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   Table of Contents - Current issue
Coverpage
September-October 2019
Volume 64 | Issue 5
Page Nos. 341-421

Online since Thursday, September 5, 2019

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ORIGINAL ARTICLES  

Role of dermoscopy in the diagnosis of hypertrophic lichen planus and prurigo nodularis Highly accessed article p. 341
Bangaru Hanumaiah, Joice Maria Joseph
DOI:10.4103/ijd.IJD_123_18  PMID:31543526
Background: A dermoscope is an office tool used in the diagnosis of various disorders. At present, studies on hypertrophic lichen planus (HLP) and prurigo nodularis (PN) are limited. Aims and Objectives: The aim of this study was to compare the dermoscopic features of HLP and PN and to determine the role of dermoscopy in the differential diagnosis of both the conditions. Materials and Methods: A cross-sectional study was undertaken. After clinical assessment and relevant investigations, dermoscopy was performed using DermLite DL3 dermoscope (×10) followed by histopathology. Dermoscopic findings in cases of HLP and PN were evaluated. Results: Thirty patients each with HLP and PN were included in the study. On dermoscopy, peripheral striations were the most common findings in both the conditions. Statistically significant features on intergroup comparison included blue–gray globules (P <0.001), comedo-like openings (P <0.001), and follicular plugging (P <0.001) in HLP and pearly white areas with white starburst pattern (P =0.028), red dots and globules (P <0.001), glomerular vessels (P =0.003), crusting (P =0.002), and erosions (P <0.001) in PN. Conclusion: Dermoscopy is useful in differentiating HLP and PN. Blue-gray globules, comedo-like openings, and follicular plugging were specific for HLP. Pearly white areas with white starburst pattern and red dots and globules were the specific findings in PN.
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The occurrence of food hypersensitivity reactions and the relation to the sensitization to grass and trees in atopic dermatitis patients 14 years of age and older p. 346
Jarmila Celakovská, Josef Bukac, Karel Ettler, Jaroslava Vaneckova, Irena Krcmova, Kvetuse Ettlerova, Jan Krejsek
DOI:10.4103/ijd.IJD_164_18  PMID:31543527
Background: Although epidemiologic data are scarce, there is no doubt that the increase in pollen allergies is going to be followed by an increase in the so-called pollen-related food allergies. The aim of this study was the evaluation of the food hypersensitivity reactions in atopic dermatitis patients and the relation to the sensitization to grass and trees. Methods: The complete dermatological and allergological examinations were performed in all included patients; the occurrence of food hypersensitivity reactions was recorded and the sensitization to inhalant allergens (grass and trees) was examined (skin prick test, and specific IgE). The statistical evaluation of the relation between the sensitization to these inhalant allergens and the occurrence of food hypersensitivity reactions was performed. Results: A total of 321 patients were included, with an average age of 26.7 years (±9.2 years) and with an average SCORAD of 33.2 (±13.3) points. The significant relation was recorded between the patients suffering from sensitization to grass and the reactions to peanuts, celery and walnuts; another significant relation was demonstrated between the patients suffering from sensitization to trees and reactions to apple, peanuts, and walnuts. In patients suffering from sensitization to grass and trees, the occurrence of food hypersensitivity reactions to tomatoes, kiwi, spices, oranges, capsicum, tangerines, and carrot was higher also, but the relation was not significant. Conclusion: The significant relation was found between the reactions to peanuts and walnuts and sensitization to grass and trees, another significant relation was found between the sensitization to grass and celery and between the sensitization to trees and apple.
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Atopic dermatitis in adults and irritable bowel syndrome: A cross-sectional study p. 355
Z Gizem Kaya İslamoǧlu, Mehmet Unal, Adem Küçük
DOI:10.4103/ijd.IJD_490_18  PMID:31543528
Background: Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder affecting a large number of people in the world. Atopic dermatitis (AD) is a common inflammatory skin condition characterized by relapsing eczematous lesions in a typical distribution. It was first described in 1933 but exists since antiquity. Aim and Objectives: To determine the relationship between AD and IBS. Materials and Methods: A total of 109 patients with AD and 100 healthy controls were included in the study. They were defined for diagnosis of IBS according to ROME-III diagnostic criteria. Supporting findings, Bristol stool scale, frequency of defecation and history of AD and IBS were also evaluated. AD severity was assessed using Severity Scoring of Atopic Dermatitis index. Results: A total of 62 patients (56.9%) in the AD group and 28 patients (28%) in the control group were diagnosed with IBS (P < 0.001). Supportive findings excluding abnormal stool frequency and passage of mucus were more frequent in AD patients. There was no significant relationship between disease severity according to SCORAD index and variables in AD patients. Conclusions: This is a rather uncultivated area in the field of AD. We observed that IBS was more common in AD group. Also, supporting findings like abnormal stool form, abdominal distension, feeling of incomplete evacuation, and straining were found more frequently in AD patients. These results may indicate the association between AD and IBS. In our opinion, patients with atopic dermatitis should be questioned in terms of IBS.
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A cross-sectional study on the dermatoses in postmenopausal patients at a rural-based tertiary health care center p. 360
Kira Pariath, Pragya A Nair
DOI:10.4103/ijd.IJD_204_19  PMID:31543529
Context: There is still a dearth of knowledge regarding the types of dermatoses occurring in postmenopausal women. The common disorders occurring in postmenopausal women and the probable effects of hormonal fluctuations on the skin have to be considered while treating postmenopausal women. Aims: To study clinical patterns of dermatosis in menopausal women. Settings and Design: It was a cross-sectional study conducted in the dermatology department from May 2017 to June 2018 after approval from ethical committee. Materials and Methods: All postmenopausal patients having dermatoses were included in the study after taking their written consent in vernacular language. Statistical Analysis Used: All findings were analyzed using STATA (14.2). Results: The study included 150 postmenopausal women. Most of the patients belonged to the age group of 61–70 years (38.67%) with a mean age of 61.52 years. The age of menopause was most commonly achieved between 40 and 50 years (57.33%). The genital dermatoses were found in 90 (60%) subjects and included atrophic vaginitis (21, 33.33%), lichen sclerosus et atrophicus (14, 15.55%), lichen simplex chronicus (14,15.55%) and tinea cruris (10,11.11%) among others. The extragenital dermatoses were found in 96 (64%) cases and common ones were dermatophytosis (16, 16.33%), lichen planus (11, 11.22%), psoriasis (9, 9.18%) and eczema (8,8.16%). Conclusion: This study is useful in understanding the various clinical patterns of postmenopausal dermatoses and thereby help the physician, dermatologist, and gynecologist to effectively manage the conditions.
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A study of risk factors of chronic venous insufficiency and its association with features suggestive of preceding or present deep venous thrombosis p. 366
Ram H Malkani, Rusina Karia, Sneh Thadani
DOI:10.4103/ijd.IJD_271_18  PMID:31543530
Background: Deep venous thrombosis (DVT), even though resolved, may damage the valves and may lead to chronic venous insufficiency (CVI). We designed the present study to examine the thrombotic markers or other ultrasound features in the absence of active thrombosis in patients presenting with features suggestive of CVI. Materials and Methods: It was a cross-sectional study of 50 DVT patients. We collected a detailed history of presenting symptoms (onset, progression, and duration) and associated history of aggravating factors. After classifying the patients, color Doppler investigation for DVT and venous incompetence and blood investigations such as Factor V, D-Dimer, total cholesterol, total triglycerides, homocysteine, high-density lipoproteins, low-density lipoproteins (LDL), and very LDL were done. Results: We found a raised Factor V significantly more in patients classified as severe under clinical classification compared with nonsevere (19% and 0%; P = 0.05) and in patients with a high Venous Severity Clinical Score (VSCS) compared to those with a low VSCS score (17% and 0%; P = 0.03). We also found that perforators were significantly more in patients with a high VSCS score (88% and 58%; P = 0.02), in patients with a primary venous etiology compared with those without any venous etiology (97% and 1%; P < 0.0001), in patients with obstruction/reflux compared to those without any pathology (95% and 0%;P < 0.0001), and in patients with severe clinical classification compared with nonsevere patient (95% and 55%; P = 0.002). Conclusions: Clinical or subclinical DVT, an important cause of CVI, may not always be seen on ultrasound, especially after resolution. However, they may have the presence of blood parameters (Factor V and hyperhomocysteinemia) suggestive of DVT; these can be used as proxy markers for the current or previous DVT.
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Bacteriological profile of aerobic and anaerobic isolates of trophic ulcer in leprosy: A study from Eastern India p. 372
Revanta Saha, Somenath Sarkar, Monalisa Majumder, Gautam Banerjee
DOI:10.4103/ijd.IJD_310_19  PMID:31543531
Introduction: Trophic ulcer is a dreaded complication of leprosy. Secondary infection compounds the damage to the already neglected ulcer. Aims: To find out the bacterial pathogens in the isolates from trophic ulcers of leprosy and to find the drug sensitivity of the aerobic isolates so as to start a suitable antibiotic therapy. Methodology: An institution-based, cross-sectional study done over a period of 2 years. Swab was taken from the deeper part of the ulcer. It was put on a suitable culture media. Bacteriological profile was determined and antibiogram was done subsequently. Results: Sixty patients with trophic ulcer secondary to leprosy were screened, among which all were screened for aerobic isolates and 38 were screened for anaerobic isolates. Among the aerobic isolates, 88% of patients were culture-positive. The most common organism was Staphylococcus aureus(37.7%), followed by Pseudomonas aeruginosa (22.64%), Proteus mirabilis (15.09%), Escherischia coli (13.2%), Klebsiella (9.43%). Maximum overall sensitivity was seen with amikacin (93.1%) and linezolid (89.65%). Maximum overall resistance was noted with cotrimoxazole (58.62%) and coamoxiclav (51.72%). Among the 38 patients cultured for anaerobic isolates, 17 were culture-positive for anaerobic organisms. Isolates showing Peptococcus were 6 (15.7%), purely Peptostreptococcus were 4 (10.5%), purely bacteroides were 3 (7.8%), and mixed growths were 4 (10.5%). Conclusion: Secondary bacterial infection is quite common in leprosy trophic ulcers. The most common organism was Staphylococcus aureus. Isolates were mostly sensitive to amikacin and linezolid and resistant to cotrimoxazole and coamoxiclav. Anaerobic isolates were not uncommon, with Peptococcus being the most common among them.
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A cross-sectional study to analyze the social, sexual, and reproductive challenges among serodiscordant couples p. 377
Neerja Saraswat, Ajay Chopra, Sushil Kumar, Reetu Agarwal, Debdeep Mitra, Parul Kamboj
DOI:10.4103/ijd.IJD_367_18  PMID:31543532
Introduction: The term “serodiscordant couples” refers to an intimate partnership in which one partner is human immunodeficiency virus (HIV) positive and the other HIV negative. They form a special population which are constantly at risk of acquiring infection, require safer sexual and reproductive options, and are in constant psychological and emotional distress. Aims: To describe the social, sexual, and reproductive issues and their impact on serodiscordant couples. Materials and Methods: A cross-sectional study was conducted on HIV-serodiscordant couples, admitted or attending our outpatient department, where the couples had not separated. A detailed interview of the partners on social, sexual, and reproductive issues was conducted and the data were endorsed in the pro forma. Results: Sixty-four serodiscordant couples were included in the study. Sixty-two (96.8%) males were seropositive compared to 2 (3.1%) females. Sixty-one (95.3%) patients were married and 3 (4.6%) were unmarried. Thirty-six (56.2%) patients were between the age group of 21 and 35 years, 21 (32.8%) between 36 and 55 years, and 7 (10.9%) between 56 and 70 years. Sixty-two (96.8%) patients had a heterosexual orientation compared to 2 (3.1%) patients who were homosexual. Twenty-one (32.8%) patients had a history of sexual encounter outside the relation while 27 (42.1%) were not aware of the source of infection. Fifty-one (79.6%) patients were on antiretroviral therapy (ART) compared to 13 (20.3%) patients who were not on ART. Thirty-one (48.4%) patients admitted to have a constant strain in relation while 16 (25%) were practicing safe sex. Thirty-nine (60.9%) patients had fear of disease transmission while 26 (40.6%) had fear of pregnancy. Forty-nine (76.5%) patients had children at the time of detection while 15 (23.4%) had no issue. Forty-one (64%) patients expressed desire to have children as compared to 23 (35.9%). Conclusion: The unique requirements of serodiscordant couples in terms of providing them safer sexual and reproductive options to prevent the transmission of HIV to the seronegative partner or the child during pregnancy need to be addressed for better patient management.
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Leprosy scenario in Ahmedabad District (Gujarat) p. 383
Deepika Uikey, Rima Joshi, Bela J Shah, Nikhil Verma
DOI:10.4103/ijd.IJD_496_18  PMID:31543533
Background: In India, leprosy still continues to be one of the major public health problems and demands a continuous awareness for its eradication. The reduction of the load of infection is the cornerstone of leprosy control. Aims: The aim of the present study was to enumerate the epidemiology of leprosy in the Ahmedabad district of Gujarat. Methods: Three hundred new cases of leprosy (multidrug therapy cases) and patients who had completed antileprosy treatment and developed new signs and symptoms after that during the period from June 2010 to December 2012 were included in the study. A detailed history, clinical examination, and relevant tests were done. Results: Out of a total of 300 patients, male-to-female ratio was 2.1:1. Family history was positive in 4.3% of patients. Lepromatous leprosy was seen in 27.3%, pure neuritic leprosy occurred in 12 (3.9%), and smear positivity was seen in (44.6%). Thirty (10%) patients developed type 1 reaction and 32 (10.6%) patients had type 2 reaction. Nearly 1.3% of the cases were relapsing cases. Limitations: The study had geographical limitation and the study did not cater the whole population but only the cases who reported to the hospital. Hence, the social stigma factor associated with leprosy could not be annulled. Conclusions: Leprosy still prevails and adequate knowledge and clinical skills, sensitive diagnostic tools and proper supply of medicines from the medical end and early reporting of symptoms, compliance regarding medicine intake, and social awareness to null social stigma associated with it from the patient's end may bring the country as a whole to the target of leprosy elimination.
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Knowledge, belief, and perception among youths with acne vulgaris p. 389
Afzaa Nizar Machiwala, Ganesh Kamath, Tanvi Pradeep Vaidya
DOI:10.4103/ijd.IJD_512_18  PMID:31543534
Background: Acne vulgaris is one of the commonest dermatological challenges faced by the youth. It lasts several years, running a chronic course with complications such as scarring. The fact that this occurs most commonly on the face, leads to profound psychological implications, that cause emotional trauma and affect a person's quality of life. Anxiety and depression are common issues arising from this. A lot of myths tend to float around acne in society, and people use all kinds of indigenous and home made remedies, as well as the wrong kinds of treatment, such as topical steroid based creams, which further worsen the situation. Aims and Objectives: To assess the awareness levels amongst youths, to understand the various beliefs and perceptions related to acne, so that we may be able to tackle this condition better. Materials and Methods: We carried out a cross-sectional study in 150 patients with acne vulgaris attending the Dermatology Out Patient Department from May 2017 to June 2018. Results: Amongst other findings, we found that a majority of people in our study believed stress and hormones to be the major aggravating factors. Most patients preferred treatment options like healthy lifestyle and cleansers and toners in our study. Amongst the treatment options, clindamycin was more commonly used than benzoyl peroxide followed by retinoids. Conclusion: There are several misconceptions and a gross lack of knowledge about acne amongst our younger population, that needs to be addressed.
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The spectrum of underlying causes of iatrogenic Kaposi's sarcoma in a large series: A retrospective study p. 392
Can Baykal, Tugba Atci, Nesimi Buyukbabani, Armagan Kutlay
DOI:10.4103/ijd.IJD_217_18  PMID:31543535
Background: The frequency of clinicoepidemiological variants of Kaposi's sarcoma (KS) differs markedly throughout the world. The iatrogenic variant is mainly associated with the use of immunosuppressive therapy. Aims: We aimed to investigate the distribution of KS variants in our practice and elucidate the underlying causes of iatrogenic KS. Methods: Consecutive KS patients seen in a single tertiary center were grouped according to the tumor variants and iatrogenic KS patients were evaluated about associated conditions. Results: Among 137 patients, classic variant was the most frequent presentation (n = 88), followed by iatrogenic (n = 37) variant. Among the iatrogenic group, ten were transplant recipients. In 16 iatrogenic KS patients, systemic corticosteroid was used, in four for myasthenia gravis (MG) and in three for rheumatoid arthritis. In three patients, KS developed under topical corticosteroid (TC) treatment. Among iatrogenic KS patients, ten of them had a second primary neoplasm and one had congenital immunodeficiency syndrome. Conclusions: Our study revealed one of the highest rates for iatrogenic KS (27%) reported in the literature. Besides well-known causes, relatively frequent association with MG was remarkable. Usage of different forms of TCs was the cause of KS in a few cases.
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CASE REPORTS Top

Blau syndrome associated with nucleotide-binding oligomerization domain containing 2 mutation in a baby from Malaysia p. 400
Kin Fon Leong, Reiko Sato, Glenda Guek Khim Oh, Uttam Surana, Zacharias Aloysius Dwi Pramono
DOI:10.4103/ijd.IJD_44_18  PMID:31543536
Blau syndrome (BS) is a very rare autosomal dominant juvenile inflammatory disorder caused by mutation in nucleotide-binding oligomerization domain containing 2 (NOD2). Usually, dermatitis is the first symptom that appears in the 1styear of life. About 220 BS cases with confirmed NOD2 mutation have been reported. However, the rarity and lack of awareness of the disease, especially in the regions where genetic tests are very limited, often result in late diagnosis and misdiagnosis. Here, we report a de novo BS case from Malaysia, which may be the first report from southeast Asia. PCR and DNA sequencing of peripheral blood mononuclear cells were performed to screen the entire coding region of NOD2 gene. A heterozygous c.1000C>T transition in exon 4, p. R334W, of the NOD2 gene was identified in the patient. This report further reaffirms the ubiquitousness of the disease and recurrency of p. R334W mutation.
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Disseminate and recurrent infundibulofolliculitis p. 404
S Rekha, Vineet Kumar, Pankaj Rao, Dilip Kachhawa
DOI:10.4103/ijd.IJD_77_18  PMID:31543537
Three patients, one female and two males, aged 18, 45, and 25 years, respectively, presented with the complaint of skin-colored papules interspersed with pustular lesions over the anterior and lateral aspect of the neck and upper chest for 2, 8, and 6 months, respectively. Histopathologically, mononuclear cell infiltrate centered over the infundibulum of the hair follicle was seen which confirmed the diagnosis of disseminate and recurrent infundibulofolliculitis. We report this case due to its rarity, especially in the Indian population in which less than five case reports have been published. We also report a specific pattern of lesions along the neck skin creases which can serve as an aid to increase the index of suspicion for diagnosing this entity.
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Lower lip plexiform schwannoma: Report of a rare case and a literature review p. 407
Reza Yaghoobi, Nader Pazyar
DOI:10.4103/ijd.IJD_207_18  PMID:31543538
Plexiform schwannoma is an uncommon benign neoplasm of the neural sheath characterized grossly and microscopically by multinodular growth. It is typically presented as a mobile, solitary, smooth-surfaced, and nontender mass. Histologically, schwannomas are classified into the following seven types: classical (Verocay), plexiform, cellular, cranial nerve, melanotic, degenerated (ancient), and granular cell schwannomas. In spite of the fact that plexiform schwannoma commonly occurs in the head-and-neck region, the involvement of the lip is considered to be extremely rare. Herein, we present the case of a 16-year-old boy with the schwannoma on the lower lip excised without any recurrence at 9 months after surgery.
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Zosteriform lymphangitic metastases of eccrine porocarcinoma p. 411
Yunfang Zhang, Ming Zhang, Weiwei Wu, Jiejie Lu
DOI:10.4103/ijd.IJD_440_18  PMID:31543539
Eccrine porocarcinoma (EPC) is a rare malignant neoplasm which originates from the intraepidermal portion of eccrine sweat glands or acrosyringium. Here, we report a unique case of cutaneous metastases of EPC presenting with an erosive plaque on the left thumb and multiple nodules on left forearm. The histopathological examination of the wrist lesion revealed islands of basaloid tumor cells with eosinophilic cytoplasm, downward infiltrating growths, ductal differentiation, and intracytoplasmic lumen formations and focally connected to the epidermis. Acrosyringeal differentiation was confirmed by positive immunohistochemical staining using antibodies to carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA) in some of porocarcinoma cells. Lymphatic embolization was shown by immunostaining of podoplanin. To the best of our knowledge, this is the first reported EPC case with a primary lesion on the left thumb and zosteriform growth pattern of lymphangitic metastases on left forearm. Our case highlights the diagnostic challenges and reveals lymphangitic metastasis mode of EPC.
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Adult onset langerhans cell histiocytosis limited to the skin p. 414
Ishwor Gurung, Yan Gao, Kai Han, Xue-Biao Peng
DOI:10.4103/ijd.IJD_504_18  PMID:31543540
Langerhans cell histiocytosis (LCH) is a proliferative disease commonly seen in the pediatric population but rarely encountered in the adult population. The exact etiology remains unclear. It has various clinical features and is very likely to be misdiagnosed. Histopathology and immunohistochemistry are very important for the diagnosis of LCH. Treatment protocols remain controversial. Herein, we report a rare adult onset LCH, which is confined to the skin. A 50-year-old Chinese man presented with a nodule with itchy rashes on the left lower leg, which gradually grew in size for the last 6 months. He also had multiple scattered rashes on the right lower leg. The skin biopsy demonstrated Langerhans cells infiltrating the superficial dermis, and the tumor cells were positive for CD1a and S-100 expression. The diagnosis was LCH based on the histopathological and immunohistochemistry results.
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CORRESPONDENCE Top

Platelet-rich plasma therapy for androgenetic alopecia Highly accessed article p. 417
Vinod K Sharma, Neetu Bhari, Suman Patra, Anita Singh Parihar
DOI:10.4103/ijd.IJD_363_17  PMID:31543541
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A rare nonvenereal presentation of oral condyloma acuminatum p. 419
Sankaran Sudhakar, Balasubramani Senthil, Shreenivas Sundar
DOI:10.4103/ijd.IJD_543_18  PMID:31543542
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CORRIGENDUM Top

Corrigendum p. 420
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NOTICE OF RETRACTION Top

Retraction: Profile of dermatophytosis in a tertiary care center in Kerala, India p. 421

DOI:10.4103/0019-5154.264758  PMID:31543544
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