Bonbon toffee sign: a new dermatoscopic feature for sebaceous hyperplasia.

INTRODUCTION: Sebaceous hyperplasia is a benign proliferation of the sebaceous gland. In this study, we tried to define the dermatoscopic features of sebaceous hyperplasia, which will help to minimize misdiagnoses. MATERIAL AND METHOD: Seventeen patients with 30 sebaceous hyperplasia lesions were included in the study. All the lesions were evaluated dermatoscopically. RESULTS: Cumulus sign, crown vessels, and milia-like cysts were detected in 100%, 86.6%, 53.3% of the lesions, respectively. In 80% of the lesions, the bonbon toffee sign was detected. CONCLUSION: During this study, we observed a feature with central umbilication surrounded by cumulus sign in 80% of our cases, and we named this entity as the 'Bonbon toffee sign', which resembled us 'bonbon toffee'. We think the 'bonbon toffee sign' is a simple and easily recognizable phrase, and it can be used as a new terminology in dermatoscopic diagnosis of sebaceous hyperplasia.

Serum interleukin 18 and tumour necrosis factor-alpha levels are increased in Behcet's disease.

Inflammation in Behcet's disease is thought to be mediated by cytokines derived from T-helper type 1 (Th1) lymphocytes. In this study, we tried to determine serum interleukin (IL)-18 and tumour necrosis factor (TNF)-alpha levels of patients with Behcet's disease. Twenty-seven patients with active Behcet's disease, and 20 healthy control subjects were included in this study. Differences between mean serum IL-18 and TNF-alpha level of patients with Behcet's disease were significantly increased when compared with the control group. A significant correlation was found between serum IL-18 and TNF-alpha levels of Behcet patients (rs = 0.627, P < 0.0001). IL-18 and TNF-alpha levels may be related to disease pathogenesis. Increased levels of IL-18 also support Th1 predominance in Behcet's disease.

Dermal fibrosis and cutaneous necrosis after recombinant interferon-beta1a injection in a multiple sclerosis patient.

The most commonly reported side-effects of recombinant interferon-beta1a and 1b include local inflammatory injection site reactions, headache, fever, myalgia and a flu-like syndrome. In this case report, we describe the occurrence of cutaneous necrosis and dermal fibrosis following intramuscular interferon-beta1a injections in a multiple sclerosis patient.

Idiopathic perianal pruritus: washing compared with topical corticosteroids.

BACKGROUND: Idiopathic perianal pruritus is a poorly managed condition. Topical corticosteroids are effective in idiopathic perianal pruritus, but they may cause some side effects. In this study, the effectiveness of topical steroids were compared with perianal cleansers in the treatment of idiopathic perianal pruritus. PATIENTS AND METHODS: Seventy two patients with the complaint of perianal pruritus were evaluated; 60 of the 72 patients were found to be idiopathic. Twenty eight patients were treated with topical steroids and 32 patients were treated only with a liquid cleanser. RESULTS: At the end of this two week period, cleansers were found to be as effective as topical corticosteroids. CONCLUSION: This study shows that perianal cleansers can be used as a safe first step treatment in idiopathic perianal pruritus.

The role of free oxygen radicals in the aetiopathogenesis of rosacea.

A possible link between superoxide dismutase activity and malondialdehyde level with the clinical manifestations of rosacea was investigated. We found differences in superoxide dismutase activities between mild rosacea (stages I and II) and severe involvement (stage III) groups, as well as between disease and control groups that were statistically significant (P < 0.05). In the mild involvement group (stages I and II), the superoxide dismutase activity was higher than in the control group (P < 0.05), while the malondialdehyde levels did not differ from the control. In the severe involvement group (stage III), the superoxide dismutase activity was lower than in the control group (P < 0.05), and this was coupled to a raised level of malondialdehyde (P < 0.05). These findings clearly show that in the mild involvement phase of rosacea patients, superoxide dismutase activity was stimulated to protect the skin against reactive oxygen species so that the malondialdehyde levels were maintained. In contrast, in more severe disease, due to a decrease in the capacity of the antioxidant defence system, the malondialdehyde levels were increased. These findings support the 'antioxidant system defect hypothesis' in rosacea patients.

Nitric oxide levels in Behçet's disease.

Behçet's disease (BD) is a chronic multisystemic disorder which is characterized by a relapsing systemic inflammatory process. In certain inflammatory conditions such as rheumatoid arthritis, over production of nitric oxide (NO) could damage host cells and tissues, either directly and/or following reaction with other free radicals, such as superoxide anion to form species including peroxynitrite or hydroxyl radicals. Excessive superoxide radical production and impaired antioxidant mechanism in both the neutrophils and plasma of patients with BD have been reported. Our study was designed to investigate the role of NO in BD. NO is an extremely unstable molecule and rapidly converted in vivo and in vitro to nitrate (NO3-) and nitrite (NO2-). For this reason serum NO2- and NO3- have been used as an index of NO generation. We measured serum nitrate + nitrite levels, by using an enzymatic one-step methodology based on the reduction of nitrate to nitrite by nitrate reductase from Aspergillus species, in the presence of beta-NADPH. When compared to healthy controls, serum nitrate + nitrite levels were found to be higher in active periods of BD patients (P < 0.01). It was concluded that increased NO production in patients with BD might have critical biological activities relevant to vasculitic events in the active period of disease.

Isotretinoin-induced nail fragility and onycholysis.

A 23 year old woman who presented with severe acne had been treated with 40 mg/day isotretinoin. On her monthly control, severe cheilitis and bilateral toe nail onycholysis were observed. It is well known that systemic retinoids have several side effects. Although dystropic nail, paronichia-like changes, median nail dystrophy have previously been reported with isotretinoin therapy, onycholysis is rare. In this report, we describe a case with isotretinoin induced nail fragility and onycholysis.

Stress and skin diseases in musicians: evaluation of the beck depression scale, general psychologic profile (the brief symptom inventory [BSI]), beck anxiety scale and stressful life events in musicians.

We had previously investigated skin problems of musicians (N = 117) working in a professional orchestra. The results of this survey suggest a significant incidence of occupational and stress-related skin problems in musicians such as hyperhydrosis, lichen planus, psoriasis, seborrheic dermatitis and urticaria. It was thought that emotional factors exacerbate their problems [6]. This article discusses the importance of psychiatric consultations in dermatologic problems.

Skin problems of musicians.

OBJECTIVE: We investigated the skin problems of high level musicians in a professional orchestra. This study was prompted by our observation of violinists with skin changes. METHODS: Ninety-seven musicians were evaluated. Twelve reporting dermatitis associated with the playing of their instruments were patch tested. We also examined 20 singers (nonplayers). RESULTS: Positive patch test reactions to nickel and colophony were found in only three patients. Musicians were subject to a variety of skin problems from playing their instruments, however, such as hyperhidrosis, cheilitis, and calluses of the fingertips. Singers had skin problems including lichen planus, psoriasis, seborrheic dermatitis, and urticaria. It was thought that emotional factors exacerbate their problems. CONCLUSIONS: The results of this survey suggest a significant incidence of occupational- and stress-related skin problems in musicians.