar Singh, Mansi Jain, PL Dhand
May-June 2015, 6(3):213-216
DOI
:10.4103/2229-5178.156418
PMID
:26009722
Cutaneous metastasis in anorectal adenocarcinoma is a rare entity. Here, we report the case of a 40-year-old female who presented with yellowish-brown, irregular, solid, elevated rashes over the pubis with a recent history off palliative colostomy for anorectal adenocarcinoma. Clinically, we suspected metastasis that was proved on biopsy. We report this case due to the rare presenting site (i.e., perineum) of a metastatic adenocarcinoma.
[ABSTRACT]
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1,088
121
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Asymptomatic papules over central and pericentral areas of the face
Atul Jain, Banashree Majumdar, Debashis Sen, Sumit Sen, Pranshu Mishra, Ayan Samanta
May-June 2015, 6(3):198-200
DOI
:10.4103/2229-5178.156404
PMID
:26009717
We report the case of a 24-year-old college girl, presenting with numerous acneiform papular eruptions over the central part of the face.
[ABSTRACT]
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1,001
182
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Rhinocerebrocutaneous mucormycosis caused by
Mucor
species: A rare causation
Snehal Balvant Lunge, Vijaya Sajjan, Ashok M Pandit, Vaibhav B Patil
May-June 2015, 6(3):189-192
DOI
:10.4103/2229-5178.156393
PMID
:26009714
Rhinocerebral mucormycosis is the most common form of mucormycosis occurring commonly in patients of diabetic ketoacidosis. Fungi of the order
Mucorales
belong to six families, among whom
Rhizopus
is the most common, while
Mucor
is a rare cause. We report a 45-year-old female with uncontrolled diabetes mellitus diagnosed to have rhinocerebrocutaneous mucormycosis caused by
Mucor
species. The diagnosis was confirmed on histology and culture. A high-index of suspicion is required for early diagnosis and timely initiation of therapy to optimize the outcome. Our patient succumbed to her infection.
[ABSTRACT]
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942
187
1
THROUGH THE LENS
Acral freckling with palmar pits
Keshavmurthy A Adya, Arun C Inamadar, Aparna Palit
May-June 2015, 6(3):234-235
DOI
:10.4103/2229-5178.156445
PMID
:26009732
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[PubMed]
917
167
1
CASE REPORTS
Giant cell tumor of the tendon sheath mimicking a plexiform neurofibroma
Swagata Arvind Tambe, Mayur Bhobe, Hemangi R Jerajani
May-June 2015, 6(3):201-203
DOI
:10.4103/2229-5178.156407
PMID
:26009718
Giant-cell tumor of the tendon sheath (GCTTS) is a benign soft tissue tumor of the limbs arising from the complex of the tendon sheath and periarticular soft tissues of small joints. It is the second most common benign space occupying lesion in the hand and usually presents as a painless soft tissue mass, which grows slowly in size for many years. We present an interesting case of an enormous GCTTS presenting as a slowly growing mass over left sole of a 52-year-old woman. The duration of GCTTS may range from a few weeks to 30 years but in our case the duration of tumor was almost 48 years, which could be the longest reported duration of GCTTS.
[ABSTRACT]
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895
185
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Diffuse leprosy with "deck-chair" sign
M Manjunath Shenoy, Mukhtar Ahmed Bendigeri, Prshanth R Kamath, B Vishal
May-June 2015, 6(3):204-206
DOI
:10.4103/2229-5178.156408
PMID
:26009719
A 55-year-old male presented with asymptomatic extensive skin lesions since one year. He was found to have diffuse lesions involving the face, trunk, arms, and thighs along with symmetric peripheral nerve thickening. Bacteriological and histopathological examination confirmed lepromatous leprosy. There was a conspicuous sparing of the abdominal creases and axillae from the infiltrative lesions suggesting a positive "deck-chair" sign. This sign has been described in the past with papulo-erythroderma of Ofuji and certain other disorders. Leprosy may be now included among the causes of "deck-chair" sign.
[ABSTRACT]
[FULL TEXT]
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[PubMed]
733
302
2
Acropigmentation of Kitamura with immigration delay disease: A rare entity
Sumir Kumar, Bharat Bhushan Mahajan, Nidhi Kamra, Pritish A Bhoyar
May-June 2015, 6(3):210-212
DOI
:10.4103/2229-5178.156415
PMID
:26009721
Reticulate acropigmentation of Kitamura (RAK) is a rare, autosomal dominant disorder first described in Japan characterised by a reticulate pattern of slightly atrophic, angulated, hyperpigmented macules affecting the acral areas of the body. We hereby report a case of RAK in a young Indian male with adermatoglyphia that has not been previously reported in the literature.
[ABSTRACT]
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871
162
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Subcutaneous leiomyosarcoma of scrotum presenting as an exophytic mass: An unusual presentation
Ashima Batra, Nisha Marwah, Sanjay Marwah, Sumiti Gupta, Rajeev Sen
May-June 2015, 6(3):193-195
DOI
:10.4103/2229-5178.156394
PMID
:26009715
Paratesticular leiomyosarcoma originates from testicular tunica (48%), spermatic cord (48%), epididymis (2%) and dartos muscle, as well as subcutaneous tissue of the scrotum (2%). Leiomyosarcomas of the scrotum, not involving the testis, epididymis or spermatic cord, are rare, and belong to the group of subcutaneous superficial leiomyosarcomas. To the knowledge of the authors, less than 10 cases of leiomyosarcoma of the scrotum have so far been reported from India. The tumor usually presents as a painless, slow-growing scrotal mass in middle-aged or elderly men. The current approach is wide local excision, often with adjuvant therapy. The prognosis is usually good following complete excision, though a local recurrence rate of 40% has been reported. Long term follow-up is, therefore, necessary to monitor for recurrence. Herein we present the case of 35-year-old male who presented with an exophytic scrotal mass. Histopathological and immunohistochemical findings of the mass were consistent with leiomyosarcoma.
[ABSTRACT]
[FULL TEXT]
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729
156
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THROUGH THE LENS
Acute methotrexate toxicity presenting as ulcers in plaques of psoriasis vulgaris
Anuj Bhatnagar, Rajesh Verma, Biju Vasudevan, Neerja Saraswat
May-June 2015, 6(3):232-233
DOI
:10.4103/2229-5178.156442
PMID
:26009731
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
701
172
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CASE REPORTS
Lupus vulgaris leading to perforation of nasal septum in a child
Archana Singal, Rahul Arora, Deepika Pandhi
May-June 2015, 6(3):196-197
DOI
:10.4103/2229-5178.156401
PMID
:26009716
Lupus vulgaris (LV) is a common form of cutaneous tuberculosis in India, mostly involving the lower half of the body. Facial involvement is uncommon. Untreated disease may lead to significant morbidity due to atrophic scarring, mutilation, and deformity. We report a case of multi-focal LV in a 10-year-old boy affecting the nose and cheek that resulted in perforation of the nasal septum, a rarely reported complication.
[ABSTRACT]
[FULL TEXT]
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710
151
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SKINDIA QUIZ
SkIndia Quiz 18: Multiple erythematous nodules in a 30-year-old woman
Martha Elena García-Meléndez, Kristian Eichelmann, Osvaldo Tomás Vázquez-Martínez, Jorge Ocampo-Candiani
May-June 2015, 6(3):228-229
DOI
:10.4103/2229-5178.153033
PMID
:26009729
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
705
111
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THROUGH THE LENS
Brownish macule on the palm
S Pradeep Nair
May-June 2015, 6(3):230-231
DOI
:10.4103/2229-5178.156439
PMID
:26009730
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
609
135
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LETTERS TO THE EDITOR
Pheohyphomycotic cyst
Bhushan Madke, Uday Khopkar
May-June 2015, 6(3):223-225
DOI
:10.4103/2229-5178.156429
PMID
:26009726
[FULL TEXT]
[PDF]
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[EPub]
[PubMed]
500
123
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Malignant peripheral nerve sheath tumour in a patient with a plexiform neurofibromatosis
Ravi Nekkanti, Raghunath Prabhu, Annappa Kudva, Sakshi Sadhu
May-June 2015, 6(3):225-226
DOI
:10.4103/2229-5178.156431
PMID
:26009727
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
475
118
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Online since 1
st
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