Nilgün Bilen

Dermoscopy is a suitable method for the observation of the pregnancy-related changes in melanocytic nevi

Background  It is a common opinion that expansion and darkening in melanocytic nevi may occur during pregnancy. The main problem is that whether it is a usual finding, or it is a condition that requires suspicion about melanoma.

Steatocystoma multiplex suppurativum: Oral isotretinoin treatment combined with cryotherapy

A 30‐year‐old man presented with numerous papules, nodules and inflamed cysts. The lesions were located all over the body, including the scalp, except the palms and soles. His mother and one sister had had similar but less extensive lesions. Histopathology of the biopsy specimens obtained from the anterior chest wall, axillae and the back region was consistent with steatocystoma multiplex (SM). A diagnosis of steatocystoma multiplex suppurativum was made. The inflamed lesions were treated with oral isotretinoin (1 mg/kg per daily) for 6 months. At the same time, cryotherapy was used for non‐suppurating lesions smaller than 2 cm. When the patient was evaluated 6 months later, cosmetic results were good. No new lesions have appeared in the subsequent 12‐month follow up.

Nitric oxide and malondialdehyde levels in plasma and tissue of psoriasis patients

Background  The pathogenesis of psoriasis has not been known exactly yet. Recently, it has been suggested that increased reactive oxygen species (ROS) such as nitric oxide (NO) and malondialdehyde (MDA) may play a part in the pathogenesis of various skin diseases, including psoriasis.

Cytokeratin expression in lichen amyloidosus and macular amyloidosis

Aim  To understand the role of epidermal cells in the pathogenesis of lichen amyloidosus (LA) and macular amyloidosis (MA).

Detection of Mycobacterium tuberculosis DNA in a patient with Melkersson-Rosenthal syndrome using polymerase chain reaction.

Sir, Langerhans cell histiocytosis (LCH) includes a spectrum of disorders with overlapping clinical features, i.e. Letterer±Siwe disease, Hand±SchuÈ ller±Christian syndrome, eosinophilic granuloma and congenital self-healing reticulohistiocytosis. The typical cutaneous findings comprise seborrhoeic dermatitis-like lesions, reddish-brown purpuric papules and nodules, oozing erosions, and ulcerations. A child with LCH is described, who presented with an uncommon pattern of pustular lesions on the forehead, hands, feet and genital region, following an atypical clinical course. One week after birth, a 14-month-old girl developed multiple, sharply demarcated itchy pustules on the forehead, together with red papules, and pustules partly covered with haemorrhagic crusts, which were predominantly on the soles of the feet (Fig. 1a). Some pustules occurred on the hands and in the genital and gluteal region. No lymphadenopathy was detectable. During topical treatment with lotio zinci (lotion with zinc oxide, talcum, glycerol and distilled water) the cutaneous lesions regressed slowly, but new lesions developed during the following months. After 5 months, an ulcer developed in the maxillary region. There was no specific family history of skin diseases. A skin biopsy of a pustule from the gluteal region revealed a dense upper dermal infiltrate of large histiocytes with a reniform nucleus, and intraepidermal collections of histiocytic cells (Fig. 1b). Immunohistochemical stains were positive for CD1 and for S-100 antigen. Electron microscopy revealed intracytoplasmic Birbeck granules within the histiocytic cells, thus confirming the diagnosis of LCH. Bacteriological and mycological examinations from skin lesions were negative. Full blood count, liver and kidney function were normal. Scintiscanning and radiography showed distinct involvement of the maxilla. Abdominal sonography was normal. Based on the occurrence of new cutaneous lesions and the subsequent involvement of the osseous part of the maxilla, chemotherapy was initiated with oral prednisolone 40 mg m daily for 4 weeks; then reduction of dose, vinblastine 0 ́2 mg kg once weekly for 6 weeks, then once monthly; and 6-mercaptopurine 50 mg m daily. Cutaneous lesions on the scalp, hands and feet, and the osseous lesion of the maxilla healed during the chemotherapy, which was performed for 1 years. In 1955, Lichtenstein summarized the three entities Letterer±Siwe disease, Hand±SchuÈ ller±Christian disease and eosinophilic granuloma under the term histiocytosis X. The cause of histiocytosis X (LCH) is unknown, but it is believed to be a proliferative process of Langerhans cells. Lesional histiocytes in the child described here were positive for S-100 antigen and CD1, as well as for intracytoplasmic Birbeck granules. The skin lesions did not clear completely

Heat shock proteins 60 and 70 expression of cutaneous lichen planus: comparison with normal skin and psoriasis vulgaris*

Background:  Heat shock proteins (HSPs) are expressed by most living cells and play fundamental roles in many biological processes. Their synthesis increases by a variety of stresses in order to enable cellular survival. Although it is known that they play an important role in immune and inflammatory responses of the skin, the role of HSPs in the pathogenesis of skin diseases has been studied in only limited skin diseases. Lichen planus (LP) is a relatively common papulosquamous dermatosis, and cell‐mediated immunity plays an important role in its pathogenesis. Although an altered expression of certain HSPs was reported in oral LP lesions, the expression of HSPs in cutaneous lesions of LP has not been investigated. In this immunohistochemical study, we aimed at investigating the role of HSPs in the pathogenesis of LP by studying whether there is any difference in HSP expression in cutaneous lesions of LP when compared to normal skin and psoriasis vulgaris (PV).

Possible role of Mycobacterium tuberculosis complex in Melkersson–Rosenthal syndrome demonstrated with Gen‐Probe amplified Mycobacterium tuberculosis direct test

Melkersson–Rosenthal (MRS) syndrome is characterized by a classical triad of recurrent or persistent orofacial swelling, peripheral facial nerve paralysis and lingua plicata. Granulomatous cheilitis (GC) is regarded as a monosymptomatic form of MRS. The exact aetiologies of MRS and GC are unknown. In this study we investigated the possible role of mycobacteria in these two conditions. A ribosomal RNA amplification‐based Gen‐Probe amplified Mycobacterium tuberculosis direct test was used to investigate the presence of M. tuberculosis complex in paraffin‐embedded skin biopsy specimens from five patients with MRS and one patient with GC. Three of the six specimens were shown to be positive using this system; one of the positive specimens also showed positive Ziehl–Neelsen staining. These results suggest a possible mycobacterial aetiology for MRS and GC.

Limited benefit of topical calcipotriol in lichen planus treatment: a preliminary study

BACKGROUND: Lichen planus (LP) is a papulosquamous dermatosis in which immunologic mechanisms play an important role in its pathogenesis. Topical calcipotriol, which mainly stimulates differentiation and inhibits proliferation of keratinocytes, also has immunosuppressive and anti-inflammatory functions. AIM: To investigate the therapeutical effects of topical calcipotriol in LP. METHODS: A total of 18 histopathologically proved LP patients were advised to apply calcipotriol ointment twice daily to all affected skin areas except genitalia. Clinical evaluation of all patients was performed monthly and response to treatment was assessed on clinical grounds (erythematous and/or violaceous color, thickness and scale of the lesions) as partial, complete or no response. If there was no response at the end of the second month, topical calcipotriol was stopped. If there was partial clinical improvement at the end of the second month, the treatment was continued for one additional month. RESULTS: In all, 16 patients completed the study. Of the study population, 56.25% (9/16) responded to topical calcipotriol treatment which was used for a maximum of 3 months. Complete clearing of the lesions with post-inflammatory hyperpigmentation and partial improvement were obtained in 31.25% (5/16) and 25% (4/16) of the patients, respectively. No improvement was observed in 43.75% (7/16) of the patients. CONCLUSION: Topical calcipotriol can be used in the treatment of LP as a therapeutic option, although it is not the first-choice drug.

Lichen amyloidosis, ankylosing spondylitis and autoimmune thyroiditis: coincidence or association?

Primary localized cutaneous amyloidosis (PLCA) is characterized by the deposition of amyloid in a previously apparently normal skin with the absence of other systemic or cutaneous disorder. Although ankylosing spondylitis may be associated with secondary systemic amyloidosis, no reports have been found showing the association of this disease with PLCA. In addition, the association of PLCA with autoimmune thyroiditis has not been previously reported. We report a concomitant occurrence of lichen amyloidosis, ankylosing spondylitis and autoimmune thyroiditis in a caucasian woman.

Lues Maligna in a Chronic Alcoholic Patient

Lues maligna, which is characterized by noduloulcerative lesions, is a rare form of secondary syphilis. It is mainly seen in either HIV‐infected or malnourished patients suffering from a depression in immunity. We presented a chronic alcoholic, HIV negative male patient with noduloulcerative lesions diagnosed as lues maligna based on his skin eruptions, results of serologic tests, and, histopathologic findings. We believe that chronic alcoholism could be the cause of immunosuppression in our case and wanted to emphasize the possibility of an association between lues maligna and chronic alcoholism.