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   Table of Contents - Current issue
July-December 2018
Volume 2 | Issue 2
Page Nos. 49-96

Online since Tuesday, July 10, 2018

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Genital lesions in a female child: Approach to the diagnosis Highly accessed article p. 49
Bhakthavatsalam Anitha, Ragunatha Shivanna
Genital lesions in a female child cause a lot of apprehension in the parents. Hence, thorough knowledge and proper approach to the diagnosis is very important. The aim of this article is to present an overview of the pattern of diseases affecting genitalia in a female child, significance of these diseases, and an approach to the diagnosis of these diseases. Most of these vulval dermatoses present with one of the four clinical scenarios such as pruritus with/without lesions, pain with/without lesions, discharge with/without lesions, and asymptomatic lesions. The approach to the diagnosis has been discussed accordingly. Diseases such as genital warts and genital herpes which are not common in this age group always raise the suspicion of child sexual abuse. There are certain adult vulval dermatoses such as chronic vulvovaginal candidiasis, which are not seen in prepubertal group.
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A randomized, assessor-blinded, comparative study to evaluate the efficacy and safety of oat extract-based moisturizer in adult individuals with dry skin p. 58
Sarvajnamurthy Aradhya Sacchidanand, Satish Udare, Dhammraj Madhukar Borade, Varsha Narayanan, Sagar Katare, Ashish Mane, Agam Shah
Background: Dry skin or xeroderma is a very frequent condition which occurs at any age. Moisturizers including conventional oatmeal have been widely used to improve dry skin conditions. Oat-based moisturizer can protect, hydrate, and promote the endogenous barrier repair. Aim: This study aims to evaluate the efficacy and safety of oat extract-based moisturizer in adult individuals with dry skin. Materials and Methods: This study was a treatment-randomized, assessor-blinded, no treatment controlled, comparative study. A total of 36 individuals were included in the study. Oat extract-based moisturizer (test product) and control treatment (no product application) were randomized, as per randomization plan and applied to all individuals on the surface of volar forearm 2 cm (1 cm radius) in diameter. In addition, right cheek as control site and left cheek as test site (oat extract-based moisturizer lotion) were considered for sebum level and facial skin pH analysis. Results: Oat extract-based moisturizer possessed excellent skin moisturizing properties. Both the Corneometer® and modified Kligman score, respectively, showed significant improvement (P < 0.0001) in skin hydration and decrease in skin dryness with respect to baseline till 24 h postapplication. Furthermore, Cutometer® reading had statistically significant increase in skin elasticity as compared to baseline till 6 h postapplication. There was no statistically significant effect on skin pH and sebum level as compared to control treatment. This concludes that oat extract-based moisturizer is effective in improving skin hydration and elasticity without any change in skin pH and sebum levels. Conclusion: Test product (oat extract-based moisturizer lotion) was safe and well tolerated. Efficacy analysis showed that the effect of oat extract-based moisturizer was significant in terms of skin hydration and skin elasticity.
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Metabolic syndrome in patients with psoriasis: A hospital-based case–control study p. 64
Narendra Gangaiah, NS Aysha Roshin, Veena Thimmappa, Ragunatha Shivanna
Background: Psoriasis is a chronic inflammatory skin disease with an increased risk of cardiovascular disease. Metabolic syndrome (MS) increases the risk of cardiovascular diseases and type 2 diabetes mellitus. Previous studies indicate a higher prevalence of MS in psoriatic patients. Objectives: The objective of the study was to determine the frequency of occurrence of MS and its individual components in patients with psoriasis. Methodology: This study was a hospital-based, case–control study involving fifty adult patients with psoriasis and fifty age- and gender-matched controls. Blood pressure, body mass index, waist circumference, fasting lipid profile, and blood sugar were assessed in all subjects. MS was diagnosed by the presence of three or more of the South Asian Modified National Cholesterol Education Program's Adult Treatment Panel III criteria. Results: MS was significantly more common in psoriatic patients than in controls (38% vs. 22%, P = 0.043). Psoriatic patients had higher prevalence of raised fasting blood sugar (32% vs. 16%, P = 0.0334), hypertriglyceridemia (34% vs. 18%, P = 0.037), low high-density lipoprotein (50% vs. 20%, P = 0.00093), and hypertension (38% vs. 20%, P = 0.025). Raised values of waist circumference as a measure of central obesity though not statistically significant (P = 0.08) were found higher in psoriatic cases. The mean age of the psoriatic patients in years was 48 ± 17.1. Mean duration of the disease was 9.2 ± 8 years. There was no correlation between the severity and duration of psoriasis with MS. Conclusion: MS is frequent in patients with psoriasis. This highlights the need for screening of all psoriatic patients for early diagnosis and treatment of associated MS.
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Outcome of pulse therapy in pemphigus: A 10-year study p. 69
Sirisha Varala, Shashikant Malkud, Geeta Kiran Arakkal, Divya Siddavaram
Background: Pemphigus is a potentially fatal autoimmune blistering disease affecting the skin and mucosa. Pulse therapy has been tried in pemphigus in India and other countries with variable results. Aims: The aim of the study was to assess the outcome of pulse therapy in pemphigus patients treated over a period of 10 years. Materials and Methods: Patients with pemphigus treated with pulse therapy from 2006 to 2016 were taken into the study. Results: A total of 122 pemphigus patients were included in the study, of which pemphigus vulgaris was diagnosed in 112 patients, pemphigus foliaceus in 9 patients, and pemphigus vegetans in 1 patient. The mean age was 37.75 ± 8.60 years, with an age range of 19–58 years. Duration of the disease ranged from 7 days to 3 years, with a mean of 6.87 ± 8.81 months. Ninety-three patients were started on dexamethasone cyclophosphamide pulse therapy and 29 on dexamethasone azathioprine pulse therapy. Thirty-three patients discontinued treatment, pulse therapy was stopped in two patients due to complications, and four patients died while on treatment. Out of the remaining 83 patients, 22 patients were in Phase I, 13 in Phase II, 7 in Phase III, and 41 in Phase IV by the end of the study. Sixty-one patients completed Phase I and were maintaining remission. Seven patients relapsed (3 in Phase II and 2 each in Phase III and IV). Ten patients completed 5 years of Phase IV and were considered cured of the disease. Generalized weakness, myalgia, headache, diabetes, and amenorrhea were the most common side effects. Conclusion: Pulse therapy was found to be effective in inducing and maintaining remission in the treatment of pemphigus. Prevention of relapses requires continuation of the treatment during Phase II and III.
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Autoimplantation therapy for recalcitrant viral warts p. 74
Anirudha Dharnidhar Gulanikar, Dhanashree Santosh Bhide, Suresh A Pethe
Background: Various methods for treatment of warts have been practiced; however, in areas such as the beard area or in patients having multiple lesions, recurrence can be a problem. In such situations, autoimplantation therapy can be a useful adjunct. Aim: The aim of the study was to evaluate the efficacy of autoimplantation of viral wart as a treatment option for extensive and recalcitrant warts. Materials and Methods: Twenty-five consecutive patients who presented with recalcitrant warts in a private clinic in Pune and at MGM Medical College in Aurangabad were included in the study. They were followed up for a period of 1 year and evaluated for clearance of lesions. Results: There was complete clearance in 22 patients, 3 patients failed to show any clinical improvement. Conclusion: Autoimplantation of wart is a promising therapeutic option in extensive and recalcitrant warts where most of the treatment options failed to show satisfactory results. However, there are no predictive parameters for the expected outcome.
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Congenital triangular alopecia of occipital scalp: A rare entity p. 78
Naveen Kumar Kansal, Payal Chauhan
Congenital triangular alopecia (CTA), a relatively less recognized condition of the scalp, presents as a localized nonscarring patch of alopecia. The condition is likely to be confused with more common diseases for example alopecia areata. Recently, a case of occipital CTA presented to us, whose parents had applied indigenous topical medicine to cure the lesion with resultant irritant reaction. The aim of our case report is to increase awareness of the condition so that unnecessary treatments may be avoided.
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Lymphoma presenting as subcutaneous periorbital nodules p. 81
Lauren N DeMaria, Codrin E Iacob, Roman Shinder
A 67-year-old female presented with a several month history of painless enlarging right periorbital growths. Examination showed multiple nontender subcutaneous nodules superior to the right eyebrow. Magnetic resonance imaging and incisional biopsy confirmed subcutaneous marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT). Subcutaneous involvement sparing the epidermis is a rare presentation in patients with prior noncutaneous marginal zone lymphomas. Recent studies have demonstrated that subcutaneous dissemination is associated with MALT lymphoma of the breast and ocular adnexa. Systemic workup is therefore critical in patients who present with subcutaneous MALT lymphoma. Radiation therapy has proven to be effective in cutaneous marginal zone B-cell lymphomas.
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An unusual amalgamation of plaques p. 83
Myfanwy Joanne D'Souza, Ramesh M Bhat, Michelle S Fernandes
A 42-year-old woman presented with asymptomatic discrete hyperpigmented plaques over the body and face since childhood. Over time, these lesions amalgamated to form diffuse plaques over the entire forearm and lower legs, with a recent onset of pinkish firm growths over the preexisting lesions of the elbows and knees. Histopathology was suggestive of Human papillomavirus (HPV) infection. The patient's history, physical examination, and HPE were conclusive of epidermodysplasia verruciformis, which is a rare genetic disorder with defective cell-mediated immunity towards HPV. It is characterized by a persistent eruption of pityriasis versicolor-like macules, verruca-like papules, and seborrheic keratosis-like plaques with an increased tendency of cutaneous malignancies. We present this case for its atypical nature, i.e., the absence of typical pityriasis versicolor-like lesions and absence of malignant transformation.
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Waldenstrom macroglobulinemia with herpes zoster, a case report and review literature p. 87
Amar Ranjan, Raja Pramanik, Meenakshi Wadhwani, Lawanya Ranjan, Rimlee Dutta
Waldenstrom macroglobulinemia (WM) is a variant of lymphoplasmacytic lymphoma. In WHO classification of hematolymphoid malignancy 2016, WM has been placed in between lymphoma and plasma cell myeloma under the broad heading “Neoplasms of mature lymphocytes”. This is a rare and slowly progressive disorder, which needs therapy only when symptoms appear. The average age of diagnosis is 60–70 years. WM may progress to lymphoma in 2% cases per year. Here, we are discussing a case of WM having typical findings of this rare disease, who presented with 10%–12% plasma cell in bone marrow aspirate smear, high immunoglobulin M, high beta 2 microglobulin, bilateral axillary lymphadenopathy and gastrointestinal bleeding. At present, the patient is on chlorambucil plus prednisolone therapy and is doing well. Typically, this case presented with lesions of herpes zoster, which makes this case further uncommon.
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Acneiform eruptions and inflammatory striae as probable reactions to adalimumab p. 91
Shilpa Garg, Priyanka Borde Bisht
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Psoriasis alba: A neglected entity p. 93
Niharika Jha, Bimal Kanish
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Striae distensae as a side effect of cyclosporine used in treatment of Autoimmune Urticaria p. 95
Anju Liya Thomas, Balakrishnan Nirmal, Sramana Mukhopadhyay
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