Search

Background: Melanocytic nevi are common pigmented lesions of the skin. They are sometimes confused with melanoma which is most malign tumor of the skin. Malign transformation of an existing nevus is one of the most seen etiological factor for melanoma formation. Objective: Although characteristics of childhood nevi well studied, there are not much study about the nevi at 18-25 years old age group. The aim of this study is to determine the clinical and dermoscopic features of melanocytic nevi in Turkish young people with 18–25 years-old. Methods: A total of 668 young people from students of Gulhane Military Medical Academy, Military Nurse School and Military Health Sergeant School and suitable patients of outpatient clinic of Gulhane Military Medical Academy Department of Dermatology were included in the study. A medical history of including age, sex, sunblock use, and sunburn asked. On clinical examination, we evaluated number of nevi, location of nevi and skin type. Nevi that are equal or greater than 3mm were examined dermoscopically, recorded and scored by using pattern analysis, ABCD total dermoscopic score, 7 point checklist, Menzies algorithm, 3 point checklist and CASH algorithm. Results: Totally 668 young people were physically examined in this study (268 of which were women and 400 of which were men). The most common skin phototype in both sexes was type 3 (91.6% of women, 85.25% of men). In 668 cases, a total of 3663 melanocytic nevi were determined. Mean number of nevi among cases were 5,4 ± 5,24. A total of 453 nevi which are equal or greater than 3 mm were examined dermatoscopically. The most common localization of nevi was on the head and neck region (n=144; 31.8%), followed by anterior trunk and abdomen (n=128; 28.3%), back (n=122; 26.9%) and extremities (n=45; 9.9%). The most common dermatoscopic global feature was the globular pattern (n=135; 29.8%), followed by reticular pattern (n=88; 19.4%), and cobblestone pattern (n=64; 8.8%). The correlations between 5 dermoscopic algorithm scores were done statically. Except the correlation between 7-point checklist and total CASH score(p=0,052 r=0,091), all algorithms were correlated with each other. Conclusion: Different dermoscopic algorithms can be used together in routine to investigate the melanocytic nevi for valuable professional follow . This is the one of the rare studies about the characteristics of melanocytic nevi at this age group and lays the foundation for future studies that will elucidate the relationship between nevi, dermatoscopic pattern and the other factors in a population-based cohort.

Aim To compare efficacy of targeted broad-band UVB phototherapy and topical psoralen with targeted UVA phototherapy treatments in localized vitiligo for three months prospectively. Material and methods The cases with symmetrical vitiligo lesions were included in the study. Broad-band targeted UVB was applied on one side and targeted UVA phototherapy with topical psoralen on the other side. Results Twenty-two patients who were diagnosed with localized vitiligo were enrolled in this study. These cases consisted of 6 (27,3%) females and 16 (72,7%) males aging between 17-69 (34,22±14,15). Fifty-four lesions (27 left, 27 right) were compared for treatments. After the first month of the treatments, the sides of the lesions were compared in order to evaluate improvement. Percentages of success were 25% for targeted broad-band UVB microphototherapy and 75% for topical psoralen with targeted UVA microphototherapy. When the two treatment methods were compared with each other, a significant difference was found in terms of treatment response. (p=0,017). At the end of the third month, the success rates were 37,5% for targeted broad-band UVB microphototherapy and 62,5% for topical psoralen with targeted UVA microphototherapy, however a statistically significant difference was not determined between the two treatments (p>0,05). Conclusion Both targeted broad-band UVB phototherapy and topical psoralen with targeted UVA phototherapy provided repigmentation for localized vitiligo at the end of the third month. Our investigation shows that both treatments are safe and they provide repigmentation with a limited response. This article is protected by copyright. All rights reserved.

Background: Internalized stigma, adoption of negative attitudes and stereotypes of the society regarding persons' illness, has not been studied previously in pediatric psoriasis patients. Objective: We aimed to investigate the internalized stigma in pediatric psoriasis patients and to determine differences according to factors affecting internalized stigma compared to adult psoriasis patients. Methods: This multicenter, cross-sectional, comparative study included 125 pediatric (55 female, 70 male; mean age±standard deviation [SD], 14.59±2.87 years) and 1,235 adult psoriasis patients (577 female, 658 male; mean age±SD, 43.3±13.7 years). Psoriasis Internalized Stigma Scale (PISS), Dermatology Life Quality Index (DLQI), Perceived Health Status (PHS), and the General Health Questionnaire (GHQ)-12 were the scales used in the study. Results: The mean PISS was 58.48±14.9 in pediatric group. When PISS subscales of groups were compared, the pediatric group had significantly higher stigma resistance (p=0.01) whereas adult group had higher scores of alienation (p=0.01) and stereotype endorsement (p=0.04). There was a strong correlation between mean values of PISS and DLQI (r=0.423, p=0.001). High internalized stigma scores had no relation to either the severity or localization of disease in pediatric group. However, poor PHS (p=0.007) and low-income levels (p=0.03) in both groups, and body mass index (r=0.181, p=0.04) in the pediatric group were related to high PISS scores. Conclusion: Internalized stigma in pediatric patients is as high as adults and is related to poor quality of life, general health, and psychological illnesses. Unlike adults, internalized stigma was mainly determined by psoriasis per se, rather than disease severity or involvement of visible body parts, genitalia or folds. Copyright © The Korean Dermatological Association and The Korean Society for Investigative Dermatology.

Lipoid proteinosis (LP) is a rare autosomal recessive genodermatosis characterized by deposition of amorphous hyaline material in different parts of the body, especially the skin and mucous membranes. Disfiguring lesions predominantly affect facial appearance. There is no curative therapy and treatment options are limited to symptomatic approaches. Facial disfigurement in this disease may have an huge negative effect on the patients' psychology and quality of life. With this regard, the patients may benefit very much from symptomatic treatments. Four patients with LP were treated with Er:YAG laser to ablate disfiguring lesions on the face. Patients were followed up for 14 months to 2 years. We obtained favorable clinical and aesthetic results in all cases with Er:YAG laser treatment and did not observe any recurrences during the follow-up. Depending on our observations Er-YAG laser can be accepted as an effective tool for dermal accumulations and scars of LP with precise ablation capability and favorable esthetic results.

WOS: 000408928500016, PubMed: 28407292, Internalized stigma is the adoption of negative attitudes and stereotypes of the society regarding a person's illness. It causes decreased self-esteem and life-satisfaction, increased depression and suicidality, and difficulty in coping with the illness. The primary aim of this study was to investigate the internalized stigma state of psoriatic patients and to identify the factors influencing internalized stigma. The secondary aim was to identify the correlation of internalized stigma with quality of life and perceived health status. This multicentre, cross-sectional study comprised 1485 patients. There was a significant positive correlation between mean values of Psoriasis Internalized Stigma Scale (PISS) and Psoriasis Area and Severity Index, Body Surface Area, Dermatological Life Quality Index and General Health Questionnaire-12 (P < 0.001 in all). Lower percieved health score (P = 0.001), early onset psoriasis (P = 0.016), family history of psoriasis (P = 0.0034), being illiterate (P < 0.001) and lower income level (P < 0.001) were determinants of high PISS scores. Mean PISS values were higher in erythrodermic and generalized pustular psoriasis. Involvement of scalp, face, hand, genitalia and finger nails as well as arthropathic and inverse psoriasis were also related to significantly higher PISS scores (P = 0.001). Our findings imply that psoriatic patients experience high levels of internalized stigma which are associated with psoriasis severity, involvement of visible body parts, genital area, folds or joints, poorer quality of life, negative perceptions of general health and psychological illnesses. Therefore, internalized stigma may be one of the major factors responsible from psychosocial burden of the disease.

Gulhane Askeri Tip Akademisi, Deri ve Zuhrevi Hastaliklar Anabilim Dali, Ankara, Turkiye *Golcuk Asker Hastanesi, Deri ve Zuhrevi Hastaliklar Klinigi, Kocaeli, Turkiye @Telif Hakki 2014 Turk Dermatoloji Dernegi Makale metnine www. turkdermatolojidergisi.com web sayfasindan ulasilabilir. @Copyright 2014 by Turkish Society of Dermatology Available on-line at www.turkdermatolojidergisi.com Gurol Acikgoz, Gulhane Askeri Tip Akademisi, Deri ve Zuhrevi Hastaliklar Anabilim Dali, Ankara, Turkiye E-posta: gacikgoz@gata.edu.tr Gelis Tarihi/Submitted: 18.07.2014 Kabul Tarihi/Accepted: 04.08.2014 Yazisma Adresi/ Correspondence: Objective: Androgenetic alopecia (AGA) is a special type, characterized with the follicular miniaturization of the frontal and parietal areas of scalp. In this study, we intended to evaluate the efficacy and safety of a hair lotion including saw palmetto and 10% trichogen veg complex (TVC) within male patients with AGA. Methods: Male patients, who treated with topical saw palmetto and TVC for four months between 2011-2012 were included to our study. Among the patient files, records of 25 patient were accepted available and taken into consideration according to the vertex photographs and tricoscan evaluations. Derived data were analyzed with SPSS program. Results: Total hair count was increased 11.9% compared with the pretreatment period. The final ratio of anagen/telogen hair was compared with the initials and the increase in ratio was 38%. According to the evaluation of vertex photographs, the observers declared that enhancement was noted in 48% of the patients and no difference was not noted in 36% of the patients. Conclusion: At the end of the study, topical saw palmetto and TVC were evaluated efficient and safe for the treatment of AGA. Randomized controlled trials among patient groups will reveal more conclusive data associated with topical saw palmetto and TVC.

Leflunomide is an immunomodulatory drug widely used in the treatment of inflammatory arthritis especially in rheumatoid arthritis and psoriatic arthritis. The common side effects of leflunomide are hepatopathy, hypertension, various gastrointestinal complaints and transient hair loss, which were mild and reversible. Although leflunomide is associated with transient hair loss, leflunomide induced alopecia areata was reported previously only in one case. In this case report, we present a 38-year-old male patient who suffered from alopecia areata after leflunomide therapy.

Pigmented lesions on the vulva are rare and their non specific features cause difficulties in their diagnosis and differential diagnosis. Because of their localization, it is difficult to follow up vulvar lesions, which are generally noticed coincidentally by patients. Vulvar pigmented lesions are classified clinically as macules/papules and patches/plaques to provide ease of the diagnosis. Nevi, angiokeratomas, seborrheic keratosis, melanoma, basal cell carcinoma and squamous cell carcinoma are classified under the macules/papules, and post-inflammatory hyperpigmentation, physiological hyperpigmentation, melanosis and acanthosis nigricans are classified under the patch/plaque. Dermatoscopic examination, which is increasing recently, is very valuable for avoiding possible cosmetic and functional complications of surgical procedures. However, epidermal pigmentations such as vulvar melanosis and vulvar intraepitelyal neoplazi are dermatoscopically indistinguishable. It may also be difficult to diagnose vulvar melanoma clinically and dermatoscopically. Histological examination is the gold standard for the diagnosis of pigmented vulvar lesions, which are clinically and dermatoscopically indistinguishable. (Turk J Dermatol 2012; 6: 39-44)

Background Topical drugs enhance the therapeutic effects of ultraviolet (UV)-based therapy for psoriasis. However, their efficacy has yet to be established in a clinical trial. Objectives This study aimed to compare the efficacy of targeted microphototherapy alone and in combination with psoralen or calcipotriol in the treatment of plaque-type psoriasis. Methods Thirty individuals, affected by plaque-type psoriasis, were treated with targeted narrowband UVB phototherapy alone (Group 1), in combination with psoralen gel (Group 2), or in combination with calcipotriol ointment (Group 3) three times per week based on predetermined minimal erythema doses for 10 weeks. Results All patients in each group completed the study. The percentages of improvement in Psoriasis Area and Severity Index (PASI) and Psoriasis Severity Index (PSI) scores were 33.9% and 38.3% in Group 1, 29.9% and 29.8% in Group 2, and 67.2% and 59% in Group 3, respectively. There was no statistically significant difference in improvement between Groups 1 and 2 (P > 0.05). Outcomes in Group 3 were found to be superior compared with those in the other groups. Conclusions The addition of calcipotriol ointment in targeted phototherapy enhances the therapeutic effects of phototherapy in the treatment of plaque-type psoriasis.

To evaluate and compare the safety and efficacy of 10% potassium hydroxide (KOH) solution and salicylic and lactic acid (SAL + LAC) combination in the treatment of molluscum contagiosum (MC).26 patients with MC randomized into two treatment groups. 12 patients treated with 10% KOH solution and 14 patients treated with SAL + LAC combination for 6 weeks. Parents of patients were instructed to apply medication once daily only to lesions at study onset. Assessment of response of the treated lesions and side effects was performed at 2, 4 and 6 weeks of the treatment. Newly acquired lesions were not included in the study.At the end of therapy, 83.3% (n = 10) of KOH group demonstrated complete remission and 16.7% (n = 2) of them showed partial remission; four patients (33%) developed new lesions during the study. All the patients in the SAL + LAC combination group (100%) demonstrated complete remission of study entry lesions at the end of 6 weeks with five patients (35%) acquiring new lesions during the study. Minor side effects were observed in two groups.10% KOH solution and SAL + LAC combination were found to be equally effective in the treatment of MC in children.

Background Peeling skin diseases (PSD) refer to a group of rare autosomal recessive dermatosis which are characterized by spontaneous, continual peeling of the skin. Three different clinical pictures can be distinguished: Inflammatory PSD also referred to as peeling skin syndrome (PSS) type B, non-inflammatory PSD also referred to as PSS type A, and localized forms i.e. acral type PSS. Objective To characterize the clinical and histopathological features of PSD in Turkey. Methods We retrospectively reviewed the medical records and clinical photographs of patients who were given diagnosis of PSD and conducted histopathological evaluation of skin biopsies to identify the site of cleavage. Also we evaluated the cases including age, gender, age onset, clinical and histological findings, family history, associated disorders and PSD type. Results Twenty-one patients with PSD were seen at Gulhane School of Medicine in Ankara between the years 1994 and 2010 in this retrospective study. All patients were men. Their ages were between 20 and 26 years (22.44 ± 2.30, Mean age ± SD). Of the patients, eight cases (40%) were type A, eight cases (40%) were type B, and five cases (20%) were acral type PSS. Eleven cases (52%) had parental consanguinity. Keratoderma, cheilitis, keratosis pilaris, melanonichia, clubbing, hyperhidrosis, onychodystrophy were observed in eight cases as an accompanying disorder. Conclusions In this case series, PSD occurred rarely and also showed generally mild course of disease in Turkey and most likely related to consanguineous of marriages. Future investigations on PSD will contribute to our progressing alternative targets for pathogenesis-based therapy.

Background: With regard to the lack of effective treatment modalities for childhood localized vitiligo, the search for newer therapeutic agents continues. Objective: To conduct an open, comparative trial to evaluate the clinical efficacy and safety of topical mometasone cream and pimecrolimus cream in the treatment of childhood vitiligo. Methods: Fifty patients with childhood vitiligo were included in the study. Patients were treated for 3 months either with mometasone cream (0.1%) once daily or with pimecrolimus cream (1%) twice daily. Results: Forty patients, 20 from each group, completed the study. The two drugs were found to be statistically significantly effective for diminishing lesion size (Z = 3.070, p = 0.002 and Z = 3.845, p < 0.001, respectively). There were no statistical differences between the two drugs: Z = 1.427, p = 0.154 (mometasone non-inferiority to pimecrolimus). The mean repigmentation rate was 65% in the mometasone group and 42% in the pimecrolimus group at the end of therapy. Atrophy, telangiectasia and erythema were observed in two patients (10%) in the mometasone cream group and a burning sensation and pruritus were observed in two patients (10%) in the pimecrolimus cream group; drop-out was not related to the observed adverse effects. Conclusion: Mometasone cream was found to be effective in the treatment of vitiligo on any part of the body. Pimecrolimus was not effective on the body except for the face in childhood localized vitiligo.

Background: Seborrheic dermatitis (SD) is a chronic inflammatory disorder that mainly affects the seborrheic region. While ketoconazole is often used, pimecrolimus has been used successfully in SD. Objective: To compare the efficacy and tolerability of pimecrolimus in comparison with ketoconazole in the treatment of SD. Methods: A total of 48 patients with SD were included in the study. Patients were randomized into two groups: 23 and 25 patients in the pimecrolimus and ketoconazole groups, respectively. Clinical measures were assessed by erythema, scaling and infiltration, which were evaluated using a four-point scale (0 to 3) at 2, 6, and 12 weeks. Results: Of these 48 patients, 38 completed the study (18 and 20 patients in the pimecrolimus and ketoconazole groups, respectively). The mean percentage decrease in clinical severity scores from baseline to the last follow-up period was 86.2% and 86.1% in the pimecrolimus and ketoconazole groups, respectively. Both pimecrolimus and ketoconazole were effective in SD. Differences between the two groups were not statistically significant. Side effects were observed more frequently with pimecrolimus than with ketoconazole and this difference was statistically significant. Conclusion: Our study showed that pimecrolimus had a comparable efficacy profile with that of ketoconazole, but side effects appeared more frequently in the pimecrolimus group than in the ketoconazole group.

BACKGROUND Various treatment regimens have been used in scars. The literature offers little consensus about appropriate therapy. OBJECTIVE To compare intralesional triamcinolone acetonide (TAC) alone or combined with onion extract in keloidal and hypertrophic scars. MATERIALS AND METHODS Fourteen patients were treated with intralesional TAC and onion extract gel, and 13 patients were treated with intralesional TAC alone. Findings were recorded and graded at each visit (weeks 0, 4, 12, and 20). The scores before treatment and at week 20 were compared. RESULTS Twenty-seven patients [17 men (63%) and 10 women (37%) aged 15 to 73 (average age 28.1±11.7)] were enrolled in the study. At baseline, the difference in the two treatment groups was not statistically significant (p>.05). At week 20, there was statistically significant improvement in both treatment groups (p

Infantile acne is an uncommon condition in pediatric age. We determined the efficacy and safety of adapalene gel 0.1% in the treatment of infantile acne. Twelve patients were enrolled for adapalene gel 0.1% application once daily over a 16-week treatment period. Efficacy evaluation included counting the inflammatory and noninflammatory lesions by the physician and global evaluation of the improvement. After 16 weeks all patients were followed up for a 1-year period. The time of clearance of the infantile acne lesions was 3 months in four (33%) patients and 4 months in eight (67%) patients (median 3.4 months). Adapalene gel produced reductions in noninflammatory and inflammatory lesions counts. Limited side effects were observed and none of them required stopping the therapy. No patient was left with scarring. Three patients were showed mild lesions in the 1-year follow-up period. Adapalene gel 0.1% was found to be a highly effective and safe drug in the treatment of mild-to-moderate infantile acne.

Eosinophilic cellulitis is characterized clinically by an acute dermatitis resembling cellulitis with unknown etiology. Eosinophilic pustular folliculitis is also a rare inflammatory dermatosis characterized by recurrent crops of erythematous follicular papulopustules that coalesce to form annular plaques with unclear etiopathogenesis. We describe a 20-year-old white male who had vesiculobullous and plaque-like lesions on the hands and feet and was diagnosed with bullous eosinophilic cellulitis clinically and histologically without any etiological agents. Following therapy with oral corticosteroid and oral tetracycline capsules, the lesions disappeared. After a 2-month asymptomatic period, the patient developed pruritic follicular papules and pustules on the lower and upper extremities and upper back. Stool examination revealed Gierdia intestinalis eggs. The patient had complete clearance with treatment of ornidazol for 2 weeks and indomethacin for 2 months. This is the first report of bullous eosinophilic cellulitis coexisting with eosinophilic pustular folliculitis without eosinophilia in the English published work.

Melasma is a common acquired disorder of facial hyperpigmentation. In this study we investigated the efficacy and safety of a combined treatment regimen including serial glycolic acid peels, topical azelaic acid cream and adapalene gel in the treatment of recalcitrant melasma. Twenty-eight patients with recalcitrant melasma were enrolled in a prospective, randomized, controlled trial lasting 20 weeks. The patients of the group receiving chemical peels underwent serial glycolic acid peels in combination with topical azelaic acid 20% cream (b.i.d.) and adapalene 0.1% gel (q.i.d., applied at night). The control group received only topical treatment including topical azelaic acid and adapalene. The clinical improvement was assessed with the Melasma Area Severity Index (MASI) at baseline and monthly during the 20-week treatment period. The results showed a prominent decrease in MASI scores at the end of the treatment in both groups, although the results were better in the group receiving chemical peels (P=0.048). All patients tolerated the topical agents well with minimal irritation observed in the first few weeks of the therapy. Three patients in the glycolic acid peel group developed a mild-degree postinflammatory hyperpigmentation with total clearance at the end of the treatment period. Therefore, the present study suggests that combined treatment with serial glycolic acid peels, azelaic acid cream and adapalene gel should be considered as an effective and safe therapy in recalcitrant melasma.

Vitiligo is a common, idiopathic, acquired, depigmenting disease characterized by loss of normal melanin pigments in the skin. The most interesting treatment methods for extensive vitiligo involve psoralen plus ultraviolet A (PUVA) therapy and ultraviolet (UV)-B phototherapy, particularly narrow-band UV-B. In this randomized and comparative study, we investigated the safety and efficacy of narrow band ultraviolet B as monotherapy and in combination with topical calcipotriol in the treatment of generalized vitiligo. Of the 40 vitiligo patients enrolled in the study, 15 were treated with the calcipotriol plus narrow-band UV-B (NBUVB) and 25 with narrow band UV-B alone. The patients were randomized into two NBUVB treatment groups. The first group, consisting of 24 patients (all male), received only NBUVB treatment; the second group, consisting of 13 patients (all male) applied 0.05% topical calcipotriol ointments twice daily. Both groups were irradiated with NBUVB (311 nm). In the NBUVB group, the percentage of the body surface affected was reduced from 27.21 +/- 10.41% to 16.25 +/- 8.54% after a mean of 30 treatment sessions. The mean repigmentation percentage was 41.6 +/- 19.4%. In clinical evaluation (moderate and marked/complete response was accepted as an effective treatment), 19 patients (19/24; 79.17%) had clinically good results. In the NBUVB plus calcipotriol group, the percentage of the body surface affected was reduced from 23.35 +/- 6.5% to 13.23 +/- 7.05% after a mean of 30 treatment sessions. The mean repigmentation percentage was 45.01 +/- 19.15%. In clinical evaluation (moderate and marked/complete response was accepted as an effective treatment), 10 patients (10/13; 76.92%) had clinically good results. Statistically significant intragroup reductions from the baseline percentage of the body surface affected were seen at the endpoint of treatment for the two treatment groups (P0.001). However, there was no statistically significant difference between the two treatment groups at the end of therapy with respect to the reduction of repigmentation rates (P0.05). The present study reconfirmed the efficacy of NBUVB phototherapy in vitiligo. It can be a therapeutic option considered in the management of patients with vitiligo. However, addition of topical calcipotriol to NBUVB did not show any advantage.

Follicular mucinosis is a rare disorder of unknown etiology characterized by accumulation of mucin in the sebaceous glands and outer root sheaths of the hair follicles. It is divided into a primary benign type and a secondary type mostly associated with lymphomas. No effective standard therapy for follicular mucinosis is available. We describe the case of a 21-year-old Caucasian male who had papules, nodules, and erythematous plaques on his left shoulder, left arm, and right scapular region. He was diagnosed as primary benign generalized follicular mucinosis, and treated with isotretinoin. Almost complete remission was achieved in 4 months.

A 20-year-old man presented with skin lesions on his forearms and legs that had started to appear at 3 years of age. On exposure to the sun, his skin became red. He suffered from dysphagia and dysdefecation. His parents’ marriage was not consanguineous, and they were well. His five brothers and sister were also well. He stated that one of his aunt's sons and his uncle's son had the same lesions, but we were unable to examine them. Physical examination revealed a reticulated pattern of atrophy, pigmentation, erythema, and telangiectasia on the neck (Fig. 1), shoulders, popliteal fossa, and limbs. Atrophic lesions were also present on the extensor aspects of the elbow and knees, and on the dorsum of the proximal and distal interphalangeal joints of both hands (Fig. 2). Oral mucosal examination showed leukokeratosis on the dorsum and sides of the tongue. There was mild hyperkeratosis on the dorsum of the feet and hands. Sclerodactyly of the hands and feet was also present. The patient had no fingerprints. The nails were thickened and rough, and had longitudinal and transverse ridges. Hairs on the legs, forearms, and trunk were sparse. There was no splenomegaly or genital abnormalities. Figure 1. Patient's neck showing reticulated, hyperpigmented, and atrophic skin lesions and telangiectasias Download figure to PowerPoint Figure 2. Thin and atrophic skin of the dorsum of the hands and dystrophic fingernails Download figure to PowerPoint Laboratory tests were as follows (normal values in parentheses): white blood count, 10,000/mm3 (4000–10,000/mm3), with 66% neutrophils and 34% lymphocytes; red blood cell count, 5.68 × 106/µL; hemoglobin, 10.6 mg/dL; hematocrit, 35.4%; mean corpuscular volume, 62.2 fL; platelet count, 419 × 103/µL; erythrocyte sedimentation rate, 4 mm/h (0–13 mm/h); vitamin B12, 285 pg/mL (211–911 pg/mL); folic acid, 6.4 ng/mL (1.1–20 ng/mL); ferritin, 3.7 ng/mL (22–322 ng/mL). There was mild anisocytosis, microcytosis, and hypochromic anemia in a peripheral blood smear. Liver transaminase levels were normal. There was a mild monoclonal gammopathy, with a serum immunoglobulin G (IgG) of 1630 mg/dL (normal, 751–1560 mg/dL) and a C3 of 155 mg/dL (normal, 79.2–152 mg/dL). The IgM and IgA levels were normal. Chest X-ray was normal, and there was no evidence of abnormal calcification on skull X-ray. An upper gastrointestinal endoscopy demonstrated a stricture at the upper esophageal sphincter. Esophagography clearly revealed an esophageal stricture at the proximal esophagus (Fig. 3). Sigmoidoscopy could not be performed because of the significant anal stricture, nor could a digital rectal examination. Figure 3. Esophagographic image demonstrating an esophageal stricture at the proximal esophagus Download figure to PowerPoint Histopathology of a biopsy specimen from the skin of the shoulder showed flattening of the epidermis, a mild infiltrate of chronic inflammatory cells and melanophages, and dilated capillaries in the dermis.

Background Skin problems are common in amputee patients. These problems may restrict the normal use of a prosthetic limb. We aimed to determine the range, incidence, causes and patterns of dermatological problems seen in a population of amputees. Materials and methods One hundred and forty two amputees, were enrolled to the study. Age, sex, age at the time of amputation, level of amputation, reason for amputation, and types of prosthesis were noted. Dermatological problems were recorded. Stumps were swabbed for bacteriological and mycological examination, and patch tests were performed in suspected patients. Results Of these 142 patients, 139 (97.9%) were males and 3 (2.1%) were females. The reasons for amputation in the majority of the cases were wounds due to mine explosion (n = 114, 80.3%) and gunshot wounds (n = 19, 13.4%). The other reasons were arterial diseases, traffic accidents, congenital absence of the tibia, and vascular complication of diabetes. At least one skin problem was detected in 105 (73.9%) of 142 cases. Positive reactions to allergens have been detected in 28 (43%) of 65 cases with dermatitis. Bacterial infection was detected in 12 patients and fungal infection was detected in 4 patients. Conclusion Our descriptive study shows that skin problems have a high prevalence, up to 73.9% in amputee patients. This high percentage indicates that dermatological problems are important in amputees. Early recognition and treatment of these problems can prevent the amputee's mental, social, and economic losses.

Linear and whorled nevoid hypermelanosis (LWNH) is a rare skin condition characterized by swirls and whorls of hyperpigmented macules in a reticulate pattern along Blaschko's lines; approximately 40 cases have been reported in the English language literature. We report a case of LWNH occurring in a 20-year-old man with widespread involvement over the trunk, face, upper limbs, and genitalia in association with scoliosis. A small hyperpigmented area on the abdomen was treated with a medium-depth chemical peel regimen using 70 percent glycolic acid and 35 percent trichloroacetic acid with no benefit. This is the first report of LWNH treated with medium-depth chemical peel.

Toxic epidermal necrolysis and Stevens-Johnson syndrome are severe skin reactions, usually to drugs, associated with a widespread destruction of the epidermis. Widespread purpuric macules and epidermal detachment of less than 10% of the body surface is indicative of Stevens-Johnson syndrome, whereas epidermal detachment between 10% and 30% is called Stevens-Johnson-toxic epidermal necrolysis overlap. Epidermal detachment involving more than 30% of the total body surface is designated as toxic epidermal necrolysis. These generalized reactions are known to occur in association with various drugs. Treatment is primarily supportive care, and there are no specific therapy regimens. Therapeutic modalities such as corticosteroids, cyclosporin, thalidomide, cyclophosphamide, and plasmapheresis, usually based on a symptomatic approach, have been tried in single patients or in small series. Intravenous immunoglobulin has recently been shown to provide rapid improvement in all three of these skin reactions. We report a 2-year-old girl who developed Stevens-Johnson syndrome-toxic epidermal necrolysis overlap after receiving ampicillin-sulbactam for an upper respiratory tract infection. She was treated successfully with a 4-day course of intravenous immunoglobulin.

As is the case with many other autoimmune diseases, there is an association between vitiligo and HLA complex. HLA subtypes vary with racial/ethnic background. The purpose of this study was to determine which HLA class I antigens and HLA class II alleles are associated with Turkish vitiligo patients. Forty-one patients with vitiligo and 61 healthy control subjects were typed for HLA class II alleles. Thirty-three out of 41 patients with vitiligo and 100 healthy transplant donors were typed for HLA class I antigens. HLA DNA typing was performed by polymerase chain reaction/sequence specific primer method for class II. HLA typing for class I was performed by serological method. The frequency of HLA DRB1*03 was 0.6340 in patients compared to 0.2950 in controls (P = 0.0014). The frequency of HLA DRB1*04 was found to be 0.6830 in patients compared to 0.2950 in controls (P = 0.00026). The allele HLA DRB1*07 was present in 0.390 of patients compared to 0.0820 of the controls (P = 0.0004). A preventive antigen for the manifestation of vitiligo has not been identified in this study. Our findings suggest that DRB1*03, DRB1*04 and DRB1*07 alleles are genetic markers for general susceptibility to vitiligo in a Turkish population.

Background and Aim: Androgenetic alopecia (AGA) is undoubtedly the most common form of hair loss in males. It is a condition which may cause cosmetic and psychosocial problems in androgen-dependent cases. In this open, randomized and comparative study we evaluated the efficacy of oral finasteride and 5% topical minoxidil treatment for 12 months in 65 male patients with mild to severe AGA. Methods: We randomly assigned 40 (61.53%) patients to receive 1 mg/day oral finasteride for 12 months, and 25 (38.47%) patients applied 5% topical minoxidil solution twice daily for 12 months. Results: There were no significant differences between the 2 groups considering age, age of onset of hair loss, family history and type of hair loss (p > 0.05). In the clinical evaluation at the endpoint of treatment, the clinical cure rates (i.e. increased intensity of hair) were 80% (32/40) for the oral finasteride group and 52% (13/25) for the 5% topical minoxidil group. Encountered side effects were all mild, and there was no need to stop the treatment. In the group given oral finasteride, side effects were noted in 7 patients: 6 patients suffered from loss of libido, and 1 patient had an increase in other body hairs; irritation of the scalp was seen in 1 patient in the group administered 5% minoxidil. These adverse events disappeared as soon as the treatment was stopped. The laboratory data on both drug groups did not show any statistically or clinically significant intragroup changes from baseline values to the endpoint (p > 0.05), except the level of serum total testosterone which was increased, and free testosterone and serum prostate-specific antigen in the finasteride group which were statistically decreased from baseline values to the endpoint (p < 0.05). Conclusion: In this comparative study of systemic finasteride and topical minoxidil, it was concluded that both drugs were effective and safe in the treatment of mild to severe AGA, although oral finasteride treatment was more effective (p < 0.05). Adverse events were not considered important either, and these side effects disappeared as soon as the treatment was stopped.

Topical colchicine has been reported to be an effective treatment for actinic keratoses, but the optimal concentration has not been fully defined.The aim of this study was to further support the beneficial effect of topical colchicine therapy for actinic keratoses, and to compare the efficacy and safety of two different concentrations of colchicine cream, 0.5% and 1%.Sixteen patients with actinic keratoses were enrolled in this comparative randomized study. Eight patients applied 1% colchicine cream, twice daily on their lesions while the other eight were treated with a 0.5% colchicine cream for 10 days. Some patients were applied a second course of 10 days' therapy. Patients were examined before treatment and at 10 days, and followed up at 1, 2 and 6 months of treatment. Visible and palpable actinic keratoses lesions in each group were counted. Safety and efficacy were also assessed by clinical examination at each study visit. Routine laboratory tests were performed before and after treatment.Actinic keratoses lesions showed significant clinical improvement following treatment with 0.5% and 1% colchicine cream. Complete healing of actinic keratoses were observed in six of the eight patients in the 1% colchicine group, and in seven of the eight patients in the 0.5% colchicine group. The reduction rate in number of actinic keratoses at the end of treatment in the 1% colchicine group was 73.9% (48/65) (p0.001), and the reduction rate in the 0.5% colchicine group was 77.7% (52/67) in total (p0.001). The reduction in number of actinic keratoses (mean +/- SD) at the end of treatment was similar in the 1% colchicine group (0.7 +/- 1.3), and the 0.5% colchicine group (mean 0.6 +/- 1.7) (p0.05). Systemic side effects were not seen in either concentration.Topical colchicine is an effective and safe alternative agent. Cream containing 0.5% of colchicine is equally effective as 1% colchicine cream in the treatment of actinic keratoses.

The aim of the present study was to determine the efficacy and the safety of topically applied 4% niacinamide gel in treating mild to moderate acne vulgaris. A single center, open study was conducted for up to 12 weeks. A total of 30 patients with mild to moderate acne were enrolled into the study. Patients were instructed to apply the 4% niacinamide gel twice daily over the affected area for 12 weeks. The patients were seen at every one month period to evaluate the lesions and side effects. To determine the efficacy we used both total lesion counting (TLC) which includes all comedones, papules and pustules and acne severity index (ASI). The mean TLC in the patients was 35.8 before the treatment and it was reduced to 20.33 (43.21% reduction) at the end of the treatment. The difference was statistically significant (p