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   Table of Contents - Current issue
January-March 2020
Volume 21 | Issue 1
Page Nos. 1-80

Online since Tuesday, December 24, 2019

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Cutaneous manifestations of physical and sexual child abuse Highly accessed article p. 1
Jennifer Noble, Earl Hartwig, Tor Shwayder
This article reviews cutaneous manifestations of physical and sexual abuse and a stepwise approach that dermatologists can apply to differentiate abusive from accidental injuries.
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Neonatal subcutaneous fat necrosis as a close differential of neonatal sepsis: Case report and review of literature p. 11
Rahul Choudhary, Garima Sachdeva, Gaurav Katoch
Subcutaneous fat necrosis (SCFN) in a newborn is a rare self-limiting disorder associated with fatty tissue inflammation, mostly seen in term and postterm neonates. It is usually seen in the 1st week following a complicated delivery and is associated with lethargy, irritability, hypotonia, polyuria, polydipsia, vomiting, dehydration, and constipation. These neonates develop hypercalcemia, and C-reactive protein is persistently elevated. These features mimic neonatal sepsis. The characteristic lesions of SCFN are multiple erythematous nodules and these can guide to the final diagnosis. Here, we report a case of SCFN, which was initially misdiagnosed as neonatal sepsis and highlights the need for early diagnosis and treatment to prevent long-term complications. A literature search was done using PubMed, Medline, and Google Scholar databases using the mesh terms neonatal subcutaneous fat necrosis (SCFN) and subcutaneous fat necrosis (SFN).
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Neonatal and infantile erythroderma revisited Highly accessed article p. 15
Bhavya Swarnkar, Rashmi Sarkar
Erythroderma is the term applied to any inflammatory skin disease affecting more than 90% of the body surface. The incidence of neonatal and infantile erythroderma was 0.11% in an Indian study. There are various causes of neonatal and infantile erythroderma such as congenital, metabolic, papulosquamous, eczematous, drug induced, infections, autoimmune diseases, and malignancy but it is quite difficult to establish the etiology in early stage of life due to less specific clinical, biochemical and histological findings as compared to adults. Proper history, examination, skin biopsy, and various other relevant investigations (based on the differential diagnoses) are imperative to the diagnosis of neonatal and infantile erythroderma. Ruling out immunodeficiency in a child with failure to thrive is important. Since erythroderma is a dermatological emergency, its wise management is mandatory. Vitals, input-output, serum electrolytes, etc., are to be precisely monitored. Barrier nursing is of utmost importance in such cases. Any complication is to be dealt with, and specific treatment of particular cause of childhood and infantile erythroderma is to be done.
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Pattern of pathological cutaneous lesions of neonates in neonatal care unit of a peripheral tertiary institution in West Bengal p. 22
Chinmay Kar, Syamal Kumar Sardar
Background: A variety of cutaneous disorders have been found in neonatal period. These disorders may be physiological or pathological, temporary or permanent, congenital or acquired. Most of the skin lesions are benign, transient and physiological. Aims and Objectives: To study the incidence of pathological cutaneous disorders of neonates in the neonatal care unit and compare these with other studies in India and also the world. Materials and Methods: It was a hospital based observational, descriptive study. Study duration was one year. Study population was the all admitted neonates in neonatal care unit in peripheral tertiary institution. The study sample size was 108 neonates. We used Chi-square test to evaluate the P value. P value of less than 0.05 was accepted as statistically significant. Results: We found 47 neonates (43.52%) as infective skin disorders, 21 cases (19.44%) as naevi and other developmental disorders, 10 cases each (9.26%) as keratinization disorder and eczematous conditions. 19 neonates (17.59%) were put into miscellaneous group. Among the infective disorders, we found 21 cases of bacterial infections, 18 cases of fungal infections, 6 cases of viral infections. Other important findings were of six aplasia cutis congenita cases, five cases of collodion babies, one harlequin baby, two cases of unilateral digital gangrene of upper limb etc. None of the neonatal dermatosis had shown significance (P > 0.05). Inadequate sample size was the possible cause for these results. Conclusion: The pattern of pathological dermatoses was evaluated. An effective knowledge about these dermatoses will be helpful to the Dermatologists and also Pediatricians for proper treatment and to assure the worried parents.
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A study to estimate the frequency of Hanifin and Rajka's minor criteria in children for diagnosis of atopic dermatitis in a tertiary care center in South India p. 31
Navya Parthasarathy, Aparna Palit, Arun C Inamadar, Keshavmurthy A Adya
Background: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease characterized by intense pruritus. Hanifin and Rajka's criteria is the most common diagnostic criteria used in the hospital setup, which consists of 4 major and 23 minor criteria. The frequency of minor criteria may vary population wise. Aims: The aim of the study is to estimate the frequency of minor diagnostic criteria of Hanifin and Rajka in children with AD. Methodology: A hospital-based cross-sectional study of 174 children (≤16 years) with AD, was conducted based on history, clinical, and ophthalmological examination. Blood test to assess serum immunoglobulin E (IgE) level was conducted. Results: The most common minor criteria observed were Dennie–Morgan infraorbital fold (71.8%), early age of onset (67.8%), palmar hyperlinearity (67.8%), xerosis (67.2%), pityriasis alba (57.5%), and perifollicular accentuation (47.7%). Out of 143 cases whose serum was tested for IgE level, elevation was seen in 92. History of winter exacerbation was seen in 8% of the cases, while summer exacerbation was seen in none. On the ophthalmological examination of 111 cases, “high reading with no obvious keratoconus” was present in two cases while three cases were labeled as “keratoconus suspect.” Conclusion: Clinical features of AD vary with geographical location. The prevalence and severity of AD are influenced by several factors such as ethnic/racial, environmental, and dietary factors. Therefore, it is relevant for dermatologists to have a knowledge regarding common clinical features of AD in a given population for the diagnosis and thereby provide treatment to reduce the morbidity along with appropriate counseling.
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A clinicoepidemiological study of eruptive hypomelanosis: A newly described entity p. 36
Savera Gupta, Manjaree Morgaonkar, Manoj Kumar Sharma, Suresh Kumar Jain, Anita Vijay
Background: Eruptive hypomelanosis is a newly described entity from India characterized by sudden onset of symmetrical hypopigmented macules over the extremities. Only a few cases have been reported till date and the etiology is unknown. Aim: To study the epidemiological and clinical profile of eruptive hypomelanosis. Materials and Methods: A total of 19 cases were seen over a period of 5 months (March–July) and subjected to detailed history and clinical examination. Routine investigations including hemogram, liver and kidney function tests, urinalysis, erythrocyte sedimentation rate, C-reactive protein, HIV, hepatitis B surface antigen, anti-hepatitis C virus antibody, and potassium hydroxide (KOH) examination were carried out in all the cases. Skin biopsy was performed in three patients. Results: All patients were of pediatric age group ranging from 3 to 7 years (average 4.42 years) and had multiple discrete to confluent well-defined, hypopigmented nonscaly macules of size ranging from 2 to 20 mm, mainly distributed symmetrically over extensor aspect of extremities. Majority of the cases (12, 63%) presented in April. Six cases (37.5%) had prodrome symptoms 3 days to 2 weeks preceding the onset of lesions and four (25%) had positive family history. The routine investigations including KOH preparation and wood's lamp examination were normal in all cases. Histopathology of the skin was essentially normal. Lesions began to fade spontaneously after a period of 3–4 weeks resulting in complete/near-complete resolution, making total duration of the illness as 4–9 weeks. Conclusion: Considering the eruptive nature of lesions presenting in pediatric population, clustering of cases in a particular season, spontaneous resolution without active intervention, history of prodrome, and positive family history in some patients, eruptive hypomelanosis can be considered as a viral exanthem. As it can be easily confused with pityriasis versicolor, it is important for the clinicians to be aware of this entity so as to avoid unnecessary treatment.
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Chanarin–Dorfman syndrome p. 42
Harshal Ranglani, Pankaj Shukla
Chanarin–Dorfman syndrome is a rare, autosomal recessive disorder of lipid metabolism, occurring due to mutation of abhydrolase domain containing 5 gene, resulting in the accumulation of triglycerides in the skin, muscles, liver, and other organs. This disorder is clinically characterized by the presence of generalized ichthyosis along with organomegaly and other systemic features, while evidence of vacuolated neutrophils and eosinophils on the peripheral blood smear confirms the diagnosis. We report a 3-year-old girl with Chanarin–Dorfman syndrome to generate awareness about this rare condition.
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Angiokeratoma circumscriptum of children: A case of postinjury with a lesion on the foot p. 45
Liuchang Tan, Xinying Li, Yuangang Lu
Angiokeratoma circumscriptum vascular lesions are defined by ectasia of the papillary dermal vessels, and the etiology is unknown. We report a rare case of angiokeratoma circumscriptum following the excision of a lipoma, from the same area, on the right foot 3 years prior. Therefore, this case indicates that the injury could be involved in the development of angiokeratoma circumscriptum.
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Woolly hair with palmoplantar keratoderma without cardiac abnormality: A rare case report p. 47
Saritha Mohanan, Alagammai Krishnappan, Udayashankar Carounanidhi, Ramachandran V Bhat
Woolly hair is a rare hair shaft abnormality characterized by extremely curly hair. It can occur in isolation or be associated with palmoplantar keratoderma (PPK) and cardiac defects. Here, we report a 3-year-old child with woolly hair and PPK without any cardiac manifestations. We report this case because of its rarity and to stress the importance of cardiac assessment in children with woolly hair.
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Bullous eruptions in a preschool child: A rare adverse effect of acyclovir p. 50
Nidhi Garg, K V Vinu Balraam
Acyclovir in children is usually associated with minimal local adverse effects, with bullous eruptions being extremely rare in occurrence. A 5-year-old boy was admitted to the pediatric intensive care unit as a case of febrile encephalopathy with status epilepticus. He was managed empirically with intravenous antibiotics and antiviral drugs (acyclovir). On day 6, he developed hemorrhagic bullae near the infusion site, which reappeared after every acyclovir infusion. No definitive cause was identified despite thorough hematological, serological, and microbiological investigations. After a meticulous literature search and application of Naranjo algorithm, acyclovir was found to be the definitive cause of the bullous eruptions.
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Median canaliform dystrophy of thumb and great toe nails in an 8 years old boy p. 53
Sonia P Jain, Ajinkya K Sawant, Pratiksha A Sonkusale
Median canaliform dystrophy is a rare nail disorder characterized by midline longitudinal ridging or splitting with canal formation in the nail plate of one or both the nails of the thumbs. It is an acquired condition that mimicks habit-tic deformity, resulting in a temporary defect in the nail matrix and cuticle. Treatment is often prolonged and unsatisfactory. Some clinicians have used topical tacrolimus (0.1%) ointment and tazarotene (0.05%) ointment successfully. We report the case of an 8-year-old boy presenting with median canaliform dystrophy of Heller affecting nails of both the thumbs and great toes, respectively.
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Monilethrix: A rare case diagnosed by dermoscopy p. 56
Aditya Rajendra Holani, Nishigandha S Haridas, Nirali G Shah, Nitin Chaudhari
Monilethrix is a rare genodermatosis characterized by hair shaft dysplasia, which is responsible for hypotrichosis. We present the case of a 2-year-old female, with involvement of the scalp, eyebrows, and eyelashes, in whom dermoscopy enabled a rapid diagnosis of monilethrix. Dermoscopy revealed the zones of intermittent constriction of the hair shaft, separated by elliptical nodes at regular intervals, giving the appearance of a characteristic “regularly bended ribbon” sign. This helped in differentiating it from pseudomonilethrix and other causes of hypotrichosis.
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A Rare Entity of S100(−)/cluster of Differentiation 68(+) Jaw Myxoid-Cellular Neurothekeoma: A Case Report and Literature Review p. 59
Vida Jawin, Foo Jen Chun, Teoh Kean Hooi, Revathi Rajagopal
Neurothekeomas are rare, benign soft tissue tumors with fairly distinctive histomorphological features. They arise from the nerve sheath (nerve sheath myxoma/myxoid type) or fibrohistiocytic matrix (cellular type) and commonly involve the face, neck, and upper extremities in young adults. We report a rare, mixed-type neurothekeoma (showing both myxoid and cellular features), affecting the jaw of an 11-year-old girl. Histology was consistent with typical myxoid pattern, while immunohistochemistry suggested a fibrohistiocytic origin (cellular pattern). We excised the mass completely without any evidence of recurrence after 6 months.
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Poikiloderma with novel gene mutation p. 63
Sunanda Mahajan, Anuja Sunkwad, Bhushan Darkase, Uday Khopkar
Poikiloderma is characterized by mottled pigmentation, telangiectasia, and epidermal atrophy. It is a common cutaneous finding in a number of genodermatoses. We present a case of a 13-month-old male child with poikiloderma, heat intolerance, and photosensitivity, which made us evaluate him for poikiloderma-associated syndromes. The diagnosis of Hereditary Fibrosing Poikiloderma (HFP) was done based on the genetic study which showed mutation in FAM 111B gene.
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A case series of pediatric leprosy p. 66
Deepika Uikey, Rima Joshi, Nikhil Verma
Children are believed to be the most vulnerable group to most of the infectious diseases and similar is the case with Mycobacterium leprae infection owing to their weak immunity. Leprosy in children carries an epidemiological significance and can be considered an index of the prevalence of disease. We aim to know the incidence, duration, spectrum, reactions, and deformities in childhood leprosy through this study. Out of the total of 300 leprosy patients, 4% (12) patients belonged to the pediatric age group (<14 yeas) and 288 (96%) patients were adolescent/adults. Family history was present in 25% of the children with leprosy and only 2.47% adults with leprosy. Tuberculoid and borderline tuberculoid were the most common among pediatric patients. Indeterminate leprosy was specifically seen among children. Majority of the pediatric patients were paucibacillary (58.33%). In pediatric patients, two cases of both type 1 and type 2 reactions were seen. Deformities (Claw hand) were seen in 2 (16.67%) children. Leprosy occurs in children in substantial proportion, thus, adequate specific measures should be taken for children in leprosy control.
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Colocalization of psoriasis and vitiligo treated with apremilast and narrowband ultraviolet B combination in an adolescent girl p. 70
Trashita Hassanandani, Maitreyee Panda, Nibedita Patro, Debjit Kar
Coexistence of psoriasis and vitiligo in the same patient is a therapeutic challenge; several modalities have been tried with varying results. Apremilast is a PDE4 inhibitor used in psoriasis, while recent reports are highlighting its additional role in repigmentation of vitiligo. However, data are scarce, regarding its usage in the pediatric population. Narrowband ultraviolet B therapy (NB-UVB) is an effective treatment modality in both psoriasis and vitiligo and can be safely combined with apremilast. Here, we present an adolescent girl with anatomical colocalization of psoriasis and vitiligo effectively treated with combination of apremilast and NB-UVB therapy.
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A case of netherton syndrome with novel mutation in SPINK5 gene expressing incomplete phenotype p. 73
Tejas D Patel, Jigna Krunal Padhiyar, Nayan H Patel, Nishi S Trivedi
Netherton syndrome (NS) is characterized by ichthyosis linearis circumflexa, trichorrhexis invaginata, and atopic diathesis. It is also considered a probable primary immunodeficiency as many patients have shown increased tendency for infections and abnormal levels of various immunoglobulins. Primary defect in NS is mutation in SPINK5 (serine protease inhibitor Kazal-type 5) gene which leads to the defective expression and function of lymphoepithelial Kazal-type-related inhibitor. We describe a case of a 7-year-old male born out of first-degree consanguineous marriage with findings of novel mutation, noninvolvement of the hair shaft, and unusual histopathology.
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Migratory unilateral laterothoracic exanthem in a child p. 76
Yashdeep Singh Pathania, Saurabh Singh
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Underlying celiac disease in children with alopecia areata: An association p. 77
Sandeep Aggarwal, Shallu Aggarwal, Riya Kaur Kalra
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Atypical manifestations of genital dermatophytosis in a male toddler p. 78
Shikhar Ganjoo, Resham Vasani
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