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Background. Cutaneous dysaesthesia syndromes are characterized by chronic cutaneous symptoms without objective findings, and their aetiologies are obscure. Trichodynia describes pain and a stinging sensation of the scalp related to diffuse alopecia. Aims. To determine the prevalence rate of trichodynia in patients with diffuse alopecia; to assess the serum zinc, folate and vitamin B12 levels; and to investigate the significance of psychological disorders in these patients. Methods. The study comprised 91 patients with a diagnosis of diffuse hair loss and 74 healthy controls. Patients were questioned about the presence of trichodynia, and their serum zinc, folate and vitamin B12 levels were assessed. They were also evaluated using the Beck Depression Inventory (BDI), the Beck Anxiety Inventory, and the Somatoform Dissociation Questionnaire (SDQ). Results. The rates of androgenetic alopecia and telogen effluvium were 26.4% and 73.6%, respectively, Trichodynia was found in 30 patients (33%), and was more common in the telogen effluvium group than in the androgenetic alopecia group ( P = 0.5). There was no significant difference between the patients with alopecia and controls for zinc, folate and vitamin B12 levels, or for psychological test scores. However, the BDI and SDQ scores were significantly higher ( P = 0.03 and P = 0.01, respectively) in patients with than those in without trichodynia. Conclusions. Trichodynia is a commonly encountered symptom in patients with diffuse alopecia, and depression and somatoform dissociation disorders may play an important role in its aetiology. Our data provide no evidence that serum levels of zinc, folate or vitamin B12 are involved in the pathogenesis of trichodynia. [ABSTRACT FROM AUTHOR]

Granular cell tumor (GCT) is a Schwann cell related benign neoplasm of soft tissue. GCT is an uncommon entity that occurs in a wide variety of body sites, but it is generally presented in the skin, oral cavity, superficial soft tissue, and respiratory and digestive tracts. Most of the GCTs are benign but clinically and radiologically these may mimic malignancy. Histopathological diagnosis is gold standard for establishing the true nature of the lesion. GCT is most commonly solitary but in about 10% of cases can be multifocal, usually involving various skin and soft tissue sites versus involving various internal sites. Therefore, these can involve skin and soft tissue or submucosa and viscera. GCT is usually benign; however, local recurrence is common due to incomplete removal. Malignant cases are rarely reported in 1-2% of cases. In this study, we report clinical and histopathological findings of a 36-year-old woman with metachronous GCT in breast and scalp. The clinical features raise the question of whether these are metachronous benign GCTs or whether this is establishment of malignant behavior. The aim of this report is to present the histopathological and clinical features of GCT and the diagnostic challenge of differentiating benign from malignant GCT.

Idiopathic scrotal calcinosis is a rare, benign condition with the presence of multiple slow-growing yellowish-white calcified asymptomatic nodules that appear within the scrotal skin. The disease affects patients in childhood or early adulthood. The etiology of idiopathic scrotal calcinosis is still controversial. It can extensively affect the scrotal skin, but primary closure is usually achievable with good esthetic outcomes., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Oral isotretinoin is the most effective choice in the treatment of severe acne. Application of isotretionin to acne has been expanded to treat those patients with less severe but scarring acne who are responding unsatisfactorily to conventional therapies. However, its use is associated with many side effects, some of which can result in very disastrous consequences. Data related with intermittent isotretinoin therapy is still limited. Our aim was to asses the efficacy and tolerability of two different intermittent isotretinoin courses and compare them with conventional isotretinoin treatment. In this multicenter and controlled study, 66 patients with moderate to severe cases were randomized to receive either isotretionin for the first 10 days of each month for 6 months (group 1), or each day in the first month, afterwards the first 10 days of each month for 5 months (group 2) or daily for 6 months (group 3). The drug dosage was 0.5 mg/kg/day in all groups. Patients were followed-up for 12 months. Efficacy values were evaluable for 22 patients in group 1, 19 patients in group 2, and 19 patients in group 3. Acne scores in each group were significantly lower at the end of treatment and follow-up periods (P < 0.001). When patients were evaluated separately as moderate (n = 31) and severe (n = 29), no statistically significant differences were obtained among the treatment protocols in patients with moderate acne. However, there was a significant difference between groups 1 and 3 to the response of the treatments in severe acne patients at the end of follow-up period (P = 0.013). The frequency and severity of isotretionin-related side effects were found to be lower in groups 1 and 2 compared with group 3. Intermittent isotretinoin may represent an effective alternative treatment, especially in moderate acne with a low incidence and severity of side effects. The intermittent isotretinoin can be recommended in those patients not tolerating the classical dosage.

Sternal malformation/vascular dysplasia association is a very rare condition comprised of midline defects and hemangiomas of the face and anterior trunk, that can be found as part of the PHACES phenotypic spectrum (posterior fossa malformations, hemangiomas, arterial anomalies, coarctations of the aorta, cardiac defects and eye abnormalities, sternal clefting). Herein, we describe a 6-month-old boy with sternal cleft, extensive segmental hemangiomas, and a depigmented scar on the tip of the xyphoid process, corresponding to a sternal malformation/vascular dysplasia association. He also had bilateral cutaneous ulcerations on the helices. Our case report indicates that ulceration of a hemangioma can occur before significant proliferation and may even be present congenitally.

Well-known cutaneous side effects of interferon (IFN)-alfa therapy include dry skin, pruritus, hair loss, and psoriasis. Presumably because of its potent immunomodulatory activity, the use of IFN-alfa has also led to the development of autoimmune diseases in susceptible individuals. Vitiligo, an autoimmune cutaneous disease, has been reported to occur during IFN-alfa therapy. We report a 10-year-old girl with chronic hepatitis B infection in whom IFN-alfa treatment induced de novo development of vitiligo and psoriasis. Neither skin condition improved after withdrawal of interferon treatment. Concomitant occurrence of vitiligo and psoriasis due to IFN-alfa has not been reported previously.

Aims: Male sex and a younger age of onset in Behçet's disease (BD) are associated with more severe disease. Eye diseases, folliculitis and thrombophlebitis are also more common among males. The disease rarely developes before puberty or after the age of 50. Clinical manifestations of BD, with the exception of eye symptoms, tend to get better with time. Clinical and histological pattern of the papulopustular lesions (PPL), the most common type of skin lesions in BD and the difference from ordinary acne is contradictory. Therefore, BD may be androgen driven to some degree. In the present study, using acne vulgaris (AV) as a prototype of an androgen driven disease, we investigated such a possibility between PPL and androgen receptor (AR) levels in the sebaceous glands (SG) of PPL from patients with BD and AV., Methods: Eighteen patients with BD (10 women, 8 men; mean +/- SD age, 34 +/- 11 years), 16 patients with AV (10 women, 6 men; mean +/- SD age, 25 +/- 6.2 years), and 10 healthy volunteers (5 women, 5 men; mean +/- SD age, 36 +/- 12 years), were included in this controlled study with blind histological study. Biopsies of the PPL and adjacent (approximately 2 cm distant) normal-appearing skin in patients with BD and AV, and of the normal-appearing skin from healthy volunteers were performed from the interscapular region, thus minimizing differences in androgenic activity. Follicle-based acneiform lesions were excluded for biopsies from patients with BD. Nuclear AR levels of SG were studied by an immunohistochemical technique, using monoclonal antibodies. The percentage of positively staining cells were recorded as the androgen receptor index (ARI)., Main Results: The lesional skin of the patients with BD showed a higher ARI than non-lesional skin of those patients (34.3% and 23.82%), or the healthy controls (21.37%). AR levels in the lesional skin of active patients was also higher than inactive patients (39.82 and 27.12%), but the differences were not statistically significant. ARI values in the lesional skin (78.58%) of acne patients were found to be significantly higher as compared with non-lesional skin (38.88%) and other groups (p<0.01)., Conclusion: Our findings indicate that androgens may play a role at least in the formation of PPL and disease activity in patients with BD. Androgen metabolism takes place peripherally in the SG, being indipendent of the central endocrine regulation. Target organ sensitivity and excess number of nuclear AR seem to be responsible for the development of AV.

Objective: To determine the therapeutic efficacy of interferon alfa-2a in the treatment of Behçet disease., Design: A randomized placebo-controlled and double-blind study., Setting: University referral center., Patients: Fifty patients with Behçet disease were involved in the study., Intervention: The patients were given interferon alfa-2a, 6 x 10(6) IU, subcutaneously 3 times per week or placebo for 3 months, and examined clinically at weekly intervals., Main Outcome Measures: For each mucocutaneous lesion and articular symptom, the mean frequency and duration were evaluated during the 3-month pretreatment, treatment, and follow-up periods. Pain for oral and genital ulcers was scored on a scale of 0 to 3. The ocular inflammatory score, the frequency of attacks, and changes in visual acuities for patients with ocular involvement were assessed before the study, at the end of treatment, and during the follow-up periods. In addition, overall responses at the end of the treatment period were graded as follows: complete remission, disappearance of all clinical signs and symptoms during treatment; partial remission, greater than a 50% decrease in the frequency, duration, and severity of pain for oral and genital ulcers and/or a decrease in the severity and frequency of ocular attacks; stable disease, less than a 50% change in the clinical signs and symptoms; and no effect or deterioration, ineffectiveness or worsening of clinical signs and symptoms., Results: Twenty-three interferon alfa-2a- and 21 placebo-treated patients, ranging in age from 16 to 55 years (mean +/- SD age, 32.38 +/- 7.94 years), were evaluable for efficacy. Interferon alfa-2a treatment significantly decreased the duration (P=.02) and pain (P=.01) of oral ulcers and the frequency of genital ulcers (P=.03) and papulopustular lesions (P=.01). The mean frequency and duration of erythema nodosum-like lesions (P=.77 and.27, respectively), thrombophlebitis (P=.29 and.61, respectively), and articular symptoms (P=.92 and.74, respectively) also decreased. But there were no statistically significant differences. An improvement in the severity and the frequency of ocular attacks occurred in 5 of 6 patients in the interferon alfa-2a-treated group and in 1 of 3 patients in the placebo-treated group. Of the 23 patients in the interferon alfa-2a-treated group, 15 responded to treatment (2 complete and 13 partial responses); and of the 21 patients in the placebo group, 3 responded to treatment (3 partial responses) (P<.005)., Conclusion: Interferon alfa-2a is an effective alternative treatment for Behçet disease, particularly for the management of the mucocutaneous lesions of the disease.

Objective: To determine the efficacy of topically applied sucralfate suspension in the treatment of oral and genital ulceration of Behçet disease., Design and Setting: A randomized, placebo-controlled, double-blind study at a university referral center., Patients: Forty patients with Behcet disease were included in the study., Intervention: Patients were given topical sucralfate or placebo 4 times a day for 3 months and examined clinically at biweekly intervals., Main Outcomes Measures: For each lesion, the mean frequency, healing time, and pain were evaluated during the pretreatment, treatment, and follow-up periods. No patients were given any concurrent disease-specific or immunosuppressive topical and systemic drugs during the 9-month study period., Results: Of the 40 patients included in the study, the results in 30 patients (16 patients treated with sucralfate and 14 patients treated with placebo, ranging in age from 16 to 52 years [mean+/-SD age, 34.3+/-8.1 years]) were evaluable for efficacy. Treatment with sucralfate decreased significantly the mean frequency, healing time, and pain of oral ulceration and healing time and pain of genital ulceration compared with the pretreatment period. The effectiveness of sucralfate on the frequency and healing time of oral ulceration continued during the post-treatment period. In the placebo group, no significant difference was found in measured parameters of oral and genital ulceration except the pain of the oral ulceration between the pretreatment and treatment periods., Conclusion: Our results showed that topical sucralfate suspension is an easy, safe, inexpensive, and effective treatment for oral and genital ulceration in patients with Behçet disease.

Interferons have been used for the treatment of many diseases because of their immunomodulatory, antiviral, antitumoral, and antiproliferative effects. Systemic interferon alpha 2a (IFN-alpha 2a) is also efficacious in the management of Behçet's disease (BD). Many adverse cutaneous reactions related to IFN-alpha have been reported. In the light of the current literature, we report here the first case of Pityriasis rosea (PR) that developed while receiving IFN-alpha 2a for BD. However, since this is the first report on this association, further observations are needed to determine their clinical relevance.

Background: Papulopustular lesions (PPL), the commonest presentation of skin lesions in Behcet's disease (BD) are cutaneous, sterile folliculitis or acne-like lesions on erythematous base. Our purpose was to determine the true frequency and anatomic location of the PPL and compare this with controls. We also sought to determine whether or not there was any relationship between PPL and either disease activity or other manifestations of BD., Methods: Fifty patients with BD, diagnosed according to the criteria of the International Study Group for Behcet's Disease, were enrolled in the study. The control group consisted of 100 patients with other dermatologic diseases (21 acne and 79 non-acne patients), selected randomly. A dermatologist counted the lesions, in a blind protocol, on seven anatomic locations: scalp, face, neck, trunk, upper and lower extremities and genitalia., Results: The frequency of PPL in patients with BD was 96% and the most common location was the trunk, whereas in the control group the frequency was 89% and the most common location was the face. In acne and non-acne patients, the frequency was 100% and 86.1% respectively. The total mean number, and mean numbers of PPL on the location of trunk, upper and lower extremities, and genitalia were higher in patients with BD than in controls. When the PPL in BD patients with a positive pathergy test was compared with that in patients with a negative pathergy test, the difference was significantly higher., Conclusions: Our results indicate that PPL appear to be non-specific. In the diagnosis of BD the mean number and anatomic location of the lesions are of more importance than the frequency.