Mehdi Iskandarli

A case of Bannayan–Riley–Ruvalcaba syndrome. A new clinical finding and brief review

Macrocephaly, genital pigmentation, and gastrointestinal (GI) polyposis are the crucial clinical findings in BRRS. In this group of patients, hamartomatous skin lesions develop due to the phosphate and tensin (PTEN) gene mutation, which is the tumor suppressor gene. There are many reports regarding cutaneous findings of BRRS, such as angiokeratoma, lymphangioma, hemangioma, lipoma, vascular malformation, genital hyperpigmentation, caf eau-lait spots, and acanthosis nigricans. However, in the literature, reports demonstrating epidermal nevus (EN) as a clinical sign of BRRS are very limited. The follow-up protocol for BRRS is still undetermined. We decided to do a brief review of the literature and find updated data regarding the follow-up protocol for BRRS.

Impact of intense pulse light on quality of life in patients with erythematotelangiectatic rosacea

Amaç: Yapılan çalışmalar göstermiştir ki, akne rozase (AR) hastalığı yaşam kalitesini (YK) ciddi bir şekilde etkilemektedir. AR tedavisinde farklı seçenekleri mevcuttur. Bu tedaviler sonrası hastaların YK’de iyileşme saptandığına dair literatürde birçok çalışma mevcuttur. Yoğun atılımlı ışıkla [intense pulse light (IPL)] AR’nin özellikle eritematöz telenjiektazik rozasenin (ETR) tedavisinde olumlu sonuçlar elde edilmiştir. Fakat, literatürde IPL’nin ETR’de etkinliğini gösteren çalışmalar olsa da, YK’yi ne kadar olumlu etkilediğine dair çalışmalar ne uluslararası, ne de ulusal düzeyde yapılmıştır. Gereç ve Yöntem: Bu çalışmada amacımız IPL’nin YK’yi ne kadar olumlu etkilediğini belirlemektir. Bu amaçla, çalışamaya ETR tanısı almış ve alınma kriterlerini karşılayan 30 hasta dahil edilmiştir. Açık-kontrolsüz, prospektif ve kohort bir çalışmada 4 haftada bir olmakla toplam 3 seans IPL tedavisi planlanan hastalara, hem IPL öncesi, hem de IPL tedavisi bitiminden sonra vizüel analog skalası (VAS), Doktor Global Değerlendirme Skalası (DGDS), Dermatolojik Yaşam Kalitesi İndeksi (DYKİ) formu ve Kısa Form-36 (KF-36) ölçeklerinin doldurulması planlandı. Bulgular: İlk seansta ve son seanstaki elde edilen veriler SPSS programı ile değerlendirilmiştir ve istatistiksel anlamlı p değerleri elde edilmiştir. VAS farkı -3,13±1,46 (p<0,01), DGDS farkı -1,6±0,6 (p<0,01), DYKİ farkı ise -11,63±3,13 (p<0,01) olmuştur. KF-36 formu ise 8 bölümde: Fiziksel Background and Design: It has been shown that acne rosacea (AR) seriously affects quality of life (QoL). Various options are available for the treatment of AR. There are many studies in the literature demonstrating that QoL of patients have improved after these treatments. Positive outcomes have been attained with intense pulsed light (IPL) in the treatment of AR and erythematotelangiectatic rosacea (ETR) in particular. However, although there are studies in the literature showing the effectiveness of IPL in ETR, no studies have been conducted at either international or national level showing to what extent it has positive impact on QoL. Materials and Methods: Our goal in this study was to reveal to what extent IPL affects QoL positively. To this end, 30 patients who were diagnosed with ETR and met the inclusion criteria were included in the study. In this open-label, prospective, uncontrolled cohort study, visual analog scale (VAS), Physician’s Global Assessment (PGA), Dermatology Life Quality Index (DLQI) and 36-Item Short Form Health Survey (SF-36) were administered before and after the IPL therapy, which was planned to be administered to the patients once in four weeks in a total of three sessions. Results: The data collected before the first session and after the last session were evaluated with the SPSS statistics software and statistically significant p values were obtained. The difference in VAS score between before and after treatment was -3.13±1.46 (p<0.01), -1.6±0.6 in PGA (p<0.01), and -11.63±3.13 in DLQI (p<0.01). The SF-36 was assessed in 8 subscales; physical functioning (PF), role-physical (RP), social functioning (SF), role-emotional (RE), bodily pain (BP), vitality (VT), mental health (MH), and general health (GH). The statistical analysis of the SF-36 showed that the difference was 35±16.24 in SF (p<0.01), 61±20 in RE (p<0.01), 8±16.9 in VT (p<0.05), 38±11.03 in MH (p<0.01), and 47.03±12.74 in GH (p<0.01). A comparison of the data obtained during the first and last visits revealed that there was a decrease of 3.13 points in VAS, 1.6 points in PGA, and 11.63 points in DLQI. Statistically significant improvements were found in the scores of SF, RE, VT, MH, and GH subscales of the SF-36. Conclusion: The results of this study revealed that IPL was an effective method in the treatment of ETR. Marked reductions were seen in the clinical symptoms after the IPL therapy as evidenced by the VAS and PGA scores. Patient satisfaction was also evidenced by the DLQI and SF-36.

Tuberculosis Cutis Orificialis in Adalimumab Related Immunosupressive Patient

114 Ann Dermatol Received October 27, 2015, Revised December 26, 2015, Accepted for publication January 7, 2016 Corresponding author: Mehdi Iskandarli, Department of Dermatology and Venereology, Ege University Faculty of Medicine, Ankara Street 31, Bornova, Izmir 35100, Turkey. Tel: 90-5545955552, Fax: 90-2323903399, E-mail: nerman111@yahoo.com This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright

Bullöses Pemphigoid als Anzeichen einer aktiven Psoriasis: Fallbericht und kurze Literaturübersicht

Hintergrund: Die Überlappung von bullösem Pemphigoid (BP) und chronischen Psoriasis-Plaques (CPP) kommt häufig vor. BP und Psoriasis pustulosa (PP) hingegen treten weniger häufig überlappend auf. Zugleich gelten periläsionales Erythem und pustulöse Läsionen bei CPP gemeinhin als Anzeichen einer instabilen Psoriasis. Instabile Psoriasis könnte durch bestimmte reizende topische Psoriasistherapien hervorgerufen werden. Diese chemischen Substanzen könnten außerdem ein lokalisiertes Muster einer generalisierten PP induzieren. Wir beschreiben hier das Aufeinandertreffen von BP und PP bei instabilen CPP. Ziel: Mit diesem Bericht postulieren wir, dass BP ein Anzeichen für aktive Psoriasis sein könnte. Vermutlich ist Psoriasis-induziertes BP ein von der Entzündungsaktivität abhängiges Ereignis. Methoden: Die vorliegende Arbeit ist ein Fallbericht mit Literaturübersicht. Ergebnisse: Das dramatische Ansprechen der bullös-pustulösen Läsionen auf eine Kurzzeitbehandlung mit Methotrexat (MTX) deutet auf die Regel «Keine Psoriasis, kein BP» hin. MTX unterdrückte vermutlich die Entzündungsaktivität der CPP; das BP klang vollständig ab, sobald die CPP unter Kontrolle waren. Schlussfolgerung: Das BP kann in diesem Fall ein Anzeichen einer aktiven Psoriasis sein.

Doxepin-induced bullous pemphigoid-like drug eruption.

But dermoscopic examination showed that the lesion was not a tick, it was a haemangioma and an invasive intervention was unnecessary. The fourth patient presented with panic and a brown lesion penetrates into the skin that noticed after working in the garden (Fig. 1a). A splinter of wood was seen on the dermoscopic examination and then it was removed easily (Fig. 1b). In the fifth patient, there was a blue–black, 3-mm papule with irregular shapes on the left leg. Dermoscopic examination revealed also an artificial formation like the fourth patient. In one of the paediatric cases, because the tick was in the larval stage and on the scalp, it was difficult to distinguish the tick macroscopically (Fig. 2a). The larval form of tick observed by dermoscopy and then removed immediately (Fig. 2b). In the other paediatric case, a small skin lesion similar to pigmented naevus was observed in the axilla. Dermoscopic examination showed a small tick in the nymphal stage that couldn’t suck blood yet. In the literature, there are small number of reports about the diagnostic effectiveness and benefits of dermoscopy for tick bite. These reports mainly involve the effectiveness of dermoscopy in detection of residual part of ticks and very small larval forms. In our cases, benign skin lesions which were considered as tick bite and really tick bites that couldn’t be understood macroscopically because of tiny forms of ticks and difficult areas are easily detected by dermoscopy. Dermoscopy can be used as a non-invasive and useful method to prevent an unnecessary intervention in suddenly noticed small coloured lesions, to diagnose in the difficult cases such as very small ticks (couldn’t suck blood or larval stage) and difficult areas (genital, scalp), or to calm and convince families especially in paediatric patients.

Successful treatment of Wilson disease‐associated IgA pemphigus with IVIG

A. Pileri,* M. Cricca, L. Gandolfi, C. Misciali, B. Casadei, P.L. Zinzani, A. Patrizi Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Division Dermatology, Departement of Surgery and Translational Medicine, University of Florence, Florence, Microbiology Unit, Department Of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Haematogy Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy *Correspondence: A. Pileri. E-mail: alessandropileri@hotmail.it The content of this manuscript has never been published or presented elsewhere.