Clinical and demographic features of hidradenitis suppurativa: a multicentre study of 1221 patients with an analysis of risk factors associated with disease severity.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, relapsing and debilitating inflammatory disease associated with profound morbidity. AIM: In this multicentre study, we investigated the demographic and clinical features of HS, and determined risk factors of disease severity. METHODS: In total, 1221 patients diagnosed with HS from 29 centres were enrolled, and the medical records of each patient were reviewed. RESULTS: The mean age of disease onset was 26.2 ± 10.4 years, and almost 70% (n = 849) of patients were current or former smokers. Mean disease duration was 8.9 ± 8.4 years with a delay in diagnosis of 5.8 ± 3.91 years. Just over a fifth (21%; n = 256) of patients had a family history of HS. The axillary, genital and neck regions were more frequently affected in men than in women, and the inframammary region was more frequently affected in women than in men (P < 0.05 for all). Acne (40.8%), pilonidal sinus (23.6%) and diabetes mellitus (12.6%) were the most prevalent associated diseases. Of the various therapies used, antibiotics (76.4%) were most common followed by retinoids (41.7%), surgical interventions (32.0%) and biologic agents (15.4%). Logistic regression analysis revealed that the most important determinants of disease severity were male sex (OR = 2.21) and involvement of the genitals (OR = 3.39) and inguinal region (OR = 2.25). More severe disease was associated with comorbidity, longer disease duration, longer diagnosis delay and a higher number of smoking pack-years. CONCLUSIONS: Our nationwide cohort study found demographic and clinical variation in HS, which may help broaden the understanding of HS and factors associated with disease severity.

Nailfold capillaroscopy in Behçet disease, performed using videodermoscopy.

BACKGROUND: Nailfold capillaroscopy is used for the identification of microvascular involvement in many rheumatic and extrarheumatic diseases. AIM: To determine the nailfold capillary changes in patients with Behçet disease (BD) by videodermoscopy, i.e. nailfold videocapillaroscopy (NVC). METHODS: We used a videodermatoscope (Molemax II, × 30 magnification) to perform nailfold capillaroscopy on 40 patients with BD and 40 healthy controls (HC). All nailfold images were evaluated for capillary density, distribution and morphology, assessing features such as enlargement or tortuosity of the capillaries, microhaemorrhages and avascular areas. RESULTS: Enlarged capillaries were detected in 14 patients, microhaemorrhages in 6 patients, and avascular area in 3 patients. There was a statistically significant difference between patients with BD and healthy controls for capillary dilatation and microhaemorrhages (P < 0.05). Capillaroscopic changes were not associated with sex or clinical characteristics. CONCLUSIONS: Using NVC, nailfold capillary changes were apparent in patients with BD, but not in HC. NVC could be a useful technique for evaluating microvascular damage in BD.

Cytodiagnosis of erosive melanoma and basal cell carcinoma of the skin using cutaneous tissue smear.

BACKGROUND: Cytomorphological assessment of erosive skin tumours offers a rapid and minimally invasive way to obtain a diagnosis. However, the studies so far conducted on this method have been relatively small. AIM: To conduct a large retrospective study on cytomorphological assessment of erosive skin tumours. METHODS: In this study, 86 cytological smears prepared from erosive cutaneous tumours clinically suspicious for melanoma were examined to test the diagnostic accuracy and practicability of cytomorphological evaluation of such tumours, and to compare the assessments of two investigators with different experience levels. In a subgroup of tumours, cytological assessment was compared with dermoscopic evaluation. RESULTS: There was agreement in the cytological and histopathological results for 68 of 86 cases (79%) assessed by the experienced investigator and in 64 of 86 cases (74%) assessed by the inexperienced investigator. The diagnosis was confirmed cytologically in 39 and 34 of 42 melanomas, and in 28 and 27 of 35 basal cell carcinomas, respectively. The sensitivity of the cytodiagnosis was not significantly different between the two investigators. The dermoscopic evaluation showed good agreement with the cytological results for melanoma (82.4%), although use of dermoscopy was only possible for 49.9% of the lesions because of difficulties with the samples. CONCLUSIONS: Cytological assessment of erosive melanoma and BCC lesions is a useful tool for gaining additional information on clinically uncertain skin tumours, and shows good agreement between different investigators.

Serum galectin-3 levels in patients with Behçet's disease: association with disease activity over a long-term follow-up.

BACKGROUND: There is a need for a laboratory marker that correlates with the clinical activity of Behçet's disease (BD). OBJECTIVE: We aimed to investigate whether serum galectin-3 (Gal-3) levels were affected during the course of the disease with regard to disease activity. METHODS: A total of 131 subjects were involved in the study as follows: Group 1: BD active (n = 39); Group 2: BD inactive (n = 31); Group 3: Disease controls with leucocytoclastic vasculitis confirmed with a skin biopsy (n = 22); and Group 4: Healthy control subjects (n = 39). The BD patients were followed regularly and samples were taken in their active and inactive periods of the disease over a 2-year period. RESULTS: Serum Gal-3 levels were significantly higher in active BD patients (mean 2.38) than inactive BD patients (mean 0.63; P < 0.0001) and the healthy control subjects (mean 0.75; P < 0.0001). There was no significant difference between the leucocytoclastic vasculitis and active BD patients (P = 0.093). Serum Gal-3 levels were positively correlated with clinical activity scores of active BD patients (r = 0.66, P < 0.0001). In addition, the Gal-3 levels were significantly higher in the active disease period when compared with the inactive period during the follow-up. There were no significant differences between the two inactive periods of the disease among the same patients. Further analyses revealed that patients with vascular involvement had significantly higher Gal-3 levels than the other active BD patients (mean 7.57; P = 0.007). LIMITATIONS: The limitation of the study is the small number of patients with vascular involvement in the active BD patient group. CONCLUSION: Gal-3 levels are correlated with the activity of Behçet's disease especially with the vascular involvement.

Successful treatment of verruca plantaris with a single sublesional injection of interferon-alpha2a.

BACKGROUND: Interferons are molecules with antiviral effects, which have been used for the treatment of verruca for many years. AIMS: To determine if sublesional interferon (IFN)-alpha injection offers an effective alternative treatment for common warts. METHODS: We compared the results of single-dose sublesional IFN application in different types of verruca and with placebo for the treatment of single verruca plantaris lesions. In total, 53 patients (mean age 22.6 years) were enrolled in the study. Of these, 45 patients received a single sublesional injection of 4.5 MU IFN-alpha2a (three study groups), and eight patients with single verruca plantaris lesions were injected with physiological saline as placebo (control group). As local anaesthesia, liquid nitrogen was sprayed only on to the injection site for 3-4 s. The injection was made directly under the lesion through the border of the lesion, at with approximately a 45 degrees angle from healthy skin. RESULTS: At the 12-month follow-up in the group of patients with single verruca plantaris, there were 19 complete cures (7.2%) and 2 partial responses (8.3%), and 3 patients (12.5%) had no response. In the control group, only 2 patients (25%) had a partial response to treatment. CONCLUSIONS: These results suggest that a single sublesional dose of 4.5 MU IFN-alpha may be of value in the treatment of patients with verruca, especially in those with single verruca plantaris lesions.

Dermal fibrosis and cutaneous necrosis after recombinant interferon-beta1a injection in a multiple sclerosis patient.

The most commonly reported side-effects of recombinant interferon-beta1a and 1b include local inflammatory injection site reactions, headache, fever, myalgia and a flu-like syndrome. In this case report, we describe the occurrence of cutaneous necrosis and dermal fibrosis following intramuscular interferon-beta1a injections in a multiple sclerosis patient.