Dermoscopy: the ultimate tool for diagnosis of nail psoriasis? A review of the diagnostic utility of dermoscopy in nail psoriasis.

Dermoscopy is a highly practical noninvasive diagnostic tool. Several dermoscopic algorithms have been proposed in the evaluation of skin diseases, which allow clinicians not only to identify and make differential diagnosis, but also to determine the treatment choices in challenging clinical circumstances. Over the years, we have witnessed a rapid increase in the utilization of dermoscopy in the assessment of nail disorders. However, to assess the diagnostic utility of dermoscopy in inflammatory nail diseases, current evidence is insufficient. Nail psoriasis is a significant challenge because of the difficulties in its diagnosis. Detection of nail involvement is of utmost importance in psoriasis because it is highly associated with arthritis, which is an indication for systemic treatment. Dermoscopy holds promise as a potential tool in the diagnosis of nail psoriasis, capable of providing characteristic clinical findings without any delay and discomfort. This review summarizes current evidence regarding the unique dermoscopic features of nail psoriasis. It addresses whether dermoscopy may serve as the gold-standard diagnostic tool, excluding the necessity of histopathological examination for the ultimate diagnosis of nail psoriasis.

Dermoscopic Features of Nail Psoriasis: Revisited.

Introduction: Nail psoriasis poses a diagnostic challenge in a context of clinical findings that are not evident. We aimed at exploring dermoscopic findings of nail psoriasis and assessing the relationship between these features with disease severity and the risk of arthritis. Methods: We enrolled 35 patients (26 men, 9 women) with severe nail psoriasis (Nail Psoriasis Severity Index [NAPSI] score of more than 50). A complete clinical evaluation, including musculoskeletal assessment and videodermoscopic examination of all nails, was carried out for each patient. Results: Splinter haemorrhage was the most common finding (94.3%), followed by distal onycholysis (88.6%) and pitting (74.3%). The presence of subungual hyperkeratosis (SUH) and the absence of mottled lunula were associated with disease severity (p < 0.05). Both SUH and nail plate crumbling (NPC) were observed more in patients with arthritis. The presence of a combination of SUH and NPC was associated to a 15-fold increase in the risk of arthritis (%95 confidence intervals: 1.55-145.2, p < 0.05). Discussion/Conclusion: This study presents preliminary evidence for the use of dermoscopy as a first step in the diagnosis of nail psoriasis. Dermoscopy is an indispensable tool in the primary evaluation of patients with nail psoriasis, which provides predictive information about the course of the disease.

Complementary and alternative treatment methods practiced by parents in pediatric cases diagnosed with atopic dermatitis.

INTRODUCTION: Atopic dermatitis (AD) is a chronic, recurrent, and inflammatory skin disease experienced mostly in childhood. Chronicity of the disease, relapses, constant need of regular skin care causes seeking for alternative treatments. AIM: The aim of this study is to evaluate the complementary and alternative treatments (CAT) used by parents' caregivers in pediatric patients diagnosed with AD, and the association between CAT use and patient characteristics. MATERIALS AND METHODS: A questionnaire questioning the sociocultural and demographic characteristics of the family, the clinical findings of the patients, their treatments and CAT applications was recorded. RESULTS: Eighty-three patients were included in the study. 68.7% of the patients used at least one type of CAT. Vitamins and oils were the most commonly used CAT (48.8% and 47%, respectively) and 73.3% of the patients using CAT continued normal AD treatment while using CAT. The biggest factor affecting CAT choice was the advice of the immediate circle (75%), and 40.6% of the patients stated that they benefited from the complementary therapy. CONCLUSIONS: CAT are widely used in AD. Physicians should know the socio-cultural structure of the region they are in, the CAT used and their side effects, and inform the families.

Telogen effluvium in daily practice: Patient characteristics, laboratory parameters, and treatment modalities of 3028 patients with telogen effluvium.

BACKGROUND: Telogen effluvium (TE) is a common form of non-scarring alopecia, characterized by excessive shedding of telogen club hairs. OBJECTIVES: The aim of the present study was to investigate patient characteristics, laboratory parameters, and treatment strategies in TE. METHODS: Electronic records of 3028 patients were retrospectively analyzed. Demographic and clinical data, as well as serum parameters screening for iron, vitamin B12, vitamin D, folate and zinc deficiencies, thyroid function, and ANA titers, were evaluated. RESULTS: In the study group, the most frequently performed test type was serum ferritin level (82.3%), followed by complete blood count (81%), both of which revealed that 6.2% of the patients had iron deficiency anemia. 4.6% of the patients had thyroid dysfunction. In screened patients, vitamin and mineral deficiencies were as follows: vitamin D (72.2%), vitamin B12 (30.7%), folate (4.4%), and zinc (2.1%). Women were more likely to be prescribed vitamin D replacement therapy. Iron replacement was the most frequently ordered treatment, comprising 37.5% of total prescriptions. CONCLUSION: To the best of our knowledge, this is the most comprehensive retrospective study having the largest number of patients with TE. Our results will not only help to augment knowledge about TE, but also provide a diagnostic algorithm for the laboratory and clinical workup of patients with TE.

Panitumumab-Induced Paronychia: A Case Report and a Brief Review of the Literature.

Panitumumab is a recombinant, fully humanized IgG2 monoclonal antibody targeting the epidermal growth factor receptor (EGFR). Panitumumab is indicated for patients with metastatic colorectal cancer with progressive refractory disease. Targeted therapies are well known to be well tolerated; however, they may induce toxicities that are distinct from those of classical chemotherapeutic agents. For instance, EGFR inhibitors (EGFRIs) are associated with some specific dermatological adverse effects, one of which is nail toxicity. Since panitumumab is fully humanized, unlike most of the other EGFRIs, it has been reported to have reduced incidence of adverse reactions. Nail-related adverse effects are frequently observed with EGFRIs. A literature search has yielded a list of reviews describing panitumumab-induced nail toxicity. However, as far as we know, there is no case report detailing this adverse effect of panitumumab. Here, we present a case of panitumumab-induced paronychia in a 60-year-old woman with metastatic colon cancer. With this case report, we would like to review the literature and discuss the possible underlying mechanisms of this condition.

Myths, Perceptions and Practices in Acne: A Study on Adolescents and Young Adults.

BACKGROUND AND AIM: Acne vulgaris is a worldwide disease, affecting 85% of adolescents and young adults. Psychological burden of the disease can be profound and may even exceed its physical impact. Adolescents often seek information from a variety of sources, which contributes misinformation and misconceptions. The aim of the present study was to investigate perspectives and attitudes of adolescents and young adults towards acne. MATERIAL AND METHODS: A total of 318 consecutive patients with acne vulgaris (236 female, 82 male) were prospectively enrolled over a period of 4 months. Following a thorough dermatological examination, patients were graded according to Investigator's Global Assessment scale for disease severity. Patients were asked to respond a 28-item self-administered questionnaire, which consisted of questions on beliefs, perceptions and practices of the patients towards acne. RESULTS: 63.5% of the patients considered acne as a 'must be treated disease' and 96.5% believed that treatment should be given by a dermatologist. 84.6% of the patients presumed that dietary changes may reduce or prevent acne lesions, while 95% regarded some dietary factors as aggravating. Female patients more frequently assumed acne as a hormonal disease. Patients with university education considered high water intake and increased fruit and vegetable consumption as ameliorating factors for acne. CONCLUSION: The overall knowledge about acne was found to be poor. These data confirm the need for public awareness and education on acne.

A Growing Mass under the Nail: Subungual Eccrine Poroma.

Eccrine poroma is a benign adnexal tumour, which originates from the acrosyringium of eccrine sweat glands. Eccrine poroma is an uncommon neoplasm, the typical clinical presentation of which is a solitary soft sessile reddish papule protruding from a cup-shaped shallow depression. Many challenges remain in the diagnosis of eccrine poroma because it does not always present with classical features and may mimic any other cutaneous benign and malignant lesions. Eccrine poromas may occur on any skin surface with sweat glands; on the other hand, the most common sites of involvement include the palms and soles, which are rich in eccrine sweat glands. Here, we present a case of subungual eccrine poroma, which is an extremely rare presentation of poromas. We also highlight dermoscopic features of eccrine poroma and review the available literature on the subject.

Smoking: Is it a Risk Factor for Common Warts?

INTRODUCTION: Common warts are one of the most prevalent infections affecting the skin. Common warts are caused by human papillomaviruses (HPV), which are ubiquitous in our environment. Most HPV infections are directly controlled and cleared by host immune system, although each case has the potential to persist and transform into a recalcitrant form. It is not exactly clear why certain populations are more susceptible to common warts. AIM: To investigate factors affecting the occurence and outcome of common warts. MATERIAL AND METHODS: A total of 188 consecutive patients with common warts (106 men, 82 women) and 188 controls were prospectively enrolled. Demographic and clinical characteristics were recorded. The Chi-square, Mann-Whitney U and Kruskal-Wallis tests were used for statistical analysis, with a significance threshold of p<0.05. RESULTS: There were not any significant associations between cigarette smoking, alcohol consumption, accompanying diseases, medications, family history of warts and the duration of warts (p=0.102, p=0.317, p=0.535, p=0.535, p=0.535, respectively). There were not any significant associations between cigarette smoking, alcohol consumption, accompanying diseases, medications, family history of warts and the number of warts (p=0.232, p=0.762, p=0.389, p=0.389, p=0.824, respectively). CONCLUSIONS: Our study has revealed that smoking is not a risk factor for common warts. However, we suspect the lack of statistical differences are likely due to small sample size of the study. Further studies with larger sample sizes are needed.

Paronychia and Periungual Granulation as a Novel Side Effect of Ibrutinib: A Case Report.

Ibrutinib is an oral covalent inhibitor of the Bruton's tyrosine kinase pathway and is approved for the treatment of B-cell malignancies including chronic lymphocytic leukaemia, mantle cell lymphoma, and Waldenström's macroglobulinaemia. It is generally a drug of choice for high-risk patients with indolent lymphomas. The safety profile of ibrutinib appears to be tolerable, with well-known side effects such as infections and haematologic complications. Additionally, dermatological adverse reactions with ibrutinib therapy have been reported to encompass maculopapular rash and hair/nail abnormalities. Here, we present a case of ibrutinib-induced paronychia and periungual granulation in a 40-year-old woman. To the best of our knowledge, this is the third description of ibrutinib-induced paronychia and periungual granulation.

Systemic Immune-Inflammation Index (SII) Predicts Increased Severity in Psoriasis and Psoriatic Arthritis.

BACKGROUND: Psoriasis is a common chronic inflammatory dermatosis. Systemic immune inflammation index (SII) is an inflammation-based biomarker, which has been shown to be an effective prognostic factor in diseases with an inflammation-related etiology. OBJECTIVES: The aim of the present study was to investigate the potential efficacy of SII as a prognostic factor in patients with psoriasis and psoriatic arthritis. MATERIALS AND METHODS: This is a study developed based on the analysis of the medical records of patients with psoriasis. The study retrospectively evaluated the records of the participants for complete blood count results. The SII was calculated by the formula: neutrophil x platelet/lymphocyte. Neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR) and platelet-lymphocyte ratio (PLR) were determined. RESULTS: SII was significantly higher in patients with psoriasis than in controls (578.1 vs. 396, p<0.001). The differences between the median NLR (2.2 vs. 1.5, p<0.001), MLR (0.25 vs. 0.21, p<0.001) and the mean red cell distribution width coefficient of variation (13.8 vs. 12.8, p<0.001) values of patient and control group were significant. SII was higher in patients with moderate/severe psoriasis than patients with mild psoriasis (687.3 vs. 506.6, p=0.034). A positive correlation was observed between SII and PASI (p<0.001; r=0.37). SII was higher in patients with arthritis than patients without (672.1 vs. 548.2, p=0.018). CONCLUSION: This is the first study to prove that SII might serve as an independent prognostic indicator for patients with psoriasis and psoriatic arthritis.

The role of IFIH1 gene rs1990760 and rs2111485 single-nucleotide polymorphisms in generalized vitiligo predisposition

Background/aim: Interferon-induced helicase (IFIH1) is a gene locus that has been recently defined as a candidate for susceptibility to generalized vitiligo (GV). The objectives of this study were to assess the association of IFIH1 gene, rs2111485, and rs1990760 single-nucleotide polymorphisms (SNP) with susceptibility to GV and the autoimmune diseases accompanying GV. Materials and methods: We prospectively studied GV patients and frequency-matched healthy controls by age and sex. The genotypes of the participants were determined for rs1990760 and rs2111485 SNPs of IFIH1. Dominant, recessive, and additive models were evaluated for each SNP adjusted for age and sex. Results: The patients and their controls were observed to be in the Hardy­Weinberg equilibrium for SNP1 (2q24.2, rs1990760, IFIH1, T/C) and SNP2 (2q24.2, rs2111485, IFIH1, G/A), respectively (all P > 0.7). For SNP1, every T allel addition was significantly associated with 1.53 times protectiveness in terms of vitiligo risk (P = 0.033). As for SNP2, every G allel addition was associated with 1.42 times protectiveness, close to statistical significance (P = 0.100). Conclusions: We detected that for SNP1, each T allel and for SNP2, each G allel are protective in terms of vitiligo development. Hereby, we confirmed that IFIH1 gene locus has a role in GV susceptibility.

Is inhaled glucocorticoids the only culprit in angina bullosa hemorrhagica?

Angina bullosa hemorrhagica (ABH) is an infrequent dermatosis characterized by acute onset of hemorrhagic bulla in the oral cavity. Clinical presentation of ABH may be quite worrisome, and clinicians often feel skeptical regarding their clinical diagnosis and lack confidence in managing this distinct entity. Indeed, ABH is a completely benign and self-limited disorder. The exact etiopathogenesis of ABH is still unknown. There have been reports in the literature addressing a central role for mechanical instability of the epithelial-connective tissue connection in the pathogenesis of ABH. Moreover, it has been claimed that long-term usage of inhaled glucocorticoids (GCs) is involved in the development of ABH, since most of the reported cases are asthmatic patients, who were treated with inhaled GCs, and GCs are well known for their degradative activities on collagen formation. Here, we describe a case with ABH, who had a drug history of inhaled GCs and nonsteroidal anti-inflammatory drugs (NSAIDs). We assume that our case not only supports the association of inhaled GCs with ABH but also suggests a possible role for NSAIDs in the pathogenesis of ABH.

Dermoscopy as a first step in the diagnosis of onychomycosis.

INTRODUCTION: Over the years, clinical studies have provided new knowledge about the dermoscopic features of the diseases of cutaneous annexes. It seems that dermoscopy has opened a new morphological dimension in the diagnosis and management of hair disorders and onychopathies. AIM: To identify and describe dermoscopic features of onychomycosis. MATERIAL AND METHODS: A total of 81 consecutive patients with onychomycosis (55 men and 26 women) were prospectively enrolled in the present study. For each patient, all fingernails and toenails were evaluated in clinical and dermoscopic examinations. Mycological tests were performed by potassium hydroxide (KOH) preparation. Mann-Whitney U and χ2 tests were used for the statistical analysis, with a significance threshold of p < 0.05. RESULTS: Dermoscopic examination of the patients' nails revealed the following: jagged proximal edge with spikes of the onycholytic area (51.9%), longitudinal streaks and patches (44.4%), subungual hyperkeratosis (27.2%), brown-black pigmentation (9.9%) and leukonychia (1.2%). Jagged proximal edge, subungual hyperkeratosis and leukonychia were positively associated with the onychomycosis type. CONCLUSIONS: Onychomycosis accounts for up to 50% of all consultations for onychopathies. Fast and effective diagnostic approaches are needed in everyday clinical practice. Dermoscopy can provide immediate and accurate information in the diagnosis of onychomycosis. We suggest that dermoscopy should be taken as a first step toward the diagnosis of onychomycosis.