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Stephen Chu-Sung Hu, Chi-Ling Lin
Indian Journal of Dermatology, Venereology and Leprology, Volume 87, pp 298-299; doi:10.4103/ijdvl.ijdvl_213_19

Chi-Feng Yen, Yu-Huei Huang, Ching-Chi Chi
Indian Journal of Dermatology, Venereology and Leprology, Volume 87, pp 223-226; doi:10.4103/ijdvl.ijdvl_455_18

Psoriasis and hidradenitis suppurativa are inflammatory dermatoses that have been associated with arthritis, metabolic syndrome, obesity, and smoking. They share common pathogenic mechanisms such as elevated levels of several proinflammatory cytokines including tumor necrosis factor (TNF), interleukin-17A, and impaired Notch pathway. Thus, treatments for both diseases are sometimes overlapping. Biological therapy such as adalimumab is effective for patients with hidradenitis suppurativa and psoriasis. Adalimumab is a monoclonal antibody that binds to TNF and inhibits the cytokine interaction with the TNF receptors, thus inhibiting the inflammatory cascade. Currently, data are lacking on the treatment for co-occurrence of psoriasis and hidradenitis suppurativa. This case series describes three patients with a diagnosis of concomitant psoriasis and hidradenitis suppurativa. In these cases, after 12 weeks of treatment with adalimumab 40 mg every other week, the average Psoriasis Area Severity Index score reduced from 21.4 to 2.9 for psoriasis, Hidradenitis Suppurativa-Physician’s Global Assessment from 3.3 to 0.7, and pain Visual Analog Scale for hidradenitis suppurativa from 4.6 to 2. The results suggest that adalimumab is a treatment of choice for patients with concomitant hidradenitis suppurativa and psoriasis.
Vishal Gupta, Pratik Mohta, Vinod Kumar Sharma, Neena Khanna
Indian Journal of Dermatology, Venereology and Leprology, Volume 87, pp 227-234; doi:10.4103/ijdvl.ijdvl_519_18

Background: Patients with reactive arthritis frequently present to dermatologists. However, there is paucity of information regarding its clinical aspects and management in dermatological literature. Objective: To review the clinical features and management of patients with chronic reactive arthritis admitted to the dermatology department of a teaching hospital. Methods: This was a retrospective analysis of patients with reactive arthritis admitted to the Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India from January 2016 to February 2018. Results: There were 12 males (disease duration 9–180 months). Biologics were used in 9 (75%) patients on 16 different occasions, the most frequent being infliximab (n = 10 times), followed by adalimumab (n = 3), etanercept, secukinumab and itolizumab (n = 1 each), in combination with other systemic agents. Response rate with treatment regimens including biologics (69% responders, 31% partial responders) was statistically significantly better than those without biologics (27% responders, 46% partial responders, 27% nonresponders; P = 0.036), using a composite measure assessing improvement in skin and joint symptoms. Biologics were discontinued on 50% of the occasions, after a median of 3.5 months (range 1.5–7.5 months) because of satisfactory response (n = 4), therapeutic fatigue (n = 3) or adverse event (n = 1). After biologic discontinuation, the response was sustained for a median of 5 months (range 3–6 months) before disease exacerbation. The number of treatment switches increased with the follow-up duration (median three switches per patient, range 1–8). The median follow-up duration was 10.5 months (range 4–76 months). Conclusion: Biologics produce rapid improvement in skin and joint symptoms in chronic reactive arthritis, but the response is not long-lasting. Patients with chronic reactive arthritis have a waxing and waning course despite regular treatment. Limitations: The limitations are retrospective design, small sample size and lack of a validated outcome measure.
Maddalena Siragusa, Maria Lentini, Carmelo Schepis
Indian Journal of Dermatology, Venereology and Leprology, Volume 87, pp 300-302; doi:10.4103/ijdvl.ijdvl_226_19

Prashant Bharti, Soniya Mahajan, Swati Mahajan, M. Ramam, Vishal Gupta
Indian Journal of Dermatology, Venereology and Leprology, Volume 87, pp 235-236; doi:10.4103/ijdvl.ijdvl_828_18

Liming Huang, Yan Wang, Minzhi Wu, Jun Zhao, Wei Zhang, Liang Zhao, Xingfan Mo, Fang Fang
Indian Journal of Dermatology, Venereology and Leprology pp 1-4; doi:10.4103/ijdvl.ijdvl_895_17

Extramammary Paget’s disease is a rare skin malignancy, and its diagnosis requires invasive biopsy and histopathological examination. Surgery is the standard treatment for extramammary Paget’s disease patients; however, as incision boundaries and the depth of tumor cell infiltration are often unclear, the postoperative recurrence rate is high. We present a case in which we used photodynamic diagnosis in combination with reflectance confocal microscopy before surgery to detect an extramammary Paget’s disease lesion that was located 3 cm away from the classical lesion. This secondary lesion exhibited a subclinical presentation, and it was eventually confirmed as an extramammary Paget’s disease lesion by pathological examination. During detection using our technique, we delineated the boundaries of the extramammary Paget’s disease lesion as a guide for surgical excision. The findings of our case demonstrate that photodynamic diagnosis combined with reflectance confocal microscopy can be used for the noninvasive diagnosis of subclinical extramammary Paget’s disease and may be used to guide strategies for planning treatment and preventing relapse.
Yingjie Lu, Hongmiao Wang, Hua Zheng
Indian Journal of Dermatology, Venereology and Leprology pp 1-4; doi:10.4103/ijdvl.ijdvl_799_18

Hamidreza Mahmoudi, Zahra Hallaji, Maryam Daneshpazhooh, Amin Kiani, Azita Nikoo, Negar Bahrololoumi Bafruee
Indian Journal of Dermatology, Venereology and Leprology pp 1-3; doi:10.4103/ijdvl.ijdvl_654_17

Hage Jana Al-, Edith Hanna, Mazen Kurban, Ossama Abbas
Indian Journal of Dermatology, Venereology and Leprology pp 1-2; doi:10.4103/ijdvl.ijdvl_630_19

Guang-Wen Yin, Meng-Meng Geng
Indian Journal of Dermatology, Venereology and Leprology pp 1-2; doi:10.4103/ijdvl.ijdvl_850_19

Xiao Ke Liu, Jun Li
Indian Journal of Dermatology, Venereology and Leprology pp 1-2; doi:10.4103/ijdvl.ijdvl_624_19

, Humoud Al-Sabah, Anwar Al-Sumait, Nadia AlNaqi, Mohammad Al-Otaibi, Atlal AlLafi
Indian Journal of Dermatology, Venereology and Leprology pp 1-4; doi:10.4103/ijdvl.ijdvl_543_19

We report a 3-year-old girl with a delayed nontuberculous granulomatous reaction on a bacillus Calmette–Guérin injection site with dissemination to distant sites who showed a favorable response to clarithromycin used for 12 weeks with no recurrence on a follow-up of more than 2 years.
Qin Jian Low, Seng Wee Cheo, Wen Yee Evelyn Yap
Indian Journal of Dermatology, Venereology and Leprology pp 1-3; doi:10.4103/ijdvl.ijdvl_983_18

Dimitra Koumaki, George Demetriou, Konstantinos Krasagakis
Indian Journal of Dermatology, Venereology and Leprology pp 1-2; doi:10.4103/ijdvl.ijdvl_616_19

Haridaran Anand Shanmugham, Sanjeev Handa, Dipankar De, Mandeep Singh Dhillon, Sameer Aggarwal
Indian Journal of Dermatology, Venereology and Leprology pp 1-5; doi:10.4103/ijdvl.ijdvl_789_18

Introduction: Patients who receive orthopedic implants have been shown to develop sensitivity to its components and there are concerns that this sensitivity might lead to contact dermatitis or implant-related problems like loosening and/or failure. The objective of the study was to determine the sensitizing potential of orthopedic implants. Methods: Fifty-four patients undergoing knee, hip, or shoulder replacement surgeries between July 2014 and July 2015 were recruited. Patch tests were performed before the implant surgery with 10 allergens likely to be implicated in metal hypersensitivity. Postimplant patch test was performed 6 months after surgery. A majority of the patch tests were applied on the arms. Results: Four positive reactions were recorded in the preimplant patch tests – three positive reactions to nickel and one to chromium. Thirty patients made themselves available for the follow-up patch test. The incidence of new contact sensitivity to components of implants was 13.8% (4/29) at 6 months. One patient who had undergone knee replacement developed eczematous lesions around the knee joint after surgery. This patient tested negative to patch test at both the times. Limitations: Short follow-up duration and performing patch tests on the arms, a site known to elicit less positive patch test response compared to the back in sensitized individuals, are limitations of the study. Conclusion: There is an increase in the sensitivity to implanted components after 6 months of joint replacement surgery. The incidence of new sensitivity to a component of the implant was 13.8% (4/29). In this context, nickel is a good sensitizer and could sensitize 50% of patients who received a nickel-containing implant.
Nesrin Samir, Rasha M. Alyafrasi, Sara S. Ashour, Suzan Shalaby
Indian Journal of Dermatology, Venereology and Leprology pp 1-4; doi:10.4103/ijdvl.ijdvl_856_18

Background: Acne is a chronic inflammatory disease of the pilosebaceous units, of multifactorial pathogenesis, one of which could be an adipokine such as visfatin. Aim: The aim of this study was to study visfatin expression both in lesional skin and serum, of acne patients versus healthy controls. The secondary aim was to study the relationship of visfatin levels with dyslipidemia/metabolic syndrome. Methods: This study included 30 patients with moderate and severe acne vulgaris and 30 age- and sex-matched healthy controls. Serum and tissue visfatin were estimated by enzyme-linked immune-sorbent assay. Clinical and laboratory examinations were done to assess the anthropometric data and various criteria of metabolic syndrome. Results: Tissue and serum visfatin levels were significantly higher in patients as compared to healthy controls. Tissue visfatin levels were significantly higher than its serum levels in both patients and controls. Serum visfatin was significantly higher in overweight individuals. No correlations were found between tissue and serum visfatin levels in both patients and controls. Moreover, serum and tissue visfatin levels did not correlate to any of the lipid profile parameters or criteria of metabolic syndrome in acne patients. Limitations: The study had a small sample size and did not localize the exact source of tissue visfatin. Polycystic ovary syndrome PCOS was not evaluated. Conclusion: Visfatin is an important proinflammatory adipokine, with significantly higher expression in acne patients. Tissue rather than serum visfatin might play a key role in acne.
Blanca Ferrer Guillén, María Macarena Giácaman von der Weth, Cristian Valenzuela Oñate, Jorge Magdaleno Tapial, Pablo Hernández Bel
Indian Journal of Dermatology, Venereology and Leprology pp 1-2; doi:10.4103/ijdvl.ijdvl_582_17

Xiu Fang Chen, Yi Zhan, Ya Ping Li, Jing Zhang, Ying Zhou, Gui Ying Zhang
Indian Journal of Dermatology, Venereology and Leprology pp 1-4; doi:10.4103/ijdvl.ijdvl_85_19

Sabha Mushtaq
Indian Journal of Dermatology, Venereology and Leprology pp 1-2; doi:10.4103/ijdvl.ijdvl_885_19

Chirag Ashwin Desai, Suchit Patil
Indian Journal of Dermatology, Venereology and Leprology pp 1-2; doi:10.4103/ijdvl.ijdvl_455_20

P. S. S. Ranugha, Priya Bishnoi, Laxmisha Chandrashekar
Indian Journal of Dermatology, Venereology and Leprology pp 1-7; doi:10.4103/ijdvl.ijdvl_655_18

Background: Face was often thought to be spared in psoriasis possibly due to the protective effect of sebum and low-dose ambient ultraviolet radiation exposure. Some have suggested that facial involvement is common and indicates disease severity. There is a paucity of data on this, particularly from India. Psoriatics have a higher prevalence of metabolic syndrome, and patients with severe disease are at greater risk. Objective: A study of the frequency and type of facial involvement in Indian psoriatic patients and its association with disease severity and metabolic syndrome. Methods: A total of 250 consecutive psoriatic patients were screened and these yielded 188 patients with facial involvement. Facial psoriatics were divided into peripherofacial, centrofacial and mixed facial types. Disease severity was assessed using whole body, scalp, facial psoriasis area severity index scores and nail area psoriasis severity index scores. Patients were evaluated for the presence of metabolic syndrome using NCEP-III criteria. All parameters were compared both between facial and nonfacial psoriatics and between cases with different types of face involvement. Results: The mean age (P = 0.04) and age of onset of disease (P = 0.02) was lower and median whole-body psoriasis area severity index score was higher in psoriatics with facial involvement (P < 0.001) than those without. No significant association was found between facial involvement and metabolic syndrome. Mixed facial was the commonest type of facial involvement and there was a significant association of mixed facial involvement with increased total body psoriasis area severity index scores (P < 0.001). Limitations: Dietary habits, physical activity level, family history of diabetes and obesity were not enquired for in our patients. Centrofacial cases were too few in number, hence statistical comparisons are not relevant. Conclusion: Facial involvement in psoriatics is associated with severe disease but not metabolic syndrome. Mixed facial type might be considered a marker of overall psoriasis disease severity in the Indian population.
Vikrant Saoji, Bhushan Madke
Indian Journal of Dermatology, Venereology and Leprology pp 1-5; doi:10.4103/ijdvl.ijdvl_853_18

Background: Treatment of dermatophytosis is becoming costlier and challenging. Aims and Objectives: To study the efficacy of salicylic acid peel in dermatophytosis. Methods: Twenty-five patients (20 males and 5 females) having dermatophytosis with positive potassium hydroxide (KOH) mounts were enrolled in the study. Salicylic acid 30% was applied over the lesions weekly for 4 weeks, thereafter patients were followed up weekly for 4 weeks. Results: Of the 25 patients, 22 (88%) patients showed clinical and microbiological cure 1 week after the last application, while the remaining 3 patients were nonresponders. Nine (41%) patients of the 22 responders showed recurrences indicating that 4 weeks’ treatment is not sufficient in some patients to eradicate fungus and may require longer treatment. Limitations: A relatively small sample size and lack of long-term follow-up are the shortcomings of our study. Conclusion: Salicylic acid peel is a cheap and useful option in the treatment of dermatophytic infection.
Xiuyan Shi, Xiaohui Shi, Aihua Jia, Xianmin Meng, Hong Luan
Indian Journal of Dermatology, Venereology and Leprology pp 1-3; doi:10.4103/ijdvl.ijdvl_587_18

Rashmi Jindal, Sanjay Dvivedi, Sheenam Sethi
Indian Journal of Dermatology, Venereology and Leprology pp 1-2; doi:10.4103/ijdvl.ijdvl_772_19

Niral K. Sheth, Pragya Ashok Nair
Indian Journal of Dermatology, Venereology and Leprology, Volume 87, pp 54-59; doi:10.4103/ijdvl.ijdvl_84_18

Aims and Objectives: (1) To determine the level of awareness among patients, pharmacists and general practitioners about commonly available topical steroids and its combinations.(2) To determine the source of recommendation/prescription of topical steroids and its combination creams.(3) To know and create awareness about the side effects of topical steroids in all the study groups. Methods: This was a prospective questionnaire-based study where three study groups, namely patients, pharmacists and general practitioners, were included. This study was approved by the institutional ethics committee. after ethical clearance. The patients who used topical steroids for dermatoses where it is an absolute contraindication, as well as those who developed side effects, were included in the study. ThoroughComplete cutaneous examination was done specifically to detect the side effects of steroids. Seminars were conducted and questionnaires were given to both the pharmacists and general practitioners of nearby areas. The questionnaire consisted of questions regarding their prescription and dispensing practices of topical steroids and its combinations. Results: Out of 95 patients seen, the most commonly used steroid molecule was clobetasol propionate 0.05% in 44 (46.3%) patients, the common source of recommendation was general practitioners in 36 (37.8%), the common indication was superficial dermatophytosis in 85 (89%) and the most common adverse effect was recurrence/increase in the extent of the infection in 72 (75.78%) patients. Out of total 44 general practitioners enrolled in the study, 22 (50%) were qualified allopathic medical practitioners and22 (50%) were homeopathic/ayurvedic doctors. Superficial dermatophytosis [19 (43.18%)] was the common dermatosis seen by them. While 29 (65.90%) preferred prescribing topical steroids or its combination, rest of them preferred plain steroid creams. Out of 179 pharmacists, 74 (41.34%) did not have appropriate knowledge of topical steroids, 35 (19.55%) were not aware that steroids are isschedule “H” drugs. Commonest molecule sold over the counterwas clobetasol propionate 0.05% by 74 (41.89%). The limitations of our study were small study group and short duration. Conclusion: As dermatologists, it is our responsibility, to correctly educate the society, particularly the non-dermatologist medical fraternity, about ethical and rational use of topical steroids.
Chander Grover, Ankita Chauhan, Sonal Sharma
Indian Journal of Dermatology, Venereology and Leprology, Volume 87, pp 127-130; doi:10.4103/ijdvl.ijdvl_772_18

Shi Yu Derek Lim, Joyce Siong See Lee, Wei-Sheng Chong
Indian Journal of Dermatology, Venereology and Leprology, Volume 87, pp 101-103; doi:10.4103/ijdvl.ijdvl_366_20

Tag Anbar, Rania M. Abdel Hay, Rehab A. Hegazy, Samia Esmat, Heba M. Diab, Hala Amer, Sahar Salah, Mohamed T. Anbar, Khadiga S. Sayed
Indian Journal of Dermatology, Venereology and Leprology, Volume 87, pp 22-28; doi:10.4103/ijdvl.ijdvl_979_19

The publisher has not yet granted permission to display this abstract.
Santosh Palla, Vandana Shekar, Jagat R. C. Reddy
Indian Journal of Dermatology, Venereology and Leprology, Volume 87, pp 60-61; doi:10.4103/ijdvl.ijdvl_573_18

Shujuan He, Weihui Zeng, Songmei Geng, Jinjing Jia
Indian Journal of Dermatology, Venereology and Leprology, Volume 87, pp 49-53; doi:10.4103/ijdvl.ijdvl_588_18

Necrolytic migratory erythema is most commonly associated with glucagonoma syndrome. We report a rare case of glucagonoma syndrome with necrolytic migratory erythema presenting as pruritic papules and follicular pustules in a 57-year-old woman; showing eosinophilic infiltration on histology. However, the final diagnosis was confirmed by demonstrating neuroendocrine tumour on histopathological examination of the liver metastases. Nutrition therapy was administered as a palliative treatment. This case also highlights the atypical clinical features and nonspecific histology of necrolytic migratory erythema which makes the diagnosis difficult.
Fang He, Fangyuan Long, Jie Tu, Zhiqiang Yin
Indian Journal of Dermatology, Venereology and Leprology, Volume 87, pp 116-119; doi:10.4103/ijdvl.ijdvl_124_20

Aparna Palit, Madhusmita Sethy, Ashish Kumar Nayak, Pavithra Ayyanar, Biswanath Behera
Indian Journal of Dermatology, Venereology and Leprology, Volume 87, pp 89-92; doi:10.4103/ijdvl.ijdvl_167_20

Saurabh Mittal
Indian Journal of Dermatology, Venereology and Leprology, Volume 87, pp 119-121; doi:10.4103/ijdvl.ijdvl_671_19

Nayankumar H. Patel, Jignaben Krunal Padhiyar, Tejas Patel, Ani Patel, Aseem Chhibber, Ranjan Raval, Bhagirath Patel
Indian Journal of Dermatology, Venereology and Leprology, Volume 87, pp 97-101; doi:10.4103/ijdvl.ijdvl_25_19

Ricardo Quiñones-Venegas, Juan Enrique Paniagua-Santos, Elizabeth Guevara-Gutierrez, Gabriel Esteban-Salerni, Roger Adrian Gonzalez-Ramirez, Alberto Tlacuilo-Parra
Indian Journal of Dermatology, Venereology and Leprology, Volume 87, pp 29-33; doi:10.4103/ijdvl.ijdvl_452_18

Background: The diagnosis of basal cell carcinoma is histopathological, but there are dermatoscopic criteria that confer high sensitivity and specificity to help the clinician improve its identification. However, the basal cell carcinoma blue-white variant does not totally meet these dermatoscopic criteria, and thus can be confused with other pigmented tumors. In the literature reviewed, we found only five cases of this variant. Aims: The present objective is to describe the dermatoscopic characteristics of the blue-white variant of basal cell carcinoma observed in a tertiary dermatology institute. Methods: The dermatoscopy files of patients with a histopathological diagnosis of basal cell carcinoma between January 1, 2006 and December 31, 2015 were reviewed. Results: A total of 32 cases with blue-white variant of basal cell carcinoma were observed over a period of 10 years. Of these cases, 97% presented dermatoscopic findings not included in the aforementioned criteria, such as whitish septa, structureless white areas, homogenous blue pigmentation and shiny white structures. Limitations: The small sample size and the retrospective nature of the design. Conclusion: We consider it important for dermatologists to know this rare variant of basal cell carcinoma and to familiarize themselves with their dermatoscopic findings, in order to prevent erroneous diagnoses or inadequate treatments.
Yu-Ying Lin, Yun-Shan Tseng, Wei Zhu
Indian Journal of Dermatology, Venereology and Leprology, Volume 87, pp 125-256; doi:10.4103/ijdvl.ijdvl_336_18

Vishal Gupta, Ananya Sharma, Neena Khanna, Swati Mahajan, Asit Ranjan Mridha
Indian Journal of Dermatology, Venereology and Leprology pp 1-3; doi:10.4103/ijdvl.ijdvl_448_19

Shekhar Neema, S. Radhakrishnan
Indian Journal of Dermatology, Venereology and Leprology pp 1-2; doi:10.4103/ijdvl.ijdvl_333_20

Daniel Rizo-Potau, Ignasi Marti-Marti, Encarnación Martin-Ortega
Indian Journal of Dermatology, Venereology and Leprology pp 1-2; doi:10.4103/ijdvl.ijdvl_1095_19

Sarvin Sajedianfard, Farhad Handjani, Nasrin Saki, Alireza Heiran
Indian Journal of Dermatology, Venereology and Leprology pp 1-4; doi:10.4103/ijdvl.ijdvl_276_18

Background and Aims: Pemphigus vulgaris is a rare autoimmune intraepidermal vesiculobullous disease involving the skin and mucosa. It impacts the quality of life of both patients and their families. Methods: A total of 70 patients with pemphigus vulgaris (either outpatient or hospitalized) were enrolled using the simple sampling method between 2016 and 2017 from the dermatology clinic at Faghihi Hospital, Shiraz, Iran. A validated Persian version of the Family Dermatology Life Quality Index (FLDQI) questionnaire was filled by a family caregiver. The questionnaire contained 10 items assessing the quality of life of the family. Demographic variables were recorded in a separate form. Results: The mean age of the patients was 51 ± 11.3 years and that of the family caregivers was 32 ± 8.8 years. The FLDQI score was higher (poorer quality of life) if the patient was male, older, had shorter disease duration or had fewer disease recurrences (P = 0.046, 0.01, 0.001 and >0.001, respectively). Higher scores were also obtained in the less-educated caregivers (P = 0.026) but there was no association with either gender or age (P = 0.399, 0.1). Conclusion: Pemphigus vulgaris significantly affects the Family Dermatology Life Quality Index. Education and counseling of family caregivers by various support groups such as Pemphigus Family Associations could be effective in improving the quality of life of the caregivers. Limitations: This study did not assess the effect of comprising domain analysis, severity of disease, patients’ Dermatology Life Quality Index (DLQI), mucosal involvement, response to treatment, outpatient or admitted status, socioeconomic status, or the quality of life among the various family members.
Mona Abdel-Halim Ibrahim, Abdelrahman Mohamed, Marwa Yassin Soltan
Indian Journal of Dermatology, Venereology and Leprology pp 1-7; doi:10.4103/ijdvl.ijdvl_1011_18

Background: Hypopigmented mycosis fungoides is a rare variant of mycosis fungoides that may mimic many benign inflammatory hypopigmented dermatoses, and as yet there is no identified marker to differentiate between them. Aim: The aim of this study was to study the expression of thymocyte selection–associated high-mobility group box (TOX) in hypopigmented mycosis fungoides and one of its inflammatory mimickers (early active vitiligo) to assess its potential as a differentiating diagnostic marker. Methods: A case–control study was done using immunohistochemical analysis of TOX expression in 15 patients with hypopigmented mycosis fungoides and 15 patients with early active vitiligo. Immunohistochemical analysis was done via a semi-quantitative method and an image analysis method. Results: Hypopigmented mycosis fungoides showed a statistically significant higher expression of TOX than early active vitiligo. The expression of TOX was positive in a majority of hypopigmented mycosis fungoides cases (14 cases, 93.3%), while only one case (6.7%) of vitiligo was weakly positive. TOX also displayed 93.3% sensitivity and specificity, with a cut-off value of 1.5. Limitations: This was a pilot study testing hypopigmented mycosis fungoides against only a single benign inflammatory mimicker (early vitiligo). Other benign mimickers were not included. Conclusion: Our findings showed that TOX expression can differentiate hypopigmented mycosis fungoides from early active vitiligo which is one of its benign inflammatory mimickers, with a high degree of sensitivity and specificity.
Geetali Kharghoria, Prashant Ramteke, Asit Ranjan Mridha, Vishal Gupta
Indian Journal of Dermatology, Venereology and Leprology pp 1-2; doi:10.4103/ijdvl.ijdvl_1016_19

Xue Gang Xu, Chao Zhang, Jie Qin, Xing Hua Gao, Liang Zhang
Indian Journal of Dermatology, Venereology and Leprology pp 1-2; doi:10.4103/ijdvl.ijdvl_1094_19

, Gaurav Kohli, Alok Sen, Rajesh Joshi, Devindra Sood, Narendra Patidar, Pradhnya Sen, Devendra Sharma, Tanya Jain
Published: 1 January 2021
Indian Journal of Ophthalmology, Volume 69, pp 937-945; doi:10.4103/ijo.ijo_2276_20

Purpose: The aim of this study was to report the outcome of cataract surgery with different surgical techniques in eyes with coexisting coloboma and to define factors of prognostic importance. Methods: Retrospective case sheet review of patients presenting between January 2016 and December 2018, who underwent cataract surgery in eyes with coexisting coloboma. Results: Of the 3,30,231 cases operated during the study period, 280 eyes of 276 patients had associated colobomatous malformation. The prevalence of coloboma in eyes undergoing cataract surgery was 0.085%. The mean age of the patients was 46.4 years (range 19 -88 years). Phacoemulsification (PE) was performed in 130 eyes (46.4%), manual small incision cataract surgery (M-SICS) was done in 115 eyes (41.1%), and 35 eyes (12.5%) underwent intra capsular cataract extraction. Intra-operative complications were noted in 26 (9%) eyes. Incidence of intra-operative and post-operative complications was comparable between PE and M-SICS groups (p = 0.94). The mean corrected distance visual acuity (CDVA) improved from logMAR 1.71 ± 0.62 to 0.87 ± 0.61 (p = 0.00009). On multivariate analysis, microcornea (p = 0.002), type 1 and 2 coloboma (p < 0.001), and intraoperative complications (p = 0.001) were associated with poor visual outcome. Conclusion: Favorable functional outcomes can be achieved with phacoemulsification in eyes with softer cataract and corneal diameter >8 mm and with M-SICS in eyes with hard cataracts and corneal diameter of 6–8 mm. PE should be considered as the primary choice whenever permissible by the corneal diameter and severity of nuclear sclerosis. Poor functional outcomes were seen in eyes with smaller corneal diameter, extensive chorioretinal coloboma, and intraoperative complications.
Prasanna V Ramesh, Shruthy V Ramesh, Meena K Ramesh, Ramesh Rajasekaran, SathyaN Parthasarathi
Published: 1 January 2021
Indian Journal of Ophthalmology, Volume 69, pp 1005-1008; doi:10.4103/ijo.ijo_2879_20

, SwapnaS Shanbhag, Swati Singh, PuduchiraGeorge Koshy, PragnyaRao Donthineni
Published: 1 January 2021
Indian Journal of Ophthalmology, Volume 69, pp 794-805; doi:10.4103/ijo.ijo_1273_20

The posterior lid margin, where the mucocutaneous junction (MCJ) between the eyelid skin and tarsal conjunctiva is located, plays a critical role in maintaining the homeostasis of the ocular surface. Posterior migration of the MCJ leads to lid-margin keratinization (LMK), which has a domino effect on the delicate balance of the ocular surface microenvironment. This occurs most commonly following Stevens-Johnson syndrome/toxic epidermal necrolysis and is not known to regress spontaneously or with medical therapy. Over time, LMK causes blink-related chronic inflammatory damage to the corneal surface which may have blinding consequences. Lid-margin mucous membrane grafting (MMG) is the only definitive therapy for LMK. Timely MMG can significantly alter the natural course of the disease and not only preserve but even improve vision in affected eyes. Literature searches were conducted on PubMed, using the keywords “mucous membrane grafts,” “lid margin keratinization,” “Stevens-Johnson syndrome,” “toxic epidermal necrolysis,” “lid related keratopathy,” and “lid wiper epitheliopathy”. This review, which is a blend of evidence and experience, attempts to describe the indications, timing, surgical technique, postoperative regimen, and clinical outcomes of MMG for LMK. The review also covers the possible complications and pearls on how they can be effectively managed, including how suboptimal cosmetic outcomes can be avoided. The authors hope that this review will aid ophthalmologists, including cornea and oculoplasty specialists, to learn and perform this vision-saving surgery better, with the aim of helping their patients with chronic ocular surface disorders, relieving their suffering, and improving their quality of life.
, Rimpi Rana, Pranita Sahay, Neeraj Gour, Siddharth Patel, Ramanuj Samanta, Anupam Singh, Sanjeev Mittal
Published: 1 January 2021
Indian Journal of Ophthalmology, Volume 69, pp 951-957; doi:10.4103/ijo.ijo_3136_20

Purpose: To ascertain ophthalmologist's perceptions about webinars as a method of continued medical education during the COVID-19 pandemic. Methods: In a cross-sectional study, a 21-question survey was circulated using digital media platform to approximately 1400 ophthalmologists in India between 16th August 2020 to 31st August 2020. The questionnaire focussed on the quality and usefulness of webinars based on the Bloom's taxonomy. The responses (on 4- or 5-point Likert scale) were analyzed among three professional groups- ophthalmologists in-training, consultants in public sector, and private practitioners. Results: 393 ophthalmologists participated in the survey, with a response rate of 28%. The mean age was 34.6 ± 9.7 years, and males constituted 49.6% (199/393) of the respondents. Forty-seven percent of the respondents perceived the quality of webinars as good or excellent (185/393), 72.8% reported knowledge gain from webinars (286/393), and 63.9% felt that webinars are important in clinical practice and should continue post-COVID-19 pandemic (251/393), with distinct responses among the professional groups. The drawbacks perceived were overt number of webinars (371; 94.4%), confusion regarding which webinars to attend (313; 79.6%), repetition of the information (296; 75.3%), limited opportunity for participant interaction (146; 37.2%) and disparate weightage to the core disciplines of Ophthalmology. Conclusion: Most respondents had favorable perceptions of Ophthalmology webinars happening during the COVID-19 pandemic. However, there is need for improvisation in the volume of webinars, target-audience-based delivery, and participant interaction to add value to this new dimension of teaching-learning.
Dong Heun Nam, Kwang Gi Kim, Young Jae Kim, Yu Jeong Kim, Seong-Woo Kim, Tae-Young Chung, Sung Jin Lee, Kyu-Hyung Park
Published: 1 January 2021
Indian Journal of Ophthalmology, Volume 69, pp 927-931; doi:10.4103/ijo.ijo_1825_20

Purpose: To compare image resolution and depth between the microscope versus intracameral illumination images during 3D heads-up cataract surgery. Methods: We collected 25 consecutive patients who had cataract surgery using the 3D viewing system. Based on bright, contrast, visibility, and color balance, the digital images (RGB color and three monochromes) extracted at the same point of the procedures were compared between the two illuminations. Results: Contrast values of green and blue channels except for red channel and visibility values of all three channels were higher in the intracameral illumination images than in the microscope images (P < 0.001, t-test). Color balance values of both green/red and blue/red were higher in the intracameral illumination images than in the microscope images (P < 0.001, t-test). Conclusion: The digital images in the digitally assisted cataract surgery were enhanced by using the intracameral illumination. Considering the contrast and color balance in the 3D cataract surgery, the intracameral illumination may be better than the microscope illumination.
, Kirti Singh, Sumit Kumar
Published: 1 January 2021
Indian Journal of Ophthalmology, Volume 69, pp 882-885; doi:10.4103/ijo.ijo_1489_20

Purpose: To compare results of a novel “conjunctival frill/smile incision” on surgically induced astigmatism (SIA) and patient discomfort vs conventional trabeculectomy in the initial postoperative period. Methods: Sixty trabeculectomy cases were subjected to either conjunctival frill incision, performed 1.5–2.0 mm from the limbus (study group) or conventional fornix-based conjunctival flap (control group). Corneal astigmatism and suture-induced discomfort were assessed by keratometry and a self-devised patient questionnaire, respectively. Results: Both groups generated a “with the rule” SIA, which was 1.77 vs 2.42 at 1 week and reduced to 1.27 vs 1.8 in the study vs control group, after removal of sutures – both scleral flap releasable and conjunctival at 1 month. Patient discomfort score revealed enhanced comfort in 37% of patients (study group) vs 17% (control group) during the early postoperative period. After 1 month of surgery, good comfort was regained in all cases. Conclusion: This novel suturing technique results in reduced SIA, patient discomfort during the 1st month after trabeculectomy.
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