Aysun Şikar Aktürk

Narrowband ultraviolet B phototherapy for alopecia areata

Although narrowband ultraviolet B (NB UVB) phototherapy is a well‐established treatment in many dermatosis, there is little evidence of efficacy of this method for alopecia areata (AA) treatment in the literature. We undertook a retrospective review of the 25 AA patients treated with NB UVB. Intramuscular triamcinolone acetonide injections per month were used as concomitant treatment in some patients who did not have any contraindication. Eight patients (32%) received monthly intramuscular corticosteroid injections. Four (22.2%) and two (20%) patients achieved excellent response in extensive patchy hair loss patients and entire scalp hair loss patients, respectively. Four of six patients who achieved excellent response also received monthly intramuscular corticosteroid injections. When patients receiving systemic corticosteroid injections were compared with patients given only NB UVB with respect to the treatment responses, a statistically significant difference was seen in patients who achieved excellent response. NB UVB is not an effective treatment with only 20% excellent treatment responses in patients with severe AA, most of whom were also treated with systemic corticosteroids.

The effects of isotretinoin on the ovarian reserve of females with acne

Abstract There are some side effects of isotretinoin in many organs. However, a study investigating the effects of isotretinoin on the human ovarian reserve has not been reported previously. The study was conducted to investigate possible effects of isotretinoin on ovarian reserve. Serum anti-Müllerian hormone (AMH) levels were measured at the beginning and at the end of isotretinoin treatment in 22 patients with acne and in 22 women without. The mean AMH level before treatment was 5.77 ng/mL in the study group and 3.79 ng/mL in the control group (p = 0.008). Following treatment, the mean AMH level was 4.69 ng/mL in the study group. This mean AMH level after treatment was statistically lower than the AMH level before treatment (p = 0.012). There was no significant difference between the mean AMH level at the end of treatment and that of the control group (p = 0.20). The high level of pre-treatment AMH levels could be an evidence of hyperandrogenism in women with acne, even if they are not identified as having polycystic ovary syndrome (PCOS) or hyperandrogenism. Decrease in AMH levels following exposure to isotretinoin may suggest that it has a detrimental effect on the ovaries.

Congenital smooth muscle hamartoma on the scalp.

Case Report An 8-day-old male infant was referred to our neonatal unitfor prematurity. It was observed that his scalp color wasdarker than the rest of his skin color when the scalp hair waspartially shaved for intravenous access. Dermatologic exam-ination revealed a slightly elevated, hyperpigmented plaqueconfined to the whole scalp. The margin of the lesion did notextend to the face and neck. His hair was abundant and dark(Fig. 1). There were no areas of alopecia and no overlyingfolds of skin. There were no dysmorphic features, such asMichelin tire baby. Pseudo-Darier’s sign was negative.A punch biopsy specimen was obtained from the lesionwith a diagnosis of congenital melanocytic nevus or congeni-tal blue nevus. The result of histopathologic examinationshowed increased smooth muscle bundles in the reticular der-mis running in various directions under a normal epidermis(Fig. 2a); immunohistochemical stain revealed desmin-positive (Fig. 2b) and S100-negative proliferation. Based onthese clinical and histopathologic findings, a diagnosis ofcongenital smooth muscle hamartoma was made. No changesin this lesion were observed during a 9-month follow-up period. Discussion Congenital smooth muscle hamartoma (CSMH) is a rarecutaneous dysembryoplasia characterized by a disorganizedproliferation of normal muscle fibers of arrector pili. Thedisease usually presents as a localized, skin-colored ormildly hyperpigmented, irregularly shaped patch or plaquewith prominent vellus hairs located on the lumbosacral area.

Comparison of effects of 5 and 10 mg oral desloratadine and levocetirizine on histamine-induced wheal and flare response in healthy volunteers

Background: Levocetirizine and desloratadine are mostly used as H1-antihistamines in the treatment of allergic disease in 5 and 10 mg doses. Objective: In this study, the efficacy of single oral dosages of 5 and 10 mg desloratadine and levocetirizine were compared by using histamine-induced wheal and flare reactions. Methods: Eighty healthy volunteers were randomized for four double-blinded treatment with desloratadine 5 and 10 mg and levocetirizine 5 and 10 mg. Wheal and flare responses were produced by histamine. Measurements were performed just before the ingestion of antihistamines (baseline) and afterward at 30, 60, 240 min and 24 h. The values obtained for each antihistamine were compared with baseline values. Results: It was found that except the flare reactions at 30th min, levocetirizine 5 and 10 mg suppressed histamine-induced wheal and flare reactions more than desloratadine 5 and 10 mg did. There were not any significant differences between desloratadine 5 and 10 mg in all periods. Levocetirizine 10 mg suppressed wheal and flare reactions significantly more than levocetirizine 5 mg only at 24th h. Conclusion: In this study, it was observed that levocetirizine 5 and 10 mg had a higher activity than desloratadine 5 and 10 mg.

Effects of isotretinoin on serum vitamin E levels in patients with acne.

Anecdotal reports suggest that using retinoids with vitamin E leads to improvements of some side effects due to isotretinoin. However, vitamin E blood levels have not been reported previously in patients with acne treated with isotretinoin. We aimed to investigate the serum vitamin E levels before and after isotretinoin therapy in patients with acne. A total of 70 patients treated with isotretinoin for acne in our dermatology department were included in this study. The serum vitamin E levels were measured as baseline before isotretinoin treatment. All patients received 0.6–0.8 mg/kg/d isotretinoin. The treatment was finished within 5–7 months while ensuring that the cumulative dose was 120 mg/kg. Serum vitamin E levels were measured again in the last month of treatment. The mean serum vitamin E levels before and after treatment were compared. Forty‐six patients completed the study. It was detected that the mean serum vitamin E level was 20.22 mg/dl before isotretinoin treatment. In the last month of treatment, the mean serum vitamin E level was 16.24 mg/dl. Serum vitamin E levels decreased in all patients except three. The mean serum vitamin E level after treatment was statistically decreased in comparison with the mean serum vitamin E level before treatment. Our results showed that vitamin E levels decreased during isotretinoin treatment. We considered that some of the side effects due to isotretinoin treatment might be related to this, and supplementation vitamin E may be useful during isotretinoin treatment.

Dyschromatosis symmetrica hereditaria: A case report from Turkey, a new association and a novel gene mutation

the antigen-presenting activity of Langerhans cells and keratinocytes, and suppresses the transcriptional activity of the androgen receptor. These non-antibiotic effects are known as novel or anti-inflammatory effects. Due to its topical application, it acts directly on epidermal keratinocytes at high local concentrations. The skin concentration of nadifloxacin 4 h after application was 82.3 ± 21.1 lg ⁄ g, and that at 12 h after application was 6.7 ± 5.8 lg ⁄ g, which is similar to the concentration used in our experiment. Matrix metalloproteinases are produced as inactive pro-MMP, which are then activated by proteolysis to become active MMP. In inflammatory tissues, pro-MMP are activated by the proteolytic enzymes which exist abundantly in inflammatory skin. In acne lesions, MMP-1, -13 and -9 are abundant, and are thought to be induced by the inflammatory cytokines such as TNF-a produced by inflammatory infiltration or by P. acnes and involved in the scar formation of acne lesions. The inhibitory effect of nadifloxacin on these MMP could partly explain its clinical effectiveness in acne treatment. We also speculate that nadifloxacin has a preventive effect on scar formation. The induction of and the inhibitory effect on MMP-9 and -13 were controlled at the RNA level, while those of MMP-1 were not. The mechanism of the suppression of MMP-1 production is not clear and needs to be elucidated. Acne vulgaris could be considered as a kind of chronic inflammatory condition, rather than as a bacterial infection. Topical application of nadifloxacin could be considered as one such anti-inflammatory treatment for acne vulgaris in addition to antimicrobial treatment. ACKNOWLEDGMENTS

Disseminated lupus vulgaris presenting with different atypical lesions

Dear Editor, Tuberculosis is still a serious medico-social problem in various parts of the world. Cutaneous tuberculosis, which constitutes a small percentage of the extrapulmonary tuberculosis, shows considerable morphological variability. The most commonly seen form of cutaneous tuberculosis is lupus vulgaris (LV). It is often seen as a red-brown papule which progresses to an atrophic plaque located on the head and neck region. Atypical LV forms such as disseminated, hypertrophic, ulcerative and vegetative forms have been described in the published work. Although LV is mostly seen as a solitary lesion, multiple lesions associated with active pulmonary tuberculosis have also been reported. A 37-year-old man was admitted to our dermatology department clinic with asymptomatic lesions on his face, extremities and trunk. The lesions had first appeared 2 years prior on his face. Within 2 years of onset, new lesions begun to appear on his trunk and extremities while the lesion on the face gradually enlarged. There were complaints of nausea, vomiting, weight loss, polyuria and lumbago in previous few months. The personal past medical history was unremarkable. Dermatologic examination revealed a 5 cm × 5 cm, erythematous infiltrated plaque lesion extending from lip to the left chin (Fig. 1). There were also numerous, 1–2-cm ulcerative nodules covered with thick crusts on his scalp, trunk and extremities (Fig. 1) and a hyperkeratotic, vegetative plaque on his left foot great toe (Fig. 1). Oral mucosa examination showed erythematous, macerated plaques extending from buccal mucosa to pharynx and larynx. Regional lymphadenopathy was not present and physical examination was normal. Routine biochemical, hematological and urine analysis were within the normal limits except for an elevated erythrocyte sedimentation rate (69 mm/h). Serological tests including anti-HIV antibody, rapid plasma reagin and treponemal pallidum hemagglutination tests were negative. Incisional biopsy specimens taken from the plaque lesion on the face and ulcerative nodules on the trunk revealed a dermal granulomatous inflammation consisting of lymphocytes, epitheloid and Langhan’s giant cells without caseation necrosis (Fig. 2). Biopsy of the vegetative plaque on the left great toe for suspected verruca vulgaris, LV and tuberculosis verrucosa cutis showed nonspecific findings. A Mantoux test was negative after 48 h. Chest radiography and computed tomography showed no signs of pulmonary tuberculosis. Bronchoscopic examination was normal and Ehrlich–Ziehl–Neelsen staining of the sputum, bronchial lavage and urine were negative for acid-fast bacilli. Culture using Lowenstein–Jensen medium was positive for sputum but negative for skin and urine. Bronchial lavage specimen tested using real-time polymerase chain reaction (PCR) was negative for Mycobacterium tuberculosis. M. tuberculosis DNA was detected in the biopsy specimen of the skin taken from face and trunk by real-time PCR. The real-time polymerase chain reaction was performed as follows: a standard protocol for extraction (QIAamp DNA mini kit; QIAGEN, Hilden, Germany) and amplification (iCycler iQ, v3.0a; Bio-Rad Laboratories, Hercules, CA, USA) of M. tuberculosis DNA was performed on the biopsy sample. Active or past pulmonary tuberculosis was excluded based on bronchoscopic examination,

Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) induced by oral metronidazole

Abstract Baboon syndrome is a special form of systemic contact dermatitis to systemic or local administration of contact allergens. Baboon syndrome without known previous cutaneous sensitisation was also described as drug-related baboon syndrome or symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). The major drugs causing SDRIFE was beta-lactam antibiotic such as amoxicillin and ampicillin. We report a case of 16-year-old woman who developed pruritic eruptions after oral metronidazole treatment for diarrhea. She was diagnosed SDRIFE according to her clinical and histopathological findings. To our knowledge, our patient is the first case who developed SDRIFE due to metronidazole in the literature.

Comedogenic acne following radiation therapy

ejd.2011.1537 Auteur(s) : Evren Odyakmaz Demirsoy1 evrenodyakmaz@yahoo.com, Rebiay Kiran1, Burcu Ozturk1, Sevgiye Ozkara Kacar2, Aysun Şikar Akturk1 1 Department of Dermatology 2 Department of Pathology, Kocaeli University Medical Faculty Kocaeli, Turkey Different types of radiation may induce acneiform eruptions. Favre-Racouchot syndrome, which is characterized by yellow atrophic plaques with large comedones, wrinkles and furrows on sun-exposed areas, is the most commonly seen form of radiation-induced [...]