Evaluation of the Quality of Life and the Demographic and Clinical Characteristics of Patients With Pemphigus With Oral Mucosal Involvement: A Multicenter Observational Study.

INTRODUCTION: Pemphigus vulgaris (PV) is an autoimmune disease primarily affecting the oral mucosa. OBJECTIVES: This study aimed to determine the demographic, clinical and treatment characteristics of PV patients with oral mucosal involvement and to assess the impact on their quality of life. METHODS: We conducted a prospective observational study among 106 patients diagnosed with PV and presenting oral mucosal involvement. Demographic data, clinical and treatment characteristics, and quality of life questionnaires were recorded. RESULTS: The study included 106 patients, 55 (51.89%) were male and there was a predominance of the mucocutaneous subtype in 83 individuals (78.38%). Oral mucosa was the initial site of manifestation in 44 patients (41.51%). Bilateral buccal mucosa was the most frequently affected site. The predominant symptom reported was a burning sensation, noted in 91 patients (85.85%). Oral mucosal examination revealed erosions in 85.85% of the patients. Systemic steroids were the most commonly administered treatment, and rituximab was used in 18 patients (16.98%). A positive and significant correlation was found between pemphigus severity and Oral Health Impact Profile-14, Dermatology Life Quality Index and Dermatological Quality of Life Scale scores (P < 0.05). The presence of superficial ulcers, flaccid bullae, lesion diameter ≥1 cm, and >10 lesions were factors that markedly diminished quality of life. Complete response to treatment was noted in all patients administered rituximab. CONCLUSIONS: The most common area of involvement was bilateral buccal mucosa, and the severity of PV closely correlated with a decline in quality of life measures. These results highlight the need for careful clinical oversight of PV, taking into account its effects on patients quality of life.

Habits of Using Social Media and the Internet in Psoriasis Patients.

Introduction: Psoriasis significantly affects the patients quality of life, which often leads patients to seek online information about this disease. Objectives: To explore the habits of patients with psoriasis related to their use of social media (SM) and the internet to obtain information about their disease. Methods: 1,520 patients completed the survey and the Dermatology Life Quality Index (DLQI) questionnaire. The Psoriasis Area Severity Index scores (PASI) and clinical data of the patients were recorded by their physicians. Results: Of the 1,114 patients that reported using SM and internet, 48.38% regularly and 31.14% sometimes resorted to obtain information about psoriasis. The use of SM and internet for psoriasis was statistically significantly higher among young people (P = 0.000), those with university or higher education (P = 0.009), higher DLQI (P = 0.000) and PASI (P = 0.011) scores, facial (P = 0.050), scalp (P = 0.032), hand (P = 0.048), genital (P = 0.001) and inverse (P = 0.000) involvement, and arthralgia/arthritis (P = 0.006). The participants mostly used the Google (86%) and Facebook (41%). More than half of the participants (62.8%) expected dermatologists to inform society that psoriasis is not contagious. Conclusions: Internet and SM being widely available and offering substantial information to be easily accessed make it very attractive for patients to use these platforms to investigate diseases, including psoriasis. If what is presented on SM conflicts with what the physician says, patients mostly trust the latter, but at the same time, they tend not to share the results of their online inquiries with their physicians.

Reflectance Confocal Microscopy Findings in a Small-Diameter Invasive Melanoma.

The diagnosis of a small-diameter melanoma may be challenging. We report the case of a 57-year-old man with a small pigmented papular lesion (2.5-mm diameter) that was suspicious on dermoscopy. A more confident differential diagnosis between an atypical nevus and a melanoma was necessary for correct management. Reflectance confocal microscopy (RCM) allowed a confident diagnosis in this lesion, which was an invasive melanoma with 0.3-mm Breslow thickness. This case highlights the benefit of RCM to reach a confident diagnosis and correct management of a small-diameter invasive melanoma.

Evaluation of platelet-rich plasma efficacy in melasma.

Platelet-rich plasma (PRP), which is widely used in many dermatologic conditions, has also been used in the treatment of melasma in recent years. The objective of this study is to determine the efficacy of PRP in melasma. Fifteen female patients with melasma participated in this study. Intradermal PRP was performed every 3 weeks for three times. We photographed all participants, performed Melasma Area and Severity Index (MASI), and measured melanin and erythema index (EI) with mexameter before every session and 1 month after the last session. Patients self-assessment of pigmentation grade (0-10) were also employed at baseline and 1 month after the last procedure. Mean MASI of the patients reduced from 10 ± 3.6 to 7.3 ± 2.5. Melanin index (MI) and EI evaluated by mexameter reduced from 256.5 ± 31 to 238.9 ± 29.9 and from 329.9 ± 53.8 to 322.7 ± 77.6, respectively. Mean patients self-assessment score (PSS) reduced from 8.3 ± 1.3 to 5 ± 1.4. Mean MASI, MI, and PSS reduction after treatment was found significant (p = .001, p = .000, p = .000). Intradermal application of PRP is an effective option for treatment of melasma. It also has other benefits like improvement in skin appearance. Because recurrence is common in melasma, depigmenting agents should be used after all procedures.

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: 11-year Demographic Clinical and Prognostic Characteristics.

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute, life-threatening, severe drug reactions. Randomized studies on these diseases are difficult to perform. Aims and Objectives: The purpose of this study was to summarize the demographic and clinical characteristics of patients with SJS and TEN in a tertiary hospital in Turkey. Materials and Methods: We evaluated the records of 33 patients with SJS and TEN who were followed in our clinic or examined between January 2008 and June 2019, retrospectively. Age, sex, time of admission to hospital, causative drug, presence of concomitant disease, skin findings, mucosal involvement, the severity-of-illness score for TEN, the medication used, antibiotic use, transfer to intensive care, development of complications, and death or discharge status were noted. Results: Of the 33 patients, 11 (33.3%) had SJS, 3 (9.1%) had SJS/TEN overlap, and 19 (57.6%) had TEN. The majority (60.6%) of the patients were female. Nineteen (57.6%) patients had one, and 13 (39.4%) had more than one suspected drug exposure in their history. The most commonly suspected drugs were antibiotics. Twelve (36.4%) patients had intensive care unit hospitalization. Ten (30.3%) patients died. Conclusion: The demographic data of our study were consistent with the literature. Similar to the literature, antibiotics were the most common reaction-causing drugs. However, antiepileptic drugs, which were more frequently reported in other studies, were identified as suspicious in only one patient. We believe that our study will contribute to the determination of characteristics of this rare disease with real-life data.

Comparison of Actinic Keratosis and Severity Index with Physician Global Assessment and Total Lesion Count and the Ability to Predict Skin Cancer.

INTRODUCTION: Actinic keratosis (AK) is a known indicator for sun damage, and subsequent squamous cell cancer may develop. The actinic keratosis and severity index (AKASI) is a recently developed tool that can evaluate both field cancerization and AK severity. OBJECTIVES: We sought to evaluate if AKASI was a good predictor of cancer in AK patients and to compare AKASI with both the Physician Global Assessment (PGA) and total lesion count (TLC). METHODS: Ninety patients with AK were included in the study. Each patient was examined, and AKs were scored with AKASI, PGA and TLC by 2 dermatologists. The AKASI, PGA and TLC values were compared between patients with skin cancer and patients without skin cancer. RESULTS: Mean AKASI, PGA, and TLC scores were 4.9, 1.7 and 9 respectively. The patients with skin cancer had higher scores of AKASI, PGA and TLC compared to the patients without skin cancer (P = 0.022, P = 0.014, P = 0.005, respectively). AKASI, PGA and TLC were very strongly correlated with each other (P < 0.001). The AKASI threshold value for non-melanoma skin cancer was determined to be 5.1. CONCLUSIONS: AKASI, PGA and TLC may be used in the assessment of the severity of AK in daily practice or studies and may be considered as valuable tools in determining high-risk patients and to choose treatment option. AKASI seems to have an advantage to give a numeric threshold value for skin cancer.

Ado-trastuzumab emtansine associated spider telangiectasia.

INTRODUCTION: Breast cancer is the most common cancer in women. Human epidermal growth factor receptor 2 (HER2) positivity rate is 20% and generally has a poor prognosis. Ado-trastuzumab emtansine (T-DM1) is an antibody-drug conjugate consisting of HER2 target monoclonal antibody trastuzumab and microtubule inhibitor emtansine. The most common side effects are fatigue, diarrhea, anemia, and it is generally a safe and tolerable agent. CASE REPORT: In our case, we reported our patient who developed mucosal and cutaneous telangiectasia after T-DM1 treatment and who had a complete response in metastases after skin lesions. MANAGEMENT AND OUTCOME: While no side effects were observed during the use of T-DM1 for HER2 positive disease, nose bleeding and spider telangiectasia on the skin developed in the 9th month of the treatment. In these lesions, which did not require any treatment, no regression was observed during T-DM1 treatment. DISCUSSION: We think that T-DM1, which was detected with a low incidence of skin toxicity in studies, may form telangiectatic lesions due to vascular dilatation through emtansine, and therefore care should be taken in the treatment of T-DM1.

Nivolumab-induced plaque morphea in a malign melanoma patient.

BACKGROUND: Nivolumab is one of the targeted cancer therapy agent that acts to increase the immune responses by inhibition of antiprogrammed-death-receptor 1, which is one of the check points of the immune response. Nivolumab can be used to treat malign melanoma, lung, renal, head and neck, colorectal, hepatocellular cancers, and special cases of Hodgkin lymphoma. AIMS: We aimed to report a rarer cutaneous side effect of nivolumab because of the increasing uses of this agent in various cancer treatments. METHODS: We present a 48-year-old female, metastatic melanoma patient who developed plaque morphea lesion without any systemic involvement during nivolumab treatment. Plaque lesion responded well to use of topical corticosteroid and calcipotriol. RESULTS: Numerous cutaneous side effects associated with nivolumab have been reported in the literature. The most common cutaneous side effects are maculopapular rash, pruritus, and vitiligo. Morphea and disorders from this spectrum reported due to PD-1 inhibitors in the literature are; morphea, sclerodermoid changes, eosinophilic fasciitis, and lichen sclerosis. CONCLUSION: Patients who are treated by PD-1 inhibitors may be examined carefully in terms of morphea and scleroderma-like conditions although they are not as common as other cutaneous side effects.

Is it necessary to perform eye examination for patients with cutaneous atypical nevi?

Regular dermatological examination for patients with dysplastic nevi is indicated. However, the literature on whether those patients should also be examined by ophthalmologists or not regarding a relation between suspicious lesions for ocular melanoma and cutaneous dysplastic nevi is limited. In this study, we aimed to compare the findings of a single ophthalmologic examination between the group of patients with multiple atypical nevi with at least one histopathologically proven dysplastic nevus and another group without atypical nevi. We examined the eyes of 110 patients with multiple atypical nevi with at least one histopathologically proven dysplastic nevus (47 had the diagnosis of dysplastic nevus syndrome type A, B, C, D1 or D2) for any lesion and compared the results with a control group consisted of 110 gender, age and skin-type matched patients without atypical nevi no ocular melanoma was detected in any of the groups. The frequency of the conjunctival nevi, iris nevi, choroidal nevi and conjunctival acquired melanosis were similar in both groups. Iris freckles were detected more frequently in the study group. Conjunctival racial hyperpigmentation was detected more frequently in the control group (P < .05). In this study, any significant difference in the distribution of the ocular lesions with any risk of malignancy in the study and control groups was not observed. However, considering the limitations of the study, there may still be a need of regular ophthalmic examination for the patients with atypical nevi in case of having high risk factors for developing melanoma.

Comparison of Skin Scraping and Standard Superficial Skin Biopsy in the Laboratory Diagnosis of Scabies

Objective: Scabies is diagnosed based on the presence of burrows on the skin, Sarcoptes scabiei adult, egg, or scybala in skin scrapings. The laboratory diagnosis of scabies poses various challenges. We aimed to compare the analytical performance of skin scraping and standard superficial skin biopsy (SSSB) and to investigate the correlation with false negative results in the laboratory diagnosis of scabies. Methods: Skin scraping and SSSB were applied from July 1 to December 31, 2018 on 42 patients whose burrows were marked using dermatoscopy, as obtained from the laboratory information system. Results: The number of patients who tested positive for scabies with skin scraping was 18 (42.9%) and 24 (57.1%) with SSSB, and the difference was significant (p=0.003). Sensitivity was 42.9% for skin scraping and 57.1% for SSSB. The number of positive cases with both techniques was 15 (35.7%). The number of patients positive with only skin scraping was 3 (7.1%) and only SSSB was 9 (21.4%). Conclusion: To date, it has seemed impossible to diagnose scabies using a single clinical or laboratory test. According to our results, SSSB is an inexpensive and easy-to-apply method with high sensitivity for obtaining skin samples for scabies laboratory diagnosis.

Experience with Omalizumab for the treatment of chronic spontaneous urticaria in a tertiary center: real life experience.

PURPOSE: Chronic spontaneous urticaria (CSU) is defined as urticaria and/or angioedema that appears spontaneously due to known or unknown causes and lasts for at least 6 weeks. Omalizumab, an anti-IgE antibody that binds circulating free IgE, has recently emerged as a promising treatment for CSU, a condition which impairs patients' quality of life. We aimed to contribute real life data by reporting our experience with omalizumab in the treatment of intractable CSU. METHODS: Of 140 patients treated with omalizumab in our clinic between September 2013 and January 2018, 86 CSU patients with available current data were retrospectively evaluated in terms of sex, age, urticaria duration, urticaria activity score over 7 days (UAS7) before and after omalizumab, relapses and time to relapse, length of remission after omalizumab cessation, adverse events, and comorbidities. RESULTS: The mean age of the patients was 45.5 ± 14.3 years and 73.3% were women. Mean duration of urticaria before initiation of omalizumab therapy was 54.5 ± 67 months. All patients had used antihistamines before starting omalizumab treatment. The mean number of omalizumab doses was 11.9 ± 9.3. The mean duration of omalizumab treatment was 13.3 ± 10.4 months. Mean UAS7 score was 38.9 ± 4.1 before the start of omalizumab treatment, and 7.9 ± 10.5 after treatment. Treatment was discontinued in 10 patients (11.6%) due to nonresponse or loss of effect. Four patients (4.65%) experienced adverse events. Treatment was discontinued in 1 patient (1.16%) due to side effects. Of the 55 patients whose treatment was discontinued after their symptoms resolved, 31 (56.3%) relapsed after omalizumab cessation. Twenty-four patients (43.6%) did not relapse after omalizumab cessation. CONCLUSIONS: Our results show that omalizumab was an effective treatment for intractable CSU and did not cause any serious adverse effects other than asthenia, vertigo, and injection site reaction in four patients. These findings are relevant because they reflect real-life data.

Reflectance confocal microscopic findings in a case of huge dermatofibrosarcoma protuberans.

Dermatofibrosarcoma protuberans is a slowly progressive, locally aggressive fibroblastic tumor which can be misdiagnosed in the early stage. Reflectance confocal microscopic features of dermatofibrosarcoma protuberans has been scarcely described in the literature. We described the dermoscopic and reflectance confocal microscopic findings of 12â€¯× 15 cm sized tumoral lesion of 45-year-old man.

Extranasal extranodal NK/T cell lymphoma: A post-transplantation lymphoproliferative disease.

Extranodal NK/T cell lymphoma (ENKTL) is a rare form of non-Hodgkin lymphoma. It mostly occurs in the upper respiratory tract. Cutaneous involvement can be seen among the extranasal ENKTLs. After solid organ and haematopoietic stem cell transplantation, post-transplantation lymphoproliferative disease because of immunosuppressive therapy is usually B cell-derived; T and NK/T cell-derived disease is rarely seen. A 43-year-old female patient who had renal transplantation 14 years ago presented with cutaneous ulceration and subcutaneous nodules located in the abdomen. The patient was diagnosed with ENKTL, nasal type. Although it is rare, ENKTL nasal type is a lymphoproliferative disease that should be considered in the differential diagnosis of ulcerated cutaneous tumoural lesions.

Swollen digits due to pachydermodactyly resembling inflammatory arthritis.

Pachydermodactyly is a rare digital fibromatosis, characterized by painless, fusiform swelling in proximal interphalangeal joints. Since it may be misdiagnosed as inflammatory arthritis, it is important to call physicians' attention to this rarely seen condition to avoid unnecessary immunosuppressive treatment. Hereby, we present a case of a pachydermodactyly that had been previously followed-up and treated as an inflammatory arthritis for 4 years. We describe the clinical, radiological, and dermoscopic features of the case.