Pınar Öztaş

Generalized pruritus: a prospective study concerning etiology.

AbstractBackground:Generalized pruritus can often be the primary manifestation of systemic disease. Objective:To determine how frequently generalized pruritus had a systemic etiology in an outpatient population seen in a dermatology department and whether any identifiable patient characteristics meant a systemic explanation of generalized pruritus was more likely. Methods:A prospective controlled study of 55 patients with generalized pruritus and 41 healthy age- and sex-matched control subjects. Clinical data were collected from patients and laboratory parameters investigated in both patients and healthy control subjects to determine the frequency of systemic disease in each group. Results: Of 55 patients, 12 had a systemic cause of pruritus. Pruritus was the initial symptom of systemic disease in eight of these patients. The underlying diseases included hypothyroidism, chronic lymphocytic leukemia, hepatitis C, hepatitis B, diabetes mellitus, lung cancer, uremia, and iron deficiency anemia. Of these, iron deficiency anemia was the most common cause. Compared with the control group, mean serum hemoglobin, iron, and cyanocobalamin (vitamin B12) levels in patients with generalized pruritus were lower. No other patient characteristics were statistically associated with systemic causes of pruritus. Conclusion:Generalized pruritus was the initial symptom of a systemic disease in 8 of 55 patients presenting to a dermatology outpatient clinic with this complaint. A number of underlying diseases were identified, of which the most common was iron deficiency anemia.

Isotretinoin-induced nail fragility and onycholysis

A 23 year old woman who presented with severe acne had been treated with 40 mg/day isotretinoin. On her monthly control, severe cheilitis and bilateral toe nail onycholysis were observed. It is well known that systemic retinoids have several side effects. Although dystropic nail, paronichia-like changes, median nail dystrophy have previously been reported with isotretinoin therapy, onycholysis is rare. In this report, we describe a case with isotretinoin induced nail fragility and onycholysis.A 23 year old woman who presented with severe acne had been treated with 40 mg/day isotretinoin. On her monthly control, severe cheilitis and bilateral toe nail onycholysis were observed. It is well known that systemic retinoids have several side effects. Although dystropic nail, paronichia-like changes, median nail dystrophy have previously been reported with isotretinoin therapy, onycholysis is rare. In this report, we describe a case with isotretinoin induced nail fragility and onycholysis.A 23 year old woman who presented with severe acne had been treated with 40 mg/day isotretinoin. On her monthly control, severe cheilitis and bilateral toe nail onycholysis were observed. It is well known that systemic retinoids have several side effects. Although dystropic nail, paronichia-like changes, median nail dystrophy have previously been reported with isotretinoin therapy, onycholysis is rare. In this report, we describe a case with isotretinoin induced nail fragility and onycholysis.

Bonbon toffee sign: a new dermatoscopic feature for sebaceous hyperplasia

Introduction  Sebaceous hyperplasia is a benign proliferation of the sebaceous gland. In this study, we tried to define the dermatoscopic features of sebaceous hyperplasia, which will help to minimize misdiagnoses.

Chronic Bullous Disease of Childhood in a Patient with Acute Lymphoblastic Leukemia : Possible Induction by a Drug

Linear IgA disease is characterized by the presence of linear IgA deposits in the basement membrane zone of the skin, and circulating basement membrane zone antibodies are detected in 80% of cases. The disease occurs in both adults and children, and is designated adult linear IgA disease in the former and chronic bullous disease of childhood (CBDC) in the latter. We describe a 5-year-old boy with acute lymphoblastic leukemia in remission, in whom CBDC developed after treatment with trimethoprim/sulfamethoxazole (cotrimoxazole). To our knowledge, this is the first reported case of possible drug-induced CBDC.

Neurofibromatosis 1/Noonan Syndrome Associated with Hashimoto's Thyroiditis and Vitiligo

Neurofibromatosis 1 (NF1) is an autosomal dominant disease which predominantly involves the skin and the nervous system. The cardinal features of NF1 include neurofibromas, cafe-au-lait spots, axillary and inguinal freckling, eye abnormalities comprising Lisch nodules, optic glioma and osseous lesions and learning disabilities (1). Noonan syndrome (NS), is a genetic disorder whose prevelance is estimated to be 1 in 1000 or 2500 live births. It is characterized by unusual triangular-shaped face, hypertelorism, down-slanting eyes, ptosis, strabismus, amblyopia, refractive errors, low-set ears with thickened helices, high nasal bridge, webbed neck, congenital heart disease (dysplastic/stenotic pulmonic valve, hypertrophic cardiomyopathy), short stature and chest deformities (pectus carinatum/excavatum, scoliosis) (2). Vitiligo, characterized by depigmented macules and patches on the skin, has been commonly reported as a component of multiple autoimmune syndromes and in association with autoimmune thyroid disease such as Hashimoto’s thyroiditis and Graves’ disease (3). Although NF1 has been seen in relation with various autoimmune diseases, coexistence with either Hashimoto’s disease or vitiligo has not been reported previously. Here we report a case with established NF1/NS who also has a diagnosis of vitiligo and Hashimoto’s disease.CASE REPORTA 20-year-old female patient was admitted to the hos-pital with hyperpigmented skin patches that had been present since birth and tumoral formations on her skin that had recently increased in number. She had also developed hypopigmented patches on her knees and elbows 4 years previously. Her family history revealed that her mother and father were second degree relatives (maternal cousins) and one of her cousins had similar skin lesions. On her physical examination she was 145 cm tall. She had scoliosis in her thoracic vertebrae and a short webbed neck. Her face was triangular with a prominent forehead and a small chin (Fig. 1a). Her ears were small and low-set with thickened helices (Fig. 1b). Her eyes were down-slanting and ptotic. Her dermatological examination revealed bilateral axillary freckling, several hyperpigmented macules and patches between 1 and 5 cm in diameter which were consis-tent with cafe-au-lait spots. She had large patches of depigmentation between 5 and 10 cm in diameter on the knees and elbows consistent with vitiligo (Fig. 1c). Skin biopsy confirmed the diagnosis of vitiligo. On laboratory examination, karyotype analyses revealed normal female with 46 XX. Complete blood count, se-rum and urine biochemistry were within normal limits. Thyroid stimulating hormone was 2.06 µIU/ml (normal range 0.35–4.95); T3 was 172 ng/dl (normal range 95–190); and T4 was 7.54 µg/dl (normal range 5–11). Antithyroid peroxidase level was 528 IU/ml (normal range 0–100 IU/ml) and antithyroglobulin was 442 IU/ml (normal range 0–100 IU/ml). The thyroid gland was firm on palpation and ultrasonography revealed a diffuse mildly enlarged gland. Abdominopelvic ultra-

Allergic contact dermatitis from Laurus nobilis (laurel) oil.

Keywords: Laurus nobilis; laurel oil; airborne; allergic contact dermatitis; herbal remedies; medicaments; cross sensitivity; plant extracts; sesquiterpene lactones

Phytocontact dermatitis due to Ranunculus illyricus: two cases

Editor Alternative herbal remedies are becoming more widely used, causing an increase in phytocontact dermatitis seen by dermatologists. Many herbal therapies are used either by local topical application or by systemic administration. In this article, two cases where ‘yellow weed’ was applied to the leg area to reduce rheumatological joint pain and where phytocontact dermatitis developed are reported.

Increased Expression of Segmental Neurofibromatosis with Bronchoalveolar Lung Carcinoma

Segmental neurofibromatosis, neurofibromatosis 5 (NF5), a special and infrequent form of neurofibromatosis, is characterized by café-au-lait (CAL) spots, freckling and neurofibromas limited to a unilateral segment. Special eye lesions of neurofibromatosis such as Lisch nodules and optic glioma are not present in NF5. The median age at onset is 28 years, and it appears not to be inherited [1]. The etiology and genetic implications of NF5 are not known. The most likely explanation is a somatic mutation that is propagated by mitosis to involve one dermatome or somatic mosaicism accompanied by gonadal mosaicism [2]. To our knowledge, no extraneural tumor associated with NF5 or no NF5 presenting as paraneoplastic disease has been reported before. We report a patient with bronchoalveolar carcinoma of the lung together with late-onset NF5 which presented as paraneoplastic NF5. A 75-year-old female patient was admitted to our hospital with a 3-year history of numerous soft nodules on her back and on the lower extremities for the last 2 months. In clinical examination she had numerous soft papules and nodules predominantly on her left upper back, left axilla, left lower leg and left plantar area. Since some of the lesions were mimicking skin tags clinically, a skin biopsy was performed. The diagnosis of neurofibroma was verified histopathologically. On the left thigh and patellar area multiple lentiginous macules and 2 CAL spots were noted which had been present since birth and early childhood. Other body areas including axillary and inguinal areas were free of lentiginous macules and CAL spots. No Lisch nodules or optic gliomas in the eyes and no skeleton abnormalities were detected. Her family history for neurofibromatosis was unremarkable. In her medical history, she was described as a nonsmoker and as having bronchoalveolar carcinoma in her left lung lower lobe diagnosed and surgically treated 3 years previously. The diagnosis of bronchoalveolar carcinoma had preceded the appearance of the skin nodules by 3 months. Complete blood count, full biochemical examination, urine analysis and computerized tomography of the abdomen were unremarkable. In computerized tomography of the thorax there were changes related to previous lobectomy without any signs of tumoral recurrence or metastasis. There is an increased incidence of specific cancers in NF patients. These include malignant peripheral nerve sheath tumor and Triton tumor, malignant glioma and extraneural malignancies such as pheochromocytoma, carcinoid tumor, rhabdomyosarcoma and juvenile chronic myeloid leukemia [3]. Only a few cases of lung cancers in neurofibromatosis 1 have been reported up to now. They include mostly adenocarcinomas, and 1 large cell tumor and 1 primary pulmonary sarcoma [4–6]. In NF5, only 2 cases of malignant peripheral nerve sheath tumors were reported [7]. No extraneural malignancies have been reported before. This is the first case of an extraneural malignancy in an NF5 patient. In the literature we have not found any neurofibromatosis presenting as a paraneoplastic skin disease. However, in the present case, the concomitant appearance of bronchoalveolar lung cancer and unusual very late onset NF5 does not seem to be coincidental. The acute and eruptive development of neurofibromas together with bronchoalveolar carcinoma suggests a paraneoplastic process accelerating the occurrence of neurofibromatosis rather than a simple coincidence in this patient with occult NF5. The factors promoting the development of neurofibromas are not clear. It has been reported that in urticaria pigmentosa cases mast cells might play a causative role in the development of neurofibroma and neurofibroma-like lesions [8]. Similarly in this case, some tumorigenic factors secreted by bronchoalveolar carcinoma cells may be responsible for the development or acceleration of neurofibromas in this patient.

Caspase-9 expression is increased in endothelial cells of active Behçet's disease patients

Background  Behçets disease is a multisystem disease of unknown etiology. Caspase‐9 is responsible for initiating the caspase activation cascade during apoptosis. The aim of this study was to examine caspase‐9 expression in both endothelial and perivascular infiltrates of patients with active Behçets disease.

Plasma homocysteine level is elevated in patients on isotretinoin therapy for cystic acne: A prospective controlled study

Purpose: Isotretinoin (Iso) has marked side effects. Homocysteine (Hcy) metabolizes in the liver, requiring folate and vitamin B12. Elevated blood levels of Hcy have been linked to an increased risk of premature coronary artery disease (CAD). In this study, we evaluated Hcy levels, vitamin B12, and folate in patients on Iso treatment for cystic acne (CA). Methods: Seventy‐four patients with CA were included to the study group. Blood levels of Hcy, vitamin B12, and folate were assessed before and after 45 days of Iso therapy. The control group consisting of 80 individuals were tested once. Results: Hcy levels were statistically significantly increased in patients on Iso treatment. Vitamins were unaltered, while lipids and liver enzymes increased statistically significantly. Conclusion: Hcy levels are elevated in patients on Iso treatment for CA. It may be due to either the inhibition of cystathionine‐β‐synthase, an enzyme required in the metabolism of Hcy, by the drug and/or the liver dysfunction. Daily supplementation with vitamin B12 and folate, which are the cofactors of the enzymatic reactions involved in Hcy metabolism, can lower plasma levels of Hcy, so it is recommended to take these vitamins in case of deficiency along with Iso to prevent premature occlusive vascular disease.