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International Journal of Research in Dermatology
Number of Followers: 1  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2455-4529
Published by Medip Academy Homepage  [12 journals]
  • Prevalence of metabolic syndrome in patients with psoriasis: a
           cross-sectional study in a tertiary care hospital of North India

    • Authors: Kamal Aggarwal, Shruti Sharma
      Pages: 440 - 445
      Abstract: Background: Psoriasis is a chronic inflammatory disorder of skin, which has been recently linked to metabolic syndrome (MetS) by studies worldwide. Paucity of Indian data in this regard led us to conduct the present study, which aimed to identify the prevalence of metabolic syndrome (and its components) in patients with psoriasis and to determine its association with disease severity and duration.Methods: This was a hospital-based cross-sectional study conducted over 50 clinically diagnosed patients of chronic plaque psoriasis and 50 age- and sex-matched control subjects. Metabolic syndrome was diagnosed by the South Asian Modified National Cholesterol Education Program Adult Treatment Panel III criteria (SAM-NCEP criteria). Data was analyzed using SPSS (version 17, SPSS Inc. Chicago, Illinois, USA). Descriptive statistics (mean, standard deviation, percentage), student’s t-test, and chi-square test were used.Results: Metabolic syndrome was more prevalent in psoriasis patients than controls but the difference was not significant statistically (30% vs 16%, p=0.0979). Although psoriasis patients had higher prevalence of hypertrigly-ceridemia, hyperglycemia, hypertension and central obesity than controls, but the difference was statistically insignificant. The prevalence of low high-density lipoprotein (HDL) cholesterol was significantly higher in cases compared to controls (40% vs 18%, OR 3.0370, p=0.0159).Conclusions: Metabolic syndrome and dyslipidemia are common in psoriasis patients, which signify the need for routine screening of metabolic syndrome in those patients.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20192136
      Issue No: Vol. 5, No. 3 (2019)
  • A comparative study of low-fluence Q-switched neodymium-doped: yttrium
           aluminum garnet laser versus 15% trichloroacetic acid peel in the
           treatment of melasma

    • Authors: Sridhar Venu, Sarath Chandran Balachandar, Kamalanathan Nallu, C. Lakshmanan
      Pages: 446 - 451
      Abstract: Background: Melasma is an acquired, circumscribed, pigmentary disorder. It is characterized by more or less symmetrically distributed, dark brown macules with well-defined geographic borders and is often resistant to treatment. The aim of our study is to compare the therapeutic efficacy of low-fluence Q-switched neodymium-doped: yttrium aluminum garnet (Qs-Nd:YAG) laser versus 15% trichloroacetic acid (TCA) peel in the treatment of melasma.Methods: Our study was an open, prospective, comparative study that included 50 melasma patients. They were then randomized into group 1 (n=25) and group 2 (n=25) by means of sequentially numbered list. Patients in group 1 were treated with 15% TCA. The procedure was repeated every two weeks for 6 times. Group 2 patients were treated with low influence Q-switched Nd:YAG laser. The treatment was given for four sittings at a gap of 3 weeks. Melasma area and severity index (MASI) was used to assess the response of therapy. Patients were followed up for 12 weeks after completing the study.Results: The total percentage of reduction in mean MASI was 41.92% in group 1 and 27.88% in group 2 which was statistically significant (p=0.007). Post inflammatory hyper- pigmentation was the most common side effect in patients treated with Nd-YAG laser, particularly Fitzpatrick skin type V.Conclusions: 15% TCA was better than Q switched Nd:YAG laser for the treatment of melasma. Qs-Nd:YAG laser is not an effective treatment option due to higher incidence of adverse effects.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193221
      Issue No: Vol. 5, No. 3 (2019)
  • Current scenario in clinical trends of psoriasis in tertiary care hospital

    • Authors: Ravichandran Velappan, Sridhar Venu, Sindhuja Ramasamy, Lakshmanan Chellappan
      Pages: 452 - 456
      Abstract: Background: Psoriasis is a common papulosquamous chronic, recurrent inflammatory skin disease with genetic predisposition and environmental factors acting as triggers. The current prevalence of common dermatoses will be useful for giving appropriate treatment for the patients. The aim of the study is to determine the different clinical pattern and prevalence of psoriasis in our institution.Methods: This study is a hospital-based descriptive study. We included 400 self-reporting patients of age group 6-87 years with psoriasis who attended our skin OPD. Period of study was 3 months from January 2019 to March 2019 in our medical college situated in Chengalpattu, Tamil Nadu.Results: Chronic plaque psoriasis is the most common (63.2%) clinical pattern observed irrespective of age and sex. Scalp and Nail involvement were common. Co-morbidities associated include diabetes mellitus, hypertension, alcoholism, hypothyroidism, and depression.Conclusions: Our data correlates with previous hospital-based prevalence studies of psoriasis.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20192068
      Issue No: Vol. 5, No. 3 (2019)
  • A randomised study to evaluate the efficacy of isotretinoin,
           electrodessication and comedone extraction in the treatment of comedonal

    • Authors: Kuraganty Ramya, Bakuru Gayatri Devi, K. V. T. Gopal, T. Narayana Rao
      Pages: 457 - 461
      Abstract: Background: Comedonal acne commonly seen in adolescents and young patients which is refractory to standard treatments. This study is being undertaken to determine the efficacy and adverse effects of oral isotretinoin, electrodessication and comedone extraction in patients of comedonalacne.Methods: A total of 120 patients of comedonal acne were enrolled and randomly divided into 4 groups of 30 patients each. Group A, B, C and D patients were treated with isotretinoin (20 mg daily), electrodessication, comedone extraction (4 weeks interval) and topical antibiotic daily for 12 weeks. The response in each group was assessed based on decrease in total comedonal count after 12 weeks of treatment. Statistical analysis was done using chi square test.Results: Eighty seven (72%) cases had predominantly closed comedones and 33 (27%) cases showed open comedones. After 12 weeks of treatment, more than 75% decrease in comedonal count was seen in 60% of patients in electrodessication group followed by 30% (isotretinoin), 13.3% (comedone extraction). The decrease in total number of comedone was significantly higher with electrodessication (84.4%) followed by isotretinoin (73%), comedone extraction (43.2%) and topical antibiotic (5.7%). After follow up of 3 months, recurrence of comedones was least with isotretinoin followed by comedone extraction and electrodessication.Conclusions: For comedonal acne, initial electrodessication followed by isotretinoin over 12 weeks gives the best outcome of quick remission and least recurrence. Electrodessication and comedone extraction are the preferred modalities in patients with predominantly closed and open comedones respectively. 
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193080
      Issue No: Vol. 5, No. 3 (2019)
  • Evaluation of therapeutic effectiveness of vitamin D3 injections in common
           warts in a tertiary care centre

    • Authors: Sushmalatha Banoth
      Pages: 462 - 465
      Abstract: Background: Warts or verrucae are the benign cutaneous manifestations caused by human papilloma virus. The treatment of wart possess a therapeutic challenge, as a result multiple modalities are existing for the treatment of cutaneous warts, which is cumbersome and may result in cosmetic disfigurement, chances of recurrences. The aim of the present study was to determine the resolution of common warts in response to vitamin D3 injections and to compare the resolution of common warts in the group receiving vitamin D3 with placebo group receiving normal saline.Methods: A total of 26 patients were enrolled and divided into Group A- received lesional injection of 0.2 ml vitamin D3 every 3 weeks for 3 months for the improvement in the size of warts. Group B- received 0.2 ml of normal saline injections as a control. The maximum of three sessions were carried in both groups. Clinical assessment was done by photographic evaluation at baseline, before each treatment session, and after completion of treatment.Results: In group A, 76.92% (10) of the patients showed complete clearance of wart with vitamin D3 injection, while in group B 8% (1) of patients with normal saline showed partial response. This therapy was well tolerated except for the minimal side effects like pain, redness and swelling at the site of injection.Conclusions: Intralesional Vit D3 injections may be a treatment option for warts, which has a good cosmetical acceptance and simple, well tolerated easily administrated in outpatient clinic rather than conventional treatment.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20192134
      Issue No: Vol. 5, No. 3 (2019)
  • Autologous serum skin test in 250 patients of chronic spontaneous
           urticaria at tertiary care hospital in Gujarat

    • Authors: Sonal Gaurang Patel, Rima Rakesh Joshi, Raksha Maganlal Patel
      Pages: 466 - 470
      Abstract: Background: Chronic urticaria (CU) is defined as urticaria persisting daily as or almost daily for more than 6 weeks and affecting 0.1% of the population. In chronic autoimmune urticaria, immunoglobulin G (lgG) auto antibodies react to the alpha subunit of the high-affinity lgE receptor (FceR1) on dermal mast cells and basophils, leading to chronic stimulation of these cells. This results in the release of histamine and other inflammatory mediators which cause urticaria and angioedema. More than half of the patients have autoimmune urticaria. ASST is the only in vivo test to detect autoimmune urticaria. The aim was to study the frequency of ASST positivity among patients with chronic spontaneous urticaria and to identify the clinical and laboratory parameters associated with positive ASST.Methods: The present study is prospective observational study of chronic spontaneous urticaria. ASST was performed in 250 patients fulfilling exclusion and inclusion criteria. Baseline investigations (CBC, ESR, urine, stool, RBS and CRP) were done for all the patients whereas specific investigations (ANA, Thyroid Profile, IgE, Anti H.Pylori IgG and skin biopsy) were done in selected cases.Results: Out of 250 patients examined, 60% had positive autologous serum skin test suggestive of autoimmune urticaria. H. pylori antibodies were significantly higher (29%) in ASST positive patients. While antinuclear antibody (ANA) was positive in 4% and thyroid antibodies were present in 7% of patients with positive ASST. Serum IgE was elevated in 32% ASST positive patients.Conclusions: ASST is an easy, simple and cost effective screening test for chronic autoimmune urticaria.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20192226
      Issue No: Vol. 5, No. 3 (2019)
  • Efficacy and safety of azathioprine in psoriasis

    • Authors: Ambresh S. Badad, Shruti A. Badad
      Pages: 471 - 475
      Abstract: Background: Psoriasis is a common, chronic, disfiguring, inflammatory and proliferative condition of the skin, in which both genetic and environmental influences have a critical role. In certain patients systemic therapy is required. Very little data about efficacy and safety of azathioprine in psoriasis is available in the Indian subpopulation.Methods: In this study, a total of fifty consecutive patients of chronic plaque psoriasis comprising inpatients and outpatients of a tertiary care hospital in Kalaburagi, Karnataka, South India during the period of 01 January 2017 to 31 June 2018 were included to study the efficacy and safety profile of azathioprine in psoriasis. The response to therapy was evaluated in terms of improvement in the PASI score at 12 weeks and 24 weeks.Results: Out of 50 patients being treated with azathioprine, 10 (20%) patients had to be dropped from the study group due to development of side effects. Of the remaining 40 patients, 11 (27.5%) showed good response, and 26 (65%) showed fair response. 3 patients (7.5%) showed poor response even after three months of therapy. The overall improvement in PASI was 65.94%.Conclusions: Azathioprine is an effective drug in treatment of chronic plaque psoriasis in selected patients in whom standard drugs like methotrexate cannot be administered either due to development of side effects or in cases where other drugs are contraindicated.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20192100
      Issue No: Vol. 5, No. 3 (2019)
  • Clinical profile of acne vulgaris: an observational study from a tertiary
           care institution in Northern Kerala, India

    • Authors: Jisy S. Raghavan, Sharim Fathima, Suhaiba Ameera, Kunnummal Muhammed
      Pages: 476 - 480
      Abstract: Background: Acne is one of the most common disease affecting adolescence. Although prior studies have evaluated epidemiologic patterns of acne in different ethnicities and regions, literature is lacking from this part of the country. The objectives of the study were to delineate the clinical and epidemiological profile of acne vulgaris in a population from northern Kerala in South India.Methods: The study was carried out for 6 months and it included 100 patients. Epidemiology including pattern, aggravating factors, seasonal variation, diet, smoking, markers of androgenecity and associations were evaluated in all newly diagnosed cases of acne vulgaris who attended the outpatient department in Kannur Medical College, Kannur, Kerala, India from January 2018 to June 2018.Results: Out of 100 patients females (74%) outnumbered males (26%) and although the majority affected belonged to the age group of 21-25 years (38%), adult acne was observed in 28%. Grade 3 acne was the commonest (44%), followed by grade 2 (30%) and grade 4 (18%). Face was affected in all patients with cheeks (91%), followed by forehead (72%), mandible (36%) and chin (28%) and trunk (23%). Scarring was found in 34% and pigmentation in 40%. Family history of acne was observed in 33%.Conclusions: This study brings out the clinical profile of acne in a tertiary care hospital in South India.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20192135
      Issue No: Vol. 5, No. 3 (2019)
  • Study of cutaneous manifestations in patients with polycystic ovarian
           syndrome attending a tertiary care centre

    • Authors: Chinmai Yerram, Garimella Venkateswara Rao, Krishna Rajesh Kilaru
      Pages: 481 - 485
      Abstract: Background: Polycystic ovary syndrome (PCOS) is a multisystem metabolic disorder, which has a significant impact on the quality of life as well as fertility.1,2 Acne, hirsutism, androgenetic alopecia, acanthosis nigricans, seborrhea are commonly associated with cutaneous manifestations of PCOS. To identify cutaneous manifestations, their incidence and frequency in patients with PCOS in different age groups.Methods: An institutional based prospective study. Seventy PCOS patients attending out-patient departments of DVL and Obstetrics and Gynaecology, NRI Medical College and General Hospital, Guntur, fulfilling the inclusion criteria were included in the study and examined for the presence of cutaneous manifestations in the two year study period between January 2017 and December 2018.Results: In the present study, 70 patients with PCOS were taken up and the commonest age group affected was 21-25 years (42.8%). Positive family history of PCOS was observed in 12.8%. The commonest cutaneous manifestation was acne vulgaris (57.14 %). Obesity was present in 47.14% of the patients and all of them were found to have striae. Hirsutism was observed in 47.14% of the total patients studied and the majority of them had terminal hair in the chin region and upper lip. Acanthosis nigricans was present in 34.28%, seborrhoea in 21.42% and acrochordons in 17.14% of the patients. Of the 70 patients, 15.7% were overweight and 47.14% were obesity.Conclusions: The cutaneous manifestations of PCOS reserves major role in its management by Dermatologist. Recognizing PCOS in women presenting with hyperandrogenism offers a significant opportunity to begin a life-long conversation about prevention and treatment of a condition that has a multi-system impact on affected women.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193229
      Issue No: Vol. 5, No. 3 (2019)
  • A retrospective study on clinical and demographic features of autoimmune
           vesiculobullous disorders from a rural tertiary care institute in Tamil

    • Authors: Rajalakshmi Ramalingam, Vikram Kumar Adaikalam Ganapathy, Seethalakshmi Rajanga Chandrasekar, Balasubramanian Narasiman, Deivam Subbaraya Gounder
      Pages: 486 - 492
      Abstract: Background: Autoimmune vesiculobullous disorders are a heterogenous group of skin diseases in which autoantibodies are directed against cell adhesion molecules which are essential for the integrity of skin and oral mucosa. They are clinically characterized by the presence of vesicles, bullae or erosions over the skin and/ or mucosa depending on the antibodies involved. They are divided into intraepidermal and subepidermal based on the location of the bulla. Among intraepidermal bullous disorders, pemphigus vulgaris (PV) is most common. Bullous pemphigoid (BP) is the most common among the subepidermal bullous disorders. Although they occur worldwide, the incidence shows geographical variation. A retrospective study was carried out with the objective to analyse the clinical and demographic profile of patients with autoimmune vesiculobullous disorders among patients attending a tertiary care teaching hospital in a rural setup.Methods: A total of 137 case sheets were audited from the Medical Records Department of our institute. Details were collected and tabulated, compiled and analysed.Results: Out of the 137 cases studied, intraepidermal autoimmune vesiculobullous disorders accounted for 63.4% of cases, and subepidermal autoimmune vesiculobullous disorders accounted for 36.6% of cases. Out of the 137 cases, 74 patients (54%) were females, and 63 patients (46%) were males. Majority of the patients were in the age group of 51-60 years (29.9%), followed by 41-50 years (24.1%) and 61-70 years (17.5%).Conclusions: Pemphigus vulgaris was the most common among the intraepidermal autoimmune vesiculobullous disorders, and bullous pemphigoid was the most common among the subepidermal autoimmune vesiculobullous disorders.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193121
      Issue No: Vol. 5, No. 3 (2019)
  • Pattern of dermatoses in elderly at tertiary care center, Jaipur,
           Rajasthan, India

    • Authors: Ankit Mehra, Anju Depan, Ashok Meherda, Deepak Bohara
      Pages: 493 - 497
      Abstract: Background: The population of India is currently moving towards and old age structure. The Indian elderly population 60 and older is currently the second largest in the world. During aging, structural and functional changes of the skin system are observed. Among the elderly, the number of cells decreases and the cell-renewing slows down in the epidermis. The skin water retention capacity decreases as well. Social and psychological circumstances also influence skin in old age.Methods: A cross-sectional study was conducted in out-patient Department of Dermatology, Venereology and Leprosy, Mahatma Gandhi Medical College and Hospital, Jaipur (Rajasthan) for a period of 18 months from January 2016 to June2017. A total of 1100 elderly were included in the study.Results: Out of 1100 total elderly patients 622 (56.50%) were males and 478 (43.50%) were females. Maximum number of males (322; 29.27%) as well as females (244; 22.18%) belonged to 65-70 years age group. Out of total 3138 diagnosis, the most common physiological changes secondary to aging process were graying of hair (1100; 35.05%) and wrinkling (1100; 35.05%). Out of the total 3256 diagnosis, the relative incidence of benign tumors was maximum (1626; 49.94%).Conclusions: Good general care of the elderly including nutritional diet, proper clothing, moderate physical activity and personal hygiene will improve many of their dermatoses and help in prevention of cases of dermatitis and infections.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20192873
      Issue No: Vol. 5, No. 3 (2019)
  • Relevance of patch testing and its correlation with clinical patterns of
           contact dermatitis of hand

    • Authors: Devaprabha Sendurpandian, M. R. Subashini
      Pages: 498 - 504
      Abstract: Background: Contact dermatitis of hand is a common dermatoses with different aetiological conditions and different morphologies. The aim of our study is to identify the clinical patterns, causative allergens and the relevance of patch testing for contact dermatitis of hand.Methods: A total of 74 patients with hand eczema were included in our study after getting informed and written consent to do patch tests during December 2016 to May 2017 in our dermatology OPD. Patch test was done by using Indian standard series battery and the readings were taken at 48 hrs and 72 hrs. The results were interpreted according to International Contact Dermatitis Research Group (ICDRG) criteria.Results: The incidence of hand eczema was 3.2 percent with male: female ratio of 1.55:1. The most common age group affected was 31-40 years. The most common morphological pattern observed in our study was fissured pattern (43%) followed by unspecified pattern (23%), hyperkeratotic (12%), lichenoid (10%), pompholyx (4%), fingertip eczema (1%), ring pattern (1%) and mixed morphology (6%). In our study, current relevance of 79% (31 allergens), doubtful relevance of 15% (6 allergens), and old relevance of 3% (one allergen) was noted. Cross sensitization was observed with one allergen (3%).Conclusions: Patch testing is a very useful scientific diagnostic tool that unravels the cause of contact dermatitis of hand. Avoidance of the substances responsible for allergy can be advised to the patient.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20192072
      Issue No: Vol. 5, No. 3 (2019)
  • Trends of common contact sensitizers in tandem with increased hair dye
           dermatitis in Shimla, a sub-Himalayan region: a study of 521 patients

    • Authors: Ghanshyam K. Verma, Saru Thakur, Gita Ram Tegta, Ajeet K. Negi, Saurabh Sharma, Prajul Mehta
      Pages: 505 - 510
      Abstract: Background: Skin is exposed to a vast variety of chemicals, organic or biological products among fashion seeking community of today’s world. This put them at risk of contact sensitization. Rapid industrialization, westernization of the society and poor labeling laws of cosmetics put us to the threat of “contact sensitization explosion” in near future. To know the drift of common contact sensitizers in the region, patch testing provides an insight into the cause of allergic contact dermatitis. The objective of the study was to determine the commonest allergen responsible for allergic contact dermatitis among patients attending contact dermatitis clinic in a tertiary care hospital.Methods: This retrospective study was conducted in the Department of Dermatology of our institution. We reviewed the medical records of all patients who were patch tested over a period of 6 years, using Indian standard series.Results: A total of 521 patients who were patch tested in the contact dermatitis clinic were included in the study. Nine patients with angry back were excluded. There were 269 males and 243 females. The commonest provisional diagnosis was allergic contact dermatitis secondary to hair dye in 172 (33.3%) patients followed by air borne contact dermatitis to parthenium in 88 (17.3%) patients. The paraphenylenediamine (PPD) being the most common sensitizer in 92 (17.9%) patients was followed by nickel in 86 (16.7%) patients, potassium dichromate in 36 (7%), parthenium in 32 (6%) and fragrance mix in 31 (6%) patients.Conclusions: This study revealed higher prevalence of hair dye dermatitis. Paraphenylenediamine was the most common allergen.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193220
      Issue No: Vol. 5, No. 3 (2019)
  • A randomised open label comparative study evaluating the effectiveness,
           adherence and safety between 2% mupirocin ointment and 2% fusidic acid
           cream in children with impetigo

    • Authors: Ravichandran Velappan, Sindhuja Ramasamy, Shridhar Venu, Muthusubramanian Chandrasekar
      Pages: 511 - 516
      Abstract: Background: Impetigo is a superficial bacterial skin infection that affects mainly children, which is highly contagious. Topical anti-bacterials are most commonly used in both primary and secondary impetigo. Clinical trials have shown high efficacy of these topicals along with systemic antibiotics in both complicated and uncomplicated impetigo. However use of these topical modalities alone in uncomplicated primary impetigo is limited. The aim of the study was to compare the efficacy, safety and adherence to treatment of mupirocin with fusidic acid in primary impetigo.Methods: A total of 60 patients with a clinical diagnosis of primary impetigo, between 2-14 years of age, having <10 lesions, skin infection rating score >4 and pus score equal to or more than one who attended Dermatology OPD, in Chengalpattu Medical College Hospital from February 2018 to March 2019. Study design was a comparative analytical study.Results: Baseline disease characteristics such as number of lesions, the severity of disease (SIRS), and pus scores were statistically similar between the two groups. The clinical improvement observed with mupirocin (25/30) and fusidic acid (24/30) treatment in primary impetigo was not statistically significant (p>0.05). Both drugs were tolerated well.Conclusions: Both mupirocin and fusidic acid showed similar clinical success in patients with primary impetigo. Though fusidic acid has additional anti-inflammatory property and its treatment is cost effective, but irritant effects observed in some patients, which reduces the compliance, lead to consider mupirocin as first line treatment in primary impetigo. 
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20192095
      Issue No: Vol. 5, No. 3 (2019)
  • Therapeutic study of onychomycosis in a tertiary care center

    • Authors: Geetha K., Muthubharathi S.
      Pages: 517 - 520
      Abstract: Background: Onychomycosis is the fungal infection of nail unit and require long-term treatment to achieve complete cure. This study aims to know the effectiveness of various treatment protocols for onychomycosis.Methods: This randomized uncontrolled open label study was undertaken in a tertiary care hospital. Patients with onychomycosis were included. Patients who received systemic or topical antifungal therapy in last six months were excluded. After obtaining ethical approval they were subjected to KOH mount and culture from nail clippings. Patients were selected randomly with both KOH and culture positive. Patients were divided into 3 groups. Group-A received oral terbinafine, Group-B received oral terbinafine and topical amorolfine, Group-C received oral itraconazole and topical amorolfine for 6 months. The patients were evaluated and assessed for the growth of the nail plate and were inquired for any adverse effects due to the drugs, at 6, 12 and 24 weeks. The results were recorded and detailed statistical analysis was done.Results: During the course of study 9 patients were lost in follow up and were excluded from the analysis of results. Mycological cure with negative KOH microscopy and culture were obtained in 56.6%, 73.3% and 70% in groups A, B and C. Clinical cure was observed in 60%, 76.6%, and 73.3% patients in group A, B and C respectively.Conclusions: There was no statistically significant difference in cure rate among the different treatment groups. Combination therapy achieved better results compared to monotherapy.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193222
      Issue No: Vol. 5, No. 3 (2019)
  • Intralesional triamcinolone acetonide versus platelet rich plasma: a
           comparative study in the treatment of alopecia areata of scalp

    • Authors: Rahul H. Ranpariya, Sanjeev B. Gupta, Mahendra S. Deora, Prachi V. Agrawal, Rachita Mathur, Aishwarya Raheja
      Pages: 521 - 527
      Abstract: Background: Alopecia areata (AA) is a chronic inflammatory disease characterized by nonscarring hair loss involving any hair-bearing surface of the body. The current therapy for AA is not curative but rather aimed at controlling or limiting the pathogenic process. Corticosteroids are the most popular drugs used, however localized atrophy is a common complication, particularly with triamcinolone. Promoting hair growth by application of autologous blood extracted platelet rich plasma (PRP) is a simple, yet effective procedure. The aim of the study was to evaluate and compare the efficacy of intralesional triamcinolone acetonide (5 mg/ml) with intralesional PRP in the treatment of two different scalp AA patches of same individual.Methods: A total of 30 patients having ≥2 patches of AA were randomized and given two separate modalities of treatment in two different patches and divided in Group I, treated with intralesional triamcinolone acetonide (5 mg/ml) and Group II, treated with PRP. Interval time between every follow-up was 3 weeks and four such follow-ups were done. Hair regrowth was calculated according to Mac Donald Hull and Norris grading system at every follow-up and was compared with the initial grading.Results: Group I patches, treated with triamcinolone acetonide have the significantly higher mean grading score than the group II patches, treated with PRP at each follow up.Conclusions: Intralesional triamcinolone acetonide is more efficacious than intralesional PRP in the treatment of scalp alopecia areata with no recurrences and very few adverse effects like atrophy and hypopigmentation.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193223
      Issue No: Vol. 5, No. 3 (2019)
  • Prevalence of oral lesions in pemphigus vulgaris: a retrospective study

    • Authors: Vinay K. N., Gouhare Afshan
      Pages: 528 - 531
      Abstract: Background: Pemphigus vulgaris is an autoimmune vesiculobullous disease characterized by vesicles and or bullae affecting skin and mucosa. Oral lesions are the first manifestation of the disease in majority of cases according to literature. This study is conducted to know the prevalence of oral lesions in pemphigus vulgaris patients at the time of presentation.Methods: This was a retrospective study. Departmental records were evaluated from January 2013 to January 2018. All the demographic data of pemphigus vulgaris patients at the time of first presentation, duration of disease, were assessed and tabulated. The clinical data of these patients during their subsequent visits to clinic were assessed for development of new oral lesions during course of disease.Results: Total number of patients were 55. The mean age was 42.5 years. 12 (21.8%) were males and 4 (78.1%) were females. Out of 55 patients 37 (67.27%) cases had oral involvement and 18 (32.72%) cases did not have oral lesions at the time of presentation. Out of 37 patients who had oral lesions, 34 (91.89%) patients had both oral and skin lesions and 3 (08.10%) patients had only oral lesions at the time of presentation. Out of the18 patients with no oral lesions, 3 (16.66%) patients developed oral lesions within 3 months. Total number of patients with oral lesions out of 55 were 40 (72.7%).Conclusions: Our study shows that oral lesions as initial manifestation of pemphigus vulgaris is 67.2%.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193224
      Issue No: Vol. 5, No. 3 (2019)
  • Knowledge and attitude about sexually transmitted infections among
           paramedical 1st year students in a tertiary care teaching institute in

    • Authors: Saurabh Krishna Misra, P. Oudeacoumar, R. Indradevi, Sushree Sovana
      Pages: 532 - 536
      Abstract: Background: Sexually transmitted infections (STI’s) are transmitted through sexual intercourse. Young individuals of 16-24 yr age group are more prone to STIs because they lack adequate knowledge about STIs and tend to have wrong perceptions towards sex. Thus it becomes important to assess the knowledge level about STIs among this age group. The main objective of this study was designed to evaluate the knowledge, awareness, perception and attitude about STIs among paramedical 1st year students in a tertiary care institute.Methods: The study was a descriptive cross sectional study. Detailed questionnaire eliciting information about knowledge, awareness, perception and attitude of the respondents towards STIs was administered to 227 paramedical 1st year students. This self-administered questionnaire was used for data collection.Results: 227 paramedical students participated in this study. Among them 103 (45%) were males and 124 (55%) females. Majority of the students (68%) got the source of information of STIs from education in school and college, 57% from internet and 49% from print media. 95% of the respondents knew about at least one STI. The two most commonly mentioned STIs were HIV (60%) and Syphilis (41%). 7% did not have any knowledge about STI. 68% mentioned sex with multiple partners as a mode of transmission and 46% knew unprotected sex. 17.6%-21.6% of them had misconception about mode of transmission. 49.8% mentioned weakness, 47.6% loss of weight as the symptoms of STIs where as 25.6% did not know anything about symptoms at all. Majority of respondents (60%) did not know about the complications of STDs. Also attitude towards sexual health and prevention of STIs was variable.Conclusions: Findings of our study showed that it is important to orient the paramedical students about sexual health and positive attitude towards STIs. This will help in prevention and control of STIs.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193225
      Issue No: Vol. 5, No. 3 (2019)
  • Comparative study of oral tranexamic acid and triple combination versus
           tranexamic acid through microneedling in patients of melisma

    • Authors: Vishal Wali, Hemangi Parwani
      Pages: 537 - 541
      Abstract: Background: Melasma can be difficult to treat due to the refractory and recurrent nature of condition. The aim of this study is to compare and evaluate the efficacy of oral tranexamic acid and triple combination versus tranexamic acid through microneedling in patients of melisma.Methods: This is a prospective study with a sample size of 20, 10 in each treatment arm.10 patients (group-A) were given topical triple combination to apply daily at night and along with oral tranexamic acid 250 mg twice a day, while in the other arm (group-B), 10 patients were given procedural treatment of microneedling with tranexamic acid (4 mg/ml). Patients were followed up for 3 consecutive months. Clinical photograph was taken after each visit, and a modified melasma area and severity index was performed at the beginning and end of the treatment.Results: According to melasma area and severity index, improvement in group-A was 65% as compared to 33% in group-B.Conclusions: Triple combination is known as gold standard treatment in melasma, but because of its long term steroidal and tretinoin side effects we can consider microneedling with TXA as an adjuvant treatment. 
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193226
      Issue No: Vol. 5, No. 3 (2019)
  • Study of genital dermatoses in pregnant females attending a tertiary care

    • Authors: Seeniammal Sivanu, Maalik Babu, Soundharyaa Moorthi Savadamoorthi
      Pages: 542 - 545
      Abstract: Background: Sexually transmitted infections (STI) prevalence in pregnancy is high and causes severe risk of transmission to the newborn. Usually they are asymptomatic and underdiagnosed. Most common STI’s are VVC, HPV, genital herpes, HIV, etc.Methods: A hospital-based cross-sectional study was done for a period of one year (September 2017- August 2018) and 31 pregnant genital dermatoses were encountered.Results: Among 31, infective etiology was seen in 15 cases (48%), non-infective etiology was seen in 3 cases (10%) and no STI’s were seen in 13 patients (42%). Vulvovaginal candidiasis was most common among pregnant females in 9 patients (60%) followed by genital warts in 3 patients (20%) followed by molluscum contagiosum, herpes genitalis and oral candidiasis in one patient (7%) respectively among infective etiology. Non-infective causes include vulval lymphangiectasia, epidermoid cyst and vascular swelling in one patient respectively (33.3%).Conclusions: Screening of antenatal cases is more important to prevent complications. 
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193227
      Issue No: Vol. 5, No. 3 (2019)
  • Clinical efficacy and safety of 20% glycolic acid versus 30% lactic acid

    • Authors: Ghazal Ahmed, Dharmendra Kumar Mishra
      Pages: 546 - 553
      Abstract: Background: Periorbital melanosis (POM) is a common aesthetic condition with significant impact. Chemical peeling is a frequently used treatment; yet, an ideal peeling agent is however to find. The aim of the study was to compare the clinical efficacy and safety of 20% glycolic acid (GA) and 30% lactic acid (LA) peels in POM.Methods: With approval and consent, the study was conducted from September 2016-August 2017. Patients aged 18-60 years of both sexes, having a constitutional POM were enrolled. Patients known to be allergic to the peeling agents were excluded. Alternate patients were enrolled into Gr-G (20% GA) and Gr-L (30% LA) and were treated every 3 weeks, for 3 sessions and evaluated till 9 weeks. Clinical improvement using POM grading, patients’ global assessment, satisfaction, and physician's global satisfaction were noted. Data are presented in number, percentages and mean±standard deviation. INSTAT software was used for statistical analysis; p<0.05 was considered significant.Results: Fifty-six (27 in Gr-G, 29 in Gr-L) were enrolled; 70.37% and 68.97% completed the study. Demographic variables, baseline POM grade, and skin types were similar. Compared to baseline, both Gr-G and Gr-L showed significant improvement (p<0.0001). Patient-reported significantly higher improvement in Gr-L (p=0.008) and higher satisfaction. Both the peeling agents were tolerated well with statistically indifferent adverse effects.Conclusions:Both GA and LA are useful in the aesthetic treatment of the constitutional type of POM. Three sessions of 30% LA peel appears to be better than 20% GA peeling used at 3 weeks apart.  
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193228
      Issue No: Vol. 5, No. 3 (2019)
  • Comparative evaluation of KOH mount, fungal culture and PAS staining in

    • Authors: Venkateswaramma Begari, Prathyusha Pathakumari, Anant A. Takalkar
      Pages: 554 - 558
      Abstract: Background: Onychomycosis is a common ailment associated with significant physical and psychological morbidity. Increased prevalence in the recent years has attributed to enhanced longitivity, co morbid conditions like diabetes, avid spots participation and emergence of HIV. The objective of the study was to evaluate KOH mount, fungal culture and PAS staining of affected nail plate in diagnosis of onychomycosis.Methods: The present study was carried out in OPD of Dermatology, PESIMSR, Kuppam, Andhra Pradesh during the period of October 2010 to October 2012 including all patients showing classical clinical features of onychomycosis.Results: Majority of patients were from 21-40 years age group i.e. 46%. 56% of finger nails were commonly involved than 36% toe nails. DLSO is the most common clinical variant accounting for 80%. Most common isolated species as Trichophyton rubrum (31.6%) followed by T. mentagrophytes and Aspergillus niger 15.8% each. The sensitivity of KOH (81.82%), PAS (84.56%) and culture 57%. Both PAS and KOH were more sensitive than culture (p<0.001). PAS was also more sensitive than KOH. The specificity of KOH 92.86%, culture 92.86% and PAS 57.14%.Conclusions: Fungal culture though is the gold standard for the identification of pathogens but it takes minimum 2-3 weeks. Histopathological examination of nail clippings with PAS stain is simple, highly sensitive screening test.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20192107
      Issue No: Vol. 5, No. 3 (2019)
  • Clinico etiological study of adverse cutaneous drug reactions

    • Authors: Peram Karunakar, Garimella Venkateswara Rao, Kilaru Krishna Rajesh
      Pages: 559 - 563
      Abstract: Background: Adverse cutaneous drug reactions (ACDR) are the most frequent ADRs (30-45%) and are responsible for about 2% of hospital admissions and few can result in significant morbidity, health care costs, hospitalization, and death. To study different clinical patterns of ACDR, assess the cause and identify the offending drug and to study the relationship of ACDRs to age and sex among patients referred to the department of DVL, NRI General Hospital.Methods: This is a retrospective study of 70 cases of colorectal carcinoma analysing incidence, clinicopathological features and outcome after different therapies including surgery, radiotherapy and chemotherapy. It was a descriptive hospital-based case series study. All out-patients and in-patients referred to the department of DVL, NRIGH, Chinakakani and in whom a diagnosis of ACDR is made, form the subjects for this study. The study was conducted over a period of two years.Results: 100 patients with adverse cutaneous drug reactions were included in the study. 42 (42%) were males and 58 (58%) were females. The age group ranged from 6 to 80 years with a maximum (43) belonging to 21 to 40 years. Maculopapular rash was most common followed by urticarial drug reaction, FDE, acneiform eruptions, EMF, erythroderma, DRESS, SJS, SJS/TEN, TEN and drug-induced hyperpigmentation. NSAIDs were the commonest culprits followed by antibiotics, antiepileptics and ATT.Conclusions: The commonest ACDR was maculopapular rash followed by urticaria, FDE and acneiform eruption. Antimicrobials as a group were the most common offending agents followed by individual drugs like diclofenac (13%), isoniazid (11%), efavirenz (9) and prednisolone (8%).
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193243
      Issue No: Vol. 5, No. 3 (2019)
  • A clinical study of prevalence of metabolic syndrome in psoriasis
           patients: a prospective cross-sectional observational study at a tertiary
           care centre in South India

    • Authors: Reshma R., Navakumar Manickam, Kannan Gopalan, Muthusamy Kandasamy
      Pages: 564 - 570
      Abstract: Background: Metabolic syndrome (MS) is a constellation of risk factors like central obesity, atherogenic dyslipidemia, hypertension and glucose intolerance.Psoriasis is associated with MS and this may be contributed by various inflammatory mediators like interleukin 6 and tumor necrosis factor α which are increased in psoriasis. Aim of the study is to assess the prevalence and risk factors associated with metabolic syndrome in psoriasis patients and to find association between metabolic syndrome and severity of psoriasis using PASI score.Methods: A hospital based prospective observational cross sectional study was conducted in Vinayaka Missions Medical College and Hospital, Salem over a period of one year (June 2017 – June 2018) involving 100 psoriasis patients, included based on the inclusion and exclusion criteria. Patients were analyzed based on a standard proforma and metabolic syndrome was diagnosed with the South Asian Modified National Cholesterol Education Program Adult Panel III (SAM- NCEP ATP III).Results: In the present study, prevalence of metabolic syndrome was 54%. The risk factors noted were female gender (p=0.015), nail involvement (p=0.249), joint involvement (p=0.007) and increasing PASI score (p=0.194).There was no significant association between type of psoriasis and metabolic syndrome. Among the different components of metabolic syndrome, majority of psoriasis patients were having raised fasting blood sugar.Conclusions: The occurrence of metabolic syndrome is high in Indian population. Therefore apart from getting treated for psoriasis, patients should be screened for components of MS and should be followed up regularly for onset of components of MS.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193230
      Issue No: Vol. 5, No. 3 (2019)
  • A study of cutaneous manifestations in diabetes mellitus patients in
           tertiary care centre

    • Authors: Kirankanth Vudayana, K. Sudheer, Dilipchandra Chintada
      Pages: 571 - 574
      Abstract: Background: Diabetes is the most common metabolic disorder with increased prevalence in developing countries like India. It affects almost all organs among which skin is affected by the acute metabolic derangments as well as by chronic degenerative complications. The aims were to study the pattern of cutaneous lesions in patients with diabetes mellitus and to determine the incidence of skin manifestations specific to and associated with diabetics.Methods: Hundred cases of diabetes mellitus with cutaneous manifestations attending skin outpatient department and other patients admitted in medical wards were included in the study.Results: The common skin disorders were cutaneous manifestations (67%), dermatosis more commonly associated with diabetes (36%), neuropathic and ischemic diabetic skin disease (11%).Conclusions: Most common cutaneous manifestation was cutaneous infections followed by dermatosis more commonly associated with diabetes. Among cutaneous infections fungal infections were more common followed by bacterial infections. Cutaneous infections were more common in patients with poor glycaemic control and the association was found to be statistically significant.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193231
      Issue No: Vol. 5, No. 3 (2019)
  • Treatment of multiple warts: efficacy of homologous autoimplantation
           therapy and comparison of homologous autoimplantation therapy and
           cryotherapy with liquid nitrogen

    • Authors: V. Suganthy, G. K. Tharini
      Pages: 575 - 579
      Abstract: Background: Though a multitude of therapies are available, treating warts remains a challenge, more so if multiple. Cryotherapy, a commonly used treatment, has limitations. Homologous autoimplantation is a newer therapy for multiple warts. The aims of the study were to evaluate the efficacy of homologous autoimplantation therapy and compare it with cryotherapy with liquid nitrogen.Methods: Hundred patients with multiple warts (≥5), were randomly selected and divided into two equal groups. One group was treated with cryotherapy with liquid nitrogen and the other with homologous autoimplantation. They were followed up for six months and the time taken for clearance of the lesions, complications and recurrences were compared.Results: Homologous autoimplantation gave a higher cure rate (78%) than cryotherapy (56%). Complications like blistering, ulceration, scarring and post-inflammatory hyperpigmentation were higher with cryotherapy (40%) than autoimplantation (6%). The recurrence rate was 4% in the cryotherapy group and none in the other. But the time taken for the resolution was lower in the cryotherapy group (2.28 weeks) than the autoimplantation group (6.46 weeks).Conclusions: Cryotherapy with liquid nitrogen and homologous autoimplantation are safe and effective therapies for warts but the latter carried a few advantages. The cure rate was higher, complications lower and recurrence was lower. Also autoimplantation can be of help in multiple warts where physical destruction of each and every wart is cumbersome. Hard to treat lesions like periungual warts, showed good results with autoimplantation.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193232
      Issue No: Vol. 5, No. 3 (2019)
  • Study on estimation of glucose-6-phosphate dehydrogenase in patients prior
           to initiation of dapsone therapy in leprosy

    • Authors: Manoj Kumar Agarwala, Pragya Agarwala, Archa Sharma
      Pages: 580 - 582
      Abstract: Background: Administration of dapsone in glucose-6-phosphate dehydrogenase (G6PD) deficient patients can lead to hemolysis which may be severe enough to warrant discontinuation of the drug. Screening for G6PD deficiency in leprosy patients before initiating treatment can prevent such adverse events.Methods: Medical records of all leprosy patients presenting between 1st January 2018 to 30th June 2018 were reviewed. G6PD levels, if done, were recorded for all patients needing dapsone therapy.Results: Of the 62 patients requiring treatment with dapsone (43 outpatients and 19 inpatients), G6PD estimation was done in 43 cases, i.e., 60.46% (26/43) of outpatients and 89.4% (17/19) of inpatients.10 patients were found deficient (6/26 outpatients and 4/17 inpatients).Conclusions: G6PD levels were not uniformly estimated in all patients requiring dapsone therapy. It was done more commonly estimated in inpatients (89.4%) when compared to outpatients (60.46%). The deficient G6PD levels were seen in 16% cases.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193233
      Issue No: Vol. 5, No. 3 (2019)
  • A prospective study on the efficacy of platelet rich plasma in alopecia

    • Authors: Ravichandran Velappan, Kamalanathan Nallu, Sindhuja Ramasamy, Muthusubramanian Chandrasekar
      Pages: 583 - 586
      Abstract: Background: Alopecia areata is an inflammatory auto-immune disease mainly affecting the scalp and other hair bearing areas. Platelet rich plasma contains concentrated platelets (more than that present in whole blood). Due to the presence of high concentration of growth factors, PRP is used in various conditions in the field of medicine and surgery. The aim of the study was to evaluate the efficacy of platelet rich plasma in alopecia areata.Methods: 20 patients, 16 male and 4 female with alopecia areata were enrolled in the study. PRP was injected in the alopecia sites for a total of 4 sessions every 28 days. Patients were followed in every month for 6 months and then at the end of one year. Pre and post treatment response was noted.Results: 13 patients responded well to treatment (65%), moderate response was seen in 3 (15%) patients and 4 patients showed no response (20%). 2 patients had relapse at the end of the study (10%).Conclusions: PRP was found to be an effective treatment modality for alopecia areata.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20192096
      Issue No: Vol. 5, No. 3 (2019)
  • Study of cutaneous manifestation of HIV disease in correlation with CD4
           lymphocyte count

    • Authors: Neeti Kumari, Kewal Krishan, Jatinder Singh Bist, Anil Kumar Mehta
      Pages: 587 - 592
      Abstract: Background: HIV infection is associated with numerous cutaneous changes even before the onset of immunologic dysfunction and AIDS. We all know that as search for reliable clinical indicators for management of human immunodeficiency syndrome in resource poor settings continues, cutaneous disorder can be considered among key clinical indicators for prediction of underlying immune status and disease progression. To study occurrence of various cutaneous manifestations and its correlation with CD4 cell counts in HIV infected Patients.Methods: 120 HIV positive patients above 14 year old with definite cutaneous manifestations attending dermatology OPD in Department of Skin, STD and Leprosy, in a tertiary care centre Dehradun (Uttarakhand, India) were studied from December 2013 to January 2016.Results: Among 120 HIV positive patients in our cross-sectional study, 50.83% of patients belonged to 31-40 years age group. Male to female ratio was 1.9:1 and heterosexual route was most common route of transmission. 69.17% of our study population had CD4 cell counts below 200 cells/mm3 and 23.33% of patients had CD4 cell counts <50 cells/mm3. Among these, commonest cutaneous manifestations were pruritic papular eruption, cutaneous drug reactions, molluscum contagiosum, seborrheic dermatitis. 17 patients (14.17%) had more than one cutaneous disorder with mean CD4 cell count of 121.5 cells/mm3 indicating advanced stage.Conclusions: At the end of study we concluded that cutaneous manifestations can be considered as a good clinical indicators for the progression of disease and underlying immune status in resource poor setting. 
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193234
      Issue No: Vol. 5, No. 3 (2019)
  • A prospective study on the etiopathogenesis, clinical types and causes for
           recalcitrant nature of scalp psoriasis

    • Authors: Shrinidhi Ramalingam, Rajkumar Kannan, Muthusubramanian Chandrasekar
      Pages: 593 - 597
      Abstract: Background: Psoriasis, a common chronic disfiguring inflammatory and proliferative papulosquamous disorder of the skin in which both genetic and environmental influences have a critical role. Scalp becomes the most common site of involvement, both at the time of onset of the disease and also throughout the course of the disease. This prospective study is designed to have a thorough insight into the etiological factors, clinical types and to unearth the factors behind the recalcitrant nature of scalp psoriasis.Methods: A prospective study, conducted in the Department of Dermatology, Chengalpattu Medical College, Tamilnadu. 50 patients of scalp psoriasis enrolled between April 2017 and March 2018 were included in the study.Results: It was found in our study that lesions of scalp psoriasis took longer time (on an average 6-8 weeks more) to resolve than lesions of psoriasis elsewhere in the body following treatment with systemic drugs like methotrexate and topical agents like 0.1% betamethasone + salicylic acid ointment and liquid paraffin. Out of 50 patients, 30 were female (60%) and 20 were male (40%). Following were the clinical types of scalp psoriasis encountered in our study. Chronic plaque psoriasis- 25 (50%), sebopsoriasis- 13 (26%), erythrodermic scalp psoriasis- 8 (16%), pityriasis amiantaceae- 4 (8%), pustular psoriasis of scalp- 0.Conclusions: The density of scalp hair leading to reduced absorption of topical treatment and the social reasons affecting the quality of life of patients are crucial factors that determine treatment outcome. All these inconveniences result in non compliance of treatment. Hairy scalp, rich vascular supply, patient’s non-compliance, adverse effects of topical agents-all throw a challenge to the treating dermatologist where it poses recalcitrant nature to treatment.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193235
      Issue No: Vol. 5, No. 3 (2019)
  • Clinicomycological study of tinea infections in and around Pune

    • Authors: Snehal Dhayagude, Vidya Arjunwadkar, Ravindranath Chavan, Renu Bharadwaj, Anju Kagal
      Pages: 598 - 602
      Abstract: Background: Tinea is a common fungal infection seen in the tropical and subtropical countries affecting the skin and its appendages. The presentation may vary from mild scaling to severe inflammation with bacterial super infection. It may be confused with other manifestation such as psoriasis, seborrhea, drug eruptions, eczema, and contact dermatitis. Hence correct diagnosis is necessary for appropriate treatment, which will reduce morbidity, discomfort and lessens possibility of transmissions. The aims and objectives were to determine clinicomycological profile of Tinea infections in patients attending dermatology OPD of B. J. Govt. Medical College and Sassoon General Hospital, Pune.Methods: Skin scrapings, nail clippings; hair samples from clinically suspected cases of tinea were collected. Identification of dermatophytes from these samples was done by conventional technique.Results: 119 clinically suspected cases of Tinea infections were processed over a period of one year. Out of these cases mixed infection of Tinea cruris with corporis was the predominant (27.73%) clinical presentation. Among all the samples, fungal filaments were seen by KOH mount in 48 (40.33%) whereas 35 (29.41%) samples were confirmed as dermatophytes by culture. Among these 35 isolates of dermatophytes 20 were T. rubrum, 7 isolates were T. tonsurans. 8 isolates were of T. mentagrophytes.Conclusions: In present study mixed infections of tinea cruris with corporis was the predominant clinical presentation and T. rubrum was the most common dermatophyte isolated.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193236
      Issue No: Vol. 5, No. 3 (2019)
  • Prevalence of skin dermatoses among fishermen in Puducherry

    • Authors: Sushree Sovana, Paquirissamy Oudeacoumar, Ramachandran Niranjjan, Saurabh Krishna Misra
      Pages: 603 - 606
      Abstract: Background: Fishermen always work and reside in environmental conditions that are harmful to their health. The primary objective of this study was to evaluate the magnitude of skin diseases among fishermen and the secondary objective was to assess the knowledge, attitude and practices related to skin diseases and their prevention.Methods: This was a cross-sectional study carried out among 420 fishermen and women belonging to fishing area of Puducherry for a period of three months from December 2018 to February 2019.Results: The majority of the study populations (26.67%) were in the age group of 30-40 years. The majority were males (1.43%), 88.57% were married, 16.19% were illiterate whereas 42.86% studied up to the secondary school level. The majority (54.29%) were working for more than 12 hours daily. The majority (30.48%) were in the fishing occupation for more than 20 years. The non-infectious skin disorders were: sunburns (25.71%), palmoplantar hyperkeratosis (19.52%), melasma (14.05%), acute urticaria (7.85%), photoaging (2.86%), wrinkles (2.14%) and freckels (1.90%). Among infections, 10.48% had tinea infections followed by pityriasis versicolor in 7.38%, bacterial infection in 3.57%, onychomycosis and warts in 1.19% each respectively and all the study population had only one type of infection. All men in the study were not using sunscreens and any protective wares and they were not aware of sun induced skin damage.Conclusions: The most common diseases encountered were sunburn, palmoplantar hyperkeratosis, melasma, acute urticaria, fungal infections, bacterial infection and photoaging. The fishermen were not using sunscreens and protective wares and they were unaware of solar skin damage.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193237
      Issue No: Vol. 5, No. 3 (2019)
  • Over the counter medication: a study among dermatology outpatients

    • Authors: Ramadevi Birudala, Shruthi Hassan Nagaraj, Kousar Begum Bannala, Vijayarangam ShivaKumar
      Pages: 607 - 610
      Abstract: Background: Over-the-counter (OTC) medicine or non-prescription medicine refer to medicine that you can buy without a prescription from a health care professional. The prevalence, clinical patterns and causative agents of cutaneous drug reactions vary among different populations. The most widely used over the counter medication in dermatological practice are topical steroids. The main objective is to know awareness among the people about over the counter medication and clinical analysis of effects caused by them, to find the most commonly used OTC medication.Methods: Prospective questionnaire based study comprising of 453 cases of cutaneous effects due to over the counter medication was carried out for a period of 1 year. Diagnosis was made mainly based on clinical features.Results: Super potent and high potent steroids were the most common OTC medication used which caused nodulocystic acne in 51.6% patients, atrophy in 3.97% patients, tinea incognito in 23.8% patients. Irritant contact dermatitis (due to hydroquinone, cotrimoxazole, neomycin) was seen in 18.5% patients. Fixed drug eruption was seen in 1.32% patients, cushingoid features in 0.66% patient.Conclusions: Indiscriminate abuse of steroids by people due to lack of awareness should be stopped. This misuse and damage have serious effect on the quality of life of the patients in general and the skin of the face in particular. Management is difficult and necessitates psychological counselling as well as physical soothing of the sensitive skin. For the safety of people Indian association of Dermatology, Venereology and Leprology (IADVL) also started IADVL Task force Against Topical Steriod Abuse (ITATSA).
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193238
      Issue No: Vol. 5, No. 3 (2019)
  • A study of thyroid profile abnormalities in vitiligo patients in tertiary
           care center of South India, in Telangana

    • Authors: Sushmalatha B.
      Pages: 611 - 614
      Abstract: Background: Several autoimmune conditions are associated with vitiligo. But thyroid is most common cause. We under took the study for the incidence of association of thyroid abnormalities involving in patients of vitiligo. The present study is conducted to know the incidence of thyroid profile abnormalities in various morphological forms of vitiligo.Methods: The present study was conducted on 53 patients of clinically diagnosed cases of vitiligo in the outpatients department of DVL of Mamata General Hospital for a period of 1 year 2018 January to 2019 January. 53 patients of age sex matched patients with other dermatosis excluding vitiligo are randomly designed as controls. Investigations were carried out in all patients of vitiligo like routine, specific like thyroid profile (T3, T4, TSH profile).Results: The presence study showing female to male ratio is 1:3:1 thyroid function abnormalities found in 33.96% of patients compared to 7.54% controls.Conclusions: In present study has shown that autoimmune thyroid diseases both in the form of hypothyroid, hyper thyroidism are frequently associated with vitiligo patients.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20192631
      Issue No: Vol. 5, No. 3 (2019)
  • A clinical profile of leprosy patients in a tertiary hospital, Karnataka:
           a retrospective study

    • Authors: Vinay K. Nirvanappa, Soumya G. Hegde
      Pages: 615 - 617
      Abstract: Background: Leprosy is a chronic mycobacterial infection and is still a major health hazard in India.Methods: This was a retrospective study over 12 years of all cases diagnosed clinically as leprosy in a tertiary hospital at Hassan district, Karnataka. Confirmation of diagnosis was based on slit skin smear and biopsy was done in doubtful cases.Results: Out of 214 patients, 152 were males and 62 were females. The prevalence was maximum in the age group 21-30 years. Borderline group formed the major part of the spectrum, consisting of 154 (71.96%) patients. Maximum patients 97 (45.3%) were of borderline tuberculoid (BT) leprosy, followed by 59 (27.57%) cases of borderline lepromatous leprosy (BL). 25 (11.68%) cases had tuberculoid leprosy (TT) and 20 (9.34%)cases were of lepromatous leprosy among which 3 were diagnosed as histoid leprosy. 6 patients had pure neuritic leprosy and 4 patients were in relapse.Conclusions: Even though leprosy is eliminated, it continues to be a public health problem in our country. Stricter surveillance for early diagnosis and treatment is needed to eradicate leprosy from India.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193239
      Issue No: Vol. 5, No. 3 (2019)
  • Uniqueness of Dr. JRK’s 777 oil and how rancidity distorts Wrightia

    • Authors: Aruna Vadivel, Amruthavalli Gatla Venkata, Soundharya Ravi, Gayathri Rajagopal
      Pages: 618 - 624
      Abstract: Background: Several oil based AYUSH formulations are available for the treatment of psoriasis. In the recent time the importance given to Wrightia tinctoria has totally side-lined the quality of oil used in such preparation. Therefore, the importance of oil used in the formulation with reference to rancidity and how that would affect the therapeutic effect of Wrightia tinctoria needs to be studied.Methods: In the present study we have adopted the following methods such as acid value, DPPH assay, nitric oxide inhibition, anti-glycation, CAM assay and fibroblast toxicity. The base oil used was studied for the above then the oil that showed least acid value was incorporated with Wrightia tinctoria extract and then studied by the above methods.Results: The above study clearly show that the activity of Wrightia tinctoria decrease significantly when it was formulated in oil with high rancidity. Whereas the activity of Wrightia tinctoria was well preserved in oil with least rancidity. The contribution of acid value of oil in decreasing the activity of Wrightia tinctoria was much higher than the effect of acid value in increasing DPPH activity, Nitric oxide production, inducing glycation event and angiogenesis and causing fibroblast toxicity.Conclusions: The present study clearly concludes that the acid value of base oil would not only worsen psoriasis but also can inactivate and convert the herbal metabolites to toxic elements. Due diligence is necessary in preparing AYUSH drugs where not only the quality of herbs should be considered but also the oil base as well. 
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193240
      Issue No: Vol. 5, No. 3 (2019)
  • A comparative study on fourth generation ELISA and rapid assay for
           diagnosing HIV infection in the high risk group

    • Authors: Sukanya Mathupal, Sathya Narayanan Rajendran
      Pages: 625 - 628
      Abstract: Background: Enzyme linked immunosorbent assay (ELISA) is a widely employed method for detecting HIV. Following its successful detection of HIV, the fourth generation ELISA was approved by FDA. The advantage of the FDA approved fourth generation ELISA is it detects p24 antigen, HIV 1&2 antibodies simultaneously and that too 5-7 days prior to conventional tests so that it detects HIV seroconversion earlier reducing its further spread.Methods: The study was conducted in a tertiary level medical centre after obtaining ethical approval. 200 patients from high risk group and their contacts were selected after a thorough physical examination and tests were done using fourth generation ELISA and rapid assay and these results were compared.Results: As per our observations, the percentage of patients tested positive by fourth generation ELISA out of 200 subjects was 37% and negative was 63%. The detection rate of HIV positivity by rapid assay in high risk group was 11% and negative was 89%. The detection rate was also higher with fourth generation ELISA when various other parameters were compared.Conclusions: In this study, the percentage of HIV positivity detected by fourth generation ELISA was higher than that detected by rapid assay showing that fourth generation ELISA is a more sensitive test than rapid assay as well as a better diagnostic modality to opt for when coming to early detection in HIV. 
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193241
      Issue No: Vol. 5, No. 3 (2019)
  • Comparative study of oral terbinafine vs. oral griseofulvin in the
           management of tinea capitis

    • Authors: Anjani Kumar Shukla, Bibhuti Bhushan, Dharmendra Kumar Mishra, Shyam Sundar Chaudhary, Mihir Kumar Jha, Sukanta Sen
      Pages: 629 - 636
      Abstract: Background: Tinea capitis (TC) is a common dermatophyte infection affecting primarily prepubertal children. The present study has been designed to assess the clinico-etiological profile of the T capitis and to compare the efficacy and tolerability of terbinafine with griseofulvin.Methods: One hundred fifty eight patients of T. capitis were divided into two groups of 79 patients each to receive either oral griseofulvin or terbinafine (according to weight). Patients in both the groups were followed up at 2, 4, 12 and 36 weeks. At every visit, clinical improvement was evaluated using clinical assessment severity score and the compliance, tolerability and side effects of the drugs were assessed along with KOH microscopy, fungal culture from the lesion and relevant blood investigations.Results: The clinical assessment score were statistically similar in group G and group T at the start of therapy. The decline in scores in both treatment groups was statistically significant at each follow up visit. In griseofulvin group, the mean score was declined from 5.9 at baseline to 4.24 at week 2 and 2.79 at week 4, 0.82 at week 12 and 1.24 at 36 week. In the terbinafine group, the score had a mean of 6.23 at 0 week and 4.03 at week 2, 2.32 at week 4, 0.69 at week 12 and 0.83 at week 36.Conclusions: At follow up study long lasting tissue effect of terbinafine was found but effect of griseofulvin was waned at 36 week. So terbinafine may be better option with similar side effect profile but it is better in residual clinical and mycological effect at higher cost.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193242
      Issue No: Vol. 5, No. 3 (2019)
  • Clinical profile of pityriasis rosea: a descriptive study from urban

    • Authors: Dayanand Raikar, Mohammed Waseem Javed, Anant A. Takalkar
      Pages: 637 - 640
      Abstract: Background: Pityriasis rosea (PR) is common, self-limited papulo-squamous dermatosis of unknown origin, which mainly appears in adolescents and young adults (10-35 years). It has a sudden onset, and in its typical presentation, the eruption is proceeded by a solitary patch termed “herald patch”, mainly located on the trunk. The objective of the study was to assess the clinical profile of pityriasis rosea.Methods: The data was collected from patients attending the Department of Dermatology, Basaveshwar Teaching and General Hospital attached to Mahadevappa Rampure Medical College, Gulbarga. It is a descriptive observational study. A total 79 patients suffering from pityriasis rosea who attended the outpatient department were included in the present study during the period from 2006 to 2007.Results: Out of 79 patients studied, majority were from 11-20 years age group 33 (41.8%) followed by 27.8% from 21-30 years age group. The mean age of study population was found to be 21.3±6.4 years. 11% gave history of acne vulgaris, 8% each had history of atopy and drugs. Commonly observed prodromal symptoms were URTI (25.3%) and fever (17.7%). Herald patch was seen on trunk in majority of patients i.e. 36 (61%) followed by 18.6% cases on upper extremity and on neck (8.5%).Conclusions: Our study concludes that pityriasis is common in 11-20 years age group with male predominance having URTI as common prodromal symptom and typical rash.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193129
      Issue No: Vol. 5, No. 3 (2019)
  • An analytical study on clinical patterns of herpes zoster in this era

    • Authors: Ravichandran Velappan, Sindhuja Ramasamy, Kamalanathan Nallu, Arulraja Ganapathi
      Pages: 641 - 645
      Abstract: Background: Herpes zoster is a major health burden in all age groups. It is caused by reactivation of varicella zoster virus from dormant form. The immunity that plays a role in this reactivation is cell mediated immunity. Prodromal features like Fever, pain and itch are common before the onset of zoster rash. The most common complication associated with this disease is post-herpetic neuralgia. Complications associated with herpes zoster depend on the age, immune status, and the time of initializing treatment. Treatment with antiviral drugs within 72 hours of onset of rash onset has been shown to reduce severity and complications associated with zoster and the post-herpetic neuralgia.Methods: We analysed 120 cases of herpes zoster patients who attended Dermatology OPD, in Chengalpattu Medical College Hospital from January 2018 to December 2018. The study design was descriptive study. A detailed history taking, thorough clinical examination and appropriate relevant investigations were done.Results: The mean age group of the 120 patients (male-56, female-64) was 35 years. Segmental distribution: Thoracic-60%, cervical-6%, lumbosacral-2%, herpes zoster ophthalmicus-22%, herpes zoster oticus-10%. 34% were diabetic, 2% HIV, 4% following surgery/trauma, 10% on steroid therapy. 13% had history of native treatment. Prodromal symptoms in 34%, post herpetic neuralgia-60%, sepsis in 52%.Conclusions: Herpes zoster occurs in dermatomes in which the rash of varicella achieves highest intensity. Herpes zoster can affect any age group with a higher incidence in elderly patients and in those with immuno-compromised status, treatment with antivirals within 72 hours of onset of rash has shown a reduction in severity and complications.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20192071
      Issue No: Vol. 5, No. 3 (2019)
  • Muir-Torre syndrome: the curious case of wobbly microsatellites and their
           mucosal Lynch

    • Authors: Robert A. Elmore, Mary K. Dick, Poonam K. Sharma
      Pages: 646 - 648
      Abstract: MSH2 mismatch repair gene is commonly associated with Lynch syndrome; however, Lynch syndrome’s phenotypic variant, Muir-Torre syndrome is a lesser known entity comprising a spectrum of benign to malignant sebaceous neoplasms and is often the first etiology of a more significant prodromal syndrome. Both syndromes encompass gastrointestinal, genitourinary tract, and prostatic pathologies. We present a 15-year patient progression starting with new sebaceous hyperplasia and congenital melanocytic nevus skin lesions presenting in a 38-year-old caucasian male. After approximately four years additional cutaneous lesions began continuously appearing identified as: ulcerated sebaceoma, basal cell carcinoma, sebaceous hyperplasia, sebaceous adenoma, and hidradenoma. The patient went on to develop prostate adenocarcinoma and tubular adenoma of the ascending colon and rectum. Immunohistochemical staining demonstrated MSH2 and MSH6 instability and patient was recommended for Lynch Syndrome genetic testing. Later genetic analysis showed pathologic variant of MSH2 confirming Muir-Torre Syndrome. When multiple pathologies are involved that affect ectoderm differentiation, a diagnostic workup for microsatellite instability is recommended in association with a genetic counselor consultation. When a familial defect in a DNA repair enzyme (MSH1, MSH2, etc.) is known, we recommend PCR amplification for microsatellite instability in offspring between ages 5-15 to reduce morbidity and mortality in this population.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193244
      Issue No: Vol. 5, No. 3 (2019)
  • Toxic epidermal necrolysis treated with filgrastim and dexamethasone

    • Authors: Nishant Choudhary, Nidhi Sharma, Sujata Sinha, Sudip Das
      Pages: 649 - 651
      Abstract: We report a case of 22 year female with toxic epidermal necrolysis while on carbamazepine. One hospital outside treated her with steroids but she didn’t show any improvement and rather worsened. The patient reported to us with fluctuating blood pressure and dyselectrolytemia. Patient also developed neutropenia (3,200/mm3) and sepsis. Patient was treated with filgrastim and dexamethasone. Filgrastim was added because of neutropenia and earlier case reports suggesting it aid in faster healing. Patient made a complete recovery. 
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193122
      Issue No: Vol. 5, No. 3 (2019)
  • Acute methotrexate toxicity in psoriasis

    • Authors: Peram Karunakar, Venkateswara Rao Garimella, Chinmai Yerram, Anusha Gogula
      Pages: 652 - 655
      Abstract: We describe two cases of low dose methotrexate (MTX) toxicity in patients with psoriasis. Patient was a 49-year-old male, known case of chronic plaque psoriasis from 10 years on and off. He was advised to take MTX 2.5 mg 2 days a week but patient took 2.5 mg twice daily (BD) for 6 continuous days following which he developed ulceration over psoriatic plaques and bone marrow suppression. MTX is safe and effective if adhered to standard treatment guidelines but inadverent use may lead to it’s toxicity.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193245
      Issue No: Vol. 5, No. 3 (2019)
  • Chromoblastomycosis complicated with co-morbidities, curbed by
           cryotherapy: a case report

    • Authors: Vivekananda Ittigi, Soumya G. Hegde
      Pages: 656 - 658
      Abstract: Chromoblastomycosis is a chronic mycosis affecting skin and subcutaneous tissue. Treatment of chromoblastomycosis is challenging due to refractory nature of the condition and varied antifungal sensitivity of the organism. Though systemic antifungals are commonly used modality of treatment, there is no “gold standard” treatment. The array of treatment options include chemotherapy and physical methods (cryosurgery/ CO2 laser/superficial X-rays/ surgical excision), either alone or in combination. A 60 year old male farmer presented with history of congestive cardiac failure (CCF), presented with gradually increasing painful, reddish elevated skin lesions over right knee since 2 years. On examination, there was a well-defined solitary, tender plaque of size 2×3 cm with smooth surface, elevated peripheral margin. Blood investigations were within normal limits except for deranged LFT. Diagnosis of chromoblastomycosis was made based on KOH mount which revealed typical sclerotic bodies and histopathology which revealed neutrophilic abscesses, muriform cells, mixed granulomatous response. In view of his comorbidities like congestive cardiac failure and deranged liver function test, we couldn’t consider the possibility of systemic drugs like Itraconazole. So, he was treated only with liquid nitrogen cryotherapy on a weekly basis for 8 weeks. Marked improvement in lesion was observed after 8 sittings. In our case, due to cardiac complications and deranged liver function test we treated the patient with cryotherapy solely and achieved marked improvement in skin lesions. Cryotherapy alone serves as an effective treatment modality when systemic antifungals can’t be given.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193247
      Issue No: Vol. 5, No. 3 (2019)
  • Aplasia cutis congenita

    • Authors: Chinmai Yerram, Krishna Rajesh Kilaru, Anusha Gogula, Peram Karunakar
      Pages: 659 - 661
      Abstract: Aplasia cutis congenita (ACC) is a rare condition in which there is congenital focal absence of skin with or without absence of underlying structures such as bone. Consanguinity may play a role. The cause of this condition is unclear and appears to be multifactorial; contributory factors may include teratogens, genes, trauma and compromised blood flow to the skin. Various expressions of Adams Oliver syndrome (AOS) have also been reported which is a rare autosomal dominant congenital disorder characterized by absence of skin and or underlying structure over scalp along with transverse limb defect. It was first described by Adam and Oliver in 1945.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193246
      Issue No: Vol. 5, No. 3 (2019)
  • Nicolau syndrome appearing approximately one-year post bicillin injection
           treated with excision

    • Authors: Mary K. Dick, Robert A. Elmore, Poonam K. Sharma
      Pages: 662 - 663
      Abstract: Nicolau syndrome (livedoid dermatitis, embolia cutis medicamentosa) is a unique and painful reaction post intramuscular injection that often ends with necessary necrotic debridement and scarring. We present a case of a 25-year-old female who developed a tender golf ball size lesion with fat necrosis, confirmed by pathology, approximately one year after a Bicillin injection in the buttock. Excision of the mass was necessary for symptomatic relief. To our knowledge, there has never been a report entailing a slow development of Nicolau syndrome over an extended period of time. The pathophysiology of this condition has been attributed to a myriad of causes such as vascular trauma, drug embolism, inflammation, or inappropriate needle length. This syndrome often progresses through three generalized stages before ending in a necrotizing plaque. While there is no current standardized treatment to Nicolau syndrome there are methods for prevention making this important information across the medical field.
      PubDate: 2019-07-24
      DOI: 10.18203/issn.2455-4529.IntJResDermatol20193248
      Issue No: Vol. 5, No. 3 (2019)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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