Skin Tags Research Articles

Grave’s disease in a case of Goldenhar syndrome

Goldenhar syndrome (GS) is a malformation complex that involves structures arising from the first and second branchial arches. Graves’ disease is an autoimmune disorder resulting in the excessive production of thyroid hormones and is the most common cause of hyperthyroidism in children. We are reporting this case since the clinical association of Graves’ disease in GS has never been reported before and is a rare association of the syndrome. An 11-year-old developmentally normal child presented to us with swelling in front of her neck for the past 6 months associated with loss of weight, increased appetite, increased frequency of defecation, and palpitations. On examination, there was diffuse swelling in the thyroid region that moved with deglutition and did not move with protrusion of the tongue. The child also had an asymmetrical face with bilateral conjunctival dermoid and bilateral preauricular skin tag and pretragal sinus tract on the left side. Hence, a provisional diagnosis of goitre with features of hyperthyroidism in a child with first and second branchial arch syndrome was considered. Technetium 99 scan confirmed diagnosis of Graves’ disease. The child was started on carbimazole and propranolol and gradual improvement in symptoms noted. Propranolol was given for 3 months until symptoms such as palpitations and anxiety subsided and then stopped. Carbimazole was continued.

Serotonin, ghrelin, and motilin gene/receptor/transporter polymorphisms in childhood functional constipation.

Functional constipation is the most common form of constipation, and its exact aetiology is still unclear. However, it is known that deficiencies in hormonal factors cause constipation by changing physiological mechanisms. Motilin, ghrelin, serotonin acetylcholine, nitric oxide, and vasoactive intestinal polypeptide are factors that play a role in colon motility. There are a limited number of studies in the literature where hormone levels and gene polymorphisms of serotonin and motilin are examined. Our study aimed to investigate the role of motilin, ghrelin, and serotonin gene/receptor/transporter polymorphisms in constipation pathogenesis in patients diagnosed with functional constipation according to the Rome 4 criteria. Sociodemographic data, symptom duration, accompanying findings, the presence of constipation in the family, Rome 4 criteria, and clinical findings according to Bristol scale of 200 cases (100 constipated patients and 100 healthy control) who applied to Istanbul Haseki Training and Research Hospital, Pediatric Gastroenterology Outpatient Clinic, between March and September 2019 (6-month period) were recorded. Polymorphisms of motilin-MLN (rs2281820), serotonin receptor-HTR3A (rs1062613), serotonin transporter-5-HTT (rs1042173), ghrelin-GHRL (rs27647), and ghrelin receptor-GHSR (rs572169) were detected by real-time PCR. There was no difference between the two groups in terms of sociodemographic characteristics. Notably, 40% of the constipated group had a family history of constipation. The number of patients who started to have constipation under 24 months was 78, and the number of patients who started to have constipation after 24 months was 22. There was no significant difference between constipation and control groups in terms of genotype and allele frequencies in MLN, HTR3A, 5-HTT, GHRL, and GHSR polymorphisms (p<0.05). Considering only the constipated group, the rates of gene polymorphism were similar among those with/without a positive family history of constipation, constipation onset age, those with/without fissures, those with/without skin tag, and those with type 1/type 2 stool types according to the Bristol stool scale. Our study results showed that gene polymorphisms of these three hormones may not be related to constipation in children.

Management of asymptomatic cutaneous lumbosacral findings in newborns: a neurosurgical perspective.

The purpose of this study was to find areas of agreement among pediatric neurosurgeons with respect to the clinical management of asymptomatic newborns with a variety of lumbosacral skin findings. An electronic survey containing 18 clinical images and brief vignettes was sent to pediatric neurosurgeons within the American Academy of Pediatrics Section of Neurological Surgery (AAP SONS). In total, 38% (n = 21) of AAP SONS members submitted complete responses to the survey. Respondents were asked if they would advise routine care, watchful waiting, imaging, or subspecialty consultation for each clinical case. Responses were categorized into two groups: 1) watchful waiting and/or routine care, or 2) imaging and/or subspecialty consultation. Consensus was categorized as good (> 90% of responses in the same group), modest (70%-90%), and poor (< 70%). Demographic information, local factors impacting management, and experiences with local referral patterns were also collected. Among the pediatric neurosurgeons within the AAP SONS network, the authors found high levels (> 90%) of agreement that subcutaneous lipomas, faun tail nevi, large skin tags, and deep/atypical lumbosacral dimples in asymptomatic newborns should prompt an imaging study. Similarly, the authors found high agreement that simple coccygeal dimples do not need imaging. The management of some types of lumbosacral vascular marks and gluteal crease deviations had poor agreement (< 70%). When imaging was recommended, there was preference for spinal MRI in most cases (67%). Pediatric neurosurgeons generally agree that imaging of the spine is indicated for asymptomatic newborns with subcutaneous lipomas, faun tail nevi, large skin tags, or deep/atypical lumbar dimples (deep or atypical appearing). They also agree that imaging is unnecessary for infants with simple coccygeal dimples. There was a notable lack of consensus on the appropriate management of certain gluteal cleft deviations and cutaneous vascular marks.

Embolization of the Superior Rectal Arteries versus Closed Hemorrhoidectomy (Ferguson Technique) in the Treatment of Hemorrhoidal Disease: A Randomized Clinical Trial

PurposeTo compare short-term and medium-term results of superior rectal artery embolization versus surgical hemorrhoidectomy in the treatment of patients with hemorrhoidal disease. Material and MethodsThis study was a prospective randomized clinical trial following 33 patients with symptomatic hemorrhoidal disease Grades 2 and 3 who were randomly assigned to 2 different groups: the superior rectal artery embolization group (n = 15) and Ferguson closed hemorrhoidectomy surgical group (n = 14). Four patients were excluded from the analysis. Pain using the visual analog scale and the use of analgesics were evaluated 3 times daily during the first 7 days of the postoperative period. Recurrent symptoms and satisfaction with treatment were also evaluated in the subsequent first, third, sixth, and twelfth months. ResultsThe mean pain during the first bowel movement after the procedure was 6.08 ± 4.41 in the surgery group and 0 in the embolization group (P = .001). The mean use of pain medication was higher in the surgery group (28.92 doses ± 15.78 vs 2.4 doses ± 5.21; P < .001). In the embolization group, the most prevalent preprocedural symptom was bleeding in 14 patients, with complete improvement in 12 (83.3%) patients. Mucus, skin tag, and pruritus were symptoms that showed little improvement in both groups. The frequency of symptoms (bleeding, pain, prolapse, and pruritus) was similar between the groups at 12 months (P = .691). No severe adverse events were observed in both groups. ConclusionsDespite no difference in outcomes, embolization of the superior rectal arteries for the treatment of hemorrhoidal disease showed pain levels lower than those observed after surgical treatment.

Skin tags are all over the body

Abstract Introduction Skin tags are reflections of insulin resistance on the skin. It is generally observed in the head and neck region. Clinical Case A fifty-year-old male patient was admitted to the outpatient clinic due to obesity. He complained of not being able to lose weight despite diet and exercise. The patient's weight was 163,8 kg, height 175 cm, and BMI 53.5. Widespread skin tags on the patient's neck and whole body were remarkable. There were prominent acanthosis nigricans in the neck and axilla. The patient had been receiving treatment for Type 2 Diabetes Mellitus for eight years. He was using metformin 2000 mg/day, gliclazide 30 mg/day and pioglitazone 30 mg/day. Fasting insulin level was 15.46 mU/L, fasting glucose level was 165 mg/dL, HbA1c was 9.6%, and HOMA-IR was 6.29. In addition to the treatment he received, lifestyle changes (exercise, healthy diet) were recommended to the patient, and orlistat 360 mg/day was started. Conclusion Skin tags are mostly seen on the neck and nape. It was observed widely throughout the body in our patient.

Immunohistochemical expression of connective tissue growth factor in skin tags

Background:Skin tags (STs), also known as acrochordons, are the most common fibro epithelial skin tumours. Connective tissue growth factor (CTGF) is a novel peptide that exhibits platelet-derived growth factor-like activities and is produced by skin fibroblasts after activation with transforming growth factor-beta (TGF-β).The aim of this research was to evaluate the immunohistochemical expression of connective tissue growth factor in skin tags to provide an insight about its role in the pathogenesis of the disease. Methods: This prospective case-control research was carried out on 20 skin tags’ cases clinically and histopathologically diagnosed, and 10 healthy individuals of matched age and sex, served as control group.All cases were subjected to dermatological examination, skin biopsy and immunohistochemical staining. Results: There was significant difference between the cases and controls regarding epidermal (Acanthosis, hyperkeratosis, papillomatosis) and dermal changes (perivascular inflammatory infiltrate, fibroblasts, collagen arrangement) (P value

Conjunctival fibroepithelial polyp – A rare case

Fibroepithelial polyp, one of the most common benign cutaneous lesions, was seen as a conjunctival mass, which, to the best of our knowledge, is the second ever reported case of fibroepithelial polyp involving conjunctiva, although it can have atypical presentation and has been reported at sites like ureteropelvic junction, genitals, bronchi, tonsils, and outer ear canal. The common benign and malignant conjunctival lesions are pterygium, pingecuela, pannus, pyogenic granuloma, limbal dermoid, papilloma, squamous cell carcinoma, lymphoma, Kaposi sarcoma, and malignant melanoma. Therefore, the possibility of fibroepithelial polyp affecting uncommon sites cannot be negated.

Aggressive Angiomyxoma Vulva: A Series of Three Cases

ABSTRACT Aggressive angiomyxoma (AA) is a rare tumor seen in female genital tract. This tumor is aggressive as it shows local spread and has a high recurrence. We describe three cases of AA in females with age ranging from 26 to 32 years which were clinically diagnosed as either fibroepithelial polyp or Bartholin’s cyst. Due to vast clinical differentials, histopathological examination becomes important in these cases. Tumor has good prognosis and surgery with long-term follow-up is treatment of choice.

Oral Cavity Acrochordon about a Case

Acrocordon or soft fibromas are very frequent benign lesions on the skin, specifically in the axillary region and neck, with reports in unusual places such as the penis, región perineal, anal, vulvar, vaginal and are extremely rare in oral mucosa. A case is presented and a documentation of what has been published is made.

Type 2 Diabetes and Precursors in Community Dwelling Asian Indian Adult Youth.

Recent studies have shown a high prevalence of Type-2-diabetes (T2DM) (24%) and prediabetes (18.1%) in Kerala. There is no community based study from South Asia regarding the prevalence of type 2 diabetes and its precursors in the young adult population. This community based study was done to find the prevalence of type 2 diabetes and its precursors in South Indian adult youth (18-30 years age) of Thiruvananthapuram district. Cross sectional design was used for this study. Multistage cluster sampling was used to enrol community dwelling youth of 18 to 30 years, residing in Thiruvananthapuram district. Six panchayath wards from rural and urban regions and 4 from coastal area were randomly selected as the primary sampling units. Trained staff nurses conducted the survey with the help of accredited-social-health-activists (ASHA). Socio-demographic data, anthropometry, clinical features of insulin resistance, and random capillary glucose (CG) and blood pressure were assessed and recorded. Oral Glucose tolerance test or HbA1c was done for participants with a CG ≥130 mg/dl for diagnosis of diabetes and prediabetes. A total of 1031 participants were included from the rural (n = 394), coastal (n = 269) and urban (n = 368) areas. Prevalence of hyperglycaemia i.e., T2DM and pre-diabetes was 0.48% (n = 5) and 2.4% (n = 25) respectively. Family-history of T2DM was present in 35.1% subjects. Prevalence of overweight, obesity and abdominal-obesity was 28.2%, 16.1% and 28.4% respectively. Clinical-features of insulin resistance (CFIR) were present in 27.1% subjects (acanthosis [17.7%], skin tags [1.7%] and PCOS phenotype [10.7%]). Among various anthropometric measurements and their derivatives, CFIR correlated best (r = 0.24, P < 0.01) with the product of BMI and the sum of abdominal circumference and hip circumference (Trivandrum Medical College [TMC] -adiposity-index), which is a newly proposed parameter. Hyperglycaemia was more common in males, did not correlate with waist hip ratio, and correlated best again with TMC-adiposity-index ((r = 0.13, P < 0.01). The burden of insulin resistance in the young South Indian population, hitherto unknown in any community based study, has been studied for the first time. The prevalence of precursors of T2DM is high in this population. Early identification of 'at risk' individuals could provide a window of opportunity for preventing or delaying future diabetes and its long term complications. TMC adiposity index could become a valuable tool in the anthropometric assessment for predicting future T2DM.

Clinicopathological Spectrum of Vulvar Lesions-A Retrospective Study

Introduction: Vulvar lesions constitute a wide spectrum ranging from non neoplastic inflammatory lesions to malignancies. Some show nodular masses and others remain asymptomatic. This poses challenges to clinicians in differentiating non neoplastic inflammatory dermatoses from benign and malignant lesions. Along with the clinical history and physical examination, a biopsy of the lesion plays an important role in proper diagnosis and treatment. Aim: The aim of the present study was to identify the morphological spectrum of vulvar lesions with clinical and histological findings. Materials and Methods: This was a retrospective observational study conducted in the Konaseema region of India for two years from January 2019 to January 2021. A total of 85 female patients with vulvar lesions were included in the study. Biopsy samples were obtained from all the 85 cases and were formalin-fixed, routinely processed, and paraffin embedded. Haematoxylin and Eosin (H&amp;E) staining was done. Special stains were done wherever necessary. The results were analysed using Microsoft excel. Results: The age of patients ranged from 18 to 88 years. The most common age of patients was in the 4th decade (30 cases amounting for 35.29%). The mean age of the study population was 39.5±15 years. Among the 82 cases, 40 (48.78%) were non neoplastic lesions, and 42 (51.21%) were neoplastic lesions. Among the neoplastic category, 27 (64.2%) were benign lesions and 15 (35.71%) were malignant lesions. The non neoplastic category included five infections (12.5%) and 35 non infectious inflammatory lesions (87.5%). The infections included one case of MC and 4 cases of condyloma acuminatum. The non infectious, and non neoplastic inflammatory lesions included 10 cases of Lichen Sclerosus Atrophicus (LSA), one case of Lipomatoushamartoma, four cases of Lichen planus, six cases of epidermal cysts, 10 cases of Bartholin cysts and four cases of Gartner duct cyst. The benign lesions in the neoplastic category included four cases of Hidradenomapapilliferum, four cases of Aggressive Angiomyxoma (AA), 12 cases of Fibroepithelial Stromal Polyps (FEP), and a case of Leiomyoma. The malignant lesions included 14 cases of squamous cell carcinoma and a case of extramammary Paget’s disease. Conclusion: Vulvar lesions can be due to eclectic causes and pose a diagnostic difficulty both clinically and histopathologically due to their similar presentation. Thorough clinical and pathological examination along with proper clinicopathological correlation is required for accurate diagnosis and treatment.

Successful Surgical Treatment of Bilateral Fibroepithelial Polyps in the Labia Minora of an Adolescent Female: A Case Report

Successful Surgical Treatment of Bilateral Fibroepithelial Polyps in the Labia Minora of an Adolescent Female: A Case Report

Excision of a Bronchial Fibroepithelial Polyp by Bronchoscopic Electrosurgical Snaring: an Evaluation by Endobronchial Ultrasound

Excision of a Bronchial Fibroepithelial Polyp by Bronchoscopic Electrosurgical Snaring: an Evaluation by Endobronchial Ultrasound

Orthopedic acne

Apert’s syndrome is a type 1 acrocephalosyndactyly syndrome presenting predominantly with craniofacial malformations and syndactyly of the hands and feet. A case presenting to the dermatologist with recalcitrant acne on unusual sites and having preauricular skin tags as a previously undescribed clinical feature is being presented and a review of all the cases in dermatological literature has been evaluated.

Orthodontic considerations for patients presenting with Goldenhar Syndrome: A long-term case report

Abstract Introduction The correction of facial asymmetry in patients presenting with Goldenhar Syndrome can be challenging due to the complexity of the orthodontic and surgical procedures required, the psychosocial considerations of the patient and the risk of relapse. Materials and methods A Caucasian male with Goldenhar Syndrome originally presented at age 8.2 years with concerns relating to a poor bite. He had previously undertaken surgery for the removal of pre-auricular skin tags on the right side. With ongoing skeletal growth, the facial asymmetry became more obvious and caused the patient to become socially withdrawn. Multidisciplinary treatment involving orthodontics and orthognathic surgery to correct the mandibular asymmetry was delayed until facial growth had slowed. The correction involved the use of an asymmetrical bilateral sagittal split osteotomy and an advancement genioplasty followed by a dermal fat graft and MedporR onlay to the right mandibular body and angle in addition to a refinement genioplasty. Results Follow-up has revealed a partial return of a buccal openbite illustrating the risk of occlusal relapse. Conclusion The case report illustrates the complexity of the orthodontic and surgical management of facial asymmetry, the psychosocial considerations of the patient and the risk of relapse. Multidisciplinary management is essential in the management of Goldenhar Syndrome.

Prevalence, clinical criteria, and risk factors of skin tags: a hospital-based study

Prevalence, clinical criteria, and risk factors of skin tags: a hospital-based study

Management of Stage 3 Haemorrhoids with Homoeopathy – A case report

Haemorrhoids are abnormal masses of dilated blood vessels that can occur both internally and externally in the rectum. This is a case report of a 60-year-old woman who presented with complaints indicating Stage 3 haemorrhoids with a longstanding history of constipation. After acute case taking, observing the pathological progress of the disease and repertorising, Aesculus hippocastanum was prescribed. The patient’s condition and improvement were evaluated using the bleeding, prolapse, reduction, skin tags and thrombosis classification and staging at each follow-up. The patient showed marked improvement within a month. This case report emphasises the role of homoeopathic medicines in cases of haemorrhoids.

Histopathologic Patterns of Oral and Maxillofacial Masses in Southwestern Ethiopia: A 5-Year Retrospective Study

Background Oral and maxillofacial region includes nasal cavity, sinuses, the lips, oral cavity, maxilla, mandible and the major and minor salivary glands with the overlying skin and soft tissues. This area is common site for different lesions, including the inflammatory and neoplastic lesions. Neoplastic tumors, in the area, account 5% of all human neoplasia. The distribution of these tumors’ changes with the socio-demographic change throughout the world and is not well-studied on the study area. Objectives To assess the histopathologic patterns of oral and maxillofacial masses among patients attending Histopathology Unit of Pathology Department in Jimma Medical Center from September 11, 2016 to September 10, 2021. Methods A retrospective cross-sectional study was conducted. Three-hundred and seventy-seventh (377) oral and maxillofacial (OMF) mass samples fulfilling the inclusion criteria were included in the study. Data was collected by structured check list and the data was interred into Epi-data version 3.1 and transferred to statistical package for the social sciences (SPSS) version 22 for analysis. The study was conducted from May 1, 2021 to August 30, 2021 GC. Results The age distribution of OMF masses are with minimum age value of 1-year and maximum value of 85-years and median age is 30-years. From 377 patient 194 (51.5%) were male while 183(48.5) were female with a ratio of M:F=1.06:1 showing increased male dominance. Mesenchymal tumors, other than bone tumor, have the highest number of 128 (33.9%) cases followed by surface epithelial tumors, 75(19.9%), odontogenic tumors 20(5.3%), salivary gland tumors 55(14.6%), benign cystic mass 47(12.5%), inflammatory masses 42(10.9%) and the least numbers of OMF biopsy was bone tumor with 11(2.9%) cases. From the benign tumors fibroepithelial tumor 53(22.8%) is the commonest. From the malignant tumors and from carcinoma, squamous cell carcinoma 56(57.1%), is the leading. From sarcomas osteosarcoma 8(8.2%) is the commonest one. Conclusion The result of this research shows the distribution of oral and maxillofacial tumors varies with the age, sex and anatomic site of the patients. OMF mass is common on the early adult age period and the risk of malignant tumors increases in those with age ≥41-years and the commonest malignant tumor is squamous cell carcinoma but in children and adolescents’ benign tumors specially fibroepithelial polyps are the commonest with male predominance.

Oral fibroepithelial polyps ("chewing granulomas") in 21 dogs: Histomorphology, immunohistochemical characterization, and clinical outcome.

Oral fibroepithelial polyps (FEPs) are common, benign, nonneoplastic lesions in humans that often develop slowly in sites of local irritation or trauma. This study analyzed 23 oral fibroepithelial polypoid lesions retrieved from 21 dogs (2014-2021). All lesions were pedunculated with usually an irregular/cauliflower-like or rarely smooth surface. FEPs most commonly arose under or lateral to the tongue; other sites included the labial and gingival mucosa, soft palate, and hard palate. All the lesions were characterized by a thick fibrovascular stalk consisting of bundles of fibrocytes and fibroblasts embedded in a collagenous matrix rich in blood vessels. The surface squamous epithelium, when evaluable, was hyperplastic (22/22; 100%) with frequent parakeratotic hyperkeratosis (12/22; 54.5%). Ulceration of variable extent was observed in 13/23 cases (56.5%). Inflammation was associated with 18/23 cases (78.3%), and was mostly lymphoplasmacytic. The connective tissue was consistently immunoreactive for vimentin and generally negative for smooth muscle actin and desmin. All FEPs in cases with available clinical outcome data did not recur after surgical excision. The presence of chronic inflammation and ulceration suggests a causative role of chronic irritation in the pathogenesis of canine oral FEPs. FEPs should be included among the differential diagnoses of proliferative lesions of the oral cavity in dogs.

Giant hypopharyngeal fibroepithelial polyp: A case report and literature review.

Hypopharyngeal fibroepithelial polyp is a rare entity. It could extend along the esophagus, leading to dysphagia. In rare cases, this polyp could present as airway compromise due to occlusion of the inlet of the larynx. The treatment of choice is surgical resection. Accurate defining of the origin of such polyp is mandatory in order to achieve complete resection and avoid recurrence. Although hypopharyngeal FEP is rare, physicians must keep this in mind when a patient presents dysphagia or airway compromise. In the current case, we present a rare case of giant hypopharyngeal FEP originating from the right pyriform sinus detected in a Caucasian female. The patient threw up the polyp after severe vomiting. This case should be the fourth and largest case of hypopharyngeal FEP reported in the literature.