Ayşe Akman-Karakaş

Diagnosis and Demarcation of Skin Malignancy Using Elastic Light Single-Scattering Spectroscopy: A Pilot Study

BACKGROUND Elastic light single‐scattering spectroscopy (ELSSS) is a noninvasive and real‐time technique that has been used to differentiate tumors from surrounding nontumor tissue in animal models and humans. OBJECTIVE To investigate potential application of ELSSS as an adjunctive tool for noninvasive, in vivo, real‐time differentiation of malignant and benign skin lesions and to detect positive surgical margins of excised biopsy samples. METHODS In vivo spectroscopic measurements were performed on 28 lesions in 23 patients. The distribution of the lesions was as follows: nine basal cell carcinoma (BCC), four melanoma, two squamous cell carcinoma (SCC), and 13 benign lesions. Intraoperative margin assessments were performed on the 28 biopsy samples using ELSSS. RESULTS The sign of the spectral slopes was positive for benign and negative for malignant tissues. It was used as a discrimination parameter between malignant and benign lesions with a sensitivity and specificity of 87% and 85%, respectively. Sensitivity and specificity of the system in detecting positive surgical margins on 14 excised biopsy samples were 80% and 90%, respectively. CONCLUSION ELSSS has the potential for use as an adjunctive tool to reduce the number of negative biopsies and to detect positive surgical margins in real time.

Human leukocyte antigens class I and class II in patients with pemphigus in southern Turkey

Background  Genetic factors that predispose individuals to pemphigus are considered to play important roles in the development of the disease. Furthermore, population studies of patients with pemphigus have clearly shown that the most prevalent alleles differ across ethnic groups.

There might be a role for CD200 in the pathogenesis of autoimmune and inflammatory skin disorders.

Background Soluble CD200 (sCD200) is a novel immuno-effective molecule, which acts to regulate inflammatory and acquired immune responses. Recently, our study group showed that sCD200 was present in serum and blister fluid in a patient with bullous pemphigoid and a patient with toxic epidermal necrolysis. We therefore planned this study to evaluate the sCD200 levels of autoimmune and inflammatory skin disorder patients and to compare them with that of healthy controls. Maleral/Methods Our study included 30 consecutive patients with psoriasis vulgaris, 15 with pemphigus vulgaris, and 15 healthy controls. Clinical examination and laboratory tests were performed on the same day. Psoriasis patients were also assessed with the Psoriasis Area and Severity Index (PASI) and pemphigus patients were assessed using the Pemphigus Disease Area Index (PDAI). Levels of sCD200 in the serum samples were quantified using ELISA kits. Results The serum sCD200 level was observed to be statistically significantly higher in patients with psoriasis vulgaris (96.7±15.8) compared to patients with pemphigus vulgaris (76.2±14.6), (p<0.001) and healthy controls (26.8±7.0) (p<0.001). The serum sCD200 levels were observed to be statistically significantly higher in patients with pemphigus vulgaris compared with that in healthy controls (p<0.001). In addition, there was a statistically significant correlation between serum sCD200 levels and PDAI (r=0.987, p=0.001). Nevertheless, there was no statistically significant correlation between serum sCD200 levels and PASI (r=0.154, p=0.407). Conclusions sCD200 might play a role in immune response in the pathogenesis of autoimmune and inflammatory skin disorders. However, it remains to be fully elucidated how sCD200 can orchestrate inflammatory response in psoriasis and pemphigus.

Diagnosis and Management of Pemphigus: recommendations by an International Panel of Experts

BACKGROUND Several European countries recently developed international diagnostic and management guidelines for pemphigus, which have been instrumental in the standardization of pemphigus management, OBJECTIVE: We now present results from a subsequent Delphi consensus to broaden the generalizability of recommendations. METHODS A preliminary survey, based on the European Dermatology Forum (EDF) and the European Academy of Dermatology and Venereology (EADV) guidelines, was sent to a panel of international experts to determine the level of consensus. The results were discussed at the International Bullous Diseases Consensus Group in March 2016 during the annual American Academy of Dermatology (AAD) conference. A second survey was sent following the meeting to more experts to achieve greater international consensus. RESULTS The 39 experts participated in the first round of the Delphi-survey while 54 from 21 countries completed the second round. The number of statements in the survey was reduced from 175 topics in Delphi I to 24 topics in Delphi II based on Delphi results and meeting discussion. LIMITATIONS Each recommendation represents the majority opinion and therefore may not reflect all possible treatment options available. CONCLUSIONS We present here the recommendations resulting from this Delphi process. This international consensus includes intravenous CD20 inhibitors as a first line therapy option for moderate to severe pemphigus.

PUVA Induced Bullous Pemphigoid in a Patient with Mycosis Fungoides

Background. Bullous pemphigoid is an autoimmune subepidermal blistering skin disease in which autoantibodies are directed against components of the basement membrane. The disease primarily affects the elderly people and in most of the patients inducing factors cannot be identified. Herein, we report a case of BP that occurred in a patient who was receiving PUVA therapy for the treatment of mycosis fungoides. Main Observation. A 26-year-old woman with mycosis fungoides developed blisters while receiving PUVA therapy. On physical examination tense bullae on the normal skin, remnants of blisters, and erosions were observed on her breasts, the chest wall, and the upper abdomen. Histopathological investigations revealed subepidermal blisters with eosinophilic infiltration and in direct immunofluorescence examination linear deposition of IgG along the basement membrane zone was observed. The diagnosis of bullous pemphigoid was also confirmed by ELISA and BIOCHIP mosaic-based indirect immunofluorescence test. Conclusions. PUVA therapy is an extremely rare physical factor capable of inducing bullous pemphigoid. So the development of blistering lesions during PUVA therapy may be suggestive sign of a bullous disease such as bullous pemphigoid and it should be excluded with proper clinical and laboratory approaches immediately after withdrawal of PUVA therapy.

Successful Treatment of a Bullous Pemphigoid Patient with Rituximab Who Was Refractory to Corticosteroid and Omalizumab Treatments

Omalizumab is a humanized monoclonal antibody which is an FDA-approved treatment of severe allergic asthma and inhibits IgE binding to FcεRI. According to increasing evidence of IgE inhibition, omalizumab was suggested as a therapeutic approach for bullous pemphigoid (BP). Rituximab has been reported to be effective in various autoimmune diseases, including autoimmune bullous dermatoses. A specific protocol for the use of rituximab to treat BP patients is not yet available. There are only small case series and case reports about the efficacy and safety of rituximab in BP. Here we present a young BP patient who responded well to rituximab therapy and was refractory to conventional and omalizumab therapies although he had elevated IgE levels and eosinophilia. Our case supports the knowledge about the effectiveness and safety of rituximab not only in pemphigus but also in BP. On the other hand, although it did not work in our case, omalizumab may be a potentially effective agent in some carefully selected patients with certain subtypes of BP.

A rare case with prominent features of both discoid lupus erythematosus and pemphigus foliaceus

The actual concurrence of lupus erythematosus (LE) and pemphigus is a rare phenomenon, that is different from pemphigus erythematosus (PE), which is a variant of pemphigus foliaceus (PF) with LE-like features (1,2). Here, we present a case that has both discoid lupus erythematosus (DLE) and PF. This article is protected by copyright. All rights reserved.

Clinical practice guidelines for the diagnosis and treatment of cutaneous leishmaniasis in Turkey

Cutaneous leishmaniasis (CL) is a vector‐born parasitic disease characterized by various skin lesions that cause disfiguration if healed spontaneously. Although CL has been endemic for many years in the southern regions of Turkey, an increasing incidence in nonendemic regions is being observed due to returning travelers and, more recently, due to Syrian refugees. Thus far, a limited number of national guidelines have been proposed, but no common Turkish consensus has emerged.

Successful Treatment of Plantar Warts with Bleomycin using Multi- Puncture Technique and review of Multi-Puncture Applications

Warts are rough, scaly, spiny papules or nodules. They can be exist on any cutaneus surface and they are a manifestation of human papillomavirus (HPV) infection. There is no treatment, which is 100% effective and different types of treatment can be utilised. 16% Salicylic acid is the best option which is suggested due to evidence based analysis and for second line treatment cryotherapy is suggested. Bleomycin is considered as third line therapy, especially encouraged for resistant warts to conventional methods. According to the modified evidence based medicine system, bleomycin has been regarded as level 1 strength of evidence for the treatment of warts [1]. Bleomycin is derived from ‘Streptomyces verticillus’ and has an antiviral activity by inhibiting DNA synthesis. Since 1970s, numerous reports have been published on the use of intralesional bleomycin for the treatment of warts, with cure rates ranging from 14% to 99% [2]. Another administration procedure of bleomycin is utilising multipuncture technique which is also thought to be safe and effective [3-7]. Very few studies are available about this technique of bleomycin administration in the current literature. There is no concensus about procedure for application, the frequency of application, concentration and dosing schedule. In this presentation, , we report a case which responded to multipuncture administration of bleomycin for her recalcitrant plantar warts and multipuncture technique for warts so far are summarized and compared.

Frequency and Dermoscopic Features of Congenital Melanocytic Naevi inAntalya, Turkey and Review of the Literature

Background: Congenital melanocytic naevi (CMN) are present at birth or they develop during the first year of life. In the literature, there is no study prospectively determining the prevalence and dermoscopic patterns of CMN among 0-12 months old infants. There is no data about its frequency in Turkish population. Dermoscopic diagnostic criteria for CMN are not clear. Aim: The aim of this study is to determine the frequency of CMN in our region and to define their dermoscopic properties. Methods: 4289 consecutive infants aged between 0 and 12 months, admitted to pediatric outpatient clinics of Akdeniz University Hospital were included in this study. Infants were first examined by a pediatrician and those with naevi were consulted to a dermatologist. Lesions of CMN were evaluated with camerated dermatoscopy device and images were recorded to a computer. Results: CMN were detected in 0,5% (n:20) of cases. Lower extremity was the most common location (60%), followed by scalp (15%), trunk (10%), upper extremity (10%) and more than one location (5%). Naevi diameter was 1.5-20 cm in 11 cases, smaller than 1,5cm in seven cases and greater than 20cm in two cases. In dermoscopic examination dot structure (n:18) and globular pattern (n:15) were mostly observed. Other findings included multifocal hypopigmentation pattern (n:6), reticular pattern (n:4), homogeneous pattern (n:4), cobblestone pattern (n:2), and parallel furrow pattern (n:1). Conclusion: This is the first prospective study to determine the prevalence and dermoscopic patterns of CMN among 0-12 months old infants admitted to a pediatric outpatient clinic. The frequency of CMN in our region is similar with some of the previous studies. Our Dermoscopic results support that CMN appearing in younger ages is more often characterized by a globular pattern and dot structure.