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   Table of Contents - Current issue
Coverpage
July-December 2019
Volume 3 | Issue 2
Page Nos. 109-162

Online since Monday, July 15, 2019

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ORIGINAL ARTICLES  

Efficacy of platelet-rich plasma in acne scars Highly accessed article p. 109
Anirudha D Gulanikar, Renu Vidholkar
DOI:10.4103/CDR.CDR_2_19  
Background: Platelet-rich plasma (PRP) is an autologous preparation which contains a large amount of platelets concentrated into a small volume of plasma. PRP provides various growth factors which aid in quick wound healing. It is used as an adjuvant therapy for acne scars. Thus, in this prospective study, the efficacy of PRP as single modality of treatment for acne scars was evaluated. Methods: Thirty patients of Grade 2 and 3 acne scars according to the Goodman and Baron's qualitative acne scar grading system and Fitzpatrick Skin Type IV and V received six sittings of PRP at an interval of 1 month and followed up for 3 months after the completion of six sittings. Patients were assessed for the improvement in the scar grade, 1 month after the last sitting. Pre- and post-treatment comparative photographs and patient's and physician's satisfaction score were used to assess the results. Results: All the types of scars showed response in terms of reduction in size. Rolling scars responded better to PRP as compared to boxcar and ice pick scars. Estimation of improvement with Goodman and Baron's global qualitative acne scarring system showed that out of 30 patients with Grade 2 and 3 acne scars, 50% showed improvement in terms of acne scar grading at the end of the treatment. Among 25 patients with Grade 3 scars, 15 patients (60%) showed improvement by one grade. Adverse effects were mild being limited to transient pain, erythema, edema, and hyperpigmentation. Conclusion: The current study introduces autologous PRP as a cost-effective, well-tolerated office procedure in the treatment of acne scars without serious side effects. Further studies are needed to be carried out to compare the results of this present study.
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Nailfold capillaries in connective tissue diseases in skin of color: A dermoscopic view p. 115
Balachandra S Ankad, Priyanka S Jaju
DOI:10.4103/CDR.CDR_15_18  
Introduction: Dermoscopy has gained tremendous importance in the recent past. It helps in the visualization of subsurface structures, whereby details of skin lesion are studied in depth. Nailfold capillaries are involved early in the course of disease process in connective tissue diseases. Videocapillaroscopy is used to examine the patterns in the nailfold capillaries. However, training, cost, and skilled technique limits the use of it. Dermoscopy, being handheld and easy to perform, is best alternative to videocapillaroscopy. Authors evaluated the utility of dermoscopy in the study of nailfold capillaries in connective tissue diseases in patient with the skin of color. To the best knowledge of authors, this is the first study from the Indian subcontinent. Materials and Methods: The study was conducted in a tertiary care hospital from January 2017 to June 2017. It was a cross-sectional pilot study. Sixteen consecutive patients with connective tissue diseases were included in the study. Connective tissue diseases comprised of systemic sclerosis, lupus erythematosus, mixed connective tissue disease, dermatomyositis, and rheumatoid arthritis. DermLite 3 dermoscope with Sony camera was employed. Polarized mode and ultrasound gel were used. Results: Of 16 patients, three, two, and three had systemic sclerosis, systemic lupus erythematosus, and discoid lupus erythematosus, respectively. Mixed connective tissue disease, dermatomyositis, and rheumatoid arthritis were seen in one, one, and five patients, respectively. One patient had Rowell syndrome. Scleroderma and nonspecific scleroderma patterns were observed in 75% and 12.5% of patients, respectively. In two patients, the nailfold capillaries appeared normal. Conclusion: Dermoscopy is an in vivo cost-effective method for studying nailfold capillaries in connective tissue diseases. Results obtained using handheld dermoscope were comparable to that of a videocapillaroscope. Authors recommend further studies involving large sample size of the population with skin of color to affirm the nailfold capillaries pattern observed in this study.
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Comparative study of safety and efficacy of oral betamethasone pulse therapy and azathioprine in vitiligo Highly accessed article p. 121
Mahajabeen Madarkar, Balachandra S Ankad, R Manjula
DOI:10.4103/CDR.CDR_13_18  
Background: Vitiligo is a common skin disorder causing depigmented macules that can impair a patient's quality of life. There are number of treatment modalities are available but at the present, there are no studies compairing betamethasone pulse therapy versus azathioprine daily therapy in treatment of vitiligo. Objectives: To compare the safety and efficacy of Azathioprine daily and Betamethasone pulse therapy in the treatment of in vitiligo. Materials and Methods: We included two vitiligo patient groups. namely group A and group B Patients of group A were given oral Azathioprine to be given 50mg twice daily and those of second group B, Betamethasone were given as a single oral dose of 5 mg on two consecutive days per week. Therapy in both groups was given for a total of 6months with follow up at 1, 3 and 6th month. Clinical photographs were taken at each visit. Side-effects if any were noted. Results were calculated with help of VASI score (vitiligo area severity index). Results: At the baseline: The patients to group A (SD 3.81± 2.3) and of group B (SD 3.76± 2.28) were having depigmented patches (P = 0.90). At the first follow up: Although there was significant improvement with perifollicular repigmentation started in both groups but the patients are of group B (SD 3.38±2.06) were showing slower response as compared to oral group A (SD 3.70± 2.28). At the second follow up: Remarkable improvement is seen in both groups compared (P = 0.17). At the third follow up: Significant improvement is seen in both groups compared (P = 0.09). Conclusions: Azathioprine and betamethasone pulse therapy are equally effective in treatment of vitiligo.
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Pellagra: A forgotten entity p. 126
Upputuri Brahmaiah, Amruth Rao Parveda, R Hemalatha, Avula Laxmaiah
DOI:10.4103/CDR.CDR_23_18  
Background: Pellagra is due to deficiency of niacin or its precursor tryptophan and is characterized by four Ds: The Dermatitis, Dementia, Diarrhea, and eventually Death if it is untreated. Not long ago, the disease was endemic in several parts of the world; including India. Over the past two decades, only a few pellagra cases have been reported. By the year 2011, Pellagra had almost disappeared due to public distribution system but, the clinical features still prevail in the Indian subcontinent to some extent. Objective: The study was carried out to report our experience with pellagra in a tertiary care hospital. Materials and Methods: We undertook a retrospective study of 335 clinically diagnosed pellagra cases attending the Nutrition Unit of tertiary care hospital from 1992 to 2012. Results: In a total of 335 patients of pellagra studied, there were 316 males and 17 females. Majority of patients were in 30–40 years with mean age 42.76 ± 11.6 years. Chronic energy deficiency was seen in 63.8% of patients. Chronic alcoholism and tuberculosis were noted in 3.88% and 1.19% of patients, respectively. Conclusion: Pellagra is a complex and multisystem disease that occurs due to varied etiological factors. Of these, inadequate diet is the best-recognized cause in the developing countries like India. This study clearly recommends that general ration should be regularly distributed, especially in areas where maize and sorghum are cultivated and consumed.
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Retrospective analysis of demographic, clinical, and histopathological parameters in patients with basal cell carcinoma p. 130
Aparna Palit, P Ram Sushruth, Keshavmurthy A Adya, Ajit B Janagond, Niranjan S Deshmukh, Arun C Inamadar
DOI:10.4103/CDR.CDR_3_19  
Background: Basal cell carcinoma (BCC) is a common malignancy among light-skin races. Chronic solar exposure is the most important precipitating factor. In India, BCC is the second in order among the nonmelanoma skin cancers, the first being squamous cell carcinoma. Actual incidence and prevalence of this tumor in various geographical regions of India remain undefined. Aim: The aim is to study the demographic, clinical, and histopathological parameters of the patients suffering from BCC residing in a rural area of northern Karnataka. Materials and Methods: Retrospective data analysis of the patients suffering from BCC was performed from the records of dermatology outpatients' department of a tertiary healthcare center in north Karnataka. Results: A total of 41 cases of BCC were examined during 12 years. The duration of the lesions varied from 6 months to 20 years. Female patients outnumbered males in a ratio of 3.36:1. Majority of the patients were homemakers and agricultural workers. Nodular, noduloulcerative, and pigmented BCC were the most common clinical pattern and 9 (28.1%) cases of morpheaform BCC were recorded. Four patients had genodermatoses; three were xeroderma pigmentosum and one case of nevoid BCC syndrome. These patients had multiple lesions of BCC. Classical histopathological features were recorded in all cases. One specimen showed evidence of metatypical epithelioma. Conclusion: Most of the patients in this series belonged to the rural part of North Karnataka, predominantly homemakers and agricultural workers. Females were more commonly affected, attributable to the intermittent type of solar exposure. Morpheaform BCC accounted for less than a quarter of cases, and multiple BCCs associated with genodermatoses were seen in four cases.
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CASE REPORTS Top

Syringomyelia diagnosed with leprosy: A case report p. 136
Vijay Sardana, Rahi Kiran Bhattiprolu
DOI:10.4103/CDR.CDR_13_19  
Leprosy has high incidence in tropical and subtropical countries. We document a case of 26-year-old female with an 18-month history of insidious onset progressive weakness and wasting of small muscles of both hands with decreased sensation distal to elbows and trophic changes without thickened nerves. The patient was on anti-leprosy treatment for the past 1 year with no response to treatment. Examination revealed diminished reflexes in the upper limbs and preserved reflexes in the lower limbs. Skin biopsy was normal. Magnetic resonance imaging of the spine was suggestive of Arnold–Chiari malformation type I with large cervico-dorsal syrinx which was ultimately treated by the surgical management. We suggest that all cases of leprosy should include syringomyelia as a differential diagnosis so that unnecessary prolonged exposure to anti-leprosy drugs with potential side effects can be prevented.
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Hydroa vacciniforme-like lymphoma p. 139
Zhang Fang, Yang Huizhi, Shi Jianqiang, Lin Jiaxi, Cai Yanxia, Chen Rongyi
DOI:10.4103/CDR.CDR_4_19  
Hydroa vacciniforme-like lymphoma is a rare cutaneous T-cell lymphoma occurring in children associated with Epstein–Barr virus (EBV) infection. We reported a 15-year-old Chinese boy who presented with a 3-month history of recurrent special clinical manifestations including vesicles, erythematous papules, ulcer, crusting, and smallpox-like scar on his head, face, neck, limbs, and ankles. EBV-DNA level was positive. Immunohistochemistry showed CD2(+++), CD3(+++), CD4(+), CD5(++), CD7(+), CD8(±), CD56(+), ki67 (30%+), Gr-B(+++). The patient showed a significant improvement in clinical symptoms after being treated with interferon alpha and prednisone.
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Verruca vulgaris over seborrheic keratosis: A locoregional immune default!! p. 142
Archana J Lokhane, Rohini Soni, Priyanka Sheoran, Mukesh Kumar Yadav, Tapankumar Dhali
DOI:10.4103/CDR.CDR_10_19  
Immunocompromised cutaneous district (ICD) or locus minoris resistentiae is an old concept in dermatology, which represents vulnerability of a particular cutaneous site to the development of secondary dermatosis due to prior insults. Seborrheic keratosis (SK) is an asymptomatic benign epidermal keratinocytic tumor, commonly seen in elderly patients. It may also act as an acquired cutaneous lesion offering lesser resistance for the development of other dermatosis. A 65-year-old female patient having SK over cheek developed a new lesion of verruca vulgaris over it. So far as published literature is concerned, this is the first report of verruca vulgaris superimposed over SK; thus, the latter is acting as an example of immunocompromised cutaneous district (ICD).
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Malar blistering: A diagnostic dilemma p. 145
Kanathur Shilpa, B Leelavathy, DV Lakshmi, Divya Gorur
DOI:10.4103/CDR.CDR_24_18  
Bullous pemphigoid (BP) is an autoimmune blistering disorder affecting elderly people. It presents as tense blisters on urticarial base and is associated with intense pruritus. It commonly involves lower abdomen, inner or anterior thighs, and flexor forearms. Localized BP limited to certain parts of the body has also been described in literature. Both classical and localized BP is diagnosed based on histopathology and immunofluorescence. Corticosteroids remain the main stay of treatment. Here, we describe a case of BP presenting as malar blistering closely mimicking bullous systemic lupus erythematosus.
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Eruptive syringoma: A rare case report p. 148
Shilpi Sharma, Deepak Kumar Mathur, Vijay Paliwal, Puneet Bhargava
DOI:10.4103/CDR.CDR_20_18  
Syringoma is a benign adnexal tumor of intraepidermal portion of the eccrine sweat ducts. Eruptive syringoma is a rare clinical variant characterized by small, flesh-colored papules with both follicular and nonfollicular distribution that occur in successive crops on the anterior body surface. We report a case of 35-year-old female with familial eruptive syringoma with predominant acral distribution. We report this case because of the rarity of disorder and acral predominance.
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CLINICAL, DIAGNOSTIC AND THERAPEUTIC PEARLS Top

Simple but effective blister-forming trick in suction blister technique p. 151
Sandeep Mahapatra, Rohit Kumar Sharma, Rani James, Kaushik D Deb
DOI:10.4103/CDR.CDR_16_18  
Vitiligo is a common skin disorder of our country. Many of the patients are refractory to medical treatment. Dermato-Surgery is very rewarding in these cases. Thus proper selection of technique will play a major role in achieving good therapeutic and end cosmetic results. Suction blister technique is convenient and cost effective, less time consuming, pure epidermal graft, excellent colour match, pigment spread from the graft to surrounding area- upto 46% and maximum pigmentation within 3-4 months happens without any scar. Suction Blister Technique: The in vivo separation of epidermis from rest of the skin by production of a suction blister using 50 ml syringe as a vacuum creating device instead of the expensive and cumbersome vacuum devices as the time taken for the blister formation is the same. The advantage in this method we needn't inject intradermal saline into the blisters as blisters formed are appropriate and chances of improper blisters are very rare.
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LETTERS TO EDITOR Top

A clinico-epidemiological study of melasma in 402 patients in an office-based practice p. 154
DA Satish, AD Aparna, VK Radhika
DOI:10.4103/CDR.CDR_39_18  
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Myxomatous form of lupus vulgaris in ear: A rare presentation p. 157
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/2542-551X.262767  
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In response to - Myxomatous form of lupus vulgaris in ear – A rare presentation p. 158
C Chandrakala, Gurusami Karuvelan Tharini
DOI:10.4103/CDR.CDR_14_19  
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Secondary diabetes mellitus in pemphigus vulgaris and management issues p. 159
C Divyalakshmi, Ravi Kant, Neirita Hazarika, Amrita Upadhyaya, Naveen Kumar Kansal, Gargi Taneja
DOI:10.4103/CDR.CDR_36_18  
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ERRATUM Top

Erratum: Facial Frictional Melanosis in Indian Patients: Defining the Entity p. 162

DOI:10.4103/2542-551X.262781  
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