Nida Kaçar

Dermoscopic evaluation of nodular melanoma

IMPORTANCE Nodular melanoma (NM) is a rapidly progressing potentially lethal skin tumor for which early diagnosis is critical. OBJECTIVE To determine the dermoscopy features of NM. DESIGN Eighty-three cases of NM, 134 of invasive non-NM, 115 of nodular benign melanocytic tumors, and 135 of nodular nonmelanocytic tumors were scored for dermoscopy features using modified and previously described methods. Lesions were separated into amelanotic/hypomelanotic or pigmented to assess outcomes. SETTING Predominantly hospital-based clinics from 5 continents. MAIN OUTCOME MEASURES Sensitivity, specificity, and odds ratios for features/models for the diagnosis of melanoma. RESULTS Nodular melanoma occurred more frequently as amelanotic/hypomelanotic (37.3%) than did invasive non-NM (7.5%). Pigmented NM had a more frequent (compared with invasive non-NM; in descending order of odds ratio) symmetrical pigmentation pattern (5.8% vs 0.8%), large-diameter vessels, areas of homogeneous blue pigmentation, symmetrical shape, predominant peripheral vessels, blue-white veil, pink color, black color, and milky red/pink areas. Pigmented NM less frequently displayed an atypical broadened network, pigment network or pseudonetwork, multiple blue-gray dots, scarlike depigmentation, irregularly distributed and sized brown dots and globules, tan color, irregularly shaped depigmentation, and irregularly distributed and sized dots and globules of any color. The most important positive correlating features of pigmented NM vs nodular nonmelanoma were peripheral black dots/globules, multiple brown dots, irregular black dots/globules, blue-white veil, homogeneous blue pigmentation, 5 to 6 colors, and black color. A model to classify a lesion as melanocytic gave a high sensitivity (>98.0%) for both nodular pigmented and nonnodular pigmented melanoma but a lower sensitivity for amelanotic/hypomelanotic NM (84%). A method for diagnosing amelanotic/hypomelanotic malignant lesions (including basal cell carcinoma) gave a 93% sensitivity and 70% specificity for NM. CONCLUSIONS AND RELEVANCE When a progressively growing, symmetrically patterned melanocytic nodule is identified, NM needs to be excluded.

The prevalence, aetiological agents and therapy of onychomycosis in patients with psoriasis: a prospective controlled trial

Background.  Nail involvement morphologically resembling onychomycosis frequently accompanies psoriatic lesions. The role of psoriasis as a predisposing factor for onychomycosis and the possible influence of psoriasis on responsiveness of onychomycosis to treatment are controversial.

The comparison of Nail Psoriasis Severity Index with a less time-consuming qualitative system

Objective  Reliable assessment of severity in nail psoriasis is essential to document treatment responses in clinical trials and routine clinical usage. In this study the correlation between Nail Psoriasis Severity Index (NAPSI) and Cannavos scoring system was assessed, and inter‐rater correlation of NAPSI scores were evaluated.

Cantharidin–podophylotoxin–salicylic acid versus cryotherapy in the treatment of plantar warts: a randomized prospective study

Background  Plantar warts are refractory to any form of treatment. High cure rates have been reported with a topical proprietary formulation consisting of 1% cantharidin, 5% podophyllotoxin and 30% salicylic acid (CPS). However, no data exists comparing the efficacy of this formulation with another treatment. Cryotherapy is a method that is also widely used in the treatment of plantar warts. Likewise, there is no evidence that it is more effective than any topical treatment.

Dermatoscopy for monitoring treatment of actinic keratosis with imiquimod.

patients. J Dermatolog Treat 2011; DOI: 10.3109/0954 6634.2010.544707. 2 Della Monica A, Ioli A. Profilo farmacologico e clinico dell albendazolo. Riv Parassitol 1986; 3: 143–51. 3 Meneghelli UG, Martinelli AL, Bellucci AD et al. Polycystic hydatid disease (Echinococcus vogeli). Treatment with albendazole. Ann Trop Med Parasitol 1992; 86: 151–6. 4 Steiger U, Cotting J, Reichen J. Albendazole treatment of echinococcosis in humans: effects on microsomal metabolism and drug tolerance. Clin Pharmacol Ther 1990; 47: 347–53. 5 Saimot AG. Medical treatment of liver hydatidosis. World J Surg 2001; 25: 15–20. 6 Dewerdt S, Machet L, Jan-Lamy V et al. Stevens-Johnson syndrome after albendazole. Acta Derm Venereol 1997; 77: 411. 7 Garcı́a-Muret MP, Sitjas D, Tuneu L, de Moragas JM. Telogen effluvium associated with albendazole therapy. Int J Dermatol 1990; 29: 669–70.

Reticulohistiocytosis: different dermatoscopic faces and a good response to methotrexate treatment

The reticulohistiocytoses are a rare group of non‐Langerhans cell histiocytic disorders. Recently, dermatoscopic features have been reported for some of the xanthomatous disorders. We report a case of diffuse cutaneous reticulohistiocytosis with 29 reticulohistiocytomas. On dermatoscopy of these lesions, we saw three typical features: a homogeneous pattern with various shades of yellow (defined previously as a ‘setting‐sun’ pattern), brown reticular structures, and central white scar‐like patches and streaks. The setting‐sun pattern was most commonly seen in combination with brown reticular structures. In four lesions, brown reticular structures surrounded a central white scar‐like patch resembling that of a dermatofibroma. However, the presence of the setting‐sun pattern in the background gave a different hue to that of the peripheral network seen in a dermatofibroma. A marked clinical improvement was associated with 6 months of systemic methotrexate treatment. Dermatoscopy may aid in the diagnosis of xanthomatous diseases. For this patient, methotrexate was beneficial.

Scientific productivity of OECD countries in dermatology journals within the last 10-year period

Background  Scientific productivity is closely related to gross income, population, and cultures of the countries. Every country, more or less, has a responsibility of contributing to science.

The investigation of the possible relationship between Coxsackie viruses and pemphigus

Pemphigus is a group of autoimmune bullous diseases on which the etiopathogenesis of several viruses has been blamed. Coxsackie viruses (CVs) are the causative agents of hand, foot, and mouth disease, and herpangina, which have been strongly associated with several autoimmune diseases. The onset of pemphigus after CV infection and cephalosporin use has been reported.

A scientometric analysis of dermoscopy literature over the past 25 years

Background  Dermoscopy is a useful method allowing the non‐invasive visualization of dermal and epidermal structures.

Nasal antibiotic‐resistant Propionibacterium acnes carriage in acne vulgaris patients in Turkey

Dear Editor Propionibacterium spp. are present in pilosebaceous units but the role of these ubiquitous organisms in the pathogenesis of acne remains unclear. Recently, however, the spreading of antibiotic-resistant Propionibacterium acnes has been accepted as a cause of therapeutic failure in acne vulgaris. Many countries have reported antibiotic-resistant P. acnes from acne patients due to widely prescribing antibiotics for acne therapy. Although forehead skin samples are preferred for cultivation of P. acnes, recent studies have focused on the importance of nasal colonization and/or carriage. The aim of the study was to investigate the presence of nasal P. acnes carriage and the search for resistance to certain antibiotics in acne vulgaris patients. In this study, 120 acne vulgaris patients who had not been on an antibiotic therapy in the prior 4 weeks, were included. The detergent scrub technique of Williamson and Kligman was used for cutaneous bacteria sampling from forehead. Sterile cotton-tipped swabs were premoistened with sampling solution (0.075 mol/L phosphate buffer saline containing 0.1% Tween 80). For each patient, 4 cm of the skin surface was rubbed with the amount of pressure similar to that is used to erase with a pencil. The swab was returned to the tube and swirled in the fluid. This procedure was repeated four times. The same procedure was applied to the inner surface of nares. The sample was incubated at 36.5°C for 5 days in thioglycollate medium Brewer’s modification. After 5 days, bacteria from visibly growing parts of the thioglycollate tubes were transported with a Pasteur pipette to Trypticase-yeast extract-glucose broth (TYG) agar (20 gL tryptone, 10 gL yeast extract, 5 gL glucose, 15 gL agar) containing 2 μg/ml furazolidone (Sigma Chemical, Poole, Dorset, UK) to inhibit the growth of Staphylococci. This medium was also used for isolation of nasal Propionibacteria. Incubation was carried out for 5 days at 37°C in anaerobic conditions. P. acnes was identified according to the method of Marples and McGinley including Gram stain, aerotolerance, indol production and catalase test. Minimum inhibitory concentrations (MIC) were determined by agar dilution on Wilkins Chalgren agar (Oxoid) as described by the National Committee for Clinical Laboratory Standards (NCCLS). Erythromycin (EM), clindamycin (CLDM), tetracycline hydrochloride (TC) and doxycycline hydrochloride (DOXY) were used for susceptibility testing. The inocula contained 10 colony-forming units (CFU)/1 μL spot in TYG broth delivered by manual inoculator. MIC were recorded after 3 days of anaerobic incubation at 37°C as the lowest concentration yielding no growth or a barely visible haze as determined by the unaided eye. The MIC breakpoints 1 μg/ml for EM and CLDM, and 4 μg/ml for TC and DOXY were accepted as resistance levels. Statistical analyses were performed with EPI Info 2000 Ver 3.3.2 program (Centers for Disease Control and Prevention (CDC), Atlanta, USA). Fifty-three (44.2%) P. acnes were isolated from both skin and nares (Table 1). In the case of isolation of P. acnes from the skin, the nasal culture positivity was detected as 66.3% (as sensitivity). In the absence of skin P. acnes isolation, the nasal culture was negative in 80.0% (as specificity). Cutaneous and nasal isolates resistance rates were not statistically different between groups for EM (12.5% vs 11.8%), CLDM (10.0% vs 11.8%) and TC (2.5% vs 5.0%) (P > 0.05). DOXY resistance was not found within groups. Table 2 shows antibiotic MIC values of skin and nasal P. acnes isolates. The antibiotic susceptibility levels did not differ in skin and nasal samples (P > 0.05).