Cengizhan Erdem

Improved efficacy and tolerability of retinoic acid in acne vulgaris: a new topical formulation with cyclodextrin complex ψ

Objectives  Retinoic acid (RA) has long been used, both topically and systemically, for disorders of keratinization, acne and related disorders. In the present study, the efficacy and tolerability of topical RA prepared as a cyclodextrin beta complex (β‐CD) is investigated in 66 acne vulgaris patients.

The efficacy, tolerability and safety of a new oral formulation of Sandimmun®–Sandimmun Neoral® in severe refractory atopic dermatitis

Aim To investigate the efficacy, tolerability and safety of a new oral formulation of Sandimmun®‐Sandimmun Neoral® in severe refractory atopic dermatitis in an open, multicenter study.

Juvenile colloid milium associated with conjunctival and gingival involvement

Juvenile colloid milium is an uncommon cutaneous disease characterized by translucent papules distributed on sun-exposed areas with early onset. Association of juvenile colloid milium with conjunctival and gingival deposits is uncommon and interesting. We report a case of juvenile colloid milium associated with conjunctival and gingivai deposits of an amyloid-like homogeneous eosinophilic material. It seems that all 3 of these in our patient may be different expressions of the same pathologic disease.

Treatment of Basal Cell Carcinoma Located in the Head and Neck Region with Intralesional Interferon α-2a

AbstractObjective: Intralesional injections of interferon have been reported to provide successful results in the treatment of basal cell carcinoma. However, there are only a few reports describing the long-term efficacy of this therapy. The aim of our study was to evaluate the efficacy and long-term results of interferon α-2a (IFNα-2a) in the treatment of basal cell carcinoma. Methods: Twenty dermatopathologically proven basal cell carcinoma lesions were treated with intralesional IFNα-2a injections three times weekly for 3 weeks. The dose per injection was 1.5 sX 106 IU if the lesion was <2cm in diameter and 3.0 sX 106 IU if it was >2cm. Eight weeks after the last injection, the lesion sites were rebiopsied and all cases were reevaluated both clinically and dermatopathologically. Patients with complete cure were followed up for 7 years to determine the long-term results. Results: Eleven lesions (55%) showed complete clinical and dermatopathological remission, six lesions (30%) showed partial remission, and two lesions (10%) showed no response. One lesion (5%) increased in size during the treatment. No serious adverse effects were observed. During the follow-up period there was only one recurrence, at the fifth year. Conclusion: Treatment with intralesional IFNα-2a was shown to be an effective therapeutic option for basal cell carcinoma, with low recurrence rates in long-term follow-up.

Long-term results of rituximab–intravenous immunoglobulin combination therapy in patients with epidermolysis bullosa acquisita resistant to conventional therapy

Abstract Background: Epidermolysis bullosa acquisita (EBA) is a rare subepidermal bullous disease. Long-term remission in this disease is difficult using current treatments, unlike that in patients with other autoimmune bullous diseases. Objective: We retrospectively evaluated the effectiveness and side effects of rituximab–intravenous immunoglobulin (IVIg) combination treatment in five patients with EBA resistant to conventional treatment. Patients and methods: Rituximab (375 mg/m2) was administered for four consecutive weeks to four patients, and their treatment continued with IVIg at a dose of 2 g/kg/month. One patient received two cycles of rituximab for three consecutive weeks, IVIg in the fourth week, followed by monthly IVIg administrations as in the other patients. Results: The total number of IVIg therapy cycles ranged from 10 to 26 (mean 19.4). Mean skin involvement, mucosal involvement, and disease severity scores decreased after a mean follow-up of 22.6 months (range, 10–28 months). In an analysis performed during months 24–28, the number of CD19-positive B cells was found to be below the normal reference range in four patients. Limitations: This was a retrospective study with a limited number of patients. Conclusion: Rituximab–IVIg combination treatment seems to be effective and safe for treating patients with EBA resistant to conventional treatments.

Juvenile non‐hyaline fibromatosis: juvenile hyaline fibromatosis without prominent hyaline changes

Abstract:  Juvenile hyaline fibromatosis (JHF) is a rare autosomal recessive disease of the connective tissue. It is characterized by papulonodular skin lesions, soft tissue masses, gingival hypertrophy, osteolytic bone lesions and flexion contractures of the large joints. Here, we report a 14‐year‐old girl with characteristic clinical features of JHF with early fatal outcome. Dermatopathologic examination of the early lesions however constantly lacked the so‐called hyalin changes in multiple skin biopsies.

Comparison of dermatoscopic diagnostic algorithms based on calculation: The ABCD rule of dermatoscopy, the seven-point checklist, the three-point checklist and the CASH algorithm in dermatoscopic evaluation of melanocytic lesions.

Dermatoscopic analysis of melanocytic lesions using the CASH algorithm has rarely been described in the literature. The purpose of this study was to compare the sensitivity, specificity, and diagnostic accuracy rates of the ABCD rule of dermatoscopy, the seven‐point checklist, the three‐point checklist, and the CASH algorithm in the diagnosis and dermatoscopic evaluation of melanocytic lesions on the hairy skin. One hundred and fifteen melanocytic lesions of 115 patients were examined retrospectively using dermatoscopic images and compared with the histopathologic diagnosis. Four dermatoscopic algorithms were carried out for all lesions. The ABCD rule of dermatoscopy showed sensitivity of 91.6%, specificity of 60.4%, and diagnostic accuracy of 66.9%. The seven‐point checklist showed sensitivity, specificity, and diagnostic accuracy of 87.5, 65.9, and 70.4%, respectively; the three‐point checklist 79.1, 62.6, 66%; and the CASH algorithm 91.6, 64.8, and 70.4%, respectively. To our knowledge, this is the first study that compares the sensitivity, specificity and diagnostic accuracy of the ABCD rule of dermatoscopy, the three‐point checklist, the seven‐point checklist, and the CASH algorithm for the diagnosis of melanocytic lesions on the hairy skin. In our study, the ABCD rule of dermatoscopy and the CASH algorithm showed the highest sensitivity for the diagnosis of melanoma.

Basosquamous carcinoma: Dermoscopic clues to diagnosis.

Basosquamous carcinoma (BSC) is a rare skin cancer which has areas of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) and a transition zone between them. However, dermoscopic features of BSC are not well described in the published work, except one study. The aim of the present study was to better identify and clarify the dermoscopic findings of BSC in the largest group of patients in the published work and to describe its dermoscopic features according to histopathologically BCC‐dominant, SCC‐dominant and intermediate categories. Dermoscopic features of 36 histopathologically proven BSC and their dermatopathological correlates were retrospectively analyzed. Dermoscopic features were evaluated by pattern analysis. Keratin mass (91.7%) was the most common dermoscopic feature. Surface scaling (77.8%), ulceration (69.4%), white structureless areas (69.4%), white clods (66.7%) and blood spots on keratin mass (66.7%) were the other frequent findings. Polymorphous vascular pattern consisting of various combinations of branched, serpentine, straight, coiled or looped vessels were detected in 61% of the lesions. BSC has BCC‐dominant vascular features together with otherwise SCC‐dominant morphology, the common pattern seen in BSC lesions being BCC‐dominant polymorphous or monomorphous vasculature, together with dermoscopic findings of keratinization. White circles, known to be a valuable clue to SCC and keratoacanthoma, were present at the same magnitude in BSC in our study. The observed histological correlation of eosinophilic keratin overlying the epithelium which lined follicular infundibulae in these tumors, provides a plausible new perspective on dermoscopic white circles.

Post-renal transplantation Leser-Trélat sign associated with carcinoma of the gallbladder: A rare association

The sign of Leser-Trélat represents the sudden appearance of multiple seborrheic keratoses in association with an underlying malignancy. The most common associated neoplasms belong to the gastrointestinal tract, mainly the stomach and colon. In the literature, there is only one case of gallbladder carcinoma associated with the Leser-Trélat sign. Thus, the hallmark of our patient is post-renal transplant malignancy-associated Leser-Trélat, which has not been reported before. Here, we report on a 57-year-old man who presented with a sudden increase in the number and size of seborrheic keratoses, particularly on sun-exposed areas 24 years after renal transplantation. The search for an underlying malignancy showed the presence of an adenocarcinoma of the gallbladder which had metastasized to the liver.

Dermatoscopy of a melanoma less than one millimeter in diameter

Dermatoscopy of a melanoma less than one millimeter in diameter Sir, We report the smallest melanoma (0.9 mm and 0.6 mm in diameter dermatoscopically and histologically, respectively) in a 32-year-old female with a history of three melanomas in the previous 3 years. The patient was under automated total body photography follow-up at 3-month intervals (FotoFinder Bodystudio ATBM), and a new 0.9 mm diameter pigmented lesion on her left lateral thigh was detected (Fig. 1). At the time of presentation, dermatoscopic features included eccentric black clods, one pseudopod, and gray branched/reticular lines. All of these clues except the grey color were equivocal. There were no compelling clues to malignancy according to any of the published algorithms except chaos and clues. Although the lesion was reasonably symmetrical, according to Chaos and Clues, a small lesion with any of the nine defined clues to malignancy or any changing lesion on an adult should be considered for biopsy even if symmetrical. Consequently, after additional consideration that this was a high-risk patient, excisional biopsy was performed, and a pathology report of melanoma in situ was rendered. Histological examination (Fig. 2) was evaluated by three pathologists and revealed disorganized nests of melanocytes located at irregular intervals within the basal epidermis and confluence of single melanocytes. Isolated melanocytes were located within the granular and spinous layers. Occasional mitotic figures were observed within the junctional melanocytes. Dermal infiltration was not detected. As most melanomas are larger than most melanocytic nevi, it is common practice for dermatoscopists not to pay attention to small lesions, with only the larger ones being examined by dermatoscopy. However, all melanomas begin as small lesions, which can subsequently grow in diameter and depth. This is consistent with the theory of tumorigenesis. If a cancer begins as one cell, then even a 1 mm melanoma has a malignant cell population at least in the thousands. This proposal is also consistent with stem cell theory that melanomas could develop from quiescent precursor cells that have accumulated a malignant complement of mutations. Any model proposed for melanomas developing from nevi, at best, can only be applied to a minority of melanomas, being fundamentally flawed for the vast majority which are known to develop de novo. While it was asserted that there were no dermatoscopic criteria to distinguish nevi from in situ melanomas, the science of dermatoscopy has progressed to a stage where dermatoscopy is now known to improve accuracy for even in situ melanomas. The clinical ABCDE acronym (asymmetry, border irregularity, color variegation, diameter >6 mm, evolution) was developed as a diagnostic approach for the early detection of cutaneous melanomas while the prognosis is still good. Critics have proposed that the existence of small melanomas (≤6 mm diameter) makes revision of the D criterion appropriate. Rosendahl et al., suggested that in the clinical ABCD method, the D for diameter could be appropriately substituted with D for dynamic, arguing that the arbitrary designation of a diameter greater than 6 mm to the clinical diagnosis of melanoma, as in the clinical ABCD method, is inappropriate. Previously dermatoscopic features of four minute melanomas with a diameter of 1.5–2 mm were reported. One of Figure 1 Clinical (upper image) and dermatoscopic (lower image) of a pigmented skin lesion 0.9 mm in diameter as measured on the dermatoscope face-plate scale. Dermatoscopy reveals grey branched lines, one equivocal pseudopod (central upper border) and equivocal peripheral black clods (lower left border). Equivocal clues are best discarded leaving the gray structures as the defining clue