X-linked Dyskeratosis Congenita Case with Mutation 1058C>T(p.Ala353Val) in Dyskerine Gene

Dyskeratosis congenita (DC) is a rare inherited bone marrow failure syndrome and telomere biology disorder, usullay consisting of a triad of oral leucoplakia, dystrophic nails, reticular skin pigmentation. The diagnosis in the majority of cases can be made following all the clinical findings of this triad are established. Here we report 7 years-old boy who had oral leukoplakia and nail abnormality without skin involvement, associated with bone marrow failure diagnosed with X-linked DC due to dyskerin (DKC1) mutation. Our report emphasizes the fact that clinical suspicion can prevent fatal consequences since all manifestations may not always be seen collectively.

Evaluation of Dermatological and Neurological Aspects of the Relationship between Rosacea and Headaches

This study aimed to investigate the relationship between rosacea and headaches, focusing on different subtypes, as well as the associated clinical features and triggering factors. In this prospective study, 300 patients diagnosed with rosacea and 320 control subjects without rosacea or any connected mast cell activation illness were included. Patients with rosacea were assessed by a dermatologist according to the 2019 updated rosacea classification (ROSCO panel). Accordingly, patients were classified based on their predominant rosacea subtype as follows: erythematotelangiectatic (ETR), papulopustular (PPR), or phymatous (RhR). Patients experiencing headaches were assessed using the International Headache Classification. Headaches were categorized as migraine, tension-type headaches (TTHs), secondary types (STHs), and cluster-type headaches (CTHs). The ratio of headache was 30.3% in the rosacea group, which did not show a significant difference compared to the control group (30.3% vs. 25.0%, p = 0.138). In 81.3% of rosacea patients with headaches, headache onset occurred after the diagnosis of rosacea. The rate of patients with headaches was higher in the ETR group compared to the PPR and RhR groups (35.2% vs. 16.2% vs. 23.1%, p = 0.007, respectively). In terms of headache subtypes, the rates of patients with migraine and STHs were higher in the ETR group compared to the PPR and RhR groups, while the rate of patients with TTHs was higher in the RhR group. A positive correlation was found between rosacea severity and migraine severity (r = 0.284, p < 0.05). Among the triggering factors for rosacea, only sunlight was found to be associated with headaches. Lower age, female gender, and moderate to severe rosacea severity were identified as independent factors increasing the likelihood of headaches. A significant portion of rosacea patients experience headaches. Particularly, different subtypes of rosacea may be associated with various types of headaches. This study, highlighting the connection between migraine and ETR, is a pioneering work that demonstrates common pathogenic mechanisms and potential triggers.

New Homozygous Missense MSMO1 Mutation in Two Siblings with SC4MOL Deficiency Presenting with Psoriasiform Dermatitis

Sterol-C4-methyl oxidase (SC4MOL) deficiency was recently described as an autosomal recessive cholesterol biosynthesis disorder caused by mutations in the MSMO1 (sometimes also referred to as SC4MOL) gene. To date, 5 patients from 4 unrelated families with SC4MOL deficiency have been reported. Diagnosis can be challenging as the biochemical accumulation of methylsterols can affect global development and cause skin and ocular pathology. Herein, we describe 2 siblings from a consanguineous Turkish family with SC4MOL deficiency presenting with psoriasiform dermatitis, ocular abnormalities (nystagmus, optic hypoplasia, myopia, and strabismus), severe intellectual disability, and growth and motor delay. We undertook whole-exome sequencing and identified a new homozygous missense mutation c.81A>C; p.Asn27Thr in MSMO1. Segregation analysis in all available family members confirmed recessive inheritance of the mutation. The siblings were treated with a combination of oral and topical statin and cholesterol which resulted in clinical improvement. This study demonstrates how genomics-based diagnosis and therapy can be helpful in clinical practice.

The effects of isotretinoin on affective and cognitive functions are disparate in adolescent acne vulgaris patients

Background: The vulnerable brain regions to isotretinoin are represented as hippocampus and prefrontal cortex, involved in mood regulation as well as coordination of cognitive functions. Adolescence is a critical period with dynamic alterations in neurocognition. Isotretinoin brought concerns about its possible effects on executive functions, attention and memory.Objective: Evaluate the impacts of isotretinoin on neurocognitive functions in adolescents with acne vulgaris and determine the emergence of psychiatric side effects.Materials and methods: Fifty-five adolescent acne vulgaris patients were assigned to either isotretinoin (n = 38) or systemic antibiotic (n = 17) groups. The neuropsychological test battery and psychometric tests were performed before treatment and during treatment with 3-months intervals.Results: Stroop-TBAG form, verbal-auditory digit span, controlled oral word association test and trail making test results improved in the isotretinoin treatment group along with stable scores in the antibiotic group. Children Depression Scale scores of the isotretinoin group showed an increase at 6^th month compared to baseline. None of the patients was evaluated as depressive by the psychiatric examination.Conclusions: In a vulnerable age group, our results demonstrate an improvement for neurocognitive functions in isotretinoin patients. The conflicting results suggest distinct mechanisms to be responsible for the effects on affective and cognitive functions.

Clinical and Sociodemographic Characteristics of Patients with Ingrown Nails

BACKGROUND

Ingrown nail is a common health problem that significantly affects daily life due to its painful nature. The purpose of this study was to reveal the clinical and sociodemographic characteristics of ingrown nails.

METHODS

The clinical and sociodemographic characteristics of patients older than 18 years presenting with ingrown nail were investigated.

RESULTS

Two hundred six patients aged 18 to 77 years (mean age, 39 years; female to male ratio, 1.45) were included in the study. A total of 729 lesions were evaluated (718 ingrown nails were on the feet and 11 were on the fingers). A family history of ingrown nail was present in 7.6% of the participants. Of the 206 patients, 26.7% were treated with surgical methods for ingrown nails previously and experienced recurrence. Ingrown toenails were in the hallux in 81.3% of patients, and 52% were on the lateral margin. Incorrect nail-cutting habits (73.5%), poorly fitting shoes (46.2%), excessive angulation of the nail plate (35.8%), obesity (34.1%), trauma to the feet (24.3%), pregnancy (23.8% of women), hyperhidrosis (16.8%), and lateral deviation of the nail plate (9.9%) were closely associated with ingrown nails.

CONCLUSIONS

This study revealed the clinical and sociodemographic characteristics of ingrown nails. The study data will be useful in preventing the development of ingrown nail and recurrences after treatment by identifying and then eliminating conditions establishing a predisposition to it.

Development of poorly differentiated invasive squamous cell carcinoma in giant Bowen's disease: a case report with dermatoscopy

Bowen’s disease (BD) is an in situ form of squamous cell carcinoma (SCC), often occurring in the chronically UV-damaged skin of elderly people. The risk of progression of BD to invasive SCC varies between 3% and 5%, and one-third of invasive tumors may metastasize. Herein we discuss the dermatoscopic findings of a case of giant Bowen’s disease, which progressed to poorly differentiated invasive SCC.

Comparison of effectiveness of 1,064-nm Nd:YAG laser and Nd:YAG laser-IPL combination treatments in hand skin rejuvenation

OBJECTIVE

Evaluation of the efficacy and side effects of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and Nd:YAG laser-intense pulsed light (IPL) combination treatments in photorejuvenations of skin of the hand, and determining their impacts on patient satisfaction.

MATERIALS AND METHODS

Thirty-five female patients with signs of photoaging on the skin of their hands were included in the study. Three sessions of IPL and four sessions of Nd:YAG laser treatment were applied to the right hand in total with 2-week intervals between each session, whereas six sessions of Nd:YAG laser treatment were applied to the left hand of patients with 2-week intervals between each session.

RESULTS

The patients' ages ranged between 31 and 78, and mean age was 60.77 ± 9.48. While there was no difference in pigment distribution, fine wrinkles, coarse wrinkles, and global scores between the right and left hand prior to treatment (p > 0.05), average pigment tone score was higher in the right hand with a statistically significant difference (p < 0.05). There was greater improvement in scores of pigment distribution, fine wrinkles, sallowness, pigment tone parameters, and global score on the right hand compared to left hand, which was statistically significant (p <0.001).

CONCLUSION

In rejuvenation of photoaged dorsal skin of the hand, IPL-Nd:YAG laser combination treatment surpasses Nd:YAG laser treatment.

Dermatoscopy of flat pigmented facial lesions: diagnostic challenge between pigmented actinic keratosis and lentigo maligna

BACKGROUND

The similarity between clinical pictures of pigmented actinic keratosis (PAK) and lentigo maligna (LM) is well known.

OBJECTIVES

To investigate the frequency of dermatoscopic findings suggestive of LM/lentigo maligna melanoma (LMM) in the other facial pigmented skin lesions (FPSL) and to assess the distinguishing dermoscopic criteria of PAK and LM.

METHODS

Eighty-nine FPSL were evaluated with conventional dermatoscopy. The lesions showing one or more dermatoscopic features considered as specific patterns for the diagnosis of LM/LMM, mainly slate-grey to black dots and globules, slate-grey areas, annular-granular pattern, asymmetrical pigmented follicular openings, black blotches, rhomboidal structures, hyperpigmented rim of follicular openings, slate-grey streaks and dark streaks, were included in the study selectively.

RESULTS

PAK was diagnosed in 67, LM or LMM in 20 and lichen planus-like keratosis in two lesions, histopathologically. Eleven essential dermatoscopic features were observed in facial PAK: slate-grey dots (70%); annular-granular pattern (39%); rhomboidal structures (36%); pseudonetwork (36%); black globules (34%); slate-grey globules (33%); black dots (30%); asymmetrical pigmented follicular openings (25%); hyperpigmented rim of follicular openings (21%); slate-grey areas (18%); and streaks (3%).

CONCLUSIONS

PAK has a striking similarity to LM/LMM in clinical and dermatoscopic features, thus representing a diagnostic challange. All dermatoscopic findings except black blotches were observed in PAK. As dermatoscopic diagnosis of a pigmented skin lesion cannot be based on the presence of a single criterion, we may conclude that histopathology still remains the gold standard for correct diagnosis.

Unilateral hyperhidrosis with accompanying contralateral anhidrosis

Localized unilateral or segmental hyperhidrosis is a rare form of increased sweat production of unknown origin. Most reported cases have occurred in otherwise healthy people, with none of the typical triggering factors found in essential hyperhidrosis. The localization of segmental hyperhidrosis is usually the forearm or forehead. We report a case of unilateral hyperhidrosis on the right sides of the forehead, and nose, and the palmar surface of the right hand with anhidrosis on the left hand.

Comparison of phenol and sodium hydroxide chemical matricectomies for the treatment of ingrowing toenails

OBJECTIVE

Chemical matricectomy is performed mainly by two agents: phenol and sodium hydroxide. Both agents have excellent cure rates, but there are no data about the comparison of postoperative healing periods. This study was designed to compare the postoperative morbidity rates of sodium hydroxide and phenol matricectomies.

MATERIALS AND METHODS

Forty-six patients with 154 ingrowing nail sides were treated with either sodium hydroxide or phenol matricectomy. In the postoperative period, the patients were evaluated for the duration and severity of pain, drainage, and peripheral tissue destruction; complete healing periods; and overall success rates.

RESULTS

The incidence of pain was higher in the sodium hydroxide group on the first visit, on the second day, but all patients became pain-free after that. The incidence and duration of drainage and peripheral tissue destruction was significantly higher in the phenol group. The mean period for complete recovery was 10.8 days in the sodium hydroxide group, whereas it was 18.02 days in the phenol group. The overall success rates in the sodium hydroxide and phenol groups were found to be 95.1 and 95.8%, respectively.

CONCLUSION

Both sodium hydroxide and phenol are effective agents giving high success rates, but sodium hydroxide causes less postoperative morbidity and provides faster recovery.

Post-renal transplantation Leser-Trélat sign associated with carcinoma of the gallbladder: a rare association

The sign of Leser-Trélat represents the sudden appearance of multiple seborrheic keratoses in association with an underlying malignancy. The most common associated neoplasms belong to the gastrointestinal tract, mainly the stomach and colon. In the literature, there is only one case of gallbladder carcinoma associated with the Leser-Trélat sign. Thus, the hallmark of our patient is post-renal transplant malignancy-associated Leser-Trélat, which has not been reported before. Here, we report on a 57-year-old man who presented with a sudden increase in the number and size of seborrheic keratoses, particularly on sun-exposed areas 24 years after renal transplantation. The search for an underlying malignancy showed the presence of an adenocarcinoma of the gallbladder which had metastasized to the liver.

Calibre persistent labial artery: clinical features and noninvasive radiological diagnosis

Calibre persistent labial artery (CPLA) is defined as a primary arterial branch that penetrates into the submucosal tissue without division or decrease in diameter. It usually presents as an asymptomatic papule on the lower lip and can be easily misdiagnosed as a varix, haemangioma, venous lake, mucocele or fibroma. When it is ulcerated, squamous cell carcinoma is the most usual differential diagnosis. The most frequently used method to confirm the diagnosis of CPLA has been excisional biopsy, which carries the risk of profuse bleeding. Angiography, another invasive method, has also been used. Here, we report a case of a 20-year-old woman with a 5-year history of multiple CPLA lesions involving both upper and lower lips. In this case, the diagnosis was made clinically and confirmed by Doppler ultrasonography, which is a noninvasive and simple diagnostic tool.

Irritable bowel syndrome in young and elderly patients with stable asthma

BACKGROUND

It has been speculated that asthma and irritable bowel syndrome may share common pathophysiological processes.

AIM

To estimate the prevalence of irritable bowel syndrome in young and elderly patients with stable asthma.

PATIENTS AND METHODS

Sixty-five young (age < 60 years) and 66 elderly (age > or = 60 years) stable asthmatics, and 119 age-matched healthy volunteers were enrolled. In all participants, presence of irritable bowel syndrome, quality of life and psychological status were evaluated.

RESULTS

The prevalence of irritable bowel syndrome in asthmatic group was higher than that in the control group (27.5% versus 16.8%; odds ratio, 1.8 [1.0-3.4]; p=0.04). The prevalence of irritable bowel syndrome was significantly higher in young asthmatics than in age-matched healthy controls (36.9% versus 20.3%; odds ratio, 2.2 [1.0-5.1]; p=0.04) and than in elderly asthmatics (36.9% versus 18.2%; odds ratio, 0.3 [0.1-0.8]; p=0.01). Logistic regression analysis identified the younger age (odds ratio, 2.1 [1.1-3.8]; p=0.01), and the presence of asthma (odds ratio, 1.9 [1.0-3.5]; p=0.03) as independent risk factors for irritable bowel syndrome in all participants after adjusting for gender. We also found impaired quality of life to be associated with the presence of irritable bowel syndrome and asthma in all participants after adjusting for age and gender.

CONCLUSION

The prevalence of irritable bowel syndrome appears to be significantly higher in young asthmatics, but not in elderly asthmatics, compared to age-matched healthy counterparts. Potential pathogenic mechanisms of higher irritable bowel syndrome prevalence in young asthmatics need to be explained by further studies.

Sodium hydroxide chemical matricectomy for the treatment of ingrown toenails: comparison of three different application periods

OBJECTIVE

Sodium hydroxide matricectomy is a successful method for the treatment of ingrown toenails. This study was designed to evaluate the optimal sodium hydroxide application period providing high success rates with minimal postoperative morbidity.

MATERIALS AND METHODS

Sixty-six patients with 225 ingrown nail edges were treated in three groups receiving 30-second, 1-minute, and 2-minute applications of sodium hydroxide. Each patient was reviewed postoperatively for pain, drainage, and tissue damage. The median long-term follow-up period was 14 months.

RESULTS

The success rate of the therapy was 70.9% in the first group, 92.7% in the second group, and 94.4% in the third group. In all groups, about half of the patients experienced minimal pain within 48 hours following the operation, but only in the third group, 20% of the patients had minimal pain, which continued about 1 week. Drainage and tissue damage were minimal or mild in all groups and disappeared within 3 weeks in the first and second groups but were prolonged to 6 weeks in the third group.

CONCLUSION

The success rate of 30-second application is significantly lower than 1-minute and 2-minute applications. Although the success rates of the latter two procedures are similar, the prolonged healing time is the disadvantage of the 2-minute application. We conclude that 1-minute application of 10% sodium hydroxide is simple, safe, and highly effective for the treatment of ingrown nails.

Treatment of Basal Cell Carcinoma Located in the Head and Neck Region with Intralesional Interferon ??-2a

OBJECTIVE

Intralesional injections of interferon have been reported to provide successful results in the treatment of basal cell carcinoma. However, there are only a few reports describing the long-term efficacy of this therapy. The aim of our study was to evaluate the efficacy and long-term results of interferon alpha-2a (IFNalpha-2a) in the treatment of basal cell carcinoma.

METHODS

Twenty dermatopathologically proven basal cell carcinoma lesions were treated with intralesional IFNalpha-2a injections three times weekly for 3 weeks. The dose per injection was 1.5 x 10(6)IU if the lesion was <2cm in diameter and 3.0 x 10(6) IU if it was >/=2cm. Eight weeks after the last injection, the lesion sites were rebiopsied and all cases were reevaluated both clinically and dermatopathologically. Patients with complete cure were followed up for 7 years to determine the long-term results.

RESULTS

Eleven lesions (55%) showed complete clinical and dermatopathological remission, six lesions (30%) showed partial remission, and two lesions (10%) showed no response. One lesion (5%) increased in size during the treatment. No serious adverse effects were observed. During the follow-up period there was only one recurrence, at the fifth year.

CONCLUSION

Treatment with intralesional IFNalpha-2a was shown to be an effective therapeutic option for basal cell carcinoma, with low recurrence rates in long-term follow-up.

Epithelioid sarcoma metastatic to the tongue: a rare entity

Epithelioid sarcoma (ES) typically arises as a firm nodule on the extremities of young men. The tumor is remarkable for diagnostic difficulties both clinically and histopathologically resulting in a high frequency of initial misdiagnosis. ES is also known to have a high rate of recurrence and high rate of metastasis predominantly to the lymph nodes, lungs, and scalp. Herein, the second case of ES with metastasis to the tongue is reported.