Christina Stefanaki

Histological and immunohistochemical study of granuloma annulare and subcutaneous granuloma annulare in children

Background:  The aim of this study was to investigate the histological and immunohistochemical features of granuloma annulare (GA) in comparison to deep granuloma annulare (DGA) and granulomatous dermatoses (GDs).

G1 cell cycle regulators in congenital melanocytic nevi. Comparison with acquired nevi and melanomas.

Background:  Congenital nevi are one of the known risk factors for the development of melanoma. However, the magnitude of the risk for both large and small congenital nevi is controversial.

Effects of Botulinum Toxin—A Therapy for Palmar Hyperhidrosis in Plantar Sweat Production

BACKGROUND Patients with focal hyperhidrosis in multiple areas often report improvement of plantar hyperhidrosis after botulinum toxin A (BTX‐A) therapy for palmar hyperhidrosis. OBJECTIVE To assess sweat production from the soles in patients receiving BTX‐A treatment for their palmar hyperhidrosis. PATIENTS AND METHODS Thirty‐six patients with both palmar and plantar hyperhidrosis received 100 U of BTX‐A per palm. Sweat production of palms and soles was assessed using a starch iodine test and gravimetry at baseline and 1, 3, and 8 months after treatment. Patients were subjectively assessed using a percentile scale. RESULTS All patients had significant improvement in their palmar hyperhidrosis that lasted for 6.2 ± 1.8 months. Gravimetry revealed marginal improvement of plantar hyperhidrosis in 12 patients (from 39.7 ± 21.3 to 31.5 ± 18.0 mg/min; p=.01) and statistically significant worsening in 24 patients (from 71.6 ± 70.60 to 109.94 ± 82.93 mg/min, p<.001). CONCLUSION Treatment of palmar hyperhidrosis with BTX‐A increased plantar sweating in many patients affected by both palmar and plantar hyperhidrosis in the population under study. Regardless, patients reported satisfaction with the results and were willing to repeat treatment.

Tumors of central and peripheral nervous system associated with inherited genetic syndromes.

There are several genetic syndromes that predispose to the development of tumors of the nervous system. In the present study, we provide a review of the tumors that are associated with neurofibromatosis type 1, neurofibromatosis type 2, tuberous sclerosis complex, von Hippel-Lindau disease, Li-Fraumeni syndrome, Cowden disease, Turcot syndrome, nevoid basal cell carcinoma syndrome (Gorlin syndrome) and rhabdoid predisposition syndrome, which are the most common.

Quality of life and psychosocial aspects in Greek patients with psoriasis: a cross-sectional study

BACKGROUND Psoriasis is a common, long-term skin disease associated with high levels of psychological distress and a considerable adverse impact on life. The effects of psoriasis, beyond skin affliction, are seldom recognized and often undertreated. OBJECTIVE The aim of the study is to evaluate the quality of life, anxiety and depression, self-esteem and loneliness in patients with psoriasis. METHODS Eighty-four patients with psoriasis were enrolled in the study. The quality of life, depression and anxiety, loneliness and self-esteem of the patient were assessed using the Dermatology Life Quality Index, Hospital Anxiety and Depression Scale, the UCLA loneliness Scale (UCLA-Version 3) and Rosenbergs Self-esteem Scale, respectively. RESULTS The Dermatology Quality of Life Index score among psoriasis patients was 12.61 ± 4.88. They had statistically significantly higher scores according to the Hospital Anxiety and Depression Scale -anxiety subscale (p=0.032)-compared with healthy volunteers. Moreover, a statistically significant difference was found between the two groups concerning the UCLA-scale (p=0.033) and RSES-scale (p<0.0001). Female patients presented with lower self-esteem than male patients. CONCLUSION Psoriasis is a distressing, recurrent disorder that significantly impairs quality of life. Therefore, the recognition and future management of psoriasis may require the involvement of multi-disciplinary teams to manage the physical, psychological and social aspects of the condition, as is the case for systemic, long-term conditions.

Management of pemphigus vulgaris: challenges and solutions.

The main objective in the treatment of pemphigus vulgaris is to control the disease, prevent relapses, and avoid adverse events associated with the prolonged use of steroids and immunosuppressive agents. Systemic corticosteroids remain the gold standard treatment for pemphigus vulgaris. Azathioprine and mycophenolate mofetil are the first line of steroid-sparing treatment. Rituximab is extremely effective in recalcitrant pemphigus, when other treatments fail to control the disease. The European Dermatology Forum recommends tapering prednisolone by 25% every 2 weeks after the consolidation phase, and a 5 mg reduction every 4 weeks when the dose is reduced to <20 mg. If the patient relapses, options include increasing steroids back to the previous dose, adding an immunosuppressant if using steroid monotherapy, or replacing a first-line immunosuppressant by another if already on combination therapy.

Cryotherapy versus imiquimod 5% cream combined with a keratolytic lotion in cutaneous warts in children: A randomized study

Abstract Background and objective: Although cutaneous warts are extremely common in children effective treatment does not exist. We combined imiquimod with a salicylic acid solution 15% (SA) on areas, with thick keratin, like palms and soles to increase its penetration through the epithelium. Methods: Patients were randomly divided into two groups. The first group was subjected to cryotherapy with liquid nitrogen every two weeks for a maximum of 3 months. The second group was subjected to treatment with imiquimod 5% daily for 6–10 h onto the warts for five consecutive days per week for a maximum of 3 months. Results: Eighty-six children were included, 35 girls and 51 boys, 49 in the cryotherapy group and 37 in the imiquimod and SA group. At the end of the third month no statistically significant difference could be noted between the imiquimod 5% and salicylic acid and cryotherapy groups (p = 0.154). Thirty (81.1%) children treated with imiquimod 5% and salicylic acid were free from their warts in comparison to 33 (67.3%) children treated with cryotherapy. Conclusions: Imiquimod 5% cream as a monotherapy or in combination with SA can be used safely in children with warts and is equally effective and more effective than cryotherapy in plantar warts. Limitations: Our study is not placebo controlled and spontaneous resolution cannot be ruled out.

Quality of life and social isolation in Greek adolescents with primary focal hyperhidrosis treated with botulinum toxin type A: a case series.

Primary hyperhidrosis, although extensively documented in adults, typically has onset that dates back to early childhood. It is an unpleasant and socially disabling problem for the affected child, but little attention has been paid to the disease in adolescents. The objective of the current study was to evaluate the effectiveness of botulinum toxin type A (BTXA) in adolescents with primary palmar and axillary hyperhidrosis and to determine its effect on quality of life and social isolation. Thirty‐five individuals (17 girls, 18 boys) with moderate to severe palmar and axillary hyperhidrosis were treated with BTXA (onabotulinum). Patients were examined at baseline and 6 months after treatment. The Hyperhidrosis Disease Severity Scale (HDSS) was used to evaluate disease severity and the Childrens Dermatology Life Quality Index (CDLQI) was used to assess quality of life. The University of California at Los Angeles loneliness scale (UCLA version 3) was used to assess personal perception of loneliness and social isolation. The median age of the participants was 14 years, and 48.6% were female. Twenty‐one had palmar hyperhidrosis, and 14 had axillary hyperhidrosis. Total CDLQI and social isolation scores decreased significantly after treatment with BTXA (both p < 0.001). There was a significant difference between pre‐ and post‐treatment levels of severity of hyperhidrosis. No statistically significant difference was documented for CDLQI and UCLA scores between boys and girls. Treatment of hyperhidrosis with BTXA resulted in improvement in quality of life, social skills, and activities.

The role of cytology and HPV typing as a screening tool in patients with intraanal warts.

Background and Aim Given that anorectal human papillomavirus (HPV) infection has been related to anal intraepithelial neoplasia (AIN) and rectal cancer, we conducted this study to evaluate the role of cytology of anal smears in the diagnosis of intraanal disease and related AIN and to correlate it to HPV genotypes. Method A total of 72 patients (58 males and 14 females) with perianal warts underwent anoscopy with biopsies and anal cytologic examination. Cytology was carried out for the identification of any dysplasia according to the Bethesda system. All specimens were examined with polymerase chain reaction (PCR) for HPV DNA identification. Exclusion criteria included immunosuppression and high-grade squamous intraepitheliel lesion (HGSIL) or SCC in anal specimens. Results Seven patients were excluded from the study. Intraanal warts were detected with anoscopy in 57 out of 65 patients, whereas histology showed HPV infection in 56 out of 65 patients and cytology was positive in 52 out of 65 low-grade squamous intraepitheliel lesion (LGSIL) patients. In 43 out of 52 positive patients, simple HPV infection was detected whereas in 9 out of 52 positive patients AIN I. HPV DNA was detected in 51 out of 65 patients, whereas 3 specimens were characterized as invalids. In the majority, HPV 6 could be identified (39/48, 81%), whereas HPV 16 was detected in 4 patients (4/48, 8.3%). One fourth of the positive patients had been infected with more than 1 HPV types (13/48, 27%). Cytology presented a sensitivity 87.5% and specificity 67% in comparison with the histology. Conclusions Cytology is highly sensitive in the diagnosis of intraanal warts comparable with histopathology. The combination of the 3 examinations (anoscopy, cytology, and PCR HPV typing) improves diagnostic accuracy and offers a global picture of the anorectal HPV disease.

Recurrent penile ulcer as a manifestation of chronic lymphocytic leukaemia.

Sir: I read with interest the audit by Murray and Jones on bloodborne virus (BBV) services in Her Majesty’s Prison Service that reported on hepatitis C virus (HCV) infections among female inmates. Their findings are comparable to what have been reported with high prevalence of HCV infection among those with intravenous drug use (IVDU). IVDU is now becoming the leading cause of HCV transmission. In our local setting, IVDU accounts for more than half of the aetiology for HCV infection and this is increasing as transmissions through haemodialysis and contaminated blood products are decreasing. All our incarcerated inmates are screened at entry for BBVs (HIV, hepatitis B, HCV and syphilis) and HCV infection represent the most common infection detected. The audit highlighted the importance of screening inmates for BBVs and the opportunities provided. There are several advantages for provision of such services. Screening helps to identify infected individuals who otherwise would not have presented themselves voluntarily for testing and would remain undetected and undiagnosed. HCV infection is a major public health problem and this is especially true in rehabilitation or correctional facilities due to the large pools of undiagnosed infections and high-risk behaviours. Undetected cases will place other inmates or even facilities staff at risk. Family members will also be at risk when inmates are released. In our local setting, family members of identified cases are offered screening. Identifications of infections allow for counselling and education on risk behaviour modifications. Treatment can be considered as treatment for IVDUs whether active or rehabilitated have been shown to be as effective as non-IVDUs. Our own experience showed that treatment responses (sustained viral response) to standard combination therapy were comparable (IVDU, 64.7% versus non-IVDU, 63.6%, P 1⁄4 ns). Treatments during incarceration provide the assurance of compliance, which is an important predictor of response to therapy. Importantly, a large proportion of the inmates in our local setting remained rehabilitated once released. Therefore, the period of incarceration provides opportunities to rehabilitate, counsel, educate and treat those infected. As such, I believed such screening programme should be introduced to all correctional or rehabilitation facilities and even made compulsory as treatments are available. Furthermore, from the public health point of view, it helps to identify the groups of patients who contribute largely to the pools of HCV-infected persons.