Nail involvements as an indicator of skin severity in psoriatic patients

Psoriasis is a recurrent chronic inflammatory skin disease with various mild to severe clinical manifestations. The relationship between severity of the skin lesions and nail involvement has always been underestimated.Aim of the study was to evaluate the severity of skin involvement in psoriatic patients with and without nail manifestations.In this analytic cross-sectional study, patients with psoriasis referred to Razi University Hospital of Rasht from November 2015 to March 2016 were enrolled. Demographical features (i.e. age, gender) were obtained. Psoriasis severity and nail involvement criteria were assessed by Psoriasis Area and Severity Index (PASI) and Nail Psoriasis Severity Index (NAPSI), respectively. All the gathered data were analyzed by SPSS software.In this study, 71 psoriatic patients with a mean age of 39.23±17.9 years (mean ± Standard Deviation; range: 4 to 77 years old) were studied. 22 patients (31%) had nail involvements. PASI scores were 11.7±5.7 and 5.7±4.5 in the two groups with and without nail involvements, respectively (P&lt;0.001). There were no significant differences between age, age of onset, and duration of the disease between the two groups (P&gt;0.05).The correlation coefficient between PASI and NAPSI was 0.367, which was statistically significant (P&lt;0.001).Based on the findings of our study, nail involvement is an important criterion in determining the severity of skin manifestations in psoriatic patients. Additionally, a high percentage of such patients probably manifest both skin and nail manifestations. Therefore it is highly recommended to consider nail involvement when evaluating psoriasis. </p

Evaluation of dermoscopic findings of longitudinal melanonychia in referred patients to dermatology clinics in Guilan, Iran

Introduction: Longitudinal melanonychia (LM) is a common clinical condition that is mostly identified by the presence of longitudinal, demarcated, and pigmented bands on the nail. Different benign or malignant pathologies can present with longitudinal melanonychia. Therefore, we aimed to investigate the frequency of dermoscopic features of LM in patients with LM referred to dermatology clinics in Guilan, Iran. Materials and Methods: This case-series study was conducted on 30 patients with LM who were referred to Besat clinic and Razi hospital, Rasht, Iran, from March 2022 to August 2022 with a complaint of LM. Demographical data and dermoscopic findings of patients were collected and analyzed using SPSS version 21. The LM and dermoscopic features were investigated using a dermatoscope (HEINE IC1, HEINE Optotechnik, Germany). Results: Out of 30 patients, 24 patients were female and 6 patients were male with a mean age of 30.08 ± 14.31 years old. Among these patients, five patients had a family history of LM, one patient with melanoma had Hutchinson’s sign, and three patients had pseudo-Hutchinson’s sign. The mean width of lesions of the nail was 2.42±2.12 mm with a mean time of onset of 7.42 ± 7.12 months. Also, the majority of the involved site of LM was hand (26.6%). Conclusion: According to our study, LM was more frequent in females and the trauma-related lesions of the nail were the most common dermatological findings among the patients

Association between Immunofluorescence Pattern and Mucosal Involvement in Patients with Bullous Pemphigoid

Bullous pemphigoid is an acquired autoimmune subepidermal blistering disease which is associated with mucocutaneous lesions. The type and amount of autoantibody deposition may have a role in mucosal lesions. We studied the association between mucosal involvement and direct immunofluorescence pattern in cutaneous lesions of patients with bullous pemphigoid. In this retrospective analytical cross-sectional study, we studied the demographic data, clinical presentations, and immunopathological findings of 69 patients with bullous pemphigoid admitted to our hospital 2008-2016. Patients were allocated into two groups on the basis of the mucosal involvement, and direct immunofluorescence patterns were evaluated. The data were analyzed using SPSS version18. The mean age of patients was 70.9±14.97 (mean ± Standard Deviation) years old. In our study, 56.5% of patients were women. All patients showed deposition of IgG and C3 in the dermoepidermal junction, with different severity. Patients with mucosal involvement (40.6% of cases) had a more prominent deposition of IgG, IgA, and C3 at the dermoepidermal junction compared with patients without mucosal involvement, which represented a statistically significant difference (P&lt;0.05). Logistic regression analysis showed that lower age, IgA, and C3 deposition (P&lt;0.05) were associated with mucosal involvement. Deposition of IgA and C3 (in addition to IgG) at the dermoepidermal junction seems to be a marker of mucosal involvement in patients with bullous pemphigoid. Attention to direct immunofluorescence pattern in patients with bullous pemphigoid may be helpful in prediction of mucosal involvement in these patients. </p

Comorbidity of Adult Attention Deficit Hyperactivity Disorder With Acne Vulgaris

Background: Based on research, acne vulgaris is associated with a high prevalence of attention deficit hyperactivity disorder (ADHD). Objectives: This study investigates the comorbidity of ADHD and acne vulgaris in individuals with acne vulgaris who were referred to the Razi Dermatology Specialist Clinic and Beesat Clinic of Guilan University of Medical Sciences, Rasht City, Iran, in 2021. Materials & Methods: This case-control study includes 85 individuals with acne vulgaris and 85 without acne vulgaris. The Conners’ adult ADHD rating scales (CAARS) were used to evaluate ADHD symptoms. The study data were analyzed with SPSS software, version 24 at a significant level of <0.05. Results: The Mean±SD age of the study participants was 35.12±13.19 years, and 64.1% of them (n=109) were women. Of the total participants, 7.6% had ADHD, and the frequency of ADHD in individuals with acne vulgaris compared to controls was 8.2% vs 7.1%, and this difference was not significant (P=0.773). The frequency of ADHD and the mean score of ADHD in individuals with acne vulgaris were higher in those aged ≤30, women, and severe types of acne, but this difference between the two groups was not statistically significant (P>0.05). Conclusion: Our findings showed no statistically significant difference between subjects with acne vulgaris and the control group in the score and frequency of ADHD. Also, we found no statistically significant difference in the score and the frequency of ADHD based on the severity of acne vulgaris

Miliarial type pseudolymphoma mimicking as granulomatous rosacea

Miliarial type lymphocytoma cutis is a rare type of psuedolymphoma which is described by numerous semi-translucent papules on the sun exposed regions. Herein, we present a 25-year-old woman with numerous permanent translucent tiny papules on the face. Microscopic examination revealed dense infiltration of lymphocytes in the reticular dermis with lymphoid follicle formation and significant B-cell lymphocytes in immunohistochemistry study. She was diagnosed as miliarial type pseudolymphoma and treated with topical momethasone furoate ointment and oral hydroxychloroquine with a good response

Bowen's Disease Associated With Two Human Papilloma Virus Types

Bowen's disease (BD) is an epidermal in-situ squamous cell carcinoma (SCC). Most Human Papilloma Viruses (HPV)-positive lesions in Bowen's disease are localized to the genital region or distal extremities (periungual sites) in which HPV type-16 is frequently detected. Patient was a 64-year-old construction worker for whom we detected 2 erythematous psoriasiform reticular scaly plaques on peri-umbilical and medial knee. Biopsy established the diagnosis of Bowen's disease and polymerase chain reaction assay showed HPV-6, -18 co-infection. Patient was referred for surgical excision

Matching between clinical examination and dermoscopy in patients with nail psoriasis: Should dermoscopy be used instead of clinical examination?

Background: Dermoscopy has emerged as a useful diagnostic tool to evaluate skin lesions, including psoriasis. We aimed to compare the clinical examination and digital dermoscopy findings of nail involvement in patients with psoriatic nails. Methods: This study included 60 patients with clinically diagnosed psoriasis. The nail findings and NAPSI were evaluated clinically and via dermoscopy, and then the severity of the disease was calculated using PASI criteria. Results: About 32 patients were males, with a median PASI score of 4.4, and pitting and subungual hyperkeratosis were the most common findings. The clinical and dermoscopic examination had a moderate diagnostic resemblance regarding onycholysis, subungual hyperkeratosis, and leukonychia. The resemblance between the two methods for the diagnosis of leukonychia in patients with a duration of disease <2 years (Kappa = 0.59) and 2–6 years was moderate (Kappa = 0.48), and for 6 years< was perfect (Kappa = 0.62). The resemblance for the diagnosis of subungual hyperkeratosis and onycholysis in subjects with a duration of disease <2 years was slight, and for 2–6 years and 6 years< were moderate. The resemblance between the NAPSI score by the two methods was also moderate (95%CI -0.89-0.81, P < 0.001). Conclusion: Dermoscopy is an efficient, supportive, and non-invasive method providing a better diagnosis of nail psoriasis

Assessment of the Prevalence and Risk Factors Associated With Glucocorticoid-Induced Diabetes Mellitus in Pemphigus Vulgaris Patients

Pemphigus vulgaris is a chronic autoimmune disease and glucocorticoids are one of the main treatments. Our study investigates the prevalence and associated factors of glucocorticoid-induced diabetes mellitus in these patients under different glucocorticoid regimens. 36 patients with first diagnosed Pemphigus vulgaris based on pathological and direct immunofluorescence findings who had received different glucocorticoid regimens (1-2 mg/kg oral or 1-2 mg/kg oral with 1g methylprednisolone pulse daily for 3 consecutive days with or without azathioprine) were evaluated during 2014-2016. Our study found that 22.2% of patients had impaired fasting glucose and incidence of corticosteroid-induced diabetes mellitus was 22.2% with no difference between oral and pulse therapy of corticosteroid. The first day after pulse therapy 19 patients of 21 had post bolus hyperglycemia that 36% of them became diabetic after 8 weeks. None of the variables, including age, BMI, HbA1c, LDL, HDL, TG, cholesterol, family history and blood pressure were associated with diabetes. Pretreatment FBS was the factor that would increase the likelihood of glucocorticoid-induced diabetes mellitus, 42.2% of patients with pretreatment FBS 100-126 developed diabetes in comparison with 17.2% in normal pretreatment FBS. Although the group who received azathioprine was associated with increased incidence of diabetes, the overall corticosteroid dose in this group was significantly higher than the other group (P=0.012), and controversy with other studies could be because of difference in corticosteroid dosage and small number of patients. The incidence of diabetes was not different between the group with glucocorticoid pulses and oral prednisolone without pulse therapy. Higher pretreatment FBS can be related to increased incidence of diabetes, but results from this study due to small number of patients are preliminary and multicenter studies are needed