Angiokeratomas are typically asymptomatic, blue-to-red papules with a scaly surface located on the scrotum, shaft of penis, labia majora, inner thigh, or lower abdomen. The treatment of angiokeratomas may be necessary if they bleed and lead to patient anxiety.To determine the safety and effectiveness of long-pulse 1,064 neodymium-doped yttrium aluminium garnet (Nd:YAG) laser for the treatment of angiokeratomas of Fordyce.Ten consecutive patients with angiokeratoma of Fordyce were treated with long-pulse Nd:YAG laser in two to six sessions. The three authors independently assessed improvement of the lesion based on digital photographs taken before the treatment and 2 months after the end of the treatment.Significant (>75%, <100%) and moderate (>50%, <75%) improvement was seen in six and two patients, respectively. Complete improvement was achieved in one patient. Transient swelling, purpura, bleeding, and some pain in the treated area were noted in all patients as short-term side effects. There were no permanent side effects.The long-pulse Nd:YAG laser is a highly effective and safe treatment for angiokeratoma of Fordyce.
Angiokeratomas are vascular malformations that are clinically or histologically verrucous, with superficial vessels just beneath the epidermis. Solitary angiokeratomas occur most commonly as a small, warty, black papule on the lower extremities. Various therapeutic methods, including laser, electrocoagulation, excision, and cryotherapy, may be used for their treatment. A 13-year-old girl presented to the laser clinic for the treatment of her lesions that were present for two months. A 1064-nm long-pulsed Nd:YAG (yttrium aluminium garnet) laser was used to treat the patient's lesions. We performed two laser treatment sessions at a 4-week interval. We saw the patient 1 month after the last treatment session and obtained successful cosmetically acceptable results. No recurrence was observed over a follow-up period of 3 months. Long-pulsed Nd:YAG laser is more effective for the treatment of hyperkeratotic angiokeratomas due to deeper skin penetration of laser. Long-pulsed Nd:YAG laser is an effective and safe therapeutic option for the treatment of solitary angiokeratomas.
Topical immunotherapy made by diphenylcyclopropenone (DPCP) is an alternative treatment that can be used safely and efficaciously in recalcitrant alopecia areata patients. DPCP-induced vitiligo is a rare, but documented, unwanted side effect. The real mechanism of DPCP-induced vitiligo is not well known.
Objective: The diameter of purified protein derivative skin test (PPD) induration in evaluation of positive reaction varies according to patient's immune status, living area and BCG vaccination. A needle prick trauma and PPD extract may lead to Koebner phenomenon after 72 hours and these applications may be the cause of false positive or increase of diameter of PPD reaction in psoriatic patients. The aim of the study was to evaluate the results of PPD skin test in psoriatic patients and to compare with control subjects. Material and Methods: The test was performed on 117 consecutive patients with psoriasis vulgaris and 102 immunocompetant control patients. The Mantoux method was used for the test and skin reaction was measured at 72 hours. A positive skin reaction was considered > 10 mm. Results: A positive PPD test was detected in 49 psoriatic patients (41.8%) and in 31 of the control subjects (30.3%). Differences in positive PPD reactions (p=0.16) and the diameter of PPD indurations (p=0.36) between two groups were not statistically significant. The diameter of PPD indurations in psoriatic patients was not associated with sex, duration of the disease or psoriasis area and severity index score (p> 0.05). Conclusion: Our results show that psoriasis has no effect on the PPD skin test. We think that this test is appropriate to recognize latent tuberculosis infection in patients with psoriasis until more sensitive diagnostic tests become available.
Background: Timely diagnosis is essential for the optimal management of psoriatic arthritis (PsA). Several instruments have been developed for screening PsA among patients with psoriasis. However, a delay in diagnosis is still frequently reported, possibly due to the lack of a wide use of these instruments. Objectives: We aimed to identify and compare the reported performance of these instruments with special emphasis on the PsA phenotypes. Methods: We conducted a systematic literature search on PubMed until 15 August 2020 using the keyword ‘psoriatic arthritis’. Two independent reviewers identified all studies published in English, that report on the validation, psychometric evaluation or use of an instrument for screening PsA. Any disagreements were resolved by the third investigator. Data on sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were extracted or calculated for each instrument. Additionally, instruments were assessed for their performance in patients with different disease phenotypes. Results: A total of 10754 references were screened, and 42 were identified that reported on 15 different screening instruments. Psoriatic Arthritis Screening and Evaluation (PASE), Psoriasis Epidemiology Screening Tool (PEST), Early Arthritis for Psoriatic Patients questionnaire (EARP) were the most commonly used instruments. There was important variability across studies regarding the sensitivity, specificity, PPV and NPV of these instruments based on the cut-offs for positivity, setting, patient population and disease phenotypes (Table 1). Specificity was higher when patients with a previous diagnosis of other rheumatic diseases were excluded. Lower sensitivity was reported among patients with shorter disease duration and when patients with a prior diagnosis of PsA were excluded from the study, whereas higher sensitivity was reported among patients with prior NSAID use. Screening tools showed differences in sensitivity in different domains (Figure 1). Figure 1. Performance Among Patients with Each Domain Conclusion: This systematic literature review revealed wide variability in the diagnostic estimates of currently available questionnaire-based screening instruments for identifying PsA among psoriasis patients, depending on study populations and disease phenotypes. There is an unmet need for a screening instrument with a better performance in all disease domains. Table 1. Diagnostic estimates of screening tools in different studies Instrument Number of studies Sensitivity % Specificity % PPV % NPV % PASE 18 24-91 38-95 18-88 13-96 PEST 11 40 – 85 37.2-98.6 23-96 47.1-99.3 EARP 9 41-97.2 34-97.2 14-93.3 57.5-100 TOPAS 6 41-89.1 29.7-90 25.7-91.8 68-81.6 TOPAS-II 4 44-95.8 80.5-98 63.4-95.8 91-98 PsA-Disk questionnaire 1 87.2 46.4 58.6 78.5 CONTEST 2 70-76.5 56.5-91 16-89 68-95 STRIPP 1 91.5 93.3 79.6 97.5 SiPAS 1 79 87 73 90 PASQ 2 67-92.7 64-81.8 43 83 GEPARD 2 77 70 66 80 Swedish- Psoriasis Assessment Questionnaire 1 63 72 45 85 PAQ 1 60 62 26 87.5 SiPAT 1 69 69 91 69 A novel, short, and simple screening questionnaire 1 86.9 71.3 53 93.6 PASE: Psoriatic Arthritis Screening and Evaluation, PEST: Psoriasis Epidemiology Screening Tool, EARP: Early Arthritis for Psoriatic Patients questionnaire, TOPAS: Toronto Psoriatic Arthritis Screening Questionnaire, STRIPP: Screening Tool for Rheumatologic Investigation, SIPAS: Simple Psoriatic Arthritis Screening questionnaire, PASQ: Psoriasis and Arthritis Screening Questionnaire, GEPARD: German Psoriatic Arthritis Diagnostic Questionnaire, PAQ: Psoriatic and Arthritic Questionnaire, SiPAT: Siriraj Psoriatic Arthritis Screening Tool Disclosure of Interests: None declared.
Acne vulgaris is a multifactorial disorder of the pilosebaceous unit. The clinical picture can range from mild comedones to fulminant, scarring cases. Approximately 83–100% of all adolescents experience acne vulgaris at some point of their lives. Although acne often tends to resolve following the adolescent period, many men and women continue to suffer from either active acne or postinflammatory scars into their twenties and thirties. Most patients with acne vulgaris are in the complicated adolescence period and thus carry a distinctive psychosocial burden. They possess a disease stigma on their skin for the external world to criticize every day. For all these reasons, acne is a disease which should be treated promptly and efficiently in all age groups. This chapter will provide a comprehensive and up-to-date review of pathophysiology of acne vulgaris, new molecular mechanisms on the evolving acne lesions, epidemiology of the disease, and latest treatment options. The molecular biology of acne lesions, novel treatment options including cosmetic approaches, their role in acne pathogenesis, pathophysiology, and mechanism of actions of the drugs, safety, and efficacy issues, and various treatment regimens will be discussed along with novel discoveries and areas in which further research is needed.
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