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   Table of Contents - Current issue
Coverpage
January-March 2020
Volume 38 | Issue 1
Page Nos. 1-66

Online since Thursday, February 27, 2020

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EDITORIAL  

Role of dermatologists in the uprising of the novel corona virus (COVID-19): Perspectives and opportunities Highly accessed article p. 1
Chih-Hung Lee
DOI:10.4103/ds.ds_5_20  
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ORIGINAL ARTICLES Top

Efficacy and safety of tofacitinib therapy in Asian patients with severe alopecia areata p. 3
Ying-Xiu Dai, Chen-Pu Yeh, Chih-Chiang Chen
DOI:10.4103/ds.ds_26_19  
Background: Patients with severe alopecia areata (AA), including alopecia totalis (AT) and alopecia universalis (AU), are usually resistant to treatment. While tofacitinib is emerging as a promising therapy for severe AA, little is known about its efficacy and safety in Asians. Objectives: To evaluate the efficacy and safety of tofacitinib for treating severe AA. Methods: We included patients with ≥50% scalp hair loss, disease for ≥6 months, and tofacitinib therapy for ≥4 months. The efficacy, evaluated based on the percent change in severity of alopecia tool (SALT) score, and response time, defined as time from baseline to reach >50% improvement in SALT score, were assessed. Results: We included 35 patients (21 with AA, 3 with AT, and 11 with AU). There were 18 men and 17 women (median age: 39 [range: 12–68] years). After 4–24 months of treatment, 74.3% showed clinical response, with 51.4% of the patients achieving ≥50% hair regrowth. Patients with AA showed higher percent change in SALT score than patients with AT/AU (median [interquartile range]: 60.7% [0–98.2] vs. 41.1% [8.9–98.7], P = 0.047). Initial SALT score was negatively associated with the latest percent change in SALT score (P = 0.025). Duration of disease and current episode were positively associated with response time to tofacitinib (P = 0.018 and 0.026, respectively). Patients tolerated tofacitinib well without serious adverse events. Conclusion: Tofacitinib effectively promoted hair regrowth in Asian patients with severe AA. Randomized controlled trials with larger sample size are needed to confirm the long-term efficacy and safety of tofacitinib for treating severe AA.
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ORIGINAL ARTICLES Top

Evaluation of problematic Internet usage, characteristics of Internet usage, and other related psychiatric factors in adolescents with acne p. 9
Evrim Aktepe, Ijlal Erturan, Adem Isik
DOI:10.4103/ds.ds_21_19  
Background: Adolescents are psychologically more unstable and are at risk for acne and problematic Internet usage (PIU). Objectives: We aimed to evaluate PIU and characteristics of Internet usage in adolescents with acne and compared it with a control group. In addition, the relationship between psychiatric variables and problematic Internet use was examined. Methods: The study included 93 adolescents with acne and 93 healthy adolescents who were matched for age, sex, and educational level. Information forms on Internet usage characteristics, PIU Scale-Adolescent, Satisfaction with Life Scale, University of California, Los Angeles-Loneliness Scale short form, and Social Anxiety Scale for Adolescents were applied to the case and control groups. In addition, a global acne grading system and Acne Quality of Life Scale were applied to the case group. Results: PIU, duration of daily Internet usage, and membership of social sharing sites were higher in adolescents with acne than the control group. Decreased quality of life, decreased satisfaction with life levels, and increased social anxiety/loneliness levels were observed in adolescents with acne. In addition, it was determined that life satisfaction of adolescents with acne decreased at par with their quality of life; moreover, increases in the level of loneliness/social anxiety were accompanied by increases in PIU. Conclusion: The negative impact of acne on the quality of life, satisfaction with life, loneliness, and social anxiety may lead to the transition of adolescents with acne to PIU.
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ORIGINAL ARTICLES Top

Is rosacea a risk factor for cancer: A population-based cohort study in Taiwan p. 15
Tsung-Hsien Chang, Hsiu J Ho, Yun-Ting Chang, Chung-Pin Li, Chun-Ying Wu, Chen-Yi Wu
DOI:10.4103/ds.ds_30_19  
Background: Rosacea is a chronic inflammatory skin disease with mounting evidence associating it with systemic disorders. Cancer, induced or facilitated by chronic inflammatory microenvironment, shares common pathogenic mechanisms with rosacea. Objectives: We performed a population-based cohort study to investigate the risk of developing cancer among people with rosacea in Taiwan. Methods: A total of 65,526 patients with rosacea and 262,104 age-, sex-, and comorbidity-matched controls were identified from the Taiwan's National Health Insurance Research Database between 1997 and 2013. All participants were followed up for 2–12 years. Incidence rates (IRs) of overall and specific types of cancer were calculated. Cumulative incidences of cancer were compared between the two cohorts by Kaplan–Meier method and modified log-rank test. Hazard ratios (HRs) adjusted for age, sex, and comorbidities for overall and specific malignancies were estimated using subdistribution proportional hazard models. Results: The IR (per 1000 person-years) of cancer was 2.83 in patients with rosacea and 3.00 in controls. There was no difference in cumulative incidence of cancer between patients with or without rosacea (P = 0.109). The risk of developing cancer did not increase among patients with rosacea (HR = 1.04; 95% confidence interval = 0.98–1.11). In addition, patients with rosacea did not have a significantly increased risk of developing any specific type of cancer. Conclusion: We found no association between rosacea and malignancy. These results did not agree with those reported in previous studies. Further research should be conducted to clarify the association between rosacea and cancer, especially focusing on the pathophysiology.
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Association of psoriasis with asthma: A systematic review and meta-analysis of observational studies p. 22
Tien-Pei Fang, Yu-Ching Lin, Ching-Chi Chi
DOI:10.4103/ds.ds_33_19  
Background: Psoriasis is a chronic inflammatory skin disease that has been associated with various inflammatory comorbidities such as cardiovascular disease and uveitis. Asthma involves inflammation of the airway. The two diseases share cytokine-mediated inflammatory mechanisms. Objectives: The main objective of the study was to examine the association of psoriasis with asthma. Methods: We conducted a systematic review and meta-analysis of observational studies that examined the association of psoriasis with asthma. We searched MEDLINE, Embase, and CENTRAL from inception to May 2, 2019 for relevant case–control, cross-sectional, or cohort studies. The risk of bias of included studies was assessed by using the Newcastle–Ottawa Scale. The random-effects model meta-analysis was used to calculate the odds ratio (OR) for case–control/cross-sectional studies and hazard ratio (HR) for cohort studies. Results: We included six case–control/cross-sectional (one case–control and five cross-sectional studies) and one cohort studies. Three studies were rated with a high risk of bias in case definition, representativeness of the cases, selection of controls, definition of controls, and ascertainment of exposure. Psoriasis was associated with significantly increased odds (OR 1.29; 95% confidence interval [CI] 1.20-'1.37) and risk (HR 1.38; 95% CI 1.23-'1.54) for asthma. A subgroup analysis revealed increased odds for asthma in both pediatric and adult patients with psoriasis (pooled OR being 1.24 [95% CI 1.10-'1.41] and OR 1.38 [95% CI 1.27-'1.50], respectively). Conclusion: The current evidence indicates a significant association of psoriasis with asthma. When psoriasis patients present with respiratory symptoms for shortness of breath, wheezing, and chest tightness, referral to pulmonologist may be considered.
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REVIEW ARTICLE Top

Social media use in dermatology p. 28
Melissa R Laughter, Tessa Zangara, Mayra B. C. Maymone, Chandler W Rundle, Cory A Dunnick, Jeremy M Hugh, Mona Sadeghpour, Robert P Dellavalle
DOI:10.4103/ds.ds_43_19  
Social media provides a readily accessible means to promote user-generated content, broaden interpersonal connections, and encourage social collaboration. In this paper, we will review the use of popular social media platforms within dermatology along with the potential benefits and harms of these platforms when used by dermatology providers and their patients. Social media has also found a place in medicine and presents new opportunities and challenges for health care professionals. In dermatology specifically, social media has become a platform for patient education, public outreach, and professional development and networking. Although there are many risks associated with social media use in dermatology, there is also opportunity to promote public health, patient education, and professional interactions.
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BRIEF REPORT Top

Personal experience and knowledge about psoriasis reduce misconceptions and discriminatory behavior toward people living with psoriasis in Malaysia p. 35
Shin Shen Yong, Leng Leng Tan, Chin Chwen Ch'ng, Fariz Yahya, Say Lee Pok, Pei Ying Ch'ng, Wee Meng Ong, Kelvin Shenq Woei Siew, Irdina Aminuddin, Lay Sim Ong, Audrey Ying Shin Lee, Lina Yusrina Iskandar Zulkarnain, Nurul Hazirah Mohd Hanafiah, Dina Suraya Mustafa Rawther, Jia Jie Chong, Li Sean Saw, Maw Pin Tan, Zhenli Kwan
DOI:10.4103/ds.ds_27_19  
Stigmatization and social anxiety affecting people living with psoriasis have been associated with poorer quality of life and psychological comorbidities. We conducted a survey among 164 individuals to evaluate misconceptions, discriminatory behavior, and prejudices toward people with psoriasis. At least one misconception was recorded in 64.6% (n = 106) of respondents. About 86.0% (n = 141) reported one or more discriminatory practices and 73.2% (n = 120) reported one or more prejudices. Misconceptions toward psoriasis were associated with an increase in likelihood of prejudicial attitudes. This is influenced by age and education. Future studies should explore whether educating the existing population can reduce prejudice.
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CASE REPORTS Top

Eruptive tumor of the follicular infundibulum with unusual clinical presentation: A case report and literature review p. 39
Szu-Yun Fang, Chien-Hui Hong
DOI:10.4103/ds.ds_37_19  
Eruptive tumor of the follicular infundibulum (TFI) is an extremely rare benign neoplasm that usually presents as asymptomatic multiple hypopigmented macules symmetrically distributed on the head, neck, and upper trunk. Herein, we report a case of eruptive TFI presenting as hypopigmented macules with central and slightly elevated erythematous papules at rarely involved locations of the four extremities, which has not been reported previously. The pathology showed characteristic features that were conclusive of the diagnosis of eruptive TFI. Because hypopigmentation is a common clinical manifestation and malignant transformation is possible with eruptive TFI, correct early diagnosis, and regular follow-ups are recommended.
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Onychocytic matricoma: Report of two cases and review of literature p. 43
Yun-Ju Tsai, Wei-Hsin Wu, Yi-Hua Liao
DOI:10.4103/ds.ds_25_19  
Onychocytic matricoma (OCM) is a benign epithelial acanthoma derived from the nail matrix. It is a rare and relatively new disease of the nail first described in 2012, with only 14 cases published in English literature so far. Here, we reported the first two cases of OCM in Taiwan, presenting as longitudinal streaks of nail thickening with yellowish-white discoloration and various amount of splinter hemorrhages. A brief introduction of the pathological characteristics of various subtypes and clinical differential diagnoses were provided through literature review. OCM should be included among the differential diagnoses of longitudinal pachymelanonychia or xantholeucopachyonychia.
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Linear immunoglobulin A bullous dermatosis with severe ocular sequela p. 48
Meng-Han Shen, Wen-Hung Chung, Tseng-Tong Kuo
DOI:10.4103/ds.ds_24_19  
Linear immunoglobulin A bullous dermatosis is a rare autoimmune disease with a good response to dapsone. We present the case of a female patient who was diagnosed with bullous pemphigoid and initially treated with systemic steroids; however, a poor response to the medication led to treatment discontinuation and loss to follow-up. The patient had lost vision in the left eye 2 years before this study and recently experienced decreased vision in the right eye.
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Improved therapeutic response to biologic treatment after bariatric surgery: Experience from an obese patient with psoriasis p. 51
Yang-Yi Chen, Cheng-Che E Lan
DOI:10.4103/ds.ds_19_19  
Psoriasis is an inflammatory skin disease with a well-established link to obesity. Excess body weight is associated with higher psoriasis severity. Besides, obesity reduces the effectiveness of systemic therapy. Herein, we reported a morbidly obese patient with severe psoriasis who had only partial response to adalimumab, achieved satisfactory clearance of psoriatic lesions after bariatric surgery in combination with adalimumab therapy. Since bariatric surgery is effective for reducing weight as well as improving psoriasis severity, morbidly obese psoriasis patients who failed noninvasive weight reduction strategies may consider bariatric surgery as a potential adjuvant treatment.
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Bullous lichen planus-like reactions in a patient with renal cancer after receiving anti-programmed cell death-1 therapy p. 55
Hua-Ching Chang, Yin-Shuo Chang, Hsin-Lun Lee, Ming-Hsiu Lin
DOI:10.4103/ds.ds_17_19  
Anti-programmed cell death 1 (anti-PD-1) agent is a promise in cancer immunotherapy for various advanced malignancies, but dermatologic toxicities are common during therapy. We report one advanced transitional cell carcinoma patient who developed multiple bullous skin lesions over bilateral lower extremities after anti-PD-1 antibody pembrolizumab treatment. Skin biopsy revealed subepidermal cleft, wedge-shaped hypergranulosis, saw-tooth acanthosis, and presence of interface band-like lymphohistiocytic infiltrate compatible with bullous lichen planus-like reactions. Potent topical steroid and temporary cessation of pembrolizumab relieved the skin eruptions. Early recognition and appropriate management of rare bullous dermatologic toxicities are critical in patients receiving immune checkpoint blockade therapy.
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Dermoscopic changes of facial melanocytic nevi in Asian skin following laser treatment p. 59
Mao-Ying Lin, Chrang-Shi Lin, Wen-Hung Chung, Sindy Hu
DOI:10.4103/ds.ds_41_19  
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Incidental extraction of susuk: The unspoken talisman and a literature review p. 61
Donald Liu, Tzu-Yu Weng, Woan-Ruoh Lee, Szu-Ying Chin, Hsin-Yi Lin
DOI:10.4103/ds.ds_32_19  
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Panhypopituitarism induced by ipilimumab p. 63
Miyu Shiratori, Toshiyuki Ozawa, Daichi Miyaoka, Yasuo Imanishi, Daisuke Tsuruta
DOI:10.4103/ds.ds_28_19  
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Discoid lupus erythematosus in a welder p. 65
Yuka Hanami, Toshiyuki Yamamoto
DOI:10.4103/ds.ds_18_19  
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