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   Table of Contents - Current issue
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January-June 2022
Volume 6 | Issue 1
Page Nos. 1-59

Online since Friday, February 25, 2022

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REVIEW ARTICLE  

Fluid and diet management in acute skin failure Highly accessed article p. 1
Neethu Mary George, Amruthavalli Potlapati, Ragunatha Shivanna
DOI:10.4103/cdr.cdr_1_21  
Acute skin failure (ASF) is due to dermatological conditions that cause total dysfunction of skin. Normal skin resists mechanical damage, protects body from external contaminants, regulates heat loss from the body, and retains body fluids and protein, all of which are lost in ASF. The treatment includes a multidisciplinary approach with aims to arrest the progression and heal the already formed lesions, wound care, fluid, electrolyte, and diet management. Along with medical management, it is extremely important to equally consider supportive therapy with correction of fluid and nutrient losses. Fluid and diet correction should neither be underdone, which can delay recovery, nor be overdone, which can lead to complications. The article covers the basis of fluid and nutritive loss and methods of correction in this dermatological emergency.
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ORIGINAL ARTICLES Top

A study of platelet-rich plasma in the management of chronic nonhealing ulcers p. 6
Angoori Gnaneshwar Rao, Kousar Fathima
DOI:10.4103/cdr.cdr_136_20  
Background: Chronic nonhealing ulcers run protracted course and require prolonged rest and complete avoidance of pressure, antibiotics, and antiseptic dressing, which at times may not yield satisfactory results. Local application of certain growth factors is known to promote healing in these cases. Objectives: To study the efficacy of autologous platelet-rich plasma in the management of chronic nonhealing ulcers. Materials and Methods: Z-statistics and Chi-square tests were used in the statistical analysis of this study. The study consisted of 30 patients of chronic nonhealing ulcers who presented to the dermatology department. Patients aged between 18 and 65 years of both sexes presenting with noninfective ulcer of duration of more than 6 weeks, treated or untreated and who have normal complete blood picture, were recruited. Diabetic patients with uncontrolled sugar levels were excluded. Ulcer examination was carried out as per clock-face method. Examination of peripheral pulses, nerves, and sensations was carried out. Routine hematological and biochemical investigations were done. Platelet-rich plasma was prepared from patient's blood, and 1.5–2 ml was injected at the healing margins using insulin syringe (26 G) after cleaning. Procedure was repeated once weekly for 6 weeks, and the ulcer healing was assessed. Results: Of the 30 cases, 21 (70%) were male and 9 (30%) were female, with a male-to-female ratio of 2.3:1. A maximum number of cases were in the fifth decade (33.3%). Trophic ulcers (TUs) due to leprosy contributed to 30 (88.23%), venous ulcers (VUs) 2 (5.88%), and diabetic ulcers 2 (5.88%). Improvement in area of TUs due to leprosy was 92.5%, in VUs 88.45%, and in diabetic ulcer 98.02% at the end of 6 weeks of platelet-rich plasma therapy. Conclusion: Platelet-rich plasma is an easily obtainable blood derivative and is a safe and potentially reasonable adjunct in the treatment of chronic nonhealing ulcers with advantage of no concern of immune reactions or cross-reactions or toxicity. It not only promotes healing but also prevents amputation necessitated by complications due to chronic ulcers.
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A study of sexually transmitted diseases and dermatological manifestations in human immunodeficiency virus-infected patients p. 10
Dinesh Reddy Gangavaram, Aneeha Ramesh Babu, Anupama Manohar Prasad
DOI:10.4103/cdr.cdr_133_20  
Background: The majority of human immunodeficiency virus (HIV)-infected patients develop skin lesions at some point during the course of the disease. The occurrence of sexually transmitted diseases (STDs) may increase the transmission and progression of HIV. Hence, it is essential to study the various infectious and noninfectious dermatoses. Objectives: (1) To study the various STDs and to familiarize with the atypical presentation of various STDs in HIV infected individuals. (2) To study clinical and epidemiological aspects of various dermatological manifestations in HIV infected individuals. (3) To identify dermatological manifestations as indicators (markers) of HIV/acquired immunodeficiency disease syndrome progression. Materials and Methods: A cross sectional descriptive study was conducted on known HIV-positive individuals attending the outpatient department of Dermatology in Siddhartha Medical College, Vijayawada, with symptoms suggestive of skin disease or sexually transmitted infections. A detailed clinical history and physical examination were done in all cases. Wherever necessary, relevant investigations were done to confirm the diagnosis in patients. Statistical analysis used: Results were tabulated and analyzed using simple statistical methods. Results: A total of 500 patients were recruited in the study among whom 363 (72.6%) had only dermatological manifestations, 127 (25.4%) had sexually transmitted infections (STIs) and 10 (2%) had overlap manifestations. The majority of them were in the age group of 28–37 years. The most common STI observed was herpes genitalis, followed by genital warts and genital molluscum contagiosum. Pruritic Papular Dermatoses were found to be the most common noninfectious dermatosis. Conclusions: There is a need to know the atypical manifestations of various dermatoses in HIV patients, as these conditions may pose a diagnostic dilemma to the treating dermatologist. This ensures correct diagnosis and the necessary treatment.
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Treatment approach for superficial dermatophytosis infections and factors contributing for noncompliance to antifungal therapy in India: An epidemiological survey p. 15
Arun Inamadar, Madhu Rengasamy, Sujeet Narayan Charugulla
DOI:10.4103/cdr.cdr_122_20  
Background: The prevalence of superficial dermatophytosis has ascended in India over the past 6–7 years. Chronic, recurrent, and steroid-modified tinea with nonresponse to the conventional treatment regimens are being commonly reported. This can be attributed to a complex interplay of factors related to environment, host, and virulence of the organism and a rampant use of topical corticosteroid, antifungal, antibacterial, and irrational combination creams. Host factors such as living conditions, immunity, poor adherence to general measures, and non-compliance to treatment may affect the spread of infection and clinical presentation. Objective: The objective of this study was to understand the prevailing treatment approach for superficial dermatophytosis in India and the host factors contributing to noncompliance to antifungal therapy. Materials and Methods: This was a cross-sectional qualitative knowledge, attitude, and practice study conducted with 220 dermatologists who participated in DERMACON national conference held at Kochi in 2018. Results: Of the 220 dermatologists, 87.3% stated that there was a rise of tinea fungal infection clinical cases in India. About, 42.3% reported that recalcitrant tinea infection attributed to 10%–30% of increase in the number of clinical cases per week. The treatment of choice for superficial dermatophytosis, as per majority of the surveyed dermatologists is a combination of oral azole and topical azole. For recalcitrant fungal infections, 37.3% of the dermatologists stated that at least 4 weeks of antifungal therapy would be the optimal duration for new tinea cases. Overall, 30%–50% of the patients were noncompliant to the prescribed treatment as per 35.5% of the dermatologists. Almost all (97.7%) dermatologists agreed that there is a need for treatment consensus on treating superficial fungal infection. Conclusion: Majority of the dermatologists agreed that there is an increase in the prevalence of superficial dermatophytosis in India. Appropriate use of oral (optimal dosage) and topical antifungals are considered vital for the successful management of this infection. Appropriate use of topical and systemic antifungal agents for the right duration along with proper counseling is considered vital for the successful management of this infection.
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Serum 25-hydroxy vitamin D: A possible role in acne vulgaris p. 22
Elshahat A Sharaf, Hamdy F Marzouk, Walaa M Abdelmageed, Mohammad A Gaballah
DOI:10.4103/cdr.cdr_3_21  
Background: Acne vulgaris (AV) is a chronic inflammatory disease of the pilosebaceous apparatus. Vitamin D controls the immune system and the proliferation and differentiation of sebocytes and keratinocytes. In addition, it has antioxidant and anti-comedogenic properties. In vitro studies showed that Vitamin D had a functional part in the acne development. Serum Vitamin D levels were previously estimated in AV patients with conflicting results. Objective: To compare 25-hydroxyvitamin D (25[OH] D) serum level in AV patients with healthy controls and to assess the association between 25(OH) D and disease severity to detect any possible role of Vitamin D in AV pathogenesis and treatment. Materials and Methods: 25 (OH) D levels were estimated in 80 AV patients and 40 age- and sex-matched controls using the enzyme-linked immunosorbemt assay technique. Results: 25(OH) D serum levels were significantly lower in patients as compared to controls. Although of no statistical significances, serum 25(OH) D levels were lower in severe and very severe cases than mild and moderate cases. There was significant negative correlation between serum 25(OH) D level and age of onset of AV. However, there were nonsignificant correlations between 25(OH) D blood levels and other patients' characters such as age, sex, occupation, duration of the disease, family history of AV, body mass index, and sites of the lesions. Conclusions: Vitamin D may have a role in the pathogenesis of in AV patients. Further studies on a larger number of patients are recommended to confirm the validity of our results and to evaluate the therapeutic role of Vitamin D supplementation or topical vitamin analogs in acne treatment.
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Comparative clinical assessment of updosing of bilastine and combination of levocetirizine and hydroxyzine in chronic spontaneous urticaria p. 28
Bela Shah, Deval Mistry, Neha Jangid, Shikha Shah, Shruti Kamat, Dhiraj Dhoot, Gaurav Deshmukh
DOI:10.4103/cdr.cdr_25_21  
Background: Second-generation antihistamines (SGAHs) are first-line drugs in management of chronic spontaneous urticaria (CSU). However, almost 50% of the patients do not respond to standard dose of SGAH. Various guidelines recommend either updosing of SGAH or combination of different antihistamines in such patients. However, the studies comparing these treatment regimens are limited. Materials and Methods: In this comparative study, CSU patients were randomized to receive standard dose of either bilastine or levocetirizine for 2 weeks. After 2 weeks of treatment, nonresponders received a double dose of bilastine while hydroxyzine 25 mg once daily was added in the levocetirizine group. Patients were primarily evaluated for improvement in CSU, quality of life (QOL), and somnolence. Results: At the end of 2 weeks, 23/39 and 17/36 achieved well-controlled urticaria, and at the end of 4 weeks, 9/16 and 5/19 patients achieved well-controlled urticaria in the bilastine and levocetirizine groups, respectively. Only one patient in the bilastine group was symptom free and none in levocetirizine at the end of 4 weeks. At week 2, there was no statistical difference in Urticaria Activity Score over 7 days (UAS7) improvement between both the groups, however, at week 4, there was a statistical difference (P < 0.05). Somnolence was significantly lower in the bilastine group (P < 0.05). Bilastine was statistically significant (P < 0.05) in the improvement of QOL by CU-Q2oL as compared to levocetirizine. No major adverse events were reported during study period, however, bilastine was associated with significantly lower Adverse events (AEs) compared to levocetirizine (P < 0.05). Conclusion: Updosing of bilastine improves CSU symptoms without compromising safety as compared to combination of levocetirizine and hydroxyzine.
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Correlation of Contact Sensitization to Common Allergens with Disease Severity in Discoid Eczema: An Analytical Observational Study p. 32
Aishwarya Raheja, Ajay Kumar, Avinash Jadhav, Mahendra Singh Deora, Dipti Mathias, Prachi Agrawal, Rahul Ranpariya
DOI:10.4103/cdr.cdr_7_21  
Background: Discoid eczema, defined by well-demarcated round or oval plaques, is a form of endogenous eczema in which the role of contact allergens is not clearly established. Objectives: This study aims to assess the role of contact allergens in discoid eczema by patch testing, determine clinical relevance and correlate patch test reactivity with the severity of disease and atopy. Materials and Methods: Sample characteristics including occupation, atopic diathesis and clinical details were recorded. Disease severity was assessed by the Eczema and Area Severity Index (EASI) and patch testing carried out with the Indian Standard Battery. Relevance of patch tests was determined by a history of exposure and patch testing with patients' own materials. Results: Fifty-one patients having a median age of 38 years were enrolled out of which 31 (60.8%) were male. Patch tests were reactive in 25 (49%) patients, common sensitizers being fragrance mix in 9 (31.0%), potassium dichromate in 4 (13.8%), paraphenylenediamine in 4 (13.8%), and nickel in 3 (10.3%) cases. Clinical relevance was established in 11 (37.9%) cases. In patch test reactive patients the mean EASI score was 3.4 as compared with 4.5 in nonreactors. Patch tests were positive in 3 (25%) atopic as compared with 22 (56.4%) nonatopic patients. Conclusion: Contact sensitization to common allergens may not contribute to disease severity in discoid eczema. Patch test reactivity is low in atopic as compared with nonatopic patients with discoid eczema.
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A clinico – epidemiological and bacteriological study of secondary pyoderma from a tertiary care hospital in South India p. 38
Deepthi Atmakuri, Arakali Lakshminarayana Shyam Prasad, DR Gayathri Devi
DOI:10.4103/cdr.cdr_10_21  
Background: Pyodermas, one of the most common clinical conditions encountered in dermatological practice in all age groups, are further classified into primary (including superficial and deep) and secondary. Bacterial infections occurring in preexisting dermatoses constitute secondary pyodermas and comprise infected eczemas/scabies/foot ulcers, surgical site infections and others. Objectives: This study was carried out to evaluate the clinical, epidemiological, and bacteriological features of secondary pyodermas in a tertiary hospital and document the various patterns of antibiotic resistance. Materials and Methods: This observational study was conducted on 101 consecutive cases of secondary pyodermas, both outpatients and inpatients, of a tertiary care hospital, over a period of 12 months. Clinicoepidemiological data was recorded, and pus samples were collected using sterile swabs for microbiological testing. Results: Diabetes mellitus was the most common comorbidity (n = 50). Of the total cases of secondary pyodermas, thirty (29.7%) were diabetic foot ulcers, and most lesions were of 2–5 cm size (n = 47), present for a duration of <1 week (n = 39), followed by 1–6 weeks (n = 35). Methicillin Susceptible Staphylococcus aureus (n = 38) among Gram-positive bacteria and Pseudomonas aeruginosa (n = 17) among Gram-negative bacteria were the most common organisms isolated. A high percentage of isolates exhibited antibiotic resistance, with Gram-positive bacteria showing resistance to Ciprofloxacin, Amoxycillin with Clavulanic acid, and Clindamycin but susceptibility to Linezolid, Cloxacillin, and Doxycycline. Among the Gram-negative isolates, there was antibiotic resistance toward most groups. Conclusion: As multi-drug resistance is an emerging concern, knowledge of associated comorbid conditions and documenting bacterial isolates and their sensitivity patterns becomes increasingly important.
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Dermatological manifestations among doctors using personal protective equipment in coronavirus disease 19 pandemic: a study based on self-reported questionnaire and telephonic consultation p. 42
Shreya Deoghare, Devayani Pol, Rohit Kothari, Ajay Kumar, Mahendra Singh Deora
DOI:10.4103/cdr.cdr_87_21  
Background: Coronavirus disease 19 (COVID-19) pandemic is a recent outbreak of a viral infection caused by severe acute respiratory syndrome coronavirus 2. Increase in the use of personal protective equipment (PPE) among doctors has resulted in increase in adverse effects such as contact dermatitis, urticaria, acne, and infections. Objectives: To identify the prevalence of common dermatosis developing in doctors using PPE. To compare if dermatosis is more common in doctors working in COVID-19 dedicated setup. To assess if the development of dermatosis use was related to the duration of PPE use. Materials and Methods: A cross-sectional type of observational study was conducted. A questionnaire was circulated on social media to the doctors. The response was collected in Microsoft Excel and analyzed. Results: Two hundred and sixty-nine (71.35%) doctors reported the development of dermatosis due to personal protective equipment (PPE) use. Eczema of the face (30%) and acne (26.25%) were the commonly reported dermatosis in our study. The development of dermatosis was significantly related to the duration of PPE use. Our study revealed a high prevalence of dermatosis among doctors using PPE, which was related to the duration of work. Conclusion: Hence, there is a need to make the doctors aware about such dermatosis, suggest prevention measures, provide them with effective dermatological treatment, and establish guidelines for prevention for occupational skin disorders at a national level.
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A study of vitamin D receptor gene polymorphisms and serum 25-hydroxyvitamin D levels in vitiligo patients and controls p. 47
Tonita M Noronha, Banavasi Shanmukha Girisha, Suchetha Kumari, Shilpa S Shetty, Muthtamil Sampath
DOI:10.4103/cdr.cdr_129_20  
Background: Vitiligo is a common pigmentary disorder affecting 0.1%–2% of the global population. Recently, interest has evoked in the role of Vitamin D in decreasing the risk of several chronic diseases. Little is known about the genetics of vitiligo. This study was conducted to investigate whether Vitamin D receptor (VDR) polymorphisms could be the susceptibility markers for vitiligo. Objectives: (i) To evaluate the potential association between VDR polymorphisms and vitiligo susceptibility and (ii) To estimate the serum levels of 25–hydroxyvitamin D in case and control groups. Materials and Methods: This study included 34 participants (17 with vitiligo and 17 age-and gender-matched healthy controls). After a written informed consent, a detailed history and examination was done. Serum 25(OH)D levels were measured using the enzyme-linked immunosorbent assay kit. Genomic DNA was extracted from the peripheral blood. The VDR polymorphisms were genotyped using the polymerase chain reaction-restriction fragment length polymorphism method. Fok1, Bsm1, Apa1, and Taq1 restriction enzymes were used to determine the genotypes of the respective polymorphisms. Results: Nonsegmental vitiligo was the most common type of vitiligo seen in 14 (82.4%) cases. The mean serum Vitamin D level in cases was 35.64 ± 15.68 ng/ml and in controls was 37.00 ± 16.45 (P = 0.81). There was no significant difference in the distribution of VDR polymorphisms between the case and control groups. Conclusion: In our study, no significant difference was observed in the distribution of Fok1, Bsm1, Apa1, and Taq1 VDR polymorphisms between the case and control groups. However, we observed a significant association between the Fok1 polymorphism and serum 25(OH) Vitamin D levels in vitiligo patients studied.
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ONLINE ONLY ARTICLES - CASE REPORTS Top

Leukemia cutis: A sign of relapse p. 53
Umamaheshwari G Chitapur, Sharathchandra B Athanikar, Asha B Panchagavi, KN Naveen, Vidisha S Athanikar
DOI:10.4103/cdr.cdr_120_20  
Leukemia cutis is an infiltration of the skin by myeloid or lymphoid neoplastic leukocytes resulting in clinically identifiable cutaneous lesions. It may follow, precede, or occur concomitantly with the diagnosis of systemic leukemia. A 55-year-old female patient was a known case of acute myeloid leukemia (AML) and was on palliative chemotherapy. She presented to the Department of Dermatology with sudden-onset nodules over the chest and abdomen which were multiple, nontender and firm in consistency. Histopathological examination from the nodule over the abdomen suggested leukemic infiltration of the skin and repeat hemogram showed reappearance of blast cells in the peripheral smear, consistent with a diagnosis of leukemia cutis with relapsed AML. The case has been reported for its rarity and poor prognosis associated with its presentation.
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Atypical mycobacterial cutaneous infection caused by mycobacterium abscessus complex: An unusual presentation masquerading actinomycosis p. 53
Gaurav Harishchandra Khandait, Rajvardhan Bagane, Swapna S Khatu, Nachiket Palaskar, Abhishek S Patokar, Himanshu Pophale
DOI:10.4103/cdr.cdr_121_20  
Atypical mycobacterial infections are caused by mycobacteria other than those from the Mycobacterium tuberculosis complex and Mycobacterium leprae. They are ubiquitous, aerobic, nonmotile, and acid-fast bacilli seen in soil and water. Here, we report the case of a 31-year-old married female who presented with multiple painful pus-filled lesions over both the breast, abdomen, and back associated with yellow-colored discharge for 6 months. Tuberculosis-polymerase chain reaction revealed the presence of atypical mycobacteria which on further investigation with matrix-assisted laser desorption/ionization-time of flight isolated Mycobacterium abscessus species.
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An Unusual presentation of Bullous pemphigoid: A toxic epidermal necrolysis variant p. 54
Ravina Naik, Varadraj V Pai, Pankaj Shukla
DOI:10.4103/CDR.CDR_107_20  
Bullous pemphigoid (BP) is a subepidermal blistering skin disease that usually occurs in the elderly population. Morphological patterns of BP are varied and include lesions such as prurigo, urticaria, dyshidrosiform eczema, vegetative, erosive, erythema annulare centrifugum, nodular, and can very rarely toxic epidermal necrolysis. Drug-induced or drug triggered BP must be suspected if the disease subsides or remits on withdrawal of the probable offending drug. Dipeptidyl peptidase 4 inhibitors, aldosterone antagonists, anticholinergics, and dopaminergic medication are the common drugs associated with BP.
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Dermatopathia pigmentosa reticularis: A rare case report and review of literature p. 54
Aswath Rajan, Vivekbhai Itaiya, Simanthini Sakhardande, Varadharaj Pai, Pankaj Shukla
DOI:10.4103/cdr.cdr_119_20  
Dermatopathia pigmentosa reticularis is a rare autosomal dominant disorder. It is an ectodermal dysplasia, characterized by a triad of generalized reticulate hyperpigmentation, noncicatricial alopecia, and onychodystrophy. The mode of inheritance is probably autosomal dominant associated with mutation in keratin 14 on chromosome 17. We report the case of a 31-year-old male presented with reticulate hyperpigmentation all over the body with diffuse noncicatricial alopecia and onychodystrophy of the finger and toe nails. He also had palmoplantar hypohydrosis and poorly developed dermatoglyphics. There were no other findings of ectodermal-derived organ involvement.
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A rare cause of interstitial lung disease with skin lesion p. 55
Smera Ramakrishnan, Spandana P Hegde, Manjunath Shenoy Mala, Nazir Attar
DOI:10.4103/CDR.CDR_101_20  
We report a case of an interstitial lung disease of unknown etiology in a middle-aged man who later presented with skin lesions on the upper back. Histopathological examination showed noncaseating granulomas suggesting a possibility of cutaneous sarcoidosis. With further workup that included histopathology, the diagnosis of sarcoidosis was established. Sarcoidosis is a multisystem granulomatous disease of unknown etiology primarily affecting the lungs and intrathoracic lymph nodes but can affect virtually any organ. In our case, appearance of cutaneous lesion and further workup lead to the diagnosis of sarcoidosis.
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Type E xeroderma pigmentosum: Rare case of siblings p. 55
Pallavi Kumari, Sonia Pramod Jain, Pratiksha Sonkusale, Abhay Vilas Deshmukh
DOI:10.4103/CDR.CDR_105_20  
Xeroderma pigmentosum (XP) is an inherited condition with an extreme sensitivity to ultraviolet radiations. This condition mostly affects the eyes and areas of skin exposed to the sun and the nervous system. Here, we report a rare type XP E present in siblings. A 24 year old married female came to the dermatology outpatient Department with chief complaints of multiple dark-colored raised lesions over the nose, cheeks, eyebrows, forehead with hypopigmented lesions over bilateral forearm since 10 years. Her 21-year-old younger brother had similar lesions over face since 8 years. Both had a history of bilateral cataract with no neurological abnormality. Based on history, clinical and histopathological examination the diagnosis of XP E type was made. As per our knowledge, very few cases of this rare variety of XP E in siblings have been reported. Hence, we report this rare XP E in siblings.
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Diagnosis of post kala azar dermal leishmaniasis in nonendemic Areas: A clinical challenge p. 56
Gandikota Raghurama Rao, M Raja Ratna Kishore, Ruchi Singh, Kollipara Haritha
DOI:10.4103/CDR.CDR_110_20  
Leishmaniasis is a heterogeneous group of disease caused by protozoans of the genus Leishmania, transmitted by Phlebotomus sandflies. Human leishmaniasis is usually classified as visceral, cutaneous (localized, diffuse, disseminated), mucocutaneous, and post-kala-azar leishmaniasis. Post-kala-azar leishmaniasis is a sequel of visceral leishmaniasis (VL) caused by Leishmania donovani (LD) and seen in India, Bangladesh, Nepal, and Sudan. In India, it develops in 5%–15% of treated VL cases within 2–5 years. It is characterized by multiple papular, nodular, and pleomorphic lesions over the sun-exposed areas such as face, neck, and arms, without systemic manifestations. It mimics a wide range of dermatoses, particularly leprosy in endemic areas for both the diseases. Inadequate immune response (Th1 and Th2) to infection during and after the treatment of VL plays a role in the pathogenesis. It is thought to be a good reservoir of LD and plays an important role in the treatment of VL. Post-kala-azar dermal leishmaniasis (PKDL) is usually diagnosed by skin smears, immunological tests such as rK39, cutaneous leishmaniasis detection tests, and polymerase chain reaction. A combination of liposomal amphotericin B and miltefosine is the first line of treatment. PKDL is a forgotten clinical entity in the nonendemic areas. We report a case of PKDL in a 52-year-old male from Andhra Pradesh, a nonendemic area for leishmaniasis. This case was treated successfully with combination therapy, liposomal amphotericin B, and miltefosine.
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Blaschkitis or lichen striatus: A splitter's view p. 56
R Bharatia Pravin, S Salunke Tejaswini, V Kulkarni Vinay, H Patki Anil
DOI:10.4103/CDR.CDR_112_20  
Blaschkitis is an uncommon inflammatory dermatosis of unknown etiology, usually affecting adults. It is characterized by unilateral linear pruritic eruptions along the Blaschko's lines, usually seen on the trunk. Here, we report a case of this rare disorder and have put forward an argument why it is different from lichen striatus.
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Porokeratoses – all in one: A coexistence of clinical variants p. 57
Kalgi Baxi, Ani P Patel, Vidhi S Chandibhamar, Nishi Trivedi, Nayan H Patel, Ranjan C Raval
DOI:10.4103/CDR.CDR_114_20  
Porokeratosis (PK) is an autosomal dominant disorder characterized by abnormal epidermal proliferation. Several clinical variants have been described, but coexistence of multiple variants in a single patient has been reported in only a few cases. We hereby report a case of multiple variants of PK (disseminated superficial actinic porokeratosis over the face and the scalp presenting with scarring alopecia and verrucous PK over genital mucosa) involving multiple unusual body sites in a single patient.
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Fetal varicella syndrome: A rare case report and literature review p. 57
Abhishek S Patokar, Aditya R Holani, Swapna Khatu, Nitin Chaudhari, Nachiket Palaskar
DOI:10.4103/CDR.CDR_118_20  
Fetal varicella syndrome (FVS) is an extremely rare condition of the newborn, characterized by cutaneous scars, limb defects, ocular, and central nervous system abnormalities. It follows maternal varicella infection during early pregnancy. We are reporting a 4-day-old female child who presented with a linear, depressed, erythematous, localized scarring over the right knee with hypoplasia of the right lower limb and malformed right great toe. Clinical presentation of her right foot was resembling congenital talipes equinovarus. Mother had a history of varicella during the first trimester of pregnancy. Ocular examination revealed subretinal hypopigmented exudation with scanty vitreous hemorrhage and tunica vasculosa lentis seen on indirect ophthalmoscopy in the right eye. Ultrasonic A/B scan of the right eye was suggestive of microphthalmia. We confirmed the diagnosis of FVS based on characteristic history, clinical features, and varicella-zoster IgG antibodies were positive.
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ONLINE ONLY ARTICLES - LETTERS TO EDITOR Top

A Rare Case of Keratosis Follicularis Spinulosa Decalvans Affecting a Female Child p. 58
Varsha Sakleshpur Prasad, Rashmi Laxman Chavan, Sir Sanjay Ramachandra Tjejaswi, Jayashree Basavaraju, Chandramohan Kudligi, Pradeep Vittal Bhagwat
DOI:10.4103/cdr.cdr_17_21  
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Coumarin in COVID long-hauler p. 58
K Geetha
DOI:10.4103/cdr.cdr_18_21  
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Angina bullosa hemorrhagica-like lesions: An underrecognized mucosal manifestation in pemphigus vulgaris p. 58
Logamoorthy Ramamoorthy, Remya Raj Rajamohanan, P Shakthi, Sreerekha Jinkala
DOI:10.4103/cdr.cdr_43_21  
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Solitary papule with central crater in a young man: Dermoscopy picks the clue p. 59
Keshavmurthy A Adya, Arun C Inamadar, Aparna Palit
DOI:10.4103/cdr.cdr_137_20  
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Spots in dermatology Highly accessed article p. 59
Swathy Prasannan, AS Savitha, TS Nagesh
DOI:10.4103/cdr.cdr_128_20  
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