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EDITORIAL |
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The menace of chronic and recurrent dermatophytosis in India: Is the problem deeper than we perceive? |
p. 73 |
Sunil Dogra, Shraddha Uprety DOI:10.4103/2229-5178.178100 PMID:27057485 |
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REVIEW ARTICLE |
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Management of tinea corporis, tinea cruris, and tinea pedis: A comprehensive review  |
p. 77 |
Alok Kumar Sahoo, Rahul Mahajan DOI:10.4103/2229-5178.178099 PMID:27057486The 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. |
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ORIGINAL ARTICLE |
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Efficacy of narrowband ultraviolet B phototherapy and levels of serum vitamin D3 in psoriasis: A prospective study |
p. 87 |
Aditi Gupta, Trilok Chand Arora, Ankur Jindal, Ajeet Singh Bhadoria DOI:10.4103/2229-5178.178081 PMID:27057487Introduction: Narrowband ultraviolet B phototherapy (NBUVB) is safe and effective treatment for psoriasis. Vitamin D plays an important role in pathogenesis of psoriasis. It is known that psoriasis patients have low serum 25(OH)D levels, which increase after NBUVB. We assessed serum 25(OH)D levels, its correlation with Psoriasis Area and Severity Index (PASI), and the effect of NBUVB on 25(OH)D levels among Indian psoriasis patients. Materials and Methods: A prospective study comprising 30 adults with psoriasis with no major comorbidities (PASI > 10 and off-therapy >4 weeks) was conducted. PASI was estimated at baseline among patients and repeated after receiving 12 weeks of NBUVB therapy. Thirty age and gender-matched healthy controls were recruited to compare 25(OH)D levels at baseline and at 12 weeks. Patient demographic parameters, treatment dose, duration, side effects, and its impact on 25(OH)D levels and PASI were serially evaluated. Results: A total of 30 patients presenting with psoriasis and 30 healthy controls were enrolled in the study. Mean baseline PASI (M: F =19:11) among patients with mean age 36.8 (±7.7) years was 20.5 (±6.3) and all patients were either 25(OH)D deficient (n = 14) or insufficient (n = 16). Their baseline 25(OH)D levels were significantly lower than controls (25.93 nmol/L vs 47.54 nmol/L; P < 0.001). After NBUVB therapy (average cumulative dose 20.76 ± 7.1 J/cm2; average treatment sessions 32.57 ± 1.9), there was a significant improvement in PASI as well as 25(OH)D (P < 0.05). There was no correlation between the mean improvement in PASI and 25(OH)D after 12 weeks of therapy. Twelve (40%) patients had therapy-related side effects [pruritus (n = 8), erythema (n = 4)], none had major side effects. Conclusion: Improvement in PASI and serum 25(OH)D levels after NBUVB in psoriasis is significant but poorly correlated with each other. Vitamin D may not be the lone mediator of the therapeutic effects of NBUVB on psoriasis. |
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CASE REPORTS |
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Hepatitis B, interferon, and acne fulminans in a young girl |
p. 93 |
Sandeep Arora, Ajay Malik, Dharmendra Kumar, Neha Sodhi DOI:10.4103/2229-5178.178080 PMID:27057488Acne fulminans (AF) is a very rare severe form of acne seen in young males, characterized by a sudden and explosive onset of hemorrhagic pustules and ulceration on the trunk, systemic features in the form of fever, polyarthropathy, malaise, erythema nodosum and painful osteolytic bone involvement with leukocytosis, and an elevated erythrocyte sedimentation rate. Conventional treatment of AF includes corticosteroids or immunosuppressive agents for the initial phase followed by isotretinoin. Active hepatitis B infection with a high viral load precludes the administration of any immunosuppressive drugs. We present the case of an 18-year-old girl with a history of occasional acne who presented with AF of sudden onset following administration of interferon-alpha-2a for her recently detected hepatitis B infection. Management of hepatitis B was withheld in view of her general condition. The patient was managed with low dose isotretinoin with subsidence of lesions. AF in a young female precipitated by interferon and its management with isotretinoin in the presence of active hepatitis B infection make the case unique. |
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Clinically granulomatous cheilitis with plasma cells |
p. 96 |
Somenath Sarkar, Sarmistha Ghosh, Dipayan Sengupta DOI:10.4103/2229-5178.178094 PMID:27057489Plasma cell cheilitis, also known as plasma cell orificial mucositis is a benign inflammatory condition clinically characterized by erythematous plaque on lips that may be ulcerated. Histopathologically it is characterized by dense plasma cell infiltrates in a band-like pattern in dermis, which corresponds to Zoon's plasma cell balanitis. On the other hand, granulomatous cheilitis, as a part of orofacial granulomatosis, manifests as sudden diffuse or nodular swelling involving lip and cheek. Initial swelling is soft to firm, but with recurrent episodes swelling gradually become firm rubbery in consistency. We hereby report a case of cheilitis in a 52-year-old man with diffuse swelling involving lower lip, which clinically resembles granulomatous cheilitis, but histopathological examination showed diffuse infiltrate of plasma cells predominantly in upper and mid-dermis. |
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Atypical cases of Dowling-Degos disease |
p. 99 |
Kikkeri Narayanshetty Naveen, Sharatchandra B Athaniker, Spandana P Hegde, Rahul Shetty, Hanumanthayya Radha, Sadashivappa Sangam Parinitha DOI:10.4103/2229-5178.178096 PMID:27057490Dowling–Degos disease (DDD) is a rare autosomal dominant condition characterized by multiple, small, round pigmented macules usually arranged in reticular pattern, chiefly distributed in axillae and groins. Here we are reporting three atypical cases of DDD in a family. They had hypopigmented macules with typical features of DDD indicating generalized DDD. Histopathology confirmed the diagnosis. We present these three cases to stress the existence of generalized DDD phenotype in the Indian population. |
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Elastosis perforans serpiginosa in a case of pseudoxanthoma elasticum: A rare association |
p. 103 |
Konakanchi Venkatachalam, Kavya Chennamsetty DOI:10.4103/2229-5178.178078 PMID:27057491Elastosis perforans serpiginosa (EPS), characterized by transepidermal elimination of fragmented elastic fibers, clinically presents as hyperkeratotic papules. EPS is classified into three types: (1) Idiopathic; (2) reactive, with associated connective tissue diseases such as pseudoxanthoma elasticum (PXE), Ehlers–Danlos syndrome, cutis laxa, Marfan syndrome, osteogenesis imperfecta, Down's syndrome; (3) the one that is induced by D-penicillamine. A rare association of EPS with PXE, which is primarily a defect of transmembrane transporter protein with accumulation of certain metabolic compounds and secondary calcification of elastic fibers has been documented in the literature. We report a case of PXE with associated lesions that were histopathologically compatible with EPS. |
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Annular elastolytic giant cell granuloma in association with Hashimoto's thyroiditis |
p. 107 |
Rishi Hassan, P Arunprasath, L Padmavathy, K Srivenkateswaran DOI:10.4103/2229-5178.178087 PMID:27057492Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous skin disease characterized clinically by annular plaques with elevated borders and atrophic centers found mainly on sun-exposed skin and histologically by diffuse granulomatous infiltrates composed of multinucleated giant cells, histiocytes and lymphocytes in the dermis along with phagocytosis of elastic fibers by multinucleated giant cells. We report a case of AEGCG in a 50-year-old woman and is highlighted for the classical clinical and histological findings of the disease and its rare co-existence with Hashimoto's thyroiditis. |
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Apocrine hidrocystoma arising from nevus sebaceous on the scalp |
p. 111 |
Cherukuri Tejaswi, Murugaiyan Rangaraj, Kaliaperumal Karthikeyan DOI:10.4103/2229-5178.178088 PMID:27057493Nevus sebaceous is a hamartoma with an uneventful course since birth but many benign or malignant tumors are known to develop in about one third of the patients. A 37-year-old woman with asymptomatic hairless raised lesion over the scalp since birth presented with change in the morphology of the lesions associated with itching and irritation since one month. On examination, multiple well-defined hyperpigmented verrucous plaques coalescing with each other were seen over the right parietal scalp associated with alopecia. A single well-defined soft skin-colored cystic swelling of size 1 × 2 cm was seen interspersed within the plaque. After a clinical diagnosis of nevus sebaceous, a biopsy of the cyst was done, which revealed a large cyst lined by columnar and myoepithelial cells in the dermis. The columnar cells at a few places showed “decapitation secretion” giving the impression of apocrine hidrocystoma. Post-excision of the cyst, biopsy of the entire nevus was done and the histopathological diagnosis correlated with the clinical diagnosis of nevus sebaceous. Apocrine hidrocystoma developing from a sebaceous nevus over the scalp is a rarity with only three other cases of it arising on the scalp being reported and none of them developed from a sebaceous nevus. |
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Pyogenic granuloma underlying cutaneous horn in a young boy |
p. 114 |
Pragya A Nair, Rahul Krishna S Kota, Abhisheik P Pilani DOI:10.4103/2229-5178.178086 PMID:27057494Cutaneous horn is an elongated, keratinous projection that usually occurs over the sun-exposed areas. It is a clinical diagnosis and may overlie any benign, premalignant, or malignant conditions. Treatment includes wide surgical excision with careful histological examination to exclude a focus of malignancy. An unusual case of a pyogenic granuloma presenting as cutaneous horn on the lower lip in an 11-year-old boy is presented here. |
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CASES FROM ACKERMAN ACADEMY |
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Irregular pigmented lesion on the genital area |
p. 117 |
Manuel Valdebran, Kruti Parikh, Deborah S Sarnoff, Dirk M Elston DOI:10.4103/2229-5178.178098 PMID:27057495 |
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A warty lesion on the penis |
p. 119 |
Kara Melissa T Torres, Dennis C Polley, Filamer Kabigting, Dirk M Elston DOI:10.4103/2229-5178.178097 PMID:27057496 |
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A firm plaque on the cheek |
p. 121 |
Kara Melissa T Torres, Dirk M Elston, Dennis C Polley, Frank Ferritto DOI:10.4103/2229-5178.178101 PMID:27057497 |
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LETTERS TO THE EDITOR |
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Topical timolol maleate: An effectual and safe recourse for infantile hemangiomas |
p. 124 |
Yasmeen Jabeen Bhat, Atiya Yaseen, Iffat Hassan DOI:10.4103/2229-5178.178076 PMID:27057498 |
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Juvenile capillary hemangioma |
p. 125 |
Smeeta Gajendra, Rashmi Ranjan Das, Manas Kumar Sahoo DOI:10.4103/2229-5178.178079 PMID:27057499 |
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Generalized eruptive syringoma: A clinical dilemma |
p. 127 |
Abhijeet Kumar Jha, Rajesh Sinha, Smita Prasad, Ruchi Sinha DOI:10.4103/2229-5178.178082 PMID:27057500 |
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Phakomatosis cesioflammea with bilateral frontal atrophy |
p. 128 |
Abhijeet Kumar Jha, Rajesh Sinha, Smita Prasad, Deepak Kumar DOI:10.4103/2229-5178.178077 PMID:27057501 |
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Granuloma faciale |
p. 130 |
Manveen Kaur, Avninder Singh, Venkat Ramesh DOI:10.4103/2229-5178.178083 PMID:27057502 |
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Acute infectious purpura fulminans caused by group A β-hemolytic Streptococcus: An uncommon organism |
p. 132 |
Divya Gupta, Laxmisha Chandrashekar, Bheemanathi Hanuman Srinivas, Devinder Mohan Thappa DOI:10.4103/2229-5178.178093 PMID:27057503 |
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Multiple erythematous nodules in a 30-year-old woman |
p. 134 |
Shikha Gupta, Paschal D’souza, Tapan K Dhali DOI:10.4103/2229-5178.178095 PMID:27057504 |
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Authors reply: Multiple erythematous nodule in a 30-year-old woman |
p. 135 |
Martha Elena García-Meléndez, Kristian Eichelmann-Herrera, Osvaldo Tomás Vázquez-Martínez, Jorge Ocampo-Candiani DOI:10.4103/2229-5178.178092 PMID:27057505 |
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SKINDIA QUIZ |
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SkIndia Quiz 23: A swelling on the tongue
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p. 137 |
S Sudhakar, J Rocky, P Ramaswamy, B Smitha, Ch Sai Kiran DOI:10.4103/2229-5178.174341 PMID:27057506 |
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THROUGH THE LENS |
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Reactive perforating collagenosis |
p. 139 |
Sandeep Arora, Ajay Malik, Anil Balki DOI:10.4103/2229-5178.178084 PMID:27057507 |
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Solitary mastocytoma with positive Darier's sign |
p. 141 |
Brijesh Nair, Sidharth Sonthalia, Ishad Aggarwal DOI:10.4103/2229-5178.178091 PMID:27057508 |
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Urbach-Weithe disease (lipoid proteinosis): A classical presentation |
p. 143 |
Ankita Sangwan, Sarabjit Kaur, Vijay K Jain, Surabhi Dayal DOI:10.4103/2229-5178.178089 PMID:27057509 |
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Cytodiagnostic copper pennies in chromoblastomycosis |
p. 145 |
Gopikrishnan Anjaneyan, Soumya Jagadeesan, Jacob Thomas DOI:10.4103/2229-5178.178085 PMID:27057510 |
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Hailey-Hailey disease |
p. 147 |
Nidhi Yadav, Bhushan Madke, Sumit Kar, Kameshwar Prasad, Nitin Gangane DOI:10.4103/2229-5178.178090 PMID:27057511 |
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