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Goyal M, Khandpur S, Ramam M, Sharma VK, Singh MK. A Study of the Histopathological Features of Alopecias on Transverse Sections of Scalp Biopsies. Indian J Dermatol 2019; 64:47-54. [PMID: 30745635 PMCID: PMC6340243 DOI: 10.4103/ijd.ijd_477_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Transverse sections of scalp biopsies are performed for the assessment of alopecias and are considered advantageous over vertical sections. Aim: The aim was to study the histopathological features of alopecias on transverse sections of scalp biopsies. Methods: It was a descriptive study. Clinically confirmed cases of noncicatricial and cicatricial alopecias were subjected to 4 mm scalp biopsies, which were sectioned transversely and analyzed. Biopsies obtained from occipital region of androgenetic alopecia (AGA) cases were taken as controls. Results: Biopsies from 41 cases were assessed, including male and female AGA, alopecia areata (AA), trichotillomania, lichen planopilaris (LPP), discoid lupus erythematosus (DLE), and folliculitis decalvans (FD). Normal scalp (control) biopsies showed the median total number of hair follicles of 35 (32–37), anagen:telogen/catagen ratio of 17.5 (16.5–31), and terminal:vellus ratio of 15 (10.7–17.5). In AGA and AA, miniaturization and shift toward telogen and catagen hair were consistently observed. Peribulbar inflammation was seen in two-third of AA. Trichotillomania showed increased catagen hair and numerous pigment casts. In DLE, besides perifollicular inflammation, prominent peri-arrector pili and peri-eccrine inflammation were observed. Type of inflammatory infiltrate was similar in DLE and LPP (lymphocytic), whereas FD showed neutrophilic and plasma cell infiltrate, both around follicles and interstitially. Basal cell damage in the follicles and pigment incontinence were seen in majority of DLE and LPP patients. DLE also showed basement membrane thickening, mucin deposition, and telangiectasia. Reduction/absence of sebaceous glands and perifollicular fibrosis were observed in almost all cicatricial alopecias. Conclusion: Transverse sectioning may be a useful tool in the diagnosis of alopecias.
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Singh S, Sahoo AK, Ramam M, Bhari N. Mucocutaneous spider angiomas in an adolescent with chronic liver disease. Arch Dis Child 2018; 103:1145. [PMID: 29298760 DOI: 10.1136/archdischild-2017-314406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2017] [Indexed: 11/04/2022]
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Jassi R, Mehta N, Ramam M, Bhari N. Blaschkoid blue vitiligo. Int J Dermatol 2018; 58:e45-e46. [PMID: 30456815 DOI: 10.1111/ijd.14297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 10/23/2018] [Indexed: 11/30/2022]
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Gupta V, Sreenivas V, Mehta M, Ramam M. What do Vitiligo Impact Scale‐22 scores mean? Studying the clinical interpretation of scores using an anchor‐based approach. Br J Dermatol 2018; 180:580-585. [DOI: 10.1111/bjd.17040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 11/30/2022]
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Kumarasinghe SPW, Pandya A, Chandran V, Rodrigues M, Dlova NC, Kang HY, Ramam M, Dayrit JF, Goh BK, Parsad D. A global consensus statement on ashy dermatosis, erythema dyschromicum perstans, lichen planus pigmentosus, idiopathic eruptive macular pigmentation, and Riehl's melanosis. Int J Dermatol 2018; 58:263-272. [PMID: 30176055 DOI: 10.1111/ijd.14189] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/18/2018] [Accepted: 07/17/2018] [Indexed: 01/19/2023]
Abstract
Ashy dermatosis (AD), lichen planus pigmentosus (LPP), erythema dyschromicum perstans (EDP), and idiopathic eruptive macular pigmentation are several acquired macular hyperpigmentation disorders of uncertain etiology described in literature. Most of the published studies on these disorders are not exactly comparable, as there are no clear definitions and different regions in the world describe similar conditions under different names. A consensus on the terminology of various morphologies of acquired macular pigmentation of uncertain etiology was a long-felt need. Several meetings of pigmentary disorders experts were held to address this problem. A consensus was reached after several meetings and collation of e-mailed questionnaire responses and e-mail communications among the authors of publications on the above conditions. This was achieved by a global consensus forum on AD, LPP, and EDP, established after the 22nd International Pigment Cell Conference held in Singapore in 2014. Thirty-nine experts representing 18 countries participated in the deliberations. The main focus of the deliberations was terminology of the conditions; as such, we present here the consensus statement of the forum and briefly review the available literature on the subject. We have not attempted to discuss treatment modalities in detail.
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Yadav D, Khandpur S, Ramam M, Singh MK, Sharma VK. Utility of Horizontal Sections of Scalp Biopsies in Differentiating between Androgenetic Alopecia and Alopecia Areata. Dermatology 2018; 234:137-147. [PMID: 30092597 DOI: 10.1159/000490459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Androgenetic alopecia (AGA) and alopecia areata (AA) are common causes of alopecia which can sometimes be difficult to differentiate clinically. Horizontal sections of scalp biopsies are used to study non-cicatricial alopecias due to the ability to perform both quantitative and morphometric analysis of hair follicles on them. METHODS It was a prospective, cross-sectional study conducted to assess the utility of horizontal sections to differentiate between the alopecias. Fifty-two cases were included: 20 cases of male AGA, 11 of female AGA and 21 cases of AA. After clinical examination and dermoscopy, a skin biopsy was taken and subjected to transverse sectioning. Histopathological assessment was done by two dermatopathologists blinded to clinical details. RESULTS Among the quantitative parameters, terminal:vellus hair ratio (3.08 in AGA and 1.83 in AA, p = 0.0091) and anagen:non-anagen hair ratio (9.25 in AGA and 3.56 in AA, p = 0.0021) were significantly lower in AA. In qualitative parameters, peribulbar inflammation was seen in 63% of AA cases (p = 0.0001). Pigment casts were seen in twice the number of AA (57%) than AGA (26%) cases. Broad avascular stelae and focal trichomalacia were seen in 9.5% of AA cases. CONCLUSION Besides peribulbar inflammation, we found a lower anagen:non-anagen hair ratio and presence of pigment casts in transverse sections of scalp biopsies favouring AA over AGA.
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Pangeni R, Mittal S, Arava S, Hadda V, Ramam M, Mohan A, Khilnani GC, Guleria R, Madan K. A 44-year-old man with hemoptysis. Lung India 2018; 35:343-347. [PMID: 29970778 PMCID: PMC6034369 DOI: 10.4103/lungindia.lungindia_282_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 44-year-old man with background history of diffuse cutaneous systemic sclerosis and dilated cardiomyopathy receiving immunosuppressive medications, presented with a 2-month history of cough and streaky hemoptysis. Clinicoradiological features were consistent with an endotracheal mass. Subsequently, the patient developed nodular skin lesions and the tracheal mass increased in size causing central airway obstruction. This clinicopathologic conference discusses the clinical and radiological differential diagnoses of such a clinical presentation and their management options.
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Ramam M, Yadav D. Epithelioid cell granuloma. INDIAN JOURNAL OF DERMATOPATHOLOGY AND DIAGNOSTIC DERMATOLOGY 2018. [DOI: 10.4103/ijdpdd.ijdpdd_13_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bhari N, Patra S, Nimitha P, Kaul S, Valakkada J, Verma K, Ramam M. Primary cutaneous histoplasmosis in an immunocompetent patient presenting with severe pruritus. Indian J Dermatol Venereol Leprol 2018; 84:465-468. [DOI: 10.4103/ijdvl.ijdvl_695_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sharma V, Gupta V, Ramam M. Authors' reply. Indian J Dermatol Venereol Leprol 2018; 84:314-315. [DOI: 10.4103/ijdvl.ijdvl_103_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gupta V, Ramam M. Monogenic autoinflammatory syndromes in children: Through the dermatologist's lens. INDIAN JOURNAL OF PAEDIATRIC DERMATOLOGY 2018. [DOI: 10.4103/ijpd.ijpd_9_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Khaitan BK, Gupta V, Asati DP, Seshadri D, Ramam M. Successful treatment outcome with itraconazole and potassium iodide in disseminated sporotrichosis. Indian J Dermatol Venereol Leprol 2017; 84:101-104. [PMID: 29210361 DOI: 10.4103/ijdvl.ijdvl_958_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Gan EY, Eleftheriadou V, Esmat S, Hamzavi I, Passeron T, Böhm M, Anbar T, Goh BK, Lan CCE, Lui H, Ramam M, Raboobee N, Katayama I, Suzuki T, Parsad D, Seth V, Lim HW, van Geel N, Mulekar S, Harris J, Wittal R, Benzekri L, Gauthier Y, Kumarasinghe P, Thng STG, Silva de Castro CC, Abdallah M, Vrijman C, Bekkenk M, Seneschal J, Pandya AG, Ezzedine K, Picardo M, Taïeb A. Repigmentation in vitiligo: position paper of the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res 2017; 30:28-40. [PMID: 27864868 DOI: 10.1111/pcmr.12561] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/10/2016] [Indexed: 02/01/2023]
Abstract
The Vitiligo Global Issues Consensus Conference (VGICC), through an international e-Delphi consensus, concluded that 'repigmentation' and 'maintenance of gained repigmentation' are essential core outcome measures in future vitiligo trials. This VGICC position paper addresses these core topics in two sections and includes an atlas depicting vitiligo repigmentation patterns and color match. The first section delineates mechanisms and characteristics of vitiligo repigmentation, and the second section summarizes the outcomes of international meeting discussions and two e-surveys on vitiligo repigmentation, which had been carried out over 3 yr. Treatment is defined as successful if repigmentation exceeds 80% and at least 80% of the gained repigmentation is maintained for over 6 months. No agreement was found on the best outcome measure for assessing target or global repigmentation, therefore highlighting the limitations of e-surveys in addressing clinical measurements. Until there is a clear consensus, existing tools should be selected according to the specific needs of each study. A workshop will be conducted to address the remaining issues so as to achieve a consensus.
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Singh S, Khandpur S, Arava S, Rath R, Ramam M, Singh M, Sharma VK, Kabra SK. Assessment of histopathological features of maculopapular viral exanthem and drug-induced exanthem. J Cutan Pathol 2017; 44:1038-1048. [DOI: 10.1111/cup.13047] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/10/2017] [Accepted: 09/11/2017] [Indexed: 12/19/2022]
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Gupta V, Khandpur S, Arava S, Ramam M. Alternating histopathologic pattern in blaschkoid dermatoses with epidermal changes: A retrospective series of 61 cases. J Am Acad Dermatol 2017; 78:812-813. [PMID: 29017841 DOI: 10.1016/j.jaad.2017.09.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/04/2017] [Accepted: 09/27/2017] [Indexed: 11/29/2022]
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Bhatia R, Shubhdarshini S, Yadav S, Ramam M, Agarwal S. Disseminated Kaposi's sarcoma in a human immunodeficiency virus-infected homosexual Indian man. Indian J Dermatol Venereol Leprol 2017; 83:78-83. [PMID: 27852989 DOI: 10.4103/0378-6323.193612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sharma VK, Gupta V, Pathak M, Ramam M. An open-label prospective clinical study to assess the efficacy of increasing levocetirizine dose up to four times in chronic spontaneous urticaria not controlled with standard dose. J DERMATOL TREAT 2017; 28:539-543. [DOI: 10.1080/09546634.2016.1246705] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jha A, Mehta M, Khaitan BK, Sharma VK, Ramam M. Cognitive behavior therapy for psychosocial stress in vitiligo. Indian J Dermatol Venereol Leprol 2017; 82:308-10. [PMID: 27088935 DOI: 10.4103/0378-6323.175925] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sharma V, Gupta V, Pahadiya P, Vedi K, Arava S, Ramam M. Dermoscopy and patch testing in patients with lichen planus pigmentosus on face: A cross-sectional observational study in fifty Indian patients. Indian J Dermatol Venereol Leprol 2017; 83:656-662. [DOI: 10.4103/ijdvl.ijdvl_469_16] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ramam M. Concluding remarks. Indian J Dermatol Venereol Leprol 2017; 83:1-3. [DOI: 10.4103/0378-6323.195073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gupta V, Bhatia R, Ramam M, Khanna N. Hypopigmented macules and papules following the lines of Blaschko: a novel variant of Darier's disease. Int J Dermatol 2016; 55:e623-e625. [PMID: 27495924 DOI: 10.1111/ijd.13382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 04/26/2016] [Accepted: 05/11/2016] [Indexed: 11/30/2022]
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Gupta V, Bhatia R, Singh UB, Ramam M, Gupta S. Penile 'tuberculid': could it be sexually acquired primary inoculation tuberculosis? J Eur Acad Dermatol Venereol 2016; 30:e164-e166. [PMID: 26515329 DOI: 10.1111/jdv.13469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ramam M. The manuscript review process: What do editors do? Indian J Dermatol Venereol Leprol 2016; 82:599-602. [PMID: 27716720 DOI: 10.4103/0378-6323.191541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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