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REVIEW ARTICLES |
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Eponymous signs in dermatology  |
p. 159 |
Bhushan Madke, Chitra Nayak DOI:10.4103/2229-5178.101810 PMID:23189246Clinical signs reflect the sheer and close observatory quality of an astute physician. Many new dermatological signs both in clinical and diagnostic aspects of various dermatoses are being reported and no single book on dermatology literature gives a comprehensive list of these "signs" and postgraduate students in dermatology finds it difficult to have access to the description, as most of these resident doctor do not have access to the said journal articles. "Signs" commonly found in dermatologic literature with a brief discussion and explanation is reviewed in this paper. |
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Psychosocial aspects of Hansen's disease (leprosy) |
p. 166 |
Gurvinder Pal Singh DOI:10.4103/2229-5178.101811 PMID:23189247In 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. |
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ORIGINAL ARTICLES |
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Immunohistochemical detection of P53 and Mdm2 in vitiligo |
p. 171 |
Ola A Bakry, Mostafa A Hammam, Moshira M Abdel Wahed DOI:10.4103/2229-5178.101812 PMID:23189248Background: Vitiligo is a common depigmented skin disorder that is caused by selective destruction of melanocytes. It is generally accepted that the main function of melanin resides in the protection of skin cells against the deleterious effect of ultraviolet rays (UVRs). Association of vitiligo and skin cancer has been a subject of controversy. Occurrence of skin cancer in long-lasting vitiligo is rare despite multiple evidences of DNA damage in vitiliginous skin. Aim: To detect the expression of P53 and Mdm2 proteins in both depigmented and normally pigmented skin of vitiligo patients and to compare it to control subjects suffering from nonmelanoma skin cancer (NMSC). Materials and Methods: Thirty-four patients with vitiligo and 30 age and sex-matched patients with nodulo-ulcerative basal cell carcinoma (BCC) as a control group were selected. Both patients and control subjects had outdoor occupations. Skin biopsies were taken from each case and control subjects. Histopathological examination of Hematoxylin and eosin-stained sections was done. Expression of P53 and Mdm2 proteins were examined immunohistochemically. Results: Both P53 and Mdm2 were strongly expressed in depigmented as well as normally pigmented skin of vitiligo patients. This expression involved the epidermis, skin adnexa and blood vessels with significant differences between cases and controls. Conclusions: The overexpression of P53 and Mdm2 proteins in both normally pigmented and depigmented skin of patients with vitiligo could contribute to the decreased occurrence of actinic damage and NMSC in these patients. |
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Prevalence and relevance of secondary contact sensitizers in subjects with psoriasis |
p. 177 |
DS Krupashankar, Shakthi R Manivasagam DOI:10.4103/2229-5178.101813 PMID:23189249Background: Psoriasis may be complicated by contact dermatitis due to an impaired cutaneous barrier. Patch testing helps elucidate sensitizers if any. Aims: To determine the prevalence and relevance of secondary contact dermatitis in subjects with psoriasis. Materials and Methods: Patch testing with Indian Standard Series was done and readings interpreted after 48 and 96 hours. Results: Among 110 subjects 47 (42.7%) showed reactions to at least one antigen. Fifteen (13.6%) reacted to fragrance mix, 10 (9.1%) to nickel sulfate, seven (6.4%) to parthenium, and six (5.5%) to balsam of Peru. Palmoplantar psoriasis was the commonest type of psoriasis patch tested. Fragrance mix was the commonest antigen showing 100% current relevance as an aggravating factor of psoriasis. Cosmetics, beauty preparations, skin and healthcare products followed by topical medications were found to be the most common sources of the patch test positivity. Conclusions: Secondary contact dermatitis is common in patients with psoriasis. Patch testing is necessary to determine the triggering or aggravating antigens in these patients to avoid sensitizers and improve quality of life. |
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Study on epidemiology of cutaneous amyloidosis in northern India and effectiveness of dimethylsulphoxide in cutaneous amyloidosis |
p. 182 |
Arvind Krishna, Bhola Nath, GG Dhir, Ranjeeta Kumari, Virendra Budhiraja, Kalpana Singh DOI:10.4103/2229-5178.101814 PMID:23189250Context: Amyloidosis, which is characterized by the extracellular deposition of a proteinaceous substance, is usually associated with considerable tissue dysfunction. However, the etiology of the disease remains uncertain and the treatment disappointing. Aim: 1. To know the epidemiology of cutaneous amyloidosis 2. To evaluate the effect of dimethylsulphoxide on cutaneous amyloidosis. Settings and Design: Data was collected from patients attending the Outpatient Department (OPD) over a period of one year. Material and Methods: Patients were screened on the basis of signs and symptoms and then confirmed histologically. A total of 62 patients who were suspected to be suffering from amyloidosis on the basis of clinical signs and symptoms and 38 patients who were further confirmed histopathologically underwent the treatment. Statistical Analysis Used: Chi-square test was used for testing the significance of proportions. Results: 63.15 percent of the patients had macular amyloidosis and the interscapular area was the most common area involved (52.63%). Pruritus, pigmentation, and papules responded excellently to dimethylsulphoxide after one month of treatment. Conclusions: Cutaneous amyloidosis is a disease found in middle-aged persons, with a female preponderance, and dimethylsulphoxide seems to be an effective therapy. |
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CASE REPORTS |
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Wells syndrome |
p. 187 |
Manish Bansal, Tulika Rai, Shyam S Pandey DOI:10.4103/2229-5178.101815 PMID:23189251Wells syndrome or eosinophilic cellulitis is characterized clinically by an acute dermatitis resembling cellulitis and histopathologically by dermal eosinophilic infiltration. Various morphological presentations have been described. We report a 32-year-old female with recurrent, erythematous plaques on left forearm of 8 months duration, associated with mild itching that resolved leaving mild hyperpigmentation. |
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Lichen scrofulosorum: A diagnosis overlooked  |
p. 190 |
Priyanka Singhal, Pankil H Patel, Yogesh S Marfatia DOI:10.4103/2229-5178.101817 PMID:23189252Lichen scrofulosorum, also known as "tuberculosis cutis lichenoides," is a rare tuberculid that presents as a lichenoid eruption of minute papules in children and adolescents with tuberculosis. The lesions are usually asymptomatic, closely grouped, skin-colored to reddish-brown papules, often perifollicular, and are mainly found on the abdomen, chest, back, and proximal parts of the limbs. The eruption is usually associated with a strongly positive tuberculin reaction. Diagnosis of these lesions can be difficult, as they resemble many other dermatological conditions that are often primarily considered. We report a case of lichen scrofulosorum in an adult male without any focus of tuberculosis. He responded promptly to antitubercular therapy with complete clearance of lesions in one month. |
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Pemphigus vegetans: An unusual presentation |
p. 193 |
Ashish Dhamija, Paschal D'souza, Ashok Meherda, Raj K Kothiwala DOI:10.4103/2229-5178.101818 PMID:23189253Pemphigus vegetans is a rare variant of pemphigus vulgaris that is characterized by vegetating lesions primarily in the flexures. We report a 45-year-old male patient with an unusual presentation of the disease. A careful analysis of the clinical and laboratory findings enabled us to reach a diagnosis and successfully treat the patient. |
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Nevus lipomatosus cutaneous superficialis: An unusual presentation |
p. 196 |
Ashish Dhamija, Ashok Meherda, Paschal D'Souza, Ram S Meena DOI:10.4103/2229-5178.101819 PMID:23189254Nevus lipomatosus cutaneous superficialis (NLCS) is an uncommon benign hamartomatous condition characterized by the presence of mature ectopic adiopocytes in the dermis. It was first reported by Hoffman and Zurhelle in 1921. Clinically they areit is classified into two forms. The classical form is characterized by groups of multiple, non-tender, soft, pedunculated, cerebriform, yellowish or skin-colored papules, nodules, or plaques. The other form of NLCS clinically manifests as a solitary dome-shaped or sessile papule. The classical NLCS is mostly reported to involve the pelvic or gluteal region. We report here a case of adult-onset classical NLCS on perianal area because of its rarity and unusual location. In addition, our patient also had some rare features of NLCS, such as recurrent in nature, presence of foul-smelling discharge, and comedo-like plugs on the lesions. |
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Childhood actinic keratosis in an albino transforming into squamous cell carcinoma |
p. 199 |
Shubhangi V Agale, Grace F D'Costa, Bhavana M Bharambe, Varsha Bhatia DOI:10.4103/2229-5178.101820 PMID:23189255Actinic keratosis is a scaly, cutaneous lesion that is often seen in elderly patients. It is almost never seen in children and young adults. It develops on areas such as the face, ears and dorsa of the hands with chronic sun exposure. Actinic keratosis is a premalignant lesion, since histological changes in the epidermis may progress to squamous cell carcinoma if left untreated. There are roughly 70,000 people with albinism in India. These patients are prone to develop actinic keratosis which may undergo spontaneous remission or develop into invasive squamous cell carcinoma, basal cell carcinoma and malignant melanoma.We present an unusual case of a 35 year old albino who developed actinic keratosis at the age 15 years which progressed to squamous cell carcinoma. |
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Pemphigus vulgaris presenting as gingival involvement |
p. 202 |
Mukhatar Ahmed Javali, Heena Zainab DOI:10.4103/2229-5178.101821 PMID:23189256Pemphigus vulgaris (PV) is an autoimmune blistering disease affecting the mucous membrane and skin. Typically, oral lesions appear before skin lesions, and in a majority of the cases only oral lesions are present. The dentist may then be the first to recognize and diagnose this disease. It is unusual for PV to present over the gingiva as a primary site of involvement. Diagnosis is based on clinical presentation and confirmed by histopathological study. Early diagnosis and management can prevent the uneven life- threatening effects of this potentially chronic mucocutaneous disorder. The case serves to enhance our awareness of the gingiva as a site at which systemic disease can manifest itself. |
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Immune reconstitution inflammatory syndrome: A therapeutic paradox |
p. 205 |
Joan Felicita Samson, V Suja, K Abdul Samad, S Sankar, GK Libu DOI:10.4103/2229-5178.101822 PMID:23189257A 41-year-old HIV positive woman was started on highly active antiretroviral therapy when her CD 4 count was 54/cu mm. Three weeks later, she developed erythematous to skin-colored plaques over the face. Investigations revealed a moderate eosinophilia, raised ESR, elevated 24-hour urinary calcium and hyperglobulinemia. Skin biopsy of the facial plaque revealed prominent epithelioid cell granulomas in the dermis. Reticulin stain showed reticulin fibers within the granulomas. Five months later, all the facial lesions regressed with continuation of HAART, with no specific treatment for facial plaques. Repeat CD 4 count was 104/cu mm. A diagnosis of cutaneous sarcoidosis occurring as a part of immune reconstitution inflammatory syndrome was made. Although systemic sarcoidosis has been reported, the occurrence of cutaneous sarcoidosis as part of immune reconstitution inflammatory syndrome has not been elucidated conclusively. |
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Extensive morphea profunda with autoantibodies and benign tumors: A rare case report |
p. 208 |
Leelavathy Budamakuntla, Dipali Malvankar DOI:10.4103/2229-5178.101823 PMID:23189258The term deep morphea describes a variant of morphea (localised scleroderma) in which inflammation and sclerosis are found in the deep dermis, panniculus, fascia or superficial muscle. It is sometimes associated with autoantibodies. We report the case of a 49 year-old male who had morphea profunda (radiologically and histopathologically confirmed) affecting mainly the left side of the body with face, trunk and limb involvement, along with autoantibody production and associated neurofibromas and lipomas. |
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MUSINGS/OPINIONS/TIPS AND EXPERIENCES |
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Dermatology and social networking sites |
p. 211 |
Bhushan Madke DOI:10.4103/2229-5178.101824 PMID:23189259 |
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DRUG PROFILE |
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Spinosad: An effective and safe pediculicide |
p. 213 |
Suruchi Aditya, Aditya Rattan DOI:10.4103/2229-5178.101825 PMID:23189260Although head lice are not a major health hazard, they have been a source of irritation and disgust for thousands of years. Despite the use of over-the-counter (OTC) treatments, it has high prevalence, and epidemics occur regularly. Permethrin 1% is currently recommended as a drug of choice, but many areas have shown resistance to this insecticide. A 0.9% suspension of spinosad, a naturally occurring pest control product, has recently been approved by the USFDA for treatment of pediculosis capitis. It acts by enhancing the action of nicotinic acetylcholine, resulting in paralysis of the parasite. Clinical trials show that spinosad is more effective and safe than current drugs of treatment. Additionally, it does not require nit combing. Spinosad appears as a powerful recruit in the battle against head lice. |
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HISTORY |
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Learning from eponyms: Jose Verocay and Verocay bodies, Antoni A and B areas, Nils Antoni and Schwannomas |
p. 215 |
Rajiv Joshi DOI:10.4103/2229-5178.101826 PMID:23189261Schwannomas 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. |
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LETTERS TO THE EDITOR |
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Subcorneal pustular dermatosis masquerading as dermatophytosis |
p. 220 |
Jayakar Thomas, K Parimalam DOI:10.4103/2229-5178.101827 PMID:23189262 |
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Towards quality improvement: Training and supportive supervision in STI control programme, Himachal Pradesh |
p. 221 |
Sunite A Ganju, Nand Lal Sharma, Anil Kanga DOI:10.4103/2229-5178.101828 PMID:23189263 |
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Systemic sclerosis presenting as lobular panniculitis |
p. 222 |
VG Binesh, Jijith Krishnan, Neelakandhan Asokan, Kidangazhiathmana Ajithkumar DOI:10.4103/2229-5178.101830 PMID:23189264 |
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Median canaliform dystrophy of Heller |
p. 224 |
Bhushan Madke, Reshma Gadkari, Chitra Nayak DOI:10.4103/2229-5178.101832 PMID:23189265 |
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Seborreic keratosis with Bowenoid transformation |
p. 225 |
A Shankar, Shaista Choudhary, YA Manjunatha DOI:10.4103/2229-5178.101833 PMID:23189266 |
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SKINDIA QUIZ |
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SkIndia Quiz 7 - Giant erythematous plaque on the arm of an elderly woman |
p. 228 |
KT Ashique DOI:10.4103/2229-5178.96771 PMID:23189267 |
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THROUGH THE LENS |
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Eczematous skin lesion with nipple destruction |
p. 230 |
Arun C Inamadar DOI:10.4103/2229-5178.101834 PMID:23189268 |
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ANNOUNCEMENTS |
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Announcements |
p. 232 |
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