A solitary lesion of idiopathic calcinosis cutis in an infant: subepidermal nodular calcinosis or milia-like idiopathic calcinosis cutis?

Milia-like idiopathic calcinosis cutis (MICC) and subepidermal calcified nodule (SCN) are described as different entities under the heading of idiopathic calcinosis cutis. Although there are some clinical differences, they share many features. Whereas MICC lesions are located mostly on the extremities and rarely on the face, SCN manifests itself mostly on the face, rarely on the extremities. Milia-like idiopathic calcinosis cutis almost always presents with multiple lesions, whereas SCN shows mainly solitary and rarely multiple lesions. Association with Down syndrome (DS) has been reported in up to two-third of the cases with MICC, but not in SCN. We herein present a 5-months-old girl without DS, manifesting a 2mm solitary, white hard papule surrounded by erythema, located on the finger. Histopathologic findings revealed the presence of dermal calcium deposits. When a solitary papular lesion of idiopathic calcinosis is seen in a child, especially if not associated with DS, it is difficult to differentiate MICC from SCN. We believe that these entities may represent variants of the same pathology and it may be more appropriate to designate a solitary lesion as SCN, regardless of its location.

A diagnostic challenge: inflamed and pigmented seborrheic keratosis. Clinical, dermoscopic, and histopathological correlation.

Pigmented and irritated types of seborrheic keratosis (SK) can be confused with melanoma, basal cell carcinoma, or pigmented actinic keratosis. Dermoscopic examination may give many clues for the diagnosis of SK, but in equivocal cases the accurate diagnosis can only be made by microscopic features. Herein, we report a striking, isolated pigmented and inflamed SK, located on the waist in an elderly man. Although the duration of the lesion was not clear, a recent change in color was reported. The striking dark pigmentation and lack of visible characteristic features for SK led us to consider other pigmented lesions, mainly melanoma, which it closely resembled. Dermoscopic examination was inconclusive with subtle clues for SK, such as brown-gray dots, small brownish clods, a few curved short lines, and few small pinkish round structures. Histopathological and immunohistochemical examinations revealed an inflamed and pigmented SK. In conclusion, pigmented and inflamed SK does not usually tend to show typical dermoscopic features of SK and may mimic other pigmented lesions, including melanoma. All skin lesions that cannot be classified as clearly benign should undergo biopsy.

Terra Firma-Forme Dermatosis Misdiagnosed as Nevoid Acanthosis Nigricans.

Terra firma-forme dermatosis (TFFD) is a clinical condition characterized by brown-gray, velvety, pigmented patches or plaques, resembling dirt on the skin. Nevoid acanthosis nigricans (NAN) is a rare and recently described form of acanthosis nigricans occurring during childhood or early adulthood. Herein we describe a patient with TFFD, initially misdiagnosed as NAN. The patient had developed hyperkeratotic and hyperpigmented plaques on and around the umbilicus during pregnancy. Though regular in bathing practices, she could not clear away the lesions and concerned marks for inesthetic appearance. Histopathological findings were compatible with NAN, and she was prescribed 10% urea lotion. On a dramatic healing after 3 weeks, a diagnosis of TFFD is considered and confirmed by the lesions getting wiped away by vigorous rubbing with alcohol pads. We discuss the key points of differentiating TFFD from NAN, and underline the importance of alcohol test for accurate diagnosis.

Comedones Induced by Vascular Laser Therapy.

A 21-year-old female presented with acne-like blackheads on brownish areas located on the cheek. She had been treated with neodymium-doped yttrium aluminium garnet (Nd-YAG) laser (1071 nm), 160 j/cm(2), three months ago for erythema and telangiectasia of her face. Afterwards, she developed atrophic, slightly depressed, hyperpigmented, 3-4 mm scars with superimposed tiny comedones within the treated areas. Topical treatment with tretinoin 0.05% cream on alternate days, and Sun Protection Factor (SPF) 50 sunscreen daily were commenced. After 2 months, comedones and hyperpigmentation mostly resolved but mild superficial atrophy persisted. According to our knowledge, this is the first case of atrophic scars studded with open comedones, developing shortly after laser therapy used for facial telangiectasia.

Hepatitis C and hepatitis B virus infections in the etiopathogenesis of pemphigus.

BACKGROUND: Previous studies have shown that some viral infections may be triggers for autoimmune diseases. The role of viral infections in the etiopathogenesis of pemphigus has also been investigated. OBJECTIVES: To investigate the relationship between pemphigus and the hepatitis B and C virus infections. METHODS: This retrospective study included 62 patients with pemphigus and 50 healthy controls of matching ages and genders. The control group included relatives who accompanied the orthopedic patients to the hospital but had no history of systemic and/or autoimmune diseases. RESULTS: The group of patients with pemphigus was composed of 43 (69.3%) females and 19 (29.7%) males, and the mean age was 48.08 ± 15.38. The hepatitis C virus antibody was negative in all of the patients. Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), or both, were studied in 44 of the 62 patients. Two (4.3%) of these patients were positive for HBsAg and found to have HBV infection. Fourteen of them were HBsAb positive. Two (4%) of the 50 control subjects showed hepatitis C virus antibody positivity, while only 1 (2%) patient with pemphigus displayed HBsAg positivity. There was no statistically significant difference between the two groups for hepatitis B and C virus infections. CONCLUSIONS: This study does not support an association between pemphigus and hepatitis B and/or C virus infections.

Hepatitis C and hepatitis B virus infections in the etiopathogenesis of pemphigus

BACKGROUND: Previous studies have shown that some viral infections may be triggers for autoimmune diseases. The role of viral infections in the etiopathogenesis of pemphigus has also been investigated. OBJECTIVES: To investigate the relationship between pemphigus and the hepatitis B and C virus infections. METHODS: This retrospective study included 62 patients with pemphigus and 50 healthy controls of matching ages and genders. The control group included relatives who accompanied the orthopedic patients to the hospital but had no history of systemic and/or autoimmune diseases. RESULTS: The group of patients with pemphigus was composed of 43 (69.3%) females and 19 (29.7%) males, and the mean age was 48.08 ± 15.38. The hepatitis C virus antibody was negative in all of the patients. Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), or both, were studied in 44 of the 62 patients. Two (4.3%) of these patients were positive for HBsAg and found to have HBV infection. Fourteen of them were HBsAb positive. Two (4%) of the 50 control subjects showed hepatitis C virus antibody positivity, while only 1 (2%) patient with pemphigus displayed HBsAg positivity. There was no statistically significant difference between the two groups for hepatitis B and C virus infections. CONCLUSIONS: This study does not support an association between pemphigus and hepatitis B and/or C virus infections. .

Arborizing vessels under dermoscopy: a case of cellular neurothekeoma instead of basal cell carcinoma.

Neurothekeoma is a slow-growing, benign tumor of nerve sheath origin. Herein we present a 62-year-old female who presented with a 5-month history of a nodule that had shown a slight enlargement. She had a diagnosis of non-Hodgkin lymphoma for 10 years for which she had received multiple sessions of chemotherapy and radiotherapy. Cutaneous examination showed a well-defined, firm, 2 cm, pink-red nodule of the right supraclavicular area, which showed thick and arborizing vessels under dermoscopy. A diagnosis of cellular neurothekeoma was made after histopathologic examination with immunohistochemistry. Thick and arborizing vessels have been described as the dermoscopic hallmark of nodular and cystic basal cell carcinoma. In the past, hydradenoma and intraepidermal poroma have been defined as dermoscopic mimics of basal cell carcinoma because of the characteristic appearance of arborizing vessels. With this report a neurogenic tumor has been added to this list.

Characteristics of fever, etiologic factors, antibiotic use and prognosis in febrile dermatology inpatients.

BACKGROUND: Generally, fever is observed in >30% of hospitalized patients. However, little is known about fever in dermatology inpatients. OBJECTIVES: The aim of this study was to investigate and document the incidence, characteristics, and etiologic factors of fever in febrile dermatology inpatients and to describe the practice of antibiotic use and prognosis in the same group. METHODS: The medical records for 928 inpatients were retrospectively analyzed. RESULTS: The incidence of fever was found to be 16.2%. Mean length of hospital stay was found to be longer in febrile patients. Of the 176 febrile episodes, 79 (44.9%) occurred in patients without infections, 43 (24.4%) in patients with community-acquired infections, 25 (14.2%) in patients with healthcare-associated infections, 18 (10.2%) in patients classified with fever of non-infectious/infectious causes, and 11 (6.3%) in a group for whom the etiologic factors of fever were undetermined. Antibiotic treatment was started in 36.2% of febrile inpatients. The overall mortality rate was 0.6%. CONCLUSIONS: This is the first study to investigate febrile episodes in dermatology inpatients. Fever is a frequently encountered symptom in dermatology inpatients. Febrile episodes resulted from mostly non-infectious entities, mainly consisting of inflammatory dermatologic disorders. Antibiotics were ordered in a higher percentage of patients in the febrile group. Dermatologists started prophylactic or empiric antibiotic therapy in febrile patients with non-infectious or inflammatory diagnoses on the assumption that these patients had an increased risk for infection as a result of impaired skin integrity and use of immunosuppressive drug therapy. The overall mortality rate was very low in the study group of dermatology inpatients.

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.

Canine scabies in humans: a case report and review of the literature.

BACKGROUND: Sarcoptes scabiei causes mange in many domestic and wild mammals, and it has been reported to be transmitted from animals to humans. Canine scabies is known to infest humans, as well. CASE REPORT: We report a 27-year-old woman who presented with severe pruritic papules on the trunk and arms. The patient reported that she had just bought a puppy which was also itchy. Direct microscopy from the dog showed scabies mites. The patient was treated by 5% permethrin which accomplished full recovery. DISCUSSION: Canine scabies in humans is a challenging disease to diagnose since mites are hard to find on skin scrapings of dogs and the burrows that are the hallmark of scabies are absent. Dermatological examination of the lesions in our patient did not show any burrows or a specific dermoscopic image of scabies. Instead, we observed curvilinear crusts on most of the papules. CONCLUSION: To our knowledge, dermoscopic appearance of canine scabies in humans has not been described before. We think this special pattern of excoriations is the result of superficially dug tunnels that had been torn leaving vacant curved linear remnants behind, and this may provide a good support for the diagnosis of canine scabies contributing to the spectrum of entodermoscopy.

Segmental neurofibromatosis: report of 3 cases.

Segmental neurofibromatosis (SNF) is an uncommon variant of neurofibromatosis type 1 (NF-1) that is characterized by café au lait spots, freckles, and/or neurofibromas limited to a body segment. In this report we describe 3 adult patients with SNF who presented with only neurofibromas. Although 2 patients had no systemic involvement, the third patient had hypertrophic cardiomyopathy, a cardiologic abnormality that is associated with neurofibromatosis.

Marie Unna hereditary hypotrichosis: a Turkish family with loss of eyebrows and a U2HR mutation.

We report a family with Marie Unna hereditary hypotrichosis (MUHH) from Turkey. MUHH is a distinct form of scalp and body hair loss characterized by the absence or scarcity of scalp hair, eyebrows, and eyelashes at birth. Coarse wiry hair begins to grow during childhood. Around puberty, progressive hair loss occurs in the affected patients. Recently, mutations were identified in U2HR, an inhibitory upstream open reading frame in the 5'-untranslated region of the human hairless gene (HR) as the underlying cause of MUHH. We are presenting hair loss of eyebrows in a Turkish family comprising eight affected and seven unaffected individuals. The pedigree is compatible with autosomal dominant inheritance. Linkage and haplotype analyses confirmed linkage of this family to the MUHH locus at cytoband 8p21. By sequencing U2HR, we identified the mutation c.2T>C (M1T) in all affected family members. We concluded that there may be considerable clinical variations in MUHH, and that eyebrow loss is an important clue for accurate diagnosis.

Pyoderma gangrenosum on the breast: a case presentation and review of the published work.

We present a case of pyoderma gangrenosum localized on the breast, without a preceding surgical intervention and associated systemic disorder. The ulcer had rapidly developed and covered a large portion of the breast. The patient responded well to systemic steroids and salicylazosulfapyridine and the ulcer completely healed with scarring after 3 months of treatment. Pyoderma gangrenosum rarely involves the breasts. A published work survey disclosed only 31 reported cases up to date. In most of these cases the lesions were related to previous surgical interventions, probably as the result of a pathergy phenomenon. The main differential diagnoses were skin and soft tissue infections including necrotizing fasciitis, and malignant neoplasms. Negative initial wound cultures and the relative sparing of nipple/areola complex helped to eliminate these disorders. Though an unusual site for pyoderma gangrenosum, lesions on the breast showed the characteristic clinical features of the disease. The types of associated disorders were also similar to those of the cases with classical pyoderma gangrenosum. As most of the lesions healed with significant scarring, early recognition and treatment of pyoderma gangrenosum located on the breast is important to prevent serious physical and psychological morbidity.