Cutaneous findings in patients with acromegaly and its relationship with concomitant endocrinopathies.

OBJECTIVES: Skin changes in acromegaly are often the first sign of the disease. The aim of this study was to describe the cutaneous findings in patients with acromegaly. In addition, a secondary aim was to investigate the possible association of these findings with remission status and concomitant endocrinopathies. DESIGN, PATIENTS, AND MEASUREMENTS: In this prospective multicenter study, 278 patients over the age of 18 years with acromegaly who were followed up in 14 different tertiary healthcare institutions were included. These patients, who were followed up by the Endocrinology Department, were then referred to a dermatologist for dermatological examination. The frequency of skin lesions was investigated by detailed dermatologic examination. Dermatological diagnosis is reached by clinical, dermatological and/or dermoscopic examination, and rarely skin punch biopsy examinations in suspicious cases. The possible association of the skin findings between remitted and nonremitted patients and with concomitant endocrinopathies were evaluated. RESULTS: The most common skin findings in patients with acromegaly in our study were skin tags (52.5%), cherry angiomas (47.4%), seborrhoea (37%), varicose veins (33%), acneiform lesions (28.8%), hyperhidrosis (26.9%) and hypertrichosis (18.3%). Hypertrichosis was significantly more prevalent in patients nonremitted (p: .001), while xerosis cutis was significantly more prevalent in patients remitted (p: .001). The frequency of diabetes mellitus and hypothyroidism was significantly higher in patients with varicose veins and seborrhoeic keratosis than those without. Additionally, the coexistence of hypothyroidism, hyperthyroidism and galactorrhea was significantly higher in patients with Cherry angioma than in those without Cherry angioma (p-values: .024, .034 and .027, respectively). The frequency of hypogonadism in those with xerosis cutis was significantly higher than in those without (p: .035). CONCLUSIONS: Cutaneous androgenization findings such as skin tag, seborrhoea, acne and acanthosis nigricans are common in patients with acromegaly. Clinicians should be aware that skin findings associated with insulin resistance may develop in these patients. It can be said that the remission state in acromegaly has no curative effect on cutaneous findings. Only patients in remission were less likely to have hypertrichosis. This may allow earlier review of the follow-up and treatment of acromegaly patients presenting with complaints of hypertrichosis. Additionally, it can be said that patients with skin findings such as cherry angioma may be predisposed to a second endocrinopathy, especially hypothyroidism. Including dermatology in a multidisciplinary perspective in acromegaly patient management would be beneficial to detect cutaneous findings earlier.

Acanthosis nigricans or terra firma-forme dermatosis? Three adolescent cases.

Terra firma-forme dermatosis (TFFD), also known as Duncan' dirty dermatosis, is a keratinization disorder that is characterized by velvety, dark brown-blackish patches, and plaques and is not associated with systemic diseases. The lesions rarely show a verrucous or reticulate appearance. Especially, in children and adolescents, neck, face, torso, and ankles are the most frequently affected areas. TFFD is a condition that should be suspected in children and adolescents that cannot be cleaned with soap, especially if the neck area looks dirty. In this article, we report 3 cases with a diagnosis of TFFD resembling acanthosis nigricans. TTFD should be included in the differential diagnosis of adolescent cases presenting with hyperpigmented patches and plaques, especially in intertriginous areas such as the neck.

Skin, mucosa and nail findings in hospitalized pediatric patients with Coronavirus disease-2019 (COVID-19)

Abstract Background: Cutaneous manifestations of Coronavirus Disease-2019 (COVID-19) disease have not yet been fully described in hospitalized pediatric patients. Objectives: This prospective study aims to demonstrate the skin, mucosal, and nail findings of hospitalized children with COVID-19. Methods: The authors included hospitalized pediatric patients. Two dermatologists examined skin, hair, nails, and mucosa. Patients with drug eruptions were excluded with an anamnesis, clinical and laboratory test results. Results: Out of 46 enlisted patients, 19 (41,3%) patients displayed skin, mucosal or nail findings. Skin findings were seen on 14 (30.4%) patients. Ten (22%) patients presented skin findings matching described patterns. Half of the patients with patterned rashes had confluent erythematous/maculopapular/morbilliform rashes. Eleven out of 46 (23.9%) patients developed periorbital erythema and edema. Ten (22%) patients had at least one oral mucosal finding. One telogen effluvium, one blue nail, and one flag sign on nails were noticed. Nine (19.5%) patients out of 46 had developed MIS-C. MIS-C patients had mucocutaneous manifestations except one (88.8%). Study limitations: The authors have detected a higher rate of mucocutaneous manifestations compared to out-patients with mild COVID-19 because the study is based on hospitalized patients only. Conclusions: Pediatric COVID-19 patients are more susceptible to developing mucocutaneous manifestations compared to adults. The authors propose COVID-19 should be acknowledged as one of the viral exanthem rashes of childhood. The authors noticed that the most common findings were periorbital erythema and edema. The confluent erythematous/maculopapular/morbilliform rashes appear to be the most common patterns associated with severe COVID-19.

Results of the patch tests with European baseline series in children: Five years of experience from a single center in Turkey and a review of the literature.

BACKGROUND: Pediatric allergic contact dermatitis (ACD) is increasingly prevalent. Patch testing is the gold-standard diagnostic method. AIMS: Our study aimed to identify common contact-sensitizing allergens in Turkish children. PATIENTS/METHODS: We retrospectively analyzed the patch test results and characteristics of 191 pediatric patients [114 (59.7%) females, 77 (40.3%) males], who received the diagnosis of allergic contact dermatitis between 2015 and 2019. RESULTS: The mean age of the patients was 12.2 years (range 4-18 years). Thirty-six (18.8%) of the patients in the study group had positive patch test outcomes with 56 positive allergens. Girls had a significantly higher rate of total positive patch test results than boys (75%/25%; p = 0.003, p < 0.05). The most frequent four allergens were nickel sulfate (n = 20, 10.4%), cobalt chloride (n = 6, 3.14%), p-phenylenediamine (n = 5, 2.61%), Methylchloroisothiazolinone/methylisothiazolinone (n = 5, 2.61%), respectively. CONCLUSIONS: In our study, we discovered that in addition to the frequently encountered metal allergens such as nickel and cobalt, p-phenylenediamine and Methylchloroisothiazolinone/methylisothiazolinone sensitivities were frequent in the Turkish population. p-phenylenediamine sensitization can cause serious systemic dermatitis during the lifetime of children. We suggest that in Turkey personal care and hygiene products containing Methylchloroisothiazolinone/methylisothiazolinone should be legally regulated. Since childhood contact dermatitis may have an impact on the quality of life by influencing family and social life, suspected allergens should be detected as early as possible.

Skin, mucosa and nail findings in hospitalized pediatric patients with Coronavirus disease-2019 (COVID-19).

BACKGROUND: Cutaneous manifestations of Coronavirus Disease-2019 (COVID-19) disease have not yet been fully described in hospitalized pediatric patients. OBJECTIVES: This prospective study aims to demonstrate the skin, mucosal, and nail findings of hospitalized children with COVID-19. METHODS: The authors included hospitalized pediatric patients. Two dermatologists examined skin, hair, nails, and mucosa. Patients with drug eruptions were excluded with an anamnesis, clinical and laboratory test results. RESULTS: Out of 46 enlisted patients, 19 (41,3%) patients displayed skin, mucosal or nail findings. Skin findings were seen on 14 (30.4%) patients. Ten (22%) patients presented skin findings matching described patterns. Half of the patients with patterned rashes had confluent erythematous/maculopapular/morbilliform rashes. Eleven out of 46 (23.9%) patients developed periorbital erythema and edema. Ten (22%) patients had at least one oral mucosal finding. One telogen effluvium, one blue nail, and one flag sign on nails were noticed. Nine (19.5%) patients out of 46 had developed MIS-C. MIS-C patients had mucocutaneous manifestations except one (88.8%). STUDY LIMITATIONS: The authors have detected a higher rate of mucocutaneous manifestations compared to out-patients with mild COVID-19 because the study is based on hospitalized patients only. CONCLUSIONS: Pediatric COVID-19 patients are more susceptible to developing mucocutaneous manifestations compared to adults. The authors propose COVID-19 should be acknowledged as one of the viral exanthem rashes of childhood. The authors noticed that the most common findings were periorbital erythema and edema. The confluent erythematous/maculopapular/morbilliform rashes appear to be the most common patterns associated with severe COVID-19.

Grading of hirsutism: a practical approach to the modified Ferriman-Gallwey scoring system.

Introduction: The modified Ferriman-Gallwey (mFG) scale is accepted as a useful clinical scoring system in the evaluation of hirsutism. Aim: To prevent overlooking hirsutism diagnoses and facilitate patient examinations in ongoing pandemic conditions by simplifying the mFG score. Material and methods: This study included 227 patients who were diagnosed with hirsutism and had mFG scores of ≥ 8. Hair distribution and hair growth intensity of nine different body regions in the mFG score were examined. Results: Among our patients with hirsutism, terminal hair was present on the chin in 97.4% (n = 221), thighs in 96.5% (n = 219), upper lip in 94.7% (n = 215), and lower abdomen in 92.1% (n = 205), and this was significantly higher compared with the remaining five regions (p < 0.001 for each comparison). Terminal hair growth scored as ≥ 1 was found in 89% of the patients (n = 202) for the combination of the chin, thighs, and upper lip, and in 87.2% (n = 198) for the combination of the chin, thighs, and lower abdomen. When the chin and thighs were evaluated together, 75.3% (n = 171) of the patients had ≥ 2 terminal hair growth. Conclusions: In addition to the chin and thighs being the main regions of terminal hair growth, examination of the upper lip or lower abdomen can sufficiently help predict hirsutism. During the ongoing pandemic conditions when we need to follow social distancing rules, a practical approach to the mFG scoring system will facilitate the work of many physicians, including dermatologists, and will shorten the patient's stay in the clinic.