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   2015| March-April  | Volume 6 | Issue 2  
    Online since March 11, 2015

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Nail as a window of systemic diseases
Archana Singal, Rahul Arora
March-April 2015, 6(2):67-74
DOI:10.4103/2229-5178.153002  PMID:25821724
Certain nail changes are specific for various dermatological disorders. In addition, examination of nails may also provide an insight into more sinister systemic manifestations in the form of both subtle as well as specific changes. These findings may present as a defect of various anatomical components of the nail unit; nail matrix, nail plate and/or nail bed or vasculature. This article is an attempt to equip the dermatologists with a foresight to suspect and diagnose the unapparent systemic connotations that may be possible by a simple but detailed nail examination.
  21,984 1,928 4
Bier spots: An uncommon cause of mottled skin
Vikram K Mahajan, Gayatri Khatri, Ravinder Singh, Pushpinder S Chauhan, Karaninder S Mehta
March-April 2015, 6(2):128-129
DOI:10.4103/2229-5178.153020  PMID:25821739
  13,162 389 2
Retinoic acid and glycolic acid combination in the treatment of acne scars
BS Chandrashekar, KR Ashwini, Vani Vasanth, Shreya Navale
March-April 2015, 6(2):84-88
DOI:10.4103/2229-5178.153007  PMID:25821727
Introduction: Acne is a prevalent condition in society affecting nearly 80-90% of adolescents often resulting in secondary damage in the form of scarring. Retinoic acid (RA) is said to improve acne scars and reduce postinflammatory hyperpigmentation while glycolic acid (GA) is known for its keratolytic properties and its ability to reduce atrophic acne scars. There are studies exploring the combined effect of retinaldehyde and GA combination with positive results while the efficacy of retinoic acid and GA (RAGA) combination remains unexplored. Aim: The aim of this study remains to retrospectively assess the efficacy of RAGA combination on acne scars in patients previously treated for active acne. Materials and Methods: A retrospective assessment of 35 patients using topical RAGA combination on acne scars was done. The subjects were 17-34 years old and previously treated for active acne. Case records and photographs of each patient were assessed and the acne scars were graded as per Goodman and Baron's global scarring grading system (GSGS), before the start and after 12 weeks of RAGA treatment. The differences in the scar grades were noted to assess the improvement. Results: At the end of 12 weeks, significant improvement in acne scars was noticed in 91.4% of the patients. Conclusion: The RAGA combination shows efficacy in treating acne scars in the majority of patients, minimizing the need of procedural treatment for acne scars.
  10,072 673 1
A comparative study of 10% KOH solution and 5% imiquimod cream for the treatment of Molluscum contagiosum in the pediatric age group
Namitha Chathra, D Sukumar, Ramesh M Bhat, B Nanda Kishore, Jacintha Martis, Ganesh Kamath, MK Srinath, Rochelle Monteiro
March-April 2015, 6(2):75-80
DOI:10.4103/2229-5178.153005  PMID:25821725
Background: Although Molluscum contagiosum (MC) is a self-limiting condition, active therapy could prevent further spread and improve cosmesis. Most of the available treatment modalities traumatize the lesions and have to be undertaken in the hospital, therefore evoking panic in children. In the quest for an alternative therapy, this study comparing 10% potassium hydroxide (KOH) solution and 5% imiquimod cream was taken up. Aims and Objectives: To compare the efficacy and tolerability of 10% KOH and 5% imiquimod in the treatment of MC. Materials and Methods: This comparative study was conducted over a period of 18 months from October 2011 to March 2013, 40 patients between the age group of 1-18 years with clinically diagnosed MC were divided into two groups (lottery method), 20 patients were treated with 5% imiquimod cream (Group A) and the other 20 were treated with 10% KOH solution (Group B). Patients were followed up on the 4 th , 8 th and 12 th week of treatment. Results: At the end of 12 weeks, out of 20 patients who received 10% KOH, 17 patients showed complete disappearance, whereas out of 20 patients who received 5% imiquimod, only 10 patients showed total clearance of the lesions. Adverse events were more frequent with 10% KOH, pigmentary disturbances being the most common. Conclusion: With only minor adverse effects, 10% KOH is an inexpensive and efficient modality for the treatment of MC in the pediatric age group. Although 5% imiquimod was effective in clearing the lesions with minimal adverse effects, the longer duration required for its efficacy may deter its wider use.
  6,157 691 7
Porokeratotic eccrine ostial and dermal duct nevus
Debabrata Bandyopadhyay, Abanti Saha, Dipti Das, Anupam Das
March-April 2015, 6(2):117-119
DOI:10.4103/2229-5178.153016  PMID:25821735
Porokeratotic eccrine ostial and dermal duct nevus (PEODDN) is a rare nevoid condition characterized by asymptomatic grouped keratotic papules and plaques with a linear pattern on the extremities, having distinct porokeratotic histopathological features. The lesions usually present at birth or in childhood. We present here a case of late-onset PEODDN in a 23-year-old man who had lesions on the palm, forearm, arm and the chest along the lines of Blaschko, strictly localized to the left side of the body.
  4,429 359 1
Porokeratosis - Head to toe: An unusual presentation
Sapnashree Bhaskar, Ashok K Jaiswal, Niranjana Raj, Divya Reddy
March-April 2015, 6(2):101-104
DOI:10.4103/2229-5178.153012  PMID:25821731
Porokeratosis is a disorder of epidermal proliferation in which many different clinical variants can be distinguished. Herein we report a rare case of porokeratosis involving almost all parts of the body with simultaneous occurrence of various forms of the disease in the same individual (classical porokeratosis of Mibelli, disseminated superficial actinic porokeratosis, hypertrophic porokeratosis, and genital porokeratosis).
  3,736 329 -
Dermatitis neglecta-to be remembered, not neglected!
M Saritha, K Karthikeyan
March-April 2015, 6(2):138-139
DOI:10.4103/2229-5178.153024  PMID:25821744
  3,424 305 5
Tuberous sclerosis
Anisha George, Bimal Kanish, Anuradha Bhatia
March-April 2015, 6(2):142-143
DOI:10.4103/2229-5178.153026  PMID:25821746
  2,702 297 -
The nondermatophyte molds: Emerging as leading cause of onychomycosis in south-east Rajasthan
KR Raghavendra, Devendra Yadav, Akshay Kumar, Mukul Sharma, Jitendra Bhuria, Anita E Chand
March-April 2015, 6(2):92-97
DOI:10.4103/2229-5178.153010  PMID:25821729
Background: Onychomycosis is a fungal disease of the nail apparatus caused by both dermatophytic and nondermatophytic strains. Treatment involves long duration antifungal therapy. However, long treatment duration without identifying the causative species may lead to resistance. Confirmation of diagnosis and speciation by culture before administering antifungal therapy is ideal. Aims: To study the clinical and epidemiological aspects of onychomycosis in Hadoti region (south-east Rajasthan) and identify various mycological strains and predisposing factors causing onychomycosis. Materials and Methods: A prospective study of clinically diagnosed cases of onychomycosis attending the outpatient Department of Dermatology in our institute conducted from June 2012 to May 2013. The clippings were subjected to potassium hydroxide (KOH) examination and culture in the appropriate medium. Results: A total of 150 cases were enrolled in our study. There were 110 males (73.33%) and 40 females (26.66%) and male to female ratio was 2.75:1. The total dystrophic onychomycosis was the most common presentation seen in the majority of cases (46%) followed by distal lateral subungual onychomycosis in 52 cases (34.6%), mixed onychomycosis in 16 cases (10.66%), superficial white onychomycosis in 11 cases (7.33%), and proximal subungual onychomycosis in 2 cases. None had the endonyx variant. Direct microscopic examination of the nail clipping mounted with 40% KOH demonstrated fungal elements in 83 (55.33%) cases. Rate of isolation of organisms by culture was 64%. Nondermatophytes were isolated in 53 (35.33%), dermatophytes in 28 (18.66%), and yeasts in 15 (10%) of cases. The most commonly isolated species was Aspergillus in 45 (30%) cases. Aspergillus flavus was more commonly isolated compared to Aspergillus niger. Conclusion: The nondermatophyte molds appear to be more common causative agents of onychomycosis compared to usual dermatophyte species in south-east Rajasthan. Our study re-emphasizes the importance of culture for diagnosis of onychomycosis in every suspected case prior to therapy.
  2,597 358 7
Comparison of levels of serum copper, zinc, albumin, globulin and alkaline phosphatase in psoriatic patients and controls: A hospital based casecontrol study
Gousia Sheikh, Qazi Masood, Sabiya Majeed, Iffat Hassan
March-April 2015, 6(2):81-83
DOI:10.4103/2229-5178.153006  PMID:25821726
Background: Psoriasis is a chronic, immune-mediated skin disease with unknown etiology, with an epidermal turnover time of <10 days compared to a normal turnover time of 4-8 weeks. This epidermal hyperproliferation accounts for many of the metabolic abnormalities including alteration in the serum levels of proteins and some trace elements. Aim: The aim was to detect any statistically significant difference in the serum levels of zinc, copper, albumin, globulin and alkaline phosphatase between psoriasis patients and healthy controls. Materials and Methods: Hundred cases of psoriasis and 100 age and sex matched controls were enrolled in a hospital based case-control study. The serum levels of zinc, copper, albumin, globulin and alkaline phosphatase were calculated and compared among the cases and controls and evaluated statistically. Results: Serum zinc levels were significantly low in the psoriasis group as compared with controls (mean 80.028 μg/dl vs. 109.179 μg/dl, P < 0.0001). Serum copper levels were significantly raised among cases as compared with controls (mean 167.317 μg/dl vs. 133.884 μg/dl P < 0.0001). Serum albumin levels were significantly decreased (3.762 g/dl vs. 4.103 g/dl, P < 0.001), whereas serum globulin levels were raised (3.296 g/dl vs. 2.596 g/dl, P = 0.0014) among cases as compared with controls, respectively. Serum alkaline phosphatase levels were comparable between the two groups. Conclusion: The results of this study show significant alterations in the serum levels of copper, zinc, albumin, and globulin in psoriatic patients. This paper aims at highlighting the possible role of trace metals copper and zinc in the aetiopathogenesis of psoriasis and also provides a proposed interplay of factors involved in the pathogenesis of psoriasis.
  2,455 464 2
Association of anti-phospholipid antibodies with connective tissue diseases
Reena Rai, T Swetha
March-April 2015, 6(2):89-91
DOI:10.4103/2229-5178.153009  PMID:25821728
Background: The antiphospholipid antibodies (APLA) are directed against phospholipids and their binding proteins and are frequently found in association with connective tissue disorders. Systemic lupus erythematoses (SLE) with APLA may cause a diagnostic dilemma as there are several manifestations like haemolytic anemia, thrombocytopenia, neurologic manifestations, leg ulcerations, serositis proteinuria which overlap in both these conditions. We conducted a study to find out the association of antiphospholipid antibodies with connective tissue diseases and compared the clinical and laboratory parameters between antiphoshpolipid antibody positive and antiphoshpolipid antibody negative group. Materials and Methods: This study was carried out in 102 patients diagnosed with connective tissue diseases. APLA testing was done at baseline and for those positive, the test was repeated after 12 weeks. Results: 14.7 % of patients with connective tissue diseases tissue had positive antiphoshpolipid antibodies. Positive antiphoshpolipid antibody was detected in 73.3% of patients with SLE group, 13.3% of patients with mixed connective tissue disease (MCTD) and 13.3% of patients with systemic sclerosis. APLA positivity was seen in SLE patients with leg ulcers (87.2%), neurologic manifestation (72.7%), hemolytic anemia (62.3%), thrombocytopenia (72.7%), serositis (27.8%) and proteinuria(19.6%). Conclusions: Antiphoshpolipid antibodies should be tested in all patients with connective tissue disease.
  2,482 358 2
A case of dyschromatosis universalis hereditaria with adermatoglyphia: A rare association
Sumir Kumar, Pritish Bhoyar, Bharat Bhushan Mahajan
March-April 2015, 6(2):105-109
DOI:10.4103/2229-5178.153013  PMID:25821732
Dyschromatosis universalis hereditaria (DUH) is a rare, autosomal dominant genodermatosis with a peculiar reticulate pigmentary change, consisting of hyperpigmented macules mingled with hypopigmented lesions to give an overall impression of mottling. We herein report a case of DUH with adermatoglyphia in a young male with family history of the disorder.
  2,453 298 -
SkIndia Quiz 17: Linear dermatoses over the hand and foot
Varadraj V Pai, Pankaj Shukla, Rakhi Godhge, Prachi Bhandhare
March-April 2015, 6(2):134-135
DOI:10.4103/2229-5178.148972  PMID:25821742
  1,985 270 -
Nonfamilial acrokeratosis verruciformis of Hopf
Nidhi Patel, Nilofar Diwan, Pragya A Nair
March-April 2015, 6(2):110-112
DOI:10.4103/2229-5178.153014  PMID:25821733
Acrokeratosis verruciformis (AKV) of Hopf is an autosomal dominant genodermatosis with unknown etiology. It is characterized by multiple flat-topped keratotic papules resembling planar warts located mainly on the dorsum of hands and feet. Superficial ablation is the treatment of choice. A 41-year-old female presented with multiple hyperpigmented, hyperkeratotic papules and plaques over flexor aspect of both forearms, extensors of both legs and dorsum of the feet. Histopathology showed changes of AKV. Patient was treated with a combination of topical corticosteroids and cryotherapy with no visible improvement.
  1,989 265 -
A lady presenting with segmental anhidrosis and heat intolerance
Piyush Kumar, Anupam Das, Ashim K Mondal, Jayant Kumar, Saumya Swarup Chattopadhyay, Gautam Guha, Nilay K Das
March-April 2015, 6(2):126-127
DOI:10.4103/2229-5178.153019  PMID:25821738
  2,021 229 -
Fibromatosis over the dorsa of both feet: An unusual presentation
Y Hari Kishan Kumar, C Sujatha, Sushmitha Jayaprasad
March-April 2015, 6(2):98-100
DOI:10.4103/2229-5178.153011  PMID:25821730
Fibromatosis is benign fibrous tissue condition intermediate between benign fibroma and metastasizing fibrosarcoma. The lesion tends to infiltrate and recur when removed, but do not metastasize. The lesion may be single or multiple, and the likelihood of recurrence after surgical removal varies with location of the lesion and age. A 40-year-old female presented with multiple raised lesions over both feet since 4 years, they were multiple well-defined firm nodules coalescing to form lobulated plaques distributed in a symmetrical pattern over the dorsum of both feet. Histopathology of skin showed epidermis with hyperkeratosis, acanthosis, mild parakeratosis, and prominent granular layer. Superficial dermis was unremarkable and deep dermis showed thick bundles of irregular collagen and fibroblastic proliferation, suggestive of fibromatosis. This case is being reported for its unusual presentation of fibromatosis over the dorsum of both feet.
  1,682 228 -
Porokeratotic eccrine ostial and dermal duct nevus: A noteworthy presentation
Avijit Mondal, Piyush Kumar, Anupam Das, Panchami Debbarman, Rajesh Kumar Mandal
March-April 2015, 6(2):130-131
DOI:10.4103/2229-5178.153021  PMID:25821740
  1,503 224 -
Hypohidrotic ectodermal dysplasia
Vagish Kumar L Shanbhag
March-April 2015, 6(2):136-137
DOI:10.4103/2229-5178.153023  PMID:25821743
  1,470 245 1
Crusted scabies presenting as palmoplantar psoriasis in Down's syndrome
Rangaraj Murugaiyan, Kumara Sengottian, Kaliaperumal Karthikeyan
March-April 2015, 6(2):140-141
DOI:10.4103/2229-5178.153025  PMID:25821745
  1,440 239 3
Palpable purpura with foot drop: Common presentations in an uncommon disease
Teena Ramesh Mathanda, Ramesh Bhat, Jayaprakash Alva
March-April 2015, 6(2):113-116
DOI:10.4103/2229-5178.153015  PMID:25821734
Churg-Strauss syndrome is a rare disease manifested by hypereosinophilia, vasculitis and tissue infiltration. This report describes the case of a 45-year-old man who presented with a history of fever, difficulty in breathing, reddish lesions over the extremities and inability to walk since two weeks. The cutaneous features prompted us to conduct serial lab investigations which led to an early, potentially life saving diagnosis.
  1,406 234 -
Sporotrichoid lupus vulgaris: A rare presentation
Anshul Maheshwari, Siddhi Tiwari, Deepak K Mathur, Puneet Bhargava
March-April 2015, 6(2):120-121
DOI:10.4103/2229-5178.153017  PMID:25821736
Lupus vulgaris is the most common presentation of cutaneous tuberculosis in India and can present as papular, nodular, plaque, ulcerative, vegetating, and tumid forms. Unusual variants include the frambesiform, gangrenous, ulcerovegetating, lichen simplex chronicus, myxomatous, and sporotrichoid types. We describe a rare sporotrichoid presentation of lupus vulgaris on the leg of a 28-year-old female of 12 years duration.
  1,366 209 -
Porocarcinoma with perineural invasion
Ciara A Maguire, Viktoryia Kazlouskaya, Daniel Buchen, Patricia Heller, Dirk M Elston
March-April 2015, 6(2):122-125
DOI:10.4103/2229-5178.153018  PMID:25821737
Herein we present the case of a 58 year old woman with porocarcinoma of the left forehead with perineural invasion, diagnosed after recurrence of previously excised benign poroma. This case serves as a reminder of the potential of malignant degeneration within long-standing benign adnexal tumors as well as the spectrum of histological features that may be seen in porocarcinoma.
  1,198 204 3
Solitary painful ulcerated plaque on the sole
Shahid Hassan, Anupam Das, Piyush Kumar
March-April 2015, 6(2):131-133
DOI:10.4103/2229-5178.153022  PMID:25821741
  1,029 209 -
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