A Case of Onychomycosis Caused by Rhodotorula glutinis.

Rhodotorula spp. have emerged as opportunistic pathogens, particularly in immunocompromised patients. The current study reports a case of onychomycosis caused by Rhodotorula glutinis in a 74-year-old immunocompetent female. The causative agent was identified as R. glutinis based on the pinkish-orange color; mucoid-appearing yeast colonies on Sabouraud Dextrose Agar at 25°C; morphological evaluation in the Corn Meal-Tween 80 agar; observed oval/round budding yeast at 25°C for 72 hours; no observed pseudohyphae; positive urease activity at 25°C for 4 days; and assimilation features detected by API ID 32C kit and automated Vitek Yeast Biochemical Card 2 system. Antifungal susceptibility test results were as follows: amphotericin B (MIC = 0.5 µg/mL), fluconazole (MIC = 128 µg/mL), itraconazole (MIC = 0.125 µg/mL), voriconazole (MIC = 1 µg/mL), posaconazole (MIC = 0.5 µg/mL), anidulafungin (MIC = 0.5 µg/mL), and caspofungin (MIC = 16 µg/mL). Antifungal therapy was initiated with oral itraconazole at a dose of 400 mg/day; seven-day pulse therapy was planned at intervals of three weeks. Clinical recovery was observed in the clinical evaluation of the patient before the start of the third cure. Although R. glutinis has rarely been reported as the causative agent of onychomycosis, it should be considered.

Prevalence of scalp disorders and hair loss in children.

Hair loss in children can have psychologic effects that interfere with a child's growth and development. In our case series, we evaluated 1003 children aged 0 months to 17 years who presented to the pediatric and dermatology outpatient clinics at Fatih University, Ankara, Turkey, from December 2009 through October 2010. The patients were routinely examined for scalp disorders and hair loss. We documented 69 patients with scalp disorders and hair loss, most commonly seborrheic dermatitis (SD), transient neonatal hair loss (TNHL), alopecia areata (AA), temporal triangular alopecia (TTA), and pityriasis amiantacea (PA); The clinical presentation of scalp disorders and hair loss in children varies widely and may be attributed to congenital or acquired causes. Hair loss in children can be associated with serious illness. Therefore, hair examination by a pediatrician or dermatologist is an important part of the physical examination.

Influence of isotretinoin on nasal mucociliary clearance and lung function in patients with acne vulgaris.

Retinoids are widely used to treat acne in patients with underlying systemic diseases. We evaluated the effect of 13-cis-retinoic acid (isotretinoin) on nasal mucociliary clearance and pulmonary function tests (PFTs) in patients with severe acne vulgaris. Each side effect was scored using a 4-point scale. Mucociliary clearance was evaluated by the saccharin test (ST). ST and PFTs were performed on all patients before and during the third month of treatment. A total of 40 acne patients (88% female, mean age 25 +/- 7 years) were included. The most common side effects were dryness, chapped lips, and xerosis. Mild epistaxis occurred in 13 patients; only two patients reported bleeding more than 10cc. There was no difference before and during the third month of treatment in forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, forced expiratory flow rate between 25% and 75% of FVC (FEF(25-75)), and their predicted percentage ratios. Mean nasal mucociliary clearance time was 12.6 +/- 4.1 min before and 15.9 +/- 5.7 after treatment (P < 0.001). We found that nasal clearance was significantly prolonged with treatment, and there was significant correlation between drug dose and mucociliary clearance time. Isotretinoin caused signs and symptoms of dry nose and disturbed mucociliary clearance without affecting PFTs. Nasal complications generally are not serious, especially when isotretinoin is taken in low doses.

Seborrheic keratoses: a distinctive diagnoses of pigmented vulvar lesions: a case report.

Seborrheic keratoses, a benign growth lesion, is a very common cutaneous lesion encountered in white races in the fourth and fifth decade. The occurrence of this lesion on the vulva is rare, as an isolated lesion or in association with lesions elsewhere. A 34-year-old woman reported with a hyperpigmented palpable lesion, approximately 5-10 mm in diameter, was found on the patient's left labium majus. The clinical differential diagnosis of the pigmented lesions of the vulva is difficult often need a biopsy.

Serum leptin, atherogenic lipids and glucose levels in patients with skin tags.

AIM: To investigate the relationship between serum leptin, atherogenic lipid and glucose levels in patients with skin tags and healthy controls. MATERIALS AND METHODS: A total of 58 patients, with at least three skin tags, aged 24 to 85 years, and 31 healthy controls aged 30 to 70 years, were examined in the present study. The subjects in all the groups were selected with statistically similar Body Mass Index (BMI). Fasting concentrations of plasma glucose, serum lipids including triglyceride, total cholesterol, and high-density lipoprotein cholesterol (HDL) and low-density lipoprotein cholesterol (LDL), HbA1c, and leptin were measured by enzyme-linked immunosorbent assay (ELISA). In addition, serum LDL level was calculated using Friedewald's formula. RESULTS: There was no significant difference in age, sex, BMI, HbA1c, triglyceride, HDL and leptin levels between the groups. Skin tags group showed significantly higher levels of total cholesterol and LDL, when compared with the healthy controls groups (P < 0.01). In addition, regression analysis showed that leptin level was positively correlated to serum triglyceride level (r = 0.265, P = 0.044). CONCLUSION: Total cholesterol and LDL serum levels should be controlled in patients with skin tags. On the other hand, glucose, leptin and HbA1c serum levels may not be as important as is being considered in recent times.

Isotretinoin: is there any arrhythmic effect?

BACKGROUND: Oral isotretinoin is currently the most effective therapy for acne, but is associated with numerous adverse effects. To investigate the cardiac effects of isotretinoin, acne patients receiving isotretinoin for 6 months were studied. Methods Twenty-six patients with acne vulgaris were enrolled in the study. The patients were treated with a dose of 0.8 mg/kg/day of isotretinoin (Roaccutane, Hoffman-La Roche, Basle, Switzerland) for 6 months. All participants were assessed pretreatment and at the third month of therapy with 24-h Holter monitoring of electrocardiography. Results Twenty-two patients completed the study (19 females and three males). Initial 24-h Holter monitoring showed normal sinus rhythm in all patients, with a mean heart rate of 79 beats/min (lowest, 63 beats/min; highest, 97 beats/min). At the third month of therapy, 24-h Holter monitoring showed normal sinus rhythm in all patients, with a mean heart rate of 81 beats/min (lowest, 67 beats/min; highest, 91 beats/min). All patients were in sinus rhythm throughout the recording period. None of the patients had supraventricular tachycardia or atrial arrhythmia. Conclusion In this study, 6 months of isotretinoin therapy significantly improved acne and did not cause any cardiac adverse effects at a dose of 0.8 mg/kg/day.

Determination of the sildenafil effect on alopecia areata in childhood: An open-pilot comparison study.

BACKGROUND: Alopecia areata is an immunologically mediated cessation of hair growth primarily involving, but not limited to, the scalp. The treatment of alopecia areata involves promotion of hair growth (for instance with topical minoxidil application), immunosuppression (intralesional or systemic steroid therapy, phototherapy) or immunomodulation (anthralin, dinitrochlorobenzene, diphenylcyclopropenone, squaric acid dibutylester). All these medications have some disadvantages and difficulties for the treatment of children with alopecia areata. OBJECTIVE: To use an open-pilot study to assess the efficacy of topical 1% sildenafil in children diagnosed with alopecia areata. METHODS: Eight patients with (25% of scalp surface area involvement) alopecia areata who were refractory to previous topical treatments applied 1% sildenafil twice daily for 3 months. All the patients completed the study. RESULTS: Two patients experienced vellus-type hair growth and one patient had terminal hair growth. However, these outcomes were accepted as the spontaneous regression of the disease. CONCLUSION: We cannot recommend the use of topical 1% sildenafil for the treatment of alopecia areata without further evidence of its therapeutic benefit.

Oral mucosa manifestations in 100 pregnant versus non-pregnant patients: an epidemiological observational study.

The effect of pregnancy on the oral mucosa is not clear. A study was designed to contrast the number and the type of oral mucosa lesions present in pregnant (study group) and non-pregnant women (control group). A total of 200 women, of whom 100 were pregnant and 100 non-pregnant controls with similar age distribution were chosen at random from obstetrics and dermatology departments, Fatih University Hospital. Oral mucosa lesions were documented in both groups. The data were presented as percentages and comparisons were made based on the chi-square test. The frequency of oral mucosa lesions was greater among the pregnant women than in control group (71.0% versus 29.0%). Cheek biting and oral candidiasis were seen more frequently in pregnant women than the control group. Pregnant women with cheek biting presented in 31 patients (31%) and in control 5 (5%) which was statistically significant, p < 0.001. Oral candidiasis presented in 15 (15%) pregnant versus 5 (5%) in control, which was also statistically significant, p = 0.018. Pregnant women with vomiting were more frequently seen with oral mucosa lesions than pregnant women without vomiting (35 (77.8%) versus 27 (49.1%)), which was statistically significant (p = 0. 003). We concluded that cheek biting and oral candidiasis were the oral mucosa lesions with the greatest prevelances during pregnancy. Pregnant women who visit dermatology clinics should be routinely examined for oral mucosa lesions.