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Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is the virus responsible for coronavirus disease 2019 (COVID‐19), which manifests as a flu‐like respiratory infection affecting multiple organ systems, including the gastrointestinal system, central nervous system, cardiovascular system, skin, and mucosa. In this review, we investigated the literature on specific manifestations of COVID‐19 in the oral mucosa. An online literature search in PubMed, Scopus, Google Scholar, and Medline was conducted to retrieve relevant studies on confirmed COVID‐19 patients with oral mucosa findings published between December 31, 2019, and April 07, 2021. After an independent review by two authors, 39 articles considering 59 laboratory‐confirmed cases of SARS‐CoV‐2 infection were included in the final analysis. The most common finding, reported in 29 patients (43.9%), was Kawasaki‐like syndrome. In addition, oral ulcers including aphthous, hemorrhagic, and necrotic ulcers were reported in 24 patients (36.3%). Other lesions reported included pustules, macules, bullae, maculopapular enanthema, and erythema multiforme‐like lesions. Concomitant skin lesions were present in 60.6% of patients. Fever was reported in 86.2% of patients. Forty‐eight patients (76.1%) were hospitalized. Loss of taste and smell was present in 30.8% of the patients. A comprehensive understanding of the dermatologic manifestations of COVID‐19 can improve and facilitate patient management and referrals.

Orf (contagious ecthyma) is a zoonotic infection caused by a dermatotropic parapoxvirus that commonly infects sheep, goats, and oxen. Parapoxviruses are transmitted to humans through contact with an infected animal or fomites. Orf virus infections can induce ulceration, and papulonodular, pustular, or ecthymic lesions of the skin after contact with an infected animal or contaminated fomite. Rarely, orf virus provokes extensive vasculo-endothelial proliferation as a skin manifestation. Here, we present the case of an 8-year old female with poxvirus-induced vascular angiogenesis that developed 10 days after a thermal burn. An 8-year-old female presented at our outpatient clinic with red swellings and a yellow-brown crust on them. After a thermal burn with hot water, she went to a clinic and the burn was dressed with nitrofurazone and covered for 2 days. When the dressing was removed after 2 days, nodules were seen in the burnt areas. When the clinical findings were considered with the histopathological features, a reactive vascular proliferation due to a viral agent was suspected. Following PCR, parapoxvirus ovis was detected. Viral infections such as pox virus can trigger pyogenic granulomas or pyogenic granuloma-like vascular angiogenesis. Infectious agents must be considered when dealing with pyogenic granuloma-like lesions.

The most severe side effect of prolonged MTX treatment is hepatotoxicity. The aim of this study is to investigate the effect of lactulose treatment on MTX-induced hepatotoxicity in a rat model. Twenty-four male rats were included in the study. Sixteen rats were given a single dose of 20 mg/kg MTX to induce liver injury. Eight rats were given no drugs. 16 MTX-given rats were divided into two equal groups. Group 1 subjects were given lactulose 5 g/kg/day, and group 2 subjects were given saline 1 ml/kg/day for 10 days. The rats were then sacrificed to harvest blood and liver tissue samples in order to determine blood and tissue MDA, serum ALT, plasma TNF-α, TGF-β, and PTX3 levels. Histological specimens were examined via light microscopy. Exposure to MTX caused structural and functional hepatotoxicity, as evidenced by relatively worse histopathological scores and increased biochemical marker levels. Lactulose treatment significantly reduced the liver enzyme ALT, plasma TNF-α, TGF-β, PTX3, and MDA levels and also decreased histological changes in the liver tissue with MTX-induced hepatotoxicity in the rat model. We suggest that lactulose has anti-inflammatory and antifibrotic effects on an MTX-induced liver injury model. These effects can be due to the impact of intestinal microbiome.

Dear Editor, Skin tags/acrochorda are very common fibrous skin lesions that are usually skin-colored, have a folded surface and often a stalk, and range in size from several millimeters to, rarely, many centimeters. 1 Herein, we report a pregnant 32-year-old woman (gravida four, para three) at the 32nd week of gestation and who had a giant skin tag on the left labium majus which grew rapidly during pregnancy.The patient presented at the outpatient clinic due to a soft, bleeding, pedunculated mass (17 cm 9 10 cm 9 4 cm) over the left labium majus that had appeared 20 months previously ( Fig. 1). It had grown rapidly during her pregnancy. Her systemic examination and hematological laboratory tests were normal. An excisional biopsy was taken. Histopathological examination revealed large and small vessels on the subepithelial stroma of the polyp covered with surface-stratified squamous epithelium.The most frequent locations of skin tags are the neck and the axillae, but any skin fold, including the groin and submammary regions, may be affected. Less commonly, they can appear on the penis or labium majus. 2,3 The only differential diagnoses are a flesh-colored dermal nevus and neurofibromatosis. Unless irritated or infarcted, skin tags are more of a cosmetic issue than a clinical concern and can easily be removed by excision, electrodessication or cryosurgery. 1 Skin tags are suggested to be associated with obesity, some endocrine diseases, diabetes mellitus, insulin resistance, genetic predisposition, carbohydrate and lipid metabolism disorders. Pregnancy is also a risk factor. Hormonal changes may affect the development of the acrochordon. Pregnancy hormones can suddenly affect blood vessel tone. During pregnancy, the small blood vessels and capillaries multiply, and most blood vessels enlarge to accommodate a larger blood volume. Therefore, the observed changes are related to this effect. For instance, relaxin 2 is a polypeptide hormone structurally related to insulin and insulin-like growth factors. The characteristic functions of relaxin are associated with the female reproductive system, especially during pregnancy. Recent studies have shown that polypeptides of the relaxin-like factor family are involved in cell proliferation, differentiation and angiogenesis. 4 Furthermore, vascular endothelial growth factor (VEGF) is a molecule involved in the physiology and pathophysiology of pregnancy. VEGF belongs to a family of growth factors controlling angiogenesis and endothelial cell permeability. 5 There are a few case reports of giant skin tags on the labium majus. 2,3 Canalizo et al. 2 reported two cases with giant skin tags on the labium major. Ghosh et al. 3 reported a case series of four patients with giant skin tags, one of whom was a 28-year-old pregnant woman with a pedunculated mass measuring 3 cm 9 2.5 cm in her left nipple which was present for 6 years but grew rapidly during pregnancy.To the best of our knowledge, there are few reports of this condition with lesions of the size reported here 3 and there h...

Angiokeratomas are vascular malformations that are characterized by one or more dilated blood vessels lying subepidermal and epidermal proliferative reaction. Fordyce angiokeratoma is the most common type of angiokeratomas and typically occurs in middle-aged men on the scrotal wall. A 44-yearold woman with violeceous, verrucous papules over her inferior trunk applied to our clinic with a history of 10 years duration. Histopathological examination of the lesions confirmed the diagnosis of angiokeratoma. We reported a case of Fordyce angiokeratoma here because of rare localization of her lesions.

Psoriasis is a chronic, inflammatory, and systemic disease. The disease activity is usually measured by Psoriasis Area and Severity Index (PASI), however, further objective laboratory tools are needed. Neutrophillymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and mean platelet volume (MPV) are objectively calculated markers that increase in inflammation. This study aimed to investigate the utility of these markers for follow-up of systemic inflammation and response to treatment. Material and methods: A total of 25 patients who had moderate or severe psoriasis vulgaris, who received ustekinumab treatment were retrospectively evaluated in the study. In patients, pre-treatment PASI, complete blood count parameters, serum CRP levels and NLR, PLR and MPV values in the follow up when they achieved PASI 75 and/or more improvement were recorded. Patients with an additional inflammatory disease or accompanying infection were excluded from the study. Results: While a statistically significant decline was recorded in NLR and PLR (p<0.05), no significant change was observed in MPV and CRP after the therapy success where patients achieved an improvement greater than or equal to PASI 75. Conclusion:We conclude that the correlation with the response to treatment and NLR and PLR levels show that these markers may be beneficial for assessment of disease severity either in combination with current scores or alone. These markers are cost effective predictors that can easily be measured in routine practice.

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