Skin tag as a cutaneous marker for impaired carbohydrate metabolism: a case-control study

BACKGROUND: Skin tags are common benign skin tumors usually occurring on the neck and major flexors of older people. A possible association with impaired carbohydrate metabolism has been suggested in previous studies, but the results are not conclusive. OBJECTIVE: To investigate and compare the prevalence of diabetes and impaired glucose tolerance (IGT) in patients with skin tag and a control group. PATIENTS AND METHODS: A case-control study was conducted in individuals over 15 years old, comparing cases (n = 104) with at least three skin tags and age-, sex-, and body mass index (BMI)-matched controls (n = 94) without skin tag. Cases and controls were recruited from patients consecutively seen at an academic outpatient dermatology clinic. All patients underwent a standard 2-h oral glucose tolerance test with 75 g glucose. RESULTS: Patients with skin tag had higher frequency of diabetes than the control group (23.07% vs. 8.51%, chi(2)-test, P = 0.005). The difference in the frequency of IGT was not significant (13.46% vs. 10.63%, chi(2)-test, P = 0.543). There was a positive correlation between the total number of skin tags and the mean fasting plasma glucose (Pearson correlation, r = 0.260, P = 0.031); patients with more than 30 skin tags were particularly at an increased risk of diabetes (52.0%). No correlation was found between the number of skin tags and BMI. We did not find any correlation between the anatomical localization of skin tags and impaired carbohydrate metabolism, except for skin tags under the breast in women. CONCLUSION: These results show an increased risk of diabetes mellitus in patients with multiple skin tags. With regard to the importance of early diagnosis of diabetes, we recommend a high level of suspicion for impaired carbohydrate metabolism in patients with skin tag.     

Cryotherapy for anogenital warts: factors affecting therapeutic response

Human papilloma virus genital infection remains a treatment dilemma; there is still no gold standard therapy, treatment options are limited, expensive and often ineffective, and recurrence rates are relatively high. The primary objective of this study is to establish the efficacy, safety, and tolerability of cryotherapy in the treatment of these lesions. From 1999 to 2003, 100 consecutive patients with at least ten genital warts were treated with liquid nitrogen cryotherapy using a cotton-tipped applicator and two freeze-thaw cycles at the outpatient dermatology clinic of Hazrat-e Rasool University Hospital. Treatment was repeated every 3 weeks until the disappearance of all visible lesions was achieved. Patients were followed up every 4 months for 18 months. Complete clinical cure (CCC) was defined as complete clearance of all lesions and no evidence of disease for a minimum of 18 months. The CCC and relapse rate were evaluated based on different demographic and clinical characteristics. Overall, 86 percent of the patients achieved CCC after an average of 3.31 treatment sessions. All of the failed cases were attributed to recurrence of warts in new sites. The cure rate increased in parallel with increasing treatment sessions until the 6th session, after which it remained constant. The cure rate was lower and the number of treatment sessions higher in older patients. The age of the patient and number of treatment sessions affect the cure rate. The recurrence rate was significantly higher for the married or multi-partner group than for unmarried patients. We concluded that cryotherapy is an effective method for treatment of anogenital warts. The age of the patient and size of the lesions affect the cure rate. However, the most important factor in relapse of the lesions is unprotected sexual contact during and after treatment.     

Broad-band ultraviolet B phototherapy in zoster patients may reduce the incidence and severity of postherpetic neuralgia

BACKGROUND: Postherpetic neuralgia (PHN) is one of the common complications of herpes zoster infection, particularly in the elderly. Current therapeutic measures are only partially effective in the affected patients. As inflammatory mediators released by different cells play an important role in the pathogenesis of this neuropathic pain and with regard to the immunomodulatory effects of ultraviolet B (UVB) spectrum, we presumed that UVB phototherapy might be effective in the prevention of PHN. METHOD: This study was performed in two phases. Phase I was a prospective open controlled trial. Twenty-five patients with severe pain in the first 7 days of zoster rash were divided into two groups: the prevention group (n=12) received oral acyclovir (800 mg five times a day for 10 days) plus broad-band UVB to the affected dermatomes, starting with 20 mJ/cm(2) and gradually increasing the dose by 10 mJ/cm(2) each session to a maximum dose of 100 mJ/cm(2). Treatment sessions were repeated three times a week until pain relief or to a maximum of 15 sessions. The control group (n=13), who had disease characteristics similar to the prevention group, received only oral acyclovir with the same dose. All patients reported their severity of pain on a verbal rating scale (VRS, score 0-4) before treatment and at 1 and 3 months' follow-up. In phase II of the study, five patients with established PHN (more than 3 months after rash onset) received UVB with the above-mentioned protocol. RESULTS: A total of 17 patients older than 40 (10 females, seven males; mean age, 65.5 years; range: 47-82 years) who had intractable pain due to zoster infection received UVB in two phases of the study. In patients who received phototherapy in the first 7 days of rash, 58.33% and 83.33% were completely pain free at 1-and 3-month follow-up, respectively. The corresponding figure in the control group was significantly lower (38.46% at 1 month and 53.85% at 3 months). The severity of pain was also lower in the phototherapy group than the control group (mean VRS 2.50 vs. 3.28 at 3 months). None of the patients who were treated more than 3 months after rash onset (established PHN) experienced significant (more than 50%) pain relief. CONCLUSION: UVB phototherapy in the acute stage of zoster rash might reduce the incidence and severity of PHN. Treatment after 3 months does not seem to have a significant beneficial effect.     

Giant congenital melanocytic nevus with neurofibroma-like changes and spina bifida occulta

A 12‐year‐old Iranian girl presented with a bathing trunk congenital melanocytic nevus. Multiple other pigmented lesions were present. The nevi were distributed over the entire body including the oral mucosa. There were also bilateral, soft, pendulous tumors and nodules in the area covered by the giant congenital melanocytic nevus. The tumors had been present since birth and showed continuous growth during childhood. She was otherwise healthy. Her parents were not consanguineous. There was no family history of similar lesions. Physical examination revealed a large dark‐brown circumferential plaque extending evenly from the upper back and abdomen down to the lumbar region, buttocks, and thighs ( Fig. 1 ). It had a smooth surface, with excessive growth of hair. There were soft, redundant, exuberant folds of skin overhanging the back and buttock, localized to the area covered by the bathing trunk nevus. On palpation, they appeared as deep, multilobulated masses mimicking giant neurofibromas. There were also several smaller dark‐ or skin‐colored, soft, dermal nodules in this area. On other parts of the integument, there were numerous pigmented nevi of different sizes and colors, including speckled nevi, café‐au‐lait spots, and some clinically dysplastic nevi. There was hypertrichosis over some of the nevi. Mucosal examination revealed dark‐brown macules on the hard palate and conjunctiva. General physical examination was otherwise normal. There was no axillary freckling. Ophthalmologic examination was negative for Lisch nodules, and the fundal appearance was normal. Neurological examination revealed no abnormalities. Spinal X‐ray showed spina bifida occulta in the fifth lumbar vertebra. Brain and spinal magnetic resonance imaging (MRI) with gadolinium contrast was performed to detect neurocutaneous melanosis, which was negative. Two deep incisional biopsies were performed of the proliferative nodules over the hips, with the clinical impression of giant neurofibroma. Histologic examination revealed superficial nests of melanocytes with focal involvement of the dermo‐epidermal junction, extending into the dermis ( Fig. 2 ). The melanocytes became spindle shaped within the reticular dermis ( Fig. 3 ). Immunohistochemical techniques showed strong positive staining for both S100 protein and MART‐1 in both the superficial and deep portions of the proliferation, consistent with a melanocytic nevus.

Figure 1 Open in figure viewer PowerPoint Bathing trunk melanocytic nevus with large, pendulous skin lesions mimicking neurofibromas over the buttocks and lower back and multiple other melanocytic nevi of variable size distributed all over the body     

The Actor–Partner Effects of Parenting Stress on Quality of Life Among Parents of Children with ASD: The Mediating Role of Mental Quality of Life

Journal of Autism and Developmental Disorders - The present study investigated the actor–partner effects of parenting stress (PS) on quality of life (QoL) among parents (96 couples) of...     

A novel mutation in RFXANK gene and low B cell count in a patient with MHC class II deficiency: a case report

Immunologic Research - Recurrence of severe microbial infections results from a primary immunodeficiency disorder known as major histocompatibility complex class II deficiency or bare lymphocyte...