Pseudoangioedema

Angioedema is a rapid, localized and temporary subcutaneous edema, which targets the lips, eyelids, gastrointestinal and respiratory mucosa resulting in abdominal pain, asthma and even serious life‐threatening conditions like airway obstruction. There are several other disorders such as allergic contact dermatitis, drug rash with eosinophilia and systemic symptoms (DRESS), superior vena cava syndrome (SVCS), orofacial granulomatosis and so on, which manifest with subcutaneous swelling and masquerade as angioedema and are known as ‘pseudoangioedema’ in the literature. Knowledge of pseudoangioedema for healthcare professionals is crucial to avoid potentially serious results of misdiagnosis such as further investigations, unnecessary applications and delayed diagnosis. We aim to discuss differential diagnosis of angioedema and help physicians recognize the typical features of angioedema and its differential diagnosis in this chapter

A Review of Possible Triggering or Therapeutic Effects of Antimicrobial Vaccines on Psoriasis

Psoriasis is a chronic, immune-mediated disease resulting from interactions of genetic background with environmental triggering factors, such as trauma, infections and drugs. Dendritic cells, activated T-cells toward a Th1 and Th17 response and inflammatory cytokines [tumor necrosis factor (TNF)-alpha, IL-6, -12, -17, -22 and -23] are the key factors in psoriasis pathogenesis. Patients diagnosed with psoriasis are at increased risk of infection due to the nature of disease and immunosuppressive therapies. Vaccination is recommended to prevent infections in patients with psoriasis. Additionally, vaccines such as Mycobacterium vaccae, live attenuated varicella zoster virus and Leishmania amastigotes have been reported to induce improvement in psoriasis patients. It has been suggested that vaccines, targeting molecules in the immunopathogenesis of psoriasis, may be a new treatment option for psoriasis patients without any serious side effects. However, induction or worsening of the psoriasis and psoriatic arthritis followed by some vaccines (e.g., influenza, rubella, tetanus, BCG) has also been reported in the literature. In this review, we focus on the vaccines in psoriasis in terms of their both triggering and therapeutic effects

Cryotherapy for Common Premalignant and Malignant Skin Disorders

Cryotherapy, also known as cryosurgery or cryoablation, is a common dermatological treatment that is an expanded area from benign to malignant lesions. The system has been designed as a localized freezing cold that causes the destruction of cell integrity. The treatment has been also used for all ages, which is not required to have a condition of wellness. It is convenient, fast, and easy to apply in clinics, and there is no need for anesthesia. Additionally, multiple lesions are also cured in the same sessions. After the treatment, recovery period has not taken much longer and also has simple adverse effects, which are tolerable. Lastly, cryotherapy has gained excellent cosmetic results. It is highly effective for actinic keratosis and is the treatment of choice for most old patients who show poor cooperation and recurrent multiple lesions. Additionally, due to increasing premalignant lesions all over the world associated with increasing age, it is a considerable choice for lentigo maligna and Bowen’s disease. In non-melanoma skin cancers, it is also the most important option in patients who do not undergo surgery and when other options are not appropriate. In this chapter, the use of cryotherapy for premalignant and malignant cutaneous disorders has been mainly focused

Audiovestibular Dysfunction and Hearing Loss in Patients with Psoriasis and Psoriatic Arthritis

Psoriasis is now considered a T cell-mediated chronic systemic inflammatory disease rather than only a simple skin disease. The relationship and coexistence of this common disease with many other comorbidities have gained increasing attention in recent years. Although psoriatic skin lesions are seen frequently in the auricle and external auditory canal, there are not many studies evaluating the possible effect of psoriatic disease (psoriasis with or without joint involvement) on the auditory system. Hearing impairment detected in psoriasis patients is mostly seen as subclinical hearing loss at high frequencies, but it can also have a significant impact on patients’ health and quality of life due to the possible risk of developing sudden sensorineural hearing loss. In this chapter, the frequency, pattern, and patient-related risk factors of hearing impairment and audiovestibular dysfunction in patients with psoriasis and psoriatic arthritis were extensively reviewed and discussed. In conclusion, it was emphasized that subclinical sensorineural hearing loss is a neglected but an important comorbidity in patients with psoriasis and psoriatic arthritis. The relationship between psoriatic disease and audiovestibular dysfunction supports the need for further studies aimed at better identification of the underlying pathogenic mechanisms, and accordingly to update diagnostic and even treatment approaches

Neuropathic Pruritus: An Underrecognized and Often Misdiagnosed and Difficult to Treat Medical Condition

It is estimated that approximately 8% of chronic pruritic cases are of neuropathic origin. Common neuropathic pruritic syndromes include different clinical presentations such as postherpetic pruritus, trigeminal trophic syndrome, anogenital pruritus, scalp dysesthesia, nerve compression syndromes (e.g., notalgia paresthetica, brachioradial pruritus), small-fiber neuropathy (secondary to various metabolic, infectious, autoimmune, and genetic diseases), and disorders affecting the central nervous system (occupying lesions, iatrogenic, infectious, neurodegenerative, or demyelinating diseases). Although general practitioners are most likely to see the itchy cases first and consider referring them to further medical advice, it would be a better approach for the physicians to cooperate with dermatologists and neurologists and physiotherapists in particular especially in chronic persistent itchy conditions. Neuropathic pruritus must first be differentiated from other possible etiologies of pruritus by medical history and physical examination, laboratory tests, skin biopsy, and radiological and functional evaluations. It often does not respond to classical antipruritic treatments and different treatment options such as neuroleptics, topical capsaicin, epidural steroid injections, botulinum injections, nerve blocks, and neurostimulation techniques have been tried with variable success responses. This chapter provides a comprehensive overview of the characteristics and clinical presentations of neuropathic pruritus and the diagnostic and therapeutic management used in such patients

Acneiform Papulopustular Eruptions in Behçet\u27s Disease

Behcet’s disease (BD) is a multisystemic inflammatory vasculitic disorder which diagnosed by clinical criteria because of the lack of specific laboratory test and/or pathognomonic histopathological findings. The most frequent diagnostic criteria of this disease are mucocutaneous lesions, appearing at the disease onset or during the course, usually begin before significant organ dysfunction. According to BD International Study Group Criteria, one of the five criteria is dermatologic findings including pseudofolliculitis, acneiform nodules or papulopustular lesions (PPL) diagnosed by clinician in postadolescent patients. In some case reports and clinical studies, the PPL of BD are also denoted as Behcet’s pustulosis, folliculitis, acneiform eruptions and pseudofolliculitis. Owing to implementation of follicular lesions in these criteria, there may be difficulties in the distinction between most of the PPL of BD and the other acneiform eruptions/nonspecific follicular lesions (e.g., acne vulgaris, bacterial folliculitis, steroid acne). Certainly, clinicians should distinguish these patterns for accurate diagnosis. Although earlier studies involve numerous quandaries regarding the diagnostic histopathologic pattern of BD (e.g., whether to include vasculitis or nonspecific folliculitis), it was reported recently that the determination of vasculitic changes in histopathological and direct immunofluorescence results might be useful in the differential diagnosis of patients suspected to have BD

Dermoscopic differentiation of facial lentigo maligna from pigmented actinic keratosis and solar lentigines

The differential diagnosis of lentigo maligna (LM) from pigmented actinic keratosis (PAK) and solar lentigines (SL) remains a challenge for clinicians, especially in the early stages of LM when there are no distinctive dermoscopic features. Objective of this study was to evaluate the frequencies of selective dermoscopic criteria in LM, PAK, and SL and to find the specific combination of distinguishing dermoscopic criteria for LM. Dermoscopists blinded to histopathological diagnosis evaluated 42 LM, 107 PAK, and 16 SL for the presence of predefined dermoscopic criteria. The differences in the presence of dermoscopic criteria between LM and others were evaluated with the chi-squared test or Fisher’s exact test as appropriate. Multivariate logistic regression analysis with the forward conditional stepwise method were performed and odds ratios and corresponding 95% confidence intervals for LM, PAK, and SL were calculated. LM, PAK, and SL showed many common dermoscopic findings. In multivariate logistic regression analysis, darkening at dermoscopic examination (sevenfold), gray circles (sevenfold), target-like pattern (sixfold), gray rhomboids (sixfold), and slate-gray dots/globules (threefold) represented the strongest predictors of LM, while hyperkeratosis (thirteenfold), white circles (twelvefold), and red rhomboids (sixfold) represented the strongest predictors of PAK. The dermoscopic diagnosis of a given lesion should be based on the presence of the combination of specific dermoscopic criteria rather than a single benign or malignant criterion. Our results suggest that the presence of darkening at dermoscopic examination, gray circles, target-like pattern, gray rhomboids, and slate-gray dots/globules should be considered supportive findings for the diagnosis of early LM.</p

Dermoscopic differentiation of facial lentigo maligna from pigmented actinic keratosis and solar lentigines

The differential diagnosis of lentigo maligna (LM) from pigmented actinic keratosis (PAK) and solar lentigines (SL) remains a challenge for clinicians, especially in the early stages of LM when there are no distinctive dermoscopic features. Objective of this study was to evaluate the frequencies of selective dermoscopic criteria in LM, PAK, and SL and to find the specific combination of distinguishing dermoscopic criteria for LM. Dermoscopists blinded to histopathological diagnosis evaluated 42 LM, 107 PAK, and 16 SL for the presence of predefined dermoscopic criteria. The differences in the presence of dermoscopic criteria between LM and others were evaluated with the chi-squared test or Fisher’s exact test as appropriate. Multivariate logistic regression analysis with the forward conditional stepwise method were performed and odds ratios and corresponding 95% confidence intervals for LM, PAK, and SL were calculated. LM, PAK, and SL showed many common dermoscopic findings. In multivariate logistic regression analysis, darkening at dermoscopic examination (sevenfold), gray circles (sevenfold), target-like pattern (sixfold), gray rhomboids (sixfold), and slate-gray dots/globules (threefold) represented the strongest predictors of LM, while hyperkeratosis (thirteenfold), white circles (twelvefold), and red rhomboids (sixfold) represented the strongest predictors of PAK. The dermoscopic diagnosis of a given lesion should be based on the presence of the combination of specific dermoscopic criteria rather than a single benign or malignant criterion. Our results suggest that the presence of darkening at dermoscopic examination, gray circles, target-like pattern, gray rhomboids, and slate-gray dots/globules should be considered supportive findings for the diagnosis of early LM.</p

Pseudobullous Anetodermic Pilomatricoma

Pilomatricoma (PM) is an asymptomatic, slowly growing, benign skin tumour originating from primitive cells of the hair matrix and hair shaft and appears mostly on the head, neck, and the upper extremities. Typical lesion is usually characterized by a solitary, firm, deep-seated dermal or subcutaneous nodule, covered by normal or erythematous skin, and usually varying in size from 0.5 to 3 cm. Bullous appearance can occur on the lesions of bullous PM and anetodermic PM which are located in the rare atypical forms of PM. Here, we present an 11-year-old girl with an anetodermic PM on her right arm that showed thick-walled flaccid bullous formation over it