Indian Journal of Paediatric Dermatology (Indian J Paediatr Dermatol)

CME ARTICLE
	Atopic dermatitis: Update on comorbidities and therapeutic advances	p. 1
	Katie Kim, Caitlin Crimp, Robert Sidbury DOI:10.4103/ijpd.IJPD_92_18   Atopic dermatitis (AD) is a chronic inflammatory disorder that primarily affects the skin. Recent literature has expanded our knowledge of associated comorbidities. In this review, we will discuss sleep loss, attention deficit hyperactivity disorder, obesity, and anemia as they relate to AD. We will also review two recently approved medications and how they fit into the therapeutic ladder.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
REVIEW ARTICLES
	Evolution of pediatric dermatology in India: A medico-historical overview	p. 5
	Amiya Kumar Mukhopadhyay DOI:10.4103/ijpd.IJPD_46_18   Pediatric dermatology is a newly emerging branch of dermatology dealing with pediatric dermatoses. It was "officially" born in 1972 when the first International Symposium of Pediatric Dermatology was held in Mexico City. Historically, in India, a well-established branch of medicine, Kaumarabhritya (pediatrics) exists since ancient times. The Unani and the Western system were introduced in the country in later days and enriched the medical system of the country. They served pediatric patients with their own methods. The activity to establish modern pediatric dermatology began in recent years. In the year 1996, the Indian Society for Pediatric Dermatology was formed to establish a platform for the further advancement of the subject. The Indian Journal of Pediatric Dermatology has served the purpose of publishing modern research on pediatric dermatology in India and abroad since 1998. The present article is a review of history and evolution of pediatric dermatology in India since ancient time.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	Leprosy in children	p. 12
	Tarun Narang, Bhushan Kumar DOI:10.4103/ijpd.IJPD_108_18   Children are believed to be the most vulnerable group to infection with Mycobacterium leprae due to their immature or nascent immunity and exposure to intrafamilial contacts. The child proportion among newly detected cases of leprosy is a strong indicator of continued transmission of the disease and one of the main targets of the current World Health Organization strategy is "to reduce transmission of the disease and reduction of grade-2 disability among new child cases." Despite an effective treatment and global achievement of leprosy elimination, the childhood leprosy proportion has not improved significantly. Leprosy in children does not just affect a child's health like other diseases; they can be stigmatized, bullied, and shunned for their lives. Hence, effective planning to bring down the incidence of leprosy and its complications in children should become a top priority. Regular school surveys and annual contact surveys for early detection of cases is therefore an important tool in achieving the goal of elimination of leprosy. In addition to continuing to administer multidrug therapy to patients, new preventive approaches need to be considered to break the chain of transmission and reach zero disease status.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
ORIGINAL ARTICLES
	Association of early-onset androgenetic alopecia with metabolic syndrome: A case–control study on 46 patients in a tertiary care hospital in South India	p. 25
	K C Dharam Kumar, Yadalla Hari Kishan Kumar, Vivekananda Neladimmanahally DOI:10.4103/ijpd.IJPD_127_17   Background: Androgenetic alopecia (AGA) has a significant psychosocial impact on the patient, especially early-onset AGA patients. The severity and prevalence increase with age in all races worldwide. "Metabolic syndrome" (MetS) is a combination of risk factors of cardiovascular and diabetes-related parameters. Aim of the Study: The aim of the study is to study the association of early-onset AGA with MetS. Materials and Methods:A case–control study was done in a tertiary care hospital, Bengaluru, from December 2015 to November 2016 with 46 cases and controls in the age group of 20–30 years. The Norwood–Hamilton classification was used to grade the AGA patients. Diagnosis of MetS was done based on the national cholesterol education program adult treatment Panel III. Independent t-test will be used as a test of significance. Categorical data were assessed using Chi-square test of significance. Value of P < 0.05 was considered to be statistically significant. Results:MetS was seen in 39.13% of cases and 4.35% of controls (P < 0.001) which was statistically significant. The mean systolic blood pressure (P = 0.017 and P < 0.05) was statistically significant when compared to healthy controls. However, no statistically significant values were seen in the mean values of other parameters. Conclusion: A higher prevalence of MetS was seen in early-onset AGA. Early screening for MetS is important in patients with early-onset AGA to minimize the complications in the future.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	Adapalene in the management of warts in pediatric population	p. 29
	Mrinal Gupta DOI:10.4103/ijpd.IJPD_76_18   Introduction: Warts are a common skin infection caused by human papillomavirus. Although any age group can be affected, plane warts and verruca vulgaris occur mostly in children and young adults. A large number of treatment modalities are available which include electrodessication, cryotherapy, topical imiquimod, tretinoin, and phenol application but most of these are not well tolerated by children owing to irritation or painful nature. Adapalene is a retinoid derivative with lesser irritant potential than tretinoin which has been tried in the management of warts. Aims: We carried out this study to assess the safety and efficacy of adapalene in the management of warts in the pediatric population. Materials and Methods: It was a prospective study carried out over a period of one and a ½ year where 50 patients in the age group of 3–18 years with different types of warts were included. After taking an informed consent from the attendants/parents of the patients, they were treated with topical bedtime application of adapalene 0.1% gel and were followed up every month for 3 months to assess the response. Exclusion criteria were extensive lesions, lesions on genitalia, eyelid involvement, secondary infection, or patients on any immunosuppressive therapies. Results: Out of 50 patients, 44 patients (M:F 25:19) completed the study. The age of patients varied from 3 to 18 years with a mean age of 11.3 ± 4.6 years. The most common type of warts in our study were plane warts in 61.36% (n = 27), followed by verruca vulgaris in 27.27% (n = 12) and plantar warts in 11.36% (n = 5). After 3 months of therapy, complete clearance of lesions was observed in 59.09% (n = 26) patients, partial clearance in 25% (n = 11) whereas no response was seen in 15.9% (n = 7) patients. Adverse effects in the form of erythema, irritation, and dryness were observed in six patients (13.64%). Conclusions: Adapalene can be used a safe and effective treatment modality in the management of plane and common warts especially in the pediatric age group.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	Evaluation of vitamin D in pediatric alopecia areata: A case–control study of thirty patients in a tertiary care hospital	p. 32
	Harsha Siddappa, Yadalla Hari Kishan Kumar, Vivekananda Neladimmanahally DOI:10.4103/ijpd.IJPD_83_18   Background: Alopecia areata is a common form of autoimmune, non-scarring alopecia and about one-third of cases affect people aged below 18 years. Alopecia in pediatric age group can cause psychological stress to parents and patients. Vitamin D plays a role in immune regulation and maintenance of hair cycle. Aims and Objectives: To evaluate serum vitamin D levels in pediatric alopecia areata cases. Methods: A comparative case-control study with 30 cases of pediatric alopecia areata and 30 age and sex matched healthy controls was conducted between Feb 2015 to July 2015. All subjects underwent complete evaluation and laboratory investigations including serum vitamin D was done. Results: Mean serum vitamin D level of pediatric alopecia areata cases (17.21±6.57 ng/ml) was significantly lower when compared to controls (25.03±13.84 ng/ml) (P < 0.05). Distribution of vitamin D deficiency was significantly higher in cases (73%) when compared to controls (46%) (P < 0.05). There was a significant inverse correlation between SALT scores of cases and their serum vitamin D levels (P < 0.05). Conclusions: There was decreased vitamin D levels observed in cases suggesting a possible role of vitamin D in alopecia areata and treating the deficiency may prevent the chronicity of the disease in children.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	A study of neonatal dermatoses in a tertiary care center	p. 36
	Vishalakshi S Pandit, K Udaya DOI:10.4103/ijpd.IJPD_49_18   Background: Neonatal dermatoses by definition encompass the spectrum of cutaneous disorders that arise during the 1st 4 weeks of life. The appreciation of normal phenomena and their differentiation from the more significant cutaneous disorders of the newborn is critical for the dermatologists and pediatricians. Aims and Objectives: The aim of the study is to estimate the prevalence of various neonatal dermatoses and identify varying patterns of various physiological and pathological dermatoses. Materials and Methods: This was a hospital-based, cross-sectional study conducted during a period of 6 months. A total of 150 neonates were examined and data were collected, and results were analyzed statistically. Results: Out of 150 neonates, 147 (98%) had cutaneous lesions. Among them, 79 (52.6%) were male and rest were female. Of these, 112 (74.6%) weighed between 2.5 and 4 kg, 35 (23.3%) <2.5 kg, and 3 (2%) >4 kg. Physiological skin lesions were most common features seen in 148 (98.6%), followed by birthmarks 46 (31.3%), transient noninfectious lesions 35 (23.3%), inflammatory eruptions 13 (8.6%), and infections 7 (4.6%). Conclusions: A good knowledge of neonatal dermatoses is necessary for the treating dermatologists and pediatricians as many of cutaneous conditions are transient, appearing in the 1st few days to weeks of life, only to disappear shortly thereafter. However, their occurrence makes the parents worrisome. Proper diagnosis of the conditions helps in relieving the anxiety of parents and caregivers.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	A controlled crossover study to assess the role of dietary eliminations in reducing the severity of atopic dermatitis in children	p. 41
	Pretty Mathew, Rajiv Sridharan, Thyvalappil Anoop, Ajayakumar Sreenivasan DOI:10.4103/ijpd.IJPD_20_18   Background: In the pathogenesis of atopic dermatitis (AD), immune sensitization to food-derived allergens has a role. However, the evidence of allergen sensitization is not a proof of clinically relevant allergy and it has to be confirmed by food challenges so that unnecessary food restrictions in growing children can be avoided. Aims and Objectives: This study was conducted to assess the clinical severity of AD in children after certain dietary modifications and to correlate absolute eosinophil count (AEC) with dietary modification. Materials and Methods: A total of thirty AD children were enrolled randomly into a trial period of egg and cow's milk exclusion diet or control period of egg and cow's milk inclusion diet of 3 weeks. At the end of 3 weeks, patients resumed their normal diet to minimize any carryover effect for next 3 weeks. In the last 3 weeks, the trial and the control groups were crossed over. Patients were assessed at baseline and at the end of each 3-week period using SCORing AD (SCORAD) index and AEC. The data were analyzed using paired t-test. Results: The mean SCORAD at the end of control and trial period was 18.3 and 14.3, respectively, with a mean difference of 3.4, which is statistically not significant (P = 0.165). The mean AEC at the end of control and trial period was 836.5 and 799.6, respectively, the reduction being statistically not significant. Conclusion: Our study could not confirm the beneficial effects of an allergen avoidance diet in AD. We propose that dietary elimination advices should be given only to patients with a definite history of food-induced exacerbations of the disease.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	Dermoscopic study of scabies in children	p. 46
	Shilpitha Srinivas, Kallappa C Herakal, Srinivasa Krishnamurthy Murthy, Shwetha Suryanarayan DOI:10.4103/ijpd.IJPD_25_18   Background: Dermoscopy is a technique involving the rapid and magnified observation of the skin. Infection with Sarcoptes scabiei in children usually presents with pruritus. Primary scabetic lesions consist of small, erythematous papules, and burrows. The definitive diagnosis of scabies is by visualizing the mites, eggs, or feces under the microscope. Aims and Objectives: The aim of the study was to compare the diagnosis of scabies in children with naked eye examination and a dermoscope. The objective was to find out if there was a significant difference between the two methods of diagnosis of scabies. Subjects and Methods: A cross-sectional study was done. Fifty children aged between 1–15 years with symptoms clinically suspicious of scabies from May 15, 2016 to May 14, 2017 were taken. Thirty were male and 20 were female. After taking history, the lesions were examined clinically and with Dermalite DL4 and photographs were taken. A triangular structure with a furrowing burrow was considered to indicate the presence of a mite. Results: Among 50 children, 37 children had clinical features of scabies: the presence of burrows and scabetic nodules. Among 50, 45 children had dermoscopic features of scabies: the presence of the delta glider sign. The data were analyzed using Z- test using MS Excel 2010. There was a significant difference (P < 0.03) on comparing the number of children diagnosed with scabies with naked eye and dermoscopic examination. Conclusion: A handheld dermoscope can be a useful tool to rapidly and non invasively diagnose scabies with high sensitivity compared to Clinical Examination.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	Clinicoepidemiological study of dermatophyte infections in pediatric age group at a tertiary hospital in Karnataka	p. 52
	Sneha Gandhi, Suma Patil, Somnath Patil, Ambresh Badad DOI:10.4103/ijpd.IJPD_35_18   Background: The incidence of fungal infections is increasing at an alarming rate, presenting an enormous challenge to healthcare professionals. Apart from the resistance of the causative organisms, there are many modifiable environmental factors contributing to this sudden pandemic. The prevalence of the disease and the associated environmental factors need to be evaluated further. Aims and Objectives: The aim of this study was to ascertain the epidemiological features of dermatophyte infection in children such as its incidence, clinical presentation, knowledge regarding over-the-counter drugs, compliance to therapy, and steroid abuse among others. Subjects and Methods: All children with dermatophytic infections up to the age group of 18 years were studied for the pattern of infection and various environmental associations. Results: The prevalence rate of pediatric dermatophyte infection was found to be 19% and was mostly seen in the age group of 10–14 years, with a male-to-female ratio of 1.27:1. About 72% of patients belonged to a rural background, and 64% were from a low socioeconomic background. Among the environmental factors, 83% of patients reported contact history with an affected family member, 55% reported joint family setup, and 81% of patients were found to maintain poor personal hygiene. Tinea corporis was the most common clinical variant of dermatophyte infection (45%). Nearly 58% of patients had been treated by unqualified personnel before visiting our hospital, and 51% had applied steroids. Out of 17% patients who had been prescribed anti-fungals only 8% received accurate dose and duration related treatment; while none of them completed their prescribed course before visiting our hospital. Conclusions: This study attempts to highlight the clinicoepidemiological features of dermatophytic infections and the various social and environmental factors associated with it.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
CASE REPORTS
	Rapidly involuting congenital hemangioma with complete resolution In Utero	p. 57
	Sabitha Lakshminarayanan DOI:10.4103/ijpd.IJPD_122_17   There are three types of congenital hemangioma - rapidly involuting congenital hemangioma (RICH), partially involuting congenital hemangioma, and noninvoluting congenital hemangioma. We report a case of RICH on the back of a 4-month-old Caucasian male infant, based on ultrasound and magnetic resonance imaging findings in the antenatal period, skin changes at birth, and a normal ultrasound after birth. He was born with an atrophic plaque at the site of the vascular swelling depicted on the scans, suggesting the complete involution of the lesion in the antenatal period.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	Zosteriform idiopathic atrophoderma of Pasini and Pierini	p. 60
	Tasleem Arif DOI:10.4103/ijpd.IJPD_85_18   Idiopathic atrophoderma of Pasini and Pierini (IAPP) is a rare disease of unknown etiology characterized by well-defined atrophic plaques with a "cliff-drop" border that show no signs of inflammation, sclerosis, and induration. The trunk is most commonly affected site. It usually affects the body in a bilaterally symmetrical distribution, although asymmetric involvement has also been reported. Very few cases occurring in a zosteriform distribution have been reported. In this article, the author reports a rare case of IAPP in an 18-year-old male where the lesions are distributed in a zosteriform distribution on the trunk.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	Hyaline fibromatoses syndrome: A rare entity	p. 64
	Resham Vasani, Deepak Parikh DOI:10.4103/ijpd.IJPD_31_18   Hyaline fibromatoses syndrome is a rare autosomal recessive disorder with very few cases reported from India till date. It is characterized by the deposition of amorphous hyaline material in the skin, bones, and viscera. It represents a disease spectrum with infantile systemic hyalinosis as the most severe form and juvenile hyaline fibromatoses (JHF) being the mild form. These conditions characteristically present with overlapping clinical features such as nodules and/or pearly papules, gingival hyperplasia, flexion contractures of the joints, and osteolytic bone defects. Identification of this condition by the treating dermatologist is important to facilitate an early diagnosis and a multidisciplinary follow-up. We report one such case of this uncommon condition– JHF.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	Pebbled skin over axilla and umbilicus	p. 68
	Ankita Agrawal, Yogesh Kalyanpad DOI:10.4103/ijpd.IJPD_58_18   Pseudoxanthoma elasticum or Grönblad–Strandberg syndrome is characterized by progressive calcification and degeneration of the elastic fibers throughout the body. They are noted in the second or third decade and comprise flat-topped, discrete-to-confluent yellowish papules in a linear or reticular pattern over flexures, and periumbilical skin giving a "cobblestone," "plucked chicken skin," or "Moroccan leather" appearance. We report a case of 13-year-old-child with yellowish pebbled skin over axilla and umbilicus. Angioid streaks were present on ophthalmological examination. On histopathology, fragmented and curled fibers were present in the dermis giving ravelled wool appearance. Von Kossa and Verhoeff-van gieson stain fibers stains showed calcified and fragmented elastic fibers in the mid-dermis.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	Zinser–Engmann–Cole syndrome: Two case report	p. 71
	Bangaru Hanumaiah, Sathish Shankar, Nanjunda Swamy B Lingaiah DOI:10.4103/ijpd.IJPD_41_18   We report two cases of dyskeratosis congenita. Case 1: An 11-year-old male child presented to us with severe anemia and pancytopenia resulting in cardiac failure, in addition to the classical clinical triad including skin atrophy with mottled pigmentation, nail dystrophy, and oral leukoplakia; he also had palmoplantar keratoderma, adermatoglyphia, mucosal involvement resulting in epiphora, and urethral stricture. Urethral involvement is usually a rare presentation. Case 2: A 5-year-old female child presented with mottled pigmentation, oral leukoplakia, palmoplantar keratoderma with adermatoglyphia, delayed milestones, mental retardation, repeated skin and pulmonary infections, and dental caries along with anemia. In addition, the child had meningocoele which is so far not reported. It is very important to have high index of suspicion about cutaneous markers of dyskeratosis congenita, and its early diagnosis helps to prevent life-threatening systemic complications and to give quality of life.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	Congenital triangular alopecia: Clinical and dermoscopic differentials	p. 75
	Vishalakshi Viswanath, Vaibhav Kalambe, Dhananjay Sanap DOI:10.4103/ijpd.IJPD_57_18   Congenital triangular alopecia (CTA), also known as temporal triangular alopecia; originally described by Sabouraud in 1905; is a type of triangular, unilateral, nonprogressive, noncicatricial type of alopecia affecting mostly the temporal region of the scalp. It usually presents at birth or in early childhood, however adult cases have also been reported. Routinely confused with alopecia areata; dermoscopy helps in the diagnosis of this condition. We report a case of CTA with clinical and dermoscopic findings and discuss the differential diagnosis.
	[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
RESIDENTS CORNER
	Meyerson phenomenon	p. 78
	Resham Vasani DOI:10.4103/ijpd.IJPD_144_18
	[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
REVIEW OF CURRENT LITERATURE
	Hot topics in pediatric dermatology	p. 81
	Rajsmita Bhattacharjee, Rahul Mahajan DOI:10.4103/ijpd.IJPD_143_18
	[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
LETTERS TO EDITOR
	Lichenoid eruption of genital region following chloroquine therapy: Uncommon presentation	p. 86
	Sudha Rani Chintagunta DOI:10.4103/ijpd.IJPD_45_18
	[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	Segmental infantile hemangioma mimicking michelin tire baby syndrome	p. 87
	Isha Gupta, Kamal Aggarwal DOI:10.4103/ijpd.IJPD_50_18
	[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	Late-onset capillary hemangioma: A rare occurrence	p. 89
	Shilpa Garg, Priyanka Borde Bisht, Seema Rao DOI:10.4103/ijpd.IJPD_66_18
	[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
	A case of congenital hemangioma treated with topical timolol	p. 91
	Kavish Chouhan, Rahulkrishna S Kota, Amrendra Kumar, Jyoti Gupta DOI:10.4103/ijpd.IJPD_131_17
	[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta