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   Table of Contents - Current issue
Coverpage
January-June 2018
Volume 2 | Issue 1
Page Nos. 1-47

Online since Friday, January 5, 2018

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REVIEW ARTICLE  

Compensatory phenomena in dermatology Highly accessed article p. 1
Keshavmurthy A Adya, Arun C Inamadar, Aparna Palit
DOI:10.4103/CDR.CDR_26_17  
Compensatory mechanisms in the human body are generally set in action when there is an absence or deficiency of an attribute to make up for the same. Such mechanisms may be intended to compensate for either the quantitative deficiency or functional impairment of an attribute performing a particular function. Frequently, in an attempt to normalize the homeostatic milieu, the compensatory mechanisms may work more than necessary producing undesired effects as well. In this review, we describe some of such compensatory phenomena in relation to clinical, immunological, pathological, and few other aspects of dermatology, as well as such phenomena characterizing some of the dermatotherapeutics.
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ORIGINAL ARTICLES Top

A study of clinical patterns of acute radiation dermatitis among patients attending dermatology outpatient department at tertiary center in Western India p. 8
Shivani Saini, Varadraj Pai, Pankaj Shukla, Harshal Ranglani
DOI:10.4103/CDR.CDR_17_17  
Background: Radiation dermatitis (RD) is a commonly encountered adverse effect of definitive radiation therapy. The severity of RD is influenced by multiple patient and treatment-related factors. Radiation depletes the basal cell layer of skin and initiates a complex sequence of events leading to dose-dependent acute or late sequelae. The management of RD requires a multidisciplinary approach. Objectives: The aim is to highlight the pattern and the profile of patients with acute RD attending dermatology outpatient department. Materials and Methods: Hospital-based cross-sectional study of 47 consecutive adult patients with acute RD attending skin outpatient department over a period of 12 months. Results: A total of 47 patients of RD attended the skin clinic, of which were 16 males and 31 were female. The RD was reported within the first 2 weeks of initiation of therapy in most of the patients. Grade 1 RD was the least common presentation. Conclusions: This study highlights the importance of grading the RD, for the appropriate management of the patients suffering from the same and is also a step toward the prevention of the RD.
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Bacteriological study of community-acquired pyoderma with special reference to methicillin-resistant Staphylococcus aureus p. 13
Neetha Thomas, Banavasi Shanmukha Girisha
DOI:10.4103/CDR.CDR_21_17  
Background: Pyoderma is one of the most frequently encountered condition in dermatology clinics in India. Staphylococcus and Streptococcus are the most common causative agents. There is considerable variation in the reported antibiotic susceptibility pattern of the organisms isolated from pyoderma with a trend toward increasing resistance. Objectives: The objectives of this study were (1) to study the clinical patterns of cutaneous bacterial infections, (2) to determine the antibiotic sensitivity of the isolates obtained, and (3) To assess the prevalence of methicillin resistance (methicillin-resistant Staphylococcus aureus [MRSA]) among the community–acquired (CA) pyoderma. Materials and Methods: Two hundred and fifty-six patients of CA pyoderma constituted the study population. A detailed history was taken and thorough clinical examination was performed. Gram-stained smear examination and culture and sensitivity test of pus were done. Results: Primary pyoderma was seen in 48.8% and secondary pyoderma in 51.2% of cases. The most common primary pyoderma was folliculitis (52%) followed by furuncle (25.6%). In secondary pyoderma, the most common condition was infected eczema (38.2%) followed by infected ulcers (22.1%). Staphylococcus was isolated in 87.5%, Streptococcus in 2%, and mixed organisms were isolated in 5.5% of cases. Maximum susceptibility was seen to tigecycline (89.1%) and linezolid (88.3%). Among topical antibiotics, mupirocin was susceptible in 75.8% and fusidic acid in 66.4% of the organisms. The highest resistance was seen to benzylpenicillin in 81.6% followed by ciprofloxacin in 53.1% of the organisms. The least resistance was seen for daptomycin in 0.8%, tigecycline in 1.6%, linezolid in 2.3%, and mupirocin in 2.7% of the organisms. The proportion of MRSA in CA pyodermas was 25.5%. Conclusion: The study yielded some useful epidemiological and clinicobacteriological data about CA pyoderma. The above observations made regarding antibiotic sensitivities may assist clinicians in choosing antibiotics for CA pyoderma in the absence of pus culture sensitivity.
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Study of cutaneous adverse effects of cancer chemotherapy p. 19
Ashok Menon, Sripathi Handattu, Jayaram Shetty, Banavasi Shanmukha Girisha
DOI:10.4103/CDR.CDR_20_17  
Background: Cancer is a leading cause of mortality and morbidity in both developed and developing parts of the world with the disease burden projected to grow exponentially in future. Over the past several decades great advances have been made in the area of cancer chemotherapy. Objectives: To study the various cutaneous adverse events associated with cancer chemotherapy. Methodology: 100 patients diagnosed with cancer attending the departments of a tertiary hospital who underwent chemotherapy and satisfied the inclusion and exclusion criteria were included in this study. It is a hospital based observational study. All patients were counselled about the study and informed written consent was obtained. Patients were examined before start of chemotherapy treatment and after every cycle of chemotherapy. Data collected was analysed using SPSS version 16.0. Results: In this study, 100 patients including 37 females and 63 males were included in this study. Majority (56%) of the patients belonged to the age group of 41-60 years. The common indications for chemotherapy were carcinoma oropharynx (24%), carcinoma breast (18%), tongue and stomach. Among the cutaneous adverse events noted, hair changes were the most common presentation and were reported in 68 patients. Skin changes were seen in 65 cases, nail changes in 30 cases and mucosal changes in 12 patients. Xerosis (26%) and hyperpigmentation (22%) were the most commonly observed adverse event affecting skin. Cisplatin, cyclophosphamide, 5 fluorouracil, carboplatin, paclitaxel and doxorubicin were the most frequently prescribed chemotherapeutic drugs. Conclusion: Our observations necessitate a joint effort between dermatology and oncology for the early recognition and adequate treatment of the cutaneous adverse effects associated with cancer chemotherapy which may help in reducing morbidity and improving compliance.
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CASE REPORTS Top

Bowenoid papulosis of genitalia responding to topical 5-Fluorouracil p. 25
Ragunatha Shivanna, Meenakshi Kapoor, B Niranjana Murthy, Gangaiah Narendra
DOI:10.4103/CDR.CDR_11_17  
Bowenoid papulosis (BP), a rare disease with malignant potential, is a distinct clinicopathological entity strongly associated with human papillomavirus (HPV) infection. We described an adult male presenting with well defined, purplish papules of varying size with verrucous to smooth surface distributed discretely over medial side of the left thigh, scrotum, and penile shaft. Histopathology showed focal areas of full thickness epidermal atypia comprising irregularly arranged nuclei which are large, hyperchromatic, and crowded at few places. Pap smear from spouse showed inflammatory infiltrate with moderate-to-severe dysplasia. The patient was treated with topical 5-fluorouracil. Excellent response was noticed at the end of 2 weeks. A patient with BP should be thoroughly educated regarding HPV infection and emphasis should be on prevention. Female patients or sexual partners of male patient with BP are at the risk of developing cervical cancer and hence should be followed with regular cytologic, colposcopic, and histologic examinations.
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“Localized” Kaposi's varicelliform eruption caused by varicella zoster virus in a patient of irritant dermatitis p. 28
Naveen Kumar Kansal
DOI:10.4103/CDR.CDR_28_17  
Kaposi's varicelliform eruption (KVE) refers to disseminated viral infections due to herpes simplex, coxsackie A16, etc., in patients of preexisting skin disease. Localized forms of KVE are less well characterized. We hereby describe localized eruption of KVE caused by varicella zoster virus in a patient of irritant dermatitis.
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Ecthyma Gangrenosum due to Pseudomonas aeruginosa and Klebsiella pneumoniae without bacteremia p. 31
Sachin Manohar Shetty, Kikkeri Narayanshetty Naveen, Sharathchandra Bhimrao Athanikar, Zaheer Abbas Alikhan Pathan
DOI:10.4103/CDR.CDR_19_17  
Ecthyma gangrenosum (EG) is a rare cutaneous manifestation classically described for pseudomonal infection in immunocompromised patients. In addition to pseudomonas, numerous other infectious agents have been implicated to cause EG. Herein, we report a case of a previously healthy 45-year-old male patient who presented with multiple irregular deep ulcers of varying sizes with eschar. A clinical diagnosis of EG was made, and empirical antibiotic therapy was initiated. The culture material from the pus grew Pseudomonas aeruginosa and Klebsiella pneumoniae, both sensitive to piperacillin and tazobactam. Skin biopsy showed features of necrotizing vasculitis consistent with the diagnosis of EG.
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Generalized bullous fixed drug eruption mimicking toxic epidermal necrolysis caused by paracetamol p. 34
Banavasi Shanmukha Girisha, Tonita Mariola Noronha, Akshata Charan Alva, Ashok Menon
DOI:10.4103/CDR.CDR_25_17  
Generalized bullous fixed drug eruptions are an uncommon presentation of adverse cutaneous drug reactions, rarely caused by paracetamol. We report a case of a 60-year-old woman who presented with extensive eroded lesions over the body, without mucosal lesions. She developed the lesions within hours of taking paracetamol. In spite of the severity of the reaction, she recovered well with treatment.
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RESIDENT PAGE Top

Olfactory diagnosis in skin p. 38
Kallappa Ravindra, Sneha Gandhi, Aishwarya Sivuni
DOI:10.4103/CDR.CDR_15_17  
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LETTERS TO EDITOR Top

Doxycycline and dapsone in chronic pyoderma gangrenosum: Revisiting the old therapies p. 41
Shilpa Garg, Divya Arora, Kamlender Singh, Surbhi Kansal
DOI:10.4103/CDR.CDR_13_17  
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Doxofylline: Another drug causing fixed drug eruption p. 42
Subramanian Kumudhini, Sudhir U K Nayak, Shrutakirthi D Shenoi, Smitha Prabhu
DOI:10.4103/CDR.CDR_24_17  
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Parameatal urethral cyst p. 44
Parul Aggarwal, Kamal Aggarwal, Ashish Amrani, Vijay Kumar Jain
DOI:10.4103/CDR.CDR_27_17  
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A refractory case of scleromyxedema p. 46
Sudhir U K Nayak, Anusha Taarinie Jha, Shrutakirthi D Shenoi, Kanthilatha Pai
DOI:10.4103/CDR.CDR_23_17  
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