Issue 2015.2

since 14. April 2015

C O N T E N T S   2.2015

 

 

 


ORIGINAL ARTICLES                                                                                                               


Khalifa E. Sharquie, Sabeeh  A. Al-Mashhadani, Adil A. Noaimi, Wasan B. Al-Zoubaidi
Microwave thermotherapy: New treatment for cutaneous leishmaniasis
      Our Dermatol Online 2015; 6(2): 125-129         DOI: 10.7241/ourd.20152.34

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 The authors deserves appreciation, authors have published a manuscript about one of the most common issue in our region:  cutaneous leishmaniasis. Poverty, malnutrition, population displacement, weakened immunity, and poor housing are all risk factors for cutaneous leishmaniasis . Such conditions are ideal for vectors of L. tropica and enable leishmaniasis to flourish as an anthroponotic disease, as seen in outbreaks in Kabul, Afghanistan. In the endemic areas, diagnosis of CL is often made by epidemiologic and lesion characteristics, but the diagnosis has to be confirmed by microscopic demonstration of the parasite, which is mostly done for the initial diagnosis (scraping, fine-needle aspiration, and touch smears), in the tissue and/or by sample culture to avoid potential misdiagnosis. Several randomized clinical trials have compared thermotherapy with other therapeutic alternatives. One of them demonstrated that it achieved the same efficacy (CR 54.3%) as intralesional antimonials (CR 59.8%) in Afghanistan (L. tropica). Later, other studies undertaken in Iran proved the superiority of thermotherapy with radiofrequency (CR 80.7%) compared with intralesional antimonials (CR 55.3 %). A third study comparing thermotherapy with intravenous antimonials in Iran and Kuwait (L. major) obtained similar CRs but with much fewer side effects than parenteral antimonials (CR thermotherapy 48%; CR intravenous antimonials 54%).  Ass. Prof. Mohammad S. Nayaf (Iraq) 

 
Yugandar Inakanti, Venkata Narsimha Rao Thimmasarthi, Anupama, Shiva Kumar, Akshaya Nagaraj, Srilakshmi Peddireddy, Abhiram Rayapati
Topical corticosteroids: Abuse and Misuse
      Our Dermatol Online 2015; 6(2): 130-134          DOI: 10.7241/ourd.20152.35

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 The authors deserve appreciation for their work. The topical corticosteroids: Abuse and Misuse is very common among patients and also among general practitioner doctors. Abuse of topical corticosteroids (TC), especially over the face, is prevalent worldwide, Even incorrect use, for instance in infectious dermatoses, produces an initial improvement in the symptoms. The problem is worsened when a patient is able to easily get an indefinite number of refills of a single prescription from the local chemist, leading to the production of adverse effects and, sometimes, dependence or addiction to TCs. This is a situation faced by dermatologists in many countries. All healthcare providers need to be sensitized about the dangers of topical corticosteroid misuse, especially on the face.  Ass. Prof. Mohammad S. Nayaf (Iraq) 

 I appreciate the authors for their study highlighting the misuse of topical corticosteroids. Topical corticosteroids have been prescribed extensively by medical practitioners for many dermatological disorders. Misuse of topical corticosteroids is a widespread phenomenon among young people in India, as they are easily available over-the-counter at a low price. Education of general public regarding the adverse effects along with legal enforcement against the over the counter availability of these drugs is required.   Dr Sandeep Kumar (India) 

 

 Topical corticosteroids misuse and abuse is a burning topic amongst dermatologists and is becoming an acute problem in developing countries like India were steroids are easily available without a prescription or supervision. Easy and unrestricted availability of topical steroids leads to self medication by the general public especially the housewives for quicker results leading to a number of complications as mentioned in the article. Triple drugs combination further aggravates these adverse effects.  Authors have rightly observed that peer pressure for cosmetic purpose is the leading cause for their misuse and abuse. Restriction must be observed by the medical fraternity regarding TCS use to reduce their adverse effects. The treatment advised by the authors for these complications must be more complication specific. Addition of more figures related to adverse effects could have given more weightage to the article.    Dr Rakesh Tilak Raj (India) 

 This is a one of the most common drug misuses in the developing Asian countries. Cutaneous adverse effects of topical steroids occur regularly with prolonged treatment and are dependent on the chemical structure of the drug, the vehicle, and the location of its application. The most frequent adverse effects include atrophy, striae, rosacea, perioral dermatitis, acne, and purpura. Those that occur with lower frequency include hypertrichosis, pigmentation alterations, delayed wound healing, and exacerbation of skin infections.    Solutions:-    Use of printing, visual & broadcast media for public education on topical steroid misuse is warranted, and the involvement of general practitioners, nursing staff, paramedics and pharmacists is needed. The legal approach should include the enforcement of the existing legislation related to the control of these drugs, so that these topical medicines are not sold without proper prescriptions.  Responsibility to disseminate proper knowledge regarding when, where, and how to use these medicines both to general practitioners and patients rests primarily with the skin specilasit. Benefits of rational and ethical use and the harm of overuse and misuse for nonmedical, especially for cosmetic purposes, should be clearly stressed before  prescribing topical steroids. This will hopefully bring down both the extremes of ever increasing cases of steroid-induced dermatoses on one hand and the irrational fears of using topical steroids in well justified indications on the other in some extent.   Dr Ajith Prasanna Kannangara (Sri Lanka)  

Virendra V. Saoji, Subodh D. Jane
Comparative study of calcipotriol ointment and mometasone furoate ointment in patients of psoriasis vulgaris: A double blind study
      Our Dermatol Online 2015; 6(2): 135-139          DOI: 10.7241/ourd.20152.36

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Vladimír Bartoš, Milada Kullová
Age-related differences in the incidence and clinicopathological findings of malignant melanoma of the skin
      Our Dermatol Online 2015; 6(2): 140-144          DOI: 10.7241/ourd.20152.37

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 Demographic or clinical factors that have been associated with survival in melanoma patients have included age, anatomic site, sex, and stage. The effect of age is the least consistent, but some studies have found better prognosis for younger patients [1,2]. Elderly has been linked to the diagnosis of melanomas with a more aggressive phenotype; greater thickness and presence of ulceration, a fact noted in multiple studies [3-6]. Some studies have shown that advanced age is an independent prognostic factor overall survival [7]. This more aggressive phenotype in this age group has several justifications. On one hand, these patients give less importance to the cutaneous changes observed. Also, do less self-examination tan younger people [8]. Finally, it is more frequent the occurrence of nodular melanomas (MN), which unlike superficial spreading melanoma (MES) or lentigo maligna melanoma (MLM) is not related to early signs and symptoms of melanoma. In the largest study referred to survival by age group, taking as censored data patients that died from another cause, was observed that below 40 years of age patients have a survival rate exceeding 77% at 10 years, whereas this diminishes with each decade. In this way have a 69, 63 and 56% survival at 10 years for patients of the sixth, seventh and eighth decades of life. The elderly over 80 years have a 43% survival in the same period [9]. This poor prognosis is also explained by mechanisms of immunosenescence resulting in an altering capacity to repair DNA or a decrease in the ability to respond to these tumors. Is a yet little-known phenomenon. In the case of pediatric melanoma appears that age of appearance is an important factor; a series published in patients under 10 years, have a disease-free survival at 5 years superior to patients over 10 years (90 vs 47%) [10]. This difference can not be attributed to tumor thickness, so melanoma in younger patients might have a different biological behavior to adult melanomas.    References:   1. Schuchter L, Schultz DJ, Synnestvedt M, Trock BJ, Guerry D, Elder DE, et al. A prognostic model for predicting 10-year survival in patients with primary melanoma. Ann Intern Med. 1996:125:369-75.   2. Cochran AJ, Elashoff D, Morton DL, Elashoff R. Individualized prognosis for melanoma patients. Hum Pathol. 2000:31:327-31.   3. Murray CS, Stokon DL, Doherty VR. Thick melanoma: the challenge persists. Br J Dermatol. 2005;152:104-9.   4. Demierre MF, Chung C, Miller DR, Geller AC. Early detection of thick melanomas in the United States: beware of the nodular subtype. Arch Dermatol. 2005;141:745-50.   5. Chamberlain AJ, Fritschi L, Kelly JW. Nodular melanoma: patient’ perceptions of presenting feature and implications for earlier detection. Australia Arch Dermatol. 2003;48:694-701.   6. Tejera-Vaquerizo A, Mendiola-Fernández M, Fernández-Orland A, Herrera-Ceballos E. Thick melanoma: the problem continues. J Eur Acad Dermatol Venereol. 2008;22:575-9.   7. Austin PF, Cruse CW, Lyman G, Schroer K, Glass F, Reintgen DS. Age as a prognostic factor in the malignant melanoma population. Ann Surg Oncol. 1994;1:487-94.   8. Oliveria SA, Christos PJ, Halpern AC, Fine JA, Barnhill RL, Berwick M. Evaluation of factors associated with skin self-examination. Cancer Epidemiol Biomarkers Prev. 1999;8:971-8.   9. Balch CM, Soong SJ, Gershenwald JE, Thompson JF, Reintgen DS, Cascinelli N, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer Melanoma Staging System. J Clin Oncol. 2001;19:3622-34.   10. Ferrari A, Bono A, Baldi M, Collini P, Casanova M, Pennacchioli E, et al. Does melanoma behave differently in younger children than in adults? A retrospective study of 33 cases of childhood melanoma from a single institution. Pediatrics. 2005;115:649-54.  Prof. Beatriz Di Martino Ortiz (Paraguay) 

Emina Kasumagic-Halilovic, Nermina Ovcina-Kurtovic, Hana Helppikangas
Anti-thyroglobulin antibody and vitiligo: A controlled study
      Our Dermatol Online 2015; 6(2): 145-148        DOI: 10.7241/ourd.20152.38

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 This research article has in-depth analysis and quite relevant to the emerging trend in vitiligo. Kasumagic-Hallovic E et al article lends further support to the theory of autoimmunity showing a direct correlation with the anti-thyroglobulin antibodies (anti-Tg) in generalized vitiligo. The concept of autoimmunity got further evolved to organ specific antibodies and thyroid antibodies are one such antibody related to depigmentation and disease activity. Taking into account the higher incidence of thyroid diseases in Indian population, it is difficult to draw definite conclusions from a small sample size (as the range of positivity of thyroid autoantibodies varied between 2.2% to 82% in different studies). Whether these antibodies are the primary cause or effect of the disease is yet to be proved as different tissue autoantibodies have been detected in vitiligo.  Dr Rakesh Tilak Raj (India) 

Zonunsanga
Efficacy of excimer light therapy for treatment of localized, progressive vitiligo
      Our Dermatol Online 2015; 6(2): 149-152          DOI: 10.7241/ourd.20152.39

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BRIEF REPORTS                                                                                                                      


Laouali Salissou, Eric Adehossi, Sani Maman Laouali, Saidou Mamadou, Hassan Nouhou
Cutaneous tuberculosis in Niger: a 9-year retrospective study
      Our Dermatol Online 2015; 6(2): 153-156          DOI: 10.7241/ourd.20152.40

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 Despite high prevalence of tuberculosis in developing countries, cutaneous tuberculosis is a rare manifestation. Its presentation can be varied, and may be difficult to diagnose on clinical grounds alone, often requiring skin biopsy and other ancillary tests to arrive at a diagnosis.In Indian Scenario however, Lupus Vulgaris is the most common clinical form of cutaneous tuberculosis, which is not observed in this study. This geographical variation probably is due to the underlying immune status of the patients. It is important for clinicians to recognize the many clinical variants of cutaneous tuberculosis to prevent missed or delayed diagnoses, as it responds well to Anti-tuberculous treatment as in this study by the authors.  Dr Kanthilatha Pai (India) 

Iqbal A. Bukhari, Osama Al Sultan, Abdulaziz Al Zahrani, Huda Alsuwaylih, Doaa Al Najim, Alla Altammar
Cutaneous manifestations in patients attending the hematology clinic at King Fahd Hospital of the University during a 13 week-period
      Our Dermatol Online 2015; 6(2): 157-159         DOI: 10.7241/ourd.20152.41

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Zonunsanga
Pyogenic granuloma treated with continuous wave CO2 laser followed by ultrapulsed CO2 laser ablation
      Our Dermatol Online 2015; 6(2): 160-162          DOI: 10.7241/ourd.20152.42

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Zonunsanga
Comparative study of efficacy of 30% Salicylic acid peel VsLong-pulsed 1064 nm Nd:YAG laser for treatment of Keratosis Pilaris
      Our Dermatol Online 2015; 6(2): 163-166          DOI: 10.7241/ourd.20152.43

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CASE REPORTS                                                                                                                       


Gauri Salgaonkar, Kanthilatha Pai, Padmapriya Jaiprakash, Sathish Pai, Anurag Ayachit
Epithelial predominant synovial sarcoma presenting as chronic non-healing ulcer of foot: a rare presentation
      Our Dermatol Online 2015; 6(2): 167-169          DOI: 10.7241/ourd.20152.44

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 Salsabil Attafi Sehli, Mariem Bel Haj Salah, Ines Smichi, Olfa Khayat, Wafa Koubaa, Aschraf Chadli Debbiche
Adventitious discovery of elastofibroma dorsi on skin biopsy
      Our Dermatol Online 2015; 6(2): 170-172          DOI: 10.7241/ourd.20152.45

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Dibakar Podder, Vidya Monappa, Prashanth Shetty
Soft tissue chondroma: a rare tumor presenting as a cutaneous nodule
      Our Dermatol Online 2015; 6(2): 173-175          DOI: 10.7241/ourd.20152.46

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Sathish Pai, Kanthilatha Pai, Shrutakeerthi Shenoi, Shastry BA 
Mimic of cellulitis: primary cutaneous B cell lymphoma – leg type
      Our Dermatol Online 2015; 6(2): 176-178          DOI: 10.7241/ourd.20152.47

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 Cutaneous lymphomas (CLs) represent a group of lymphoproliferative disorders that can be difficult to diagnose in the early stage, because it mimics many benign inflammatory cutaneous disorders [1]. World Health Organization (WHO)- European Organization for Research and Treatment of Cancer (EORTC) classified CLs in two groups: Cutaneous T-cell lymphomas (CTCL) characterized by proliferation of T lymphocytes in the skin and Cutaneous-B cell lymphomas (CBCL) associated with a proliferation of B-cell [2]. Clinically CLs can appear like chronic eczema, psoriasis, squamous dermatosis, allergic contact dermatitis, drug eruptions, and connective tissue disease [3]. The gold standard in the diagnosis of CLs is not only the routine performed histopathological examination, but each case should have a full knowledge of the clinical aspects and course of the disease. Considering the long evolution of CLs before the diagnosis, repeated biopsies correlated with clinical aspects and immunophenotype analysis may clarify the diagnosis [4]. Because the incidence of the diagnosis increases with age , a rigorous monitoring of  elderly patients diagnosed with recurrent benign dermatosis (lymphadenitis, vasculitis) must be performed [5]. The essential sign in history of CLs is the persistence of lesions with poor response to classic therapy or with. Recurrent skin lesions must be evaluated clinically and histopathologically  by repeated skin biopsies. Incidence of CLs is increased in elderly with a predilection for males [6,7]. Primary Cutaneous B cell lymphomas (PCBCL) represent 20-25% of primary cutaneous lymphomas [8]. There are three main type of CBCL: Primary cutaneous follicle center lymphoma(PCFCL), Primary cutaneous marginal zone B-cell lymphoma(PCMZL), Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT) other variants (intravascular large Bcell lymphoma and NOS) [9]. A proper diagnosis is the condition for therapeutic cure. It is to be mentioned  the prognostic value of immunochemistry for Bcl-2 in those cases. The absence of Bcl-2 expression is considered a hallmark of good prognosis [10].  Frequently B cell lymphomas in the elderly are related to chronic inflammation, viral infections (Epstein Barr virus, cytomegalic virus, hepatitis B virus, Herpes virus types) or even Helicobacter pylori or Borrelia burgdorferi [11-13]. In conclusion, it may be said that CLs must be suspected in elderly patients who present with recurrent and refractory dermatosis. The diagnosis may be initial a difficult one. Lesions can persist for years and histopathological findings may not be characteristic. These types of chronic dermatoses must remain under suspicion for a CL until a definitive diagnosis is made.   References:   1. Elmer KB, George RM. Cutaneous T-cell lymphoma presenting as benign dermatoses, Am Fam Physician. 1999;59:2809-13.   2. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, et al. WHO classification of tumors of haematopoietic and lymphoid tissues. Lyon: IARC;2008.   3. Burg G. From inflammation to neoplasia. Arch Dermatol. 2000;137:949-51.   4. Glusac EJ, Shapiro PE, Mcniff M. Cutaneous T-cell lymphoma:Refinement in the application of controversial histologic criteria, Dermatol Clin. 1999;17:601-14.   5. Inchara YK, Rajalakshmi T. Early Mycosis fungoides vs. inflammatory mimics: How reliable is histology? Indian J Dermatol Venereol Leprol. 2008;74:462-6.   6. Bradford P, Devesa S, Anderson W, Toro G. Cutaneous lymphoma incidence patterns in the United States: a population-based study of 3884 cases. Blood. 2009;113:5064-73.   7. Roman E, Smith AG. Epidemiology of lymphomas. Histopathology. 2011;58:4-14.   8. Hwang ST, Janik JE, Jaffe ES, Wilson WH. Mycosis fungoides and Sezary syndrome. Lancet. 2008;371:945-57.   9. Senff NJ, Noordijk EM, Kim YH, Bagot M, Berti E, Cerroni L, et al. European Organization for Research and Treatment of Cancer and International Society for Cutaneous Lymphoma consensus recommendations for the management of cutaneous B-cell lymphomas. Blood. 2008;112:1600-9.   10. Willemze R, Jaffe ES, Burg G, Cerroni L, Berti E, Swerdlow SH, et al. WHO-EORTC classification for cutaneous lymphomas. Blood. 2005;105:3768-85.   11. Song MK, Chung JS, Shin DH, Seol YM, Shin HJ, Choi YJ, et al. Prognostic significance of the Bcl-2 negative germinal centre in patients with diffuse large B cell lymphoma treated with R-CHOP. Leuk Lymphoma. 2009;50:54-61.   12. Bogle MA, Riddle CC, Triana EM, Jones D, Duvic M. Primary cutaneous B-cell lymphoma, J Am Acad Dermatol. 2005;53:479-84.   13. Michaelis S, Kazakov DV, Schmid M, Dummer R, Burg G, Kempf W. Hepatitis C and G viruses in B-cell lymphomas of the skin. J Cutan Pathol. 2003;30:369-7. Prof. Caius Solovan and Prof. Anca Chiriac (Roamnia) 

 This manuscript is very valuable that reminds us  to consider primary cutaneous diffuse large B-cell lymphoma-leg type (PCDLBCL-LT) in the cellulitis cases. I also want to add that PCDLBCL-LT  can arise on chronic lymphedematous leg and we should be alert if violaceous nodules appear on the chronic lymphedematous limbs and perform biopsy for histopathological examination. Thanks author for this educative presentation.   Dr Şule Güngör (Turkey)  

 The authors have presented a very interesting case of PCBCL LT. A very good point is done in alert clinicians about how this entity may simulate other benign conditions originally. Authors did a good follow up and a proper workup in order to have a final diagnosis. Histologically B cell lymphomas usually have a grenz zone, they exhibit a large cell population of lymphocytes with a predominance or confluent sheets of centroblasts and immunoblasts [1]. Tumors cells express CD20, which indicates the B cell origin of the line and are negative for CD3, which is a T-Cell marker. They also further stain positive for Bcl-2 and NUM-1.    References:   1. Grange F, Beylot-Barry M, Courville P, Maubec E, Bagot M, Vergier B, et al. Primary cutaneous diffuse large B-cell lymphoma, leg type: clinicopathologic features and prognostic analysis in 60 cases. Arch Dermatol. 2007;143:1144-50.   Dr. Manuel Valdebran (Dominican Republic) 

Yugandar Inakanti, Thimmasarthi Venkata Narsimha Rao
A tricky man Issue: angiokeratomas of scroti
      Our Dermatol Online 2015; 6(2): 179-182          DOI: 10.7241/ourd.20152.48

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 I recall when I was Military Pharmacist as Lieutenant at Bologna, Italy, ( magnificent town that was reputed as the Babylon of XXI century) during   the era when AIDS and its dread had triumphed in Italy, and I was charged, together with a myriad of colleagues,  to control soldiers' scrota periodically and angiokeratomas was a common lieu of terror and psychological distress in young boys. The remedy that was created about that disease was an ointment made with Zinc chloride (2%, the optimal percentage as mild eschariotic), Podophillin rhizome powder, Chelidonium majus glyceric extract (thanks to the presence of berberine, chelinodine,sanguinarine and chelerythrine with the specific analgisic, antimicrobial,oncostatic and lenitive/sedative activities), all dispersed in spermaceti, cause of its extreme analogy and diachysic attitude towards  the thinnest stratum corneum of scrotum. Results were exceptional, even though I must deliberately assert that Inakanti and Rao has got plenty of reason that the best treatmet is to ensure the men presenting this manifestation that this dermatological disease is not to correlate with oncologic evolutions nor to sexual transmission!   Compliments to the Indian colleagues!  Lorenzo Martini, M.Sc. (Italy) 

Marta Stawczyk-Macieja, Aneta Szczerkowska-Dobosz, Izabela Błażewicz, Aleksandra Wilkowska, Roman Nowicki
Dermatomyositis related to the relapse of cervical cancer
      Our Dermatol Online 2015; 6(2): 183-186          DOI: 10.7241/ourd.20152.49

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Iqbal A. Bukhari, Nada Al Ghamdi, Abdulaziz Al Zahrani, Muhammad Al Shawarby
Generalized keratosis pilaris rubra
      Our Dermatol Online 2015; 6(2): 187-189          DOI: 10.7241/ourd.20152.50

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Salsabil Attafi, Dorra Ben Ghachem, Amen Dhaoui, Wided Ajouli, Habib Dougui, Khadija Bellil
Kyrle disease: report of a Tunisian case
      Our Dermatol Online 2015; 6(2): 190-192          DOI: 10.7241/ourd.20152.51

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 This is yet another report of trans elimination cutaneous disorders which is under recognised. I appreciate the corresponding authour DR. Salsabil Attafi  for bringing out an excellent case report with all the requried diagnostic approaches in complete form. Please remove the line ‘ The patient’s informed consent was obtained‘ on paragraph 3, page 01 which is not required as the next paragraph contains all the details. This presentation emphasises the importance of diagnosing Kyrle  disease in certain systemic disaeses. Biopsy of the lesions will be most helpful. World incidence of 10 percent in haemodialised patients is really a huge margin. It may be more if more confirmed reports come in. Points  to remember in this presentation are: 1. Kyrle disease is also seen in children and 2. More common afro-americans .   But, throughout the world  where more and more diabetes mellitus  are coming up due to changing life styles and also unrecognised diabetes. The cutaneous manifestations are all the more likely to be missed during the diagnosis. So I appreciate the authour from Tunisia for a brilliant approach for bringing out the case for all the dermatologists  throughout the world to remember Kyrle disease. Prof. Sundaramoorthy Srinivasan (India)  

 Thanks to authors for enlighten an interesting case report. Kyrle disease was first described in 1916 by Kyrle as ‘hyperkeratosis follicularis et follicularis in cutem penetrans’ and identified as a perforating disease. Kyrle disease is characterised by the formation of large papules with central keratin plugs and appears to occur more frequently in patients with certain systemic disorders like Diabetes mellitus, renal disease, Hepatic failure and Congestive heart failure. The pathophysiology of Kyrle disease is unclear. In Kyrle disease keratinization focally occurs at the basilar layer of the epidermal, rather than normal proliferation with keratinization higher in the epidermis [1]. This elicits a host inflammatory response, resulting in keratin, cellular material, and connective tissue being forced out of the skin through the epidermis [2].   References: 1. Carter VH, Constantine VS. Kyrle's disease. I. Clinical findings in five cases and review of literature. Arch Dermatol. 1968;97:624-32.   2. Constantine VS, Carter VH. Kyrle's disease. II. Histopathologic findings in five cases and review of the literature. Arch Dermatol. 1968;97:633-9.    Dr. Yugandar Inacs (India) 

Sanjay N. Agrawal, Yogeshree R. Deshmukh, Subodhkumar D. Jane, Anuprita A. Rawal
Addison’s Disease: A rare case report
      Our Dermatol Online 2015; 6(2): 193-195          DOI: 10.7241/ourd.20152.52

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Tasleem Arif
Acral pityriasis versicolor – A rare clinical presentation
      Our Dermatol Online 2015; 6(2): 196-197          DOI: 10.7241/ourd.20152.53

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 Thanks to author for an interesting case report. Pityriasis versicolor is caused by Malassezia furfur. The most common presentation is scaly hypo- or hyperpigmented macules observed in characteristic areas of the body, including the chest, back, abdomen, and proximal extremities. Less common areas of involvement include the face, scalp, and genitalia. Facial lesions and penile lesions occur fairly commonly in infants and immunocompromised patients. The disease may even rarely occur on the palms, and soles. The characteristic scale is described as dustlike or furfuraceous.Tinea versicolor must be differentiated from seborrheic dermatitis, pityriasis rosea, pityriasis rubra pilaris, pityriasis alba, leprosy, syphilis, and vitiligo. Dr. Yugandar Inacs (India) 

 

Zonunsanga
Atypical pityriasis versicolor: case report
      Our Dermatol Online 2015; 6(2): 198-200          DOI: 10.7241/ourd.20152.54

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 Atypical cases of PV can be related with topography, clinical morphological cases or mycological findings. In tropical areas these manifestations are not uncommon [1,2].   References:    1. Isa Isa R, Cruz AC, Arenas R, Duarte Y, Linares CM, Bogaert H. Pitiriasis  versicolor en niños. Estudio epidemiológico y micológico de 797 casos estudiados en la República Dominicana. Med Cut Iber Lat Am. 2002;30:5-8.   2. Arenas R, Isa Isa R, Cruz AC. Pitiriasis versicolor en Santo Domingo, República Dominicana. Datos morfológicos de Malassezia spp. In vivo en 100 casos. Rev Iiberoam Micol. 2001;18:29-32.  Prof. Roberto Arenas (Mexico) 

 

Kanthilatha Pai, Poornima Baliga, Sathish Pai, Swati Sharma
Acrodermatitis Enteropathica in an adult: a case report
      Our Dermatol Online 2015; 6(2): 201-203          DOI: 10.7241/ourd.20152.55

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 With interest and I have a few mentions: The case is quite interesting, not a novelty but rather rare in adults. The pictures, case description and literature review of ADE are well done with accent on important aspect for practical activity. It is not mentioned the zinc level at the beginning of the treatment and during follow-up of the patient. Also the administration of diluted topical fluticasone propionate once at night in periocular areas is risky for long term side effects. It would have been interesting to know more in details the evolution of the disease in this case and the duration of therapy. I congratulate the authors for presenting such a case that caught our attention. Prof. Anca Chiriac (Romania)  

 The authors deserve appreciation for their deep insight in presenting case report of acrodermatitis enteropathica  in an adult with no other comorbid associations. Acrodermatitis enteropathica is a rare genetic disorder characterised by diarrhoea, an inflammatory rash around the mouth or anus, and hair loss.  It is associated with mutations in a gene (SLC39A4) that codes the zinc transporter protein, ZIP4. Symptoms usually occur in bottle-fed infants within a few days or weeks after birth and breast-fed infants soon after weaning. Both males and females are equally affected. Zinc deficiency may also rarely arise in adults. Probable aetiology may be inadequate zinc in the diet (especially in alcoholics and previously, with intravenous nutrition),Intestinal malabsorption (inflammatory bowel disease, intestinal bypass surgery, pancreatic disease) and Excessive urinary loss of zinc (nephrotic syndrome).   Dr. Yugandar Inaacs (India) 

Denitza Zheleva, Razvigor Darlenski
Occupational fingertip eczema from acrylates in a manicurist
      Our Dermatol Online 2015; 6(2): 204-206          DOI: 10.7241/ourd.20152.56

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OPINION ARTICLE                                                                                                                  


Neerja Puri
Platelet rich plasma in dermatology and aesthetic medicine
      Our Dermatol Online 2015; 6(2): 207-211          DOI: 10.7241/ourd.20152.57

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REVIEW ARTICLES                                                                                                                  


Pramod Kumar Nigam
Antifungal drugs and resistance: Current concepts
      Our Dermatol Online 2015; 6(2): 212-221          DOI: 10.7241/ourd.20152.58

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 This review article written by Prof Pramod Kumar Nigam is contemporary and draws serious attention of the dermatologists towards the antifungal drug resistance. Today clinical failures and relapses after the interruption of antifungal therapy are frequently observed by the dermatologists with routine antifungal therapy. These failures and relapses are associated with drug resistance. This antifungal drug resistance not only requires high level of suspicion but it also requires well established laboratory backup. The various biochemicals, genetic and clinical aspects of resistance have been convincingly explained in the article making it worth reading. The observations made by the author require use of surveillance studies to determine the true frequency of antifungal resistance in various countries all over the globe and thereby opening a new vista of research in dermatology. Now the burden of the problem lies with the researchers to find newer and better antifungal drugs along with cheaper method of their detection. This article also highlighted the importance of detecting appropriate etiological genera of the dermatophytoses, due to taking inappropriate low dose of antifungal drugs during self medication.  Multidrug resistance via a molecular switch and a protein called PXR working as drug sensor in human cells contributing to fungal resistance was captivating. Dr Rakesh Tilak Raj (India)  

 The introduction of latest systemic antifungal agents during the last decade has revolutionized the treatment of invasive and noninvasive mycoses. However, with these new weapons  comes a need for increased awareness of the important limitations in their spectrum of activity, pharmacokinetics, and risk for pharmacokinetic drug interactions. Long-term toxicities have become more of a concern because ambulatory patients with long-term immunosuppression are taking antifungal therapies for longer periods. For most patients, however, the benefits of safer and more effective antifungal therapy vastly outweigh the manageable risks of developing toxicity and undertreating a life-threatening systemic fungal infection. I think we all should thank Pramod Kumar Nigam for timely important readable article.    Dr Ajith Prasanna Kannangara (Sri Lanka) 

Zonunsanga
Targeted Phototherapy (newer phototherapy)
      Our Dermatol Online 2015; 6(2): 222-227          DOI: 10.7241/ourd.20152.59

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CLINICAL IMAGES                                                                                                                    


Tasleem Arif
Holter induced contact dermatitis
      Our Dermatol Online 2015; 6(2): 228-229          DOI: 10.7241/ourd.20152.60

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Salsabil Attafi, Olfa Lamine, Wafa Rekik
Neuroglial heterotopia of the scalp in an adult
      Our Dermatol Online 2015; 6(2): 230-231          DOI: 10.7241/ourd.20152.61

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LETTER TO THE EDITOR  –  Practical Issue                                                                          


Tasleem Arif, Iffat Hassan, Nuzhatun Nisa
Morphea and vitiligo-A very uncommon association
      Our Dermatol Online 2015; 6(2): 232-234          DOI: 10.7241/ourd.20152.62
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 An Interesting case report with peerless  association. Congratulations to authors. Morphea and vitiligo are two distinct entities of unknown etiology. Segmental form of vitiligo, which follows a dermatomal or Blaschko's lines-like distribution has an earlier age of onset, exhibits rapid progression and is relatively resistant to therapy.Several hypotheses for segmental vitiligo have been proposed like neuronal mechanisms, somatic mosaicism and microvascular skin homing, whether or not leading to an autoimmune destruction of melanocytes. Segmental morphea has rarely been reported. In addition to trauma, neurological and infectious agents, immunological abnormalities have been postulated as the causative agents for morphea. Various pathogenesis have been proposed for the two entities, of which autoimmune mechanism is common to both. Dr. Yugandar Inaacs (India)  

 Very interesting phenomenon. The association between Morphea and vitiligo has been documented infrequently. Co-occurance of linear scleroderma and homolateral segmental vitiligo has also been reported. The concurrence of these two diseases can be by sheer chance also, but the recent understanding of the Immuno- patho-physiology of these diseases suggests that it is more than a mere coincidence. Based on the various pathogenetic factors proposed for the two disorders, the immunological factor seems to be playing an major role in this patient.   Dr Ajith Prasanna Kannangara (Sri Lanka)  

 

LETTER TO THE EDITOR  –  Observation                                                                           


Seray Külcü Çakmak, R?dvan Güneş, Emine Tamer, Ferda Artüz, Ayşe Y?lmaz Çiftçi
Recurrent Targetoid Hemosiderotic Hemangioma
      Our Dermatol Online 2015; 6(2): 235-236          DOI: 10.7241/ourd.20152.63
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LETTERS TO THE EDITOR                                                                                                      


Shagufta Rather, Nuzhatun Nisa, Tasleem Arif
Lipoid Proteinosis treated as post acne scars – A clinical diagnostic error
      Our Dermatol Online 2015; 6(2): 237-239          DOI: 10.7241/ourd.20152.64

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Yuka Hanami, Toshiyuki Yamamoto, Mikio Masuzawa
A unique case of tiny disseminated angiomas from childhood: a variant of “petechial” angiomata?
      Our Dermatol Online 2015; 6(2): 240-241          DOI: 10.7241/ourd.20152.65

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Tasleem Arif
Localised facial pityriasis versicolor-A very uncommon presentation of a common disease
      Our Dermatol Online 2015; 6(2): 242-243          DOI: 10.7241/ourd.20152.66

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Salsabil Attafi Sehli, Mariem Bel Haj Salah, Olfa Khayat, Ines Smichi, Aschraf Chadli Debbiche
A pedunculated protruding lesion of the back
      Our Dermatol Online 2015; 6(2): 244-245          DOI: 10.7241/ourd.20152.67

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Lorenzo Martini
Balanitis evoked by abuse of intimate washing: two case reports where circumcision encourages the solution of the problem
      Our Dermatol Online 2015; 6(2): 246-247          DOI: 10.7241/ourd.20152.68

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HISTORICAL ARTICLE                                                                                                            


Patrice Bourée
Romana’s sign

      Our Dermatol Online 2015; 6(2): 248          DOI: 10.7241/ourd.20152.69

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OBITUARY                                                                                                                       


Aliis inserviendo consumor – Professor Kovalchuk Leonid Yakymovych
      Our Dermatol Online 2015; 6(2): 249-251          

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