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Access statistics : Table of Contents
2019| January-February | Volume 10 | Issue 1
Online since
January 14, 2019
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REVIEW ARTICLE
Apremilast in psoriasis and beyond: Big hopes on a small molecule
TP Afra, T Muhammed Razmi, Sunil Dogra
January-February 2019, 10(1):1-12
DOI
:10.4103/idoj.IDOJ_437_18
PMID
:30775293
Apremilast, an orally administered small molecule inhibitor of phosphodiesterase 4 (PDE4), has been licensed by the US Food and Drug Administration for the management of active psoriatic arthritis (March 21, 2014) and moderate to severe plaque psoriasis (September 23, 2014). It has got approval from Drug Controller General of India for marketing in India in 2017. The drug has drawn much attention from the practising dermatologists for its commendable safety profile and prescription convenience. Introduced initially as an orally administered small molecule in psoriasis patients, the drug has now been used in various other indications as evident by the recent surge in literature for its off-label uses. Being a relatively new drug in the treatment armamentarium of psoriasis and other inflammatory dermatoses; in this review, we will discuss various practical aspects of prescribing oral apremilast, based on the current and emerging literature.
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CASE REPORTS
Acute methotrexate toxicity due to overdosing in psoriasis: A series of seven cases
Swetalina Pradhan, Chandra Sekhar Sirka, Arpita Nibedita Rout, Gaurav Dash, Kananbala Sahu
January-February 2019, 10(1):64-68
DOI
:10.4103/idoj.IDOJ_157_18
PMID
:30775303
Overdosing is the major cause of acute methotrexate toxicity in psoriasis patients. There are no published data regarding the acute cumulative dose causing acute toxicity, duration to achieve acute cumulative toxic dose and various reasons for wrong dosing of methotrexate in Indian patients. We are presenting a series of seven cases of toxicity due to overdosing of methotrexate in psoriasis. The acute cumulative dose of methotrexate ranging from 35 mg to 150 mg, taken over 3–7 days was responsible for acute toxicity in the psoriasis cases. Lack of counselling regarding the disease course, drug dosing, schedule and awareness about possible outcome of high and daily dose were found to be the causes of overdosing and toxicity in our patients. All cases presented with ulceration, bleeding and pain in skin lesions and five cases had oral mucosal ulceration and genital mucosa was involved in two cases. All cases were given injectable folinic acid. Five cases recovered and two cases expired. Authors postulate counselling about the course of disease, regarding dosing schedule of methotrexate and consequences of methotrexate overdosing is mandatory for all patients of psoriasis in country like India where drug regulation is not strict to prevent methotrexate toxicity and its dreaded consequences.
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ORIGINAL ARTICLES
The efficacy and safety of intralesional immunotherapy with measles, mumps, rubella virus vaccine for the treatment of common warts in adults
Pushpinder Singh Chauhan, Vikram K Mahajan, Karaninder Singh Mehta, Ritu Rawat, Vikas Sharma
January-February 2019, 10(1):19-26
DOI
:10.4103/idoj.IDOJ_142_18
PMID
:30775294
Background
: Most therapeutic modalities for common warts remain unsatisfactory.
Objectives
: To evaluate efficacy and safety of intralesional MMR (measles, mumps, rubella virus) vaccine in the treatment of common warts in adults.
Patients and Methods
: There were 110 (M:F = 61:49) patients aged 19–62 years having 1–211 warts over dorsal hands, feet, palms, soles, and periungual skin for 1–252 months. MMR vaccine 0.25 mL was injected intralesionally in the largest wart and repeated at 2-week interval until complete clearance or maximum of five doses. The outcome was evaluated as complete clearance, excellent, good, or unsatisfactory response on visual analog scale at every visit and at 4 and 8 weeks, thereafter by comparing baseline clinical photograph. Likert scale was used for patient satisfaction level assessment similarly.
Results
: Only 51 patients completed the study and 42 (82.4%) of them showed complete clearance of warts and 9 (17.6%) patients showed good or unsatisfactory response. In 4 (7.8%) patients, the warts subsided completely after one dose itself. The four patients showing excellent response after five doses initially also continued to improve during follow-up period of 8 weeks. Except for injection site pain, no adverse effects were noted. There was no recurrence of warts among cured who were also very much satisfied from treatment.
Conclusion:
Despite variable results, intralesional MMR vaccine immunotherapy appears another possible safe and effective treatment option for common warts in a set of adult patients with advantages of regression of distant warts, no significant adverse effects and low recurrence. However, well-designed, controlled studies for minimum effective dose and treatment schedule are highly desirable to make any recommendation.
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BRIEF REPORTS
Clinico-epidemiological profile of patients with vitiligo: A retrospective study from a tertiary care center of North India
Vikram K Mahajan, Sanket Vashist, Pushpinder Singh Chauhan, Karan Inder Singh Mehta, Vikas Sharma, Anuj Sharma
January-February 2019, 10(1):38-44
DOI
:10.4103/idoj.IDOJ_124_18
PMID
:30775297
Background:
We studied clinico-epidemiological features of 945 patients with vitiligo with an objective to delineate epidemiological and clinical aspects of vitiligo from this part of the country.
Materials and Methods:
The medical records of patients with vitiligo attending outpatient clinic over a 5-year period from January 2013 to December 2017 were analyzed retrospectively for this descriptive, observational study.
Results:
There were 449 men and 496 women (m:f 1:1.1) aged between 2 and 83 years (mean 24.4 years) and having vitiligo for 1 week to 64 years (mean 5.1 years). The majority, 478 (50.6%) patients were aged ≤20 years and 248 (26.2%) were children aged ≤12 years. The age at the onset was between 6 months and 82 years (mean 20.5 years), and the majority 674 (71.3%) patients had it before 25 years of age. The consultation time was within 5 years in 692 (73.2%) patients. A family history of vitiligo was present in 150 (15.9%) patients. The majority 871 (92.2%) patients had involvement of up to 10% body surface area and vitiligo vulgaris in 562 (59.5%) and focal vitiligo in 117 (18.7%) patients were the most common clinical types. An association with other systemic disorders was in 124 (13.1%) patients and predominately included thyroid abnormalities and diabetes mellitus.
Conclusions:
Our observations are essentially consistent with the literature. There was no difference in clinico-epidemiological features of vitiligo. Patients with an affected first-degree family member had early onset, but difference was not statistically significant. Screening for concurrent thyroid disorders appears important. However, our inferences remain limited by single center, retrospective, observational, and cross-sectional nature of the study.
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RESEARCH SNIPPETS
Types of variables, descriptive statistics, and sample size
Feroze Kaliyadan, Vinay Kulkarni
January-February 2019, 10(1):82-86
DOI
:10.4103/idoj.IDOJ_468_18
PMID
:30775310
This short “snippet” covers three important aspects related to statistics – the concept of
variables
, the importance, and practical aspects related to
descriptive statistics
and issues related to
sampling
– types of sampling and sample size estimation.
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BRIEF REPORTS
Evaluation of association of vitamin D in alopecia areata: A case–control study of 100 patients in a tertiary rural hospital of Southern India
Harsha Siddappa, Y Hari Kishan Kumar, N Vivekananda
January-February 2019, 10(1):45-49
DOI
:10.4103/idoj.IDOJ_84_18
PMID
:30775298
Background:
Alopecia areata is a common autoimmune disorder which is characterized by non-scarring hair loss. Vitamin D plays an important role in immune regulation, cell growth, differentiation, and maintenance of hair cycle.
Aims and Objectives:
(1) To evaluate serum vitamin D levels in alopecia areata. (2) To compare serum vitamin D levels in new versus old cases and with respect to severity of alopecia areata.
Materials and Methods:
A retrospective case–control study with 100 cases of alopecia areata and 100 age- and sex-matched healthy controls was conducted from December 2014 to November 2015. All subjects underwent complete clinical evaluation and serum vitamin D levels. Results: The mean serum vitamin D level was significantly lower in patients with alopecia areata (18.90 ± 8.32 ng/mL) (64%) as compared to healthy controls (28.21 ± 18.32 ng/mL) (38%) (
P
< 0.001). The mean serum vitamin D levels was significantly lower in old cases (15.11 ± 4.75 ng/mL) as compared to new cases (20.85 ± 9.09 ng/mL) (
P
< 0.001). The proportion of subects with vitamin D deficiency was significantly higher among old cases (84.3%) as compared to new cases (53.1%) (
P
< 0.05). There was a significant inverse correlation between Severity of Alopecia Tool scores and serum vitamin D levels (
r
= −0.298,
P
< 0.05).
Conclusion:
Decreased vitamin D levels were observed in patients with alopecia areata and significant inverse correlation exists between vitamin D levels and duration/severity of the disease. These findings may suggest a causal role of vitamin D deficiency in the pathogenesis and therapeutic role of vitamin D supplementation in the management of alopecia areata.
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ORIGINAL ARTICLES
Comorbidities in lichen planus: A case–control study in Indian patients
S Ashwin Kumar, PV Krishnam Raju, K. V. T Gopal, T Narayana Rao
January-February 2019, 10(1):34-37
DOI
:10.4103/idoj.IDOJ_48_18
PMID
:30775296
Background:
Many previous studies have observed an association of lichen planus (LP) with one or two comorbidities such as diabetes mellitus and thyroid dysfunction. This study was undertaken to determine the association of LP with common comorbidities including diabetes mellitus, dyslipidemia, metabolic syndrome, thyroid dysfunction, and hepatitis C virus (HCV) infection.
Materials and Methods:
The study included 75 patients with clinical diagnosis of LP and 75 age- and sex-matched controls. After taking complete history, general examination and thorough dermatological examination were performed in all cases. Fasting serum samples were taken from all cases and controls and assayed for fasting plasma glucose, lipid profile, T3, T4, and thyroid-stimulating hormone levels, and anti-HCVantibodies. Metabolic syndrome was diagnosed according to 2005 revised National Cholesterol Education Programme's Adult Treatment Panel III. Two-sample Student's
t
-test was used for statistical analysis.
Results:
Increased triglyceride levels were seen in 26 cases (34.67%) compared with 14 controls (14%), which was significant (
P
= 0.024). Statistically significant increased prevalence of increasedlow-density lipoprotein levels
(P
= 0.027), low high-density lipoprotein levels (
P
= 0.0189), and diabetes mellitus (
P
= 0.0217) was also observed in LP. Metabolic syndrome (
P
= 0.656) and hypothyroidism (
P
= 0.117) were not significantly associated with LP. Strong association was observed between oral LP and hypothyroidism. All patients screened for anti-HCV antibodies were found to be negative.
Conclusion:
There is a clear associationof LP with dyslipidemia and diabetes mellitus. Screening for dyslipidemia and diabetes mellitus in all patients of LP will help in early detection, initiation of treatment, and prevent long-term morbidity.
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Clinical profile and comparison of causality assessment tools in cutaneous adverse drug reactions
Ranjana Beniwal, Lalit Kumar Gupta, Ashok Kumar Khare, Asit Mittal, Sharad Mehta, Manisha Balai
January-February 2019, 10(1):27-33
DOI
:10.4103/idoj.IDOJ_207_18
PMID
:30775295
Background:
Cutaneous adverse drug reactions (CADRs) are probably the most frequent of all manifestations of drug sensitivity. As a considerable number of new drugs are periodically introduced into the market, the incidence of CADR is likely to increase. The pattern of CADR and the causative drugs is likely to change accordingly. There is no uniformly accepted and reliable method of objectively assessing the causal link between drug and adverse reaction.
Aim:
To study the clinical patterns and causative drugs and compare causality assessment [World Health Organization (WHO) and Naranjo algorithm] of CADR among patients attending the dermatology department.
Materials and
Methods: This is a cross-sectional hospital-based study in which all patients with suspected CADR attending the dermatology department of a tertiary care center over a 9-month period were evaluated using the causality assessment criteria recommended by the WHO-Uppsala Monitoring Centre (UMC) and Naranjo scale. The severity of the reaction was assessed using Adverse Drug Reaction Severity Assessment Scale (modified Hartwig and Siegel scale). Results: A total of 200 consecutive patients with CADR were evaluated. The causality assessment for a drug as per WHO scale yielded 63 (31.5%) cases as certain, 12 (6%) as probable, and 125 (62.5%) as possible, whereas Naranjo scale showed 26 (13%) cases to be definite, 138 (69%) as probable, and 36 (18%) as possible. There was poor agreement between the two scales. Fixed drug eruption was the most common pattern of CADR (82.41%). The average number of drugs received by patients was 2.09. The most common suspected drug group was antimicrobials (
n
= 170; 40.5%), followed by nonsteroidal anti-inflammatory drugs (
n
= 148; 35.3%) and antiretroviral drugs (
n
= 41; 9.7%). Fixed drug eruption was most commonly caused by paracetamol. Antiepileptics and antimicrobials were the most common suspects among severe cutaneous adverse reactions.
Limitations:
Multiple concomitant drug usage by patients and inability to provoke all patients/measure drug levels in blood resulted in higher number of drugs with causal association as probable/possible.
Conclusion:
WHO-UMC scale was found to be easier to apply and evaluate, with greater practical utility. Poor agreement between the two commonly used scales emphasizes the need for a consistent and uniform causality assessment tool.
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CONCISE COMMUNICATIONS
Diffuse hair loss in females
Soumya Agarwal, Vibhu Mendiratta, Pravesh Yadav, Ram Chander
January-February 2019, 10(1):73-74
DOI
:10.4103/idoj.IDOJ_129_18
PMID
:30775306
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ORIGINAL ARTICLES
A 10-year retrospective descriptive study on pure neuritic leprosy from a tertiary referral centre
Jouhar Jabeen Kolleri, Sarita Sasidharanpillai, Bindu Vadakkayil, Anuradha Thalian Chathoth
January-February 2019, 10(1):13-18
DOI
:10.4103/idoj.IDOJ_118_18
PMID
:30788282
Context:
Pure neuritic leprosy is a risk factor for grade 2 disability owing to the early nerve damage. Aims: To study the clinical patterns of neuritic leprosy, to determine the percentage of patients manifesting grade 2 disability at the time of diagnosis and to identify any risk factors for the same.
Settings and Design:
Retrospective descriptive study from previous case records of pure neuritic leprosy patients who attended a tertiary centre from 1
st
July 2007 to 30
th
June 2017.
Subjects and Methods:
Data on patients who satisfied the World Health Organization (WHO) cardinal criteria for diagnosis of leprosy, who had no skin lesion of leprosy and had acid-fast bacilli negative status on skin smears were collected using a pre-set proforma.
Statistical Analysis Used:
The Chi-square test was used to assess statistical significance and logistic regression model was applied to avoid the effects of confounding factors. Results: A diagnostic delay of >1 year was observed in 44% patients. At the time of diagnosis, grade 2 disability was documented in 60 (80%) of patients. No statistically significant risk factor was identified for grade 2 disability.
Limitations:
Retrospective nature and the study conducted in a tertiary care centre not reflecting the status in the community were the limitations.
Conclusions:
Grade 2 disability noted in 80% of patients points to the inherent nature of disease to cause early nerve damage. Diagnostic delay of >1 year documented in 44% of patients underscores the diagnostic challenges in the absence of skin lesions.
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THROUGH THE DERMOSCOPE
Dermoscopy of morphea
Yasmeen Jabeen Bhat, Saniya Akhtar, Iffat Hassan
January-February 2019, 10(1):92-93
DOI
:10.4103/idoj.IDOJ_350_17
PMID
:30775314
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THROUGH THE LENS
Angina bullosa hemorrhagica
Bhagyashree B Supekar, Gitesh Sawatkar, Vaishali H Wankhade
January-February 2019, 10(1):89-89
DOI
:10.4103/idoj.IDOJ_108_18
PMID
:30775312
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1,319
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SKINDIA QUIZ
SkinIndia Quiz 49: Pigmented nodular growth of the nose
Manas Bajpai, Nilesh Pardhe
January-February 2019, 10(1):79-81
DOI
:10.4103/2229-5178.245059
PMID
:30775309
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1,316
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CASE REPORTS
Paraneoplastic eosinophilic dermatosis in a case of chronic lymphocytic leukemia
Chetan D Rajput, Balkrishna P Nikam, Shailesh S Malani
January-February 2019, 10(1):61-63
DOI
:10.4103/idoj.IDOJ_121_18
PMID
:30775302
Eosinophilic dermatosis of hematologic malignancy is a rare paraneoplastic manifestation particularly associated with chronic lymphocytic leukemia (CLL).Clinically, it presents as a peculiar polymorphic pruritic eruption with characteristic histological findings of superficial and deep dense perivascular infiltrate of lymphocytes and eosinophils without any vasculitis. Although it has been reported intermittently with different names, there is paucity of reports of this condition in Indian literature. Here, we report a patient of CLL having insect bite-like eruptions nonresponsive to conventional therapy and confirmed as eosinophilic dermatosis on histology. Patient was having eruptions well before the diagnosis of malignancy, and intensity as well as frequency increased as the disease progressed. Good control over the disease was achieved using chemotherapy and steroids. Thus, this case explains diagnostic and prognostic significance of eosinophilic dermatosis in CLL.
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A case of rhupus-reporting of a rare entity
Preema Sinha, Anuj Singhal, Saikat Bhattacharjee, Bhavni Oberoi
January-February 2019, 10(1):58-60
DOI
:10.4103/idoj.IDOJ_55_18
PMID
:30775301
Rhupus syndrome, a rare entity, is the co-existence of systemic lupus erythematosus (SLE) with rheumatoid arthritis (RA). It manifests as more RA and less SLE related damages. The duration of the disease is longer than typical RA or SLE. Controversies exist regarding the definition of Rhupus. The incidence of Rhupus in patients with arthritis is 0.01%–0.2% and <2% in patients with connective tissue diseases. However, we report a rare case of rhupus in a 55-year-old lady with polyarthritis and joint deformities of 6 year duration, presenting with features of lupus erythematosus.
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1,056
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THROUGH THE DERMOSCOPE
Dermoscopy of pubic louse
Sidharth Sonthalia, Sangeeta Varma, Abhijeet K Jha
January-February 2019, 10(1):90-91
DOI
:10.4103/idoj.IDOJ_35_18
PMID
:30775313
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897
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CASE REPORTS
Monoclonal gammopathy of undetermined significance-associated scleromyxoedema
Kalgi D Baxi, Raju G Chaudhary, Santoshdev P Rathod, Ashish Jagati
January-February 2019, 10(1):54-57
DOI
:10.4103/idoj.IDOJ_138_18
PMID
:30775300
Scleromyxoedema is a rare generalized cutaneous mucinosis, which in absence of thyroid disease, occurs almost invariably in patients with monoclonal gammopathies. A 54-year-old female patient presented with complaint of tightening of skin on the extremities, abdomen, forehead, gradually progressive since 1 year, episodes of generalized tonic–clonic convulsions, and acute psychosis since 5 days. Cutaneous examination revealed nonpitting edema over the face and sclerodermoid changes over extremities. Laboratory investigations showed presence of M-band on serum-protein electrophoresis and monoclonal spike of IgG lambda component on immunofixation. Magnetic resonance imaging of the brain showed periventricular subcortical lacunar infarcts. Skin biopsy with mucin staining was suggestive of scleromyxoedema. All other investigations were normal. Bone marrow biopsy showed a mild focal increase in plasma cells. The cutaneous, serological, and electrophoretic findings as well as the clinical profile of the patient were consistent with the diagnosis of monoclonal gammopathy of undetermined significance associated with scleromyxoedema. This case is presented because of its rare occurrence.
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CONCISE COMMUNICATIONS
How atopic is prurigo in the tropics?: An etiological survey in South India
M Saranya, M Saritha, K Karthikeyan, T Mangaiyarkarasi
January-February 2019, 10(1):69-71
DOI
:10.4103/idoj.IDOJ_82_18
PMID
:30775304
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CASE REPORTS
Plasma cell myeloma masquerading as scleromyxedema
Varun Victor, Rashmi Maria Margareat
January-February 2019, 10(1):50-53
DOI
:10.4103/idoj.IDOJ_135_18
PMID
:30775299
Scleromyxedema is a rare progressive cutaneous mucinosis of unknown etiology with equal prevalence in both men and women. It is usually associated with monoclonal gammopathy in most of the cases. Various treatment modalities have been tried for scleromyxedema including steroids, intravenous immunoglobulin (IVIg), autologous hematopoietic stem cell transplantation, and melphalan, but none has proved to be fully effective. This paper reports a case of scelromyxedema in a patient who was found to have multiple myeloma on further evaluation. The patient was treated with six cycles of bortezomib, thalidomide, and dexamethasone, following which he had complete resolution of his skin lesions. While recent case reports have mentioned treatment of patients of scleromyxedema with varying combinations of IVIg, thalidomide, bortezomib, and dexamethasone, we describe a patient who has been successfully treated with a combination of bortezomib, thalidomide, and dexamethasone with complete resolution of all skin lesions.
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CONCISE COMMUNICATIONS
Dermatitis artefacta in a child: An interesting morphological presentation
Swetalina Pradhan, Chandra S Sirka, Gaurav Dash, Debadatta Mohapatra
January-February 2019, 10(1):72-72
DOI
:10.4103/idoj.IDOJ_132_18
PMID
:30775305
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665
116
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LETTERS TO THE EDITOR
A rare concomitance of two blaschkoid pigmentary disorders: A juggle of pigmentary mosaicism
Manju Daroach, Seema Manjunath, Sendhil Muthu Kumaran
January-February 2019, 10(1):75-76
DOI
:10.4103/idoj.IDOJ_218_18
PMID
:30775307
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605
92
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THROUGH THE LENS
Primary systemic amyloidosis
Jaskaran Batra, Sukhjot Kaur Goraya, Sahil Goel
January-February 2019, 10(1):87-88
DOI
:10.4103/idoj.IDOJ_175_18
PMID
:30775311
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583
113
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THROUGH THE DERMOSCOPE
Dermatofibroma over the face
Sanjay Singh, Suman Patra, Neetu Bhari
January-February 2019, 10(1):94-95
DOI
:10.4103/idoj.IDOJ_308_17
PMID
:30775315
[FULL TEXT]
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538
87
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LETTERS TO THE EDITOR
Widespread superficial dermatophytosis in patient on secukinumab for treatment of chronic plaque psoriasis
Shekhar Neema, Sehdev Singh, Niloy Pathak, MA Khan
January-February 2019, 10(1):76-78
DOI
:10.4103/idoj.IDOJ_170_18
PMID
:30775308
[FULL TEXT]
[PDF]
[Mobile Full text]
[EPub]
[PubMed]
485
88
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Medknow
Online since 1
st
June, 2010