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Side-effects of topical steroids: A long overdue revisit
Arijit Coondoo, Meghana Phiske, Shyam Verma, Koushik Lahiri
October-December 2014, 5(4):416-425
The introduction of topical steroids (TS) of varying potency have rendered the therapy of inflammatory cutaneous disorders more effective and less time-consuming. However the usefulness of these has become a double edged sword with constantly rising instances of abuse and misuse leading to serious local, systemic and psychological side effects. These side effects occur more with TS of higher potency and on particular areas of the body like face and genitalia.The article reviews the side effects of TS with special mention about peadiatric age group, also includes the measures for preventing the side effects.
  30 14,722 1,440
Mantoux test and its interpretation
Surajit Nayak, Basanti Acharjya
January-April 2012, 3(1):2-6
DOI:10.4103/2229-5178.93479  PMID:23130251
The tuberculin skin test is one of the few investigations dating from the 19 th century that are still widely used as an important test for diagnosing tuberculosis. Though very commonly used by physicians worldwide its interpretation always remains difficult and controversial. Various factors like age, immunological status coexisting illness etc influence its outcome, so also its interpretation. Utmost care is required while interpreting the result and giving an opinion. This article has been written with the purpose of elucidating the performance and interpretation of the standard tuberculin test.
  29 61,592 3,485
Vitamin C in dermatology
Pumori Saokar Telang
April-June 2013, 4(2):143-146
DOI:10.4103/2229-5178.110593  PMID:23741676
Vitamin C is a potent antioxidant drug that can be used topically in dermatology to treat and prevent changes associated with photoageing. It can also be used for the treatment of hyperpigmentation. Because it is unstable and difficult to deliver into the dermis in the optimum dosage, research is being directed to find stable compounds of Vitamin C and newer methods of delivery of Vitamin C into the dermis.
  24 17,608 2,043
Nanocarriers and nanoparticles for skin care and dermatological treatments
Sanjeev Gupta, Radhika Bansal, Sunita Gupta, Nidhi Jindal, Abhinav Jindal
October-December 2013, 4(4):267-272
DOI:10.4103/2229-5178.120635  PMID:24350003
Nanotechnology (nano: One billionth) is a novel arena with promising applications in the field of medicine, especially pharmaceuticals for safe and targeted drug delivery. The skin is a phenomenal tool for investigation of nanocarriers for drug delivery for topical and dermatological application. The physicochemical characteristics of the nanoparticles, such as rigidity, hydrophobicity, size and charge are crucial to the skin permeation mechanism. Many nanocarriers such as polymeric, inorganic and lipid nanoparticles and nanoemulsions have been developed and some like carbon nanotubes and fullerenes still need further exploration for future use in skin care and dermatological treatments. Risks of nanopollution and cytotoxicity also need to be kept in mind while exploring various nanoparticles for medical use.
  24 5,307 3,409
Microneedling: Advances and widening horizons
Aashim Singh, Savita Yadav
July-August 2016, 7(4):244-254
DOI:10.4103/2229-5178.185468  PMID:27559496
Microneedling is a very simple, safe, effective, and minimally invasive therapeutic technique. It was initially introduced for skin rejuvenation, however, now it is being used for a very wide range of indications including acne scar, acne, post-traumatic/burn scar, alopecia, skin rejuvenation, drug delivery, hyperhidrosis, stretch marks, and many more. Moreover, during the last 10 years, many new innovations have been made to the initial instrument, which was used for microneedling. This technique can be combined with other surgical techniques to provide better results. In particular, it is a very safe technique for dark skin types, where risk of postinflammatory pigmentation is very high with other techniques that damage the epidermis. In this review article, we are updating on the different instruments now available for this procedure, and its efficacy when performed alone or in combination with other techniques for various indications.
  20 19,680 2,812
Topical rapamycin (sirolimus) for facial angiofibromas
Bhushan Madke
January-March 2013, 4(1):54-57
DOI:10.4103/2229-5178.105488  PMID:23439391
Rapamycin (sirolimus) is a fungal fermentation product that inhibits the proper functioning of a serine/threonine protein kinase in mammalian cells eponymously named mammalian target of rapamycin, or mTOR. Rapamycin is a novel class of anticancer and immunosuppressant drugs targeting the proteins at molecular level. Rapamycin (sirolimus) is routinely incorporated in drug-eluting stents used for cardiac angioplasty. In recent years, rapamycin was found to be efficacious in managing the symptom complex of tuberous sclerosis, i.e. renal angiomyolipoma, giant cell astrocytoma and pulmonary lymphangiomyomatosis. Various investigators have also proved that topically applied rapamycin causes regression of facial angiofibromas, giving better cosmetic results.
  17 12,623 1,425
Acne inversa (Hidradenitis suppurativa): A review with a focus on pathogenesis and treatment
Uwe Wollina, André Koch, Birgit Heinig, Thomas Kittner, Andreas Nowak
January-March 2013, 4(1):2-11
DOI:10.4103/2229-5178.105454  PMID:23439959
Acne inversa (AI) is a disabilitating chronic inflammatory disease with major negative impact on quality of life and significant co-morbidities. This is an important link to insights into immune dysfunction, which stimulated therapeutic approaches like tumor necrosis-α inhibitor therapy. This new off-label drug treatment is particularly beneficial when used in combination with wide excision of inflamed skin and subcutaneous tissue. Retinoids have been reported to be helpful in secondary prevention. The standard of therapy in advanced cases is surgery with wide excisions and healing by secondary intention. This treatment results in significant reduction of complaints and achieves satisfactory body contouring.
  16 24,472 1,885
Cutaneous lupus erythematosus: An update
Carina M Grönhagen, Filippa Nyberg
January-March 2014, 5(1):7-13
DOI:10.4103/2229-5178.126020  PMID:24616847
Lupus erythematosus (LE) is a chronic, autoimmune, multisystem disease that displays many diverse symptoms in which localized cutaneous LE (CLE) is on one end of the spectrum and severe systemic LE (SLE) on the other end. The underlying cause of LE is unknown but the etiology is thought to be multifactorial and polygenic. CLE is a disfiguring, chronic skin disease, with a significant impact on the patients' everyday life. CLE are further divided into three main subsets: Acute CLE (ACLE), subacute CLE (SCLE) and chronic CLE (CCLE), where classic discoid LE (DLE) is the most common form. These subsets are defined by clinical symptoms, average duration of symptoms and histological and serological findings, although, the three subtypes can have overlapping clinical features. CLE patients display well-defined skin lesions, often in sun-exposed areas. The disease often has a chronic and relapsing course that can be induced or aggravated by UV light. It is important to confirm a CLE diagnosis histopathologically by a biopsy and in that there are several differential diagnoses and because CLE is a chronic disease in which regular follow-up is important and systemic treatment is sometimes indicated.
  16 7,362 1,517
Pyoderma gangrenosum: An update
Ramesh M Bhat
January-April 2012, 3(1):7-13
DOI:10.4103/2229-5178.93482  PMID:23130252
Pyoderma gangrenosum (PG) is an uncommon, distinctive cutaneous ulceration which is usually idiopathic, but may be associated with many systemic disorders. The etipathogenesis of of PG is still not well understood. Clinically it is classified into ulcerative, pustular, bullous and vegetative types. A few atypical and rare variants have also been described. The diagnosis mainly depends on the recognition of evolving clinical features as investigations only assist in the diagnosis. In view of this a few criteria have been proposed for the diagnosis of PG. the treatment mainly consists of corticosteroids and immunosuppressive agents. A few new agents have also been tried in the management.
  14 16,445 1,948
An approach to acanthosis nigricans
Meghana Madhukar Phiske
July-September 2014, 5(3):239-249
DOI:10.4103/2229-5178.137765  PMID:25165638
Acanthosis nigricans (AN) is characterized by dark, coarse and thickened skin with a velvety texture, being symmetrically distributed on the neck, the axillae, antecubital and popliteal fossae, and groin folds, histopathologically characterized by papillomatosis and hyperkeratosis of the skin. A high prevalence of AN has been observed recently. Different varieties of AN include benign, obesity associated, syndromic, malignant, acral, unilateral, medication-induced and mixed AN. Diagnosis is largely clinical with histopathology needed only for confirmation. Other investigations needed are fasting lipoprotein profile, fasting glucose, fasting insulin, hemoglobin and alanine aminotransferase for obesity associated AN and radiological investigations (plain radiography, ultrasonography, magnetic resonance imaging/computerized tomography) for malignancy associated AN. The most common treatment modalities include retinoids and metformin.
  13 28,234 2,970
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.
  13 5,208 1,099
Management of tinea corporis, tinea cruris, and tinea pedis: A comprehensive review
Alok Kumar Sahoo, Rahul Mahajan
March-April 2016, 7(2):77-86
DOI:10.4103/2229-5178.178099  PMID:27057486
The prevalence of superficial mycotic infection worldwide is 20–25% of which dermatophytes are the most common agents. Recent developments in understanding the pathophysiology of dermatophytosis have confirmed the central role of cell-mediated immunity in countering these infections. Hence, a lack of delayed hypersensitivity reaction in presence of a positive immediate hypersensitivity (IH) response to trichophytin antigen points toward the chronicity of disease. Diagnosis, though essentially clinical should be confirmed by laboratory-based investigations. Several new techniques such as polymerase chain reaction (PCR) and mass spectroscopy can help to identify the different dermatophyte strains. Management involves the use of topical antifungals in limited disease, and oral therapy is usually reserved for more extensive cases. The last few years have seen a significant rise in the incidence of chronic dermatophyte infections of skin which have proven difficult to treat. However, due to the lack of updated national or international guidelines on the management of tinea corporis, cruris, and pedis, treatment with systemic antifungals is often empirical. The present review aims to revisit this important topic and will detail the recent advances in the pathophysiology and management of tinea corporis, tinea cruris, and tinea pedia while highlighting the lack of clarity of certain management issues.
  12 62,943 7,176
Clinical variants, stages, and management of basal cell carcinoma
Lyubomir A Dourmishev, Darena Rusinova, Ivan Botev
January-March 2013, 4(1):12-17
DOI:10.4103/2229-5178.105456  PMID:23439912
Basal cell carcinoma (BCC) is the most common paraneoplastic disease among human neoplasms. The tumor affects mainly photoexposed areas, most often in the head and seldom appears on genitalia and perigenital region. BCC progresses slowly and metastases are found in less than 0.5% of the cases; however, a considerable local destruction and mutilation could be observed when treatment is neglected or inadequate. Different variants as nodular, cystic, micronodular, superficial, pigment BCC are described in literature and the differential diagnosis in some cases could be difficult. The staging of BCC is made according to Tumor, Node, Metastasis (TNM) classification and is essential for performing the adequate treatment. Numerous therapeutic methods established for treatment of BCC, having their advantages or disadvantages, do not absolutely dissolve the risk of relapses. The early diagnostics based on the good knowledge and timely organized and adequate treatment is a precondition for better prognosis. Despite the slow progress and numerous therapeutic methods, the basal cell carcinoma should not be underestimated.
  12 8,793 1,132
Prevention of venous leg ulcer recurrence
M Manjunath Shenoy
July-September 2014, 5(3):386-389
DOI:10.4103/2229-5178.137824  PMID:25165681
  12 1,866 389
Learning from eponyms: Jose Verocay and Verocay bodies, Antoni A and B areas, Nils Antoni and Schwannomas
Rajiv Joshi
September-December 2012, 3(3):215-219
DOI:10.4103/2229-5178.101826  PMID:23189261
Schwannomas are benign peripheral nerve sheath neoplasms composed almost entirely of Schwann cells and are diagnosed histopathologically by the presence of singular architectural patterns called Antoni A and Antoni B areas. These were described first in 1920 by the Swedish neurologist Nils Antoni. The Antoni A tissue is highly cellular and made up of palisades of Schwann cell nuclei, a pattern first described in 1910 by the Uruguayan neuro-pathologist Jose Verocay and are known as Verocay bodies. This article describes the structure and appearance of Verocay bodies and Antoni A and B areas with a brief biographical introduction of the men who described these patterns.
  10 8,496 653
Androgenetic alopecia, metabolic syndrome, and insulin resistance: Is there any association? A case-control study
Ola Ahmed Bakry, Mohamed Abdel Moneim Shoeib, Maather Kamel El Shafiee, Ahmed Hassan
July-September 2014, 5(3):276-281
DOI:10.4103/2229-5178.137776  PMID:25165643
Context: Although several previous studies have investigated the association of metabolic syndrome (MS) and insulin resistance (IR) with androgenetic alopecia (AGA), the results have been inconsistent. Aim: We attempted to assess the presence of MS and IR in patients with AGA. This may help to detect if AGA can be considered as a clue for underlying serious systemic diseases. Materials and Methods: One hundred male patients with stages III-VII AGA, in Hamilton-Norwood classification, and 100 normal, gender- and age-matched control subjects were included. Anthropometric measures, blood pressure, fasting glucose, fasting insulin, high-density lipoprotein cholesterol, and triglycerides were measured for the all participants. The presence of MS and IR was evaluated. Results: There were statistically significant differences regarding mean values of body weight (P < 0.001), height (P = 0.002), waist circumference (P < 0.001), body mass index (P < 0.001), systolic (P < 0.001), and diastolic blood pressure (P < 0.001), fasting glucose (P < 0.001), triglycerides (P < 0.001), high-density lipoprotein cholesterol (P < 0.01), fasting insulin (P = 0.02) and homeostasis model assessment of insulin resistance (P < 0.001) between cases and controls. A statistically significant association was found between AGA and MS (P = 0.002) and between AGA and IR (P < 0.001). Multiple logistic regression analysis revealed that waist circumference (>102 cm) was the most significant risk factor for developing MS. It increased the risk of MS by 1.25-folds (95% CI = 1.10-1.42, P < 0.001). Conclusion: Our results support the recommendation for assessing MS and IR in all young males with stage III or higher AGA. Early intervention is critical to reduce the risk and complications of cardiovascular disease and type 2 diabetes mellitus later in life.
  10 2,483 592
Melasma update
Rashmi Sarkar, Pooja Arora, Vijay Kumar Garg, Sidharth Sonthalia, Narendra Gokhale
October-December 2014, 5(4):426-435
Melasma is an acquired pigmentary disorder characterized by symmetrical hyperpigmented macules on the face. Its pathogenesis is complex and involves the interplay of various factors such as genetic predisposition, ultraviolet radiation, hormonal factors, and drugs. An insight into the pathogenesis is important to devise treatment modalities that accurately target the disease process and prevent relapses. Hydroquinone remains the gold standard of treatment though many newer drugs, especially plant extracts, have been developed in the last few years. In this article, we review the pathogenetic factors involved in melasma. We also describe the newer treatment options available and their efficacy. We carried out a PubMed search using the following terms "melasma, pathogenesis, etiology, diagnosis, treatment" and have included data of the last few years.
  10 21,993 3,476
Achieving hemostasis in dermatology-Part II: Topical hemostatic agents
Jaimie B Glick, Ravneet R Kaur, Daniel Siegel
July-September 2013, 4(3):172-176
DOI:10.4103/2229-5178.115509  PMID:23984226
Bleeding is a common occurrence during any dermatologic surgery that disrupts blood vessels. The complications of excess bleeding can include delayed wound healing, hematoma formation, infection, dehiscence, and necrosis. In part one of this review, we discussed the pre-operative, intra-operative, and post-operative management of patients undergoing dermatologic surgery. In Part two, we discuss traditional and new topical hemostatic agents used to achieve hemostasis in dermatological procedures and surgery. We will evaluate the caustic and non-caustic hemostatic agents as well as hemostatic dressings. The mechanisms of action, side effect profile, and advantages and disadvantages of the topical hemostatic agents are provided. Sources for this article were found searching the English literature in PubMed for the time period 1940 to March 2012. A thorough bibliography search was also performed and key references examined.
  10 5,120 718
Psychosocial aspects of Hansen's disease (leprosy)
Gurvinder Pal Singh
September-December 2012, 3(3):166-170
DOI:10.4103/2229-5178.101811  PMID:23189247
In general, the prevalence of psychiatric disorders among people with Hansen's disease has greatly increased to date. However, inadequate psychiatric care of people with Hansen's disease is an area of increasing concern. Many studies have been conducted in India and abroad to find out the prevalence of comorbid psychiatric disorders in patients suffering from Hansen's disease. Although efforts have been made by the government and international organizations to solve the medical problems among this group of patients, this disease still carries a number of psychosocial issues. The social stigma connected to these patients makes this disease completely different from others. Even nowadays people affected by Hansen's disease have to leave their village and are socially isolated. Depression is the most common psychiatric disorder found in these patients. Early detection and treatment of psychiatric disorders among Hansen's disease patients is a powerful psychotherapeutic measure. Integrated healthcare strategy will be beneficial to these patients. A comprehensive MEDLINE search and review of relevant literature was carried out and the data extracted and studied with particular reference to psychosocial issues in Hansen's disease. The focus of this research work is related to psychiatric and social aspects vis-à-vis stigma in these patients with Hansen's disease.
  10 5,308 2,177
Compression therapy for venous leg ulcers
Brijesh Nair
July-September 2014, 5(3):378-382
DOI:10.4103/2229-5178.137822  PMID:25165679
  10 2,876 542
Morbihan syndrome
Stefano Veraldi, Maria Chiara Persico, Claudia Francia
April-June 2013, 4(2):122-124
DOI:10.4103/2229-5178.110639  PMID:23741671
We report a case of severe Morbihan syndrome (chronic erythematous edema of the upper portion of the face) in a 60-year-old man. The syndrome was characterized clinically by erythematous edema involving the forehead, glabella, and both eyelids, because of which the patient was not able to open completely his eyes. Furthermore, erythema and telangiectasiae were visible on the nose and cheeks. Laboratory and instrumental examinations were within normal ranges or negative. Histopathological examination showed dermal edema, perivascular and periadnexal lympho-histiocytic infiltrate, and sebaceous gland hyperplasia. Oral isotretinoin was ineffective despite the relatively long duration of the therapy (26 weeks).
  9 7,519 633
Ingenol mebutate: A novel topical drug for actinic keratosis
Suruchi Aditya, Sanjeev Gupta
July-September 2013, 4(3):246-249
DOI:10.4103/2229-5178.115538  PMID:23984250
The global incidence of non-melanoma skin cancer is rising. Significant morbidity leading to unacceptable cosmetic outcomes and/or functional impairment is a major concern. Search for non-surgical, non-invasive and tissue-sparing treatment modalities has led to development of new therapeutic agents. Actinic keratoses (AK) are one part of a continuous spectrum of benign sun damage to squamous cell carcinoma (SCC). Although it is not possible to predict which AK might progress to SCC, the presence of AK is a biomarker of risk for patients and must be treated to avoid possible morbidity and mortality. Ingenol mebutate is a novel topical drug from the latex sap of a plant-Euphorbia peplus that acts by chemoablative and immunostimulatory properties. Clinical studies have proven it to be safe and efficacious, leading to FDA approval of this chemotherapeutic agent for field therapy of AK in 2012. Current topical agents for field therapy of AK must be applied for weeks, whereas ingenol needs to be applied for three days. Ingenol offers a new therapeutic option that is convenient, safe, effective, acceptable and well-tolerated.
  9 2,706 493
Fexofenadine in higher doses in chronic spontaneous urticaria
Kiran V Godse, Nitin J Nadkarni, Gaurang Jani, Sunil Ghate
July-December 2010, 1(1):45-46
DOI:10.4103/2229-5178.73262  PMID:23130196
  9 8,662 696
Livedo reticularis: A review of the literature
Vijaya Veeranna Sajjan, Snehal Lunge, Manjunathswamy Basavapuruda Swamy, Ashok Maharudrayya Pandit
September-October 2015, 6(5):315-321
DOI:10.4103/2229-5178.164493  PMID:26500860
Livedo reticularis (LR) is a cutaneous physical sign characterized by transient or persistent, blotchy, reddish-blue to purple, net-like cyanotic pattern. LR is a benign disorder affecting mainly middle-aged females, whereas livedo racemosa (LRC) is pathologic, commonly associated with antiphospholipid antibody syndrome. This article aims to review the causes of LR and LRC along with the evaluation and management.
  9 8,213 1,414
Fumaric acid esters in dermatology
Uwe Wollina
July-December 2011, 2(2):111-119
DOI:10.4103/2229-5178.86007  PMID:23130241
Fumaric acid esters (FAE) are substances of interest in dermatology. FAE exert various activities on cutaneous cells and cytokine networks. So far only a mixture of dimethylfumarate (DMF) and three salts of monoethylfumarate (MEF) have gained approval for the oral treatment of moderate-to-severe plaque-type psoriasis in Germany. DMF seems to be the major active component. There is evidence that FAE are not only effective and safe in psoriasis but granulomatous non-infectious diseases like granuloma annulare, necrobiosis lipoidica and sarcoidosis. In vitro and animal studies suggest some activity in malignant melanoma as well.
  8 5,261 700
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