Although basal cell hyperplasia is commonly observed in dermatofibromas (DF), the coexistence of true basal cell carcinoma (BCC) with DF is exceptionally rare. This report describes a unique case of an aneurysmal DF colliding with superficial BCC and aims to interpret the potential causality of this unusual association.
Background: Complete lesion clearance is important to patients with psoriasis. Objective: To conduct a network meta-analysis of randomized controlled trials of biologic agents available for psoriasis in Japan, using mixed-treatment comparisons. Methods: MEDLINE and EMBASE were searched to identify randomized clinical trials (placebo-controlled or head-to-head) of infliximab, adalimumab, ustekinumab, secukinumab, ixekizumab, brodalumab, risankizumab or guselkumab in adult patients with moderate-to-severe plaque psoriasis published in English between 01 January 2000 and 31 August 2019. We assessed the proportion of patients who achieved a 100 %, 90 % and 75 % reduction in their Psoriasis Area and Severity Index (PASI) score (PASI100, PASI90 and PASI75) at 10, 12 or 16 weeks after starting biologic treatment, using contrast-based network meta-analysis methods and risk difference (RD). Probabilities of rank and surface under the cumulative ranking (SUCRA) were also estimated. Results: Data were pooled from 41 trials in 19,248 patients. All biologics were significantly more effective than placebo for PASI100, PASI90 and PASI75. The RD for PASI100 for brodalumab vs ixekizumab was 0.05 (95 % Confidence intervals [CI] -0.02, 0.11), brodalumab vs risankizumab was 0.04 (95 %CI -0.03, 0.11), and risankizumab vs ixekizumab was -0.01 (95 %CI -0.08, 0.06). The SUCRA for PASI100 and PASI90 achievement was 96.8 % and 86.8 %, respectively, for brodalumab, 82.6 % and 90.3 %, respectively for risankizumab, and 78.3 %, 80.9 %, respectively, for ixekizumab. Conclusion: Of the biologics assessed, brodalumab, ixekizumab and risankizumab were the greatest rates of PASI90 and PASI100 achievement, and a higher probability of being most effective in the induction phase, compared with the other biologics.
Background and Design: Erythroderma is an inflammatory condition characterized by widespread erythema and scaling affecting most of the skin surface. Its annual incidence is estimated to be approximately 1 in 100,000. We aimed to evaluate the demographic and clinical characteristics, treatments, and treatment responses of patients hospitalized with erythroderma. Materials and Methods: This single-center study retrospectively included patients with erythroderma who were hospitalized between January 1, 2013, and June 1, 2023. Results: The study included 108 patients, 37 of whom were female (34.2%) and 71 were male (65.7%). The mean age of the patients was 59.0 +/- 20.1 years, with males being older than females. The three most common causes of erythroderma were psoriasis (n=44), atopic dermatitis (n=17), and drug reactions (n=17), followed by mycosis fungoides (MF) (n=16). Inflammatory dermatoses (60.8%), drug-related reactions (22.5%), and neoplastic conditions (15.7%) were the most common disease groups associated with erythroderma. Psoriasis, atopic dermatitis, and MF were more common in men than in women. Antibiotics were the most common drug group responsible for erythroderma. Erythema/squamation and pruritus were the most common findings in all patients with erythroderma. Compared to patients with atopic dermatitis, those with psoriasis were more likely to have nail dystrophy and peripheral edema. In contrast, facial edema was more common in the drug-related reaction group, whereas the Omnibus phenomenon and lymphadenopathy were more common in the MF group. Conclusion: Erythroderma is a dermatological condition that requires urgent intervention. Identifying its common causes can help reduce the associated morbidity and mortality.
Background and Design: Use digital infrared thermal imaging to analyze thermal patterns of diverse types of skin cancer. Skin cancer constitutes a substantial global health burden, with melanoma being the primary cause of skin cancer mortality. The ability to detect the disease in its early stages is of paramount importance, as it has been shown to lead to a significant improvement in survival rates, which can reach nearly 99%. Materials and Methods: This study explored the use of digital infrared thermal imaging to analyze the thermal patterns of skin lesions. A total of 90 thermal spots were analyzed from 50 patients diagnosed with various types of skin cancer, including basal cell carcinoma, squamous cell carcinoma, melanoma, and Results: Our results indicate that basal cell carcinoma lesions exhibit negative temperature differences (Delta T) with values ranging from -3.8 degrees C to -5.8 degrees C, whereas melanoma and squamous cell carcinoma lesions tend to appear warmer with positive Delta T values. With this trend, we observed a correlation between the thermal Conclusion: The findings indicate that thermography has the potential to function as a screening instrument within clinical practice, associating the malignancy of tumors with the thermal signature and improving accurate initial assessment in clinical environments without on-site dermatologists.
Background and Design: Psoriasis is a chronic inflammatory disease, with one-third of cases beginning in childhood. Pediatric presentations may differ from those in adults. This study evaluated the demographics, clinical features, and treatment of pediatric patients with psoriasis. Materials and Methods: This study included 89 psoriasis patients aged 0-18 years who were followed up at the dermatology clinics of Giresun Training and Research Hospital between January 2021 and February 2025. Demographics, clinical features, involvement sites, and treatments were extracted from electronic medical records and statistically analyzed. Results: Of the 89 patients, 52 were female (58.4%) and 37 were male (41.6%). The mean age at onset was 10.1 +/- 4.3 years, with a mean disease duration of 69.8 +/- 50.9 months. Plaque psoriasis was the most common (88.8%), followed by guttate psoriasis (15.7%) and palmoplantar psoriasis (8.9%). In 46% of cases, body surface area (BSA) involvement was <5%, and in 2.2%, it was >50%. The extremities (60.7%) and scalp (56.2%) were the most frequently affected sites. No gender-based differences were found in BSA, type, or site of involvement (p>0.05). Arthritis was present in 14.6% of the patients, and family history was present in 31.5% of the patients, with a significantly higher frequency in men (p=0.043). Cutaneous comorbidities were observed in 8.9% of patients. Topical treatments included steroid-calcipotriol (41.6%), steroids alone (37.1%), steroid-salicylic acid (29.2%), calcineurin inhibitors (16.8%), calcipotriol (6.7%), and tazarotene (1.1%). Systemic therapies included methotrexate (28.1%), acitretin (16.8%), and adalimumab (7.9%). Narrow band UVB phototherapy was used in 20.2% of patients. Conclusion: Our findings on age at onset, gender distribution, clinical subtypes, extent, and sites of involvement align with those of previous studies. A family history was present in approximately one-third of patients, although the reported rates varied widely, indicating genetic heterogeneity. The rate of concomitant arthritis was higher than expected based on previous reports. As pediatric psoriasis is less common than adult psoriasis, larger multicenter studies are needed to better understand its characteristics and its management.
Background and Design: Alopecia areata (AA) is a chronic immune-mediated disease characterized by sudden-onset sharply circumscribed alopecic patches, primarily on the scalp. Although its etiology is not fully understood, increasing evidence suggests a relationship between oxidative stress (OS) and AA. This study aimed to evaluate OS using ischemia-modified albumin (IMA), total oxidant state (TOS), total antioxidant state (TAS), and oxidative stress index (OSI) in patients with new-onset mild AA. Materials and Methods: This prospective, single-center, case-control study included 36 patients with AA and 34 healthy controls. Serum TAS, TOS, OSI, and IMA levels were measured and compared between the two groups. Results: TOS and OSI levels were significantly higher, and TAS levels were significantly lower in the AA group than in the control group (p<0.05). Although IMA levels were higher in the AA group, the difference was not statistically significant (p>0.05). Conclusion: These findings support the association between oxidative stress and AA. In mild acute AA, antioxidant defense mechanisms may be insufficient to counterbalance elevated oxidant levels. IMA levels may increase in chronic or more severe disease stages. Further studies on diverse AA populations are required.
Background and Design: Giant condyloma acuminata (GCA), or Buschke-Loewenstein tumor, is a rare anogenital and perianal verrucous tumor associated with human papillomavirus infection, characterized by circular, exophytic, cauliflower-like tumors commonly seen in the anogenital area. This study aimed to identify the risk factors associated with GCA among patients with condyloma acuminata (CA) at the dermatology and venereology outpatient clinic of a tertiary referral hospital in Indonesia. Materials and Methods: This retrospective descriptive study used secondary data from the medical records of patients who visited the dermatology and venereology outpatient clinic of a tertiary referral hospital in Surakarta, Indonesia, from January 2013 to December 2022. The data were statistically analyzed using a bivariate chi-square test, and significance was set at p<0.05. Results: Of the 2202 outpatient visits, 313 patients were diagnosed with CA, of whom 28 were diagnosed with GCA. These GCA patients were predominantly male (71.43%) and aged between 21 and 40 years (57.14%). Most subjects were high school graduates (42.9%), private employees (50%), men who have sex with men (42.86%), and human immunodeficiency virus (HIV)-reactive (67.86%). The most common predilection site was the anal region (35.71%). The duration of the disease was less than one year (53.6% of patients). The most common therapy was cryotherapy (82.14%), followed by oral cimetidine (78.57%), topical potassium hydroxide (75%), and topical trichloroacetic acid 80% (67.86%). Bivariate analysis revealed that male sex (p=0.023), sexually active age (p=0.025), high school graduation (p=0.000), employment (p=0.000), and reactive HIV (p=0.001) were the risk factors for GCA. Conclusion: GCA is a rare disease. The risk factors for GCA include being a sexually active male, having a high school education, being employed, and being HIV-reactive.
Background and Design: Trichostasis spinulosa (TS) is a common but frequently underdiagnosed dermatological condition. Dermoscopy has recently been identified as the most practical and useful noninvasive diagnostic tool. This study aimed to assess the demographic, clinical, and dermoscopic features of TS, as well as the patients' perspectives. The objective was to increase awareness of this disease. Materials and Methods: This was a prospective descriptive study. A total of 100 adult patients diagnosed with facial TS at a tertiary center between October 2021 and April 2023 were included. Physical and dermoscopic examinations were performed. Demographic data, reasons for admission, age at onset, subjective complaints, comorbidities, previous treatments, treatment responses, lesion location, dermoscopic findings, and patient perspectives on the disease were recorded. Results: Ninety-nine percent of the patients presented to the clinic with other dermatological conditions. The most common age group was 18-25 years. Of the patients, 81% were female and 19% were male. When patients' perspectives were evaluated, 67% were aware of the TS findings, 52% reported being disturbed by the lesions, and 56% requested treatment of the lesions. On dermoscopy, vellus hairs surrounded by keratotic plugs were observed in 68% of patients and black comedone-like structures in 58% of patients, together with hair tufts. The combined presence of hair tufts, vellus hairs surrounded by keratotic plugs, and black comedone-like structures was observed in 33% of the patients. Conclusion: TS can cause cosmetic distress, particularly in young adults. TS should be considered in the differential diagnosis of treatmentresistant, comedone-like facial lesions. In most cases, a practical diagnosis can be established using a dermatoscope.
Background and Design: Systemic therapies are frequently used off-label for the treatment of atopic dermatitis (AD); however, real-world data are limited. Materials and Methods: This study aimed to evaluate the efficacy and safety of phototherapy and systemic treatments in patients with severe AD aged <18 years using real-world data. The study, designed as a single-center retrospective observational study, evaluated patients who received at least one systemic treatment or phototherapy between 2019 and 2022. Treatment response was assessed using the Physician Global Assessment (PGA) ordinal scale. Results: This study evaluated 30 patients and 81 treatment courses. The most common treatment was cyclosporine (CSA), administered to 25 (83.3%) patients, followed by systemic corticosteroids (SCS), administered to 18 (60%) patients (treatment course: 21 patients). Azathioprine (AZA) was used in 12 (40%) patients, methotrexate (MTX) in 7 (23.3%) patients, phototherapy in 5 (16.6%, 6 treatment courses), intravenous immunoglobulin (IVIG) in 5 (16.6%), omalizumab in three (10%), dupilumab in one (3.3%), and mycophenolate mofetil in one (3.3%). While all courses of SCS and IVIG resulted in at least a good response (PGA1 or PGA2), the rates of patients with at least a good response to CSA, AZA, MTX, and phototherapy were 92%, 66.7%, 57.1%, and 50%, respectively (p=0.001). The percentage of patients experiencing side effects was 32% (n=8) for CSA, 23.8% (n=5) for SCS, 33.3% (n=4) for AZA, 14.3% (n=1) for MTX, and 33.3% (n=2) for phototherapy. Two patients discontinued CSA treatment due to side effects: one due to nausea and the other due to impetigo and febrile seizure. None of the patients discontinued other treatments because of side effects. Conclusion: This observational study indicates that classical immunosuppressive treatments are effective alternatives for children with severe AD without serious side effects. However, comprehensive studies involving novel treatment modalities, such as biologics and small molecules, are warranted.
Aquagenic syringeal acrokeratoderma (ASA) is a rare, transient skin disorder characterized by the appearance of white papules and plaques on the palms after short-term exposure to water. We report a two-year case series involving 12 patients (8 males, 4 females) aged 7 to 32 years (mean age 19.25), all diagnosed with ASA. Symptoms developed within 1-6 min of water contact and resolved spontaneously within 20-52 min. Palmar involvement was present in all cases, without lesions on the fingertips, dorsal hands, or plantar surfaces. Diagnosis was made clinically in 10 patients and histopathologically confirmed in two. Seven patients reported symptoms, including itching, burning, or hyperhidrosis, whereas five remained asymptomatic. None had relevant medication use, recent viral illness, or known genetic predisposition, such as cystic fibrosis. Topical therapies provided partial relief; however, recurrence was common during the follow-up period. This study highlights the characteristic clinical presentation of ASA, the importance of clinical recognition, and the challenges in achieving sustained treatment success.
Background and Design: Demodex mites are common ectoparasites of human hair follicles, and Demodex folliculorum (D. folliculorum) and Demodex brevis live on human skin. The role of Demodex in acne vulgaris remains controversial, and there is limited information regarding the effects of systemic isotretinoin on these mites. This study aimed to determine the presence and type of Demodex in acne vulgaris patients and to investigate the impact of oral isotretinoin treatment on Demodex infestation. Materials and Methods: This prospective study included a total of 53 patients with moderate-to-severe acne vulgaris who were scheduled to start oral isotretinoin therapy. Standardized superficial skin biopsies were obtained from lesional areas before treatment and at the third and sixth months of therapy to assess the presence of Demodex. Results: Demodex was detected in 31 (58.49%) of the 53 patients (39 female, 14 male). D. folliculorum + Demodex brevis (n=16), D. folliculorum (n=14), and Demodex brevis (n=1) were determined. Demodex was negative in all patients at 3 and 6 months of treatment. There was no statistically significant difference between Demodex positivity and Demodex type, disease duration, acne type, or acne localization (p>0.05). Conclusion: Demodex brevis was frequently observed along with D. folliculorum. Oral isotretinoin treatment was effective against Demodex. Systemic isotretinoin may be considered a treatment option for patients with demodicosis.
