Lichen sclerosus et atrophicus (LSA) is a benign chronic inflammatory dermatosis with unclear pathogenesis affecting both the epidermis and the dermis. The typical finding is white opalescent papules that may cluster and progressively result in parchment-like appearance of the skin. Most commonly, it presents as atrophic plaques in the genital region, but can occur in extra-genital locations 1 . Mostly, extragenital lichen sclerosus is common on the face, neck, shoulders and upper trunk 2 . Uncommon presentations include lesions on the oral mucosa and scalp 3 . In this report, a case with unusual localization of LSA was presented. A 34-year-old female patient was admitted to our dermatology department for a ten-year history of atrophy on her scalp, face and hands. It was learned from her past
Brazilian porcupines quills have the following distinct regions: a conical black tip containing a layer of microscopic barbs oriented towards its base and a cylindrical yellow base without such barbs. 2,9 These microscopic structures facilitate penetration of the skin and lodging of the quill in the tissues. In some cases, quill removal requires sedation or anaesthesia. 9 One of the major concerns regarding quill wounds is the potential risk of infection. 10
Otoimmün progesteron dermatiti, nadir görülen ve endojen progesterona karşı gelişen bir hipersensitivite reaksiyonudur. Döngüsel olarak menstrüel siklusun luteal fazında başlayıp, menstrüel kanamanın başlamasından sonra sonlanan, kutanöz ve mukokutanöz bulgularla karakterize bir durumdur. Bu çalışmada, ürtikeryal lezyonlarla seyreden ve otoimmün progesteron dermatiti tanısı konulan 42 ve 49 yaşındaki iki olgu sunulmaktadır. Her iki hastanın da menstrüel kanamadan bir ya da iki hafta önce başlayıp, kanamayla birlikte sonlanan ürtikeryal döküntü öyküsü vardı. Parenteral progesteron preparatı ile yapılan intradermal testler her iki hastada da pozitif olarak saptandı. Hastaların öyküsü, klinik bulguları ve progesteron ile yapılan intradermal testin pozitif olması sonucunda otoimmün progesteron dermatiti tanısı kondu. Bu çalışma, nadir görülen bir hastalık olması nedeniyle tanının atlanabileceğini ve iyi bir anamnezin tanıdaki önemini vurgulamak amacıyla sunulmuştur.
Öz AbstractAutoimmune progesterone dermatitis is a rare hypersensitivity reaction that develops against endogenous progesterone. This condition is characterized by cutaneous and mucocutaneous findings that begins cyclically in the luteal phase of the menstrual cycle and ends after the onset of menstrual bleeding. In this study, we present two cases aged 42 and 49 years who were had urticarial lesions and diagnosed with autoimmune progesterone dermatitis. Both patients had a history of urticaria rash that started one or two weeks before the menstruation and ended with bleeding. Intradermal tests with parenteral progesterone preparation were found to be positive in both patients. As a result of patients' history, clinical findings and the positive intradermal test with progesterone, autoimmune progesterone dermatitis diagnosed. It has been aim to emphasize the importance of anamnesis in diagnosis of this rarely seen disease.
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