Dermatologic Findings Research Articles

Combined use of CROSS TCA and modified subcision with PRP administration for acne scars

Background: Acne vulgaris is a skin disease that can cause permanent scarring. Various therapeutic options are available to treat atrophic scars, but combination therapy is still the best choice according to different types of scars in a single patient. Chemical reconstruction of skin scars (CROSS) trichloroacetic acid (TCA), modified subcutaneous incisionless (subcision), and platelet-rich plasma (PRP) can be used as a combination therapy to treat acne scars. Case Illustration: A 25-year-old man complained of acne scars on both sides of his face. Dermatologic findings were blackheads, icepick, boxcar, and rolling scars. Clinically he had moderate to severe acne scores. He was treated with a combination of CROSS TCA for icepick-type acne scars, modified subcision, and PRP injection for rolling and boxcar-type acne scars on both sides of the face. During treatment, the patient was given oral and topical antibiotics. The patient was followed-up after one month. It resulted in a good therapeutic response, which showed 25%-49% of Goodman and Baron’s classification, and a visual analog scale of 6. Discussion: CROSS TCA is a therapeutic choice for icepick-type acne scars with a simple, practical technique and provides a significant effect. Modified subcision is modified therapies from the previous Khunger subcision technique and a new alternative that can be applied to damaged tissue. This can maximally repair scarring, facilitate surgeon, provide avenues, and increase maximum PRP penetration. Conclusion: CROSS TCA with subcision and PRP are simple procedures that can be applied as an alternative therapy to acne scars with good therapeutic response. Keywords: CROSS TCA, PRP, scars, subcision

Clinical and dermoscopic findings of benign longitudinal melanonychia due to melanocytic activation differ by skin type and predict likelihood of nail matrix biopsy

Longitudinal melanonychia (LM) is a common dermatologic finding in clinical practice with a broad differential diagnosis. Melanocytic activation is the most common LM etiology. To investigate clinical and dermoscopic differences of benign LM based on Fitzpatrick skin type and in biopsied versus nonbiopsied patients. A 10-year retrospective cohort of 248 benign LM cases at Weill Cornell Dermatology was identified and analyzed. Darker-skinned versus lighter-skinned patients had higher band width percentage (P=.0125), had lower band brightness (P<.001), had more band changes (P=.0071), and received more biopsies (P=.032). Biopsied (n=47) versus nonbiopsied patients (n=201) had less multidigit band involvement (P=.0008), higher band width percentage (P=.0213), lower band brightness (P=.0003), and more band changes (P<.0001). Darker skin types more often had brown versus gray coloration on dermoscopy (P=.0232). The mean band width percentage for all biopsied patients was 30.81% (range: 5.80%-100%). Single-center retrospective design. Subungual melanoma and other benign LM etiologies were not analyzed. Only 18.95% of patients received a biopsy. Darker versus lighter skin types more often present with darker and wider bands, present with brown versus gray coloration on dermoscopy, and receive more biopsies. Multi-institutional studies on LM are needed to determine nail matrix biopsy criteria in different skin types.

Case series study on skin manifestations in diabetic patients

Aim: The present study aimed to investigate the skin manifestation in diabetic patients. Patients and Methods: A case-series study was conducted on 120 diabetes patients having skin manifestation investigated in the Department of Dermatology, PIMS Hospital, Islamabad from 11th March 2021 to 10th March 2022. Study protocol was approved by the institute research and ethical committee. Patients of either gender or age with diabetes mellitus and having at least one skin manifestation were enrolled. Each individual underwent dermatological examination and systemic findings were noted. Blood samples from each individual were taken for measuring the blood glucose level. Skin manifestation images and relevant investigations such as histopathological and microbiological were conducted. SPSS version 26 was used for data analysis. Results: Of the total 120 DM patients, there were 86 (71.7%) type 2 DM or non-insulin dependent and 34 (28.3%) were type I DM or insulin dependent. Out of 120 DM patients, there were 22 (18.3%) male and 98 (81.7%) females. The overall mean age was 48.62± 16.48 years with an age range 16 to 70 years. The mean duration of the disease was 9.84± 8.42 years varied from 5 months to 25 years.

Biologic Therapies for the Management of Cutaneous Findings in Genodermatoses: A Review.

Genodermatoses are genetically inherited dermatologic conditions. The management of cutaneous findings in genodermatoses is challenging, and first-line therapies, such as steroids and/or retinoids, are often inadequate. In recent years, research on the molecular basis of genodermatoses has led to the use of biologic therapies for intractable disease. Here, we review the evidence regarding the use of available biologic therapies for the management of dermatologic findings in genodermatoses. Biologic therapies appear to be promising therapeutic options for several recalcitrant genodermatoses, especially those with underlying immune dysregulation. However, not all genodermatoses are amenable to biologic therapies, and some have been shown to paradoxically worsen under treatment. Biologic therapies offer a novel avenue to target refractory genodermatoses. However, evidence supporting the use of biologic therapies in the management of genodermatoses is mostly limited to case reports and case series. Further studies are warranted to determine the safety and efficacy of biologic therapies for the management of cutaneous findings in genodermatoses.

A novel desmoplakin mutation causes dilated cardiomyopathy with palmoplantar keratoderma as an early clinical sign.

BackgroundPPKs represent a heterogeneous group of disorders with hyperkeratosis of palmar and/or plantar skin. PPK, hair shaft abnormalities, cardiomyopathy and arrhythmias can be caused by mutations in desmosomal genes, e.g. desmoplakin (DSP). PPK should trigger genetic testing to reveal mutations with possible related cardiac disease.ObjectivesTo report a large multigenerational family with a novel DSP mutation associated with early‐onset PPK and adult‐onset cardiomyopathy and arrhythmias.MethodsA custom‐designed in‐house panel of 35 PPK related genes was used to screen mutations in the index patient with focal PPK. The identified DSP mutation was verified by Sanger sequencing. DNA samples from 20 members of the large multigenerational family were sequenced for the DSP mutation. Medical records were reviewed. Clinical dermatological evaluation was performed, including light microscopy of hair samples. Cardiac evaluation included clinical examination, echocardiography, cardiac magnetic resonance imaging (CMR), electrocardiogram (ECG), Holter monitoring and laboratory tests.ResultsWe identified a novel autosomal dominant truncating DSP c.2493delA p.(Glu831Aspfs*33) mutation associated with dilated cardiomyopathy (DCM) with arrhythmia susceptibility and focal PPK as an early cutaneous sign. The mutation was found in nine affected family members, but not in any unaffected members. Onset of dermatological findings preceded cardiac symptoms which were variable and occurred at adult age.ConclusionsWe report a novel truncating DSP mutation causing focal PPK with varying severity and left ventricular dilatation and ventricular extrasystoles. This finding emphasizes the importance of genetic diagnosis in patients with PPK for clinical counselling and management of cardiomyopathies and arrhythmias.

An observational study of infant dermatoses at a tertiary care health center in Delhi region

Objectives To know the prevalence and clinical patterns of infant dermatosis at a tertiary care referral institute. Patients and methods The present observational cross-sectional study was carried out on 508 neonates and infants with physiological and pathological skin conditions from August 1, 2018 to February 1, 2020. A standard study proforma was used to obtain detailed systemic and dermatological findings. Data entry was done in MS Excel, and data analysis was carried out using Statistical Package for Social Sciences, version 22.0. Results The common dermatoses were bacterial infection [folliculitis (29.03%) and staphylococcal scalded skin syndrome (19.35%)], fungal infections [candidal intertrigo (41.67%) and pityriasis versicolor (37.50%)], developmental abnormalities [accessory tragi (21.43%), anencephaly (14.29%), and cleft lip (14.29%)], diaper area eruptions [diaper dermatitis (81.82%), atopic dermatitis (45.92%), hemangiomas: infantile congenital hemangioma (60.87%) and nevus simplex/stork bite (21.74%)], hyperpigmentation disorders [Café-au-lait (44.44%) and congenital melanocytic nevi (22.22%)], hypopigmentation disorder [pityriasis alba (42.31%)], iatrogenic/traumatic disorders [Stevens-Johnson syndrome (40%)], immunologic disorders [insect bite hypersensitivity (41.18%) and acute urticaria (29.41%)], and transient benign disorders [Mongolian spots (23.28%) and Lanugo (14.29%)]. Conclusion Physiological dermatoses are transient and self-resolving and need to be differentiated from the pathological ones for management and parents’ reassurance. The pathological dermatoses are caused most commonly by infections and infestation, which warrants a clean and hygienic living. Owing to wide variety, burden, and public health problem of cutaneous dermatoses in infants, the current data can be useful in creating awareness among the dermatologists, pediatricians, and the health care system.

Clinical Characteristics, Wound Culture Results and Ulcer-Related Dermatological Findings in Patients with Active Venous Ulcers

Amaç: Bu çalışmanın amacı, aktif venöz ülseri olan hastalarda klinik özellikleri, yara kültürü sonuçları ve ülserle ilişkili dermatolojik bulguları belirlemekti. Materyal ve Metod: Çalışmamıza aktif venöz ülseri olan 28 hasta dahil edildi. Veriler hasta dosyalarından geriye dönük olarak analiz edildi. Bulgular: Hastaların %89,2'si erkek,% 75'i 40 yaşın üzerindeydi. Ortalama yaş 53,89 ± 14,46 idi. Hastaların %42,8'inde ilk kez ülser görülürken, diğerlerinde (%57,2) tekrarlayan ülser vardı. Ortalama ülser süresi 3,08 ± 3,35 yıldı. Ortalama ülser boyutu 6,3 x 8,4 cm2 idi. Venöz ülser hastaların %50'sinde solda, %42.8'inde sağda ve %7.2'sinde her iki ekstremitede idi. Ülser sıklıkla tekti (%89.2). Ülser en çok medial malleolün (%71,5) üzerinde yerleşmişti. Etiyolojide ikincil nedenler (%71,5) ilk sırada yer aldı. Anatomik olarak derin venöz tutulum (%78.6) en sıktı. Hastaların %64.3'ünde posttrombotik sendrom ve %35.7'sinde izole venöz yetmezlik vardı. Yara kültüründe en sık üreyen mikroorganizmalar sırasıyla pseudomonas aeruginosa (%32,1), proteus mirabilis (%28,5), escherchia coli (%28,5) ve staphylococcus aureus (%21,3) idi. Ülserle ilişkili dermatolojik bulgular; lipodermatoskleroz (%92,8), hiperpigmentasyon (%92,8), ödem (%75), ekzematöz staz dermatiti (%32,1), korona flebektatika (%28,5), likenifikasyon (%25), flebolenfödem (%17,8), selülit (%17,8), atrofi blanche (%10,8), otosensitizasyon dermatiti (%7.1) ve onikomikoz (%21,3) idi. Sonuç: Aktif venöz ülser klinik olarak kronik venöz yetmezliğin son aşamasıdır. Venöz ülser tedavisi zordur ve nüksü sıktır. Venöz ülser tedavisinde başarıya ulaşmak için multidisipliner bir yaklaşım gereklidir.

Association between biophysical properties and anxiety in patients with sensitive skin.

Sensitive skin (SS) is a syndrome in which neurosensory disorders accompany epidermal barrier dysfunction. However, it is not yet clear how high anxiety levels affect the biophysical parameters of the skin in patients with SS. We aimed to investigate the relationship between anxiety levels and facial neurosensitivity, the erythema index, sebum content, and sensitive skin scale scores in individuals with sensitive skin. The study was carried out on 35 individuals with SS and 40 without SS over three months. In the study, a questionnaire to detect the presence of sensitive skin, the sensitive skin scale for sensitive skin severity, the lactic acid sting test (LAST) to show facial neurosensitivity, a Mexameter for erythema index measurement, and a Sebumeter for sebum content measurement were used. In addition, the anxiety levels of the patient and control groups were measured using the hospital anxiety and depression scale (HADS). While the HADS-Anxiety scores were found to be significantly higher in patients with sensitive skin, there was no significant difference in the HADS-Depression scores. Moreover, a strong positive correlation was found between the HADS-Anxiety scores and the erythema index in patients with sensitive skin. Sensitive skin is a disorder that can sometimes occur without any dermatological examination findings. In particular, the sensations of the patients, along with their anxiety levels, are essential parameters that should be evaluated in the approach to patients with sensitive skin.

Prevalence of Skin Disease and Its Associated Factors Among Primary Schoolchildren: A Cross-Sectional Study from a Northern Ethiopian Town.

BackgroundSkin disease affects people of all ages, yet children are one of the most common victims of it. Although some data indicate a high prevalence of skin disorders among Ethiopian primary schoolchildren, little is known regarding it, particularly in the study area. Hence, the study aimed to investigate the prevalence of skin disease and its associated factors among primary schoolchildren in Debre Berhan town, North Shoa, Ethiopia.MethodsInstitutional-based cross-sectional study was conducted. The samples were chosen using a multistage stratified random sampling technique. Data were collected using both a self-administered and an interviewer-administered questionnaire. Children were clinically examined to detect and record the dermatological findings. A potassium hydroxide test was used to confirm some doubtful cases. The data were entered in Epi Info version 3.5.1 and analyzed using SPSS version 20.0. Variables with a p-value <0.05 were designated as having statistical significance.ResultsThe overall point prevalence of any skin disease was 61.2% (95% CI: 56.4–66.1). In a multivariable logistic regression model, a significant association between skin diseases and the occupation of the father being a farmer (AOR: 4.21, 95% CI: 1.06–16.63), bad personal hygiene (AOR: 1.78, 95% CI: 1.03–4.38), previous history of skin disease (AOR: 2.74, 95% CI: 1.41–5.30), exchange of clothes and towels with other family members (AOR: 1.50, 95% CI: 1.09–2.85), presence of trauma in the last one month (AOR: 2.09, 95% CI: 1.18–3.72) and not being a member of health insurance (AOR: 1.95, 95% CI: 1.16–3.28) has been found.ConclusionThe point prevalence of any skin disorder is alarmingly high. The commonest disorders found in this study were simple and could usually be cured easily. Hence, preventive and curative health services should be provided for these schoolchildren to achieve a considerable reduction in the prevalence of skin disorders.

A rare breast cancer in a patient with pierced nipples.

Paget disease of the breast is a rare form of breast cancer that affects the nipple and areolar complex. Clinicians should have a high suspicion for this condition in patients who fail conservative treatment for benign-appearing dermatologic findings regardless of age or sex. This article describes a patient with whose presumed nipple infection was initially thought to be related to her nipple piercing.

Isolated Skin Rash in Patient With Coronavirus Disease 2019: A Case Report of Skin Manifestation in COVID-19 Virus Disease

Coronavirus Disease 2019 was initially identified as an infection of the lower respiratory tract but has so far manifested itself with very different symptoms. One of these symptoms is skin lesions associated with an active viral infection that can occur from the onset of infection until treatment. Therefore, observing these skin manifestations can be helpful in diagnosing and managing the disease. Our case is a 56-year-old man who came to the infectious clinic with a chief complaint of skin rashes. The patient was in good general condition on arrival and had no evidence of systemic symptoms of infection, such as fever, body aches, and cough. However, the PCR test for COVID-19 was positive. Although many dermatological findings have been reported with Coronavirus Disease, this case has reported with no symptoms other than skin manifestations that describe a viral infection. It seems that this disease can cause unexpected symptoms, even in mild cases. Therefore, it is better to have the COVID-19 in the corner of your mind when examining people with these symptoms.

New dermatological findings of MIS-C: Can mucocutaneous involvement be associated with Severe Disease Course?

Little is known about mucocutaneous involvement in critically ill patients with the multisystem inflammatory syndrome in children (MIS-C). The aim of our study was to describe the localisation and variety of rash and to investigate whether presenting with rash at admission alters the clinical course of MIS-C. This prospective, observational cohort study was conducted amongst children under 18 years of age who were admitted to our paediatric intensive care unit (PICU) between May 2020 and May 2021 with a possible diagnosis of MIS-C. A total of 33 children with MIS-C, 21 boys (64%), with a median age of 9.4 years (3.4-11.5) were enrolled. Twenty-four children presented with mucocutaneous symptoms (72%). Age, male gender, PICU length of stay, presenting symptoms, inotrope requirement, the existence of myocarditis or respiratory failure were higher but not significantly different in patients with rash compared to those without rash (P > 0.05). The median duration of symptoms before admission and presence of cervical lymphadenopathy were significantly higher in patients than those without rash (P < 0.05). Children with a rash had a significantly higher neutrophil count, CRP, procalcitonin, troponin levels and lower lymphocyte counts and albumin levels than those without rash (P < 0.05). Twelve children with rash (50%) had symmetrical intertriginous distribution. Two children had erythematous lesions on the areola and the surroundings. In conclusion, intertriginous involvement, periareolar erythema and other mucocutaneous manifestations might be the first alarming symptoms of moderate to severe MIS-C. Therefore, close monitoring with a multidisciplinary approach should be considered for these patients to assess potential disease progression.

Bilateral benign isolated choroidal melanocytosis

Isolated choroidal melanocytosis is a congenital, typically unilateral melanocytic hyperpigmentation involving the choroid without any other features of ocular melanocytosis. It is a distinct clinical diagnosis that must be distinguished from an expansive list of choroidal pigmentary disorders. We present the rare case of bilateral isolated choroidal melanocytosis in a 40-year-old female of Asian heritage. The patient had no systemic illnesses or systemic symptoms and no dermatologic findings. On dilated fundus examination, she was found to have extensive bilateral choroidal melanosis.

COVID-19 und Hautmanifestationen: Übersicht der aktuellen Literatur im Rückblick auf die bisherige Pandemie

HintergrundDie durch das Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) ausgelöste anhaltende globale Pandemie manifestiert sich neben bekannten Organsystemen auch an der Haut. In der Literatur wurden verschiedene klinische Muster von Hauterscheinungen mit COVID-19 in Verbindung gebracht. Die Kenntnis der kutanen Manifestationen kann bei der Früherkennung, Risikostratifizierung von Patienten, Diagnose und den therapeutischen Strategien hilfreich sein. In dem vorliegenden Artikel wird der aktuelle Kenntnisstand zu dermatologischen Befunden im Zusammenhang mit COVID-19 unter Berücksichtigung der klinischen Präsentation, aktuellen pathophysiologischen Konzepten und Management zusammengefasst. Zukünftig sollen auch Erkenntnisse aus einem aktuell geführten Register der Universität Harvard gezogen werden können. Derzeit werden hier Hautveränderungen in Assoziation mit COVID-19 gesammelt (https://ilds.org/covid-19/international-dermatology-covid19-registry/).Ziel der ArbeitZiel dieses Übersichtsartikels ist es, die aktuell verfügbare Literatur mit Hinweisen auf Hautveränderungen im Zusammenhang mit COVID-19 zu analysieren, zu strukturieren und die wichtigsten Aspekte zusammenzufassen.Material und MethodenEs wurde eine systematische Literaturrecherche in der medizin-wissenschaftlichen Datenbank PubMed und Medline für englischsprachige Originalartikel, Fallserien und -berichte sowie Übersichtsarbeiten unter Verwendung der Suchbegriffe „Covid“, „COVID-19“ oder „SARS-CoV-2“ in Kombination mit „skin“ oder „dermatol“ durchgeführt, welche bis Februar 2021 (Einträge bis zum 28.02.2021) veröffentlicht wurden. Untersucht wurde der Zusammenhang zwischen bestätigten oder vermuteten SARS-CoV-2-Infektionen in Assoziation mit Hautmanifestationen. Eingeschlossen wurden vorwiegend Arbeiten, welche ein möglichst großes Patientenkollektiv, das Erwachsenenalter und einen positiven Corona-Nachweis beinhalteten. Ziel der Arbeit ist es, einen Überblick der am häufigsten beobachteten Hautmanifestationen bei Infektionen mit SARS-CoV‑2 zu geben.Ergebnisse und DiskussionDie Zuordnung der Hautmanifestationen im Rahmen einer SARS-CoV-2-Infektion nach klinisch dermatologischen Mustern kann dazu beitragen, Patienten mit erhöhtem Risiko frühzeitig zu identifizieren und adäquat zu behandeln, um einem möglicherweise schwereren Krankheitsverlauf wie er beispielsweise bei der Livedo auftritt, entgegenzuwirken. Die erworbenen Kenntnisse der pathophysiologischen Mechanismen können zu einem verbesserten Management der Erkrankung und Hilfestellung möglicher Gegenmaßnahmen in der Bewältigung der Erkrankung beitragen.

B12 VİTAMİN EKSİKLİĞİ OLAN ÇOCUKLARDA HEMATOLOJİK BULGULAR

Objective&#x0D; Vitamin B12 deficiency is a common condition in&#x0D; childhood and various neurological, hematological,&#x0D; and dermatological findings could be seen due to its&#x0D; deficiency. The aim of the study is to evaluate the&#x0D; hematological findings in children diagnosed with&#x0D; vitamin B12 deficiency.&#x0D; Materials and Methods&#x0D; Hematological data of children with B12 deficiency&#x0D; who were examined in Pediatric Hematology&#x0D; Department were retrospectively reviewed.&#x0D; Results&#x0D; Hematological data of one hundred twenty-four&#x0D; patients were assessed in our study. Anemia,&#x0D; thrombocytopenia and leucopenia were detected in&#x0D; 48 patients, 8 patients and 6 patients, respectively.&#x0D; Two infants presented with prolonged jaundice and&#x0D; hemolytic anemia. The mean vitamin B12 levels of the&#x0D; patients were 97.3±30.6 (5-140) pg/ml.&#x0D; Conclusion&#x0D; Vitamin B12 deficiency is a common disease in&#x0D; developing countries and it is mostly of maternal&#x0D; origin. In our study, vitamin B12 deficiency in mothers&#x0D; of 42 out of 52 infants (80%) were discovered. This&#x0D; percentage clearly shows the importance of the vitamin&#x0D; B12 level determination in pregnant women and its&#x0D; treatment in case of deficiency. Patients with vitamin&#x0D; B12 deficiency might be admitted to the hospital for&#x0D; various reasons. Therefore, it is recommended to&#x0D; keep in mind that vitamin B12 deficiency might be&#x0D; the base of various diseases, especially for patients&#x0D; presenting prolonged jaundice and hemolytic anemia.

EP262: De novo heterozygous variant in the RAB11B gene presenting with combined cardiac defect and neurodevelopmental disorder: A case report

The RAB11B gene (OMIM: 604198) encodes for a GTP-binding protein within the Rab11 GTPase subfamily which is associated with the regulation of exocytic and endocytic pathways. It also plays an essential role in ciliogenesis and vesicular trafficking. Pathogenic variants in RAB11B were first described in five patients in 2017. Subsequently, an additional patient was diagnosed through the Korean Undiagnosed Diseases Program (KUDP) in 2019. Clinical features shared by these patients were predominantly a neurological phenotype, including global developmental delay, epilepsy, hypotonia and gait disturbances. Ophthalmological, musculoskeletal, dermatological, and urological findings were also reported in some patients. MRI brain abnormalities were present in many of these patients and include decrease in white matter volume, patchy white matter signals, cerebellar hypoplasia, ventriculomegaly, thin corpus callosum and atypical partial rhombencephalosynapsis. Here we describe a 6-year-old male with previously unreported clinical findings of congenital heart defect in this disorder. A 5-year-old term male presented with prenatal complications of fetal congenital heart disease, maternal hypertension and maternal gestational diabetes. Fetal echocardiogram identified a tetralogy of Fallot (TOF) and post-natal echocardiogram confirmed the TOF with pulmonary valve atresia and 2 aorto-pulmonary collateral vessels from the descending aorta. Clinical examination at birth revealed bilateral congenital vertical talus but no other dysmorphic features. Fluorescent in-situ hybridization test for 22q11.2 deletion was negative. Chromosomal microarray analysis revealed a 133kb deletion of uncertain significance on chromosome 5q14.3. A head and renal ultrasound was normal at birth. He was diagnosed with congenital nystagmus and microcoria at 6 months of age with low amplitude on visual evoked potential testing. MRI brain revealed an extremely hypoplastic corpus callosum and brainstem, bilateral optic nerve hypoplasia, marked depletion of white matter and delayed myelination. He requires a G-tube for feeding. He has significant global developmental delays and is non-verbal. A clinical trio exome sequencing revealed a de novo, heterozygous, missense variant of unknown significance in the RAB11B gene (c.64 G>A; p.al22Met). This variant has since been re-classified as a pathogenic variant based on the published case series of 6 other individuals with similar phenotype. Given the fact that RAB11B is highly expressed in brain, cardiac and testicular tissue with various roles in ciliogenesis and vesicular trafficking, this patient’s cardiac defect is likely secondary to the pathogenic variant the RAB11B gene. We present this case of a de novo, heterozygous RAB11B variant presenting with a congenital heart defect in addition to a neurodevelopmental phenotype, thus expanding the phenotypic spectrum of this rare disorder.

Mucocutaneous Manifestations of People Living with HIV in Current Antiretroviral Therapy Era.

It has been reported that approximately 90 % of patients infected with the human immunodeficiency virus (HIV) have various cutaneous symptoms related to the virus. This study aims to describe the cutaneous disorders that have developed in HIV-infected patients and to investigate the factors that may be related, such as relationships to drug use and CD4 counts. This cross-sectional study included people living with HIV and being followed by our hospital's infectious diseases clinic after being referred to the dermatology clinic because of skin lesions. These patients had been diagnosed with HIV by enzyme-linked immunosorbent assay tests and were included in the study if they were older than 18 years and had agreed to participate. Findings from detailed dermatological examinations were recorded, along with the patients' CD4 counts, the durations of their illnesses, and the treatments they received. 144 patients were included in the study. The most common mucocutaneous manifestation was seborrheic dermatitis, at 28.5 % (n = 41). The mean CD4 count was 607.1 (min-max = 10.6- 1982). The CD4 counts were divided into three groups in the study as follows: 22 (15.3 %) patients with <200, 35 (24.3 seborrheic dermatitis) patients between 200 and 500, and 87 (60.4 %) patients with >500. There were no statistical differences between these groups in terms of dermatological findings. Nevertheless, the highest rate of patients with three or more dermatological conditions was found among those with CD4 counts <200 (n = 11.50 %). Skin manifestations are common in patients who are HIV-positive; however, many skin disorders can be seen in HIV/acquired immunodeficiency syndrome (AIDS) patients whatever CD4 cell counts of these patients are.

Cutaneous Manifestation of Diabetes Mellitus in an Unsheltered Male Leading to Emergent Hospitalization

Diabetes mellitus (DM) is one of the most common chronic diseases in the United States. It is characterized by increased patient morbidity and mortality due to the many complications that can arise. Certain dermatological findings can be indicative of poorly controlled DM and can be a useful clue to further management. Persons experiencing homelessness (PEH) with DM often have higher rates of diabetic complications than the general diabetic population. Medical providers caring for PEH in the setting of limited resources should carefully evaluate cutaneous disease as a potential indicator of underlying illness. This physical manifestation of illness can serve to guide the next appropriate steps in management. A 41-year-old unsheltered male with an extensive medical history of hypertension, seizures, chronic diarrhea, and cocaine use was seen at a “foot-washing” medical outreach event. He presented with fevers, chills, and multiple painless right lower extremity ulcerated lesions of unspecified origin. A finger-stick glucose measurement was found to be 650 mg/dL. After immediate administration of 10 units of insulin, he was transported immediately to the emergency department and admitted. His month-long hospital course was complicated and involved the amputation of multiple toes. Preemptive outreach and management could have prevented the marked deterioration of his disease and represents the importance of outreach and regular follow-up with the PEH community.

Characterizing dermatologic findings among patients with PTEN hamartoma tumor syndrome: Results of a multicenter cohort study

BackgroundDermatologic phenotypes in PTEN hamartoma tumor syndrome (PHTS) are heterogeneous and poorly documented. ObjectiveTo characterize dermatologic findings among PHTS and conduct an analysis of genotype-dermatologic phenotype associations. MethodsMucocutaneous findings were reviewed in a multicenter cohort study of PHTS. Genotype-dermatologic phenotype associations were tested using multivariable regression. ResultsA total of 201 patients were included. Children were significantly less likely than adults to have oral papillomas, vascular malformations, benign follicular neoplasms, and acral keratoses. There were no cases of skin cancer among children. Basal cell carcinoma, cutaneous squamous cell carcinoma, and melanoma developed in 5%, 2%, and 1% of White adults, respectively. After adjusting for age, missense mutations were associated with 60% lower odds of developing cutaneous papillomatous papules (odds ratio: 0.4; 95% confidence interval [0.2, 0.7]), oral papillomas (0.4; 95% confidence interval [0.2, 0.9]), and vascular malformations (0.4; 95% confidence interval [0.2, 0.8]). LimitationsPartly retrospective data. ConclusionChildren are less likely than adults to have certain dermatologic findings, likely due to age-related penetrance. The risk of pediatric melanoma and the lifetime risk of nonmelanoma skin cancer in PHTS may not be elevated. Missense variants may be associated with the development of fewer dermatologic findings but future validation is required.

Dermatological Findings in Fibromyalgia Syndrome and Their Effects on Quality of Life, Clinical Findings, and Depression

Purpose: The aim was to investigate the skin findings in patients with Fibromyalgia Syndrome (FMS), and the relations of these findings with the clinical symptoms of the disease, quality of life and depression levels of the patient. Materials and Methods: A total of 77 patients with FMS were included in the study as the study group, 74 individuals were included as the control group. The pain levels were evaluated with Visual Analogue Scale (VAS). The short form-36 (SF-36) was used to evaluate the quality of life levels of the patients. The Beck Depression Scale (BDS) was used to evaluate the depression levels of the patients. All participants were evaluated by the same dermatology specialist. Results: Although 37.1% patients who had FMS had at least one cutaneous symptom, 19.9% of the control group had at least one cutaneous symptom (p<0.01). According to the BDS, significant increases were detected in FMS patients (p=0.001). Significant decreases were detected in terms of all SF-36 parameters in the FMS group (p=0.001). There was at least one dermatological disease in 43% of the patients, and in 20.5% of the controls. Although no significant differences were detected between BDS and VAS scores of the FMS patients with and without dermatological findings, SF-36 total score and physical role strength score were found to be significantly lower in the patients who had dermatological symptoms. Conclusions: It must be known that there may be dermatological symptoms in FMS, a more multidisciplinary approach must be used in treatment and follow-up.