Evaluation of Lipid Profile in Patients with Cherry Angioma: A Case-Control Study in Guilan, Iran

Benign skin tumors in older persons: a population-based study

BACKGROUND

Benign skin tumors become more common with advanced age. However, little is known about the etiology of these common lesions. Our objectives were to evaluate the risk factors for seborrheic keratosis, lentigo solaris, cherry angiomas and melanocytic nevi in an elderly population. Our candidate predisposing factors were sex, age, Fitzpatrick skin type, history of outdoor work, life style factors and anthropometric measurements and laboratory tests.

METHODS

In this retrospective cross-sectional study of a large, well-documented cohort, a total body skin examination (TBSE) was performed by dermatologists. The information gathered was augmented with self-reported data. The associations between benign skin tumors and the risk factors analysed with the Chi square test, Fischer exact test and analysis of variance as appropriate.

RESULTS

The study included 552 participants aged between 70 and 93 years. According to the TBSE, benign skin tumors were present in up to 78.7% in certain subsets of participants. Seborrheic keratosis was the most common lesion type, and 15.6% of all cases had > 50 lesions. Seborrheic keratosis were more common in males (p < 0.05), while lentigo solaris and cherry angiomas were more common in females (p < 0.05). A history of outdoor working associated with higher number of lentigo solaris and seborrheic keratosis lesions (p < 0.05). There was an association between lower glycated haemoglobin levels and the presence of multiple cherry angiomas (p < 0.05). Female subjects with multiple cherry angiomas had higher levels of high-density cholesterol and lower triglyceride values than in those with fewer cherry angiomas (p < 0.05 for both). In males, lower mean haemoglobin levels were associated with multiple cherry angiomas (p < 0.05).

CONCLUSIONS

We found sex differences and several new possible etiological factors behind benign skin tumors which, despite being common, remain poorly characterized.

Serum lipid profile in adolescents and adults with acne vulgaris receiving isotretinoin

Background

Acne vulgaris is a chronic, inflammatory disease and one of the most common skin diseases. Isotretinoin is the best treatment for severe nodulocystic acne compared to other systemic medicine. Although serum lipids elevation is one of the side effects of this medicine; recent studies have shown controversial results. This study aimed to assess the serum lipid profile in adolescents and adults with acne vulgaris receiving isotretinoin.

Methods

This is a cross-sectional study on 65 adolescents and adults older than 16 years old (55 females and 10 males) with moderate to severe degrees of acne vulgaris under a fixed low dose of 20 mg/day Isotretinoin treatment for 120 days. We analyzed the data using the SPSS software Version 16 using paired sample t-test, Wilcoxon, and ANCOVA test.

Results

In this study, 65 records of patients with a mean age of 22.21±6.25 years were assessed. There was a significant elevation in Cholesterol and LDL levels, but in HDL and triglyceride levels no significant change occurred. A significant change in cholesterol levels was noticed in the adolescent age group, the female sex, and the normal weight group. Triglyceride had a significant change in the female sex and normal weight group and HDL significantly increased in male patients.

Conclusion

Although a low dose of isotretinoin can be used with minimal concern for changes in lipid profile in acne vulgaris patients, in the long-term follow-up and treatment, it seems that we have to administer it cautiously.

Approach of Multiple Endocrine Neoplasia Type 1 (MEN1) Syndrome-Related Skin Tumors

Non-endocrine findings in patients with MEN1 (multiple endocrine neoplasia) syndrome also include skin lesions, especially tumor-type lesions. This is a narrative review of the English-language medical literature including original studies concerning MEN1 and dermatological issues (apart from dermatologic features of each endocrine tumor/neuroendocrine neoplasia), identified through a PubMed-based search (based on clinical relevance, with no timeline restriction or concern regarding the level of statistical significance). We identified 27 original studies involving clinical presentation of patients with MEN1 and cutaneous tumors; eight other original studies that also included the genetic background; and four additional original studies were included. The largest cohorts were from studies in Italy (N = 145 individuals), Spain (N = 90), the United States (N = 48 and N = 32), and Japan (N = 28). The age of patients varied from 18 to 76 years, with the majority of individuals in their forties. The most common cutaneous tumors are angiofibromas (AF), collagenomas (CG), and lipomas (L). Other lesions are atypical nevi, basocellular carcinoma, squamous cell carcinoma, acrochordons, papillomatosis confluens et reticularis, gingival papules, and cutaneous T-cell lymphoma of the eyelid. Non-tumor aspects are confetti-like hypopigmentation, café-au-lait macules, and gingival papules. MEN1 gene, respective menin involvement has also been found in melanomas, but the association with MEN1 remains debatable. Typically, cutaneous tumors (AF, CG, and L) are benign and are surgically treated only for cosmetic reasons. Some of them are reported as first presentation. Even though skin lesions are not pathognomonic, recognizing them plays an important role in early identification of MEN1 patients. Whether a subgroup of MEN1 subjects is prone to developing these types of cutaneous lesions and how they influence MEN1 evolution is still an open issue.

Skin anomalies in acromegalic patients (Review of the practical aspects)

Acromegaly is a hormonal disorder which occurs as the result of growth hormone (GH) and insulin growth factor 1 (IGF-1) over-secretion; both hormones are related to skin anomalies. The skin acts as a large endocrine organ, hosting GH receptors in every cell while IGF-1 receptors are expressed only in keratinocytes. This review is a literature review of skin anomalies found in acromegaly, either related to the disease itself or associated with related complications such as secondary diabetes mellitus, or involving associated conditions such as genetic syndromes. The following clinical points are mentioned as follows. Excessive skin and enlargement of soft tissue are due to glycosaminoglycan deposits, edema, and hyperhidrosis (mostly facial and acral). Acanthosis nigricans, a body fold dermatosis associated with insulin resistance, involves local or diffuse hyperkeratotic plaques with or without hyperpigmentation, caused by growth factors including GH/IGF-1. Other findings include cherry angiomas (due to the effects of lipid anomalies on small vessels); oily skin features with keratosis, epidermoid cysts, crochordons, pseudo-acanthosis nigricans; a potentially higher prevalence of varicose veins and psoriasis; low level of evidence for basal cell carcinoma, respective hidroadenitis suppurativa has been noted. In addition, complicated uncontrolled secondary diabetes mellitus (DM) may result in necrobiosis lipoidica diabeticorum, diabetic dermopathy, skin bacterial infections, dermatological complications of diabetic neuropathy, and nephropathy. Finally, associated hereditary syndromes may cause collagenomas, fibromas/angiofibromas, lipomas in multiple endocrine neoplasia type 1 (MEN1) syndrome; café-au-lait macules, early onset neurofibromas, juvenile xanthogranuloma (involving non-Langerhans cell histiocytes), and intertriginous freckling in neurofibromatosis type 1. Clinical findings are differentiated from pseudo-acromegaly such as pachydermoperiostosis. Iatrogenic rash, lipodystrophy (lipoatrophy with/without lipohypertrophy) are rarely reported after pegvisomant/somatostatin analogues or after insulin use for DM. Experiments using human cell lines have shown that GH/IGF-1 over-secretion are prone to epithelial-to-mesenchymal transition (EMT) in melanoma. In non-acromegalic subjects, the exact role of GH/IGF-1 in skin tumorigenesis is yet to be determined. Skin in acromegaly speaks for itself, either as the first step of disease identification or as a complication or part of a complex syndromic context.

Cherry angioma: A case-control study

BACKGROUND:

Cherry angiomas (CAs) are very common asymptomatic vascular skin lesions. There are only a few studies on CAs in the literature and those assessing risk factors of CAs are scarce. The aim of our study was to determine risk factors for the development of CAs.

MATERIALS AND METHODS:

A case–control study was conducted at a tertiary care center in Riyadh, Saudi Arabia. Patients underwent a full-body examination for CAs. Demographics and other data including medical history and medications were extracted from electronic medical records.

RESULTS:

A total of three hundred patients were enrolled: one hundred cases with at least five CAs and two hundred controls without CAs. Bivariate analysis identified benign prostatic hyperplasia (odds ratio [OR]: = 2.591), malignancy (OR = 2.567), tamsulosin (OR = 3.171), and clopidogrel (OR = 0.321) as statistically significant associations. After multivariate logistic regression analysis, only tamsulosin (OR = 3.475, P = 0.009) and clopidogrel (OR = 0.281, P = 0.028) were found to be independent risk factors for CAs. Malignancies tended to be more associated with CAs, but this did not reach statistical significance (P = 0.07).

CONCLUSION:

Tamsulosin is a possible risk factor for the development of CAs. Clopidogrel seems to have a protective role preventing the development of CAs.