Prognostic factors of patients with mycosis fungoides.

INTRODUCTION: Mycosis fungoides (MF) is the most common type of primary cutaneous T-cell lymphoma. Prognostic factors may help to evaluate the course of the disease and may also be useful in selecting appropriate treatment plans for patients. AIM: To investigate the potential prognostic factors of MF and their correlations with MF stage. MATERIAL AND METHODS: We evaluated the records of patients with MF who were followed in our lymphoma clinic between 1998 and 2015. Age, sex, disease stage, peripheral blood eosinophilia, eosinophil cationic protein, serum total IgE, lactate dehydrogenase (LDH), and ß2-microglobulin levels were investigated and recorded at the time of diagnosis. RESULTS: There was a statistically significant positive correlation between high ß2-microglobulin levels and the advanced stage of disease (p < 0.001). The older group of patients had statistically significantly higher levels of ß2-microglobulin compared to the younger group (p = 0.001). We found strong, significantly positive correlations between disease stage and ß2-microglobulin, LDH, and total IgE levels (p < 0.001, rho = 0.335; p = 0.001, r = 0.302; p = 0.001, r = 0.311, respectively). Additionally, there were significantly positive correlations between LDH levels and ß2-microglobulin, total IgE levels (p < 0.001, rho = 0.484; p = 0.001, r = 0.212, respectively). Study limitations: A limited number of patients and the retrospective nature of the study. CONCLUSIONS: We found that ß2-microglobulin was a significant prognostic factor in our study population of MF patients. Also, elevated LDH, ß2-microglobulin, and total IgE levels were correlated with advanced disease. Thus, these parameters can be used together to identify patients who have progressed to the later stages of the disease and who require more aggressive treatment.

Challenges in early diagnosis of primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma: a case series of four patients.

BACKGROUND: Primary cutaneous aggressive epidermotropic CD8+ cytotoxic T-cell lymphoma (AECTCL) is a rare and aggressive lymphoma characterised by ulcerated lesions and a poor prognosis. OBJECTIVES: To present a case series of four previously misdiagnosed AECTCL patients and discuss the importance of early diagnosis. MATERIALS AND METHODS: All patients in this study were identified from the database of the Dermatology Department of the Medical School of Bezmialem Vakif University, based on clinical and histopathological diagnosis of AECTCL between 2010 and 2018. RESULTS: AECTCL cases may mimic many benign dermatoses and accurate diagnosis may be delayed. CONCLUSION: Because of its poor prognosis, early diagnosis of AECTCL may be helpful in improving the likelihood of patient survival, but further study is needed to address the challenges in diagnosing this rare and aggressive lymphoma.

Which dermatology patients attend to Dermatology Outpatient Clinics during the SARS-CoV-2 outbreak in Turkey and what happened to them?

Coronavirus disease, first emerged in Wuhan, rapidly spread all over the world since December 2019. There are concerns about elective dermatology appointments and its results. Herein, we aimed to find out which type of dermatologic patients attended to dermatology outpatient clinic. The patients visiting the clinics for elective dermatologic diseases between March 11 and 18, 2020, were included in this study. Their age, sex, diagnosis of disease, requirement for emergent intervention, and their medical records about COVID-19 were obtained. There were 390 patients attending to the dermatology outpatient clinic in this period. The most common disease was acne (N: 94, 24%), only 19% of patients need emergent interventions or dose adjustment. There were 40 (10%) patients over the age of 65. After their visits, five patients were diagnosed as COVID-19 in 2weeks. Dermatologic examinations may be a vector for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission since being closed to the patient. Five of our patients were diagnosed as COVID-19 after their elective visit to hospital. Since the asymptomatic course of some young patients, most of our patients were not screened for COVID-19. Our findings support the concerns of elective physician examinations.

Is rituximab therapy a risk factor for development of melanoma?

In the literature, there are reports about dermoscopic and size changes of nevi in patients undergoing biologic therapy and chemotherapeutics. There has not been any established data for melanoma and Rituximab therapy. Sixteen patients, with 94 nevi were included in this study. Dermoscopic images of follow-up visits, which were performed at baseline, 3, 6, and 12 months after treatment, were evaluated. Suspicious lesions were excised. There was no increase in total nevus count. Although 61.7% of the 94 nevi have shown a stable duration without size changes, 26.5% had enlarged, and 11.7% had become smaller during our 1-year experience of dermoscopic monitoring. There was not any pattern transformation. Atypical dots and clods appeared in 17% of nevi. All of the excised nevi were comparable with Clark nevi, there was no clue for melanoma development. According to our results, we found that Rituximab therapy influences nevus morphology, but there is no evidence that this was linked to melanoma development.

Three years dermoscopic follow-up of atypical nevi.

Atypical nevi are dynamic lesions and may progressively transform into more or less atypical lesions. We aimed to investigate the dermoscopic features of atypical nevi and dynamic changes in these lesions over a period of 3-years. Patients with 3-year dermoscopic follow-up records were enrolled in the study. We compared the dermatoscopic features of the nevus recorded in the first dermoscopic examination and at the end of the third year. Changes in size (mm), pattern, and color were investigated. The most common dermoscopic patterns were reticular (18 patients; 34%), reticular-homogeneous (17 patients; 32.1%), and reticular-globular (7 patients; 13.2%). The most common pigmentation patterns were central hyperpigmentation (28 patients; 52.8%), regular pigmentation (nine patients; 17.0%), and multifocal hypo/hyperpigmentation (eight patients; 15.1%). Twenty-one (39.6%) patients showed changes in pattern. The transformation from reticular-homogeneous pattern to the homogeneous pattern was the most frequent change in pattern (7 of 21 patients; 33.3%). The transformation from reticular pattern to reticular-homogeneous pattern was the second most common change in pattern (5 of 21 patients; 23.8%). Fourteen (26.4%) patients experienced symmetrical enlargement. Symmetrical enlargement was statistically more frequent in patients who showed dermoscopic changes in pattern than in those who did not show any changes in the pattern (p: .038). In this study, we did not observe any new dermoscopic clues for the diagnosis of melanoma during the follow-up. The nevi tended to turn into a homogeneous (structureless) pattern. We observed that the most common dermoscopic change in pattern was the transformation from reticular-homogeneous pattern to homogeneous pattern, and the lesions had symmetrical enlargement during this transformation. In conclusion, despite the known association between atypical nevi and the risk of developing melanoma, most atypical nevi do not transform into melanoma. Therefore, our study suggests that the excision of atypical nevi is not necessary and dermatoscopic follow-up can reduce the number of unnecessary excisions.

A rare and severe cutaneous adverse effect of telaprevir: drug rash with eosinophilia and systemic symptoms.

Telaprevir is a specific inhibitor of the hepatitis C (HCV) serine protease 3. Cutaneous side effects have been reported with telaprevir. Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare yet severe adverse drug-induced reaction characterized by exfoliative dermatitis and maculopapular rash, lymphadenopathy, fever, eosinophilia, leukocytosis, and myriad internal organ involvement. We report a case of DRESS due to telaprevir. A 64-year-old Caucasian man with chronic hepatitis C developed a progressive diffuse, painful maculopapular exanthema with fever, facial edema, lymphadenopathy at week 11 of chronic hepatitis C therapy with telaprevir, Peg-Interferon alfa-2a, and ribavirin. He had no exposures to any other medications. He presented an eosinophilia (up to 6.29 X 109 cells/L), skin biopsy was consistent with a drug reaction. The HCV treatment was stopped and methylprednisolone 0.75 mg/kg/day was started. Cutaneous and systemic symptoms had a rapid resolution in few days. Telaprevir can activate severe skin reactions that can mimic an infectious disease, therefore early diagnosis and discontinuation of chronic hepatitis C treatment is mandatory.

Evaluation of Neopterin Level and Disease Severity in Patients with Psoriasis Vulgaris Treated with Narrowband UVB.

BACKGROUND: Neopterin is a biochemical marker of cellular immunity. It has been reported that serum and urine neopterin levels increase in psoriasis and decrease with treatment. Nevertheless, assessment of a direct link between narrowband ultraviolet B (UVB) therapy and neopterin level in association with Psoriasis Area and Severity Index (PASI) scores has not been performed yet. We aimed to evaluate the serum neopterin level in patients with psoriasis treated with narrowband UVB therapy in association with disease severity. MATERIALS AND METHODS: The study included 35 patients with chronic plaque-type psoriasis who had PASI scores of >10 or below 10 but resistant to topical therapies and 30 healthy individuals. The narrowband UVB therapy was administered to the patient group (n = 35). Serum neopterin analysis was performed with an enzyme-linked immunosorbent assay method before and after treatment. RESULTS: There was statistically significant correlation between neopterin level and PASI score in the patient group (P = 0.011). The serum neopterin level was significantly increased in patients with higher PASI score. Moreover, the serum neopterin level was found to be statistically higher in severe psoriasis group (PASI score ≥10, n = 14) than the mild-moderate group (PASI score <10, n = 21) (P = 0.001). Furthermore, a significant decrease was observed according to serum neopterin level after the narrowband UVB therapy in the remaining 20 patients who were able to comply with the scheduled therapy and follow-up procedure (P = 0.026). CONCLUSION: Serum neopterin levels were found to be an useful marker for evaluating disease severity and efficacy of narrowband UVB treatment. Thus, our findings may provide a new approach with the management of disease and follow-up strategies in patients with psoriasis.

Dermoscopic Evolution of Pediatric Nevi.

BACKGROUND: The incidence of pediatric melanoma is very rare. Dermoscopic features help to distinguish pediatric melanoma and common nevi. OBJECTIVE: To study the evolution of dermoscopic findings in benign nevi in childhood through serial observation and photography. METHODS: We examined 504 melanocytic lesions in 100 patients. From each participant, dermoscopic images of the nevi from 4-year dermoscopic follow-up were obtained, including randomly selected nevi. RESULTS: The most common dermoscopic patterns were homogeneous (193 nevi; 38.3%), globular (92 nevi; 18.3%), and reticular (86 nevi; 17.1%). Dermoscopic pattern changes were detected in 27% of patients aged 2~10 years and in 20% of patients aged 11~16 years. The main pattern changes consisted of the transition from homogeneous to globular-homogeneous (16%), from homogeneous to reticular-homogeneous (12%) and from globular to globular-homogeneous (10%). Although 257 of the 504 nevi (51.0%) have stable duration without size changes, 169 of the 504 nevi (33.5%) were enlarged, and 78 of the 504 nevi (15.5%) had become smaller. CONCLUSION: These results contrast with the prevailing view that dermoscopic patterns in pediatric nevi are usually characterized by globular patterns and that melanocytic nevi generally undergo a characteristic transition from a globular pattern to a reticular pattern. Fifty one percent of patients did not exhibit a size change. While 33% of patients had symmetrical enlargement, 15% of patients had involution. Therefore, enlargement is a common dermoscopic change in pediatric nevi, and is not a specific sign of pediatric melanoma.

Etiology of Onychomycosis in Patients in Turkey.

BACKGROUND: Onychomycosis is a chronic nail infection caused by dermatophytes, Candida, nondermatophyte molds, and Trichosporon. The purpose of this study was to identify the underlying pathogen in patients with onychomycosis in our region. METHODS: A retrospective analysis of 225 cases with onychomycosis, diagnosed over a 27-month period at the Department of Dermatoveneorology, Bezmialem Vakif University, Istanbul, Turkey, and confirmed with culture, was performed. RESULTS: Patient age ranged from 2 to 87 years (mean ± SD, 41.59 ± 17.61), and female patients were more commonly affected (120 cases, 53.3%) than male patients. Lateral and distal subungual onychomycosis was detected in 180 cases (80%). Etiologic agents were as follows: Trichophyton rubrum, 77 cases (34.2%); Trichophyton mentagrophytes, 30 cases (13.3%), Candida albicans, 28 cases (12.4%); Candida parapsilosis, 25 cases (11.1%); Acremonium species, one case (0.4%); Aspergillus species, two cases (0.9%); Fusarium species, four cases (1.3%); and Trichosporon species, three cases (1.3%). CONCLUSIONS: The most frequent isolated etiologic agents were T rubrum for toenails and C albicans for fingernails.

Evaluation of mean platelet volume in localized scleroderma.

BACKGROUND: Localized scleroderma is a chronic inflammatory skin disease characterized by sclerosis of the dermis and subcutaneous tissue. Platelets play an important role in inflammation. Following activation, platelets rapidly release numerous mediators and cytokines, which contribute to inflammation. OBJECTIVES: To evaluate whether there was any relation between localized scleroderma and platelet parameters. METHODS: Forty-one patients with localized scleroderma were enrolled in the study. The control group consisted of 30 healthy subjects. RESULTS: The mean platelet volume level in the patient group was 9.9 ± 1.3 fl and in the control group was 7.6 ± 1.1 fl. This difference was statistically significant (p< 0.001). The plateletcrit values are minimally higher in the patient group as compared to the control group. It was statistically significant (p<0.001). There was no significant difference in the platelet counts between the two groups (p= 0.560) In the patient group, there was no significant relation between the mean platelet volume levels and clinical signs of disease (p=0.09). However, plateletcrit values are higher in generalized than localized forms of disease (p=0.01). STUDY LIMITATIONS: The limited number of patients and the retrospective nature of the study were our limitations. CONCLUSIONS: This study suggests that platelets might play a role in the pathogenesis of scleroderma. Platelet parameters may be used as markers for evaluating disease severity and inflammatory processes. Thus, there is a need for more detailed and prospective studies.

Evaluation of mean platelet volume in localized scleroderma

Abstract: Background: Localized scleroderma is a chronic inflammatory skin disease characterized by sclerosis of the dermis and subcutaneous tissue. Platelets play an important role in inflammation. Following activation, platelets rapidly release numerous mediators and cytokines, which contribute to inflammation. Objectives: To evaluate whether there was any relation between localized scleroderma and platelet parameters. Methods: Forty-one patients with localized scleroderma were enrolled in the study. The control group consisted of 30 healthy subjects. Results: The mean platelet volume level in the patient group was 9.9 ± 1.3 fl and in the control group was 7.6 ± 1.1 fl. This difference was statistically significant (p< 0.001). The plateletcrit values are minimally higher in the patient group as compared to the control group. It was statistically significant (p<0.001). There was no significant difference in the platelet counts between the two groups (p= 0.560) In the patient group, there was no significant relation between the mean platelet volume levels and clinical signs of disease (p=0.09). However, plateletcrit values are higher in generalized than localized forms of disease (p=0.01). Study Limitations: The limited number of patients and the retrospective nature of the study were our limitations. Conclusions: This study suggests that platelets might play a role in the pathogenesis of scleroderma. Platelet parameters may be used as markers for evaluating disease severity and inflammatory processes. Thus, there is a need for more detailed and prospective studies.

Evolution of Spitz Nevi.

BACKGROUND/OBJECTIVES: Spitz nevi are melanocytic lesions with clinical, dermoscopic, and histopathologic presentations that may resemble those of melanoma. The evolution of Spitz nevi is a well-known feature. The objectives of this study were to investigate the clinical and dermoscopic features of Spitz nevi and define their evolution. METHODS: A retrospective observational study was performed and 70 Spitz nevi were analyzed using clinical and dermoscopic examination. RESULTS: Seventy patients were included in the study. The most common dermoscopic pattern was globular (n = 35 [50%]) followed by starburst (n = 24 [34.3%]), reticular (n = 8 [11.4%]), and homogeneous (n = 3 [4.3%]). Follow-up data were available for 27 of 70 patients. Of these, 21 demonstrated evolution on the follow-up images. A stable pattern (no evolution) was noted in 6 of 27 lesions. The patients who exhibited evolution were younger on average than the stable group (p = 0.04). CONCLUSION: Based on our study, the most common biologic behavior for Spitz nevi is evolution. Although no significant differences were observed in other clinical features, the inverse relationship between evolution and age is important to consider when attempting to differentiate Spitz nevus from melanoma.

Age and Anatomical Location-Related Dermoscopic Patterns of 210 Acral Melanocytic Nevi in a Turkish Population.

BACKGROUND: Dermoscopy is a useful tool for earlier diagnosis and differentiating benign lesions from melanoma. OBJECTIVES: We aim to investigate dermoscopic features of acral nevi, age, and localisation-related findings of these lesions. METHODS: This was an observational, descriptive study. Patients were retrospectively collected from the Department of Dermatology. The patients with acral nevi were included in the study. Inclusion criteria were Turkish nationality and the presence of at least 1 acral nevus diagnosed both clinically and dermoscopically. Lesions in dorsal and subungual areas were excluded. All nevi were examined by the same dermatologist. RESULTS: The most common dermoscopic patterns were as follows: parallel furrow (87 patients; 41.4%), globular (24 patients; 11.4%), fibrillar (22 patients; 10.5%), combination patterns (19 patients; 9.1%), globulostreak-like (16 patients; 7.6%), lattice-like (15 patients; 7.1%), homogeneous (12 patients; 5.7%), nontypical (8 patients; 3.8%), parallel ridge (4 patients; 1.9%), reticular (2 patients; 1.0%), and crista dotted pattern (1 patient; 0.5%). The parallel furrow pattern was the most common pattern in all localisations. The number of parallel furrow patterns (5 lesions) was equal to the globulostreak-like pattern (5 lesions) on the thenar area. The number of parallel furrow patterns (4 lesions) was equal to the fibrillar pattern (4 lesions) on the heel. Parallel furrow (dotted variants) (11 lesions) and globulostreak-like patterns (5 lesions) were the most common patterns in the pediatric population (0-15 years old). The fibrillar pattern showed a tendency for soles (12 lesions), while a lattice-like pattern was seen more often in the plantar arch (3 lesions). CONCLUSIONS: Description of the dermoscopic features of acral nevi is important to improve management and reduce the number of unnecessary excisions. The most common patterns were parallel furrow, globular, and fibrillar in our study. Parallel furrow (dotted variants) and globulostreak-like patterns were the most common patterns in the pediatric population. The fibrillar pattern showed a tendency for soles, while a lattice-like pattern was seen more often on the plantar arch. Therefore, there may be a relation between anatomic localisation, age, and dermoscopic pattern.

Does verruca vulgaris affect social anxiety and self-esteem in adolescents?

Objective Sensitivity about appearance is one of the sine qua non of adolescence and adolescents' self-esteem effecting their socialization processes. We explored if verruca vulgaris, a common visible infectious skin disease, affects social anxiety levels and self-esteem in adolescents compared to controls. Also, the difference in sociodemographic properties between two groups and the effect of clinical properties (the distribution and number of warts) on these parameters were investigated in the patient group. Materials and methods The study group consisted 98 adolescents (49 controls and 49 patients) without other medical/psychiatric diseases. The Sociodemographic form (SDF), the Çapa Social Phobia Scale for Children and Adolescents (ÇCASPS) and the Rosenberg Self-Esteem Scale (RSES) were completed by both groups. Results There was no difference in social anxiety levels and self-esteem between the two groups. Also, the control and patient groups were found matched. However, lower self-esteem was the only factor that increased the risk for social phobia in the patient group. Conclusion Verruca vulgaris distributed in hands and face in adolescents were not found to be related with higher social anxiety and lower self-esteem. However, clinicians should monitor psychiatric symptoms and especially lower self-esteem should be taken into account.

Red Blood Cell Distribution Width and Neutrophil-to-Lymphocyte Ratio in Patients with Cutaneous Vasculitis.

BACKGROUND: Vasculitis represents a specific pattern of inflammation of the blood vessel wall that can occur in any organ system of the body. The neutrophil to lymphocyte ratio (NLR) and red blood cell distribution width (RDW) are currently used as markers of inflammation in several diseases. OBJECTIVES: This study analyzed C-reactive protein level (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC), NLR, and RDW in patients who had cutaneous vasculitis, or cutaneous vasculitis with systemic involvement, and in healthy controls. METHODS: A total of 85 individuals were included in our study: 45 with vasculitis and 40 healthy controls. Patients who had complete blood count (CBC) analysis, CRP, and ESR at the time of skin biopsy were included in the study. NLR was calculated from these parameters. RESULTS: NLR, CRP, ESR, and WBC were significantly higher in patients with vasculitis than in healthy controls (p≤0.05), but RDW did not significantly differ between the two groups. CONCLUSIONS: This study suggests that blood NLR may be used for predicting vasculitis, especially cutaneous vasculitis with systemic involvement.