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   Table of Contents - Current issue
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January-June 2021
Volume 25 | Issue 1
Page Nos. 1-48

Online since Tuesday, May 4, 2021

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REVIEW ARTICLE  

Management of localized juvenile spongiotic gingival hyperplasia: A systematic review p. 1
Hani H Mawardi, Soulafa A Almazrooa, Heba A Turkstani, Razan S Balkhair, Alaa G Almasoudi, Bushra A Bakhamis, Lujain Z Azzouz, Tahani A Alshareef, Soha E Alsulami, Sarah A Alsahafi, Asma A Albarqi
DOI:10.4103/jdds.jdds_8_20  
Background: Localized juvenile spongiotic gingival hyperplasia (LJSGH) is an uncommon condition presenting as a well-circumscribed, papillary, and exophytic red soft-tissue lesion commonly on the gingival margin and attached gingiva with distinctive histological features. Up to date, the exact etiology is yet to be determined, while a reactive nature of the disease was suggested. Purpose: The aim of this systematic review is to investigate various LJSGH treatment options for the best outcome. Methods: A search was conducted using PubMed/Medline and Medscape up to April 2019. All English literature on management of LJSGH was included and systematically reviewed for bias and using different levels of elimination by multiple reviewers. The required data from eligible studies were extracted and analyzed. Results: Twelve articles met the inclusion criteria following the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. In total, 97 cases were treated by surgical excision in which 12 had recurrence within a median follow-up of 29 months. Two cases were treated with cryotherapy, one with photodynamic therapy, and one case with surface cauterization with topical clobetasol all with no reported recurrence. In addition, one case was treated with scaling and chlorhexidine application without significant response. Conclusion: Based on the available evidence, the complete excision of LJSGH using any method may have the most predictable outcome. Further studies are needed to confirm these findings and explore alternative management options.
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ORIGINAL ARTICLES Top

Clinico-epidemiological factors related to lichen planus and its clinical variants at a tertiary care hospital: A descriptive study p. 6
Ankit Gupta, Chitra S Nayak
DOI:10.4103/jdds.jdds_66_19  
Background: Lichen planus (LP) is an immune_mediated, chronic inflammatory disease involving skin, oral and genital mucosa, nails, and hair with several morphologic variants. The exact etiology remains unclear, but several factors have been implicated. Purpose: To study the clinico-epidemiological profile of patients of LP and its clinical variants and to find out whether LP is relatively uncommon in children. Methods: This prospective, cross-sectional, descriptive, time-bound, clinico-epidemiological study was conducted in the outpatient department of dermatology at a tertiary care hospital during the period of June 2017 to October 2018. A total of 170 patients were included in the study. Microsoft Excel and SPSS 23 software packages were used for data entry and statistical analysis. The results were averaged for each parameter for continuous data and numbers and percentage for categorical data. Statistical tests were applied wherever necessary. Results: The overall prevalence of LP was 0.4% (n = 170) out of 42,127 patients who attended the OPD during the study period. The gender-wise prevalence of LP was 41% among females and 59% among males, and the difference was not statistically significant (P = 0.3). The male-to-female ratio was 1.5:1. The highest prevalence among the variants of LP was of classical form (29%) and lowest was of inverse LP (0.6%). Overall, the mean age of the patients was 36 years, with a standard deviation of 17. There was one instance of LP occurring in both father and son. Conclusion: The most common age group of LP was 18 -40 years. Most patients came to seek health care within 1 year of beginning of disease. More than one variant of LP can coexist in the same individual. Childhood LP is not uncommon in the Indian subcontinent.
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A comparative study of therapeutic efficacy of intralesional measles, mumps, and rubella vaccine and intralesional Vitamin D3 in the treatment of recurrent warts p. 14
Shishira R Jartarkar, Manjunath Kadnur, P Mamatha, Swayam S Mishra, B Spoorthy
DOI:10.4103/jdds.jdds_89_20  
Background: Recurrent or resistant warts may be due to defective cell-mediated immune response. Immunotherapy is directed at manipulating the immune system to achieve an anti-human papillomavirus immune reaction. Purpose: Our study compared the safety and efficacy of intralesional measles/mumps/rubella (MMR) vaccine to intralesional Vitamin D3 injection in recurrent warts. Methods: Sixty-six patients were divided into two groups of 33 each. In Group A and B, patients were injected with 0.5 ml of Vitamin D3 and 0.5 ml of MMR vaccine, respectively, intralesionally into the base of the largest wart every 2 weeks until complete clearance or for a maximum of 4 doses. The patients were evaluated for clinical improvement and any adverse effects. Results: Complete clearance of warts was noted in 52% (17) in Group A and in 70% (23) in Group B. Excellent to complete response was noted in 82% (27) in Group A and in 91% (30) in Group B. The clinical improvement noted with intralesional MMR vaccine was not statistically different than with intralesional Vitamin D3 (P > 0.05). Conclusion: Intralesional MMR and Vitamin D3 are promising options for recurrent warts.
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Acral subcorneal hematoma: Additional dermoscopic findings differentiating it from acral melanocytic lesions p. 18
Ahmed H Nassar, Abdullah S Abu-Aliat, Soha A Hawwam
DOI:10.4103/jdds.jdds_63_19  
Background: Acral subcorneal hematoma (ASH) is a dark-colored skin lesion of the palms and/or soles due to bleeding. ASH may be difficult to be clinically differentiated from acral melanocytic lesions, resulting in unnecessary biopsies. Few researches reported the importance of dermoscopy in differentiating ASH from acral melanocytic lesions. Purpose: This study aims at reporting the dermoscopic features in a series of ASH to facilitate precise diagnosis and to avoid performing unnecessary surgical techniques. Methods: Eighteen patients with ASH were studied. Dermoscopic images were obtained using a handheld dermoscope and a dermoscope-adopted phone camera. Paring test was performed on all lesions. Results: The preliminary diagnoses of the lesions were ASH in 55.6%, acral melanocytic nevi in 33.3%, and acral lentiginous melanoma in the remaining 11.1%. Dermoscopically, the lesion colors were red-black in 44.4%, black in 27.8%, and brown in the remaining 27.8%. The pigmentation patterns were homogeneous (structureless) in 55.6%, parallel ridge in 27.8%, and negative pseudonetwork in the remaining 16.6%. Over 44% of the lesions had red and/or brown globular satellites. Peripheral red lines with/without radial extensions were noticed around ASH in 55.6%. Paring led to complete removal of pigmentation in all ASH (100%), with the appearance of post-paring blood-tinged serum in 55.6%. No skin biopsies were performed. Conclusion: Although there is clinical similarity between ASH and acral melanocytic lesions, dermoscopy and paring test can facilitate a precise diagnosis and markedly decrease the need for unnecessary invasive procedures.
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Psychiatric morbidity among dermatology patients: A hospital-based cross-sectional study p. 22
Dasetima D Altraide, Chukwuma U Okeafor, Bolaji I Otike-Odibi
DOI:10.4103/jdds.jdds_41_20  
Background: Increased frequency of psychiatric and emotional health problems has been reported among patients with dermatological lesions. These problems could negatively affect the quality of life of these patients. Purpose: The aim of the study was to evaluate the psychiatric morbidity among dermatology patients. It also sought to determine the relationship between sociodemographic factors and psychiatric morbidity. Methods: This was a cross-sectional study consisting of 90 consenting patients attending the dermatological clinic of University of Port Harcourt Teaching Hospital. These patients filled the study questionnaire which comprised of a sociodemographic questionnaire, general health questionnaire (GHQ-12), and a perceived stigma scale. A GHQ score of ≥ 3 was considered as having psychiatric morbidity. Statistical analysis was performed at the 0.05 significance level. Results: The mean age of the patients was 32 ± 13 years and a male to female ratio of 1:2; 34 of the 90 patients (38%) had psychiatric morbidity. Forty-three (48%) patients had perceived stigma, with mild perceived stigma as the most common category (40%) of perceived stigma. There was no significant relationship between sociodemographic characteristics of the patients and psychiatric morbidity (P > 0.05). Conclusion: Psychiatric morbidity is common among patients with dermatological lesions irrespective of their sociodemographic characteristics. Addressing the psychosocial care of patients who attend the dermatologic outpatient clinic may be helpful.
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Assessment of the knowledge, attitude, and practice of using hair-smoothing products among women in Saudi Arabia p. 26
Fawwaz F Alshammrie, Tamam M Alshammari, Mohammad A Altraifi
DOI:10.4103/jdds.jdds_44_20  
Background: Hair-smoothing products have been developed by the cosmetic industry, targeting the popular desire among women for beautification. The products are also used as a treatment for hair. All hair-smoothing products contain different levels of formaldehyde, which is classified as a carcinogen by the World Health Organization. Purpose: This study aimed to assess the knowledge, attitude, and practice of using hair-smoothing products among women in Saudi Arabia, as well as identifying common side effects of their use. Methods: A cross-sectional study was conducted in 2020 in Saudi Arabia. Self-administered questionnaires were distributed to more than 1600 women, administered in the Arabic language using paper and an online survey. Results: Only 35% of the participants had previously used hair treatments, whereas 24% of the participants identified formaldehyde as a carcinogen. Close to two-thirds (59%) of the participants used hair treatments to facilitate management of their hair. About one-third (35%) of participants read the instructions for hair treatments before their use. The main symptom participants mentioned related to formaldehyde exposure was hair loss (34%). The majority of users (71%) use personal protective equipment during their use of hair-smoothing products. Conclusion: Our study demonstrated low levels of knowledge, a number of misconceptions, and faulty practices. Women must be made aware of the risks of some hair-straightening products that contain large concentrations of formaldehyde exceeding the recommended exposure levels. Therefore, we recommend raising the overall general public knowledge and awareness of hair-straightening products by establishing marketing campaigns and spreading knowledge through social media.
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The use of dermoscopy among dermatologists in Riyadh, Saudi Arabia: A cross-sectional study p. 30
Nouf N Alqahtani, Faten A AlBukhari
DOI:10.4103/jdds.jdds_58_20  
Background: Dermoscopy aids in visualizing skin and has been used commonly by dermatologists around the world. Purpose: The purpose was to estimate the prevalence of dermoscopy usage in Saudi Arabia (SA), to identify the determinants of its use, and to assess the desire of dermatologists to learn more about it. Methods: One hundred questionnaires were distributed to dermatologists practicing in Riyadh; 65 were answered and returned. Results: About 56.9% own a dermatoscope or find it available in their clinics, and 36.9% of them use it regularly. About 67.7% report knowing how to use it, whereas 32.3% do not. The majority (41.5%) learned how to use it clinically by spending time with senior expert dermatologists. About 93.8% find it helpful in diagnosing melanoma and pigmented skin lesions; 81% believe that it is more accurate than the naked eye examination alone. On the other hand, 41.5% find it ineffective mostly because it requires extensive training.Comparing the postgraduate training place of the respondents. Showed no difference in terms of dermoscopy availability P = 0.09, use P = 0.51, or specialized training P = 0.09 between dermatologists currently training or did their training in SA and other dermatologists who trained outside SA. About 8.3% of dermatologists practicing for more than 10 years are using it regularly, in comparison to 91.4% of those who have been practicing for 10 years or less. Conclusion: Age, postgraduate training place, years of practice, and clinical experience are the main factors affecting the use of dermoscopy in SA. The majority of the respondents expressed their desire to expand their knowledge and improve their skills to use dermoscopy more efficiently.
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Hyperpigmentation post laser hair removal in patients taking Vitamin D supplements p. 33
Saad Altalhab, Mohammed I AlJasser, Ziad M Alshaalan, Rima M Ahmad, Leena Alghamdi, Abdulaziz A Alnoshan
DOI:10.4103/jdds.jdds_60_19  
Background: Laser hair removal (LHR) is a common procedure for the removal of unwanted hair. Although it is generally safe, it is associated with some adverse effects including hyperpigmentation. Purpose: In this study, we aimed to assess the prevalence of postlaser hyperpigmentation in patients taking Vitamin D supplements. Methods: This is a cross-sectional study of patients who underwent LHR. Each patient was interviewed and asked about their intake of Vitamin D supplements, and the primary outcome was whether hyperpigmentation was reported after LHR in the past 6 months. LHR treatment details were also documented. Results: A total of 508 patients were included with a mean age of 29 ± 9 years. Post-LHR hyperpigmentation was more prevalent in females and in those taking oral Vitamin D. Multivariate logistic regression analysis showed that Vitamin D intake was independently associated with more risk of hyperpigmentation post LHR (odds ratio [95% confidence interval]; 2.6 [1.17–5.80], P = 0.020). Conclusion: Vitamin D intake may be associated with an increased risk of hyperpigmentation post LHR. Causality cannot be assessed.
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Oral isotretinoin therapy and milia formation in patients with acne vulgaris: A prospective study p. 37
Fahad AlSaif, Abdulrhman AlDakhil, Nourah AlSyefi, AlBatool AlAmari, Ahmad AlAmari, Faisal AlSaif, Hend AlOtaibi, Amal Balbeesi, Nora AlBabtain
DOI:10.4103/jdds.jdds_57_19  
Background: Isotretinoin (13-cis-retinoic acid) is effective in acne treatment. Isotretinoin can cause hair loss, xerosis, cheilitis, and nail changes. Milia is a reported side effect; however, little is known about the relationship between oral isotretinoin and milia formation. Purpose: The objective was to investigate milia as a potential side effect of oral isotretinoin treatment. Methods: Fifty-one patients (male/female: 21/30) aged 18–25 years with moderate-to-severe acne vulgaris were treated with a standard dose of oral isotretinoin 0.5 mg/kg/day and a cumulative dose of 120–150 mg/kg. Clinical assessments of milia were obtained at 0, 2, 4, 6, and 8 months of treatment. Results: None of the patients who received oral isotretinoin therapy developed milia. Conclusion: We found no association between oral isotretinoin at a standard dose of 0.5 mg/kg/day and milia formation in patients with moderate-to-severe acne vulgaris.
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CASE REPORTS Top

Case Report of Oculocerebrocutaneous (Delleman) syndrome and review of cutaneous features p. 39
Maha AlQusayer, Asma Alkheraiji, Mei AlQusayer, Abdullah Alakeel
DOI:10.4103/jdds.jdds_25_20  
Oculocerebrocutaneous syndrome (OCCS) is a rare disorder with specific clinical presentation. It can be diagnosed clinically upon specific dermatological, neurological, and ophthalmological criterion. We present the case of a 5-week-old baby boy with OCCS syndrome, highlighting its dermatological manifestations and a review of skin features as well. The patient presented with a unilateral microphthalmia with orbital cysts, postauricular crescent-shaped skin defect, and pedunculated skin appendages with multiple focal hypoplastic skin lesions. Early diagnoses and long-term follow-up may improve the prognosis of such a rare disease.
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Pachydermodactyly: Case Report p. 42
Jumana Aldhalaan, Ruaa Alharithy
DOI:10.4103/jdds.jdds_67_19  
Pachydermodactyly (PDD) is a rare benign form of digital fibromatosis characterized by a progressive painless fusiform swelling of the periarticular soft tissue, surrounding the dorsolateral aspects of the proximal interphalangeal joint. PDD most commonly affects young adolescent males and is frequently unrecognized and misdiagnosed as inflammatory arthritis. In this report, we present a 17-year-old male with a 1-year history of progressive finger swelling in both of his hands diagnosed as PDD. We also highlight PDD's clinical and histologic features with the aim to enhance physician's awareness of this benign condition to cut unnecessary diagnostic tests and interventions.
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Hydroxyurea-induced azure lunula: Case Report p. 44
Sejal Chandak, Bhushan Madke, Sugat Jawade, Adarshlata Singh
DOI:10.4103/jdds.jdds_14_20  
Alteration in the color of the lunula can either be due to a cutaneous or systemic disorder or may be due to a drug effect. Azure or blue lunula is a disorder of pigmentation of nail lunula. This bluish discoloration was noted in fingernails of both hands and great toes. Hereby, we report a case of azure lunula in a child with sickle cell disease receiving oral hydroxyurea 500 mg daily.
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Dowling–Degos disease: A case report of a follicular variant p. 46
Khalid Al Hawsawi, Rehab Aser, Zaker Khoj, Ghassan Barnawi, Waseem Alhawsawi
DOI:10.4103/jdds.jdds_32_20  
Dowling–Degos disease (DDD) is an uncommon autosomal dominant genodermatosis characterized by reticular hyperpigmentation in the intertriginous areas. Herein, we report a case of follicular DDD which is a very rare variant of DDD. A 45-year-old healthy male presented with 1-year-history of asymptomatic slowly progressive skin lesions in the axillae. Skin examination revealed multiple nonscaly pigmented follicular papules and macules in both axillae but more severe in the right side. No other skin lesions elsewhere in the body. Hair, nails, and mucus membrane were all normal. Skin biopsy showed follicular plugging with the presence of pigmented filiform rete ridges originating from the follicular epithelium. The patient was diagnosed as follicular DDD. The patient was reassured. Electrocautery treatment was used, which leads to a remarkable improvement of the lesions.
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