Ekin Savk

Notalgia paresthetica : a study on pathogenesis

Abstract

Transcutaneous electrical nerve stimulation offers partial relief in notalgia paresthetica patients with a relevant spinal pathology

There is yet no established mode of curative treatment for notalgia paresthetica (NP). We had previously shown a correlation of NP localization with relevant spinal changes which led us to speculate on the possible role of spinal nerve impingement in the pathogenesis of this entity. Based on these findings we aimed to investigate the possible effect of physical therapy in selected cases of NP. Fifteen NP patients with a relevant spinal pathology (four men and 11 women) were included in the study. The mean age was 52.80 ± 8.83 years (± SD; range, 39–73). NP duration was 8.9 ± 8.13 years (range, 1.5–30). All patients received 10 conventional transcutaneous electrical nerve stimulation (TENS) sessions in the symptomatic area of 20 min duration and high frequency (50–100 Hz). From an initial pruritus score of 10, the mean score by the end of first week was 7.67 ± 2.02 (range, 5–10) and by the end of second week it was 6.80 ± 2.73 (range, 4–11). The differences between the pretreatment and post‐treatment scores were statistically significant. There was no correlation of therapeutic benefit with age or disease duration. We believe that the partial therapeutic benefit of TENS in NP patients is of importance and further research on the effects of various physical therapeutic modalities would be worthwhile.

Cutaneous basosquamous carcinoma infiltrating cerebral tissue.

Basosquamous carcinoma of the skin is a rare malignancy with specific histopathological features of both basal cell carcinoma and squamous cell carcinoma. Some authors believe that basosquamous carcinoma is a variant of basal cell carcinoma, while others suggest that this tumour may behave more aggressively.

Topical pimecrolimus: A new horizon for vitiligo treatment?

Objectives: The purpose of this study was to assess the efficacy of pimecrolimus cream 1% in vitiligo and to evaluate the effects of age of the patients, age of onset and duration of disease on response rate. Materials and methods: Twenty‐three patients with vitiligo were enrolled in our study; 19 patients (seven male, 12 female) completed the 6‐month study period. Patients were treated with topical pimecrolimus 1% cream once daily. The response was evaluated as excellent (76–100%), moderate (51–75%), mild (26–50%), minimal (1–25%), or no response. Results: The mean age of the 19 patients was 29.3±16.6 (range 7–62 years) and the mean duration of vitiligo was 68.4±81.3 months. Three patients demonstrated an excellent response to the therapy. Four patients had moderate, six patients had mild and five patients had minimal responses; one patient had no response to the treatment. Side effects were noted as a burning and stinging sensation in only three patients. The correlations between response rate and duration of the disease (r = 0.02, p = 0.95), onset age (r = −0.17, p = 0.48), and age of the patients (r = −0.16, p = 0.53) were not significant. Conclusions: Pimecrolimus has a mild therapeutic effect on vitiligo without significant side effects and can be an alternative therapy agent.

Power Doppler ultrasonography for the evaluation of skin tumors other than malignant melanoma

Abstract. The purpose of this prospective study was to evaluate the value of power Doppler ultrasonography (PDUS) in assessing the vascularity of skin tumors other than malignant melanoma, and to investigate possible diagnostic criteria to help to distinguish malignant from benign tumors preoperatively. Seventy-one patients with the clinical diagnosis of a skin tumor were initially evaluated by ultrasonography. Then PDUS was performed and the presence and type of vascularity (peripheral or mixed) were investigated. Of the 19 benign and 52 malignant lesions, 3 could not be visualized with US. Forty-nine lesions were found to have vascularity (21 peripheral, 28 mixed-type) on PDUS. Of the malignant lesions, 26 showed mixed and 17 showed peripheral-type vascularity; for benign lesions these numbers were 2 and 4 respectively. The presence of vascularity correlated well with pathological behavior (malignant versus benign) (P=0.00002), width (P=0.0001), thickness (P=0.001), dermal disruption (P=0.0018), and subdermal extension (P=0.002) of the tumor; however, the type of vascularity correlated only with thickness (P=0.014). In relation to malignancy, the sensitivity of the presence of vascularity on PDUS was 88% and the specificity was 63%. These values were 93% and 40% respectively, for the mixed type of vascularity when it was accepted as a feature of malignancy. PDUS may help to distinguish malignant from benign skin tumors during preoperative evaluation.

Reverse sural artery flap for distal lower extremity defects

Traumatic and various dermatological conditions resulting in skin and subcutaneous tissue loss on the lower limb cause a therapeutic challenge for the dermatological surgeon, because this anatomical location lacks adequate skin laxity and has limited local soft tissue, especially around the heel. In this report, we present our experience with the reverse sural artery flap on seven patients. The soft tissue defect was traumatic in two patients. We also treated three diabetic patients. There were no immediate or late surgical complications in four cases; flap and donor site healing was uneventful. The remaining three cases were diabetic, and all presented with the following complications: rejection of split skin graft at donor site, infection at the flap border and superficial flap necrosis. The flap necrosis was concluded to be at least in part due to the patients noncompliance with postoperative measures. We conclude that the reverse sural artery flap is a satisfactory alternative in the reconstruction of lower limb defects, but we also feel that the importance of proper evaluation prior to surgery in terms of vascular impairment and patient compliance should be emphasized to ensure a successful surgical outcome.

Position Statement - Linear Prurigo is a Subtype of Chronic Prurigo

Chronic prurigo (CPG) is a distinct disease characterized by chronic pruritus, history and/or signs of prolonged scratching and multiple pruriginous lesions. It may present with various clinical manifestations, including papules, nodules, plaques or umbilicated lesions. Some patients with chronic pruritus show pruriginous linear and scaring scratch lesions (LSSL) and it is unclear whether these lesions belong to the spectrum of CPG.