Zillikens, 2013), no associated malignancy was observed. In contrast, in lichen sclerosus, carcinomas of the genitalia and the skin were revealed (Powell and Wojnarowska, 1999). A possible drawback of this study is its reliance on the ICD-10 coding of doctors from different specialities. Although the large majority of autoimmune bullous diseases are diagnosed by dermatologists, coding of these disorders by non-dermatologists might have led to mistakes. On the basis of the coding of pemphigoid gestationis in one man and four female patients older than 50 years, the false-coding rate was estimated to be 4%. The present findings will be relevant for the future care of patients with autoimmune bullous disorders. Regardless of the reason for the higher incidence of cancer in some of these diseases, an increased awareness in combination with regular differential blood counts and inspection of the entire skin, as well as routinely performed gastroand coloscopy in patients with pemphigus vulgaris might be helpful to detect the associated malignancies as early as possible in the majority of patients.
Increased photosensitivity and sunburn after minimal sun exposure should lead physicians to examine the skin for poikiloderma and the mouth for fragility of the gums, periodontitis and other associated findings. Also, patients should be questioned about any history of blister formation as well as family history.
Although preliminary, the results of this study showed that oral and topical statins, agents with anti-inflammatory properties, can be considered as effective treatment for acne vulgaris adjunct to standard treatment. However, further studies with larger sample size and longer follow-up are needed to confirm these results.
A 25‐year‐old woman living in Hamedan, Iran, presented originally at 7 years of age with erythematous, hyperkeratotic lesions on the palms and soles with extension to the dorsal side of the hands and feet. Involvement of the elbows and knees was also seen. From 12 years of age, she started to lose her teeth. At the same age, she experienced fever, chills, malaise, myalgia, and right upper quadrant abdominal pain. With a diagnosis of pyogenic liver abscesses, the patient underwent successful surgical treatment.
Examination revealed erythematous, hyperkeratotic, scaling plaques on the palms and soles, dorsal side of the hands and feet (Fig. 1), elbows and knees. All the teeth were missing from the mouth (Fig. 2), and she used a dental prosthesis. A surgical scar was observed on the right upper quadrant of the abdomen (Fig. 3). Skull X‐ray and computed tomography scan were normal. Skin biopsy of the dorsal right hand demonstrated hyperkeratosis, focal parakeratosis, hypergranulosis, and acanthosis with a mild inflammatory infiltrate around the vessels (Fig. 4).
1
Hyperkeratotic plaques on the hands and feet
2
Loss of permanent teeth
3
Surgical scar on the right upper quadrant of the abdomen and hyperkeratotic plaques on the hand
4
Hyperkeratosis, focal parakeratosis, hypergranulosis, and acanthosis (hematoxylin and eosin, ×40)
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