Trichoscopic Evaluation of Tinea Capitis.

Tinea capitis is a widespread fungal infection that is even more common in rural areas of the world predominantly among children. The diagnosis of the infection and the identification of the responsible dermatophyte are determined by potassium hydroxide mount microscopy, Wood's lamp examination and mycological culture of the skin scrapings and hair samples. Nevertheless, this conventional setting has several limitations such as lack of availability, low sensitivity and specifity, and particularly prolonged turnaround time for fungal culture. Trichoscopy is a well-proven practical and beneficial aid to faciliate the diagnosis of scalp and hair disorders. Studies performed during the last 15 years revealed several characteristic trichoscopic findings of non-inflammatory tinea capitis namely comma hairs, corkscrew hairs, Morse code-like hairs and zigzag hairs. Thereby, trichoscopy has proved itself in the establishment of prompt diagnosis of TC, identification of the responsible fungus enabling to appropiate treatment on time, and evaluating treatment response by screening the clearance of the trichoscopic features.

Comparison of 10 versus 20 sessions tap water iontophoresis efficacy in the treatment of palmoplantar hyperhidrosis.

BACKGROUND: Tap water iontophoresis (TWI) is an effective treatment option for palmoplantar hyperhidrosis (HH). However, the optimal number and frequency of TWI sessions to control profuse sweating are unclear. OBJECTIVE: To compare the efficacy of 10 and 20 sessions of TWI in patients with palmoplantar HH and determine the adequate number of sessions to achieve a favorable clinical response. METHODS: Eighty patients treated with TWI for palmoplantar HH were included. The alteration in sweating intensity considering the mean value of gravimetric measurement and mean visual analog scale (VAS) scores after the 10th and 20th session of TWI were calculated. The difference between performing 10 and 20 sessions of TWI in providing improvement of HH was analyzed. We also conducted a telephone-based inquiry to determine the patients' outcome. RESULTS: The reduction in sweating intensity was significant both after the 10th (p < 0.001) and 20th (p < 0.001) sessions when compared with the basal level considering gravimetry and VAS. When the mean sweating intensity after the 10th and 20th sessions were compared, no difference was observed gravimetrically (p = 0.03); the difference between the mean score of VAS after the 10th and 20th sessions (p < 0.001) was significant. Eleven and nine patients not considering a maintenance or an alternative treatment had lower and same sweating intensity as compared with the baseline, respectively. CONCLUSION: Ten TWI sessions within two weeks for managing palmoplantar HH are adequate to achieve a clinical response. However, the patients are more satisfied when they receive 20 sessions instead of 10 sessions of TWI.

Evaluation of a Handheld Dermatoscope in Clinical Diagnosis of Primary Cicatricial Alopecias.

INTRODUCTION: Clinical diagnosis of primary cicatricial alopecias presents difficulties. Studies regarding their trichoscopic features are scarce and mostly not comprehensive. The aim of this study is to evaluate the potential benefit of a handheld dermatoscope in clinical diagnosis of primary cicatricial alopecias. METHODS: In all, 69 patients with primary cicatricial alopecias were included in this prospective study. Preliminary diagnoses were established clinically, and confirmed by scalp biopsy in all cases. Trichoscopic examination was performed using a polarized-light handheld dermatoscope with tenfold magnification. The images were taken using a digital camera with threefold optical zoom. RESULTS: The following findings were significantly more common, or noted only, in particular types of primary cicatricial alopecias: "target" pattern blue-grey dots, perifollicular scaling, perifollicular cast in lichen planopilaris (n = 27); short vellus hairs, tufted hairs, crust formation, yellowish tubular scaling, pustule, red dots in folliculitis decalvans (n = 17); large keratotic yellow dots in discoid lupus erythematosus (n = 7); yellow dots, yellow dots with "three-dimensional" structure, black dots in dissecting cellulitis of the scalp (n = 6). Absence of vellus hairs was observed in patients with lichen planopilaris, frontal fibrosing alopecia, and discoid lupus erythematosus without a significant difference between the groups. Short vellus hairs were detected in all types, including frontal fibrosing alopecia (n = 7). CONCLUSION: We suggest that a polarized-light handheld dermatoscope is useful for revealing several typical trichoscopic features of primary cicatricial alopecias that guide clinical diagnosis. As a novel observation, our data indicate that absence of vellus hairs is not an identifying feature for frontal fibrosing alopecia.

Management of Kaposi sarcoma after solid organ transplantation: A European retrospective study.

BACKGROUND: Systemic therapeutic management of post-transplant Kaposi sarcoma (KS) is mainly based on 3 axes: reduction of immunosuppression, conversion to mammalian target of rapamycin (mTOR) inhibitors, chemotherapy, or a combination of these. OBJECTIVE: To obtain an overview of clinical strategies about the current treatment of KS. METHODS: We conducted a multicenter retrospective cohort study including 145 solid organ transplant recipients diagnosed with KS between 1985 and 2011 to collect data regarding first-line treatment and response at 6 months. RESULTS: Overall, 95%, 28%, and 16% of patients had reduction of immunosuppression, conversion to mTOR inhibitor, and chemotherapy, respectively. Patients treated with chemotherapy or mTOR inhibitor conversion were more likely to have visceral KS. At 6 months, 83% of patients had response, including 40% complete responses. LIMITATIONS: The retrospective design of the study. CONCLUSION: Currently available therapeutic options seem to be effective to control KS in most patients. Tapering down the immunosuppressive regimen remains the cornerstone of KS management.

Treatment of class II malocclussion: A comparative study of the effects of twin-block and fatigue resistant device.

AIM: This is a retrospective cephalometric study aimed to compare the treatment effects of Twin-Block (TB) appliance with The Forsus Fatigue Resistant Device (FRD) appliance in class II division I patients in a composite of peak and post peak growth of period time. MATERIALS AND METHODS: The experimental sample consisted of the lateral cephalograms of 40 patients who were treated with either TB appliance (n = 15), FRD (n = 15) or the untreated control ones. In treatment groups lateral cephalograms taken before therapy as initial records (T1) and at the completion of functional therapy (T2) were used. The control group comprised 10 children with untreated skeletal Class II malocclusions. The normality of distribution of continuous variables was tested by Shaphiro wilk test. Oneway ANOVA and LSD test in parametric; Kruskall Wallis and all pairwaise multible comparison tests in non-parametric samples were used for comparing differences among 3 groups. RESULTS: Cephalometric analysis revealed that both TB and FRD appliances stimulated mandibular growth (P < 0.05) and no restriction was seen in maxilla in both groups (P > 0.05). The unwanted mandibular proclination was seen more in FRD group (P ≤ 0.001). Soft tissue didn't imitate the hard tissue (P > 0.05). CONCLUSION: FRD group produced skeletal effects as much as TB group in peak and post peak period of growth with still more mandibular incisor proclination.

The Prevalence of Malassezia Folliculitis in Patients with Papulopustular/Comedonal Acne, and Their Response to Antifungal Treatment.

Because Malassezia folliculitis (MF) may clinically mimic acne vulgaris (AV), patients usually receive unnecessary and prolonged antibiotic treatment. We aimed to determine the prevalence of MF among patients with AV, and to evaluate its response to antifungal treatment. A total of 217 patients with AV underwent cytologic examination for the presence of Malassezia yeasts. Samples were obtained from lesional and nonlesional skin and stained with May-Grünwald-Giemsa. MF was diagnosed if there were more than six spores in one microscopic field (at ×400 magnification). A modified "lesion-counting" method was used to assess the clinical severity of acne. Treatment included oral itraconazole (2×100 mg daily) and topical ketaconazole for 4 weeks. Fifty-five (25.3%) patients were diagnosed with MF; of these, 38 (69.1%) completed the antifungal treatment. The lesions decreased by 50% or more in 26 (68.4%) of the patients who completed the antifungal treatment, which reduced the number of closed comedones/comedolike or molluscoid papules and inflammatory papules. The average number of spores in lesional samples was significantly decreased after treatment (P=<.0005). We observed that MF can present with AV-like lesions, or the two diseases may coexist. Cytology is helpful for making the correct diagnosis and providing proper management of MF.

Maternal low-quality protein diet exerts sex-specific effects on plasma amino acid profile and alters hepatic expression of methyltransferases in adult rat offspring.

Nutrition during pregnancy and lactation is a critical factor in the development of the offspring. Both protein content and source in maternal diet affect neonatal health, but the long-term effects of maternal low-quality protein diet on the offspring are less clear. This study aimed to examine the effects of maternal low-quality protein diet on offspring's growth, development, circulating metabolites and hepatic expression of methyltransferases. Virgin Wistar rats were mated at 11 weeks of age. Dams were then maintained on either a chow diet with 20% casein as the control group (C), or a low-quality protein diet with 20% wheat gluten as the experimental group (WG) throughout gestation and lactation. After weaning, all offspring were fed a control chow diet until the age of 20 weeks. Male WG offspring had significantly lower body weight and energy intake, whereas female WG offspring had significantly higher body weight and energy intake when compared with controls. Early life exposure to WG diet had no significant effect on circulating metabolites. However, fasting insulin concentrations and homoeostasis model assessment-insulin resistance were decreased in WG male and female offspring. Maternal low-quality protein diet increased plasma aspartic acid, glutamic acid, histidine, cystathione and decreased lysine in male WG offspring. Conversely, the same amino acids were reduced in female WG offspring. Adult offspring exposed to WG diet had significantly upregulated hepatic DNMT3a and DNMT3b expressions. Our study showed that there were differential effects of maternal poor-quality protein diet upon adult offspring's metabolism.

Natural Thermal Spa Water Versus Hyperthermic Tap Water for Treatment of Recalcitrant Hand Warts in Organ Transplant Recipients: A Patient-Blinded, Comparative Preliminary Study.

OBJECTIVES: Cutaneous warts represent a major problem in organ transplant recipients because of their extensive involvement and persistent course. Current therapeutic modalities often fail to achieve a successful response in patients with warts. We experienced a case involving an organ transplant recipient with recalcitrant mosaic warts who presented with complete clearance of lesions in 3 days after thermal spa bathing. Here, we evaluated the efficacy of natural thermal water versus hyperthermic tap water for treatment of recalcitrant hand warts in organ transplant recipients. MATERIALS AND METHODS: In this preliminary study, the right hands of 5 organ transplant recipients with hand warts were immersed in thermal water, while the left hands were soaked in tap water at 44°C to 47°C. Treatment involved three 45-minute sessions per week for 1 month. The total number and size of the warts and the hyperkeratosis severity grade were noted. RESULTS: After 12 sessions, none of the patients exhibited any marked improvement in the size or number of warts, although 3 patients had a slight decrease in their hyperkeratosis severity grade. CONCLUSIONS: Our preliminary data indicate that neither thermal spa water nor hyperthermic tap water is effective for treatment of recalcitrant hand warts in organ transplant recipients. However, new trials using thermal water supplied from different geographical locations should be performed before this observation can be generalized.

Skin Cancer Risk Awareness and Sun-Protective Behavior Among Solid-Organ Transplant Recipients.

OBJECTIVES: Solid-organ transplant recipients are at an increased risk of developing skin cancer; this risk is due to long-term graft-preserving immunosuppressive therapy, and excessive sun exposure is a major contributing factor to this process. The aim of this study was to evaluate the skin cancer awareness and sun-protective behavior of solid-organ transplant recipients. MATERIALS AND METHODS: In all, 70 consecutive solid-organ transplant recipients were evaluated regarding knowledge of their increased skin cancer risk and regarding the influence of this knowledge on their sun-protective practices, by applying a questionnaire during their routine check-up visits. RESULTS: Of 70 solid-organ transplant recipients, 38 (54.3%) stated knowledge of hazardous consequences of sun exposure; however, only 28 (40%) had the knowledge of causal relationship between sun and skin cancer development. There were 31 patients (44.3%) who were unable to recall anybody giving any information to them about sun protection, and 40 patients (57.1%) had never visited a dermatology clinic. The 10 solid-organ transplant recipients (14.3%) who used sunscreen creams daily had been undergoing regular dermatologic examination. Regarding sun-protective clothing, only 8 patients (11.4%) had been wearing a suitable hat, long sleeves, and sunglasses when outdoors. There was a statistically significant difference between the groups who had visited a dermatology clinic versus those who had not regarding knowledge of sun protection, the causal relationship between sun exposure and skin cancer, the use of sunscreens, and use of sun-protective clothing (P < .05). CONCLUSIONS: Our data showed that dermatologic examination and education of patients about skin cancer development and sunscreen measures improved the sun-protective habits of solid-organ transplant recipients. Therefore, orderly visits once or twice a year should be strongly advised for this patient population by their medical care providers.

Direct Observation of "Pac-Man" Coarsening.

We report direct observation of a "Pac-Man" like coarsening mechanism of a self-supporting thin film of nickel oxide. The ultrathin film has an intrinsic morphological instability due to surface stress leading to the development of local thicker regions at step edges. Density functional theory calculations and continuum modeling of the elastic instability support the model for the process.

Morphometric analysis of the lumbar vertebrae in the Turkish population using three-dimensional computed tomography: correlation with sex, age, and height.

BACKGROUND: Morphometric measurements of lumbar vertebrae are different in European and Asian populations. Transpedicular screws are candidates for the ideal method to treat instability of lumbar vertebrae and provide very strong stabilisation. Our study reflects the variation of morphometric measurements of lumbar vertebrae in the Turkish population according to sex, age, and height. The aim of our study was to measure the transverse pedicle diameter (TPD), vertical pedicle diameter (VPD), pedicle axis length (PAL), and transverse pedicle angle (TPA) of the lumbar vertebrae, using three-dimensional computed tomography (3D-CT), and assess variations according to sex, age, and height. MATERIALS AND METHODS: Prospective cohort, Therapeutic Level III, Urban Level III Trauma Centre. The study design adopted a morphometric analysis using 3D-CT of the lumbar vertebrae in the Turkish population, with variation in terms of sex, age, and height and comparison with previous studies. In 240 cases, measurements of TPC, VPD, PAL, and TPA with 3D-CT were performed on a total of 1200 lumbar vertebrae. The values at each lumbar level were compared in groups based on sex, age, and height. RESULTS: The results of our study determined the normal values of TPD, VPD, PAL, and TPA of lumbar vertebrae in the Turkish population using 3D-CT. Additionally there were variations in TPD, VPD, and PAL according to sex, age, and height. TPA varied according to age, while no difference was found in terms of sex or height. CONCLUSIONS: The morphometric measurements of lumbar vertebrae in the Turkish population are similar to western populations. Sex, age, and height are factors affecting reliable screw choice.

Painful skin lesions and squamous cell carcinoma predict overall mortality risk in organ transplant recipients: a cohort study.

BACKGROUND: Organ transplant recipients (OTRs) have a highly increased risk of cutaneous squamous cell carcinomas (SCCs). Sensation of pain in cutaneous tumours is a powerful patient-reported warning signal for invasive SCCs in OTRs. OBJECTIVES: To investigate the impact of painful vs. painless skin lesions and SCC vs. other skin lesions on the overall mortality risk in OTRs. METHODS: We followed 410 OTRs from 10 different centres across Europe and North America between 2008 and 2015. These patients had been enrolled in an earlier study to define clinically meaningful patient-reported warning signals predicting the presence of SCC, and had been included if they had a lesion requiring histological diagnosis. Cumulative incidences of overall mortality were calculated using Kaplan-Meier survival analysis, and risk factors were analysed with Cox proportional hazard analysis. RESULTS: There was an increased overall mortality risk in OTRs who reported painful vs. painless skin lesions, with a hazard ratio (HR) of 1·6 [95% confidence interval (CI) 0·97-2·7], adjusted for age, sex and other relevant factors. There was also an increased overall mortality risk in OTRs diagnosed with SCC compared with other skin lesions, with an adjusted HR of 1·7 (95% CI 1·0-2·8). Mortality due to internal malignancies and systemic infections appeared to prevail in OTRs with SCC. CONCLUSIONS: We suggest that OTRs have an increased overall mortality risk if they develop painful skin lesions or are diagnosed with cutaneous SCC.

Tzanck smear as an accurate and rapid diagnostic tool for cutaneous alternariosis in a renal transplant recipient.

Alternaria species are becoming increasingly important opportunistic pathogens in recipients of solid organ transplant, as it has been shown that dissemination with systemic involvement is not as rare as previously reported. Therefore, rapid and accurate diagnosis is necessary for appropriate patient management. We report a patient with renal transplant who developed recurrent cutaneous alternariosis. Tzanck smear successfully and very rapidly revealed hyphae and spores in both the primary and subsequent lesions. Furthermore, Tzanck smear provided guidance for histopathological examination of the second lesion, which failed to disclose the fungal elements until additional deeper serial sections were performed. The present case emphasizes that the Tzanck smear is a useful clinical tool leading to the immediate correct diagnosis even in deep fungal infections.