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Herein we review the applicability of reflectance confocal microscopy to pediatric dermatologists as well as the barriers that must be overcome to adopt this technology., (© 2024 Wiley Periodicals LLC.)

Background: Actinic keratoses (AKs) are common skin lesions associated with an increased risk of developing squamous cell carcinoma. Few studies in Europe have focused on AK prevalence., Aim: To determine the point prevalence of AKs in a dermatology outpatient population in Spain, to describe the clinical characteristics of these lesions and to characterise the profile of AK patients., Methods: Observational, cross-sectional, multicentre study conducted in 19 hospitals (dermatology outpatient services) around Spain. A total of 204 consecutive patients per hospital who were ≥45 years old were screened for the presence of AKs., Results: 3877 patients were assessed and the overall AKs prevalence was 28.6%. Prevalence was significantly higher in men than women (38.4% vs. 20.8%, p<0.0001) and increased with age for both sexes (45.2% in 71-80 years). Scalp and ear lesion locations were significantly more frequent in men (51.9% vs. 2.7% and 16.9% vs. 2.4%, respectively, p<0.0001 both cases) and the cheek, nose and neckline in women (46.3% vs. 34.0% [p<0.0001], 43.0% vs. 24.8% [p<0.0001] and 5.3% vs. 1.8% [p=0.002]). Men showed a significantly higher frequency of ≥2 affected areas than women (42.7% vs. 20.3%, p<0.0001). Among patients with AK lesions, only 65% confirmed that they were the reason for the visit to the clinic., Conclusions: Approximately a quarter of the dermatology outpatient population in Spain aged ≥45 years old have AKs, with the prevalence rate being highest in men and in older age groups. AK is underdiagnosed and a proactive strategy is needed for the diagnosis and early treatment of these lesions., (Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: The ability to reliably recognize and classify a range of skin signs and symptoms remains a necessary skill across most clinical disciplines but one that is traditionally mastered via nonsystematic experience over long periods., Objective: We investigated whether online Perceptual and Adaptive Learning Modules (PALMs) could efficiently train preclerkship medical students to identify and discriminate primary skin lesion morphologies, configurations, and anatomic distributions., Methods: Medical students completed an online skin lesion morphology PALM voluntarily in year 1 and by requirement, along with configuration and anatomic distribution PALMs, in year 2. In controlled before-and-after studies, multiple-choice pretests and posttests using previously unused images, assessed PALM-induced learning. In prospective cohort studies, differences in year-2 performance between students who had and had not completed the morphology PALM in year 1 were also assessed., Results: Multiple-choice tests, used to evaluate PALM effectiveness, demonstrated large (effect sizes of 1.1 [±0.1 SE] to 2.2 [±0.1 SE]) and statistically significant (P < .0001) improvements after PALM training, with learning retention when tested after 1 year., Limitations: Results are from self-selected groups and a single class at 1 institution., Conclusion: PALMs are a useful tool for efficient development of the core clinical skills of pattern recognition and classification of skin lesion characteristics., (Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background Objectives Animals Materials and Methods Results Conclusions and Clinical Relevance Hospital‐related dermatological conditions are well‐studied and reported in human medicine. However, studies about these dermatological disorders in veterinary medicine are lacking.To report the incidence, type and distribution of hospital‐acquired skin lesions (HASL) in dogs, and to investigate risk factors that may be associated with their development.Hospitalised client‐owned dogs with HASL and a control group of hospitalised dogs without skin lesions.Prospective clinical evaluation of all HASL and dermatological tests, when indicated, were performed, over 6 months. A variety of potentially predisposing factors also were recorded.Thirty‐one dogs with HASL and a matched control group of 60 hospitalised dogs without skin lesions were included. The incidence of HASL was 11.2% (31 of 278). The most common lesion was erythema in 74.2% of dogs (23 of 31) and the most affected area was the abdomen in 58.1% (18 of 31) of dogs. Faecal and/or urinary incontinence was identified as an important risk factor for the development of skin lesions during hospitalisation (odds ratio 14.445, 95% confidence interval 1.444–144.479, p = 0.023). Immobilisation and changes in body temperature also may play a role in the development of such lesions in dogs.Faecal and/or urinary incontinence was found to be an important factor in the development of HASL. The impact of HASL on patient outcomes and the prevention of these lesions requires further investigation. [ABSTRACT FROM AUTHOR]

Background: Skin cancer is the most common form of cancer worldwide. As artificial intelligence (AI) expands its scope within dermatology, leveraging technology may aid skin cancer detection. Objective: To assess the safety and effectiveness of an elastic-scattering spectroscopy (ESS) device in evaluating lesions suggestive of skin cancer. Methods: This prospective, multicenter clinical validation study was conducted at 4 US investigational sites. Patients with skin lesions suggestive of melanoma and nonmelanoma skin cancers were clinically assessed by expert dermatologists and evaluated by a device using AI algorithms comparing current ESS lesion readings with training data sets. Statistical analyses included sensitivity, specificity, AUROC, negative predictive value (NPV), and positive predictive value (PPV). Results: Overall device sensitivity was 97.04%, with subgroup sensitivity of 96.67% for melanoma, 97.22% for basal cell carcinoma, and 97.01% for squamous cell carcinoma. No statistically significant difference was found between the device and dermatologist performance (P = .8203). Overall specificity of the device was 26.22%. Overall NPV of the device was 89.58% and PPV was 57.54%. Conclusion: The ESS device demonstrated high sensitivity in detecting skin cancer. Use of this device may assist primary care clinicians in assessing suspicious lesions, potentially reducing skin cancer morbidity and mortality through expedited and enhanced detection and intervention.

Mpox (formerly called monkeypox) is a zoonosis caused by the monkeypox virus (MPXV). MPXV is an orthopoxvirus genetically and antigenically similar to the variola virus responsible for smallpox. Mpox is endemic to Central and West Africa, but in 2022 it spread rapidly leading to many cases in non-endemic countries. Human-to-human contact is currently the main mode of transmission. Patients usually present with a prodromal syndrome of fever, myalgia, headache, lymphadenopathy, and fatigue. The characteristic centrifugal rash with mucocutaneous lesions develops 1–4 days later. Lesion evolution typically follows a sequence of changes (macules, papules, vesicles, pustules, and crusts). The disease is mostly mild and self-limiting. Distinct clinical presentations have been observed during the ongoing outbreak. Prodromal symptoms may be less pronounced or absent. Lesions are located predominantly in the anogenital and perioral areas. Patients may present with few lesions clustered in the genital region or a solitary lesion. Mpox diagnosis is usually confirmed through viral DNA detection with polymerase chain reaction (PCR). There is no specific treatment for mpox. Therapy remains supportive in most cases. Antiviral drugs include tecovirimat, cidofovir, and brincidofovir. Antibody-based therapies are another treatment option. Smallpox vaccines should be considered for high-risk patients (pre-exposure prophylaxis) and following high-risk exposures (post-exposure prophylaxis). Comprehensive differential diagnosis and screening for co-infections with other sexually transmitted pathogens are needed.

Jingya Zhang, Fei Qi, Xuan Zhang, Jie Dong, Chunguang Tong, Xiuying Zhang, Fang Liu Department of Dermatology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Fang Liu, Department of Dermatology, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongti South Road, Chaoyang District, Beijing, 100020, People’s Republic of China, Tel +86-10-85231688, Fax +86-10-85231217, Email roseliufang@qq.comAbstract: Sjögren’s syndrome (SJS) is a systemic disease in which the accumulated skin can include xeroderma, eyelid dermatitis, and annular erythema (AE). To the best of our knowledge, there are few reports on cases of SJS with concomitant lichen sclerosus (LS). Herein, we report the case of a 69-year-old woman with these two diseases. The patient’s skin showed atrophic leukoplakia and AE. Based on the comprehensive evaluation of general condition, the patient was diagnosed and actively received treatment. After systematic treatment, her symptoms were controlled. However, the patient’s condition requires long-term management.Keywords: annular erythema, skin atrophy, depigmentation, skin lesions

Dermatoscopes are commonly utilized by medical professionals for the qualitative visual inspection of skin lesions. While automated image processing techniques and varied illumination strategies can aid in structural analysis of lesions, robust quantification of functional information is largely unknown. To address this knowledge gap, we have developed a compact, handheld dermatoscope that enables real-time blood flow measurements of skin using coherent illumination and laser speckle imaging (LSI). A second color camera attached to the dermatoscope helps with the simultaneous real-time observation of the skin lesions and allows the user to acquire and save color images via a custom Graphical User Interface. In-vitro characterization utilizing a blood flow phantom demonstrated that the dermatoscope is capable of quantifying changes in blood flow across a physiologically relevant range even when used in a handheld manner with ambient lighting. We also demonstrated that the dermatoscope can quantify blood flow in skin lesions in human subjects and that significant differences in blood flow are present among lesion types. There was significantly increased blood flow relative to the surrounding skin in cherry angiomas compared to solar lentigos (p

Resumen: Introducción: La piel es fundamental en la transición de la vida intrauterina a la extrauterina. El recién nacido presenta cambios fisiológicos, siendo frecuente observar hallazgos cutáneos benignos y transitorios que varían según las características maternas, neonatales y de la gestación. Objetivos: Estimar la frecuencia de distintos hallazgos dermatológicos en neonatos en las primeras 72 h de vida e identificar la existencia de diferencias de proporciones estadísticamente significativas con factores neonatales, maternos y de la gestación. Métodos: Se realizó un estudio descriptivo, observacional de corte transversal entre abril-julio 2015 y julio-noviembre de 2017 en la maternidad del Centro Hospitalario Pereira Rossell. Se incluyeron neonatos de hasta 72 h de vida, a los que se les practicó un examen dermatológico completo. Se presenta la proporción de cada uno de los hallazgos con el intervalo de confianza (IC) correspondiente. Se analiza la relación entre los hallazgos y determinados factores asociados. Resultados: Se incluyeron 2811 neonatos. El 100% presentó al menos un hallazgo a nivel de la piel. La mediana fue de 8 lesiones por paciente (rango intercuartílico: 6-9/mínimo-máximo: 1-16). De los 46 hallazgos explorados clínicamente se encontraron 42. Las lesiones benignas y transitorias correspondieron al 99,9%. Entre ellas se observó: lanugo 98% (IC: 97,7-98,7), descamación fisiológica 79,7% (IC: 78,2-81,1) e hiperplasia sebácea 73,3% (IC: 71,6-74,9). El lanugo (p = 0,001), la descamación fisiológica (p

Summary: Background: Leprosy is an infectious disease that mostly affects underserved populations. Although it has been largely eliminated, still about 200’000 new patients are diagnosed annually. In the absence of a diagnostic test, clinical diagnosis is often delayed, potentially leading to irreversible neurological damage and its resulting stigma, as well as continued transmission. Accelerating diagnosis could significantly contribute to advancing global leprosy elimination. Digital and Artificial Intelligence (AI) driven technology has shown potential to augment health workers abilities in making faster and more accurate diagnosis, especially when using images such as in the fields of dermatology or ophthalmology. That made us start the quest for an AI-driven diagnosis assistant for leprosy, based on skin images. Methods: Here we describe the accuracy of an AI-enabled image-based diagnosis assistant for leprosy, called AI4Leprosy, based on a combination of skin images and clinical data, collected following a standardized process. In a Brazilian leprosy national referral center, 222 patients with leprosy or other dermatological conditions were included, and the 1229 collected skin images and 585 sets of metadata are stored in an open-source dataset for other researchers to exploit. Findings: We used this dataset to test whether a CNN-based AI algorithm could contribute to leprosy diagnosis and employed three AI models, testing images and metadata both independently and in combination. AI modeling indicated that the most important clinical signs are thermal sensitivity loss, nodules and papules, feet paresthesia, number of lesions and gender, but also scaling surface and pruritus that were negatively associated with leprosy. Using elastic-net logistic regression provided a high classification accuracy (90%) and an area under curve (AUC) of 96.46% for leprosy diagnosis. Interpretation: Future validation of these models is underway, gathering larger datasets from populations of different skin types and collecting images with smartphone cameras to mimic real world settings. We hope that the results of our research will lead to clinical solutions that help accelerate global leprosy elimination. Funding: This study was partially funded by Novartis Foundation and Microsoft (in-kind contribution).

[Display omitted] Skin cancer is one of the most common types of cancer and its early diagnosis significantly reduces patient morbidity and mortality. Reflectance confocal microscopy (RCM) is a modern and non-invasive method of diagnosis that is becoming popular amongst clinical dermatologists. The frequent occurrence of artifacts in the images is one of the most challenging factors in making a diagnosis based on RCM. It impedes the diagnosis process for the dermatologist and makes its automation difficult. In this work, we employ artificial neural networks to propose a local quality assessment system. It allows for the detection of artifacts and non-informative component images both retrospectively or in real-time during the examination. In this research we address the quality assessment issue by proposing an artificial intelligence-based solution. 612 RCM mosaics were divided into small component images and manually classified in order to train the ResNeXt model in the quality verification context. A trained network was used to create an application that marks individual classes of the component images on the mosaic. We achieved the average classification precision of 0.98 both for the validation and test data sets. In addition, we present local quality assessment statistics of the 1540 cases of skin lesions to show which types of skin lesions most often present with artifacts in their RCM images. In this research we investigate the utility of the deep convolution neural networks for the local quality assessment of the RCM images. We propose an AI-based system that may be effectively used as real-time support for the dermatologist during a RCM examination and as a base for the automation of the diagnostic process. [ABSTRACT FROM AUTHOR]

Modern dermatology distinguishes premature diagnosis for example an important part in reducing the death percentage and promising less aggressive treatment for patients. The classifications comprise various stages that must be selected suitably using the characteristics of the filter pointing to get a dependable analysis. The dermoscopic images hold challenges to be faced and overcome to enhance the automatic diagnosis of hazardous lesions. It is calculated to survey a different metaheuristic and evolutionary computing working for filter design systems. Approximately general computing techniques are observed to improve features of infect design method. Nevertheless, the median filter (MF) is normally multimodal with respect to the filter factors and so, reliable approaches that can provide optimal solutions are required. The design of MF depends on modern artificial swarm intelligence technique (MASIT) optimization algorithm which has proven to be more effective than other population-based algorithms to improve of estimation stages for segmentation skin lesions. A controlled artificial bee colony (ABC) algorithm is advanced for solving factors optimization problems and, also the physical-programming-depend on ABC way is applied to proposal median filter, and the outcomes are compared to another approaches. [ABSTRACT FROM AUTHOR]

Background: Angioimmunoblast T-cell lymphoma (AITL) is a rare T-cell lymphoproliferative disease that is accompanied by generalized lymphadenopathy, hepatosplenomegaly, intoxication symptoms and extranodal lesions. The extranodal manifestations of the disease frequently involve various skin changes. One of the first such manifestations is maculopapular rashes observed in about half of AITL patients and usually preceding the appearance of lymphadenopathy. Other forms of skin lesions accompany the disease considerably less frequently.Aim: To characterize the range of skin changes in patients suffering from AITL, to establish a correspondence between the nature of skin changes and their histological picture.Materials and methods: 54 AITL patients were being treated at the National Research Centre for Hematology from 2000 to 2017, with the male/female ratio being 30/24. The median age was 61 (29–81) years.Results: Changes in the skin were observed in 24 (44.4 %) of 54 AITL patients, out of whom 18 (75 %) and 6 (25 %) were male and female patients, respectively. Maculopapular rash was observed in 22 (91.7 %) out of 24 patients. The morphological and molecular investigations of skin biopsy specimens exhibiting maculopapular rash demonstrated nonspecific reactive changes. Patients with maculopapular rash demonstrated an increase in the level of total (polyclonal) IgE. Specific skin lesions detected in 8 (14.8 %) cases were represented by a ‘livedo reticularis’, focal skin hyperpigmentation, erythroderma, left eyelid tumour and tumour in 3, 2, 1, 1 and 1 cases, respectively.Conclusion: Maculopapular rash frequently observed in AITL patients is a reactive process not associated with a specific skin lesion. Specific skin lesions in AITL are much less common and can be represented by various forms. In some AITL cases, skin changes of the reactive and tumour nature can be simultaneously observed.

Breast cancer is the most common malignant neoplasm among women in Poland and in the European Union. According to most recent data of the Polish National Cancer Registry, in 2014 breast cancer was diagnosed in over 17,000 women. Based on the National Health Fund records, it is estimated that there are about 55,000–60,000 women in Poland who have a history of breast cancer diagnosis and are potentially at a risk of relapse. The most common sign of breast cancer is the presence of a nodule, however women also seek medical attention because of skin lesions. The aim of the study is to present diverse clinical manifestations of direct infiltrates and/or skin metastases of breast cancer. Attention is drawn to the importance of including breast cancer in the differential diagnosis of skin lesions.

Feline leishmaniosis (FeL) is increasingly reported throughout the world and skin lesions predominate in the clinical picture. There are, however, few evidence-based data on cutaneous feline leishmaniosis and directions are strongly needed for a better management of the disease. In this study, we systematically reviewed what is currently known about the clinical dermatological presentation of FeL through analysis of the literature and, further, by adding unpublished cases managed by Italian veterinary dermatologists. Sixty-six feline cases of cutaneous leishmaniosis published in 33 articles between 1990 and 2020 met the inclusion criteria and were analyzed. Six unpublished cases of cutaneous FeL managed by Italian dermatologists were also reviewed. The majority of cases were reported from South America, followed by Europe and North America. Nodules were the most frequently reported clinical signs and the presence of Leishmania in lesioned skin was assessed mainly by cytology. A total of six Leishmania species have been identified as being responsible for skin lesions. Coinfections by FIV or FeLV were reported in 12.1% and 9.1% of the cases, respectively. Clinical data including treatment have been analyzed and discussed to provide directives for proper management of the disease for which cats may also serve as domestic reservoirs for human infections.

Objective: To describe clinical patterns, identify associated drugs, and perform causality assessment of cutaneous adverse drug reactions. Materials and Methods: In this prospective, observational study, patients with signs of cutaneous drug reaction from the department of dermatology of a tertiary teaching hospital were included. Patients with viral exanthemas were excluded. The patterns of cutaneous drug reactions, and associated drugs were noted. Naranjo scale was used for causality assessment of adverse drug reactions. Results: Sixty-five patients (mean age 38.1 years) were included. Skin lesions were seen after 2 days of drug consumption in 25 (38.5%) patients. Pigmentation, fixed drug eruption, and maculo-papular rashes were seen in 13 (20%), 22 (33.8%), and 12 (18.5%) patients, respectively. Thirty-five (53.85%) patients had other associated symptoms. Fever was seen in 22 (33.8%) patients. Thirty-two (49.2%) cases had exposure to antibacterial agents. Most commonly associated drugs with reactions were nonsteroidal anti-inflammatory agents 14 (21.5%) followed by beta-lactam antibiotics 12 (18.5%), and fluroquinolones 7 (10.8%). Fifty-seven (87.7%) adverse drugs reactions had “probable” association with the drug.” Conclusion: Fixed drug eruption is the commonest presentation of cutaneous adverse drug reactions and antimicrobial agents are most commonly associated with it. According to the Naranjo scale, the majority of the cutaneous drug reactions have a “probable” association with the offending drugs.

Patients suffering from endocrine disorders often present a wide profile of skin lesions. In hyperthyroidism we observe hair loss, lower leg myxedema and onycholysis or, in the case of hormone deficiency, generalized swelling of the skin, which becomes cold and pale. Primary hyperparathyroidism is revealed by pruritus, presence of chronic urticaria or deposition of amorphous calcium salts. In hypoparathyroidism, the skin is dry while the nails become very brittle. Skin lesions in diabetes include necrobiosis lipoidica, granuloma annulare, scleroderma-like diabetic edema and acanthosis nigricans. Overactive pituitary gland is often manifested as acromegaly with hypertrophy of soft tissue thickening and hypertrichosis. The skin in the early stages of hypopituitarism feels swollen, is pale yellow and oily, and finally becomes alabaster and dry. The characteristic features of Cushing syndrome are central obesity, lunar face, buffalo hump, and striae. In Addison’s disease we observe hyperpigmentation. Hyperandrogenism in women leads to acne, hirsutism and virilization.

Introduction: General practitioners (GPs) require the necessary skills to identify potentially malignant skin lesions and refer patients in an appropriate and timely manner. We examined the impact of a single consultant delivered education session to GP trainees on their diagnosis of common skin lesions.Methods: A prospective analysis of baseline knowledge was assessed using a photographic questionnaire. A dedicated education session was delivered by a consultant plastic surgeon. Their knowledge was re-assessed after 3 months.Results: There were 23 participants. Baseline ability to correctly diagnose skin lesions improved significantly at 3 months following dedicated teaching (baseline mean 30.2%, 3-month mean 65.9%, p = 0.001). All trainees recommended that dedicated skin education should be incorporated into GP training curricula.Conclusion: Dedicated education sessions on skin lesions can improve the diagnostic accuracy of GP trainees, and we suggest that they are incorporated into the GP training curriculum. [ABSTRACT FROM AUTHOR]

This article outlines the issues involved in assessing and managing people who present with skin infections. Inflammatory skin conditions such as eczema, psoriasis and skin lesions are the commonest reason for referral to a specialist, whereas skin infections are commonly seen by generalists (Schofield et al 2009). If the skin's integrity is damaged, it can become vulnerable to microorganisms, resulting in an infection. Skin infections are common and are often upsetting for people and their families because of the stigma surrounding them -- the perception being that the infections are the result of poor hygiene and the person being dirty. As a result, many people with dermatology problems experience negative reactions from others. This article will provide an overview of skin infections commonly seen by nurses working in primary care. It will look at examples of bacterial, viral and fungal infections, focusing on their aetiology, history, clinical findings, diagnosis, treatment and management. [ABSTRACT FROM AUTHOR]

Background: Skin lesions - benign and malignant - occur frequently in organ transplant recipients receiving long-term immunosuppressive therapy. These patients are at greater risk of skin cancers. Aims: To study dermatologic problems in renal transplant recipients (RTRs). Methods: One hundred patients (53 men and 47 women) were consecutively examined for benign and malignant skin complications since transplantation in Razi Hospital in Tehran Medical University. The main immunosuppressive therapy regimen in these patients was a combination of prednisolone, azathioprine, and cyclosporine. Results: The early and most common complication was cosmetic side effects that occurred in 98% patients. Skin infections occurred in 83% of the patients and most of them were viral infections (65%), especially of human papilloma viruses (HPVs) in 40% of the patients. We found six cases of malignancy in these patients in that four cases were skin cancers, including one case of SCC, one BCC, and two cases of Kaposi′s sarcoma. Dermatologic problems occur most frequently in RTRs, especially skin cancers which have higher frequency in these patients than general population, particularly, Kaposi sarcoma. Sun exposure has an important role in developing epithelial skin cancers following transplantation. The age of developing skin cancer in these patients was early than normal population. Conclusion: Our results emphasize the importance of dermatologic examinations and monitoring RTRs to obtain an early diagnosis and treatment of cutaneous manifestations.

A complete academic autopsy includes an external examination with inspection of gross dermatologic findings. At our institution, the postmortem examination also includes a standard skin biopsy. We determined the microscopic yield of this standard postmortem skin biopsy and the overall frequency of macroscopic dermatologic diagnoses. We reviewed 389 complete autopsies conducted between 2012 and 2014. Both microscopic and macroscopic dermatologic diagnoses were analyzed. A macroscopic dermatologic diagnosis was made in 32% of cases while a microscopic diagnosis was recorded in 10% of cases. Dermatologic diagnoses were identified as leading directly to cause of death in 4% of patients and as contributing to death in another 20%. Targeted biopsies were more likely to reveal histologic abnormalities than routine biopsies from a standard anatomic site. Better training in skin gross examination in addition to systematic sampling of both skin lesions and grossly normal skin may improve diagnostic accuracy and enhance clinical pathologic correlations. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus affects individuals of all ages and socioeconomic status. Skin is affected by the acute metabolic derangements as well as by chronic degenerative complications of diabetes. Aims: To evaluate the prevalence of skin manifestations in patients with diabetes mellitus. To analyze the prevalence and pattern of skin disorders among diabetic patients from this region of Western Himalayas. Materials and Methods: One hundred consecutive patients with the diagnosis of diabetes mellitus and having skin lesions, either attending the diabetic clinic or admitted in medical wards were included in this study. Results: The common skin disorders were: x0 erosis (44%), diabetic dermopathy (36%), skin tags (32%), cutaneous infections (31%), and seborrheic keratosis (30%). Conclusion: Skin is involved in diabetes quite often and the manifestations are numerous. High prevalence of xerosis in our diabetic population is perhaps due to cold and dry climatic conditions in the region for most of the time in the year.

Aim: The mucocutaneous changes observed during vitamin B12 deficiency in children have been published only as case studies and small case series. In this study, we aimed to demonstrate the frequency of mucocutaneous changes (particularly hyperpigmentation) seen during vitamin B12 deficiency and resolving time of these symptoms with vitamin B12 treatment. Material and methods: This prospective study was conducted at the pediatrics outpatient clinic of Harran and Yuzuncu Yil University Faculty of Medicine, among 57 patients, aged between 6 and 24 months, who were diagnosed with vitamin B12 deficiency following various examinations and tests. A detailed examination was performed in respect to skin and mucosal findings. Patients with vitamin B12 deficiency were administered intramuscular cyanocobalamin. Prospective examination was continued, and resolving time of symptoms after treatment was recorded. Results: The mean age of the patients enrolled in the study was found to be 12.75 ± 4.75. Hyperpigmentation was reported in 49 (85.96%) patients enrolled in the study; atrophic glossitis in 40 (70.17%), brittle and matt hair in 13 (22.80%), skin lesions (particularly diaper dermatitis) in eight (15.78%) and cheilosis in four (7.01%) patients. Three months after the treatment initiation, hyperpigmentation improved in 87.75%, atrophic glossitis in 97.5% and brittle and matt hair in 92.3% of the patients. Five patients (8.77%) with continuing pigmentation by the end of sixth months were considered as nonresponsive to the treatment. Conclusion: Deficiency of vitamin B12 should be considered in the differential diagnosis of infants who present with skin and mucosal lesions. [ABSTRACT FROM AUTHOR]