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Indian Journal of Dermatology
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   2010| April-June  | Volume 55 | Issue 2  
    Online since April 22, 2010

 
 
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CME ARTICLE
Dandruff: The most commercially exploited skin disease
S Ranganathan, T Mukhopadhyay
April-June 2010, 55(2):130-134
DOI:10.4103/0019-5154.62734  PMID:20606879
The article discuss in detail about the prevalence, pathophysiology, clinical manifestations of dandruff including the etio-pathology. The article also discusses in detail about various treatment methods available for dandruff. The status of dandruff being amphibious - a disease/disorder, and relatively less medical intervention is sought after for the treatment, dandruff is the most commercially exploited skin and scalp disorder/disease by personal care industries.
  11 27,756 1,222
THERAPEUTIC ROUND
Comparative assessment of topical steroids, topical tretenoin (0.05%) and dithranol paste in alopecia areata
Sudip Das, RC Ghorami, T Chatterjee, Gautam Banerjee
April-June 2010, 55(2):148-149
DOI:10.4103/0019-5154.62747  PMID:20606883
Background: There have been various controversial reports regarding the efficacy of topical agents in topical therapy of alopecia areata. Aim: The study aims to find out the effective ones among the readily available ones for a dermatologist. Materials and Methods: Eighty patients were chosen from the skin OPD of Bankura Sammilani Medical College, Bankura, West Bengal, after evaluating the exclusion criterions. Treatments were continued for 3 month period and a follow up after further 3 months. After dividing them into four groups-group-I (topical steroids), group-II (topical tretinoin 0.05%) group-III (dithranol paste 0.25%), and group-IV (white soft petrolatum jelly)-patients were evaluated. Results: Seventy percent of group-I, 55% of group-II, 35% of group-III, and 20% of the control group (white soft petrolatum jelly) responded favorably. Side effects in the form of dermatitis and hyperpigmentation were seen in group-III. However, no patient discontinued from the study. Conclusion: We conclude that both topical steroids and tretinoin were fairly effective in limited variant of alopecia areata.
  10 5,581 309
ORIGINAL ARTICLE
Nondermatophytic moulds as a causative agent of onychomycosis in Tehran
Shahindokht Bassiri-Jahromi, Ali Asgar Khaksar
April-June 2010, 55(2):140-143
DOI:10.4103/0019-5154.62743  PMID:20606881
Background: In the last few years the number of cases of nondermatophytic onychomycosis has greatly increased. Aim: To evaluate the incidence, the clinic characteristics, and predisposing factors of nondermatophytic onychomycosis. Materials and Methods: All collected specimens were analyzed by direct microscopy and culture. Microscopic examination of these specimens was carried out in potassium hydroxide solution (20%) with dimethyl sulfoxide (4%). These specimens were cultured on sabouraud's glucose agar with chloramphenicol and sabouraud's glucose agar with chloramphenicol and cycloheximide. Cultures were incubated at 25ΊC for up to 28 days and checked twice weekly for growth. Results: Nondermatophytic onychomycosis were 11.5% of all onychomycosis. We found that Aspergillus spp. were the more responsible etiologic agents of nondermatophytic onychomycosis, resulting in a total of 28 patients (59.6%). In our study other causative agents were Acremonium spp. (17%), Fusarium spp. (12.7%), Geotrichum spp. (4.2%), Trichosporun spp., (4.2%) and Scopulariopsis spp (2.1%). In our patients moulds onychomycosis developed mainly in toenails (74.5%). Conclusion: Knowing the exact pathogen is important and has implications in therapy and prognosis.
  8 5,582 268
IJD SYMPOSIUMS
SCID mouse model of psoriasis: A unique tool for drug development of autoreactive T-cell and TH-17 cell-mediated autoimmune diseases
Smriti K Raychaudhuri, Siba P Raychaudhuri
April-June 2010, 55(2):157-160
DOI:10.4103/0019-5154.62752  PMID:20606886
In both skin and synovial tissues of psoriatic arthritis (PsA) patients, there are prominent lymphocytic infiltrates localized to the dermal papillae in the skin and the sublining layer stroma in the joint. T-cells, with a predominance of CD4+ lymphocytes, are the most significant lymphocytes in the tissues; in contrast, this ratio is reversed in the epidermis, synovial fluid compartment, and at the enthesis, where CD8+ T-cells are more common. This differential tropism of CD8+ T-cell suggests that the CD8+ T-cells may be driving the immune response in the joint and skin. This is supported by an association with MHC class I. The cytokine network in the psoriatic skin and synovium is dominated by monocyte and T-cell-derived cytokines: IL-1β, IL-2, IL-10, IFN-γ, and TNF-α. In PsA synovium, higher levels of IFN-γ, IL-2, and IL-10 have been detected than in psoriatic skin. An analysis of T-cell receptor beta-chain variable (TCRβV) gene repertoires revealed common expansions in both skin and synovial inflammatory sites, suggesting an important role for cognate T-cell responses in the pathogenesis of PsA and that the inciting antigen may be identical or homologous between the afflicted skin and synovium. Traditionally, T-cells have been classified as T helper 1 (Th1) or Th2 cells by production of defining cytokines, IFN- γ and IL-4, respectively. Recently, a new type of T-cell, Th17, has been linked to autoimmune inflammation. T-helper 17 (Th17) cells are a unique effector CD4+ T-cell subset characterized by the production of interleukin (IL)-17. Murine diseases that were previously considered to be pure Th1-mediated responses have been shown to contain mixed populations of Th1 and Th17 cells. Also, in humans, a critical immunoregulatory role of Th-17 cells in infectious and autoimmune diseases has been identified. It has been postulated that IL-17 may be important in psoriasis. Our initial observations demonstrate that IL-17 and its receptor system are important for PsA also. In in vivo and in vitro studies we have demonstrated that IL-17/IL-17R are enriched in skin, synovial tissue, and synovial fluid of psoriatic arthritis patients and Th17 cells are functionally significant in the pathogenesis of psoriasis and psoriatic arthritis. Here we will share our experience of the SCID mouse model of psoriasis in respect to its use in investigating psoriatic diseases and development of immune-based drugs for psoriasis, psoriatic arthritis, and other autoimmune diseases.
  7 4,463 274
Biological therapy of psoriasis
Raja K Sivamani, Genevieve Correa, Yoko Ono, Michael P Bowen, Siba P Raychaudhuri, Emanual Maverakis
April-June 2010, 55(2):161-170
DOI:10.4103/0019-5154.62754  PMID:20606887
The treatment of psoriasis has undergone a revolution with the advent of biologic therapies, including infliximab, etanercept, adalimumab, efalizumab, and alefacept. These medications are designed to target specific components of the immune system and are a major technological advancement over traditional immunosuppressive medications. These usually being well tolerated are being found useful in a growing number of immune-mediated diseases, psoriasis being just one example. The newest biologic, ustekinumab, is directed against the p40 subunit of the IL-12 and IL-23 cytokines. It has provided a new avenue of therapy for an array of T-cell-mediated diseases. Biologics are generally safe; however, there has been concern over the risk of lymphoma with use of these agents. All anti-TNF-α agents have been associated with a variety of serious and "routine" opportunistic infections.
  7 8,977 798
SHORT COMMUNICATION
A meta-analysis comparing efficacy of continuous terbinafine with intermittent itraconazole for toenail onychomycosis
NA Trivedi, PC Shah
April-June 2010, 55(2):198-199
DOI:10.4103/0019-5154.62746  PMID:20606897
Background: Toenail onychomycosis is a challenge for clinicians to treat. While both Itraconazole and terbinafine have proven to be effective against onychomycosis, very little is known about their comparative efficacy in achieving mycological and clinical cure. Aim: The purpose of this meta-analysis is to compare the efficacy of continuous terbinafine with intermittent itraconazole in the treatment of toenail onychomycosis. Material and Methods: all RCTs comparing continuous terbinafine with intermittent itraconazole were identified from PUBMED and BIDS electronic database. Results: analysis of total eight trials including 1181 patients state that treatment with continuous terbinafine is more likely to produce mycological and clinical cure compared to intermittent itraconazole with odds ratio 2.3(95% CI, 1.7 to 3.0 P<0.0001) Conclusion: though both itraconazole and terbinafine are well tolerated and highly effective drugs, continuous terbinafine is more effective than intermittent itraconazole at achieving mycological cure of toenail onychomycosis
  7 5,046 290
BASIC RESEARCH
Nerve growth factor, neuropeptides and cutaneous nerves in atopic dermatitis
Abeer Hodeib, Zeinab Abd El-Samad, Hesham Hanafy, Amani Abd El-Latief, Amal El-bendary, Azza Abu-Raya
April-June 2010, 55(2):135-139
DOI:10.4103/0019-5154.62735  PMID:20606880
Introduction: Neurogenic components, as neurotrophic factors and neuropeptides, are probably involved in the pathogenesis of atopic dermatitis (AD) with the neuroimmunocutaneous system as they modify the functions of immunoactive cells in the skin. Nerve growth factor (NGF) is the best-characterized member of the neurotrophin family. Both NGF and neuropeptides (NPs) may be associated with the disease pathogenesis. Aim: This study aims to evaluate the plasma level of NGF and NPs in AD patients and correlate them with the disease activity and nerve changes in the skin by electron microscopy. Materials and Methods: Plasma levels of NGF and vasoactive intestinal peptide (+VIP) were measured by an immunoenzymatic assay while plasma levels of calcitonine gene related peptide (CGRP) and neuropeptide Y (NPY) were measured by radioimmunoassay in 30 AD patients in comparison to 10 normal non-atopic controls. Electron microscopic study was done in 10 AD patients. Results: It has been found that there is significant increase of plasma levels of NGF and NPs in AD patients compared with controls. There is a positive correlation between the plasma levels of NGF and disease activity (correlation coefficient = 0.750, P<0.005). There is a significant correlation between the number of Schwann axon complex, evidenced by electron microscopic examination and plasma level of NGF in AD patients. Conclusion: It has been concluded that these neurogenic factors; NGF and NPs modulate the allergic response in AD, probably through interactions with cells of the immune-inflammatory component. NGF might be considered as a marker of the disease activity.
  6 4,553 238
CASE REPORTS
Perianal basal cell Carcinoma - An unusual site of occurrence
DV Nagendra Naidu, V Rajakumar
April-June 2010, 55(2):178-180
DOI:10.4103/0019-5154.62758  PMID:20606890
Basal cell carcinoma is the most common nonmelanoma skin cancer. Its occurrence in the perianal region is very rare. Awareness of its benign behavior in this region, in contrast to the earlier reports, is vital in its management. Local excision seems to provide adequate control. We are herewith reporting an extremely rare case of a 69-year-old male with basal cell carcinoma treated adequately with local excision.
  6 4,994 128
IJD SYMPOSIUMS
Genetics of psoriasis and psoriatic arthritis
Vinod Chandran
April-June 2010, 55(2):151-156
DOI:10.4103/0019-5154.62751  PMID:20606885
It is well established that psoriasis and psoriatic arthritis (PsA) have a strong genetic component. Recent advances in genetics have confirmed previous associations and new loci have been discovered. However, these loci do not fully account for the high heritability of psoriasis and PsA and therefore many genetic as well as environmental factors remain to be identified. This paper reviews the current status of genetic studies in psoriasis and PsA.
  6 6,656 424
CASE REPORTS
Giant pityriasis rosea
Vijay Zawar
April-June 2010, 55(2):192-194
DOI:10.4103/0019-5154.62750  PMID:20606895
Pityriasis rosea is a frequent papulo-squamous disease and is known for various atypical clinical presentations. We report an adult female patient with a clinical diagnosis of giant pityriasis rosea, which is a rarity in clinical practice.
  4 4,453 210
IJD SYMPOSIUMS
Targeting IL-23: Insights into the pathogenesis and the treatment of psoriasis
Hermenio Cavalcante Lima, Alexandra Boer Kimball
April-June 2010, 55(2):171-175
DOI:10.4103/0019-5154.62760  PMID:20606888
Therapeutic experience strongly supports the use of TNF antagonists as important modalities in the treatment of psoriatic arthritis and plaque psoriasis. Studies with anti-IL-12/23 therapeutic agents, which act in different steps of the psoriatic inflammatory cascade, have also shown demonstrable efficacy. Here, we discuss this approach and its potential within the armamentarium for the treatment of psoriasis. Evidences that the selective blocking of IL-23 may be effective and safe therapy are also addressed.
  4 5,294 330
CASE REPORTS
Recurrent impetigo herpetiformis with diabetes and hypoalbuminemia successfully treated with cyclosporine, albumin, insulin and metformin
Chembolli Lakshmi, CR Srinivas, Sarah Paul, TV Chitra, K Kanchanamalai, LS Somasundaram
April-June 2010, 55(2):181-184
DOI:10.4103/0019-5154.62757  PMID:20606891
We report the case of a patient with recurrent impetigo herpetiformis associated with diabetes mellitus, hypoalbuminemia, and hypocalcaemia; who was refractory to corticosteroids. Cyclosporine along with other supportive measures proved to be life-saving with maintenance of pregnancy.
  3 4,323 143
Galenicals in the treatment of crusted scabies
P Sugathan, Abhay Mani Martin
April-June 2010, 55(2):195-197
DOI:10.4103/0019-5154.62748  PMID:20606896
Crusted scabies is rare. It is a therapeutic challenge, as the common drugs used against scabies are unsatisfactory. The successful use of galenicals in a 10-year-old girl with crusted scabies is reported.
  3 3,881 199
REVIEW ARTICLE
Psychological approach in cosmetic dermatology for optimum patient satisfaction
Mohamed Lotfy Elsaie
April-June 2010, 55(2):127-129
DOI:10.4103/0019-5154.62733  PMID:20606878
Knowledge and skills are required to deal with certain skin disorders and their corresponding cosmetic complaints. The field of cosmetic dermatology is growing as an overlap between the medical treatment of skin diseases and traditional cosmetology. This poses problems for dermatologists and other professionals, including regulation agencies. Dermatology should enable patients to benefit from all that is necessary for their care, whether that is surgery, drugs or cosmetics. There is no need to modify current regulations. A patient-orientated approach is advocated. The author tries to address fellow Dermatologists and those dealing with cosmetology on how to optimally maximize the outcome of their results by simple advices on how to deal with their patients.
  3 4,857 522
THERAPEUTIC ROUND
Intensive treatment of leg lymphedema
Jose Maria Pereira de Godoy, Lina M.O Azoubel, Maria de Fatima Guerreiro de Godoy
April-June 2010, 55(2):144-147
DOI:10.4103/0019-5154.62745  PMID:20606882
Background: Despite of all the problems caused by lymphedema, this disease continues to affect millions of people worldwide. Thus, the identification of the most efficacious forms of treatment is necessary. Aim: The aim of this study was to evaluate a novel intensive outpatient treatment for leg lymphedema. Methods: Twenty-three legs of 19 patients were evaluated in a prospective randomized study. The inclusion criteria were patients with Grade II and III lymphedema, where the difference, measured by volumetry, between the affected limb below the knee and the healthy limb was greater than 1.5 kg. Intensive treatment was carried out for 6- to 8-h sessions in the outpatient clinic. Analysis of variance was utilized for statistical analysis with an alpha error of 5% (P-value <0.05) being considered significant. Results: All limbs had significant reductions in size with the final mean loss being 81.1% of the volume of edema. The greatest losses occurred in the first week (P-value <0.001). Losses of more than 90% of the lymphedema occurred in 9 (39.13%) patients; losses of more than 80% in 13 (56.52%), losses of more than 70% in 17 (73.91%) and losses of more than 50% were recorded for 95.65% of the patients; only 1 patient lost less than 50% (37.9%) of the edema. Conclusion: The intensive treatment of lymphedema in the outpatient clinic can produce significant reductions in the volume of edema over a short period of time and can be recommended for any grade of lymphedema, in particular the more advanced degrees.
  3 7,956 200
CASE REPORTS
Blister fluid immunofluorescence in a case of pemphigus vulgaris
C Shanmugasekar, VR Ram Ganesh, Alamelu Jayaraman, CR Srinivas
April-June 2010, 55(2):188-189
DOI:10.4103/0019-5154.62755  PMID:20606893
Indirect immunofluorescence with serum is used in the diagnosis of pemphigus. We report a case in whom blister fluid was used as the specimen for indirect immunofluorecscence.
  2 3,509 154
Pseudoepitheliomatous, keratotic, and micaceous balanitis
PS Murthy, Kusumika Kanak, Leena Raveendra, Pallavi Reddy
April-June 2010, 55(2):190-191
DOI:10.4103/0019-5154.62753  PMID:20606894
A 51-year-old circumcised male presented with hard, thick, keratotic, nail-like covering of the skin of his glans penis of 2 year duration. Histology showed acanthosis, papillomatosis, and elongated rete ridges into the dermis suggestive of pseudoepitheliomatous, keratotic, and micaceous balanitis with features of cellular atypia. Partial penile amputation was done. There was no recurrence after 6 months of follow up.
  2 4,369 136
CORRESPONDENCES
Malignant melanoma presenting as multiple discharging sinuses
Pradeep Vittal Bhagwat, Chandramohan Kudligi, BM Shashikumar, Arun Thirunavukkarasu, Mohan Eshwara Rao Shendre, Sujata Shivanand Giriyan
April-June 2010, 55(2):201-204
DOI:10.4103/0019-5154.62742  PMID:20606900
  2 3,104 131
CASE REPORTS
Pancreatic panniculitis in a child
Angoori Gnaneshwar Rao, Indira Danturty
April-June 2010, 55(2):185-187
DOI:10.4103/0019-5154.62756  PMID:20606892
Pancreatic panniculitis is an uncommon cause of panniculitis. It is associated with acute or chronic pancreatic disease. 1½ year old boy was referred for erythematous tender nodules involving both legs and associated with abdominal distention, fever, and vomiting. Dermatological examination revealed multiple erythematous tender nodules distributed over front and back of legs. Blood chemistry showed raised serum amylase (430 IU/ l). Ultrasonography showed a pseudopancreatic cyst. Multislice CT scan was suggestive of a pseudopancreatic cyst. A skin biopsy showed typical features of pancreatic panniculitis which included lobular panniculitis with lipocyte degeneration with few Ghost cells.
  1 3,182 126
Acute generalized exanthematous pustulosis: An unusual side effect of meropenem
Mohammed Hanafy Khalel, Salhamooud Abdel Fattah Saleh, Abdel-Hamid F El-Gamal, Nabeel Najem
April-June 2010, 55(2):176-177
DOI:10.4103/0019-5154.62759  PMID:20606889
A male patient was hospitalized as a case of pneumonia. He was diabetic, hypertensive and post Hepatitis "C" "H-C". He reported skin eruption following administration of meropenem. Skin biopsy revealed acute generalized exanthematous pustulosis. To elucidate this side effect, we conducted a literature search - this is the second case induced by meropenem. The diagnosis was made after excluding all other possible causes. Dermatologists and clinicians must be aware of this an unusual side effect.
  1 4,660 174
IJD SYMPOSIUMS
Recent advances in psoriasis: Bench to bedside
Siba P Raychaudhury
April-June 2010, 55(2):150-150
DOI:10.4103/0019-5154.62749  PMID:20606884
  1 3,345 450
CORRESPONDENCES
Eczema herpeticum in a patient with terminal renal failure under narrow-band UVB therapy
Lorea Bagazgoitia, Sonia Bea, Maite Garate, Ramon Moreno, Pedro Jaen
April-June 2010, 55(2):200-201
DOI:10.4103/0019-5154.62744  PMID:20606898
  - 2,892 110
Neonatal tinea corporis
Ashok Kumar Khare, Lalit Kumar Gupta, Asit Mittal, CM Kuldeep, Anshu Goyal
April-June 2010, 55(2):201-201
DOI:10.4103/0019-5154.62741  PMID:20606899
  - 3,513 181
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