Cutaneous findings in patients with acromegaly and its relationship with concomitant endocrinopathies.

OBJECTIVES: Skin changes in acromegaly are often the first sign of the disease. The aim of this study was to describe the cutaneous findings in patients with acromegaly. In addition, a secondary aim was to investigate the possible association of these findings with remission status and concomitant endocrinopathies. DESIGN, PATIENTS, AND MEASUREMENTS: In this prospective multicenter study, 278 patients over the age of 18 years with acromegaly who were followed up in 14 different tertiary healthcare institutions were included. These patients, who were followed up by the Endocrinology Department, were then referred to a dermatologist for dermatological examination. The frequency of skin lesions was investigated by detailed dermatologic examination. Dermatological diagnosis is reached by clinical, dermatological and/or dermoscopic examination, and rarely skin punch biopsy examinations in suspicious cases. The possible association of the skin findings between remitted and nonremitted patients and with concomitant endocrinopathies were evaluated. RESULTS: The most common skin findings in patients with acromegaly in our study were skin tags (52.5%), cherry angiomas (47.4%), seborrhoea (37%), varicose veins (33%), acneiform lesions (28.8%), hyperhidrosis (26.9%) and hypertrichosis (18.3%). Hypertrichosis was significantly more prevalent in patients nonremitted (p: .001), while xerosis cutis was significantly more prevalent in patients remitted (p: .001). The frequency of diabetes mellitus and hypothyroidism was significantly higher in patients with varicose veins and seborrhoeic keratosis than those without. Additionally, the coexistence of hypothyroidism, hyperthyroidism and galactorrhea was significantly higher in patients with Cherry angioma than in those without Cherry angioma (p-values: .024, .034 and .027, respectively). The frequency of hypogonadism in those with xerosis cutis was significantly higher than in those without (p: .035). CONCLUSIONS: Cutaneous androgenization findings such as skin tag, seborrhoea, acne and acanthosis nigricans are common in patients with acromegaly. Clinicians should be aware that skin findings associated with insulin resistance may develop in these patients. It can be said that the remission state in acromegaly has no curative effect on cutaneous findings. Only patients in remission were less likely to have hypertrichosis. This may allow earlier review of the follow-up and treatment of acromegaly patients presenting with complaints of hypertrichosis. Additionally, it can be said that patients with skin findings such as cherry angioma may be predisposed to a second endocrinopathy, especially hypothyroidism. Including dermatology in a multidisciplinary perspective in acromegaly patient management would be beneficial to detect cutaneous findings earlier.

Sonographic Findings of Cervical Chondrocutaneous Branchial Remnants-A Comparison With Dermal Lesions/Cysts and a Literature Review: A Pilot Study.

OBJECTIVES: Cervical chondrocutaneous branchial remnants (CCBRs) and dermal lesions, such as epidermoid cysts or brachial anomalies, including lateral cervical cysts/sinuses or dermal sinuses of anterior chest lesions, are usually located at the lower neck at the anterior or posterior border of the sternocleidomastoid muscle (SCM). We aimed to demonstrate the usefulness of ultrasonography in the differential diagnosis and evaluation of CCBRs. METHODS: We evaluated 22 lesions of 20 pediatric patients, classified into CCBR and dermal lesion groups. We used Fisher's exact test to evaluate differences between these groups in terms of lesion shape (low-echoic mass- or tubular-like), whether the lesion was adjacent to/in contact with the SCM or not, and the presence or absence of a concave SCM caused by the lesion. RESULTS: Of the 22 lesions, 8 were CCBRs, and 14 were dermal lesions. We found a significant difference in the presence/absence of adjacency to or contact with the SCM (presence/absence of adjacency to or contact with the SCM in CCBRs vs that in dermal lesions: 6/2 vs 1/13, P = .002) and presence/absence of lesion-induced concavity of the SCM (presence/absence of lesion-induced concavity of the SCM in CCBRs vs that in dermal lesions: 3/5 vs 0/14, P = .036). The lesion shape (low-echoic mass-like/tubular-like lesions) did not significantly differ between the two study groups (low-echoic mass-like/tubular-like lesions in CCBRs vs that in dermal lesions: 5/3 vs 11/6, P = .624). CONCLUSIONS: CCBRs have a strong association with the SCM. These sonographic findings may be useful in the differential diagnosis of dermal cervical lesions.

Skin tags imaged by reflectance confocal microscopy, optical coherence tomography and multispectral optoacoustic tomography at the bedside.

BACKGROUND: Skin tags are common and mostly benign, but occasionally contain skin cancers. This study analysed skin tags by combining three advanced optical imaging technologies: reflectance confocal microscopy (RCM), optical coherence tomography (OCT) and multispectral optoacoustic imaging (MSOT) supplemented by dermoscopy MATERIALS AND METHODS: A prospective clinical study recruiting patients with skin tags from a university hospital clinic over a 2-week period. OCT, RCM and MSOT imaging were performed prior to excisional biopsies. Image features such as pigmentation, cell types and skin architecture, angiographic information demonstrating vascular pattern were captured, analysed, and compared to melanin and haemoglobin content in MSOT as well as histopathology. RESULTS: Six patients with dermal naevi (2); compound naevi (3); neurofibroma (1) were included. All skin tags except the neurofibroma were pigmented (5/6), with sparse (5/6) and dense (4/6) hyperreflective nests and band-like collagen in dermis in 6/6 lesions on RCM. Dermoscopy showed dots (5/6) and coiled vessels (5/6). Linear vertical vessels were present in all OCT images. MSOT images consisted of a compact shell-like superficial melanin area, same shape and size as the skin tag, dermal vessels were visible in 4/5 naevi, HbO2 signal clearly demarcated blood vessels located below the melanin signal. CONCLUSION: OCT showed linear vessels in all lesions. Pigmentation was identified by RCM as benign nests of melanocytes. MSOT supplemented with spatial distribution of melanin and HbO2 that indicated all skin tags were benign with no infiltration of vessels inside the melanin signal. Each advanced method proved indispensable for fast diagnosis. Larger studies are warranted for validation.

Ectopic immature renal tissue presenting as a pedunculated sacral mass in a neonate.

Ectopic immature renal tissue (EIRT) has been reported in a variety of tissues of mesodermal origin, including the dermis of the skin. We report a case of a newborn with a congenital lumbosacral mass with pathologic findings consistent with EIRT. This report highlights the clinical and pathologic considerations of EIRT, including associations with spinal dysraphism, teratoma, and Wilm's tumor.

Giant fibroepithelial polyp of the thigh and retroperitoneal fibromatosis in a young woman: a rare case.

We present a case of 20-year-old woman who presented with a large pedunculated skin covered mass lesion arising from the left thigh, measuring 40 × 25 cm, with no history of pain or skin ulceration and a feeling of a lump with dragging pain in the left side of the abdomen for about 7 years. Subsequently, ultrasound, contrast-enhanced computed tomography, and magnetic resonance imaging of abdomen and left thigh region were carried out. The lesion was broad-based toward the left upper thigh with a central core of interspersed fat supplied by branches of the superficial and deep femoral arteries. Another lesion was seen in the left retroperitoneum anterior to the psoas muscle in a left paravertebral location encasing the left common iliac vessels extending into the left pelvic cavity and inguinal region inferiorly. The lesion showed dense post-acoustic shadowing on ultrasound, mild enhancement on contrast-enhanced computed tomography, and appeared hypointense on T1- and T2-weighted images. A left thigh lesion was excised, whereas incisional biopsy was done for the left retroperitoneal lesion. The diagnosis of a giant fibroepithelial polyp arising from the left thigh and left retroperitoneal fibromatosis was made. This is the first report of such a giant fibroepithelial polyp arising from the thigh with associated retroperitoneal fibromatosis.

Is Skin Tag Associated with Diabetic Macro and Microangiopathy?

INTRODUCTION: Although skin tag is associated with diabetes mellitus, no data in the literature show that the presence of skin tag is associated with diabetic macro and microangiopathy. The purpose of this study was to investigate the frequency of hypertension, dyslipidemia, obesity, macro and micro angiopathy in type 2 diabetic patients with and without skin tag. MATERIAL AND METHODS: We evaluated 99 (40 female and 59 male) type 2 diabetic patients. All patients were evaluated for blood pressure, body mass index, lipids, HbA1c, macroangiopathy (peripheral vascular disease, cerebrovascular disease and coronary heart disease), microangiopathy (neuropathy, nephropathy, retinopathy) and skin tag. RESULTS: Age, HbA1c and body mass index were 65.0 ± 14.2 years, 8.1 ± 2.0% and 30.5 ± 6.4 kg/m2, respectively. The frequency of skin tags 53.5%, dyslipidemia 68.7%, hypertension 69.7%, obesity 39.4%, macroangiopathy 61.6% (peripheral vascular disease 12.1%, cerebrovascular disease 16.2%, and coronary heart disease 49.5%), microangiopathy 63.6% (neuropathy 21.2%, nephropathy 38.4%, retinopathy 38.4%) were detected. Higher body mass index (p = 0.04) and frequency of obesity (p = 0.03) were detected in patients with skin tag than without skin tag. Age (p = 0.8), gender (p = 0.6), HbA1c (p = 0.4) and the presence of dyslipidemia (p = 0.4), hypertension (p = 0.6), macroangiopathy (p = 0.2), and microangiopathy (p = 0.9) were not different in patients with and without skin tag. CONCLUSION: We conclude that presence of skin tag is merely related to obesity and may not be strongly associated with macro- and microangiopathy in type 2 diabetic individuals. Further studies with large patient population are required to elucidate the association between the presence of skin tag and diabetic angiopathy.

Rhabdomyomatous mesenchymal hamartoma presenting as a sacral skin tag in two neonates with spinal dysraphism.

Rhabdomyomatous mesenchymal hamartoma (RMH) is a rare congenital malformation involving the dermis and subcutaneous tissue, of which there were 62 reported cases through 2014. We report RMH in two neonates presenting as a sacral skin tag. In both cases, magnetic resonance imaging (MRI) of the spine showed evidence of spinal dysraphism, including a lipomyelomeningocele and a tethered cord. Surgical repair of the defects was performed. Histopathologic examination of the skin tags showed a haphazard arrangement of mature skeletal muscle fibers and adnexal elements, consistent with RMH. The second patient also had a hemangioma on the sacrum and was diagnosed with LUMBAR (lower body hemangioma and other cutaneous defects, urogenital anomalies/ulceration, myelopathy, bony deformities, anorectal/arterial anomalies, and renal anomalies) syndrome, an association between cutaneous infantile hemangiomas of the lower body and regional congenital anomalies. The apparent association of paraspinal RMH with spinal dysraphism suggests that aberrant migration of mesodermally derived tissues (including skeletal muscle fibers) during neural tube development may be responsible for the pathologic findings in the skin. Additional study of patients with spinal dysraphism and congenital cutaneous lesions may further support this hypothesis.

Androgen Receptor-Positive Penile Acrochordon: A Case Report.

Acrochordons are polypoid, skin-colored lesions usually present at the site of skin folds. They are extremely rare in the preputial area of the penis and do not tend to grow. To the best of our knowledge, in English literature, this report presents the first case of an androgen receptor-positive penile acrochordon, which is located on the penis and showed rapid growth along with body development during puberty with no underlying causes such as acromegaly, diabetes, obesity, and trauma.

Giant inflamed fibroepithelial scrotal polyp mimicking an anogenital wart.

We report the case of a young man who has never had any sexual contact presenting with a large scrotal lump with secondary bacterial infection. He reported no prior warts - genital or cutaneous. On examination, he had a large pink cauliform mass on the scrotum with four smaller but similar satellite lesions. Appearances were thought to be consistent with giant condyloma of Buschke and Lowenstein. Once superinfection was treated with oral antibiotics, he had a trial of imiquimod without success and was then referred to urology. After surgical excision, pathology concluded it was an inflamed fibroepithelial polyp with no malignant changes. To our knowledge, this is the first case report of a giant scrotal fibroepithelial polyp with characteristic gross warty features in an adult.

Serious Skin Injuries Following Exposure to Unapproved Mole and Skin Tag Removers.

Objective: We sought to describe skin injuries associated with unapproved topical mole and skin tag removers containing concentrated salicylic acid, Sanguinaria canadensis, or other caustic agents. Methods: We identified skin injuries associated with unapproved non-device topical mole and skin tag removers reported to the US Food and Drug Administration (FDA) through October 30, 2021 or described in Amazon consumer product reviews between 2019 and 2021. Results: We identified 38 cases, including 30 from Amazon consumer product reviews and eight reported to the FDA. Twenty-eight were from 2021. The most common reason for use was for mole and/or skin tag removal. Listed ingredients included salicylic acid, Sanguinaria canadensis, botanicals (includes homeopathic products), and calcium oxide. Seven cases involved products without ingredients listed. Adverse events included burns, pain, and ulceration, some resulting in permanent scarring and disfigurement. There were 14 facial injuries, including four adjacent to the eye. Reported treatments included antibiotics, hospital care, wound care, and dermatology advice to have a skin graft. Limitations: Limitations include underreporting of adverse events to the FDA, limited clinical details and potential bias in consumer reviews, and poor replicability of review searches due to the dynamic nature of the Amazon website. Conclusion: Unapproved, non-device topical mole and skin tag removers are associated with serious skin injuries. We found Amazon consumer reviews to be a novel and useful data source for safety surveillance of these types of skin products. When dermatologists are consulted about skin injuries, exposure to these products should be considered in the differential diagnosis.

Novel findings, mini-review and dysmorphological characterization of 16p13.11 microduplication syndrome.

The short arm of chromosome 16 and especially the region 16p13.11 is a chromosome region where many structural variants, especially deletions and duplications, can be observed. Although deletions of this region are clinically well defined, duplications are rare, and so far, there is no established clinical consensus in regard with its clinical picture, and especially the dysmorphic perspective of the disease is far from being clear. A 5-year-and-2-month-old patient who presented with epilepsy, autism and late speech onset complaints was evaluated in our genetics department. On physical examination, unilateral preauricular skin tag and upslanting palpebral fissures were noted. Microarray analysis was performed and reported as ([hg19]: 16p13.11 (14.897.804-16.730.375) x3). The literature review revealed only a few reports about the syndrome, but some dysmorphological findings appear to recur in different reports, which enables a possible characterization. Dysmorphic findings were discussed.

"An eye for a tooth:" Orbital teratoma in an adult.

A 27-year-old female presented with progressive prominence of her right eye since childhood. On examination, a pinkish mass filling the right orbit with no evidence of an eyeball was seen. She also had bilateral preauricular skin tags. Imaging revealed a mass with solid and cystic components in the right orbit, with a well-formed tooth in situ, suggestive of a teratoma. The tumor was removed and histopathology confirmed the diagnosis. Orbital teratoma in an adult is a rare presentation. The presence of preauricular skin tags in association with orbital teratoma is a new finding.

Anal skin tag - An unusual presenting feature of food protein-induced allergic proctocolitis in a neonate.

BACKGROUND: Anal skin tags are commonly seen with anal fissures, haemorrhoids, inflammatory bowel disease and their association have been extensively studied. However the presence of anal skin tag in food protein-induced allergic proctocolitis has rarely been reported in literature. We report a neonate with food protein-induced allergic proctocolitis who presented with blood in stool and anal skin tag. CASE DESCRIPTION: A 26-day-old baby presented with history of passing intermittent blood in stools for two days. The baby was exclusively breast-fed and was well-appearing with no failure to thrive. Two anal skin tags were present but there was no evidence of anal fissures or haemorrhoids. The biopsy of anal skin tag showed fibroepithelial polyp. Colonoscopy was suggestive of food protein-induced allergic proctocolitis. In view of poor response to elimination diet in the mother and extensively hydrolysed formula, the baby was started on amino acid formula with complete recovery. CONCLUSION: Through this case we wish to highlight that clinicians should consider food protein-induced allergic proctocolitis in their differential diagnosis in a neonate presenting with blood in stools and anal skin tag.

Efficacy Evaluation of the Pixie® Skin Tag Cryogenic Device on Skin Tags in a Prospective, Single-Blinded, Randomized, Comparative Clinical Trial.

INTRODUCTION: Cryotherapy is an efficient method to treat various cutaneous lesions. In the current clinical evaluation, the efficacy of the Pixie® Skin Tag cryogenic pen as a home treatment for benign skin tags was evaluated against a marketed comparator device. In addition, the safety, tolerability, and expected visual effects of the treatment were assessed. METHODS: Fifty-six healthy volunteers presenting with skin tags were included and randomized in a prospective, single-blinded, parallel, single-center, comparative trial and subjected to treatment with either Pixie® Skin Tag or a comparator device, Wortie® skin tag remover. Selected skin tags located on the neck, breast, and under the armpits were topically treated according to device prescriptions for maximally three times with a 15-day interval between treatments. RESULTS: Of the skin tags treated with Pixie® Skin Tag, 64.3% completely disappeared during the study, of which half of the skin tags were cleared after one treatment, compared with 7.1% of the study population treated with Wortie® skin tag remover (p < 0.001). Both medical devices were safe to use, painless, and very well tolerated by 64.3% in the Pixie® Skin Tag and 96.4% in the Wortie® skin tag remover group. In addition, 72% of the subjects using Pixie® Skin Tag were satisfied with the results, and two-thirds of this study group would buy and use the device for the treatment of other skin tags. For the comparator device, only 11.0% were satisfied and 7.0% would buy the device. CONCLUSION: Treatment of skin tags with Pixie® Skin Tag showed superior clinical performance when compared to Wortie® skin tag remover. Both treatments were safe and well tolerated, with the majority of skin response serving as a predictor for clinical performance in the Pixie® Skin Tag treated group. TRIAL REGISTRATION NUMBER: ANSL Registration: 2018-A01804-51.

A Case of Infantile Perianal Pyramidal Protrusion Masquerading As Imperforate Anus at Birth.

Infantile perianal pyramidal protrusion (IPPP) is an uncommon and underreported benign cutaneous lesion characterized by a protrusion from the anal orifice. It is also believed to be often mistaken for other conditions. The unawareness of this lesion may be responsible for underreporting and an excessive concern both in providers and in parents. Timely diagnosis and reassurance need to be emphasized in the provider community. We report an interesting case of IPPP on the first day of life, which was erroneously diagnosed as imperforate anus at her delivery.

Acrochordons and autoimmunity: Significance of preconceptional counseling.

BACKGROUND: Acrochordons are benign hypertrophic lesions of the skin of which the pathophysiology is unclear. OBJECTIVE: This study aimed to examine the association of acrochordons with autoimmune disorders in patients with a poor obstetric history. METHODS: This retrospective cohort involved 350 female patients with poor obstetric history who were included in a preconceptional care program to investigate risk factors for obstetric complications. These patients were further investigated for the co-existence of autoimmune disorders (defined by either a diagnosis of autoimmune diseases or autoimmune antibody positivity) and acrochordons. RESULTS: An autoimmune disorder was present in 55.7% (195/350) of the patients. The rate of acrochordons was significantly higher in patients with autoimmune disorders (n= 195) compared to the control group (n= 155) (8.21% versus 2.58%, respectively) (p= 0.043). When the autoimmune disease positive (n= 58) and autoimmune antibody-positive (n= 137) groups were separately analyzed, acrochordons were found more frequently in the autoimmune disease group (p= 0.004). However, there was no statistically significant co-occurrence of autoimmune antibody positivity and the presence of skin tags (p= 0.135). CONCLUSION: There may be immune system-related biological mechanisms underlying the pathogenesis of acrochordons. Preconceptional counseling is beneficial for women with poor obstetric history and acrochordons.

Correlation between Serum Leptin Level with Type and Number of Lesion Skin Tag.

BACKGROUND: Skin tag is a benign tumour of connective tissue in the skin, sessile or pedunculated, skin-like to brownish coloured and often arises in the flexure area. Etiopathogenesis of skin tag is still unclear, but one of the aetiology is associated with leptin hormone. AIM: To determine the correlation between leptin serum level with type and number of the lesion skin tag. METHODS: This study is an observational analytic study with a cross-sectional design involving 33 skin tag patients. Diagnosis of skin tag was based on history and clinical examination; we conducted blood sampling and measurement of serum leptin level to the patients. RESULTS: We found the mean serum leptin level of skin tag patients were highest on the type of lesion mixed (31.54 ± 12.85 ng/ml). The mean number of skin tag lesions was 13.6 ± 5.8 lesions. There is a very high positive correlation between serum leptin level with a number of skin tag (r = 0.86) with p < 0.05 and significant correlation between serum leptin level with the type of lesions (p = 0.037). CONCLUSION: Serum leptin level has a very high positive correlation to a number of skin tag and significant correlation between serum leptin level with the type of lesion.