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   Table of Contents - Current issue
January-June 2021
Volume 8 | Issue 1
Page Nos. 1-28

Online since Wednesday, August 11, 2021

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KOH wet mount versus cellophane strip without mounting medium for rapid diagnosis in superficial mycoses p. 1
Sandeep Arora, Reetika Pal, Devinder Kumar Suhag, Rajeshwari Dabas, Gulhima Arora, Satish Chand
Context: Diagnosis of superficial mycoses in clinically doubtful cases relies on demonstration of fungal elements on a 10% potassium hydroxide (KOH) slide mount which takes 30 min to 2 h. Rapid results will lead to reduced time to diagnosis. Aims: A comparative study of conventional 10% KOH wet mount against the cellophane strip method without a mounting medium under bright-field and phase-contrast microscopy was aimed to determine the comparative efficacy of these methods in demonstrating fungal elements of superficial mycoses. Settings and Design: The study was conducted at a skin center of a tertiary care hospital between November 2019 and January 2020. Material and Methods: One hundred and fifty consecutive clinically suspect cases of superficial cutaneous mycoses were examined. Skin scrapings for 10% KOH were collected with a blunt scalpel on one slide and examined half hour later. A cellophane strip collection of squames stuck onto another slide and examined directly by bright-field and phase-contrast microscopy. Statistical Analysis Used: Descriptive and inferential statistical analysis was carried out in the present study using SPSS 22.0, and R environment version 3.2.2 was used for the analysis of the data. Chi-square/Fisher’s exact test was used to find the significance of study parameters on categorical scale between two or more groups, nonparametric setting for qualitative data analysis. Fisher’s exact test was used when samples were very small. Results: The mean percentage positivity for fungal hyphae as seen on KOH mount was 76%, for cellophane tape 97.33%, and under phase-contrast microscopy 97.33%. Pityriasis versicolor was detected by all three methods (100%). Tinea corporis had the least positive result on KOH mount. Conclusion: Cellophane strip method without a mounting medium adequately demonstrates fungal elements on light microscopy.
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Comparative evaluation of potassium hydroxide mount, fungal culture, and histopathology of nail clipping with periodic acid–Schiff stain in the diagnosis of onychomycosis p. 6
Manjyot Gautam, Nidhi Shah, Prachi Bhattar, Nitin Nadkarni, Sharmila Patil
Context: Onychomycosis (OM) is a commonly encountered problem in clinical practice, which needs to be differentiated from other causes of dystrophic nails as its treatment is long-term and may have potential side effects. Routinely used laboratory tests like direct microscopy with potassium hydroxide (KOH) and fungal culture (FC) show inconsistent sensitivity. Hence, newer methods of diagnosis are required. Aim: This study aims to compare the efficacy of KOH mount, fungal culture, and histopathology of nail clippings with periodic acid–Schiff stain for the diagnosis of onychomycosis. Settings and Design: This was a cross-sectional study conducted in the Dermatology Outpatient Department of a tertiary care center in Navi Mumbai from September 2013 to September 2014. Subjects and Methods: A total of 102 patients with clinically suspected OM were included in the study and evaluated for the following three methods: KOH mount, FC, and HP/PAS stain. To determine the efficacy and performance characteristics of each test, FC was chosen as the gold standard for statistical analysis. Statistical Analysis Used: Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each test. Association among the study group was assessed with the help of Chi-square test. Results: Of the 102 patients, direct microscopy with KOH mount was positive in 47, FC in 30, and HP/PAS in 71 patients. Ninety-one out of the 102 patients had at least one of the three diagnostic tests positive. Using this as the denominator, KOH mount, culture, and HP/PAS had sensitivities of 51.64%, 32.96%, and 78.02%, respectively. Diagnostic sensitivity increased to 89.38% when both KOH and HP/PAS were combined.For calculation of specificity of KOH and HP/PAS, we used FC as the gold standard because it gives precise identification of the pathogen. Specificity for KOH and HP/PAS was 59.7% and 34.7%, respectively. It increased to 73.7% if both KOH and HP/PAS were positive. Conclusion: Using PAS on nail scraping can yield higher diagnostic sensitivity with no loss of specificity and hence can be considered as the method of choice for the diagnosis of OM. Accuracy of diagnosis can be increased by combining the two tests (KOH and HP/PAS) instead of one test (HP/PAS).
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Primary cutaneous primitive neuroectodermal tumor/Ewing sarcoma: A rare case with an unusual presentation p. 13
Shobhna Sharma, Deepa Goel, Paritosh Gupta
Primitive neuroectodermal tumors (PNET)/Ewing sarcomas (ES) are a group of malignant tumors composed of small round cells of neuroectodermal origin, that affect soft tissue and bone, primarily in children and young adults. About 10%–20% of all cases are extraskeletal, out of which primary cutaneous and superficial cases are rare. We report a case of primary cutaneous PNET/ES in a 57-year-old diabetic man without osseous or other extraskeletal involvement. Differential diagnosis of this rare entity includes other cutaneous malignant round cell tumors such as lymphoma, melanoma, malignant glomus tumor, Merkel cell carcinoma, and malignant cutaneous adnexal neoplasms. The correct diagnosis is important for managing these chemosensitive tumors, which can be achieved with the help of special stains and immunohistochemistry. This case report aims to increase the awareness about rarer clinical presentation of this rare entity with emphasis on histomorphological differential diagnosis.
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Cutaneous metastases in a case of adenocarcinoma cervix with atypical presentation p. 17
Sandeep Arora, Rajeshwari Dabas, Eeshaan Ranjan, Aradhana Rout
Cutaneous metastasis of carcinoma cervix is quite uncommon, with a reported incidence of 0.1%–4.4%, with zosteriform or dermatomal distribution being a rare presentation. Although zosteriform cutaneous metastases have been reported with other malignancies, namely lung carcinoma, breast carcinoma, and malignant melanoma, there are no reports of dermatomal cutaneous metastases with adenocarcinoma cervix. We report a case of adenocarcinoma cervix who developed cutaneous metastases in an unusual dermatomal distribution mimicking herpes zoster.
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Pseudoepitheliomatous keratotic and micaceous balanitis: A distinct entity p. 20
Antoine Salloum, Julien Bachour, Nagham Bazzi, Hala Abi Rached Megarbane
Pseudoepitheliomatous keratotic and micaceous balanitis (PKMB), an uncommon glans penis skin disorder, affects mainly elderly men and can progress to verrucous carcinoma or invasive squamous cell carcinoma. A 22-year-old male presented with a 5-year history of a slightly pruritic thick scaly plaque on the glans penis that appeared 2 months after undergoing circumcision. Physical examination revealed a well-defined hyperkeratotic plaque with thin mica-like scales. Histological examination of previous biopsies showed acanthosis with elongation of the rete ridges, prominent granular cell layer, and marked orthokeratotic hyperkeratosis. The diagnosis of plaque-stage PKMB was made. The patient had monthly sessions of topical liquid nitrogen and after 20 weeks, the plaque shrank significantly.
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Dermoscopic evaluation of crusted scabies: A case report p. 23
Balachandra S Ankad, Varsha R Koti, Sahebpatel M Mahajabeen, Balakrishna P Nikam
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Leukemia cutis presenting as non-healing ulcers with marginal umbilicated nodules p. 27
Arunima Ray, Ishan Agrawal, Rashmi Patnayak, Bikash Ranjan Kar
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