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   Table of Contents - Current issue
Coverpage
April-June 2020
Volume 38 | Issue 2
Page Nos. 67-130

Online since Friday, May 29, 2020

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ORIGINAL ARTICLES  

A study on the knowledge, attitudes, and practices of Asian dermatologists in the management of atopic dermatitis p. 67
Siqing Ee, Yong-Kwang Tay, Chia-Yu Chu, Kam-Lun Ellis Hon, Kin-Fon Leong, Siriwan Wananukul
DOI:10.4103/ds.ds_31_19  
Background: Atopic dermatitis (AD) is a prevalent skin disease in Asia. Attitudes and practice vary among the Asian cities. Objectives: This study aimed to survey similarities and differences in dermatologists' attitudes and practice in Asian cities. Methods: A questionnaire survey was sent to 118 dermatologists in Singapore, Malaysia, Thailand, Taiwan, and Hong Kong. Results: About 30.8% of respondents from Taiwan and 44.4% of respondents from Hong Kong saw most of their patients presenting with severe AD. This is significantly higher than respondents from Singapore, Malaysia, and Thailand (4%–12%). Majority of the respondents would use topical corticosteroids in infants and children with AD. About 55.6% of the respondents from Hong Kong used topical calcineurin inhibitors in AD, which is a significantly lower than the other countries. Top 3 most prescribed antibiotics in infected AD were cephalexin, cloxacillin, and amoxicillin/clavulanic acid combination. Most respondents used oral corticosteroids in severe AD. Many respondents from Singapore and Malaysia use cyclosporin (70%–92%), azathioprine (80%–100%), and methotrexate (72%–75%). Fewer respondents from Thailand, Taiwan, and Hong Kong used cyclosporin (22.2%–59%), azathioprine (0%–66.7%), and methotrexate (8%–25.6%). A large majority of respondents from Singapore, Taiwan, and Malaysia use phototherapy in management of AD (90%–100%). About 24% of respondents from Thailand and 33.3% of respondents from Hong Kong use phototherapy in AD. Conclusion: Compared to the previous study, there is improvement in the proportion of dermatologists in Asia using topical calcineurin inhibitors and phototherapy. This may signify better access to these treatment modalities throughout the region. Educational programs that allow a patient-centered approach should be recommended as an adjunct to medical therapy. The management of AD among Asians requires a holistic approach while considering accessibility and cultural differences.
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Association of the attachment styles with depression, anxiety, and quality of life in patients with psoriasis p. 81
Onur Okan Demirci, Bilge Ates, Eser Sagaltici, Zehra Gizem Ocak, Ilknur Kivanc Altunay
DOI:10.4103/ds.ds_35_19  
Objectives: This is a cross-sectional study to investigate the attachment styles and their impact on depression, anxiety, and quality of life in people with psoriasis. Methods: All participants completed socio-demographic and illness specific questionnaires along with Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS) and Adult Attachment Style Scale (AASS). 100 individuals with psoriasis and 130 individuals with no dermatological problems participated in the study. Results: HADS scores for depression (38% versus 15.4%, P < .001) and anxiety (28% versus 6.9%, P < .001) were higher in participants with psoriasis compared to the healthy participants in the control group. AASS scores of participants for anxious/ambivalent attachment (13.7±4.0 versus 13.3±3.9, P = .465), secure attachment (15.8±4.4 versus 16.2±3.9, p = .510), and avoidant attachment (11.0±3.6 versus 11.3±3.6, P = .598) did not differ significantly in two groups. There was a significant correlation between DLQI scores and anxious/ambivalent attachment scores of participants with psoriasis (P < .05, r = .222). HADS scores of participants with psoriasis were also found significantly correlated with insecure attachment styles; anxious/ambivalent attachment (depression, P < .001/ anxiety, P < .001), avoidant attachment (depression, p < .001/ anxiety, p < .01). Conclusion: This study demonstrates that there is a relationship between the insecure attachment styles and depression, anxiety and reduced quality of life in people with psoriasis and also support the idea that attachment insecurities can impair the physiological stress response by increasing the perceived stress in these patients.
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Is there a relationship between rosacea with gut dysbiosis? p. 88
Kerem Yilmaz, Mustafa Altindis, Bahar Sevimli Dikicier, Gülcan Yüksekal, Mehmet Köroglu
DOI:10.4103/ds.ds_3_20  
Background: Rosacea is a common chronic inflammatory dermatosis that affects about 10% of the population. Although various environmental stimulants and endogenous factors have been shown to stimulate the innate immune response and abnormal neurovascular signaling in the etiology, the variety of clinical forms leads to a poor understanding of the pathophysiology of rosacea. Objectives: In this study, we aimed to determine the relationship between rosacea disease and the intestinal microbiome. Methods: For this purpose, 20 patients with clinical diagnosis of rosacea in the Education and Research Hospital of Sakarya University and 10 healthy volunteers with age and sex matched to the control group were included. 16s ribosomal RNA sequence and metagenomic analyses were performed from fecal samples. Results: We determined the relationships between various changes in the rosacea clinic and intestinal microbiome. According to the results of metagenomic DNA analysis in rosacea patients according to healthy volunteers, Lachnospira, Lachnoclostridium, Roseburia, and Roseburia intestinalis were found to be higher and Coriobacteriaceae, Ruminococcaceae, Butyricimonas virosa, and Clostridiales bacteria were found to be higher. Conclusion: These differences were thought to be related to indirect dysbiotic pathways with rosacea clinic. Since only one study examining the relationship between rosacea and intestinal microbiome can be reached in the literature, it is needed to have more and more sampling studies in order to make sense of the microorganisms that stand out.
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BRIEF REPORT Top

Dermatoses in children in the Republic of Palau p. 94
Haw-Yueh Thong, Chung-Kuan Wu, Ching-Hwa Lin, Te-Yu Lo, Chieh-Chen Huang
DOI:10.4103/ds.ds_2_20  
The spectrum of dermatoses in the pediatric population of the Republic of Palau is unknown and largely unmentioned in publication. All Palauan pediatric patients who consulted the Shin Kong Medical Assistant Program to Palau dermatology services at Belau National Hospital (BNH) and local dispensaries from 2015 to 2018 were analyzed. The results were classified according to age and sex and also analyzed by region. This population included a total of 155 patients, with 92 girls and 63 boys. Eczema (52.9%), superficial fungal infection (21.93%), and bacterial infection (16.77%) were the most frequent conditions. More than 20% of the patients presented with more than one concurrent skin disease. Among the disease spectrum, the frequency of atopic dermatitis was comparable: 29.1% in girls and 28.6% in boys. Superficial fungal infections were more common in boys, with a frequency of 31.7% as opposed to 15.2% in girls. The results were also analyzed according to region: 123 patients were seen at BNH and 32 patients were seen at the local dispensaries. Bacterial infection was more common at the local dispensaries (37.5%) than at BNH (11.4%). Hereby, we describe the pattern of skin diseases in Palauan children.
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CASE REPORTS Top

A 45-year-old Italian male with p.(Gly1815Ser) FBN1 mutation causing a mild variant of Marfan syndrome: A case study p. 98
Francesca Cortini, Chiara Villa, Barbara Marinelli, Sara Franchetti, Luciano Riboldi, Alessandra Bassotti
DOI:10.4103/ds.ds_16_19  
A 45-year-old Italian male was referred as suspected of having a heritable connective tissue disorders by clinical findings, including joint hyperlaxity and soft, smooth, velvety, and slightly elastic skin. Using a specific custom panel including genes involved in these disorders, next-generation sequencing (NGS) analysis led to the identification of the c. 5443G>A, p.(Gly1815Ser), (rs745680336) variant in fibrillin-1 (FBN1) gene, encoding the FBN1. Mutations in this protein are responsible for different connective tissue disorders, collectively known as type 1 fibrillinopathies, including Marfan syndrome (MFS). Multiple sequencing alignment of human FBN1 protein with various species revealed that the mutation occurred within a highly conserved region of the calcium-binding epidermal growth factor-like domain and affected the protein structure/function, suggesting its pathogenic role. NGS techniques successfully identified the molecular defect in this patient, clinically resembling as MFS, even if a clear genotype–phenotype correlation remains still challenging.
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Nipple adenoma: A report of two cases p. 102
Ting-Ting Yang, Yue-Chiu Su, Cheng-Che E Lan
DOI:10.4103/ds.ds_38_19  
Nipple adenoma is a rare benign tumor of the nipple due to mammary proliferation of the lactiferous ducts. Common presentation of the tumor includes nipple erosion, erythema, scaling, and eczematous change of the overlying skin. Delayed diagnosis is common since its clinical presentation resembles that of other benign or malignant condition of the nipple, such as nipple eczema or Paget's disease. Timely identification with histopathological correlation is essential for appropriate management. We herein describe the clinical and histopathological characteristics of two cases of nipple adenoma.
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Extranodal natural killer/T-cell lymphoma, nasal type, presenting with acneiform eruptions: A previously undescribed variant p. 105
Chen-Pu Yeh, Yun-Wen Chiu, Chih-Chaung Chen, Han-Nan Liu
DOI:10.4103/ds.ds_39_19  
Extranodal natural killer/T-cell lymphoma (ENKTL), nasal type, is an Epstein–Barr virus (EBV)-associated aggressive form of lymphoma that primarily involves areas outside the nasal cavity. Skin is also commonly involved resulting in a variety of skin manifestations. Here, we report an ENKTL, nasal type, in a 29-year-old male with a previously undescribed acneiform presentation. Skin biopsy revealed an angiodestructive, perivascular lymphocytic infiltration, which stained positive for CD3, CD56, and TIA-1 in various proportions. Scattered EBV-infected cells were demonstrated by in situ hybridization. The patient received chemotherapy with almost complete resolution of the skin lesions initially but later experienced flare-ups.
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An unusual localization of neurofibromas in a patient with neurofibromatosis type-1: The great auricular nerve p. 110
Tugba Falay Gur, Sevim Baysak, Mehtap Toprak, Sevil Savas Erdogan, Cüneyt Kara, Bilal Dogan
DOI:10.4103/ds.ds_40_19  
Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder characterized by café au lait macules, axillary freckling, neurofibromas, Lisch nodules, skeletal abnormalities, and a tendency to develop neoplasms. Neurofibromas are benign peripheral nerve sheath tumors that occur commonly in individuals with NF-1. Neurofibromas originating from the vagus nerve and spinal nerves are rarely reported in the literature. Here, we report an interesting case of NF-1 with a striking cutaneous presentation and bilateral localization in the great auricular nerve with bilateral vagal and multiple spinal neurofibromas. This is the first report of an NF-1 case with bilateral symmetric localization in the great auricular nerve.
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CORRESPONDENCE Top

Reactivation of Epstein–Barr virus and cytomegalovirus in patients with psoriasis after ustekinumab treatment p. 113
Chang-Yu Hsieh, Hsien-Yi Chiu, Tuan-Chun Hua, Tsen-Fang Tsai
DOI:10.4103/ds.ds_20_19  
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Melanocytic nevus with amyloid deposit – Report of three cases p. 115
Hsing-San Yang, Chao-Kai Hsu, Cheng-Lin Wu, Julia Yu-Yun Lee
DOI:10.4103/ds.ds_36_19  
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Palmar and lateral digital papules as a distinct feature of fatal anti-melanoma differentiation-associated gene 5 dermatomyositis p. 117
Tzong-Yun Ger, Fang-Ying Wang, Shih-Jyun Yang, Hsi Yen, Chun-Bing Chen
DOI:10.4103/ds.ds_42_19  
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Concomitant development of morphea and lipoatrophy after local corticosteroid injection p. 119
Yang Lo, Shiou-Hwa Jee, Yi-Hua Liao
DOI:10.4103/ds.ds_44_19  
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Primary thin nodular melanoma: An early tumorigenic vertical growth phase melanoma p. 121
Luca Roncati, Francesco Piscioli
DOI:10.4103/ds.ds_45_19  
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Insulin resistance and insulin-like growth factor-1 level in patients with acne: A systematic review and meta-analysis p. 123
Tsung-Yu Tsai, Yuan-Chen Chao, Wei-Ting Chou, Yu-Chen Huang
DOI:10.4103/ds.ds_46_19  
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A case of composite hemangioendothelioma associated with lymphangioma-like feature p. 125
Chao-Yu Liao, Chi-Shun Yang, Juan-Chao Kuei
DOI:10.4103/ds.ds_47_19  
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Serum sickness–like reaction after diphtheria, tetanus, acellular pertussis, inactivated polio and Haemophilus influenzae type b conjugate (5-in-1 vaccine) vaccination: A case report p. 127
Wei-Yu Chen, Sung-Jen Hung
DOI:10.4103/ds.ds_1_20  
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Lupus erythematosus/lichen planus overlap syndrome in a breast cancer patient receiving aromatase inhibitor: A case report and review of the literature p. 129
Hsing-San Yang, Bryan Edgar K Guevara, Kuo-Ting Lee, Cheng-Lin Wu, Julia Yu-Yun Lee, Chao-Kai Hsu
DOI:10.4103/ds.ds_4_20  
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