Aydın Yücel

The anticonvulsant hypersensitivity syndrome.

Background The anticonvulsant hypersensitivity syndrome is a potentially fatal multisystemic reaction to anticonvulsant medications.

Cutaneous leishmaniasis: new dermoscopic findings

Cutaneous leishmaniasis (CL) has a worldwide distribution. Delayed and incorrect diagnosis may cause the significant spread of this disease and consequent increases in morbidity and drug resistance.

Clinical evaluation of Behcet's disease : A five year follow-up study

The frequencies of clinical features of Behçets disease vary in different studies according to the diagnostic criteria used in the study, the department where the study is done, and the ethnic origin of patients included in the study. In this study, we aimed to evaluate the influence of the length of the follow‐up period of patients on the frequencies of clinical features of Behçets disease. Out of 231 patients who applied to our dermatology clinic from June of 1991 to October of 1996, only 52 patients that were followed up for at least five years were included in this retrospective study. The baseline characteristics of these 52 patients were almost the same as those of the 179 patients who dropped out. Almost all of the frequencies of clinical features at the end of the follow‐up period of five years were higher than those at the time of presentation. The most prominent increases were observed for erythema nodosum (59.6% to 75.0%), papulopustular lesions (84.6% to 94.2%), and large vessel involvement (23.1% to 30.8%). According to our results, it is most likely that studies mainly including mostly patients with long‐standing disease will report higher figures for the frequencies of these clinical features of Behçets disease.

A Family with Waardenburg Syndrome

To the Editor: Waardenburg syndrome (WS) is a rarely seen inherited disease characterized by dystopia canthorum, broad nasal root, congenital deafness, heterochromic irises, medial eyebrows, and piebald-like lesions of the skin and hair. Four types of this syndrome have been defined so far. Types I, II, and III are autosomally dominant while Type IV is autosomally recessive (1–4). The incidence of WS in the general population is around 1 in 42,000 and is responsible for 1–2% of all congenital deafness (5). Several case reports of Waardenburg syndrome have been published in different literatures (5, 6). The syndrome is characterized by an increased distance between the inner canthi with a normal interpupillary distance (dystopia canthorum), congenital deafness, heterochromic irises, white forelock and hypomelanotic macules (2–4, 7). The diagnostic criteria for WS Type I are as follows: Major criteria: Congenital sensorineural hearing loss, pigmentary disturbances of the iris (complete heterochromia iridum, partial or segmental heterochromia, hypoplastic blue eyes) hair hypopigmentation, white forelock, dystopia canthorum, affected first degree relative. Minor criteria: congenital leucoderma, synophrys or medial eyebrow flare, broad or high nasal root, hypoplasia of alae nasi, premature graying of the hair (before age 30). At least two major criteria or one major and two minor criteria are needed to confirm the diagnosis (8). We present two siblings and their two children with WS (Fig. 1). WS was found de novo in our cases and the penetrance was different in each case. The two siblings were males and their ages were 40 and 31. They The Journal of Dermatology Vol. 31: 434–436, 2004

Evaluation of a Guideline for Etiological Diagnosis of Chronic Urticaria

ABS TRACT Back gro und: Ex hi bi ting po ten ti al ca u ses of chro nic ur ti ca ri a in ro u ti ne da ily prac ti ce is a comp lex pro ce du re. A gu i de li ne, de ve lo ped by the re se arc hers, in ves ti ga ting the eti o logy of chro nic ur ti ca ri a was eva lu a ted in this study. In this gu i de li ne eryt hrocy te se di men ta ti on ra te, comp le te blo od co unt, uri ne analy sis and di rect mic ros co pic exa mi na ti on of sto ol for pa ra si tes we re ro u ti ne and ot her di ag nos tic pro ce du res we re re qu es ted ac cor ding to cli ni cal fin dings of po ten ti al ca u ses. Ob jec ti ve: The pur po se of the study was to de ter mi ne the ra te of imp le men ta ti on of the gu i de li ne con si de ring a da ily prac ti ce. Ma te ri al and Met hods: Fol lo wing di ag no sis of chro nic ur ti ca ri a, pa ti ents we re in ter ro ga ted with a stan dard qu es ti on na i re form, and we re exa mi ned in or der to de ter mi ne the cli ni cal fin dings of pos sib le ca u ses of the di se a se. The re cords of 903 pa ti ents in to tal we re ret ros pec ti vely eva lu a ted. Du ring the eva lu a ti on pro cess, the ne ces sary and un ne ces sary di ag nos tic pro ce du res re gar ding the gu i de li ne we re de ter mi ned by using com pu te ri zed al go rithms. During eva lu a ti on so me pa ra me ters such as age and gen der of pa ti ents, du ra ti on and se ve rity of the di se a se, and num bers and types of di ag nos tic pro ce du res af fec ting the gra de of the re qu est and comp le ti on we re al so ta ken in to ac co unt. Re sults: The to tal num ber of ne ces sary pro ce du res was 4070, less than one third of which we re re qu es ted by the physi ci ans. Ho we ver, the pa ti ents comp le ted mo re than thre e fo urths of the re qu es ted pro ce du res. Mo re o ver, the physi ci ans re qu es ted so me unne ces sary pro ce du res in al most one third of the pa ti ents. Conc lu si on: Ac cor ding to cli ni cal fin dings, lo wer thres hold for ne ces sity of in ves ti ga ti on le ads to mo re fa i lu re in imp le men ta ti on of a gu i de li ne. Gu i de li nes de ve lo ped for the eti o lo gi cal di ag no sis of chro nic ur ti ca ri a sho uld be eva lu a ted retros pec ti vely on da ta from da ily prac ti ces to eva lu a te the uti lity of a gu i de li ne.

The influence of training on the recognition of gross features of dermoscopy images.

BACKGROUND In a dermoscopic examination, besides structural components, inexperienced clinicians should also be able to recognize the gross features of the images. AIM The aim of this study is, whether or not an inexperienced clinician has problems in the recognition of gross features of the images on dermoscopic examination. METHODS Two dermatologists, of whom one was experienced in the field of dermoscopy and the other was not, examined 161 dermoscopic images of melanocytic lesions in the gross features of their borders. Inner and outer borders were defined for each lesion. Both dermatologists separately evaluated the borders of the lesions for irregularity, asymmetry, and wideness of fading. For subjective image analysis they scored each lesion by using the four-point ordinal scale. For computerized image analysis they manually marked borders with dots, by using a computer program. We used quadratic-weighted kappa for interobserver reliability assessments for subjective scores and intraclass correlation coefficients (ICC) for automatically calculated scores. RESULTS In a subjective evaluation the inexperienced observer used a higher score than the experienced observer and the kappa values were between 0.241-0.286. ICC for the automatically calculated scores were between 0.357 and 0.522. According to both the outer and the inner borders, the concordance between experienced and inexperienced observers was almost perfect in measurements of diameter, perimeter, and area (ICC scores were between 0.948 and 0.990). CONCLUSIONS An inexperienced person, in comparison with an experienced person, sees lesions in the same sizes, but in different shapes on dermoscopy. Therefore, it is advisable that making learners familiar with the borders of lesions should be included in the training on dermoscopy.