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2020| May-June | Volume 11 | Issue 3
Online since
May 10, 2020
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REVIEW ARTICLES
Biologics in dermatology: Off-label indications
Debdeep Mitra, Ajay Chopra, Neerja Saraswat, Barnali Mitra, Krishna Talukdar, Reetu Agarwal
May-June 2020, 11(3):319-327
DOI
:10.4103/idoj.IDOJ_407_18
Skin and subcutaneous diseases affect millions of people worldwide, causing significant morbidity. Biologics are becoming increasingly useful for the treatment of many skin diseases, particularly as alternatives for patients who have failed to tolerate or respond to conventional systemic therapies. Biological therapies provide a targeted approach to treatment through interaction with specific components of the underlying immune and inflammatory disease processes. Advances in the understanding of disease pathophysiology for inflammatory skin diseases and in drug development have ushered in biologic therapies in dermatology. Biologic therapies are molecules that target specific proteins implicated in immune-mediated disease. This review article highlights the increasing evidence base for biologics in dermatology for off-label use.
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2,522
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CASE REPORTS
Klippel–Trenaunay syndrome with arterio-veno-lymphatic malformation: A rare presentation
Bhagyashree B Supekar, Apoorva D Chopkar, Vaishali H Wankhade, Rajesh Pratap Singh, Dharitri Mukund Bhat, Parvathy Suresh
May-June 2020, 11(3):404-408
DOI
:10.4103/idoj.IDOJ_220_19
Klippel–Trenaunay syndrome (KTS) is a rare disorder characterized by triad of vascular malformations, varicose veins, and bony or soft tissue hypertrophy involving an extremity. Port wine stain is the most common vascular malformation associated with this syndrome. Various other rare vascular malformations described are angiokeratomas, angiokeratoma circumscriptum naeviformae, angiodermatitis, etc. This is the first instance, to the best of our knowledge, describing the capillary, venous, and lymphatic malformations in a same case of KTS.
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ORIGINAL ARTICLES
Peripheral arteriovenous malformations—A case series
Lydia Mathew, Renu George, Raja Sekhar Meeniga, Vinu Moses, Shyamkumar N Keshava
May-June 2020, 11(3):367-372
DOI
:10.4103/idoj.IDOJ_207_19
Context:
Arteriovenous malformations (AVMs) are aggressive vascular malformations that often result in significant morbidity. Patients may present to a dermatologist due to associated skin changes. Early diagnosis is important as treatment is available to halt their progression toward irreversible destruction of adjacent tissues.
Aims:
To study the clinical profile of peripheral AVMs presenting to the dermatologist and to provide a diagnostic algorithm.
Settings and Design:
A retrospective study of patients of all age groups with peripheral AVMs who presented to the Department of Dermatology at a tertiary care hospital in India was performed. Syndromic forms were also included.
Subjects and Methods:
We conducted a search of patients with peripheral AVMs, which were seen over a period of 51 months, i.e., from July 2014 to September 2018, from electronic medical records and reviewed their clinical details.
Statistical Analysis Used:
Descriptive statistics such as frequency, mean, and median were computed.
Results:
We report a series of 13 patients with peripheral AVMs, which constituted 6.7% (13/193) of all vascular malformations during this period. Of these, 8.3% (1/12) belonged to Schobinger's stage 1, 41.7% (5/12) to stage 2, 50% (6/12) to stage 3, and one with subcutaneous involvement devoid of cutaneous changes. The most common location was the extremities, which was seen in 53.8% (7/13). Syndromic association was present in 46.2% (6/13). Management included embolization, surgery, and medical treatment.
Conclusions:
The proportion of peripheral AVMs out of all vascular malformations was similar to reported studies. The extremities were more frequently involved as compared to the head and neck. The diagnostic algorithm provided will help us to optimize investigations and direct early management.
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GUEST EDITORIAL
Teledermatology in the wake of COVID -19 scenario: An Indian perspective
Karalikkattil T Ashique, Feroze Kaliyadan
May-June 2020, 11(3):301-306
DOI
:10.4103/idoj.IDOJ_260_20
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CASE REPORTS
Metastatic Crohn's disease of the vulva: A rare presentation
Jaskaran Batra, Sukhjot Kaur Goraya, Sandeep Grewal, Aminder Singh
May-June 2020, 11(3):416-418
DOI
:10.4103/idoj.IDOJ_352_19
Crohn's disease, a chronic inflammatory granulomatous disease of gastrointestinal tract, may rarely have extra intestinal manifestations. Vulvar Crohn's disease may be contiguous or noncontiguous with the gastrointestinal tract. It can cause significant symptoms and has a major impact on quality of life.
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Dowling–Degos disease with hidradenitis suppurativa and inflammatory arthritis in two generations
Anju George, Renu George, Ashish J Mathew, Ramesh B Telugu
May-June 2020, 11(3):413-415
DOI
:10.4103/idoj.IDOJ_337_19
Dowling–Degos disease (DDD) is a rare autosomal dominant genodermatosis characterized by reticulate brown-to-black pigmentation of the flexures, pitted perioral acneiform scars, and comedo-like follicular papules on the flexures. The diagnosis is based on characteristic clinical and histopathological features. DDD has been found to occur in association with hidradenitis suppurativa (HS), arthritis, epidermoid cysts, keratoacanthomas, and squamous cell carcinoma. To date, there is only one report of DDD associated with HS and polyarticular arthritis.
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CONCISE COMMUNICATIONS
Chemical leucoderma of oral and labial mucosal surfaces from neem [
Azadirachta indica
]. A case series
Prashant B Jadhav
May-June 2020, 11(3):433-435
DOI
:10.4103/idoj.IDOJ_226_19
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CASE REPORTS
Secondary syphilis with polymorphous and sweet syndrome like lesions: A rare case report
Chandra S Sirka, Arpita N Rout, Kananbala Sahu
May-June 2020, 11(3):409-412
DOI
:10.4103/idoj.IDOJ_237_19
Secondary syphilis can present with wide range of mucocutaneous lesions. Because of its varied morphology, it is considered a great mimicker. However, syphilitic lesions presenting as Sweet syndrome is uncommon. We report a case of a 28 year adult male presenting with erythematous edematous papules and plaques with pseudovesicular appearance, lichenoid annular plaques on skin, and painless indurated ulcer over the glans. The Venereal Disease Research Laboratory test was reactive (1:32 dilutions), and treponema pallidum hemagglutination test was positive. The histopathology from erythematous edematous lesion and genital ulcer revealed neutrophilic abscess and characteristic plasmacytic picture in biopsy, respectively. He was treated successfully with single dose intramuscular injection of benzathin penicillin 2.4 million units. This case is reported for its rarity.
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DERMATOLOGY PEARLS
A simple and succinct simulation of Nikolsky phenomenon and sign
Keshavmurthy A Adya, Arun C Inamadar, Aparna Palit
May-June 2020, 11(3):465-465
DOI
:10.4103/idoj.IDOJ_247_19
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ORIGINAL ARTICLES
Psychosocial and financial impact of disease among patients of dermatophytosis, a questionnaire-based observational study
Nayankumar H Patel, Jignaben K Padhiyar, Ani P Patel, Aseem S Chhebber, Bhagirath R Patel, Tejas D Patel
May-June 2020, 11(3):373-377
DOI
:10.4103/idoj.IDOJ_331_19
Introduction:
In the present epidemic of chronic, recalcitrant, and widespread dermatophytosis, impact of disease on quality of life (QoL) can be severe. Similarly, financial impact due to treatment cost and loss of wages needs consideration too.
Aims and Objectives:
Our primary aim was to evaluate the impact of dermatophytosis on QoL and the financial burden on individual and family.
Materials and Methods:
Adult patients having dermatophytosis were included in the study. Standard Dermatology Life Quality Index (DLQI) questionnaire was used to evaluate the psychosocial impact, and financial burden was evaluated by nine binary questions.
Results:
A total of completed 299 DLQI surveys and 275 financial burden surveys were taken for final analysis. Mean DLQI was 12.25 (SD = 5.56,
n
= 299). Significant association between total body surface area (BSA) and DLQI score was observed (
r
s
= 0.251
,
P
<0.001,
n
= 299). Presence of tinea corporis was found to be significantly affecting the choice of clothing (
P
= 0.018, χ
2
= 5.127, CI 95%). More numbers of male respondents reported loss of work or study hours due to their illness (
P
= 0.015, χ
2
= 5.196, CI 95%), which was significantly associated with the BSA involved (
P
< 0.05,
t
= 5.529, CI 95%). Some difficulties in sexual activity were reported by 35.6% patients, which has significant association with tinea cruris (
P
= 0.001, χ
2
= 10.810, CI 95%). Median household income was 10,000 INR and interquartile range (IQR) being 8,000–19,000. Mean financial burden calculated at 3.458 (SD = 1.696,
n
= 275), whereas mean financial worry reported by patient stood at 3.661 (SD = 1.216,
n
= 275). Financial burden showed significant correlation with “previous treatment approximate cost,” financial worry, and DLQI (
P
< 0.05, CI 95%). Financial worry (
P
= 0.016,
r
s
= 0.145, CI 95%) and financial burden (
P
= 0.002,
r
s
-
= 0.145
,
CI 95%) both showed positive correlation with duration of disease.
Conclusion:
In present scenario of Dermatophytosis in India, the disease and its treatment causing impact on QOL as well as on personal financial burden and worry need consideration.
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CONCISE COMMUNICATIONS
Camisa disease: A rare case report
Arpita N Rout, Kananbala Sahu, Chandra S Sirka
May-June 2020, 11(3):438-439
DOI
:10.4103/idoj.IDOJ_236_19
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Odontogenic cutaneous sinus tracts: A clinician's dilemma
Muthu Sendhil Kumaran, Tarun Narang, Sunil Dogra, Sudhir Bhandari
May-June 2020, 11(3):440-443
DOI
:10.4103/idoj.IDOJ_261_19
Background:
Odontogenic cutaneous sinus tract (OCST) is one of the rare manifestations of chronic dental infections. Although well reported in literature, it is often misdiagnosed or under diagnosed. Apart from isolated case reports especially in dental literature there is a paucity of comprehensive case series on OCST.
Aims and Objectives:
We undertook this study to observe the prevalence, clinico epidemiological features and management issues in these patients from a dermatological perspective.
Methods:
A retrospective study was undertaken analyzing the clinical records of patients registered at our outpatient department (OPD) from 2011 to 2018. Cases with a clinical and radiological diagnosis of odontogenic cutaneous sinus were included in the study. We studied the following variables: frequency, gender, age, localization, morphology, mean time of evolution and treatment response.
Results
: 21 patients with OCST were identified from our records. Females outnumbered males; patients in the age group between 31-40 years were more commonly affected. Three morphological presentations were noted in the form of flesh-colored dry nodules with sinus, adherent plaques with mucopurulent discharge and ulcer. Posterior set of teeth were commonly affected and mandible was the commonest site for location of sinus. The time taken for appropriate diagnosis in these cases ranged from 7-16 months. Almost all the patients responded to endodontal or root canal treatment and there were no recurrences.
Conclusion:
A CST of dental origin is often a diagnostic challenge, especially in cases with minimal or no dental symptoms. A thorough skin and dental examination is required for sinuses on the head and neck area with a high index of suspicion for OCST. Most cases respond to conservative, root canal therapy. An early diagnosis can save the patient from unnecessary and ineffective therapies and sometimes surgeries.
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SKINDIA QUIZ
Multiple facial nodules in an elderly woman
Mónica Garcia-Arpa, Lucía González-Ruiz, Fernanda Relea-Calatayud, María Rogel-Vence
May-June 2020, 11(3):466-468
DOI
:10.4103/idoj.IDOJ_439_18
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Translucent growth over hairline
Chandra S Sirka, Kananbala Sahu, Arpita N Rout
May-June 2020, 11(3):469-470
DOI
:10.4103/idoj.IDOJ_464_18
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COVID-19 IADVL ACADEMY SIGS SYMPOSIUM - PRACTICE RECOMMENDATIONS
Dermatosurgery practice and implications of COVID-19 pandemic: Recommendations by IADVL SIG Dermatosurgery (IADVL Academy)
Anup K Lahiry, Chander Grover, Syed Mubashir, Karalikkattil T Ashique, C Madura, Nilesh Goyal, Ankur Talwar, Sanjeev Gupta, Anirudh D Gulanikar, Sidhartha Das
May-June 2020, 11(3):333-336
DOI
:10.4103/idoj.IDOJ_237_20
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CONCISE COMMUNICATIONS
Unilateral limb atrophy: Is it a forme fruste localized scleroderma?
Dharmagat Bhattarai, Pandiarajan Vignesh, Sandesh Guleria, Anindita Sinha, Manphool Singhal
May-June 2020, 11(3):451-452
DOI
:10.4103/idoj.IDOJ_349_19
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COVID-19 IADVL ACADEMY SIGS SYMPOSIUM - PRACTICE RECOMMENDATIONS
Lasers use in dermatology practice in the evolving COVID-19 scenario: Recommendations by SIG lasers (IADVL academy)
Sachin Dhawan, Pradeep Kumari, Abhishek De, Anuj Pall, David Pudukadan, Ekta Romi, K Jyothy, MD Selvam, Sahil Mrigpuri, Swapnil Shah, Salim Thurakkal, Sunil Trivedi
May-June 2020, 11(3):337-342
DOI
:10.4103/idoj.IDOJ_239_20
The COVID-19 pandemic has taken the entire world by storm. Almost all dermatology laser procedures are considered non-essential and there is a consensus that they should be deferred till the threat of the COVID-19 is well and truly over. The article presents recommendations for the use of lasers and energy based devices in a safe manner during and in the immediate aftermath of COVID-19 pandemic. Plume generating procedures need full personal protective equipment to be used. Special precautions are required for specific laser and energy based procedures. A robust disinfection strategy based on preventing fomite borne COVID-19 transmission in the laser operating room is essential.
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REVIEW ARTICLES
Update on pharmacotherapy in psychodermatological disorders
Shrutakirthi D Shenoi, Savitha Soman, Ravindra Munoli, Smitha Prabhu
May-June 2020, 11(3):307-318
DOI
:10.4103/idoj.IDOJ_330_19
Psychodermatological (PD) conditions encountered in dermatologic practice include primary psychiatric conditions such as delusions of parasitosis or secondary psychiatric conditions such as anxiety and depression due to dermatologic disease. The psychotropics include antipsychotic agents, anti-anxiety agents, antidepressants, and miscellaneous drugs such as anti convulsants. Anti psychotics are further divided into first-generation and second-generation drugs. Currently, second-generation drugs e.g., risperidone are preferred over first-generation drugs e.g., pimozide in delusional infestation owing to the side effect profile of the latter. Anti-anxiety agents include benzodiazepines used in acute anxiety and buspirone in chronic anxiety disorders. They are frequently prescribed along with antidepressants. Although dependence and necessity of tapering is a problem with benzodiazepines, delayed onset of action is a feature of buspirone. The commonly used antidepressants in dermatology include selective serotonin reuptake inhibitors (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline), selective serotonin norepinephrine reuptake inhibitors (venlafaxine, desvenlefaxine, and duloxetine), norepinephrine dopamine reuptake inhibitors (bupropion), tricyclic antidepressants (doxepin, amitriptyline, imipramine, and clomipramine), and tetracyclic antidepressants (mirtazapine). Miscellaneous drugs include anticonvulsants such as gabapentin and pregabalin, naltrexone, and N-acetyl cysteine. The principles of PD treatment are first establish the psychiatric diagnosis, followed by initiating drug treatment. The choice of drugs is dependent on multiple factors such as side-effect profile, drug interactions, and co-morbid conditions. Usually, drugs are started at a low dose and gradually increased. A literature search was done in Pubmed, Google Scholar, and Medline databases, and articles on treatment were analyzed.
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ORIGINAL ARTICLES
A randomized study to evaluate the efficacy fractional CO
2
laser, microneedling and platelet rich plasma in post-acne scarring
T Pooja, KV T. Gopal, T Narayana Rao, B Gayatri Devi, S Ashwin Kumar
May-June 2020, 11(3):349-354
DOI
:10.4103/idoj.IDOJ_370_19
Background:
Acne scarring commonly seen in young adults causes marked psychological distress. Commonly used procedural treatments for post-acne scarring have limited efficacy. This prospective, randomized study was undertaken to evaluate the efficacy and adverse effects offractional CO2 laser, microneedling, and platelet-rich plasma (PRP) in post-acne scarring.
Materials and Methods:
Sixty clinically diagnosed cases of post-acne scarring of both sexes were enrolled and divided into three groups of 20 patients each. The severity of scarring was graded as per the qualitative and quantitative grading system proposed by Goodman and Baron. Group A, B, and C patients were treated with fractional CO2 laser, microneedling, and PRP,respectively, at monthly intervals for foursessions. Improve men tin quantitative and qualitative grades of scars and adverse effects were noted at each session and 1 month after the final sitting. Statistical analysis was done using Student 't' test for quantitative values and Chi square test for qualitative values.
Results:
At the end of foursessions, based on mean percentage of improvement in quantitative grade, the efficacy of fractional CO2 laser is significantly greater than that of PRP (
P
= 0.00), while CO2 laser and microneedling did not show significant difference (
P
= 0.106). Based on qualitative scores, fractional CO2 laser group showed statistically higher therapeutic efficacy compared to microneedling and PRP (
P
= 0.00).No significant adverse effects were encountered in any groups.
Conclusion:
Fractional CO
2
laser resurfacing is more efficacious than microneedling and PRP. Unsatisfactory results were obtained with PRP as monotherapy in post-acne scarring.
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COVID-19 IADVL ACADEMY SIGS SYMPOSIUM - PRACTICE RECOMMENDATIONS
Management of leprosy in the context of COVID-19 pandemic: Recommendations by SIG leprosy (IADVL academy)
Santoshdev Rathod, Sujai Suneetha, Tarun Narang, Abhishek Bhardwaj, Sunil K Gupta, Sushruth G Kamoji, PK Ashwini, Swetalina Pradhan, Shagufta P Rather, Satyadarshi Patnaik, Vikas Shankar, Sridhar Jandhyala, P Narasimha Rao, Sunil Dogra
May-June 2020, 11(3):345-348
DOI
:10.4103/idoj.IDOJ_234_20
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Dermoscopy practice during COVID-19 pandemic: Recommendations by SIG Dermoscopy (IADVL academy)
Deepak Jakhar, Yasmeen J Bhat, Manas Chatterjee, Vinay Keshavmurthy, Balachandra S Ankad, Abhijeet K Jha, Puravoor Jayasree, Sushrut Save, Samipa S Mukherjee, Hita Mehta, Satish Udare, Savitha Beergouder
May-June 2020, 11(3):343-344
DOI
:10.4103/idoj.IDOJ_231_20
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CONCISE COMMUNICATIONS
Nail care for healthcare workers during COVID-19 pandemic
Ishmeet Kaur, Deepak Jakhar, Archana Singal, Chander Grover
May-June 2020, 11(3):449-450
DOI
:10.4103/idoj.IDOJ_232_20
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MUSINGS, OPINIONS, TIPS AND EXPERIENCES
Total cumulative dose of methotrexate is not the same as continuous cumulative dose: A clinician's perspective
Binod K Khaitan, Savera Gupta
May-June 2020, 11(3):425-427
DOI
:10.4103/idoj.IDOJ_361_19
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ORIGINAL ARTICLES
A cross-sectional observational study of clinical spectrum and prevalence of fixed food eruption in a tertiary care hospital
Loknandini Sharma, Reetu Agarwal, Ajay Chopra, Barnali Mitra
May-June 2020, 11(3):361-366
DOI
:10.4103/idoj.IDOJ_340_19
Background:
Fixed food eruption (FFE) is a rare type of hypersensitivity reaction occurring after ingestion of some food items in the form of recurrent erythematous patches, bullae, vesicle, or pustule at the same site after ingestion of same or related food products. Various items listed responsible for causing FFE include tree nuts, groundnuts, legumes, lentils, eggs, fruits like kiwi, strawberry, tonic water, and tartrazine. Its more commonly reported in developed countries with no Indian studies as of yet. We studied the clinical spectrum and prevalence of FFE in a tertiary care hospital.
Objective:
To study the prevalence and pattern of FFE after eliminating all other possible causes including drug rash.
Materials and Methods:
A cross-section observational study of 27 consecutive patients suspected to have fixed food eruption after eliminating all possibilities of any drug reaction to the best of our knowledge. Informed consent was obtained from the patients, and ethical clearance was taken from the hospital ethical committee.
Results:
A total of 27 patients were studied out of which 18 (66.66%) were females and 9 (33.33%) were males. The prevalence of fixed food eruption was calculated to be 0.072%.Fixed food eruption was noted secondary to cashew nuts (14.8%), almonds (7.4%), walnut (7.4%), pistachio (3.7%), strawberry (3.7%), kiwi (3.7%), and cheese crisps (3.7%).
Conclusion:
This observational study highlights the varied patterns of fixed food eruptions as well as the burden of disease in population secondary to certain diets.
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CASE REPORTS
Lichen simplex chronicus on the scalp: Broom fibers on dermoscopy; gear wheel sign and hamburger sign on histopathology
Sandip Agrawal, Rachita Dhurat, Smita Ghate, Aseem Sharma, Ravina Surve, Sanober Daruwalla
May-June 2020, 11(3):401-403
DOI
:10.4103/idoj.IDOJ_350_19
Lichen simplex chronicus (LSC) is characterized by lichenification of the skin because of primary excessive scratching. Herein, we present two cases of scalp LSC with a patch showing localized hair loss and paroxysmal severely itching on that area. Dermoscopy examined the presence of broom hair fibers while histopathological examination revealed gear wheel sign, hair shafts split in two (the hamburger sign), and decrease in the size of the sebaceous glands.
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61
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CONCISE COMMUNICATIONS
Tuberculin skin test reaction and sarcoidosis – An unexpected sequela
Puravoor Jayasree, Karalikkattil T Ashique, Nandakumar Gopinathan Nair
May-June 2020, 11(3):431-432
DOI
:10.4103/idoj.IDOJ_276_19
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DRUG PROFILE
Hydroxychloroquine in dermatology and beyond: Recent update
Kabir Sardana, Surabhi Sinha, Soumya Sachdeva
May-June 2020, 11(3):453-464
DOI
:10.4103/idoj.IDOJ_280_20
Hydroxychloroquine is one of the most frequently used drugs in dermatology with a wide variety of uses due to its immunomodulatory, anti-inflammatory, photoprotective, and metabolic actions and low side effect profile. Demonstration of its antiviral action
in vitro
has led to renewed interest by physicians worldwide during the ongoing coronavirus disease of 2019 (COVID-19) pandemic. Like its immunomodulatory action, its antiviral activity is also due to its ability to alkalinize the intracytoplasmic milieu, leading to disordered viral entry/fusion and deranged viral protein synthesis. However, randomized controlled trials are the need of the hour to conclusively determine its clinical efficacy in such infections. A review of the multitude of mechanisms of action, updated screening and monitoring guidelines, drug interactions, side effects, and its use in special populations is described.
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THROUGH THE DERMATOSCOPE
Dermoscopy of pityriasis lichenoides chronica in an Indian girl
Sidharth Sonthalia, Sangeeta Varma, Uday Khopkar
May-June 2020, 11(3):477-478
DOI
:10.4103/idoj.IDOJ_455_18
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687
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Dermoscopy of urticaria pigmentosa
Payal Chauhan, Nancy Bhardway, Nadia Shirazi
May-June 2020, 11(3):475-476
DOI
:10.4103/idoj.IDOJ_438_18
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MUSINGS, OPINIONS, TIPS AND EXPERIENCES
Involvement of little discussed anatomical locations in superficial dermatophytosis sundry observations and musings
Shyam Verma, Resham Vasani, Sanjeev Gupta
May-June 2020, 11(3):419-424
DOI
:10.4103/idoj.IDOJ_612_19
A rather quick change in epidemiological shift from Trichophyton rubrum to Trichophyton mentagrophytes (ITS genotype VIII), several changes in clinical presentation of superficial dermatophytoses and the the response/ the lack of it, makes this current epidemic very interesting and novel. We present here some of the relatively less discussed variants that have been described under the broad terms of tinea corporis and tinea faceie. Many of them are found to occur uncharacteristically frequently and some in areas that were never described. We describe some representative cases of female genital dermatophytoses, periumblical and periocular dermatophytosis and discuss some unusual variants like those showing sole involvement of the ear (tinea auricularis), lip (tinea labialis) and superficial dermatophytosis of the scalp skin.
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ORIGINAL ARTICLES
Profile of defaulters and pattern of treatment default among leprosy patients at a tertiary care hospital: A 10-year analysis
Sabha Mushtaq, Devraj Dogra, Nafis Faizi, Naina Dogra
May-June 2020, 11(3):355-360
DOI
:10.4103/idoj.IDOJ_393_19
Background:
The focus of leprosy control programs worldwide today is the WHO multidrug therapy which adequately cures the disease. Incomplete treatment puts not only the patient but the entire community at risk which may further jeopardize the leprosy control program.
Objective:
To study the magnitude of treatment default among leprosy patients, its trend in the last 10 years, and association with clinicodemographic variables.
Materials and Methods:
This was a retrospective study conducted at the urban leprosy center (ULC) attached to the dermatology department of a tertiary care centre. Data were obtained from the standard leprosy cards maintained at ULC from 2005–14. The following data were collected from the preformatted cards: age, gender, residence, occupation, type of leprosy, treatment, time of default, and so on and analyzed to see the association of defaulter status with sociodemographic and disease-related variables.
Results:
In a total of 743 cases, the rate of treatment default was 39.3%. The default status was found to have decreased significantly over the years from 2005–14 (
P
= 0.03). Majority of the treatment defaulters were migrants (47.9%) as compared with natives (29.7%) (
P
< 0.001). Regardless of the residential status, treatment default was more in pure neuritic (58.5%) and tuberculoid type (40.7%) as compared with others (
P
< 0.001). Smear negative cases (40.0%) were more likely to default than smear-positive cases (31.4%) (
P
< 0.001). Rate of defaulting was more among patients in the district where ULC was located than in the districts away from ULC (
P
= 0.017).
Conclusion:
Though the study period witnessed an overall decreasing trend over the 10-year period, treatment default remains a major concern in leprosy. Adherence to treatment is central to the success of leprosy control programs and therefore the factors associated with defaulting from treatment need to be addressed.
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SKINDIA QUIZ
Subcutaneous fat necrosis of the newborn
Vibhu Mendiratta, Anuja Yadav, Mani Makhija
May-June 2020, 11(3):471-472
DOI
:10.4103/idoj.IDOJ_318_19
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BRIEF REPORTS
Nailfold capillaroscopy and retinal findings in patients with systemic sclerosis: Is there an association?
Deepak Jakhar, Chander Grover, Archana Singal, GK Das
May-June 2020, 11(3):382-386
DOI
:10.4103/idoj.IDOJ_264_19
Introduction:
Systemic sclerosis (SSc) is characterized by fibrosis and intimal proliferation of cutaneous and visceral small vessels. These architectural abnormalities can be visualized with nailfold capillaroscopy (NFC); the changes being quite characteristic. At the same time, morphological alterations in retinal vascular bed are expected but sparsely described.
Aim:
We aimed to characterize the frequency and type of retinal microvascular changes in patients with SSc and to analyze any association with NFC changes.
Patients and Methods:
With institutional ethical committee approval, we recruited 45 consecutive patients with SSc (diagnosed based on American College of Rheumatology and European League against Rheumatism [ACR/EULAR-2013] criteria). NFC was done for all of them with a Universal Serial Bus (USB) dermatoscope; additionally, fundoscopy, fundus photography, and optical coherence tomography (OCT) were analyzed. Disease characteristics in patients with and without retinal disease were compared.
Results:
Among the 45 SSc patients, 12 (26.67%) had limited cutaneous SSc (lSSc) while 33 (73.33%) had diffuse cutaneous disease (dSSc). Retinal microvascular changes seen as mild arteriolar alteration and arteriovenous crossing changes were recorded in 13 patients (28.89%); mostly in those with dSSc (12/13). The NFC architectural changes were more severe in patients with retinal disease, though the difference was not statistically significant.
Conclusion:
Patients with SSc can often have retinal microvascular abnormalities commensurate with the vascular changes characteristic of SSc. The severity of retinal changes correlates with changes in NFC. NFC, which is now an essential tool for the management of SSc, could be a surrogate marker for retinal involvement in these patients.
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CASE REPORTS
Eccrine porocarcinoma with squamous differentiation in a patient with oculocutaneous albinism
Biswajit Dey, Vandana Raphael, Caleb Harris
May-June 2020, 11(3):398-400
DOI
:10.4103/idoj.IDOJ_223_19
Eccrine porocarcinoma is a rare malignant skin appendage tumor of sweat gland origin. Eccrine porocarcinoma arising in a patient of oculocutaneous albinism is extremely rare and only two cases have been reported in English literature to the best of our knowledge. Out of the two cases of eccrine porocarcinoma in oculocutaneous albinism, one case had squamous differentiation. We report a case of eccrine porocarcinoma with squamous differentiation in a 39-year-old male, who presented with a nodular lesion on the upper left chest wall. He also had nodal and distant cutaneous metastasis.
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CONCISE COMMUNICATIONS
Response of acitretin in greither's disease: A rare case report
Bhagyashree B Supekar, Suyash Singh Tomar, Apoorva D Chopkar, Rajesh P Singh
May-June 2020, 11(3):428-430
DOI
:10.4103/idoj.IDOJ_311_19
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Dermoscopy-aided diagnosis of nose ring-associated pyogenic granuloma
Puravoor Jayasree, Feroze Kaliyadan, Haritha M Raja
May-June 2020, 11(3):436-437
DOI
:10.4103/idoj.IDOJ_155_19
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SKINDIA QUIZ
Cutaneous squamous cell carcinoma in background of chronic arsenicosis
Sweta Subhadarshani, Soniya Mahajan
May-June 2020, 11(3):473-474
DOI
:10.4103/idoj.IDOJ_366_19
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BRIEF REPORTS
Etiopathological and clinical study of acute generalized exanthematous pustulosis: Experience from a tertiary care hospital in North India
Yasmeen J Bhat, Saniya Akhtar, Muzaffar Ahmad, Iffat Hassan, Rohi Wani
May-June 2020, 11(3):391-397
DOI
:10.4103/idoj.IDOJ_232_19
Background:
Acute generalized exanthematous pustulosis (AGEP) is a type of severe cutaneous adverse reaction that is characterized by the rapid development of nonfollicular, sterile pustules on an erythematous base.
Objectives:
The aim of our study was to enroll all cases of AGEP reporting to our department over a period of one year and to find out the clinical and etiological profile of the patients.
Materials and Methods:
All the patients reporting to our department with clinical features suggestive of AGEP were enrolled for the study. Careful history and examination were done to rule out other causes of pustular eruptions, which can resemble AGEP. AGEP validation score of the EuroSCAR study group was used to establish the diagnosis.
Results:
A total of 16 patients were enrolled during the study period of one year. The majority of the patients were females with a mean age of 28.41 ± 12.2 years. Twelve (75%) of the patients had a history of drug intake while 4 (25%) had developed AGEP following an insect bite. Penicillins were the causative factor in five patients followed by cephalosporins in three patients, nonsteroidal anti-inflammatory drugs (NSAIDs) in 2 patients, and terbinafine in 1 patient. Tetanus toxoid was responsible for the development of AGEP in one patient. The insect bites were all spider bites.
Conclusion:
AGEP is a rare type of severe cutaneous adverse drug reaction.We encountered 16 patients of AGEP over a period of one year. An important cause of AGEP was spider bite in our study group.
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Use of transient elastography in detection of liver fibrosis in psoriasis patients – A cross- sectional study
Shekhar Neema, D Banerjee, S Radhakrishnan, Biju Vasudevan, Preema Sinha, Bhavni Oberoi
May-June 2020, 11(3):387-390
DOI
:10.4103/idoj.IDOJ_312_19
Background and Aims:
The risk of liver damage in psoriasis increases with increase in cumulative dose of methotrexate and guidelines suggest use of liver biopsy for risk mitigation. Recently, transient elastography (TE) has been used for detection of liver fibrosis. Most studies for TE are in hepatitis B and C patients. However, psoriasis patients have risk factors like metabolic syndrome which predisposes them to increased risk of liver damage due to methotrexate. This underlying liver disease may change the TE values in patients with psoriasis. The aim of this study is to determine utility of transient elastography in detection of liver fibrosis in patients with psoriasis.
Methods:
82 patients with chronic plaque psoriasis requiring systemic therapy or already on methotrexate were included in the study. Clinical examinationand biochemical investigations were conducted. Data were analysed using STATA 12.1 (Texas, USA). Univariate analysis using Chi-square and independent't-test' was carried out to evaluate the association between categorical variables and outcomes.
Results:
Patients consists of 62 males and 20 females. TE value >7 kPa (kilopascal) were seen in 23 patients and <7 kPa were seen in 59 patients. Value of >7 kPa was significantly associated with age, waist circumference, diastolic blood pressure, fasting and post prandial blood sugar, AST, PASI and presence of metabolic syndrome. Cumulative methotrexate dose was not significantly associated with high TE value. Mean TE value in patients with metabolic syndrome was significantly higher.
Limitations:
Small sample size and inability to confirm TE findings on liver biopsy.
Conclusion:
TE is a non-invasive tool for detection of liver fibrosis. Value of >7 kPa correlates with liver fibrosis in most chronic liver diseases. However, high prevalence of metabolic syndrome in psoriasis patientsmayconfound utility of TE for monitoring of methotrexate toxicity.
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CONCISE COMMUNICATIONS
Pigtail hair in acute telogen effluvium – Lest we forget!
Rachita S Dhurat, Sandip Agrawal, Aseem Sharma, Smita Ghate
May-June 2020, 11(3):444-445
DOI
:10.4103/idoj.IDOJ_399_19
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BRIEF REPORTS
Correlation of cutaneous manifestations with body mass index, blood glucose, and hormonal levels in patients with polycystic ovarian disease
Yugal K Sharma, Shivanti Chauhan, Pallavi Singh, Kirti Deo
May-June 2020, 11(3):378-381
DOI
:10.4103/idoj.IDOJ_193_18
Background:
Polycystic ovarian disease (PCOD) is characterized by oligo/anovulation, ultrasonographic evidence of polycystic ovaries and cutaneous features such as hirsutism, acne, acanthosis nigricans, androgentic alopecia, and signs of virilization.
Aim:
Correlation of dermatological manifestations with body mass index (BMI), blood glucose, and levels of free testosterone, dehydroepiandrosterone sulfate (DHEAS), follicle stimulating hormone (FSH), and luteinizing hormone (LH) in patients of PCOD hailing from Pimpri, Pune.
Subjects and Methods:
This observational study was carried out from November 2015–April 2017 on 102 patients (aged 12–45 years, non-pregnant) of PCOD, attending dermatology/gynecology outpatient departments. After recording socio-demographic/menstrual and medical history, BMI was calculated and examination of cutaneous manifestations were done. Participants were then subjected to pelvic ultrasonography and blood sugar/hormonal estimation.
Statistical Analysis:
By using statistical package for the Social Sciences 17.0 software, Chi-square test, and Fisher's exact test.
Results:
Age: 59.80% belonged to the third decade (range,12–40; mean, 26.27 ± 5.05 years); ultrasonography revealed polycystic ovaries in 79.41%. Cutaneous manifestations recorded were – acne (74.50%); acanthosis nigricans (50%); striae (49.02%); hirsutism (40.19%); acrochordons (36.27%); seborrheic dermatitis (32.35%), and androgenetic alopecia (30.39%). Free testosterone (35;34.31%), DHEAS (9;8.82%), LH and FSH (2;1.96% each), and LH: FSH ratio (51;50%) were raised. Statistical association of acanthosis nigricans emerged with free testosterone
(P
= 0.034), DHEAS
(P
= 0.016), fasting blood sugar
(P
= 0.01), and raised BMI
(P
= 0.002) and of hirsutism with raised DHEAS
(P
= 0.016), free testosterone
(P
= 0.012), and BMI
(P
= 0.022).
Conclusion:
Significant correlations demonstrated were acanthosis nigricans with free testosterone, DHEAS, FBS, and BMI and hirsutism with DHEAS, free testosterone, and BMI.
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CONCISE COMMUNICATIONS
Vesiculobullous subacute cutaneous lupus erythematosus: A rare presentation
Mariana Esteves, Sofia Lopes, Paulo Santos, Filomena Azevedo
May-June 2020, 11(3):446-448
DOI
:10.4103/idoj.IDOJ_341_19
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EDITORIAL
Impact of COVID-19 pandemic on dermatologists and dermatology practice
Yasmeen Jabeen Bhat, Aaqib Aslam, Iffat Hassan, Sunil Dogra
May-June 2020, 11(3):328-332
DOI
:10.4103/idoj.IDOJ_180_20
The COVID-19 pandemic has directly or indirectly affected every human being on this planet. It's impact on the healthcare system has been devastating. The medical fraternity across the world, including India, is facing unprecedented challenges in striving to cope up with this catastrophic outbreak. Like all other specialties, dermatology practice has been profoundly affected by this pandemic. Measures have been taken by dermatologists to control the transmission of the virus, whereas providing health care to patients in the constrained environment. Preventive measures such as social distancing and hand hygienic practices along with patient education is being prioritized. Dermatological conferences and events scheduled across the globe in the first half of year 2020 have been either cancelled or postponed to discourage gatherings. Rationalization of resources and practice of teledermatology are being encouraged in current scenario. Non-urgent visits of the patients are being discouraged and elective dermatology procedures are being postponed. Many national and international dermatology societies have recently proposed recommendations and advisories on usage of biologicals and immunomodulators in present context of COVID-19 pandemic. Urticarial, erythematous, varicelliform, purpuric and livedoid rash as well as aggravation of preexisting dermatological diseases like rosacea, eczema, atopic dermatitis, and neurodermatitis rash have been reported in Covid-19 patients. Self medications and poor compliance of dermatology patients in addition to lack of proper treatment protocols and monitoring are a serious concern in the present scenario. Strategies for future course of action, including the dermatology specific guidelines need to be framed. This issue includes a special symposium on dermatology and COVID-19 having recommendations from special interest groups (SIGs) of Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) Academy on leprosy, dermatosurgery, lasers and dermoscopy.
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Online since 1
st
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