Acta Dermatovenerologica Croatica最新文献

While SARS-CoV-2 is known to cause pneumonia and acute respiratory distress syndrome (ARDS), many extrapulmonary manifestations of COVID-19 have also been observed. Cutaneous manifestations including erythematous rash, urticaria, and chickenpox-like vesicles have been described in patients with SARS-CoV-2. Six patients, two men and four women, in the age group of 50 to 60 years old, hospitalized with SARS-CoV-2 infection confirmed with real-time polymerase chain reaction (real-time PCR) presented cutaneous manifestations. The rash was confluent, spotty, centrifugal, and non-itchy on the head and torso. It was not hemorrhagic, and no crust or blisters were observed. The results of laboratory tests were normal, and the rash disappeared on its own. Several cases of cutaneous manifestations have been reported in patients with SARS-CoV-2 infection. Further studies are needed in order to assess the skin lesions and determine their association with COVID-19.

COVID-19 infection can have a poor prognosis, especially in patients with chronic diseases and those receiving immunosuppressive or immunomodulating therapies. This study aimed to investigate the severity of COVID-19 infection in patients with psoriasis and compare the infection severity for systemic treatments and comorbidities. We conducted a study in the dermatology clinics of five different centers in the Eastern Black Sea region of Turkey. Four hundred and eighty-eight patients were included, and 22.5% were confirmed as having COVID-19 infection. In our study, the frequency of hospitalization rates due to COVID-19 infection were similar (15.4%, 25.9% respectively) in patients receiving biological treatment and receiving non-biological systemic treatment (P=0.344). Hospitalization rates were higher in patients with hypertension, androgenetic alopecia, and acitretin use (P=0.043, P=0.028, P=0.040). In conclusion, current biologic treatments and non-biologic systemic treatments in patients with psoriasis did not appear to increase the risk of the severe form of COVID-19, except for acitretin.

Ichthyoses are a heterogeneous group of skin disorders featuring erythroderma and generalized scaling. The relationship between ichthyosis and melanoma has not been well-characterized. Herein we present a unique case of acral melanoma of the palm developing in an elderly patient with congenital ichthyosis vulgaris. Biopsy revealed a superficially spreading melanoma with ulceration. To the best of our knowledge, no acral melanomas have been reported so far in patients with congenital ichthyosis. Nevertheless, considering the potential for invasion and metastasis, patients with ichthyosis vulgaris should undergo regular clinical and dermatoscopic screening for melanoma.

The association of cutaneous and extracutaneous abnormalities is a common phenomenon, widely described in a variety of genetic syndromes. Nevertheless, yet undescribed syndromic combinations may still exist. Herein we present a case report of a patient who was admitted to the Dermatology Department due to multiple basal cell carcinomas arising from nevus sebaceous. In addition to the cutaneous malignancies, the patient presented with palmoplantar keratoderma, prurigo nodularis, hypothyroidism, multiple lumbar abnormalities, uterine myoma, an ovarian cyst, and highly dysplastic colon adenoma. Such a combination of multiple disorders may indicate a genetic origin of the diseases.

Dear Editor, Photoallergic reactions are classic T-cell-mediated or delayed-type hypersensitivity reactions of the skin in response to a photoallergen (or a cross-reacting chemical) to which a subject was sensitized in the past (1). The immune system recognizes the changes caused by ultraviolet (UV) radiation; it produces antibodies and causes inflammation of the skin in the exposed areas (2). Common photoallergic drugs and ingredients are included in some sunscreens, aftershave lotions, antimicrobials (especially sulfonamides), non-steroidal anti-inflammatory drugs (NSAIDs), diuretics, anticonvulsants, chemotherapy drugs, fragrances, and other hygiene products (1,3,4). A 64-year-old female patient was admitted to the Department of Dermatology and Venereology with erythema and underlining edema on her left foot (Figure 1). A few weeks earlier, the patient had had a fracture of the metatarsal bones and since then she had been taking NSAIDs systemically every day to suppress pain. Five days before being admitted to our Department, the patient started applying 2.5% ketoprofen gel to her left foot twice daily and was frequently exposed to the sun. For the last twenty years, the patient had been struggling with chronic back pain and was frequently taking different NSAIDs (ibuprofen, diclofenac, etc.). The patient also suffered from essential hypertension and was regularly taking ramipril. She was advised to discontinue ketoprofen application, avoid sunlight, and apply betamethasone cream twice daily for 7 days, which lead to complete resolution of the skin lesions in a few weeks. Two months later, we performed patch and photopatch tests to baseline series and topical ketoprofen. Only the irradiated side of the body where ketoprofen-containing gel was applied showed positive reaction to ketoprofen. Photoallergic reactions manifest as eczematous, pruritic lesions, which may spread to involve other areas of the skin that were not previously exposed to the sun (4). Ketoprofen is a nonsteroidal anti-inflammatory drug composed of a benzoylphenyl propionic acid that is commonly used both topically and systemically for the treatment of musculoskeletal diseases because of its analgesic and anti-inflammatory effects and low toxicity, but it is one of the most frequent photoallergens (1,5,6). Ketoprofen-induced photosensitivity reactions usually present as photoallergic dermatitis characterized as acute dermatitis with edema, erythema, papulovesicles, blisters, or erythema exsudativum multiforme-like lesions at the application site 1 week to 1 month after the initiation of use (7). Depending on the frequency and intensity of sun exposure, ketoprofen photodermatitis may continue or reoccur up to 1 to 14 years after discontinuing the medication (6,8). Moreover, ketoprofen contaminates clothing, shoes, and bandages, and some cases of photoallergy relapses have been reported that were induced by ketoprofen-contaminated objects after they were used again in the

Mycosis Fungoides (MF) and Sézary syndrome (SS) are the most common forms of cutaneous T-cell lymphomas. Few validated prognostic factors have been reported in MF/SS, especially when compared with non-cutaneous lymphomas. Increased C-reactive protein (CRP) levels have recently been associated with poor clinical outcome in various malignancies. The aim of this study was to evaluate the prognostic significance of serum CRP levels at diagnosis in patients with MF/SS. This retrospective study included 76 patients with MF/SS. Stage was assigned according to the ISCL/EORTC guidelines. The follow-up period was 24 months or more. Disease course and response to treatment were determined using quantitative scales. Wilcoxon's rank test and multivariate regression analysis were used to analyze the data. Increased CRP levels correlated significantly with advanced stages (Wilcoxon's test, P>0.0001). Furthermore, increased CRP levels were associated with a lower treatment response rate (Wilcoxon's test, P=0.0012). Multivariate regression analysis showed that CRP is an independent predictor of advanced clinical stage at diagnosis.The present data suggest that elevated CRP levels could serve as a useful prognostic factor in MF/SS and may assist in guiding treatment choices.

Dear Editor, Pilonidal cyst disease is a common, acquired, inflammatory disease predominantly affecting the natal clefts of the buttocks (1,2). The disease has a predilection for men, with a male-to-female ratio of 3-4:1. Patients are generally young, towards the end of second decade of life. Lesions are initially asymptomatic, while the development of complications such as abscess formation is associated with pain and discharge (1). Patients with pilonidal cyst disease may present to dermatology outpatient clinics, especially when the disease is asymptomatic. Herein we report the dermoscopic features of four cases of pilonidal cyst disease encountered in our dermatology outpatient clinic. Four patients who presented to our dermatology outpatient department for evaluation of a solitary lesion on buttocks were diagnosed with pilonidal cyst disease based on clinical and histopathological examination. All patients were young men and presented with solitary, firm, pink, nodular lesions in the region in proximity to the gluteal cleft (Figure 1, a, c, e). Dermoscopy of the first patient revealed a red structureless area in the central part of the lesion, consistent with ulceration. Additionally, white lines reticular as well as glomerular vessels were present at the periphery on the pink homogenous background (Figure 1, b). In the second patient, a yellow structureless central ulcerated area was surrounded by linearly arranged multiple dotted vessels at the periphery on a homogenous pink background (Figure 1, d). In the third patient, dermoscopy revealed a central yellowish structureless area with peripherally arranged hairpin and glomerular vessels (Figure 1, f). Lastly, similar to the third case, dermoscopic examination of the fourth patient showed a pink homogenous background with yellow and white structureless areas and peripherally arranged hairpin and glomerular vessels (Figure 2). Demographics and clinical features of the four patients are summarized in Table 1. Histopathology of all our cases revealed epidermal invagination and sinus formation, free hair shafts, and chronic inflammation with multinuclear giant cells. Histopathological slides of the first case can be seen in Figure 3 (a-b). All patients were referred to general surgery for treatment. The current knowledge pertaining to dermoscopy of pilonidal cyst disease is scarce in the dermatologic literature, and was previously evaluated in only two cases. Similar to our cases, the authors reported the presence of a pink-colored background, radial white lines, central ulceration, and multiple peripherally arranged dotted vessels (3). The dermoscopic features of pilonidal cysts differ from other epithelial cysts and sinuses. As for epidermal cysts, the presence of punctum and an ivory-white background color have been reported as characteristic dermoscopic findings (4,5). In addition, unruptured epidermal cysts reveal arborizing telangiectasia, while the ruptured epidermal cysts show per

INTRODUCTION Genital herpes is the most common sexually transmitted disease and is most commonly caused by herpes simplex virus -2 (HSV2) which is usually sexually transmitted (1). We report a case of a 28-year-old woman with an unusual case of HSV presentation that rapidly resulted in necrosis and rupturing of the labia less than 48 hours after first appearance of symptoms. CASE PRESENTATION We report the case of a 28-year-old female patient who presented to our clinic with painful necrotic ulcers of both labia minora, urinary retention, and extreme discomfort (Figure 1). The patient reported unprotected sexual intercourse a few days prior to the pain and burning sensation and swelling of the vulva. A urinary catheter was inserted immediately due to intense burning and pain while urinating. The vagina and cervix were covered with ulcerated and crustal lesions. The Tzanck smear test showed multinucleated giant cells, and polymerase chain reaction (PCR) analyses were conclusive for HSV infection, while syphilis, hepatitis, and HIV tests were negative. Since there was progression of the labial necrosis and the patient became febrile two days after admission, we performed debridement twice under systemic anesthesia, and the patient receive systemic antibiotic together with acyclovir. On the follow-up visit, four weeks later, both labia had epithelized completely. DISCUSSION In primary genital herpes, after a short incubation period, multiple bilaterally located papules, vesicles, painful ulcers, and crusts appear, which resolve over a period of 15 to 21 days (2). Clinically atypical presentations include either unusual sites or atypical morphological forms of genital disease, exophytic (verrucoid or nodular) superficially ulcerated lesions, mostly seen in patients with HIV, fissures, localized recurrent erythema, nonhealing ulcers, and burning sensation in the vulva in a patient with lichen sclerosus (1). This patient was discussed in our multidisciplinary team, as we know that ulcerations could be associated with rare malignant vulvar pathology (3). The golden standard for diagnosis is PCR from the lesion (1). Antiviral therapy should be initiated within 72 hours of primary infection and continued for 7 to 10 days. CONCLUSION The process of removing nonviable tissue is called debridement. Debridement is only necessary when a herpetic ulceration is not healing on its own, which is when necrotic tissue that can harbor bacteria that may cause more extensive infections is formed. Removing the necrotic tissue speeds up healing and reduces the risk of further complications.

The number and variety of patients admitted to hospitals have changed due to the COVID-19 pandemic. These changes have also affected dermatology clinics. The pandemic has had an adverse effect on the psychology of people by negatively affecting their quality of life. Patients who were admitted to the Bursa City Hospital Dermatology Clinic between July 15, 2020 and October 15, 2020 and from July 15, 2019 to October 15, 2019 were included in this study. The data of patients were gathered retrospectively by reviewing the electronic medical records and International Classification Diseases (ICD-10) codes. Our results showed that, despite the decrease in the total number of applications, a significant increase was observed in the frequency of stress-related dermatological diseases such as psoriasis (P<0.001), urticaria (P<0.001), atopic dermatitis (P<0.001), and seborrheic dermatitis (P=0.035). However, there was no significant change in the rates of alopecia areata, vitiligo, herpes zoster, and lichen simplex chronicus (P>0.05, for all). There was a significant decrease in the telogen effluvium rate during the pandemic (P<0.001). Our study demonstrates that the incidence of certain stress-related dermatologic diseases increased during the COVID-19 pandemic, which may increase awareness of dermatologists on this issue.

Dystrophic epidermolysis bullosa inversa is a very rare subtype of inherited dystrophic epidermolysis bullosa with a unique clinical manifestation. Generalized blistering in the neonatal period and in early infancy improves with age, with lesions becoming restricted to intertriginous areas, axial parts of the trunk, and mucous membranes. In contrast to other variants of dystrophic epidermolysis bullosa, the inverse type has a more favorable prognosis. We present a case of a 45-year-old female patient with dystrophic epidermolysis bullosa inversa, diagnosed in adulthood based on typical clinical presentation, transmission electron microscopic findings, and genetic analysis. Additionally, genetic analysis revealed that the patient also suffered from Charcot-Marie-Tooth disease, a hereditary motor and sensory neuropathy. To our knowledge, the coexistence of these two genetic diseases has not been reported so far. We describe clinical and genetic findings in the patient and review previous reports on dystrophic epidermolysis bullosa inversa. A possible temperature-related pathophysiology for the peculiar clinical manifestation is discussed.