Basak Kandi Coskun

Sporotrichosis Successfully Treated with Terbinafine and Potassium Iodide: Case Report and Review of the Literature

Sporotrichosis is rare in Turkey. We report a 40-year-old woman who had subcutaneous sporotrichosis caused by sporothrix schenckii that was successfully treated with terbinafine (250 mg, twice a day) for a period of 6 months. She received a saturated solution of potassium iodide orally for two months. Terbinafine and potassium iodide are suggested to be the agents of choice for treatment of subcutaneous sporotrichosis.

Monilethrix: improvement with acitretin.

Monilethrix is a rare hereditary disorder that affects the hair and is characterized by shaft anomaly. There is no known treatment that successfully cures the condition. In this report we present a case of monilethrix in a 7-year-old girl treated with oral acitretin. A very good clinical and cosmetic result was obtained while treatment was continued. However, clinical symptoms recurred after discontinuation of acitretin therapy.

Topical lidocaine helps reduce pain of digital ulcers in systemic sclerosis (scleroderma)

Sir, Digital ulcerations are prominent features of systemic sclerosis (SSc; scleroderma) and can occur for various reasons. Ulcerations can be very painful, thereby limiting functions, and healing with scarring and/or digital resorption and when infected can lead to serious soft tissue infections and osteomyelitis. Ulcerations reportedly occur in approximately one third of patients with SSc per year, and the etiology appears to be multifactorial. Ischemia, vasculitis, and traumas are the most commonly encountered causes for digital ulcers [1, 2]. Herein, we report a single case of a scleroderma patient whose pain of digital ulcers could be successfully managed by an application of topical lidocaine. A 47-year-old woman with a 10-year history of SSc (limited SSc) presented with very painful digital ulcers on her hands and feet. She complained of Raynaud’s phenomenon on her upper limps. The initiation of these ulcers was simultaneous with minor traumas while doing housework. She complained of sharp pain on her fingers and of knife-wound sensation over the lesions on the dorsum of the hand and foot fingers, soles, and heels. She had a history of depression, hypertension, and osteoporosis. On physical examination, she had a typical ‘sclerotic bound-down’ appearance, telangiectasia in her hands, forearms, feet, and peri-malleolar regions, and furrowing of the perioral skin. She had also Raynaud’s phenomenon, esophageal dysfunction resulting in gastroesophageal reflux, shortness of breath, and contractures of the proximal interphalangeal (PIP) joints. She had a drug history of penicillamine, pentoxifylline, glucocorticoids, calcium channel blockers, serotonin re-uptake inhibitors, angiotensin converting enzyme inhibitors, and antibiotics. She had painful ulcers of various sizes on her fingertips and 0.5×0.5 cm of cutaneous ulcer on the right second PIP joint with a thick eschar, which had developed cellulites. Superficial cutaneous ulcers were present on bilateral heels and were very painful and tender on palpation. There were fissures and cracks on some of these lesions. The patient was instructed to take ciproflaxacin orally twice daily and an antibiotic pomade (Fucidate sodium 5%, twice daily). However, the patient complained of increased sharp and unbearable pain during the application of the antibiotic pomade. Therefore, lidocaine (5%) pomade was applied to the lesions to reduce the pain and discomfort during the application. The sharp and disturbing pain experienced by the patient resolved within 5 to 10 min after lidocaine application, and the antibiotic pomade applied thereafter was well tolerated. The patient was highly satisfied with the dramatic improvement in her pain and asked that lidocaine pomade be used not only prior to the antibiotic pomade but also every 6 or 8 h. Lidocaine pomade was administered three times a day. After 10 days, erythema surrounding the ulcers on the PIP joint and pain were significantly reduced. The patient’s need of lidocaine almost entirely disappeared. Oral and topical antibiotic application was maintained for 15 days and was stopped. The patient was instructed to use protective gloves during housework and to keep her hands and feet from minor or major traumas. Digital ulcers are clinical problems in SSc that are difficult to resolve. Although various alternatives like direct vasodilators, hemorheologic agents, and endothelin receptor antagonist (bosentan) have been reported to be S. Ozgocmen . A. Kaya Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Firat University, Elazig, Turkey

Prevalence of psychological factors in chronic dermatoses.

Aim To investigate, retrospectively, psychiatric consultation results of inpatients staying in Fırat University Dermatology Clinic. Materials and method Records of 520 inpatients who were treated in Fırat University Dermatology Clinic between May 2000 and May 2003 were examined and their psychiatric consultation reports were retrospectively evaluated. Results Of the 520 patients who were included in the study, 272 were female and 248 were male. Ninety-two patients were asked to have psychiatric consultation and when consultation results of these patients were examined it was seen that 67 of them (61.7%) were given a psychiatric diagnosis. Of the 67 patients who were given a psychiatric diagnosis, 34 (50.7%) were female and 33 (49.3%) were male. Mean age of the patients was 39.4 (the youngest being 24 and the oldest 63). It was established that 35.9% of patients (24 individuals) were diagnosed as depressive disorder, 29.8% (20 individuals) as anxiety disorder, 13.4% (nine individuals) as mixed depressive anxiety disorder, 13.4% (nine individuals) as borderline personality disorder and 7.5% (five individuals) as obsessive–compulsive disorder, and that psychiatric treatment was started in 91% of patients. Dermatological diagnoses of patients who were given psychiatric diagnoses were as follows in order of frequency: psoriasis in 22 patients (32.9%), urticaria in 31 patients (46.2%), prurigo nodularis in five patients (7.4%) and others in nine patients (13.5%), respectively. Conclusions Dermatological diseases and psychiatric disorders frequently go together. Psychiatric treatment was started in a high number of patients who were given psychiatric diagnoses and had dermatological problems in the present study. Referring patients with chronic dermatological problems to the psychiatry clinic with a view to supporting their dermatological treatments, we believe, will increase the success rate of dermatosis treatment.

Multiple metastatic tuberculosis abscesses in a patient with Pott disease and lung tuberculosis: a case report

Abstract:  The incidence of tuberculosis in Western countries is rising, and continued vigilance together with an awareness of its protean manifestations is essential. Cutaneous tuberculosis is a relatively rare manifestation of the disease, accounting for only 1% of extrapulmonary cases of tuberculosis and 0.14% of all reported cases of tuberculosis. A 19‐year‐old male patient was admitted to our clinic with skin lesions both at the front and at the back of his body. With clinical findings, histopathology, polymerase chain reaction, PA lung graph, and computerised tomography, the patient was diagnosed with metastatic tuberculosis abscess associated with lung tuberculosis and Potts disease. Antituberculosis drugs were administered. An increased awareness of the re‐emergence of cutaneous tuberculosis will allow for the proper diagnosis and management of this increasing common skin disorder.

Are erythema nodosum-like lesions and superficial thrombophlebitis prodromal in terms of visceral involvement in Behcet's disease?

Erythema nodosum (EN)‐like lesions and superficial thrombophlebitis (ST) are skin symptoms that are frequently observed in Behcets disease. In most of the patients, skin symptoms precede serious visceral involvement. The study included 78 patients whose mean age was 33.48 ± 6.16 (21–48). Of the cases, 37 were females and 41 were males. Forty‐two patients (53.8%) had EN‐like lesion and 12 (15.3%) had ST. Six of 54 patients, who had EN‐like lesion and ST, were found to have no visceral involvement. In six of the remaining 48 patients, it was established that visceral involvement developed before lesions. It was found in 42 patients that these two lesions preceded visceral involvement. In addition, 18 of 24 patients who did not have these two lesions, do not still have visceral involvement. Therefore, we think that EN‐like lesion and ST can be guiding in predicting serious visceral involvement and complications that can develop in advanced stages of Behcets disease.

Idiopathic unilateral hyperhidrosis with Holmes-Adie syndrome: case report.

Hyperhidrosis is a disease that is characterized by excessive sweating due to hyperactivation of eccrine sweat glands. It may be localized or generalized form. Holmes‐Adie syndrome is an idiopathic disease with unilateral pupil dilatation and loss of deep tendon reflexes. We present a 37‐year‐old female patient diagnosed with unilateral hyperhidrosis coincident with Holmes‐Adie syndrome because of this unusual presentation.

Congenital Hemihypertrophy with Hemihypertrichosis

The rare condition in which one side of the body seems to grow faster than the other is called hemihypertrophy. This may be accepted as normal, but there are certain serious conditions that may be associated with this type of growth pattern. Congenital hypertrichosis is believed to be a genetic disorder that is inherited or occurs as a result of spontaneous mutation. The incidence of generalised congenital hypertrichosis is about one in a billion. A seven‐month‐old female case was brought to the hospital with growth and hairiness complaints, which were more apparent in the right side of the face, the right arm and the right leg. Physical examination showed more apparent hypertrophy and hypertrichosis, which covered the entire right side of the body beginning from the face and including the lower extremities and the genitalia. Hypertrichosis was more evident above the right scapula and on the right leg. The diameter of the right upper extremity and the right lower extremity were measured at 13 mm and 14 mm thicker than the left side, respectively. The infant did not have teeth yet and had totally normal nail growth. Skeletal structure, cardiovascular, respiratory, urogenital, central nervous system and eye examinations were all normal. Results of all laboratory analyses, including genetic examination, and those of the imaging techniques were found to be normal. We hereby present the rare co‐presence of hemihypertrophy and hemihypertrichosis, for which we could not identify an etiological cause and which is the third such case in the literature.

Calcium Acetate-Induced Linear Fixed Drug Eruption

Introduction Fixed drug eruption (FDE) is a common dermatological disease, and its mechanism is currently uncertain. It develops after intake of a responsible drug and always occurs at the same sites [1]. Lesions are egg-shaped or circular with sharp borders and emerge within hours after administration of the drug. Initially they have a dark red color, but their color fades within 7–10 days and they recover with postinflammatory hyperpigmentation [1, 2]. Hyperpigmented lesions may persist for months or years. Pigmentation may increase in later episodes. Recurrence of the lesion at the same site after intake of the same drug is diagnostic. Lesions are most frequently found on the trunk, upper part of extremities and penis [1, 2]. Drugs that most frequently cause FDE are cotrimoxazole, phenolphthalein and nonsteroidal anti-inflammatory drugs [3]. Calcium acetate is used for hyperphosphatemia due to chronic renal failure. Its most common side effects are nausea, vomiting and diarrhea. However, no dermatological side effects have been reported so far. In the present study, we present a case of FDE due to calcium acetate that was linearly arranged.