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   2021| October-December  | Volume 15 | Issue 4  
    Online since December 6, 2021

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Dental patch test results and clinical relevance: 10 years of retrospective experience
Oguz Yilmaz, Asli Bilgic, Soner Uzun
October-December 2021, 15(4):90-94
Background: Patch testing with dental screening series [dental patch test (DPT)] is used to detect triggers for mucositis and/or oral lichen planus as well as to detect contact sensitization due to substances and restorative materials used mostly in dentistry. Aim: We aimed to retrospectively evaluate the DPT results performed in our clinic in the last 10 years and to assess their clinical relevance. Methods: Data of 127 patients who had DPT in our allergy unit between January 2010 and July 2020 were included in our study. In our clinic, DPTs were applied to patients mostly when they have history of metal allergies, oral lichen planus especially close to dental materials, chronic mucositis, and history of allergy after dental procedures. The forms routinely used in our allergy unit were examined retrospectively. Results: The most common five allergens were nickel (II) sulfate hexahydrate (29.9%), palladium chloride (18.9%), sodium tetrachloropalladate (II) hydrate (18.9%), gold (I) sodium thiosulfate dihydrate (12.6%), and mercury (10.2%). Fifty-eight of 71 patients with positive PT had a current relevance according to the COADEX coding system (P < 0.05). Of the 38 individuals with nickel sensitization, 36 were females and 2 were males, and this result was statistically significant (P = 0.034). Conclusion: Nickel, palladium, sodium tetrachloropalladate, gold, and mercury, which are frequently found in dental prosthesis and materials, were the most common allergens in our study and this is in accordance with the literature.
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An adverse impact of concurrent cranial irradiation therapy and phenytoin-erythema multiforme, phenytoin, and cranial irradiation therapy syndrome
Sharon Joseph, Myfanwy Joanne D’Souza, Aryambika Krishnan, Jacintha Martis
October-December 2021, 15(4):102-106
Prophylactic antiepileptics, especially phenytoin, are very commonly prescribed post brain tumor excision. Its concomitant use with radiotherapy (RT) increases its adverse effect profile and leads to skin lesions ranging from erythema multiforme, maculopapular eruption to SJS/TEN. Erythema multiforme, phenytoin and cranial irradiation therapy (EMPACT) syndrome is the term that describes this reaction. Herein, we report a case of EMPACT syndrome in a 32-year-old woman, receiving targeted RT and prophylactic antiepileptics post astrocytoma excision. The patient developed facial swelling more over the right side and blanchable erythematous maculopapular rash with atypical target lesions all over the body. These lesions were seen 1½ months post prophylactic phenytoin treatment and 7 days after targeted RT of the right frontal area. Immediate cessation of phenytoin, alternative antiepileptics, and systemic corticosteroids aided in complete recovery. EMPACT syndrome is a rare, but serious complication and clinicians should be made aware of this entity.
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The effect of omalizumab treatment on hematological inflammatory parameters and immunoglobulin E levels in patients with chronic spontaneous urticaria
Gözde Emel Gokcek, Eda Öksüm Solak, Emine Çölgeçen
October-December 2021, 15(4):95-101
Objectives: We aimed to evaluate the effect of omalizumab use on hematological parameters, inflammatory markers, and immunoglobulin E (IgE) in patients with chronic spontaneous urticaria and to determine whether there would be any difference between patient and control groups in terms of these values and whether IgE levels before and after omalizumab treatment are correlated with the Urticaria Control Test (UCT). Materials And Methods: Forty-five patients with chronic spontaneous urticaria and 45 healthy controls who presented to the dermatology outpatient clinic of Yozgat Bozok University Research and Training Hospital were analyzed retrospectively. Age, gender, neutrophil, lymphocyte, monocyte, eosinophil, basophil, and thrombocyte counts and IgE values before and after 24 weeks of treatment were recorded, and IgE ratios before and after treatment were calculated. The UCT was performed on the patients. The neutrophil/lymphocyte, platelet/lymphocyte, lymphocyte/monocyte, eosinophil/basophil, and eosinophil/lymphocyte ratios were calculated for the control group and the patient group, both before and after treatment. Mean platelet volume (MPV), which is also considered an inflammatory marker, was recorded before treatment, in both the control group and the patient group. Results: The patients’ median pre-treatment IgE level [189.0 (1.0–1824.0)] was significantly lower than the post-treatment level [561.0 (2.0–4301.0)] (P<0.001). No significant difference was determined in basophil, platelet, eosinophil, monocyte, lymphocyte, and neutrophil counts and neutrophil/lymphocyte, platelet/lymphocyte, lymphocyte/monocyte, eosinophil/basophil, and eosinophil/lymphocyte ratios before and after omalizumab treatment. The mean UCT score of the patients was found to be 11.5 (± 3.9). The mean IgE ratio post-omalizumab treatment/pre-omalizumab treatment was 5.8. No significant difference was found between the patient and control groups regarding neutrophil/lymphocyte, platelet/lymphocyte, lymphocyte/monocyte, eosinophil/basophil, and eosinophil/lymphocyte ratios, as well as MPVs. A significant correlation was found between the patients’ UCT scores and IgE levels after omalizumab treatment (r=0.313; P=0.046). Conclusion: No changes were observed in hematological inflammatory markers of patients with chronic spontaneous urticaria, compared with healthy controls. Besides, no changes were observed in either inflammatory markers or hematological parameters, following the use of omalizumab in these patients. Hence, it is considered that there is no harm in using omalizumab in diseases such as chronic disease anemia, chronic idiopathic neutropenia, and idiopathic thrombocytopenic purpura. The fact that omalizumab treatment caused a significant increase in IgE levels, in correlation with previous studies, made us think that the methods of reducing the dose or extending the dose interval should be preferred, instead of abruptly interrupting the treatment during the discontinuation period to prevent relapses.
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A study of cutaneous manifestations of COVID-19: An Indian perspective
Suyog S Dhamale, Amit Jain, Snehal B Lunge, Vijay Adhe, Vidyadhar R Sardesai, Sujata V Rege
October-December 2021, 15(4):83-89
Background: Coronavirus disease-2019 (COVID-19) has been shown to involve multiple-organ systems during disease process. Dermatologists have also reported various findings in patients of COVID-19 and have pointed out few cutaneous manifestations that are novel and are probably related to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, currently very limited data are available regarding various aspects of cutaneous involvement. Aims: This study aimed to investigate various aspects of cutaneous involvement in COVID-19. Methods: Institutional ethics committee approval was secured before conducting a study. Patients with at least one positive nasopharyngeal swab result for SARS-CoV-2 carried out by reverse transcription polymerase chain reaction (RT-PCR) were enrolled. After informed consent subjects were interviewed and monitored for appearance of any cutaneous signs and symptoms. Those with relevant findings were evaluated for characteristics of cutaneous findings. Data of all patients were collected and analyzed. Results: A total of 303 patients were enrolled for the study. Approximately 1.98% of patients developed cutaneous manifestations. Four types of skin lesions were observed in study subjects: urticarial lesions, maculopapular rash, acro-ischemia, and glossitis. Limitations: Relatively less number of patients, collection of data from single center, and absence of histopathological confirmation were limitations of the study. Conclusion: COVID-19 disease process has a cutaneous component; however, incidence of cutaneous findings remains low. Urticaria was the most common type of cutaneous finding, whereas acro-ischemia was the most characteristic one.
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Multiple papulonodules over face and trunk: A rare case report
Apoorva Dhananjay Chopkar, Pallavi Rupkumar Rokade, Bhagyashree B Supekar, Vaishali H Wankhade
October-December 2021, 15(4):107-112
Familial cylindromatosis (turban tumor syndrome) is a very rare neoplasm originating from eccrine or apocrine glands. It is an autosomal dominant condition, characterized by multiple cylindromas commonly presenting over face or scalp. We report a case of familial cylindromatosis diagnosed on the basis of clinical, dermoscopic, and histopathological findings in a 70-year-old female. The case is reported due to its rare occurrence in Indian scenario.
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An extremely uncommon case of giant cell tumor of skin: A case report in a 16-year-old female
Lalit Kumar, Pooja Agarwal, Afreen Parvez, Yatendra Chahar
October-December 2021, 15(4):113-115
Giant cell tumors of the skin are known to be extremely rare tumors, grossly, and histologically similar to that of giant cell tumors of bone. A 16-year-old girl presented with an asymptomatic swelling over the right cheek, which had progressed over 5 months duration without any antecedent history of local trauma and infection. Grossly, the specimen was brown-colored without any pigmentation, fleshy, and consisted of a skin-covered globular mass measuring 1.5 × 1.0 × 0.5 cm. On histopathologic examination, sections examined show a well-circumscribed lesion involving the dermis and revealed biphasic population of round to spindle-shaped mononuclear cells with intimately admixed osteoclast-like giant cells. On immunohistochemistry, osteoclast-like giant cells and mononuclear cells showed strong cytoplasmic granular positivity for CD68 and final diagnosis of giant cell tumor was given.
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