Clinicopathological consistency in skin disorders: a retrospective study of 3949 pathological reports.

BACKGROUND: Although the clinicopathological approach plays an important role in skin disorder diagnoses, few studies have evaluated the consistency between clinical and histopathological diagnoses of skin disorders. OBJECTIVE: We sought to investigate the consistency, and factors affecting consistency, between clinical diagnoses and pathological diagnoses in patients with skin disorders referred for biopsy by dermatologists. METHODS: We retrospectively examined 3949 pathological reports of biopsy specimens, between 1999 and 2008. The relationships between clinical and pathological diagnoses were studied in 4 groups, namely: (1) definite pathological diagnoses consistent with the clinical diagnoses, (2) descriptive pathological diagnoses consistent with the clinical diagnoses, (3) definite pathological diagnoses inconsistent with the clinical diagnoses, and (4) descriptive pathological diagnoses inconsistent with the clinical diagnoses. The first two groups show consistency, whereas the latter two groups show inconsistency between the diagnoses. RESULTS: The pathological diagnoses were consistent with the clinical diagnoses in 3034 biopsy reports (76.8%), and they were inconsistent in 915 reports (23.2%). In all types of skin disorders, clinicopathological consistency was higher in patients with sufficient clinical descriptive information. No correlation was observed between clinicopathological consistency and biopsy type, number of clinical diagnoses, or specifying the location of disease. Disease duration was shorter in the biopsy reports showing clinicopathological consistency. Moreover, a statistically significant increase was found in clinicopathological consistency for inflammatory dermatoses, when pathologists evaluated the specimens with clinical diagnoses, in comparison with blind evaluation. LIMITATIONS: The retrospective nature of the study might have resulted in a loss of data. CONCLUSION: In a dermatology clinic setting, providing sufficient clinical descriptive information for pathology requisition forms increases the probability of making an accurate diagnosis.

The investigation of insulin resistance and metabolic syndrome in male patients with early-onset androgenetic alopecia.

Epidemiological studies have shown that diseases associated with insulin resistance and coronary artery disease are more frequently observed in men with androgenetic alopecia (AGA). We aimed to identify the presence of insulin resistance and metabolic syndrome in male patients with early-onset AGA. Fifty male patients (18-30 years) with AGA stage ≥ 3 (Hamilton-Norwood scale), body mass index < 27 and 40 weight- and age-matched male subjects were the study population. The weight, height, and waist circumference of all patients was measured. Levels of fasting glucose, insulin, and lipids were evaluated and oral glucose tolerance tests undertaken. Insulin resistance was analyzed through various indices and the presence of metabolic syndrome was assessed. Values of diastolic blood pressure and total cholesterol were significantly higher in the AGA group. Among insulin indices, only HOMA insulin resistance (HOMA-IR) and fasting insulin resistance index (FIRI) were higher in the AGA group. Given the criteria for metabolic syndrome, no significant differences were observed between the two groups. Although not supported by the other indices, high scores of HOMA-IR and FIRI suggest that male patients with early onset-AGA have insulin resistance. These data may raise awareness in susceptible individuals that lifestyle changes in the early period of life can reduce the risk of insulin resistance.

The presence of insulin resistance and comparison of various insulin sensivity indices in women with androgenetic alopecia.

We aimed to identify the association of female androgenetic alopecia with insulin resistance and to evaluate various simple insulin sensitivity indices and beta cell function in women with androgenetic alopecia (AGA). A cross-sectional study was performed in 66 non-obese women (24-44 years old), 41 with AGA alone and 25 healthy individuals. Blood glucose, insulin, c-peptide levels, oral glucose tolerance test (OGTT); insulin sensitivity and beta cell function indices derived from a single blood sample and OGTT were determined and compared in the two groups. Women with AGA had impaired glucose tolerance (IGT) rates of 12.5%. In the control group IGT was 0%. Fasting glucose, c-peptide, insulin were higher in AGA group. When the indices were evaluated, Raynaud index, FIRI and HOMA-IR results found to be higher in the AGA group than in controls (p < 0.05, for all). Fasting insulin(-1), GIR, FIRI(-1), QUICKY index, ISI HOMA, HOMA-IS results were lower in AGAs than in controls (p < 0.05, for all). Our study showed that women with AGA alone were more insulin resistant than healthy subjects. We suggest that beta cell function and insulin sensitivity indices are useful methods for measuring insulin resistance in AGAs, and HOMA-IR is a good predictor of insulin resistance. We propose that OGTT should be applied in women with AGA.

Lupus vulgaris of the popliteal fossa: a delayed diagnosis.

Lupus vulgaris (LV) is the most common form of cutaneous tuberculosis. It commonly presents on the head and neck regions. The diagnosis may be difficult when LV occurs at unexpected regions or in unusual clinical forms. Sometimes special stains for the organism and mycobacterial cultures may be negative. Nevertheless, it is usually possible to reach the correct diagnosis of LV using clinical and histopathological findings. But at times, a therapeutic trial with antitubercular agents may be required.

Phototrichogram findings in women with androgenetic alopecia.

BACKGROUND/PURPOSE: Androgenetic alopecia (AGA) in women is characterized by diffuse thinning in the frontal and parietal areas of the scalp; preservation of the frontal hairline is norm. Hair over the occipital scalp is preserved. The purpose of this work was to investigate the findings of phototrichogram (PTG) of the affected and the spared areas in women with AGA and to compare them with those of healthy subjects. METHODS: Twenty-two controls and 60 untreated women with AGA (32 with Ludwig I, 28 with Ludwig II) were included in this study. Hair density, percentages of thin hair, and non-growing hair were estimated both on the midscalp and on the occiput by using PTG with digital camera attached to a dermoscope. RESULTS: In the control group, hair density was higher on the midscalp than the occiput. In AGA groups, hair density was lower on the midscalp than the occiput and percentages of thin hair and non-growing hair were higher on the midscalp than the occiput. These findings were more prominent in Ludwig II group. In the occiput there were findings mimicking the changes seen on the midscalp. These were less striking than those seen on the midscalp yet the difference between the control and Ludwig II group was statistically significant. CONCLUSION: We concluded that the hair is not equally distributed on the scalp, the occiput may be affected in females with AGA and further studies are necessary to support these findings.

Prurigo pigmentosa treated with doxycycline.

Prurigo pigmentosa is characterized by an inflammatory phase with pruritic erythematous papules and a resolution phase with reticulated pigmentation. It is not a well known entity except in Japan. We present a Turkish young man with prurigo pigmentosa treated with doxycycline.

Congenital blaschkoid eccrine spiradenoma on the face.

Eccrine spiradenoma is an uncommon tumour of the sweat gland(s) and generally occurs as a solitary small painful nodule. Very rarely, it may present as multiple tumours arranged in a linear/blaschkoid pattern. An 8-year-old girl had many papulonodular lesions, arranged in a linear pattern on the left half of the face, involving the forehead and lateral side of the nose. The lesions were along Blaschko's lines. Lesions were reported to be present at birth; no family member had similar lesion(s), either in solitary or multiple form. Histopathologic examination of a biopsy specimen revealed characteristic features of eccrine spiradenoma. The case is reported because of the rare occurrence of this presentation.

Incidence of cutaneous tuberculosis in patients with organ tuberculosis.

BACKGROUND: Tuberculosis continues to be a health problem in some countries. The development of resistance to antituberculitic drugs and the increase in diseases and conditions associated with immunodeficiency such as AIDS and chemotherapy have caused tuberculosis to increase recently. As a result, the incidence of cutaneous tuberculosis has been increasing as well. AIM: To detect cutaneous tuberculosis in patients with organ tuberculosis and to establish some characteristics of the relation between organ and cutaneous TB. MATERIAL AND METHODS: A total of 370 patients (145 females and 225 males), aged 2-76 years (mean age 27.5), enrolled for this screening study. These patients were hospitalized patients who already had pulmonary or extrapulmonary tuberculosis diagnosed before admission. All patients underwent a general skin examination, and, if needed, cutaneous biopsies were taken from involved skin areas. RESULTS: Three hundred and forty-seven (93.78%) out of 370 patients had pulmonary tuberculosis only or in association with one of other organ tuberculoses. Twenty-three patients had extrapulmonary TB: nine were TB adenitis, six were TB peritonitis, three were bone tuberculosis, and five were TB meningitides. Of 370 patients, only 13 (3.51%) had cutaneous TB: seven scrofuloderma (SCD; 2.16%), four lupus vulgaris (LV; 1.35%), one LV and SCD, and one Bacille Calmette-Guerin (BCG) adenitis (0.027%). Cutaneous tuberculosis was observed in seven out of 260 patients with parenchymal tuberculosis (2.96%). Four out of nine patients with TB adenitis (44.4%), one out of 12 pulmopleuretic (8.3%), and one out of 67 pleuresic patients (1.40%) had cutaneous TB as well. Mean age of the 13 patients was 32.46 years: mean age of SCD and LV was 24.8 and 48 years, respectively. The one patient with BCG adenitis was 7 months old. Five (62.5%) out of eight patients with SCD, and only one (20%) out of five patients with LV were new cases. Four patients with SCD had a positive family history, while LV patients did not. CONCLUSIONS: Organ tuberculosis is rarely associated with cutaneous tuberculosis. Scrofuloderma and LV are the most frequent forms of skin TB associated with organ TB in this population. Tuberculosis adenitis is the organ TB that causes cutaneous TB most often among other organ tuberculoses. More than one form of cutaneous TB affected only one patient with pulmonary TB; therefore, it is very rare. Tuberculids were not observed in any of the patients.