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

The Coexistence of Coeliac Disease, Psoriasis and Vitiligo

It has been defined that coeliac disease is associated with most of the autoimmune diseases including psoriasis and vitiligo. Here, a 26-year-old woman who was diagnosed palmoplantar pustular psoriasis and already had coeliac disease and vitiligo is reported. According to our opinions, this is the first report describing the development of these three disorders in one patient, even though vitiligo, psoriasis and coeliac disease are common disorders, and the coexistence of the two of them has been previously reported in the literature. This case has been presented to emphasize the importance of considering and inquiring the possible coeliac disease in chronic and autoimmune dermatoses, although psoriasis and vitiligo may have coincidental associations with coeliac disease

INEFFICACY OF DAPSON TREATMENT IN A PATIENT WITH ERYTHEMA DYSCHROMICUM PERSTANS

Eritema diskromikum perstans gövde, ekstremiteler, yüz ve boyunda simetrik dağılım gösteren, asemptomatik ve yavaş ilerleyen kül grisi renginde maküllerle karakterize nadir görülen, benign, kronik ve idiyopatik bir pigmentasyon bozukluğudur. Bu hastalıkta tamamen etkili olan bir tedavi seçeneği henüz mevcut değildir. Birçok tedavi seçeneğinin denendiği görülmüş, ancak klofazimin ve dapson dışındaki tedavilerin büyük çoğunluğunun etkisiz olduğu bildirilmiştir. Burada dapson tedavisine yanıtsız EDP'lu 36 yaşında bir erkek olgu sunulmaktadır Erythema dyschromicum perstans is an uncommon, benign, chronic, idiopathic pigmentary disorder characterized by asymptomatic, slowly progressive, ashy-gray macules over the trunk, extremities, face and neck with symmetrical distribution. No consistently effective treatment is yet available for this disease. Many therapeutic options have been tried, but the majority of them have been ineffective except clofazimine and dapson. Herein, we report a 36-year-old male of EDP who did not response to dapson treatment

Lupus band test in patients with borderline systemic lupus erythematosus patients with discoid lesions

Patients with lupus erythematosus (LE) that have discoid lesions who fulfill the four diagnostic criteria of systemic lupus erythematosus (SLE) with only mucocutaneous findings and antinuclear antibody (ANA) positivity were classified as borderline SLE in the literature. Objective of this study was to determine the place of borderline SLE with discoid lesions on the LE spectrum according to the lupus band test (LBT). Lesional and sun-protected non-lesional (SPNL) skin LBTs of 94 patients with LE that had discoid lesions were retrospectively evaluated. Firstly, patients were divided into two main groups: discoid LE (DLE; group A) and SLE (Group B); three subgroups were then classified as DLE (Group A), borderline SLE (Group B1) and SLE (Group B2) using another method. Each group had its own comparisons. Immunoreactant (IR) deposition was observed on the lesional skin in all patients and on the SPNL skin in 42 (44.7%). In patients with borderline SLE, the deposition of IgM was lower on the lesional LBTs, whereas isolated IgG was higher than SLE; thus, it shows similarity with DLE. Additionally, it was also closer to DLE because of the low deposition of C3, multiple IRs, and a double conjugate of IRs on the SPNL skin. However, it showed similarity with SLE in the high percentage of LBT positivity and more immunoglobulin M (IgM) and immunoglobulin G (IgG) deposition on the SPNL skin. The deposition of multiple conjugates on SPNL skin in patients with LE with discoid lesions may reflect systemic involvement. Despite the fact that LBT positivity on SPNL skin in borderline SLE was higher than DLE, less deposition of multiple conjugates compared to SLE indicates that the classification of borderline SLE with discoid lesions in the LE spectrum is questionable.  </p

UPPER RESPIRATORY TRACT INFECTİONS IN PATIENTS WITH PSORIASIS: DEMOGRAPHIC AND CLINICAL FEATURES

Amaç: Literatürde psoriyazisli olgularda bakteriyel veya viral boğaz enfeksiyonlarının deri lezyonlarının oluşumu ve/veya alevlenmesini tetikleyebildiği bildirilmiştir. Bu çalışmada psoriyazis vulgaris klinik alt tiplerinde Üst Solunum Yolu Enfeksiyonu (ÜSYE) sıklığının değerlendirilmesi ve ÜSYE olan olgulardaki klinik ve demografik özelliklerin ÜSYE olmayan olgularla karşılaştırılması amaçlanmıştır. Gereç ve yöntem: Retrospektif olarak planlanmış çalışmamızda kliniğimizde yatan 258 psoriyazis vulgaris olgusunun dosyası psoriyazis klinik tipi, demografik veriler, psoriyazis alan şiddet indeksi ve eşlik eden ÜSYE'ları açısından taranmıştır. Klinik olarak plak psoriyazisli olgular "stabil", guttat psoriyazisli veya guttat saçılımları olan plak psoriyazisli olgular ise "aktif" psoriyazis olarak tanımlanmıştır. Bulgular: Toplam 258 psoriyazis olgusunun 188 (%72,9)'inin aktif psoriyazis, 70 (%27,1)'inin ise stabil psoriyazis klinik özelliklerini taşıdığı saptanmıştır. Toplam 103 (%39,9) olguda ÜSYE belirlenmiş olup, aktif psoriyazisli olgularda %45,2 olarak saptanan ÜSYE sıklığının stabil psoriyazisli olgulara (%25,7) göre istatistiksel olarak anlamlı şekilde daha fazla olduğu gösterilmiştir. Aktif grupta ÜSYE olan olgularda yaş ortalamasının anlamlı olarak daha düşük olduğu, ayrıca ÜSYE saptanan aktif ve stabil psoriyazisli olgularda psoriyazis başlangıç yaşının daha düşük, aile öyküsünün daha fazla, son alevlenme sürelerinin daha kısa ve psoriyazis alan şiddet indeksi değerlerinin 10 olduğu saptanmıştır. Sonuç: Aktif psoriyazisli olgularda ÜSYE sıklığının stabil olgulara göre daha fazla görülmesi nedeniyle guttat psoriyazis ve guttat saçılımlı plak psoriyazis olgularında ÜSYE araştırılmasının yararlı olacağı görüşündeyiz. Objective: In the literature, it has been reported that bacterial or viral infections of the throat can trigger the occurrence and/or exacerbation of the skin lesions in patients with psoriasis. The aim of our study was to evaluate the frequency of Upper Respiratory Tract Infection (URTI) and compare the clinical and demographic features of cases with and without an URTI in clinical subtypes of psoriasis vulgaris. Material and method: In this retrospective study, the files of 258 psoriasis vulgaris inpatients were evaluated for clinical type of psoriasis, demographic data, psoriasis area severity index and accompanying URTIs. Clinically, the patients of plaque psoriasis were defined as "stable" psoriasis, and those of guttate psoriasis or guttate flare of plaque psoriasis were defined as "active" psoriasis. Results: Of the 258 psoriasis patients, 188 (72.9%) patients were in active group and 70 (27.1%) of them were in stable group. Of all the patients, 103 (39.9%) were determined to have URTI. In patients with active psoriasis, the frequency of URTI was statistically higher (45.2%) than the stable group (25.7%). In active group, mean age was significantly lower in patients with URTI. Additionally, it was determined that the mean onset age of psoriasis was earlier, family history was more common, the time of the last exacerbation of lesions was shorter and the psoriasis area severity index values were ≥ 10 in both active and stable psoriasis patients with URTI compared to those of without URTI. Conclusion: Because of the higher frequency of URTI in patients with active psoriasis than stable psoriasis, we assumed that it would be beneficial to investigate of URTI in guttate psoriasis or guttate flare of plaque psoriasis

ONSET CHARACTERISTICS AND ACCOMPANYING AUTOIMMUNE DISEASES IN AUTOIMMUNE BULLOUS DERMATOSES

Amaç: Demografik ve klinik özellikleri açısından bazı farklılıklar gösteren otoimmünbüllöz dermatoz (OBD)'lara bazı otoimmün hastalıkların eşlik edebildiği bildirilmiştir.Bu çalışmada kliniğimizde yatan OBD olgularında demografik ve klinik başlangıçözellikleri ile eşlik eden otoimmün hastalıkların araştırılması amaçlanmıştır.Gereç ve yöntem: Bu çalışmada 2000-2009 tarihleri arasında kliniğimizde yatanOBD'lu 97 olgunun dosyası cinsiyet, başlangıç yaşı, dökülerin başlangıç yeri ve eşlikeden otoimmün hastalıklar açısından retrospektif olarak taranmıştır.Bulgular: Çalışmaya alınan 97 olgunun 50 (%51,5)'si pemfigus (37'si pemfigusvulgaris, 4'ü pemfigus vejetans, 9'u pemfigus foliaseus), 40 (%41,2)'ı pemfigoid (38'ibüllöz pemfigoid, 2'si sikatrisyel pemfigoid), 5'i (%5,1) dermatitis herpetiformis, 1(%1,1)'i lineer Ig A büllöz dermatozu ve 1 (%1,1)'i ise edinsel epidermolizis büllozaolarak saptanmıştır. Pemfigus vulgaris, pemfigus vejetans ve büllöz pemfigoidliolgularda hem deri hem mukozada başlayan dökülerin görüldüğü, pemfigus foliaseus,dermatitis herpetiformis, lineer IgA büllöz dermatozu ve edinsel epidermolizisbüllozalı olgularda sadece deri başlangıçlı dökülerin olduğu ve sikatrisyel pemfigoidliolgularda ise sadece mukozal başlangıçlı dökülerin görüldüğü belirlenmiştir. Ayrıca,genel olarak OBD'lu olguların %26,8'inde en sık diabetes mellitus (%17,5) olmak üzerepsoriyazis, liken planus, Hashimato tiroiditi, Graves hastalığı, romatoid artrit veülseratif kolit gibi eşlik eden otoimmün bir hastalık saptanmıştır.Sonuç: Farklı başlangıç özellikleri gösteren OBD'lara farklı oranlarda olmakla birliktebazı otoimmün hastalıkların eşlik edebildiği gösterilmiştir.SUMMARYObjectives: It has been reported that some autoimmune diseases may be accompaniedwith autoimmune bullous dermatoses (ABD) which may show some differences indemographic and clinical characteristics. In this study, we aimed to investigate thedemographic and clinical onset characteristics, and the accompanying autoimmunediseases in ABD patients previously hospitalized in our clinic.Material and method: In this study, the files of 97 ABD patients who had been hospi-talized between years 2000-2009 were retrospectively reviewed in terms of gender, ageat onset, onset localization of lesions, and the accompanying autoimmune diseases.Results: Between the 97 patients, 50 (51.5%) had pemphigus (pemphigus vulgaris in37 patients, pemphigus vegetans in 4 patients, pemphigus foliaceus in 9 patients), 40(41.2%) had pemphigoid (bullous pemphigoid in 37 patients, cicatricial pemphigoid in2 patients), 5 (5.1%) had dermatitis herpetiformis, 1 (1.1%) had linear IgA bullousdermatosis and 1 (1.1%) had epidermolysis bullosa acquisita. It is determined that thedisease began from both skin and mucosa in patients with pemphigus vulgaris,pemphigus vegetans and bullous pemphigoid, only skin in patients with pemphigusfoliaceus, dermatitis herpetiformis, linear IgA bullous dermatosis and epidermolysisbullosa acquisita, and only mucosa in patients with cicatricial pemphigoid.Furthermore, 26.8% of all ABD patients accompanied by autoimmune diseasesprimarily diabetes mellitus (17.5%), subsequently psoriasis, lichen planus, Hashimatothyroiditis, Graves disease, romatoid arthritis and ulcerative colitis.Conclusion: This study demonstrated that some autoimmune diseases in differentproportions may accompany ABD which show different onset characteristics