María Sierra Girón-Prieto

Cardiovascular Risk Factors in Patients with Lichen Planus

BACKGROUND Chronic inflammation was found to play an important role in the development of cardiovascular risk factors. Recently a case-control study found that lichen planus was associated with dyslipidemia in a large series of patients. However, no data were presented about lipid values, glucose levels, or blood pressure. OBJECTIVE The objective of this case-control study was to evaluate cardiovascular risk factors included in Adult Treatment Panel III criteria for metabolic syndrome in men and women with lichen planus and in healthy controls. PATIENTS AND METHODS This case-control study included 200 patients, 100 with lichen planus (50 men and 50 women) and 100 controls consecutively admitted to the outpatient clinic in Dermatology departments in Granada, Spain. RESULTS Analysis of metabolic syndrome parameters revealed a higher significant prevalence of dyslipidemia in patients with lichen planus. No significant differences were observed in glucose levels, abdominal obesity, or blood pressure. Elevated levels of C-reactive protein, erythrocyte sedimentation rate, and fibrinogen were noted in patients with lichen planus. Adjusted odds ratio for dyslipidemia in patients with lichen planus was 2.85 (95% confidence interval, 1.33-5.09; P=.001). CONCLUSION Chronic inflammation in patients with lichen planus may explain the association with dyslipidemia. Lipid levels screening in men or women with lichen planus may be useful to detect individuals at risk and start preventive treatment against the development of cardiovascular disease.

A comparative study of dyslipidaemia in men and woman with androgenic alopecia.

Several studies have analyzed the relationship between androgenetic alopecia and cardiovascular disease (mainly heart disease). However few studies have analyzed lipid values in men and women separately. This case-control study included 300 patients consecutively admitted to an outpatient clinic, 150 with early onset androgenetic alopecia (80 males and 70 females) and 150 controls (80 males and 70 females) with other skin diseases. Female patients with androgenic alopecia showed significant higher triglycerides values (123.8 vs 89.43 mg/dl, p = 0.006), total cholesterol values (196.1 vs 182.3 mg/dl, p = 0.014), LDL-C values (114.1 vs 98.8 mg/dl, p = 0.0006) and lower HDL-C values (56.8 vs 67.7 mg/dl, p <0.0001) versus controls respectively. Men with androgenic alopecia showed significant higher triglycerides values (159.7 vs 128.7 mg/dl, p = 0.04) total cholesterol values (198.3 vs 181.4 mg/dl, p = 0.006) and LDL-C values (124.3 vs 106.2, p = 0.0013) versus non-alopecic men. A higher prevalence of dyslipidemia in women and men with androgenic alopecia has been found. The elevated lipid values in these patients may contribute, alongside other mechanisms, to the development of cardiovascular disease in patient with androgenic alopecia.

Androgenetic alopecia as an early marker of benign prostatic hyperplasia.

BACKGROUND Androgenetic alopecia (AGA) and benign prostatic hyperplasia are both androgen-dependent entities that respond to the blocking of 5-alpha-reductase. OBJECTIVES The objective of this study was to determine whether prostatic volumes and urinary flow changes were higher in patients with early-onset AGA than in healthy control subjects. METHODS This was an observational case-control study of 87 men: 45 with early-onset AGA diagnosed in the dermatology department and 42 control subjects. End-point variables were prostatic volume, measured by transrectal ultrasound, and urinary flow, measured by urinary flowmetry. A hormone study was performed on all participants, and the International Prostate Symptom Score and International Index of Erectile Function score were determined. RESULTS The groups did not significantly differ in mean age (cases, 52.7 years vs control subjects, 49.8 years; P = .12). Patients with AGA had significantly higher mean prostate volume (29.65 vs 20.24 mL, P < .0001), International Prostate Symptom Score (4.93 vs 1.23, P < .0001), and prostate-specific antigen value (1.53 vs 0.94 ng/mL, P < .0001) and significantly lower maximum urinary flow (14.5 vs 22.45 mL/s, P < .0001) versus control subjects. Binary logistic regression analysis showed a strong association between the presence of AGA and benign prostatic hyperplasia after adjusting for age, urinary volume, urination time, International Prostate Symptom Score, abdominal obesity, glucose levels, systolic blood pressure, insulin levels, fibrinogen, and C-reactive protein (odds ratio = 5.14, 95% confidence interval 1.23-47.36, P = .041). LIMITATIONS The study of larger sample sizes would facilitate stratified analyses according to the Ebling type of androgenetic alopecia. CONCLUSION There is a relationship between the presence of AGA and prostate growth-associated urinary symptoms, likely attributable to their pathophysiological similarity. This study suggests that early-onset AGA may be an early marker of urinary/prostatic symptomatology. Future studies may clarify whether treatment of patients with AGA may benefit the concomitant benign prostatic hypertrophy, which would be present at an earlier stage in its natural evolution.

Sex hormone–binding globulin and risk of hyperglycemia in patients with androgenetic alopecia

BACKGROUND Low circulating levels of sex hormone-binding globulin (SHBG) are a strong predictor of the risk of type 2 diabetes. Androgenetic alopecia (AGA) has been related to an increase in cardiovascular risk, but the mechanism of this association has not been elucidated. AGA can be associated with low levels of SHBG and insulin resistance, which could be related to hyperglycemia and type 2 diabetes. OBJECTIVE The objective of this study was to evaluate SHBG and blood glucose levels in men and women with early-onset AGA and control subjects to determine whether low levels of SHBG are associated with hyperglycemia. METHODS This case-control study included 240 patients consecutively admitted to the outpatient clinic (Dermatology Department of San Cecilio University Hospital, Granada, Spain), 120 with early-onset AGA (60 men and 60 women) and 120 control subjects (60 men and 60 women) with skin diseases other than alopecia. RESULTS Of patients with AGA, 39.1% presented with hyperglycemia (>110 mg/dL) versus 12.5% of controls (P < 0.0001). AGA patients with hyperglycemia or diabetes presented lower significant levels of SHBG than alopecic patients without hyperglycemia or type 2 diabetes, respectively. Patients with AGA and hyperglycemia presented significantly lower levels of SHBG than controls with hyperglycemia (22.3 vs 39.4 nmol/L for AGA patients and controls, respectively, P = .004). No significant differences in SHBG levels were noticed between patients and controls without hyperglycemia. Binary logistic regression showed a strong association between lower SHBG levels and glucose levels greater than 110 mg/dL in patients with AGA even after additional adjustment for sex, abdominal obesity, and free testosterone (odds ratio = 3.35; 95% confidence interval = 1.9-5.7; P < .001). LIMITATIONS The study of a wider sample of AGA patients would confirm these findings and would permit analysis of the pathogenic mechanisms underlying the increase in cardiovascular risk in patients with AGA. CONCLUSION An association between early-onset AGA, hyperglycemia/diabetes, and low levels of SHBG was observed in the current study. Low levels of SHBG could be a marker of insulin resistance and hyperglycemia/diabetes in patients with AGA.

Osteopenia/osteoporosis in patients with calcium nephrolithiasis

The objective of this study is to analyze the alterations in bone mineral density and bone and calcium–phosphorus metabolism in patients with calcium nephrolithiasis. We designed a study with 182 patients who were distributed among three groups: group O, 56 patients without nephrolithiasis; group A, 67 patients with calcium nephrolithiasis and mild lithogenic activity; and group B, 59 patients with calcium nephrolithiasis and severe lithogenic activity. Metabolic parameters of blood and urine that were related to calcium–phosphorous and bone metabolism and bone densitometry were assessed in all patients. A comparative study was performed on the variables of bone and calcium–phosphorus metabolism and bone densitometry as well as the presence or absence of osteopenia/osteoporosis. The patients in group B had a greater loss of bone mineral density, measured by the T-score, than the patients in groups O and A. Moreover, the proportion of patients in group B with osteopenia/osteoporosis was statistically significantly higher than the proportion of patients in groups O and A. We observed higher values of calciuria, fasting calcium/creatinine ratio, and 24-h calcium/creatinine among the patients in group B compared to the other two groups. Calciuria, citraturia, and fasting calcium/creatinine were independent factors that showed a relationship with severe lithogenic activity compared to the control group, and β-crosslaps is an independent factor that has a relationship with severe lithogenic activity as compared to mild lithogenic activity. Patients with calcium lithiasis and severe lithogenic activity have a greater loss in bone mineral density and therefore a greater risk of osteopenia/osteoporosis.

Lipid levels in women with androgenetic alopecia

Discussion Breast cancer is the most common malignant neoplasia in women. It is extremely rare in males with an incidence below 1%. The ratio of male : female patients with breast cancer is about 1 : 100. The prevalence of mamma carcinoma in men runs parallel with the prevalence of breast cancer in women. Clinically recognized changes are mostly centrally subareolar located resistances or other pain-free lesions of the mammilla. In the majority of all cases the patients palpate the tumor themselves. In 7–20% gynecomastia is present. At the time of diagnosis, an axillary lymph nodule is seen in over 60% of the patients. Diagnostic evaluation and staging of breast cancer in men is done identically to the procedures in female patients. The TNM system is applied in both sexes to define the stage of the disease. Histologically the tumors are predominantly carcinomas of the ductal type with high percentages of expression of steroid receptors. The most important prognostic factor is the axillar nodal status at the time of diagnosis. The main reasons for a generally worse prognosis in affected men compared to women are higher (with respective to age) at occurrence of the disease (on average 10 years later than in women) and also the late time of making the diagnosis in the course of the disease (median after6–22 months). Predisposing for the occurrence of breast cancer in men are all factors that lead directly or indirectly to an imbalance of the estrogen–testosterone equilibrium, that is to a predominance of estrogen. Causing factors that are considered to be certain for the appearance of male breast cancer are Klinefelter’s syndrome (in about 7.5% of cases) or a hereditary mutation on the BRCA2 gene. Besides various other factors are suspected to lead to these tumors, for example, adipositas, liver affections or drug related exceeding supply with estrogens as seen in the treatment of tumors of the prostate. Frequently there are also cases of maldescending of testicles and also mumps orchitis or testicular trauma in the patient’s history. The treatment of choice in breast cancer without presence of metastases is the complete surgical excision of the tumor. Selection of a regimen for an adjuvant treatment is made according to the recommendations for female patients. A decision for an adjuvant hormonal treatment should be made on the basis of the status of hormonal receptors and is administered usually with Tamoxifen in hormone-receptor positive patients.

Multiple clustered dermatofibromas

ejd.2013.1951 Auteur(s) : Maria Jose Espineira-Carmona1, Maria Salazar-Nievas1, Maria Sierra Giron-Prieto1, Jose Aneiros-Fernandez2, Agustin Buendia-Eisman3, Salvador A Arias-Santiago1,3,4 salvadorarias@hotmail.es 1 Dermatology Department, 2 Pathology Department, San Cecilio University Hospital. Av Dr. Oloriz 16. Granada. 18012. Spain 3 School of Medicine, University of Granada, Granada, Spain 4 Baza General Hospital, Granada. Spain Dermatofibroma is a benign fibrohistiocytic tumor often seen [...]

Foreskin trapped by zipper: a case report

We present an 84 year-old-male patient with foreskin trapped by his zipper. After several failed attempts with scissors, screwdriver and others we practise an elliptic incision to resolve the problem. Foreskin injuries are frequent in children but are rare in adult men. There are some techniques described for solving the problem using scissors, screwdriver, traction and surgery.

A pregnant woman with a nodule on the tongue: a quiz. Lobular capillary haemangioma (pyogenic granuloma).

A 34-year-old woman, in her fourth month of pregnancy, presented with an isolated exophytic lesion of the tongue, which had developed 2 months previously and which caused discomfort when swallowing. On examination, we found a pink nodule (diameter 15 mm) of hard consistency on the dorsutn of the tongue (Fig. 1 A). A cutaneous examination revealed nothing abnormal. Analysis of a biopsy sample revealed multiple separate vascular lobules within the dermis, each composed of aggregates of endothelial cells (Fig. IB). Cells were positive for CD34 (Fig. lC), and negative for Factor Vlll, HHV-8 and androgen, estrogen and progesterone receptors.

A scalp disorder: dermatoscopy as a useful diagnostic tool.

Figure 1. Alopecia with a “Y”morphology located on parietooccipital area. Closer view shows black point corresponding with follicular openings in area of alopecia. A 2-year-old girl presented with a plaque of alopecia on the occipital area for two months and the scalp was not itching or painful. Parents reported that she did not pull her hair. Physical examination showed an irregular area of alopecia without scaly or inflammatory signs (Figure 1). No abnormality was found on the nails or other sites of her skin. Pull-test on the edges of alopecia was negative. Dermatoscopic examination showed hairs of different lengths, including black dots, short vellus and broken hairs (fraying ends), and coiled hairs (Figure 2). The diagnosis was trichotillomania. Some authors prefer the syndromic term “hair puller syndrome” because the term “trichotillomania” implies a well-defined psychopathologic condition defined in the Diagnostic and Statistical Manual-Fourth Edition, and not all cases of hair puller syndrome correspond to an obsessive-compulsive condition. In fact, in early childhood, trichotillomania seems to present a good prognosis, representing a transitory habit without high psychopathological significance, similar to thumbsucking habit. The hair puller syndrome, like other selfinduced alopecias, habitually produces significant alopecia in which patients characteristically, either because of age or because of the underlying psychopathologic condition, do not admit their responsibility in the act of pulling their hair. Physical examination, including dermatoscopy, is especially important for physicians in the diagnosis of trichotillomania or hair puller syndrome. Moreover, some cases are