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It has been mentioned in the article that metformin can be used throughout pregnancy and it is indeed safe. The apparent lack of teratogenicity has earned it an FDA pregnancy category B classification. If a pregnant woman has evidence of virilization then one should think of luteoma of pregnancy as a possible cause. Eruption of acne or hirsutism during lactational amenorrhoea is rarely due to PCOS and one needs to look for other causes. As such, PCOS is a diagnosis of exclusion! The sex hormone-binding globulin (SHBG) levels can be measured in patients with PCOS and are usually low. However, SHBG levels vary according to ethnicity and age. Moreover, the assays for SHBG are not standardized. Measuring SHBG levels in all patients of PCOS is not the current clinical practice. The validity of free androgen index (FAI) as an accurate reflector of free testosterone levels has been questioned and additional data are required to support its use.[6] It has been recommended that free testosterone should be used only in those patients who have signs of hyperandrogenism in the presence of normal levels of testosterone. In a recent systematic review, polymorphism of the androgen receptor gene seems to be a promising biomarker for PCOS because shorter repeats may be linked to the disorder. However, further studies are needed to understand the association fully.[7] Though measurement of carotid artery intimamedia thickness is a simple non-invasive test for cardiovascular screening, PCOS occurs in 2nd-3rd decade and unless other risk factors are present, it should not be performed routinely. Even highy specific C-reactive protein (hsCRP) is a good, reliable and clinically practical biomarker for cardiovascular screening in PCOS patients.

Nina Madnani, Kaleem Khan, Phulrenu Chauhan1, Parmar1 Departments of Dermatology and 1Endocrinology, P. D. Hinduja National Hospital, Mahim, Mumbai, Maharashtra, India Address for correspondence: Dr. Nina Madnani, Department of Dermatology, P.D. Hinduja National Hospital, Veer Savarkar Marg, Mahim, Mumbai - 400 016, Maharashtra, India. E-mail: [email protected]

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Apter D, Vihko R. Premenarcheal endocrine changes in relation to age at menarche. Clin Endocrinol (Oxf) 1985;22:753-60. Rosenfield RL, Ghai K, Ehrmann DA, Barnes RB. Diagnosis of the polycystic ovary syndrome in adolescence: Comparison of adolescent and adult hyperandrogenism. J Pediatr Endocrinol Metab 2000;13:1285-9. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. Task Force on the Phenotype of the Polycystic Ovary Syndrome of The Androgen Excess and PCOS Society. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: The complete task force report. Fertil Steril 2009;91:456-88. Khan U. Polycystic ovary syndrome in adolescents. J Pediatr Adolesc Gynecol 2007;20:101-4. Holm K, Laursen EM, Brocks V, Müller J. Pubertal maturation of the internal genitalia: An ultrasound evaluation of 166 healthy girls. Ultrasound Obstet Gynecol 1995;6:175-81. Miller KK, Rosner W, Lee H, Hier J, Sesmilo G, Schoenfeld D, et al. Measurement of free testosterone in normal women and women with androgen deficiency: Comparison of methods. J Clin Endocrinol Metab 2004;89:525-33. Lin LH, Baracat MC, Maciel GA, Soares JM Jr, Baracat EC. Androgen receptor gene polymorphism and polycystic ovary syndrome. Int J Gynaecol Obstet 2013;120:115-8.

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Website: www.ijdvl.com DOI: 10.4103/0378-6323.129399 PMID: 129399

Delleman syndrome or Haberland syndrome? Sir, We read the article by Nocito et al.[1] with interest and wish to make the following observations: 1.

The authors have described a dermoid cyst over the iris impairing patient’s vision in the left eye. We disagree as the location of dermoid is on the cornea and limbus, rather than iris. Iris is the intraocular pigmented structure of eye, which regulates the entry of light into the eye. Authors also state that patient is having a blue-gray dermoid cyst over the right eye sclera. We disagree with the diagnosis in the right eye since the color of dermoid ranges from yellow to gray to pink rather than blue-gray.[2] It seems

Indian Journal of Dermatology, Venereology, and Leprology | March-April 2014 | Vol 80 | Issue 2

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to be an anterior staphyloma because the color of staphylomata is almost always blue-gray due to underlying uveal tissue. The visible blood vessels over the surface of the lesion also favor the diagnosis of staphyloma since they are known to be present in staphyloma and are always absent in dermoid cyst. Furthermore, dermoid cysts usually have hair on their surface or in rare circumstances, a bunch of hair may be visible through thinned out cyst wall. Anterior and intercalary staphyloma may develop after chronic scleritis, trauma and limbal dermoid excision.[2] Congenital anterior staphyloma has also been reported in the literature. The minimal diagnostic criteria for Delleman-Oorthuys syndrome include a central nervous system cyst or hydrocephalus, microphthalmos with orbital cyst and focal dermal hypoplasia or aplasia.[3] As two of these components, that are microphthalmos with orbital cyst and focal dermal hypoplasia or aplasia were missing from the case report of Nocito et al.,[1] it does not appear to be a typical case of Delleman-Oorthuys syndrome. The constellation of findings in this case, i.e., limbal dermoid, frontal alopecia (? nevus psiloliparus), upper eyelid coloboma, papular lesion on the eyelid and arachnoid cyst is suggestive of encephalocraniocutaneous lipomatosis or Haberland syndrome or Fishman syndrome.[4] Authors did not report the status of visual acuity and intraocular pressure in their case and have stated that enucleation of eyeball is the only possible treatment for cosmetic purposes. We think that the present case is a potential candidate for limbal dermoid excision with keratoplasty in his left eye and staphyloma repair with donor scleral grafting with or without keratoplasty in his right eye. Surgical correction of limbal dermoids should be performed as early as possible to prevent amblyopia. Even if the patient has no perception of light in either eye, enucleation is never a procedure of choice. In such cases (absent light perception or blind eye), evisceration with orbital implant may be the procedure of choice, because it provides better cosmesis in term of greater ocular prosthesis motility and less chances of orbital implant extrusion.[5] Enucleation alone can lead to post enucleation socket syndrome, which is characterized by

enophthalmos, deep upper eyelid sulcus, ptosis and laxity of the lower lid.[6]

Shivcharan Lal Chandravanshi, Sujata Lakhtakia Department of Ophthalmology, Shyam Shah Medical College and Associated Gandhi Memorial Hospital, Rewa, Madhya Pradesh, India Address for correspondence: Dr. Shivcharan Lal Chandravanshi, Department of Ophthalmology, Shyam Shah Medical College and Associated Gandhi Memorial Hospital, Rewa - 486 001, Madhya Pradesh, India. E-mail: [email protected]

REFERENCES 1. 2. 3. 4. 5. 6.

Nocito MJ, Luna PC, Contardi ML, Mazzini MA. Delleman syndrome: Report of a case in an adolescent boy. Indian J Dermatol Venereol Leprol 2012;78:229. Mansour AM, Barber JC, Reinecke RD, Wang FM. Ocular choristomas. Surv Ophthalmol 1989;33:339-58. McCandless SE, Robin NH. Severe oculocerebrocutaneous (Delleman) syndrome: Overlap with Goldenhar anomaly. Am J Med Genet 1998;78:282-5. Hunter AG. Oculocerebrocutaneous and encephalocranio cutaneous lipomatosis syndromes: Blind men and an elephant or separate syndromes? Am J Med Genet A 2006;140:709-26. Nakra T, Simon GJ, Douglas RS, Schwarcz RM, McCann JD, Goldberg RA. Comparing outcomes of enucleation and evisceration. Ophthalmology 2006;113:2270-5. Steinkogler FJ. The treatment of the post-enucleation socket syndrome. J Craniomaxillofac Surg 1987;15:31-3. Access this article online Quick Response Code:

Website: www.ijdvl.com DOI: 10.4103/0378-6323.129400 PMID: 129400

Multibacillary leprosy: Follow up observations on 19 patients treated with 12 monthly doses of rifampicin, ofloxacin and minocycline therapy in Agra Sir, Triple drug combination using World Health Organization-multidrug therapy (WHO-MDT), as recommended for multibacillary (MB) patients, given for 24 or 12 months is effective in producing a clinical

Indian Journal of Dermatology, Venereology, and Leprology | March-April 2014 | Vol 80 | Issue 2

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Delleman syndrome or Haberland syndrome?

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