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   Table of Contents - Current issue
Coverpage
January-June 2020
Volume 7 | Issue 1
Page Nos. 1-62

Online since Friday, July 10, 2020

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EDITORIAL  

COVID-19 and the dermatologist: finding calm in the chaos Highly accessed article p. 1
Soumya Jagadeesan, Rashmi Sarkar
DOI:10.4103/Pigmentinternational.Pigmentinternational_24_20  
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REVIEW ARTICLES Top

Novel corona virus infection: a dermatologist’s perspective p. 5
Rashmi Sarkar, Preethi B Nayak
DOI:10.4103/Pigmentinternational.Pigmentinternational_35_20  
Novel corona virus infection or COVID-19 saw its dawn in first fortnight of Decemberin the city of Wuhan, China, since then it is unstoppable and has spread like a wild-fire, involving most parts of the world. The causative virus is named as SARS-CoV-2. Although the reproductive number (R0) of two to three has been suggested, it is still unknown. The symptoms of COVID-19 infection have a broad spectrum of severity, which ranges from asymptomatic to mildly symptomatic to severe illness that require mechanical ventilation. The virus seldom causes any viral exanthem, but dermatologists should have good working knowledge about COVID-19 and its manifestations, which would help to explore the unexplored cutaneous manifestation of the disease in near future. Due to limited availability of testing kits, RT-PCR test is done only in patients who have a clinical diagnosis of COVID-19 based on symptoms, exposures and chest imaging. Basic public health measures like frequent efficient handwashing, social distancing, staying home, respiratory etiquette like covering nose and mouth while coughing and sneezing are to be followed to prevent the spread of disease. It is now time for our specialty to get involved actively and share the burden of COVID-19. Though not directly connected in dealing with COVID-19 patients, dermatologists should work together with other specialties as a multidisciplinary team. We carried out a PubMed, Medline search using the following terms “COVID-19, dermatology, rash, skin, health care” and have included all data and latest national guidelines related to COVID-19 in dermatology.
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Tranexamic acid in melasma: a review p. 12
Amrit Kaur, Mala Bhalla, Rashmi Sarkar
DOI:10.4103/Pigmentinternational.Pigmentinternational_9_20  
Tranexamic acid (TA), an anti-fibrinolytic agent, originally used for treating blood loss during surgery and various medical conditions, has been found to show promising results in melasma. TA has been tried as oral therapy, topical formulations and even intradermally, with or without adjuvants by various researchers in melasma but still there is no consensus on the optimum route, dose and timing of the treatment. A systematic literature search of the PubMed electronic database was performed using the keywords ‘melasma’, ‘chloasma’ and ‘tranexamic acid’ in the title. The abstracts of the articles were screened and reviewed for relevance. The selected articles were read in detail for inclusion and also the relevant references were traced. This review is an attempt to evaluate the role of TA by various routes in melasma and offer suggestions for future directions of research.
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ORIGINAL ARTICLES Top

A clinicoepidemological study of Lichen planus pigmentosus and its association with metabolic syndrome and cutaneous manifestations in Indian population p. 26
Rozy Badyal, Ramesh Kumar Kushwaha, Arti Singh Rajput, Suresh Kumar Jain, Asha Nyati, Devendra Yadav
DOI:10.4103/Pigmentinternational.Pigmentinternational_1_19  
Background: Lichen planus pigmentosus (LPP) is considered an infrequent variant of Lichen planus (LP) clinically characterized by insidious onset of discrete, ill-defined, and dark brown or slate gray macules, primarily appearing over sun-exposed areas and flexures. Materials and method: This was a cross-sectional study conducted over a period of 1 year from July 2017 to July 2018 among the patients attending the OPD of the Department of Dermatology, Government Medical College, Kota, India. This study evaluated the LPP and its association with metabolic syndrome and cutaneous manifestations. Serum high-density lipoprotein (HDL)-cholesterol (HDL-C) and triglycerides (TG) were measured with enzymatic procedures. Plasma glucose was measured using hexokinase method. Results: There were 16 (32.0%) males and 34 (68.0%) females affected with LPP. Majority of the patients were in the age group of 40 to 49 years [15 (30.0%)] and above 50 years [16 (32.0%)]. Diabetes mellitus type 2 was reported among 17 (34.0%), hypertension among five (10.0%), and obesity among five (10.0%) patients. Increased low-density lipoprotein (LDL) and very LDL was found among 15 (30.0%) patients and decreased HDL was found among 19 (38.0%) patients. Conclusion: A 34.0% prevalence of metabolic syndrome was found in patients with LP. Central obesity, increased fasting blood sugar (FBS), and low HDL-C were the metabolic syndrome parameters found to be more common in patients with LP in our study.
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A randomized controlled study to compare the efficacy of methotrexate vs. oral minipulse (betamethasone) along with NBUVB in patients with vitiligo vulgaris p. 32
Ashish Deshmukh, Garima Khurana
DOI:10.4103/Pigmentinternational.Pigmentinternational_23_19  
Background: Several different treatment modalities are available to treat vitiligo. One of them is topical corticosteroids but it has limitations if used for longer time. To overcome the side effects, we evaluated the efficacy of oral steroids in minipulse form along with antimetabolite methotrexate (MTX) and narrow-band ultraviolet B (NBUVB). Aim: This article aims to compare the efficacy of oral MTX with NBUVB vs. oral minipulse with betamethasone along with NBUVB in the patients of vitiligo vulgaris. Materials and Methods: A prospective study was conducted in 100 clinically diagnosed cases of vitiligo vulgaris; 50 of them were given NBUVB twice in a week along with MTX orally in a dose of 7.5 mg once weekly for 6 months. Remaining 50 were given NBUVB twice in a week along with betamethasone in a dose of 5 mg on two consecutive days per week for 6 months. The patients were assessed after every 2 weeks for 6 months. Blood pressure was checked regularly at each visit. Complete blood count, liver function tests, kidney function tests, blood sugar levels, and even ophthalmic examination was done at the end of 3 months. Repigmentation in the patients was assessed at the end of 6 months according to the Vitiligo European Task Force scoring system. Results: There was a significant reduction (P < 0.05) in depigmented area and staging with complete cessation of spreading of the vitiligo lesion after 6 months of therapy with MTX and NBUVB and also with another group taking oral minipulse betamethasone and NBUVB. Limitations: It was an open-labeled study. Conclusion: MTX along with NBUVB is equally an effective modality in controlling the progression of vitiligo vulgaris with minimal side effects, and hence MTX can be used as a steroid-sparing drug in patients with active vitiligo wherever corticosteroids are contraindicated.
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“Pigmented irritant contact dermatitis” − an issue of concern due to dithranol misuse in Andaman and Nicobar: an observational study p. 39
Pradeep Balasubramanian, Anjali J Anil
DOI:10.4103/Pigmentinternational.Pigmentinternational_28_19  
Background: Dithranol (anthralin) ointment is a topical medication that is widely being misused by the people in Andaman and Nicobar (A&N) that results in a characteristic irritant reaction. Aim of the study: This study was performed to analyze the various aspects pertaining to the irritant dermatitis due to dithranol misuse such as epidemiological aspects, clinical features, and management. Methodology: The study was done in the Outpatient Department of Dermatology of G.B. Pant Hospital, Port Blair, A&N. This study includes all the patients who presented with irritant reaction due to dithranol ointment and its combination, the clinical features, the common dermatoses in which it is being misused, source of usage (suggested by), and its management and measures undertaken to arrest its misuse. The variables are mentioned as frequency and percentage. Results: The dithranol irritant reaction was commonly seen in the setting of cutaneous dermatophyte infection. Groin was the common site affected. It was commonly encountered among male (76%) and in the age group of 21 to 40 years (75.9%). The medication was commonly suggested by the pharmacists. The “brown stain” due to dithranol was the classical feature seen in all the patients. Conclusion: This study lays emphasis on identifying the irritant reaction due to dithranol ointment through the characteristic “brown stain,” the management of the condition, and the measures that had successfully reduced its misuse. Through the awareness imparted to the pharmacists and the general public, the misuse of the dithranol could be well curtailed in A&N.
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Terra firma-forme dermatosis: a hospital-based clinico-epidemiological study at a tertiary care centre in northern India p. 44
Ramesh Kumar, Arti Singh, Rozy Badyal, Suresh Kumar Jain, Asha Nyati
DOI:10.4103/Pigmentinternational.Pigmentinternational_29_19  
Background: Terra firma-forme dermatosis is an idiopathic keratinization disorder characterized by acquired, dirt-like plaques despite normal hygiene which was first described in 1987. Aims: We conducted a clinical study in patients who presented with Terra-firma forme dermatosis. In this we describe the clinical features of Terra firma-forme dermatosis along with a proposal of its diagnostic criteria. Methods: A prospective study was conducted at the dermatology department of a tertiary care hospital to identify cases of Terra firma-forme dermatosis diagnosed over a period of 14 months (July, 2016, to September, 2017). The diagnosis of Terra firma-forme dermatosis was confirmed in all patients who had com­plete resolution of each lesion after the application of 70% isopropyl alcohol. Results: Prevalence of Terra firma-forme dermatosis was 0.05% at our outpatient department. Male to female sex ratio was 4:1(37:9). 46 patients with Terra firma-forme dermatosis were identified, including 27 (58.6%) who presented with it as their primary concern. 36 (78.26 %) were from 6 to 18 years of age group. The mean duration of lesions was 6.86 months. The most common location was the neck. The commonest cause was ignorance regarding proper cleansing techniques, inadequate pressure while scrubbing the affected area. Limitations: A small sample size and relatively short duration of follow up. Conclusions: Terra-firma forme dermatosis is a benign dermatologic condition. Awareness among the clinicians about the existence of Terra firma-forme dermatosis is essential to save time for the clinician and to reduce the economic burden on the patient.
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CASE REPORTS Top

Congenital vitiligo with positive paternal history − a rare case report p. 50
Niharika Jha, Vanya Narayan
DOI:0.4103/Pigmentinternational.Pigmentinternational_4_20  
Vitiligo is considered to be an acquired skin disorder in which melanocytopenia occurs. It is characterized by development of achromic patches on skin. Most of the patients develop this disease in the second or third decade of life. We present a case of a 7 month old child who had depigmented patches on skin since birth, which questions the concept of acquired etiology of vitiligo.
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A systematized Becker’s nevus without systemic features: a rare case report p. 53
Prekshi Bansal, Surabhi Sinha, Konchok Dorjay, Gauri Vats
DOI:10.4103/Pigmentinternational.Pigmentinternational_44_19  
Becker’s nevus is a cutaneous hamartoma relatively common in peripubertal age. The classical presentation of the Becker’s nevus is characterized by unilateral, hyperpigmented patch with varying degrees of hypertrichosis on upper trunk or proximal upper extremities. The occurrence of multiple Becker’s nevi with extensive involvement is relatively rare. Also, the systematized Becker’s nevus is usually associated with other cutaneous and extra-cutaneous features like breast hypoplasia, leg lipodystrophy, etc. But, we herein report a peculiar case of systematized Becker’s nevus without systemic features.
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Exaggerated physiological hyperpigmentation of pregnancy in the post-partum period p. 56
Preema Sinha, Rajesh Verma, Saikat Bhattacharjee, Anwita Sinha
DOI:10.4103/Pigmentinternational.Pigmentinternational_47_19  
Hyperpigmentation during pregnancy is commonly due to endocrinological changes. The pigmentation generally fades away in a few months post-partum. However sometimes it may persist for longer periods causing distress to the patient. Here we report one such case where the pigment persisted for more than a year.
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LETTER TO EDITOR Top

Fixed drug reaction to itraconazole: an uncommon incident p. 59
Abheek Sil, Anupam Das
DOI:10.4103/Pigmentinternational.Pigmentinternational_52_19  
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THE CLINICAL PICTURE Top

Rain drop pigmentation in chronic arsenic poisoning p. 61
Anupam Das, Anand Toshniwal, Kunal Majumdar
DOI:10.4103/Pigmentinternational.Pigmentinternational_54_19  
Contamination of ground water with arsenic is a problem being faced by over 30 countries in the world, since a few decades. Arsenicosis is a multisystem disorder characterised by cutaneous, gastrointestinal, urological and hematological manifestations. The WHO defines arsenicosis as a chronic health condition arising from prolonged ingestion (not less than 6 months) of arsenic above a safe dose, usually manifested by characteristic skin lesions, with or without involvement of internal organs. The WHO guideline for arsenic in drinking water is 0.01mg/ml. Cutaneous lesions are the earliest manifestations characterised by mottled pigmentation of covered areas of body called as rain drop pigmentation, blotchy mucosal pigmentation, depigmentation, palmoplantar pitting and keratosis.[1] Cutaneous malignancies which can be caused by arsenicosis include bowens disease, squamous cell carcinoma, basal cell carcinoma and melanoma.[2] It can also cause ischemic heart disease, hepatosplenomegaly, black foot disease and internal malignancies. [3]
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