Multiple verrucous squamous cell carcinomas developing on chronic hidradenitis suppurativa lesions-a rare case report from Romania.

Hidradenitis suppurativa (HS) is an uncommon, recurrent, inflammatory skin illness of the apocrine glands, with a questionable etiology. The disease is associated with a multitude of comorbidities, of which the appearance of malignancy is the most important. Squamous cell carcinoma is considered the most frequent malignancy that can appear in HS. A case report of a 72 years-old male is presented, who suffered over 40 years from persistent, extensive hidradenitis suppurativa in stage Hurley III, on the buttocks and perianal region, who recently presented two verrucous semi-consistent, skin-colored tumors on the right buttock. The biopsy and histopathological exam confirmed a verrucous type of squamous cell carcinoma. There are about 100 reported clinical cases of squamous cell carcinoma complicating hidradenitis suppurativa in the literature, but only a few describe a verrucous carcinoma as a clinical form. The particularity of the case is the rare appearance of multiple verrucous types of squamous cell carcinomas in a male patient, in Hurley Stage III, with a long HS disease duration, appearing on the perianal/gluteal region, being the first case report in our country. We suggest that a tumor screening should be done for all the patients with HS who have these risks.

Embolia cutis Medicamentosa (Nicolau syndrome): case series.

Introduction: Embolia cutis medicamentosa or Nicolau syndrome is a rare drug reaction associated with the administration of various injectable medications. The pathogenesis of the disease is unknown, though intra and periarterial injection of the drug is a possible cause. The aim of this study was to describe and analyze the clinical characteristics of Nicolau syndrome in patients examined in daily dermatological practice. Methods: We performed a retrospective chart review, between January 2011 and December 2020, in patients diagnosed with Nicolau syndrome, from the cases of a private dermatology medical office in Târgu Mureș, Romania. Results: During the 10-year period, 7 patients were diagnosed with Nicolau syndrome. Of these, 4 (57%) patients were males and 3 (43%) were females, The male to female ratio was 1.33. The median age was 64 (interquartile range, IQR, 62-71), with the youngest patient being diagnosed at age 61 and the oldest at age 74. Regarding the drugs classes that caused Nicolau syndrome, these were intravenous antibiotics in 57%, and non-steroidal anti-inflammatory drugs in 43% of cases. Conclusion: All patients healed in a period of 6 to 8 weeks. No complications occurred. In conclusion, Nicolau syndrome is a rare side effect of injectable drug administration.

Exploratory axis factoring for identifying the self-esteem latent factors and their correlation with the life quality of persons suffering from vitiligo.

Objective: Our research aimed to measure the importance of self-esteem in assessing the disease burden in patients with vitiligo, which, according to our knowledge, had not been studied earlier. The purpose of this research study was to expand the state of knowledge regarding the influence of vitiligo on the quality of patients' life, with a particular focus on their self-esteem. We have formulated the following two hypotheses which include H1: two latent factors characterize the self-esteem of patients with vitiligo; H2: the self-esteem of the patients with Vitiligo is correlated with their life quality, by influencing it to a high degree. Methods: We have used two validated questionnaires called Rosenberg (Q1), for the evaluation of self-esteem (for proving H1), and Dermatology Life Quality Index (DLQI) (Q2), to measure the health-related quality of life of patients (for proving H2). Both questionnaires with 10 questions were applied to the same set of 114 carefully selected patients with no missing values to questions. An in-depth statistical and reliability analysis was performed on the outcomes provided by Q1, applying a scale and subscale reliability analysis, using the Cronbach's alpha reliability indicator (Cα). An exploratory analysis called Principal Axis Factoring (PAF) with Oblimin with Kaiser Normalization rotation was applied to prove H1, verifying the assumptions regarding the average variance extracted (AVE) and convergent and discriminant validity (CDV). A scale reliability analysis of outcomes provided by Q2 was performed for proving H2, by calculating Cα. Additionally, a nonparametric correlation analysis was performed, by calculating the Spearman r correlation coefficient between the Rosenberg index and DLQI index, and the 95% confidence interval (CI). Results: Based on the provided data, the value of Cα obtained in Q1 was 0.84. As a result of applying PAF on Q1, H1 has been proven and two latent factors of self-esteem have been extracted. These factors were named competence (eigenvalue = 4.126; 41.258% of total variance explained) and value (eigenvalue = 1.857; 18.57% of total variance explained). For the two subscales determined by the two factors, we have obtained the Cα values of 0.848 and 0.8, all indicating good reliability. For testing H2, on Q2 data we obtained Cα = 0.914. The Spearman correlation coefficient r = -0.734 (p < 0.0001), between the self-esteem questionnaire evaluation result and the life-quality index result indicated the existence of a strong negative correlation, which is significant according to 95% CI [-0.81, -0.63]. Discussion: The study focused on analyzing the self-esteem of patients with vitiligo. In addition, the psychometric properties of the Q1 questionnaire were analyzed and Q1 proved to have good internal consistency. PAF indicated a two-factorial structure, with factors called competence and value, proving H1, with a moderate correlation of 0.427 between the two latent constructs. The competence factor includes motivation, self-efficacy, initiative, and persistence in action. The value factor is much more complex, indicating a feeling, a personal evaluation, or a positive or negative attitude toward one's person, which better captures the entire phenomenology of self-esteem. The statistical analysis of the results provided by the self-esteem questionnaire included questions that proved to be internally consistent. The AVE and CDV assumptions were met. Q2 was proved to have excellent scale reliability. H2 proved a statistically significant strong negative correlation between the Rosenberg score and DLQI score.

Conflicting Issues of Sustainable Consumption and Food Safety: Risky Consumer Behaviors in Reducing Food Waste and Plastic Packaging.

Food-related consumer decisions have an impact on the environment. However, trending patterns of sustainable consumption often pose a challenge for food-safety authorities: these initiatives may unintentionally compromise food safety. The objective of this review is to support public agencies in the integration of sustainability issues into food-safety risk communication schemes. Environmentally conscious but risky behaviors aimed at the reduction of food waste and plastic packaging were chosen for discussion and scrutinized based on expert opinions. Those expert opinions clearly indicated that a significant part of environmentally conscious behaviors, such as removing mold, eating expired perishable food, overstoring leftovers, avoiding single-use plastic packaging even when cross-contamination is a threat, and using reusable bags without cleaning for a long time, often contribute to food-safety risks. Short, easy-to-remember messages were collected for each recognized risky behavior; they concentrated on prevention or providing an alternative that was still environmentally sensible but kept food-safety risks low (such as planning ahead to avoid leftovers, freezing leftovers in time, and sanitizing reusable bags). The identified challenges and solutions might encourage authorities to rethink their risk-communication practices and integrate a sustainability aspect in them.

Balanitis xerotica obliterans: An observational, descriptive and retrospective clinical study.

Lichen sclerosus is a chronic disease of unknown etiology that can occur in the genital area of both sexes. Balanitis xerotica obliterans (BXO) occurs only in the genital area of men and typically affects the foreskin, penile glans, and/or the meatus. In the present report, an observational, descriptive, and retrospective epidemiological clinical study of available data between January 2006 and December 2020 in patients diagnosed with BXO from the casuistic of CMI DERMAMED (Târgu Mureș, Romania) was performed. During this 15-year period, 164 patients were diagnosed with BXO, of whom 70 (42.8%) were in the 51-60-year-old age group. They presented at the medical consultation at 3-9 months after onset of symptoms, where 124 (75.6%) the patients were found to be with stage III of the disease. The most important comorbidities were found to be diabetes mellitus and obsesity, who were treated with potent steroids (betamethasone and clobetasol) with favorable results, with only nine (5.48%) cases necessitating surgical treatment. In general, BXO is a rare, acquired, non-infectious and chronically inflammatory (autoimmune) skin disease that has an unknown etiology. Although the risk of developing this condition is particularly high in patients in the 40-60-year-old age group, it can occur at any age. In the present report, the majority of the patients presented after a long period of disease development, such that they were already in advanced stages of the condition with clinically subjective symptoms and severe sexual problems. This delay in diagnosis has several causes, including misdiagnosis, psychological issues, and sexual behavior. Diabetes mellitus and overweight/obesity tended to be important comorbidities of BXO since the majority of the patients were also affected by these conditions. These comorbidities can exert an important pathophysiological influence on BXO. The first-line treatment option for this condition is the local application of potent steroids, with favorable effects. Due to the risk of malignant transformation as a result of BXO, it is recommended that these patients should be followed up for a longer period.

Low cholesterol level as a possible suicide risk factor / Az alacsony szérumkoleszterin-szint mint lehetséges öngyilkossági rizikótényezo.

Összefoglaló. Bevezetés: A koleszterinszint a köztudatban elsosorban mint cardiovascularis rizikófaktor van jelen. Nem mellékes azonban, hogy akár a magas, akár az alacsony koleszterinszint direkt összefüggésbe hozható számos pszichiátriai kórképpel. Célkituzés: A jelen tanulmány célja felhívni a figyelmet a holisztikus nézopont kialakítására, hisz a hypercholesterinaemia korai cardiovascularis elhalálozáshoz vezethet, viszont alacsony koleszterinszint esetén megnövekedhet a hangulatzavarra és foleg az öngyilkosságra való hajlam. Módszer: Kutatásunkban 200 olyan pszichiátriai beteg összkoleszterinszintjét vizsgáltuk meg, akik öngyilkossági gondolatokkal küszködtek. Az öngyilkossági veszélyt a Modified Scale for Suicide Ideation (Miller és mtsai) segítségével mértük. Eredmények: Az elért pontszámok alapján 3 kategóriába soroltuk a betegeket: 52 minimális suicid késztetésu, 49 középsúlyos és 99 súlyos rizikójú beteg. A legsúlyosabb kategóriába tartozó betegek nagy többségének (83 páciens, 84%) összkoleszterinje 4,5 mmol/l alatti volt. A másik két kategóriában ezen arány jelentosen kisebbnek bizonyult: a minimális suicid késztetésu kategóriában ez az érték csak 3 betegre (6%) volt vonatkoztatható, és a középsúlyosak esetén is csak 13 betegre (29%). Megbeszélés: Ezen tanulmányunk hátrányát képezheti a relatíve kis betegszám és a longitudinális utánkövetés megvalósításának hiánya. Következtetés: Jelen eredményeink alapján jogosan vetodhet fel a koleszterinszint mérésének rutinszeru bevezetése mint hatásos, szurésre alkalmas öngyilkossági rizikófaktor biomarker. Orv Hetil. 2021; 162(43): 1732-1739. INTRODUCTION: High cholesterol levels are widely recognized as cardiovascular risk factors. However, lower or higher cholesterol levels can be in a solid relationship with several mental disorders, too. OBJECTIVE: Our study aims to raise awareness about the fact that hypocholesterolemia is involved in various mood disorders and even suicidal behavior looks to be much more frequent. METHOD: Our current study implicates 200 psychiatric patients. These subjects had suicidal ideation upon hospital referral. In the first 24 hours, their total cholesterol levels were measured and the severity of self-harm intentions was evaluated with the Modified Scale for Suicide Ideation by Miller et al. Results: By the obtained evaluation score we differentiated 3 groups: 52 patients with low suicide risk, 49 with moderate risk and 99 with high suicide risk. In this last group, 83 patients had their serum total cholesterol level under 4,5 mmol/L (84%). By comparison, in the low-risk category only 3 patients (6%) and in the moderate-risk 13 patients (29%) were with such levels. DISCUSSION: Clear conclusion cannot be drawn due to the reduced number of our patients, due to the absence of long-term consequent monitorization, and due to the heterogeneity of the studied population. CONCLUSION: Considering these data, a possible usefulness of total cholesterol levels in psychiatric patients may be suggested as a screening tool for the severity of suicidal ideation. Orv Hetil. 2021; 162(43): 1732-1739.

Keratosis pilaris atrophicans faciei: An observational, descriptive, retrospective clinical study.

Keratosis pilaris atrophicans faciei (KPAF) is a hereditary follicular disorder, an atrophicans subtype of keratosis pilaris (KP) with a highly elusive diagnosis. Clinically, it presents with follicular, horny papules surrounded by an erythematous halo of the cheeks, forehead, chin and eyebrows, and it is followed by a gradual hair loss on the lateral margins of the eyebrows. The onset is as early as a few months after birth, but it is mainly diagnosed in children and adolescents and it can persist through adulthood. At present, the natural progression of the disease is poorly understood, which makes a correct diagnosis highly unlikely. The aim of the present study was to describe the clinical characteristics of KPAF in patients encountered in daily practice, in order to find common characteristics that may aid in the earlier recognition of the disease. An observational, descriptive, retrospective study was performed on 14 patients diagnosed with KPAF between January 2000 and December 2020. The mean age at diagnosis was 17.04 years and the onset of clinical symptoms appeared at a mean age of 4.85 years. The first clinical symptom was KP involving either the upper or lower limbs, or both. Then, erythema of the face appeared at a mean age of 7.21 years, keratotic papules on the face at a mean age of 8.35 years and, finally, loss of hair on the lateral margins of the eyebrows at a mean age of 14 years. The patients also had concomitant xerosis cutis, multiple mole syndrome, acne, contact dermatitis and Laugier-Hunziker syndrome. Evidence of disease progression, associations, as well as efficacious treatment measures are lacking. An earlier diagnosis potentially allows for a more efficacious, targeted treatment option. Either topical emollients, systemic retinoids or laser therapy may prove effective for each patient individually.

Implications of self-esteem in the quality of life in patients with psoriasis.

Skin has an integrative role in daily life, being a communication organ between the patient and the world. Skin affection in psoriasis has consequences on the patient's self-esteem, with direct implications on the quality of life. This study focused on the impairment of self-esteem in a group of 110 patients: Patients with severe cutaneous and psoriasis arthritis and patients with mild types of psoriasis, using the Rosenberg Self-Esteem Scale. Patients with severe cutaneous and psoriasis arthritis have a lower self-esteem compared with patients with mild psoriasis. The statistical data of two groups regarding the degree of education (secondary and higher education), in the male patients with severe cutaneous and psoriasis arthritis with higher education showed a lower self-esteem, compared with male patients with severe cutaneous and psoriasis arthritis with secondary education. In mild forms of psoriasis, the self-esteem of women and men is relatively equal, but below the general population average. Male patients with psoriasis arthritis have a much lower self-esteem compared with that of women, looking at life prospects more negatively. Psoriasis has a major impact on self-esteem, which correlates with quality of life in patients with psoriasis arthritis, depending on the skin condition that creates a major visual impact in society.

Acyclovir-induced immune thrombocytopenia: Case report and review of the literature.

There are a number of medications which can serve as catalysts for drug-induced immune thrombocytopenia (DIPT). A minimum of six different mechanisms have been put forward as the means by which drug-induced antibodies can encourage platelet destruction, thus emphasising the complexity of the pathogenesis of DITP. Acyclovir, has been widely used because of its highly potent prohibitive properties for infections caused by HSV and VZV. The common adverse effects of this drug are well known, the severe adverse reactions are mostly related to high dose intravenous administrations. The immune thrombocytopenia induced by acyclovir is unusual. The authors present a rare clinical case of acyclovir-induced immune thrombocytopenia in a 72-year-old female patient with typical herpes zoster treated with acyclovir. The clinical and laboratory findings, taken together with the transitory relationship between acycolvir and the start of thrombocytopenia, combined with the elimination of the other know sources of thrombocytopenia, allowed us to reach the diagnosis of acyclovir-induced immune thrombocytopenia. An international database search was employed to complete an extensive review of the current literature. Contemporary information on acyclovir-induced immune thrombocytopenia was collected by the analysis of present day review articles and accessible case reports. The authors found five published cases of acyclovir-induced immune thrombocytopenia. Analyzing these articles it was concluded that immune thrombocytopenia induced by acyclovir is rare, and an unusual side effect, with good prognosis. Prompt diagnosis is vital to appropriate management, therefore clinicians need to be cognisant of this rare potential adverse reaction.

Assessment of suicidal behavior in dermatology (Review).

Many diseases that affect physical health can also affect mental health. Many of these diseases are studied in terms of quality of life, depression and suicidal behavior. Dermatological disorders, although having a strong impact on the individual's life, are less studied with regard to suicidal behavior. There is a need to approach several dermatological diseases from the perspective of suicidal behavior in order to intervene early with specific treatment or to prevent suicide. Psoriasis, acne, melanoma, atopic dermatitis and urticaria are scarcely studied from the point of view of suicidal behavior. In addition to these diseases, there are others that require attention in terms of suicidal behavior, such as vitiligo or oculocutaneous albinism, most probably due to a small number of people suffering from these diseases, research is almost non-existent in these cases. We want to draw attention to the importance of early detection of suicidal behavior in dermatological practice and to highlight the need for several studies on this subject.

Penile carcinoma and HPV infection (Review).

Penile carcinoma is a relatively frequent health issue in the developing countries such as Africa, Asia and South America, usually affecting men aged between 50 and 70 years. It is a highly treatable disease in its early stages, but has serious physical and psychological consequences. Usually, penile carcinoma is located in the penile glans, in approximately half the cases, with the most frequent histological type being squamous cell carcinoma with its microscopic subtypes. A large number of risk factors have been reported for this disease, having a multifactorial etiology, HPV infection being one of the most important factors involved in its appearance. Out of the HPV DNA positive genital cancers HPV-16 is the most frequently found type in men, followed by HPV-18. The evolution of penile cancer includes two independent carcinogenic pathways, related or unrelated to HPV infection. There is limited data available in literature regarding HPV-related neoplasia, as well as on the efficacy of vaccination in men, with studies still ongoing.

Paraneoplastic pityriasis rubra pilaris in association with prostate carcinoma: A case report and literature review.

Pityriasis rubra pilaris (PRP) is a chronic papulosquamous disorder of unknown etiology, characterized by reddish orange scaly plaques, islands of sparing, palmoplantar keratoderma, and keratotic follicular papules. The disease can be acquired or inherited, being divided into 5 categories: classic adult type, atypical adult type, classic juvenile type, circumscribed juvenile type, and atypical juvenile type. More recently, an HIV-associated type has been added to this classification. The cases of PRP associated with malignancy are unusual. We present a case of a 58-year-old man, with the typical clinical aspect of PRP with a four-month onset of the disease. The histopathological and dermatoscopical findings confirmed the PRP diagnosis. The routine laboratory results were in normal limits, except the number of eosinophils, which was elevated and the number of lymphocytes, which was lower. After a thorough examination within a hematological consultation, the cause of hypereosinophilia remained unknown. An imagistic examination was performed and a prostate hypertrophy was noted. The prostate-specific antigen (PSA) level was found to be increased. The urologic consultation based on clinical, imagistic and microscopic features diagnosed an early stage prostate carcinoma. The conclusion was a paraneoplastic PRP in association with prostate carcinoma. The search in international databases revealed twelve published cases regarding the association of PRP with malignancies. The presented case represents a rare coexistence of PRP with malignancy, particularly with prostate carcinoma, and indicates that PRP can occur as paraneoplastic dermatosis, heralding a malignancy. This case is the first one to present PRP associated with prostate carcinoma. Nonetheless, in the authors' opinion, PRP can be considered a paraneoplastic syndrome; therefore, tumor screening is mandatory in cases presenting this disease.

Cutaneous leukocytoclastic vasculitis associated with erlotinib treatment: A case report and review of the literature.

Erlotinib is a targeted anticancer therapy used for treating epidermal growth factor receptor (EGFR) mutation positive lung cancer in advanced stage as well as for other malignancies. The most common cutaneous side effect of erlotinib, are well documented; however the number of reports regarding cutaneous leukocytoclastic vasculitis (CLCV) are limited. We report a case, a 58-year-old, 60 kg weight, non-smoking woman suffering of lung adenocarcinoma and brain metastases treated with erlotinib monotherapy with 150 mg/day dose, who presents cutaneous leukocytoclastic vasculitis after 8 months of initiating the treatment. The administration of the drug was discontinued and oral prednisolone treatment was introduced at 1 mg/kg body weight dose for two weeks, decreasing the dose with 5 mg, at every 3 days. The treatment was combined with topical potent steroid and antibiotic therapy used once, daily. The lesions cleared within 7 weeks without recurrence. The treatment with erlotinib was restarted after 14 days with a lower dose of 100 mg/day. The skin lesions have not occurred anymore. Unfortunately the evolution was unfavorable, our patient died 3 months after the vasculitis healing, due to the complications of new metastases that occurred. This may indicate the inefficiency of erlotinib. The late onset of 240 days of the vasculitis and the presumed inefficiency of the drug lead to the speculation that the appearance of cutaneous vasculitis could be a worsening clinical marker of the tumor response. This limited number of cases precludes any meaningful interpretation of data about the erlotinib induced cutaneous vasculitis. Further investigations are needed to assess cutaneous vasculitis.

[The value of radial shock wave therapy in the management of extended crural ulceration. Case report]. / A radiális lökéshullám-kezelés szerepe a nagyméretu ulcus cruris gyógyításában.

The authors present the history of a 36-year-old woman who had crural ulceration in the ventral side of the left lower limb due to venous circulatory failure for 5 years. In addition to the application of dressing adapted to the actual status of the wound, the authors applied an extracorporal shock wave therapy two times per week. After this treatment the size of the ulcer significantly decreased and it became suitable for mesh-graft cover. The patient is currently asymptomatic. The authors draw attention to the fact that the number of patients having crural ulcer is increasing in developed countries including Hungary. Lower limb ulcers occur in 1-5% of the adult population. Predisposing factors include older age and civilization hazards such as obesity, diabetes and sedentary lifestyle. The main cause of the disease is circulatory failure; venous insufficiency occurs in about two-thirds of the patients, arterial ischemia in 15% and diabetic angiopathy in 15% of the cases. Infections, metabolic diseases and immunological disorders may be also an underlying cause in a small number of patients. In several patients the causative factors occur simultaneously making difficult to find and effective treatment. Despite the use of numerous preventive and therapeutic protocols, treatment is usually long and does not always match expectations of the patients.

[Rare case of duplex colon invagination]. / Kettos invaginációs vastagbél ileus ritka esete.

Authors recite the records of a patient (26) with a 3-year history of dubious abdominal complaints and subileus resulting in numerous examinations and surgical observations, with the diagnosis of lower abdominal pain of unknown origin. He was acutely admitted to the department of surgery because of haemorrhage ex ano and convulsive left abdominal pain. Image creative examinations revealed ileus of a probable invagination origin. Partial resection of the transverse colon with "end to end" anastomosis was performed. Histology verified Peutz-Jeghers syndrome. The authors draw attention to the fact that although invaginations are rare above 18 years, when verified preoperatively, elective procedures can be carried out with lower risk to the patient.

[Surgical treatment of malignant small bowel neoplasms--report on four cases]. / Malignus vékonybéldaganatokról szerzett tapasztalataink osztályunk ötéves beteganyagában.

About 0.3% of all malignancies and 2% of gastrointestinal tumours are malignant small bowel tumours. Many of these tumours are diagnosed during emergency surgery because of severe bleeding or acute intestinal obstruction. Planned surgical intervention if early and appropriate morphological and histological diagnosis is available offers lower short term complication rate and results in better longterm prognosis. We present the history of four patients operated on for malignant small bowel lesions between 1998 and 2002. We describe the possibilities and difficulties of diagnosis and surgical treatment of these rare gastrointestinal tumours.