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   Table of Contents - Current issue
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March-April 2021
Volume 12 | Issue 2
Page Nos. 211-379

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REVIEW ARTICLES  

Polymorphous light eruption- An Indian Scenario Highly accessed article p. 211
Kaliaperumal Karthikeyan, Manju Aishwarya
DOI:10.4103/idoj.IDOJ_434_20  
Polymorphous light eruption (PMLE) is the most common, idiopathic, acquired photodermatosis, characterized by abnormal, recurrent, and delayed reaction to sunlight. Polymorphous light eruption is common worldwide but the morphology, distribution, and pigmentary changes are unique in Indian skin which is discussed in this review. The prevalence of PMLE is around 10–20% in the general population. It commonly occurs in females between 20and 30 years of age. It is the most common photodermatosis in school-going children. Visible light sensitivity is an important phenomenon in PMLE. It typically presents as recurrent and chronic lesions over photoexposed sites. Initially, patchy erythema occurs with pruritus. Most of the Indians belong to type IV to type VI skin and pigmentary changes are commonly seen. The unique feature of PMLE in Indian skin is the pigmentary change which varies from hypopigmented to hyperpigmented lesions. These pigmentary changes may occur alone or in combination with erythematous or skin-colored lesions. The pigmentary lesions are seen in more than 50% of lesions. The histopathology of PMLE is characterized by the presence of hyperkeratosis, spongiosis with or without the presence of liquefactive degeneration in the epidermis. Dermal changes in the upper and mid dermis include the presence of dense perivascular lymphocytic infiltrate. The management of PMLE includes both preventive measures and medical management. Topical sunscreens, topical steroids, hydroxychloroquine and antioxidants play a very important role.
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Entodermoscopy update: A contemporary review on dermoscopy of cutaneous infections and infestations p. 220
Sidharth Sonthalia, Mahima Agrawal, Jushya Bhatia, Md Zeeshan, Solwan Elsamanoudy, Pankaj Tiwary, Yasmeen Jabeen Bhat, Abhijeet Jha, Manal Bosseila
DOI:10.4103/idoj.IDOJ_559_20  
Infectious cutaneous diseases are very common, especially in certain geographic and tropical regions. Sometimes they may simulate other dermatoses, ordering verification of diagnosis with particular investigations. Dermoscopy is among one of the most important tools readily available in the outpatient setting for the dermatologist to confirm the diagnosis. In this up-to date review, literature concerning the various dermoscopic features of parasitic, viral, dermatophytic and bacterial cutaneous infections is composed. In addition artefacts as well as practical issues in dermoscopy usage are discussed; with the aim to empower dermatologists to promptly and non-invasively diagnose and manage cutaneous infections and infestations.
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ORIGINAL ARTICLES Top

Iatrogenic cushing's syndrome in patients with superficial dermatophytosis p. 237
Priyesh Thakran, Sonia Agrawal, Archana Singal, Shyam Verma, SV Madhu
DOI:10.4103/idoj.IDOJ_432_20  
Background: The epidemic-like scenario of superficial fungal infections in India has been complicated by the prescription of systemic and topical potent steroids. As a result, alarming number of patients are presenting with exogenous Cushing's syndrome. Methods: This cross-sectional study involved 23 patients of superficial dermatophytosis on steroids who presented with clinical features like that of Cushing's syndrome. Their clinical details and laboratory investigations including fungal culture and serum cortisol, were recorded on a pre-designed proforma. Results: There were 23 patients (14 males and 9 females) with mean age of 29.47 ± 15.5 years, majority with extensive tinea cruris and corporis. All of them received oral (Betamethasone) or parenteral corticosteroids along with potent topical steroids (clobetasol propionate and betamethasone valerate) for at least two months. In majority (56.5%), treatment was prescribed by unqualified medical practitioners and in the rest by alternative medical practitioners. Striae, buffalo hump, hirsutism were observed in 16 (69.5%), 15 (65.2%), 13 (56.5%) patients, respectively. Serum cortisol estimation revealed low levels and ranged from 0.66 to 6 μg/ml with a mean of 1.53 ± 1.27 μg/ml (normal 7-25 μg/ml). Conclusions: Corticosteroids are life saving for many dermatological diseases; their injudicious use (topical, oral, and parenteral) for prolonged periods in the treatment of superficial dermatophytosis can lead to Cushing's syndrome.
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Assessment of patients with periorbital melanosis for hyperinsulinemia and insulin resistance p. 244
Devinder M Thappa, Laxmisha Chandrashekar, Medha Rajappa, R Usha, K Muthupandi, Palani S Mohanraj, Malathi Munisamy, Nidhi Singh
DOI:10.4103/idoj.IDOJ_491_20  
Background: Periorbital melanosis (PM) is one of the most common dermatological condition seen in routine practice. Several cutaneous markers such as acanthosis nigricans have been associated with insulin resistance (IR). However, the association of PM with IR needs to be substantiated. Objective: The objective of the study is to evaluate the association of circulating adipokines and IR with PM. Materials and Methods: In this cross-sectional study, we recruited 100 patients with PM and 100 age- and gender-matched healthy controls. The serum levels of leptin, adiponectin, fasting glucose, fasting insulin, insulin-like growth factor-1 (IGF-1), homeostatic model assessment of insulin resistance (HOMA-IR), and leptin: adiponectin ratio (L/A ratio) were assayed. Results: The serum levels of leptin, fasting glucose, fasting insulin, HOMA-IR, L/A ratio were significantly higher in patients with PM as compared to controls. The serum levels of adiponectin were significantly lower in cases as compared to controls. On multivariate regression analysis, leptin, adiponectin, and HOMA-IR were found to be significant, even after adjusting for BMI, blood pressure and LDL and HDL cholesterol.Conclusion: Our findings suggest that patients with PM have hyperinsulinemia, IR, and elevated L/A ratio. PM as a marker of IR in adults may help in identifying patients early and thus aid in the early prevention and management of the disease.
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Clinico-epidemiological profile of childhood alopecia areata along with dermoscopic correlation: A cross-section, observational study p. 250
Pallawi Bhardwaj, Dibyendu Basu, Indrashis Podder, Ramesh C Gharami
DOI:10.4103/idoj.IDOJ_451_20  
Background: Childhood alopecia areata (AA) is a common cause of dermatologic consultation; however, data is scarce in the present set-up. Objectives: To evaluate the clinico-epidemiological profile of childhood AA along with dermoscopic correlation. Methods: We conducted a cross-sectional study including 50 new cases of childhood AA for 1 year. Dermoscopy was performed in each child and findings recorded. Results: Childhood AA was more common in girls (M: F 1:1.4), mean age being 11.1 ± 3.7 years. Scalp was commonest site of involvement in 86% cases, while 32 (64%) children had mild disease (<25% involvement). Localized circumscribed patch was the commonest presentation in 37 (74%) children, while sisaipho was the least (2%). A positive family history of AA was noted in 5 (10%) children. Twenty-four children (48%) provided a history of atopic disorders, while 30% had a positive family history of atopy. Stress was the commonest precipitating factor in 13 (26%) subjects. Nail involvement was observed in 19 (38%) children (pitting >thinning), while systemic associations like vitiligo and thyroid dysfunction were present in 26% and 24% cases, respectively. Dermoscopy revealed yellow-dots to be the commonest finding in 44 (88%) cases, followed by short vellus hair and black dots in 76% and 28% children, respectively, while exclamation-mark hair was rare. Conclusion: Female gender, younger age, nail involvement, and presence of concomitant atopy, vitiligo, and thyroid dysfunction were associated with severe disease, but not statistically significant (p > 0.05). Regression model failed to detect any risk factors for severe AA. Dermoscopy is an important non-invasive tool for evaluating childhood AA.
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Factors predicting the outcome of stevens–Johnson syndrome and toxic epidermal necrolysis: A 5-year retrospective study p. 258
Vishal Thakur, Keshavamurthy Vinay, Sheetanshu Kumar, Rajat Choudhary, Ashok Kumar, Davinder Parsad, Muthu Sendhil Kumaran
DOI:10.4103/idoj.IDOJ_437_20  
Background: Clinicodemographic and laboratory parameters predicting the outcome of Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) may vary among populations owing to genotypic and environmental variations. There is a scarcity of studies evaluating these parameters in Indian population. Aims: To analyze clinicodemographic and laboratory parameters predicting disease outcome in patients of SJS/TEN. Materials and Methods: Clinical records of patients admitted with a diagnosis of SJS/TEN from January 2014 to December 2018 were reviewed retrospectively with respect to data pertaining to clinicodemographic details, laboratory parameters, and disease outcome. Results: Of 51 patients included in the study, 24 (47.06%) were females. Anticonvulsants [phenytoin (19.6%), carbamazepine (13.7%), others (5.88%)] were the most commonly implicated drugs followed by NSAIDs (19.6%). The overall mortality was 21.6% [SJS (0%), SJS-TEN overlap (18.8%), and TEN (28.6%)]. The mean detached body surface area (BSA) (35.4% ± 10.4% vs. 25.7% ± 11.8%; P = 0.02) was significantly higher among patients with mortality. Blood urea nitrogen, serum HCO3 levels, and random blood sugar were significantly associated with mortality. Presence of sepsis during the disease course was associated with higher mortality (9/12 vs. 2/39; P = 0.001). Other components of SCORTEN like age and heart rate were not significantly associated with poor outcome in our study. None of our patients had associated malignancy. Conclusion: A higher detached BSA, presence of sepsis, higher blood urea nitrogen and random blood sugar, and lower serum HCO3 levels were associated with mortality. Refinement of scoring systems predicting the outcome of SJS-TEN is needed for better disease prognostication.
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REFLECTIONS ON RESEARCH Top

Practical guidelines to develop and evaluate a questionnaire p. 266
Kamal Kishore, Vidushi Jaswal, Vinay Kulkarni, Dipankar De
DOI:10.4103/idoj.IDOJ_674_20  
Life expectancy is gradually increasing due to continuously improving medical and nonmedical interventions. The increasing life expectancy is desirable but brings in issues such as impairment of quality of life, disease perception, cognitive health, and mental health. Thus, questionnaire building and data collection through the questionnaires have become an active area of research. However, questionnaire development can be challenging and suboptimal in the absence of careful planning and user-friendly literature guide. Keeping in mind the intricacies of constructing a questionnaire, researchers need to carefully plan, document, and follow systematic steps to build a reliable and valid questionnaire. Additionally, questionnaire development is technical, jargon-filled, and is not a part of most of the graduate and postgraduate training. Therefore, this article is an attempt to initiate an understanding of the complexities of the questionnaire fundamentals, technical challenges, and sequential flow of steps to build a reliable and valid questionnaire.
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BRIEF REPORTS Top

Impact of a psychodermatological education package on the subjective distress, family burden, and quality of life among the primary caregivers of children affected with epidermolysis bullosa p. 276
PA Manomy, Vamsi K Yenamandra, Garima Dabas, Poonam Joshi, Atul Ambekar, Vishnubhatla Sreenivas, Vinod K Sharma, Manju Vatsa, Surya Ravindran, Gomathy Sethuraman
DOI:10.4103/idoj.IDOJ_658_19  
Background: Epidermolysis bullosa (EB) has profound effect on the subjective distress, family burden, and quality of life (QOL) of the primary caregivers (PCG). Knowledgeable PCG can efficiently manage children with these skin diseases and also improve their QOL. Objectives: To assess the subjective distress, family burden, and QOL, to develop and assess the short-term effectiveness of a psycho-dermatological education package (PDEP) for the PCG of children with EB. Methods: In this interventional study, 30 PCG of EB were assessed for subjective distress, family burden, and QOL. PDEP, a structured educational tool explaining the disease and its care and stress management, was developed by the authors for the PCG and administered to them after one month of enrolment. They were reassessed after three months and compared with the baseline assessment scores. For comparison, 37 PCG of CI were also studied. Results: The mean age (years) of the subjects was 28.7 ± 6.7 for EB and 30.5 ± 4.6 for CI. The mean or median (range) baseline scores for subjective distress, family burden and QOL of PCG (n = 20) of EB were 8.4 ± 7.9, 6.5 (0-30); 28.5 ± 17.5, 24 (7-77) and 12.6 ± 6.7, 11.5 (4-28) and for PCG (n = 14) of CI were 12 ± 4.3, 38.9 ± 16.2 and 17.7 ± 3.6 respectively. The PDEP improved the QOL (p = 0.01), knowledge (p < 0.01) and practices (p < 0.001) for PCG of EB and it improved subjective distress (p < 0.001), QOL (p < 0.01) and knowledge (p < 0.01) for PCG of CI. Conclusions: PDEP is an effective educational tool in improving the QOL and knowledge of PCG, which in turn provides efficient management and psychological support to children affected with EB and CI. It should, therefore, be routinely used for educating the PCG of children with EB and CI.
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Psoriasis and periodontitis: Exploring an association or lack thereof p. 281
Shipra Gupta, Sunil Dogra, Gurparkash Singh Chahal, Savita Prashar, Angadveer Pal Singh, Mili Gupta
DOI:10.4103/idoj.IDOJ_445_20  
Objectives: Psoriasis is a common, chronic, non-communicable skin disease with no clear etiology or cure. Periodontitis is a chronic inflammatory condition which is now known to significantly influence various systemic diseases as an established risk factor. This study aimed at comparatively evaluating the periodontal status of Psoriatic patients vis. a vis. that of age and gender matched systemically healthy volunteers. An attempt was also made to explore a possible association, if any, amongst the two diseases. Materials and Methods: Forty two residents of Chandigarh, suffering from Psoriasis and attending the Psoriasis Clinic of Department of Dermatology & Venereology, Post Graduate Institute of Medical Education & Research, Chandigarh were recruited over a period of 10 months (Case group) and their periodontal status was compared with forty two age and gender matched systemically healthy volunteers (Control group) randomly selected from the Out Patient Department of Periodontics, Dr. Harvansh Singh Judge Institute of Dental Sciences & Hospital, Panjab University, India. Their serum IL-33 levels were evaluated and compared in an attempt to identify an underlying common pathological pathway. Results: The periodontal status was comparable in the two groups in terms of the debris index (p = 0.932), calculus index (p = 0.088), plaque index (p = 0.097), and mean clinical attachment loss (p = 0.401). A higher bleeding points index was recorded amongst healthy individuals as compared to the Psoriasis group, the difference being statistically significant (p = 0.001). The mean number of teeth were more in the Psoriasis group as compared to the healthy group (p=0.034). IL 33 levels were also not significantly different (p = 0.491). Conclusion: Contrary to currently available evidence in literature, the study did not find a statistically significant association between Psoriasis and Inflammatory Periodontal Disease.
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Actinomycetoma by Actinomadura madurae: Clinical characteristics and treatment of 47 cases p. 285
Alexandro Bonifaz, Andrés Tirado-Sánchez, Denisse Vazquez-Gonzalez, Javier Araiza, Rigoberto Hernández-Castro
DOI:10.4103/idoj.IDOJ_474_20  
Context: Mycetoma is a chronic, granulomatous disease caused by fungi (eumycetoma) or aerobic filamentous actinomycetes (actinomycetoma). Actinomadura madurae is one of the most frequent actinomycetes. Aim: The study aims to provide an update on clinical, diagnostic, therapeutic, and outcome data for patients with actinomycetoma in a single center in Mexico. Settings and Design: This was a retrospective study of 47 cases diagnosed with actinomycetoma. Subjects and Methods: The cases were selected from a total of 536 mycetoma obtained during 35 years (from 1985 to 2019). Clinical data were retrieved from the clinical records of our department. Microbiological data were obtained from our Mycology laboratory. Statistical Analysis: Frequencies and percentages were used for categorical variables. Normality was determined with the Kolmogorov–Smirnov test. We used means and medians to describe the variables. Results: Forty-seven patients with actinomycetoma were included; female:male ratio 1.9:1; median age 38 years. The foot was the most affected region in 76.5% of cases. The bone invasion was observed in 89%. The time between symptoms onset and diagnosis was 5.5 years. Grain detection by direct examination was positive in 95% of cases. The most commonly used, as well as the most effective treatment scheme was streptomycin + sulfamethoxazole-trimethoprim with dapsone. Sixty-three percent (30 patients) achieved clinical and mycological cure, and 10.6% (5 patients) had treatment failure. Conclusions: We highlight the importance of designing therapeutic strategies to standardize treatments and gain more experience to improve the care of these patients.
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9 Tips and pearls for safer performance of dermatological procedures during Covid-19 pandemic p. 290
Venkataram Mysore, Aniketh Venkataram, Anuradha Jindal, Ashwini L Hirevenkangoudar, Deepthi Malayanuru, Malcom Noronha, Sajin Alexander
DOI:10.4103/idoj.IDOJ_544_20  
SARS-CoV2 pandemic has affected dermatologypractice greatly. In view of the risk of transmission, physicians need to devise methods to perform procedures in a safer way. Our institute has adopted a number of innovative safety precautions steps, which are being outlined here.
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Leprosy in elderly and children among new cases – A 3-year retrospective study p. 294
Potharaju Arunraghav, Kallappa Herakal
DOI:10.4103/idoj.IDOJ_177_18  
Background: Leprosy occurs in all age groups, with adults constituting the majority. However, leprosy in children always drew the attention of epidemiologists as a guide to transmission of leprosy. With increasing life expectancy and decreasing prevalence of leprosy, there is going to be a significant rise of leprosy among elderly in India. In elderly leprosy patients, clinical signs are often quiet, which makes it a hidden source of infection. The detection of leprosy in elderly is of epidemiological importance, hence it is critical that due attention be given to leprosy in elderly as a possible contributor to hidden leprosy in India. Aim: To analyze leprosy in elderly and in children from the records of new patients seen over the past 3-year period. Methods: Analysis of details of “leprosy in elderly” and “leprosy in children'” from the records of new leprosy patients seen at a dermatology OPD of a teaching hospital over a period of 3 years. Results: Out of 157 patients, 34 (21.6%) were above 45 years, while 18 (11.4%) were below 15 years, the difference being statistically significant (P > 0.05). Bacteriological Index (BI) values in elderly were higher compared to children. In addition, elderly had a higher percentage of multibacillary (MB) leprosy compared to children both clinically (35% vs 22%) and histopathologically (38% vs 22%). Conclusion: Leprosy in elderly is an important entity, and there is a need to study it as a distinct group. It will provide information on hidden leprosy load and apprise us on sources of infection in the community.
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CASE REPORTS Top

Mycetoma due to Nocardia Africana/Nova treated successfully with cotrimoxazole and moxifloxacin p. 298
Molisha Bhandari, Sushruta Kathuria, Niti Khunger, Bhawna Sharma
DOI:10.4103/idoj.IDOJ_533_20  
Nocardia africana is a recently identified organism and has rarely been reported to cause mycetoma. Here we report the case of a 40-year-old woman who presented with discharging sinuses and nodules for the past 7 years along with few discrete axillary lymph nodes. Cultures and Maldi-TOF MS (Matrix-assisted laser desorption/ionization–time of flight mass spectrometry) method identified the causative organism as Nocardia africana/nova. The organism was acid-fast positive on modified Ziehl-Neelsen stain and Gram's stain revealed branched filamentous beaded gram-positive bacilli, while histopathology showed granulation tissue along with few ill-defined epithelioid cell granulomas, with giant cells. Based on the sensitivity report, the patient was started on tablet moxifloxacin and cotrimoxazole, and has shown considerable improvement at 2.5 months of follow-up.
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Nevus unius lateris with bilateral oral mucosal lesions: An unusual presentation p. 302
Lovleen Kaur, Bharat B Mahajan, Mohita Mahajan, Shaminder Singh Dhillon
DOI:10.4103/idoj.IDOJ_454_20  
Verrucous epidermal nevi (VEN) are cutaneous hamartomas characterized by keratinocytic hyperplasia. Majority are linear in distribution and tend to follow the Blaschko lines; however, some may have zosteriform (segmental) or systematized distribution involving widespread areas of skin. The systematized ones are further classified into “Nevus Unius Lateris” when one-half of the body is affected, and “Ichthyosis Hystrix” showing bilateral distribution, both being the uncommon forms. Although it can affect any body part, it rarely involves the head and neck region with seldom involvement of mucosae, scalp, and ear lobes. We saw a 6-year-old child with multiple hyperpigmented verrucous plaques predominantly present over left half of the body, ipsilateral alopecia scalp, and verrucous lesions involving mucosae of palate and tongue, which were present bilaterally. Previously, case reports of oral lesions related to VEN had demonstrated segmental, midline, or unilateral distribution. Hereby, we report this peculiar case of Nevus Unius Lateris with bilateral oral mucosal involvement, owing to its rarity.
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Basidiobolomycosis: Case report and literature overview p. 307
Mitanjali Sethy, Satyajit Sahu, Suvigya Sachan
DOI:10.4103/idoj.IDOJ_456_20  
Basidiobolomycosis or subcutaneous zygomycosis or subcutaneous phycomycosis is a chronic granulomatous infection of skin and subcutaneous tissue, caused by a saprophytic filamentous fungus, Basidiobolus ranarum, clinically characterized by firm, painless subcutaneous swelling with smooth and rounded edges. Histopathological features include the peculiar Splendore–Hoeppli phenomenon. Culture on Sabouraud dextrose agar shows creamy white, heaped up, and furrowed colonies. This entity has been reported from tropical and subtropical regions of the world and the southern part of India. We report a case of Basidiobolomycosis in a seven-year-old girl from Eastern India, which was excised twice before presenting to us. We diagnosed the case as Basidiobolomycosis based on clinical features, histopathology, and culture findings, and treated it with itraconazole.
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The puzzle of papules over face and extrafacial areas: A rare case of disseminated idiopathic T-Cell pseudolymphoma p. 312
Sumit A Hajare, Vaishali H Wankhade, Gitesh U Sawatkar, Rajesh Pratap Singh
DOI:10.4103/idoj.IDOJ_568_20  
Papular lesions over face have a wide range of differential diagnoses. The clinical differentiation among these is difficult and often requires clinicopathological correlation. We hereby report the case of a 28 year old female presenting with numerous skin colored papular lesions over face, pinna and upper limbs.
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MUSINGS, OPINIONS, TIPS AND EXPERIENCES Top

Progressive osseous heteroplasia is not an autosomal dominant trait but reflects superimposed mosaicism in different GNAS inactivation disorders p. 316
Rudolf Happle
DOI:10.4103/idoj.IDOJ_584_20  
Progressive osseous heteroplasia (POH) is a rarely occurring genetic condition characterized by severe segmental ossification involving the skin and deep connective tissues including the muscles. So far, the disorder is generally described as an autosomal dominant trait. By contrast, the following arguments are in favor of the alternative concept that POH should rather be taken as a non-specific segmental manifestation of different GNAS inactivation disorders such as Albright hereditary osteodystrophy (AHO) with hormone resistance, AHO without hormone resistance, and osteomatosis cutis. Presently, POH has got its own OMIM number 166350 but this is obviously wrong because the disorder does not reflect heterozygosity for a GNAS mutation. Conversely, the disorder is most likely due to an early event of postzygotic loss of heterozygosity with loss of the corresponding wild-type allele. This alternative concept, as proposed in 2016, offers a plausible explanation for the following features of POH. Familial occurrence is usually absent. POH is usually observed in families with one of the three GNAS inactivation disorders as mentioned above. Mosaicism is suggested by the pronounced segmental manifestation of POH and by its lateralization. Some patients have, in addition to POH, bilaterally disseminated features of osteomatosis cutis or AHO, and other patients have family members with one of these nonsegmental disorders. Remarkably, POH tends to appear much earlier than the nonsegmental GNAS inactivation disorders. – Molecular support of the concept was documented in a superficial variant of POH called 'plate-like osteoma cutis'. In several other autosomal dominant skin disorders, molecular corroboration of the theory of superimposed mosaicism has been provided. – For all of these reasons, it is unlikely that POH can further be taken as a distinct autosomal dominant trait. Generation of more molecular data in multiple cases of POH occurring in GNAS inactivation disorders will be crucial to corroborate the proposed concept.
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CONCISE COMMUNICATIONS Top

Pleomorphic and widespread lesions of phaeohyphomycosis in a leprosy patient on corticosteroid p. 319
Chandra S Sirka, Kananbala Sahu, Vinaykumar Hallur, Arpita N Rout, Anupama Bains
DOI:10.4103/idoj.IDOJ_294_20  
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Segmental zoster paresis of lower thoracic segment presenting as pseudohernia—A report of three cases p. 324
Veeranna Shastry, P.S.S Ranugha, R Vinutha, S Pratheeksha
DOI:10.4103/idoj.IDOJ_223_20  
Segmental zoster paresis is characterized by focal motor weakness affecting the myotome corresponding to the dermatomal distribution of the rash. Clinically, it presents as pseudohernia when it involves abdominal wall muscles. We report three cases of segmental zoster paresis presenting as pseudohernia of abdominal wall. All patients developed asymptomatic bulge in anterolateral side of abdomen between 10 and 15 days after appearance of vesicles. All patients developed post-herpetic neuralgia. One patient developed pseudo-obstruction of colon due to visceral involvement. Segmental zoster paresis of lower thoracic spinal segment often goes unnoticed due to its asymptomatic nature.
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Isolated unilateral facial angiofibroma or segmental tuberous sclerosis complex? p. 327
Bhagyashree B Supekar, Vaishali H Wankhade, Shashank Agrawal, Rajesh P Singh
DOI:10.4103/idoj.IDOJ_272_20  
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Amyloidosis cutis dyschromica, A rare subtype of primary cutaneous amyloidosis: Case report and literature review p. 330
Jagdish Sakhiya, Dhruv Sakhiya, Mehul Patel, Feral Daruwala
DOI:10.4103/idoj.IDOJ_293_20  
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Pigmented aqua-exacerbated symmetrical acral hyperkeratosis: Washing shows its true colour p. 335
M Bandhala Rajan, Abhishek Bhardwaj, Sudeep Khera, Varun Rajagopal
DOI:10.4103/idoj.IDOJ_242_20  
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Mycosis fungoides with photosensitivity mimicking chronic actinic dermatitis p. 337
Anwita Sinha, Vikas Pathania, Aradhana Sood, Divya Shelly
DOI:10.4103/idoj.IDOJ_284_20  
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Toxic epidermal necrolysis-like lesions as cutaneous manifestation of acute methotrexate toxicity p. 340
Raju Singh, Manju Meena, Abhilasha Patidar, Asit Mittal
DOI:10.4103/idoj.IDOJ_256_20  
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Newer signs in dermatology [2016-2020] p. 342
Anupam Das, Anand Toshniwal, Bhushan Madke
DOI:10.4103/idoj.IDOJ_214_20  
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Atrophia maculosa varioliformis cutis: A rare case report p. 346
Mitanjali Sethy, Suvigya Sachan, Chakravarthi R Srinivas, Satyajit Sahu
DOI:10.4103/idoj.IDOJ_270_20  
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LETTERS TO THE EDITOR Top

Palmoplantar pustulosis associated with membranous glomerulonephritis p. 349
Vishal Thakur, Jasmine Sethi, Debajyoti Chatterjee, Keshavamurthy Vinay
DOI:10.4103/idoj.IDOJ_431_20  
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Basal cell carcinoma arising from an epidermoid cyst: A histopathological surprise p. 351
Geeti Khullar, Deepti Agarwal, Mithilesh Chandra
DOI:10.4103/idoj.IDOJ_357_20  
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Azithromycin-induced linear fixed drug eruption: A rare instance p. 353
Anupam Das, Shouvik Ghosh, Arijit Coondoo, Piyush Kumar
DOI:10.4103/idoj.IDOJ_422_20  
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Successful treatment of acquired perforating dermatosis with colchicine p. 355
Francisco Gil, José Carlos Cardoso, José Gil
DOI:10.4103/idoj.IDOJ_504_20  
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An unusual case of linear cutaneous lupus erythematosus p. 357
Piyush Kumar, Anupam Das, Tanumay Raychaudhury
DOI:10.4103/idoj.IDOJ_465_20  
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DERMATOLOGY PEARLS Top

Surgical pearl: A novel technique of wicking hypodermic needles for chemical cauterization p. 359
Muhammed Mukhtar
DOI:10.4103/idoj.IDOJ_579_20  
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A novel cost-effective autologous dermal filler for atrophic acne scar p. 361
Devayani Pol, Ajay Kumar, Mahendra Singh Deora
DOI:10.4103/idoj.IDOJ_128_20  
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SKINDIA QUIZ Top

Annular atrophic plaque with peripheral crusted papules p. 363
Prakriti Shukla, Swastika Suvirya, Sucheta Pathania, Meenakshi Batrani
DOI:10.4103/idoj.IDOJ_76_20  
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A slow growing firm swelling over proximal nail fold with nail dystrophy p. 366
Suman Patra, Ankita Agrawal, Jai Chaurashia, Richa Rupla
DOI:10.4103/idoj.IDOJ_591_19  
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CLINICOPATHOLOGICAL CHALLENGE Top

Hairless hyperhidrotic plaque in a young male p. 368
Akanksha Kaushik, Debajyoti Chatterjee, Keshavamurthy Vinay
DOI:10.4103/idoj.IDOJ_467_20  
An 18-year-old male presented with an erythematous plaque on the left side of face and neck since 4 years. The lesion was devoid of hair, had follicular prominences, and showed increased localized sweating. Histopathology revealed an increased number of eccrine glands in the myxoid stroma with multiple vascular elements in the dermis, favoring the diagnosis of eccrine angiomatous hamartoma. This case illustrates a relatively uncommon clinical presentation of eccrine angiomatous hamartoma as a hairless, hyperhidrotic plaque in the head and neck region.
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THROUGH THE DERMATOSCOPE Top

Hyperpigmented stage of incontinentia pigmenti p. 371
Rhea Ahuja, Akash P Mustari, Neetu Bhari
DOI:10.4103/idoj.IDOJ_628_19  
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Dermoscopy of acrokeratosis verruciformis of hopf p. 374
M Bandhala Rajan, Anupama Bains, Deepak Vedant
DOI:10.4103/idoj.IDOJ_598_19  
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Dermoscopy of cilia incarnatum externum p. 376
Sandip Agrawal, Sradda N Kona, Rachita S Dhurat, Sanober B Daruwalla
DOI:10.4103/idoj.IDOJ_443_19  
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Darier's disease with guttate leukoderma: Correlation of dermoscopic and histological findings p. 378
Sachin Gupta, Nikhil Mehta, Shipra Agarwal, Neetu Bhari
DOI:10.4103/idoj.IDOJ_478_19  
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