Hairy tongue and hairy oral leukoplakia--a differential histopathologic diagnosis

10 specimens taken from oral hairy leukoplakia were compared to 8 histological preparations from hairy tongue. We found 9 criteria helpful concerning the histopathologic differential diagnosis of these entities. Oral hairy leukoplakia shows a gently papillated surface, a prominent horny layer with confluent bacterial overgrowth, and ballooned epithelial cells with a distinct perinuclear halo in a bandlike arrangement. Hairy tongue, in contrast, grows exophytically with a digitiform surface, the horny layer is rather thin, and the microorganisms are confined to the ends of the digitations; the ballooned epithelial cells show pale cytoplasm. Considering the growing incidents of HIV infection, the dermatologist should be familiar with the characteristics of oral hairy leukoplakia and its histopathological differential diagnosis.     

The prevalence and significance of fissured tongue and geographical tongue in psoriatic patients

BACKGROUND: Tongue lesions are not uncommon in psoriasis, but their significance is not clear. Aims. To determine the prevalence of tongue lesions in patients with psoriasis and to detect possible associations. METHODS: All consecutive patients with psoriasis seen in a dermatology clinic in northern Iran between January 2000 and January 2005 were enrolled in a prospective study. A questionnaire detailing the clinical and epidemiological features of the disease was completed for each patient, and all patients were examined for tongue lesions. RESULTS: In total, 306 patients with psoriasis were enrolled in the study (170 women, 136 men; female : male ratio 1.25 : 1; mean age 29.7 years; mean age at onset of psoriasis 23.3 years). Overall, 47 patients (15.4%) had tongue lesions; 25 (8.2%) had fissured tongue, 17 (5.6%) had geographical tongue (benign migratory glossitis) and 5 (1.6%) patients had both fissured and geographical tongue. Geographical tongue was seen in 7.2% of patients with early onset psoriasis and only in 1.3% of patients with late-onset psoriasis. Overall, patients with tongue lesions were found to have more nail and genital involvement. CONCLUSION: It appears that geographical tongue, but not fissured tongue, is more common in early onset psoriasis and may be an indicator of disease severity.     

Congenital syphilis in The Netherlands: diagnosis and clinical features.

From 1982 to 1985 the 19S IgM-Fluorescent Treponemal Antibody Absorption (19S-IgM-FTA-ABS) test gave a positive result in 19 children. These 19 children plus one dizygotic twin sister were evaluated. Seventeen children were diagnosed as having congenital syphilis and treated. Clinical evidence was seen in 10 children, CSF abnormalities in seven, radiological abnormalities in eight. Of the 17 children treated, only one did not meet the Center for Disease Control (CDC) criteria of a compatible case of congenital syphilis. Of the children not diagnosed as having congenital syphilis, one child was considered to be a compatible case of congenital syphilis according to the CDC-criteria. The CDC-criteria may be a valuable aid in diagnosing congenital syphilis. Guidelines for adequate therapy are given.     

The clinical diagnosis of genital ulcer disease in men in the tropics

Since the clinical diagnosis of genital ulcers without laboratory confirmation is not reliable in developed countries, we postulated that clinical diagnosis alone would be no more reliable in developing countries. A presumptive clinical diagnosis of chancroid, genital herpes, syphilis, or lymphogranuloma venereum was made for 100 male patients at the Special Treatment Clinic in Nairobi, Kenya. This diagnosis was then compared to the final diagnosis determined by laboratory identification of the pathogen, by culture, or by serologic response. In 64 patients, a final diagnosis of either chancroid, syphilis, or genital herpes was established. The diagnostic accuracy varied from 75% for chancroid to 42% for syphilis and 43% for herpes. The overall diagnostic accuracy was 66%. The predictive values of positive clinical diagnoses were 84% for chancroid, 60% for syphilis, and 75% for herpes. Thus, clinical diagnosis of genital ulcer disease was not sufficiently reliable in this study.     

The porphyrias: clinical presentation, diagnosis and treatment

The porphyrias comprise a clinically and genetically heterogeneous group of diseases mostly arising from a genetically determined dysfunction of specific enzymes along the pathway of heme biosynthesis. Based on the occurrence or absence of cutaneous symptoms and life-threatening acute neurological attacks, the different types of porphyrias can either be classified into cutaneous and non-cutaneous forms or acute and non-acute forms. Establishing an accurate diagnosis might be difficult for two reasons: i) the porphyrias can manifest with a broad but unspecific spectrum of clinical symptoms mimicking several other disorders, and ii) biochemical examination of urine, feces, and blood can reveal overlapping findings. Fortunately, however, the advances in the fields of molecular genetics during recent years have provided us with the possibility of overcoming these diagnostic pitfalls. Therefore, in controversial cases the correct diagnosis can finally be made using molecular biological techniques. Due to the various facets of the porphyrias, diagnosis and treatment should always imply a close interdisciplinary collaboration to counsel and help patients and their families most efficiently.     

The dermoscopic versus the clinical diagnosis of melanoma.

Dermoscopy is an useful technique for the diagnosis of melanoma. All the diagnostic dermoscopic methods developed until now have been tested on dermoscopic slides and the real improvement given by this technique to the clinical diagnosis based upon ABCDE criteria is still unknown. For this reason, we decided to undertake a prospective study to compare the clinical diagnosis made with ABCDE criteria, to the dermoscopic diagnosis, made with the method 7FFM, developed by us. A total of 401 lesions were evaluated clinically and dermoscopically. On the basis of the number of the clinical criteria considered sufficient to diagnose a melanoma, various clinical scores, ranging from 1 to 5, can be obtained; data about the sensitivity of the clinical diagnosis of melanoma suggest that the most often used score is score 3. Our method 7FFM presents a sensitivity and a specificity better than those obtained with score 3: 80% versus 66.6% and 89.1% versus 79.3%. Besides this, we have evaluated if the sensitivity of our method 7FFM in the diagnosis of melanoma can be improved with the adjunct of the clinical criteria or of the clinical scores. The best values of sensitivity 93.3% and predictive value negative 97.3% have been obtained with score 2 plus 7FFM. Our results confirm that our method can be used in the screening of pigmented skin lesions in daily office practice and that an improvement in sensitivity without an excessive sacrifice of specificity can be obtained with the adjunct of the clinical score 2.     

皮肤镜在某些色素性皮肤病诊断中的应用价值

目的：探讨皮肤镜在色素性和非色素性皮肤病的临床诊断中的应用价值。方法：对某些色素性和非色素性皮肤病的临床诊断、皮肤镜诊断和皮肤病理活检结果进行比较。结果：皮肤镜对于咖啡斑及甲下出血等临床常见色素性疾病的良恶性判断率特异度和灵敏度达到100%;对于恶性黑素瘤、色素痣、脂溢性角化的特异度和灵敏度也较高。结论：皮肤镜对于黑素瘤、色素性痣、细胞痣及脂溢性角化的良恶性判断具有较好的辅助诊断和临床应用价值。     

57例皮肤变应性血管炎的临床特点及诊治

目的探讨皮肤变应性血管炎的临床特点、早期诊断及治疗。方法对2003年12月~2004年12月接诊的57例皮肤变应性血管炎的临床表现及并发症情况进行回顾性分析,制定合理的早期诊治方案。结果归纳出典型临床特点,结合实验室检查结果,予以正确诊断并获满意治疗效果。结论早期诊断,及时对症合理的药物治疗,可以有效改善皮肤变应性血管炎的预后。     

超声诊断小儿急性睾丸附睾炎的临床研究

目的探析对小儿急性睾丸附睾炎患儿使用超声诊断的临床应用价值。方法随机选取2013年至2016年深圳市福田区妇幼保健院超声科诊治的84例小儿急性附睾炎患儿为研究对象,对其使用彩色多普勒超声方式进行检查。采用回顾性方式对患儿相关临床资料进行研究,分析和归纳超声方法在诊断小儿急性睾丸附睾炎上的临床价值。结果超声检查提示,患儿附睾明显增大,回声出现异常上升或下降,部分患儿伴有阴囊壁增厚或鞘膜积液的情况。附睾内部发现存在丰富血供,有睾丸炎症状并发时睾丸明显变大,回声下降,睾丸和附睾头两者之间及睾丸旁并无发生高回声或中回声结节情况;有48例患儿病灶位于左侧,26例患儿病灶位于右侧,10例患儿病灶位于两侧;54例患儿附睾尾部明显增大,16例患儿附睾头部增大,14例患儿则是弥漫性增大。结论对小儿急性睾丸附睾炎患儿采用彩色多普勒超声方式检查,能够帮助医生清楚了解附睾的性质如大小、结构和形态等,还可以全面掌握血流动力学的具体变化状况,在临床与其他类似疾病鉴别时有突出优势,是医生为患儿制定针对性治疗方案的可靠依据,值得临床推广。     

The combined utilization of clinical and histological findings in the diagnosis of trichotillomania

BACKGROUND: Trichotillomania (TM) is a chronic disorder in which patients traumatically remove their own hair in a bizarre pattern. TM histopathological findings are not well defined. METHODS: Twenty-eight scalp biopsies of TM were reviewed. Multiple vertical sections and special stains were used to evaluate the specimens. Twenty-six patients (24 female, 2 male) were in the cohort, 2 patients had 2 sets of biopsies. RESULTS: Age range was 13-78 years (mean 41 years), most of them presented with chronic TM. Specific histological findings included trichomalacia (57%) and pigmented casts (46%). Non-specific histological findings included: follicular plugging (96%), decreased number of follicles (96%), reversed anagen:telogen ratio (86%), decreased number of sebaceous glands (68%), melanoderma (68%), increased number of fibrous tracts (64%) and vellus hairs (57%), superficial dermal inflammation (57%), evidence of hemorrhage (18%) and presence of hair granulomas (18%). CONCLUSIONS: Even though TM is often a disease of the young people, middle aged and elderly patients with TM have more often a biopsy to confirm the diagnosis. This paper suggests diagnostic criteria for TM. Specific histological findings and clinical suspicion of TM were considered major criteria, while the non-specific histological findings were considered minor diagnostic criteria for TM.