A. Hakan Erbil

Comparison of the efficacy and tolerability of 3% diclofenac sodium gel and 5% imiquimod cream in the treatment of actinic keratosis

Background: Topical diclofenac and imiquimod have been reported to be effective in the treatment of actinic keratosis, but a study to compare these two drugs has not been reported yet. Objective: To compare the efficacy and safety of topical 3% diclofenac gel plus hyaluronic acid and 5% imiquimod cream in the treatment of actinic keratosis. Methods: Forty‐nine patients with actinic keratosis were enrolled in this randomized comparative open‐label study. Twenty‐four patients applied 3% diclofenac gel once a daily to their lesions, while the other 25 patients were treated with a 5% imiquimod cream three times a week for 12 weeks. Patients were examined before treatment and every month of the treatment. Assessments were made by investigators according to the Investigator and the Patient Global Improvement Indices (IGII) and (PGII). Results: According to the IGII results, a complete response was observed in 12% of the diclofenac group and 22% of the imiquimod group. For the PGII scores, a complete response was observed in 28% of the diclofenac group and 23% of the imiquimod group. There were no significant differences between the two groups (p>0.05). Both treatments were well tolerated, with most adverse events related to skin. Conclusion: The two drugs were found to be equally effective and safe in the treatment of actinic keratosis but complete remission was very low. Therefore, topical treatments with these two drugs were not seen to be completely effective, and combined therapies and further studies are needed.

Skin problems in amputees : a descriptive study

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.

Effectiveness of Low-Voltage Radiofrequency in the Treatment of Xanthelasma Palpebrarum: A Pilot Study of 15 Cases

BACKGROUND Xanthelasma palpebrarum (XP) is the most common form of xanthoma, which is mostly located on the eyelids. Various treatment options are available, with certain limitations, and none of them is satisfactory. OBJECTIVES To offer another treatment option (low‐voltage radiofrequency (RF)) and to evaluate its efficacy in XP. METHODS Fifteen patients were included in the study. The patients were examined before treatment, at the end of treatment, and 5 months later at a follow‐up visit. Improvement was judged according to clinical examination by comparing before and after photographs. Electrodes from a dual‐frequency 4.0‐MHz RF machine were applied superficially to the lesions. The clinical scores were calculated using a 5‐point scale (0=no result, 0–25%=mild, 26–50%=moderate, 51–75%=good, 76–100%=excellent). RESULTS All participants completed the study. Of these, scores of nine patients were excellent, scores of five were good, and the score of one was moderate. Statistically significant percentage improvement of the clinical scores from baseline was seen at the end (p<.05). CONCLUSION Low‐voltage RF treatment of XP is effective. If the lesions are too close to the eyes or are multiple or patched with indistinct borders, low‐voltage RF can be used. &NA; The authors have indicated no significant interest with commercial supporters.

Immunohistochemical analysis of small plaque parapsoriasis: Involvement of dendritic cells

Small plaque parapsoriasis (SPP) is one of the cutaneous T-cell lymphoproliferative disorders. The aim of the present study was to show the antigenic profile of a subset of dendritic cells and lymphocytes in SPP in comparison with normal cells to provide data on the role of these two cell types in the pathogenesis of SPP. Skin biopsy specimens of lesions were obtained from 8 patients with SPP. Biopsies of the healthy skin from 9 control individuals were also analyzed. Immunohistochemistry was performed on the frozen tissue sections to reveal binding of anti-HLA Class II, anti-CD1a, anti-CD4, anti-CD8, anti-CD44, anti-CD45, and anti-CD68 monoclonal antibodies. There was a statistically significant increase in the number of CD1a(+), Langerhans cells (LCs), HLA-DR-immunoreactive and, CD1a-positive dermal dendritic cells and CD68(+) macrophages in the SPP group (p=0.008, 0.008, 0.002 and <0.0009, respectively). The number of lymphocytes positive for CD4, CD8 and CD45 was significantly higher than normal in the SPP group (p=0.015, <0.0009 and <0.0009, respectively). Our study demonstrates that both peptide- and lipid-based antigens are involved in the persistent antigenic exposure in SPP. Dendritic cells play a pivotal role in SPP by presenting antigens by both LC and dermal dendritic cells via MHC Class II and CD1a molecules. The CD68(+) macrophages are thought to be involved in the immune response in this pathology as an antigen-presenting cell.