Indian Journal of Dermatology
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   Table of Contents - Current issue
September-October 2020
Volume 65 | Issue 5
Page Nos. 337-440

Online since Tuesday, August 11, 2020

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Bio-medical research in COVID-19 times Highly accessed article p. 337
Amrita Sil, Nilay K Das, Dwijendra N Gangopadhyay
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Gene therapy and its application in dermatology p. 341
Tanusree Sarkar, Somenath Sarkar, Dwijendra Nath Gangopadhyay
Gene therapy is an experimental technique to treat genetic diseases. It is based on the introduction of nucleic acid with the help of a vector, into a diseased cell or tissue, to correct the gene expression and thus prevent, halt, or reverse a pathological process. It is a promising treatment approach for genetic diseases, inherited diseases, vaccination, cancer, immunomodulation, as well as healing of some refractory ulcers. Both viral and nonviral vectors can be used to deliver the correct gene. An ideal vector should have the ability for sustained gene expression, acceptable coding capacity, high transduction efficiency, and devoid of mutagenicity. There are different techniques of vector delivery, but these techniques are still under research for assessment of their safety and effectiveness. The major challenges of gene therapy are immunogenicity, mutagenicity, and lack of sustainable therapeutic benefit. Despite these constraints, therapeutic success was obtained in a few genetic and inherited skin diseases. Skin being the largest, superficial, easily accessible and assessable organ of the body, may be a promising target for gene therapy research in the recent future.
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Next-generation technologies in dermatology: Use of artificial intelligence and mobile applications p. 351
Abhishek De
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Use of artificial intelligence in dermatology p. 352
Abhishek De, Aarti Sarda, Sachi Gupta, Sudip Das
Artificial intelligence (AI) has emerged as a major frontier in computer science research. Although AI has been available for some time and found its application in many fields of medicine, its use in dermatology is comparatively new and limited. A sound understanding of the concepts of AI is essential for dermatologists as skin conditions with their abundant clinical and dermatoscopic data and images can potentially be the next big thing in the application of AI in medicine. There are already a number of artificial intelligence studies focusing on skin disorders, such as skin cancer, psoriasis, atopic dermatitis and onychomycosis. This article presents an overview of AI and new developments relevant to dermatology, examining both its current applications and future potential.
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The ethics of machine learning in medical sciences: Where do we stand today? p. 358
Treena Basu, Sebastian Engel-Wolf, Olaf Menzer
Advances in Machine Learning and availability of state-of-the-art computational resources, along with digitized healthcare data, have set the stage for extensive application of artificial intelligence in the realm of diagnosis, prognosis, clinical decision support, personalized treatment options, drug development, and the field of biomedicine. Here, we discuss the application of Machine Learning algorithms in patient healthcare and dermatological domains along with the ethical complexities that are involved. In scientific studies, ethical challenges were initially not addressed proportionally (as assessed by keyword counts in PubMed) and just more recently (since 2016) this has started to improve. Few pioneering countries have created regulatory guidelines around how to respect matters of (1) privacy, (2) fairness, (3) accountability, (4) transparency and (5) conflict of interest when developing novel medical Machine Learning applications. While there is a strong promise of emerging medical applications to ultimately benefit both the patients and the medical practitioners, it is important to raise awareness on the five key ethical issues and incorporate them into medical practice in the near future.
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Artificial intelligence: How is it changing medical sciences and its future? p. 365
Kanadpriya Basu, Ritwik Sinha, Aihui Ong, Treena Basu
Artificially intelligent computer systems are used extensively in medical sciences. Common applications include diagnosing patients, end-to-end drug discovery and development, improving communication between physician and patient, transcribing medical documents, such as prescriptions, and remotely treating patients. While computer systems often execute tasks more efficiently than humans, more recently, state-of-the-art computer algorithms have achieved accuracies which are at par with human experts in the field of medical sciences. Some speculate that it is only a matter of time before humans are completely replaced in certain roles within the medical sciences. The motivation of this article is to discuss the ways in which artificial intelligence is changing the landscape of medical science and to separate hype from reality.
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Use of mobile applications in dermatology p. 371
Feroze Kaliyadan, Karalikkattil T Ashique
Smartphones and applications related to the same are ubiquitous now. As dermatologists, we have a wide array of smartphone apps at our disposal which we can use to improve our practice in all aspects—clinical, academic, research, and administrative. This article provides an overview of available apps, tips on using apps—both general and specific for dermatology, as well as discusses the scientific validity of some of these apps and the future of smartphone apps in the context of dermatology.
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Clinico-demographic profile of patients with foot dermatitis: A cross-sectional study with special reference to patch test results p. 377
Swosti Mohanty, Indrashis Podder, Anupama Ghosh, SN Chowdhury, Debabrata Bandyopadhyay
Background: Foot dermatitis is a common debilitating dermatological disorder where the eczematous process predominantly involves the feet. Aims and Objectives: To analyze the clinico-demographic profile, type, clinical pattern, and evaluate the role of patch testing to determine the causative factors of foot dermatitis. Materials and Methods: Fifty-eight new patients clinically diagnosed with foot dermatitis were subjected to detailed history taking and physical examination. The patients were subjected to patch testing using the Indian standard battery and Indian footwear series (Contact and Occupational Dermatoses Forum of India [CODFI]). Results: Among the 58 patients (mean age 31.48 ± 16.4 years, M:F 1:1.2), the majority (39.7%) presented with allergic contact dermatitis (ACD) followed by irritant contact dermatitis (ICD) (19%), while atopic dermatitis was the least (3.45%). However, 48% of our patients reported a history of atopy. About 43.5% of ACD patients showed a positive patch test reactions to at least one allergen of Indian standard battery and footwear series. Mercaptobenzothiazole (MBT) was the commonest allergen (50%), followed by potassium dichromate (40%), thiuram mix (20%) while paraphenylenediamine was the least common (10%). Dorsum of the foot was affected most commonly (55.17%), followed by toe (46.55%) and sole (41.38%). Scaling was observed in almost 80% of patients followed by crusting. Housewives were affected most commonly followed by students and cement workers. Conclusion: Rubber and rubber chemicals were found to be the commonest allergen inciting foot dermatitis. Atopy might be a predisposing factor in these patients. Thus, patch testing is recommended to determine the cause of foot dermatitis and provide suitable treatment.
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A profile of 23 indian patients with purpura fulminans: A retrospective, descriptive study p. 381
Sudip Kumar Ghosh, Debabrata Bandyopadhyay, Abhijit Dutta, P Esther Jane, Surajit Kumar Biswas
Background: Purpura fulminans (PF) is a potentially fatal uncommon disorder of intravascular thrombosis and is clinically characterized by rapidly progressive hemorrhagic infarction of the skin. Objective: To describe the clinical feature and outcome of a series of patients with PF. Materials and Methods: A descriptive study based on review of case records was carried out at a tertiary care hospital in Kolkata. Results: Twenty three consecutive cases seen over a period of 8 years were studied. The age range was 4 days to 78 years (mean 35.6 years) with a male to female ratio of 1:2.8. Hemorrhagic rash was the universal presenting symptom. Other major presenting features included pneumonia (26.1%), sudden-onset shock syndrome (21.7%), and urinary tract infection (17.4%). All patients presented with retiform purpura and lesional necrosis and 8 (34.8%) patients had associated peripheral gangrene. Nineteen (82.6%) patients had sepsis and 60.9% patients had vesiculo-bullous lesion. Pneumococcus was the most common (26.1%) pathogenic organism detected. The precise cause of PF could not be detected in two (8.7%) patients. One patient (4.3%) with neonatal PF had protein C deficiency. All patients had evidence of disseminated intravascular coagulation (DIC). One patient had to undergo a below knee surgical amputation and one patient had autoamputation of the digits. Ten (43.5%) patients succumbed to their illness. Seven of the 8 patients who had peripheral gangrene had a fatal outcome. Limitations: Relatively small sample size and a referral bias were a few limitations of the present study. Conclusion: The present study emphasizes that PF is a cutaneous marker of DIC. Association of peripheral gangrene, leukopenia and neutropenia may be the reason for the high mortality rate.
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The depigmented literature: A holistic analysis of global vitiligo publications between 1975 and 2017 p. 388
Engin Şenel
Background: Vitiligo is a common depigmenting disorder with a prevalence of 0.5–2%. Despite the increasing popularity of bibliometric studies in recent years, medical literature lacks a report investigating bibliometric features of vitiligo literature. Aim: It was aimed to analyze vitiligo literature by evaluating productivity of countries, institutions, and authors, and performing assessment of publication trends, bibliometric networks, and correlations. Material and Methods: We collected all data in this study by searching databases provided by Web of Science. All documents published on vitiligo literature between 1975 and 2017 were included. We performed correlation analyses between productivity and demographical and economical features of the countries publishing vitiligo articles. Results: A total of 7187 documents were detected and 72.2% of which was original article. The peak year for publication number by year was 2016 with 528 articles and the highest number of citations was reported in 2017. The USA was the leading country by total publication number (24.82%) followed by the United Kingdom (UK), India, China, and Italy (10.91%, 8.64%, 7.54%, and 6.87% respectively). Estonia was found to be the most productive country of vitiligo literature (13.01) followed by Netherlands, the UK, and Switzerland (12.64, 11.78, and 9.25, respectively). We found a high correlation between GDP per capita and the productivity of the countries (r = 0.732,P < 0.001). Conclusion: As revealed in our study, although vitiligo occurs worldwide, developed countries dominated vitiligo literature. Researchers from developing and least-developed countries should be encouraged and supported to perform novel vitiligo studies.
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Real-world insight on apremilast therapy in patients with plaque psoriasis: Indian experience p. 396
Abhishek De, Sudip Das, Dhiraj Dhoot, Aarti Sarda
Introduction: Psoriasis is an immune-mediated inflammatory skin disorder, which follows a chronic course. Apremilast is a novel phosphodiesterase 4 (PDE4) inhibitor, approved by US-FDA for the treatment of moderate to severe plaque psoriasis and psoriatic arthritis. A majority of the data related to the effectivity and safety of apremilast use in psoriasis is extracted from clinical trials. The present study was planned to get an insight into real-world experience with the use of apremilast in patients with moderate-to-severe plaque psoriasis related to its effectiveness and safety in India. Materials and Methods: The present study was a retrospective one, wherein a review of the medical records of patients with psoriasis was conducted at one center in Kolkata, who were prescribed apremilast for 16 weeks in a community dermatology practice, from December 2017 to May 2018. Results: Out of 39 patients, two patients discontinued treatment due to diarrhea. Only three patients were treatment naïve; the rest had taken some form of systemic therapy before apremilast. At the end of 16 weeks of treatment with apremilast, PASI 100 was achieved in one patient (2.7%), PASI 90 in one (2.7%), PASI 75 in 18 patients (48%), while 14 patients (38%) achieved PASI 50. Eighteen (46%) experienced adverse events, diarrhea being the most common (29.7%). Conclusion: The findings of the present study indicate that apremilast is effective in a real-world setting, as compared with clinical trials in achieving certain endpoints like PASI 75, as was found in other real-world studies in other countries, as well.
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A clinicohistopathological analysis of cutaneous fibrous histiocytomas of the finger p. 401
Kyung-Hwa Nam, Sang-Woo Park, Seok-Kweon Yun
Background: Cutaneous fibrous histiocytoma (CFH) is a common, benign skin tumor predominantly occurring on the extremities or trunk. However, CFH on the finger is rare. Objective: This study was undertaken to examine the clinicohistopathological features of CFH of the finger. Materials and Methods: This is a retrospective study of 12 CFHs located on fingers in a tertiary hospital in Korea. All case slides were retrieved from saved files. Results: Ages of the CHF of the finger affected individuals ranged from 9 to 48 years with a male-to-female ratio of 1.4:1. Picker's nodule or wart was the most common clinical diagnosis. In only 2 out of the 12 cases was the pre-biopsy diagnosis of CFH ventured. Fibrocollagenous type was the most common histological type. Majority of the cases were mitotically inactive, exhibiting only 0–1 mitoses per high-power field and there was no recurrence. Tumor cells were uniformly CD34 negative. Conclusion: Because CFH can resemble malignancies including dermatofibrosarcoma protuberans, a lack of familiarity with the occurrence of CFH of the finger may lead to more aggressive treatment. Dermatologists should include CFH in their differential diagnosis of circumscribed nodules on the fingers to ensure proper management.
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The Effectiveness of cryosurgery combined with curettage and electrodessication in the treatment of keratoacanthoma: A retrospective analysis of 90 cases p. 406
Antonios Panagiotopoulos, Nikolaos Kyriazis, Eleni Polychronaki, George D Leotsakos, Polytimos Vassis, Dimitrios Rigopoulos
Background: There are several treatment options for keratoacanthoma (KA). However, there are limited data available on the use of cryosurgery. Objective: To evaluate the effectiveness and safety of a combination treatment for KA and to evaluate the cosmetic outcome. Materials and Methods: The combination treatment incorporates the use of curettage, electrodessication, and cryotherapy. A retrospective study was conducted on 90 patients with KA who had been treated with this method between 2000 and 2014. The follow-up period lasted 2 years and photographs were available for every visit of the patients to the department. Results: The success rate was found to be 97.8%. No serious adverse events were observed. No infections were reported. The cosmetic outcome was evaluated as excellent for all patients. Discussion: The combination method appears to combine the advantages of both destructive treatment and surgical excision. It appears to be a safe and effective treatment method. However, there are certain limitations to this study. Conclusions: More studies are needed to evaluate the effectiveness and safety of this method.
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A child with enlarged extremities – A case of macrodystrophia lipomatosa p. 409
K Gunasekaran, N Sundareswaran, G Gopinath
Macrodystrophia lipomatosa (ML) is a rare, non-hereditary, developmental anomaly that occurs because of the progressive proliferation of all mesenchymal elements of single or multiple digits or entire extremity, with a disproportionate increase in fibroadipose tissue. Commonly one or few digits of an extremity will be enlarged and present as macrodactyly or as enlarged limb. Lower limb involvement is more common and frequently unilateral. The diagnosis of ML is made by accurate clinical assessment and imaging modalities, such as plain X-ray, computed tomography scan, magnetic resonance imaging, and confirmed by histopathological study. In this case, we described a 10-year-old child who was brought to us with enlarged upper and lower extremities and was diagnosed as a case of ML with the help of clinico-radiological studies and presented here because of focal gigantism involving all four limbs, which is very rare.
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A rare case of lichen planus follicularis tumidus involving bilateral retroauricular areas p. 414
Vaishali H Wankhade, Pranita P Daware, Bhagyashree Babanrao Supekar, Rajesh Pratap Singh
Lichen planus follicularis tumidus (LPFT) is an extremely rare variant of lichen planus characterized by white to yellow milia-like cysts and comedones on a violaceous to hyperpigmented plaque most commonly involving retroauricular area. Clinically, it resembles milia en plaque. It is usually asymptomatic, more common in middle-aged females. Histopathologically, it has features of lichen planopilaris along with follicular cysts in dermis surrounded by lichenoid infiltrate. We are reporting a case of LPFT in a 62-year-old male patient involving bilateral retroauricular areas due to the rarity of this condition.
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A rare case of poikilodermatous mycosis fungoides p. 417
Preema Sinha, Durga Madhab Tripathy, Divya Shelly, Shekhar Neema
Poikilodermatous mycosis fungoides (PMF) is a rare clinical variant of early-stage mycosis fungoides with peculiar histological features and with low risk of disease progression. Since poikiloderma can coexist with classical mycosis fungoides lesions, PMF can only be considered when poikilodermatous lesions are predominant (>50% of lesions). We here report one such rare case of PMF with poikilodermatous lesions covering almost 70% of the body surface and with characteristic clinical, histopathological, dermoscopic, and immunohistochemical findings.
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Zosteriform cutaneous metastases with primary endometrial carcinoma p. 420
Roopa Raghupathy, Anuradha Priyadarshini, V Mahalakshmi, R Sudha, M Krishnakanth, M Banu Priya
Cutaneous metastases from endometrial adenocarcinoma are ominous and are seldom seen, though metastases occurring at the local sites, such as pelvic and para-aortic lymph nodes, vagina, peritoneum, and lungs are well recognized. The zosteriform pattern of lesions is even more rare. Here, we describe an interesting case of a 60-year-old female with carcinoma endometrium, presenting with zosteriform cutaneous metastasis.
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Antifungal resistance of candida species isolated from HIV patients in a tertiary care hospital, Mysuru, Karnataka p. 423
Umamaheshwari Shivaswamy, MN Sumana
Context: Candidiasis still remains as a common opportunistic infection in patients with human immunodeficiency virus (HIV). Drug resistance has become a serious health concern because of indiscriminate usage and dosage. Aim: To determine the antifungal resistance pattern of Candida albicans and non-albicans Candida (NAC) from HIV patients. Subjects and Methods: The study was carried out in the department of microbiology at a tertiary care hospital. Candida isolates obtained from HIV patients were tested for drug susceptibility by Vitek-2 automated system. Results: Antifungal susceptibility pattern (n=109) revealed that 15% of the isolates were resistant to at-least one and 85% were sensitive to all the drugs tested. About 10% and 19% of C. albicans showed resistance to fluconazole and flucytosine respectively. Among non-albicans tested, only C. tropicalis (14%) exhibited resistance to flucytosine. Conclusions: Knowledge on epidemiology, species prevalence, and drug resistance pattern may guide for effective therapy. This reduces morbidity and also improves the quality of life.
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Dyskeratosis congenita with DKC1 mutation: A case report p. 426
Xing-Yun Zhao, Wei-Long Zhong, Jie Zhang, Gang Ma, Hao Hu, Bo Yu
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A case of eosinophilic fasciitis presenting with palmar stiffness p. 427
Maryam Nasimi, Zahra Safaei Naragh, Anahita Rostami
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Dermoscopy of focal epithelial hyperplasia p. 429
Ali Al Ameer, Feroze Kaliyadan, Yusef M Almarzooq, Maryam Imran, Hassan F Alkhars
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Meyerson phenomenon in lobular capillary hemangioma Highly accessed article p. 430
Mudita Gupta, Reena Kumari Sharma, Simranjot Kaur, Kuldeep Verma
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Rapidly progressing generalized morphea with high lyme disease titer p. 432
Mi Soo Choi, Gi Hyun Seong, Myeong Jin Park, Minkee Park, Seung Phil Hong, Byung Cheol Park, Myung Hwa Kim
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Aseptic Abscess Syndrome with Severe Skin Involvement: Case Report p. 434
Senay Agirgol, Eda Ustaoglu, Filiz Topaloglu Demir, Tugba Ozkok Akbulut, Zafer Turkoglu, Hasan Kaya, Filiz Pehlivanoğlu
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Spontaneous regression of papular acantholytic dyskeratosis of genitocrural area: A case report with positive DIF findings Highly accessed article p. 437
Xia Jiang, Tangyou Zhu
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Auricular schwannoma: An uncommon location p. 438
Irving Llibran Reyna-Rodriguez, Nereyda Gonzalez-Benavides, Sonia Sofia Ocampo-Garza, Jorge Ocampo-Candiani
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