Hülya Albayrak

Relation of Nickel Allergy with in-Stent Restenosis in Patients Treated with Cobalt Chromium Stents

Background In-stent restenosis (ISR) is the major limitation of percutaneous coronary stenting procedure. The elements like nickel, chromate and molybdenum are known to cause contact allergy. Hypersensitivity reaction, against these metal ions, may be one of the reasons of ISR. Cobalt chromium coronary stents, which are increasingly being used in percutaneous coronary interventions, have more nickel amount than the stainless steel stents. Objective We aimed to investigate the association between nickel hypersensitivity reaction and ISR in patients treated with cobalt chromium coronary stents. Methods Epicutaneous patch tests for nickel were applied to 31 patients who had undergone elective cobalt chromium coronary stent implantation and had ISR in control angiogram. Thirty patients, without ISR, were included as the control group. Patch test results and other clinical variables were compared. Results There was no statistically significant difference of the mean age, sex, body mass index, rate of hypercholesterolemia, diabetes, hypertension and smoking between the patients with and without ISR. All other lesion characteristics were similar in the 2 groups. According to the patch test results, 7 patients had nickel contact allergy. All of these patients were in the ISR group, which was statistically significant (p<0.006). Conclusion Patients treated with cobalt chromium coronary stents and had ISR were found to have significantly more nickel allergy than the control group. Nickel allergy may play role in restenosis pathophysiology.

Laugier-Hunziker syndrome : Diffuse large hyperpigmentation on atypical localization

Dear Editor, Laugier–Hunziker syndrome (LHS) is a benign, rare and acquired pigmentation disorder that typically involves the lips and oral mucosa, and was first described in 1970. We report a 51-year-old white man with the clinical features of LHS, which was associated with diffuse pigmentation of the right pretibial area of the skin. In our published work review, this was found to be the first case of diffuse hyperpigmentation on atypical localization in LHS. Laugier–Hunziker syndrome is a benign, rare and acquired pigmentation disorder that typically involves the lips and oral mucosa frequently and is associated with longitudinal melanonychia without systemic diseases. Laugier and Hunziker reported five cases in 1970 with melanotic pigmentation of the buccal mucosa and lips. Two of these patients also had longitudinal nail pigmentation. The etiology is still unknown. To date, only one case of familial LHS has been described. A 51-year-old white man presented to our clinic with slowly enlarging pigmentation of the right pretibial area of the skin during the prior year. The lesion was 9 cm × 14 cm in diameter, well-defined with diffuse hyperpigmentation of dark-brown color. On examination, he was found to have multiple lenticular dark brown macules of 3–5 mm diameter on his lips and buccal mucosa. He also had multiple pigmented macules on palmar and plantar areas (Fig. 1). There was no history of recurrent abdominal pain or rectal bleeding and no family history of gastrointestinal disease. Routine laboratory investigations were normal. Upper gastrointestinal endoscopy and colonoscopy did not reveal any abnormality. A short synacthen test for Addison’s disease was normal. He had not used any medication which

Iododerma following topical povidone-iodine application

Abstract A 43-year-old male patient presented with two well-demarcated, elevated plaques, measuring 4 cm in diameter, with yellow-black crusts over it that appeared 3 d earlier. With the help of history, physical examination and histopathological features, the patient was diagnosed with iododerma secondary to topical povidone-iodine use. Iododerma develops frequently after oral or intravenous but rarely after topical use of iodine. Its pathogenesis is not well-known though it is widely believed that it is a delayed hypersensitivity reaction.

Dermoscopic appearance of hair casts

Dear Editor, A 23-year-old woman presented to our clinic with complaints of hair loss and dandruff for the past 6 months. She was otherwise healthy. On examination, grayish-white dandruff-like particles were observed on her scalp (Fig. 1a). They were most common in the frontal and temporal areas. They were easily removable along the hair shaft by using fingers. She had no alopecia and her scalp was not inflamed. Upon performing dermoscopy, whitish-colored elongated tubular structures were observed encircling the shafts of the patient’s hair (Fig. 1b). We examined the patient’s hair shaft under light microscopy and did not find any hair shaft abnormality. She was wearing a tight ponytail at the vertex during the day. Based on the clinical and dermoscopic appearance, hair casts were diagnosed; consequently, salicylic acid as a keratolytic lotion and an antidandruff shampoo were prescribed. In addition, we recommended using a thin-toothed comb and avoiding traction by releasing her hair from the ponytail. Hair casts are 2–7-mm long, white, cylindrical, freely movable tubular structures that encircle the proximal hair shafts of the scalp. Few cases of hair casts have been reported in the published work. The condition affects children and is more common in females, particularly in patients who subject their hair to excessive traction for a long period. The exact pathogenesis is unknown. They are classified as primary when there is no associated scalp condition, and as secondary when associated with scaling scalp conditions such as seborrheic dermatitis, psoriasis, lichen planus, lichen spinulosus and traction alopecia, hairstyles with significant traction, and the use of hair-care products. In primary hair casts, change is an accumulation of parakeratotic cells in the follicular infundibulum encasing the internal root sheath. Ultimately, passive upward transport occurs when the hair grows. As regards a secondary type hair cast mechanism, traction folliculitis may explain a fracture in the root sheath, but the failure of the inner root sheath to disintegrate remains unsolved. They may be clinically misdiagnosed as nits of pediculosis capitis. The differential diagnosis includes dandruff, white piedra, trichorrhexis nodosa, monilethrix, trichomycosis and trichonodosis. Hair casts can be differentiated from nits by their mobility along the hair shaft. This characteristic is of paramount importance in their diagnosis and helps in differentiating them from other scalp disorders. Dermoscopic appearance can be an important clue for the diagnosis of this rare condition. Upon dermoscopic examination, hair casts appear as white-to-brown cylindrical structures with spindled edges that encircle the proximal hair shafts. Even though they are benign, there may be comorbidity with anxiety and trichotillomania induced by psychological trauma. Solutions containing keratolytic agents, such as salicylic acid and retinoic acid, have yielded good results. In addition to physical removal, antidandruff shampoos are helpful. We report this case: (i) because this patient was older than most reported cases in the published work; (ii) to inform practitioners that hair casts can be observed, especially in female patients with their hair under secondary traction; and (iii) to distinguish this condition from similar diseases.

Pustular irritant contact dermatitis caused by dexpanthenol in a child

Abstract Pustular irritant contact dermatitis is rare and unusual clinic form of contact dermatitis. Dexpanthenol is the stable alcoholic analogue of pantothenic acid. It is widely used in cosmetics and topical medical products for several purposes. We present the case of 8-year-old girl with pustules over erythematous and eczematous areas on the face and neck. To the best of our knowledge, this is the first case reported that is diagnosed as pustular irritant contact dermatitis caused by dexpanthenol.

Bullous skin reaction seen after extravasation of calcium gluconate

Intravenous (IV) calcium is usually given to temporarily treat the effects of hyperkalaemia on muscle and heart. When extravasation of a calcium gluconate infusion occurs, there may be rapid and marked swelling and erythema, with signs of soft‐tissue necrosis or infection, and ensuing extensive local calcification, called calcinosis cutis. We report a 26‐year‐old woman who was hospitalized for exacerbation of acute intermittent porphyria. She had a history of hypertension and chronic renal failure. On the second day of her hospitalization, she developed hyperpotassaemia (6.7 mEq/L potassium; normal range 3.5–5 mEq/L). She was given an IV infusion of 10 mL calcium gluconate into the left dorsal pedal vein. Bullous skin reactions occurred in the infusion area nearly 2 h after administration. The patient’s leg was elevated and the lesions cleaned with 0.9% saline. By day 9 of hospitalization, the lesions had markedly regressed. Several drugs have been associated with dermoepidermal blistering as an adverse drug reaction, but there is only one existing report in the literature about this side‐effect associated with calcium gluconate. Clinicians should be alert to the possibility of bullous skin reactions, which may be a predictor of extravasation and necrosis, when treating patients with IV calcium gluconate.

Eruptive vellus hair cysts occurring on the ears.

and the etiology is still unknown. Fewerthan 10 cases of EVHC on the face have beenreported. We describe a 38-year-old woman whopresented with EVHC on both cheeks and ears. Tothe best of our knowledge, this is the first case ofEVHC occurring on the ears.A 38-year-old woman presented with a 3-yearhistory of asymptomatic multiple papules on herbilateral cheeks and ears. The number of the lesionshad gradually increased. There was no family historyof similar lesions.The physical examination revealed multiple 2–3-mm skin-colored papules on her bilateral ears andcheeks (Fig. 1). The rest of the results from theexamination and laboratory investigations werewithin normal limits. Biopsy specimens from theright ear and right cheek similarly revealed a smallcyst in the dermis containing multiple oblique andlongitudinal hair shafts along with keratinous debris(Fig. 2). Laser therapy was suggested but thepatient rejected this treatment.Eruptive vellus hair cysts were first described in1977 by Esterly

Acitretin-induced spiny follicular hyperkeratosis.

Abstract Spiny follicular hyperkeratosis (SFH) is follicular flesh-colored hyperkeratotic spicules that are linked to different situations including drug reactions. Previously suspected drugs are BRAF inhibitors and cyclosporine. We described a 51-year-old psoriasis patient with SFH who had been using acitretin.

Alopesi Areata Hastalarında Nötrofil/Lenfosit Oranının ve Diğer İnflamatuar Parametrelerin Normal Popülasyon İle Karşılaştırılması

Objective: The objective of this study is to calculate the neutrophil-lymphocyte ratio (NLR) and other inflamatory paramaters like erythrocyte sedimentation rate (ECR) and C-reactive protein results (CRP) in Alopecia areata(AA) patients and determine the association between thoose laboratory values and AA. Method: 234 patients with AA and 37 healthy subjects were enrolled in the study. Number of neutrophil, lymphocyte, leucocyte, ESR and CRP were ascertained from patient’s medical records. NLR was calculated and recorded. Results: While the difference between patient and control groups in terms of value of Neutrophils, Leukocytes, Hb and Esr were found to be insignificant (p>0.05), numbers of Lymphocyte (p=0,02) and value of Crp ( P <0.001) in patients were found to be higher than those of healthy controls. Conclusion: This study demonstrates that NLR can not serve as a usuful marker for AA. And, as for CRP, larger-scale studies need to be done in order to demonstrate if it can serve as a marker or not.

Scrofuloderma: 30 years of experience from eastern Turkey.

Editor, Scrofuloderma is the most common form of cutaneous tuberculosis seen in many developing countries and in some European series. It is caused by the continuous propagation of infection from an underlying structure, most commonly a lymph node or bone. Children, young adults, and elderly patients are usually affected. An abscess will form by continuity or fistula formation from an underlying nidus with subsequent induration of surrounding areas, resulting in an ulcer surrounded by keloid tissue. Although scrofuloderma is one of the more frequent forms of cutaneous tuberculosis, it has not been evaluated extensively in Turkey. This study documents the clinical and laboratory findings of scrofuloderma in Erzurum, a major city in eastern Turkey, and its surrounding area. Between 1975 and 2005, 304,566 patients visited the outpatient clinics of Ataturk University Medical School Hospital. Of these, 168 (0.05%) patients diagnosed with cutaneous tuberculosis were analyzed retrospectively. Fifty-five of the 168 (32.7%) cutaneous tuberculosis patients had scrofuloderma. The mean age of the patients was 25.1 years (range: 1–70 years). The female : male ratio was 1.61. The localizations of the lesions were as follows: 30 (54.5%) were in the head and neck region; four (7.3%) were on the trunk; 14 (25.3%) were on the upper limbs; and seven (12.7%) were on the lower limbs. The mean duration of lesions was 2.72 years (range: 2 months to 30 years). Thirty-eight (69.1%) patients had a positive Mantoux test. Nine (16.4%) patients had positive culture results. Scrofuloderma is a form of cutaneous tuberculosis which arises in previously sensitized individuals with a high degree of tuberculin sensitivity. In Europe and the USA, scrofuloderma is rare but still presents as a common type of cutaneous tuberculosis, as it does in India and South Africa. The ratio of detected scrofuloderma varies greatly between different regions worldwide. The incidence of scrofuloderma in cutaneous tuberculosis has been reported to be 72% in Morocco, 26.9% in Hong Kong, 19.6% in Pakistan, and 53.3% in northern India. In our study, the incidence of scrofuloderma was 32.7%, which was similar to the findings in northern India. The most commonly affected areas in scrofuloderma are the neck, axillae, chest wall, and groin. The patient may have active pulmonary or pleural disease with systemic symptoms. In Europe, over 80% of lesions are on the head and neck, particularly on the nose and cheek. In a study from India, the most commonly involved nodes were cervical (76.3%), followed by nodes in the inguinal (28.9%), axillary (28.9%), and submandibular (10.5%) regions. In cervical nodes, bilateral involvement was seen in 30% of cases, and the upper deep cervical site was the most common location. The Mantoux test is positive in most cases of scrofuloderma. Rates of positive Mantoux skin tests in scrofuloderma have been reported as 82.8% in India, 81% in Morocco, and 94.7% in northern India. In our study, the incidence of positive Mantoux skin tests in scrofuloderma was 69.1%, which was lower than rates in previous studies. Cultures are negative in a significant number of cases of scrofuloderma and cutaneous tuberculosis. Cultures were positive in 16.7% and 9% of cases in studies conducted in Hong Kong and Morocco, respectively. In our study, 16.4% of cultures were positive, which accords with figures reported in the literature. In conclusion, tuberculosis is still an important health problem in underdeveloped and developing countries. Scrofuloderma is paucibacillary tuberculosis. It is commonly seen in persons who have high immunity, and it is usually localized to the head and neck region nodes.