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

An Unusual Presentation of Vogt–Koyanagi–Harada

This is a Photo Essay and does not have an abstract. Please download the PDF or view the article in HTML

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

Sun-related risk factors, perceived seriousness of disease and accompanying non-melanoma skin cancer in patients with actinic keratoses

Background: Actinic keratoses are the most common premalignant skin lesions worldwide. They are of public health importance since their presence has been associated with the significantly increased incidence of non-melanoma skin cancers (NMSCs), especially when they are numerous and have coalesced into an area with severe photodamage. The current study aimed to evaluate the relationships between sun-related risk factors, perceived seriousness of actinic keratosis (AK), skin cancer examination (SCE) history, and newly detected NMSC in AK patients. Methods: In this descriptive, cross-sectional, case–control study, firstly we examined the demographics, phenotypic traits, sun exposure history, cancer history and newly detected NMSC with full-body skin examinations in AK patients (n = 198) and controls. Secondly, the effects of these parameters, AK knowledge and AK-related clinical findings on the perceived seriousness of AK, SCE history and the presence of newly detected NMSC in AK patients were evaluated. Results: The presence of newly detected NMSC was significantly higher in patients aged ≥65 years, with personal or family skin cancer history, higher AK severity and photoaging grade; however, it was observed that these cases did not perceive AK as a serious illness and did not visit a physician for an SCE previously. Conclusion: This is the first study evaluating sun-related risk factors, knowledge and perceived seriousness of disease and SCE findings of AK patients in Turkey. Our results indicate that national health awareness campaigns and skin cancer scanning programs should be developed especially for the patients under the sun-related risks of AKs and NMSC occurrence. Keywords: Actinic keratoses, Non-melanoma skin cancer, Sun exposure, Knowledge, Perceived seriousness, Full-body skin examinatio

Examination of the Microbial Spectrum in the Etiology of Erythema Nodosum: A Retrospective Descriptive Study

Even though infections are the most common cause of erythema nodosum (EN), only certain microorganisms take the great interest such as streptococci in knowledge. Our aim was to examine the frequency and type of infections in EN, to determine the characteristics of patients with an infectious etiology, and to discuss the role of these microbes in EN pathology in the context of their interactions with humans. Charts of 81 patients with EN who were seen between 2003 and 2017 were retrospectively reviewed. Identified etiological factors were classified into three groups: infectious, noninfectious, and idiopathic. While there were no significant demographic and clinical differences between the infectious and idiopathic groups, systemic symptoms (p=0.034) and the number of EN lesions (p=0.016) were significantly lower; the mean erythrocyte sedimentation rate was significantly higher (p=0.049), but the mean aspartate aminotransferase value was significantly lower in the infectious group compared to the noninfectious group (p=0.019). Besides streptococci, many other microbes, including the ones living on and inside us, were identified in the etiology of EN. There is a need for large-scale prospective studies involving control groups for a better understanding of the microbial immunopathology of EN

Possible Triggering Effect of Influenza Vaccination on Psoriasis

Psoriasis is a chronic, recurrent, immune-mediated inflammatory disease and it can be provoked or exacerbated by a variety of different environmental factors, particularly infections and drugs. In addition, a possible association between vaccination and the new onset and/or exacerbation of psoriasis has been reported by a number of different authors. The aim of this study is to investigate the effects of influenza vaccination on patients with psoriasis. Here, we report the findings from 43 patients suffering from psoriasis (clinical phenotypes as mixed guttate/plaque lesions, palmoplantar or scalp psoriasis) whose diseases had been triggered after influenza vaccination applied in the 2009-2010 season. The short time intervals between vaccination and psoriasis flares in our patients and the lack of other possible triggers suggest that influenza vaccinations may have provocative effects on psoriasis. However, further large and controlled studies need to be carried out to confirm this relationship

Possible Triggering Effect of Influenza Vaccination on Psoriasis

Psoriasis is a chronic, recurrent, immune-mediated inflammatory disease and it can be provoked or exacerbated by a variety of different environmental factors, particularly infections and drugs. In addition, a possible association between vaccination and the new onset and/or exacerbation of psoriasis has been reported by a number of different authors. The aim of this study is to investigate the effects of influenza vaccination on patients with psoriasis. Here, we report the findings from 43 patients suffering from psoriasis (clinical phenotypes as mixed guttate/plaque lesions, palmoplantar or scalp psoriasis) whose diseases had been triggered after influenza vaccination applied in the 2009-2010 season. The short time intervals between vaccination and psoriasis flares in our patients and the lack of other possible triggers suggest that influenza vaccinations may have provocative effects on psoriasis. However, further large and controlled studies need to be carried out to confirm this relationship