Ahu Yorulmaz

A study of dermoscopic features of nail psoriasis

Introduction Dermoscopy is a non-invasive imaging method that enables the evaluation of pigmented and non-pigmented skin lesions. More recently, dermoscopy has been recognized as an effective tool in the diagnosis of nail diseases. Aim To evaluate the dermoscopic features of nail psoriasis and to assess the relationship between these features and disease severity. Material and methods A total of 67 patients with clinically evident nail psoriasis (14 women, 53 men) were prospectively enrolled. Following a thorough clinical examination, patients were graded according to the Nail Psoriasis Severity Index and physician’s global assessment score. A dermoscopic examination of all fingernails and toenails was performed using a videodermatoscope. Mann-Whitney U and χ2 tests were used for statistical analysis, with a significance threshold of p < 0.05. Results The most frequently observed dermoscopic features were splinter haemorrhage (73.1%), pitting (58.2%), distal onycholysis (55.2%), dilated hyponychial capillaries (35.8%) and the pseudo-fiber sign (34.3%). The pseudo-fiber sign, dilated hyponychial capillaries, nail plate thickening and crumbling, subungual hyperkeratosis, transverse grooves, trachyonychia, pitting and salmon patches were positively associated with disease severity. Conclusions The pseudo-fiber sign described in this study appears to be a novel dermoscopic feature of nail psoriasis. We have demonstrated positive associations between a number of dermoscopic manifestations and disease severity. Further studies are required to support the present findings.

A case of generalized allergic contact dermatitis after laser tattoo removal.

Abstract Tattoos are popular body decorations mainly done for cosmetic purposes. Regarded as a form of self-expression, tattoos reflect the character of the person wearing it. However, as tatoos are persistent visual markings on the body, frequently misperceived by the others causing tattooed to seek removal. Today most of the tattoos can be successfully treated with laser ablation. Here we present a case of generalized allergic contact dermatitis after laser tattoo removal which is a rare adverse reaction of laser tattoo removal.

An unusual side effect of isotretinoin: retinoid dermatitis affecting external urethral meatus

Abstract Isotretinoin (Iso) is the most effective drug against severe nodulocystic acne. As a synthetic oral retinoid, Iso exerts its actions by modulating cell growth and differentiation. Targeting all the pathophysiologic processes in acne development, Iso has been considered to be an unique drug, however it has several side effects. While chelitis, xerosis, ocular sicca, arthralgia, myalgia, headache, hyperlipidemia are the most common side effects, teratogenicity and depressive symptoms are the most concerning ones. In addition, Iso has unusual side effects which have been described for the first time in the literature. Here, we report a remarkable side effect of Iso in a 23-years-old male patient with retinoid dermatitis affecting the external uretral meatus. To our knowledge, only few cases of retinoid dermatitis in the urethral mucosa due to Iso have been reported in the literature so far.

Acquired Partial Lipodystrophy with Autoimmune Thyroiditis

156 ipodystrophies are familial or acquired diseases characterized by a paucity or complete absence of adipose tissue. According to fat tissue loss, lipodystrophies have been classified as generalized, partial or localized lipodystrophy.1,2 Acquired partial lipodystrophy is a rare form of lipodystrophy, which is also known as Barraquer-Simons syndrome or cephalothoracic lipodystrophy.3 Acquired partial lipodystrophy is also recognized as having a close association with autoimmune diseases.4-16 Here, we report a very rare case of acquired partial lipodystrophy accompanied by autoimmune thyroiditis. As far as we know, this is the second case report describing an association between acquired partial lipodystrophy with autoimmune thyroiditis.

Dermoscopy as a first step in the diagnosis of onychomycosis

Introduction Over the years, clinical studies have provided new knowledge about the dermoscopic features of the diseases of cutaneous annexes. It seems that dermoscopy has opened a new morphological dimension in the diagnosis and management of hair disorders and onychopathies. Aim To identify and describe dermoscopic features of onychomycosis. Material and methods A total of 81 consecutive patients with onychomycosis (55 men and 26 women) were prospectively enrolled in the present study. For each patient, all fingernails and toenails were evaluated in clinical and dermoscopic examinations. Mycological tests were performed by potassium hydroxide (KOH) preparation. Mann-Whitney U and χ2 tests were used for the statistical analysis, with a significance threshold of p < 0.05. Results Dermoscopic examination of the patients’ nails revealed the following: jagged proximal edge with spikes of the onycholytic area (51.9%), longitudinal streaks and patches (44.4%), subungual hyperkeratosis (27.2%), brown-black pigmentation (9.9%) and leukonychia (1.2%). Jagged proximal edge, subungual hyperkeratosis and leukonychia were positively associated with the onychomycosis type. Conclusions Onychomycosis accounts for up to 50% of all consultations for onychopathies. Fast and effective diagnostic approaches are needed in everyday clinical practice. Dermoscopy can provide immediate and accurate information in the diagnosis of onychomycosis. We suggest that dermoscopy should be taken as a first step toward the diagnosis of onychomycosis.

Malignant Transformation of Dental Material-induced Oral Lichenoid Contact Reaction: A Case Report Describing Outcomes After Amalgam Removal

Oral liken planus (OLP), etiyolojisi henuz tum yonleriyle aydinlatilamamis kronik immun aracili bir dermatozdur. Oral mukozanin en sik hastaliklari arasinda kabul edilen OLP, premalign bir durum olarak tanimlanmasindan bu yana cok daha fazla ilgi goren bir hastalik haline gelmistir. Oral likenoid kontakt reaksiyonlar (OLKR), OLP’den gerek klinik, gerekse histopatolojik olarak neredeyse ayirt edilemez, bu nedenle OLP lezyonlarinin analogu olarak gorulurler. Hali hazirda, OLP iliskili malign oral skuamoz hucreli karsinomaya neden olan tetikleyici hastaligin, OLP ya da OLKR’den hangisinin oldugu konusunda suregelen tartismalar vardir. Dahasi, gunumuzde halen kayda deger sayida OLKR tanili hasta, altta yatan spesifik etiyolojiler arastirilmadan OLP olarak kabul edilmekte ve tedavi gormektedir. Dental restoratif materyaller OLKR’in en onemli tetikleyicileri arasindadir. Biz de burada, dental restoratif materyal iliskili OLKR tanisi koydugumuz ve bize basvurmadan once OLP’nin neden oldugu oral mukozanin iyi diferansiye malign oral skuamoz hucreli karsinoma tanisiyla marjinal mandibulektomi ve boyun diseksiyonu uygulanan bir olguyu sunmak istiyoruz. Biz, her OLP ve OLKR olgusunda olasi etiyolojik faktorlerin aydinlatilmasi gerektigi kanaatindeyiz, cunku yapilacak bir bazal yama testi hastaligin klinik seyrini tamamiyla degistirebilir.

A Painful Periungual Red Spot in a Patient with Onychodystrophy

A 40-year-old male patient came to our outpatient clinic with a history of a painful red spot on the edge of his left middle finger for several days. He had a medical history of psoriasis, for which he was receiving 35 mg/day of acitretin. His family history also revealed psoriasis in the father. Upon dermatological examination, we observed partial shedding of the nail plate and scaling of the nail bed and periungual skin on his left thumb and foreReceived: December 7, 2016 Accepted: January 24, 2017 Published online: February 16, 2017

A rare cutaneous tumor: Dermatofibrosarcoma protuberans

Dermatofibrosarcoma protuberans (DFSP) is a rare low-grade soft tissue sarcoma, which usually tends to be localized though frequently exhibits signs of recurrence. Seldomly metastasizing, its locally aggressive behavior has been attributed to its tendency to multiple recurrences. Although it may arise anywhere on the body, typical site of involvement is the trunk and proximal extremities. DFSP is also an exceptional dermatological disease in that it is associated with a genetic translocation involving chromosomes 11 and 22 [t(17;22) (q22;q13)] [1-5].

Comparison of pigmentary side effects of taxanes and anthracyclines: an onychoscopic evaluation

Abstract Background: Taxanes and anthracyclines are considered as fundamental drugs for the treatment of a broad range of cancers. They have several side effects, which may limit their usage. Drug-induced nail pigmentation (DHNP) has been reported as one of the most striking dermatological side effect of both taxanes and doxorubicin. Objective: This study aimed to evaluate and compare pigmentary side effects of taxanes and doxorubicin with the help of onychoscopy. Methods: Forty-one consecutive patients (30 women, 11 men) with a diagnosis of cancer (16 gastric cancer, 25 breast cancer) were prospectively enrolled in a period of six months. Patients were categorized according to the chemotherapy regimens they had been administered: docetaxel received group [docetaxel (60 mg/m2, day 1), cisplatin (60 mg/m2, day 1) and fluorouracil (500 mg/m2, days 1–5) every 3 weeks], paclitaxel received group [paclitaxel (80–175 mg/m2) every 21 days with or without trastuzumab/zoledronic acid] and doxorubicin received group [doxorubicin 50–60 mg/m2 and cyclophosphamide 600–750 mg/m2 every 21 days]. All the patients were asked whether they had diabetes mellitus (DM) and peripheral neuropathy. At the 16 weeks of chemotherapy, for each patient, all fingernails and toenails were evaluated in clinical and dermoscopic examinations for nail pigmentation. Dermoscopic examination was performed using a videodermatoscope. Descriptive statistics were computed for means, standard deviations, and frequencies. Chi-square test or Fisher’s exact tests were used for the statistical analysis, with a significance threshold of p < 0.05. Results: 34.1% of the patients (14/41) demonstrated clinical signs of nail pigmentation. Nail pigmentation was observed in 4 of 13 patients (30.8%), who had received doxorubicin; 10 of 28 patients (35.7%), who had received taxanes (docetaxel and paclitaxel). There was no statistically significant relationship between the nail pigmentation and the type of the chemotherapeutic regimen administered (Fisher’s exact test, p = 1.000). In addition, no statistically significant results were observed between nail pigmentation and DM (Fisher’s exact test, p = 0.393), and nail pigmentation and peripheral neuropathy (Fisher’s exact test, p = 1.000). Conclusions: DHNP may cause considerable distress to patients. Dermoscopy is a noninvasive imaging method that increases diagnostic accuracy of both pigmented and nonpigmented lesions. Typical dermoscopic features of DHNP consist of a homogeneous brownish-gray coloration of the background with thin, longitudinal, gray lines, which allow the examiner to clearly make the correct diagnosis. Further studies are needed to assess both clinical and dermoscopical findings of DHNP.

An evaluation of thiol/disulphide homeostasis in patients with psoriasis

Introduction The role of oxidative stress in the pathogenesis of psoriasis has been investigated in previous studies with conflicting results. On the other hand, well-established treatments currently used in psoriasis exert their effects via a boost of oxidative stress. Recently, a strong positive association between psoriasis, metabolic syndrome and dyslipidemia has also been described showing the complex nature of the disease. Aim To examine thiol/disulphide homeostasis, a newly developed homeostasis assay in psoriasis and evaluate the possible association between thiol/disulphide homeostasis and dyslipidemia in psoriasis. Material and methods The study population included 92 psoriasis patients and 71 healthy subjects. Serum native thiol, total thiol and disulphide levels were investigated in patients with psoriasis and in healthy subjects. In addition, lipid profile (serum total cholesterol, triglyceride, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol) levels were investigated in both groups. The association between thiol-disulphide parameters and dyslipidemia was also evaluated. Results Serum total cholesterol and triglyceride levels were found to be higher in patients with psoriasis than in the healthy group. Lower plasma disulphide and higher native thiol levels were found in patients with psoriasis indicating an antioxidant status. Conclusions To our knowledge, this is the first study showing the shift of dynamic thiol/disulphide homeostasis towards the thiol form in psoriasis which indicate higher antioxidant status.