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   Table of Contents - Current issue
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April-June 2020
Volume 21 | Issue 2
Page Nos. 81-160

Online since Wednesday, April 1, 2020

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REVIEW ARTICLE  

Cutaneous melanoma in a 9-year-old girl: case report and review of literature p. 81
Athanasios Papas, Prodromos Chitiroglou, Efterpi Demiri
DOI:10.4103/ijpd.IJPD_116_19  
Melanoma in children is a rare entity with an estimated incidence of one/million/year. Only 1.3% of melanomas reported in the United States of America affect individuals under the age of 20 years, and this neoplasm accounts for only 0.9% of all malignancies in children under the age of 15 years. Melanoma is particularly rare in prepubertal children before the age of 10 years. We present a case of a 9-year-old girl with a melanoma of the right foot. Her sentinel node biopsy was positive for isolated melanoma cells, and none of 5 additional lymph nodes removed following inguinal dissection were found to contain malignant melanoma cells. To our knowledge, this is the youngest melanoma patient recorded in the Greek population. The histological diagnosis of melanoma in this age group can be extremely difficult, and physicians ought to be cautious. The rarity of the disease results in small series of cases from which reliable figures are difficult to obtain. Unfortunately, this also applies to currently available treatments whose effectiveness is unclear.
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REVIEW OF CURRENT LITERATURE Top

Hot topics in dermatology p. 87
Hitaishi Mehta, Dipankar De
DOI:10.4103/ijpd.IJPD_42_20  
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ORIGINAL ARTICLES Top

A cross-sectional study of dermatological manifestations in children with human immunodeficiency virus/acquired immunodeficiency syndrome p. 92
Santoshdev P Rathod, Bela B Padhiar, Bela J Shah
DOI:10.4103/ijpd.IJPD_16_19  
Background: In children, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a significant cause of acquired immunodeficiency in children. HIV/AIDS is associated with change in the clinical presentation of the opportunistic infections and increased likelihood of development of certain inflammatory dermatoses in children. Aims and Objectives: The primary objective of this study was to study dermatological manifestations in children with HIV/AIDS. The secondary objectives were to study the association of dermatological manifestation with degree of immunosuppression and any clinical alteration in the disease presentation. Materials and Methods: This was a cross-sectional, descriptive study carried out in the setting of a state government hospital with an attached antiretroviral therapy referral center. The duration of the study was 30 months, and the sample size was based on children enrolled in the study during this duration. Inclusion Criteria: Children <15 years of age having HIV/AIDS and any cutaneous manifestation associated with HIV/AIDS were included in the study. Exclusion Criteria: Dermatological manifestations in children with inherited cause of immunodeficiency, drug-induced immunosuppression, and juvenile diabetes mellitus were excluded from the study. Results: Recurrent skin and soft-tissue infections in 26.11% (n = 11) were the most common dermatological manifestation, followed by pruritic papular eruption of HIV (n = 7, 16.66%), herpes zoster (n = 6, 14.28%), seborrheic dermatitis (n = 4, 9.52%), and human papillomavirus infections (n = 4, 9.52%), which were other common manifestations. The mean CD4 count of patients with pruritic papular eruption was 517 cells/cm3. Extrapulmonary tuberculosis was the most common form in 66.66% (n = 8) of children of total 12 children with tuberculosis. Conclusion: Pruritic papular eruption of HIV in children is seen at all ranges of CD4 count and does not correlate or suggest an advanced degree of immunosuppression. Older children aged 10–14 years acquired HIV through high-risk sexual behavior which suggests a need of sex education.
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Cyclosporine a in recalcitrant pediatric dermatoses – A retrospective analysis of thirty children p. 98
Nibedita Patro, Maitreyee Panda, Mrutunjay Dash
DOI:10.4103/ijpd.IJPD_97_19  
Background: The therapeutic use of cyclosporine is gradually extending to various dermatoses including both in adults and children. There are meager studies from India supporting its safe use in pediatric dermatoses. Aims and Objectives: The aim is to study the safety and efficacy profile of children treated with cyclosporine for recalcitrant dermatoses. Materials and Methods: A retrospective analysis of the case files of children below 18 years of age where cyclosporine A (CsA) was used within the past 5 years was done. Results: A total of thirty cases were studied. The CsA dose used in our patients ranged from 3 to 4 mg/kg/day for a time period varying from 4 to 24 weeks. A good to excellent response was seen in 23 (76.66%) cases. Few children developed side effects mostly reversible with dose modification. Conclusion: Cyclosporine within the therapeutic range can be used safely in recalcitrant pediatric dermatoses.
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Clinicoepidemiological profile of childhood leprosy in Western Odisha: A retrospective, hospital-based study p. 105
Swetalina Pradhan, Bibhu Prasad Nayak, Tanmay Padhi, Kananbala Sahu
DOI:10.4103/ijpd.IJPD_147_18  
Background: At this postelimination era, childhood leprosy is still a major concern for the society. Studies regarding the clinicoepidemiological profile of childhood leprosy from Western Odisha are unavailable despite the area being endemic to leprosy. Aim and Objective: The aim and objective was to study the clinicoepidemiological profile of childhood leprosy in Western Odisha. Materials and Methods: Patients aged <18 years with a clinical diagnosis of Hansen's disease were included in the study. Data regarding demographic profile, type of Hansen's disease, family history of Hansen's disease, various types of deformities, lepra reactions, treatment status, and any side effects of treatment were collected from the leprosy register and proformas. Results: Out of the total 1460 leprosy patients, 239 (16.4%) patients were children. The mean age of the patients was 13.43 ± 1.09 years. Borderline tuberculoid leprosy was the most common type of presentation (141 cases). Family contacts were identified in 33.2% of cases, with majority being multibacillary. Disabilities and lepra reactions were found in 9.3% and 19.2% of children, respectively. Mononeuritis was found in 141 (59%) patients. Ulnar nerve was the most commonly involved nerve in 97 (67.8%) cases, followed by common peroneal nerve in 44 (31.2%) cases in patients with mononeuritis. Out of 98 patients presenting with polyneuritis, ulnar nerve was the most common nerve enlarged clinically in 66 (67.3%) patients followed by common peroneal in 51 (52.04%), great auricular in 7 (7.14%), radial cutaneous nerve in 5 (5.1%), sural in 4 (4.1%), posterior tibial in 3 (3.1%), and superficial peroneal in 1 (1.02%) patients. Out of 239 cases, 11 had completed treatment, 37 cases were continuing treatment from outside, and 191 new cases (13.1%) had started treatment. At the end of 2 years, a total of 157 cases had completed treatment and the rest were continuing treatment. No defaulter and relapse case were found within the 2-year period. Side effect profile of antileprosy treatment was available in 47 patients with dapsone hypersensitivity syndrome in 2 cases, maculopapular drug reaction in 5 cases, and clofazimine-induced pigmentation in all. Conclusion: Higher proportion of childhood leprosy indicates transmission of leprosy in Western Odisha. Clustering of multibacillary cases in family suggests that family contact tracing is mandatory in all cases. Though less commonly found, physicians should be aware of the side effects of antileprosy treatment and counseling should be done regarding the side effect profile while initiating treatment.
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Mucocutaneous findings in patients with cerebral palsy: A cross-sectional observational study p. 110
Bhabani STP Singh, Tapaswini Tripathy, Manish Kumar Sahu, Sweta , Bikash Ranjan Kar
DOI:10.4103/ijpd.IJPD_103_19  
Introduction: Cerebral palsy (CP) is a condition characterized by abnormal muscle tone or posture and coordination. It is caused due to injury to the immature brain usually at or before birth. Speech, cognition, visual, and other neurological problems have been studied in this disorder. However, dermatological and mucosal changes seen in CP have rarely been studied. Materials and Methods: Mucocutaneous findings of CP patients visiting a rehabilitation center on two different visits were analyzed by two dermatologists. Results: Trauma, motor incoordination and deformities, drug-related side effects, and cognitive and behavioral impairment are the major causes of various cutaneous and mucosal changes seen in CP patients. Conclusion: Our study finds majority of dermatoses are secondary to cerebral palsy and they are preventable.
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A study on the treatment of infantile hemangiomas with topical timolol p. 116
Neerja Puri
DOI:10.4103/ijpd.IJPD_2_20  
Introduction: With the advent of topical timolol, there has been a tremendous change in the management of infantile hemangiomas. Aims: The aim of the study was to evaluate the treatment response with topical 0.5% timolol drops in 20 children of infantile hemangiomas. Methods: The response to treatment was seen as regression of growth or flattening of lesion or lightening of the surface. Timolol drops 0.5% were applied over the hemangiomas and three drops were applied twice daily. Results: Head-and-neck involvement was seen in 40% of the infants, the trunk was involved in 30% of the infants, the limbs were involved in 25% of the infants, and the genitalia were involved in 5% of the infants. Response to treatment with timolol was excellent in 60% of the infants, very good in 20% of the infants, good in 15% of the infants, average in 5% of the infants, and none of the infants showed poor response. Regarding the side effects of topical timolol, sleep disturbances and poor feeding were seen in 5% of the infants. Discussion: Timolol is used for hemangiomas that do not involute spontaneously or for infected or ulcerated hemangiomas or those hemangiomas in which there is a risk of scarring, disfigurement, or impairment of vital structures.
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Clinicoepidemiological study of prevalence and pattern of dermatoses among patients of pediatric age group in southeast region of Rajasthan p. 119
Shivani Saini, Devendra Yadav, Ramesh Kumar
DOI:10.4103/ijpd.IJPD_154_18  
Background: Pediatric dermatoses present as one of the most common clinical entities in dermatology clinics. They differ in clinical presentation and management from adults. Their prevalence and pattern differ from region to region due to several factors such as environmental, social, genetic, and cultural. Aims and Objective: The aim of the study was to determine the prevalence and pattern of various dermatoses among children of the age group 0–18 years in Southeast region of Rajasthan. Materials and Methods: Our study included 1000 cases of 0–18 years age group attending the dermatology outpatient and inpatient department of Government Medical College and attached group of hospitals, Kota. It was carried out from December 2017 to September 2018 (10 months). Appropriate history was taken, and a complete thorough examination was done as required. Relevant investigations were done, and all the findings were recorded in predesigned pro forma. Results: Our study included 560 males and 440 females of 1000 with the male-to-female ratio of 1.272:1. There were 553 urban and 447 rural participants. The patients were subgrouped in the age group of 0–1 year, 1–7 years, 8–12 years, and 13–18 years. The most prevalent dermatoses in 0–1 year age group were eczematous disorders (31.91%). Viral infections were predominant in 26.08% and 23.47% in the age groups of 1–7 years and 8–12 years, respectively. The most common dermatoses in the age group of 13–18 years were disorders of sweat and sebaceous glands (20.15%). Conclusion: Our study demonstrates variability of dermatoses among pediatric patients according to their age groups. This information should contribute to raising the awareness of pediatricians and dermatologists regarding the most common dermatological diagnosis in those patient populations.
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Orofacial pigmentary lesions in the pediatric age group: A descriptive observational study p. 126
Neerja Saraswat, Ajay Chopra, Sushil Kumar, Shekhar Neema, Parul Kamboj
DOI:10.4103/ijpd.IJPD_18_19  
Background: Pigmentary disorders on the face are frequently encountered in all age groups and both genders but are more common in pediatric patients. These lesions can be isolated incidental findings or indicative of a congenital or acquired systemic or genetic disorder. Aims and Objectives: The aim and objective of this study is to study the frequency and pattern of pigmented orofacial lesions in the pediatric age group and to describe the underlying associated condition if any. Materials and Methods: A descriptive study was conducted over a period of 6 months (June–November 2018) in the dermatology department of a tertiary care hospital in Eastern Uttar Pradesh. All the children from 2 to 14 years of age who reported to us with complaints of pigmentary lesions on the face or oral cavity were included, and attempt was made to find out if any underlying conditions. Results: A total of 207 children were included in the study. Pityriasis alba was the most common pigmentary disorder on the face in the study population in 146 (70.5%) children, while pityriasis versicolor was noted in 21 (10.1%). Other facial dermatoses noted were vitiligo, congenital melanocytic nevus, and postinflammatory hypopigmentation and hyperpigmentation. Eight (3.8%) children had associated underlying diseases such as xeroderma pigmentosum, dyskeratosis congenita, Vitamin B12 deficiency, Laugier–Hunziker syndrome, and juvenile dermatomyositis. Conclusions: Pigmentary disorders of the face and oral cavity are frequently seen in children which forms a major part of dermatology consultation. Although most of these disorders are of cosmetic concerns, few conditions are associated with systemic conditions. A thorough investigation and management are the keys to manage such cases.
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CASE REPORTS Top

CHILD syndrome: A rare case report p. 132
Sharad Mehta, Asit Kumar Mittal, Manisha Balai, Rekha Virath
DOI:10.4103/ijpd.IJPD_5_20  
CHILD syndrome is a rare unilateral icthyosiform naevus, characterized by congenital hemidysplasia with icthyosiform erythroderma and limb defect. It is inherited as X- linked dominant trait with lethality for male embryo. We report a case of 9-year-old female child with right sided patchy psoriasiform epidermal nevus and ipsilateral limb defect. The rarity of the syndrome prompted us to report this case.
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Anterior cervical hypertrichosis with linear and whorled nevoid hypermelanosis in a 12-year-old girl: A rare association p. 135
Shivani Saini, Ramesh Kumar, Devendra Yadav
DOI:10.4103/ijpd.IJPD_120_19  
Anterior cervical hypertrichosis (ACH) is a very rare form of primary localized hypertrichosis. It is characterized by a tuft of terminal hairs on the anterior neck just above the laryngeal prominence. Although it frequently presents with an isolated defect, it can be associated with other abnormalities. Here, we report the case of a 12-year-old girl who presented to our outdoor with a complaint of localized excessive hairs over the anterior aspect of the neck. She also gave a history of the persistence of irregular hyperpigmented areas on the right cheek. The diagnosis of ACH with linear and whorled nevoid hypermelanosis was made. Their concurrence might be coincidental. So far, ACH associated with linear whorled nevoid hypermelanosis has not been reported in the literature.
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Keratosis follicularis spinulosa decalvans: A dermoscopic perspective p. 138
Sudharani Chintagunta, Priyanka Jaju
DOI:10.4103/ijpd.IJPD_133_19  
Keratosis follicularis spinulosa decalvans (KFSD) is a rare follicular disorder characterized by widespread keratosis pilaris and progressive scarring alopecia of the scalp, eyebrows, and axillae. This condition is sometimes associated with photophobia and keratoderma. This is X-linked genodermatoses predominantly seen in males. It is unusual in females as they are carriers or have milder symptoms. Here, we report a dermoscopic perspective of this rare presentation of KFSD in an 11-year-old female.
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Mycoplasma pneumonia-associated Fuchs syndrome: Challenging case of a young boy p. 142
Dimple Chopra, Aarushi Kaushik, Loveleen Kaur
DOI:10.4103/ijpd.IJPD_122_19  
Stevens–Johnson syndrome without skin involvement has been termed as Fuchs syndrome. In children, infections are the leading causes of SJS, with the most common being Mycoplasma pneumoniae infection. This is a case of a schoolboy who presented with erosions on the lips which were preceded by vesicles. There was an involvement of all four mucosae and an active respiratory tract infection. A detailed clinical examination is needed to rule out the common differential diagnosis. A suspicion of Mycoplasma in such cases can avoid delay in diagnosis and adverse sequelae. The identification of causative agent can be done by PCR or ELISA technique. A prompt treatment to treat the cause and halt the disease process can lead to rapid improvement.
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Recurrent pyogenic granuloma with satellitosis in a 5-year-old child p. 145
Vikrant A Saoji, Kinjal Deepak Rambhia, Mayank M Goyal
DOI:10.4103/ijpd.IJPD_81_19  
A 5-year-old male child presented with multiple asymptomatic red raised lesions over the left lateral side of his abdominal wall since 2 years. Cutaneous examination revealed multiple bright red, nontender, dome-shaped papules, and nodules arranged discretely. At few places, the lesions coalesced to form plaques with crusting on the surface. The lesions appeared to be arranged in a peculiar manner; with an increased concentration of the lesions in the vicinity of an atrophic central scarred area (of previous surgery) and few satellite discrete papules and nodules away from it. The differential diagnoses of pyogenic granuloma (PG), epithelioid hemangioendothelioma, and bacillary angiomatosis were considered. Histopathological examination from a nodule revealed angiomatous tissue composed of dilated thin-walled capillaries and groups of poorly canalized vascular tufts located in the upper and mid dermis suggestive of PG. A diagnosis of recurrent PG with satellitosis in a 5-year-old child was made. This case is described for the rarity of the condition in children and to emphasize the alarming presentation of a benign condition.
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Michelin tire baby syndrome and achondroplasia: A rare association p. 147
Sayan Banerjee, Poulami Das, Gobinda Chandra Das
DOI:10.4103/ijpd.IJPD_100_19  
Michelin tire baby (MTB) syndrome is a rare genodermatosis characterized by generalized excessive skin folds. It is known to be associated with various syndromes and phenotypic abnormalities. It is mainly a clinical diagnosis, and its exact pathogenesis remains unclear. Herein, we report an association of MTB with achondroplasia which has not been reported of previously.
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Homozygous familial hypercholesterolemia with corneal arcus: A rare case report p. 150
Bablu Kumar Gaur, Baljeet Maini, Atul Goel
DOI:10.4103/ijpd.IJPD_112_19  
We report here a case of an 11-year-old adolescent boy who presented with asymptomatic multiple yellowish skin lesions and corneal arcus. A family history of similar complaints was present in the elder male sibling who died with underlying coronary artery disease. Laboratory findings and family history were consistent with homozygous familial hypercholesterolemia. He was started on lipid-lowering drugs and is under regular follow-up. Early diagnosis and timely initiation of treatment helped to save the affected individual and the other family members.
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Blau syndrome: A case report of a rare granulomatous disorder p. 153
Preema Sinha, S Kartik, Jasvinder Kaur Bhatia, Thrinley Choden
DOI:10.4103/ijpd.IJPD_23_19  
Blau syndrome is a rare condition characterized by the triad of granulomatous skin lesions, symmetric polyarthritis with boggy joint swellings, and ocular inflammation. It has an autosomal dominant mode of inheritance and occurs due to a mutation in CARD-15/NOD-2 gene which encodes the cytosolic NOD2 protein, a key molecule in the regulation of innate immunity. Clinical onset is generally in the 1st year of life and is characterized by articular, cutaneous, and ocular noncaseating granulomatous inflammation, which can be variably associated with a heterogeneous systemic spectrum. Here, we describe one such rare case.
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LETTERS TO EDITOR Top

Infantile pyramidal perianal protrusion – Description of a case with dermoscopy findings p. 156
Resham Vasani, Sushrut Save
DOI:10.4103/ijpd.IJPD_111_19  
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Acrodermatitis enteropathica in an exclusively breastfed infant with low breast milk zinc: A case report p. 158
Bijay Kumar Meher, Alok Ranjan Swain, Saroj Kumar Das
DOI:10.4103/ijpd.IJPD_107_19  
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