Eccrine Syringofibroadenomatosis of the Soles.

Eccrine syringofibroadenoma is a rare adnexal tumor with acrosyringeal differentiation. It was first described by Mascaro in 1963. Its clinical presentation varies from a solitary nodule, keratotic papule, verrucous plaque, or palmoplantar keratoderma to multiple lesions with linear or diffuse distributions. Age at onset ranges from 16 to 80 years. Lesion distribution is wide and includes the face, back, abdomen, buttocks, extremities, and, rarely, nails. There are five subtypes of eccrine syringofibroadenoma. Histologically, eccrine syringofibroadenoma, independent of the subtype, is characterized by anastomosing cords of acrosyringeal cells forming ductal structures in a fibrovascular stroma and attached to the undersurface of the epidermis in multiple foci. In this article, we describe a 51-year-old woman diagnosed as having eccrine syringofibroadenomatosis.

A case of mesotherapy-induced panniculitis.

Mesotherapy was first introduced in Europe for the treatment of localized pain. It is currently used mainly for aesthetical purposes and gradually getting widely used for body contouring, cellulite reduction, and skin rejuvenation. The reports concerning about mesotherapy is increasing in number in the literature. There are reported systemic and local side effects of mesotherapy. Panniculitis is a rare side effect of mesotherapy. In this article, we report a case of mesotherapy-induced panniculitis who responded to dapsone therapy.

Effect of different doses of isotretinoin treatment on the levels of serum homocysteine, vitamin B 12 and folic acid in patients with acne vulgaris: A prospective controlled study.

OBJECTIVE: To investigate the effects of different doses of isotretinoin on serum homocysteine, vitamin B12 and folic acid in patients with acne vulgaris. METHODS: The case-control study was conducted at Gazi University School of Medicine, Ankara, Turkey, from November 2012 to March 2013, and comprised male or non-pregnant female patients more than 18 years of age. The cases had moderate to severe nodulocystic acne, while an equal and matching control group had healthy individuals. Isotretinoin was started in a dosage of 0.5 mg/kg/day, and 1.0 mg/kg/day in patients with medium and severe acne vulgaris respectively. Homocysteine, vitamin B12, folic acid, liver function tests, serum cholesterol and triglyceride levels were tested at the baseline and on day 45. SPSS 11 was used for statistical analysis. RESULTS: The two groups had 62 subjects each. The cases had 47(76%) women and 15(25%) men with a group mean age of 21.0±2.7 years. The controls had 45(72.6%) women and 17(27.4%) men with a group mean age of 21.6±3.0 years. Homocysteine levels were significantly increased in both groups taking 0.5 mg/kg/day and 1.0 mg/kg/day isotretinoin (p<0.05). There were no statistically significant differences in the levels of vitamin B12, folate and liver function tests (p>0.05 each). Total cholesterol level increased significantly in the group using 1.0 mg/kg/day (p<0.05). In the triglyceride levels, significant increases were seen in both groups (p<0.05). CONCLUSIONS: Evaluation of homocysteine, vitamin B12 and folic acid beside the routine tests were beneficial for the patients before they started isotretinoin treatment.

The prevalence of interdigital erythrasma: a prospective study from an outpatient clinic in Turkey.

BACKGROUND: Erythrasma is a superficial skin infection caused by Corynebacterium minutissimum . Interdigital erythrasma is the most common form and is easily confused with tinea pedis. The aim of this study was to determine the prevalence of interdigital erythrasma in patients with clinically suspected tinea pedis. METHODS: This study was performed between January 1, 2011, and January 31, 2012. It included 182 patients who presented with concerns about interdigital lesions. All of the patients were examined with a Wood's lamp, and smears were stained with Gram's method. Direct examination with 20% potassium hydroxide was performed. RESULTS: Of 182 patients with interdigital lesions, 73 (40.1%) were diagnosed as having erythrasma. The mean ± SD age of the patients with erythrasma was 45.52 ± 10.83 years (range, 22-70 years). Most of the patients with erythrasma were women (56.2%). The most often clinical finding was desquamation. Using only Wood's lamp examination or Gram's staining resulted in 31 (42.5%) or 14 (19.2%) positive patients, respectively. Using Wood's lamp examination and Gram's staining concurrently resulted in 28 positive patients (38.4%). CONCLUSIONS: Interdigital erythrasma is a common condition and can be difficult to differentiate from tinea pedis. Simple and rapid diagnosis can be made with Wood's lamp examination, but Gram's staining is also a useful method, especially in patients with negative Wood's lamp examination findings.

Dermatological Complaints of the Elderly Attending a Dermatology Outpatient Clinic in Turkey: A Prospective Study over a One-year Period.

The geriatric population is continuously growing, which leads to more aged patients being admitted to dermatology clinics. The aim of this study is to determine the dermatological complaints of the elderly attending a dermatology outpatient clinic. All of the patients aged 65 years and older admitted to our dermatology outpatient clinic over a 1-year period were included. Patients were divided into 2 groups according to their ages as group I (65-74 years) and group II (≥75 years). The patients were asked about their dermatologic complaints. A total of 240 geriatric patients attended to the dermatology outpatient clinic over a 1-year period. Overall, the five most frequent dermatologic complaints of the patients were eczematous dermatitis (21.7%), pruritus (19.6%), fungal infections (16.7%), precancerous and malignant lesions (9.6%), and bacterial infections (7.1%). The most frequent types of eczematous dermatitis were asteatotic eczema (26.9%), neurodermatitis (26.9%), and stasis dermatitis (17.3%). Among fungal infections, the most frequent was tinea pedis (62.5%), followed by onychomycosis (32.5%) and tinea versicolor (5.0%). The most common precancerous lesion was actinic keratosis (78.3%). Bacterial infections encountered were pyoderma (58.8%), cellulitis (23.5%), and erythrasma (17.6%). Most of the skin problems in the elderly are preventable or treatable, so proper skin care and treatment of skin diseases should be emphasized in general health care for the elderly.

Faun tail: a rare cutaneous marker of spinal dysraphism.

A 10-year-old girl who was admitted to the urology department with complaints of urinary incontinence was referred to our dermatology outpatient clinic because of a congenital, circumscribed, hypertrichotic area on the lumbosacral region. Cutaneous examination revealed a circumscribed area of coarse, dark terminal hair measuring 25 x 15 cm overlying the lumbosacral area with normal underlying skin (Figure 1). There were erythematous macular lesions on the superior of the hairy area. The lesion had been present since birth, and no other family member had similar lesions. Her history revealed back pain and a long history of urinary incontinence. On neurologic examination, no motor weakness or sensory changes were observed. Babinski reflex was positive on the left. Magnetic resonance imaging (MRI) findings included diastematomyelia between T12 and L1 levels and slight flattening of lumbar lordosis (Figure 2). A diagnosis of faun tail with underlying spinal dysraphism was made. There was also urinary incontinence as late sequelae of spinal dysraphism.

Allergic contact dermatitis to pure henna.

Henna is a naturally occurring brown dye made from the leaves of the tree Lawsonia inermis. The active ingredient of henna is lawsone (2-hydroxy-1, 4-naphthoquinone). It is traditionally used in Islamic and Hindu cultures as a hair coloring and as a dye for decorating the nails or making temporary skin tattoos. Actually, henna has a very low allergic potential. In most cases, allergic reactions not caused by henna, but by the chemical coloring additives that are added to henna mixtures. These additives include agents such as daiminotoluenes and diaminobenzenes. In this article, we report a case of allergic contact dermatitis from pure henna that is also used for the relief of rheumatic pain.

Complete dermatological examination in the elderly: an exploratory study from an outpatient clinic in Turkey.

BACKGROUND: The geriatric population is growing continuously, therefore more aged patients are being admitted to dermatology clinics. Successful management of these patients requires a thorough understanding of the features of geriatric patients and prevalence of skin diseases in this group. MATERIALS AND METHODS: Patients aged 65 years and older admitted to the dermatology outpatient clinic over a 3-month period were included. Patients aged between 65 and 74 years were included in group I, and patients older than 74 years were included in group II. Demographic features of the patients were noted. Total dermatological examination was performed in each patient. Fifteen days after the first visit, the patients were phoned up to obtain information about their level of satisfaction regarding the treatments and were invited to the clinic for reexamination where their improvement levels were scored. RESULTS: A total of 209 patients were included in this study. The most common complaints were in the chronic eczema-dermatitis group. However, the most commonly detected disorders were in the chronic sun exposure group. Some severe cutaneous and noncutaneous diseases were detected incidentally at total dermatological examination. Treatment satisfaction scores of patients and improvement scores of doctor had a significantly good correlation. DISCUSSION: The study results indicated that in the management of elderly patients, social and physical evaluation should be carried out and treatment must be recommended accordingly. In all elderly patients, total dermatological examination must be performed because it may reveal some severe cutaneous or underlying noncutaneous diseases.

Flare-up of pustular psoriasis with fluoxetine: possibility of a serotoninergic influence?

In this article, we report two cases of pustular psoriasis flaring up after fluoxetine administration. A 21-year-old male patient with localized pustular psoriasis became erythrodermic following commencement of fluoxetine. Even though the lesions were unresponsive to cyclosporine A (Cyc A) treatment, dramatic resolution was observed with discontinuation of fluoxetine. A 44-year-old female patient with pustular psoriasis who was on Cyc A and acitretin therapy was given fluoxetine for her psychiatric symptoms. In the following 5 days, her lesions flared. Owing to previous experience, fluoxetine was stopped. Her lesions improved dramatically in the following 3 days. Exacerbation of psoriasis with antidepressant therapy has been rarely described. An extensive review of the literature revealed four such cases, all of which were seen after the use of selective serotonin reuptake inhibitors (SSRI). A serotoninergic influence in the etiopathogenesis of psoriasis may be possible together with a pharmacogenetic difference in the drug metabolism of these patients. Considering the two patients we presented and the patients previously reported in the literature, aggravation of pustular psoriasis by SSRI should be borne in mind.

Prevalence of skin diseases among pediatric patients in Turkey.

The pediatric population is composed of persons under 16 years of age, and few studies are available on the dermatological diseases of this group. In the present study, data on a total of 6300 pediatric patients admitted between the years 2004-2006 were analyzed. Hospital-based patient registry records were used for data collection. The data were analyzed according to age, sex and time of admittance. A female preponderance (53%) was observed, and adolescents (12-16 years old) constituted the largest group within the patient population (47.6%). A total of 125 dermatoses were recorded. Acne vulgaris was the most prevalent dermatosis (12.4%), followed by atopic dermatitis (11.8%), contact dermatitis (11.3%), warts (9.5%), seborrheic dermatitis (4.3%) and impetigo (4.1%). Atopic dermatitis was the most frequently seen dermatosis in both infants and preschool-age children, whereas contact dermatitis was more prevalent in school-age children, and acne vulgaris was more prevalent in the adolescent group. The frequencies of some diseases showed seasonal variations. Acne vulgaris, atopic dermatitis, contact dermatitis, psoriasis, xerosis and alopecia areata were more common in winter. In contrast, insect bites, vitiligo, dyshidrotic eczema, impetigo and tinea corporis were more common in summer. Studies of the pediatric population, which constitutes the cornerstone of the community, can play an important role in determining the policies of protective medicine and public health. New studies will help us to better understand the frequency of dermatological diseases in the pediatric population according to age, gender and season, and take precautions with regard to these conditions.

Plasma homocysteine level is elevated in patients on isotretinoin therapy for cystic acne: a prospective controlled study.

PURPOSE: Isotretinoin (Iso) has marked side effects. Homocysteine (Hcy) metabolizes in the liver, requiring folate and vitamin B12. Elevated blood levels of Hcy have been linked to an increased risk of premature coronary artery disease (CAD). In this study, we evaluated Hcy levels, vitamin B12, and folate in patients on Iso treatment for cystic acne (CA). METHODS: Seventy-four patients with CA were included to the study group. Blood levels of Hcy, vitamin B12, and folate were assessed before and after 45 days of Iso therapy. The control group consisting of 80 individuals were tested once. RESULTS: Hcy levels were statistically significantly increased in patients on Iso treatment. Vitamins were unaltered, while lipids and liver enzymes increased statistically significantly. CONCLUSION: Hcy levels are elevated in patients on Iso treatment for CA. It may be due to either the inhibition of cystathionine-beta-synthase, an enzyme required in the metabolism of Hcy, by the drug and/or the liver dysfunction. Daily supplementation with vitamin B12 and folate, which are the cofactors of the enzymatic reactions involved in Hcy metabolism, can lower plasma levels of Hcy, so it is recommended to take these vitamins in case of deficiency along with Iso to prevent premature occlusive vascular disease.

Acquired aquagenic papulotranslucent acrokeratoderma: report of two cases.

Aquagenic papulotranslucent acrokeratoderma (APA) is an acquired, unusual condition characterized by bilateral, symmetric, translucent-to-white papules located on the hands and feet. These lesions are accentuated following a short period of water exposure. Since its first description in 1973 as hereditary papulotranslucent acrokeratoderma, only a few cases of APA have been reported. We report two cases of teenage girls with APA. Both patients responded well to 5% salicylic acid ointment but recurrence of lesions still occurred. The close temporal proximity of presentation of these two cases may indicate that APA is not as rare as previously thought.

Phytophotodermatitis due to Ficus carica.

The genus Ficus belongs to the Moraceae (the mulberry family). Figs can cause irritant or phototoxic reactions. Phytophotodermatitis is a common cutaneous phototoxic reaction. Contact with plant-derived phototoxic substances (furocoumarins or psoralens) followed by sunlight exposure produces the clinical lesions. Here, we present a case of phytophotodermatitis after contact with fig fruits and leaves. The vesicular dermatitis was primarily located in areas of vitiligo.

Generalized pruritus: a prospective study concerning etiology.

BACKGROUND: Generalized pruritus can often be the primary manifestation of systemic disease. OBJECTIVE: To determine how frequently generalized pruritus had a systemic etiology in an outpatient population seen in a dermatology department and whether any identifiable patient characteristics meant a systemic explanation of generalized pruritus was more likely. METHODS: A prospective controlled study of 55 patients with generalized pruritus and 41 healthy age- and sex-matched control subjects. Clinical data were collected from patients and laboratory parameters investigated in both patients and healthy control subjects to determine the frequency of systemic disease in each group. RESULTS: Of 55 patients, 12 had a systemic cause of pruritus. Pruritus was the initial symptom of systemic disease in eight of these patients. The underlying diseases included hypothyroidism, chronic lymphocytic leukemia, hepatitis C, hepatitis B, diabetes mellitus, lung cancer, uremia, and iron deficiency anemia. Of these, iron deficiency anemia was the most common cause. Compared with the control group, mean serum hemoglobin, iron, and cyanocobalamin (vitamin B(12)) levels in patients with generalized pruritus were lower. No other patient characteristics were statistically associated with systemic causes of pruritus. CONCLUSION: Generalized pruritus was the initial symptom of a systemic disease in 8 of 55 patients presenting to a dermatology outpatient clinic with this complaint. A number of underlying diseases were identified, of which the most common was iron deficiency anemia.

Chronic bullous disease of childhood in a patient with acute lymphoblastic leukemia: possible induction by a drug.

Linear IgA disease is characterized by the presence of linear IgA deposits in the basement membrane zone of the skin, and circulating basement membrane zone antibodies are detected in 80% of cases. The disease occurs in both adults and children, and is designated adult linear IgA disease in the former and chronic bullous disease of childhood (CBDC) in the latter. We describe a 5-year-old boy with acute lymphoblastic leukemia in remission, in whom CBDC developed after treatment with trimethoprim/sulfamethoxazole (cotrimoxazole). To our knowledge, this is the first reported case of possible drug-induced CBDC.