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   Table of Contents - Current issue
April-June 2022
Volume 23 | Issue 2
Page Nos. 101-186

Online since Wednesday, March 30, 2022

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Hot topics in paediatric dermatology p. 101
Neha Thakur, Rahul Mahajan
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Acanthosis Nigricans: An overt clinical marker of insulin resistance and its association with serum adiponectin levels in obese pediatric population Highly accessed article p. 105
Rupinder Walia, Amandeep Riyat, Baljinder Kaur, Maninder Kaur, Shayna Aulakh, Dimple Chopra
Background: Childhood obesity (OB) is becoming increasingly prevalent in recent times. Acanthosis nigricans (AN) is a clinical condition linked to OB and insulin resistance (IR). Serum adiponectin is one of the major adipokines that is inversely related to the severity of IR. Objective: The main aim of this study is to evaluate the correlation of severity (grades) of AN with serum adiponectin levels and IR. Materials and Methods: A total of 80 subjects were studied, 50 having OB with AN (OB+AN) and 30 having OB without AN (OB-AN), having age 10–18 years fulfilling the set inclusion and exclusion criteria. Body mass index, fasting blood glucose, HOMA-IR (Homeostatic Model Assessment of IR) and serum adiponectin levels were measured in all subjects. Results: Compared to OB-AN group, OB+AN group had statistically significant lower serum adiponectin levels and higher HOMA-IR values. AN grades correlated positively with HOMA-IR values and negatively with serum adiponectin levels in a statistically significant manner. Conclusion: Grading AN clinically can be easy and useful tool to detect IR in obese subjects. Serum adiponectin levels can be used as another lab parameter in obese subjects guiding the severity of AN.
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Comparing the effectiveness of topical fluticasone 0.05% cream versus topical tacrolimus 0.1% ointment in pediatric atopic dermatitis: A randomized controlled trial Highly accessed article p. 111
Sanjeev Handa, Ariganesh Chandrasegaran, Amrinder Jit Kanwar, Rahul Mahajan
Background: There is sparsity of data on the comparative effectiveness of topical steroids and topical tacrolimus in the treatment of pediatric atopic dermatitis (AD) and prevention of its relapse. Materials and Methods: Fifty eligible pediatric AD patients (with an objective SCORAD >40) were included in the study and were randomized into two groups of 25-those receiving topical fluticasone 0.05% cream twice daily and those receiving topical 0.1% tacrolimus ointment twice daily. All the patients were assessed at baseline and weeks 2, 4, and 6. At week 6, patients achieving >75% improvement were put on maintenance therapy of thrice weekly application of the respective drugs in each group and the patients were followed up at 10 and 14 weeks to observe for any flare of the disease. Results: The two treatment groups were similar at baseline. In the fluticasone group, 21 out of 25 patients (84%) achieved >75% improvement in SCORAD, while in the tacrolimus group, 17 out 25 patients (68%) achieved >75% improvement; P = 0.185]. Complete remission (100% improvement) was seen in 16 patients (64%) in the fluticasone group compared to 13 patients (52%) in the tacrolimus group at the end of 6 weeks (P = 0.38). The mean SCORAD values at 2, 4, and 6 weeks were compared between the 2 groups. The number of relapses was 1 in each group among patients on maintenance treatment. Conclusion: Both fluticasone cream and tacrolimus ointment are effective and safe for treatment of childhood AD, and for the prevention of AD flares.
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Clinico-Epidemiological study of childhood vitiligo and its associations: A hospital-based cross-sectional study p. 116
Fatima Tuz Zahra, Syed Suhail Amin, Mohammad Adil, Fariz Sarshar, Prateek Pathak
Background: Vitiligo is a chronic pigmentary disorder resulting in hypopigmentary areas which progressively become amelanotic. The onset of vitiligo in childhood leads to severe psychological trauma to both patients and their parents. Aim: The aim was to study the clinical profile of childhood vitiligo (<18 years) and its association with other autoimmune diseases. Materials and Methods: It was a cross-sectional study of 256 clinically diagnosed childhood vitiligo cases over a period of two years. Detailed history of disease onset, duration, progression, associated diseases, and family history was recorded after informed consent from parents/guardians. Assessment of vitiligo was done by Vitiligo Area Severity Index (VASI). Results: Of the total 256 patients, females (n = 149) outnumbered males (n = 107) with a mean age of 9.80 ± 4.59 years with a mean disease duration of 1.9 years. The most common morphological type was vitiligo vulgaris (48.8%), while the most common site of disease onset was face (30.5%). Positive family history was seen in 49 patients (19.1%) and Koebner phenomenon in 54 patients (21.1%). The mean VASI score was 1.64. Conclusion: Childhood vitiligo is more common in females with anemia present in significant number of cases. Premature canities is the most common cutaneous association. Thyroid dysfunction was seen in nonsegmental variant. Children with the positive family history of vitiligo had higher mean VASI than those with the negative family history (P = 0.002).
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Assessment of coronavirus disease 2019 severity in hospitalized pediatric patients with atopic dermatitis: a case‒control study p. 123
Alpana Mohta, Bhikam Chand Ghiya, Rajesh Dutt Mehta, Vijeta Prasad
Introduction: The Centers for Disease Control and Prevention has included asthma as a risk factor for developing severe coronavirus disease 2019 (COVID-19) illness. Respiratory viruses are known to run a more severe course in patients with underlying respiratory illnesses. However, the reports on the association of atopic dermatitis and COVID-19 infection are contrasting. Aims and Objectives: We aimed at assessing the difference between the severity of COVID-19 illness in patients having concurrent atopic dermatitis compared to those without concurrent atopic dermatitis. Materials and Methods: Study subjects included real-time polymerase chain reaction (RT-PCR) positive COVID-19 patients under the age of 18 years. The patients were divided into two groups, namely, cases and controls. Cases included children with atopic dermatitis diagnosed according to revised Hanifin and Rajka criteria with positive COVID-19 RT-PCR report. Controls were age-and sex-matched children from the same center with COVID-19, without atopic dermatitis. Disease severity was compared between the two groups. In addition, the COVID-19 severity was correlated with the SCORAD in the "cases" group. Results: While assessing the severity of COVID-19 illness on the basis of computed tomography score and clinical severity, there was a higher proportion of "severe" illness in "cases" compared to "controls," however, the difference was statistically insignificant. There was no significant correlation between high SCORAD scores and severe COVID-19 illness. Conclusion: Our study contributes to the ever-growing data suggesting that atopic diathesis is not a risk factor for acquiring COVID-19.
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Infantile systemic hyalinosis – Report of two cases with identification of a novel gene mutation p. 126
Sandipan Dhar, Rashmi Agarwal, Sahana M Srinivas, Subhra Dhar, Apurba Ghosh
Infantile systemic hyalinosis (ISH; MIM #236490) and juvenile hyaline fibromatosis (MIM #228600) represent two spectrums of the rare autosomal recessive disorder, the hyaline fibromatosis syndrome caused by mutations in ANTXR2/CMG2 encoding capillary morphogenesis protein-2. Herein, we report two cases of ISH with different clinical presentations confirmed by CMG2 gene mutations. Homogenous 79 bp deletion of the entire exon 11 reported in one of the cases has not been reported previously.
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Langerhans cell histiocytosis presenting as post-COVID-19 multisystem inflammatory syndrome: A rare case report p. 129
KM Sudhakar Rao, Varsha R Koti, Balachandra Suryakant Ankad
Langerhans cell histiocytosis is a rare clonal disease of monocyte-macrophage system characterized with uncontrolled proliferation and accumulation of immature dendritic cells. Acute disseminated form of this disease known as Letterer-Siwe disease is life threatening. Here, we report such a case who presented as multisystem inflammatory syndrome following COVID-19 infection.
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Juvenile systemic lupus erythematosus presenting only as nonscarring alopecia p. 133
NM Vinitha, Reena Rai, G Uma Maheswari
Juvenile onset systemic lupus erythematosus (JSLE) is a rare multisystem, autoimmune disorder. Alopecia in SLE generally follows a pre-established disease with systemic symptoms. A 13-year-old girl presented with sudden hair loss over the vertex of scalp of 1-month duration. No other cutaneous or systemic symptoms were noted. Trichoscopy, histopathology, positive ANA, and low complement levels helped in diagnosing JSLE. Patchy nonscarring alopecia, as the sole presenting feature without systemic involvement, is rare.
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Congenital leukemia cutis in an infant p. 136
Carol Lobo, JP Prathibha
Background: The infiltration of neoplastic leukocytes or their progenitors into the epidermis, dermis, or subcutis, resulting in clinically evident cutaneous lesions, is known as leukemia cutis. Leukemia cutis may arise after, before, or concurrently with a diagnosis of systemic leukemia. Case Report: We present a case of congenital leukemia cutis that was later diagnosed as acute myeloid leukemia. Discussion: Congenital leukemia is defined as leukemia that is present at birth or develops within the first 6 weeks of life. Leukemia cutis has been identified in 25%–30% of patients with congenital leukemia. Typical clinical features often include papules, macules, and nodules.
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Pediatric scalp psoriasis: Therapeutic response to oral apremilast: A report of two cases p. 139
Anil Kumar Panda, Farheen Begum, Maitreyee Panda, Chinmoy Raj
Localized childhood scalp psoriasis is usually controlled with topical therapy. Therapies resistant to topical treatment require a switch to oral therapy. Standardized guidelines for treating childhood psoriasis are lacking, and there are only limited evidence-based data and approved treatments. However, in this current pandemic situation, oral immunosuppressants should be avoided, and a safer molecule-like apremilast can be a better option. We present two cases of childhood scalp psoriasis not responding to topical therapy and showing excellent results with apremilast with better safety profile.
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Tick masquerading as skin tag − A rare case report p. 142
Seethalakshmi Ganga Vellaisamy, Navakumar Manickam, Anbulenin Kulandaivel, Kannan Gopalan
We report the case of a 16-year-old boy who presented with a painful skin lesion over the left lower eye lid following a history of travel to forest which masqueraded as skin tag. Excision biopsy showed features suggestive of hard tick. We report this unusual case of tick bite mainly to stress the importance of proper clinical evaluation, appropriate treatment like limited surgical excision, regular follow-up in view of prevention of potential disease transmission by the tick. Timely detection and treatment of tick bite is important to prevent multisystem complication that may develop later in life.
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Clinicopathological features of secondary syphilis in a human immunodeficiency virus-infected teenager p. 145
Ana San Juan Romero, Edgardo Gómez Torres, Mabel Vanessa Urtusuástegui García, Georgina Elizabeth Feìlix Bermuìdez
Syphilis and human immunodeficiency virus (HIV) are both sexually transmitted diseases that affect the same risk group practices, which make co-infection common. Syphilis-infected individuals typically follow a disease course divided into primary, secondary, latent, and tertiary stages. Atypical manifestations, fulminant presentation, serological irregularities, and treatment failures appear more frequently in HIV-seropositive patients. We present the case of a 15-year-old boy with a penicillin allergy who developed dermatological and systemic manifestations in which laboratorial and histopathological studies corresponded to a syphilis-HIV co-infection with a positive response to treatment.
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An unusual case of isolated unilateral palmar lichen nitidus p. 150
Shreya Singh, Kinjal Rambhia, Meena B Makhecha
Lichen nitidus (LN) is a benign chronic eruption characterized by numerous asymptomatic papules on the body, clustered at specific sites of predilection like the dorsum of hands, abdomen, and genitalia. A 10-year-old boy presented to us with asymptomatic roughness of the left palm for 2 years. Clinical examination revealed multiple discrete pin-point papules over the left palm. Histopathological examination revealed focal lichenoid granuloma with overlying parakeratosis suggestive of LN. Hence, we are reporting this case of LN which required histopathology for confirmation due to its atypical presentation and distribution.
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First record of Aspergillus brunneus causing fingernail aspergillomycosis in a primary schoolchild p. 153
Anjali Sharma, Geeta Sumbali
Onychomycosis among children has been reported to be of less common occurrence than in adults. However, species of Aspergillus are emerging as the new causative agents of onychomycosis. Here, we report a new case of fingernail aspergillomycosis in an 11-year-old schoolboy. The thumbnail of the patient demonstrated thickening, yellow discoloration, and onycholysis at the distal end. Culturing of the clinical nail sample on Sabouraud dextrose agar medium supplemented with chloramphenicol (0.05 mg/ml) produced yellowish-white colonies repeatedly on more than three consecutive occasions. Slide cultures showed uniseriate phialides covering two-third of the vesicle. Further, DNA sequencing of the internal transcribed spacer region confirmed its identity as Aspergillus brunneus. This is the first documented report of A. brunneus as an etiological agent of onychomycosis.
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Infantile tremor syndrome, often overlooked diagnosis in dermatology p. 156
Dimple Chopra, Shayna Aulakh, Archit Garg, Aashi Garg
Infantile tremor syndrome (ITS) is a clinical condition defined by a tetrad of pallor, development regression, pigmentary changes, and hypotonia which may be accompanied by tremors. The clinical spectrum of ITS may also vary. Not every patient may present with all the symptoms, some of them may show only very subtle features of ITS which may lead to underdiagnosis of this condition in daily clinical practice. We report a case of ITS where the patient had predominantly dermatological features such as hyperpigmentation over the dorsal aspect of hands, knees, feet, axilla, buttocks, brittle nails, thin sparse hairs but without characteristic tremors. This report, with brief review of literature, tends to sensitize dermatologists to keep ITS as a differential diagnosis while dealing with infantile hyperpigmentation and recognizing it in pretremor stage, especially in the exclusive breastfed population of Indian children, where ITS is still widely prevalent.
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Successful treatment of juvenile generalized pustular psoriasis with secukinumab monotherapy. A case report and review of the literature p. 159
Raghavendra Rao, Krithiga Muralidharan, Varsha M Shetty, Sudhir U K. Nayak, Vishwapriya Godkhindi, Pallavi Hegde
Juvenile generalized pustular psoriasis (GPP) is an extremely rare variant of psoriasis, often accompanied by systemic symptoms. It adversely affects the psychosocial aspect of the child as well as their caregivers. Hence, there is a need for rapid control of the disease and induction of remission at the earliest possible time. In this report, we describe a case of a 15-year-old juvenile GPP patient with a history of multiple relapses, who responded dramatically to secukinumab monotherapy. This report is intended to highlight the use of safer biologics such as secukinumab in patients where other conventional drugs are not suitable to use.
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Dermoscopic features of wilson's disease p. 162
Rashmiben Sabbirali Agharia, Hita H Mehta, Amitkumar Rameshbhai Gorasiya, Shreya Pradipbhai Somani
Wilson's disease (WD) is characterized by predominantly hepatic, neurological, ophthalmic, and psychiatric manifestations. Early clinical features are nonspecific and sometimes maybe misleading in establishing a definitive diagnosis, especially in younger patients and with concurrent other infections. In contrast to this, dermatological manifestations of WD including skin, mucosa, nail, and hair examination may be indicative of a diagnosis of disease, particularly in early cases. Here, we have reported dermoscopic and trichoscopic findings of the 11-year-old male patient.
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Poststeroid panniculitis – A rare case report p. 165
Taru Garg, Riaz Ahmed, Apoorva V Bharadwaj, Shailaja Shukla
Poststeroid panniculitis (PSP) is a very rare form of lobular panniculitis that occurs due to rapid tapering of long-term corticosteroid therapy. Herein, we present a case of a 2-year-old boy with PSP following discontinuation of oral prednisolone administered for the treatment of West syndrome. Histopathology revealed lobular panniculitis along with the characteristic needle-shaped clefts. Through this case report, we want to highlight the importance of gradual tapering of steroids and discuss important differential diagnoses with such a case scenario.
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Early-onset, severe prurigo nodularis in a young child with atopic dermatitis treated successfully with dupilumab p. 170
Henrietta Albela, Kin Fon Leong
Prurigo nodularis is an extremely pruritic skin condition as a result of chronic and vicious cycle of itching and scratching. It is rare in children. We report a case of a 4-year-old child with a background of poorly controlled atopic dermatitis with early-onset, severe prurigo nodularis, who was treated successfully with off-label use of dupilumab injection. There was a significant reduction in itchiness by week 2 of treatment, and achieved 80% reduction in Eczema Area and Severity Index with almost complete resolution of prurigo nodules by week 8. Dupilumab can be considered a treatment option for young pediatric patients with early-onset prurigo nodularis.
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Dermoscopic aid in the diagnosis of dermatitis artefacta p. 172
KM Sudhakar Rao, SV Smitha
Dermatitis artefacta (DA) is a condition where the patient produces cutaneous lesions to fulfil an unconscious psychological need. It is most commonly seen in prepubertal and adolescent age group with female predominance. Among children, causes include delayed developmental milestones, disturbed parent–child relationship, bullying in school, conflict with siblings, academic pressure, gender bias, and loss of close relative in the recent past. We present a case of DA in an 8-year-old girl with dermoscopic evaluation. In pediatric age group, special attention is required to identify such cases. Early diagnosis and intervention for the DA is required for the prevention chronic physical and psychological disabilities.
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Netherton syndrome presenting with persistent pneumonia in a newborn p. 175
Gayatri Nerakh, Ramya Nadipineni, P Santosh Rajeev, Tejopratap Oleti
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Generalized multiple eruptive milia in an infant – An unusual presentation p. 177
Anjaly Girija Sethukumaran, Satyadarshi Patnaik, Arpita Nibedita Rout, Surajit Nayak
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Bullous variant of aplasia cutis congenita: A rare entity p. 179
Avita Dhiman, Ramesh Pratap Anuragi, Sheetanshu Kumar, Neirita Hazarika
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Plica polonica in an 11-year-old female – A rare entity p. 181
Neerja Puri
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Imiquimod-Induced vulval erosions in a child p. 183
Resham Vasani, Sushrut Save
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A neworn with a skin lesion and wrist drop p. 185
Muhammed Haneefa Vadakkumpadam, Mohammed Alshahrani, Abdullah Saeed Abualiat, Tariq Aziz, Abdulmajeed Alshahrani
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