Issue 2015.4

since 28. September 2015

C O N T E N T S   4.2015

 

 

 


ORIGINAL ARTICLES                                                                                                               


Dusi Ratna Harika, Anaparthy Usharani
A study of onychomycosis in Krishna district of Andhra Pradesh, India
      Our Dermatol Online 2015; 6(4): 384-391         DOI: 10.7241/ourd.20154.105

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 Onychomycosis affects 3- 5% of the population worldwide and represents 20-40% of onychopathies and about 30% of mycotic cutaneous infections. This brilliant Indian study highlights mycological, etiological and  epidemiological aspects of onychomycosis. Interesting to note that most of people affected  belong to low socio-economic status. Wet work is a decisive factor.  Medications for onychomycosis are a complicated item for its poor efficiency. It can be administered topically or orally. The combination of both topical and systemic is the best choice, but even so, it´s quite slow to heal. Ciclopirox olamine 8% Amorolfine nail lacquer are used with poor results. Efinaconazole 10% and Tavaborole 0.5% for toenail onychomycosis are new topical solution medications but only limited to cases involving less than half of the distal nail plate.Topical treatments may be useful to prevent recurrence in patients cured with systemic agents.  Oral therapy – Terbinafine / Itraconazole / Fluconazole – have important side effects especially on the liver.  We are having good results with Long-pulse Nd:YAG 1064-nm laser treatment for onychomycosis. It can inhibit fungal growth and it is well known that  lasers can penetrate as deep as the lower nail plate to “ exterminate “ fungus. It is a simple, not expensive and effective method without significant complications or side effects and is expected to become an alternative or replacement therapy for onychomycosis.   Dr César Bimbi (Brasil)  

C. Abhinav, Vikram K Mahajan, Karaninder S. Mehta, Pushpinder S. Chauhan, Mrinal Gupta, Ritu Rawat
Weekly methotrexate versus daily isotretinoin to treat moderate-to-severe chronic plaque psoriasis: a comparative study
      Our Dermatol Online 2015; 6(4): 392-398          DOI: 10.7241/ourd.20154.106

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 This is an interesting article which highlights the utility of isotetrinoin as part of the armamentarium for the treatment of psoriasis. Especial consideration is given to patients who do not tolerate methotrexate, in cases where biologics are unavailable and women in reproductive age who are not willing to plan contraception for a long period of time after stopping the medication, in particular, when considering the use of acitretin. It is worth to mention other therapeutical agents available such as cyclosporine, a very convenient drug, usually used as a second line of treatment which is available in many countries. While isotetrinoin, used as a monotherapy, offers improvement in mild to moderate plaque psoriasis, addition of ultraviolet light might provide additional benefit as described by others [1,2]. Good job and effort from the authors.   References:   1. Mortazavi H, Khezri S, Hosseini H, Khezri F, Vasigh M. A single blind randomized clinical study: the efficacy of isotretinoin plus narrow band ultraviolet B in the treatment of psoriasis vulgaris. Photodermatol Photoimmunol Photomed. 2011;27:159–61.  2. Gahalaut P, Soodan PS, Mishra N, Rastogi MK, Soodan HS, Chauhan S. Clinical efficacy of psoralen + sunlight vs. combination of isotretinoin and psoralen + sunlight for the treatment of chronic plaque-type psoriasis vulgaris: a randomized hospital-based study. Photodermatol Photoimmunol Photomed. 2014;30:294-301.  Dr Manuel Valdebran (Dominican Republic)  

 A good effort was done to study the comparative effects of methotrexate versus isotretinoin for the treatment of chronic plaque psoriasis. In most of the previous studies, acitretin has been used more commonly as compared to isotretinoin. Methotrexate is a time tested drug for the treatment of chronic plaque psoriasis but its prolonged use has its own limitations, especially the hepatotoxicity limits its use for prolonged periods. So, in patients with liver toxicity, retinoids can be used  as an alternative drug. Although, the efficacy  of  retinoids  is more in erythrodermic and pustular psoriasis, it has been used in plaque psoriasis also. Important advantage of isotretinoin is that it is not immunosuppressive. Therefore, it is the drug of choice in human immunodeficiency virus (HIV) positive patients with psoriasis. Retinoids have several advantages over conventional systemic drugs like they are not immunosuppressive, there is no limitation of cumulative dose, and they cause no significant hepatic or renal toxicity. Therefore, these are good candidates for maintenance therapy The main limitation of high dose isotretinoin is the dryness part especially lip cheilitis, due to which some patients abandon the treatment and therefore the drop out rates are higher with isotretinoin.   Dr Neerja Puri (India)  

 Psoriasis is a chronic disease with remission and relapses. All present treatment modalities have shown various efficacies but still the search for ideal drug is continuing. Out of the available treatments Methotrexate have been regarded as the first line therapy (gold standard) unless there is a contraindication due to its efficacy in showing the initial response. Most of the comparative trails conducted had methotrexate as a control group against which the efficacies of other drugs was tested. In the light of these observations, this well written article of Dr C Abhinav et al deserves appreciation. The only point of concern in this trail was the high dropout rate which might have affected the outcome of the trial. The highlight of the article is that Isotretinoin can be used as a alternative therapy  where there is contraindication or intolerance to immunosuppressive or they  have achieved their maximum cumulative dose. Another inference which can be drawn is that Isotretinoin could be used as a alternative therapy or as a part of rotational therapy. To devise a standard protocol regarding this; larger sample size clinical trials are required.   Dr Rakesh Tilak Raj (India)    

 

BRIEF REPORTS                                                                                                                      


Shivanand Gundalli, Rutuja Kolekar, Amit Kolekar, Vikrant Nandurkar, Kaveri Pai, Sunita Nandurkar
Study of basal cel carcinoma and its histopathological variants
      Our Dermatol Online 2015; 6(4): 399-403          DOI: 10.7241/ourd.20154.107

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Ravi Reddy, Sreekar Harinatha, Nithya Raghunath
The role of Bleomycin in management of hypertrophic scars and keloids – A clinical trial
      Our Dermatol Online 2015; 6(4): 404-406          DOI: 10.7241/ourd.20154.108

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 Different researchers have used different modalities and different techniques in the management of keloid and hypertrophic scars. They remain one of the most challenging dermatological conditions today due to cosmetic disfigurement and in its having  psychological aspect resulting in negative impact on the quality of life. There are no universal guidelines available. Various methods have been tried such as cryotherapy, anticancer drugs, surgical excision, radiotherapy, steroids, 5%, 5 Fluorouracil, verapamil, Interferons, lasers, silicon sheets, pressure garments etc either as monotherapy or in combination therapy. The combination therapies are preferred over the monotherapies due to the fact that despite treatment recurrences are common. Out of these treatments chemotherapeutic agents like bleomycin and fluorouracil have attracted the attention of the researchers in recent years. Clinical trial conducted by Dr Ravi Reddy and his colleagues is a step forward in this direction for which they deserve praise. The highlight of the article is that bleomycin is safe and effective drug against keloid. However, this article should have been subjected to rigorous peer review to avoid major drawbacks which a researcher notices while reading this article are: the lack of clinical trial registry number that is required as per the latest guidelines; no serial photograph of the patients have been submitted to the readers for evaluating the flatting of the keloid, Inclusion and exclusion criteria is not well defined, the period during which this trial was conducted is also not mentioned. While evaluating the response it is difficult to draw conclusions as the range to keloid and hypertrophic scar under treatment along with the total dose used (unit wise) are missing. Addition of demographic table would have help improved the overall impact of this clinical trial. This provides grounds for the researchers to conduct further rigorous clinical trial along with a comparative group to subsistent their findings.   Dr Rakesh Tilak Raj (India)  

 Keloids and hypertrophic scars cause disfigurement and are symptomatic at few instances. Patients may feel pain, pruritus and burning sensation. Importantly they are very difficult to treat in every day practice. This article on efficacy of Bleomycin is well written.It highlights the usefulness of Bleomycin in keloids and hypertrophic scars and side-effects associated with treatment. Pharmacological aspects of Bleomycin are discussed in detail. This article is very useful for dermatologist and surgeons in their practice. It is an appropriate article in the field of dermatology.   Ass. Prof. Balachandra S. Ankad (India)    

Kaur Brar Balwinder, Nidhi Kamra, Sukhmani Kaur Brar
Topical corticosteroid abuse on face: A clinical, prospective study
      Our Dermatol Online 2015; 6(4): 407-410          DOI: 10.7241/ourd.20154.109

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Lorenzo Martini, Alessandro Valle
Burmese thanaka powder and benedict’s reagent to struggle the liaison dangereuse: inverse psoriasis plus intertrigo
      Our Dermatol Online 2015; 6(4): 411-414         DOI: 10.7241/ourd.20154.110

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CASE REPORTS                                                                                                                       


Seray Külcü Çakmak, Duru Onan, Emine Tamer, Nuran All?, Ferda Artüz, Servet Güreşçi
A generalized case of purpura annularis telangiectoides of Majocchi
      Our Dermatol Online 2015; 6(4): 415-417          DOI: 10.7241/ourd.20154.111

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Mrinal Gupta, Sarthak Sharma, Anish Gupta
Beer induced angioedema – A case report
      Our Dermatol Online 2015; 6(4): 418-419          DOI: 10.7241/ourd.20154.112

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 My comments for the article Beer induced Angioedema is as follows: I appreciate the author for reporting an unusual case of Beer induced Angioedema. This case report helps in creating an awareness among all the beer lovers in the world.October Festival in Germany and Netherlands should be kept in mind for its Beer Festival, but no case of angioedema has been reported so far.  Unanswered question is whether the person who consumed beer took a branded beer or a home brewed beer. Apart from the ingredients mentioned here,other flavouring agents must also be thought of. We always learn something new everyday in dermatology.   Prof. Srinivasan Sunderamoorthy (India)  

Ahu Yorulmaz, Seray Kulcu Cakmak, Esra Ar?, Ferda Artuz
Bier spots
      Our Dermatol Online 2015; 6(4): 420-423          DOI: 10.7241/ourd.20154.113

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Edoardo Torres-Guerrero, Erick Martínez-Herrera, Stefanie Arroyo-Camarena, Carlos Porras, Roberto Arenas
Kerion Celsi: A report of two cases due to Microsporum gypseum and Trichophyton tonsurans
      Our Dermatol Online 2015; 6(4): 424-427          DOI: 10.7241/ourd.20154.114

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Celeste Valiente Rebull, Tatiana Moreno, Lizza Salgueiro, Gladys Arguello, Valdovinos Gloria, Beatriz Di Martino Ortiz, Oilda Knopfelmacher, Mirtha Rodríguez Masi, Lourdes Bolla de Lezcano
Dermatosis Eosinofílica: Síndrome de Wells. Presentación de caso
[Eosinophilic Dermatosis: Wells Syndrome. A case report]
      Our Dermatol Online 2015; 6(4): 428-432          DOI: 10.7241/ourd.20154.115

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Mohammad Abid Keen
Hypomelanosis of Ito: report of two cases
      Our Dermatol Online 2015; 6(4): 433-435          DOI: 10.7241/ourd.20154.116

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 The author presents, in detail, two cases of Hipomelanosis of Ito, highlighting the clinical signs of this debatable entity. It is defined as a syndrome with dermatological lesions (due to reduced melanin in the epidermis), eye involvement, central nervous system and psychiatric problems (including autism) and musculoskeletal anomalies. Skin lesions represent only a part of the syndrome, the most visible one, who leads to searching the other anomalies. Well documented and written, up-to date information, practical issues, and valuable case presentations for daily practice.   Prof. Anca Chiriac (Romania) 

Mrinal Gupta, Anish Gupta
Pseudoainhum associated with Psoriasis vulgaris
      Our Dermatol Online 2015; 6(4): 436-437          DOI: 10.7241/ourd.20154.117

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Agnieszka Terlikowska-Brzósko, Elwira Paluchowska, Witold Owczarek, Robert Koktysz, Ryszard Galus
Coexistence of psoriasis and atopic dermatitis
      Our Dermatol Online 2015; 6(4): 438-439          DOI: 10.7241/ourd.20154.118

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 I read with interest the above article and though the association of psoriasis with atopic dermatitis is rare, but sometimes undiagnosed. The age incidence of psoriasis and atopic dermatitis is different. While most of the cases of  atopic dermatitis occur in infancy and childhood, psoriasis starts at later in life. But one thing is common that both the diseases show exacerbation in winters. Family history positivity is more in psoriasis as compared to atopic dermatitis. The resolution of atopic dermatitis occurs by the age of 10 years in most of the patients and the psoriasis usually begins after this age. I believe that more studies should be conducted on the concomitance of both the diseases using larger sample sizes and such studies will help to understand the pathophysiology of both the diseases in a better way. To conclude, the coexistence of both the diseases is a relative phenomenon depending on various other factors including environmental and genetic factors.  Dr Neerja Puri (India)  

 It is very suggestive the fact that prior to attribute a definitive pathogenesis to a coexistence of psoriatic manifestation and AD in caucasian men, an accurate  hystological examination is carried out and the Einchenfield criteria are severely questioned.  Anyway, since genetic disturbances in filaggrin codifications have been recently discosed in Japanese population too, I think it could be advantageous to proof to treat the patient with previous  hypodermic injections of pure filaggrin, loricrin and involucrin, to confirm the preponderance of AD respect to a conclamated psoriasis, idest, if after a certain number of injections,  the response to right  filaggrin should be positive, AD could be excluded from diagnosis.  But this is only a modest advice, as I found some traces that seem to affirm this assumption  in recent nipponian literature and these kinds of injections are to be reputed as simplest dermal-cosmeticologic ones and thus not aggressive and/or invasive. (see: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0013216).   Lorenzo Martini, M.Sc. (Italy)    

Fadime Kilinc, Ayse Akbas, Sertac Sener, Sibel Orhun Yavuz, Ayse Akkus, Akin Aktas
A case of facial lentiginous lichen planus pigmentosus associated with Hashimoto’s thyroiditis and diabetes mellitus
      Our Dermatol Online 2015; 6(4): 440-442          DOI: 10.7241/ourd.20154.119

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Radhika Vidyasagar, P. Sudarshan, Sreedhar Suresh, Vidya Bhat, M. Subramanya
Rare case report of mesenteric fibromatosis
      Our Dermatol Online 2015; 6(4): 443-446          DOI: 10.7241/ourd.20154.120

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Sancar Serbest, U?ur Tiftikçi, Engin Kesgin, Hac? Bayram Tosu
Giant lipoma of the upper back: A case report
      Our Dermatol Online 2015; 6(4): 447-449          DOI: 10.7241/ourd.20154.121

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Radhika Vidyasagar, P. Sudarshan, N. Ravindranath Singh, S. Shivaram
A rare presentation of an ectopic breast tissue in axilla
      Our Dermatol Online 2015; 6(4): 450-452          DOI: 10.7241/ourd.20154.122

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Mrinal Gupta, Anish Gupta
Parameatal urethral cyst of glans penis in children – a report of three cases
      Our Dermatol Online 2015; 6(4): 453-455          DOI: 10.7241/ourd.20154.123

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Alin Laurentiu Tatu
The use of a topical compound cream product with Chitosan, Silver Sulfadiazine Bentonite hidrogel and Lactic acid for the treatment of a patient with Rosacea and ulcerated Livedoid Vasculopathy
      Our Dermatol Online 2015; 6(4): 456-459          DOI: 10.7241/ourd.20154.124

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 Compounded creams have traditionally used by dermatologists around the world. In the context of an ever increasing prices of commercial topical products, the utilization of novel actives not usually found in commercial preparations may be beneficial and cost effective to patients, especially when long term treatment is required.  In recent years there has been a wide diversity of research oriented to wound and ulcer healing. Certain bases used in cream preparations such as bentonite has been demonstrated to be efficacious in decreasing clotting time and accelerate wound healing [1]. By the other hand, chitosan plays an important role in tissue regeneration and has antimicrobial activity [2].   Silver derivatives are frequently used in dermatology as a topical antimicrobial however, they are not exempt of side effect which may include allergic contact dermatitis, cytotoxicity, silver staining, hyperosmolality and less frequently methemoglobinemia and hemolysis.  The use of nanostructured systems such as chitosan particles is advantageous especially in combination with bentonite as it potentially reduces drug cytotoxicity maintaining its antimicrobial properties, additionally, it enhances wound healing and decreases clotting time [2].   Further clinical research has to be done in this regard with these interesting combination of actives.  References:  1. Alavi M, Totonchi A, Okhovat MA, Motazedian M, Rezaei P, Atefi M. The effect of a new impregnated gauze containing bentonite and halloysite minerals on blood coagulation and wound healing. Blood Coagul Fibrinolysis. 2014;25:856-9.   2. Aguzzi C, Sandri G, Bonferoni C, Cerezo P, Rossi S, Ferrari F, et al. Solid state characterisation of silver sulfadiazine loaded on montmorillonite/chitosan nanocomposite for wound healing. Colloids Surf B Biointerfaces. 2014;113:152-7.     Dr. Manuel Valdebran (Dominican Republic)  

Zonunsanga
Isotretinoin induced rash, urticaria, and angioedema: a case report
      Our Dermatol Online 2015; 6(4): 460-462          DOI: 10.7241/ourd.20154.125

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Michał Andres, Andrzej Jaworek, Tomasz Stramek, Anna Wojas-Pelc
Skin reaction to bed bugs bite reflecting erythema multiforme. Case report
      Our Dermatol Online 2015; 6(4): 463-465         DOI: 10.7241/ourd.20154.126

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REVIEW ARTICLE                                                                                                                   


Zonunsanga
Hepatitis C in dermatology
      Our Dermatol Online 2015; 6(4): 466-470          DOI: 10.7241/ourd.20154.127

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CLINICAL IMAGES                                                                                                                    


Salsabil Attafi, Hela Zribi
Une tumeur infantile rare
[A rare child tumour]
      Our Dermatol Online 2015; 6(4): 471-472          DOI: 10.7241/ourd.20154.128

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Tasleem Arif, Syed Suhail Amin
Facial nevus spilus mistakenly treated as melasma
      Our Dermatol Online 2015; 6(4): 473-474          DOI: 10.7241/ourd.20154.129

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LETTERS TO THE EDITOR                                                                                                      


Harinatha Sreekar, Ravi Reddy, Nithya Raghunath, Nikhitha Raghunath, Harinatha Sreeharsha
Did Sushrutha first describe ear lobe repairs? A peep into the Samhita
      Our Dermatol Online 2015; 6(4): 475-476          DOI: 10.7241/ourd.20154.130

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Natsuko Matsumura, Masato Ishikawa, Tomoko Hiraiwa, Nobuyuki Kikuchi, Yasunobu Kato, Toshiyuki Yamamoto
Cement burn
      Our Dermatol Online 2015; 6(4): 477-478          DOI: 10.7241/ourd.20154.131

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Mariem Bel Haj Salah, Anissa Zaouek, Ines Smichi, Wafa Koubâa, Achraf Chadly-Debbiche
Pleomorphic basal cell carcinoma: report of an uncommon histological variant
      Our Dermatol Online 2015; 6(4): 479-480          DOI: 10.7241/ourd.20154.132

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 Basal cell carcinoma (BCC) of the skin exhibits a very heterogeneous histomorphology. Therefore, an extremely broad diversity of BCC subtypes and variants have been described untill now. It is reported that 66 various subtypes of BCC are presented in the scientific literature, of which 33 are listed in conventional dermatopathology textbooks. Mariem Bel Haj Salah and co-authors briefly introduce a case of pleomorphic BCC of the skin. This is one of the rarest variants of this malignancy. The key feature of pleomorphic BCC is the presence of mononuclear or multinucleated giant (monster) tumor cells, whose nuclei are 2 – 10 times larger than the nuclei of the surrounding tumor cells. However, this definition lacks the remark about a precise amount or quantitative extent of these atypical cellular elements within the entire tumor mass. Thus, it is possible that in a routine biopsy practice, many BCCs containing only scattered giant neoplastic cells are finally classified and named according to the histomorphological growth pattern without mention about their presence in tumor tissue. Hence, I am of the opinion that a true incidence of this BCC variant may be underestimated. On the other hand, since cellular differentiation and nuclear pleomorphism do not have prognostic significance in this neoplasia, I personally questioned, whether it would not be better to use  a word „pleomorphic“ only as additional description, for example „nodular BCC with pleomorphic tumor cells“. A designation pleomorphic BCC as such does not provide information about the real microarchitecture and growth pattern of BCC, which are much mor important for the clinicians.     Vladimír Bartoš, MD., PhD., MHA. (Slovakia) 

Shetty Shricharith, Jindal Anuradha, Rao Raghavendra, Sathish Pai
Entodermoscope: A tool to diagnose and monitor pediculosis captitis
      Our Dermatol Online 2015; 6(4): 481-482          DOI: 10.7241/ourd.20154.133

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Müzeyyen Gönül, Hasan Benar, Aysun Gökce, Murat Alper
A case of inverse psoriasis with interdigital involvement
      Our Dermatol Online 2015; 6(4): 483-484          DOI: 10.7241/ourd.20154.134

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 The inverse psoriasis, also called flexural or skin-fold psoriasis represent an unusual form of psoriasis characterized by erythematous plaques associated with poor or absence of scales and affects between 3-7% of the patients with psoriasis [1]. The common sites are represented by the genital area, groin and armpits. It is often misdiagnosed and treated like a fungal infection. Thanks to authors for describing an intersting case of inverse psoriasis with the involvement of the interdigital area, a very uncommon location for this condition. The case is very well documented with a detailed histopatological exam and very useful for the daily practice.  Reference:  1. Wang G, Li C, Gao T, Liu Y. Clinical analysis of 48 cases of inverse psoriasis: a hospital-based study. Eur J Dermatol. 2005;15:176–8.   Dr Ana Maria Draganita (Romania) 

Ravi Reddy, Harinatha Sreekar, Nithya Raghunath, Harinatha Sreeharsha
General public perception of a dermatologist in urban India
      Our Dermatol Online 2015; 6(4): 485-485          DOI: 10.7241/ourd.20154.135

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HISTORICAL ARTICLES                                                                                                           


Nadeem Toodayan
Jean Alfred Fournier (1832-1914): His contributions to dermatology
      Our Dermatol Online 2015; 6(4): 486-491          DOI: 10.7241/ourd.20154.136

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Piotr Brzeziński, Jana Zímová, Ewelina Cywinska, Anca Chiriac
Dermatology Eponyms – sign –Lexicon (Q)
      Our Dermatol Online 2015; 6(4): 492-497          DOI: 10.7241/ourd.20154.137

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