Ercan Çalışkan

Comparison of the efficacy and tolerability of 3% diclofenac sodium gel and 5% imiquimod cream in the treatment of actinic keratosis

Background: Topical diclofenac and imiquimod have been reported to be effective in the treatment of actinic keratosis, but a study to compare these two drugs has not been reported yet. Objective: To compare the efficacy and safety of topical 3% diclofenac gel plus hyaluronic acid and 5% imiquimod cream in the treatment of actinic keratosis. Methods: Forty‐nine patients with actinic keratosis were enrolled in this randomized comparative open‐label study. Twenty‐four patients applied 3% diclofenac gel once a daily to their lesions, while the other 25 patients were treated with a 5% imiquimod cream three times a week for 12 weeks. Patients were examined before treatment and every month of the treatment. Assessments were made by investigators according to the Investigator and the Patient Global Improvement Indices (IGII) and (PGII). Results: According to the IGII results, a complete response was observed in 12% of the diclofenac group and 22% of the imiquimod group. For the PGII scores, a complete response was observed in 28% of the diclofenac group and 23% of the imiquimod group. There were no significant differences between the two groups (p>0.05). Both treatments were well tolerated, with most adverse events related to skin. Conclusion: The two drugs were found to be equally effective and safe in the treatment of actinic keratosis but complete remission was very low. Therefore, topical treatments with these two drugs were not seen to be completely effective, and combined therapies and further studies are needed.

The effect of oral cyclosporine in the treatment of severe alopecia areata.

Abstract Context: Alopecia areata (AA) is a common non-scarring hair loss condition with an unpredictable and relapsing disease course. T-cell mediated autoimmune process is mainstay of the pathogenesis of AA, therefore immunosuppressive therapies are widely used in the treatment of AA. Objective: The aim of the study was to evaluate efficacy of oral cyclosporine therapy and reveal effects of prognostic factors in the treatment of severe AA. Materials and methods: We evaluated case histories of patients who were admitted to our department between December 2004 and September 2011 for the treatment of severe AA. A total of 25 patients were included in the study. Patients’ data that included sex, age, alopecia type, alopecia duration, family history, atopic history, previous treatments, treatment dosage, treatment duration, adverse events and clinical response were retrieved from patients’ records. Twelve patients had multifocal AA, nine patients had alopecia universalis and four patients had alopecia totalis. Patients were treated with 2.5–6 mg/kg/d doses of oral cyclosporine for 2–12 months. Results: The mean age of patients was 21.92 ± 3.56 (range: 19–34) years. All patients were male. The mean duration of disease was 8.3 ± 6.48 (range: 0.5–21) years. Four patients had positive family history and three patients had atopy history. Three of 25 (16%) patients discontinued treatment due to adverse events. Of remaining 22 patients, significant hair growth was observed in 10 (45.4%) patients; five patients with multifocal AA, three patients with alopecia universalis and two patients with alopecia totalis. In addition to this, six of nine patients with less than four years disease duration showed significant hair growth. But in patients with more than four years disease duration, only 4 of 13 patients showed significant hair growth. Conclusion: This study indicates that oral cyclosporine treatment may be a beneficial treatment option for severe AA. In addition to this, disease duration is an important prognostic factor that influences efficacy of oral cyclosporine treatment.

Case report of a rare dermatosis in pregnancy: Impetigo herpetiformis

Impetigo herpetiformis (IH) is a very rare type of dermatosis seen in pregnancy. According to the published work, IH during pregnancy is associated with the risk of stillbirth, and obstetric management in such cases is very important. Early recognition is important to reduce both maternal and fetal morbidity. We present a case of IH resistant to corticosteroid therapy in a 27‐year‐old pregnant woman where the pregnancy was terminated by the induction of labor.

Targeted photochemotherapy in alopecia areata

Alopecia areata (AA) is a common cause of localized non‐scarring alopecia. Usage of targeted UVA after the topical application of 8‐methoxypsoralen (8‐MOP) is one of the rising treatment modalities for AA. Our aim was to assess the efficacy and safety of topical 8‐MOP plus targeted UVA phototherapy in the treatment of patchy AA.

A case of Marshall's syndrome and review of the literature

This skin disorder may present in an inherited or anacquired form. Previously, the acquired form of CL wassubdivided into two groups, respectively, type 1, a gener-alized acquired elastolysis, and type 2, Marshall’ssyndrome. Marshall’s syndrome is characterized by post-inflammatory elastolysis associated with various inflam-matory dermatoses.

Narrow band ultraviolet-B versus Goeckerman therapy for psoriasis with and without acitretin: A retrospective study.

BACKGROUND Narrow band ultraviolet-B (NB-UVB) is now one of the most widely used modalities in the treatment of psoriasis. However, despite its high efficacy, conventional Goeckerman treatment has fallen out of favor in recent years and some institutions are now using NBUVB with coal tar as their regimen. OBJECTIVE To evaluate the efficacy of NB-UVB, Goeckerman therapy and the effect of addition of retinoid to the treatment regimen in the treatment of psoriasis,. PATIENTS AND METHODS A retrospective analysis of 65 patients who underwent 81 courses of treatment in our department was undertaken. The efficacy of NB-UVB and Goeckerman therapy individually, and in combination with acitretin was assessed. Data were analysed to evaluate the contribution of acitretin to these modalities. RESULTS PASI-75 responses in the NB-UVB, retinoid+NB-UVB (re-NB), Goeckerman and retinoid+Goeckerman (re-Goeckerman) groups were achieved for 12 of 31 patients (39%), 13 of 21 patients (62%), 15 of 17 patients (88%) and 10 of 12 patients, respectively. The addition of acitretin to both modalities reduced both the number of sessions and the cumulative ultraviolet-B dose delivered. LIMITATIONS This is a retrospective study, the patients were not randomized and the number of patients in the treatment groups were dissimilar. CONCLUSION Goeckerman therapy is more effective than NB-UVB phototherapy. Although the addition of acitretin to both NB-UVB and Goeckerman therapy did not contribute to treatment outcomes in terms of PASI-75 responses, it enabled a reduction in UV exposures and enhanced efficacy.

Treatment of lipoid proteinosis with ablative Er:YAG laser resurfacing

Lipoid proteinosis (LP) is a rare autosomal recessive genodermatosis characterized by deposition of amorphous hyaline material in different parts of the body, especially the skin and mucous membranes. Disfiguring lesions predominantly affect facial appearance. There is no curative therapy and treatment options are limited to symptomatic approaches. Facial disfigurement in this disease may have an huge negative effect on the patients’ psychology and quality of life. With this regard, the patients may benefit very much from symptomatic treatments. Four patients with LP were treated with Er:YAG laser to ablate disfiguring lesions on the face. Patients were followed up for 14 months to 2 years. We obtained favorable clinical and aesthetic results in all cases with Er:YAG laser treatment and did not observe any recurrences during the follow‐up. Depending on our observations Er‐YAG laser can be accepted as an effective tool for dermal accumulations and scars of LP with precise ablation capability and favorable esthetic results.

A case of atypical scleromyxedema without gammopathy treated with cyclosporine

Sir, Lichen myxedematosus is a disorder characterized by the formation of numerous lichenoid papules causing extensive thickening of the skin. Scleromyxedema, which is characterized by generalized lichenoid papules or scleroderma-like lesions, is considered to be generalized lichen myxedematosus or representative of the papular mucinosis group of cutaneous disorders.[1] The fibroblasts are triggered by an unknown mechanism resulting in excessive mucin deposition in dermis. The disease primarily affects the skin but extracutaneous manifestations including myositis, monoclonal gammopathy and neurological, cardiovascular, and renal involvement are well recognized.[2,3] Herein, we describe a patient presenting with dermatological features of scleromyxedema and myositis without any monoclonal gammopathy.

Phenol application to distal nail matrix for the treatment of nail thickening

vulvar hypertrophy, vulvar mass, vulvar edema, draining sinuses, ulceration, or abscess formation. “Knife-cut” ulcers which resemble lacerations are almost pathognomonic of Crohn’s disease although they have been reported in herpetic infections in the immunocompromised and in cutaneous tuberculosis. “Apthous-like” ulcer is the other morphological presentation seen. Vulvar involvement in Crohn’s disease may be by virtue of contiguity, as a direct extension of intestinal involvement, or non-contiguous (metastatic) in which there is no connection between the vulva and the bowel.[6] In a review by Andreani et al., 91% of cases of vulvar Crohn’s disease had metastatic spread, while only 5% had contiguous spread.[4] In the same study, 25% of vulvar Crohn’s disease did not have any intestinal involvement at the time of the vulvar lesion. It is in these cases that making a correct diagnosis becomes difficult. Werlin et al., have reported that vulvar ulcers may precede intestinal manifestations by up to 18 years.[7] Initial stages of vulvar Crohn’s disease can be medically managed. Metronidazole alone or in combination with steroids has been the most effective treatment with a success rate of 87.5%.[4] The optimal recommended dose of metronidazole is 20 mg/kg/day for at least 12 to 36 months.[8] Bilateral pedal paresthesia is a complication reported with long-term metronidazole. Other drugs like sulfasalazine, azathioprine, infliximab, and thalidomide have been used with varied response. Advanced cases may require vulvectomy, but local excision has been reported to show recurrence of the disease.

A case of Marshall's syndrome (postinflammatory elastolysis)

Indian Journal of Dermatology, Venereology, and Leprology | March-April 2017 | Vol 83 | Issue 2 218 necrosis in the biopsy specimen. The Mantoux test is positive in most cases, as in our case. The absolute criteria for the diagnosis of cutaneous tuberculosis include a positive culture of M. tuberculosis from the lesion or deoxyribonucleic acid amplification by polymerase chain reaction. However, the culture was negative and polymerase chain reaction could not be performed in our case. A therapeutic trial with antitubercular therapy is justified, if clinical suspicion is strong and the diagnosis can be made based on the therapeutic response.