Dermatologie Vénéréologie

EDITORIAL
	The peer review process: Yesterday, today and tomorrow	p. 239
	Saumya Panda DOI:10.4103/ijdvl.IJDVL_296_19  PMID:30971533
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VIEW POINT
	Let's not let the guard down! – Early indications of syphilis resurgence?	p. 246
	Vinay Kulkarni, Ritu Parchure, Shrinivas Darak DOI:10.4103/ijdvl.IJDVL_728_17  PMID:30829295
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REVIEW ARTICLE
	Hidradenitis Suppurativa: A Systematic Review and Meta-analysis of Therapeutic Interventions	p. 248
	Huidi Tchero, Christian Herlin, Farid Bekara, Sergiu Fluieraru, Luc Teot DOI:10.4103/ijdvl.IJDVL_69_18  PMID:30924446 Hidradenitis suppurativa is a chronic inflammatory condition that affects skin regions bearing apocrine glands. Although hidradenitis suppurativa is difficult to treat and cure, the currently available treatments are directed toward managing the lesions and associated symptoms. This review presents an evidence-based outline of the available treatment options. We searched four electronic databases and extracted data from retrieved studies for qualitative or quantitative analysis. Meta-analysis was conducted using the comprehensive meta-analysis software to generate pooled standardized mean differences or risk ratios. Numerous medical treatments are available for hidradenitis suppurativa such as antibiotics, retinoids, antiandrogens, immunosuppressive and anti-inflammatory agents and radiotherapy for early lesions. Adalimumab, an anti-tumor necrosis factor antibody, was superior to placebo in reducing Sartorius score (standardized mean difference = −0.32, confidence interval [−0.46, −0.18], P < 0.0001) and pain (risk ratio = 1.42, confidence interval [1.07, 1.9], P = 0.02), when given weekly (not every other week). Combination therapies (such as antibiotics and hyperbaric oxygen therapy) have been tested, which have shown promising results that are yet to be confirmed. Based on the quality of evidence, the most recommended treatments for hidradenitis suppurativa include adalimumab and laser therapy. Surgery (either by simple excision or complete local excision followed by skin graft) is the first choice for intractable disease presenting in the late stages. However, the evidence on most of these treatments is deficient and further randomized trials are needed to establish the most efficient therapies for hidradenitis suppurativa management.
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ORIGINAL ARTICLES
	Melanocyte spheroids are formed by repetitive long-term trypsinization	p. 258
	Di Li, Ru-Zhi Zhang, Hai-Xia Shi, Yu-Hua Yang, Ting Tian, Li Wang DOI:10.4103/ijdvl.IJDVL_275_17  PMID:30785123 Background: Autologous melanocyte transplantation plays an important role in the treatment of vitiligo. Objective: Previous studies have indicated that, compared with melanocytes growing in monolayers, melanocyte spheroids have a better survival in growth factor- and serum-deprived conditions. Methods: Melanocyte spheroids were obtained from human epidermis by repetitive long-term trypsinization and maintained an aggregated morphology for a short period in certain conditions. Results: Melanocyte spheroids were capable of growing into normal dendritic melanocytes in monolayer when they were harvested and reinoculated in 24-well plates. Immunohistochemical analysis of the melanocyte spheroids revealed that they were positive for HMB45, a melanosome-specific marker. No melanomas occurred when melanocyte spheroids were transplanted into mice. Conclusion: Our study provides a promising approach for melanocyte transplantation to treat vitiligo.
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	Predictors of disease severity in drug reaction with eosinophilia and systemic symptoms	p. 266
	Sarita Sasidharanpillai, Anuradha Thalian Chathoth, Anza Khader, Olasseri K Reena Mariyath, Najeeba Riyaz, Manikoth Payyanadan Binitha, Kunnummal Muhammed, Biju George, Parvathy Santhosh, Sangeetha Roslind, Nina Paul, Mithun Harold Thomas DOI:10.4103/ijdvl.IJDVL_482_17  PMID:30058562 Background: Drug reaction with eosinophilia and systemic symptoms is an outcome of a complex interaction between specific drugs, certain herpesviruse types and the immune system of the affected individual and is characterized by an unpredictable course and recurrent flares even after withdrawal of the offending drug and administration of systemic steroids. Aims: To identify the predictors of disease severity in drug reaction with eosinophilia and systemic symptoms. Methods: After obtaining ethical clearance from the institutional ethics committee and a written informed consent from individual study participant, the first hundred patients who required inpatient care in Government Medical College, Kozhikode with drug reaction with eosinophilia and systemic symptoms from January 1st 2011 were included in this study aimed to identify the predictors of disease severity in drug reaction with eosinophilia and systemic symptoms. Results: Male-to-female ratio of the study group was 0.8:1. The presence of atypical cells in peripheral smear and advanced age were found to be predictors of disease severity in drug reaction with eosinophilia and systemic symptoms, whereas, sex, facial erythema and edema and absolute eosinophil count were found not to be predictors of the same. Limitations: The main limitation of this study was our inability to assess the role of human leukocyte antigen (HLA) association and herpes virus reactivation in disease severity in drug reaction with eosinophilia and systemic symptoms. This study was also not designed to evaluate the response to treatment given and the mortality caused by drug reaction with eosinophilia and systemic symptoms. Conclusions: Studies on the predictors of severity in drug reaction with eosinophilia and systemic symptoms in different population groups may enable us to identify the warning signs and help to formulate the standard therapeutic guidelines.
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	A randomized, double-blind trial of amorolfine 0.25% cream and sertaconazole 2% cream in limited dermatophytosis	p. 276
	Anirban Das, Amrita Sil, Tushar Kanti Sarkar, Arpita Sen, Sriparna Chakravorty, Manideepa Sengupta, Anupam Das, Somodyuti Chandra, Santasmita Pal, Debabrata Bandyopadhyay, Nilay Kanti Das DOI:10.4103/ijdvl.IJDVL_907_17  PMID:30409926 Background: Dermatophytosis is becoming increasingly unresponsive to conventional antifungals. Newer topical antifungals may be more effective in these patients. Aims: To evaluate and compare the efficacy and safety of amorolfine 0.25% cream and sertaconazole 2% cream in limited tinea cruris/corporis. Methods: A single-center, randomized (1:1), double-blind, parallel group, active-controlled trial (CTRI/2014/12/005246) was performed. Sixty-six untreated adults with acutely symptomatic tinea cruris/corporis were included in the study. All patients had limited cutaneous involvement and were KOH mount positive. Group A received amorolfine 0.25% cream, and group B received sertaconazole 2% cream twice daily application to the lesions for 4 weeks. After the baseline visit, four follow-up visits were carried out. The outcome measures for effectiveness were clinical and mycological cure. Safety parameters studied were treatment-emergent adverse events and changes in routine laboratory parameters. Results: Both sertaconazole and amorolfine significantly reduced symptoms (P < 0.001) in both groups. However, improvement in symptoms (pruritus, burning sensation, erythema, scaling and crusting) was significantly greater in the sertaconazole group at every follow-up visit. Sertaconazole cream was also more effective than amorolfine cream in reducing the number of lesions (P = 0.002 at 12 weeks) and improving the Dermatology Life Quality Index (P < 0.001) at all the follow-up visits. Adverse events were similar in the two groups (P = 0.117). Fungal cultures became negative in 92.3% of the sertaconazole group as compared to 80% in the amorolfine group (P = 0.010). Limitations: Antifungal susceptibility testing could not be done. Conclusion: Sertaconazole 2% is superior to amorolfine 0.25%, both in terms of effectiveness and tolerability. Improvement can be appreciated from second week onwards.
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	Does using a high sun protection factor sunscreen on face, along with physical photoprotection advice, in patients with melasma, change serum vitamin D concentration in Indian conditions? A pragmatic pretest-posttest study	p. 282
	Sanjay Singh, Bandana Jha, Narendra Kumar Tiwary, Neeraj Kumar Agrawal DOI:10.4103/ijdvl.IJDVL_575_17  PMID:30409925 Background: Use of sunscreens on the face is becoming popular, and patients with melasma are prescribed sunscreen for use on the face. Results of a few Western studies on the effect of sunscreen use on serum vitamin D concentration are not applicable to Indian conditions. Aims: To examine the effect of use of a high sun protection factor (SPF 50+, PA++++) sunscreen on face in patients with melasma on serum concentration of 25-hydroxyvitamin D. Methods: Forty-five Indian patients (Fitzpatrick skin types III and IV) with melasma were advised to use a sunscreen with SPF 50 + for 3 months, 43 (33 female, 10 male; age 32.9 ± 8 years) completed the study. Patients staying outdoor for <4 hours applied sunscreen once daily after bath. Patients staying outdoors for >4 hours reapplied sunscreen 4 hours after first application. Patients were provided a container to measure the amount of sunscreen for use, which was approximately equal to recommended thickness. Compliance was tested by weighing the used tubes and tubes in use during monthly visits. Serum concentration of 25-hydroxyvitamin D was tested before and after the study period. Results: Amount of sunscreen advised (100.5 ± 29.2 ml) and the actual amount used (96.6 ± 27.9 ml) were similar (P = 0.53, t-test). The difference between serum concentrations of 25-hydroxyvitamin D at the baseline (19.20 ± 9.06 ng/ml) and at 3 months (18.91 ± 8.39 ng/ml) was not significant (P = 0.87, paired t-test, 95% confidence interval of difference −3.33 to 3.92). No correlation was found between the amount of sunscreen used and the percentage change in serum 25-hydroxyvitamin D concentration at 3 months (rho = 0.099, P = 0.528, Spearman's rank correlation). Limitations:Longer duration of application and a larger sample size may detect minor differences in vitamin D concentration. Conclusion: Using a high SPF sunscreen on the face, along with physical photoprotection advice, in patients with melasma for 3 months does not influence serum 25-hydroxyvitamin D concentration in Indian conditions.
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CASE REPORTS
	Cutaneous inflammation as a marker of malignant transformation in a patient with linear unilateral basaloid follicular hamartoma	p. 287
	Pablo Del Barrio-Diaz, Rodrigo Meza-Romero, Sergio González, Cristián Vera-Kellet DOI:10.4103/ijdvl.IJDVL_927_16  PMID:30246704 Basaloid follicular hamartoma is a rare, benign and superficial malformation of hair follicles, characterized histologically by epithelial proliferation of basaloid cells with radial disposition. It can be mistaken for basal cell carcinoma. Even though these hamartomas are considered benign lesions, malignant transformation has rarely been reported. We report the case of a 45-year-old healthy woman, with linear, unilateral basaloid follicular hamartoma which developed inflamed papules histologically suggestive of basal cell carcinoma. We believe that identification of local inflammation could be a clinical clue to guide us towards a malignant transformation of basaloid follicular hamartoma.
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	Synovial sarcoma complicating Maffucci syndrome	p. 291
	Rima Gammoudi, Amina Aounallah, Colandane Belajouza, Rafiaa Nouira DOI:10.4103/ijdvl.IJDVL_547_17  PMID:29667613 Maffucci syndrome is a rare nonhereditary disorder comprising of lymphovascular malformations and multiple enchondromas, which may be associated with several internal malignancies. This report describes a new association of Maffucci syndrome with pedal synovial sarcoma. Our case is also remarkable as lymphangioma circumscriptum is the sole lymphovascular component, which has been rarely reported. The aim of this report is to generate awareness about this rare condition and also highlight the importance of screening for malignancies in this disorder.
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BRIEF REPORTS
	Serum and tissue angiotensin-converting enzyme in patients with alopecia areata	p. 295
	Shabnam Fahim, Fatemeh Montazer, Hamid Reza Tohidinik, Zahra Safaei Naraghi, Robabeh Abedini, Maryam Nasimi, Narges Ghandi DOI:10.4103/ijdvl.IJDVL_158_17  PMID:29582789 Background: Alopecia areata is an immune-dependent disorder characterized by the interaction of T-lymphocytes with follicular antigens. Recent studies have shown the existence of a local renin–angiotensin system in the skin, where angiotensin-converting enzyme (ACE) plays a role in autoimmunity and inflammation. Aim: The objective of this study was to evaluate serum and tissue ACE activity in patients with alopecia areata. Methods: This case–control study was conducted on patients with alopecia areata and healthy controls. Serum and tissue ACE activity were assessed and compared between the two groups. Results: Twenty-five alopecia areata patients (60% male, mean age 32.1 ± 9.9 years) and 24 controls (50% male, mean age 37.4 ± 8.8 years) were included. Mean serum ACE activity was 52.1 ± 9 U/L in cases and 55.3 ± 14.7 U/L in controls (P = 0.37). Tissue ACE activity was significantly lower in cases in all parts of the skin i.e. epidermis (P = 0.016), follicular epithelium (P = 0.004), and endothelium (P = 0.037). Among cases, serum ACE activity was significantly higher in patients with more severe disease (P = 0.030), nonpatchy alopecia areata (alopecia universalis; ophiasis, patchy and ophiasis, diffuse) (P = 0.029), and with nail involvement (P = 0.027). Limitations: The sample size was too small to draw definite conclusions. Further, most of the patients had only mild or moderate alopecia areata. Conclusion: Unlike in some other inflammatory diseases, the tissue level of ACE seems to be significantly lower in alopecia areata compared to normal controls. Serum ACE was significantly higher in patients with more severe disease.
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	Effect of low-dose acitretin treatment on pituitary hormones in psoriasis vulgaris: A retrospective study	p. 300
	Ayse Serap Karadag, Emin Ozlu, Osman Kostek, Serap Gunes Bilgili, Ragıp Balaharoglu, Derun Taner Ertugrul DOI:10.4103/ijdvl.IJDVL_628_17  PMID:29855455 Background: It has been reported that retinoids may lead to hormonal alterations. Aim: In this retrospective study, we aimed to study the effect of acitretin on pituitary hormones in psoriasis patients. Methods: Out of 50 patients intended to be studied, blood samples of 43 patients could be tested before and after 3 months of acitretin therapy (0.2 to 0.5 mg/kg/day). Results: Patients mean ± standard deviation ages and female/male ratio were 46 ± 17 years and 19/24, respectively. After treatment with acitretin, gamma-glutamyltransferase, alkaline phosphatase, total cholesterol and triglyceride levels increased significantly (P < 0.05). After treatment, total protein, free thyroxine (T4) levels decreased significantly (P < 0.05). No significant differences were observed between before–after acitretin treatment regarding pituitary hormone levels in psoriasis patients (P > 0.05). Limitations: The retrospective nature of the study, inability to retest blood samples of 7 patients at 3 months post treatment, low dose and short duration of acitretin treatment were limitations of this study.Conclusion: This study showed that pituitary hormones were not affected except free T4 (thyroid hormone) by acitretin treatment. Further experimental and clinical studies are needed to clarify the effect of acitretin on pituitary hormones.
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IMAGES IN CLINICAL PRACTICE
	Papillomatosis cutis lymphostatica	p. 305
	Sabah Bazouti, Siham Dikhaye, Nada Zizi DOI:10.4103/ijdvl.IJDVL_763_17  PMID:29697069
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QUIZ
	Erythematous eroded plaque on the left nipple in a 75-year-old woman	p. 307
	Sergio Alvarez-Veliz, Paula Majluf-Caceres, Sergio González-Bombardiére DOI:10.4103/ijdvl.IJDVL_446_17  PMID:30058561
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LETTERS TO THE EDITOR - LETTERS IN RESPONSE TO PREVIOUSLY PUBLISHED ARTICLES
	Is semen analysis necessary prior to initiation of finasteride treatment?	p. 310
	Oliver Clement Lobo, Venkataram Mysore DOI:10.4103/ijdvl.IJDVL_149_19  PMID:30971531
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	Authors' reply	p. 311
	Piyush Kumar, Anupam Das, Niharika Ranjan Lal, Sourabh Jain, Anupama Ghosh DOI:10.4103/ijdvl.IJDVL_245_19  PMID:30971532
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	Transepidermal elimination: Role in leprosy transmission	p. 313
	Naveen Kumar Kansal DOI:10.4103/ijdvl.IJDVL_877_18  PMID:30829298
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	Authors' reply	p. 314
	Hiral Shah, Anup Kumar Tiwary, Piyush Kumar DOI:10.4103/ijdvl.IJDVL_192_19  PMID:30950408
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LETTERS TO THE EDITOR - CASE LETTER
	Acral peeling skin syndrome: An underdiagnosed skin disorder	p. 316
	Eva Sticova, Martin Květoň, Monika Dubská, Andrea Kubátová DOI:10.4103/ijdvl.IJDVL_3_18  PMID:30688214
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LETTERS TO THE EDITOR - OBSERVATION LETTERS
	A case of hidroacanthoma simplex with new dermoscopic features	p. 319
	Roja Toosi, Kambiz Kamyab, Cliff Rosendahl, Soheil Tavakolpour, Maryam Daneshpazhooh, Hamidreza Mahmoudi DOI:10.4103/ijdvl.IJDVL_426_18  PMID:30860169
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	Dermoscopic features of trichilemmal carcinoma	p. 321
	Zulkuf Arslan, Z Ulaş Bali, M Kürşat Evrenos, Peyker Temiz, Aylin Türel Ermertcan DOI:10.4103/ijdvl.IJDVL_468_18  PMID:30860170
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	Dermoscopy combined with ink staining as one more method to diagnose nodular scabies	p. 324
	Yangyang Ma, Wenting Hu, Ping Wang, Ke Bian, Zehu Liu DOI:10.4103/ijdvl.IJDVL_516_18  PMID:30880719
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LETTERS TO THE EDITOR - THERAPY LETTER
	Aggressive erosive lichen planus associated with hepatitis C responding to sofosbuvir/ledipasvir treatment	p. 326
	Daniel Morgado-Carrasco, Andrea Combalia, Xavier Fustà-Novell, José Manuel Mascaró Jr, Pilar Iranzo DOI:10.4103/ijdvl.IJDVL_225_18  PMID:30860163
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LETTERS TO THE EDITOR - STUDY LETTER
	Does rapamycin induce melanin formation? An in vitro study assessing the effect of rapamycin on normal cultured melanocytes	p. 330
	Muthu Sendhil Kumaran, Niharika Srivastava, Keshavamurthy Vinay, Supriya Bhardwaj, Davinder Parsad DOI:10.4103/ijdvl.IJDVL_45_18  PMID:30829293
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IMAGES IN CLINICAL PRACTICE
	Primary follicular mucinosis in childhood	p. 333
	Parul Verma, Asha Kubba, Aditi Jha DOI:10.4103/ijdvl.IJDVL_615_17  PMID:29697068
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QUIZ
	Ringworm-like skin lesion is not always tinea	p. 335
	Ramona Zanniello, Caterina Ferreli, Federico Patta, Anna Luisa Pinna, Laura Atzori DOI:10.4103/ijdvl.IJDVL_253_17  PMID:29547137
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RESIDENTS' PAGE
	Atopy patch test	p. 338
	Varsha Vaidyanathan, Aarti Sarda, Abhishek De, Sandipan Dhar DOI:10.4103/ijdvl.IJDVL_397_17  PMID:30058560
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HISTORY
	Prof. Nékám's Corpus Iconum Morborum Cutaneorum (1938): The most elaborate historical dermatovenerological atlas of the first half of the 20th century	p. 342
	Zoltan Szep, Juraj Majtan DOI:10.4103/ijdvl.IJDVL_643_17  PMID:30924445
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BOOK REVIEW
	Dermoscopy – Text and atlas	p. 346
	Laxmisha Chandrashekar DOI:10.4103/ijdvl.IJDVL_108_19  PMID:30950410
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NET STUDY
	Profile of HIV serodiscordant couples in a tertiary care center	p. 347
	Srihari Sahana, Jayadev Betkerur DOI:10.4103/ijdvl.IJDVL_1101_16  PMID:30860165 Background: Globally, 36.7 million people are infected with Human Immunodeficiency Virus (HIV). Of these 36.7 million people, 2.1 million are in India. Integrated counseling and testing centers are the cornerstones of early access to prevention and support services. The term "serodiscordant couple" refers to a couple where one partner is HIV-positive and the other HIV-negative. Aim: To study the serodiscordance rates in a cohort of people attending integrated counseling and testing center. Materials and Methods: Aretrospective descriptive study of data from integrated counseling and testing center from January 2013 to December 2014 was done. Results: Of the 7489 persons tested, 306 persons were positive for HIV (192 males and 114 females) with a prevalence of 4 percent. Of the 126 couples tested, serodiscordance was found in 46 couples, while 80 couples were seroconcordant. The overall prevalence of HIV serodiscordance was 36.5 percent. Male positive and female negative couples (M+ F−) were 35 (76.0%) and female positive and male negative (F+ M−) were 11 (23.9%). Discordant M+ F− couples were significantly higher than discordant F+ M− couples (P < 0.001). Most participants were aged between 21 and 40 years. The average age of men was 41.91 years and that of women was 34.21 years. The average age difference between life partners was 7.7 years. Significant association was seen between age and gender, as females were found to be younger (P value = 0.001). Limitation: Information regarding years of married life, number of sex partners or sexual behavior pre- and post-detection were not collected. Thus, our data present only the magnitude of serodiscordance in a cohort but does not analyze the other predictors of serodiscordance. Conclusion: Serodiscordant relationships occur more commonly in India than is presumed. Our study highlights the profile of serodiscordant couples in this part of the country. Effective measures to prevent transmission of HIV within a serodiscordant relationship are necessary steps in halting the HIV epidemic.
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NET QUIZ
	Erythematous scaly facial plaques with overlying hair loss	p. 347
	A Narayanan, M Ramam, Neetu Bhari DOI:10.4103/ijdvl.IJDVL_501_18  PMID:30860166
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NET LETTERS
	Rapid response of Kasabach–Meritt phenomenon to a combination of oral prednisolone and sirolimus	p. 348
	Sanjay Singh, Neetu Bhari, Snehal Agrawal, Kaushal K Verma DOI:10.4103/ijdvl.IJDVL_453_17  PMID:29798936
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	A case report of buffalopox: A zoonosis of concern	p. 348
	Ritu Gujarati, Siva Rami Reddy Karumuri, T Naresh Babu, B Janardhan DOI:10.4103/ijdvl.IJDVL_222_17  PMID:29667609
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	Dermoscopic manifestations of Talaromyces (Penicillium) marneffei infection in an AIDS patient	p. 348
	Xiaoxi Xu, Xin Ran, Sushmita Pradhan, Song Lei, Yuping Ran DOI:10.4103/ijdvl.IJDVL_118_17  PMID:29873309
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ERRATUM
	Erratum: "Crusted nipple and areola: a new aetiology of secondary hyperkeratosis of the nipple and areola"	p. 349
	DOI:10.4103/0378-6323.256524
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ANNOUNCEMENT OF IADVL SCHOLARSHIPS
	Announcement of IADVL Scholarships	p. 350
	DOI:10.4103/0378-6323.256525
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