Dermatoscopic Findings in Palmoplantar Dermatoses

Dermatoscopy is a useful, non-invasive method in the diagnosis of various dermatological diseases. Dermatoscopy of non-pigmented skin lesions shows additional morphologic features, such as cutaneous vascular pattern, scale color and scale distribution pattern, and background color. Dermatoscopy can be useful tool in differential diagnosis in palmoplantar dermatoses. The most specific dermatoscopic features of hand eczema include yellowish-orange globules, yellowish scales and yellowish crusts. Light red background color, regular vascular distribution pattern, dotted vessels and white scale color have been reported in previous studies as dermatoscopic features of palmoplantar psoriasis. Dotted vessels can be seen in various dermatoses, such as psoriasis, eczema, lichen planus, porokeratosis and keratodermas. The distribution pattern and color of the scales are also important in the differential diagnosis of palmoplantar dermatoses. Previous studies have shown that scales are mainly localized in skin furrows in patients with tinea manum. Patchy distributed, homogeneous, structureless, orange areas were reported in palmar keratoderma due to pityriasis rubra pilaris. Amber scales, white-to-pinkish background; sparse whitish scales were reported in palmar keratoderma due to mycosis fungoides. Dermatoscopical findings of palmoplantar area can help in the differential diagnosis of various dermatoses

Retrospective evaluation of patients with pityriasis rosea within last 5 years

Amaç: Pitiriyazis rozea tanısı alan hastalardaki olası etiopatogenik ve çevresel faktörler yanısıra klinik özelliklerin değerlendirilmesi. Yöntem: 1996-2001 yılları arasında Celal Bayar Üniversitesi Dermatoloji polikliniğine başvuran ve pitiriyazis rozea tanısı alan 112 hasta çalışmaya alındı. Bulgular: Hastaların yaşları 1 ile 65 arasında değişmekte olup yaş ortalaması 46.7 14.7 idi. Hastaların 76'sı (%67.9) kadın, 36'sı (%32.1) erkekti. Hastalık süresi 1-90 gün arasında değişmekte olup, ortalama süre 18.4 19.1 gündü. Hastaların 89'unda (%79.5) öncesinde infeksiyon öyküsü yoktu. Seksenaltı olguda (%76.8) kaşıntı yakınması mevcuttu. Beş hasta (%4.5) öncesinde stres öyküsü tanımlıyordu. Mevsimsel dağılıma baktığımızda hastaların 43'üne (%38.4) kış mevsiminde, 22'sine (%19.6) yaz, 28'ine (%25.0) sonbaharda, 19'una (%17.0) ilkbaharda tanı konmuştu. Hastaların 97'sinde (%86.6) madalyon plağı gözlendi. Lezyonların dağılımına bakıldığında; 77 hastada (%68.8) gövde yerleşimli, 34'ünde (%30.3) generalize, 1'inde (% 0.9) alt ekstremite yerleşimliydi. Sonuç: Polikliniğimizde tanı alan pitiriyazis rozealı hastaların büyük çoğunluğunun kış mevsiminde ortaya çıktığı, kaşıntılı seyrettiği ve daha çok gövde yerleşimli olduğu sonucuna varılmıştır.Objective: Theaimofthe study was to assess thepossible aetiopathogenic and environmental factors along with the clinical findings in patients with pityriasis rosea. Material and Method: We performed a retrospective study of 112 patients with pityriasis rosea who attended our outpatient clinic (Celal Bayar University Dermatology Department) from 1996 to 2001. Results: The mean age of patients was 46.7+14.7, range between 1 to 65 years. Seventy-six of the patients were female (67.9%) and 36 of them were male (32.1%). Duration pityriasis rosea period was ranging between 1 and 90 days (mean value: 18.4+19.1 days). Eighty-nine (79.5%) of the patients did not have a history of infection. Itching was present in 86 cases (76.8%). Five patients (4.5%) had previous history of stress. When seasonal distrubition was evaluated, the number of patients who were diagnosed in winter, summer, autumn and spring was 43 (38.4%), 22 (19.6%), 28 (25.0%), and 19 (17.0%) successively. Amedallion plaque was observed in 97 patients (86.6 %). Of 112 patients, 77 had lesions localized to trunk (68.8%), 34 had generalized lesions (30.3%) andone showedlesions inlowerextremities (0.9%). Conclusion: Our results confirm that pityriasis rosea, in our population, is more prevalent in winter, has a predilectin for the trunk and is pruritic

Psychiatric disorders detected among dermatology inpatients who are in need of psychiatric consultation

Kliniığimizde çeşitli dermatolojik şikayetlerle yatan hastalardan psikiyatrik konsültasyon gerektirenlerdeki ruhsal bozuklukları saptamak. Ocak 1996 - Aralık 2001 tarihleri arasında Celal Bayar Üniversitesi Tıp Fakültesi Dermatoloji kliniığinde çeşitli tanılarla yatarak tetkik ve tedavi edilen 394 hasta retrospektif olarak deığerlendirildi. Psikiyatri kliniıği tarafından deığerlendirilen 66 hasta çalışma grubuna dahil edildi. Çalışma grubuna alınan 66 yatan hastanın 42'si (% 63.6) kadın, 24'ü (% 36.4) erkekti.Yaşları 15 ile 79 arasında deığişen hastaların yaş ortalaması 43.74 14.34 idi. Hastaların servisimizde yatış süreleri 3 ile 150 gün arasında deığişmekte olup, ortalama yatış süresi 22.57 26.71 gündü. Psikiyatri kliniığince deığerlendirilen hastaların 10'unda (%15.2) herhangi bir patoloji saptanmadı. 27'si (%40.9) depresyon, 6'sı (%9.1) BTA (başka türlü adlandırılamayan) anksiyete bozukluığu, 6'sı (%9.1) obsesif kompulsif bozukluk, 5'i (%7.6) karışık anksiyete-depresif bozukluk, 3'ü (%4.5) distimik bozukluk, 2'si (%3.0) major depresyon, 1'i (%1.5) konversiyon bozukluığu, 1'i (%1.5) obsesif kompulsif bozukluk ve depresyon, 1'i (%1.5) mikst anksiyete-depresyon ve obsesif kompulsif bozukluk, 1'i (%1.5) konversiyon bozukluığu ve reaktif depresyon, 1'i (%1.5) atipik depresyon, 1'i (%1.5) konversiyon bozukluığu ve distimik bozukluk, 1'i (%1.5) mental retardasyon tanısı aldı. Dermatolojik hastalıklarla çeşitli psikiyatrik bozuklukların birlikteliığinin oldukça yüksek olduığu ve bu konunun gözardı edilmemesi gerektiıği sonucuna varıldı.We aimed to determine psychiatric disorders detected among dermatology inpatients who are in need of psychiatric consultation. 394 dermatology inpatients, who were treated between January 1996 and December 2001 in Celal Bayar University Hospital, were evaluated retrospectively. 66 patients, examined by psychiatrists were included in the study. Of 66 patients 42 (63.6%) were female and 24 (36.4%) were male. Mean age of the patients was 43.74 14.34. Mean hospitalization period was 22.57 26.71 days, ranging from 3 to 150 days. According to the psychiatric evaluations, no psychiatric abnormality was found in 10 (15.2%) patients. On the other hand, there was depression in 27 patients (40.9%), anxiete disorder, that can not be named otherwise, in 6 (9.1%), obsessivecompulsive disorder in 6 (9.1%), mixed anxiete and depressive disorder in 5 (7.6%), distimic disorder in 3 (4.5%), major depression in 2 (3.0%), conversion disorder in 1 (1.5%), obsessive-compulsive disorder and depression in 1 (1.5%), mixed anxiete-depression and obsessive-compulsive disorder in 1 (1.5%), conversion disorder and reactive depression in 1 (1.5%), atypic depression in 1 (1.5%), conversion disorder and distimic disorder in 1 (1.5%), and mental retardation in 1 (1.5%) successively. As dermatological diseases are associated with psychiatric disorders quite often, one should keep this in mind while approaching to patients with dermatologic diseases

Post-adolescent acne in the spectrum of acne

Polikliniğimizde akne vulgaris tanısı alan hastalarda postadolesan akne sıklığını belirlemek ve bu hastalarda lezyon tipi, lokalizasyonu, eşlik eden hirsutismus, menstruel düzensizlikler ve hormonal bozuklukları değerlendirmektir. 1996- 2001 yılları arasında Celal Bayar Üniversitesi Dermatoloji polikliniğine başvuran 25 yaş üstündeki akneli hastalar retrospektif olarak incelendi. Toplam 1853 akneli hastadan 175'i (%9.4) postadolesan akne olarak değerlendirildi. 175 postadolesan akneli hastanın 143'ünde (%81.7) aknenin 25 yaşından sonra başladığı, 32'sinde (%18.3) ise persistan olduğu saptandı. Postadolesan akne tanısı alan hastaların yaşları 25 ile 48 arasında değişmekte olup, yaş ortalaması 29.71 5.08 idi. Hastalık süresi 1 ile 240 ay arasında değişmekteydi; ortalama süre 34.37 53.72 ay olarak belirlendi. Hastaların 144'ü (%82.3) kadın, 31'i (%17.2) erkekti. Lezyon dağılımına baktığımızda 125'i (%71.4) yüz yerleşimli, 11'i (% 6.3) gövde yerleşimli, 39'u (%22.2) yüz ve gövde yerleşimliydi. Hastaların 159'u (%90.9) papülopüstüler, 16'sı (%9,1) nodülokistik akne olarak değerlendirildi. Hirsutismus hastaların 20'sinde (%11.4) gözlendi. Menstruasyon düzensizliği tanımlayan ve/veya hirsutismus saptanan 28 hastadan istenen hormon tetkikleri, 11 (%39.3) hastada anormal bulunurken; pelvik ultrasonografi tetkikini yaptıran 23 hastadan 7'sinde (%30.4) polikistik over saptandı. Hiperandrojenizm ile ilişkisi nedeniyle postadolesan akne tanısı alan hastaların hormonal bozukluklar açısından araştırılması gerektiği sonucuna varıldı.Our aim was to determine the frequency of post-adolescent acne among acne patients, together with the type and localization of their lesions, concurrent hirsutismus, menstrual irregularities and hormonal abnormalities. We performed a retrospective study of patients with acne over 25-year-old, who attended our outpatient clinic from 1996 to 2001. Of 1853 acne patients, 175 (9.4%) were diagnosed as post-adolescent acne. Among these 175 postadolescent acne patients, 143 (81.7%) had history of acne after 25-years of age, while 32 (18.3%) had persistent acne. The ages of patients with post-adolescent acne were ranging between 25 and 48 (mean value: 29.71 5.08). The duration period of disease was ranging between 1 and 240 months (mean value: 34.37 53.72). 144 of the postadolescent patients (82.3%) were female and 31 (17.2%) were male. When distribution of the lesions were evaluated, there were facial lesions in 125 patients (71.4%), trunk lesions in 11 patients (6.35%), and both face and trunk lesions in 39 patients (22.25%). Of 175 patients, 159 (90.9%) had papulopustular and 16 (9.1%) had nodulocystic acne. Hirsutism was observed in 20 cases (11.4%). When hormones were evaluated in 28 patients with hirsutism and/or irregular menstruation, abnormal levels were determined in 11 (39.3%) of them; while pelvic ultrasonographic evaluations revealed polycystic ovary syndrome in 7 (30.4%) of 23 patients, who had completed their ultrasonographic examinations. Because of the close association with hyperandrogenetism, postadolescent acne patients have to be investigated thoroughly in the aspect of hormonal irregularities

Comparison of dermoscopic and histopathologic diagnoses of naevus naevocellularis

Melanositik pigmente deri lezyonlarının birbirinden ayırımı, planlanacak tedavi yaklaşımı açısından önemlidir. Bu amaçla yapılacak histopatolojik incelemeye alternatif olarak son zamanlarda preoperatif tanısal doğruluğu belirgin arttıran dermoskopi yöntemi olarak ön plana çıkmıştır. Bu çalışmada, sıkça karşılaştığımız melanositik pigmente lezyonlardan olan nevus nevosellularislerde dermoskopinin histopatolojik incelemenin yerine geçip, geçemeyeceği araştırılmıştır. Çalışmamızda, Eylül 1998- Haziran 1999 tarihleri arasında Celal Bayar Üniversitesi Tıp Fakültesi Dermatoloji Anabilim Dalı Ben Takip Polikliniği' ne başvuran 22 hastadaki toplam 25 nevus nevosellularis dermoskopik olarak incelendikten sonra alınan biyopsi materyallerinin histopatolojik tetkiki yapılmış ve her iki yöntemle konulan tanılar karşılaştırılmıştır. Dermoskopik muayenede el dermatoskopu, slayt çekimlerinde Dermaphot kullanılmıştır. Dermatoskopi ve histopatoloji yöntemlerinin tutarlılığını ölçmek için Kappa analizi yapılmıştır. Dermoskopik olarak 7 jonksiyonel nevus naevocellularis (NNC), 15 bileşik NNC, 3 intradermalNNC tanısı konulurken, histopatolojik olarak 7 jonksiyonel NNC, 10 bileşik NNC, 8 intradermal NNC tanısı konulmuştur. Dermoskopik olarak 25 lezyonun 20'si (%80), histopatolojik tanıyla aynı tanıyı almıştır. Kappa istatistiğinde iki yöntemle konulan tanıların iyi derecede tutarlı olduğu bulunmuştur (K= 0.69). Noninvaziv tanı yöntemi olarak son yıllarda ön plana çıkan dermoskopinin melanositik pigmente deri lezyonlarından nevus nevosellularislerin tanısında ve ayrımında histopatolojik incelemenin yerine geçemeyeceği sonucuna varılmıştır.Differential diagnosis in melanocytic skin lesions is important in determining the treatment modality. In the past, histopathologic examination was mostly used for this aim. Recently, dermoscopy is widely used as an alternative noninvasive diagnostic method, so that it increases preoperative diagnostic accuracy. In this study our aim was to determine whether dermoscopy can substitute for histopathologic examination in the diagnosis of naevus naevocellularis. 25 naevus naevocellularis of 22 patients, who had admitted to our nevus follow-up clinic between September 1998-June 1999, were enrolled in this study. After dermoscopic and histopathologic examinations of all the lesions were completed, the concordance between dermoscopic and histopathologic diagnoses were evaluated. Manual dermoscope was used for routine dermoscopic examinations. Finally, dermoscopic photographs of the lesions were taken by Dermaphot. Kappa value was interpreted to assesss the agreement between dermoscopic and histopathologic methods. Dermoscopic examination revealed 7 jonksiyonel nevus naevocellularis (NNC), 15 bileþik NNC, 3 intradermal NNC, where as histopathologic examination revealed 7 jonksiyonel NNC, 10 bileþik NNC, 8 intradermal NNC. Of the 25 lesions dermoscopically examined, the diagnoses of 20 (80%) were concordant with the histopathologic diagnoses. The agreement between dermoscopic and histopathologic methods was good (K value= 0.69). Although dermoscopy is widely used as an alternative noninvasive diagnostic method in the differential diagnosis of melanocytic skin lesions recently, our results have led us to conclude that this popular method can not substitute for histopathologic examination in the diagnosis of naevus naevocellulari

Bullous pemphigoid associated with prostate adenocarcinoma

Bullous pemphigoid is a common autoimmune skin disease characterized by the presence of subepidermal blisters. It has been associated with underlying neoplasia in isolated reports. A 78-year-old man with generalized blisters was diagnosed as bullous pemphigoid on clinical, histopathological and direct immunofluorescence grounds. His free and total prostate specific antigen (PSA) levels were high and histopathological examination of a prostate specimen revealed prostate adenocarcinoma. We present this rare case to discuss the possible association between bullous pemphigoid and prostate adenocarcinoma

Distribution pattern of psoriasis, anxiety and depression as possible causes of sexual dysfunction in patients with moderate to severe psoriasis

BACKGROUND: Psoriasis may significantly impair sexual function. Depression and organic factors appear to play a key role in this relation. However, beyond genital psoriasis, the importance of the disease's distribution patterns has not been considered. OBJECTIVES: To research sexual function in psoriasis patients and investigate the roles of anxiety, depression and psoriasis' distribution patterns in sexual dysfunction. METHODS: A comparative study matched for sex and age was performed. Eighty patients with moderate to severe psoriasis and 80 healthy controls were included. The participants completed the Massachusetts General Hospital-Sexual Functioning Questionnaire, the Hospital Anxiety and Depression Scale, and the Self-Administered Psoriasis Area and Severity Index. RESULTS: Psoriasis was associated with sexual dysfunction, odds ratio=5.5 (CI 95% 2.6-11.3; p<0.001). Certain distribution patterns of psoriasis, involving specific body regions, were associated with an increase in sexual dysfunction in the group presenting the disease, odds ratio 7.9 (CI 95% 2.3-33.4; p<0.001). Multivariate logistic regression analysis identified anxiety and depression, and the involvement of these specific areas, as possible independent risk factors for sexual dysfunction in patients with moderate to severe psoriasis. CONCLUSION: This study identifies body areas potentially related to sexual dysfunction, independently of anxiety and depression, in psoriasis patients. The results suggest that the assessment of sexual dysfunction and the involvement of these body areas should be considered as disease severity criteria when choosing the treatment for psoriasis patients

Evaluation of the occurrence of sexual dysfunction and general quality of life in female patients with psoriasis

Background: Psoriasis has a significant impact on quality of life (QoL). Sexual life can also be affected, with sexual dysfunction being reported by 25-70% of patients. Objectives: To determine the occurrence of sexual dysfunction and evaluate QoL in women with psoriasis. Methods: This case-control study included women aged 18-69 years. The validated Brazilian Portuguese versions of the Female Sexual Function Index (FSFI) and of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were administered to all participants to assess sexual function and QoL, respectively. Patients with psoriasis underwent clinical evaluation for the presence of comorbidities, especially psoriatic arthritis and other rheumatic manifestations. Location of lesions and the extent of skin involvement were also assessed. Results: The sample consisted of 150 women, 75 with diagnosis of psoriasis and 75 healthy controls. Prevalence of sexual dysfunction was high in women with psoriasis (58.6% of the sample). Prevalence was statistically higher in women with psoriasis than in controls (P = 0.014). The SF-36 domain scores were also lower in women with psoriasis, with role limitations due to physical health, limitations due to emotional problems, and mental health being the most affected domains. Study limitations: Sample size was calculated to evaluate the association between the occurrence of sexual dysfunction and psoriasis, but it did not include the determination of the possible causes of this dysfunction. Conclusions: QoL and sexual function were altered in women with psoriasis and should be taken into consideration when assessing disease severity