Peyker Türkdoğan

Wolf's Isotopic Response: A Case of Zosteriform Lichen Planus

Lichen planus is a lichenoid disorder characterized by shiny, flat papules. In addition to the classical appearance, there are several variants. Zonal or zosteriform lesions have been described. A 25‐year‐old male with a complaint of increasing numbers of erythematous swellings on his left groin for twenty days was admitted to our out‐patient clinic. He had a history of herpes zoster in the same localization which had been treated with topical acyclovir two weeks prior to his admission. Dermatological examination revealed multiple, shiny, erythematous, umblicated papules localized to the left inguinal region in a linear pattern. A biopsy was taken from the lesions. According to the clinical and pathological findings the diagnosis was zosteriform lichen planus. Zosteriform lichen planus is a rare variant of lichen planus; its differentiation from zona zoster and other linear dermatoses is difficult. We presented our case because of its rarity as a variant of lichen planus and its appearance in the area of healed herpes zoster as an isotopic response.

Erythromelanosis follicularis faciei et colli associated with keratosis pilaris in two brothers

Abstract:  Erythromelanosis follicularis faciei et colli is characterized by well‐demarcated erythema, hyperpigmentation, and follicular papules. Since the original description, it has seldom been reported in the literature. We present two adolescent brothers who had this disorder associated with keratosis pilaris on the shoulders and the extensor surfaces of the arms. Dermatologic examination found brown‐red pigmentation, erythema, and follicular papules on both maxillary, preauricular regions, and the cheeks. The lesions of the older brother were more prominent. Histopathologic examination of skin biopsy specimens taken from both brothers revealed hyperpigmentation of the basal layer, follicular plugging, dermal vascular dilatation and congestion, and perivascular inflammatory infiltration. We suggest that the coexistence of these two conditions in brothers implies a genetic inheritance and a possible relationship between the disorders.

Histopathological evaluation of the urethra after the Snodgrass operation: an experimental study in rabbits.

Objective  To investigate the histopathological outcome of the incised urethral plate after tubularized incised‐plate urethroplasty (the Snodgrass procedure to repair hypospadias) in a hypospadiac rabbit model, as it can produce meatal and neourethral strictures, and healing with scarring.

Trombosed solitary angiokeratoma of Mibelli simulating malignant melanoma: the importance of dermoscopy in differential diagnosis

102 JEADV 2006, 20 , 100–122

Cyclic Lymphocytic Vasculitis Associated with Chronic Lymphocytic Leukemia

Lymphocytic cutaneous vasculitis associated with a haematological malignancy has rarely been reported. Here, we describe a 61 year-old woman with chronic lymphocytic leukemia (CLL) who presented with cutaneous lesions on both hands. These lesions improved after all combination chemotherapy courses and recurred before each course. Repetitive skin biopsies revealed lymphocytic vasculitis. After 7 courses of chemotherapy, she had a complete remission. Skin lesions disappeared and did not recur. The cyclic pattern of lymphocytic vasculitis and its relation with CLL disease activity are interesting clinical features in this case.

Generalized granuloma annulare in a patient with type II diabetes mellitus: successful treatment with isotretinoin

JEADV 2006, 20, 100–122

Palmoplantar Lichen Planus Presenting with Vesicle-Like Papules

Palmoplantar lichen planus is a rare, localized variant of the disease that may create difficulty in diagnosis if it is present as an isolated finding. Although several morphological patterns may be seen, plaques or small papules with compact hyperkeratosis are usually observed. We present a 25‐year‐old woman with a one‐month history of slightly pruritic, red papules on her palms and soles. Dermatologic examination revealed numerous, asymptomatic, unscaly, red papules on her palms and soles, some of them resembling vesicles and white reticulate plaques on both sides of the buccal mucosa. The diagnosis was established by the typical histopathological features of lichen planus. Although resistant to topical corticosteroids, she responded well to systemic corticosteroid therapy, and no recurrence was observed during the follow‐up period of one year.

Transient eruptive seborrhoeic keratoses associated with erythrodermic pityriasis rubra pilaris

In contrast to the sign of Leser-Trélat, which is the appearance of multiple seborrhoeic keratoses in association with underlying internal malignancy, the sudden appearance of seborrhoeic keratoses in association with erythroderma has been described in very few case reports. The initial reports of erythroderma-associated transient eruptive seborrheic keratoses (TESK) included patients with underlying generalized eczema, benign renal tumour, pityriasis rubra pilaris (PRP), psoriasis and erythrodermic drug eruption. A 69-year-old woman with an erythrodermic PRP developed multiple seborrheic keratoses during treatment with etretinate. Her PRP was brought under control with etretinate therapy. At the time this therapy began, the patient noticed the onset of small, reddish-brown verrucous papules on the erythrodermic femoral triangles bilaterally, and that these lesions began to appear in conjunction with the erythrodermic flaring of the PRP. Dermoscopic examination revealed comedo-like openings and milia-like cysts, which are the dermoscopic hallmarks of seborrheic keratosis. Histopathologic examination revealed hyperplastic epidermis overhanging the surrounding skin, uniform basaloid cells, keratin cysts and melanocytes. In conclusion, the clinical, dermoscopic, and pathologic findings were all consistent with seborrheic keratosis. As the erythroderma cleared, more seborrheic keratoses, which had not been present before the recent flare, became evident. On resolution of the erythroderma, the keratoses began to involute and fall off; 4 months after resolution there were no seborrheic keratoses remaining. The appearance of multiple lesions in four patients with generalized erythroderma, clinically and histologically consistent with seborrheic keratoses, was first described by Williams. These lesions were described as acanthoma ; they differed from classic seborrheic keratoses only by their transient nature. The lesions spontaneously involuted within 6 months of clearing of the erythroderma. Barriére et al. reported similar findings, again with the diagnosis of acanthoma and the resolution of skin lesions paralleling resolution of the erythroderma. The two cases of Flugman et al. represent the same phenomenon as in these original descriptions; the descriptive term acanthoma is a semantic distinction based only on the transient nature of these seborrheic keratoses. We believe that our case fits the descriptions by Williams and by Barriére et al. Berman and Winkelmann suggested that the seborrheic keratoses regressed with the same type of mononuclear cell inflammation seen in other spontaneously regressing cutaneous tumours, such as verruca plana, keratoacanthoma, molluscum, and halo nevi. Schwengle and Rampen likewise reported the histologic findings of seborrheic keratoses with mononuclear cell inflammatory infiltrate in their patient with TESK due to erythrodermic PRP. If seborrheic keratoses can arise as a result of an array of diseases, including psoriasis, PRP, benign neoplasms, allergic contact dermatitis, and eczema, then it may be true that erythroderma resulting from any aetiologic factor, including malignancy, may cause seborrheic keratoses. A recent report of eruptive seborrheic keratoses occurring in a postoperative graft site suggests that there may be many other potential aetiologic factors that can cause this transient eruption. The role of etretinate in the regression of the seborrheic keratoses in our patient is not clear. Although systemic retinoid therapy has not been reported to influence the course of seborrheic keratoses, Schumacher and Stüttgen reported an effect of topical retinoic acid in eight patients with such keratoses. In our patient, the seborrheic keratoses regressed further after withdrawal of etretinate therapy and did not recur during follow-up; Schwengle and Rampen’s case was similar. Therefore, it is uncertain whether the lesions regressed after control of the cutaneous inflammation or as a result of the etretinate therapy. The association of eruptive seborrheic keratosis with erythrodermic skin conditions is an important clinical entity that has been underrepresented in the dermatologic literature. TESK is a self-limiting condition that can occur within the context of many different underlying diseases that produce erythroderma. The seborrheic keratoses characteristically involute and disappear as the erythroderma resolves; this process most likely represents regression through mononuclear cell infiltration. Thus, the term TESK should be used to denote cases in which the eruptive lesions are associated with an inflammatory skin condition. We report this case in order to bring TESK to the attention of clinicians and also to review the literature describing erythroderma-induced TESK. To the best of our knowledge, this case represents the second report of TESK associated with erythrodermic PRP.

Effect of adhesion barrier (interceed TC7) on two-stage orchidopexy operation

Objective: In two-stage orchidopexy, adhesions formed after the first stage usually cause difficulty during the second operation and may even lead to injury to the testis itself or to the spermatic cord. We investigated whether the use of adhesion-preventing barriers in the abdominal or pelvic region during surgery could lessen adhesions formed during two-stage orchidopexy and thus ease dissection. Material and Methods: The study subjects comprised 21 male, albino, 30-day-old Wistar rats that were divided into three equal groups. In Group 1, the right testes were enveloped in adhesion barriers after dissection and sutured to the inguinal canal. In Group 2, the right testes were sutured to the inguinal canal without the barriers. In Group 3 (sham-operated group), all testes were dissected but no suturing was performed. Rats were sacrificed after 21 days and the ipsilateral testes were harvested. Results: Dissection of barrier-enveloped testes was relatively easy; however, no significant (p < 0.535) difference was seen in adhesion scores between Groups 1 and 2. Total tissue collagen was estimated by means of the hydroxyproline content. Tissue hydroxyproline levels were 16.04 ± 8.58, 13.20 ± 6.34 and 14.71 ± 5.51 μg/mg wet tissue in Groups 1-3, respectively and these differences were not significant. The histopathologic evaluation revealed significant differences only in the thickness of the tunica albuginea in Groups 1 and 2 (110.0 ± 30.0 vs 77.1 ± 21.3 μm, respectively; p < 0.038). Conclusion: The adhesion scores and the biochemical and histopathological examinations showed that an adhesion barrier is not beneficial in two-stage orchidopexy.