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BACKGROUND: The new severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) is the causative agent of coronavirus 2019 (COVID-2019) disease. A wide variety of symptoms of the disease has been frequently reported in the literature in recent years. However, information on the findings in keratinized tissues is still limited. Data on changes in keratinized tissues such as nails, teeth and hair, and oral mucousa due to drugs used in the treatment of this disease are also extremely insufficient. AIM: With this study, it was aimed to evaluate the changes in the keratinized tissues of our patients with COVID-19, who are frequently encountered in the Ear Nose and Throat outpatient clinic. MATERIALS AND METHOD: The study was carried out on patients who applied to Baskent University Ear Nose and Throat clinic. There were 3 groups. The first group consisted of patients diagnosed with COVID-19 and received relevant medical treatments, the second group included individuals who have never experienced COVID-19 infection but have been vaccinated against COVID-19, and the third group is the control group with normal healthy individuals who have never been diagnosed with COVID-19 infection and have not been vaccinated so far. With the Wood's lamp, fluorescent changes in nails, hair, tooth, and the oral mucousa were recorded. RESULTS: A total of 124(75 females, 49 males) patients were included in the study. Positive Wood's finding was significantly higher in COVID-19 group(Group 1) who received Favipravir when compared with individuals who did not receive Favipravir (p < 0.001). Wood's positivity was not detected in any of the individuals who did not use favipravir. The rate of determining Wood's positivity in favipravir users decreases after 58 days. DISCUSSION: Accordingly, Favipravir accumulation in the kretainized tissues manifest positive Wood's sign in our study. CONCLUSION: The adverse effects of the accumulation of the drugs-mainly Favipravir-used in the treatment of COVID-19 disease, have not yet been clearly demonstrated so far. Revealing the findings in these tissues with this study will pave the way for investigating changes or drug sequestrations in other organs in the long term.

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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.

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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.

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BACKGROUND: Behçet's disease (BD) is a multisystemic inflammatory disorder of unknown origin. The disease usually occurs between the second and the fourth decades, whereas it is uncommon in children. OBJECTIVE: In this multicenter study, we aimed to describe the demographic and clinical features along with severity in juvenile- versus adult-onset BD. METHODS: Patients with initial symptoms at age 16 years or younger were considered as having juvenile-onset BD. In all, 83 patients with juvenile-onset BD (38 male and 45 female; mean age 19.6 +/- 7.6 years) and 536 with adult-onset (>16 years) BD (293 male and 243 female; mean age 39.2 +/- 10.1 years) who fulfilled the classification criteria of the International Study Group for BD were involved in the study. RESULTS: Familial cases were more frequent in juvenile-onset compared with adult-onset BD (19% vs 10.3%; P = .017). The mean age of disease onset was 12.29 +/- 3.54 years in juvenile-onset BD and 31.66 +/- 8.71 years in adult-onset BD. Mucocutaneous lesions and articular symptoms were the most commonly observed manifestations in both groups. The frequency of disease manifestations was not different between juvenile- and adult-onset BD, except neurologic and gastrointestinal involvement, which were higher in juvenile-onset BD than adult-onset BD (P = .027 and P = .024, respectively). Oral ulcer was the most common onset manifestation of both juvenile-onset (86.74%) and adult-onset (89.55%) BD. The frequencies of onset manifestations of BD were similar, except genital ulcer, which was higher in adult-onset BD (P = .025). LIMITATIONS: Our study consisted of patients with BD mainly applying to dermatology and venerology departments. Therefore, it can be speculated that this study includes rather a milder spectrum of the disease. CONCLUSIONS: Although the clinical spectrum of juvenile-onset BD seems to be similar to adult-onset BD, the frequency of severe organ involvement was higher. Because of the higher prevalence of familial cases in juvenile-onset BD, it can be speculated that genetic factors may favor early expression of the disease with severe organ involvement.

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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.

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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.

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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.

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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.

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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.

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