Engin Sezer

Lipid peroxidation and antioxidant status in lichen planus

Background.  Lichen planus (LP) is an inflammatory skin disease of unknown aetiology. Recently, increased oxidative stress has been implicated in the pathogenesis of various skin diseases such as atopic dermatitis, psoriasis vulgaris and vitiligo.

Narrow-band ultraviolet B as monotherapy and in combination with topical calcipotriol in the treatment of vitiligo.

Vitiligo is a common, idiopathic, acquired, depigmenting disease characterized by loss of normal melanin pigments in the skin. The most interesting treatment methods for extensive vitiligo involve psoralen plus ultraviolet A (PUVA) therapy and ultraviolet (UV)‐B phototherapy, particularly narrow‐band UV‐B. In this randomized and comparative study, we investigated the safety and efficacy of narrow band ultraviolet B as monotherapy and in combination with topical calcipotriol in the treatment of generalized vitiligo. Of the 40 vitiligo patients enrolled in the study, 15 were treated with the calcipotriol plus narrow‐band UV‐B (NBUVB) and 25 with narrow band UV‐B alone. The patients were randomized into two NBUVB treatment groups. The first group, consisting of 24 patients (all male), received only NBUVB treatment; the second group, consisting of 13 patients (all male) applied 0.05% topical calcipotriol ointments twice daily. Both groups were irradiated with NBUVB (311 nm). In the NBUVB group, the percentage of the body surface affected was reduced from 27.21 ± 10.41% to 16.25 ± 8.54% after a mean of 30 treatment sessions. The mean repigmentation percentage was 41.6 ± 19.4%. In clinical evaluation (moderate and marked/complete response was accepted as an effective treatment), 19 patients (19/24; 79.17%) had clinically good results. In the NBUVB plus calcipotriol group, the percentage of the body surface affected was reduced from 23.35 ± 6.5% to 13.23 ± 7.05% after a mean of 30 treatment sessions. The mean repigmentation percentage was 45.01 ± 19.15%. In clinical evaluation (moderate and marked/complete response was accepted as an effective treatment), 10 patients (10/13; 76.92%) had clinically good results. Statistically significant intragroup reductions from the baseline percentage of the body surface affected were seen at the endpoint of treatment for the two treatment groups (P < 0.001). However, there was no statistically significant difference between the two treatment groups at the end of therapy with respect to the reduction of repigmentation rates (P > 0.05). The present study reconfirmed the efficacy of NBUVB phototherapy in vitiligo. It can be a therapeutic option considered in the management of patients with vitiligo. However, addition of topical calcipotriol to NBUVB did not show any advantage.

Efficacy and safety of serial glycolic acid peels and a topical regimen in the treatment of recalcitrant melasma

Melasma is a common acquired disorder of facial hyperpigmentation. In this study we investigated the efficacy and safety of a combined treatment regimen including serial glycolic acid peels, topical azelaic acid cream and adapalene gel in the treatment of recalcitrant melasma. Twenty‐eight patients with recalcitrant melasma were enrolled in a prospective, randomized, controlled trial lasting 20 weeks. The patients of the group receiving chemical peels underwent serial glycolic acid peels in combination with topical azelaic acid 20% cream (b.i.d.) and adapalene 0.1% gel (q.i.d., applied at night). The control group received only topical treatment including topical azelaic acid and adapalene. The clinical improvement was assessed with the Melasma Area Severity Index (MASI) at baseline and monthly during the 20‐week treatment period. The results showed a prominent decrease in MASI scores at the end of the treatment in both groups, although the results were better in the group receiving chemical peels (P = 0.048). All patients tolerated the topical agents well with minimal irritation observed in the first few weeks of the therapy. Three patients in the glycolic acid peel group developed a mild‐degree postinflammatory hyperpigmentation with total clearance at the end of the treatment period. Therefore, the present study suggests that combined treatment with serial glycolic acid peels, azelaic acid cream and adapalene gel should be considered as an effective and safe therapy in recalcitrant melasma.

Local narrowband UVB phototherapy vs. local PUVA in the treatment of chronic hand eczema

Background: Hand eczema is a chronic skin disorder characterized by a poor response to conventional therapies. Although local PUVA has been proven to be effective in the treatment of chronic hand eczema, little is known about the efficacy and safety of local narrowband UVB (TL‐01) for this condition. The aim of our study was to compare the efficacy and safety of local narrowband UVB phototherapy with paint‐PUVA in patients with chronic hand eczema of dry and dyshidrotic types unresponsive to conventional therapies.

Comparison of the efficacy of local narrowband ultraviolet B (NB-UVB) phototherapy versus psoralen plus ultraviolet A (PUVA) paint for palmoplantar psoriasis

Palmoplantar psoriasis is an idiopathic disabling condition, often resistant to conventional therapies. The purpose of this study was to evaluate the efficacy and safety of local narrowband ultraviolet B (NB‐UVB) phototherapy and to compare it with local psoralen plus ultraviolet A (PUVA) paint in patients with palmoplantar psoriasis unresponsive to conventional therapies other than phototherapy. A cohort of 25 patients with palmoplantar psoriasis were included in this study, which was based on a left‐to‐right comparison pattern. The treatments were administered with local narrowband UVB irradiation on one side and local PUVA on the other side three times a week over 9 weeks. Clinical assessments were performed at baseline and every 3 weeks during the 9‐week treatment. There was a statistically significant decrease in the mean clinical scores at the third, sixth and ninth week with both treatments. The difference in clinical response between the two treatment modalities was statistically significant at the end of the treatment period, with the percentage reduction in severity index scores with the PUVA‐paint‐treated side being 85.45% compared with 61.08% for the NB‐UVB treated side (t = 5.379, P = 0.0001, Students t‐test for unpaired samples). Our results show that, although some clinical improvement was achieved with local NB‐UVB phototherapy, the results were better with local PUVA, and such a treatment option may be reserved for patients with palmoplantar psoriasis who experience phototoxic reaction to psoralens.

Comparison of dose-related ocular side effects during systemic isotretinoin administration.

Purpose To compare the effects of high- (Group 1) and low-dose (Group 2) isotretinoin treatments for acne vulgaris on lacrimal functions and other ocular complications. Methods Twenty-six patients receiving high-dose (>0.5 mg/kg per day) systemic isotretinoin treatment and 25 patients treated with low-dose systemic isotretinoin (<0.5 mg/kg per day) underwent complete ophthalmologic assessment of both eyes before treatment, at days 45 and 90 of treatment, and 1 month after the completion of treatment, together with a microbiologic evaluation of conjunctival flora, tear film break-up time (BUT), and anesthetized Schirmer test of the right eye of each patient. Results When the results of the anesthetized Schirmer test for Groups 1 and 2 were compared (pretreatment, days 45 and 90 of treatment, and 1 month after treatment), there was no statistically significant difference between the groups (p > 0.05). Although BUT did not differ significantly between the two groups before treatment (p > 0.05), there was a statistically significant decrease in BUT in Group 1 when compared with Group 2 at days 45 and 90 of treatment (p < 0.05). One month after the completion of treatment, there was no difference in BUT between the two groups (p > 0.05). No difference in Staphylococcus aureus colonization was detected between the two groups at days 45 and 90 of treatment (p > 0.05). Conclusions During systemic isotretinoin treatment, eye dryness was related to the dose used, at least during the period of treatment. Conversely, the rate of conjunctival S aureus colonization was unrelated to the dose of isotretinoin.

Onychomycosis infections in the Middle Black Sea Region, Turkey.

Background  Onychomycosis, a fungal infection of the nail, is caused by dermatophytes, yeasts, and nondermatophyte molds. The causative pathogen and incidence of onychomycosis depend on age, gender, geographic and climatic conditions, living habits, and immune status of the host.

Keratosis lichenoides chronica treated with acitretin plus narrowband ultraviolet B phototherapy

Dear Editor, A 19-year-old Caucasian male presented for evaluation of an 8-year history of a pruritic rash, localized on the face and extremities, and which was resistant to topical corticosteroids. The physical examination revealed symmetrical violaceous lichenoid keratotic papules on the upper and lower extremities which tended to display a reticulated, linear, and confluent pattern on the hands and feet. Rosacea-like papular lesions were also noted on the face (Figs 1,2). Laboratory studies, including complete blood count, hepatic and renal function tests, and urinalysis, were all within normal limits. Histopathological examination of a punch biopsy specimen revealed epidermal hyperplasia with irregular elongation of rete ridges, parakeratosis and orthokeratosis, as well as colloid bodies. The basal layer of the epidermis showed vacuolization and spongiosis. A band-like lymphocytic cell infiltration with a predilection for the dermal–epidermal junction, occasional melanophages and dilated lymphatic channels, were visualized in the upper dermis (Fig. 3). A diagnosis of keratosis lichenoides chronica (KLC) was established based on the clinical and histopathological features and oral acitretin (1 mg/kg/day) plus narrowband ultraviolet B (NB-UVB) treatment, thrice weekly, was initiated. Complete clearance of the facial lesions and regression of the lesions on the extremities were noted 2 months after treatment commenced (Fig. 1b). There was no recurrence of the lesions during a 12-month follow-up period. Also known as Nekam’s disease, KLC is a rare, progressive and chronic dermatosis of unknown etiology. KLC is a rare entity with approximately 60 cases reported in the published work. Clinically, the papular lesions of KLC are usually distributed symmetrically, with a linear or reticulate pattern, which is observed mainly on the extensor aspect of the extremities. Facial papular lesions may occasionally reveal a rosacea-like eruption. Because the lesions on the dorsum of the hands revealed a symmetrical, linear and reticular pattern; the clinical aspect of the facial papules was compatible with a rosacea-like pattern of KLC in our patient. Mucous membrane involvement is detected in 50% of cases. Palmoplantar keratoderma and nail changes, such as yellow discoloration, thickening, ridging of the nail plate and hyperkeratosis of the nail bed, may be observed in up to 30% of the patients. Such palmoplantar keratoderma and nail changes were not present in our patient. The characteristic histopathological features include irregular acanthosis or atrophic changes in the epidermis, local hyperkeratosis and parakeratosis, intraepidermal keratotic plugs, a band-like lichenoid infiltrate consisting of lymphocytes and histiocytes that obscures the dermal–epidermal junction in the upper dermis, colloid bodies and basal layer vacuolization. The course of the disease is chronic and progressive, extending over many years. Some lesions, however, may disappear spontaneously. Complete spontaneous remission is very rare and has been reported in only two cases. Improvement with natural sunlight is more common and the severity of cutaneous involvement in most patients improves during the summer months. The treatment of KLC is a matter of debate. Topical and systemic corticosteroids, anti-malarials, dapson, tetracycline, cyclosporine and methotrexate have been shown to be ineffective in most reported cases. Oral acitretin, isotretinoin, etretinate, psoralen and ultraviolet A (PUVA), retinoid PUVA and topical calcipotriol have been utilized with mixed results. In our patient, we achieved resolution of the pruritus,

Acrokeratoelastoidosis treated with the erbium:YAG laser.

Acrokeratoelastoidosis is a rare skin disorder characterized by grouped, small, firm, translucent papules distributed on the margins of the hands and feet. We report a 21‐year‐old white patient with acrokeratoelastoidosis in whom Er:YAG laser surgery was carried out, resulting in a slight post‐treatment improvement of the disease with slight flattening of the lesions. No clinical recurrence of the lesions developed during the 6 months of follow‐up. We suggest that Er:YAG laser surgery of acrokeratoelastoidosis may be considered as a treatment option for this rare disease; however, patients should be informed of the limited clinical improvement obtained with this treatment.

Eccrine angiomatous hamartoma of the fingers with nail destruction

and fibrosis (with increased fibroblast chemotaxis, proliferation and collagen synthesis) in SSc and of fibrosis in sarcoidosis. Increased plasma, BAL and urine levels of endothelin-1 have been reported to be correlated with disease activity in patients with sarcoidosis. Our data indicate that sarcoidosis-related increased blood levels of endothelin-1 may have played a role in the deterioration of vascular clinical manifestations in our patient with lcSSc: following treatment, our patient concomitantly exhibited improvement of SSc-related vascular clinical manifestations and decreased plasma levels of endothelin-1. Finally, the present case also underscores that bosentan is a useful therapy in complicated Raynaud’s phenomenon (with digital ischaemic ulcers) in SSc, as our patient exhibited resolution of multiple fingertip ulcers after institution of bosentan therapy; our findings are in accordance with those of Korn et al. who found a 48% reduction in the mean number of new digital ulcers in patients under bosentan. Because our patient also showed improvement of sarcoidosis (as evidenced by PFT and CT scans of the lungs), we further suggest that bosentan may be useful in management of pulmonary sarcoidosis; although these data remain to be confirmed, this finding is of particular interest as high-dose corticosteroids (>15 mg daily) are not a safe therapy for sarcoidosis in SSc, and may result in increased risk of SSc-related onset of renal crisis. Several clinical trials are currently under way to evaluate the efficacy of bosentan in pulmonary fibrosis.