Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 848  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Reader Login 
    Small font sizeDefault font sizeIncrease font size Print this page Email this page
Export selected to
Endnote
Reference Manager
Procite
Medlars Format
RefWorks Format
BibTex Format
  Citation statistics : Table of Contents
   2012| July-August  | Volume 57 | Issue 4  
    Online since June 29, 2012

 
 
  Archives   Previous Issue   Next Issue   Most popular articles   Most cited articles
 
Hide all abstracts  Show selected abstracts  Export selected to
  Cited Viewed PDF
THERAPEUTIC ROUND
Efficacy of 2% metronidazole gel in moderate acne vulgaris
Effat Khodaeiani, Rohollah F Fouladi, Neda Yousefi, Mehdi Amirnia, Shahla Babaeinejad, Javad Shokri
July-August 2012, 57(4):279-281
DOI:10.4103/0019-5154.97666  PMID:22837561
Background: Acne vulgaris is an inflammatory disease of the pilosebaceous units. Various systemic and topical options are available for its treatment. Aims: This study aimed to evaluate the efficacy of 2% metronidazole gel in acne vulgaris. Materials and Methods: Double-blind, randomized, placebo-controlled, split-face clinical trial. Seventy young adults with moderate acne vulgaris received 2% metronidazole gel on the right side of their face and placebo on the left side of their face twice daily for 8 weeks. The number of inflamed and noninflamed facial lesions and side effects of treatment were documented on weeks 1, 2, 4, and 8. The patients' overall satisfaction was recorded at the end of the study. For statistical analysis we used the repeated-measures analysis, the chi-square test, Fisher's exact test, and the independent-samples t-test as appropriate. Results: Counts of inflamed and noninflamed facial lesions were comparable between the two sides at baseline. The number of the lesions was significantly lower on the metronidazole-treated side at all follow-up visits. Erythema and oily face decreased by 85.7% and 87.1%, respectively, on the metronidazole-treated side. Mild burning sensation and dryness on the metronidazole-treated side was reported by 3.4% and 22.9% of the patients, respectively. Eighty-eight percent of the patients were satisfied with the results of treatment on the metronidazole-treated side. Conclusions: Metronidazole gel (2%) is an effective, safe, and well-tolerated topical medication for moderate acne vulgaris.
  19 5,536 192
CASE REPORTS
Tinea capitis in the form of concentric rings in an HIV positive adult on antiretroviral treatment
Kirti Narang, Manish Pahwa, V Ramesh
July-August 2012, 57(4):288-290
DOI:10.4103/0019-5154.97672  PMID:22837564
Dermatophyte infection may present in the form of concentric rings caused by Trichophyton concentricum, known as Tinea Imbricata. In immunosuppressed patients, there are reports of lesions in the form of concentric rings caused by dermatophytes other than Trichophyton concentricum too, mostly by Trichophyton tonsurans, known as Tinea indesiciva or Tinea pseudoimbricata. We report a case of tinea capitis in a HIV-positive adult woman on antiretroviral therapy, who presented with concentric rings of papules and pustules with slight scaling on the scalp along with diffuse thinning of hair. Both Potassium hydroxide mount and culture showed the presence of Dermatophytes. Tinea capitis is considered rare in adults, but new cases are being reported in immunocompromised as well as in immunocompetent patients. The pertinent features of this case are: HIV-positive adult female on antiretroviral therapy, presenting with tinea capitis in the form of concentric rings; culture from the lesion grew Microsporum audouinii; responding to oral Terbinafine.
  6 4,506 85
CORRESPONDENCE
Zosteriform fixed drug eruption to levofloxacin
TP Vetrichevvel, R Sudha, S Shobana, S Anandan
July-August 2012, 57(4):327-328
DOI:10.4103/0019-5154.97688  PMID:22837580
  4 2,430 85
CASE REPORTS
Chronic bullous disease of childhood with IgG predominance: What is the locus standi?
Nayeem Sadath Haneef, S Ramachandra, Arun Kumar Metta, L Srujana
July-August 2012, 57(4):285-287
DOI:10.4103/0019-5154.97670  PMID:22837563
Linear IgA disease (LAD) is an acquired, autoimmune, subepidermal, blistering disease, characterized by linear deposition of IgA along the dermoepidermal junction on immunofluorescence. Some cases known as 'mixed immunobullous disease' show weak staining with other immune reactants like IgG, IgM or C3. We report a rare case of a child having typical manifestations of LAD (chronic bullous disease of childhood), but with IgG predominance rather than IgA. Obviously it is improper to term this as linear IgA disease. Such cases are reported in literature as variants of LAD, with a multitude of terms like mixed immune bullous disease, linear IgG / IgA disease, linear IgA / IgG disease, and so on. In view of the tremendous confusion that these multiple terms cause in the absence of any practical benefit, we propose that the broad term 'chronic bullous disease of childhood' be applied to all childhood cases, irrespective of the nature of the immune deposits.
  3 4,774 82
REVIEW ARTICLE
Rational and ethical use of topical corticosteroids based on safety and efficacy
Sanjay K Rathi, Paschal D'Souza
July-August 2012, 57(4):251-259
DOI:10.4103/0019-5154.97655  PMID:22837556
Topical corticosteroids (TC) have greatly contributed to the dermatologist's ability to effectively treat several difficult dermatoses. The available range of formulations and potency gives flexibility to treat all groups of patients, different phases of disease, and different anatomic sites. However, the rapid rise in incidence of improper use of these drugs by dermatologists, general physicians, and patients threatens to bring disrepute to the entire group of these amazing drugs. Responsibility to disseminate proper knowledge regarding when, where, and how to use TC both to internists and patients rests primarily with the dermatologist. Benefits of rational and ethical use and the harm of overuse and misuse for nonmedical, specially for cosmetic purposes, should be clearly conveyed before penning a prescription involving TC. Simultaneous efforts to use political, legal, and other institutions to prevent misuse of these drugs by rationing their availability only through proper prescriptions will greatly help the cause. This will hopefully bring down both the extremes of ever increasing cases of steroid-induced dermatoses on one hand and the irrational fears of using TC in well justified indications on the other.
  3 25,653 722
SHORT COMMUNICATION
High risk factors for severe hand, foot and mouth disease: A multicenter retrospective survey in Anhui Province China, 2008-2009
Jiahua Pan, Mingwu Chen, Xuzhong Zhang, Yulong Chen, Hui Liu, Wei Shen
July-August 2012, 57(4):316-321
DOI:10.4103/0019-5154.97683  PMID:22837575
Objectives: This study sought to determine the high risk factors for severe hand, foot, and mouth disease (HFMD). Materials and Methods: Retrospective 229 severe HFMD cases from four hospitals in FuYang, HeFei, and BoZhou (Anhui Provincial Hospital, Fuyang City People's Hospital, No. 2 People's Hospital of Fuyang and Bozhou city People's Hospital) in 2008-2009 were studied, with 140 mild HFMD cases in the same area. Using univariate and multivariate logistic regression analyses, the high risk factors of HFMD were identified by comparing clinical and laboratory findings between severe cases and mild cases. Results: There was a significant difference in age, total duration of fever, rate of respiratory and heart, shake of limbs, white blood cell count, blood sugar, and CK-MB between the two groups. Univariate logistic regression analysis showed that severe cases were associated with age (<3 years), withdrawnness and lethargy, shake of limbs, tachycardia, total leukocyte count (≥17×10 9 /l), blood sugar (≥7 mmol/l), and CK-MB (≥16 mmol/l). Furthermore, age (<3 years), withdrawnness, and lethargy, shake of limbs, WBC (≥17×10 9 /l), and CK-MB (≥16 mmol/l) were found to be high risk factors for severe cases after multivariate logistic regression analysis. Conclusions: Clinicians should give importance to these risk factors. Early recognition of children at risk and timely intervention is the key to reduce acute mortality and morbidity.
  3 4,777 71
CASE REPORTS
In-transit metastases from squamous cell carcinoma penis
L Padmavathy, L Lakshmana Rao, Sylvester , M Dhana Lakshmi, N Ethirajan
July-August 2012, 57(4):291-293
DOI:10.4103/0019-5154.97674  PMID:22837565
An in-transit metastasis is one that is located between the primary tumor and the closest lymph node region and results from tumor emboli getting trapped in the lymphatic channels. A 65-year-old male patient who had undergone partial amputation of the penis and bilateral inguinal lymph node resection for squamous cell carcinoma of the penis 4 months earlier developed multiple cutaneous metastatic lesions in the pubic region and scrotum. The case is reported for the uncommon presentation of in-transit metastases.
  2 5,544 46
Congenital calcinosis cutis of the foot
GK Tharini, D Prabavathy, SJ Daniel, J Manjula
July-August 2012, 57(4):294-295
DOI:10.4103/0019-5154.97675  PMID:22837567
Calcinosis cutis is a rare disease characterized by deposition of insoluble calcium salts in the skin. Subepidermal calcified nodule is a form of idiopathic calcinosis cutis that commonly affects children but rarely presents at birth. Herein we describe a healthy 10-month-old boy who had a solitary hard nodule on the left foot since birth. Surgical excision of the nodule was done and histopathology confirmed the diagnosis of subepidermal calcified nodule.
  2 3,357 52
Multicentric reticulohistiocytosis: A rare case report
Soumya Mukherjee, Dwijendra N Gangopadhyay
July-August 2012, 57(4):302-303
DOI:10.4103/0019-5154.97678  PMID:22837570
A 58-year-old lady presented with polyarthritis followed by multiple shiny erythematous dome-shaped papulonodules mainly over the face, around joints and coral bead sign on fingers without any mucosal involvement. Characteristic histopathology with well-defined dermal infiltrate consisting of multinucleated giant cells and large macrophages having abundant eosinophilic cytoplasm clinched the diagnosis of multicentric reticulohistiocytosis.
  2 3,447 78
CORRESPONDENCE
Mometasone menace in melasma
Kiran V Godse, Vijay Zawar
July-August 2012, 57(4):324-326
DOI:10.4103/0019-5154.97686  PMID:22837578
  2 4,914 128
DERMATOSURGERY ROUND
Efficacy of suction blister epidermal graft without phototherapy for locally stable and resistant vitiligo
Masoud Maleki, Mahnaz Banihashemi, Vahid Sanjari
July-August 2012, 57(4):282-284
DOI:10.4103/0019-5154.97669  PMID:22837562
Introduction: Surgical methods for treatment of vitiligo include punch grafts, blister grafts, follicular grafts and cultured melanocyte grafts. The aim of this study was to determine the efficacy of suction blister grafts for treatment of vitiligo, without the use of phototherapy. Materials and Methods: This clinical trial study was conducted on 10 patients with vitiligo that was resistant to usual treatments and with limited involvement in the affected sites. We used cryotherapy and a manual suction device for blistering at the recipient and donor sites, respectively. The blister was separated and fixed with sutures and a dressing to the recipient site. Repigmentation of lesions was evaluated monthly for 6 months after treatment. Repigmentation rates higher than 90%, between 71%-90%, from 51%-70%, and less than 50% were graded as complete, good, moderate, and poor, respectively. Results: Ten patients (five females with a mean age of 23.2±3.96 years and five males with a mean age of 30.60±4.15 years) were enrolled in the study. Reponses to treatment after a 6-month follow-up were 'complete,' 'good,' and 'moderate' in 7 (70%), 1 (10%), and 2 (20%) patients, respectively. Conclusion: With this technique, patients with restricted sites of involvement, that did not respond to the usual treatments showed very good repigmentation without any additional phototherapy over a 6-month follow-up; moreover, there were no side effects such as scarring.
  2 3,366 107
ORIGINAL ARTICLES
Pattern of pediatric dermatoses in a tertiary care centre of South West Rajasthan
Manisha Balai, Ashok Kumar Khare, Lalit Kumar Gupta, Asit Mittal, CM Kuldeep
July-August 2012, 57(4):275-278
DOI:10.4103/0019-5154.97665  PMID:22837560
Background: The evaluation for skin disorders forms an important component of primary health care practice for all including children. The prevalence of certain skin diseases in children can reflect status of health, hygiene, and personal cleanliness of a community. Aims: This study was planned to evaluate the magnitude of skin diseases, pattern of various dermatoses, factors contributing to these dermatoses and concurrent systemic disease among children up to five years of age. Materials and Methods: Consecutive 1000 children, aged up to five years, attending the Dermatology OPD of RNT Medical College and MB Government Hospital, Udaipur were the subjects of this study. A detailed general, systemic and cutaneous examination followed by relevant investigations were carried out. The findings were recorded in a proforma for analysis and interpretation of data. Results: One thousand twenty seven (1027) diagnoses were made in 1000 children. Etiological analysis revealed that majority (417; 40.60%) of dermatoses belonged to infection and infestation group followed by eczematous (358; 34.86%) and hypersensitivity (105; 10.22%) groups. Of the infection and infestation group, bacterial infection (141; 13.72%) was the most common entity followed by scabies (107; 10.42%), fungal (67; 6.52%), and viral infection (35; 3.40%). Conclusion: This study provides a preliminary baseline data for future clinical research. It might also help to assess the changing trends of pediatric dermatoses.
  2 3,298 245
SPECIAL ARTICLE
Cutaneous manifestations of internal malignancy
A Ayyamperumal, GK Tharini, Vidhya Ravindran, B Parveen
July-August 2012, 57(4):260-264
DOI:10.4103/0019-5154.97657  PMID:22837557
Background: Many malignancies affecting the internal organs display cutaneous manifestations which may be either specific (tumor metastases) or nonspecific lesions. Aims: The study is aimed at determining the frequency and significance of cutaneous manifestations among patients with internal malignancy. Materials and Methods: 750 cases of proven internal malignancy, who attended a cancer chemotherapy center in South India, were studied. Specific infiltrates were confirmed by histopathology, fine needle aspiration cytology (FNAC) and marker studies. Results: Out of the 750 patients with internal malignancy, skin changes were seen in a total of 52 (6.93%) patients. Conclusion: Cutaneous metastases (specific lesions) were seen in 20 patients (2.66%): contiguous in 6 (0.8%), and non-contiguous in 14 (1.86%). Nonspecific skin changes were seen in 32 patients (4.26%). None of our patients presented with more than one type of skin lesions. Herpes zoster was the most common nonspecific lesion noticed in our patients, followed by generalized pruritus, multiple eruptive seborrheic keratoses, bullous disorder, erythroderma, flushing, purpura, pyoderma gangrenosum, insect bite allergy and lichenoid dermatitis.
  2 5,845 469
BASIC RESEARCH
Netherton syndrome in one Chinese adult with a novel mutation in the SPINK5 gene and immunohistochemical studies of LEKTI
Zhang Xi-Bao, Zhang San-Quan, He Yu-Qing, Luo Yu-Wu, Luo Quan, Li Chang-Xing
July-August 2012, 57(4):265-268
DOI:10.4103/0019-5154.97660  PMID:22837558
Background : Netherton syndrome (NS) is a severe autosomal recessive ichthyosis. It is characterized by congenital ichthyosiform erythroderma, trichorrhexis invaginata, ichthyosis linearis circumflexa, atopic diathesis, and frequent bacterial infections. The disease is caused by mutations in the SPINK5 (serine protease inhibitor Kazal-type 5) gene, a new type of serine protease inhibitor involved in the regulation of skin barrier formation and immunity. We report one Chinese adult with NS. The patient had typical manifestation of NS except for trichorrhexis invaginata with an atopic diathesis and recurrent staphylococcal infections since birth. Aims: To evaluate the gene mutation and of its product activity of SPINK5 gene in confirmation of the diagnosis of one Chinese adult with NS. Materials and Methods: To screen mutations in the SPINK5 gene, 33 exons and flanking intron boundaries of SPINK5 were amplified with polymerase chain reaction (PCR) and used for direct sequencing. In addition, immunohistochemical staining of LEKTI (lymphoepithelial Kazal-type-related inhibitor) with specific antibody was used to confirm the diagnosis of NS. The results were compared with that of healthy individuals (twenty-five blood samples). Results: A G318A mutation was found at exon 5 of patient's SPINK5 gene which is a novel missense mutation. The PCR amplification products with mutation-specific primer were obtained only from the DNA of the patients and their mother, but not from their father and 25 healthy individuals. Immunohistochemical studies indicated there was no LEKTI expression in NS patient's skin and there was a strong LEKTI expression in the normal human skin. Conclusion: In this report, we describe heterozygous mutation in the SPINK5 gene and expression of LEKTI in one Chinese with NS. The results indicate that defective expression of LEKTI in the epidermis and mutations of SPINK5 gene are reliable for diagnostic feature of NS with atypical clinical symptoms.
  1 2,830 49
CASE REPORTS
Fusarium solani : A causative agent of skin and nail infections
Thomas S Kuruvilla, Meena Dias
July-August 2012, 57(4):308-309
DOI:10.4103/0019-5154.97680  PMID:22837572
Fusarium spp are non-dermatophytic hyaline moulds found as saprophytes and plant pathogens. Human infections are probably a result of various precipitating predisposing factors of impaired immune status. Immunocompetent individuals of late are also vulnerable to various unassuming saprophytic and plant pathogens. To stress the need to identify correctly and institute appropriate antifungal therapy in newly emerging human fungal infectious agents. Repeated mycological sampling of the skin and nails of the suspected fungal infection were processed as per the standard format including direct microscopy and fungal culture on Sabouraud's dextrose agar. The fungus was isolated as Fusarium solani. Fusarium is an important plant pathogen and soil saprophyte. Infection is acquired by direct inoculation or inhalation of spores. It is associated with a variety of diseases like keratitis, onychomycosis, eumycetoma, skin lesions and disseminated diseases.
  1 3,072 77
ABSTRACTS
Conference Abstracts (CUTICON WB 2011)

July-August 2012, 57(4):0-0
Full text not available  [PDF]
  - 1,004 62
BOOK REVIEW
Under My Skin
Arijit Coondoo
July-August 2012, 57(4):333-334
  - 1,073 63
CASE REPORTS
Giant seborrheic keratosis of the genitalia
Amiya Kumar Nath, Rashmi Kumari, G Rajesh, Devinder Mohan Thappa, Debdatta Basu
July-August 2012, 57(4):310-312
DOI:10.4103/0019-5154.97681  PMID:22837573
Genital seborrheic keratosis (SK) is a rare entity, which can be easily misdiagnosed as genital warts. Dermoscopy is a useful tool to make diagnosis of SK in such cases. We report a 50-year-old woman with a large polypoidal growth on the external genitalia. Dermoscopic examination showed fissures and ridges, cerebriform appearance, and comedo-like openings consistent with SK. The histopathology confirmed the diagnosis of SK.
  - 9,454 113
Eccrine angiomatous naevus revisited
Sumit Sen, Gobinda Chatterjee, Pradip K Mitra, Anusree Gangopadhyay
July-August 2012, 57(4):313-315
DOI:10.4103/0019-5154.97682  PMID:22837574
Hamartomatous, circumscribed swellings of the extremities make an interesting study. Presentations are manifold and the naevi are not always present from birth. Excessive growth of hairs leads to remarkable appearance of such swellings. A young woman presented to the dermatology department, complaining of tenderness over 4 th finger of her left hand. The defect was present for the last couple of years and was typified by visible hyperhidrosis on gentle tapping. Counseling of the affected lady made her agree for a skin biopsy. The histopathology revealed it to be of the nature of eccrine angiomatous hamartoma. Blood vessels were scarce. Eccrine ducts were plentiful without other associated anomalies. The deformity was removed by simple excision with good result.
  - 2,380 58
Not just skin deep: A case report of multiple endocrine neoplasia type 1
SM Simi, Beena Narayanan, G Nandakumar
July-August 2012, 57(4):304-307
DOI:10.4103/0019-5154.97679  PMID:22837571
Multiple endrocrine neoplasia (MEN) type 1 is characterized by mainly a triad of pancreatic, pituitary and parathyroid involvement. This is a case report of a 41-year-old male in whom recognition of collagenoma and gingival papule led to the identification of MEN type 1. Often the recognition of such dermatological manifestations help in the presymptomatic diagnosis of complex syndromes.
  - 5,639 61
Syphilis D' Emblee
Sunil K Gupta, Aarti Bhattacharya, RR Singh, Vivek K Agarwal
July-August 2012, 57(4):296-298
DOI:10.4103/0019-5154.97676  PMID:22837568
A 28-year-old male patient presented to Skin, V.D. and Leprosy outpatient with a single gray white plaque on the left side of the lower lip for last 8 months and multiple papulosquamous lesions all over the body for last 6 months. There was history of blood transfusion for anemia 1 year back. Histopathology of lip lesion and reactive VDRL and TPHA tests confirmed the diagnosis as syphilis. We report this rare case of Syphilis d' emblee.
  - 3,264 108
Cardiofaciocutaneous syndrome: A rare entity
S Pavithra, H Mallya, GS Pai
July-August 2012, 57(4):299-301
DOI:10.4103/0019-5154.97677  PMID:22837569
The cardiofaciocutaneous (CFC) syndrome is a condition of sporadic occurrence, with patients showing multiple congenital anomalies and mental retardation and characteristic dysmorphic features. We, thus, report a rare case of this syndrome in a 1-year-old child who presented with typical features of CFC syndrome.
  - 2,336 64
CORRESPONDENCE
Extensive discoid lupus erythematosus in a HIV patient responding to hydroxychloroquine monotherapy
Pradeep Vittal Bhagwat, Chandramohan Kudligi, BM Shashikumar, Arun Thirunavukkarasu, Mohan Eshwara Rao Shendre
July-August 2012, 57(4):326-327
DOI:10.4103/0019-5154.97687  PMID:22837579
  - 2,181 57
Clinicomycological study of 150 cases of dermatophytosis in a tertiary care hospital in South India
H Hanumanthappa, K Sarojini, P Shilpashree, Sushmita Bhimsen Muddapur
July-August 2012, 57(4):322-323
DOI:10.4103/0019-5154.97684  PMID:22837576
  - 2,319 237
Dramatic response to oral zinc in a case of subacute form of generalized pustular psoriasis
Shikha Verma, Binod Kumar Thakur
July-August 2012, 57(4):323-324
DOI:10.4103/0019-5154.97685  PMID:22837577
  - 3,720 115
Twenty nail dystrophy in association with zosteriform lichen planus
Satyaki Ganguly, Kranti C Jaykar
July-August 2012, 57(4):329-329
DOI:10.4103/0019-5154.97689  PMID:22837581
  - 1,954 73
Granular cell tumor of skin diagnosed on fine needle aspiration cytology
Avninder Singh, Manav Sawhney, Sushruta Das
July-August 2012, 57(4):330-331
DOI:10.4103/0019-5154.97690  PMID:22837582
  - 2,052 55
Clinicopathological evaluation of non-melanoma skin cancer
Rafael Denadai, Larissa Kirylko, Luís R M Souto
July-August 2012, 57(4):331-332
DOI:10.4103/0019-5154.97691  PMID:22837583
  - 1,464 56
ORIGINAL ARTICLES
A clinico-epidemiological study of macular amyloidosis from North India
Anshu Bandhlish, Asok Aggarwal, Ravinder V Koranne
July-August 2012, 57(4):269-274
DOI:10.4103/0019-5154.97662  PMID:22837559
Background : Macular amyloidosis (MA) is the most subtle form of cutaneous amyloidosis, characterized by brownish macules in a rippled pattern, distributed predominantly over the trunk and extremities. MA has a high incidence in Asia, Middle East, and South America. Its etiology has yet to be fully elucidated though various risk factors such as sex, race, genetic predisposition, exposure to sunlight, atopy and friction and even auto-immunity have been implicated. Aim: This study attempts to evaluate the epidemiology and risk factors in the etiology of MA. Materials and Methods: Clinical history and risk factors of 50 patients with a clinical diagnosis of MA were evaluated. Skin biopsies of 26 randomly selected patients were studied for the deposition of amyloid. Results: We observed a characteristic female preponderance (88%) with a female to male ratio of 7.3:1, with a mean age of onset of MA being earlier in females. Upper back was involved in 80% of patients and sun-exposed sites were involved in 64% cases. Incidence of MA was high in patients with skin phototype III. Role of friction was inconclusive . Lymphohistiocytic infiltrate in the dermis and in perivascular distribution was seen in almost all the histopathology sections studied. Focal disruption of basal layer with pigmentary incontinence was present in a small number of patients. Amyloid deposits could be detected better with Congo red staining viewed under polarized light . Conclusion: Lack of clear-cut etiological factors makes it difficult to suggest a reasonable therapeutic modality. Histopathology is not specific and amyloid deposits can be demonstrated only in a small number of patients. For want of the requisite information on the natural course and definitive etiology, the disease MA remains an enigma and a source of concern for the suffering patients.
  - 8,960 186
  Search 
  The Journal 
  The Association 
  Dermalinks  
  Book of Abstracts 
  Site Statistics 
  Addresses 
  My Preferences 
  Online Submission