Tuğrul Dereli

Treatment of Ingrown Toenail With Proximolateral Matrix Partial Excision and Matrix Phenolization

PURPOSE Ingrown toenail is one of the most common nail conditions. Although many surgical treatments are described for complicated cases, recurrence of pain and postoperative disability are common. We evaluated the long-term efficacy of proximolateral matrix partial excision followed by chemical matricectomy with phenol. METHODS We performed 348 proximolateral partial matricectomies and phenol ablations in 225 patients with stage 2 or 3 ingrown toenail. Patients were examined weekly until full wound healing was achieved and were observed for 24 months to assess the long-term efficacy of the treatment. RESULTS Short-term results were good. We observed only 1 recurrence during the 24-month follow-up period, at 8 months. The success rate was therefore 99.7%. No severe complications occurred. Cosmetic results were remarkably good. CONCLUSIONS Proximolateral partial matricectomy with phenol ablation is an excellent surgical method for the treatment of ingrown toenails, having low morbidity and a high success rate, even in the long term.

Relapsing polychondritis in a child with common variable immunodeficiency.

Common variable immunodeficiency (CVID) is associated with recurrent infections and autoimmunity. The most common autoimmune conditions are idiopathic thrombocytopenic purpura, autoimmune hemolytic anemia, chronic arthritis, and gastrointestinal inflammation. Relapsing polychondritis (RP) is an episodic and progressive systemic inflammatory disease, characterized by auricular chondritis, polyarthritis, nasal, and respiratory tract chondritis. Autoimmunity to cartilage‐related components is thought to be involved in its pathogenesis. So far, RP has not been included within many autoimmune conditions that have been reported in patients with either CVID or any other primary immunodeficiency. In this report, a case of CVID with RP and chronic arthritis is presented.

Porokeratosis of Mibelli: successful treatment with cryosurgery.

Porokeratosis of Mibelli, a disorder of keratinization, should be treated because of the possibility of development of malignant epithelial tumors on the porokeratotic lesions. Liquid nitrogen cryosurgery is considered to be particularly useful in the treatment of precancerous and benign skin lesions. We aimed to evaluate the efficiency of this method in the treatment of porokeratosis of Mibelli. Eight patients with 20 porokeratotic lesions were treated with spray cryosurgery. Each lesion was frozen for 30 seconds with a spray tip after the keratotic borders were removed conically by sharp dissection. Eighteen of the 20 lesions were healed successfully with slight atrophy in one session. One more session was necessary for the other two lesions. Liquid nitrogen cryosurgery may be considered superior to other destructive methods in the treatment of porokeratosis of Mibelli, with advantages such as simplicity, high cure rates, low cost, short treatment period, and few complications.

Porokeratosis of Mibelli induced by topical corticosteroid

Background:  Porokeratosis of Mibelli is a chronic disorder characterised by slightly atrophic plaques surrounded by keratotic border.

Candida folliculitis mimicking tinea barbae

A 55‐year‐old man, a farmer, was referred to our dermatology department in June 1993 with inflammatory and infiltrated nodular lesions on his left cheek and neck. These nodular lesions had appeared about a month previously and had enlarged quickly. He was unaware of any antecedent trauma.

Amiodarone-induced multiorgan toxicity with ocular findings on confocal microscopy.

Amiodarone is an antiarrhythmic medication that can adversely effect various organs including lungs, thyroid gland, liver, eyes, skin, and nerves. The risk of adverse effects increases with high doses and prolonged use. We report a 54-year-old female who presented with multiorgan toxicity after 8 months of low dose (200 mg/day) amiodarone treatment. The findings of confocal microscopy due to amiodarone-induced keratopathy are described. Amiodarone may cause multiorgan toxicity even at lower doses and for shorter treatment periods.

Stewart-Bluefarb syndrome: a case report with angiographic findings.

Acroangiodermatitis is a group of benign, angioproliferative cutaneous disease caused by chronic venous insufficiency, acquired or congenital arteriovenous shunts and limb paralysis. Stewart–Bluefarb syndrome is the type of acroangiodermatitis which is associated with a congenital arteriovenous malformation. This is a rare syndrome characterized by cutaneous kaposiform lesions that usually onset at the second decade. In this report, a case of acroangiodermatitis associated with a congenital arteriovenous malformation, which has been diagnosed after 40 years, is described.

A rare human‐to‐human transmission of orf

the dose was then tapered gradually. However, polyarthralgia recurred after two years of treatment. Löfgren’s syndrome, an acute form of sarcoidosis, is characterized by erythema nodosum, bilateral hilar lymphadenopathy, and arthralgia. It is a common form of sarcoidosis in Caucasian populations but not in Japanese subjects. It is usually a self-limiting disease, becoming inactive within the first two years. Patients with this syndrome may have arthralgia, requiring NSAIDs, but corticosteroids are rarely required. In addition, the presence of erythema nodosum is a predictor of good prognosis in patients with sarcoidosis. However, some patients with Löfgren’s syndrome are resistant to NSAIDs and show a chronic course. In the present case, symptoms persisted despite treatment with NSAIDs. Histopathological confirmation is important in establishing the diagnosis of sarcoidosis, including Löfgren’s syndrome, particularly if corticosteroid treatment is considered. It is necessary to exclude the possibility of diseases such as lymphoma, tuberculosis, fungal infection, berylliosis, and other conditions associated with hilar lymphadenopathy. Careful physical examination may reveal skin lesions suggestive of granulomatous lesions. More frequently, an asymptomatic myopathy is present in patients with Löfgren’s syndrome and other forms of sarcoidosis. The myopathy is frequently associated with systemic involvement, although the link with specific organ damage is not known. Muscle biopsies in patients with sarcoidosis are useful for histological confirmation of granulomatous inflammation despite the absence of muscle symptoms. It has been recommended to biopsy the gastrocnemius muscle, which has a diagnostic yield of 20–75%. We used high-frequency sonographic imaging for evaluation of myopathy and performed muscle biopsy based on these findings. High-frequency sonography is frequently used for evaluating the thickness of skin tumors in dermatology. As muscle biopsy is an invasive surgical procedure, accurate evaluation of muscle condition before the biopsy is essential to minimize patient discomfort. High-frequency sonography is a useful means of detecting muscle alterations, even in patients with no symptoms, and thus allows us to determine biopsy sites precisely. Atsuko Ohashi, MD Hiroshi Koga, MD Koichi Hayashi, MD, PhD Hisashi Uhara, MD, PhD Ryuhei Okuyama, MD, PhD Department of Dermatology Shinshu University School of Medicine Matsumoto Japan E-mail: rokuyama@shinshu-u.ac.jp

Pachyonychia congenita type 2, N92S mutation of keratin 17 gene: clinical features, mutation analysis and pathological view

Pachyonychia congenita (PC) type 2 is a rare inherited genetic disease characterized by hypertrophic nail dystrophy, palmoplantar hyperkeratosis and multiple pilosebaceous cysts. In some cases, natal teeth and hair abnormalities may be present. It is caused by mutations in keratin 17 or its expression partner keratin 6b. Here, an N92S (p.Asn92Ser) germline keratin 17 gene mutation in a pachyonychia congenita type 2 female patient is presented. The pedigree includes the 15 members of a family who showed a severe expression of the phenotype for six generations with a similar clinical picture consisting of sebaceous cysts, nail dystrophy, hyperkeratosis, hair abnormalities, natal teeth, hoarseness and hyperhydrosis. In conclusion, we emphasize the importance of diagnosing and managing pachyonychia congenita in childhood for the assistance of affected children and for the development of potential therapies.

Leuprolide acetate-induced leukocytoclastic vasculitis

Leukocytoclastic vasculitis (LCV) is a distinct clinicopathological entity with cutaneous lesions from purpuric macules to necrotic ulcers, and the other systemic manifestations, such as fever, arthritis, gastrointestinal complaints, renal failure, etc. Although the exact cause cannot be established in more than half of the cases, various infections, connective tissue disorders, malignancies, cryoglobulinemia, and certain drugs are implicated (1). Leuprolide acetate is a synthetic analog of gonadotropin-releasing hormone that is used in the treatment of endo-metriosis, leiomyomas, and in the palliative treatment of advanced prostatic cancer. Adverse cutaneous reactions rarely occur with leuprolide acetate treatment (2). However, LCV associated with leuprolide acetate has not been reported until now. Here, a leuprolide acetate-induced LCV in a patient who had been treated for endometriosis by leuprolide acetate is presented.