Nilay Duman

Rosacea and cardiovascular risk factors: a case control study.

Rosacea is an inflammatory skin disease with a chronic course. This study aimed to investigate the risk of cardiovascular disease (CVD) in rosacea patients.

Screening for latent tuberculosis infection in psoriasis and psoriatic arthritis patients in a tuberculosis-endemic country: a comparison of the QuantiFERON®-TB Gold In-Tube test and tuberculin skin test.

Since the introduction of biologic therapies for tuberculosis (TB), screening for latent TB infection has increased in importance, especially in countries in which TB is endemic. The aim of this study was to evaluate the effect of psoriasis on tuberculin skin test (TST) results and to compare two TB screening tests, the TST and QuantiFERON®‐TB Gold In‐Tube (QFT–GIT) test, in psoriasis and psoriatic arthritis (PA) patients living in a TB‐endemic country (Turkey). This prospective study included 61 psoriasis and 40 PA patients, and 58 healthy controls. Demographic data, medical history, human immunodeficiency virus (HIV) status, level of education, smoking status, exposure to TB, personal and family histories of TB, and bacillus Calmette–Guérin (BCG) vaccination status were recorded for all participants. The TST and QFT–GIT were performed in all participants. The mean ± standard deviation TST indurations in the patient and control groups were 12.6 ± 6.4 mm and 10.2 ± 6.5 mm, respectively (P = 0.051). The TST positivity rate was higher in patients than in controls (86.1% vs. 37.9%; P < 0.001), whereas QFT–GIT positivity did not differ significantly (patients: 20.8%; controls: 17.2%; P = 0.737). False positive results can lead to unnecessary prophylactic TB treatment; therefore, the cut‐off point for TST positivity in psoriasis and PA patients should be re‐evaluated, or other tests, such as the QFT–GIT, should be used.

Nevus-Associated versus de novo Melanoma: Do They Have Different Characteristics and Prognoses?

Aim: The aim of this study was to determine if nevus-associated melanoma differs in characteristics and prognosis from de novo melanoma. Patients and Methods: The study included 118 melanoma patients. Clinical findings were retrospectively evaluated. For histopathological parameters, HE sections were reexamined. The differentiation between de novo and nevus-associated melanoma was based on the histopathological evidence of a precursor nevus. In addition, all analyses were repeated in all cases in which nevus-associated melanoma was defined based on patient anamnesis. Results: Among all patients, 28 (23.7%) had nevus-associated melanoma. Nevus-associated melanoma was most commonly located on the extremities (50%), followed by the trunk (25%), whereas de novo melanoma was most commonly located in the head and neck region (32.2%), followed by the acral region (31.1%). Other clinical findings and histopathological parameters did not differ significantly between the two groups (p > 0.05). The findings remained consistent following the repeated analysis of all cases in which nevus-associated melanoma was defined based on patient anamnesis. Conclusions: Nevus-associated melanoma was most commonly located on the extremities and the trunk, whereas de novo melanoma was most commonly located in the head and neck and the acral region. Furthermore, nevus-associated melanoma was similar to de novo melanoma in terms of prognosis and other disease characteristics.

Syringocystadenoma papilliferum arising on naevus sebaceus: A 6-year-old child case described with dermoscopic features

Naevus sebaceus (NS) has a well-documented potential to develop a wide variety of benign or malignant neoplasms of both epidermal and adnexal origins, especially at puberty or adulthood. Syringocystadenoma papilliferum (SCAP) is a rare cutaneous adnexal neoplasm with variable clinical appearance but characteristic histology. It is one of the most common benign tumours developing on NS. Childhood cases of SCAP arising on NS are rare. Furthermore, there is only one report describing the dermoscopic features of SCAP arising on NS. A 6-year-old boy presented with a pruritic papule over a hairless area on his scalp that had been present since birth. A dermatological examination revealed a 2 × 1 cm yelloworange hairless plaque over the occipital scalp consistent with NS, with a flesh-colored papule on its left side (Fig. 1). A non-polarised dermoscopic examination of the papule revealed central yellowish-white discolouration with polymorphic vessels including irregular dotted, hairpin-like, glomerular and linear vessels and a surrounding pinkishwhite rim with peripheral hairpin-like vessels (Fig. 2). A histopathological examination of the papule revealed cystic invaginations extending into the dermis, with numerous papillary projections and stroma rich in plasma cells, consistent with SCAP (Fig. 3). The parents were informed about the risk of an although rare, malignant transformation and new tumours that would probably arise on NS, and elective total excision before puberty was suggested. The actual value of dermoscopy in the diagnosis of adnexal tumours is not yet known. As far as we know, there is only one case report describing the dermoscopic features of SCAP. In this case, Bruno and colleagues reported a polymorphous vascular pattern including irregular linear and glomerular vessels, some of which were surrounded by a whitish halo and others grouped in a horseshoe arrangement on a pinkish-white background. In our patient we observed polymorphic vessels including irregular, dotted, hairpin-like, glomerular and linear vessels on a central yellowish-white discoloration and a surrounding pinkishwhite rim with peripheral hairpin-like vessels. However, we do not know if those dermoscopic features are specific for SCAP, whether or not it arises on NS. Additionally, the lesion in our patient was pruritic, therefore we do not know if some of the vascular features are secondary to scratching and the healing of scratches or trauma due to brushing and so on, rather than reflecting the SCAP per se. Various types of vessels were reported in a dermoscopic evaluation of adnexal tumours. Crown vessels were described in sebaceous hyperplasia, arborising vessels were shown in cylindroma, hidradenoma and intraepidermal poroma. In a recent study with 13 cases of nonpigmented ecrine poroma, a polymorphous vascular pattern was found in most cases. Four lesions presented with irregular linear and branched vessels with semi-elliptical or semicircular endings, which the authors named as chalice-form and cherry-blossoms vessels. In conclusion, our case provides evidence that tumours such as SCAP can develop on NS in patients as young as

Long-term follow-up of early mycosis fungoides patients treated with narrowband ultraviolet B phototherapy

Background: Narrowband ultraviolet B (UVB) provides complete response (CR) in 54–91% of early mycosis fungoides (MF) patients. Data concerning relapse rate and relapse-free interval after discontinuation of therapy need clarification. The purpose of this study was to evaluate the relapse rate and the relapse-free intervals of early MF patients after achieving complete response with narrowband UVB phototherapy. Methods: Retrospective evaluation of data, which belong to early MF patients treated with narrowband UVB phototherapy between May 2000 and July 2010, and followed-up until May 2012 in a single institution, for the occurrence of relapse and the time to relapse. Results: Of 31 patients, who were followed-up for a mean of 56.5 ± 30.2 months (median 55 months, range 20–120 months), relapse was observed in 11 (35.5%) patients, within a mean of 28.8 ± 18.2 months (median 33 months, range 4–59 months), whereas 20 (64.5%) patients stayed relapse-free for a mean of 54.2 ± 28.8 months (median 55.5 months, range 20–119 months). Patients received maintenance phototherapy with a median duration of 12 months (range 1–30 months) after achieving complete response. Conclusion: Results indicate that narrowband UVB phototherapy may induce low relapse rates and long relapse-free intervals for early MF.

Angioma serpiginosum: report of two cases suggesting type 1 mosaicism and proposal of adding it to the list of mosaic skin conditions

mosaic skin conditions Angioma serpiginosum (AS) is a rare nevoid vascular disorder first described by Hutchinson in 1889. Etiopathogenesis of AS is not known exactly. Although AS was previously regarded as only a telangiectatic process, it is not a simple telangiectasia of pre-existing vessels; an element of vascular proliferation also appears to be present, and nowadays it is regarded as a type of capillary nevus. Histopathological examination shows single or grouped ectatic, congested, thin-walled capillaries in the papillary dermis without the presence of inflammation, hemorrhage, or hemosiderin. AS usually occurs sporadically, but rare familial cases with autosomal dominant (OMIM 106050) and X-linked dominant (OMIM 300652) inheritance have been reported. AS is clinically characterized by asymptomatic multiple, grouped, red punctate nonblanchable macules in serpiginous and gyrate patterns often on an erythematous background. It usually occurs in the first to second decades of life and mostly observed in females. Although often seen unilaterally in lower extremities, it can occur on any part of the body, except for mucous membranes and palms. However, a case with sole involvement was reported. Bilateral asymmetric lesions, extensive cutaneous involvement, and linear and segmental lesions suggesting mosaicism have also been reported. Herein, we describe two AS cases with patterned lesions suggesting mosaicism. A 10-year-old boy had a 2-year history of an asymptomatic lesion. Physical examination revealed a linear lesion comprised of multiple punctate non-blanchable macules extending along Blaschko lines from the left upper arm to the medial forearm and hand (Fig. 1). Dermoscopic evaluation revealed well-demarcated red lagoons (Fig. 2). The second patient was a 9-year-old girl that presented with a slowly progressing asymptomatic lesion that was present for three years. Physical examination revealed multiple reddish, non-blanchable macules clustered as broad bands extending from the right upper back to the front of the shoulder (Fig. 3). Well-demarcated red lagoons were observed in dermoscopic examination. With these clinical findings, a diagnosis of AS was made, and follow-up without treatment was recommended. In both cases, unilateral nevoid telangiectasia was in the differential diagnosis. Unilateral nevoid telangiectasia presents as a linear or segmental patch composed of telFigure 1 A linear patch composed of multiple punctate nonblanchable red macules extending from left upper arm to the medial forearm along Blaschko lines (case 1)

Host immune responses and peritumoral stromal reactions in different basal cell carcinoma subtypes: histopathological comparison of basosquamous carcinoma and high-risk and low-risk basal cell carcinoma subtypes

BACKGROUND/AIM The literature does not include sufficient data on the associations between host immune responses and stromal reactions in different basal cell carcinoma (BCC) subtypes. The aim of the study was to compare host immune responses and stromal reactions between basosquamous carcinoma (BSC) and high-risk (HR) and low-risk (LR) BCC subtypes. MATERIALS AND METHODS The study included 35 BSC, 40 HR-BCC, and 40 LR-BCC patients. Age, sex, lesion location, density of peritumoral/adjacent perivascular inflammation, presence of lymphoid follicle formation, and stromal reaction type were compared between groups. RESULTS In all 3 groups, age, sex distribution, and lesion location were similar. Overall, 70% of lesions in the LR-BCC group exhibited mild peritumoral inflammation, whereas in the BSC and HR-BCC groups dense inflammation was observed in 50% and 57.5% of lesions, respectively (P < 0.001). All lesions (100%) in the LR-BCC group had fibromyxoid stroma, whereas 61.8% and 80% of lesions in the BSC and HR-BCC groups, respectively, had desmoplastic stroma (P < 0.001). CONCLUSION The BSC and HR-BCC groups were similar in terms of host immune responses and stromal reactions. Furthermore, BSC and HR-BCC were associated with dense peritumoral inflammation, adjacent perivascular inflammation, and desmoplastic stroma.

Peripheral Radial Vessels: A Dermoscopic Finding in Annular Lichen Planus: Case Report

124 ichen planus is an idiopathic chronic inflammatory skin disease affecting skin, hair, nails and mucous membranes. Classic lichen planus is characterized with pruritic, small, and violaceous papules favoring the flexor surfaces of the extremities.1 Annular lichen planus is a rare clinical variant affecting about 10% of patients and it is characterized with annular lesions with hyperpigmented or skin-colored center and slightly raised purple to white peripheral borders.2 Annular lesions may be scattered among more typical lesions, or may be found as an isolated finding.2 Literature data about dermoscopic features of annular lichen planus is very Peripheral Radial Vessels: A Dermoscopic Finding in Annular Lichen Planus: Case Report

A pediatric case with vasculitis-like viral eruption induced by Epstein–Barr virus

four Chinese individuals and six Malaysians have been reported to harbor the same mutation. Thus, the mutation appears to be relatively common in Asians. The second case discussed here showed juvenile-onset GPP. After considering the high incidence of such cases, we can hypothesize that this splice-site mutation may result in early-onset GPP. In conclusion, herein we report T123M and 115+6T>C mutations, both homozygous in nature, in two Japanese individuals with Zumbusch type of GPP. Recently, the mutations of the IL36RN gene were shown to be associated with palmoplantar pustulosis, acrodermatitis continua of Hallopeau, and acute generalized exanthematous pustulosis. Mutation analysis for GPP and these related pustular disorders have been instrumental in the development of specific treatment armamentarium for IL36 signaling.

Multiple Eclipse Naevi on Scalp of a Child: Awareness Can Prevent Unnecessary Surgery

Eclipse naevi are a kind of signature naevi that are mostly observed on trunks of adults and on scalps of children. As they can have some of the criteria for melanoma and can be difficult to follow up especially when they are located on scalp, removal might be recommended frequently by dermatologists. However they are actually benign and they only need observation. In this report a child with multiple eclipse naevi on scalp was described and literature data about eclipse nevus was reviewed to make physicians to be aware of this innocent lesion and to prevent unnecessary surgical procedures. Fifteen years old boy presented with 8 similar naevi on scalp characterized by tan homogenous centers and brown peripheral rims. Dermatoscopy of the lesions demonstrated central homogenous tan areas that were structureless except focal globules and regular brown pigment networks in the periphery. Excisional biopsy of a lesion was done and histopathological diagnosis was consistent with benign compound melanocytic naevus. With these findings diagnosis of eclipse naevus was made. To be aware of eclipse naevi is important to prevent unnecessary concern and surgical procedures.