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   Table of Contents - Current issue
Coverpage
April-June 2019
Volume 37 | Issue 2
Page Nos. 63-115

Online since Tuesday, June 18, 2019

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ORIGINAL ARTICLES  

Methods for diagnosing onychomycosis: Acomparative study of 459cases p. 63
Yang-Chih Lin, Pei-Lun Sun, Pa-Fan Hsiao, Fang-Ju Sun, Yu-Hung Wu
DOI:10.4103/ds.ds_6_18  
Background: Onychomycosis is a common infectious nail problem but shares similar clinical presentation with some other noninfectious disorders, such as psoriasis and lichen planus. Acorrect diagnosis is essential to proper management. There are three common tests used in the outpatient clinic, including direct potassium hydroxide(KOH) examination, nail plate histology study, and fungal culture. Objective: This study aimed to compare the accuracy and feasibility among these three tests in the diagnosis of onychomycosis. Materials and Methods: We retrospectively reviewed the patients diagnosed with onychomycosis and had positive result of any of the three tests from June 2005 to June 2015. The age, gender, and results of the diagnostic methods were collected and analyzed. Results: Atotal of 459patients were enrolled. The positive rates were significantly different between nail plate histology study(93.0%, 427/459), KOH examination(67.3%, 309/459), and fungal culture(42.1%, 193/459)(P<0.05). Conclusions: Nail plate histology study has the highest positive rate in the diagnosis of onychomycosis than KOH examination and fungal culture. However, KOH examination is most inexpensive and is the fast way to obtain the result with moderate reliability. Acombination of two or three diagnostic tests could provide useful information to the clinician to manage onychomycosis appropriately.
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The role and relationship of the serum D-dimer level and autologous serum skin test response in chronic spontaneous urticaria p. 67
Bok Won Park, Ye Ji Jang, Eun Byul Cho, Eun Joo Park, Kwang Ho Kim, Kwang Joong Kim
DOI:10.4103/ds.ds_13_18  
Background: The severity of chronic urticaria(CU) may be associated with the D-dimer level, and CU patients often have other autoimmune disorders. The autologous serum skin test(ASST) is believed to identify autoimmune/autoreactive diseases in CU patients. Aim: This study evaluated whether the levels of D-dimer, total immunoglobulin E(IgE), and autoimmune markers, such as antithyroid peroxidase(TPO) and antithyroglobulin(TG), differ between ASST-positive and ASST-negative patients among CU patients. In addition, the study assessed whether these laboratory findings were related to CU severity. Methods: The study enrolled 54 adults with CU (16 ASST positive, 38 ASST negative). D-dimer, total IgE, autoimmune marker(anti-TPO and anti-TG), and thyroid hormone levels and the urticaria activity score(UAS) were measured. Results: The levels of D-dimer, total IgE, anti-TPO, and anti-TG and the thyroid function test result showed no difference between the ASST-positive and ASST-negative groups. The UAS was higher in the ASST-positive group than in the ASST-negative group, but the ASST-positive group showed a better treatment response. The UAS was higher in patients with an elevated D-dimer level than in those with a normal level. Total IgE was related to the UAS in only the ASST-negative group, and anti-TPO and anti-TG levels were not related to the UAS. Conclusions: There were no associations between the ASST response and the D-dimer level, total IgE level, thyroid function test results, and thyroid autoantibody levels. However, our findings suggest that the ASST response, D-dimer level, and total IgE level are potential predictors of CU severity.
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The effect of striae gravidarum on quality of life in a sample of Turkish pregnant woman population p. 72
Atiye Ogrum, Hatice Yilmaz Dogru
DOI:10.4103/ds.ds_22_18  
Background: Striae gravidarum is a commonly occurred physiological change among women with pregnancy. Although these changes are accepted as physiological, the lack of therapeutical and preventive techniques led to impaired quality of life of women. The aim of this study is to evaluate the effect of striae gravidarum on quality of life in a sample of Turkish pregnant woman population and the usage of cream/lotion to prevent the striae. Methods: Women with pregnancy whose completed 36weeks of their pregnancy and admitted to the Obstetrics and Gynecology outpatient unit between March 2017 and August 2017 were included in the study. The severity of striae was assessed using Davey's score. The effects of striae on patient's quality of life were evaluated by Skindex-29 questionnaire. The usage of cream/lotion whether or not was also asked and recorded. Results: Atotal of 153 women with pregnancy were included in the study. Of those 43.1%(n=66) was primiparae and 56.9%(n=87) was multiparae. The prevalence of striae gravidarum in total, primiparae and multiparae was 75.8%, 66.7%, and 82.7%, respectively. There was a weak positive correlation found between the parity and severity of striae(ρ =0.190, P =0.018). The emotion and symptom score of primiparae women with severe striae were higher than women without striae(P=0.001; P =0.028, respectively). The usage of cream/lotion was significantly higher in primiparae compared to multiparae(P<0.001). The symptom and emotion scores of the women with striae those applied cream were higher than nonusers(P<0.001; P =0.038, respectively). Conclusions: Striae gravidarum may cause psychological and physical effects among women, especially primiparae women with severe striae and negatively affects the quality of life. Cream/lotion may be used to prevent striae development and reduce symptoms of pregnant women with higher emotion scores.
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Using a nonablative monopolar radiofrequency laser in the treatment of acne vulgaris p. 77
Ju-Yeon Choi, Sang Hyeon Hwang, Junghwa Yang, Ga-Young Lee
DOI:10.4103/ds.ds_4_18  
Background: Acne vulgaris is a prevalent cutaneous disorder that significantly affects patient quality of life. There have been several reports of successful acne treatment using lasers. However, few studies have reported the use of radiofrequency(RF) lasers for acne. Objective: The purpose of this study was to evaluate the efficacy and safety of a noninvasive monopolar RF laser in the treatment of acne vulgaris on the face. Methods: Arandomized, prospective, split-face study was performed. Eleven participants were recruited. Patients were treated with the RF laser on one half of the face and no laser treatment on the other half. Two treatments were performed at 2-week intervals. Patients returned for follow-up 2weeks after the final treatment. Results: After 4weeks, the lesion counts of papules, comedones, red macules, and the sebumeter measured values all significantly decreased on the treated area compared to those on untreated areas. In the photograph analysis, the grade of acne(using Cook's acne grading method) also significantly improved after treatment. Patients reported tolerable pain and mild erythema with laser treatment. However, there were no permanent adverse events. Conclusion: Treatment with the noninvasive RF laser successfully reduces acne lesions(papules, comedones, and red macules) and sebum secretion without severe adverse events.
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CASE REPORTS Top

Novel compound heterozygous mutations of ECM1 in a Chinese family with lipoid proteinosis p. 82
Wei Wu, Jian-Qiang Shi, Ding Li, Fang-Gu Li, Yan-Xia Cai, Di-Qing Luo
DOI:10.4103/ds.ds_23_18  
Lipoid proteinosis(LP) is a rare autosomal recessive genodermatosis caused by mutations of the ECM1 gene. The common variations of the ECM1 gene are nonsense and missense mutations, and in rare instance, compound heterozygotes may occur. We describe two siblings of LP from a nonconsanguineous family of China who were detected novel compound heterozygous mutations of c. 157C>T(p. R53X) in exon 3 and c. 857G>A(p. C286Y) in exon 7 of the ECM1 gene. Their mother was a carrier of missense mutation of c. 857G>A in exon 7 of ECM1, their father and one of the old sisters were the carriers of nonsense mutation of c. 157C>T in exon 3, respectively. All the carriers presented normally. The results support the opinion that the mutations of the ECM1 gene for LP are of varieties.
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Toxic epidermal necrolysis in an infant induced by drug intake through breast milk p. 86
Yeh-Ni Chu, Ming-Sheng Lee, Shun-Cheng Yang, Hui-Chun Tai, Wen-Hung Chung, Tsu-Man Chiu
DOI:10.4103/ds.ds_12_18  
Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis(TEN) are life-threatening severe cutaneous adverse drug reactions, and SJS/TEN in infancy is rare. Here, we present a case of a 4-month-old infant with generalized exanthema, flaccid blisters, and mucosal erosions. He was diagnosed with TEN within 2days using a granulysin quick screen test and subsequently verified with histopathologic findings. Transmission of cephalexin through breastfeeding was suspected to be a possible cause based on drug history, breastfeeding history, and lymphocyte transformation test. The patient survived with only skin hyperpigmentation remaining.
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Sparing of injection sites in patients with extensive psoriasis treated with various biologics p. 90
Ya-Chu Tsai, Tsen-Fang Tsai
DOI:10.4103/ds.ds_31_18  
Although biologic agents have emerged as the preferred strategy for moderate-to-severe psoriasis, sparing around injection sites may be an underreported effect and represent inadequate systemic efficacy with fair local response of biologic treatment for psoriasis. Herein, we report six cases of extensive psoriasis presenting injection site sparing at biologics administration sites.
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The gift of honeymoon: An interesting case of furuncular myiasis caused by Dermatobia Hominis in Taiwan and review of the literature p. 93
Yung-Wei Chang, Han-Chi Tseng
DOI:10.4103/ds.ds_27_18  
Travel-related cutaneous diseases are very common, and among them, myiasis ranks in the fourth place. Hereby, we present a case of a 28-year-old Taiwanese woman infested by Dermatobia hominis during honeymoon trip to Amazonas region and Peru. The diagnosis was confirmed by extracting the larva intraoperatively. The epidemiology, distinctive life cycle, clinical features, auxiliary diagnostic tools, therapeutic methods, and prophylactic measures of human botfly infestation will be discussed in the article. Owing to the progressive increment of international travels and ecological explorations, raising awareness of tropical diseases should be more emphasized.
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Radix Aucklandiae(dried root of Saussurea costus)-induced acute generalized exanthematous pustulosis confirmed by patch testing p. 98
Po-Han Ho, Yung-Tsu Cho, Chia-Yu Chu
DOI:10.4103/ds.ds_16_18  
A 40-year-old female presented with rapid-onset generalized erythematous eruption with pustules agminated over the flexural areas and the flanks for 2days. In skin histopathology, extensive subcorneal pustules, spongiosis and neutrophilic exocytosis, papillary dermal edema, and perivascular and interstitial mixed-cell infiltrates were observed. No psoriasis history but irregular intake of numerous kinds of Chinese herbal medications and the last-modified regimen including Radix Aucklandiae 14days before the onset of pustular eruption were unveiled. Patch test showed positive result with only Radix Aucklandiae. Thus, acute generalized exanthematous pustulosis induced by Radix Aucklandiae was diagnosed.
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Keratitis-ichthyosis-deafness syndrome with GJB2 mutation manifesting generalized erythematous plaques of porokeratotic eccrine ostial and dermal duct nevus p. 103
Yu-Chen Chen, Julia Yu-Yun Lee, Sheau-Chiou Chao
DOI:10.4103/ds.ds_34_18  
Porokeratotic eccrine ostial and dermal duct nevus or porokeratotic eccrine nevus(PEN) is a rare nevoid condition characterized by asymptomatic spiny, keratotic papules, and plaques in linear distribution along Blaschko's lines on the extremities clinically and discrete vertical cornoid lamellae at eccrine ostia pathologically. Keratitis–ichthyosis–deafness(KID) syndrome manifests generalized erythematous plaques with tiny papules and keratotic spicules. Both rare diseases are associated with mutations of the GJB2 gene encoding for gap junction protein, connexin 26. We present a case of KID syndrome in an 11-year-old boy. The patient presented with bilateral hearing loss, and large erythematous plaques with grained leather-like appearance and occasional keratotic spicules on the face and trunk as well as prominent hyperkeratosis on the acral parts, especially distal digits. Skin biopsy of two skin lesions revealed features of PEN. Mutation analysis of peripheral blood revealed GJB2 c. 263C>T(p.A88V). This is the first report of GJB2 gene mutation in a Taiwanese boy with KID syndrome. The histologic features of PEN in the present case provide additional support that PEN may be part of the manifestation of KID syndrome.
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CORRESPONDENCE Top

Pityriasis rubra pilaris with acantholysis mimicking pemphigus foliaceus: Adiagnostic pitfall p. 106
Teng-Li Lin, Chao-Kuei Juan, Yi-Ju Chen, Chi-Shun Yang, Chien-Shan Chiu
DOI:10.4103/ds.ds_30_18  
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A rare case of degos disease presenting with severe spinal impairment p. 108
Qisi Wu, Gang Yu, Kui Shan, Xinyue Qin
DOI:10.4103/ds.ds_20_18  
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Is the bradycardia caused by cetirizine only or the interaction of escitalopram and cetirizine? p. 110
Hsiu-Hui Chiu, Yi-Chun Yeh, Chieh-Shan Wu
DOI:10.4103/ds.ds_24_18  
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Plasmablastic lymphoma with initial presentation in the skin in an old patient p. 112
Yi-Hsuan Hu, Jen-Yu Wang, Chia-Jui Liu, Yu-Hung Wu
DOI:10.4103/ds.ds_8_18  
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Eruptive disseminated porokeratosis: Arare variant and therapeutic intervention p. 114
Chen-Yu Wu, Hsien-Ching Chiu, Shiou-Hwa Jee
DOI:10.4103/ds.ds_25_18  
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