Daisy Kopera

Association of hypovitaminosis D with metabolic disturbances in polycystic ovary syndrome

OBJECTIVES Women with polycystic ovary syndrome (PCOS) frequently suffer from metabolic disturbances, in particular from insulin resistance. Accumulating evidence suggests that vitamin D deficiency may contribute to the development of the metabolic syndrome (MS). Hence, the aim of our study was to investigate the association of 25(OH)D levels and the components of the MS in PCOS women. METHODS 25(OH)D levels were measured by means of ELISA in 206 women affected by PCOS. Metabolic, endocrine, and anthropometric measurements and oral glucose tolerance tests were performed. RESULTS The prevalence of insufficient 25(OH)D levels (<30 ng/ml) was 72.8% in women with PCOS. PCOS women with the MS had lower 25(OH)D levels than PCOS women without these features (17.3 vs 25.8 ng/ml respectively; P<0.05). In multivariate regression analysis including 25(OH)D, season, body mass index (BMI), and age, 25(OH)D and BMI were independent predictors of homeostatic model assessment-insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI; P<0.05 for all). In binary logistic regression analyses, 25(OH)D (OR 0.86, P=0.019) and BMI (OR 1.28, P<0.001) were independent predictors of the MS in PCOS women. We found significantly negative correlations of 25(OH)D levels with BMI, waist circumference, waist-to-hip ratio, systolic and diastolic blood pressure, fasting and stimulated glucose, area under the glucose response curve, fasting insulin, HOMA-IR, HOMA-beta, triglycerides, and quotient total cholesterol/high-density lipoprotein (HDL) and positive correlations of 25(OH)D levels with QUICKI and HDL (P<0.05 for all). CONCLUSION We demonstrate that low 25(OH)D levels are associated with features of the MS in PCOS women. Large intervention trials are warranted to evaluate the effect of vitamin D supplementation on metabolic disturbances in PCOS women.

Different treatment modalities for the management of a patient with the nevoid basal cell carcinoma syndrome

Nevoid basal cell carcinoma (BCC) syndrome is a genetically linked disorder characterized by multiple BCCs associated with various skeletal abnormalities and sometimes with mental retardation. Because of the large number of lesions, treatment of BCCs in these patients may be extremely difficult. The value of different therapeutic options was assessed in a patient with multiple, disfiguring nevoid BCC syndrome. Surgical excision and split-skin grafting was used to remove three larger tumors. Photodynamic therapy led to healing of flat lesions; small papules within the treated areas, however, did not respond to this type of management. Three nodular BCCs treated with intralesional application of interferon alfa-2b were markedly reduced in size. Still, complete healing could not be achieved. Nodular lesions vaporized with the CO2 laser disappeared and showed no recurrence after 2 years of follow up. Our experience indicates that CO2 laser vaporization of BCCs allows the treatment of a large number of lesions in a single session, and is indicated when surgical treatment is not feasible for all lesions. Photodynamic therapy with 5-amino-levulinic acid may be a valid therapeutic option for flat lesions only. Intralesional application of interferon alfa-2b removes papular lesions of small size.

Verrucae vulgares: flashlamp‐pumped pulsed dye laser treatment in 134 patients

Background  Various approaches have been taken in the management of verrucae vulgares, but there is still no first‐choice treatment. Thus, a study was designed to evaluate the efficacy of a flashlamp‐pumped pulsed dye laser (FPDL) in the treatment of verrucae vulgares.

Ex vivo Quality-Switched Ruby Laser Irradiation of Cutaneous Melanocytic Lesions: Persistence of S-100-, HMB-45- and Masson-Positive Cells

AIM To assess changes in human pigmented melanocytic skin lesions after quality-switched ruby laser (QSRL) irradiation. METHODS Investigations were performed ex vivo on 21 melanocytic pigmented lesions (10 nevus cell nevi, 2 pigmented dermal nevi, 4 congenital nevi, 3 lentigo maligna lesions, 2 superficial spreading melanomas) immediately after surgical excision. A total of 42 biopsy specimens was obtained for comparative investigations before and after QSRL impact. Electron microscopy was performed in 3 lesions. RESULTS Hematoxylin-eosin stainings showed selective vacuolization of pigmented structures (melanin granules, melanophages, pigmented melanocytes, pigmented keratinocytes) immediately after QSRL irradiation due to selective photothermolysis. Cryosections stained with nitroblue tetrazolium chloride featured minimal thermal damage of the surrounding tissue proving the high selectivity of QSRL light. Immunohistochemical techniques employing anti-S-100, HMB-45 antimelanoma antibody and Fontana-Masson staining revealed selective photothermal damage (vacuolization) of basal melanin granules, pigmented basal melanocytes and epidermal keratinocytes, as well as pigmented superficial dermal melanocytes. Deeper melanocytes and nests of nonpigmented melanocytes persisted unaltered and retained their S-100 and HMB-45 positivity. Massons staining revealed persisting dermal melanophages. Electron microscopy showed specific damage of both keratinocytes and melanocytes with numerous melanosomes and confirmed the light-microscopic findings. Deeper dermal melanocytes containing only few melanin granules remained unaltered. CONCLUSION In pigmented lesions extending into the dermis, deeper pigmented melanocytic cells (nevus cells) persist throughout a single course of QSRL exposure. Nonpigmented melanocytic cells remain totally unaffected by QSRL irradiation. Therefore QSRL therapy of melanocytic nevi and congenital nevi should only be performed in controlled studies. Long-term results have to be evaluated before recommendations can be given.

An update on pachydermodactyly and a report of three additional cases

Pachydermodactyly is a benign condition characterized by symmetrical, painless, diffuse swelling of the skin on the lateral aspects of the proximal Interphalangeal joints of the lingers. Histopathological examination shows epidermal hyperplasia, an increase of dermal collagen bundles and a slightly increased number of fibroblasts. We report three adolescent males with pachydermodactyly. We also review 20 published cases, and discuss the differential diagnosis, clearly distinguishing pachydermodactyly from ‘true’ and ‘false’ knuckle pads.

Multinucleate cell angiohistiocytoma: treatment with argon laser

Multinucleate cell angiohistiocytoma mainly affects middle‐aged women, and usually presents as grouped reddish‐brown papules. Hislopathological features include the presence of multinucleate cells in the reticular dermis, and numerous dilated dermal vessels. The lesions are benign, and may persist for years. Treatment is needed for cosmetic reasons. We report the successful use of the argon laser to treat two patients who had multinucleate cell angiohistiocytoma.

Treatment of molluscum contagiosum with a pulsed dye laser: Pilot study with 19 children.

Background: Molluscum contagiosum is a common, self‐limiting viral disease of childhood caused by a poxvirus. Often the children themselves and their parents desire treatment for cosmetic reasons or because of pruritus. Laser therapy offers another option to the traditional methods of treatment.

Nonablative laser treatment of wrinkles: meeting the objective? Assessment by 25 dermatologists

Background  Established skin resurfacing methods causing superficial wounds and extended recovery times have become less popular since the introduction of nonablative lasers.

Botulinum toxin historical aspects: from food poisoning to pharmaceutical

Background  In the history of medicine, unexpected coincidences indicated the development of new treatment options.

Endocrinology of hirsutism.

Hirsutism represents a primary clinical indicator of androgen excess. The most common endocrine condition causing hirsutism is polycystic ovary syndrome (PCOS). Diagnosing PCOS is not easy as the signs and symptoms are heterogenous. The newest diagnostic guideline made by the Androgen Excess and PCOS Society in 2006, claims the presence of hyperandrogenism, and ovarian dysfunction (oligo / anovulation and / or polycystic ovaries). Obesity associated reproductive and metabolic dysfunctions may aggravate the symptoms of PCOS. PCOS might be underdiagnosed in non obese women because lean PCOS phenotypes might be underestimated for the syndrome. Effective medical treatment of PCOS and associated hirsutism depends on the endocrinological expertise and experience of the therapist in each individual case. An algorithm for the treatment has not been established yet.