Orf Mimicking a Venous Ulcer in the Foot.

Orf virus is a DNA virus belonging to the parapoxvirus family which is transmitted to humans by zoonotic routes through contact with infected animals. It is a worldwide spreading pathogen that can cause significant financial losses in animal production. Here, we present the case of a 42-year-old man diagnosed with orf but presenting as a venous ulcer in his on the inside of the left foot. He had been caring for his neighbor's sheeps which had been recently ill with "sore mouth." This case draws attention to the fact that orf should be included in the differential diagnosis of patients presenting with foot ulcers.

Acanthosis nigricans or terra firma-forme dermatosis? Three adolescent cases.

Terra firma-forme dermatosis (TFFD), also known as Duncan' dirty dermatosis, is a keratinization disorder that is characterized by velvety, dark brown-blackish patches, and plaques and is not associated with systemic diseases. The lesions rarely show a verrucous or reticulate appearance. Especially, in children and adolescents, neck, face, torso, and ankles are the most frequently affected areas. TFFD is a condition that should be suspected in children and adolescents that cannot be cleaned with soap, especially if the neck area looks dirty. In this article, we report 3 cases with a diagnosis of TFFD resembling acanthosis nigricans. TTFD should be included in the differential diagnosis of adolescent cases presenting with hyperpigmented patches and plaques, especially in intertriginous areas such as the neck.

Dermoscopic features of pleomorphic dermal sarcoma on scalp, mimicking squamous cell carcinoma.

Pleomorphic dermal sarcoma (PDS) is an undifferentiated high-grade tumour and is considered the most common primary soft tissue tumour in adults. The most common locations of PDS are the trunk, extremities and retroperitoneal regions. Skin involvement of PDS is rare, and involvement of the scalp is less common. Most cases of PDS appear as a gradually growing lesion for 1 to 2 years and are associated with ulceration and bleeding. The definitive treatment for PDS is usually surgical resection. We present an unusual case of a primary PDS involving the scalp of a 78-year-old male patient and discuss its unusual clinical presentation, dermoscopic features, histopathological correlation and its management.

Necrotizing fasciitis arising from squamous cell carcinoma of the vulva.

Necrotizing fasciitis (NF) is a devastating soft tissue infection affecting fascias and subcutaneous soft tissues. While it is associated with several risk factors, including malignancy, alcoholism, liver disease, drug use, malnutrition, diabetes, male gender and old age, few case reports in the literature describe its rare connection with genital malignancy. Vulvar squamous cell carcinoma (SCC) is the fourth most common malignancy, representing 5% of all gynaecological tumours among women. NF due to vulvar SCC is a rare complication. In this article, we present the 1991 case of a 58-year-old diabetic female patient with NF due to vulvar SCC. While surgical intervention was successful, the prognosis for vulvar SCC was poor because of late detection.

Efficacy of Erb-Laser on Inferior Turbinate Hypertrophy: A Retrospective and Cohort Study.

Objectives: Nasal obstruction (NO) is a very common complaint in the practice of otolaryngology. The cause of NO can be due to inferior turbinate hypertrophy (ITH), which may be a result of allergic rhinitis, hyperreactivity, hormonal causes, rhinitis medicamentosa or idiopathic. The most commonly used treatments today include local nasal or systemic corticosteroids, cauterization or microdebrider, or thermal ablation with radiofrequency, coblation or ablative laser (mainly carbon dioxide or diode lasers), and submucosal reduction. Erbium YAG laser in non-ablative and SMOOTH thermal mode is considered as a non-invasive treatment and could be a novel and safe alternative.The aim of this study was to evaluate the safety and performance of a new Erb-laser treatment protocol on bilateral ITH, during and after 3 sessions of treatment throughout 6 months. Methods: This retrospective study was carried out over 30 patients with complaints of NO, sneezing, itching, discharge, and nasal congestion refractory to medical management from July 2019 to December 2020 in the Department of Otorhinolaryngology of a private hospital in Famagusta, North Cyprus. Symptoms were evaluated subjectively by using NO Score and Visual Analog Scale (VAS). Patients were evaluated at the post-procedural 1st-week, and 1st-, 3rd-, and 6th-month postoperatively. During each follow-up visit, symptoms were reassessed by VAS and NO Score. Results: Differences between pre-operative and post-operative VAS and NO Scores were statistically significant. All patients had significant symptomatic improvements, which started from the post-operative 1stweek and persisted throughout the follow-up period. The active laser treatment showed high improvement during and after the procedure, regarding NO, and decreased the nasal burden on quality of life. Conclusion: Erbium YAG laser treatment is a simple, safe, effective, and non-invasive method effective on ITH, with minimal damage on the nasal mucosa. It can be done as an office procedure, with minimal complications. This method will provide a great advantage in the future treatment of NO.

Evaluation of musculoskeletal pain and related factors in school-age children (8-12 years).

OBJECTIVES: The aim of this study was to evaluate the frequency of pain and related factors in musculoskeletal system in children. METHODS: A total of 313 primary school students were analyzed in this cross-sectional study conducted in the Famagusta city center and surrounding villages. The physical activity musculoskeletal pain (MSP) level, health-related quality of life weight, height, and school bag weights of the students were measured by a blinded researcher. RESULTS: The study group consisted of 164 (52.40%) boys and 149 (47.6%) girls with a mean age of 9.53±0.82 years. In the present study, MSP frequency was found to be 39.0%. There was no relationship between MSP and the following parameters: Age, sex, body mass index, hours of weekly gym lesson, regular participation in sports, weekly time spent with sports, school bag type, and school bag weight. There was also no relationship between these parameters and region of pain. CONCLUSION: Excessive walking and sitting were associated with increased MSP. Contrary to popular opinion, it was found that school bag weight and school bag type were not effective on MSP. Our results show that the quality of life of children can be improved by reducing MSP.

Doors Syndrome: Case Report.

DOORS syndrome is an autosomal recessive genetic neurometabolic disorder. It occurs equally in men and women. Major causes include TBC1D 24 mutations and genetic factors. Here, we discuss a 23-year-old male patient who applied to our clinic with anonychia of the toes and was diagnosed with DOORS syndrome with other accompanying clinical symptoms.

Treatment Analysis of Patients Followed up With Postherpetic Neuralgia in Nothern Cyprus.

Background: Postherpetic neuralgia (PHN) is a frequent complication of herpes zoster (HZ). Treatment of this chronic pain syndrome and results are often not clear. Tricyclic antidepressants, gabapentinoids and potent opioids are first-line treatments and are highly effective, but their use is limited due to adverse effects that may occur in elderly patients with significant medical comorbidities or interaction due to multiple drug use. There are no head-to-head comparisons of non medical treatments. Dry needling appears comparable to conventional physical therapy for treating PHN. Objective: Our aim is to determine the incidence of PHN in our population and to compare the treatments in patients with postherpetic neuralgia. Methods: A search for HZ and PHN was conducted in a general practice research database, comprising 2 general practices (dermatologist and physiatrist) and representing 5600 people. We analyzed a retrospective 37 case with PNH of 170 herpes zoster patient admmited to the dermatology and physical therapy and rehabilitation outpatient clinic between October 2018 and October 2020. Dry needling and physical therapy methods applied in addition to medical treatment in PHN treatment were compared. Results: In patients with postherpetic neuralgia, both dry needling therapy group and physical therapy group LANSS scores decreased significantly in the first week and in the third week compared to baseline. Dry needling therapy group has also similar results in VAS scores in the first and third week. But in physical therapy group, the VAS score did not show a significant decrease in the first week compared to the baseline, but it decreased significantly in the third week. Conclusion: PHN is a complex, difficult to treat and severe neuropathic pain that affects patients' daily function and quality of life. Various agents and methods are available to relieve the symptoms of PHN. This study shows as both physical therapy and dry needling therapy are effective treatment for postherpetic nevralgia..

Report on 25 Notalgia paresthetica cases: Clinical features and treatments.

OBJECTIVES: Notalgia paresthetica (NP) is a neuropathic condition that manifests as a chronic itch on the back. The aim of this retrospective study was to examine the characteristics of patients diagnosed with NP. METHODS: A total of 25 female patients, aged 26-64 years (mean+-10.67 years; median 47.17 years), were studied to determine the spinal or peripheral origin of NP. RESULTS: On radiological examination, discopathy was observed in 24% of the patients, arthrosis in 32%, and degeneration in 56%. There was no significant relationship found between dermatological symptoms and magnetic resonance imaging posi-tivity (p=0.188). The patients' treatment programs were based on either physical therapy (44%), local injection (28%), exercise therapy (16%), or physical therapy and kinesiotherapy (12%). Subjective measures for pain were validated with an average visual analog scale (VAS), and the 'Douleur Neuropathique 4' (DN4) questionnaire was used to screen for neuropathic pain. The VAS score of the patients before treatment was 7, and after treatment was 2. The mean DN4 score was 7 before treatment and 2 after treatment. CONCLUSION: NP is a rare syndrome of unknown etiology. We aim in this study to analyse NP clinical properties and treatment.

Two Sisters with Mal de Meleda: Case Series Report.

Mal de Meleda (MDM) is a rare autosomal recessive type of palmoplantar keratoderma that is characterized by transgradient keratoderma with scleroatrophy, pseudoainhum around the fingers, and perioral erythema. Its features may also include lichenoid lesions, brachydactyly, and nail dystrophy. The disease has high morbidity and significantly impairs quality of life. Here, we describe two sisters with typical clinical presentations of MDM and a history of consanguinity between the parents.

In-transit metastasis of cutaneous squamous cell carcinoma: report of two cases.

Transit metastases include metastatic foci of the skin and subcutaneous tissue located between the tumor and the nearest regional lymph node. Although transit metastases have been described for malignant melanoma, some cases of transit metastases have also been reported among primary cutaneous non-melanoma cancers. Treatment of patients with in-transit squamous cell carcinoma (SCC) is a multimodal approach for advanced staging imaging and therapy, including Mohs micrographic surgery, adjuvant radiation, and possibly sentinel lymph node biopsy and immunotherapy or chemotherapy. Here we report two cases of in-transit metastasis with primary cutaneous SCC.

Venous Lakes of the Lips Successfully Treated With a Sclerosing Agent 1% polidocanol: analysis of 25 report cases.

BACKGROUND: Venous lakes of the lip is vascular ectasia that generally appears on the lower lip and other sun-damaged surfaces of skin in elderly patient. There are many local therapies for treatment of lip venous lake such as surgical excision, cryotherapy, infrared coagulation and laser therapy. Sclerotherapy as treatment is used in varicose veins, leg telangiectasia, hemorrhoids and hemangiomas but for lip venous lake only two case has been reported. Therefore, we managed this study to determine the efficacy of injection of 1% polidocanol in the treatment of venous lake lesions. METHODS: This is retrospective study. Twenty five adult patient presenting with several localizations of venous lake were enrolled in the study. Informed consent was given before the treatment and a photo of the venous lake was taken. After the lesion was cleaned with an antiseptic, was slowly injected 1% polidocanol into each patient's lesion, followed by compression for 5 min. Visual Analog Scale (VAS) scale was used to indicate patient satisfaction. RESULT: Lesions were completely cleared in all patients after treatment. The lesions generally disappeared in two cases leaving an insignificant scar, in two cases become angioedema with two sessions of sclerotherapy. In other cases side effects were not observed. CONCLUSION: Sclerotherapy with polidocanol is an easy, inexpensive method and is found very effective in the treatment of lip venous lake. In the future it offers an alternative to other classic methods.

The Effect of Personal Protective Equipment (PPE) and Disinfectants on Skin Health During Covid 19 Pandemia.

BACKGROUND: Based on the available evidence, the COVID-19 virus is transmitted through close contact and droplets, not in the form of airborne transmission (airborne) among humans. People at risk of infection are those who are in close contact with or looking after COVID-19 patients. Preventive and mitigation measures are key in both the healthcare sector and the community. Personal protective equipment (PPE) is mandatory to protect healthcare workers from the new coronavirus, but healthcare workers may have skin damage especially associated with long-term use of PPE. OBJECTIVE: The main purpose in this study is to forward the effects of PPE and disinfectants on health care workers skin health. METHODS: From March to May 2020, self-administered face to face questionnaires were distributed to 200 individuals, consisting of healthcare workes who served in the designated departments of tertiary hospitals Famagusta /Cyprus. The questionnaire included questions about the condition of skin damage and the frequency or duration of several infection-prevention measures. RESULTS: The most common protection equipment were surgery mask (91.5%), gloves (87.5%) and hand sanitizer (52.0%). In addition, 141 (70.5%) individuals stated take a bath/shower frequently as a protection method from COVID and135 (67.5%) individuals stated air conditioning. Most individuals use latex gloves with powder (65.0%) or powder free (62.0%). Mean daily duration of wearing mask was 7.32 ± 4.54 (range 0-24) hours, wearing visor or glasses was 3.16 ± 3.97 (range 0-24) hours, wearing protective apron was 4.20 ± 4.57 (range 0-24) hours and wearing gloves was 5.33 ± 4.03 (range 0-24) hours. Eighty (40.0%) individuals bought personal protective equipment for COVID. Most individuals (73.0%) did not see a COVID patient while 18 (9.0%) individuals sampled from a COVID patient. None of the individuals was COVID positive. Mean stress level was 70.24 ± 23.58 (range 0-100). Most individuals (92.0%) stay at home except working times. Fifty-two (26.0%) individuals had hand dryness (xerosis cutis), 38 (19.0%) individuals had body itching or exanthema, 41 (20.5%) individuals had facial wounds because of mask, visor etc. and 68 (34.0%) individuals had rhinitis. Twenty-nine (14.5%) individuals had treatment because of dermal problems. CONCLUSION: Atopy, winter season, low humidity frequency of hand washing with detergents / disinfectants can disrupt the hydro-lipid cover of the skin surface and also cause irritation and even the development of contact dermatitis. Two-thirds of healthcare workers wash their hands 10 times a day, but only 22% applied skin protective cream. Also, according to a study, prophylactic dressings have been shown to alleviate pressure injuries associated with the device. Also, longer exposure time is an important risk factor. Latex-free gloves are now a mandatory standard in many hospitals and clinics and have the potential to reduce occupational skin diseases.

Norwegian scabies in a child with Down syndrome.

Crusty scabies or Norwegian scabies is a highly contagious type of scab that is characterised by intense infestation by Sarcoptes scabiei in the skin and widespread, crusty, hyperkeratotic papules, plaques and nodules. The infection can be missed due to its atypical appearance. Patients with cognitive impairment or an immunodeficiency disorder (including immunosuppressive therapy) are prone to developing crusty scabies. Although the relationship between Down syndrome and crusted scabies is explained as an absence of effective immune system, it is still not fully understood. In this communication we report a 28-month-old girl with Down syndrome who presented with crusted scabies.

Chronic Pain and Pain Belief in Active Military Personnel: a Cross-sectional Study.

BACKGROUND: Chronic pain (CP) and mental disorders are common among active military personnel (AMP) due to their potential exposure to various physical and psychological stressors. AIM: The aim of this study was to evaluate pain perception and beliefs regarding their pain among AMP suffering from CP using self-reported measures, and to understand the development and persistence of pain in AMP. METHODS: Sixty male AMP outpatients suffering CP were included. All participants completed the following forms and questionnaires: Oswestry Disability Index(ODI), Visual Analogue Scale(VAS), Neck Disability Index(NDI), Bournemouth Questionnaire for neck(BQN), International Physical Activity Questionnaire(IPAQ), Hospital Anxiety and Depression Index(HADS), 36-item Short Form Survey(SF-36), Automatic Thoughts Questionnaire(ATQ), and Pain Belief Questionnaire(PBQ). RESULTS: The mean age of the participants was 22.85±3.50 years, the median duration and frequency of pain were 12 months and 14.5 days in a month, respectively. The median of ODI scores was 26; three of patients were evaluated as crippled while 8 patients had severe disability. The HADS and PBQ-psychological scores were high in the patient group. Positive correlations were found between pain frequency and the ODI, VAS, NDI and PBQ-psychological scores. Relationships were also shown between PBQ-psychological and the VAS and ATQ scores. Correlations between ODI scores and ATQ scores were also revealed. CONCLUSIONS: Our results suggest that, in addition to the organic basis of pain, there is strong evidence for significant contribution from the psychological characteristics and pain-related beliefs of the patients. Physicians may choose a multi-dimensional perspective in the diagnosis and treatment of pain, especially in patients suffering from CP.

Telangiectatic Carcinoma - Like Lymphangioma Circumscriptum. A Rare Form of Cutaneous Metastasis of Breast Carcinoma: Case Report.

INTRODUCTION: The Breast cancer is the most common malignancy in middle-aged women and that causes skin metastasis. Skin metastasis in internal cancer cases is a very rare condition and may be difficult to diagnose and have poor prognostic marker. Cutaneous metastasis of breast carcinoma is mostly seen as direct invasion and/or local infiltration. However, in addition to the well-known types, cutaneous metastases may mimic many benign skin lesions and therefore may be difficult to diagnose. CASE REPORT: In this article we present a 36-year-old woman with telangiectatic carcinoma-like lymphangioma circumscriptum, a rare form of cutaneous metastasis skin metastases. It can be the first sign of internal malignancies, so early diagnosis is very important at this stage. CONCLUSION: Therefore, solitary lesions or benign dermatoses seen in the skin and not associated with specific disease should be considered as tumor metastasis especially in female patients with a history of breast cancer and differential diagnosis must be made.

Partial unilateral lentiginosis is mosaic neurofibromatosis type 1 or not?

Partial unilateral lentiginosis (PUL) is a rare pigmentation disorder characterized by numerous lentigines with sharp margins in the midline in one or more dermatomes. Its segmental pattern suggests that this presentation accompanied by café-au-lait spots, Lisch nodule or neurofibromas has a close relationship with mosaic neurofibromatosis type 1 or segmental neurofibromatosis (NF) in particular. In a group of 16 patients with PUL, who presented at the dermatology outpatient clinic between 1998 and 2015, an examination was made of consanguineous marriage in the family history, the presence of a similar lesion or NF in first-degree relatives, neurofibroma in the physical examination, the involvement pattern, axillary/inguinal freckling and the presence and number of café-au-lait spots. The ophthalmological examination investigated Lisch nodule and optic glioma. The skeletal system was examined for NF involvement. Of 16 patients, 13 (81.2%) were female and three (18.8%) were male with a mean age of 31.19 years (range, 15-48). There was no family history of PUL in any case. Consanguineous marriage was absent in 15 patients (93.8%). While there were accompanying café-au-lait spots in three patients (18.8%). Lisch nodule was an accompanying finding in three patients (18.8%). Axillary freckling was detected in four (25%) patients. Neurofibroma was found in only one patient. Although café-au-lait spots, axillary freckling, neurofibroma and Lisch nodule were present in a small number of the patients, the presence of the findings may be considered to be specific to NF suggests that PUL is a variant of mosaic NF-1. Genetic studies will help to further elucidate this subject.