Depression and anxiety in patients with Behçet's disease compared with that in patients with psoriasis

Background Behçet's disease (BD) is a chronic, episodic disease with an often devastating course. The aim of this study was to evaluate the depression and anxiety levels in patients with BD and to compare them with those in patients with psoriasis. Methods Patients were collected from the Dermatology Department, Faculty of Medicine, Gazi University, Ankara, Turkey. One hundred and twelve patients with BD and 95 patients with psoriasis were enrolled in the study. Patients were evaluated by Beck's depression inventory (BDI), Beck's anxiety inventory (BAI), automatic thoughts questionnaire (ATQ), and Beck's hopelessness scale (BHS). Results The group with BD had higher scores for BDI, BAI, ATQ, and BHS than the group with psoriasis (P < 0.05). Almost one‐half of the patients with BD had depression. BAI only was higher in the younger BD group than in the corresponding psoriasis group, whereas all test scores were higher in the older BD group than in the corresponding psoriasis group. There was a strong correlation between the duration of BD and BDI, ATQ, and BHS scores, which was not observed in the psoriasis patients. BD increased the depression risk four‐fold in this sample, and BD with a duration of over 3 years increased the depression risk 12‐fold. Conclusions In the present study, BD patients had higher levels of psychopathology than did psoriasis patients in terms of psychologic test scores. The duration of illness affected the severity of the psychiatric symptoms in the BD group, but not in the psoriasis group. The duration of illness was a major risk factor for the development of depression in BD. These findings indicate the need for early recognition of psychiatric symptoms in patients with BD.     

Onychomycosis with onychodystrophy or acrolentiginous melanoma with onychomycosis and onychodystrophy?

A 68-year-old female patient had been treated locally and systemically for onychomycosis of the left thumbnail for 1 year. During the course of treatment there was increasing destruction of approximately 50% of the nail without Hutchinson's sign. Dermoscopically there were yellow to brown vertical stripes of varying width in the remaining parts of the nail. In the visible nail matrix reddish, brownish and grey-black colored components with varying differential structures could be detected. An acrolentiginous melanoma with a diameter of 1.04?mm could be identified histologically and the associated onychomycosis was confirmed by culturing.     

Behçet's syndrome with pyoderma-gangrenosum-like lesions treated successfully with dapsone monotherapy

Behçet's syndrome (BS) is a rare multisystem disorder belonging to a group of neutrophilic dermatoses. We report a 65‐year‐old male patient who had suffered from recurrent painful orogenital ulcers for 50 years from the age of 15 and started developing pustular and bullous lesions evolving into non‐healing ulcers similar to those seen in pyoderma gangrenosum (PG) two months prior to presenting to us. There was no evidence of systemic disease or malignancy. Routine baseline investigations were within normal limits. The patient was treated successfully with dapsone, antibiotics, and local wound care.     

Sézary syndrome associated with granulomatous lesions during treatment with bexarotene

Sézary syndrome (SS) is a leukaemic variant of cutaneous T-cell lymphoma (CTCL). We report a patient with SS who developed granulomatous lesions. These lesions broke out during treatment with bexarotene when the disease had appeared to stabilize. After a partial clinical remission the disease showed rapid progression and finally led to the patient's death. This contradicts the initial assessment, which considered the granulomatous inflammation as a good prognostic factor in CTCL.     

Epidermolysis bullosa acquisita associated with relapsing polychondritis: an association with eosinophilia?

Epidermolysis bullosa acquisita is a blistering disorder that has been associated with other autoimmune diseases. It has not previously been associated with relapsing polychondritis (RPC). RPC is an autoimmune disorder that frequently displays peripheral eosinophilia. The eosinophil has been implicated in mediation of tissue damage and bullae formation. RPC should be added to the list of diseases seen in association with EBA.     

Necrobiosis lipoidica associated with Köbner's phenomenon in a patient with diabetes

Necrobiosis lipoidica (NL) is a granulomatous disease that usually presents on the lower extremities of patients with diabetes mellitus. We present a rare case of NL k?bnerizing in a surgical scar on the upper extremity of a patient with diabetes. NL is generally refractory to treatment.     

PNP with Waldenström's macroglobulinaemia

We describe a 65-year-old Caucasian man with Waldenstrom's macroglobulinaemia who developed paraneoplastic pemphigus (PNP) 3 years after his haematological diagnosis. This is a very rare malignancy that is associated with PNP. The evolution of PNP in this patient appears to exhibit the postulated immunological phenomenon of epitope spreading.     

A Newborn with Acanthosis Nigricans: Can It Be Crouzon Syndrome with Acanthosis Nigricans?

Abstract:  Crouzon syndrome is a craniosynostosis syndrome, characterized by cloverleaf skull, hypertelorism, exophthalmos, external strabismus, parrot-beaked nose, short upper lip, hypoplastic maxilla, and mandibular prognathism. The 5% of individuals with Crouzon syndrome who have pigmentary changes in the skin are said to have Crouzon syndrome with acanthosis nigricans (CAN). Choanal atresia, hydrocephalus and the cranial features of Crouzon syndrome should suggest the diagnosis of CAN even before acanthosis appears. We present a 10-hour-old newborn who presented with bilateral choanal atresia, craniosynostosis and acanthosis nigricans. Molecular tests identified the FGFR3 Ala391Glu substitution confirming the diagnosis of CAN. Of the 35 cases of CAN reported in literature till date, only one child had acanthosis nigricans at birth. This is the first case from India to have been reported with this mutation.     

Pyoderma gangrenosum with pulmonary involvement?

Pyoderma gangrenosum is a rare, painful, noninfectious, ulcerative, reactive neutrophilic skin condition. It is characterized by ulcers that can spread quickly showing undermined violaceous borders. Since there is no single diagnostic test, early diagnosis is always challenging. The aggressive nature of classical pyoderma gangrenosum may become apparent only with time. Pulmonary involvement of pyoderma gangrenosum maybe underreported. We describe a case of classical pyoderma gangrenosum in a 65-year-old man with pulmonary involvement, who presented with a painful fluctuate nodule and ulcer with mucopurulent and hemorrhagic exudates, and with a monoclonal gammopathy, IgA type. One month later the ulcer and hemoptysis all disappeared after treatment with glucocorticosteroids. The pulmonary manifestations of pyoderma gangrenosum were also reviewed.     

Cutaneous Normolipemic Plane Xanthoma with Supraglottic Involvement in a Patient with Hand-Schüller-Christian Disease

Normolipemic plane xanthoma (NPX) is a histiocytic disorder characterized by yellow-orange plaques in the periorbital areas, neck, upper trunk, and flexural folds. Association with systemic disease or paraproteinemia has been reported previously, but rarely with Langerhans cell histiocytosis (LCH). We report a case of Hand-Schüller-Christian disease (a type of LCH) in a patient who developed NPX with supraglottic involvement. NPX developed after several courses of chemotherapy and the supraglottic xanthoma occurred about 2 years later. The coexistence of LCH and non-LCH histiocytic lesions in this patient could be a result of chemotherapy-induced changes or may be just coincidental.     

Adult Henoch-Schönlein purpura with severe abdominal pain treated with dapsone and factor XIII concentrate

We describe an adult patient with Henoch‐Schönlein purpura who had arthralgia, severe abdominal pain, and low plasma factor XIII activity. Corticosteroids were not used because of his history of multidrug‐resistant pulmonary tuberculosis. Dapsone had no immediate effect on his abdominal pain, but appeared to have some effect on the purpura and arthralgia. Marked improvement of the abdominal pain was observed immediately after the administration of factor XIII concentrate. Factor XIII concentrate may be useful for alleviating abdominal pain in Henoch‐Schönlein purpura patients when corticosteroids are contraindicated