Chilblains in Turkey: a case-control study

BACKGROUND

Chilblains are rather common in winter months in our country.

OBJECTIVES

Determination of demographical and clinical characteristics of patients presenting with chilblains in Diyarbakir, Turkey. Evaluation of body mass index (BMI) as risk factor for development of chilblains.

METHODS

Sixty-nine patients who were diagnosed as chilblains at our outpatient clinics were included in this study. No exclusion criteria were sought. Demographical data including height and weight and answers to questions related to personal history were recorded. A control group consisting of 108 controls were chosen from among patients presenting with complaints of hair loss. Statistical analyses were conducted using SPSS 17.0.

RESULTS

Of the 69 patients with chilblains, 45 (65.2%) were females and 24 (34.8%) were males. Mean age (±SD) of the patients was 21±9. 71.2% of the patients complained of itching, 51.6% of pain, 31.3% of burning in the lesions. 61.3% of the patients reported recurrence of the lesions every winter season. Mean BMI of the patients was 20.5±2.9. Mean BMI of the controls was 22.4±3.7 and the difference was statistically significant (p=0.01).

CONCLUSIONS

Low BMI may be a risk factor contributing to development of chilblains in persons exposed to cold weather conditions. Apart from external factors, there seems to be a personal tendency to develop lesions, as many patients report recurrences every year. Diagnosis of chilblains requires wariness, as history of cold exposure may not be evident.     

150例皮肤纤维瘤组织病理与临床分析

目的 分析皮肤纤维瘤（DF）的组织病理与临床特征,探讨两者的相互联系。方法 回顾分析2017年9月至2018年8月在上海市皮肤病医院病理科经皮肤组织病理检查确诊的150例DF患者的临床和组织病理资料。结果 150例患者中,男65例,女85例,年龄（42 ± 13.8）岁,病程3个月至 > 30年,部分有伴随症状,主要表现为瘙痒,有自发痛、轻压痛,18例皮损有外伤、虫咬或感染病史。皮损主要位于四肢（107例,71.3%）,以单发皮损为主（105例,70%）。病理检查前拟诊为“DF”102例,“表皮样囊肿”16例,“色痣”13例,“瘢痕疙瘩”3例,“皮肤肿物”12例,“恶性黑素瘤”1例,“黄色肉芽肿”1例,“结节性痒疹”1例,“神经纤维瘤”1例。在这些患者的169张苏木精-伊红染色切片中,66张（39.1%）为细胞性,36张（21.3%）硬化性,25张（14.8%）表现为动脉瘤样型DF,22张（13.0%）上皮样型。12张切片内可见两种或两种以上亚型并存的现象。还可见少数新的变异型,如DF伴汗腺导管增生（1例）、深在型DF（3例）、上皮样细胞与增生胶原相间的DF（1例）等。动脉瘤样型DF病程长短不一,7个月至> 30年,多表现为发生于下肢的皮肤肿物样损害。细胞性DF病程相对较短,常发现数月后就诊,好发于四肢,常伴痒痛。硬化性或萎缩性DF病程长,为数年或数十年,好发于上肢,多无伴随症状。上皮样型DF病程长短不一,临床表现多样,多发于下肢,无伴随症状。结论 DF的临床表现及病理表现均具有多样性,不同的DF皮损可有相似的典型组织病理学表现,不典型的病理表现可干扰疾病诊断。     

Perception of brittle nails in dermatologic patients: a cross-sectional study

Brittle Nails Syndrome is characterized by fragility of the nail plate, affecting 27% of women. We evaluated dermatology patients in a cross-sectional study about perception of nail fragility. One hundred and thirtyeight women were included, with median age of 36.5 years. Nail examination showed changes in 57% and 49% reported nail fragility. The first three fingernails were the most affected. Onychoschizia was related to onychophagia (OR = 3.29), housework (OR = 2.95) and water contact (OR = 2.44). Onychorrhexis had the strongest association with nail fragility perception (OR = 17.89). The fragility was more perceived by those who were black, of mixed race and atopic, and was associated with depressed mood.     

Immunohistochemical analysis of S100-positive epidermal Langerhans cells in dermatofibroma

Dermatofibroma is a dermal fibrohistiocytic neoplasm. The Langerhans cells are the immunocompetent cells of the epidermis, and they represent the first defense barrier of the immune system towards the environment. The objective was to immunohistologically compare the densities of S100-positive Langerhans cells in the healthy peritumoral epidermis against those in the epidermis overlying dermatofibroma (20 cases), using antibodies against the S100 molecule (the immunophenotypic hallmark of Langerhans cells). The control group (normal, healthy skin) included ten healthy age and sex-matched individuals who underwent skin biopsies for benign skin lesions. A significantly high density of Langerhans cells was observed both in the epidermis of the healthy skin (6.00 ± 0.29) and the peritumoral epidermis (6.44 ± 0.41) vs. those in the epidermis overlying the tumor (1.44 ± 0.33, p < 0.05). The quantitative deficit of Langerhans cells in the epidermis overlying dermatofibroma may be a possible factor in its development.     

Keratosis pilaris and prevalence of acne vulgaris: a cross-sectional study

BACKGROUND

Acne vulgaris has an important genetic predisposition, as well as keratosis pilaris. Clinical observations suggest that patients with keratosis pilaris have less frequent or less severe acne breakouts; however, we found no studies on this regard

OBJECTIVE

To determine if the presence of keratosis pilaris is associated with lower prevalence and severity of acne.

METHODS

A cross-sectional study was conducted with dermatology outpatients aged between 14 and 35 years. We evaluated history and clinical grade of acne, demographic variables, history of atopy, smoking, and use of hormonal contraceptives. Two groups were defined by the presence or absence of moderate to severe keratosis pilaris on the arms and were compared by bivariate analysis and by conditional multiple logistic regression.

RESULTS

We included 158 patients (66% women), with a median age of 23±11 years. Twenty-six percent of them had keratosis pilaris, which was associated with a history of atopy (odds ratio [OR]=2.80 [1.36 to 5.75]; p<0.01). Acne was present in 66% of subjects, and was related to family history of acne (OR=5.75 [2.47 to 13.37]; p<0.01). In bivariate and multivariate analysis, the group with keratosis pilaris had a less frequent history of acne (OR=0.32 [0.14 to 0.70]; p<0.01).

CONCLUSION

The presence of moderate to severe keratosis pilaris on the arms was associated with lower prevalence of acne vulgaris and lower severity of facial lesions in adolescents and young adults.     

Unilateral punctate porokeratosis - Case report

This case report involves a 20-year-old man with unilateral punctate porokeratosis. The patient presented an 8-year history of numerous asymptomatic keratotic papules and pits with linear distribution on his left pal-mar surface and fifth finger of the left hand. Histopathological examination of the keratotic plug revealed findings of distinct epidermal depressions containing cornoid lamellae. This report review draws attention to differential diagnoses of punctate porokeratosis.     

Case for diagnosis

We report the case of an 11-year-old male patient with a histopathological and immunohistochemical diagnosis of dermatofibroma with an atypical clinical presentation on the right forearm. Although dermatofibroma is considered a benign skin tumor, some of its differential diagnoses, such as dermatofibrosarcoma protuberans and malignant fibrous histiocytoma, are truly aggressive. Lesions with atypical clinical aspects and topology associated with specific histopathological variants are some of the criteria for complete tumor excision.     

Vitiligo - Part 2 - classification,histopathology and treatment

In an unprecedented effort in the field of vitiligo, a global consensus resulted on asuggested new classification protocol for the disease. The main histopathologicalfinding in vitiligo is the total absence of functioning melanocytes in the lesions,while the inflammatory cells most commonly found on the edges of the lesions are CD4+and CD8+ T lymphocytes. Physical and pharmacological treatment strategies aim tocontrol the autoimmune damage and stimulate melanocyte migration from the unaffectededges of lesions and the outer hair follicle root sheath to the affected skin;moreover, surgical treatments can be combined with topical and physicaltreatments.     

Clear cell acanthoma of the areola and nipple: clinical, histopathological,and immunohistochemical features of two Brazilian cases

Clear cell acanthoma or Degos'' acanthoma is a distinct disease concerning itsclinical, histopathological, and immunohistochemical features. Its pathologic nature- whether neoplastic or reactive - is still under dispute among researchers. Thedisease shows a chronic course and often presents with a single papulonodular lesionon the lower limbs of adults. However, cases with multiple lesions, sometimesoccurring in an eruptive fashion, and with clear variation in the size and shape ofthe cutaneous lesions have been reported. So far, five cases in which the lesionswere exclusively located in the nipple area have been reported, all in Korean women.Four of these cases mimicked eczema and one, a polypoid nodule. The aim of thisarticle is to present clinical, histopathological, and immunohistochemical featuresof two additional cases in Brazilian women with similar nipple topography.     

Quality of life and psychosocial aspects in Greek patients with psoriasis: a cross-sectional study

BACKGROUND

Psoriasis is a common, long-term skin disease associated with high levels of psychological distress and a considerable adverse impact on life. The effects of psoriasis, beyond skin affliction, are seldom recognized and often undertreated.

OBJECTIVE

The aim of the study is to evaluate the quality of life, anxiety and depression, self-esteem and loneliness in patients with psoriasis.

METHODS

Eighty-four patients with psoriasis were enrolled in the study. The quality of life, depression and anxiety, loneliness and self-esteem of the patient were assessed using the Dermatology Life Quality Index, Hospital Anxiety and Depression Scale, the UCLA loneliness Scale (UCLA-Version 3) and Rosenberg''s Self-esteem Scale, respectively.

RESULTS

The Dermatology Quality of Life Index score among psoriasis patients was 12.61 ± 4.88. They had statistically significantly higher scores according to the Hospital Anxiety and Depression Scale -anxiety subscale (p=0.032)-compared with healthy volunteers. Moreover, a statistically significant difference was found between the two groups concerning the UCLA-scale (p=0.033) and RSES-scale (p<0.0001). Female patients presented with lower self-esteem than male patients.

CONCLUSION

Psoriasis is a distressing, recurrent disorder that significantly impairs quality of life. Therefore, the recognition and future management of psoriasis may require the involvement of multi-disciplinary teams to manage the physical, psychological and social aspects of the condition, as is the case for systemic, long-term conditions.     

Tumoral chromoblastomycosis: a rare manifestation with typical complementary exams

Chromoblastomycosis is a chronic subcutaneous fungal infection caused bytraumatic implantation of dematiaceous fungi in the skin. The clinicalpresentation is usually a verrucous plaque lesion and the diagnosis isconfirmed by the visualization of muriform bodies at direct examination orat the histologic study. This report describes a rare case of tumoralchromoblastomycosis confirmed by histologic study and whose agent wasidentified by culture and micromorphology.     

Clinical and histological challenge in the differential diagnosis of diffuse alopecia: female androgenetic alopecia,telogen effluvium and alopecia areata - Part II

Diffuse alopecia is mainly caused by telogen effluvium, diffuse androgenetic alopecia (female-pattern hair loss) and diffuse alopecia areata. Differential diagnosis between the three disorders may be difficult in several occasions. In this second part of our study, chronic telogen effluvium and diffuse alopecia areata are discussed in detail, including clinical, dermoscopic and histological aspects. A flowchart presents a practical and objective differential diagnostic approach to diffuse alopecia.     

Brazilian guidelines for diagnosis,treatment and follow-up of primary cutaneous melanoma - Part II

The last Brazilian guidelines on melanoma were published in 2002. Development in diagnosis and treatment made updating necessary. The coordinators elaborated ten clinical questions, based on PICO system. A Medline search, according to specific MeSH terms for each of the 10 questions was performed and articles selected were classified from A to D according to level of scientific evidence. Based on the results, recommendations were defined and classified according to scientific strength. The present Guidelines were divided in two parts for editorial and publication reasons. In this second part, the following clinical questions were answered: 1) which patients with primary cutaneous melanoma benefit from sentinel lymph node biopsy? 2) Follow-up with body mapping is indicated for which patients? 3) Is preventive excision of acral nevi beneficious to patients? 4) Is preventive excision of giant congenital nevi beneficious to patients? 5) How should stages 0 and I primary cutaneous melanoma patients be followed?     

Angiogenic effects of cryosurgery with liquid nitrogen on the normal skin of rats,through morphometric study

BACKGROUND

Cryosurgery is an efficient therapeutic technique used to treat benign and malignant cutaneous diseases. The primary active mechanism of cryosurgery is related to vascular effects on treated tissue. After a cryosurgical procedure, exuberant granulation tissue is formed at the injection site, probably as a result of angiogenic stimulation of the cryogen and inflammatory response, particularly in endothelial cells.

OBJECTIVE

To evaluate the angiogenic effects of freezing, as part of the phenomenon of healing rat skin subjected to previous injury.

METHODS

Two incisions were made in each of the twenty rats, which were divided randomly into two groups of ten. After 3 days, cryosurgery with liquid nitrogen was performed in one of incisions. The rats'' samples were then collected, cut and stained to conduct histopathological examination, to assess the local angiogenesis in differing moments and situations.

RESULTS

It was possible to demonstrate that cryosurgery, in spite of promoting cell death and accentuated local inflammation soon after its application, induces quicker cell proliferation in the affected tissue and maintenance of this rate in a second phase, than in tissue healing without this procedure.

CONCLUSIONS

These findings, together with the knowledge that there is a direct relationship between mononuclear cells and neovascularization (the development of a rich system of new vessels in injury caused by cold), suggest that cryosurgery possesses angiogenic stimulus, even though complete healing takes longer to occur. The significance level for statistical tests was 5% (p<0,05).     

Distribution of Brazilian dermatologists according to geographic location,population and HDI of municipalities: an ecological study

This study investigated the geographic distribution of dermatologists in Brazilian municipalities in relation to the population, regions of the country and human development index. We conducted an ecological study based on data from the 2010 census, the 2010 human development index, and the records of the Brazilian Society of Dermatology. 5565 municipalities and 6718 dermatologists were surveyed. Only 504 (9.1%) municipalities had dermatologists, and accounted for 56.2% of the Brazilian population. The smallest population size and lowest HDI rate that best discriminated municipalities that did not have dermatologists were found to be 28,000 and 0.71, respectively. The average population density of dermatologists in cities was 1/23.000 inhabitants, and variations were independently associated with the HDI, the population of the municipalities and the region of the country.     

Treatment of pityriasis versicolor with topical application of essential oil of Cymbopogon citratus (DC) Stapf - therapeutic pilot study

BACKGROUND

Pityriasis versicolor is a fungal infection caused by Malassezia spp. that has frequent relapses.

OBJECTIVES

The main objective of this research was to perform phase I and II clinical studies, using formulations containing essential oil of Cymbopogon citratus in patients with pityriasis versicolor.

METHODS

Phase I study included twenty volunteers to ascertain the safety of the formulations. In phase II, 47 volunteers randomly received essential oil formulations at 1.25 μL/mL concentration, for forty days. The shampoo should be applied three times a week and the cream twice a day. A control group in phase II, consisting of 29 volunteers, received the same formulations but with 2% ketoconazole as the active ingredient.

RESULTS

No significant adverse events were observed in volunteers during Phase I. In Phase II, 30 (63.83%) volunteers using essential oil and 18 (62.07%) using ketoconazole remained until the end of the study. We observed a predominance of lesions in disseminated form, with M. sympodialis detected as the predominant agent identified in cultures. After 40 days of treatment, the rate of mycological cure was 60% (p <0.05) for the group treated with essential oil of C. citratus and over 80% (p <0.05) for the group treated with ketoconazole formulations.

CONCLUSIONS

Notwithstanding the safety and antifungal effects observed in this study after application of formulations containing the essential oil of C. citratus, further studies with larger populations should be performed to confirm the actual potential of these formulations in the treatment of patients with Pityriasis versicolor.     

Efficacy and safety of a single dose pentamidine (7mg/kg) for patients with cutaneous leishmaniasis caused by L. guyanensis: a pilot study

BACKGROUND

There have been few studies on pentamidine in the Americas; and there is no consensus regarding the dose that should be applied.

OBJECTIVES

To evaluate the use of pentamidine in a single dose to treat cutaneous leishmaniasis.

METHODS

Clinical trial of phase II pilot study with 20 patients. Pentamidine was used at a dose of 7 mg/kg, in a single dose. Safety and adverse effects were also assessed. Patients were reviewed one, two, and six months after the end of treatments.

RESULTS

there was no difference between the treatment groups in relation to gender, age, number or location of the lesions. Pentamidine, applied in a single dose, obtained an effectiveness of 55%. Mild adverse events were reported by 17 (85%) patients, mainly transient pain at the site of applications (85%), while nausea (5%), malaise (5%) and dizziness (5%) were reported in one patient. No patient had sterile abscess after taking medication at a single dose of 7mg/kg.

CONCLUSIONS

Clinical studies with larger samples of patients would enable a better clinical response of pent amidine at a single dose of 7mg, allowing the application of more powerful statistical tests, thus providing more evidences of the decrease in the effectiveness of that medication. Hence, it is important to have larger studies with new diagrams and/or new medications.     

Variants of CARD14 gene and psoriasis vulgaris in southern Chinese cohort

BACKGROUND:

Recent mutation analysis identified several missense mutations in CARD14 in psoriasis.

OBJECTIVES:

We performed the genomic sequence analysis on CARD14 in southern Chinese Han Cantonese with Psoriasis Vulgaris (PsV) to reveal more causative missense mutations.

METHODS:

A total of 131 patients with PsV and 207 matched controls were included. We conducted sequence analysis of all the exon and exon-intron boundaries of CARD14 in the group of PsV patients and subsequent case control analysis of potential sequence variants of significance.

RESULTS:

We found five rare mutations and four of them are annotated or reported. Only the variant (c.1291C>G) has not been reported and annotated, but the variant was also found in controls. No significant difference was detected among all rare variant allele frequencies of patients and controls.

CONCLUSION:

None of the new definite variants were pathogenic. The other pathogenic mutations for PsV are still elusive in our cohort.