Cutaneous leishmaniasis: new dermoscopic findings.

BACKGROUND: Cutaneous leishmaniasis (CL) has a worldwide distribution. Delayed and incorrect diagnosis may cause the significant spread of this disease and consequent increases in morbidity and drug resistance. OBJECTIVES: We aimed to determine dermoscopic features of CL that may help to improve the accuracy of clinical diagnosis of the disease. METHODS: A total of 145 lesions in 102 patients were evaluated dermoscopically. Following the diagnosis of CL, all lesions were evaluated by experienced dermoscopists. RESULTS: A total of 51 papules, 40 nodulo-ulcerative lesions, 31 plaques, and 23 nodules were evaluated by dermoscopy. Generalized erythema appeared in all lesions (100%), yellow tears in 58 lesions, both crust and ulcer in 51 lesions, white starburst-like patterns in 27 lesions, ovoid salmon-colored structures in 19 lesions, and a perilesional hypopigmented halo pattern in four lesions. Various vascular structures were present in 126 lesions. The most common vascular structure observed was an irregular linear pattern in 78 lesions, followed by a tree-like pattern in 53 lesions. The rest of the vascular structures included hairpin vessels in 25 lesions, glomerulus-like vessels in 24 lesions, dotted vessels in 23 lesions, comma-shaped vessels in six lesions, and polymorphous/atypical vessels in four lesions. We did not identify the types of parasite involved. CONCLUSIONS: Yellow tears, white starburst-like patterns and salmon-colored ovoid structures seem to appear specifically in CL lesions. In geographical areas in which CL is common, dermoscopy may be utilized as a useful diagnostic tool that is practical and non-invasive.

Contribution of T-cell receptor gamma gene rearrangement by polymerase chain reaction and immunohistochemistry to the histological diagnosis of early mycosis fungoides.

OBJECTIVE: To study the role of immuno-histochemistry and T-cell receptor (TCR) gamma gene rearrangement analysis in the diagnosis of mycosis fungoides (MF). METHODS: The study design was retrospective, and 73 cases were selected from the archive of the Pathology Department, School of Medicine, Cukurova University, Adana, Turkey, between January 2004 and December 2009. Thirty-nine MF cases with classical histomorphology, 16 cases with suspicious histomorphology for MF as the inconclusive group, and 18 cases with benign inflammatory dermatoses as the control group were involved in the study. The slides were evaluated for the presence or absence of the histopathological criteria for MF. Immunohistochemically, CD3, CD4, and CD8 were performed in all cases, and their counts and CD4/CD8 ratio were noted. Presence clonal TCR gamma gene rearrangement was evaluated by polymerase chain reaction (PCR). RESULTS: The histopathological parameters suggestive of MF were epidermotropism (p=0.000), presence of Pautrier microabscess (p=0.004), and atypical lymphocyte (p=0.000). Immunohistochemically, CD4 percentage (p=0.006) and CD4/CD8 ratio (p=0.010) were statistically significant parameters with univariate analysis. Clonality was present in 76.9% of MF cases and 37.5% in the inconclusive group. Four of 6 clonality positive cases in the inconclusive group were diagnosed as MF in rebiopsies. The CD8 percentage was not statistically different between the 3 groups. CONCLUSION: In suspicious cases, CD4/CD8 ratio and TCR gamma gene rearrangement can support histopathology in early MF.

[Investigation of tinea pedis and toenail onychomycosis prevalence in patients with psoriasis]. / Psöriazisli olgularda tinea pedis ve ayak tirnagi onikomikozu prevalansinin arastirilmasi.

The data about the prevalence of onychomycosis in patients with psoriasis is contradictory. In this study, we investigated the prevalence of onychomycosis and tinea pedis in patients with psoriasis compared to control group. A total of 60 patients with psoriasis (27 male, 33 female; mean age: 40.8 +/- 17.6 years) and 60 subjects without psoriasis (27 male, 33 female; mean age: 42.8 +/- 17.3 years) who were admitted to dermatology outpatient clinics of our hospital were included to the study. Scrapings from both normal and abnormal toenails as well as toewebs were examined using microscopy and fungal culture. Foot dermatomycosis was diagnosed in 6 (5 onychomycosis and 1 tinea pedis) patients with psoriasis (10%) and in 8 (5 onychomycosis and 3 tinea pedis) control subjects (13.3%) (p > 0.05). The only dermatophyte fungi isolated in both patients with psoriasis and control group were Trichophyton rubrum (75%) and Trichophyton interdigitale (25%). Onychomycosis was more predominant in male psoriatic patients (p = 0.01). Both distero-lateral subungual onychomycosis (DLSO) and total dystrophic onychomycosis were detected in patients with psoriasis, however, DLSO, was the only clinical type in the control group. Pitting is the most typical lesions in nails in patients with psoriasis (p = 0.04). The use of common showers play a role in transmission of foot dermatomycosis (p = 0.04). In this study, psoriasis was not found as a risk factor for onychomycosis. However, onychomycosis is a major problem in psoriatic nails, and mycological methods would be useful in differential diagnosis. Since dermatomycosis is still an important public health problem, it may be controlled by education of the patient about proper foot hygiene and avoiding walking barefooted in shower areas.