Tattoos: Demographics, Motivations, and Regret in Dermatology Patients.

Background: Tattoos are very popular in today's world. Objectives: The aim of this study was to determine the demographics, the characteristics of tattoos, motivations for getting tattoos, tattooing practices and tattoo regret. Materials and Method: This multi-centre, cross-sectional study was conducted among. 302 patients attending to the dermatology outpatient clinics and having at least one tattoo. A questionnaire form including all needed data about patients, tattoo characteristics and possible reasons for obtaining tattoos was designed and applied to all participants. Results: Of 302 patients, 140 (46,4%) were females and 162 (53,6%) were men. The mean age was28,3 ± 8,1 years (min-max, 16-62) for all study group, 53% of participants (n = 160) had at least one tattoo involving letters or number, 80 participants (26%) stated regret for at least one of their tattoos, and 34 of them (42,5%) had their unwanted tattoo removed or camouflaged with a new tattoo. The most common reason for regret was 'not liking the tattoo anymore'. The most common motivations for having tattoos were 'to feel independent', 'to feel better about himself/herself' and 'to look good'. Women had higher scores than men regarding tattoo motivations of 'to be an individual' and 'to have a beauty mark'. Conclusion: Given the rates, tattoo regret is a significant issue and as motivations differ between genders, age groups and other demographic characteristics; tattoos are not just an ink or drawing on the body, but a tool for individuals to express themselves and to construct self-identity. Tattoos have deep symbolic meanings for emotions, and they may be a clue for behavioural patterns of individuals.

Investigation of skin self-examination and sunscreen use in adolescents in northern Cyprus.

INTRODUCTION: Regular skin self-examination (SSE) is very important for the early diagnosis of malignant melanoma (MM). Since sun exposure is the most important trigger factor for the development of skin cancers, effective and regular sun protection is the main preventive method. AIM: To investigate the awareness of SSE, risky nevus and sun protection of the adolescents in the Turkish Republic of Northern Cyprus (TRNC). MATERIAL AND METHODS: The data used within this research were obtained from questionnaires administered to volunteer high school students in the TRNC. RESULTS: 39.8% of the participants included in the study stated that they conducted SSE. All the participants who said they conducted SSE reported that they performed a face exam. The body regions that the participants did not examine were the scalp (47.7%), foot (36.9%), back (35.4%) and genital area (35.4%). The features of the nevus perceived by the participants as risk factors included rapid growth, bleeding and itching. While 74% of respondents said they used sunscreen products, only 9% of users reported using them every day. CONCLUSIONS: In the TRNC where the exposure to the sun is high, young people perform skin examinations at high rates in order to monitor their nevi. Nevertheless, the results of this research show that hard-to-reach areas are neglected.

Views and experiences of dermatologists in Turkey about teledermatology during the COVID-19 pandemic.

BACKGROUND: Teledermatology is an alternative medical science that allows evaluation of patient's clinical information over a distance without requiring face-to-face examination. Due to COVID-19, social distancing has become important these days, and teledermatology can help physicians and patients in overcoming the barriers of accessing health care. AIM: In this study, we aim to evaluate how dermatologists in our country have viewed and experienced teledermatology during the pandemic through surveys. PATIENTS/METHODS: The study was carried out by using an online survey for evaluating the teledermatology experiences of dermatologists in Turkey and how they have viewed teledermatology during the 2-month pandemic period and the 2-month prepandemic period. RESULTS: The number of patients evaluated with teledermatology methods was found to be significantly higher in the pandemic period when compared with the prepandemic period. The rates of using video calls with mobile phone and online video calls were found to be significantly higher in the pandemic period when compared with the prepandemic period. CONCLUSION: Our study results show that the teledermatology method had a higher rate of usage compared to before the pandemic.

Platelet Count and Mean Platelet Volume in Psoriasis Patients.

OBJECTIVES: Psoriasis is a chronic inflammatory, immune-mediated disease, and platelets have an important role in the pathomechanisms of psoriasis. Recent studies showed that MPV (mean platelet volume) could be used as a marker of platelet activation. In this study, we aimed to investigate the MPV level and platelet count in psoriasis patients and its association with disease severity. METHODS: We designed a case-control study with 28 psoriasis patients and age and sex-matched 30 healthy controls. Haematologic parameters and sedimentation rates compared between groups. These parameters also correlated with PASI (Psoriasis Area and Severity Index) score. RESULTS: MPV and platelet count were significantly higher in patients with psoriasis than controls (p=0.012, p=0.015). Also, platelet count was showed positive correlation with PASI scores (r=0.424, p=0.025). The sedimentation rate was not statistically different between groups. CONCLUSION: There are many conflicting results about the correlation of haematologic parameters and psoriasis. We found that MPV and platelet counts higher in the psoriasis group, which suggests that platelets play an important role in the pathomechanism of psoriasis and may be helpful in assessing treatment outcomes.

Follicular unit extraction as a valuable method for the restoration of beard: Retrospective case series study.

BACKGROUND: Beard and mustache are important components of body image. Beard transplantation is the procedure to restore congenital absence or inefficient growth of beard and mustache. OBJECTIVES: The aim of the study is to report our results and experience in beard transplantation. METHODS: Patients with a demand for beard restoration who were treated with follicular unit extraction (FUE) hair transplantation method were included in this retrospective, case series study. Patients' birth date, race, presence of eunuchoidism, hair color, type and shaft thickness, and treatment details were retrieved from medical records. Patients were evaluated at least one year after the operation, and defect closure rates were calculated. At the follow-up examination, patients were asked to evaluate their satisfaction from the procedure. RESULTS: Ten patients were consecutively treated between May 2007 and June 2016. The mean age of the patients was 29.6 years. Three of our patients were eunuchoid and the others wanted beard transplantation to have a more masculine look. Follow-up period was median of 39 months. Four patients were satisfied and four patients were very satisfied with the procedure with a mean 53% closure rate. Better closure rates were associated with brown and red hair color, medium and fine hair thickness, and absence of eunuchoidism. Patients with straight hair were satisfied with the procedure significantly. CONCLUSION: Beard reconstruction by using the FUE method is a safe and effective method with high patient satisfaction rates.

Topical polyphenol treatment of sacrococcygeal pilonidal sinus disease: use of ultrasonography to evaluate response to treatment - clinical case series study.

INTRODUCTION: Sacrococcygeal pilonidal sinus disease (SPSD) is a common disorder and encountered more frequently in hairy young males after puberty. AIM: To assess effectiveness of topical polyphenol treatment of SPSD by using physical examination and ultrasonography (USG). MATERIAL AND METHODS: Fourteen patients with SPSD diagnosis were treated by natural polyphenol products and were retrospectively included in this study. All of the patients were assessed by superficial ultrasonography before and after treatment. Demographic and clinical information of the patients was obtained from medical records. RESULTS: Patients were aged 18-45 years and the median disease duration was 2 years. The most common findings in physical examination were sinus openings and subcutaneous nodules and the most common ultrasonographic findings were abscess/cyst formation and presence of fistula at the pre-treatment visit. All of the patients applied topical polyphenols for a median period of 3 months. Topical polyphenol treatment was effective in 92.9% of patients. Follow-up examinations at 18.3 months post-treatment revealed that 12 (85.7%) patients were free of disease. Control physical examination and ultrasonographic assessment were completely normal in 11 (78.6%) patients. CONCLUSIONS: Topical polyphenol therapy is a promising alternative treatment for SPSD and its effectiveness can be objectively evaluated by ultrasonography. It is advised that topical polyphenols should be tried first in every young and active patient with SPSD. Majority of these patients can avoid demanding and expensive alternative treatment methods such as complex surgical procedures. This topical therapy method makes surgical SPSD a dermatologically treatable disease.

Systemic Retinoids and Scar Dehiscence.

Systemic retinoids such as isotretinoin and acitretin are associated with numerous side effects but are therapeutically valuable in dermatological practice. Several studies have reported the wound-healing effects of treatment with concurrent systemic retinoids in addition to surgical treatments. Herein, we describe two patients with scar dehiscence that developed after initiation of systemic retinoid treatment following cutaneous surgery. In Case 1, isotretinoin was thought to decrease collagen production to a greater degree than did degradation during the wound remodeling phase, which resulted in wound dehiscence. In Case 2, acitretin was thought to decrease fibroblast proliferation and collagen production during the proliferation phase of wound healing, which resulted in wound dehiscence. Based on the two presented cases, it is advisable to postpone systemic retinoid treatment for 6 months to 1 year following cutaneous surgery, located especially in cosmetically important sites.

A case of lipomembranous panniculitis with a dramatic response to the treatment of venous insufficiency.

Lipomembranous panniculitis (LP) is a peculiar type of fat necrosis and is reported with various clinical conditions, mostly with peripheral vascular diseases. Here, a case of a 57-year-old woman with a painful erythematous swelling of the right leg in association with venous insufficiency has been reported. Although LP is frequently associated with venous insufficiency, to the best of our knowledge, this is the first report on the beneficial effect of venous insufficiency treatment in LP.

Verruciform Xanthoma of a Lower Lip Lesion: A New Case and Review of the Literature.

A non-smoking man in his seventh decade presented with a lesion he had had for about 5 years on the right external surface of the lip 1 mm from the vermilion border. On physical examination, a yellowish-coloured, non-tender, verrucous mass of 0.5 × 0.7 cm was observed. A histopathological examination of the first 3-mm punch biopsy was non-diagnostic. The histopathological evaluation of a second, 5-mm-deep punch biopsy made by a pathology expert in oral lesions revealed a diagnosis of verruciform xanthoma. The key to the diagnosis of verruciform xanthoma is to recognize xanthoma cells. However, these cells may be insufficient in number in small and superficial biopsy material and overlooked by a pathologist especially when lacking knowledge of this uncommon lesion. Verruciform xanthoma of the lower lip at the vermilion border is an extremely rare entity described in 5 cases worldwide to date. We aimed to bring verruciform xanthoma to readers' attention for a differential diagnosis of lower lip diseases and to prevent overdiagnosis and overtreatment of this lesion unfamiliar to otorhinolaryngologists.

Depression and anxiety in patients with Behçet's disease compared with that in patients with psoriasis.

BACKGROUND: Behçet's disease (BD) is a chronic, episodic disease with an often devastating course. The aim of this study was to evaluate the depression and anxiety levels in patients with BD and to compare them with those in patients with psoriasis. METHODS: Patients were collected from the Dermatology Department, Faculty of Medicine, Gazi University, Ankara, Turkey. One hundred and twelve patients with BD and 95 patients with psoriasis were enrolled in the study. Patients were evaluated by Beck's depression inventory (BDI), Beck's anxiety inventory (BAI), automatic thoughts questionnaire (ATQ), and Beck's hopelessness scale (BHS). RESULTS: The group with BD had higher scores for BDI, BAI, ATQ, and BHS than the group with psoriasis (P < 0.05). Almost one-half of the patients with BD had depression. BAI only was higher in the younger BD group than in the corresponding psoriasis group, whereas all test scores were higher in the older BD group than in the corresponding psoriasis group. There was a strong correlation between the duration of BD and BDI, ATQ, and BHS scores, which was not observed in the psoriasis patients. BD increased the depression risk four-fold in this sample, and BD with a duration of over 3 years increased the depression risk 12-fold. CONCLUSIONS: In the present study, BD patients had higher levels of psychopathology than did psoriasis patients in terms of psychologic test scores. The duration of illness affected the severity of the psychiatric symptoms in the BD group, but not in the psoriasis group. The duration of illness was a major risk factor for the development of depression in BD. These findings indicate the need for early recognition of psychiatric symptoms in patients with BD.

UVA and UVB decrease the expression of CD44 and hyaluronate in mouse epidermis, which is counteracted by topical retinoids.

The transmembrane glycoprotein CD44 is currently thought to be the main cell surface receptor for the glycosaminoglycan hyaluronate. We previously showed that (1) CD44 regulate keratinocyte proliferation; (2) topical retinoids dramatically increase the expression of CD44, hyaluronate and hyaluronate synthase (HAS)s in mouse epidermis; (3) topical retinaldehyde restores the epidermal thickness and CD44 expression which are correlated with clinical improvement in lichen sclerosus et atrophicus lesions; and (4) retinaldehyde-induced proliferative response of keratinocytes is a CD44-dependent phenomenon and requires the presence of HB-EGF, erbB1 and matrix metalloproteinases. In this study, we analyzed the effect of UV irradiation on the levels of epidermal hyaluronate and CD44 in mice, as well as its potential prevention by topical retinoids. UVA (10 J/cm(2)) or UVB (1 J/cm(2)) irradiation significantly decreased the expression of CD44 and hyaluronate in the epidermis of hairless mice after 2 h. Expression of both epidermal CD44 and hyaluronate was reconstituted within 24 h. Topical application of retinaldehyde for 3 days prior to UVA or UVB irradiation prevented the decrease of CD44 and hyaluronate expression. Topical retinol and retinoic acid also increased the basal levels of epidermal CD44 and hyaluronate, although their preventive effect on UV-induced decrease of these molecules was less pronounced as compared to topical retinaldehyde. These data confirm the relationships between retinoid and CD44 pathways, although the primary target(s) of UV leading to CD44 and hyaluronate degradation remain to be elucidated.

Reliability of Web-based teledermatology consultations.

We studied the reliability of teledermatology diagnoses made using a Web-based system. Clinical photographs and information relating to 125 patients were placed on a Web server. Three dermatologists made the most likely diagnosis via a Web interface. The reference diagnosis was made in a face-to-face consultation with a fourth dermatologist; where appropriate it was confirmed histologically. The teledermatologists were correct in 57% of cases when viewing the images alone. Their diagnostic accuracy improved to 70% when additional clinical information was available. The rate of agreement between the teledermatologists ranged from 44% to 70% (kappa= 0.22-0.32). Seventy-seven per cent of the patients were correctly diagnosed by at least two dermatologists when clinical information was provided. A Web-based system appears to be reliable for teledermatology. A single well trained teledermatologist may give better results than a group of less well trained clinicians.

Decreased CD44 expression and stromal hyaluronate accumulation in myxoid dermatofibroma.

BACKGROUND: Dermatofibroma (DF) is a common benign histiocytic tumor, which has several clinicopathological variants. Myxoid DF is one of these variants, which is characterized by a stromal mucin deposition. CD44 is a polymorphic transmembrane glycoprotein and the principal cell surface receptor of hyaluronate (HA), the major component of the extracellular matrix. In a recent study, we have observed an abnormal accumulation of HA in the superficial dermis of transgenic mice with a keratinocyte-specific CD44 expression defect. We have also shown that HA was accumulated in large amounts in the superficial dermis of lichen sclerosus et atrophicus (LSA) lesions and that the epidermal CD44 expression of LSA skin was significantly decreased or lost. In an another study, we have suggested that a decrease in CD44 expression in follicular epithelial proliferations might be correlated with an abnormal HA accumulation in perifollicular solitary cutaneous myxoma. Recently we have also demonstrated that classical DF lesions displayed a strong CD44 expression in tumor cells and a weak HA positivity in tumor stroma whereas CD44 expression was significantly reduced or absent in dermatofibrosarcoma lesions and the tumor stroma showed strong HA staining. OBJECTIVE AND METHODS: Here we present 3 cases of myxoid DF, in which we explored the nature of the mucinous material in myxoid stroma by colloidal iron and hyaluronic acid binding protein stainings, as well as the expression of CD44 in the tumor cells by immunohistochemistry. RESULTS: We show that HA is accumulated in the stroma of all myxoid DF lesions with a significant decrease in CD44 expression in the tumor cells. CONCLUSION: Our results suggest that a decrease in CD44 expression in the tumor cells may result in stromal myxoid changes characterized by an abnormal HA accumulation in myxoid DF.

CD44 and hyaluronate in the differential diagnosis of dermatofibroma and dermatofibrosarcoma protuberans.

The histological distinction between dermatofibroma (DF) and dermatofibrosarcoma protuberans (DFSP) may be extremely difficult. CD34 and Factor XIIIa have been used to differentiate DF from DFSP. However, there is an overlap and relative lack of specificity of their expressions. CD44 is a widely distributed integral membrane glycoprotein, which is expressed as a multitude of isoforms generated by alternative splicing of at least 10 different variant exons and post-translational modifications. CD44 is currently thought to be the principal cell surface receptor for hyaluronate (HA), the major component of the extracellular matrix. In this study we aimed to assess the expression of standard CD44 (CD44s) and its isoforms (CD44v3, CD44v4, CD44v5, CD44v6, CD44v7, CD44v7v8, and CD44v10), and HA in DF and DFSP. Immunohistochemical staining was performed on the biopsy specimens of 15 cases of DF and four cases of DFSP, using antibodies that recognize the CD44s, different CD44 isoforms and the hyaluronate binding protein (HABP). Tumor cells displayed a strong CD44s immunoreactivity in all cases of DF whereas a faint HA positivity was observed in the tumor stroma. The DF cells were negative for CD44v3, CD44v4, CD44v6, CD44v7 and CD44v7v8 but showed a strong reactivity for CD44v5 and CD44v10. In contrast, CD44s' expression was significantly reduced or absent in all DFSP lesions and the tumor stroma displayed strong staining for HA. Our results indicate that CD44 and HA can be used as additional diagnostic markers to distinguish DF from DFSP.

Pseudo-knuckle pads: an unusual cutaneous sign of obsessive-compulsive disorder in an adolescent patient.

Knuckle pads are discrete benign cutaneous lesions overlying the extensor surfaces of the fingers and hand joints and are unrelated to trauma, whereas pseudo-knuckle pads may be considered as a form of callosity that appears after repeated trauma. This type of knuckle pad has been described in children with obsessive behavior as "chewing pads" and in adults as occupational disorder. Cases of pachydermodactyly, benign fibromatosis of the fingers, have been described as the unusual forms of knuckle pads that usually affect young adult males. We believe that pseudo-knuckle pads, chewing pads or pachydermodactyly are terms which have been used to decribe the same clinical situation reported in different patients. Here we describe a 12-year-old male patient with pseudo-knuckle pads along the metacarpophalangeal joints developed secondary to repeated trauma reflecting obsessive-compulsive disorder characterized by a tic-like habit. He received fluvaksamine 25 mg/day. The lesions started to disappear after three months of therapy. The recognition of pseudo-knuckle pads by dermatologists and pediatricians is very important in adolescent patients because these lesions may be clues for diagnosis of serious psychiatric problems. The collaboration of a dermatologist or pediatrician with a psychiatrist is essential in the follow-up of these patients.

Hyaluronate accumulation and decreased CD44 expression in perifollicular solitary cutaneous myxoma.

BACKGROUND: Myxomas are rare cutaneous tumors which may be solitary or associated with Carney's complex, NAME or LAMB syndromes. The mucinous material which constitutes the stroma of cutaneous myxomas is predominantly composed of hyaluronate (HA), the major component of the extracellular matrix. CD44 is a polymorphic integral membrane glycoprotein which serves as the principal cell surface receptor for HA. OBJECTIVE AND METHODS: Here we present 2 cases of solitary cutaneous myxomas displaying microscopically a perifollicular localization, in which we explored the nature of the accumulated mucinous material by colloidal iron and HA-binding protein stainings, as well as the epidermal expression of CD44 protein by immunohistochemistry. RESULTS: We show that HA is accumulated in the stroma of the cutaneous myxoma lesions and that the protein expression of CD44 in the keratinocytes of the trichofolliculoma-like epithelial buds projecting from the hair follicle centering these lesions is significantly decreased. CONCLUSIONS: Our results suggest that a decrease in CD44 expression in follicular epithelial proliferations may be correlated with an abnormal HA accumulation in cutaneous myxoma.