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Various benign and malignant tumors may arise from the skin. These may be of epidermal, dermal, subcutaneous or appendageal origin. Skin biopsy is the gold standard for diagnosis of skin tumors. There is paucity of published data on the role of imaging modalities in diagnosis of skin tumors. High-frequency ultrasonography (7–50 MHz) is a potential non-invasive, objective modality which can be utilized in the diagnosis and localization of skin tumors. It provides valuable information about the tumor characteristics such as size, shape, depth, consistency and vascularity before invasive skin biopsy or surgery is planned. Sentinel lymph nodes in malignant melanoma can be well visualized and studied by this technique. It is also a good modality to detect local recurrence of tumors during post-operative follow up, especially those with a high likelihood of local recurrence or lesions excised with inadequate margins. High-frequency ultrasonography is additive to clinical diagnosis and can be considered a useful non-invasive method to plan the management of various skin tumors and is of prognostic value in some cases.

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Background: Psoriasis is becoming increasingly recognized as a chronic systemic inflammatory disease. Statins are generally well-tolerated drugs with pleiotropic effects including decreasing inflammation and may have the potential to reduce psoriasis severity. Aims: To examine whether oral statins reduce the severity of psoriatic skin disease. Methods: We searched MEDLINE, EMBASE and adapted for Google Scholar, Cochrane Central Register for Controlled Trials and Clinical trials.gov to January 6, 2016. We primarily examined randomized controlled trials that assessed the change in PASI score over a follow-up period of at least 8 weeks, for participants with an established diagnosis of psoriasis taking an oral statin versus placebo or other active treatment. Beyond this, we also examined other interventional studies that investigated the effect of statins on psoriasis severity using other designs. We extracted efficacy and adverse event data. The two study authors examined issues of study quality and study inclusion independently. Results: Three studies were identified which measured the change in psoriasis severity using PASI, comparing statin with placebo or standard therapy alone in a prospective, randomized study design; these showed conflicting results. However, among the excluded studies, majority of which used a single arm, non-placebo controlled study design, most showed an improvement in PASI scores after statin use. Limitations: Included studies were of limited sample size and quality. They were not amenable to pooled analysis. Conclusions: This review highlights the paucity of high quality, randomized, double-blinded, placebo-controlled trials investigating the effects of statins on psoriasis severity using clinically objective measures. There is insufficient evidence that the use of oral statins as an adjunctive therapy can reduce the severity of psoriasis.

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Background: There are few population-based studies on prevalence of cutaneous problems in diabetes mellitus. Aims: To identify skin problems associated with diabetes mellitus among elderly persons in a village in Kerala. Methods: In this population-based cross-sectional survey, we compared the prevalence of skin problems among 287 elderly diabetics (aged 65 years or more) with 275 randomly selected elderly persons without diabetes mellitus. Results: Numbness, tingling and burning sensation of extremities,“prayer sign”, finger pebbling, skin tags, stiff joints and acanthosis nigricans were noted more frequently in diabetics as compared to non-diabetics. Ache in extremities, dermatophytosis, candidiasis, seborrheic keratoses/dermatosis papulosa nigra, xerosis/ichthyosis, idiopathic guttate hypomelanosis, nonspecific itching, and eczema were equally frequent in both groups. Among the diagnostic categories, neurovascular, metabolic and autoimmune findings were associated with diabetes mellitus, whereas bacterial and fungal infections were not. Limitations: Initial misclassification errors, no laboratory confirmation of dermatological diagnosis during survey, coexistence of findings related to aging and not analyzing the effects of glycemic level, concurrent diseases and medications. Conclusions: Numbness, tingling and burning sensation of extremities, prayer sign, finger pebbling, skin tags, stiff joints and acanthosis nigricans were associated with diabetes mellitus among elderly persons in a village in Kerala.

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Introduction: Neurological diseases are important co-morbidities found in association with bullous pemphigoid. Various neurological conditions (stroke, Parkinson's disease, dementia, epilepsy and multiple sclerosis) have been reported as associations of this bullous disease; whether these are significant has not been definitely proved. However, the presence of neurological conditions is a predictor of poorer prognosis. Objectives: Our aim was to examine the association of bullous pemphigoid and neurological diseases in Iranian bullous pemphigoid patients. Methods: The medical records of one hundred and sixty consecutive bullous pemphigoid patients who presented to the Autoimmune Bullous Diseases Research Center, Tehran, Iran, from 2006 to 2011 were examined for evidence of any neurological disease. The control group comprised of 317 age- and sex-matched subjects. Results: Neurological diseases were seen in 42 (26.4%) patients with bullous pemphigoid and in 29 (9.1%) controls (odds ratio: 3.53 (2.1–5.9), P< 0.001). Comparing cases to controls, stroke was seen in 17.5% versus 4.1%, odds ratio 4.96 (2.49–9.88); dementia in 5.6% versus 1.9%, odds ratio 3.09 (1.08–8.84); Parkinson's disease in 2.5% versus 2.2%, odds ratio 1.14 (0.33–3.94); epilepsy in 2.5% versus 0.6%, odds ratio 4.04 (0.73–22.3); and multiple sclerosis in 0 versus 0.3% odds ratio 1.00 (0.98–1.01). Limitations: The main limitations of our study were referral bias, retrospective design and a rather low sample size. Conclusions: Neurological diseases in general, and stroke and dementia in particular, were significantly associated with bullous pemphigoid in our study.

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Background: A wide variety of systemic diseases and internal malignancies have cutaneous manifestations. In the context of internal malignancy, many cutaneous changes are highly specific to the underlying malignancy, while other changes are nonspecific. Some changes are also due to the modalities employed in the treatment of malignancies. Methods: Two hundred and fifty patients who were diagnosed with internal malignancy and who were attending the department of radiation oncology, were evaluated at the Department of Dermatology, Sexually Transmitted Diseases and Leprosy of Government Medical College, Srinagar. The study was conducted over a period of 5 months. Relevant investigations, wherever needed, were carried out. Results: Among the 250 cases examined, nonspecific cutaneous changes were seen in 39 (15.6%) cases, whereas specific skin lesions in the form of cutaneous metastases were seen in two (0.8%) patients. Nail changes and hair changes were also seen in some patients. Limitations: As this was a cross-sectional study and most of the patients were lost to follow up, we could not assess the outcome of the dermatological changes seen in the affected patients. Conclusion: Many dermatological changes are noticed early in the course of malignancy, reflecting a strong association of the cutaneous change with malignancy. Few manifestations occur late in the course of the disease, indicating dissemination or immunosuppression. Some changes reflect radiation-induced or chemotherapy-induced toxicity, indicating the need for treatment modifications.

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Background: Both performer- and device-dependent variabilities have been reported in sizes of wheal responses to skin prick tests. Objective: We aimed to evaluate whether or not variabilities in sizes of wheal responses influence the final interpretation of skin prick tests; in other words, the decision on whether or not there is an allergy to a given antigen. Methods: Skin prick tests with positive and negative controls and extracts of Dermatophagoides farinae and Dermatophagoides pteronyssinus were done for 69 patients by two different persons, using two different puncturing devices- disposable 22-gauge hypodermic needles and metal lancets. Results: Among four different skin prick tests, the average coefficients of variation in sizes of wheal responses were near to or higher than 20% for all of them. On the other hand, in the final interpretation of results, kappa values indicated substantial or almost perfect agreements between these tests. However, the frequency of establishing allergy to the house dust mites widely ranged in these tests (20.8–35.8% for D. farinae and 20.8–28.3% for D. pteronyssinus). Limitations: The conduction of the study in a single center and the comparisons of results of only two performers. Conclusion: We feel that variabilities in sizes of wheal responses of skin prick test can influence its categorical results.

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Background: Protein tyrosine phosphatase, non-receptor type 22 gene, which translates to lymphoid tyrosine phosphatase, is considered to be a susceptibility gene marker associated with several autoimmune diseases. Several studies have demonstrated the association of protein tyrosine phosphatase, non-receptor type 22 +1858C→T polymorphism with vitiligo. However, these studies showed conflicting results. Meta-analysis of the same was conducted earlier that included fewer number of publications in their study. Aim: We performed a meta-analysis of a total of seven studies consisting of 2094 cases and 3613 controls to evaluate the possible association of protein tyrosine phosphatase, non-receptor type 22 +1858C>T polymorphism with vitiligo susceptibility. Methods: We conducted a literature search in PubMed, Google Scholar and Dogpile for all published paper on protein tyrosine phosphatase, non-receptor type 22 +1858C→T polymorphism and vitiligo risk till June 2016. Data analysis was performed by RevMan 5.3 and comprehensive meta-analysis v3.0 software. Results: Meta-analysis showed an overall significant association of protein tyrosine phosphatase, non- receptor type 22 +1858C→T polymorphism with vitiligo in all models (allelic model [T vs. C]: odds ratio = 1.50, 95% confidence interval [1.32–1.71], P< 0.001; dominant model [TT + CT vs. CC]: odds ratio = 1.61, 95% confidence interval [1.16–2.24], P = 0.004; recessive model [TT vs. CT + CC]: odds ratio = 4.82, 95% confidence interval [1.11–20.92], P = 0.04; homozygous model [TT vs. CC]: odds ratio = 5.34, 95% confidence interval [1.23–23.24], P = 0.03; co-dominant model [CT vs. CC]: odds ratio = 1.52, 95% confidence interval [1.09–2.13], P = 0.01). No publication bias was detected in the funnel plot study. Limitations: Limited ethnic-based studies, unable to satisfy data by gender or vitiligo-type are some limitations of the present meta-analysis. Conclusion: Stratifying data by ethnicity showed an association of protein tyrosine phosphatase, non-receptor type 22 +1858C→T with vitiligo in European population (odds ratio = 1.53, 95% confidence interval [1.34–1.75], P< 0.001) but not in Asian population (odds ratio = 0.59, 95% confidence interval [0.26–1.32], P = 0.2). In conclusion, protein tyrosine phosphatase, non-receptor type 22 +1858 T allele predisposes European individuals to vitiligo.

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Background: Hyperinsulinism is related to the presence of acanthosis nigricans and atherosclerosis; however, we were unable to find any study on the prevalence of atherosclerosis in acanthosis nigricans. Aims: To evaluate the prevalence of carotid atherosclerosis and metabolic alterations in Mexican patients with acanthosis nigricans. Methods: We carried out a cross-sectional study that included 45 patients with acanthosis nigricans, age- and gender-matched with 45 healthy participants. Volunteers with any comorbidity or taking weight reduction, glucose- and/or lipid-lowering medication or drugs capable of causing acanthosis nigricans were not included in the study. B-mode ultrasound tests were done to measure the carotid intima-media thickness. Body mass index, insulin, glucose and lipid blood serum levels were measured. Chi-square or Fisher's exact test and paired Student t-test were used for statistical analysis. Results: Carotid intima-media thickness was greater in patients with acanthosis nigricans (mean 0.52 mm vs. 0.46 mm, P = 0.002). The prevalence of abnormal intima-media thickness was higher in patients with acanthosis nigricans versus healthy participants (62.2% vs. 35.5%, P = 0.02). The same occurred with hyperinsulinemia (73.3% vs. 13.3%, P< 0.001), insulin resistance (86.6% vs. 33.3%, P< 0.001), obesity (86.6% vs. 13.3%, P< 0.001) and dyslipidemia (95.5% vs. 77.7%, P = 0.01). Limitations: The sample size is small and serum markers of cardiovascular risk were not measured. Conclusion: Acanthosis nigricans is a skin marker for metabolic disturbances and is also associated with carotid atherosclerosis, a finding which is not well documented. We propose that individuals with acanthosis nigricans should be routinely evaluated for these cardiovascular risks.

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