Mehmet Emin Yanik

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

Does MBL2 codon 54 polymorphism play a role in the pathogenesis of psoriasis

Background  Psoriasis is a T cell‐mediated immune disease in which various cytokines, primarily tumor necrosis factor‐α (TNF‐α), are complexly involved. Mannose‐binding lectin (MBL) gene polymorphisms decrease MBL serum levels, thereby increasing the synthesis of proinflammatory cytokines such as TNF‐α.

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.

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.

Effect of left ventricular diastolic function of psoriasis

The objective of our study was to evaluate the diastolic left heart functions of patients with no known cardiovascular disease via tissue Doppler imaging method. 50 psoriasis patients along with 30 healthy individual controls were included in the study. When the psoriasis group was compared with the control group, a decrease in left ventricular early filling time (71.8±14.9 versus 81±13.8, P

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.

Patch testing for allergic contact dermatitis: Three years retrospective results in Tekirdağ

Türkderm-Deri Hastalıkları ve Frengi Arşivi Dergisi, Galenos Yayınevi tarafından basılmıştır. Turkderm-Archives of the Turkish Dermatology and Venerology, published by Galenos Publishing. Background and Design: Allergic contact dermatitis (ACD) is a delayed-type hypersensitivity reaction to allergens in individuals who have been previously sensitized to an allergen. The causative allergens may change in time and may vary by geographic area and population. Materials and Methods: We retrospectively analyzed the patch test results and characteristics of 169 patients-107 (63.3%) male, 62 (36.7%) female-,who received the diagnosis of ACD between 2011 and 2014. Results: The mean age of the patients was 41.06 years and the mean disease duration was 19.5 months. The most common occupation was service sector/housewifery (26.6%). The most frequent localization of the disease was the hands (n=105, 73%) and 50.3% of patients were skin test positive to at least one allergen. The most frequent seven allergens were nickel sulfate (n=50, 29.6%), cobalt chloride (n=23, 13.6%), potassium dichromate (n=22, 13%), sesquiterpene lactone mix (n=18, 10.7%), thiuram (n=10, 5.9%), clioquinol mix (n=10, 5.9%), and 4-tert-butilfenol formaldehyde resin (n=10, 5.9%), respectively. On the other hand, no patient, had a positive reaction to N-Isopropyl-Nphenyl-4-phenylenediamine, epoxy resin, balsam of peru, formaldehyde, quaternium-15, primin, tixocortol-21-pivalate, and fragrance mix-2. Conclusion: In comparison of this study which is the first report of patch test results of patients in Tekirdağ-a city in Thrace region-and other studies that report patch test results in different regions of our country; it was observed that the mean age of patients in the present study was higher than in other studies and there was no significant difference in terms of occupations of the patients and localization of the disease between the eastern region and Thrace region. We believe that further multicenter studies in a larger population performed in different cities of the country are needed to specify allergen characteristics of Thrace region. (Turkderm 2015; 49: 129-33)

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.

Darier disease with asymmetrical involvement of the leg

Dear Editor, Darier disease (DD) is an autosomal dominant disorder characterized by acantholysis and abnormal keratinization of the epidermis, nails and mucous membranes. DD lesions are predominantly localized on the trunk and scalp, and occur symmetrically in a seborrheic distribution. A unilateral, or localized, variant has also been identified. In this report we describe an asymmetric presentation of DD in a 67-year-old man. A 67-year-old man presented with hyperkeratotic papules with pruritus localized on his trunk and both of his upper extremities, but also on his right lower leg. Subungual hyperkeratosis and nail dystrophies were noted on his nails. Oral mucosa changes were not observed. These lesions had been present for 10 years (Fig. 1). There was no family history. He was treated with acitretin 20 mg ⁄day and a topical steroid for this condition 3 years prior and the patient’s lesions had cleared in 3 months. There was no history of rubbing or contact with any particular materials. Also, a negative patch test was observed. Laboratory studies and fungal cultures from his nails were normal. The initial differential diagnosis included lichen amyloidosis and DD. Histopathological examination of a punch biopsy from the back and leg revealed suprabasilar acantholysis in the epidermis with dyskeratotic cells (Fig. 2). The histopathological features of the lesions in the back and leg were similar. Amyloid deposits were not found for lichen amyloidosis. Direct immunofluorescence microscopy was negative. Darier disease was diagnosed, and treated with acitretin 25 mg ⁄day and a topical steroid. Darier disease is also known as keratosis follicularis or Darier–White disease. Its prevalence has been estimated to be between 1:30.000–100.000. The onset of this chronic disease occurs typically in the first two decades of life. DD affects both sexes, although men