A case of chronic ulcer due to subcutaneous arteriolosclerosis in an obese patient mimicking pyoderma gangrenosum

The differential diagnosis of chronic ulcers covers a wide range of diseases and poses a diagnostic challenge. Subcutaneous ischemic arteriolosclerosis can lead to local ischaemia and ulceration as a result of arteriolar narrowing and reduction of tissue perfusion. This pathophysiological feature can be seen in eutrophication (nonuremic calciphylaxis) in morbid obesity, hypertensive ischemic leg ulcer (Martorell ulcer) and calciphylaxis in chronic renal insufficiency. All of the ulcers happened in this way can be wrongly diagnosed as pyoderma gangrenosum because of clinical similarity and inadequate biopsies. We report a case of chronic ulcer due to subcutaneous arteriolosclerosis in morbid obesity, wrongly diagnosed as pyoderma gangrenosum. It can be detrimental to misdiagnose the ulcers due to subcutaneous arteriolosclerosis as pyoderma gangrenosum since they need a diametrically different approach

Serum osteopontin levels in patients with psoriasis vulgaris and its relation with oxidative stress

Background and Design: Oxidative stress is known to play a role in the etiopathogenesis of psoriasis. Recent data suggest that osteopontin (OPN) can also play a role in the pathogenesis of psoriasis. In the current study, OPN levels and oxidative stress were evaluated in patients with psoriasis. Materials and Methods: The study included 61 patients with psoriasis and 62 healthy controls. The OPN levels, total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were measured using serum. The disease severity was evaluated using the psoriasis area and severity index (PASI). Results: No statistically significant differences in OPN, TAS, and OSI values were identified between the psoriasis and control groups. A negative correlation was found with the TAS. There was no statistically significant correlation between the PASI score and OPN, TAS, TOS, and OSI values. Conclusion: We did not find a statistically significant correlation between OPN levels and oxidative stress in patients with psoriasis. We believe that larger and more detailed studies are needed to highlight the role of OPN and oxidative stress in the etiopathogenesis of psoriasis

The use of dermoscopy in differantiating psoriasis and seborrheic dermatitis on scalp

Tıpta Uzmanlık TeziSon yıllarda saç ve saçlı deri hastalıklarının incelenmesinde dermoskopinin önemi giderek artmaya başlamıştır. Dermoskopi, çıplak gözle görülemeyen morfolojik yapıları görünür hâle getirerek hastalıkların patogenezini anlamaya yardımcı olur ve tanının doğruluğunu arttırır. Bu çalışmada, dermoskopinin saçlı deride psoriasis ve seboreik dermatit ayrımında yararlı olup olamayacağı araştırıldı. Çalışmaya klinik olarak tanısı konmuş, saçlı deri tutulumu olan 46 psoriasis ve 50 seboreik dermatit hastası alındı. Hastaların saçlı derideki lezyonlarından yapılan dermoskopik çekimlerde, mikrovasküler paternlerin varlığı incelendi. Kıvrımlı lup, glomerüler damar, kırmızı nokta-globül, polimorfik boncuklu daire-çizgi paternlerinin psoriasis grubundaki görülme sıklığı seboreik dermatit grubundakinden; basit lup ve dallanan damar paternlerinin de seboreik dermatit grubundaki görülme sıklığı psoriasis grubundakinden anlamlı derecede yüksekti (p0.05). Hastalık süresi ve hastalık şiddeti ile bulgular arasında her iki grupta da korelasyon saptanmadı (p>0.05). Psoriasis grubunda tırnak tutulumu ve artralji varlığında da bulguların görülme sıklığında anlamlı bir fark bulunmadı(p>0.05). Çalışmamızın sonucunda, dermoskopik incelemenin, saçlı deride psoriasis ve seboreik dermatit ayrımında, kolay ve başarılı bir yöntem olduğu kanısına vardık. Anahtar kelimeler:Psoriasis, seboreik dermatit, dermoskopi, saçlı deriAbstractDermoscopy has been gaining an increasing importance for hair and scalp disorders in recent years. It helps to understand the pathogenesis of disease by enabling to see the morphologic structures which can not be seen by naked eye and improves diagnostic capability. Herein, we investigated the usefulness of dermoscopy in the clinical differentiation of psoriasis and seborrheic dermatitis on scalp. The study included clinically diagnosed, 46 psoriasis and 50 seborrheic dermatitis patients who had scalp lesions. Images taken from lesional scalp were then reviewed for microvascular paterns. The frequency of twisted loops, glomerular vessels, red dot-globules and polimorphous beaded lines-circles were statistically higher in psoriasis than in seborrheic dermatitis, where as the frequency of simple loops and arborizing vessels were statistically higher in seborrheic dermatitis than in psoriasis (p0.05). Also in psoriasis group, there was no significant difference in the frequency of findings for nail and joint involvement (p>0.05). In conclusion we thought that dermoscopy is a valuable and easy tool for differentiating psoriasis and seborrheic dermatitis on scalp. Key words: Psoriasis, seborrheic dermatitis, dermoscopy, scal

Onychophagia Induced Melanonychia, Splinter Hemorrhages, Leukonychia, and Pterygium Inversum Unguis Concurrently

Onychophagia, which refers to compulsive nail-biting behavior, is common among children and young adults. Onychophagia can cause destruction to the cuticle and nail plate, leading to shortening of nails, chronic paronychia, and secondary infections. Relatively uncommon effects include pigmentary changes, such as longitudinal melanonychia and splinter hemorrhages. We report a case of a young adult with longitudinal melanonychia, splinter hemorrhages, punctate leukonychia, and pterygium inversum unguis, concurrently induced by onychophagia. Importantly, patients usually do not report this behavior when asked about nail-related changes. Even upon questioning, they may deny nail-biting behavior. As in many other dermatological disorders, dermoscopy can be helpful in the diagnosis of nail disorders