Granulomatous slack skin: report of a case with response to electron beam therapy.

Granulomatous slack skin (GSS) is a rare form of cutaneous T-cell lymphoma, closely related to mycosis fungoides. It is characterized by pendulous skin folds with a predilection for flexural areas. Histology shows an elastolytic granulomatous infiltrate with atypical lymphoid cells. Granulomatous mycosis fungoides is an important histologic differential diagnosis to be considered. We present a 19-year-old man with a gradually enlarging erythematous, and bulky lesions on his body. Histologically, a dense atypical lymphoid cell infiltration with numerous multinucleated giant cells and elastolysis was observed. T-cell receptor gene rearrangement was detected in skin lesions. He was treated with PUVA and interferon alpha, but improvement in skin lesions was not observed. Marked regression of all lesions was achieved by using electron beam therapy. This case report supports that GSS is an indolent variant of mycosis fungoides due to clinical, histological and T-cell gene rearrangement results. However, there is no definitive data about prognosis of the disease. We suggest that further clinical studies are needed to understand this rare condition.

Subcutaneous cryptococcosis due to Cryptococcus diffluens in a patient with sporotrichoid lesions case report, features of the case isolate and in vitro antifungal susceptibilities.

Environmental fungi, in particular primary pathogens and Cryptococcus spp. can be responsible for skin lesions mimicking sporotrichosis. In this paper, we report a case of subcutaneous cryptococcosis in an apparently healthy, young male patient due to a non-C. neoformans Cryptococcus species, C. diffluens. The isolate showed in vitro phenotypic switching that may affect virulence and host inflammatory and immune responses, and in vitro resistance to amphotericin B and 5-flucytosin. This species shares several phenotypic traits with C. neoformans, and, therefore, decisive diagnosis should be based on biopsy and culturing results followed by molecular identification.

The presence of insulin resistance and comparison of various insulin sensivity indices in women with androgenetic alopecia.

We aimed to identify the association of female androgenetic alopecia with insulin resistance and to evaluate various simple insulin sensitivity indices and beta cell function in women with androgenetic alopecia (AGA). A cross-sectional study was performed in 66 non-obese women (24-44 years old), 41 with AGA alone and 25 healthy individuals. Blood glucose, insulin, c-peptide levels, oral glucose tolerance test (OGTT); insulin sensitivity and beta cell function indices derived from a single blood sample and OGTT were determined and compared in the two groups. Women with AGA had impaired glucose tolerance (IGT) rates of 12.5%. In the control group IGT was 0%. Fasting glucose, c-peptide, insulin were higher in AGA group. When the indices were evaluated, Raynaud index, FIRI and HOMA-IR results found to be higher in the AGA group than in controls (p < 0.05, for all). Fasting insulin(-1), GIR, FIRI(-1), QUICKY index, ISI HOMA, HOMA-IS results were lower in AGAs than in controls (p < 0.05, for all). Our study showed that women with AGA alone were more insulin resistant than healthy subjects. We suggest that beta cell function and insulin sensitivity indices are useful methods for measuring insulin resistance in AGAs, and HOMA-IR is a good predictor of insulin resistance. We propose that OGTT should be applied in women with AGA.

Phototrichogram findings in women with androgenetic alopecia.

BACKGROUND/PURPOSE: Androgenetic alopecia (AGA) in women is characterized by diffuse thinning in the frontal and parietal areas of the scalp; preservation of the frontal hairline is norm. Hair over the occipital scalp is preserved. The purpose of this work was to investigate the findings of phototrichogram (PTG) of the affected and the spared areas in women with AGA and to compare them with those of healthy subjects. METHODS: Twenty-two controls and 60 untreated women with AGA (32 with Ludwig I, 28 with Ludwig II) were included in this study. Hair density, percentages of thin hair, and non-growing hair were estimated both on the midscalp and on the occiput by using PTG with digital camera attached to a dermoscope. RESULTS: In the control group, hair density was higher on the midscalp than the occiput. In AGA groups, hair density was lower on the midscalp than the occiput and percentages of thin hair and non-growing hair were higher on the midscalp than the occiput. These findings were more prominent in Ludwig II group. In the occiput there were findings mimicking the changes seen on the midscalp. These were less striking than those seen on the midscalp yet the difference between the control and Ludwig II group was statistically significant. CONCLUSION: We concluded that the hair is not equally distributed on the scalp, the occiput may be affected in females with AGA and further studies are necessary to support these findings.

Prurigo pigmentosa treated with doxycycline.

Prurigo pigmentosa is characterized by an inflammatory phase with pruritic erythematous papules and a resolution phase with reticulated pigmentation. It is not a well known entity except in Japan. We present a Turkish young man with prurigo pigmentosa treated with doxycycline.

Features of patients with vulvar dermatoses in dermatologic and gynecologic practice in Turkey: is there a need for an interdisciplinary approach?

AIM: Vulvar dermatoses are very common problems in women and they are associated with significant morbidity. The aims of the present study were to evaluate the features of patients with vulvar diseases in gynecology and dermatology out-patient clinics in Turkey, and to determine the need for a multidisciplinary vulvar clinic in this country. METHODS: A total of 310 patients with vulvar problems as their primary complaints were included in the study. There were 144 women from a dermatology clinic and 166 women from a gynecology clinic. The following factors were recorded for all patients: physical examination findings, menarche age, age at first intercourse, education level, marital status, clinical diagnoses and associated gynecologic problems. RESULTS: There were no significant differences between the two groups when the mean age, menarche age and age at first intercourse were compared (P > 0.05). The number of unmarried women was statistically significantly higher in the dermatology group than in the gynecology group (P < 0.0001). The number of women who graduated from high school and university was also statistically significantly higher in the dermatology group than in the gynecology group (P < 0.01). The frequency of gynecologic problems was statistically significantly higher in the gynecology group than in the dermatology group (P < 0.001); however, dermatologic conditions were the most frequent diagnosis overall (33.54%). Forty patients in the gynecology group were referred to the dermatology clinic. CONCLUSIONS: The approach to patients with vulvar disorders varies from country to country. However, multidisciplinary clinics seem to improve the understanding of vulvar diseases, to make correct diagnoses and to raise patients' quality of life. The need for a multidisciplinary vulvar clinic should not be ignored by the physicians in Turkey.

Narrow-band ultraviolet B phototherapy in patients with psoriasis: for which types of psoriasis is it more effective?

Narrow-band ultraviolet B phototherapy with Philips TL-01 lamps is being used increasingly in the treatment of psoriasis. However, the effectiveness of phototherapy with narrow-band ultraviolet B in different clinical types of psoriasis vulgaris has not yet been evaluated in the literature. In the present study, we aimed to determine the efficacy and safety of narrow-band ultraviolet B therapy for different clinical forms of psoriasis vulgaris in our patient population. In this open study, 53 patients with psoriasis vulgaris, skin types II--IV, were enrolled. The patients were classified as guttate, nummular, plaque, or mixed according to their predominant morphological lesions. Evaluation of therapeutic efficacy was performed by comparing their Psoriasis Area and Severity Index (PASI) scores before and after treatment. The cumulative dose and the number of treatments were also calculated. Side effects were noted during the therapy. With respect to the different types of psoriasis, reductions of the PASI were not significantly different (p>0.05). The mean cumulative dose and total sessions in the plaque-type group were greater than those in the guttate and nummular groups (p<0.01, p<0.05). Complete clearing was observed in all patients in the guttate-type group, but the result was not statistically significant (p=0.064). Side effects were reported in five (11%) patients. During the 12 months follow-up period, there were no statistically significant differences in the relapse of the disease among the psoriasis groups (p=0.317). In conclusion, we found that the efficacy of narrow-band ultraviolet B therapy in patients with psoriasis decreased as the predominant lesion size enlarged. Before considering narrow-band ultraviolet B therapy for psoriasis, assessment of lesion size may be useful. Combination therapies may be more effective than phototherapy alone if the patient has predominantly large plaques.

Congenital blaschkoid eccrine spiradenoma on the face.

Eccrine spiradenoma is an uncommon tumour of the sweat gland(s) and generally occurs as a solitary small painful nodule. Very rarely, it may present as multiple tumours arranged in a linear/blaschkoid pattern. An 8-year-old girl had many papulonodular lesions, arranged in a linear pattern on the left half of the face, involving the forehead and lateral side of the nose. The lesions were along Blaschko's lines. Lesions were reported to be present at birth; no family member had similar lesion(s), either in solitary or multiple form. Histopathologic examination of a biopsy specimen revealed characteristic features of eccrine spiradenoma. The case is reported because of the rare occurrence of this presentation.

The presence of trichodynia in patients with telogen effluvium and androgenetic alopecia.

BACKGROUND: Trichodynia refers to pain, discomfort, and/or paresthesia in the skin of the scalp or the hair. There may be an associated psychologic comorbidity. Although androgenetic alopecia (AGA) and telogen effluvium (TE) are different entities in terms of pathogenesis, etiology, and clinical picture, both may be influenced by psychologic stress and may be the cause of secondary stress. AIMS: To investigate the presence of trichodynia in patients with TE and AGA and to evaluate psychologic comorbidity in patients with trichodynia. MATERIALS AND METHODS: A total of 248 patients (153 females, 95 males), presenting with hair loss due to either TE or AGA, were enrolled in this study. The prevalence of trichodynia in these two groups was compared with that in controls (n = 184). In addition, psychiatric evaluation was performed in 25 patients with trichodynia (13 females, 12 males) and in 25 controls (16 females, nine males) without alopecia and trichodynia by a psychiatrist; Diagnostic and Statistical Manual of Mental Disorders (DSM)IV criteria were used for the assessment. RESULTS: Trichodynia was found in 72 patients (29%) with hair loss and in six controls (3.3%; P < 0.0001); 25 of the 72 patients with trichodynia underwent psychiatric evaluation and 19 of the 25 patients were found to have psychopathologic signs (76%). In the control group, only five patients had psychopathologic signs (20%; P = 0.0004). Of those with hair loss, trichodynia was more frequent in the TE group than in the AGA group (P < 0.0071). CONCLUSIONS: Trichodynia is a common symptom in patients with TE and AGA, and often coexists with psychopathologic findings, including depression, obsessive personality disorder, and anxiety.

Incidence of cutaneous tuberculosis in patients with organ tuberculosis.

BACKGROUND: Tuberculosis continues to be a health problem in some countries. The development of resistance to antituberculitic drugs and the increase in diseases and conditions associated with immunodeficiency such as AIDS and chemotherapy have caused tuberculosis to increase recently. As a result, the incidence of cutaneous tuberculosis has been increasing as well. AIM: To detect cutaneous tuberculosis in patients with organ tuberculosis and to establish some characteristics of the relation between organ and cutaneous TB. MATERIAL AND METHODS: A total of 370 patients (145 females and 225 males), aged 2-76 years (mean age 27.5), enrolled for this screening study. These patients were hospitalized patients who already had pulmonary or extrapulmonary tuberculosis diagnosed before admission. All patients underwent a general skin examination, and, if needed, cutaneous biopsies were taken from involved skin areas. RESULTS: Three hundred and forty-seven (93.78%) out of 370 patients had pulmonary tuberculosis only or in association with one of other organ tuberculoses. Twenty-three patients had extrapulmonary TB: nine were TB adenitis, six were TB peritonitis, three were bone tuberculosis, and five were TB meningitides. Of 370 patients, only 13 (3.51%) had cutaneous TB: seven scrofuloderma (SCD; 2.16%), four lupus vulgaris (LV; 1.35%), one LV and SCD, and one Bacille Calmette-Guerin (BCG) adenitis (0.027%). Cutaneous tuberculosis was observed in seven out of 260 patients with parenchymal tuberculosis (2.96%). Four out of nine patients with TB adenitis (44.4%), one out of 12 pulmopleuretic (8.3%), and one out of 67 pleuresic patients (1.40%) had cutaneous TB as well. Mean age of the 13 patients was 32.46 years: mean age of SCD and LV was 24.8 and 48 years, respectively. The one patient with BCG adenitis was 7 months old. Five (62.5%) out of eight patients with SCD, and only one (20%) out of five patients with LV were new cases. Four patients with SCD had a positive family history, while LV patients did not. CONCLUSIONS: Organ tuberculosis is rarely associated with cutaneous tuberculosis. Scrofuloderma and LV are the most frequent forms of skin TB associated with organ TB in this population. Tuberculosis adenitis is the organ TB that causes cutaneous TB most often among other organ tuberculoses. More than one form of cutaneous TB affected only one patient with pulmonary TB; therefore, it is very rare. Tuberculids were not observed in any of the patients.