Nursel Dilek

Fungal infections of the folds (intertriginous areas)

Superficial fungal infections are widespread, regardless of age and gender, in populations all around the world and may affect the skin and skin appendages. Although there are thousands of fungal infections from various genera and families in nature, those that are pathogenic for humans and nesting in skin folds are limited in number. The prevalence and distribution of these fungi vary according to the patients and certain environmental factors. Because the areas including the lids, external auditory canal, behind the ears, navel, inguinal region, and axillae, also called flexures, are underventilated and moist areas exposed to friction, they are especially sensitive to fungal infections. Fungi can both directly invade the skin, leading to infections, and indirectly stimulate immune mechanisms due to tissue interaction and their antigenic character and contribute to the development or exacerbation of secondary bacterial infections, seborrheic dermatitis, atopic dermatitis, and psoriasis. Superficial fungal infections can be classified and studied as dermatophyte infections, candidal infections, Malassezia infections, and other superficial infections independently from the involved skin fold areas.

Cutaneous drug reactions in children: a multicentric study.

Introduction According to studies conducted in outpatients, it is estimated that 2.5% of children who are treated with a drug will experience a cutaneous adverse drug reaction (CADR). Aim To analyze the CADR reports involving pediatric patients recorded by three different university hospitals for describing common, serious, and interesting cutaneous drug eruption patterns. Material and methods For this purpose, the patients’ data from three different universities were reviewed retrospectively. Diagnosis was based on history, clinical findings and laboratory test results. The CADRs were classified into seven categories; urticaria, angioedema, maculopapular eruption, fixed drug eruption, erythema multiforme, acute generalized exanthematous pustulosis, drug rash with eosinophilia and systemic symptoms syndrome. Results A total of 122 patients who had CADRs were enrolled in the study. The most frequently detected cutaneous drug reactions were urticaria + angioedema. Most of patients had no previous experience with the same drug and the most common causative agent of CADRs was antimicrobials. Conclusions Since CADRs are relatively rare, the current multicentric study can provide meaningful information about the cutaneous eruption patterns of commonly used drugs.

Coexistence of aplasia cutis congenita, faun tail nevus and fetus papyraceus.

BACKGROUND Aplasia cutis congenita is a disorder of the skin embryonic development characterized by a defect of localized or widespread areas of skin at birth. The lesions are mostly oval, 1-3 cm in diameter, with localization on the parietal part of scalp (60%) and rarely on the face and extremities. MAIN OBSERVATIONS Herein, we reported a case of aplasia cutis congenita termly born at 39 weeks of gestation to a 30-year-old mother with bronchial asthma attacks. She was referred for 3 punched-out punctate depressed defective lesions in 0.4 cms diameter on the vertex covered with necrotic and hemorrhagic crusts. There was a hypertrichotic area consisting of tufts of terminal hair on the lumbosacral area over a sinus tract. Maternal perinatal drugs included aerosol salbutamol sulfate, ipratropium bromide and oral montelukast sodium for bronchial asthma. The pregnancy was firstly started as a di-chorionic, di-amniotic twin gestation, but deteriorated after the fetal resorption of the co-twin in the 20th gestational week resulting in fetus papyraceus. CONCLUSION In multi-gestational pregnancies, the presence of the fetus papyraceus or the death of the co-twins should make the neonatologists and dermatologists be aware of the possible cutaneous defects like aplasia cutis congenita. We emphasize that the possibility of this rare entity should be kept in mind in the presence of fetus papyraceus, perinatal drug use, maternal cigarette smoke, or maternal diseases like bronchial asthma in multiple gestations.

The relationship between severity of the disease and circulating nucleosomes in psoriasis patients

Psoriasis was initially considered to represent a disease of abnormal epidermal keratinocyte proliferation. Proliferation of keratinocytes is restricted by apoptotic cell death to maintain a constant thickness of epidermis. Nucleosomes are mainly released by apoptotic cells. Tumor necrosis factor-α (TNF-α) is an important factor affecting the apoptosis. In the present study, the relationship between TNF-α, nucleosome and the Psoriasis Area and Severity Index (PASI) score was investigated. The patients were divided according to PASI score into three groups (mild, moderately, severe). Serum TNF-α and nucleosome levels were measured using Enzyme-linked immunosorbent assay (ELISA) method. Our findings show a correct relationship between PASI scores and TNF-α and an inverse relationship between nucleosome and PASI score. According to the results obtained from the study, we believe that serum nucleosome levels can be used as a new indicator in follow-up of patients with psoriasis and monitoring of the effectiveness of drugs which used in the treatment of psoriasis.

Cutaneous leiomyoma in a child: A case report

Leiomyoma is a benign tumour commonly encountered in the genitourinary and gastrointestinal organs in adults. Cutaneous leiomyomas are rare benign tumors arising from the arrector pili muscle of hair follicles. Cutaneous leiomyomas are more likely to occur in adults than in children. We describe a case of a 10-year-old female who presented with multiple, firm, red-brown masses on the back. A punch biopsy was performed. Under high-power examination, spindle cells with an eosinophilic cytoplasm were observed and immunohistochemical studies were performed; the cells stained strongly positive for smooth muscle actin (SMA). The patient was subsequently diagnosed with pilar leiomyoma and referred to a plastic surgeon for surgical treatment. Although cutaneous leiomyoma is a rare disorder, we identified a case of pilar leiomyoma in a young female. A careful clinical assessment led to the correct diagnosis and therapy in the present case. We propose that leiomyoma ought to be considered in the differential diagnosis of any cutaneous or mucosal mass in children.

Hepcidin expression in psoriasis patients.

Background: Iron is an essential nutrient for mammals. Accelerated loss of nutrients through hyperproliferation and desquamation from the skin in psoriasis is known. Hepcidin is an important and recently discovered regulator of iron homeostasis. Aims and Objectives: The present study was undertaken to investigate the hepcidin expression in psoriasis patients. Materials and Methods: We examined peripheral blood cell counts, serum Fe, ferritin, interleukin-6 (IL-6) and hepcidin levels using respectively automated hematology analyzer, Iron assay on the AEROSET system, chemiluminescent microparticle immunoassay with automated analyzer, and enzyme-linked immunosorbent assay. Results: The independent comparison of Fe, ferritin, IL-6 and hepcidin levels in psoriasis patients and control group (healthy volunteers) revealed lower Fe and higher IL-6, hepcidin levels in psoriasis patients. No significant difference was seen in the ferritin level between the psoriasis and the control group. Conclusions: We think that studies on hepcidin expression in psoriatic plaques will contribute to our understanding the role of iron and hepcidin in the pathogenesis of psoriasis.

Contribution of myeloperoxidase and inducible nitric oxide synthase to pathogenesis of psoriasis

Introduction Histological changes of psoriasis include invasion of neutrophils into the epidermis and formation of Munro abscesses in the epidermis. Neutrophils are the predominant white blood cells in circulation when stimulated; they discharge the abundant myeloperoxidase (MPO) enzyme that uses hydrogen peroxide to oxidize chloride for killing ingested bacteria. Aim To investigate the contribution of neutrophils to the pathogenesis of psoriasis at the blood and tissue levels through inducible nitric oxide synthase (iNOS) and MPO. Material and methods A total of 50 adult patients with a chronic plaque form of psoriasis and 25 healthy controls were enrolled to this study. Serum MPO and iNOS levels were measured using ELISA method. Two biopsy specimens were taken in each patient from the center of the lesion and uninvolved skin. Immunohistochemistry was performed for MPO and iNOS on both normal and psoriasis vulgaris biopsies. Results While a significant difference between serum myeloperoxidase levels were detected, a similar statistical difference between participants in the serum iNOS levels was not found. In immunohistochemistry, intensely stained leukocytes with MPO and intensely staining with iNOS in psoriatic skin was observed. Conclusions Neutrophils in psoriasis lesions are actively producing MPO and this indirectly triggers the synthesis of iNOS. Targeting of MPO or synthesis of MPO in the lesion area may contribute to development of a new treatment option.

Amelanotic malignant melanoma: a case study demonstrating pitfall of frequently missed opportunity for early diagnosis

Abstract Malignant melanoma is the most common primary malignant tumor of the foot. Amelanotic/hypomelanotic melanoma is characterized by either little or no pigmentation and account for 2-8% of all primary melanomas.

Epidermoid Cyst on the Nipple: A Rare Location

lateral section of the ascending aorta (Fig. 2a and b). Following these findings, a positron-emission tomography and a computed tomography scan were taken, which showed an increased metabolism in the lesion with standardized uptake values of 2.5 and suggested an active disease (Fig. 2c). After thorough consultation with a patient, a left side thoracotomy and resection of lesion was performed along with a resection of pericardium and diaphragm. Histopathologic finding showed that the lesion was a metastasis from a primary ILC (Fig. 3). She is currently undergoing her 18 month of treatment with capecitabine therapy and tolerating it well. Although metastatic breast cancer is considered as an incurable disease, a small number of patients remain disease-free for a long time. This is the first imaging report of breast cancer metastasis in the retrosternal fat tissue. The management of patients who have metastatic cancer is a systemic treatment, and the role of breast cancer metastasectomy is still unclear. The evidence of improved survival outcomes when systemic therapy is combined with local therapy (surgery or radiation), should raise up a possibility of incorporating other imaging modalities in standard for breast cancer follow-up, emphasizing the importance to recognize breast cancer metastasis at the time of suggestive symptoms.

The Different Distribution of Hepatitis C Virus Genotypes in Eastern BlackSea Region of Turkey

Hepatitis C virus (HCV) has infected about 170-200 million people worldwide and HCV genotypes have been related with a particular geographic distribution. The information of genotypes in chronic hepatitis C is critical for the decision of the pharmaceutical regimen, and for the therapeutic outcome. The aim of the study was determining the dispersion of hepatitis C Virus genotype in our area. The study was conducted on 42 patients who referred from various clinics infected with HCV. Serum HCV RNA levels were quantified by using the COBAS AMPLICOR HCV Monitor 2.0. An 851 bp long fragment spanning codons 63 to 347 of the RNA-dependent RNA polymerase in the NS5b part of the HCV genome was amplified. PCR amplifications were conducted in a BioRad DNA Engine using Quantitect SYBR Green PCR mix. Purified PCR products expressively sequenced with the ABI PRISM 310 Genetic Analyzer appliance utilizing DYEnamic ET Terminator Cycle Sequencing Kit. The most prevalent genotype was type 1b (90.4%) in our study. In the other types, type 3 and 4 were detected. We believe that distribution of HCV genotype in this region should be followed strictly due to difference from reports, which reported other parts of Turkey.