Clinical and dermoscopic progression of subungual hematomas.

Subungual pigmentation is a very common problem and can result from pigments derived from melanin, blood, or fungi. Subungual hematoma usually appears as a reddish to reddish-black pigment depending on the age of the bleed, and it can easily be misdiagnosed as melanoma. In this study, we tried to show the clinical and dermoscopic progression of subungual hematomas. Thirty-six patients with the history of first nail trauma within the last 7 days were included in the study. All the patients were evaluated three times with 3-week intervals. The distance from proximal nail fold to the hematoma was measured by a paper ruler. The area and the largest diameter of the hematoma were calculated by using the Molescore software. At the beginning, the most common dermoscopic finding was the homogen area (n = 36, 100%) followed by small globules (n = 32, 88.9%), large globules (n = 29, 80.6%), and streaks (n = 19, 52.8%). At week 3, the most common dermoscopic finding was the homogen area (n = 36, 100%) followed by large globules (n = 27, 75%), small globules (n = 19, 52.8%), and streaks (n = 11, 30.6%). At the sixth week, the most common dermoscopic finding was homogen area (n = 36, 100%) followed by large globules (n = 16, 44.4%), small globules (n = 7, 19.4%), and streaks (n = 2, 5.6%). The diameter and the area of the hematoma shrunk gradually between weeks 0, 3, and 6 (P < 0.001). Dermoscopy is a very useful tool in the evaluation and differential diagnosis of subungual hematomas. Determination that the pigmented plague grows out distally and shrinks gradually will support the diagnosis of subungual hematoma.

Youngest netherton patient with infantile asthma.

Netherton syndrome is a very rare disorder characterized with icthyosis, atopy, bamboo hair and intermittant aminoaciduria. The specifity of clinical and histopathological features of netherton syndrome is low in neonates and young infants who presents with predominating erythrodermia. Being the youngest infant presenting with the symptoms of infantile asthma we found it worth to report a six months old girl presenting with the feature of severe respiratory distress, generalized erythrodermia, and brittle hair.

Treatment of idiopathic pyoderma gangrenosum with infliximab: induction dosing regimen or on-demand therapy?

Pyoderma gangrenosum is an ulcerative skin disease of unknown origin. Recently tumor necrosis factor alpha inhibitors have been gaining attention in the treatment of recalcitrant pyoderma gangrenosum. However, there is a lack of an optimal dosing strategy in the published literature about the treatment of idiopathic pyoderma gangrenosum, and this is responsible for substantially different treatment strategies. Therefore, it is necessary to report experiences in this patient population in order to develop an optimal dosing strategy and to clarify whether regularly scheduled or on-demand therapy is suitable for idiopathic pyoderma gangrenosum. Herein we report a recalcitrant case of an idiopathic pyoderma gangrenosum treated successfully with a dosing regimen similar to the one that has been used in psoriasis. By doing so, we were capable of controlling the disease and improving the quality of life in our patient.

Dermoscopic features of accessory nipples.

CASE 1: A 27-year-old woman presented with a 6 x 6 mm, soft, pink-brown papule located on the right axilla (Fig. 1). Dermoscopic examination showed a central scar-like white-colored area, a cleft-like appearance in the central area, and a fine pigment network in the periphery of the lesion (Fig. 2). CASE 2: A 5-year-old girl presented with a 4 x 4 mm pink nodule on her left abdominal region. Dermoscopic examination showed a central scar-like white-colored area, and a fine pigment network in the periphery of the lesion. CASE 3: An 18-year-old man presented to our outpatient clinic suffering from a firm, tender, painful, 7 x 7 mm brownish pink nodule located on his left hypochondrium. Upon dermoscopic examination, a central white scar-like area was detected. A cleft-like appearance was also detected in the central region. In the periphery of the lesion, there was a fine pigment network. CASE 4: An 8-year-old girl reported to our outpatient clinic with a congenital 5 x 5 mm brownish papule on her right inguinal region. Dermoscopic examination showed a central white scar-like area, a cleft-like appearance in the central region, and a fine pigment network in the periphery of the lesion (Fig. 3). CASE 5: A 2-month-old girl was referred to our pigmented lesions clinic with a 3 x 3 mm brownish pink papule located on the right subcostal region lesion that had been noted by a pediatrician. Dermoscopic examination showed a central white area, central streak, and a very faint pigmented network at the periphery.

A case report of neonatal convulsions due to maternal herpes gestationis.

Herpes gestationis is a rarely seen autoimmune vesiculobullous and pruritic dermatosis of pregnancy. Neonatal morbidity associated with maternal herpes gestationis is controversial. The authors report the first case of neonatal convulsion with abnormal electroencephalography findings and transient vesicular eruption due to maternal herpes gestationis.

Caspase 9 is decreased in psoriatic epidermis.

Psoriasis is a proliferative and inflammatory disease of the skin. Caspase 9 is responsible for initiating the caspase activation cascade during apoptosis. Apoptosis is a physiological mechanism of homeostasis and development, and caspases are the executioners of apoptosis. This study reports the immunohistochemical localisation of caspase 9 in psoriatic skin and compares it with that seen in normal, healthy control skin. Skin biopsy specimens of lesions were obtained from 15 patients with plaque type psoriasis vulgaris. The specimens were labelled immunohistochemically for binding of an anti-caspase 9 primary antibody. Biopsies of healthy skin from 10 age-matched and sex-matched healthy control individuals were also analysed. The caspase 9 positive cell fraction was calculated for both epidermal and dermal cells in psoriatic lesions and healthy control skin. Counts of caspase 9 positive cells from the epidermis of psoriatic skin lesions were significantly lower than those seen in healthy skin (p<0.05). The caspase 9 immunolabelled perivascular cell counts in the dermis were not statistically significantly different in psoriatic lesions versus normal skin (p>0.05). Psoriatic epidermis contains little of the apoptotic marker, caspase 9. The results of this study are indicative of decreased apoptosis in psoriatic epidermis, and no change in the perivascular area in psoriatic lesions. These findings support the idea that decreased apoptosis is seen in psoriatic epidermal cells. Greater understanding of the nature of the disease may open new avenues for further therapeutic modalities.

Is there any relationship between human leucocyte antigen class II and chronic urticaria? (chronic urticaria and HLA class II).

The Human Leukocyte Antigen (HLA) typing of large groups of patients with various autoimmune diseases has demonstrated that some HLA alleles occur at higher frequencies in specific diseases than in the general population. Chronic urticaria has been shown to have an autoimmune basis by a previous study which found an association between chronic urticaria and specific HLA groups. We investigated the HLA subtypes of Turkish chronic urticaria patients. For this purpose 42 Turkish patients with chronic urticaria and 115 healthy controls were typed for HLA-DR and DQ by PCR-SSP (Polymerase Chain Reaction Sequence Specific Primers) low resolution DNA technique. We found an increased frequency of DR4 (42.9%, p=0.01) in chronic urticaria patients in comparison with that in healthy controls. This study supports the hypothesis that HLA alleles may be involved in the pathogenesis of chronic urticaria and that they appear to be directly involved in the initiation of the immune response.

Reliability of Web-based teledermatology consultations.

We studied the reliability of teledermatology diagnoses made using a Web-based system. Clinical photographs and information relating to 125 patients were placed on a Web server. Three dermatologists made the most likely diagnosis via a Web interface. The reference diagnosis was made in a face-to-face consultation with a fourth dermatologist; where appropriate it was confirmed histologically. The teledermatologists were correct in 57% of cases when viewing the images alone. Their diagnostic accuracy improved to 70% when additional clinical information was available. The rate of agreement between the teledermatologists ranged from 44% to 70% (kappa= 0.22-0.32). Seventy-seven per cent of the patients were correctly diagnosed by at least two dermatologists when clinical information was provided. A Web-based system appears to be reliable for teledermatology. A single well trained teledermatologist may give better results than a group of less well trained clinicians.

Childhood lichen planus with nail involvement: a case.

Childhood lichen planus is a very rare entity which is characterized by violaceous, scaly, flat-topped polygonal papules commonly involving the flexor aspects of the wrists and legs, and oral and genital mucous embranes. The incidence of lichen planus peaks between the ages of 30 and 60 years, where as children comprise only 2% to 3% of reported cases. We report a nine-year-old girl with widespread lichen planus, involving the nails, with no mucosal involvement and regressing after treatment with a starting dosage of 20 mg/day systemic flucortolon (Ultralan) therapy.

A novel missense mutation in CYLD in a family with Brooke-Spiegler syndrome.

Brooke-Spiegler syndrome (BSS, familial cylindromatosis or turban tumor syndrome) is an inherited disease characterized by neoplasms of the skin appendages such as cylindroma, trichoepithelioma, and spiradenoma. The disease has been mapped to 16q12-13, and mutations in the CYLD gene have been identified in families with this disorder. Of interest, multiple familial trichoepithelioma (MFT) has been described as a distinct disorder characterized by the familial occurrence of trichoepitheliomas. MFT has been mapped to 9p21; however, to date a candidate gene has not been identified. In this report, we describe a four-generation family with BSS presenting predominantly with trichoepitheliomas (resembling MFT phenotype). We identified a novel missense mutation in the CYLD gene, designated E474G, in the affected individuals of this family. Our findings exemplify clinical heterogeneity within BSS and extend the body of evidence that mutations in CYLD are implicated in this disease. Although not conclusive, these findings suggest that BSS and MFT may represent a single entity.

Nargile (Hubble-Bubble) smoking-induced hand eczema.

A 65-year-old retired man with hand eczema presented to the Dermatology clinic in October of 2001. He complained of scaly, fissured plaque-type lesions over the radial margin of his right index finger and thumb (Fig. 1). He first noticed these changes 2 years ago. There was no history of irritation from his occupation. None of the other family members were affected. There was no history of atopy or psoriasis. The physical examination was remarkable for scaly, fissured, hyperkeratotic patches on the palms and palmar surfaces of the finger tips of the right hand. No nail changes were noted. The other fingers were free from lesions. There were no changes on the feet or soles. A diagnosis of eczema was suspected. Hobbies and repeated trauma to the hands were investigated. He had a habit of "nargile" smoking,starting at 35 years of age and he was using this apparatus more than 2 h a day. We performed patch tests with European standart test serial and they were negative. Yeast examination using KOH was negative. The diagnosis of Nargile (Hubble-bubble) eczema was made. It was advised that he stop smoking. Mild topical corticosteroids and emollient with urea were started. Clinical evaluation demonstrated resolution of the lesions after 2 weeks of therapy.

Serum homocysteine level in Behçet's disease.

Recent studies of the prevalence of hyperhomocysteinemia in Behçet's disease have shown contradicting results. The aim of the present study was to investigate the serum homocysteine level in patients diagnosed as having Behçet's disease. Venous blood was taken from 27 patients with Behçet's disease and 21 healthy controls. Serum homocysteine levels were measured using fluorescence polarization immunoassay. In addition, serum vitamin B12 and folic acid levels were measured by chemiluminescent enzyme immunoassay. The mean levels of vitamin B12, folic acid, and homocysteine were not significantly different in patients with Behçet's disease when compared with the healthy controls (p = 0.17, p = 0.13, and p = 0.05, respectively). The results of this study confirmed that homocysteine levels were not elevated in Behçet's disease when compared with the control group. Further studies in a subset of Behçet patients with a history of thrombosis are needed to determine the prevalence of hyperhomocysteinemia in the thrombotic form of the disease.