Duriye Deniz Demirseren

Treatment of ocular rosacea: comparative study of topical cyclosporine and oral doxycycline.

AIM To compare the effectiveness of topical cyclosporine A emulsion with that of oral doxycycline for rosacea associated ocular changes and dry eye complaints. METHODS One hundred and ten patients with rosacea were screened. Thirty-eight patients having rosacea associated eyelid and ocular surface changes and dry eye complaints were included in the study. Patients were randomly divided into two groups: nineteen patients were given topical cyclosporine twice daily and nineteen patients were given oral doxycycline 100 mg twice daily for the first month and once daily for the following two months. Symptom and sign scores, ocular surface disease index questionnarie and tear function tests were evaluated at baseline and monthly for 3mo. Three months after results were compared with that of baseline. RESULTS Mean values of symptom, eyelid sign and corneal/conjunctival sign scores of each treatment group at baseline and 3mo after treatments were compared and both drugs were found to be effective on rosacea associated ocular changes (P<0.001). Cyclosporine was more effective in symptomatic relief and in the treatment of eyelid signs (P=0.01). There was statistically significant increase in the mean Schirmer score with anesthesia and tear break up time scores in the cyclosporine treatment group compared to the doxycycline treatment group (P<0.05). CONCLUSION Cyclosporine as a topical drug can be used in the treatment of rosacea associated ocular complications because it is more effective than doxycycline. In addition ocular rosacea as a chronic disease requires long term treatment and doxycycline has various side effects limiting its long term usage.

Basal Cell Carcinoma of the Head and Neck Region: A Retrospective Analysis of Completely Excised 331 Cases

The aim of the study is to analyze all completely excised BCCs in the head and neck region with regard to age, sex, personal and familial history, skin type, tumor localization and size, histopathological subtype of tumor, reconstruction method, and recurrence rates. Incompletely excised BCCs were not included in this study since incomplete excision is the most important preventable risk factor for recurrence. In 320 patients, 331 lesions were retrospectively evaluated by dividing into the following 8 subunits: scalp, frontotemporal, orbital, nose, cheek, auricula, perioral, and chin-neck area. Most of the patients were in 60–70 age group (34.7%). The nose (32.3%) was the most common site of presentation. Clinically, all lesions and, histopathologically, most of the lesions (42.2%) presented were of the nodular type. All cases of recurrence after complete excision (n = 9, 2.7%) were located in the median parts of the head and neck region and were mainly diagnosed histopathologically as sclerotic and micronodular. Even though completely excised, head and neck region BCCs, especially which are more prone to recurrence due to anatomical and histopathological properties, should be more closely monitored in order to decrease morbidity and health care costs.

The weeks and the cumulative doses of the first adverse events related to oral isotretinoin in acne patients: analysis of 300 patients

Abstract Background: The purpose of our study is to find out in which weeks and in which cumulative doses the side effects emerge and to study whether or not there is a significant variance between the observed period and doses of the emergent side effects of the patients taking the daily doses of below and above 0.5 mg/kg. Methods: Patients were started treatment with doses of 0.25–1 mg/kg isotretinoin, and a form was given to the patients to mark which probable side effects occurred in which weeks and called for weekly follow-up for the first 2 months. Results: The median of the complaints of emerged side effects such as chellitis, dry face and facial erythema, photobia and nyctalopia was in less than 4 weeks. When the doses taken below and above 0.5 mg/kg are compared, the side effects observed to have differences between both the week they occurred and the cumulative doses are xerosis, dry face, exacerbation of acnes, nervousness, and somnolence. Conclusions: We believe that knowing which weeks the side effects are observed first, warning about the side effects that may especially occur in the first 4 weeks, and ensuring some measures are taken before the side effects are observed will increase the success of patient compatibility and management of side effects.

Dynamic thiol/disulfide homeostasis and effects of smoking on homeostasis parameters in patients with psoriasis

Abstract Purpose: Recently, increased reactive oxygen species (ROS), reduced antioxidant capacity, and oxidative stress have been suggested in the pathogenesis of psoriasis. The aim of this study to evaluate the thiol/disulfide homeostasis in patients with psoriasis. Materials and methods: Ninety patients with psoriasis who did not receive any systemic treatment in the last six  months were included in the study. Seventy-six age and gender-matched healthy volunteers served as control group. Thiol/disulfide homeostasis was measured in venous blood samples obtained from patient and control groups. Results: Native thiol and total thiol levels were significantly higher in patients than in control group. When thiol/disulfide hemostasis parameters and clinical and demographic characteristics were compared, a negative correlation was detected between native thiol and total thiol with age. The levels of total thiols had also negative correlation with PASI and duration of the disease. When we divided the patients into smokers and non-smokers, native thiol and total thiol levels were significantly higher in smokers than in controls, whereas native thiol and total thiol levels were comparable in non-smoker patients and controls. Conclusions: Thiol/disulfide balance shifted towards thiol in psoriasis patients and this may be responsible for increased keratinocyte proliferation in the pathogenesis of psoriasis.

Dynamic thiol/disulphide homeostasis in patients with basal cell carcinoma

Abstract Background: The aim of this study is to measure and compare the dynamic thiol/disulphide homeostasis of patients with basal cell carcinoma and healthy subjects with a newly developed and original method. Objective: Thirty four patients attending our outpatient clinic and clinically and histopathologically diagnosed as nodular basal cell carcinoma, and age and gender matched 30 healthy individuals have been involved in the study. Thiol/disulphide homeostasis tests have been measured with a novel automatic spectrophotometric method developed and the results have been compared statistically. Results: Serum native thiol and disulphide levels in the patient and control group show a considerable variance statistically (p = 0.028, 0.039, respectively). Total thiol levels do not reveal a considerable variation (p = 0.094). Disulphide/native thiol ratios and native thiol/total thiol ratios also show a considerable variance statistically (p = 0.012, 0.013, 0.010, respectively). Conclusions: Thiol disulphide homeostasis in patients with basal cell carcinoma alters in the way that disulphide gets lower and thiols get higher. Thiol/disulphide level is likely to have a role in basal cell carcinoma pathogenesis.

Reconstruction of an infraorbital defect with deepithelialized forehead flap.

To the Editor: A 65-year-old woman was admitted to the dermatology department with erythema and induration in the left infraorbital region. Punch biopsy of the lesion revealed squamous cell carcinoma. The patient had consulted to our department for surgical management. The lesion had first been noticed 15 years ago and had grown rapidly from 1 to 4 cm in diameter in the last year. Ulceration was noticed in the last few months. Surgical excision of the lesion and reconstruction with malar advancement flap were performed 3 months ago in another clinic. An erythematous and indurated C-shaped scar with a downward concavity was present in the left infraorbital region upon physical examination (Fig. 1). No pathologic lymph nodes were found in clinical and ultrasonographic examination. Computed tomography revealed no maxillary bone invasion. The patient’s medical history included hypertension and chronic renal failure as comorbidities. Reexcision was planned with a diagnosis of recurrent squamous cell carcinoma. An extensive excision in the supraperiosteal plane was done under general anesthesia. The frozen section revealed clear surgical margins. The vertical and horizontal dimensions of the defect were 3 and 5 cm, respectively, with a caudally increasing depth up to 2 cm. The existing scar of the previous operation precluded planning of a reliable local flap from the malar region. Ipsilateral paramedian forehead flap was chosen as the reconstruction method. First, the flap was deepithelialized and turned 180 degrees horizontally at the supraorbital rim level.While the flapwas inset into the cavity, the distal portion of the flap was turned over to obtain more adequate thickness for filling the deeper caudal part of the defect (Figs. 2, 3). The skin graft obtained by the deepitheliazation process was used to cover the subcutaneous part of the flap. The flap donor areawas closed primarily. Daily wound dressings with topical antibiotics were made after the surgery. The pedicle was divided at the 16th postoperative day under local anesthesia. No complication was seen in the early postoperative period. In the 1-year follow-up, there was no sign of recurrence and the result was found to be aesthetically and functionally satisfactory (Fig. 4).

The treatment of ingrown nail: Chemical matricectomy with NAOH versus wedge resection

Ingrown nail is a common problem seen in the dermatology clinics. The aim of this study is to compare the wedge resection method and chemical matricectomy with NaOH in terms of operation time, postoperative pain severity, postoperative drainage, recurrence rates, recovery time, and the effects of these two methods on Dermatology Quality of Life Index. This study included 60 patients. About 42 nail edges of 30 patients were treated with NaOH for chemical matricectomy and wedge resection was performed for 33 nail edges of 30 patients. Operation time for chemical matricectomy and wedge resection was an average of 7.66 ± 3.65 and 19.25 ± 5.54 min (p < .001). Recovery time was an average of 17.27 ± 14.22 days for chemical matricectomy and an average of 28.85 ± 17.03 days for wedge resection (p = .004). Recurrence was detected in 5.4% of the nail edges treated with chemical matricectomy and 3.6% of the nail edges treated with wedge resection (p = 1.000). Absence of differences for the recurrence rates between wedge resection method and chemical matricectomy method with NaOH shows that effectiveness of these approaches are similar. It seems that quite short operation and recovery times in the chemical matricectomy are the main advantage of the method.

An Algorithmic Approach for the Reconstruction of Nasal Skin Defects: Retrospective Analysis of 130 Cases

Bulgular: Çalışmada 70 kadın, 60 erkek olmak üzere toplam 130 hasta incelendi. Ortalama yaş 67,8 idi. Tümörlerin en sık dorsum, alar bölgeler ve burun ucunda olduğu görüldü. Rekonstrüksiyon yöntemleri değerlendirildiğinde; %14,6 hastada primer onarım, %25,3’ünde tam kalınlıkta deri grefti, %60’ında fleple onarım tercih edildi. Alt bölgelere göre farklı flepler tercih edildi. En sık dorsal nazal, iki loblu, nazolabial flep ve alın flebinin kullanıldığı görüldü.

An Important Complication in Augmentation Mammoplasty: Striae Distensea

Striae distensae (SD) is a common linear atrophic depression in dermatology practice presenting with epidermal atrophy and dermal injury. Generally it does not cause a medical problem for the patients but an aesthetically unpleasing condition. Etiological factors could be physiologic like height and weight gaining and iatrogenic like hypercortisolism. In this case report, a female case of SD formation following breast augmentation surgery was presented. Its presentation after aesthetic breast augmentation could be devastating for both patient and plastic surgeon. Preoperative evaluation of risk factors together with dermatology department and proper treatment in case of occurrence would be beneficial in both medical and legal aspects for patients with risk factors.

Linear atrophoderma of Moulin located on the face

Linear atrophoderma of Moulin (LAM) is a dermatosis characterized by hyperpigmented and depressed band-like lesions localized along the Blaschko lines. This dermatosis was described for the first time by Moulin et al. in five patients with similar characteristics in 1992 and referred to atrophoderma of Moulin, with referrance to the first publication [1,2]. Major characteristics of LAM are being unilateral, following the Blaschko lines, long remain unchanged, onset in the childhood or adolescent period and lack of the induration. The lesions indicate progression over the first few months, then after having a linear atrophic state they stop the progression, limit themselves and become persistent [3]. Despite clinically atrophic appearance of the lesions, elastic and collagen fibers are usually normal in histopathological examination [2]. Etiology of LAM is unknown. Its localization matching the Blaschko lines is thought to be a reflection of mosaicism, which is believed to develop due to a somatic mutation occurring during early embryogenesis [4,5].