Clinical characteristics of pediatric hidradenitis suppurativa: a cross-sectional multicenter study of 140 patients.

Hidradenitis suppurativa (HS) rarely affects pediatric patients. The literature on pediatric HS patients is scarce. This is a cross-sectional study based on case note review or interviews and clinical examination of 140 pediatric patients undergoing secondary or tertiary level care. Patients were predominantly female (75.5%, n = 105) with a median age of 16. 39% reported 1st-degree relative with HS. Median BMI percentile was 88, and 11% were smokers (n = 15). Median modified Sartorius score was 8.5. Notable comorbidities found were acne (32.8%, n = 45), hirsutism (19.3%, n = 27), and pilonidal cysts (16.4%, n = 23). Resorcinol (n = 27) and clindamycin (n = 25) were the most frequently used topical treatments. Patients were treated with tetracycline (n = 32), or oral clindamycin and rifampicin in combination (n = 29). Surgical excision was performed in 18 patients, deroofing in five and incision in seven patients. Obesity seemed to be prominent in the pediatric population and correlated to parent BMI, suggesting a potential for preventive measures for the family. Disease management appeared to be similar to that of adult HS, bearing in mind that the younger the patient, the milder the disease in majority of cases.

Prevalence of smoking, alcohol consumption and metabolic syndrome in patients with psoriasis.

BACKGROUND: Coexistence of obesity, hypertension, insulin resistance and dyslipidemia is defined as metabolic syndrome (MBS), which is among the important risk indicators for cardiovascular diseases, diabetes and stroke. Smoking and alcohol consumption are the other factors which lead to an increase in the risk of cardiovascular disease. OBJECTIVE: To investigate the prevalence of metabolic syndrome, smoking and alcohol consumption in psoriasis patients and the relationship between disease severity and these factors. METHODS: This cross-sectional study enrolled 563 patients with chronic plaque-type psoriasis, all of which completed a questionnaire and underwent a complete physical examination. Data about MBS components, psoriasis severity/duration, smoking and alcohol consumption, and cardiovascular diseases were recorded. RESULTS: A total of 563 patients with ages ranging from 18 to 78 years were evaluated. Metabolic syndrome was found in 12.6% of the patients [central obesity (38.7%), hypertension (14.3%), dyslipidemia (18.6%), diabetes (9.2%)], while 50.3% had smoking, and 3.3% had alcohol consumption. Patients with metabolic syndrome were older and more likely to have a longer disease duration than those without metabolic syndrome (p<0.05 for each). The prevalence of metabolic syndrome was higher in women than in men. Psoriasis was more severe in patients with central obesity, diabetes and smoking than in those without (p<0.05 for each). STUDY LIMITATIONS: Retrospective design. CONCLUSIONS: Our results indicate that MBS is a risk factor for psoriasis patients with advanced age. The relationship between disease severity and obesity, diabetes, and smoking in psoriasis patients indicates that the patients should be informed about the potential metabolic risks and receive therapies for behavioral changes besides anti-psoriatic treatment in order to minimize these risks.

Prevalence of smoking, alcohol consumption and metabolic syndrome in patients with psoriasis

Abstract: Background: Coexistence of obesity, hypertension, insulin resistance and dyslipidemia is defined as metabolic syndrome (MBS), which is among the important risk indicators for cardiovascular diseases, diabetes and stroke. Smoking and alcohol consumption are the other factors which lead to an increase in the risk of cardiovascular disease. Objective: To investigate the prevalence of metabolic syndrome, smoking and alcohol consumption in psoriasis patients and the relationship between disease severity and these factors. Methods: This cross-sectional study enrolled 563 patients with chronic plaque-type psoriasis, all of which completed a questionnaire and underwent a complete physical examination. Data about MBS components, psoriasis severity/duration, smoking and alcohol consumption, and cardiovascular diseases were recorded. Results: A total of 563 patients with ages ranging from 18 to 78 years were evaluated. Metabolic syndrome was found in 12.6% of the patients [central obesity (38.7%), hypertension (14.3%), dyslipidemia (18.6%), diabetes (9.2%)], while 50.3% had smoking, and 3.3% had alcohol consumption. Patients with metabolic syndrome were older and more likely to have a longer disease duration than those without metabolic syndrome (p<0.05 for each). The prevalence of metabolic syndrome was higher in women than in men. Psoriasis was more severe in patients with central obesity, diabetes and smoking than in those without (p<0.05 for each). Study Limitations: Retrospective design. Conclusions: Our results indicate that MBS is a risk factor for psoriasis patients with advanced age. The relationship between disease severity and obesity, diabetes, and smoking in psoriasis patients indicates that the patients should be informed about the potential metabolic risks and receive therapies for behavioral changes besides anti-psoriatic treatment in order to minimize these risks.

Ultraviolet A1 Phototherapy in the Treatment of Early Mycosis Fungoides.

BACKGROUND: Phototherapy has been the mainstay of therapies for early mycosis fungoides (MF). The beneficial role of ultraviolet (UV) light on MF is suggested by the observation that lesions occur on non-sun-exposed areas. Therapeutic light sources that are available today are broadband UVB, psoralen and UVA, narrowband UVB, and long-wave UV (UVA1). Current literature provides increasing evidence on the use of UVA1 to treat MF. AIM: To investigate the treatment responses of early MF patients treated with fixed 30 J/cm2 doses of UVA1 phototherapy. MATERIAL AND METHODS: Nineteen patients with early MF, stage IA-IIA of the TNM staging system, received fixed 30 J/cm2 doses of UVA1, given 5 times weekly over 5 weeks. Therapeutic effectiveness was assessed by clinical examination and was confirmed by histological evaluation. RESULTS: Of the 19 patients, complete responses were achieved in 12 (63%) and partial responses were achieved in 7 (37%) patients after UVA1 radiation exposures. During the study, UVA1 therapy was well tolerated. During the follow-up, 7 (58%) of the 12 patients with complete response relapsed within 3 months of the UVA1 therapy. CONCLUSION: The current study provides clinical and histological evidence for the effectiveness of UVA1 (30 J/cm2 5 times a week for 5 weeks) as a skin-directed therapy in the treatment of early MF; however, such a treatment failed to maintain a long and sustained response. Thus, studies to identify the optimal dosing protocol regarding the therapeutic efficacy, the factors affecting relapse time/rate, and the necessity of maintenance treatment are needed.

Ustekinumab for the treatment of acrodermatitis continua of Hallopeau refractory to anti-TNF agents.

Acrodermatitis continua of Hallopeau (ACH) is a variant of pustular psoriasis that is often very difficult to treat. Almost all anti-psoriatic agents have been used in the treatment of ACH. Ustekinumab, a fully human monoclonal antibody of the IgG1 class, is directed to the shared p40 subunit of cytokines IL-12 and IL-23. Herein, we present our experience of ustekinumab use in a 50-year-old man who was resistant to anti-tumor necrosis factor-α agents. Though initial therapy with ustekinumab achieved a sustained response in our patient, after a seven months of interruption, retreatment resulted in a slower and poorer response than the initial regimen. Both responses of our patient reflects: (i) the recalcitrant chronic nature of ACH in some patients, (ii) the value of ustekinumab in ACH treatment, (iii) the fact that, as with other biologics, a loss of response may also occur with ustekinumab when the treatment is interrupted. All these data provides evidence for the fact that the course of ACH is unpredictable and possibly indicate that concerning current biologics used in the treatment of ACH, we have still failed to hit the target we aimed for.

Trichofolliculoma: a rare variant of hair follicle hamartoma.

Trichofolliculoma is a rare hair follicle hamartoma, which is often regarded as a hair follicle tumor. Mostly, it presents as a papule or nodule, involving the skin of the face and scalp area. A central, dilated keratin plugged ostium with vellus hair(s) is often present. We report a 19-year-old woman with typical clinical and histopathological findings of trichofolliculoma.

Transient reactive papulotranslucent acrokeratoderma in a 50-year-old woman: case report and review of the literature.

A 50-year-old woman who presented with intermittent symmetric edema and wrinkling of the palms after soaking in water was found to have transient reactive papulotranslucent acrokeratoderma (TRPA). This is the oldest patient ever reported to have this condition. The patient was advised to avoid water exposure as much as possible and to wear gloves. Topical treatment with 5% salicylic acid in Vaseline also provided some relief. TRPA presents with translucent, white, confluent papules that become evident on the palms after 3-5 minutes' exposure to water (the so-called 'hand-in-the-bucket' sign) and resolve within a short time after drying. It is a rare disorder with fewer than 40 cases having been reported in the world literature. The disease is seen mostly in female patients, with ages ranging from 6 to 44 years prior to our case in a 50-year-old woman. The most common histologic findings are hyperkeratosis and dilated eccrine ostia. The etiopathogenesis of the disease remains unknown but a transitory structural or functional alteration of components of the stratum corneum or aberration of the sweat duct have been considered. TRPA has been reported in patients with cystic fibrosis and more recently, in patients taking selective cyclo-oxygenase-2 inhibitors. Therefore, the pathogenesis of the condition appears to be related to increased water absorption as a result of an increased epidermal sodium level. Treatment with barrier creams such as hydrophilic petrolatum, glycerin emollients, 5-20% salicylic acid in Vaseline, 10% urea cream, and 12% ammonium lactate cream have been reported. Cases with associated hyperhidrosis respond well to aluminum chloride-containing products.

Treatment of idiopathic pyoderma gangrenosum with infliximab: induction dosing regimen or on-demand therapy?

Pyoderma gangrenosum is an ulcerative skin disease of unknown origin. Recently tumor necrosis factor alpha inhibitors have been gaining attention in the treatment of recalcitrant pyoderma gangrenosum. However, there is a lack of an optimal dosing strategy in the published literature about the treatment of idiopathic pyoderma gangrenosum, and this is responsible for substantially different treatment strategies. Therefore, it is necessary to report experiences in this patient population in order to develop an optimal dosing strategy and to clarify whether regularly scheduled or on-demand therapy is suitable for idiopathic pyoderma gangrenosum. Herein we report a recalcitrant case of an idiopathic pyoderma gangrenosum treated successfully with a dosing regimen similar to the one that has been used in psoriasis. By doing so, we were capable of controlling the disease and improving the quality of life in our patient.

A mild form of Proteus syndrome.

Proteus syndrome is a multisystem disorder and diagnosis has been difficult because of the variability of the syndrome's manifestations. Dermatologists have an important role as cutaneous findings could provide clues for the early diagnosis of the disease. Herein we report a case who had cerebriform connective tissue nevus and lipoma as the sole manifestations of the disease.

Dermoscopic features of accessory nipples.

CASE 1: A 27-year-old woman presented with a 6 x 6 mm, soft, pink-brown papule located on the right axilla (Fig. 1). Dermoscopic examination showed a central scar-like white-colored area, a cleft-like appearance in the central area, and a fine pigment network in the periphery of the lesion (Fig. 2). CASE 2: A 5-year-old girl presented with a 4 x 4 mm pink nodule on her left abdominal region. Dermoscopic examination showed a central scar-like white-colored area, and a fine pigment network in the periphery of the lesion. CASE 3: An 18-year-old man presented to our outpatient clinic suffering from a firm, tender, painful, 7 x 7 mm brownish pink nodule located on his left hypochondrium. Upon dermoscopic examination, a central white scar-like area was detected. A cleft-like appearance was also detected in the central region. In the periphery of the lesion, there was a fine pigment network. CASE 4: An 8-year-old girl reported to our outpatient clinic with a congenital 5 x 5 mm brownish papule on her right inguinal region. Dermoscopic examination showed a central white scar-like area, a cleft-like appearance in the central region, and a fine pigment network in the periphery of the lesion (Fig. 3). CASE 5: A 2-month-old girl was referred to our pigmented lesions clinic with a 3 x 3 mm brownish pink papule located on the right subcostal region lesion that had been noted by a pediatrician. Dermoscopic examination showed a central white area, central streak, and a very faint pigmented network at the periphery.

Caspase 9 is decreased in psoriatic epidermis.

Psoriasis is a proliferative and inflammatory disease of the skin. Caspase 9 is responsible for initiating the caspase activation cascade during apoptosis. Apoptosis is a physiological mechanism of homeostasis and development, and caspases are the executioners of apoptosis. This study reports the immunohistochemical localisation of caspase 9 in psoriatic skin and compares it with that seen in normal, healthy control skin. Skin biopsy specimens of lesions were obtained from 15 patients with plaque type psoriasis vulgaris. The specimens were labelled immunohistochemically for binding of an anti-caspase 9 primary antibody. Biopsies of healthy skin from 10 age-matched and sex-matched healthy control individuals were also analysed. The caspase 9 positive cell fraction was calculated for both epidermal and dermal cells in psoriatic lesions and healthy control skin. Counts of caspase 9 positive cells from the epidermis of psoriatic skin lesions were significantly lower than those seen in healthy skin (p<0.05). The caspase 9 immunolabelled perivascular cell counts in the dermis were not statistically significantly different in psoriatic lesions versus normal skin (p>0.05). Psoriatic epidermis contains little of the apoptotic marker, caspase 9. The results of this study are indicative of decreased apoptosis in psoriatic epidermis, and no change in the perivascular area in psoriatic lesions. These findings support the idea that decreased apoptosis is seen in psoriatic epidermal cells. Greater understanding of the nature of the disease may open new avenues for further therapeutic modalities.

Silicone gel sheeting for the management and prevention of onychocryptosis.

BACKGROUND: Onychocryptosis, commonly referred to as ingrown nails, has many therapeutic alternatives for its management. Although mild cases can be treated conservatively, in severe cases, surgical treatment is preferred. Silicone gel sheeting is found to be effective in the treatment of hypertrophic scars and keloids. OBJECTIVE: To document the effectiveness of silicone gel sheeting in the management of patients with onychocryptosis and in the prevention of the recurrences by breaking the devil's circle, which usually took place after the surgical procedures used in the treatment of the onychocryptosis. METHODS: Fourteen patients were enrolled in the study. Entry criteria required the presence of slight (2 patients), moderate (2 patients), or severe (10 patients) onychocryptosis. The simple technique used in the study was the excision of the one-quarter part of the lesional side of the nail plate without excising the granulation tissue. After 24 hours, the silicone was placed on the granulation tissue and the exposed nail bed. Silicone gel sheet was bandaged loosely without applying any pressure. Patients entering the study were given detailed instructions in applying and using the gel for 12 hours during the daytime. The study lasted for 14 months and was composed of a treatment period of 4 months and a follow-up period of 10 months. The patients were evaluated every 2 weeks in the first month and then monthly. The change in thickness of granulation tissue was evaluated by comparing them with the baseline photographs and those taken at each visit. RESULTS: The management and prevention of onychocryptosis were achieved in 12 of 14 patients (85.71%). The silicone gel sheeting treatment was well tolerated except for an occasional transient exudation, which was resolved when the treatment was withdrawn. CONCLUSION: The results show that the new method that we used for the treatment of onychocryptosis is successful in reducing the thickness of the hypertrophic nail fold and prevents the recurrence of the condition during the regrowth of the nail plate by breaking the devil's circle. The advantage of this method is that it is not destructive to the nail matrix and the adjacent tissue.

The seroprevalence of Helicobacter pylori and nitric oxide in acne rosacea.

BACKGROUND: Acne rosacea is a dermatosis with unknown etiology. Some studies have reported a high prevalence of Helicobacter pylori infection in acne rosacea. Other studies have reported a decrease in the severity of the lesions of acne rosacea after eradication of H. pylori. H. pylori is a Gram-negative bacterium which colonizes the gastric mucosa and increases the synthesis of oxygen radicals, such as superoxide and proinflammatory cytokines. These cytokines have been demonstrated to stimulate the synthesis of the inflammatory species nitric oxide (NO). In this study, we examined the role of NO in the possible effect of H. pylori in acne rosacea. METHODS: Thirty-three acne rosacea patients were included in the study and the control group comprised 20 healthy individuals. The levels of immunoglobulin G antibodies against H. pylori in the serum samples were measured using the enzyme-linked immunoabsorbent assay method. Measurement of nitrate was performed using chemiluminescence in accordance with the method described by Braman and Hendrix (Braman RS, Hendrix SA. Nanogram nitrite and nitrate determination in environmental and biological materials by vanadium(iii) reduction with chemiluminescence detection. Anal Chem 1989; 61: 2715-2718). For statistical analysis, the t-test was used. RESULTS: The seropositivity of H. pylori in acne rosacea patients was found to be high; however, the serum nitrate levels were found to be normal. CONCLUSIONS: The results of the study indicate that the inflammatory species NO, which has been hypothesized to be associated with H. pylori, has no role in the inflammatory mechanism of acne rosacea.

The effects of EGb 761 on lipid peroxide levels and superoxide dismutase activity in sunburn.

BACKGROUND/PURPOSE: Free oxygen radicals are involved in inflammatory skin reactions induced by ultraviolet B (UVB). In this study, the effect of a herbal antioxidant Ginkgo biloba extract (EGb 761) was investigated in UVB irradiated mice skin. METHODS: The study was carried out on four groups of mice (n = 6 in each group). The first group was a control group (G1). The second group (G2) was only exposed to acute UVB irradiation. The third group (G3) received 100 mg/kg/day of EGb 761 orally for 5 days before UVB irradiation and the fourth group (G4) was given only a single dose of EGb 761 immediately after UVB irradiation. Eighteen hours after exposing to UVB, lipid peroxide levels, and superoxide dismutase (SOD) activities were studied and UVB damage was evaluated histopathologically according to "sun-burn cell count". RESULTS: The SOD activities and Malondialdehyde (MDA) levels in G2, G3 and G4 were found to be decreased significantly when compared with G1 (P < 0.05). The SOD activities of G3 and G4 were higher when compared with G2 (P < 0.05). The number of sunburn cells (SBCs) was the highest in G2. CONCLUSIONS: Our results suggest that EGb 761 may have an important effect, both as a protective and therapeutic agent, in sunburn after UVB irradiation.