A. Tülin Mansur

Collagen-elastic tissue changes and vascular involvement in granuloma annulare: a review of 35 cases

Background:  The pathogenesis of granuloma annulare (GA) is unclear. Collagen fiber degeneration is commonly reported, and there are several conflicting studies on elastic fiber and vascular changes associated with GA. In this study, we aimed to evaluate histopathologic characteristics, collagen and elastic tissue changes and vascular changes in GA.

Lipedematous scalp and lipedematous alopecia: Report of three cases in white adults

Lipedematous scalp (LS) and lipedematous alopecia (LA) are rare conditions of unknown etiology characterized by a thick and boggy scalp due to increase in the subcutaneous fat layer. Besides the changes in the texture of skin, varying degrees of hair loss are seen in patients with LA. In this report, we present two cases with LA and one case with LS in white adults. On examination, a boggy and soft swelling of the scalp was detected in all patients. In addition, the patients with LA had alopecic areas over the boggy scalp. Histopathologic examinations of skin biopsy specimens and magnetic resonance imaging of the scalp showed increased thickness of subcutaneous fat tissue in all patients. The exact etiopathogenesis of LA and LS remain unknown. These conditions may be either reactive or compansatory responses versus yet undetected stimuli, or represent a genetic tendency. Both of the these entities have been initially reported mostly in adult black females, however, we believe that LA and LS may well occur in white subjects and may be more widespread and frequently observed than previously supposed.

Colocalization of lipedematous scalp and nevus lipomatosus superficialis: a case report

Lipedematous scalp (LS) is a rare condition of unknown etiology characterized by a thick, boggy scalp that occurs mostly in adult black females. The main pathologic finding consists of increased thickness of scalp resulting from thickening of the subcutaneous fat layer.

Reverse isotopic response: a rarely reported phenomenon

Tumor necrosis factor (TNF) inhibitors have been associated with an increased risk of serious infections. Several recent reports have documented severe NTM infections in the setting of TNF inhibition, including sporotrichoid M. marinum infection following infliximab therapy for ankylosing spondylitis and M. marinum tenosynovitis during etanercept treatment for RA. 6,7 Similarly, our patient’s infection was probably exacerbated by continued therapy with methotrexate and infliximab. The treatment of M. marinum infection consists of single or multiagent antimicrobial therapy with medications such as clarithromycin, trimethoprim/sulfamethoxazole, or minocycline. The use of ethambutol and rifampin may be considered in severe NTM infections. 2,8 Surgical debridement may be necessary, especially in cases of deep infection involving the joint. 2

Acral melanoma with satellitosis, disguised as a longstanding diabetic ulcer: a great mimicry.

Acral lentiginous melanoma affects the palms, soles, and nail apparatus. Around 3–15% of all cutaneous melanomas are located on the foot and have a poorer prognosis than melanoma elsewhere. Possible reasons for this prognostic difference may be omitting this area during routine skin check by both the patient and the physicians, in addition to misdiagnosis of melanoma as other benign skin lesions. We describe here an elderly female patient treated for a non‐healing foot ulcer interpreted as a diabetic ulcer, which after 2 years was diagnosed as acral melanoma with satellitosis. Histopathological examination of the amputated distal phalanx revealed an advanced stage melanoma with 1·2 cm Breslow thickness and of Clark level 5. Dermoscopy of the bluish papulonodules scattered on the dorsal foot showed characteristic findings described for metastasis of skin melanoma.

A rare complication of follicular hair unit extraction: Kaposi’s varicelliform eruption

Follicular hair unit extraction (FUE) is becoming a popular type of hair transplantation recently. Kaposi’s varicelliform eruption (KVE) is an uncommon skin emergency due to cutaneous dissemination of several types of viruses, most notably herpes virus, over the lesions of preexisting skin disorders. A 34-year-old man visited our dermatology outpatient clinic with a blistering, itchy and tender eruption on his head and body. He had undergone follicular FUE for androgenic alopecia 12 days previously, and 5 days after the procedure, umbilicated and/or hemorrhagic vesiculopustules appeared firstly on the occipital scalp skin where the hair units were taken. The lesions had rapidly spread over the upper chest and back. After the operation, he had taken oral methylprednisolone, amoxicillin clavulanate and had used fusidic acid ointment without any benefit. Bacterial culture of the pustules yielded no microorganism, while Tzanck smear from the vesicles revealed multinuclear giant cell groups. Based on a diagnosis of KVE, we treated the patient with oral valacyclovir hydrochloride 1000 mg 3 times a day for 14 days. Symptoms cleared rapidly, pustules and vesicles dried in a few days, and re-epithelialization of the eroded areas started at the end of the first week. The reported complications of FUE include necrosis of the donor site, postoperative hyperesthesia, recipient area folliculitis, keloids, bleeding, infection and pyogenic granuloma. Up to this date there are only three reports of KVE developing just after dermatological surgery, including dermabrasion, laser resurfacing, and skin grafting. According to our knowledge, this is the first case of KVE occurring after the FUE procedure. We think that the traumatic effects and skin barrier disruption due to operation and immune alteration due to postsurgical steroid treatment might have precipitated the activation and dissemination of latent herpesvirus infection.