Bengü Gerçeker Türk

Total body skin examination for skin cancer screening in patients with focused symptoms

BACKGROUND The value of total body skin examination (TBSE) for skin cancer screening is controversial. OBJECTIVE We sought to determine whether TBSE could be helpful in patients with focused skin symptoms who would not otherwise have undergone TBSE. METHODS In a prospective, multicenter, cross-sectional study consecutive adult patients were recruited during a period of 18 months. Physicians first inspected problem areas and uncovered areas and then performed TBSE. Equivocal lesions detected in both steps were excised or biopsied. Primary outcomes were the absolute and relative risks of missing skin cancer and the number of patients needed to examine to detect melanoma or another malignancy. A secondary outcome was the proportion of false-positive results obtained by TBSE. RESULTS We examined 14,381 patients and detected 40 (0.3%) patients with melanoma and 299 (2.1%) with at least one nonmelanoma skin cancer by TBSE. In 195 (1.3%) patients equivocal lesions found by TBSE turned out to be benign. We calculated that 47 patients need to be examined by TBSE to find one skin malignancy and 400 patients to detect one melanoma. The risk of missing one malignancy if not performing TBSE was 2.17% (95% confidence interval 1.25-3.74). Factors significantly increasing the chance to find a skin cancer were age, male gender, previous nonmelanoma skin cancer, fair skin type, skin tumor as the reason for consultation, and presence of an equivocal lesion on problem/uncovered areas. LIMITATIONS The impact of TBSE on skin cancer mortality was not evaluated. CONCLUSIONS TBSE improves skin cancer detection in patients with focused skin symptoms and shows a low rate of false-positive results.

Adverse cutaneous drug reactions among hospitalized patients: five year surveillance

Context: Cutaneous Adverse Drug Reactions (CADRs) are observed in 2-3% of hospitalized patients. The clinical presentation of the CADRs varies among different populations. Objective: To study the CADRs in hospitalized patients and their outcome. Materials and methods: Patients hospitalized at our department between 2005 May and 2010 May were retrospectively reviewed for the diagnosis of CADRs. Results: A total of 94 patients (3.3%) were diagnosed with CADR among 2801 hospitalized patients. Of them, 56 patients were female (59.6%) and 38 patients were male (40.4%). The culprit drugs were antibiotics (24.5%), non-steroid anti-inflammatory drugs (NSAID) (22.4%), anticonvulsants (13.8%), antihypertensive agents (8.5%), paracetamol with or without pseudoephedrine or phenylephrine (6.4%), intravenous contrasts (3.2%), terbinafine (2.1%), biologic agents (2.1%) and various other medications (17.0%). The most common clinical type of CADRs was morbilliform exanthemas in 59.6% of the patients, followed by erythroderma (6.4%), drug reactions with eosinophilia and systemic symptoms (6.4%), lichenoid drug reaction (5.3%), urticaria and angioedema (4.3%), acute generalized exanthematous pustulosis (4.3%), drug-induced vasculitis (3.2%), drug induced psoriasis (2.1%), Stevens–Johnson syndrome/toxic epidermal necrolysis overlap (2.1%), psoriasiform drug reaction (2.1%). Fixed drug reaction, erythema multiforme, bullous drug reaction, drug induced panniculitis were observed in one each. No deaths occurred on the follow-up. Fever was observed in 35.1% of the patients. Eosinophilia was present in 51.1% of them. Latency period ranged between 0–15 days in 59 patients (62.8%), 15–30 days in 19 patients (20.2%), 30–90 days in 13 patients (13.8%), 90–120 days in three of them (3.2%). The latency for anticonvulsant drugs was statistically longer than the other group of drugs (p: 0.027). Discussion and conclusions: CADRs were more common in women and most of them were caused by antimicrobial agents followed by NSAIDs and anticonvulsants. Latency period of anticonvulsants were longer than the other groups.

Eruptive disseminated Spitz naevi: dermatoscopic features

Eruptive disseminated Spitz naevi is a rarely reported condition. Although the dermatoscopic features of nondisseminated, solitary forms of Spitz naevi are well known, there are no reports describing the dermatoscopic features of eruptive disseminated variant. We report an additional case and describe the dermatoscopic features. Two patterns were observed. In all pink lesions, the vascular pattern was seen, composed of dotted, linear or comma‐like vessels located at the centre of the meshes of the reticular depigmentation. In all brown lesions, we observed only the reticular pattern, which is quite interesting as the reticular pattern is a rare feature of Spitz naevi. This observation may be a special feature particularly seen in the eruptive disseminated variant. A superficial black network also accompanied reticular pattern in some lesions. In dichromatic lesions, both patterns were observed in different areas of the body.

Relapsing polychondritis in a child with common variable immunodeficiency.

Common variable immunodeficiency (CVID) is associated with recurrent infections and autoimmunity. The most common autoimmune conditions are idiopathic thrombocytopenic purpura, autoimmune hemolytic anemia, chronic arthritis, and gastrointestinal inflammation. Relapsing polychondritis (RP) is an episodic and progressive systemic inflammatory disease, characterized by auricular chondritis, polyarthritis, nasal, and respiratory tract chondritis. Autoimmunity to cartilage‐related components is thought to be involved in its pathogenesis. So far, RP has not been included within many autoimmune conditions that have been reported in patients with either CVID or any other primary immunodeficiency. In this report, a case of CVID with RP and chronic arthritis is presented.

Porokeratosis of Mibelli induced by topical corticosteroid

Background:  Porokeratosis of Mibelli is a chronic disorder characterised by slightly atrophic plaques surrounded by keratotic border.

Amiodarone-induced multiorgan toxicity with ocular findings on confocal microscopy.

Amiodarone is an antiarrhythmic medication that can adversely effect various organs including lungs, thyroid gland, liver, eyes, skin, and nerves. The risk of adverse effects increases with high doses and prolonged use. We report a 54-year-old female who presented with multiorgan toxicity after 8 months of low dose (200 mg/day) amiodarone treatment. The findings of confocal microscopy due to amiodarone-induced keratopathy are described. Amiodarone may cause multiorgan toxicity even at lower doses and for shorter treatment periods.

Stewart-Bluefarb syndrome: a case report with angiographic findings.

Acroangiodermatitis is a group of benign, angioproliferative cutaneous disease caused by chronic venous insufficiency, acquired or congenital arteriovenous shunts and limb paralysis. Stewart–Bluefarb syndrome is the type of acroangiodermatitis which is associated with a congenital arteriovenous malformation. This is a rare syndrome characterized by cutaneous kaposiform lesions that usually onset at the second decade. In this report, a case of acroangiodermatitis associated with a congenital arteriovenous malformation, which has been diagnosed after 40 years, is described.

A rare human‐to‐human transmission of orf

the dose was then tapered gradually. However, polyarthralgia recurred after two years of treatment. Löfgren’s syndrome, an acute form of sarcoidosis, is characterized by erythema nodosum, bilateral hilar lymphadenopathy, and arthralgia. It is a common form of sarcoidosis in Caucasian populations but not in Japanese subjects. It is usually a self-limiting disease, becoming inactive within the first two years. Patients with this syndrome may have arthralgia, requiring NSAIDs, but corticosteroids are rarely required. In addition, the presence of erythema nodosum is a predictor of good prognosis in patients with sarcoidosis. However, some patients with Löfgren’s syndrome are resistant to NSAIDs and show a chronic course. In the present case, symptoms persisted despite treatment with NSAIDs. Histopathological confirmation is important in establishing the diagnosis of sarcoidosis, including Löfgren’s syndrome, particularly if corticosteroid treatment is considered. It is necessary to exclude the possibility of diseases such as lymphoma, tuberculosis, fungal infection, berylliosis, and other conditions associated with hilar lymphadenopathy. Careful physical examination may reveal skin lesions suggestive of granulomatous lesions. More frequently, an asymptomatic myopathy is present in patients with Löfgren’s syndrome and other forms of sarcoidosis. The myopathy is frequently associated with systemic involvement, although the link with specific organ damage is not known. Muscle biopsies in patients with sarcoidosis are useful for histological confirmation of granulomatous inflammation despite the absence of muscle symptoms. It has been recommended to biopsy the gastrocnemius muscle, which has a diagnostic yield of 20–75%. We used high-frequency sonographic imaging for evaluation of myopathy and performed muscle biopsy based on these findings. High-frequency sonography is frequently used for evaluating the thickness of skin tumors in dermatology. As muscle biopsy is an invasive surgical procedure, accurate evaluation of muscle condition before the biopsy is essential to minimize patient discomfort. High-frequency sonography is a useful means of detecting muscle alterations, even in patients with no symptoms, and thus allows us to determine biopsy sites precisely. Atsuko Ohashi, MD Hiroshi Koga, MD Koichi Hayashi, MD, PhD Hisashi Uhara, MD, PhD Ryuhei Okuyama, MD, PhD Department of Dermatology Shinshu University School of Medicine Matsumoto Japan E-mail: rokuyama@shinshu-u.ac.jp

Generalized pustular eruptions due to terbinafine

Terbinafine, a widely used antifungal agent, may rarely cause cutaneous side effects with an incidence of 2.7%. Generalized pustular eruptions are quite uncommon but severe adverse cutaneous reactions of terbinafine have been reported. The main pustular eruptions due to terbinafine include acute generalized exanthematous pustulosis and drug induced pustular psoriasis. In this report, two cases of acute generalized exanthematous pustulosis and one case of generalized pustular psoriasis triggered with terbinafine are presented.

Leuprolide acetate-induced leukocytoclastic vasculitis

Leukocytoclastic vasculitis (LCV) is a distinct clinicopathological entity with cutaneous lesions from purpuric macules to necrotic ulcers, and the other systemic manifestations, such as fever, arthritis, gastrointestinal complaints, renal failure, etc. Although the exact cause cannot be established in more than half of the cases, various infections, connective tissue disorders, malignancies, cryoglobulinemia, and certain drugs are implicated (1). Leuprolide acetate is a synthetic analog of gonadotropin-releasing hormone that is used in the treatment of endo-metriosis, leiomyomas, and in the palliative treatment of advanced prostatic cancer. Adverse cutaneous reactions rarely occur with leuprolide acetate treatment (2). However, LCV associated with leuprolide acetate has not been reported until now. Here, a leuprolide acetate-induced LCV in a patient who had been treated for endometriosis by leuprolide acetate is presented.