Analysis of clinical characteristics and factors affecting treatment responses in patients with pyoderma gangrenosum: a multicenter study of 239 patients☆.

BACKGROUND: Pyoderma Gangrenosum (PG) is a chronic disease characterized by recalcitrant skin ulcers. OBJECTIVE: We aimed to evaluate the demographic, clinical characteristics, treatments and factors affecting the treatment responses of patients with PG. METHODS: We performed a multicenter study of 12 tertiary care centers. We analyzed the data of the patients who were followed up with a diagnosis of PG between the years 2012‒2022 retrospectively. RESULTS: We included a total of 239 patients of whom 143 were female and 96 were male, with an average age of 54.2 ±â€¯17.4 years. The most common treatment was systemic steroids (n = 181, 75.7%). Among these patients, 50.8% (n = 92) used systemic steroids as the sole systemic agent, while 49.2% (n = 89) used at least one adjuvant immunosuppressive agent. The independent factors determined in regression analysis to influence response to systemic steroids positively were disease onset age ≥ 30-years, negative pathergy, absence of leukocytosis, negative wound culture, presence of a single lesion, and absence of upper extremity involvement. Biological agents were used in 18.4% (n = 44) of the patients in the present study. We also analyzed pathergy positive PG and early onset (onset age < 30) PG separately due to their distinct clinical features which were revealed during statistical analysis. STUDY LIMITATIONS: Retrospective nature of the present study. CONCLUSIONS: Analyses of the factors influencing treatment responses are addressed in this study. Also, we concluded that investigation for accompanying autoinflammatory diseases of pathergy positive PG and early onset PG is necessary and the patients in these two groups are more resistant to treatment, necessitating more complicated treatments.

The effect of COVID-19 on development of hair and nail disorders: a Turkish multicenter, controlled study.

BACKGROUND: A broad spectrum of skin diseases, including hair and nails, can be directly or indirectly triggered by COVID-19. It is aimed to examine the type and frequency of hair and nail disorders after COVID-19 infection. METHODS: This is a multicenter study conducted on consecutive 2171 post-COVID-19 patients. Patients who developed hair and nail disorders and did not develop hair and nail disorders were recruited as subject and control groups. The type and frequency of hair and nail disorders were examined. RESULTS: The rate of the previous admission in hospital due to COVID-19 was statistically significantly more common in patients who developed hair loss after getting infected with COVID-19 (P < 0.001). Telogen effluvium (85%) was the most common hair loss type followed by worsening of androgenetic alopecia (7%) after COVID-19 infection. The mean stress scores during and after getting infected with COVID-19 were 6.88 ± 2.77 and 3.64 ± 3.04, respectively, in the hair loss group and were 5.77 ± 3.18 and 2.81 ± 2.84, respectively, in the control group (P < 0.001, P < 0.001). The frequency of recurrent COVID-19 was statistically significantly higher in men with severe androgenetic alopecia (Grades 4-7 HNS) (P = 0.012; Odds ratio: 2.931 [1.222-7.027]). The most common nail disorders were leukonychia, onycholysis, Beau's lines, onychomadesis, and onychoschisis, respectively. The symptoms of COVID-19 were statistically significantly more common in patients having nail disorders after getting infected with COVID-19 when compared to the control group (P < 0.05). CONCLUSION: The development of both nail and hair disorders after COVID-19 seems to be related to a history of severe COVID-19.

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.

Factors affecting adherence and patient satisfaction with treatment: a cross-sectional study of 500 patients with acne vulgaris.

Background: Acne Vulgaris is a chronic inflammatory disease that requires long-term treatment. Adherence to treatment is a problem in chronic diseases and may affect treatment outcomes.Objective: We aim to investigate treatment adherence and satisfaction of patients with acne and identify independent factors that affect them.Methods: Five hundred patients with acne were included in this cross-sectional study. Demographic and clinical characteristics of the patients were recorded. Severity of acne was assessed using the Investigator Global Assessment (IGA) scale, and a five-point Likert scale was used to assess patients' satisfaction and adherence.Results: Adherence to treatment was poor in 64.4% of the patients. Multivariate logistic regression analysis showed that using oral isotretinoin (OR: 4.1, 95% CI 2.44-6.92, p < .001) and satisfaction with treatment (OR: 2.1, 95% CI 1.31-3.43, p = .002) were independent factors that affect adherence in patients. 51.8% of the patients were satisfied with their treatments and treatment satisfaction was higher in females (OR: 2.2, 95% CI 1.3-3.8, p = .004) and patients using oral isotretinoin (OR: 14.8, 95% CI 9.4-23.2, p < .001).Conclusions: Treatment adherence is poor among patients with acne. Identifying the factor that affects adherence may help the dermatologist recognize non-adherent patients and develop strategies to improve adherence.

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.