Indian Journal of Dermatology
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   Table of Contents - Current issue
March-April 2020
Volume 65 | Issue 2
Page Nos. 85-171

Online since Tuesday, February 25, 2020

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Ablation of DJ-1 enhances oxidative stress by disturbing the function of mitochondria in epidermal melanocytes Highly accessed article p. 85
Man Li, Fang Wang, Juan Du, Lijuan Wang, Jianzhong Zhang, Xiaolan Ding
Background: Oxidative stress is implicated in the pathogenesis of vitiligo. The function of DJ-1 in oxidative damage of melanocytes is still elusive. Aims: The aim of this study was to investigate the role of DJ-1 in oxidative damage of melanocytes. Material and Methods: The expression of DJ-1 in melanocytes was studied by reverse transcription-quantitative polymerase chain reaction and Western blot. Short-interfering RNAs (siRNA) were employed to downregulate DJ-1. The cells were pooled into three groups: mock group (cells with transfection reagent), negative control (NC) group (negative siRNA control), and siRNA group. After H2O2treatment for 24 h, the morphological changes, cell viability, apoptosis, intracellular reactive oxygen species (ROS) levels, mitochondrial membrane potential (MMP), and mitochondrial respiration were measured in different groups. Results: DJ-1 was highly expressed in PIG1 melanocytes. DJ-1 knockdown rendered PIG1 melanocytes more susceptible to oxidative stress. Loss of DJ-1 led to apoptosis of PIG1 cells by impairing the function of mitochondria, including morphological abnormalities, ROS accumulation, depolarization of MMP, less adenosine-triphosphate (ATP) production, and less proton leak. Conclusions: DJ-1 plays a role in maintaining the antioxidative capacity in epidermal melanocytes.
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Fine Particulate matter (PM2.5) is a risk factor for dermatitis by promoting the expression of thymic stromal lymphopoietin (TSLP) in keratinocytes p. 92
Fei Li, Yongpin Dong, Chunya Ni, Haidong Kan, Shuxian Yan
Aim: Common indoor pollutants, as fine particulate matter (PM2.5), can damage people's health and cause skin allergies. However, it remains unknown which common pollutants can lead to allergy, such as, in children atopic dermatitis, and what is the key molecule. This study aimed to investigate the thymic stromal lymphopoietin (TSLP) produced from keratinocytes after environmental pollutant stimulation. Methods: PAM212 cells were treated by several pollutants, including PM2.5, formaldehyde, m-xylene, and 1,2,4-trimethylbenzene, and tried to analyze their relationships. The mRNA expression level of TSLP was determined by qPCR. The protein level of TSLP was detected by ELISA analysis. Results: The mRNA expression of TSLP was significantly up-regulated when PAM212 cells were stimulated by PM2.5 at 25 μg/ml for 12 h. Meanwhile, the protein level of TSLP in culture supernatant was increased. However, TSLP protein production was not detected in culture supernatant treated with formaldehyde, m-xylene, and 1, 2, 4-trimethylbenzene. Conclusion: PM2.5 promotes the expression of TSLP and may aggravate allergic response using this pathway.
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Food hypersensitivity reactions to seafish in atopic dermatitis patients older than 14 year of age – The evaluation of association with other allergic diseases and parameters p. 97
Jarmila Celakovska, Bukač Josef, Jaroslava Vaneckova, Irena Krcmova, Michaela Komorousov, Petra Cetkovská, Radka Vankova, Jan Krejsek
Background: Seafood allergy is among one of the common food allergies. Decrease in consumption of omega-3 polyunsaturated fatty acids (PUFAs), prevalent especially in oily fish, has been proposed to contribute to the increased prevalence of allergic diseases. Aim: The aim of this study was to evaluate, in atopic dermatitis (AD) patients, the relation between the occurrence of food hypersensitivity reaction (FHR) to seafish and the occurrence of other atopic diseases and parameters. Methods: Complete dermatological and allergological examination was performed in patients included in the study; 332 patients were examined, with the average age 26.8 years (SD 9.2 years). Results: The FHR to seafish was confirmed in 11% of patients. Patients suffering from FHR to seafish suffered significantly more from sensitization to fungi (in 46%), from reactions to celery (in 34%), and from persistent eczematic lesions (in 82%). Conclusion: FHRs to seafish in AD patients are associated with persistent eczematic lesions and with the higher occurrence of sensitization to fungi and reactions to celery. The occurrence of bronchial asthma, rhinitis, positive family history, and onset of AD under 5 years of age is higher in patients with reactions to seafish, but the difference is not statistically significant.
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Epidemiology and treatment of calcinosis cutis: 13 years of experience p. 105
Lili Róbert, Norbert Kiss, Márta Medvecz, Enikő Kuroli, Miklós Sárdy, Bernadett Hidvégi
Background: Calcinosis cutis is a rare condition associated with different diseases, which is difficult to manage. Aims and Objectives: In this retrospective study, the epidemiology of calcinosis cutis and the effectiveness of various treatment regimens in its management were assessed in a single center. Materials and Methods: The data of 34 patients suffering from calcinosis cutis (male:female = 12:22; mean age = 48.6 ± 18.6 years) treated at our department between 2003 and 2016 were analyzed retrospectively. Results: Dystrophic, idiopathic, metastatic subtype, and calciphylaxis occurred in 70.6%, 11.8%, 5.9%, and 11.8% of the cases, respectively. Underlying diseases of dystrophic calcinosis included autoimmune connective tissue disease, skin trauma, cutaneous neoplasm, and inherited disorder in 58.3%, 20.8%, 12.5%, and 8.3% of the cases, respectively. Extremities were most frequently affected (n = 18). In the management, diltiazem was most frequently used in monotherapy with partial response in five of eight cases. Other drugs in monotherapy or in combination were administered in single cases. Surgical treatment resulted in least partial response in all of the cases followed (n = 7). Conclusion: Dystrophic was the most common subtype and autoimmune connective tissue disease was the most frequent underlying disease. We conclude that lower doses of diltiazem have only partial efficiency, and surgical therapy is at least partially effective in localized calcinosis.
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Association of acanthosis nigricans and acrochordon with insulin resistance: A cross-sectional hospital-based study from North India p. 112
Satyendra K Singh, Neeraj K Agrawal, Ajay K Vishwakarma
Background: Insulin resistance (IR) is a pre-diabetic condition and has been reported in patients with acanthosis nigricans (AN) and acrochordon. AN and acrochordon are claimed to be cutaneous markers of IR. Aim: The purpose of this paper was to study the association of AN and acrochordon with IR. Methods: It was a cross-sectional hospital-based study. Both groups were assessed for IR by using homeostatic model assessment of insulin resistance (HOMA-IR) formula. Results: A total of 70 cases and an equal number of controls were studied. IR was observed more in cases (41.4%) compared to controls (17.1%) (P < 0.01). Mean HOMA-IR value was also significantly higher in cases (4.32 ± 4.44) compared to controls (2.27 ± 0.90) (P < 0.05). Limitations: Low number of cases and controls were taken in the study. Association with hyperlipidemia and metabolic syndrome was not elicited. Conclusions: AN and acrochordons were found to be associated with IR.
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The current Indian epidemic of dermatophytosis: A study on causative agents and sensitivity patterns Highly accessed article p. 118
Sudip Das, Abhishek De, Rajdeep Saha, Nidhi Sharma, Monika Khemka, Sonal Singh, Abu Hena Hesanoor Reja, Purushottam Kumar
Background: In the recent years, the frequency, severity, clinical characteristics, treatment response, and relapse rate of dermatophytosis have dramatically changed in India. Given the surge in dermatophytosis, we had undertaken a study to isolate and identify the common species causing dermatophyte infection and to know the in vitro efficacy of the common antifungals against them. Materials and Methods: total of 103 new cases that were not on any treatment for the past 3 months were included. Skin scrapings were collected for direct microscopic examination and for fungal culture in Sabouraud 4% dextrose agar (SDA) with chloramphenicol and cycloheximide slant tubes, and dermatophyte test media. Fungi were identified on the basis of their macroscopic and microscopic features with the help of lactophenol cotton blue staining and urease test. Also, the drug sensitivity of the dermatophytes was tested with the common antifungals. Results: Of the 55 cases (53.4%) that were positive for dermatophytes in the culture, 29 showed possible contamination. Trichophyton was the predominant organism (49 cases) with T. verrucosum being the commonest species (26 cases), followed by T. rubrum (15 patients), and T. mentagrophytes(8 cases). All species of Trichophyton were found to be most sensitive to itraconazole amongst systemic antifungals and luliconazole amongst topical antifungals. Conclusion: This study concluded that the causative agent for the dermatophytosis was changing in India and in our subset, T. verrucosum caused the maximum number of infections. Itraconazole and luliconazole had the highest sensitivity amongst systemic and topical antifungals, respectively. It also showed that terbinafine had comparatively less sensitivity to most organisms.
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Mycosis fungoides: A clinicopathological study of 60 cases from a tertiary care center p. 123
Saira Fatima, Sabeehuddin Siddiqui, Muhammad Usman Tariq, Hira Ishtiaque, Romana Idrees, Zubair Ahmed, Arsalan Ahmed
Background: Mycosis fungoides (MF) is the most common primary cutaneous lymphoma. It affects usually the covered areas of the body in elderly males in 6th and 7th decades of life. Atypical dermal lymphoid infiltrate is seen along with epidermotropism. Nuclei of neoplastic cells are convoluted. The neoplastic cells demonstrate positivity for CD3 (Pan T) immunohistochemical stain. Majority show increased CD4 to CD8 ratio. The present study was done to study the clinicopathological features, which might be of help in reaching a correct diagnosis in these cases. Materials and Methods: A retrospective descriptive study was conducted on 60 reported cases of MF. The retrieved slides were reviewed for clinical and histopathological features and immunohistochemical profile. Results: The ages ranged from 20–84 years, mean age was 47 years. Majority (75%) of patients were male. Trunk and extremities were the sites most commonly affected. There was significant inverse correlation between epidermal thickness and tumor stage (P = 0.02). Thickened epidermis was seen in patch stage and thickness reduced with progressing stage. The intensity of dermal infiltrate and cell size was also statistically significantly linked to stage progression (P < 0.001 each). In addition, proliferation index also correlated significantly with tumor stage (P = 0.002). Conclusion: Clinical information and histological features are equally important in the accurate diagnosis of MF. Papillary dermal fibrosis is a useful diagnostic clue. CD4:CD8 ratio is not increased in all cases; it may be decreased or remain unchanged.
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Follicular Becker's nevus: A new clinical variant p. 130
Yashpal Manchanda, Binod K Khaitan, M Ramam, Sudip Das, Nawaf Al-Mutairi
Becker's nevus, also known as pigmented hairy epidermal nevus, is characteristically described as a unilateral, hairy, light to dark brown macule with sharply outlined but irregular border. The etiopathogenesis of Becker's nevus is still not clearly understood. Perifollicular pigmentation has been described earlier by some authors. But, Becker's nevus presenting exclusively with follicular lesions has not been described. We are reporting a series of patients of Becker's nevus with follicular lesions. The diagnosis in all the patients was made after clinicopathological correlation. Follicular epithelium may hold a significant role in the etiopathogenesis of Becker's nevus.
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Primary chylous lymphangiectasia of female genitalia p. 133
Pradeep Balasubramanian, K Akila, CR Srinivas, KK Kamaleshwar
We report a case of a 50-year-old female who presented with multiple thick-walled vesicles involving the labia majora and minora which started developing at the age of 10 year. The vesicles extruded milky white fluid when punctured. Biochemical analysis of the fluid was consistent with chyle. Lymphoscintigraphy showed reflux of the radioactive tracer into the genitalia, thus confirming the diagnosis of primary chylous lymphangiectasia. The patient was not willing to undergo definitive surgical treatment. We report the case considering the rarity and to depict the usage of biochemical analysis of the vesicular content and lymphoscintigraphy to detect this entity.
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Lichen Planopilaris developing at the margins of a sebaceous nevus of jadassohn: Co-existence or etiologic association? p. 136
Alexander C Katoulis, Despina Mortaki, Dimitrios Sgouros, Aikaterini I Liakou, Evangelia Bozi, Dimitra Koumaki, Korina Tzima, Ioannis Panayiotides
Sebaceous nevus (SN), is a skin hamartoma, combining a variety of epidermal, follicular, sebaceous, and apocrine abnormalities. Although usually present at birth, it may become apparent later in life appearing as a yellowish-brown, verrucous plaque with alopecia. SN is implicated with secondary tumors arising on the hairless plaque during the adulthood. Lichen planopilaris is a common, primary lymphocytic scarring alopecia of unknown etiology, characterized by lichenoid/interface perifollicular lymphocytic infiltrate occurring at the level of the infundibulum and the isthmus. Here, we present a case of a 48-year-old Caucasian male with lichen planopilaris lesions developing at the periphery of a preexisting SN. Our case raises the question, whether the development of lichen planopilaris was coincidental, or is it indicative of an etiologic association between the lichen planopilaris and SN.
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Intractable chronic granulomatous perioral dermatitis in patients receiving growth hormone therapy: A new association between CGPD and GH p. 139
Ji Young Young, Jung Im Na
Childhood granulomatous periorificial dermatitis (CGPD) is a self-limiting skin condition characterized by papular eruptions around the mouth, nose and eyes of preadolescent children. We report two cases of intractable CGPD in which patients receiving growth hormone (GH) therapy showed persistent symptoms despite multiple treatment modalities. This association may suggest the role of GH in the pathogenesis of CGPD.
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Autologous platelet-rich gel treatment of chronic nonhealing ulcerated tophaceous gout p. 141
Dawei Chen, Chun Wang, Lina Cui, Xingwu Ran
Ulcers resulting from tophaceous gout are uncommon and very difficult to heal. Here we report a case with chronic refractory tophaceous gout, not responding to conventional treatment modality for several months in a 39-year-old man with a 12-year history of gout with recurrent acute arthritis attacks. Two times after treatment with autologous platelet-rich gel (APG), the ulcer healed finally for 2 months. This is the first study to confirm that APG can improve tophus ulcer healing. Based on conventional medical therapy and standard debridement, APG might be a novel and effective method to stimulate tophus ulcer healing.
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Lymphoma on the nasal dorsum: Report of a rare case p. 145
Lei Zhu, Haibo Liu, Zhongying Fu, Jianmei Yin
Lymphoma over the nasal dorsum has never been reported. Herein, we report the case of a 74-year-old man who presented with a rapid swelling on the nasal dorsum. A physical examination revealed a firm, immobile, non-tender mass. Computed tomography revealed a space-occupying lesion in the subdermal layer of the nasal dorsum that was most likely a fibroma. An excisional biopsy was performed. Surprisingly, histopathological and immunohistochemical analyses identified a diffuse large B-cell lymphoma. The patient underwent seven cycles of chemotherapy comprising of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone. He responded well to the regimen. No evidence of persistent or recurrent disease had been detected during the 9 months after his last chemotherapy session. Although never reported previously, lymphoma can mimic common midline nasal soft-tissue tumors and should be considered in the differential diagnosis.
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Cutaneous metastasis of signet cell gastric carcinoma p. 148
Simay Cokgezer, Nilay Sengul Samanci, Mert Bektas, Nuray Kepil, Fuat Hulusi Demirelli
Gastric cancer is the fourth most commonly diagnosed cancer and the second most common cause of cancer-related death worldwide. Cutaneous metastases of signet-ring cell gastric carcinoma are uncommon. Here, we report a metastatic gastric adenocarcinoma, which manifested itself as an asymptomatic scar-like lesion on the epigastric area and histopathological features of the cutaneous lesion showing signet-ring cell.
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Hidradenoma papilliferum: Everyone else's diagnosis p. 151
Shreya Patel, William Clark Lambert, Sara Behbanani, Jose D Espinal-Mariotte, Patricia Lee
A 52-year-old female presented with an asymptomatic cyst-like lesion on her right labia majora present for several years. Excision revealed a 3-mm cystic lesion containing complex networks of thin fronds of clear apocrine cells and basaloid cells, features characteristic of hidradenoma papilliferum (HP). In contrast to the medical literature, the lesion was connected to the overlying epithelium by a straight duct, a feature characteristic of apocrine glands. Searching of six different dermatopathology study sets revealed 11 cases diagnosed as HP. Histological review of the eight available cases for review revealed none that were diagnosed correctly. Six were syringocystadenoma papilliferum and two were trichoepithelioma. HP is a fascinating lesion that needs further study and requires better diagnostic criteria.
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Tumor necrosis factor-alpha polymorphisms in the pathogenesis of chronic spontaneous urticaria p. 154
Zenon Brzoza, Barbara Rymarczyk, Wladyslaw Grzeszczak, Wanda Trautsolt, Anita Oles-Krykowska, Marzena Pluta-Kubicz, Dariusz Moczulski
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A rare case of Kimura disease p. 155
Preema Sinha, Saikat Bhattacharjee, Aradhana Sood, Jasvinder Kaur Kaur, Sunmeet Sandhu
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Atypical targetoid eruption induced by sorafenib in a patient with hepatocellular carcinoma p. 158
Pinar Incel Uysal, Onder Bozdogan, Nuran Alli, Pelin Demirel
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Urticaria due to acitretin in a patient with lichen planus p. 160
Hilal Kaya Erdogan, Tuba Erdogan, Ersoy Acer, Zeynep N Saracoglu
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The value of HLA typing in severe cutaneous drug reactions p. 162
Sujoy Khan, Biswajit Ghosh
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Bullous erythema elevatum diutinum associated with immunoglobulin a monoclonal gammopathy: An atypical variant p. 164
Pedro Jesus Gomez Arias, José Luis Hernández Romero, Juan Luis Sanz Cabanillas, Beatriz Baleato Gómez, Antonio José Vélez García-Nieto
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Preliminary assessment for postsurgical scar treatment with the novel low-energy plasma skin regeneration technique p. 166
Adone Baroni
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Diagnostic clues for pagetoid Bowen's disease p. 167
Binluen Chiang, Koji Kamiya, Takeo Maekawa, Mayumi Komine, Satoru Murata, Mamitaro Ohtsuki
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Cutaneous myopericytoma on the forehead: A rare localization p. 169
Dua Cebeci, şirin Yaşar, Pembegül Güneş, Sema Aytekin
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