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   Table of Contents - Current issue
July-December 2022
Volume 6 | Issue 2
Page Nos. 61-155

Online since Friday, August 26, 2022

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Androgenetic alopecia p. 61
Ajithkumar Kidangazhiathmana
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Androgenetic alopecia: Clinical features and trichoscopy Highly accessed article p. 63
Shashank Bansod, Aseem Sharma, Madhulika Mhatre
Androgenetic alopecia, known alternatively as male pattern baldness when men are affected, and female pattern hair loss, when it affects women, is a form of alopecia characterized by miniaturization – a process wherein thick, long terminal hair are converted to short, thin, miniaturized hair due to the effect of dihydrotestosterone. Various pathogenetic mechanisms exist that support the process. Due to the unusually high disease burden and the psychosocial affliction, a lot of research in underway in the field. Clinically, this subtype of patterned hair loss presents with typical and atypical patterns presenting with thinning of hair and / or balding, or both. It is of paramount importance to recognize and grade the disease early to administer appropriate therapy. Trichoscopy also plays a major role in diagnosing, prognosticating and even monitoring patient response to therapy.
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Pathogenesis of androgenetic alopecia p. 69
Ajithkumar Kidangazhiathmana, Parvathy Santhosh
The pathogenesis of androgenetic alopecia (AGA) is a complex interplay of genetic, hormonal, and environmental factors. In scalp follicles of susceptible individuals, androgens promote miniaturization of hair and shorten hair growth in the anagen stage, ultimately leading to AGA. The major circulating androgen, testosterone, is converted to the more potent androgen dihydrotestosterone by the enzyme 5α-reductase (5αR). Androgen receptors (ARs) and 5αR are significantly more in balding scalp hair follicles than those from nonbalding follicles. Genetic predisposition plays a crucial role in AGA. Various genetic loci including AR gene and the ectodysplasin A2 receptor (EDA2R) (AR/EDA2R locus in Xq11-q12) have been strongly implicated. The basic pathology of AGA is progressive miniaturization of the terminal hair follicles and eventual conversion of terminal hair to vellus hair. The duration of the anagen phase diminishes progressively with each cycle, while the length of telogen phase remains constant or may be prolonged. This eventually results in a reduction of the anagen to telogen ratio. With each successive shortening of hair cycle, the length of each hair shaft is reduced, and it becomes too short for the growing hair to attain even the minimum length required to reach the skin surface, resulting in an empty follicular pore. Hair follicle miniaturization leads to conversion of terminal hairs into secondary vellus hairs. Although many mechanisms have been proposed, the actual mechanism of hair miniaturization has not yet been fully elucidated. This article attempts to collate the existing information regarding the pathogenesis of AGA.
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Androgenetic alopecia – Medical management p. 75
Feroze Kaliyadan
There are a number of options available for the medical management of androgenetic alopecia. The key questions for practitioners are what the available medications are and what is their efficacy? What are the possible side-effects of these options? Are there differences in response according to parameters like gender? Are combinations effective? What are the newer options available and what could the future hold? This narrative review attempts to answer these questions. The main focus is on the medical treatment options which have significant evidence as of now – minoxidil, 5 alfa-reductase inhibitors, low light laser therapy, and platelet-rich plasma.
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Hair transplantation: A brief review Highly accessed article p. 80
T Muhammed Razmi, Kiruthika Subburaj
Hair transplantation is a safe and effective treatment option in patients with male and female pattern hair loss. Alopecia leads to a lack of self-confidence and social withdrawal in young patients when compared to their peers with good hair density. Patient selection, counseling, and planning the procedure have equal importance as that of the hair transplantation surgery itself. Follicular unit transplantation (FUT) and follicular unit extraction (FUE) are the two commonly used techniques of hair restoration. In FUT, a strip of tissue is excised from the occipital donor area resulting in a linear scar. Whereas in FUE, the scarring can be avoided as small individual follicular units are harvested and transplanted in the recipient area. FUE is emerging as a most opted hair restoration procedure in patients with patterned hair loss. This review elaborates on the procedure of FUE in brief and gives a detailed step-by-step guide for performing the procedure.
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Hidradenitis suppurativa: A review of available immunotherapeutic agents and advancement in treatment p. 88
Ana Preda-Naumescu, Josiah Sowell, Hana N Ahmed, Tiffany T Mayo, Nabiha Yusuf
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition that poses a significant diagnostic, as well as therapeutic, challenge for clinicians. The purpose of this review is to explore current treatment guidelines, as well as the newer, investigative immunotherapies, used in the management of HS. Through a detailed, albeit nonexhaustive, literature review, the most-recently published management guidelines and clinical trials concerning HS therapy were identified and their implication in current and future disease management was explored. An understanding of available treatment options, and what lies on the horizon, is important as researchers and clinicians work toward better understanding this unique disease.
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Immunohistochemical demonstration of interleukin-17 positivity in skin biopsy specimens of patients with chronic plaque psoriasis and its correlation with severity of psoriasis and associated metabolic syndrome and cardiovascular changes p. 97
Madivalara Yallappa Suparna, Praveen Kumar Shanmugam Reddy, Tharayil Kunneth Sumathy, Vijaya V Mysorekar
Background: Psoriasis is a chronic inflammatory disease which can be associated with metabolic syndrome and cardiovascular abnormalities. Objectives: The aim and objective of the study are to demonstrate interleukin-17 (IL-7) positivity in histopathological sections of psoriatic plaques and to correlate with metabolic syndrome and cardiovascular changes. Materials and Methods: Forty-seven patients with chronic plaque psoriasis with body surface area >10% and psoriasis area and severity index (PASI) score >12, in whom skin biopsy showed munro's microabscesses, were evaluated for IL-17 positivity (intensity and proportion) with associated metabolic syndrome according to the National Cholesterol Education Program adult treatment panel III criteria and cardiovascular comorbidities. A co-relation with PASI score was made. IL-17 intensity and proportion were graded with a score ranging from 0 to 3. IBM SPSS version 16.0 was used for statistical analysis and independent t-test and Chi-square test were used for proportion. Results: The mean age of patients was 43 years. A total of 15 (31.9%) female and 32 (68.1%) male patients were enrolled. The mean PASI score was 21.6. Metabolic syndrome was seen in 31 (65.96%) patients. There was statistically significant association with raised diastolic blood pressure in patients with metabolic syndrome (P = 0.042). The total number of patients with IL-17 positivity with metabolic syndrome was 21 (63.6%). Of these, 9 (42.9%) cases showed IL-17 positivity in the munro's microabscess, 14 (66.7%) cases in the rest of the epidermis, and 18 (85.7%) cases in the dermis. Conclusion: In our study, there was no significant difference in IL-7 positivity between patients with or without metabolic syndrome. Further studies need to be done with large sample size to confirm the significance.
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Prevalence of psychological distress and quality of life among people living with HIV/acquired immunodeficiency syndrome at tertiary health-care center in coastal Karnataka, institutional-based cross-sectional study p. 103
AR Hariprasada, HN Shruthi, Akshay Phatak
Background: With increase in cases of HIV, in addition to the direct effect of HIV, the social stigma causes psychological distress in people living with HIV/AIDS (PLWHA). With improvements in antiretroviral therapy (ART), HIV has become a chronic disease, which increases the incidence of other psychiatric comorbidities. Objectives: To assess the predisposing factors causing psychological distress and to assess the quality of life (QOL) in people living with HIV. Materials and Methods: A total of 380 patients who visited ART center in a Coastal Karnataka tertiary health-care center were included in this study. They were given questionnaires, which included World Health Organization-QOL-Bref, HAM-Depression, MOS-social support survey, perceived stress scale (PSS), and substance abuse. Result: Out of 380, the prevalence of psychological distress in patients with HIV/acquired immunodeficiency syndrome (AIDS) was 30.5%. The mean of the total QOL scores was 78. Prevalence of poor QOL in patients with HIV/AIDS was 1.58%. About 5.8% were mild or moderately depressed. Only 0.5% were found to be with severe depression. There was no statistically significant substance abuse among PLWHA. Conclusion: PLWHA who were in the age group of 30–60 years, illiterate, those with history of alcohol abuse, and having lower QOL scores and high scores in PSS had increased odds of psychological distress. Thus, concerned medical fraternity should collaborate on integrating HIV/AIDS treatment services with mental health services. Future interventions are needed to improve the level of social support and psychological support to the people living with chronic illnesses like HIV/AIDS.
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Influence of internet health information on patient compliance in dermatology: A survey p. 109
Pragya Ashok Nair, Jinal Tandel, Pratiksha Shah, Rutoo , Dharmesh Parmar, Brijesh Patel
Background: Many patients use the Internet to self-diagnose and find treatment options, thus avoiding the need to visit a doctor in person. Objectives: This study was done with the primary objective to determine how Internet health information impacts the patient–physician relationship, compliance, and its effect on patient treatment. Materials and Methods: It was a cross-sectional study, done at the Department of Dermatology, Venereology, and Leprosy, over a period of 6 months from January to June 2019. All patients with any dermatological diseases above the age of 12 years, who conducted an Internet search for the disease were included in the study. Participants were provided with an information sheet, outlining the details of the study. They were asked to fill out a questionnaire in their vernacular language. The questionnaire had questions about the patient's perspective toward his health as well as the doctor's advice before and after Internet usage. Descriptive analysis was used for statistical analysis. Results: A total of 110 patients were included in the study with 56.36% of males and 34.54% between 21 and 40 years of age group. Wikipedia was used by 51.81% of participants, followed by 40% who used Google. After Internet use, participants strongly agree that doctors possess more information than the information on Internet in 39.09%, while 61.81% of participants believe that there is good communication between doctor and patient. After Internet use, a maximum of 48.18% agree and followed the doctor's recommended medication. Conclusion: Online medical information has a positive effect on patient disease status and on patients' relationships with their physicians. Doctors should be more aware of the health information available online and should be able to guide patients to accurate and reliable websites.
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Unmasking dermoscopic evaluation of melasma: findings of a cross-sectional study in central India p. 114
Sahana Sreenath, Yoganand J Phulari, Ravishekar N Hiremath, Sandhya Ghodke, Rishi Raj
Background: There exists a wide range of variations in skin tone around the world, with Asian and Indian subjects showing a greater susceptibility toward pigmentation disorder. Objective: This study was carried out with the objective to assess the clinical and dermoscopic findings among different types of melasma in a single center of Central India. Materials and Methods: A cross-sectional study was carried out among patients with clinical features of melasma attending the outpatient department at multispecialty hospital with a sample size of 100. A prestructured pro forma was used to collect the baseline data. Clinical and dermatological examination was done after taking a detailed history. Clinical pattern of melasma such as centrofacial, malar, and mandibular was noted. The areas of melasma were examined using a contact polarized Dermlite DL4 3rd Gen Dermoscope attached to an iPhone. Results: The mean age of study participants was 38.15 years with a standard deviation of 6.93. Seventeen percentage were of male gender. Thirty-one percentage of the female patients had a history of oral contraceptive pill (OCP) usage, and 22% of the female patients had a history of menstrual abnormalities. Fitzpatrick skin Type IV was the most commonly affected skin type. Centrofacial type of melasma is the most common clinical type and reticuloglobular pattern is the commonly seen pattern on dermoscopy. The color of dermoscopy was predominantly brown in malar (52.2%) and mandibular (57.1%) and mixed in Centrofacial (45.7%), which was followed by 26.1%–28.6% mixed color in malar and andibular types and 41.4% brown color in centrofacial type. The difference in the color of dermoscopy (P = 0.48), presence of telangiectasia on dermoscopy (P = 0.23), pattern of dermoscopy (P = 0.15), and mean Melasma Severity Index scores with different clinical types was not statistically significant. Similarly, the association between different clinical types of melasma with duration of sun exposure (P = 0.33) and topical photo protection (P = 0.34) was also not statistically significant. Conclusion: Our study findings concluded that melasma is common in women in the age group of 27–56 years range. Exposure to sunlight and the hormonal changes (due to OCP usage) were those among the various factors influencing the development of melasma. Centrofacial melasma was the most common pattern seen in our study group. Epidermal melasma features on dermoscopy were reticuloglobular patterns with a brownish hue, while the features of dermal melasma were irregular patterns with a bluish hue and mixed melasma had irregular patchy brown pigmentation. Perifollicular globules and telangiectasia were also seen.
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Sweet's syndrome: A study of 16 cases and review of literature p. 121
H Bangaru, KR Raghavendra, Sathish Shankar
Background: Sweet's syndrome (SS) is a classical representative of neutrophilic dermatosis characterized by the abrupt onset of fever, erythematous tender plaques and nodules on exposed parts, and histopathological reaction in response to different external and internal stimuli. Objectives: The aim of this study was to assess the clinical, epidemiological, histological features and therapeutic outcomes of SS. Materials and Methods: A retrospective study of all patients diagnosed with SS over a 4-year period (2016–2020) was conducted. Results: Over a period of 4 years, a total number of cases of SS were 16. Female patients were predominant around 13 (81.25%), and male patients were 3 (18.75%). The most common site affected was face in 87.5% (14), followed by upper limb in 50% (8) and lower limb in 25% (4). Among the systemic manifestations, fever was there in all cases. The associated causes were infectious conditions in 6 (37.5%) cases, among which five cases were upper respiratory tract infection, hematological malignancy in three cases, one case with solid tumors, one case was associated with acquired cutis laxa (Marshall' s syndrome), one was drug induced (diclofenac sodium), one case was pregnancy associated, and other three cases were idiopathic. Conclusion: SS can be diagnosed based on clinical and laboratory findings. In all atypical and recurrent SS cases, thorough evaluation for malignancy is essential. Dapsone can be considered a concomitant therapy along with steroids and also a steroid-sparing agent.
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A study to compare efficacy of non cultured autologus melanocyte transfer versus punch grafting technique for stable vitiligo patients p. 127
Ambresh S Badad, Amrit Singh Bhatia, Ashok Hogade, Shruti Ambresh Badad, Debdeep Mitra
Background: Vitiligo is a common acquired idiopathic hypomelanosis, which is characterized by loss of melanocytes in the epidermis associated with autoimmune and hereditary causes. The various surgical modalities available are tissue grafting techniques such as punch grafts, suction blister grafts, and split-thickness grafts as well as cellular grafts such as autologous noncultured epidermal cell suspensions and cultured melanocyte suspensions. Objective: We aimed to study and compare the efficacy of noncultured melanocyte transfer technique and punch grafting technique in the management of stable vitiligo. Materials and Methods: Fifty patients of both sexes between the ages of 15 and 50 years having stable vitiligo for minimum 1 year were included in the study and divided in two groups. Group 1 was treated with autologous noncultured melanocyte-rich cell suspension and Group 2 was treated by punch grafting technique. Response to treatment was evaluated on the basis of degree of repigmentation (both subjective and objective assessment), which was carried out at monthly intervals for a period of 6 months along with clinical photographs. Results: The results were statistically analyzed using “Chi-square test” and “statistical significance” (p-value) methods. An excellent (>75% repigmentation) result was obtained in 77.27% of patients by NCMT (noncultured melanocyte transfer) technique whereas good (60%–75% repigmentation) result was obtained in 78.57% of patients by punch grafting technique after 6 months. Conclusion: Noncultured melanocyte transfer is a simple and effective technique to produce uniform pigmentation in short duration and is suitable to cover large body surface areas with a cosmetically better outcome and is better than punch grafting.
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A clinicopathological study of primary cutaneous amyloidosis in tertiary care center, Hubballi p. 133
Sanjay Ramachandra Thejaswi, Mohan Eshwar Rao Shendre, Chandramohan Kudligi, Raghavendra Tophakhane
Background: Cutaneous amyloidosis has a varied clinical presentations. Clinically, it is difficult to distinguish different subtypes of PCA. Objectives: This study was been taken up to correlate clinicohistological profile of all three forms of primary cutaneous amyloidosis (PCA) and to study various factors affecting the disease. Materials and Methods: A total number of 85 patients of PCA attending Skin and STD in tertiary care center in Hubballi were included in the study. A detailed history was taken, complete general physical, systemic, and cutaneous examination was done, and details of skin lesions were noted. Patient was subjected to skin biopsy from the affected area. Clinicohistological findings so obtained were analyzed, and results were correlated. Results: Out of 85 cases, 36 (42.35%) were macular amyloidosis (MA), 43 (50.58%) lichen amyloidosis (LA), and 6 (7.05%) were biphasic amyloidosis (BA). Majority of the patients were in the age group of 21–50, with a male: female ratio of 1:1.3. History of scrubbing while taking bath was given by 90.58%. Housewives were the most frequently involved group (38.82%). In MA, most frequently involved sites were upper back (58.33%) and extensor aspect of arm (55.55%). In LA, majority had involvement of the pretibial area (86.04%). The dermal changes seen in MA and LA were almost the same, while the epidermal changes were less frequent in MA. Conclusions: In the present study, most of the patients of macular and LA had clinical and histopathological correlation. There is not much difference in the demographic profile and histopathological characteristics between LA and MA. The findings confirm that the two forms of primary localized cutaneous amyloidosis are closely related variants of one disease. Histological examination will help in confirming the diagnosis.
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Pharmacovigilance of Severe Cutaneous Adverse Drug Reactions p. 140
Kriteeka Saini, Amita Sutaria, Bela Shah
Background: Severe cutaneous adverse drug reactions (SCARs) are idiosyncratic reactions comprising 2% of all drug-induced skin reactions. These include Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, and acute generalized exanthematous pustulosis. These dermatologic emergencies lead to increased morbidity, mortality, and economic burden and may be a cause of litigation. Objectives: The aim was to study the clinicoepidemiological profile of SCARs and establish causal association. Materials and Methods: Patients presenting with SCARs over a period of 2 years were included in this observational, cohort, hospital-based study conducted in a tertiary care center in western India. The patterns of drug reactions were analyzed, and the drug causality was established. Results: A total of 62 patients were included in this study. SJS was the most common pattern of drug reaction observed. Aromatic anticonvulsants (phenytoin and carbamazepine), antimicrobials (co-trimoxazole and amoxicillin), and nonsteroidal anti-inflammatory drugs were the most common drugs implicated. Drug reactions in people living with HIV/AIDS on antiretroviral therapy were noteworthy. Conclusion: SCARs represent the most challenging dermatoses in terms of survival, sequelae, and quality of life. Prompt withdrawal of the offending drug and strict pharmacovigilance can improve the prognosis of SCARs. There is a need for exploration of newer genetic associations which may be the only tool to predict these severe reactions.
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Teledermatology in the era of COVID-19, perspective from a developing country: Are we future-ready? p. 144
Paras Choudhary, Rajesh Datt Mehta, Divya Sharma, Dilip Kacchawa, Bhikam Chand Ghiya, Kamaldeep Singh
Background: With the advent of the COVID-19 pandemic, the medical fraternity across the world, including India, is facing unprecedented challenges, and to cope with this, creative solutions are required. During this COVID-19 crisis, telemedicine has emerged as a weapon to reduce disease transmission while continuing with non-COVID care. Objectives: The purpose of this study is to highlight the changes and challenges in dermatology practice, to explore the usefulness of tele-dermatology during the pandemic, and to understand the dermatologist's perspective. Materials and Methods: An online cross-sectional survey was done among Indian dermatologists to evaluate the changes in their practice, impact of telemedicine, and their experience, during COVID-19. Results: A total of 177 responses from qualified Indian dermatologists were analyzed. Teleconsultation was done by 20.5% of consultants before lockdown which increased up to 82% after lockdown. Most commonly preferred device was mobile phone (83%), and the most common format was chat applications (WhatsApp/Messenger) (55.7%). Discontinued consultation was due to technical issues, patient's misbehavior, and poor-quality clinical photographs. Only 13.5% of practitioners were satisfied with teledermatology. Conclusion: With the onset of the COVID-19, the shift of clinical care to telemedicine practice has hastened. However, continuous investment in systems and technology as well as refinement of regulations for telemedicine is needed to sustain its widespread adoption.
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Usage of learning management system to implement online teaching methodology in undergraduate medical students: A cross sectional study p. 149
Shivakumar Ajay Kumar, G Niveditha, P Seema, Girish M Bengalorkar
Background: The COVID-19 pandemic caused a temporary roadblock in learning among medical colleges in India as traditional classroom teaching was suspended temporarily. Students and faculty members had to adapt in a short period of time to transition from traditional practices of live classroom lectures to a virtual mode by using learning management system (LMS). Objectives: The present study aims to describe the perceptions of students and faculty members about their experience using the LMS to attend online classes. It also aims to assess the possibility of using the same for postgraduate medical education, particularly in specialties requiring visual aid for learning such as radiology, dermatology, and pathology. Materials and Methods: A cross-sectional survey-based observational study was conducted on 123 MBBS students and 36 faculty members after 6 months of the online teaching using LMS. Responses were collected on their experience with the LMS and assessed using a three-point Likert scale. Results: About 62.6% of the students who participated in the study felt that it was easy to log into the LMS platform. About 58.6% of the students felt that the audio and video quality of the classes on the platform was good. The majority of students (93.5%) felt that the user interface of the LMS was easy to use. Poor Internet connectivity issues accounted for the main cause of interruptions during online classes for 48% of the students. About 88.9% of the faculty members felt that it was easy to log into the LMS to conduct online classes. Around 86.1% of them felt that the audio and video quality was good on the platform. Browsing through the platform during online lectures was easy according to 75% of them. Conclusion: The majority of students and faculty members felt that the user interface and quality of the audiovisual feed of the LMS were very good. The LMS platform made the scheduling of classes, marking attendance, and usage of additional annotation tools convenient. Usage of LMS can supplement the traditional face-to-face lecture classes to enhance learning in medical undergraduate and postgraduate education.
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Adult-Onset linear verrucous epidermal nevus in an Indian male p. 149
UK Sudhir Nayak, Shrutakirthi D Shenoi, Rupika Singh, Kanthilatha Pai
Verrucous epidermal nevus is the most common form of epidermal nevi with usual onset at birth or early life. Adult onset is rare, and we report a case of verrucous epidermal nevi with onset in the fourth decade, dermatoscopy and histopathology of which were consistent with verrucous epidermal nevi.
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Toxic epidermal necrolysis due to dual infection of Mycoplasma pneumoniae and Streptococcus complicated by herpes simplex virus p. 150
Suma D Gudi, Sambasiviah Chidambara Murthy, Niveditha Nagaraja, Vandana Devendra
Stevens–Johnson syndrome and toxic epidermal necrolysis (TEN) are severe mucocutaneous reactions, characterized by blistering and epidermal sloughing. They are mainly caused by drugs and less commonly due to infections. A 9-year-old boy presented with fever, cough, atypical target lesions involving >30% of body surface area along with few erosions and positive pseudo-Nikolsky sign. Multiple mucous membranes were involved. Clinical features were consistent with TEN. Radiological and laboratory investigations showed evidence of Mycoplasma pneumonia and Group A Streptococcal infection. The course was further complicated by herpes simplex 1 infection. He responded well to systemic antibiotics, corticosteroids, cyclosporine, acyclovir, and supportive care. This report highlights the occurrence of TEN due to dual infections that further got complicated by a third infection.
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Vulval lymphangiectasia post-radiotherapy in cervical cancer: A rare case report p. 150
P Aswathi Raj, C Kanmani Indra, MI Nasrin, Niji Sara Jacob
Cutaneous lymphangiectasia is a benign cutaneous disorder of dilatation of the dermal and subcutaneous lymphatic channels, which occurs rarely on the vulva. It can be congenital or acquired developing secondary to tuberculosis, surgery, and radiotherapy. We report the case of a 58-year-old female patient who gives a history of cervical cancer, for which she underwent hysterectomy and postsurgery radiotherapy 3 years back, now presenting with multiple lumps over the vulva, which discharged clear fluid for 1 year. Acquired vulval lymphangiectasia develops 7–15 years postradiotherapy or surgery commonly, while in our case, it developed earlier. On local examination, there were multiple shiny translucent and hyperpigmented “frog-spawn like” vesicles and papules present over the lower midabdomen, mons pubis, and labia majora. Diagnosis of vulval lymphangiectasia was made on the clinical findings and biopsy. Biopsy revealed dilated lymphatic channels in the superficial and deep dermis. CO2 laser treatment was done for the patient.
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An unusual paraneoplastic manifestation of adenocarcinoma lung: Tripe palm p. 151
Niji Sara Jacob, C Kanmani Indra, MI Nasrin, P Aswathi Raj
Tripe palms (TP) are the rare paraneoplastic manifestation with the thickened palms and pronounced dermatoglyphics. In cancer patients with mere TP, the most occurring malignancy is pulmonary carcinoma. Although it precedes a malignancy, it may arise at any point in the course of the disease. Here, we present a patient who came with complaints of thickened blackish discoloration of palms and soles for 3 weeks and a clinical diagnosis of TP was made. He had concomitant adenocarcinoma lung TNM stage IB diagnosed 5 months back. Thus, he was diagnosed with TP secondary to adenocarcinoma lung. Although TP precede internal malignancy we report this case as TP occurred after the diagnosis of adenocarcinoma of the lung was made.
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Herpes zoster ophthalmicus in an healthy infant with intrauterine infection p. 151
R Megha, Sweta R Prabhu, KN Naveen, SB Athanikar, Vijay Kulkarni
Herpes zoster (HZ) or shingles is a viral infection with segmental eruption due to reactivation of varicella zoster virus (VZV) from the dorsal root ganglion. HZ is uncommon in immunocompetent children and early adult life. Incidence increases in individuals over the age of 50 years. However, zoster can occur in childhood following intrauterine infection or exposure to VZV at an early age. We report this case, as HZ is rare in infants, especially HZ ophthalmicus due to both intrauterine infection and exposure after birth.
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Twenty nail dystrophy: A feature of direct nail apparatus involvement in leprosy p. 152
Ashish Kumar Nayak, Biswanath Behera, Siddhartha Dash, Madhusmita Sethy, Aparna Palit
Lepromatous leprosy (LL) is a systemic illness which involves various organs either directly due to Mycobacterium leprae or as a part of lepra reaction. Nail changes occur in leprosy with variable frequency but may not have a direct causal relationship with leprosy. Hereby, we are describing a case of untreated LL presenting with twenty nail dystrophy and a direct causal relationship of the same due to M. leprae.
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Calcinosis cutis in chronic myeloid leukemia p. 152
Arun C Inamadar, Anusha Lingaiah, Ajit B Janagond
Calcinosis cutis is a rare condition of calcium deposition in skin and subcutaneous tissue. Multiple underlying diseases have been implicated for calcification, the pathogenesis of which is poorly understood. We report a case of calcinosis cutis secondary to chronic myeloid leukemia. The case is being reported for its rarity of association.
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Poroid hidradenoma over dorsum of the hand p. 152
A Savitha Somaiah, R Raghunath Reddy, H Apoorva, L Eshwari
Poroid hidradenoma is a rare, benign cutaneous neoplasm which presents as a solitary swelling. It has eccrine differentiation with features of both hidradenoma and poroma. We hereby present a case of a 50-year-old female patient with a slowly growing asymptomatic lesion over the dorsum of the left hand for 1½ years. Histopathology was consistent with poroid hidradenoma. The hidradenoma component consists of solid and cystic areas and poroma by poroid and cuticular cells. There was no recurrence of the lesion after 1 year of follow-up. Very few cases of poroid hidradenoma have been reported in the literature.
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Reticulate acropigmentation of dohi: Dermatoscopic features in two cases p. 153
Jinal Jainendra, Juhi Devyangbhai Shah, Dhruv Ramanbhai Patel, Pragya Ashok Nair
Reticulate acropigmentation of Dohi is a rare genodermatosis inherited as an autosomal dominant trait. It is a localized form of dyschromatosis universalis hereditarian, characterized by the presence of hyperpigmented and hypopigmented macules with symmetrical, irregular size and shape forming a reticulate pattern over the dorsa of the hands and feet. Onset is normally in the first decade but occasionally be delayed. Biopsy is not diagnostic but helps to rule out its differentials. Dermoscopy is a new investigative tool which gives specific characteristic changes. We report two cases of acropigmentation of Dohi with classical dermatoscopic changes reported previously and some new features. No treatment is effective for this genodermatosis.
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Cutaneous Mucormycosis in the Setting of Disseminated Intravascular Coagulation Following Snakebite: A Rare Case Report p. 153
Rajendra Devanda, C Kanmani Indra
We report a case of cutaneous mucormycosis occurring in the setting of disseminated intravascular coagulation following snakebite in an adult. It occurred in the chest wall presenting as a necrotic patch with satellite spots. This case occurred in a different clinical scenario in which mucormycosis is not usually suspected. This highlights the importance of a wide range of clinical suspicion to diagnose such cases in an unusual scenario. Since mucormycosis spreads rapidly with a bad prognosis, it warrants early diagnosis and treatment. Hence, this case has been reported for its unusual presentation. There is also the need to suspect and diagnose these cases early for effective management.
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Pemphigus herpetiformis with atypical features p. 154
Sukriti Arora, Raghavendra Rao
Pemphigus herpetiformis (PH) is considered as an uncommon and mild variant of pemphigus. Here, we report the case of a 34-year-old woman who presented with intensely pruritic, annular crusted lesions with vesicles arranged in the periphery over the abdomen, back, and scalp. Cutaneous features were consistent with the clinical diagnosis of PH. However, she had certain unusual clinicoimmunopathological features. She also had oral erosions, which is a rare finding in this variant of pemphigus. The results of histopathological examination and enzyme-linked immunosorbent assay were also in line with the diagnosis of pemphigus vulgaris. She responded well to dapsone with significant objective and subjective improvement in 1-week follow-up.
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Dermatodendrosophy and dermatokarposophy – A bird's eye view p. 154
Anil Harishchandra Patki, Paras Choudhary
Dermatodendrosophy is defined to describe the relation between dermatology and the trees whereas Dermatokarposophy describes the connection between dermatology and fruits. Here were are describing these two new terms, Dermatodendrsophy and Dermatokarposophy, in details.
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A facial micropapular variant of polymorphous light eruption: An infrequently reported entity p. 154
Preema Sinha, Veena Kharayat, Deep Kumar Raman, Manoj Gopal Madakshira
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Cutaneous manifestations of chronic kidney disease - A cross sectional study p. 155
Ambresh S Badad, Harshima Gadwal, Ashok S Hogade
Background: Systemic disorders often have cutaneous manifestations. Health of the skin usually reflects the overall health of a person. Therefore, early recognition of cutaneous signs and prompt initiation of treatment are essential in reducing morbidity and mortality. Cutaneous changes can be observed in all the stages of renal disease. They can be due to the cause, the disease, or the treatment. Aim: The aim is to study the pattern and proportion of cutaneous manifestation in chronic kidney disease (CKD) patients visiting a tertiary care center. Materials and Methods: This cross-sectional study was carried out at a tertiary care hospital. A total of 80 patients with CKD were included in this study. All patients were clinically examined after written consent. Results: Every patient included in this study had minimum one dermatological manifestation of CKD. The most common cutaneous manifestation was pallor in 80% of patients, followed by xerosis in 60%, pruritus in 50%, pigmentary changes in 40%, and hair changes in 35% of patients. Cutaneous infections were seen in 30%, oral mucosa changes in 20% of patients. Nail changes were observed in 10% of patients, the most common being onychomycosis. Kyrle's disease was seen in 5% of patients. Conclusion: There is a broad range of cutaneous manifestations of CKD. Although often benign, they may negatively impact the quality of life and can be life-threatening. Early detection and treatment are required to decrease the morbidity, mortality, and improve the quality of life of CKD patients.
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Hand–Foot syndrome to sorafenib: A case report p. 155
Sherin Dominic, Vijay Venkatraj Aithal
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Cutaneous arteriovenous malformation: successful treatment with embolization and excision – A case report p. 155
Vinupriya Sakkaravarthi, Remya Raj Rajamohanan, Elango Swamiappan, Laxmisha Chandrashekar
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