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   2021| May-June  | Volume 12 | Issue 3  
    Online since May 12, 2021

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Follicular unit extraction [FUE] – One procedure, many uses
Amit S Kerure, Nitika Deshmukh, Sandeep Agrawal, Narendra G Patwardhan
May-June 2021, 12(3):381-388
Follicular unit extraction [FUE] is a minimally invasive hair restoration surgery popularly known for its utility in androgenetic alopecia (AGA). In FUE, individual follicular grafts are extracted from donor area and implanted in the recipient area. Advantages of FUE are that it is comparatively 'scarless', has faster healing time, has less downtime and requires less technical staff. This article is aimed to highlight upon the multi-faceted utility of FUE technique in various dermatological indications like androgenetic alopecia, alopecia areata, facial hair restoration, tractional alopecia, scarring alopecia, body hair transplant, vitiligo as well as hirsutism.
  3,821 360 -
Immunopathogenesis of dermatophytoses and factors leading to recalcitrant infections
Kabir Sardana, Aastha Gupta, Sinu Rose Mathachan
May-June 2021, 12(3):389-399
The pathogenesis of dermatophytic infections involves the interplay of three major factors: the dermatophyte, the inherent host defense, and the adaptive host immune response. The fungal virulence factors determine the adhesion and invasion of the skin while the immune response depends on an interaction of the pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMP) with pattern recognition receptors (PRRs) of the host, which lead to a differential Th (T helper) 1, Th2, Th17, and Treg response. While anthropophilic dermatophytes Trichophyton rubrum and now increasingly by T. interdigitale subvert the immune response via mannans, zoophilic species are eliminated due to a brisk immune response. Notably, delayed-type hypersensitivity (Th1) response of T lymphocytes causes the elimination of fungal infection, while chronic disease caused by anthropophilic species corresponds to toll-like receptor 2 mediated IL (interleukin)-10 release and generation of T-regulatory cells with immunosuppressive potential. Major steps that determine the ultimate clinical course and chronicity include genetic susceptibility factors, impaired epidermal and immunological barriers, variations in the composition of sebum and sweat, carbon dioxide tension, skin pH, and topical steroid abuse. It is important to understand these multifarious aspects to surmount the problem of recalcitrant dermatophytosis when the disorder fails conventional therapeutic agents.
  3,228 404 1
A comparative study of topical 5% 5-fluorouracil with needling versus 30% trichloroacetic acid with needling in the treatment of plantar warts
Sushma Jankal Basavarajappa, Radhakrishnan Subramaniyan, Rajeshwari Dabas, Sandeep V Lal, Manasa S Janney
May-June 2021, 12(3):412-416
Background: Warts are benign proliferations of keratinocytes caused by Human Papilloma Virus (HPV). Plantar warts are caused by HPV types 1, 2, 4, 27 and 57. It is challenging to treat them due to frequent recurrences. Aim: To compare the efficacy and safety of topical 5% 5-Fluorouracil (5-FU) with needling versus 30% Trichloroacetic acid (TCA) with needling in the treatment of plantar warts. Materials and Methods: Sixty consecutive patients of plantar warts were randomly allocated into two groups of 30 each and treated with either 30% TCA with needling or 5% 5-FU with needling once in four weeks, until complete clearance of warts or for a maximum of three sessions. Baseline clinical photographs were taken and subjective response at the end of treatment was recorded. Objective assessment at 4, 8, and 12 weeks was carried out and outcome was evaluated by reduction in number and size of warts. Adverse effects of each group were noted and compared. Follow-up of patients was done at 6 months for clinical assessment of results and to study recurrence. Results: Out of 30 patients in 30% TCA group, 28 patients (93.33%) had complete response and 02 patients (6.66%) had partial response at the end of 12 weeks. In 5-FU group, 26 patients (86.66%) showed complete response, 02 patients (6.66%) had partial response, and 02 patients (6.66%) had no response to treatment. The mean reduction in size and number of warts was better in the TCA group and was significant at 4th week of follow up while at the end of 8th week and 12th week, the response was identical. There was no recurrence of warts in the complete responders at the end of 6 months. The main adverse effect seen in both groups was pain at the needling site. Conclusion: Needling with both topical 5% 5-FU and 30% TCA are highly effective in clearing plantar warts. However, 30% TCA has the advantage of early action and complete clearance of plantar warts with fewer adverse effects.
  1,910 244 1
Dermatology and randomized control trials
Nayankumar Patel, Amrita Sil
May-June 2021, 12(3):400-407
Well-designed and rigorously conducted randomized controlled trial (RCT) can produce most valid and precise scientific evidence. Any intervention, be it systemic or topical medicine, dermatology procedure needs to be tested for its efficacy in improving particular disease condition and RCT should come into mind of investigator. The biggest strength of RCT lies in two self-explanatory factors; they are randomized and controlled. Randomization of study subjects eliminates selection and confounding bias and controlling of study condition improves the internal and external validity of findings. “Blinding” eliminates assessment bias. If one starts a comparative study without stating proper hypothesis, he/she would end up collecting lots of data which does not make sense. PICOT format helps in formulating research question. Writing a detailed protocol based on hypothesis describing in detail methodology, sample size calculation, randomization method, and blinding procedure up to statistical analysis plan is very important step in planning of RCT. Trials registered prospectively contribute to transparency of the trial and are considered to reduce the publication bias by reducing selective publication of positive outcomes. Adverse events can occur at any time during conduct of an RCT and should be reported and kept track of. Physical injury resulting from clinical trial participation is entitled to financial compensation. During preparation of final manuscript of study, the CONSORT guidelines must be followed to improve the quality of reporting of RCTs. Clinical trials provide evidence-based approach in medicine and a designed and well-implemented trial can alter clinical dermatology practice for a healthier tomorrow.
  1,485 191 -
Dermoscopy of circinate balanitis
Avik Panigrahi, Surajit Kumar Biswas, Abheek Sil
May-June 2021, 12(3):488-489
  1,299 90 -
Rose petal appearance: The dermoscopic finding in pigmented fungiform papillae of the tongue
Abheek Sil, Avik Panigrahi, Dibyendu B Bhanja
May-June 2021, 12(3):490-491
  1,243 91 1
An observational survey to appraise the influence of COVID-19 pandemic on dermatology training programs in India: Residents' standpoint
Anupam Das, Abheek Sil, Aditi Chakrabarti
May-June 2021, 12(3):423-428
Background: Given the all-encompassing foothold of COVID-19, it is plausible that the pandemic would have a long-lasting impact on medical training programs, including dermatology. We conducted a survey amongst the residents of dermatology (across India) to assess the impact of COVID-19 pandemic on their teaching and education programs. Materials and Methods: An online semi-structured English questionnaire was prepared on the Google-forms platform and the link was circulated among the residents. The questionnaire comprised of five sections (demographic details, impact on clinical training, procedural training, academic curriculum, and research activities). Appropriate statistical tests were carried out to analyze the data obtained. Results: Three-hundred and seventy-eight responses were taken into consideration. A majority of the respondents (63.5%) were engaged in both COVID-19-related duties and departmental work (out-patient and in-patient duty). Around two-thirds of the trainees (65.1%) claimed a reduction in patient footfall (greater than 50% compared to pre-COVID times). Sixty-nine percent reported a decline of more than 50% in in-patient admission; 47.6% felt that the discontinuity in patient care had severely affected their residency training; 50.8% highlighted that no procedures were being performed in their department; 54.5% opined that academic activities were relatively unhampered as regular seminars were being conducted through online web-based applications; and 65.1% of the trainees were not able to devote any time to their thesis-related work. Conclusion: Since the after-effects of this pandemic will last long, it is advisable that residents and faculties adapt themselves to web-based learning programs in the academic curriculum so that the training of the future consultants does not get jeopardized. Our survey, being the first of its kind in dermatology, will throw some light on the perspective of residents and the way forward to combat the untoward consequences on their training programs.
  1,151 116 -
A hospital based cross sectional study of midline cutaneous lesions in neonates and its association with spinal dysraphism detected using ultrasound
MR Resmi, Devinder Mohan Thappa, Laxmisha Chandrashekar, Nishad Plakkal, A Ramesh
May-June 2021, 12(3):408-411
Background: Spinal dysraphism occurs due to incomplete fusion of the midline mesenchymal, bony, or neural elements of the spine. The defects in the spinal cord can be associated with skin lesion since both have same embryonic origin. Aims and Objectives: This study was conducted to determine the association of midline and paramedian cutaneous lesions with spinal dysraphism by using spinal ultrasonography. Materials and Methods: Two thousand apparently healthy neonates were screened in the postnatal ward of a tertiary care center in South India. Those neonates with cutaneous lesions in the midline and paramedian region were screened for evidence of spinal dysraphism by using spinal ultrasonography. Results: Among 2000 neonates, 120 (6%) had at least one cutaneous lesion, of which 114 (5.7%) were in the midline and 6 (0.3%) were on the paramedian region of dorsal and ventral aspect of the body. Among these neonates, two cases had more than one skin lesions. The most common cutaneous lesion observed was typical dimple (82, 68%) followed by hypertrichosis (12, 10%). Ultrasonography revealed spinal anomaly in six (5%) of them. The cutaneous lesions associated with spinal dysraphism were obvious midline swelling, dermal sinus, and multiple skin lesions. Conclusion: Congenital midline and paramedian skin lesions may be the marker of spinal dysraphism. In the presence of such cutaneous lesions, only 5% of them had associated spinal anomaly in our study.
  1,010 116 -
Revisiting the origin, evolution and morphological nuances of the “Butterfly sign”
Shyam B Verma
May-June 2021, 12(3):475-476
  990 83 -
Doughnut wart following salicylic acid application: A rare case report
Mitanjali Sethy, Chakravarthi R Srinivas, Vamshi Krishna, Pragathi Chadalavada
May-June 2021, 12(3):451-453
  910 109 -
Management of naevoid conditions following the lines of blaschko in paediatric age group
Jagdish Jadavbhai Sakhiya, Dhruv J Sakhiya, Trusha Gajjar, Neha Virmani, Jashmin Gandhi, Madhav Purohit, Krishna Bhalala, Ravi Khambhati, Feral Daruwala
May-June 2021, 12(3):433-438
  819 102 -
Latent tuberculosis in psoriasis patients planned for systemic therapy – A prospective observational study
Shekhar Neema, S Radhakrishnan, Disha Dabbas, Biju Vasudevan
May-June 2021, 12(3):429-432
Background: India has a high prevalence of tuberculosis and latent tuberculosis infection (LTBI) is common in the general population. LTBI can progress to active tuberculosis in almost 10% patients and the risk increases with immunosuppression. This predisposes patients of psoriasis on systemic therapy for the development of active tuberculosis. Aims: To find the prevalence of LTBI in patients with psoriasis planned for systemic therapy. Methodology: It was a prospective observational study conducted in a tertiary care center during period Jan-Dec 2019. Patients older than 18 years with chronic plaque psoriasis planned for systemic therapy and willing to be part of the study were included. Baseline clinical data were collected. Radiograph of chest and tuberculin skin test (TST) was performed in all patients. Detailed evaluation including sputum examination and computed tomography of the chest and abdomen were performed in patients with TST >10 mm. Results: A total of 105 patients met the inclusion criteria of the study, with the mean age of patients being 29.5 ± 2.12 years. Out of these patients, 58 were males and 47 females. The mean duration of psoriasis was 2.95 ± 1.3 years. The mean PASI score was 16.71 ± 4.384. Mantoux was positive (>10 mm) in 33 (31.42%) patients. Two patients were found to have features of active tuberculosis based on imaging and microbiological investigations. Totally, 31 (29.5%) patients had LTBI and were treated with isoniazid and rifampicin for three months while 2 (1.9%) patients were treated with four drugs antitubercular regimen. Limitations: Small sample size, convenience method of sampling and study population limited to those visiting medical college hospital are its major limitations. Conclusion: LTBI is common in study population and screening for LTBI should be performed in all patients of psoriasis planned for systemic therapy. A thorough search for active tuberculosis should be performed. Timely detection of LTBI helps in the prevention of development of active tuberculosis in the patients on immunosuppressive treatment.
  776 98 -
A retrospective study to evaluate the impact of in-patient dermatological consultations on diagnostic accuracy in a tertiary care setting
Keshavamurthy Vinay, Vishal Thakur, Rajat Choudhary, Anubha Dev, Debajyoti Chatterjee, Sanjeev Handa
May-June 2021, 12(3):417-422
Background: Dermatology is primarily an outpatient specialty. However, dermatology consultations play an important role in care of inpatients. Data on inpatient dermatological consultations in tertiary care settings is limited. Objectives: To evaluate clinical characteristics of inpatient dermatological consultations and effect on clinical outcomes in a tertiary care setting. Methods: This was a single-center retrospective study where the records of all dermatological consultations for patients admitted under various specialties, emergency services, and intensive care units (ICU) at our tertiary care institute over 2 years period were reviewed. The details of patients, primary care unit, dermatological complaints, diagnosis, investigations performed, treatment given, and follow-up were recorded and analyzed. Results: Total of 1717 dermatologic consultations (1000 males) were recorded, with mean age of study population being 33.6 ± 21.6 years (median - 32 years). Out of total 1717 patients, 136 (7.9%), 321 (18.7%), 1135 (66.1%), and 125 (7.3%) patients were infants, children, adolescents, adults, and elderly, respectively. The most frequent diagnostic group was infective diseases (586; 34.1%) followed by inflammatory diseases (442; 25.7%), mucocutaneous adverse drug reactions (160; 9.3%), and autoimmune diseases (65; 3.8%). Primary team's diagnosis was concordant with the dermatology consultation in 1112 (64.8%) patients and discordant observations were recorded in 605 patients (35.2%). Most discordant dermatological diagnoses included inflammatory disorders such as lichen planus, atopic dermatitis, bullous pemphigoid; mechanical disorders; nutritional deficiency disorders, and benign neoplasms. Conclusion: Common skin conditions account for a large majority of dermatologic consultations in a hospital setting. Inpatient dermatology consultations improve the diagnostic accuracy.
  710 122 -
A study of itch in psoriasis
Manju Meena, Kriti Maheshwari, Kapil Vyas, Asit Kumar Mittal
May-June 2021, 12(3):477-479
  729 94 -
Secondary plaque over primary plaque on scalp
Rashi Pangti, Rhea Ahuja, Neetu Bhari
May-June 2021, 12(3):482-483
  719 80 -
A case of histoid leprosy presenting as immune reconstitution inflammatory syndrome (IRIS) in a patient of human immunodeficiency virus (HIV) infection on highly active retroviral therapy (HAART)
M Sivasankari, Preema Sinha, BS Sunita, Shivali Awasthi
May-June 2021, 12(3):441-443
  626 101 -
Unilateral linear capillaritis
Piyush Kumar, Chirag Desai, Anupam Das
May-June 2021, 12(3):486-487
  646 76 -
Recurrent pustular erythema nodosum leprosum: A rare case report
Chandra S Sirka, Arpita N Rout, Suvendu Purkait
May-June 2021, 12(3):439-440
  612 85 -
Zosteriform-fixed drug eruption secondary to ciprofloxacin
Ravi Bhushan, Bhagyashree B Supekar, Jayesh Mukhi, Rajesh P Singh
May-June 2021, 12(3):456-458
  608 83 -
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: An unusual presentation with multiple follicular papules
Yashdeep S Pathania, Meenakshi Rao, Anil Budania
May-June 2021, 12(3):467-468
  608 69 -
Multidermatomal zosteriform collagenoma: A rare case report with dermoscopic findings and review of literature
Siddhartha Dash, Aparna Palit, Suvradeep Mitra, Biswanath Behera
May-June 2021, 12(3):447-450
  603 68 -
Imatinib-induced classical lichen planopilaris in blaschko-linear distribution leading to cicatricial alopecia
Priyesh Thakran, Archana Singal, Vinod K Arora
May-June 2021, 12(3):444-446
  593 75 -
Surgical pearl: Looped razor blade for excision surgery on concha and fossa of the ear
Muhammed Mukhtar
May-June 2021, 12(3):480-481
  568 69 -
Yellow palms with underlying type II diabetes mellitus
Ankur Guliani, Sheetanshu Kumar, Anuradha Bishnoi
May-June 2021, 12(3):484-485
  570 65 -
Follicular dowling degos disease with lichen planus in two siblings: A rare association
Pooja Agarwal, Ashish Jagati, Sabha Neazee, Shefali V Patel
May-June 2021, 12(3):459-461
  560 68 -
Linear systematized porokeratosis—A Rare Case and Dermoscopic Clues to Diagnosis
Manoj K Nayak, Aditi Dhanta, Neirita Hazarika, Arvind Kumar
May-June 2021, 12(3):465-466
  510 71 -
Basal cell carcinoma with flexural predilection in basal cell nevus syndrome
Raihan Ashraf, Akanksha Kaushik, Kirti Gupta, Keshavamurthy Vinay
May-June 2021, 12(3):469-471
  506 66 -
Concomitant presence of late-onset segmental neurofibromatosis and linear and whorled nevoid hypermelanosis: genetic mosaicism with twin spotting
Sinu Rose Mathachan, Kabir Sardana, Ananta Khurana, Arvind Ahuja
May-June 2021, 12(3):472-474
  502 65 -
Disseminated indeterminate dendritic cell tumor: A rare presentation
Mary Z Chhangte, Debopriya Paul, Reena Lamba, Biswajit Dey
May-June 2021, 12(3):462-464
  494 68 -
Radiation recall dermatitis triggered by iodinated contrast in a patient with mandibular intraosseous squamous cell carcinoma
Leandra Reguero del Cura, Beatriz Castro Gutiérrez, Íñigo Navarro Fernández, Marcos Antonio González López
May-June 2021, 12(3):454-455
  440 64 -
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