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  Most popular articles (Since March 15, 2004)

 
 
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RESIDENT’S PAGE
Guidelines for writing a research project synopsis or protocol
Jayadev Betkerur
November-December 2008, 74(6):687-690
DOI:10.4103/0378-6323.45136  PMID:19172017
  127,273 1,035 1
LETTER TO EDITOR
Foreign body in the vagina of a 3½-year-old child: Sexual abuse or a childish prank?
L Padmavathy, N Ethirajan, L Lakshmana Rao
March-April 2004, 70(2):118-119
PMID:17642584
  98,721 402 -
STUDIES
Efficacy of desonide 0.05% cream and lotion in steroid-responsive dermatoses in Indian patients: A post-marketing surveillance study
Dimple A Bhankharia, Percy H Sanjana
September-October 2004, 70(5):288-291
PMID:17642640
BACKGROUND: Desonide, a non-halogenated, low-potency topical steroid, is indicated in the treatment of steroid-responsive dermatoses. AIMS: A post-marketing surveillance study was conducted to evaluate the efficacy and safety of DesowenTM (Desonide 0.05%) cream and lotion in Indian patients for the treatment of steroid-responsive dermatoses of mild to moderate severity. METHODS: A 3-week, multicenter, open-label, non-comparative Phase IV trial involving 1789 patients from 229 centers across India was conducted between January and August 2003. RESULTS: Of the 1789 patients, 1483 patients completed the treatment as per protocol. At the end of the therapy, 98.5% of the patients showed an improvement in their dermatitis from baseline. More than half of the patients showed a greater than 75% improvement in their signs and symptoms. No adverse effects were noted in any of the patients. Both the lotion and cream were found to be equally effective. CONCLUSIONS: Desonide 0.05% is a safe and effective low-potency corticosteroid for the treatment of mild to moderate dermatoses in Indian patients. No clinically apparent side-effects were observed in infants less than 1 year of age.
  95,571 449 2
REVIEW ARTICLE
Treatment of keloids and hypertrophic scars
Sharad Mutalik
January-February 2005, 71(1):3-8
DOI:10.4103/0378-6323.13777  PMID:16394352
Clinicians always find it difficult to treat hypertrophic scars and keloids. Various treatment modalities are available. Intralesional corticosteroids, topical applications, cryotherapy, surgery, laser therapy, and silicone sheeting are the widely used options. Radiation therapy can also help in cases of recalcitrant keloids. Most recently, pulsed-dye laser has been successfully used to treat keloids and hypertrophic scars. There are no set guidelines for the treatment of keloids. Treatment has to be individualized depending upon the distribution, size, thickness, and consistency of the lesions and association of inflammation. A combination approach to therapy seems to be the best option.
  87,713 2,333 60
REVIEW ARTICLES
Improving adherence to antiretroviral therapy
KC Nischal, Uday Khopkar, DG Saple
September-October 2005, 71(5):316-320
DOI:10.4103/0378-6323.16780  PMID:16394454
Antiretroviral therapy (ART) has transformed HIV infection into a treatable, chronic condition. However, the need to continue treatment for decades rather than years, calls for a long-term perspective of ART. Adherence to the regimen is essential for successful treatment and sustained viral control. Studies have indicated that at least 95% adherence to ART regimens is optimal. It has been demonstrated that a 10% higher level of adherence results in a 21% reduction in disease progression. The various factors affecting success of ART are social aspects like motivation to begin therapy, ability to adhere to therapy, lifestyle pattern, financial support, family support, pros and cons of starting therapy and pharmacological aspects like tolerability of the regimen, availability of the drugs. Also, the regimen's pill burden, dosing frequency, food requirements, convenience, toxicity and drug interaction profile compared with other regimens are to be considered before starting ART. The lack of trust between clinician and patient, active drug and alcohol use, active mental illness (e.g. depression), lack of patient education and inability of patients to identify their medications, lack of reliable access to primary medical care or medication are considered to be predictors of inadequate adherence. Interventions at various levels, viz. patient level, medication level, healthcare level and community level, boost adherence and overall outcome of ART.
  86,510 866 29
RESIDENTS«SQ» PAGE
Wood's lamp
Lalit Kumar Gupta, MK Singhi
March-April 2004, 70(2):131-135
PMID:17642589
  68,754 1,994 3
REVIEW ARTICLES
Nail changes and disorders among the elderly
Gurcharan Singh, Nayeem Sadath Haneef, Uday A
November-December 2005, 71(6):386-392
DOI:10.4103/0378-6323.18941  PMID:16394478
Nail disorders are frequent among the geriatric population. This is due in part to the impaired circulation and in particular, susceptibility of the senile nail to fungal infections, faulty biomechanics, neoplasms, concurrent dermatological or systemic diseases, and related treatments. With aging, the rate of growth, color, contour, surface, thickness, chemical composition and histology of the nail unit change. Age associated disorders include brittle nails, trachyonychia, onychauxis, pachyonychia, onychogryphosis, onychophosis, onychoclavus, onychocryptosis, onycholysis, infections, infestations, splinter hemorrhages, subungual hematoma, subungual exostosis and malignancies. Awareness of the symptoms, signs and treatment options for these changes and disorders will enable us to assess and manage the conditions involving the nails of this large and growing segment of the population in a better way.
  65,042 1,349 33
ORIGINAL ARTICLE
A study on the pH of commonly used soaps/cleansers available in the Indian market
Gulrez Tyebkhan
November-December 2001, 67(6):290-291
PMID:17664779
Cleansers, commonly referred to as soaps (though all soaps are cleansers, all cleansers are not soaps), are an important adjuvant in the treatment of any dermatological condition. In order to recommend a cleanser, many aspect should be taken into consideration one important being its pH. pH of a cleanser tends to have an impact on the skin in several ways viz. alteration of bacterial flora and pH, moisture content and irritation. A study was conducted to evaluate the pH of various commonly available soaps/cleansers available in the Indian market. Most of the commonly used soaps have an alkaline pH.
  64,807 1 -
DERMATOSURGERY SPECIALS
Disinfection, sterilization and operation theater guidelines for dermatosurgical practitioners in India
Narendra Patwardhan, Uday Kelkar
January-February 2011, 77(1):83-93
DOI:10.4103/0378-6323.74965  PMID:21220895
Modern day dermatologists conduct different esthetic and surgical procedures, with risk of infective complications. Hence, infection control practices need to be established in dermatological practice to minimize the risk of exogenous infections. These practices include hand washing, cleaning, sterilization, disinfection, operation theater sterilization and specifications. Proper hand washing after examination of each patient and prior to any surgery with a formulation containing alcohol alone or as a combination with other agents reduces the chances of transferring infections to and from patients. Sterilization and disinfection constitute the most important aspect of infection control. Disinfectants and disinfecting procedures vary according to the environment and equipment. Proper knowledge of different processes/agents for sterilization and disinfection is essential. Disinfectants for use in hospitals should always be freshly prepared and should be of adequate strength. Sterilization is carried out most commonly using steam sterilizers or ethylene dioxide sterilizers. The waste generated during practice is a potential source of nosocomial infections and should be treated as per the proper protocol and guidelines. Trained staff to carry out these practices is essential.
  62,289 862 1
RESIDENT’S PAGE
Tzanck smear: A useful diagnostic tool
Lalit Kumar Gupta, MK Singhi
July-August 2005, 71(4):295-299
DOI:10.4103/0378-6323.16632  PMID:16394449
  58,481 2,703 17
SEMINAR
Relationship between nickel allergy and diet
Ashimav Deb Sharma
September-October 2007, 73(5):307-312
DOI:10.4103/0378-6323.35733  PMID:17921609
Nickel is a ubiquitous trace element and it occurs in soil, water, air and of the biosphere. It is mostly used to manufacture stainless steel. Nickel is the commonest cause of metal allergy. Nickel allergy is a chronic and recurring skin problem; females are affected more commonly than males. Nickel allergy may develop at any age. Once developed, it tends to persist life-long. Nickel is present in most of the dietary items and food is considered to be a major source of nickel exposure for the general population. Nickel content in food may vary considerably from place to place due to the difference in nickel content of the soil. However, certain foods are routinely high in nickel content. Nickel in the diet of a nickel-sensitive person can provoke dermatitis. Careful selection of food with relatively low nickel concentration can bring a reduction in the total dietary intake of nickel per day. This can influence the outcome of the disease and can benefit the nickel sensitive patient.
  54,753 1,164 38
CONTINUING MEDICAL EDUCATION
Treatment of lymphatic filariasis: Current trends
K Anitha, RK Shenoy
March-April 2001, 67(2):60-65
PMID:17664709
  55,327 0 -
FOCUS
Systemic skin whitening/lightening agents: What is the evidence?
Munisamy Malathi, Devinder M Thappa
November-December 2013, 79(6):842-846
DOI:10.4103/0378-6323.120752  PMID:24177629
  53,391 946 1
NET CASE
Bardet-Biedl syndrome: A rare case report from North India
Sumir Kumar, Bharat B Mahajan, Jyotisterna Mittal
March-April 2012, 78(2):228-228
DOI:10.4103/0378-6323.93656  PMID:22421669
The Bardet-Biedl syndrome (BBS) is a rare ciliopathic human autosomal-recessive disorder, affecting multiple organ systems. Less than 15 cases have been reported from India. The authors present a classical case of BBS presenting to dermatology outpatient with hypogonadism and features such as marked central obesity, retinal dystrophy, polydactyly, structural renal abnormalities and mental retardation, along with a brief review of the literature. This case exemplifies the need for multidisciplinary management in such cases.
  53,254 242 2
REVIEW ARTICLES
Newer and upcoming therapies for melasma
Rashmi Sarkar, Shikha Chugh, Vijay K Garg
July-August 2012, 78(4):417-428
DOI:10.4103/0378-6323.98071  
Melasma is one of the most common and distressing pigmentary disorders presenting to dermatology clinics. The precise cause of melasma remains unknown; however, there are many possible contributing factors. It is notably difficult to treat and has a tendency to relapse. The existing and most tried topical therapy is hydroquinone and the triple combination with tretinoin and corticosteroids, which is considered the gold standard for melasma. Besides that, azelaic acid, kojic acid, arbutin, ascorbic acid, glycolic acid and salicylic peels have also been tried with limited success. However, multiple novel topical agents are being investigated for their potential as hypopigmenting agents with unique mode of action. But, further trials are required to study their efficacy and safety before they can be further recommended. The article highlights these newer formulations and also briefly mentions about the newer chemical peels and the much hyped lasers in treating this difficult and frustrating condition.
  48,704 1,939 4
RESIDENT’S PAGE
Appearances in clinical dermatology
Bhushan Madke, Bhavana Doshi Chougule, Sumit Kar, Uday Khopkar
September-October 2014, 80(5):432-447
DOI:10.4103/0378-6323.140304  PMID:25201846
  47,941 1,418 -
ORIGINAL ARTICLE
Safety and efficacy of adapalene gel 0.1% in acne vulgaris: Results of a post-marketing surveillance study
SH Percy
July-August 2003, 69(4):277-280
PMID:17642911
Introduction: Adapalene is a novel retinoid indicated for the topical treatment of acne vulgaris. The drug was introduced in India in 2001. Aims: A post-marketing surveillance study was conducted to assess the safety and efficacy of adapalene gel 0.1% when used as monotherapy or in combination with other anti-acne agents in Indian patients of acne vulgaris. Material and Methods: A 12-week, multicentre, open-label, non-comparative study involving 571 patients from 21 centers across India was conducted between January and September of 2002. Concomitant prescription of other anti-acne drugs was permitted, if needed. Results: Of the 571 patients, 441 completed the treatment as per protocol. At the end of therapy, 96.3% of patients showed an improvement in their acne from baseline, with greater than 75% improvement seen in two-thirds of patients. Adverse events were reported in 24% of the patients, none of which were serious. The tolerability of therapy was rated as excellent/good in 81% of patients by physicians and in 78% by the patients. Conclusion: Adapalene gel 0.1% is a safe and effective topical agent in the treatment of mild to moderate acne vulgaris in Indian patients. It may be safely combined with other topical and oral anti-acne agents.
  48,171 780 1
RECOMMENDATIONS
Standard guidelines of care for chemical peels
Niti Khunger
January 2008, 74(7):5-12
PMID:18688104
Chemical peeling is the application of a chemical agent to the skin, which causes controlled destruction of a part of or the entire epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. Indications for chemical peeling include pigmentary disorders, superficial acne scars, ageing skin changes, and benign epidermal growths. Contraindications include patients with active bacterial, viral or fungal infection, tendency to keloid formation, facial dermatitis, taking photosensitizing medications and unrealistic expectations. Physicians' qualifications : The physician performing chemical peeling should have completed postgraduate training in dermatology. The training for chemical peeling may be acquired during post graduation or later at a center that provides education and training in cutaneous surgery or in focused workshops providing such training. The physician should have adequate knowledge of the different peeling agents used, the process of wound healing, the technique as well as the identification and management of complications. Facility : Chemical peeling can be performed safely in any clinic/outpatient day care dermatosurgical facility. Preoperative counseling and Informed consent : A detailed consent form listing details about the procedure and possible complications should be signed by the patient. The consent form should specifically state the limitations of the procedure and should clearly mention if more procedures are needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures, presentations, and personal discussions. The need for postoperative medical therapy should be emphasized. Superficial peels are considered safe in Indian patients. Medium depth peels should be performed with great caution, especially in dark skinned patients. Deep peels are not recommended for Indian skin. It is essential to do prepeel priming of the patient's skin with sunscreens, hydroquinone and tretinoin for 2-4 weeks. Endpoints in peels: For glycolic acid peels: The peel is neutralized after a predetermined duration of time (usually three minutes). However, if erythema or epidermolysis occurs, seen as grayish white appearance of the epidermis or as small blisters, the peel must be immediately neutralized with 10-15% sodium bicarbonate solution, regardless of the duration of application of the peel. The end-point is frosting for TCA peels, which are neutralized either with a neutralizing agent or cold water, starting from the eyelids and then the entire face. For salicylic acid peels, the end point is the pseudofrost formed when the salicylic acid crystallizes. Generally, 1-3 coats are applied to get an even frost; it is then washed with water after 3-5 minutes, after the burning has subsided. Jessner's solution is applied in 1-3 coats until even frosting is achieved or erythema is seen. Postoperative care includes sunscreens and moisturizers Peels may be repeated weekly, fortnightly or monthly, depending on the type and depth of the peel.
  46,326 2,608 5
SYMPOSIUM-NAILS-PART II
Nail avulsion: Indications and methods (surgical nail avulsion)
Deepika Pandhi, Prashant Verma
May-June 2012, 78(3):299-308
DOI:10.4103/0378-6323.95444  
The nail is a subject of global importance for dermatologists, podiatrists and surgeons. Nail avulsion is a frequently undertaken, yet simple, intriguing procedure. It may either be surgical or chemical, using 40% urea. The former is most often undertaken using the distal approach. Nail avulsion may either be useful for diagnostic purposes like exploration of the nail bed, nail matrix and the nail folds and before contemplating a biopsy on the nail bed or for therapeutic purposes like onychocryptosis, warts, onychomycosis, chronic paronychia, nail tumors, matricectomy and retronychia. The procedure is carried out mostly under local anesthesia with or without epinephrine (1:2,00,000 dilution). Besides the above-mentioned indications, the contraindications and complications of nail avulsion are briefly outlined.
  47,151 600 4
SPECIALTY INTERFACE
Minimizing side effects of systemic corticosteroids in children
CT Deshmukh
July-August 2007, 73(4):218-221
DOI:10.4103/0378-6323.33633  PMID:17675727
Corticosteroids are potent drugs used in management of various inflammatory and autoimmune disorders. The antiinflammatory effects of corticosteroids cannot however be separated from their metabolic effects. Children are more vulnerable to their side effects, particularly the effects on growth, immunity and adrenal suppression. It is essential for the treating physician to be aware of the side effects and the measures to be taken to minimize them. A side effect that is unique to children is growth suppression, which is helped by alternate day treatment. Administration of small doses of prednisolone (10-15 mg/day or < 0.5 mg/kg/day single dose) on alternate days, does not slow growth velocity significantly. The potency of dexamethasone and betamethasone in suppressing growth is nearly 18 times higher than that of prednisolone. There is some evidence that the administration of growth hormone can reverse these changes.
  44,233 1,273 15
REVIEW ARTICLES
Diffuse hair loss in an adult female: Approach to diagnosis and management
Shyam Behari Shrivastava
January-February 2009, 75(1):20-28
DOI:10.4103/0378-6323.45215  PMID:19172026
Telogen effluvium (TE) is the most common cause of diffuse hair loss in adult females. TE, along with female pattern hair loss (FPHL) and chronic telogen effluvium (CTE), accounts for the majority of diffuse alopecia cases. Abrupt, rapid, generalized shedding of normal club hairs, 2-3 months after a triggering event like parturition, high fever, major surgery, etc. indicates TE, while gradual diffuse hair loss with thinning of central scalp/widening of central parting line/frontotemporal recession indicates FPHL. Excessive, alarming diffuse shedding coming from a normal looking head with plenty of hairs and without an obvious cause is the hallmark of CTE, which is a distinct entity different from TE and FPHL. Apart from complete blood count and routine urine examination, levels of serum ferritin and T3, T4, and TSH should be checked in all cases of diffuse hair loss without a discernable cause, as iron deficiency and thyroid hormone disorders are the two common conditions often associated with diffuse hair loss, and most of the time, there are no apparent clinical features to suggest them. CTE is often confused with FPHL and can be reliably differentiated from it through biopsy which shows a normal histology in CTE and miniaturization with significant reduction of terminal to vellus hair ratio (T:V < 4:1) in FPHL. Repeated assurance, support, and explanation that the condition represents excessive shedding and not the actual loss of hairs, and it does not lead to baldness, are the guiding principles toward management of TE as well as CTE. TE is self limited and resolves in 3-6 months if the trigger is removed or treated, while the prognosis of CTE is less certain and may take 3-10 years for spontaneous resolution. Topical minoxidil 2% with or without antiandrogens, finestride, hair prosthesis, hair cosmetics, and hair surgery are the therapeutically available options for FPHL management.
  43,176 2,143 15
Acute skin failure: Concept, causes, consequences and care
Arun C Inamadar, Aparna Palit
November-December 2005, 71(6):379-385
DOI:10.4103/0378-6323.18007  PMID:16394477
Acute skin failure is a state of total dysfunction of the skin resulting from different dermatological conditions. It constitutes a dermatological emergency and requires a multi-disciplinary, intensive care approach. Its effective management is possible only when the underlying pathomechanism of each event is clear to the treating clinician. The concept of skin failure is new to non-dermatologist clinicians and sketchy among many dermatologists. Here the pathomechanism of skin failure has been analyzed and a guideline for monitoring has been provided. There is a need for intensive care units for patients with acute skin failure.
  41,033 2,870 14
Lichenoid tissue reaction/interface dermatitis: Recognition, classification, etiology, and clinicopathological overtones
Virendra N Sehgal, Govind Srivastava, Sonal Sharma, Shruti Sehgal, Prashant Verma
July-August 2011, 77(4):418-430
DOI:10.4103/0378-6323.82389  PMID:21727689
Lichenoid tissue reaction or interface dermatitis embrace several clinical conditions, the prototype of which is lichen planus and its variants, drug induced lichenoid dermatitis, special forms of lichenoid dermatitis, lichenoid dermatitis in lupus erythematosus, and miscellaneous disorders showing lichenoid dermatitis, the salient clinical and histological features of which are described to facilitate their diagnosis. Background of lichenoid reaction pattern has been briefly outlined to enlighten those interested in this entity.
  42,723 1,131 2
REVIEW ARTICLE
Photosensitivity in children: An approach to diagnosis and management
Arun C Inamadar, Aparna Palit
March-April 2005, 71(2):73-79
DOI:10.4103/0378-6323.13988  PMID:16394377
Photosensitivity disorders in children include a wide array of conditions, many of which are unique to this age group. Prompt diagnosis of these disorders becomes difficult at times because of the overlapping clinical pictures. Genodermatoses and metabolic disorders may have associated systemic involvement, which may lead to these children presenting to pediatricians who may overlook the photosensitivity. A dermatologist's consultation is essential in such cases for specific instructions and counseling of parents regarding photoprotection in these children. This intervention may improve the quality of life by reducing the morbidity and chances of early mortality. This review includes a comprehensive discussion of the distinguishing clinical features of childhood photodermatoses along with general guidelines regarding their investigation and treatment.
  41,192 969 10
SYMPOSIUM DERMATOPATHOLOGY
Appearances in dermatopathology: The diagnostic and the deceptive
Bhushan Madke, Bhavana Doshi, Uday Khopkar, Atul Dongre
May-June 2013, 79(3):338-348
DOI:10.4103/0378-6323.110769  PMID:23619438
Dermatopathology involves study of the microscopic morphology of skin sections. It mirrors pathophysiologic changes occurring at the microscopic level in the skin and its appendages. Sometimes, we come across certain morphologic features that bear a close resemblance to our physical world. These close resemblances are referred to as "appearances" in parlance to dermatopathology. Sometimes, these "appearances" are unique to a certain skin disorder and thus help us to clinch to a definitive diagnosis (e.g., "tadpole" appearance in syringoma). However, frequently, these appearances are encountered in many other skin conditions and can be therefore be misleading. In this paper, we attempt to enlist such "appearances" commonly found in the dermatopathologic literature and also enumerate their differential diagnoses.
  39,206 1,797 -
Online since 15th March '04
Published by Wolters Kluwer - Medknow