Dermoscopy of dermatofibromas: A new perspective.

AIM: In dermoscopic studies on dermatofibromas, some publications divide the appearance of lesions into standardised patterns, and some publications classify the clinical appearance of the lesions by comparing them with existing dermatological lesions. This study aims to re-evaluate the dermoscopic findings and patterns of dermatofibromas from a different perspective. MATERIALS AND METHODS: In this study, 142 lesions of 72 patients were evaluated dermoscopically and their patterns were schematised. RESULTS: In our study, a total of 15 patterns consisting of main and sub-patterns were created. The most common patterns we detected were pattern 1 (1a: 13.4%, 1b: 8.5%), pattern 8 (8a: 10.6%, 8b: 4.2%) and pattern 2 (2a: 9.2%, 2b: 4.2%), respectively. CONCLUSION: Patterns of DFs were reclassified while preserving basic patterns. We think that the new sub-patterns and schematisation with this study can contribute to a better understanding of DFs.

A Proposal for Determining a Diagnostic Cutoff Value of a New Ultrasonographic Index of Retronychia Inversely Correlating with Disease Severity.

BACKGROUND: Ultrasonography has demonstrated a shortening of the distance between the origin of the nail plate and the base of the distal phalanx in retronychia. The aim of this study was to analyze the clinical and ultrasonographic features of retronychia. METHODS: We evaluated the clinical findings in 18 patients with retronychia, along with the ratio of ultrasonographic distance a, extending between the nail plate origin and the base of the distal phalanx, to distance b, perpendicular to distance a, extending between the nail plate origin and the upper margin of the distal phalanx. RESULTS: Retronychia was present in 26 nails. The mean ± SD distance a was 7.66 ± 1.64 mm and distance b was 3.56 ± 1.95 mm. The mean ± SD a/b ratio was 2.59 ± 1.11. There was a significant inverse correlation between a/b ratio and clinical severity (Pearson correlation = -0.668; P < .001). The cutoff value of this ratio was 3.319, with specificity of 90% and sensitivity of 69%. CONCLUSIONS: The ratio of distance a/distance b and the cutoff value of this ratio may help in making the diagnosis, in objectively determining the disease severity, and in selecting a patient-specific treatment approach.

The role of dermoscopy in the diagnosis of distal lateral subungual onychomycosis.

Recently dermoscopic patterns, that can be useful in the diagnosis of distal and lateral subungual onychomycosis, were identified. In this study, we aimed to determine the frequency of the defined patterns so far and additionally to identify other patterns that were observed and to investigate the place of these patterns in the diagnosis of Distal Lateral Subungual Onychomycosis (DLSO) in the dermoscopic examination of the patients with pre-diagnosis of DLSO. Patients admitted dermatology outpatient clinic of Haydarpasa Numune Training and Research Hospital with the complaint of nail disturbance suspicious for DLSO (97 patients) between the August 2015 and February 2016. Clinical and dermoscopic photographs of the cases with a pre-diagnosis of DLSO were taken and their nails were cut for pathological examination and culture. In hematoxylin and eosin, and periodic acid schiff examination, hyphe and/or spore were observed in 134 (65.4%) and fungal growth was detected in 99 (48.3%) of the nail samples. As a result of logistic regression model analysis, the p values of the 'ruin appearance', 'homogeneous leukonychia', 'punctate leukonychia', and 'black discoloration' patterns preserved their statistical significance (p = 0.015, p = 0.009, p = 0.026, p = 0.040, respectively). We believe that in nail disorders clinically resembling DLSO patients, the presence of dermoscopic patterns of ruin appearance, homogenous leuconychia, punctate leuconychia, and black discoloration strongly supports the clinical diagnosis of DLSO.

A Proposal for a New Severity Index for the Evaluation of Chronic Paronychia.

INTRODUCTION: Chronic paronychia (CP) is an inflammatory disease of the nail folds. Staging of CP is important for clinicians. We developed an objective scale that evaluates each finding of CP separately in addition to evaluating the treatment process and follow-up. METHODS: A new "chronic paronychia severity index scale" was developed to enable dermatologists to examine all features of CP. A previous categorical severity scale and this new scale were used for the evaluation of CP by 6 different dermatologists. The dermatologists evaluated the nails with both scales again 20 days later using randomly ordered photographs. RESULTS: Using the previous scale, the intra-observer intraclass correlation coefficient (ICC) values between the first and second evaluations were 0.767, 0.860, 0.734, 0.609, 0.900, and 0.840 for the 6 dermatologists. Using the new proposed scale, the intra-observer ICC values between the first and second evaluations were 0.930, 0.931, 0.942, 0.934, 0.938, and 0.920 for the 6 dermatologists. All intra-observer ICC values were higher for the results of the proposed scale than for those of the previous scale. The inter-observer ICC values were also higher for the proposed scale than for the previous scale for the 6 dermatologists. CONCLUSION: The new scale is a standardized, more suitable, objective, and valuable method to use in clinical practice and studies on CP.

Relationship between Human Papilloma Virus and Subungual Keratoacanthoma: Two Case Reports and the Outcomes of Surgical Treatment.

Subungual keratoacanthoma (SUKA) is a rare form of keratoacanthoma, with the majority of the lesions appearing as rapidly growing, painful hyperkeratotic masses located under the distal nail plate of the thumb. In some cases, SUKA causes damage to the underlying bone. The first case presented here was treated by surgical excision alone, and human papilloma virus (HPV) type 6 was detected in the tissue samples. The second case was treated by surgical excision plus curettage; however, HPV was not detected, and tumor cells were not found in the curettage material. There was near complete improvement in both the clinical appearance and the distal phalanx destruction, with no recurrence at the final follow-up in either patient (30 and 14 months, respectively). Overall, simple excision alone or in combination with curettage seemed to be sufficient in the treatment of SUKA; however, the etiopathogenetic role of HPV in SUKA remains controversial, as in its classical form.