Berna Aksoy

The impact of rosacea on quality of life: effects of demographic and clinical characteristics and various treatment modalities.

Summary Background  Rosacea has a major psychosocial impact on a patient’s life.

Clinical Experience in the Treatment of Different Vascular Lesions Using a Neodymium‐Doped Yttrium Aluminum Garnet Laser

BACKGROUND A neodymium‐doped yttrium aluminum garnet (Nd:YAG) laser has been used with good results for the treatment of various vascular lesions. OBJECTIVE To report our experience with a variable long‐pulsed Nd:YAG laser for the treatment of different vascular lesions. MATERIALS AND METHODS One hundred ten patients with different vascular skin lesions were included. Patients were examined before the treatment; 1 week after each treatment session; and 1, 2, and 3 months after the last treatment session. Improvement was judged according to clinical examination of the patients and by comparing pre‐ and post‐treatment photographs. Results were graded in four groups using percentage resolution (0–25%, 26–50%, 51–75%, and 76–100%. RESULTS One hundred five patients (19 port wine stains, 48 telangiectasias, 25 hemangiomas, and 13 other vascular lesions) completed the study; 71.5% of patients showed greater than 50% improvement. Good to excellent (more than 50%) results were achieved in 63.2% of patients with port wine stain, 80.0% of patients with hemangioma, 66.7% of patients with telangiectasia, and 84.6% of patients with other vascular lesions; 71.5% of all patients were very satisfied or satisfied with the results. CONCLUSION A variable long‐pulsed Nd:YAG laser was found to be effective in the treatment of different vascular lesions ranging from easy to difficult to treat.

Basal cell carcinoma in Turkey

Basal cell carcinoma (BCC) is the most common form of cancer in Caucasians. This study was undertaken to define clinical features of BCC treated by surgical excision in Turkish patients. One‐hundred and ninety‐eight patients with 216 BCC, all treated by surgical excision, were studied prospectively. Age and sex distribution, personal and family history, skin type, site and size of the lesions, clinical type of the lesions, status of surgical margins and incidence of recurrence were analyzed. The male to female ratio was 9:10, and the average age of the patients was 64.5 years. Of the tumors, 91.5% occurred on the head and neck. There was also personal and/or family history of cancer in 24.8% of our cases. Of all BCC treated, 83.8% had a noduloulcerative clinical appearance. The vast majority of our patients were Fitzpatrick type 3 (53.0%) and type 2 (41.5%). There were seven recurrences after follow‐up periods varying between 3 months and 2 years. In conclusion, clinical characteristics of BCC in Turkish patients have both similarities and differences compared with other countries.

Does recurrent aphthous stomatitis affect quality of life? A prospective study with 128 patients evaluating different treatment modalities

Abstract Introduction: Quality of life measures are increasingly being used in the evaluation of oral disease outcome. To date, there has been less focus on oral health-related quality of life (OHR-QoL) measures for oral diseases in dermatologic literature. Objective: To test whether patients with recurrent aphthous stomatitis (RAS) report a lower OHR-QoL than the general population and to evaluate therapeutic regimens for RAS by using OHR-QoL measures. Method: A total of 128 patients and 40 controls were enrolled. A questionnaire entitled the 14-item oral health impact profile (OHIP-14) was completed. Forty-three (33%) of the patients were followed-up and completed the OHIP-14 following treatment. Results: The median total score of patients on colchicine before treatment was 21. Following use of colchicine, the total score was 10. There was a significant difference concerning the impact of oral health following use of oral colchicine. However, no reduction of OHIP-14 scores was observed in the topical treatment group. Conclusion: When the influence of one of the most common oral diseases such as RAS on OHR-QoL was taken into consideration, OHR-QoL provides an additional dimension that may help to improve the impact of a disease on an individuals life. In relation to this, colchicine seems to be one of the most effective management strategies used in RAS.

Effectiveness of topical use of natural polyphenols for the treatment of sacrococcygeal pilonidal sinus disease: a retrospective study including 192 patients

Sacrococcygeal pilonidal sinus disease (SPSD) is a common disorder. None of the current treatment methods seems to be the ideal treatment for SPSD. In this study, we evaluated the effectiveness of polyphenols produced from the components of natural organic matter in soil in the treatment of SPSD. One hundred and ninety two patients with SPSD who used topical polyphenols for the treatment of their disease were studied retrospectively. Information on the characteristics of patients and treatment and results of treatment were obtained from the patient files and/or by telephone surveys. The median duration for total treatment was 12 weeks and the mean follow up period was 22 months. One hundred and sixty six (86.5%) patients got benefit from the treatment. Fifty one (26.6%) patients had minor temporary side effects. In 64 (33.3%) patients SPSD relapsed. Patients were able to continue their normal daily activities during the treatment period and there was no loss of work days. Locally applied natural polyphenols are one step in the direction of finding an ideal treatment of SPSD. They are easy to apply, cheap, safe and associated with a low risk of complications. Their use was not associated with time off work, unnecessary hospital stay or any anatomical distortion of the natal cleft.

Hair transplantation for therapy-resistant alopecia areata of the eyebrows: is it the right choice?

Alopecia areata is a common skin disorder of presumed autoimmune etiology and it usually shows an unpredictable course. Treatment of alopecia areata is challenging. There is very little information on the use of surgical therapies for the treatment of alopecia areata in the medical published work. A 24‐year‐old male patient was referred to a private hair transplantation clinic owned by one of the authors for the treatment of therapy‐resistant alopecia areata affecting both eyebrows. He had quickly lost all body hair 4 years prior beginning from the scalp. He received psoralen and ultraviolet A (PUVA) therapy for alopecia universalis and all body hair re‐grew except his eyebrows. Alopecia areata was stable for the 18 months following the last medical treatment he received. Because there was no response to various medical therapeutic agents, we decided to transplant occipital hairs to the eyebrow area. After the patient understood and accepted all risks, occipital hairs were transplanted to the eyebrows by using the follicular unit extraction technique. Postoperatively, the patient did not receive any topical or systemic therapies for alopecia areata. Although 40% hair re‐growth was detected in his eyebrows at 1 year postoperation, this rate was 80% by 2 years postoperation. However, there was resistance to re‐growth in the medial eyebrow regions. New eyebrows grew as occipital hairs and required trimming. His satisfaction from the surgical procedure was 90% at the end of the 24th postoperative month. Surgical treatment of diseases like alopecia areata is still controversial. Our case report offers an additional contribution to the published work on the surgical methods used in the treatment of stable alopecia areata.

Effectiveness of topical zinc oxide application on hypertrophic scar development in rabbits

BACKGROUND The etiology, biology, prevention and effective treatment of hypertrophic scars have not exactly been defined. Topical zinc oxide application was shown to be effective in the treatment of proliferative scars. We studied the effectiveness of topical zinc oxide ointment in the prevention of hypertrophic scar development by using the rabbit ear hypertrophic scar model. METHODS Circular full-thickness skin excisions were performed on both ears of 10 rabbits. The rabbits were divided into two groups and topical 40% zinc oxide ointment was applied daily to one ear and the ointment base was applied as placebo to the other ear. Scar samples were taken in the 3rd week in group 1 and in the 6th week in group 2. All of the specimens were divided into two halves: one half for histopathologic/histomorphometric examinations and the other half for biochemical studies. RESULTS Application of topical zinc oxide ointment decreased clinical scar hypertrophy scores significantly (p=0.017) at 6th week in comparison with placebo. Topical zinc oxide also reduced nodule formation histopathologically at 6th week in comparison with placebo but this was not significant statistically (p>0.05). CONCLUSION The findings of this study may have clinical implications on the management of human hypertrophic scars.

Lateral Foldplasty with or without Partial Matricectomy for the Management of Ingrown Toenails

BACKGROUND Ingrown toenails are common and lead to significant morbidity. OBJECTIVE This retrospective study was aimed at evaluation of our new surgical technique of lateral foldplasty with limited lateral matrix resection in some cases for the management of ingrown toenails with regard to recurrence rates, spicule formation, local infection, partial flap necrosis, and cosmetic outcome. METHODS & MATERIALS Thirty‐two patients with 52 ingrown nails were included in this study. Lateral foldplasty procedure alone was preferred for the surgical treatment of 18 ingrown toenails of mild to moderate severity. Lateral foldplasty with limited lateral matrix resection was performed in 34 ingrown nails in patients with broad nail plates or for moderate to severe cases with significant granulation tissue formation. RESULTS Relapse rate, local infection rate, and partial flap necrosis rate were very low. Spicule formation was not observed. The cosmetic appearance of the nail did not disturb any patient treated with this procedure. CONCLUSION The lateral foldplasty procedure alone or combined with limited lateral matrix resection is a cheap, simple, and satisfactory technique for the treatment of ingrown toenails with a low risk of relapse. This technique also has good cosmetic results. The authors have indicated no significant interest with commercial supporters.

Confetti‐like macular atrophy: A new entity?

Anetoderma, is characterized by herniated atrophic macules clinically and by decreased to absent dermal elastic fibers histopathologically. Atrophoderma is characterized by depressed, atrophic, pigmented patches clinically and by thickened and homogenized dermal collagen bundles with absence of elastolysis histopathologically. Atrophoderma elastolyticum discretum describes lesions that are reminiscent of atrophoderma clinically but they are compatible with anetoderma histopathologically. A 34‐year‐old female patient presented with diffuse, hypopigmented, atrophic, shiny macules on the upper limbs and upper trunk. Histopathological examination revealed an atrophic epidermis with disorganized, hyalinized and coarse collagen bundles in the middle and lower dermis. Elastic fiber loss and fragmentation were detected in the upper dermis. The other patient was a 42‐year‐old female patient. She applied with diffuse, hypopigmented, shiny, atrophic macules on the upper limbs and upper trunk. Histopathological examination revealed findings that were similar to those of the first case but there was near complete loss of elastic fibers throughout the whole thickness of dermis. Our cases did not show depressed or herniated atrophic macules clinically but the macules were at the same level with the surrounding healthy skin. Histopathological findings in these cases showed the histopathological features of both atrophoderma and anetoderma. These two cases are interesting because they may represent a clinicopathological entity which has not been described before.

A new experimental delayed wound healing model in rabbits

Chronic wounds pose important problems in clinical practice and their treatment is difficult and costly. Here we describe a new delayed wound healing animal model. Fifteen male New Zealand rabbits were used in this study. A horizontal incision 4 cm in length was made on the dorsal part of the torso and pure skin flaps were raised in front of and behind this incision. This exposed the panniculus carnosus layer and it was resected. Skin flaps were returned to their places and sutured. After a 3 week period of healing third degree burn injury was inflicted using hot metal plates both on the healed flaps and at the same location on the opposite side. Scar samples were sent for histopathological examination after healing. The wounds on the panniculectomy side healed in an average of 43.20 days but on the control side they healed in an average of 32.80 days (p < 0.05). Wound healing was slower and scars were broader and more irregular on the panniculectomy side. In our new model, addition of panniculectomy to full thickness burn injury significantly delayed wound healing with a decrease in scar quality. This is a simple, economic and effective animal model to study delayed wound healing.