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   2017| January-June  | Volume 1 | Issue 1  
    Online since December 28, 2016

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Lines in dermatology
AS Savitha
January-June 2017, 1(1):27-31
  47,545 2,336 1
A randomized, single-blind, active controlled study to compare the efficacy of salicylic acid and mandelic acid chemical peel in the treatment of mild to moderately severe acne vulgaris
Shishira R Jartarkar, Bugude Gangadhar, M Mallikarjun, P Manjunath
January-June 2017, 1(1):15-18
Background: Various modalities of treatment have been used in the treatment of acne and nowadays, clinicians seek to employ new technologies in acne care like chemical peeling. Objectives: The objective of this study is to compare the efficacy of salicylic acid and mandelic acid peel in the treatment of mild to moderately severe acne vulgaris. Methodology: A total of fifty patients with mild to moderately severe acne graded based on Global Acne Grading System were divided randomly into two groups of 25 patients each. Group A patients were treated with 20% salicylic acid and Group B patients were treated with 30% mandelic acid every 15 days for six sessions. Pre- and post-peel sunscreen and moisturizer were prescribed. Percentage of improvement in inflammatory and noninflammatory lesions at the end of six sessions was the primary endpoint measure. The improvement was graded as mild, moderate, good, and significant. Results: All the patients showed improvement of acne at the end of the treatment. The mean improvement of inflammatory acne in Group A was 73.3% and in Group B was 65.4%. The mean improvement of noninflammatory acne in Group A was 39.4%, and Group B was 27.9%. In both groups, the improvement in both inflammatory and noninflammatory lesions was found to be statistically significant (P < 0.05). Conclusion: Salicylic acid peel was found to be more efficacious than mandelic acid peel. However, the side effects were less common with no postinflammatory hyperpigmentation with mandelic acid peel.
  10,589 915 4
Comparison of cutaneous manifestations of diabetic with nondiabetic patients: A case-control study
Banavasi S Girisha, Neethu Viswanathan
January-June 2017, 1(1):9-14
Background: Diabetes mellitus is a metabolic disorder characterized by raised fasting and postprandial blood glucose levels and a variety of multisystem complications. The prevalence of skin manifestations seems to be similar between type 1 and type 2 diabetes mellitus patients. Cutaneous manifestations usually develop following the diagnosis of diabetes, but in some patients, they are the initial presenting signs, thereby helping in the early diagnosis of diabetes mellitus. Objectives: The objective of this study is to describe the cutaneous lesions in patients with type 2 diabetes mellitus and to compare the pattern of skin manifestations in diabetics and nondiabetics in coastal Karnataka and neighboring districts of Kerala. Methodology: This case-control study included 400 patients with type 2 diabetes mellitus and cutaneous manifestations attending the outpatient Departments of Dermatology and General Medicine and those admitted under these departments. A total of 400 age and sex-matched nondiabetic patients were included as controls. Results: Cutaneous infections were noted in 148 (37%) diabetics of which fungal infections were the most common seen in 106 (26.5%) patients, followed by xerosis in 121 (30.25%) and acrochordons in 71 (17.75%) patients. Other dermatoses associated with diabetes mellitus noted were acanthosis nigricans (5.5%), scleredema diabeticorum (0.25%), diabetic bullae (0.5%), and Kyrle's disease (1%). Cutaneous changes associated with neurovascular complications included diabetic foot in 3%, diabetic dermopathy in 2%, and pigmented purpuric dermatosis in 0.25% of the diabetics. Conclusion: A joint effort between dermatology and general medicine is necessary for the early recognition and treatment of the skin conditions and also to ensure adequate metabolic control.
  9,768 667 3
Red dots caught red handed: Dermoscopy of genital psoriasis
Balachandra Suryakant Ankad, Mahajabeen Madarkar
January-June 2017, 1(1):25-26
Dermoscopy is an in vivo diagnostic technique that aids in the visualization of epidermis, dermoepidermal junction, and papillary dermis. Histopathology contributes tremendously in confirming the clinical diagnosis of unusual presentations of inflammatory skin disorders. Being noninvasive, dermoscopy assists significantly in differentiation of many inflammatory skin disorders which clinically resemble one another. In this report, authors describe the importance of dermoscopy in the diagnosis of genital psoriasis which was mimicking dermatophytic infection and contact dermatitis.
  9,335 430 -
Pemphigus foliaceus: A rare case of exfoliative dermatitis
Vaishnavi Gopal, Malcolm Pinto, Manjunath Shenoy Mala
January-June 2017, 1(1):19-21
Exfoliative dermatitis (ED) is a dermatological condition necessitating admission as it can sometimes be fatal because of its metabolic burden and complications. Papulosquamous disorders and drug reactions comprise over 75% of all the causes of ED. One must be vigilant for the rarer causes of ED as treatment protocols vary and prompt institution of treatment is lifesaving. We present a case of a 56-year-old man with ED who had a history of developing recurrent crusted lesions over the scalp and trunk over the last 3 years. He was treated with oral steroids which he stopped abruptly 6 months ago. Then, he applied topical herbal medications over the lesions before the skin disease progressed to the present state of ED. We uncovered his old records where the histopathology and direct immunofluorescence studies aided in the diagnosis. Based on the history, examination findings supported by histopathology and immunofluorescence studies we came to a final diagnosis of ED secondary to pemphigus foliaceus. This case has been reported for the rare presentation of a common immunobullous disorder and to highlight its diagnostic difficulties.
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Methicillin-resistant Staphylococcus aureusmenace: A dermatologist's perspective
Manjunath Hulmani, Shruti Kakar, V Jagannath Kumar
January-June 2017, 1(1):4-8
Staphylococcus aureus is a facultative anaerobic, Gram-positive coccal bacterium. In contemporary times, one of the major concerns in all fields of medicine is the emerging resistance to S. aureus. There are two types of methicillin-resistant S. aureus (MRSA), that is, hospital acquired (HA) and community acquired (CA). HA-MRSA strains contain staphylococcal cassette chromosome mec (SCCmec) I and II, which are larger and have the capacity for multidrug resistance. High expression of Panton-Valentine leukocidin (PVL), phenol-soluble modulins (PSM), α-toxin, core genome-encoded superantigen SEIX, and teichoic acid contributes to increased virulence in CA-MRSA strains. Methicillin resistance in staphylococci is due to the acquisition of a mobile genetic element (mec) called the SCCmec. All SCCmec types include the mecA gene, which codes for the low-affinity penicillin-binding protein (PBP) 2a. Resistance is due to the fact that β-lactam antibiotics cannot inhibit PBP2a. Biofilms are surface-attached bacterial agglomerations embedded in extracellular matrix. There are various toxins such as PVL, PSMs, surface-anchored S. aureus-binding proteins, and SasX protein. It can cause folliculitis, furunculosis, abscesses, carbuncles, cellulitis, necrotizing pneumonia, urinary tract infection, osteomyelitis, septic arthritis, thrombophlebitis, endocarditis, and toxic shock syndrome. Many diagnostic modalities are available to identify MRSA. The mainstay of treatment is incision and drainage. Systemic antibiotics such as clindamycin, doxycycline, trimethoprim-sulfamethoxazole, linezolid, daptomycin, tigecycline, and tedizolid are the most commonly used antibiotics. The prevalence of CA-MRSA is on the rise, and as a dermatologist, our concern is to prevent the occurrence of recurrent furunculosis and patient dissatisfaction.
  5,403 506 -
Cutaneous pseudolymphoma: An enigma
BM Shashikumar, MR Harish, Kirti P Katwe, M Kavya
January-June 2017, 1(1):22-24
Cutaneous pseudolymphoma, also called lymphoid infiltrates of the skin mimicking lymphomas, is defined as reactive polyclonal benign lymphoproliferative process predominantly composed of either B-cells or T-cells, localized or disseminated. A 62-year-old male presented with multiple asymptomatic swellings over the posterior aspect of the left ear of 1-year duration. On examination, multiple nodules were present over the left retroauricular area, 2 of which were skin colored, firm, and nontender. Histopathology revealed pseudolymphoma with the features of a dense diffuse and nodular infiltrate of small and large lymphocytes and histiocytoid cells involving the whole of reticular dermis and extending to subcutis. A patch test was done using Indian standard battery series showed positive reaction - 2+ for paraphenylenediamine. A diagnosis of cutaneous pseudolymphoma was made. The lesions were treated with intralesional Triamcinolone acetonide injection 10 mg/ml for 2 sittings, 3 weeks apart following which there was remission of the nodules. Pseudolymphomas are benign but persistent lymphoid proliferations in the dermis, which may be difficult to distinguish from a low-grade malignant lymphoma. Pseudolymphomas are classified according to the histological components into B-cell and T-cell variants. So far no case of cutaneous pseudolymphoma suggestive of insect bite with coincidental paraphenylenediamine allergy has been reported. Hence, this case is reported as its histopathology was suggestive of pseudolymphoma secondary to insect bite reaction.
  5,220 408 -
Coal tar to biologic: Search for ideal therapy for psoriasis continues…
Arun C Inamadar
January-June 2017, 1(1):1-3
  3,512 386 -