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Abstract

Introduction. Scabies is a highly contagious parasitic skin infestation caused by Sarcoptesscabiei mite causing social stigma in patients owing to skin lesions over the exposed body-parts. The present study was aimed at assessing the quality of life in scabies patients. Material and Methods. This non-interventional and cross section study included a total of a hundred newly diagnosed scabies cases above 5 years of age. The patients were given the questionnaire on the life quality affected by their disease and a detailed analysis was done afterwards. Results. Out of a hundred patients, 52% were females. The age group 21-40 years was most affected: 25.7% of adult patients had moderate effect while 55.9% of children suffered no effect on their quality of life. Conclusion. Scabies moderately affected the quality of life of the patients in the present study in the form of feeling of embarrassment, stigmata and shame associated with disease.

Abstract

Bednar tumor is a rare pigmented type of the dermatofibrosarcoma protuberans characterized histologically by the coexistence of two distinct cell populations, including spindle-shaped cells and melanin-containing dendritic cells. We report dermoscopic features of Bednar tumor observed in a 54-year-old female patient. The dermoscopy of Bednar tumor revealed a multicomponent pattern composed of a homogeneous blue-gray pigmentation with shiny white lines, structureless light-brown pigmented areas and a peripheral pigment network. The dermoscopic features observed in the present case are consistent with reported dermoscopic descriptions of Bednar tumor. Although dermoscopy may be suggestive of the diagnosis of Bednar tumor, pathohistological examination remains a gold standard for diagnosis.

Abstract

Currently, most authors believe that disseminated superficial actinic porokeratosis (DSAP) is an inherited or acquired dermatologic disorder of keratinization that occurs in genetically predisposed individuals after adequate exposure to ultraviolet (UV) rays, or immunosuppression. Lesions in DSAP start in sun-exposed areas most commonly in the third or fourth decade of life. The lesions are pink to brownish papules and plaques with a raised scaling ridge, histologically seen as a column of parakeratotic keratinocytes, the cornoid lamella. DSAP is not only the most common, but also the most often overlooked form of porokeratosis (P). Here we present a 77-year-old male with DSAP, who sporadically developed initial skin lesions at the age of 67, at the time when his personal and medical history were significantly long for chronic intensive sun exposure and type 1 insulin dependent diabetes mellitus. We established the diagnosis of DSAP based on personal and medical history, clinical presentation, auxiliary methods such as dermoscopy, and confirmed with pathohistological findings. We advised the patient to avoid sun exposure and to apply photo-protective sunscreens, emollients and keratolytics. After five years of monitoring his changes, we continue to control his lesions for any possible alteration. Although mutations in several genes and data on sun exposure may be responsible for the onset of the disease, most cases of DSPA occur sporadically and without involving the facial skin, as in our case. Lesions usually begin in the third or fourth decade of life. In the elderly, an additional trigger may be present, such as e.g. age-related decreased immune competence. Diabetes mellitus may also be associated with immunodeficiency in the elderly. Recently, DSPA has been a special subtype of DSPA in the elderly. Malignant alteration can occur in DSPA, most commonly in lesions that are long lasting, large, in the elderly, or in lesions in immunocompromised individuals. In conclusion, this is the case of a 77-year-old male person, who sporadically developed the so-called subtype DSPA in the elderly. In addition to UV radiation, the relevant suggestive trigger factors were the immunosuppressive effects of diabetes mellitus and chronological aging.

Abstract

Introduction. Psoriasis is a chronic inflammatory skin disease with hyperproliferation, abnormal differentiation and inflammatory infiltration in epidermis and dermis. Sometimes it is clinically and histopathologically challenging to distinguish psoriasis from other non-psoriatic psoriasiform dermatoses (NPPD) like eczema, pityriasis rosea, pityriasis rubra pilaris, and lichen simplex chronicus. Ki-67 is a non-histone nuclear protein complex that regulates the cell cycle and is the most widely used proliferation immunohistochemistry (IHC) marker. Its levels have been shown to be raised in psoriasis compared to normal skin.

Aim. To elucidate and compare expression of IHC Ki-67 in psoriasis and NPPD, correlate these levels with clinical variants and disease severity in psoriasis and to observe change in levels with demographic and psoriasis-related variables.

Material and Methods. Thirty patients, each with clinically diagnosed psoriasis (cases), and NPPD (controls) were enrolled. Biopsy was taken for histopathology and IHC Ki-67 immunohistochemistry. Statistical analysis was performed.

Results. We found a significantly higher expression of IHC Ki-67 in psoriasis as compared to all types of NPPD. The higher level of Ki-67 in pustular and erythrodermic psoriasis compared to plaque-type emphasizes the greater severity and activity of these forms. The Ki-67 expression was found to increase with increasing body surface area involvement and disease severity (PASI) in chronic plaque type. Pityriasis rubra pilaris had the highest Ki67 expression among NPPD group.

Conclusion. Ki-67 is a promising tool with diagnostic and prognostic utility in psoriasis, particularly when it comes to its differentiation from nonpsoriasis psoriasiform disorders.

Abstract

Acute Generalized Exanthemataous Pustulosis (AGEP) is a rare acute pustular eruption that is mostly induced by drugs. Aside from cutaneous eruptions, systemic symptoms such as leukocytosis, neutrophilia, and internal organ involvement such as liver, kidney, respiratory system, and bone marrow, may occur, although uncommon. Liver involvement usually results in a two- or three-fold increase of liver enzymes and rarely exceeds that. Pyrazinamide is the first-line anti-tuberculosis drug that is potentially hepatotoxic, but rarely shows dermatologic manifestations. We report a rare case of AGEP with drug induced liver injury due to pyrazinamide in a young patient with tuberculosis.

Abstract

Flagellate dermatitis represents a unique cutaneous eruption associated with several causes, including treatment with certain chemotherapeutic agents, ingestion of toxins and rheumatologic conditions like adult-onset Still’s disease and dermatomyositis. We present the case of a 35-year-old woman with stage IIA Hodgkin lymphoma who was treated with the ABVD chemotherapy regimen (doxorubicin, bleomycin, vinblastine and dacarbazine). During the third cycle of chemotherapy, she developed multiple linear erythematous macules and hyperpigmentation in a striking flagellate-like pattern localized on the upper chest, submammary folds, neck and upper part of the back. The lesions resolved completely within three months after the withdrawal of bleomycin. Clinicians should be aware of this distinctive cutaneous toxicity in patients receiving bleomycin combination chemotherapy.

Abstract

Perifollicular fibroma (PFF) is a rare proliferative lesion originating from the perifollicular connective tissue sheath. It may be congenital or acquired manifesting as skin colored to pink, asymptomatic papules of 1-5 mm in size. They are commonly distributed in the head and neck region. Multiple PFFs may be associated with internal malignancy or as a part of Birt-Hogg-Dube syndrome. Histopathology serves as an essential tool in clinching the diagnosis. Herein we report a case of giant congenital PFF.

Abstract

Combined nevi (CN), a rare nevus type represent a category of so-called compound tumors. Determined by the presence of two or more different nevus in one biopsy specimen, CN commonly show variable clinical and dermatoscopic features. Therefore, CN could be a diagnostic challenge. We present a 7-year-old Caucasian girl with a pigmented lesion on the arm of no specified duration. Clinical examination showed sharply demarcated pigmented papule. Dermatoscopy revealed a nonchaotic lesion with structureless well defined, minimally eccentric blue area, structureless brown area and brown clods in a symmetric fashion, no vessels and no other clues for melanoma. Histopathology showed a compound common melanocytic nevus, blue nevus in the centre of the lesion with no signs of atypia. Up to now, only 25 cases of CN with dermatoscopic description have been published, withno precise dermatoscopic features established yet. Therefore, studies with larger number of cases are needed for the final conclusions.

Abstract

Introduction. We undertook a prospective, interventional study to evaluate the efficacy and safety profile of Intense Pulsed light (IPL) treatment of melasma in dark skin phenotypes.

Material and Methods. The study was conducted in 32 patients of skin type IV and V. IPL with 640 nm and 690 nm filters was used. The patients were called once a month to undergo 6 sessions. Melasma area and severity index (MASI) and Clinician Global Impression Scores were used for evaluation. We followed “per protocol” analysis.

Results. Out of 26 patients who completed the treatment, 12 patients showed improvement, MASI remained unchanged in 10 patients and 4 patients showed deterioration. MASI scores before and after treatment were 6.70 ± 3.53 and 6.32 ± 3.90 (p value=0.6891). Erythema and pain were the common side effects noted. Seventeen out of 32 patients had thyroid disorders.

Conclusion. IPL should be avoided as a first line therapy in darker skin type. However, it can be used as an adjuvant therapy in some cases after careful deliberations.