Burhan Engin

The levels of depression, anxiety and quality of life in patients with chronic idiopathic urticaria

Background  Chronic idiopathic urticaria (CIU) is associated with severely impaired quality of life (QoL).

Treatment of Chronic Urticaria with Narrowband Ultraviolet B Phototherapy : a Randomized Controlled Trial

Data regarding narrowband ultraviolet B (NB-UVB) phototherapy in patients with chronic urticaria is limited. The aim of this open, controlled study was to determine whether NB-UVB is effective in treating urticaria in combination with antihistamin. A total of 81 patients with chronic urticaria were recruited, 48 of whom were randomized into the NB-UVB plus antihistamine group. The control group (n = 33) received only antihistamine. Patients were assessed using the urticaria activity score and a visual analogue score (VAS). The 2 groups were evaluated at the same time-points: at treatment sessions 10 and 20 and at follow-up 3 months post-treatment. The reduction in urticaria activity score and VAS was statistically significant (p < 0.05 for both groups). When comparing the groups, the mean urticaria activity score was significantly lower in the NB-UVB group at session 10 (22.6 vs. 27.3) and session 20 (17.4 vs. 20.7). Statistically significant differences were also noted in VAS between the 2 groups (p < 0.01) at 3 months post-treatment. We conclude that NB-UVB may be an effective complementary treatment for patients with chronic urticaria.

Axis I and Axis II diagnoses in patients with chronic idiopathic urticaria

OBJECTIVE This study presents the current prevalence of Axis I and Axis II psychiatric diagnoses and factors associated with the existence of Axis I psychiatric disorders in patients with chronic idiopathic urticaria (CIU). METHOD The study sample was composed of 89 patients with CIU and 64 control subjects. Axis I and Axis II psychiatric disorders were ascertained by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders, respectively. RESULTS Of patients with CIU, 44 (49.4%) had at least one Axis I diagnosis, and 40 (44.9%) had at least one personality disorder. The most common Axis I disorder was obsessive-compulsive disorder (25.8%), and the most common Axis II disorder was obsessive-compulsive (30.3%) personality disorder in patients with CIU. Obsessive-compulsive disorder, major depression, obsessive-compulsive and avoidant personality disorders were more prevalent in patient group compared to control group. Obsessive-compulsive and avoidant personality disorders were related to the existence of Axis I disorders in patients with CIU. CONCLUSION Psychiatric morbidity seems to be a frequent healthy problem in patients with CIU.

Treatment of facial port-wine stains with intense pulsed light: a prospective study

Background  Intense pulsed light (IPL) has been used for the treatment of port‐wine stains for 10 years. There are many IPL systems that have different setting. Some of them have been reported in the treatment of fresh or laser‐resistant port‐wine stains localized in different body regions.

Treatment of Angiokeratoma of Fordyce with Long‐Pulse Neodymium‐Doped Yttrium Aluminium Garnet Laser

BACKGROUND Angiokeratomas are typically asymptomatic, blue-to-red papules with a scaly surface located on the scrotum, shaft of penis, labia majora, inner thigh, or lower abdomen. The treatment of angiokeratomas may be necessary if they bleed and lead to patient anxiety. OBJECTIVE To determine the safety and effectiveness of long-pulse 1,064 neodymium-doped yttrium aluminium garnet (Nd:YAG) laser for the treatment of angiokeratomas of Fordyce. MATERIALS AND METHODS Ten consecutive patients with angiokeratoma of Fordyce were treated with long-pulse Nd:YAG laser in two to six sessions. The three authors independently assessed improvement of the lesion based on digital photographs taken before the treatment and 2 months after the end of the treatment. RESULTS Significant (>75%, <100%) and moderate (>50%, <75%) improvement was seen in six and two patients, respectively. Complete improvement was achieved in one patient. Transient swelling, purpura, bleeding, and some pain in the treated area were noted in all patients as short-term side effects. There were no permanent side effects. CONCLUSION The long-pulse Nd:YAG laser is a highly effective and safe treatment for angiokeratoma of Fordyce.

Quality of life in patients with chronic idiopathic urticaria: the impact of Axis I and Axis II psychiatric disorders.

OBJECTIVE Chronic idiopathic urticaria (CIU) associated with lower quality of life (QoL) levels. Psychiatric disturbances are frequently present in patients with CIU. This study examined the impact of Axis I and Axis II psychiatric disorders on the QoL of patients with CIU. METHOD The study sample consisted of 100 subjects including CIU patients with only Axis I psychiatric diagnoses (n=25), CIU patients with only Axis II diagnoses (n=25), CIU patients with both Axis I and Axis II diagnoses (n=25), CIU patients without any Axis I and Axis II diagnosis (n=25), and healthy control subjects with respect to urticaria and psychiatric disorders (n=25). The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (SCID-1) and the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders (SCID-II) was used to determine Axis I and Axis II psychiatric disorders, respectively. QoL levels were assessed by means of the World Health Organization QoL Assessment-Brief (WHOWOL-BREF). RESULTS There were significant differences among the groups with respect to all WHOQOL-BREF subscale scores. The QoL levels were similar among CIU patients with only Axis I psychiatric diagnoses, CIU patients with only Axis II diagnoses and CIU patients with both Axis I and Axis II diagnoses, and between CIU patients without any Axis I and Axis II diagnosis, and healthy control subjects. When compared with those of CIU patients without any Axis I and Axis II diagnosis, CIU patients without concurrent psychiatric diagnoses had significantly lower scores in most domains of the QoL scale. CONCLUSIONS Axis I and Axis II psychiatric disorders seem to be considerable factors influencing the QoL in CIU patients.

Treatment of plaque-type localized scleroderma with retinoic acid and ultraviolet A plus the photosensitizer psoralen: a case series

© 2007 The Authors 519 JEADV 2008, 22, 499–527 Journal compilation

Evaluation of application of multiple needle pricks on the pathergy reaction

Background  The pathergy reaction (PR) to a needle prick is a well‐known feature of Behçets disease (BD). Although PR is accepted as a major criterion in this disease, there is a lack of a standardized method to measure PR. The aim of this study was to evaluate the effect on the positive rate of PR of the application of numerous (one to six) needle pricks.

Patch test results in patients with progressive pigmented purpuric dermatosis

Editor Pigmented purpuric dermatoses are chronic and relapsing disorders characterized by a symmetrical rash of petechial and pigmentary macules confined to the lower limbs. 1–5 The patch test results had present relevance in some case reports related to progressive pigmented purpuric dermatosis (PPPD). 6,7 We tested the hypothesis that contact allergy plays a role in PPPD. Patch tests were carried out with the European Standard Series including 23 ‘type IV’ substances. The patch tests were applied to unaffected skin of the upper back and then positive patch test allergens were applied to the lesion site. Incriminated allergen was eliminated in patch test-positive patients and they were evaluated after 1 month. During this period, any systemic or topical treatments were not given to the patients. Twenty-two patients with PPPD were enrolled in the study and were patch tested. One patient’s test result could not be evaluated because of back erythema and oedema. Male-to-female ratio was 13 : 9. The ages ranged between 23 and 64 years (average, 48 years). The average duration of the skin disease was 10 months (range, 3–24 months). In all patients, the lower extremities were the main affected sites. In total, 23 reactions, as shown in Table 1, were recorded in PPPD patients. Patch tests were positive in 12 of 22 patients (54%), although none of the patients had actual signs of contact dermatitis. The positive patch test results persisted until the day 7 reading in 6 patients. Of the 12 patients with positive reactions, 3 (25%) reacted to only one allergen, 6 (50%) to two, and 3 (25%) to four allergens. None of the patients had a purpuric response to patch tests. Four allergens were applied to the lesion site (legs) of the patch test-positive patients. Of the 12 patients with positive reactions, allergic reaction to nickel sulphate, fragrance mix, Disperse Blue 106 and formaldehyde resins were recorded positive in 2 (22%), 4 (44%), 2 (22%) and 1 patients, respectively. Clinically test areas revealed oedema and erythema. However, petechiae were not recorded in any test areas. Four patients whose patch test was positive at the usual site and at the lesion site cleared after elimination of the allergen. While clearing was complete in three patients, one patient showed partial clearing. There has been little data on the relationship between contact allergens and PPPD and the underlying mechanisms are unknown. PPPD might have been suggestive of a pigmented purpuric contact dermatitis triggered by determined test series. Up till now, some cases of purpuric contact dermatitis have been reported to be related to azo dyes, para -phenylenediamine, black rubber chemicals, cobalt, benzoyl peroxide, epoxy resin, methylmethacrylate and eutectic mixture of local anaesthetics. 6 The allergens triggering the allergic reaction in our series were nickel sulphate, fragrance mix, Disperse Blue 106 and formaldehyde resins. Vascular damage and erythrocyte extravasation in PPPD may be secondary to localized cell-mediated immunological events. In our series, allergens may indicate a possible role in the pathogenesis of the PPPD, which may be acting directly through cell-mediated immune reactions inducing lymphocytic capillaritis, the characteristic pathological feature in the pigmented purpuric dermatosis. The importance of alternative patch testing modalities related to the applying sites was shown and it was speculated that only patch testing at the lesion site made an aetiologic relation possible. 6 However, patch tests performed on the back, as in our case series, have revealed the positive patch testing correlation between the usual site and the lesion site. And also, four patients cleared after elimination of the allergen. This result supports the evidence that both patch testing at the usual site and the lesion site may give a correct aetiologic relationship between an allergen and PPPD.

Pyogenic granuloma following treatment of a port-wine stain with intense pulsed ligt.

Pyogenic granuloma (PG) is acquired benign vascular hyperplasia, and it has been reported to be associated with many traumatic processes. PG can appear within an existing portwine stain (PWS), either de novo or following traumatic manipulations such as smallpox vaccination and laser treatment. Hormonal factors may also be responsible for this association. 1 Although the development of PG in PWS has been reported after treatment with several kinds of laser sources, 2 this association has not been described after or during treatment with an intense pulsed light (IPL) source. For this reason, we report a PG within a facial PWS during treatment with an IPL source (Lumina system). A 20-year-old female was admitted with a congenital PWS on the left aspect of her face for IPL treatment (Fig. 1). Her skin type was III according to Fitzpatrick skin types. Color of the PWS was from pink to reddish purple. Lumina IPL system [585-nm handpiece (550–1100 nm)] was used for the treatment. The light was delivered to the patient via a quartz contact block, the size of which was 2.5 × 1 cm 2 . A clear USG gel was applied between the tip of the block and the patient skin. The patient’s skin was cooled using ice packs after the treatment. Four treatment sessions were applied the patient. In the first treatment session, 28 J/cm 2 fluency and 2 pulses and 20-ms delay were used. Because of achievement of moderate fading of PWS, 22 J/cm 2 fluency and 2 pulse with 20-ms delay was used in three following sessions. An after-sun cream was applied after the treatment, and the patient was advised to use a higher sunscreen during the treatment period. Transient erythema, crust, and blister formation was seen in some treated area after every treatment session. The patient was warned to avoid scratching or picking scab or blisters. After four treatment sessions, 70% fading and mild hyperpigmentation in a small area were seen in the patient’s PWS. In the left preauricular region, a violaceous nodule occurred within PWS after 1 month of the fourth treatment session (Fig. 2). The nodule bled spontaneously and with mild trauma. Shave excision of the nodule was done followed by electrodessication. A mass of numerous dilated capillaries with variable luminal diameters was seen in histopathology of the lesion. The capillaries were organized into lobules separated by fibrous stroma. The stroma showed an increase in pericytes and an acute and chronic inflammatory infiltrate. These findings were consistent with the diagnosis of PG. PG is regarded as a reactive rather than a neoplastic tumor, and it may have a propensity to develop at sites of microscopic arteriovenous anastomoses such as the fingers, hands, face, tongue, and PWS. The etiology and pathogenesis of PG are not fully understood. However, some factors (minor trauma, traumatic therapeutic manipulations, chronic irritation, pregnancy, infections, viral oncogenes, and burn) have been accused of