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REVIEW ARTICLE |
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Utility of immunofluorescence in dermatology  |
p. 1 |
Varsha M Shetty, Kumudhini Subramaniam, Raghavendra Rao DOI:10.4103/2229-5178.198774 PMID:28217464Immunofluorescence (IF) tests have redefined our understanding of many immune-mediated skin diseases, especially autoimmune blistering diseases (AIBDs). Nomenclature of certain AIBDs (for example, linear IgA diseases and IgA pemphigus) has been done based solely on the finding of tissue-bound immunoreactants as detected by IF tests. Direct and indirect are the two major types of IF tests; they are not only useful in the diagnosis but also guide the clinician in the treatment at least in certain AIBDs, as the titer of circulating antibodies as detected by IF reflects the disease activity. In this review, we describe techniques, various types of IF, and its modification. |
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ORIGINAL ARTICLES |
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Cutaneous manifestations in disorders of hepatobiliary system |
p. 9 |
Shashi K Godara, Devinder M Thappa, Biju Pottakkatt, Abdoul Hamide, Jagadisan Barath, Malathi Munisamy, Minu J Chiramel DOI:10.4103/2229-5178.198760 PMID:28217465Background: Hepatobiliary diseases are associated with various mucocutaneous changes that are directly and indirectly associated with these diseases. There is a dearth of studies from India dealing with cutaneous manifestations in liver disorders. Aim: This study was conducted to know the spectrum of cutaneous changes and their correlation with liver function tests in patients with disorders of hepatobiliary system. Methods: This was a descriptive study conducted among in patients and outpatients with primary hepatobiliary disorders at a tertiary care center in South India. Detailed history taking and examination was done. Visual analog score (VAS) and 5D itch score was employed to quantify pruritus. Correlation of liver function tests with pruritus and comparison of skin changes in the major disease groups was attempted. Results: A total of 303 patients were recruited. Hepatic mass/malignancy followed by nonalcoholic liver disease were the most common diagnoses. Icterus followed by pruritus were the most common cutaneous complaints. The mean VAS and 5D itch scores among the patients with pruritus were 4.7 ± 1.9 and 13.6 ± 4.9. The most common mucocutaneous findings observed were icterus (241 patients; 79.5%), ichthyosis/xerosis (172 patients; 56.7%), pallor (131 patients; 43.2%), excoriations (118 patients; 38.9%), hyperpigmented palmar creases (118 patients; 38.9%), clubbing (113 patients; 37.2%), and pedal edema (85 patients; 28%).There was statistically significant correlation between serum bilirubin levels and pruritus. Conclusion: The common mucocutaneous manifestations associated with primary hepatobiliary disorders were icterus, ichthyosis/xerosis, pallor, excoriations, hyperpigmented palmar creases, clubbing, and pedal edema. |
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Secukinumab efficacy and safety in indian patients with moderate-to-severe plaque psoriasis: Sub-analysis from FIXTURE, a randomized, placebo-controlled, phase 3 study  |
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Ramesh M Bhat, B Leelavathy, Sacchidanand S Aradhya, Maragondanahalli G Gopal, D. V. S. Pratap, Mir Mubashir, Putta Srinivas, Sushil Y Pande, Amit S Thavkar DOI:10.4103/2229-5178.198765 PMID:28217466Title: Secukinumab efficacy and safety in Indian patients with moderate-to-severe plaque psoriasis: sub-analysis from FIXTURE (Full Year Investigative Examination of Secukinumab vs. Etanercept Using Two Dosing Regimens to Determine Efficacy in Psoriasis), a randomized, placebo-controlled, phase 3 study. Background: Evidence has suggested Interleukin (IL)-17A to be an important effector cytokine in the pathogenesis of psoriasis. Here, we report results for an Indian sub-population from a multinational study FIXTURE, designed to assess the safety, tolerability, and long-term efficacy of fully human anti–IL-17A monoclonal antibody secukinumab in patients with moderate-to-severe plaque psoriasis. Materials and Methods: In this double-dummy, placebo controlled, 52-weeks phase 3 study FIXTURE, 149 Indian patients were randomized 1:1:1:1 to receive secukinumab at a dose of 300 mg or 150 mg, etanercept, or placebo. The study objective was to show the superiority of secukinumab over placebo at week 12, vis-à-vis proportion of patients achieving a reduction of 75% or more from the baseline in the psoriasis area-and-severity index score (PASI 75) and a score of 0 (clear) or 1 (almost clear) on a 5-point modified investigator's global assessment (IGA mod 2011) (co-primary end points). Results: At week 12, 61.0% and 55.9% patients in secukinumab 300 mg and 150 mg groups, respectively, achieved PASI 75 response compared to 20.0% in the etanercept and 7.1% in the placebo groups. Similarly, IGA mod 2011 0 or 1 response was achieved by 43.9% and 20.6% in patients in the secukinumab 300 mg and 150 mg group, respectively, vs. 13.3% in the etanercept and 2.4% in the placebo groups at week 12. Likewise, higher proportions of patients in secukinumab 300 mg (41.5%) and 150 mg (20.6%) group were PASI 90 responders at week 12 than those in the etanercept (10.0%) or placebo (0.0%) groups. The incidences of adverse events (AEs), during the induction period were similar in all the treatment groups. Overall secukinumab was well-tolerated at both doses in the Indian sub-population. Conclusion: The results from the Indian sub-population suggest that secukinumab is an efficacious and safe drug for use in moderate-to-severe chronic plaque psoriasis |
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Pattern of inpatient referrals to dermatology at a tertiary care centre of South Rajasthan |
p. 25 |
Manisha Balai, Lalit K Gupta, Ashok K Khare, Asit Mittal, Sharad Mehta, Garima Bharti DOI:10.4103/2229-5178.198759 PMID:28217467Background: Dermatologists besides providing service to patients in the outdoors, also play a vital role in the care of inpatients admitted to dermatology unit and other departments. Aims: The aim of this study was to evaluate the pattern of referrals sent to the dermatology department by other departments. Materials and Methods: The study included all inpatients referred to dermatology department of a tertiary care centre of South Rajasthan during a 5-year period from October 2008 to September 2013. Results: A total of 1560 consultations with 1603 diagnoses were recorded. Most (770; 49.3%) consultations were received from internal medicine, followed by surgery (177; 11.3%), pediatrics (104; 6.7%), psychiatry (86; 5.5%) and gynecology (69; 4.4%) wards. Infectious skin diseases were most common (29.7%) followed by eczema (12.0%) and drug reactions (9.0%). Conclusion: Dermatology referrals can enhance the dermatological knowledge of non-dermatologists to diagnose and manage common dermatoses thus improving overall patient care. |
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CASE REPORTS |
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Subcutaneous phaeohyphomycosis in an immunocompetent Individual: A case report |
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Sudharani Chintagunta, Geetakiran Arakkal, Sudha V Damarla, Akshay K Vodapalli DOI:10.4103/2229-5178.198770 PMID:28217468Phaeohyphomycosis is a rare mycotic infection caused by various heterogenous groups of phaeoid (dematiaceous) fungi involving the skin and subcutaneous tissue. Common clinical manifestations are subcutaneous abscesses or cystic swellings. Here, we report a case of subcutaneous phaeohyphomycosis presenting as multiple asymptomatic cystic swellings over the hands and feet without any predisposing factors. Histopathology showed granulomatous inflammation and special stain with Grocott's methanamine silver stain revealed broad pigmented hyphae. Culture showed black-colored colonies identified as Exophiala jeanselmi. The patient was treated with surgical excision of the lesions. |
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Clinicopathological diagnosis of orofacial granulomatosis |
p. 32 |
Fatma Sule Afsar, Hatice Demirlendi Duran, Gungor Yilmaz, Murat Ermete DOI:10.4103/2229-5178.198768 PMID:28217469Orofacial granulomatosis is a rare chronic inflammatory disorder characterized by persistent or recurrent soft tissue swellings, oral ulceration, and other orofacial features in the absence of an identifiable granulomatous disease. We report a case of a 61-year-old woman with recurrent ulcerations and swellings in her oral mucosa. She was diagnosed as orofacial granulomatosis based upon clinicopathological correlation after exclusion of other granulomatous diseases and showed a favorable response to systemic corticosteroid treatment. |
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A case report of reactive solitary eccrine syringofibroadenoma |
p. 35 |
Anup K Tiwary, J Firdous, Dharmendra K Mishra, Shyam S Chaudhary DOI:10.4103/2229-5178.198766 PMID:28217470Eccrine syringofibroadenoma is a very rare benign tumour of acrosyringium of eccrine sweat duct. Based on the evidences of known etiological factors, two forms have been proposed; reactive and nonreactive. Reactive forms are rarer, and on even rarer occasions, trauma complicated by secondary nonspecific infections may lead to the development of reactive eccrine syringofibroadenoma, as in our case. Here, we are documenting a case of reactive solitary eccrine syringofibroadenoma in a 65-year-old male presenting with coalescing, firm, pinkish, verrucous nodules and painful deep ulceration on the right sole preceded by trauma and secondary infection. Histopathologic revelation of distinctive microscopic findings confirmed the diagnosis in our case. |
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Disseminate and recurrent infundibulo-folliculitis in an Indian patient: A case report with review of literature |
p. 39 |
Sukumaran Pradeep Nair, Mini Gomathy, Gopinathan Nanda Kumar DOI:10.4103/2229-5178.198775 PMID:28217471A 17-year-old male patient presented with multiple discrete and confluent monomorphic skin-colored pinhead-sized follicular papules, with occasional pustules distributed on the neck, upper chest, upper posterior trunk, and proximal extremities of 4 months duration. The lesions were asymptomatic, and there was no prior history of topical application or history of atopic dermatitis. Routine investigations were normal. Histopathology of the papules showed a mononuclear infiltrate at the infundibulum of the hair follicle. We made a final diagnosis of disseminate and recurrent infundibulo-folliculitis. The patient was started on NB-UVB and topical tacrolimus. We are reporting an interesting case in an Indian patient. |
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Yellow pseudochromhidrosis in a young female |
p. 42 |
Pragya A Nair, Rahul Krishna S Kota, Nishit K Surti, Nilofar G Diwan, Shailee S Gandhi DOI:10.4103/2229-5178.198778 PMID:28217472Chromhidrosis is a rare disorder in which there is pigmentation of sweat in a variety of colors. It can be classified into apocrine, pseudoeccrine, and true eccrine chromhidrosis. Pseudochromhidrosis is a condition in which the excreted sweat is colorless, but later acquires color due to contact with chromogenic chemicals. Systemic and topical antibiotics are the mainstay of treatment. Although it does not constitute a major health issue, it causes psychological stress and social embarrassment. A 20-year-old female presented to us with yellow-colored sweat and discoloration of clothes since 1 month. Routine laboratory investigations were normal. Skin scrapings were negative for fungus and bacteria. Skin biopsy was also normal. She was labelled as a case of pseudochromhidrosis, and oral and topical antibiotics were prescribed, to which she responded well. |
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CD34 negative superficial acral fibromyxoma: A rare case report |
p. 45 |
Reza M Robati, Sahar Dadkhahfar, Azadeh Rakhshan DOI:10.4103/2229-5178.198776 PMID:28217473Superficial acral fibromyxoma (SAF) is a slow growing soft tissue tumor that mainly appears in the acral areas. Here, we report a case of a SAF with distinctive immunophenotype charachteristics. An 18-year-old female was referred to our clinic with the complaint of painless subungual nodule of great toe for a few months. The diagnosis of SAF was made according to histopathology and immunohistochemical (IHC) study, however, the IHC assessment showed positive staining with vimentin, focal reaction with smooth muscle actin, negative reaction with CD34, and positive staining pattern with CD99. These IHC findings are unusual for SAF. This reported case of SAF supports the fact that, although CD34 expression is characteristic for SAF, it is not always present. |
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LETTERS TO THE EDITOR |
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Chondrodermatitis nodularis chronica helicis |
p. 48 |
Piyush Kumar, Rizwana Barkat DOI:10.4103/2229-5178.198767 PMID:28217474 |
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Corns in scleroderma: An underreported entity |
p. 49 |
Namitha Chathra, Ramesh M Bhat DOI:10.4103/2229-5178.198764 PMID:28217475 |
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A case of scleromyxedema responding to lenalidomide and dexamethasone |
p. 50 |
Sweta Rambhia, Kinjal Rambhia, Amit Gulati, Nirmal Raut DOI:10.4103/2229-5178.198779 PMID:28217476 |
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Solitary lesion in papular elastorrhexis: A diagnostic challenge |
p. 53 |
Premanshu Bhushan, Sarvesh Thatte, Avninder Singh DOI:10.4103/2229-5178.198758 PMID:28217477 |
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Diffuse scalp hair loss due to levothyroxine overdose |
p. 55 |
Mahmood Dhahir Al-Mendalawi DOI:10.4103/2229-5178.198769 PMID:28217478 |
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Piezogenic pedal tumors of obesity: Unusual presentation of an innocuous dermatosis |
p. 56 |
Saurabh Singh, Geeti Khullar, Dipankar De DOI:10.4103/2229-5178.198757 PMID:28217479 |
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Extragenital lichen sclerosus et atrophicus co-exististing with pemphigus vulgaris |
p. 57 |
Chirag Desai, Utpal Durve, Uday Khopkar DOI:10.4103/2229-5178.198761 PMID:28217480 |
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Traumatic anserine folliculosis  |
p. 59 |
Kinjal Deepak Rambhia, Vaishali Wankhade, Jayesh Mukhi, RP Singh DOI:10.4103/2229-5178.198773 PMID:28217481 |
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Pebbling of skin: Cutaneous marker of Hunter syndrome |
p. 62 |
Sahana M Srinivas, Madhuri Maganthi, GN Sanjeev DOI:10.4103/2229-5178.198772 PMID:28217482 |
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Benign vulvar vestibular papillomatosis: An underreported condition in Indian dermatological literature  |
p. 63 |
Sushil Kakkar, Prafulla K Sharma DOI:10.4103/2229-5178.198777 PMID:28217483 |
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Segmental neurofibromatosis: An unusual association with ocular, skeletal, and cerebral anomalies |
p. 65 |
M Poornimambaa, Paul V Puthussery, Sandhya George, Beena Narayanan, N Asokan, Priya Prathap DOI:10.4103/2229-5178.198762 PMID:28217484 |
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SKINDIA QUIZ |
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SkIndia Quiz 32: A strange sessile formation appearing as a penis-like structure |
p. 68 |
Matteo Megna, Nicola Balato, Maddalena Napolitano, Claudia Costa, Pietro Gisonni, Massimo Mascolo, Anna Balato DOI:10.4103/2229-5178.193927 PMID:28217485 |
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SkIndia Quiz 33: Solitary pigmented plaque containing a blue-gray papule |
p. 70 |
Cody J Connor, Brian L Swick DOI:10.4103/2229-5178.193928 PMID:28217486 |
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THROUGH THE LENS |
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Cutaneous metastasis from prostate carcinoma |
p. 73 |
Savera Gupta, Manjaree Morgaonkar, Suresh K Jain DOI:10.4103/2229-5178.198763 PMID:28217487 |
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THROUGH THE DERMATOSCOPE |
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Dermoscopy of erythema multiforme |
p. 75 |
Feroze Kaliyadan DOI:10.4103/2229-5178.198771 PMID:28217488 |
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