Indian Journal of Dermatology
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   Table of Contents - Current issue
Coverpage
July-August 2020
Volume 65 | Issue 4
Page Nos. 251-335

Online since Thursday, June 11, 2020

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SPECIAL ARTICLE  

Coronavirus disease of 2019 (COVID-19) facts and figures: What every dermatologist should know in this hour of need Highly accessed article p. 251
Yashpal Manchanda, Sudip Das, Abhishek De
DOI:10.4103/ijd.IJD_360_20  
Coronavirus disease of 2019 (COVID-19) pandemic has affected India and world as a whole, like nothing in the recent history and we, dermatologists, are also affected directly or indirectly. In this review, we have tried to address all COVID-19-related information we need to be aware of as a health-care professional. We have discussed the relevant details of the disease: the agent, the symptomatology, common preventive measures, investigations, and management outline. We have also discussed the implications of COVID-19 in dermatology practice and given a basic guideline for dermatology practice during the pandemic
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BASIC RESEARCH Top

Vitamin D Receptor gene polymorphisms taq-1 and cdx-1 in female pattern hair loss p. 259
Iman Seleit, Ola Ahmed Bakry, Eman Badr, Mai Mabrouk
DOI:10.4103/ijd.IJD_482_18  
Background: Female pattern hair loss (FPHL) is an important cause of hair loss in adult women and has a major impact on patient's quality of life. It evolves from the progressive miniaturization of follicles that leads to a subsequent decrease of hair density, leading to non-scarring diffuse alopecia, with characteristic clinical, dermoscopic, and histological patterns. Vitamin D receptor (VDR) is expressed in follicular keratinocytes and dermal papilla cells and is shown to have important role in hair growth and regulation of hair cycle. VDR polymorphism was not extensively investigated in hair disorders including FPHL. Aim: To investigate the association between VDR gene polymorphism (Cdx-1 and Taq-1) and FPHL to explore if these polymorphisms affect the disease occurrence or influence its clinical presentation. Methods: A case-control study was conducted on 30 female patients with FPHL and 30 age-matched female healthy subjects, as a control group. Degree of hair loss was assessed by Ludwig grading. VDR gene polymorphisms, Taq-1 and Cdx-1 were investigated by real time polymerase chain reaction. Results: CC genotype, TC genotype, and T allele of Taq-1 were more prevalent in FPHL patients than in control group. They increased disease risk by 12.6, 2.1, and 2.9 folds, respectively. AA genotype, GA genotype, and G allele of Cdx-1 were significantly more prevalent among FPHL patients than in control group. They increased disease risk by 7.5, 5.2, and 5.5 folds, respectively. Conclusion: Taq-1 and Cdx-1 can be considered as risk factors for FPHL. They may play role in disease persistence rather than disease initiation. This association may be explained by failure of new anagen growth and decreased proliferation of hair follicle stem cells. Further studies are recommended to confirm current findings.
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ORIGINAL ARTICLES Top

Correlation of buccal micronucleus with disease activity score using buccal micronucleus cytome analysis (BMCA) in systemic lupus erythematosus p. 265
Khalil Assiri, Mohammad Shahul Hameed, Ali Azhar Dawasaz, Eman Alamoudi, Alhussain Mohammad Asiri, Hitesh Vij, Muhammed Ajmal
DOI:10.4103/ijd.IJD_620_18  
Background: A disease activity score obtained by using systemic lupus erythematosus disease activity index (SLEDAI) has traditionally been a reliable method to assess the SLE status of patients. More recently, a buccal micronucleus cytome assay (BMCA) has been developed for use as a biomarker of DNA damage in patients with SLE. There has been a very limited number of studies pertaining to the oral lesions in Arab population suffering from SLE in Asir region. Hence, it became utmost important to study epidemiological data of oral mucosal lesions in SLE patients. Distribution of oral lesions in SLE patients could also be helpful in better management of oral complications. Aim: The aim of this study was to determine the existence of a correlation between SLEDAI score and the degree of micronuclei (MN) formation using BMCA. Materials and Methods: After thorough oral examination of adult Saudi SLE patients of Asir hospital and that of healthy control subjects, the subjects underwent BMCA from normal unaffected bilateral buccal mucosae. Results: Pearson's correlation test showed that MN count did not significantly correlate with either disease activity or duration of SLE. Conclusions: Controlled state SLE does not lead to a significant increase in MN formation. Thus, the occurrence of premalignant lesions in the oral cavity could be minimized using proper management protocols.
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Epidemiological pattern of contact dermatitis among urban and rural Patients attending a tertiary care center in a semi-urban area in Eastern India p. 269
Shinjini Ghosh, Sourav Kundu, Sanjay Ghosh
DOI:10.4103/ijd.IJD_792_19  
Background: There is a trend of increase in number of contact dermatitis cases. Studies on the prevalence and epidemiological pattern of allergic skin disorders in Indian scenario are not much available. The present study was designed to assess the epidemiological pattern of contact dermatitis in rural and urban areas in a peripheral district in eastern India. Aims and Objectives: This study was undertaken to find the prevalence of contact dermatitis and to assess the epidemiological pattern of contact dermatitis both in rural and urban community. Materials and Methods: The study was conducted in a medical college located at a semi-urban area in eastern India with written informed consent obtained from each participant. This hospital-based cross-sectional study was done from May 2017 to April 2018. Study population consisted of patients attending the dermatology OPD and having lesions clinically suggestive of contact dermatitis and there were 268 such patients. Patients attending the OPD were divided into urban and rural as per their address. Data analysis was done using suitable, standard, and appropriate statistical methods. Results: The prevalence of contact dermatitis was 4.38% among the dermatology OPD attendees. Urban prevalence was statistically significantly (P < 0.05) higher than rural prevalence. Contact dermatitis was common in the age group of 41–50 years. In urban areas, females were more affected than those in rural areas. Occupationally, the difference between urban and rural patients of contact dermatitis was statistically significant (P < 0.05). Cosmetic history in the urban group was significantly more (P < 0.05). Conclusions: Contact dermatitis prevalence and patient profile in certain factors showed a statistically significant difference between urban and rural patients.
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Clinical features, risk factors, and prognostic markers of drug-induced liver injury in patients with stevens-johnson syndrome/toxic epidermal necrolysis p. 274
Zhibin Zhang, Sisi Li, Zhixiong Zhang, Kaihui Yu, Xunxin Duan, Lin Long, Shulan Zhang, Meiying Jiang, Ougen Liu
DOI:10.4103/ijd.IJD_217_19  
Background: The liver and skin are the most common organs involved in Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Drug reactions rarely affect both organs concurrently. The clinical features, risk factors, and prognostic markers of drug-induced liver injury (DILI) in patients with SJS/TEN are not well studied. Materials and Methods: The clinical features, risk factors, and prognostic markers of DILI in patients with SJS/TEN hospitalized at the dermatology department of our hospital from January 2009 to December 2018 were retrospectively analyzed. Results: A total of 298 patients with SJS/TEN were enrolled in this study. Of them, 40 had liver injury and the rest served as control. Causative drugs mainly included antipodagrics (xanthine oxidase inhibitors occupying 100% among antipodagrics), anticonvulsants (dibenzazepine occupying 76.92% among anticonvulsants), and traditional Chinese medicines. There was a statistically significant difference between the patients with liver injury and the control group in the history of liver disease, diabetes, and hyperlipidemia (P < 0.05). Nine of the 40 patients with liver injury died. High serum total bilirubin and creatinine levels were significantly associated with poor prognosis of DILI in patients with SJS/TEN (P < 0.05). Conclusion: DILI usually occurs in patients with SJS/TEN. Pre-existing liver disease, diabetes, and hyperlipidemia are independent risk factors for DILI in patients with SJS/TEN. High serum total bilirubin and creatinine levels may be useful prognostic markers for DILI in patients with SJS/TEN.
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Comparative evaluation of topical corticosteroid and moisturizer in the prevention of radiodermatitis in breast cancer radiotherapy p. 279
Bora Uysal, Hakan Gamsız, Ferrat Dincoglan, Selcuk Demiral, Omer Sager, Bahar Dirican, Murat Beyzadeoglu
DOI:10.4103/ijd.IJD_607_18  
Background: Radiodermatitis is a frequent side effect of breast cancer radiotherapy (RT). Treating radiation oncologist should know the prevention and treatment of every grade of radiodermatitis. Aims: The aim of this study was to compare the topical corticosteroid and moisturizer usage in breast cancer RT. Materials and Methods: Fifty patients with early-stage breast cancer undergoing breast-conserving surgery referred to our department for adjuvant RT between October 2009 and October 2016 were compared with regard to topical steroid or moisturizer usage. Patients were followed up weekly after the start of treatment. Results: Mean age was 46 years. Twenty-four patients had stage 1 breast cancer and 26 patients had stage 2 disease. KPS (Karnofsky performance score) was 100 for all patients. Five patients (20.8%) had grade 2 and seven (29.1%) patients had grade 1 acute radiodermatitis in the first group. Eleven (42.3%) patients had grade 2 and 12 (46.1%) patients had grade 1 acute radiodermatitis in the second group. Thirteen (54.1%) patients in the first group had no acute radiodermatitis and three (11.5%) patients in the second group had no acute radiodermatitis. No patient in either group experienced grade 3 radiodermatitis. Conclusions: Daily use of topical betamethasone for breast cancer RT improves dermal sparing, reduces acute radiodermatitis, and may be recommended for patients receiving RT to the breast.
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Efficacy of terbinafine and itraconazole in different doses and in combination in the treatment of tinea infection: A randomized controlled parallel group open labeled trial with clinico-mycological correlation Highly accessed article p. 284
Satyendra K Singh, Najuma Subba, Ragini Tilak
DOI:10.4103/ijd.IJD_548_19  
Background: There is a rising prevalence of dermatophyte infection especially in the tropics. It has been observed that the antifungals are not as effective as they used to be. Aims: To determine the effectiveness of terbinafine and itraconazole in different doses and in combination in the treatment of tinea infection. Materials and Methods: Study design was a randomized parallel group trial. Patients were randomly divided into five parallel arms in which two of the standard drugs in recommended doses were compared with their double doses and with combination of both the drugs. Patients were followed up every 2 weeks. Outcomes were assessed at 4 and 8 weeks. Cure was considered as complete clinical resolution of the lesions. Fungal culture and sensitivity were done by disk diffusion method for all patients. Parametric one-way analysis of variance (F test) and Chi-square test were used for the analysis. Results: Two-hundred seventy-five patients were included in the study. Itraconazole containing groups showed significantly higher cure rates than terbinafine only groups both at 4 and 8 weeks (P < 0.001). Itraconazole containing groups, when compared against each other, were not found to be significantly different. The outcomes between terbinafine only groups were also not significantly different. Cure rates at 8 weeks were found to be greater than that at 4 weeks for all groups which were found to be highly significant (P < 0.001). Conclusions: Itraconazole seems to be more effective than terbinafine. There is no benefit in increasing the dose or using a combination regimen in the treatment of tinea. Prolonged duration of treatment is required for complete cure.
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CASE REPORTS Top

Dermoscopy of follicular dowling–degos disease p. 290
Garima Dabas, Rahul Mahajan, TP Afra, Dipankar De, Sanjeev Handa, Divya Aggarwal, Bishan Das Radotra
DOI:10.4103/ijd.IJD_260_18  
Dowling–Degos disease (DDD) is a late-onset genodermatosis characterized by hyperpigmented macules on the flexures along with scattered comedo-like lesions and pitted acneiform scars. Follicular Dowling–Degos is a rare type of DDD, with only two reports so far. It presents with follicular papules and comedo-like lesions predominantly on the face and trunk. Dermoscopy of follicular DDD shows irregular star-shaped/Chinese letter pattern pigmentation along with comedo-like lesions. Herein, we describe diagnostic clues including dermoscopy in three patients of follicular DDD which can help in differentiating it from other disorders presenting with comedo-like lesions .
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Dowling–Degos disease with follicular involvement associated with hidradenitis suppurativa: A manifestation of follicular occlusion phenomenon? p. 295
Bhagyashree Babanrao Supekar, Kinjal Deepak Rambhia, Rajesh Pratap Singh, Jayesh Ishwardas Mukhi
DOI:10.4103/ijd.IJD_392_18  
A 30-year-old female patient presented with progressive reticulate pigmentation of the neck, upper chest, back, cubital fossa, and axillae since the age of 15 years. The patient also complained of recurrent multiple tender nodules and plaques associated with sinuses and pus discharge over the axillae, groins, and buttocks which healed with scarring for 4 years. There were multiple pitted scars and hyperpigmented macules over the perioral area and cheeks. Scattered comedo-like lesions were present over the upper back, chest, cubital fossae, and buttocks. Histopathology from the pigmented lesion revealed thinning of the suprapapillary epidermis, epidermal hyperplasia with finger-like elongation of the rete ridges, and increased pigmentation of their lower part, suggestive of Dowling–Degos disease (DDD). Biopsy section from comedonal lesion showed dilated infundibulum and antler-like rete ridges suggestive of follicular DDD. We report a case of DDD with follicular involvement and hidradenitis suppurativa (HS) which is a rare association and can be explained on the basis of single underlying defect in follicular epithelial proliferation. DDD-HS has been shown to result from mutations in PSENEN, encoding a critical component of the γ-secretase complex.
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Sisters with no pain, no tears: A report of a new variant of hereditary sensory and autonomic neuropathy (Type IX) Caused by a novel SCN11A mutation p. 299
Shital Poojary, Saurabh Jaiswal, Kapisha Sunny Shah, Krishna B Bhalala
DOI:10.4103/ijd.IJD_416_18  
Lack of pain sensation in children involves a rare group of heritable disorders; hereditary sensory and autonomic neuropathy (HSAN). Till date, eight types of HSAN have been described depending on the clinical phenotype and the underlying gene mutation. We report a new variant of HSAN (Type IX) in two siblings (of Indian origin) with a novel mutation of SCN11Agene and a distinct clinical phenotype.
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Crusted scabies complicated with herpes simplex and sepsis p. 304
Arghavan Azizpour, Maryam Nasimi, Alireza Ghanadan, Fariba Mohammadi, Safoura Shakoei
DOI:10.4103/ijd.IJD_463_18  
Crusted scabies is a rare and extremely contagious infestation by Sarcoptes scabiei. Kaposi's varicelliform eruption (KVE) refers to herpes simplex virus infection superimposed on pre-existing dermatosis such as atopic dermatitis, Darier's disease, and pemphigus. We report a case of KVE superimposed on crusted scabies in a middle-aged woman. Her condition was complicated with sepsis. She was treated with IV meropenem, vancomycin, and acyclovir and was released 2 weeks later in good condition. To our knowledge, only rare cases of crusted scabies complicated by KVE have been reported.
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Arthropod bite-like eruption as rare presentation of secondary syphilis in an HIV-infected patient p. 307
Chih-Yu Chen, Yu-Hsuan Lu, Yu-Chun Lin, Chih-Tsung Hung, Wei- Ming Wang, Chien-Ping Chiang
DOI:10.4103/ijd.IJD_522_18  
Secondary syphilis represents a diagnostic challenge due to its varied clinical manifestations. Co-infection with human immunodeficiency virus (HIV) adds to the diversity of the clinical presentation of syphilis. We herein report a case of secondary syphilis as an arthropod bite-like eruption in a previously undiagnosed HIV-coinfected patient. A 24-year-old homosexual male presented with multiple corticosteroid-resistant insect bite-like nodules on his trunk and bilateral arms. Skin biopsy disclosed plasma cell infiltration and positive Treponema pallidum staining. His symptoms got dramatic remission after benzathine penicillin G therapy. The presented case extends the clinical spectrum of secondary syphilis in HIV patient.
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A rare case of tumoral scleromyxedema p. 310
Ali Sadeghinia, Mohammad Al Salman, Jafar Taghizadeh Fazli, Pedram Normohammadpour, Amir Hooshang Ehsani, Seyed Naser Emadi
DOI:10.4103/ijd.IJD_450_18  
Scleromyxedema is an uncommon disease, affecting the skin mainly and other internal organs sometimes, characterized by fibroblasts proliferation, fibrosis, and mucous deposition in the absence of thyroid disorder. It is associated with monoclonal gammopathy in most cases. We are reporting a case with a rare presentation of tumoral scleromyxedema in the neck, with a mass mimicking other tumoral lesions, highlighting the importance of diagnosis and histopathologic correlation.
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QUIZ Top

A depressed hyperpigmented nodule on back of a middle aged man p. 313
Mohamad R Namazi, Poorya Neshat, Ahmad Monabati, Maryam Hadibarhaghtalab
DOI:10.4103/ijd.IJD_603_18  
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CORRESPONDENCES Top

Three sequential lymphomatous tumors in a patient - Reader's question p. 315
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/ijd.IJD_487_18  
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Three sequential lymphomatous tumours in a patient - Authors' reply p. 315
Ellie Choi, Sam Yang, Kong Bing Tan, Derrick Aw, Nisha Suyien Chandran
DOI:10.4103/ijd.IJD_687_18  
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Useful dermoscopic findings for differentiating rosacea from seborrheic dermatitis p. 316
In-Hye Kang, Jong-Kil Seo, Min-Kyung Shin
DOI:10.4103/ijd.IJD_44_19  
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Cricumscribed and multiple hidroacanthoma simplex p. 318
Hao Luo, Wei Zhao, Fei Wu, Long Jiang, Jianna Yan, Yuchong Chen, Xiaogang Chen, Liang Li, Xiaojing Liu, Yichen Tang, Yeqiang Liu
DOI:10.4103/ijd.IJD_4_19  
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A report of multiple autoimmune syndrome: Pemphigus vulgaris associated with several immune-related diseases after thymectomy p. 320
Xiao-Lei Ge, Si-Zhe Li, Wei Wang, Ya-Gang Zuo
DOI:10.4103/ijd.IJD_89_19  
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Comedonic isotopic response: An uncommon sequela of a common disorder p. 322
Shuang Xu, Cheng Tan
DOI:10.4103/ijd.IJD_198_19  
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Amicrobial pustulosis of the folds: Report of three new cases p. 323
Francesco Bellinato, Martina Maurelli, Chiara Colato, Giampiero Girolomoni
DOI:10.4103/ijd.IJD_120_19  
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Recurrent disseminated cutaneous rhinosporidiosis - Where is the end? p. 325
C Chandrakala, GK Tharini
DOI:10.4103/ijd.IJD_164_19  
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Varicella infection: A rare but important consideration in a toxic epidermal necrolysis-like eruption p. 327
Brian Keng Yong Chia, Inny Busmanis, Yeo Yi Wei, Shiu Ming Pang
DOI:10.4103/ijd.IJD_377_18  
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Fractional CO2Laser treatment for cutaneous leiomyomas in a patient with Reed's syndrome p. 329
Tubanur Çetinarslan, Aylin Türel Ermertcan, MK Evrenos, Peyker Temiz
DOI:10.4103/ijd.IJD_126_19  
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Hibernoma of the eyelid p. 331
Shreya Patel, Loka Thangamathesvaran, Sara Behbahani, Radhika Shah, Paul Langer, James Milite, William Clark Lambert
DOI:10.4103/ijd.IJD_345_18  
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A rare case report of photosensitivity in non-hodgkin's lymphoma treated with lenalidomide p. 333
Rajesh K Soni, Bhagyashree B Supekar, Jayesh I Mukhi, Rajesh P Singh
DOI:10.4103/ijd.IJD_64_19  
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