Şeniz Ergin

Skin Tags and Atherosclerotic Risk Factors

An association between skin tags and insulin resistance, obesity, impaired carbohydrate and lipid metabolism has been suggested. However, there still is a need for comprehensive and controlled clinical studies. We aimed to evaluate the atherogenic risk factors in patients with skin tags. Thirty‐six patients with skin tags who were admitted to the dermatology department and 22 healthy controls were included in this study. Possible subjects who were taking systemic drugs or who had a systemic disease that may be associated with lipid or carbohydrate metabolism abnormalities were excluded from the study. All the measurements were completed in 26 patients. Standard oral glucose tolerance tests were performed on the patient and control groups. Serum insulin, total cholesterol, triglyceride and HDL‐cholesterol levels were measured. LDL‐cholesterol and VLDL‐cholesterol ratios and HOMA‐IR and body mass indices were calculated. The mean levels of body mass index, HOMA‐IR, and total cholesterol were significantly higher in patients than in controls. In conclusion, skin tags may not be innocent tumoral proliferations; instead, follow‐up of such patients with regard to the development of diseases associated with atherosclerosis may be beneficial.

Relapsing Henoch‐Schönlein Purpura in an Adult Patient Associated with Hepatitis B Virus Infection

Henoch‐Schölein purpura is usually a disease of children presenting with arthralgia, abdominal pain, renal involvement, and palpable purpura. Viral and bacterial infections may have a role in its etiology. We present a 32‐year‐old male patient with recurrent Henoch‐Schölein purpura in association with a chronic hepatitis B infection of ten years duration. The patient had received lamuvudine and interferon‐α for the treatment of hepatitis B infection for a year. The skin lesions disappeared with the treatment of the hepatitis B infection. Four months after discontinuation of the therapy, the purpuric papules reappeared with reactivation of the hepatitis B infection. Although rarely reported, hepatitis B virus infection should be considered in patients with Henoch‐Schölein purpura.

Cantharidin–podophylotoxin–salicylic acid versus cryotherapy in the treatment of plantar warts: a randomized prospective study

Background  Plantar warts are refractory to any form of treatment. High cure rates have been reported with a topical proprietary formulation consisting of 1% cantharidin, 5% podophyllotoxin and 30% salicylic acid (CPS). However, no data exists comparing the efficacy of this formulation with another treatment. Cryotherapy is a method that is also widely used in the treatment of plantar warts. Likewise, there is no evidence that it is more effective than any topical treatment.

Dermatoscopy for monitoring treatment of actinic keratosis with imiquimod.

patients. J Dermatolog Treat 2011; DOI: 10.3109/0954 6634.2010.544707. 2 Della Monica A, Ioli A. Profilo farmacologico e clinico dell albendazolo. Riv Parassitol 1986; 3: 143–51. 3 Meneghelli UG, Martinelli AL, Bellucci AD et al. Polycystic hydatid disease (Echinococcus vogeli). Treatment with albendazole. Ann Trop Med Parasitol 1992; 86: 151–6. 4 Steiger U, Cotting J, Reichen J. Albendazole treatment of echinococcosis in humans: effects on microsomal metabolism and drug tolerance. Clin Pharmacol Ther 1990; 47: 347–53. 5 Saimot AG. Medical treatment of liver hydatidosis. World J Surg 2001; 25: 15–20. 6 Dewerdt S, Machet L, Jan-Lamy V et al. Stevens-Johnson syndrome after albendazole. Acta Derm Venereol 1997; 77: 411. 7 Garcı́a-Muret MP, Sitjas D, Tuneu L, de Moragas JM. Telogen effluvium associated with albendazole therapy. Int J Dermatol 1990; 29: 669–70.

Mal de Meleda: a new geographical localization in Anatolia.

Background: Mal de Meleda (MDM) is an autosomal recessive form of palmoplantar keratoderma first described on the Dalmatian island of Meleda. MDM has been observed in many other countries so that the origin of the MDM gene may be elsewhere than in Meleda. Objective: After identification of the first MDM patient during a medical visit, a study was planned to reveal other families with MDM in the Köprüçay region in Anatolia. Methods: The patient was interviewed with a questionnaire including a pedigree drawing. All the subsequent cases reported to be of MDM were visited for clinical examination and pedigree drawings. Results: Thirty-nine patients, 8 families and 2 additional cases with MDM were identified in a 50-km2 mountainous region in Köprüçay canyon in Anatolia. The prevalent clinical features were nail involvement (80%), ‘glove-and-sock’ distribution of the keratoderma (60%), edema on the hands/feet (60%), conical tapering of the fingertips (60%) and hyperhidrosis on the palms and soles (50%). Conclusion: To our knowledge, this is the largest series reported. The relationship between the patients in Meleda and those in Anatolia awaits discovery by further researches that will be carried out with the collaboration of dermatology, genetics and medical history departments.

Nasal antibiotic‐resistant Propionibacterium acnes carriage in acne vulgaris patients in Turkey

Dear Editor Propionibacterium spp. are present in pilosebaceous units but the role of these ubiquitous organisms in the pathogenesis of acne remains unclear. Recently, however, the spreading of antibiotic-resistant Propionibacterium acnes has been accepted as a cause of therapeutic failure in acne vulgaris. Many countries have reported antibiotic-resistant P. acnes from acne patients due to widely prescribing antibiotics for acne therapy. Although forehead skin samples are preferred for cultivation of P. acnes, recent studies have focused on the importance of nasal colonization and/or carriage. The aim of the study was to investigate the presence of nasal P. acnes carriage and the search for resistance to certain antibiotics in acne vulgaris patients. In this study, 120 acne vulgaris patients who had not been on an antibiotic therapy in the prior 4 weeks, were included. The detergent scrub technique of Williamson and Kligman was used for cutaneous bacteria sampling from forehead. Sterile cotton-tipped swabs were premoistened with sampling solution (0.075 mol/L phosphate buffer saline containing 0.1% Tween 80). For each patient, 4 cm of the skin surface was rubbed with the amount of pressure similar to that is used to erase with a pencil. The swab was returned to the tube and swirled in the fluid. This procedure was repeated four times. The same procedure was applied to the inner surface of nares. The sample was incubated at 36.5°C for 5 days in thioglycollate medium Brewer’s modification. After 5 days, bacteria from visibly growing parts of the thioglycollate tubes were transported with a Pasteur pipette to Trypticase-yeast extract-glucose broth (TYG) agar (20 gL tryptone, 10 gL yeast extract, 5 gL glucose, 15 gL agar) containing 2 μg/ml furazolidone (Sigma Chemical, Poole, Dorset, UK) to inhibit the growth of Staphylococci. This medium was also used for isolation of nasal Propionibacteria. Incubation was carried out for 5 days at 37°C in anaerobic conditions. P. acnes was identified according to the method of Marples and McGinley including Gram stain, aerotolerance, indol production and catalase test. Minimum inhibitory concentrations (MIC) were determined by agar dilution on Wilkins Chalgren agar (Oxoid) as described by the National Committee for Clinical Laboratory Standards (NCCLS). Erythromycin (EM), clindamycin (CLDM), tetracycline hydrochloride (TC) and doxycycline hydrochloride (DOXY) were used for susceptibility testing. The inocula contained 10 colony-forming units (CFU)/1 μL spot in TYG broth delivered by manual inoculator. MIC were recorded after 3 days of anaerobic incubation at 37°C as the lowest concentration yielding no growth or a barely visible haze as determined by the unaided eye. The MIC breakpoints 1 μg/ml for EM and CLDM, and 4 μg/ml for TC and DOXY were accepted as resistance levels. Statistical analyses were performed with EPI Info 2000 Ver 3.3.2 program (Centers for Disease Control and Prevention (CDC), Atlanta, USA). Fifty-three (44.2%) P. acnes were isolated from both skin and nares (Table 1). In the case of isolation of P. acnes from the skin, the nasal culture positivity was detected as 66.3% (as sensitivity). In the absence of skin P. acnes isolation, the nasal culture was negative in 80.0% (as specificity). Cutaneous and nasal isolates resistance rates were not statistically different between groups for EM (12.5% vs 11.8%), CLDM (10.0% vs 11.8%) and TC (2.5% vs 5.0%) (P > 0.05). DOXY resistance was not found within groups. Table 2 shows antibiotic MIC values of skin and nasal P. acnes isolates. The antibiotic susceptibility levels did not differ in skin and nasal samples (P > 0.05).

Calcinosis Cutis in a Newborn with Transient Pseudohypoparathyroidism

Pseudohypoparathyroidism (PHP) is a heterogenous group of disorders characterized by hypocalcemia with hyperphosphatemia, increased serum concentration of parathyroid hormone (PTH), and insensitivity to the biological activity of PTH. Calcinosis cutis, the cutaneous deposition of calcium salts in the dermis, is a rare clinical symptom in infancy. The deposition of calcium in the skin may be classified as dystrophic, metastatic, idiopathic, and iatrogenic. Although a few infants with PHP and calcinosis cutis have been reported, to the authors’ knowledge, the combination of neonatal transient PHP and calcinosis cutis associated with calcium treatment has not been previously reported. The authors report a newborn boy with transient PHP presenting with early hypocalcemia, hyperphosphatemia, increased PTH levels, and calcinosis cutis after intravenous treatment of calcium gluconate.

Carpet weaving: an occupational risk for onychomycosis?

Background  Some occupations carry a risk for fungal infections.

Analysis of clinical and histopathological findings of PAS positive dermatophytose cases

Purpose: In most cases, dermatophytosis is diagnosed routinely without histopathological examination. Spongiotic or psoriasiform features are frequently found in fungal dermatoses but these histopathological findings are not proficient for diagnosis. The aim of the study is to identify characteristic histopathogical clues and to emphasize the diagnostic significance of dermatophytosis stained with histochemical method of Periodic acid-Schiff [PAS]. Materials and methods: In this study; PAS and Hematoxylin and eosin [H&E] stained slides and their clinical parameters of 19 dermatophytose cases confirmed by PAS stain were reevaluated. We compared histopathological and histochemical findings with clinical findings of all cases. Results: Fungal microorganisms were identified with PAS stained slides in 68.4 % cases in which fungal infection had not been suspected clinically. We detected perifolliculitis in all endothrix infection visualised cases. This finding and the presence of parakeratosis were significant for fungal infections. Conclusion: Therefore, histochemical PAS stain is required for fungal diagnosis in any spongiotic or psoriasiform dermatitis. Also, the presence of parakeratosis and endothrix as well as the perifolliculitis findings should be kept in mind as helpful pathologic clues to facilitate an accurate diagnosis of dermatophytic infections. Pam Med J 2015;8(3):171-177

A case of acquired reactive perforating collagenosis with diabetes mellitus and renal failure

Reactive perforating collagenosis is a rare disease of elimination of altered collagen through the epidermis. Its synonym is collagenoma perforans verruciforme. The disease exists especially with diabetes mellitus and chronic renal failure and also with hyperparathyroidism, hypothyroidism, lymphoma, malignancy, neurodermatitis, liver disease, atopic dermatitis, scabies, acquired immune deficiency syndrome, pulmonary fibrosis and herpes zoster infection. In the review of literature, we present a case with acquired reactive perforating collagenosis associated with diabetes mellitus and renal failure.