Anca Chiriac, Anca Eduard Chiriac, Cristian Podoleanu and Simona Stolnicu
Introduction: Pilomatrixoma or pilomatricoma is a benign appendageal growth, originating from hair cortex cells.
Case presentation: We present an unusual case of a 65-year-old female patient who has been diagnosed and treated for a presumed recurrent furunculosis localized on the abdominal area. Ultrasonography raised the suspicion of pilomatrixoma. A large excision was performed and histopathology confirmed the diagnosis.
Conclusions: Ultrasonography could be a simple and reliable diagnostic tool in daily practice.
Anca Chiriac, Anca Eduard Chiriac, Tudor Pinteala, Liliana Foia and Piotr Brzezinski
Infantile hemangiomas are reported in 10-12% of children less than 1 year of age, with ulceration in about 5-13% of cases. Little is known about the mechanism of this disease and explanations are still being looked for.
We present a 4-month-old female infant with haemangioma on the left buttock; the hemangioma was noticed at 2 weeks of age, progressively enlarging and ulcerated.
Anca Chiriac, Cristian Podoleanu and Simona Stolnicu
Background: Self-induced skin lesions, especially in young children, can create confusion within pediatricians, dermatologists, or other medical care providers, leading to different diagnoses, unnecessary investigations, and delaying the correct therapeutic psychiatric evaluation.
Case report: We report the case of a 4-year-old boy who was referred to Dermatology after being hospitalized in the Allergy Department for a chronic allergic contact dermatitis. He had been previously diagnosed with chronic hand dermatitis, atopic dermatitis, and psoriasis, and treated with no favorable outcome. Scaly erythematous plaques were noticed on the dorsal aspects of both hands and on the lateral folds of the fingers. The skin lesions were distributed in a non-symmetrical way. A diagnosis of self-injurious behavior was presumed, and psychiatric evaluation was asked. The child was transferred to the Psychiatry Department, and a diagnosis of schizophrenia was concluded.
Anca Chiriac, Cristian Podoleanu and Simona Stolnicu
Alopecia areata represents an autoimmune process against an unidentified autoantigen in the follicle of the hair, which affects all ages, from young children (a few months old) to elderly patients. Alopecia areata has an important impact on the quality of life, leading to a predisposition towards anxiety and depression, especially if the patients are treated with corticoid therapy that heightens the risk for such psychiatric disorders. We present the case of a patient with alopecia areata who was diagnosed at the age of 18 months, and had been followed-up until the age of 27 years.
Anca Chiriac, Piotr Brzezinski, Anca E. Chiriac, Marius Florin Coroș, Cosmin Moldovan, Cristian Podoleanu and Simona Stolnicu
Introduction: The aim of this presentation is to highlight the usefulness of high-frequency ultrasound (18 MHz) in localized morphea for: identification of the lesion, guided skin biopsy, quantification of skin thickness, evaluating the severity by measuring total echogenicity.
Case presentation: A 62-year-old Caucasian woman was referred to the Dermatology Department for a well-circumscribed indurate plaque localized on the right side of the abdominal wall and thigh. On clinical examination, a large well-delimited, indurate plaque, silvery in the center and surrounded by a purplish-red halo (lilac ring) was noticed on the right side of the abdomen and thigh. An ultrasound-guided punch biopsy was carried out and the microscopic examination of the biopsy revealed moderate interstitial inflammatory infiltrate together with abundant collagen bundles in the dermis and subcutis and a diagnosis of localized morphea (scleroderma) was established. Ultrasonography was performed and skin thickness was measured using high-frequency US (18 MHz) and was found to be 3.1 mm to 3.9 mm.
Conclusion: high frequency ultrasound is an inexpensive, easy to perform, noninvasive method, replacing surgical biopsy and offering a valuable quantification of skin fibrosis.
Anca E. Chiriac, Adrian Naznean, Cristian Podoleanu, Simona Stolnicu and Anca Chiriac
Superficial venous malformations can be clinically diagnosed since birth as localized, bluish or purple lesions, especially on the lower extremity, but deep venous malformations are difficult to diagnose only by clinical appearance. The diagnostic algorithm for superficial venous malformations in newborns includes clinical examination and Duplex ultrasonography. The latter allows differentiating tumors (hemangiomas) from vascular malformations and evaluating flow characteristics as well as localizing the site of the malformation.
Anca E. Chiriac, Doina Azoicai, Anca Chiriac, Adrian Naznean, Francesca Larese Filon, Simona Roxana Georgescu, Liliana Foia, Cristian Podoleanu and Simona Stolnicu
Occupational skin diseases have an unknown prevalence in Romania, although they are considered the most frequent occupational diseases reported in Western European countries. Self-reported hand eczema among healthcare providers by questionnaire aims to estimate the prevalence of work-related hand eczema and associated risk factors in hospitals and outpatient units in Romania. The aim of this study is to discuss and to validate a questionnaire for surveying work-related skin diseases and exposure among healthcare providers.
Anca Chiriac, Cristina Birsan, Cristian Podoleanu and Simona Stolnicu
Introduction: An ingrown toenail is a serious medical problem that cannot be overlooked, and the decision of choosing between conservative versus surgical treatment may be difficult in daily practice.
Case series presentation: We present the cases of two young men with a long history of ingrown toenails, previously treated by complete nail avulsion, numerous topical applications of antibiotics, and 5% silver nitrate, successfully treated with caustic chemical agents, compared to a 19-year-old athlete with debilitating pain, intense inflammatory changes, infection, granulation tissue induced by skin penetration of lateral nail edge by an incurved toenail, in whom surgical treatment was needed.
Conclusion: Chemical matricectomy in the absence of any surgical intervention, along with patience allowing the nail to grow, could be an option that is easy to perform in case of ingrown nails. However, the selection of cases is important, taking into balance the benefit-risk ratio.
Anca Chiriac, Adrian Năznean, Cristian Podoleanu, Claudiu Molnar and Simona Stolnicu
Background: Daclizumab is a humanized monoclonal antibody against the D-subunit (CD25) of the high-affinity interleukin (IL)–2 receptor, used for the treatment of relapsing-remitting multiple sclerosis with a large spectrum of cutaneous adverse reactions. Case presentation: We present the case of a middle-aged man treated with daclizumab for multiple sclerosis, who developed skin reactions difficult to evaluate. A 4 mm punch-biopsy was taken from the plantar area. Histological examination of the biopsy revealed hyperkeratosis and acanthosis but no parakeratosis, while a discrete inflammatory infiltrate was noticed around vessels in the dermis. Treatment with fluconazole 50 mg/day for 10 days, moisturizers, and grade I topical steroids was followed by slight improvement of the clinical picture. Treatment with daclizumab was not discontinued. Conclusion: The clinical efficacy and side effects of daclizumab have to be reported and confirmed in clinical practice in the following years. Any clinical report can contribute to validate the efficacy and risk of the drug’s administration. Any type of adverse skin reaction must be reported for clarifying the diagnosis.
Cristian Podoleanu, Bogdan Dobrovat, Simona Stolnicu and Anca Chiriac
Lipodermatosclerosis and diabetic dermopathy are low-risk skin lesions with many similar clinical features, except for venous abnormalities such as chronic venous insufficiency, but are rarely a reason for referring the patient to vascular ultrasound examination. We present 3 serial cases in which the compression ultrasound examination (CUS) of the venous circulation of the affected limbs was of utmost importance in the severity stratification. Asymptomatic deep venous thrombosis (DVT) was found in the first two cases, while in the third case the CUS excluded any type of vascular involvement, leading to a definite diagnosis of diabetic dermopathy. Lipodermatosclerosis may be associated with asymptomatic DVT due to chronic venous insufficiency, and early referral to CUS positively impacts further patient management.