Indian Journal of Dermatology
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   2020| May-June  | Volume 65 | Issue 3  
    Online since April 14, 2020

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Is NAT2 gene polymorphism associated with vitiligo?
Daya Shankar Lal Srivastava, Kamal Aggarwal, Gajendra Singh
May-June 2020, 65(3):173-177
Background: N-acetyltransferase-2 (NAT2) is a phase II xenobiotic enzyme that plays an important role against oxidative stress-mediated reactive oxygen species protection. Polymorphism in specific genotypes of NAT2 may lead to increase an imbalance in antioxidant systems and may influence the pathogenesis of vitiligo. We conducted this study to see the association between NAT2 gene polymorphism and risk of vitiligo. We looked into whether single-nucleotide polymorphisms (SNP) at positions 857, 481 and 590 of the coding region of the NAT2 gene play as a risk factor for vitiligo among north Indian people. Materials and Methods: In this study, we assessed 100 patients with vitiligo and 160 healthy individuals as controls. Genomic DNA was extracted from human peripheral blood and polymerase chain reaction–restricted fragment length polymorphism was done to identify the single nucleotide polymorphism at positions 857, 481, and 590 of the coding region of the NAT2 gene. Results: In this study, we observed a significant higher risk with slow acetylator genotypes of NAT2 (OR = 2.85; 95% CI = 1.68-4.84, P value < 0.001) for the vitiligo. Furthermore, in the association between NAT2 acetylator genotypes with percentage of body surface area (BSA) of disease, we observed that slow acetylator genotypes of NAT2 has significant higher risk with low grade of disease (1%–10% >11%–30% >30% of BSA). Limitations: A major limitation of this study was the small sample size and warrants further investigation on a large epidemiological study to confirm these findings. Conclusions: Our preliminary data indicate that NAT2 slow acetylator genotype exhibits significant association for the risk of vitiligo, especially in disease predisposition and initiation.
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Decreased Sox2 messenger RNA expression in basal cell carcinoma
Reza Ahmadi-Beni, Fatemeh Vand-Rajabpour, Mohamadreza Ahmadifard, Maryam Daneshpazhooh, Pedram Noormohammadpour, Javad Rahmati, Kambiz Kamyab Hesari, Mehdi Yaseri, Mina Tabrizi
May-June 2020, 65(3):178-182
Background: Sox2, zeb1, and p21 have been implicated in aggressive behavior of squamous cell carcinoma (SCC) and melanoma. However, their expression level in basal cell carcinoma (BCC) has not been elucidated. We hypothesized BCC, contrary to SCC, and melanoma, could be a suitable model to study mechanisms which attenuate tumor metastasis. The aim of this study was to examine the messenger RNA (mRNA) expression levels of sox2, zeb1, and p21 in BCC. Materials and Methods: Twenty-seven nonmetastatic BCC and twelve normal skin samples were evaluated using real-time reverse transcriptase polymerase chain reaction. Results: The stemness marker sox2 demonstrated marked down-regulation, but zeb1 and p21 showed no significant change. Conclusions: Here, we report a negative association between sox2 mRNA expression level and nonmetastatic BCC, thus, providing a likely explanation for the fact that normal skin is more reliant on sox2 than BCC. BCC may be using decreased sox2 mRNA to remain incognito from metastatic potential.
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Nail changes induced by chemotherapeutic agents
Neerja Saraswat, Aradhana Sood, Rajesh Verma, Dhramesh Kumar, Sushil Kumar
May-June 2020, 65(3):193-198
Introduction: Nail toxicity is a relatively uncommon cutaneous adverse effect of chemotherapeutic agents. Rapidly dividing cells of the nail matrix are perturbed by the antimitotic activity of these agents. Although most of these changes are cosmetic and regress once the therapy is completed, a few of these adverse effects are challenging to manage and require temporary or permanent suspension of chemotherapeutic agents. Materials and Methods: A total of 205 patients with various malignancies and under chemotherapy in oncology ward of the hospital over a period of 3 months were screened for nail involvement postchemotherapy. Relevant details, protocol of chemotherapeutic agents were assessed. Nail examination was carried out in daylight and the changes were analyzed. Results: A total of 124 (60.4%) patients had nail changes due to chemotherapeutic agents. The most common change was diffuse hyperpigmentation in 101 (81.4%) patients commonly due to a combination of cyclophosphamide and adriamycin in 43 (42.5%) patients. Longitudinal melanonychia was seen in 36 (29%), Beau's lines in 31 (25%), onychomadesis in 17 (13.7%), Mees' lines in 15 (12%), paronychia in 12 (9.6%), subungual hyperkeratosis in 10 (8%), and Muehrcke's lines in 4 (3.2%) patients. All the patients who developed Muehrcke's lines were on a combination of cyclophosphamide/doxorubicin/5 FU. Exudative onycholysis was observed in 2 (1.6%) patients; both these patients were on paclitaxel therapy. A total 2 (1.6%) patients who developed exudative onycholysis were advised discontinuation and another substitute chemotherapy was advised. Therapy for 2 (1.6%) patients who developed acute paronychia due to gefitinib was temporarily suspended. Unfortunately, most of the patients were on multiple chemotherapeutic agents hence, we could not pinpoint one drug as a cause. Therefore, a combination of agents was implicated in most cases. Conclusion: Nail toxicities are common with chemotherapeutic agents, however less importance is given to nail involvement. Apart from being cosmetically significant, a few adverse effects may warrant modification of the chemotherapy.
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Normocomplementemic urticarial vasculitis: An unusual presentation
Robin George Manappallil, Bhargavan Pallivalappil, Abhay Mani Martin, Neena Mampilly, Apurva Rao
May-June 2020, 65(3):208-210
Urticarial vasculitis (UV) is a form of cutaneous vasculitis which lasts for >24 h. Clinically, the patients present with erythema and wheals. The level of complement decides the type of UV. This is a case of a middle-aged lady, who developed vesiculobullous lesion over her leg after trekking. She was diagnosed to have normocomplementemic UV. Bullous presentation of UV is a rare scenario.
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A cross-sectional study of clinico-etiological profile and associated comorbidities in Indian patients of pigmented purpuric dermatoses
Gunjan Gupta, Sabha Mushtaq, Devraj Dogra, Ghanshyam Dev, Rahul Sudan, Naina Dogra
May-June 2020, 65(3):187-192
Background: Pigmented purpuric dermatoses (PPDs) are a group of chronic benign vascular disorders with varied clinical presentation. The etiopathogenesis of the condition largely remains unknown with a paucity of clinico-epidemiological and/or clinico-etiological studies. Objective: To study the clinico-epidemiological pattern, etiological factors and associations of PPD and correlate them with its severity in a set of Indian patients. Materials and Methods: In a cross-sectional study, all clinically diagnosed and histopathologically confirmed cases of PPD attending the outpatient department of dermatology from November 2015 to October 2016 were included in the study. Patients were evaluated based on a detailed history of the illness, comorbid conditions, drug usage, general physical, systemic, and cutaneous examinations, severity of disease (mild, moderate, or severe), laboratory parameters, and Doppler ultrasonography of the lower extremities. Results: There were a total of 60 patients with a female-to-male ratio of 1.14:1. The mean age of patients was 47 ± 12.10 (range: 15–70) years. Majority (70%) of the patients were housewives, bankers, and businessmen. The possible etiological and/or aggravating factors included prolonged standing (28.3%), drug intake (13.3%), alcohol ingestion (10%), strenuous exercise (5%), and varicose vein (3.3%). Schamberg's disease (90%) was the most common type observed. The most common systemic comorbidity identified was hypertension (58.3%) followed by diabetes mellitus (31.6%) and dyslipidemia (28.3%). A positive correlation was found between severity of the disease and presence of comorbidities (Mantel–Haenszel method,P< 0.0001). Conclusion: PPD was found to be associated with a variety of disorders and comorbidities. The number of the comorbidities increased with increasing severity of the disease. Besides exposing the patient to various risk factors, this may contribute to the vessel wall damage seen in the condition. All patients with PPD should, therefore, undergo an initial screen for these comorbidities.
  727 72 -
Effectiveness of paint psoralen and ultraviolet-A in alopecia areata – Our experience in the national skin center
Lucinda Siyun Tan, Melissa Mei Hsia Chan, Daryl Jian An Tan, Joyce Siong See Lee, Wei-Sheng Chong
May-June 2020, 65(3):199-203
Background: Alopecia areata (AA) is usually a benign cause of patchy hair loss that often resolves within a few weeks to months. Most treatment modalities are ineffective in the treatment of severe AA. The use of paint psoralen and ultraviolet-A (PUVA) in the treatment of patients with severe forms of AA has been reported in the literature. Aims and Objective: The aim of this study was to evaluate the effectiveness of paint PUVA therapy in the treatment of AA in Singapore. Materials and Methods: We performed a 10-year retrospective analysis of patients who underwent paint PUVA for AA. We evaluated patient demographics and treatment outcomes in the form of percentage change in baseline severity of alopecia tool score and final amount of hair regrowth and relapse rate. Results: Ten patients were included in this study. With paint PUVA therapy, significant hair regrowth was seen in six patients. Paint PUVA therapy in our study showed minimal side effects. Conclusion: PUVA gives fair response in AA in a reasonable time as per our center's experience in Singapore.
  703 35 -
Impact of psychosocial profile on alopecia areata in pediatric patients: A case control study from a tertiary care hospital in Eastern Uttar Pradesh
Neerja Saraswat, Pooja Shankar, Ajay Chopra, Sushil Kumar, Debdeep Mitra, Reetu Agarwal
May-June 2020, 65(3):183-186
Background: Alopecia areata (AA) is a common form of nonscarring alopecia characterized by patchy loss of hair from the scalp and body. It is a complex outcome of factors such as autoimmunity, genetic factors, infectious diseases, as well as psychological factors, such as stress, personality type, familial conditions. Around 20% of patients are in the pediatric age group, and 60% of the patients develop AA before the age of 20 years. Aim: The present study looked into the impact of psychosocial factors in AA. Materials and Methods: This was a case-control study conducted over a period of 1 year. One hundred and two patients and age and gender-matched control group between the ages of 2 and 14 years were included. A questionnaire was administered to identify the stress arising due to personal or familial conditions, school-related issues, psychotrauma or illness, and accidents prior to developing AA. Age and gender-matched patients with other dermatoses with low psychosomatic component to it and unlikely to be influenced by stress were selected as control. Result: Fifty-three patients (52 %) were male and 49 were female (48 %). Fifty-five (53.9%) patients were in the age group of 10 to 14 years. Forty (39.2%) children had multiple patches. Onset was <5 months in 30 patients (29.4%). Forty-nine (48%) children reported stress due to school-related issues compared to 13 (12.7%) in the control group. Eighteen (17.6%) children had familial issues compared to 6 (0.05%) in the control group. Nineteen children (18.6%) had multiple stressors. Sixty-nine (67.6%) patients related their disease to a stress component compared to 33 (32.3%) who could not relate to any stress. A significant association was noted between examination pressure and academic performance with onset of AA compared to control (P < 0.05%), which was stronger among female compared to male. Conclusion: The psychological profile and comorbidities have a significant impact on the onset or recidivism of AA. Impact of a stressful personal or family life, parental pressure to perform better in school, and psychological vulnerability can significantly contribute to the onset or exacerbation of AA.
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Blastic plasmacytoid dendritic cell neoplasm: Case report and literature overview
Anastasiia Kolerova, Irina Sergeeva, Julia Krinitsyna, Natalia Pronkina, Svetlana Sizikova, Pavel Filimonov, Irina Kryuchkova
May-June 2020, 65(3):217-221
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a malignancy with high frequency of skin involvement. A 39-year-old Caucasian female was suffering from weakness, myalgia, and skin eruption, which appeared during treatment of chlamydiosis with antibiotics in July 2016. Based on clinical presentation, laboratory investigations, and histological examination of skin and bone marrow biopsy, a diagnosis of BPDCN with the involvement of skin, bone marrow, and central nervous system was made. The patient was put on acute lymphoblastic leukemia-like chemotherapy and achieved complete remission in November 2016, the eruption regressed. In January 2017, allogeneic bone marrow transplantation from matched sibling was performed. Since May 2017, the cutaneous relapse with loss of CD56 expression has developed. This clinical case demonstrates the importance of laboratory tests. Histological examination helps to clarify a diagnosis of cutaneous lymphoma; however, a specific type of lymphoma needs immunohistochemical analysis. In our case, BPDCN at the initial stage presented like a systemic vasculitis.
  660 24 -
Extensive verrucae over healed pemphigus vulgaris lesions in an immunocompetent female: A rare presentation of wolf's isotopic response
Pooja Agarwal, Amit S Mistry, Santosh Rathod, Shruti Patel
May-June 2020, 65(3):211-213
Wolf's isotopic response refers to the occurrence of a skin disorder at the site of another unrelated and already healed skin disease. The cases described so far in the literature include herpes (simplex or zoster) as the primary disease in most cases and a myriad of skin diseases as the secondary disease. Here, we report a case where extensive verrucae developed over the sites of healed lesions of pemphigus vulgaris, in an immunocompetent female. Pemphigus vulgaris being the primary disease and absence of verrucae over normal skin makes this case, a rare presentation.
  614 32 -
Disseminated cutaneous rhinosporidiosis: Revisited
Sumit Sen, Widhi Agrawal, Somnath Das, Partha S Nayak
May-June 2020, 65(3):204-207
A vegetative growth in the nasal mucosa and nasopharynx present for a considerable period of time raises the possibility of rhinosporidiosis. Such presentation in the Indian subcontinent is not rare but erythematous cauliflower-like or tumor-like growths often reaching large size present on various areas of the skin without necessarily involving the nasal apparatus are often confusing to the attending clinician. A dermatologist may suspect the disseminated form of cutaneous rhinosporidiosis and perform a diagnostic histopathology. Early institution of treatment may give significant relief to the patient.
  599 37 -
A rare case of “Paraquat Tongue''
Rakesh K Patel, Dilip Kumar Sa, Akhilesh Behra, Kamalini Meher
May-June 2020, 65(3):245-246
  583 47 -
Nivolumab-induced bullous pemphigoid managed without drug withdrawal
Mónica Munera-Campos, Adrià Plana-Pla, Noelia Rivera, Aram Boada, Carlos Ferrándiz
May-June 2020, 65(3):214-216
The widespread use of anti-programmed cell death receptor-1 (PD-1) agents has shed light to unusual immune-related adverse effects, especially affecting the skin. We report a case of bullous pemphigoid secondary to nivolumab therapy for metastatic renal carcinoma with a previously unreported complete response to clobetasol ointment alone. The autoimmune blistering disease was successfully treated without oral corticosteroids, and the anti-PD-1 agent could be maintained without recurrence of the skin lesions. Topical therapy remains a good option in selected, mild-to-moderate cases of induced bullous pemphigoid.
  605 23 -
An elderly male with a chronic rash on the right foot
Sakeena Fatima, Helen D'sa, Marsha L Chaffins, Madhu Menon, Ben J Friedman
May-June 2020, 65(3):222-224
  577 33 -
Atypical hidradenitis suppurativa on the leg in a psoriatic patient
Masahito Yasuda, Akira Shimizu, Atsushi Tamura, Osamu Ishikawa
May-June 2020, 65(3):231-232
  583 20 -
Oral manifestations as an early clinical sign of acute myeloid leukemia: A report of two cases
Preeti Chawla Arora, Aman Arora, Saurabh Arora
May-June 2020, 65(3):241-243
  516 21 -
Acute paronychia and reactive capillary proliferation in a patient on erlotinib
Ishmeet Kaur, Vijay Gandhi, Deepak Jakhar
May-June 2020, 65(3):236-237
  497 23 -
Novel manifestations of acroangiodermatitis: A report of two cases
Adinia Santosa, Nisha Suyien Chandran
May-June 2020, 65(3):246-247
  490 29 -
Bullous pemphigoid-like presentation of disseminated herpes zoster: A case report
Roshni Kakitha, Srikanth Shanmugam
May-June 2020, 65(3):234-235
  498 19 -
A rare case of persistent xanthoma disseminatum without any systemic involvement
Akhilesh Behra, Dilip Kumar Sa, Reena Naik, Rakesh Kumar Patel
May-June 2020, 65(3):239-241
  449 27 -
Mechlorethamine gel usage in patients with mycosis fungoides in a lymphoma clinic
Robert Duffy, Tara Jennings, Joya Sahu
May-June 2020, 65(3):237-239
  456 12 -
Evaluation of the association of metabolic syndrome with psoriasis and its severity: A cross-sectional study
Satyendra K Singh, Ruchika Tripathi
May-June 2020, 65(3):243-244
  444 18 -
Multiple penoscrotal cysts
Manojit Midya
May-June 2020, 65(3):248-249
  431 30 -
Dermoscopy of two cases of cutaneous leishmaniasis
Yasmeen Jabeen Bhat, Atiya Yaseen, Sheema Sheikh, Iffat Hassan
May-June 2020, 65(3):232-234
  417 25 -
Walter cooper dendy (1794-1871) and the first book on pediatric dermatology
Amiya K Mukhopadhyay
May-June 2020, 65(3):225-228
  425 15 -
Tin tack sign in localized cutaneous leishmaniasis: Reader's question
Ayda Acar
May-June 2020, 65(3):230-230
  367 20 -
Metabolic syndrome and dyslipidemia among Nigerians with lichen planus: A cross-sectional study - Reader's question
Mahmood D Al-Mendalawi
May-June 2020, 65(3):228-229
  349 18 -
Author's reply: Tin-tack sign in cutaneous leishmaniasis
Shagufta Rather, Atiya Yaseen
May-June 2020, 65(3):230-231
  348 16 -
Author's reply- Metabolic syndrome and dyslipidemia among Nigerians with lichen planus: A cross-sectional study
Ifeanyi Chibuzor Okpala, Adeolu Oladayo Akinboro, Ifeanyi Ogochukwu Ezejoifor, Abel N Onunu, Benson Uchechukwu Okwara
May-June 2020, 65(3):229-229
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