Esra Adışen

A retrospective analysis of treatment responses of palmoplantar psoriasis in 114 patients

Background  Treatment options remain unsatisfactory for patients with palmoplantar psoriasis (PP) and palmoplantar pustular psoriasis (PPP).

Patch test results in a Turkish paediatric population

Allergic contact dermatitis is increasing in childhood. In children, population‐based patch test studies point to different contact sensitizers and reflect the variations in the exposure to certain allergens among different countries. Our aim is to show common contact allergens in a paediatric population in Turkey. Contact dermatitis and identifying the suspected allergen in children are important as sensitization occurring during childhood may cause a susceptibility to the contact dermatitis later in their life.

A new indication of botulinum toxin: Leiomyoma-related pain

Cutaneous leiomyomas are benign neoplasms with smooth muscle differentiation. They are painful tumors of the skin. Nearly 90% of patients report lesion-associated pain, characteristically precipitated by cold or trauma. In the published literature, surgical excision and pharmacologic agents such as analgesics, nifedipine, phenoxybenzamine hydrochloride, gabapentin, and doxazosin have been used in the treatment of leiomyomas with varying degrees of success. Herein we report the use of botulinum toxin for the relief of pain in leiomyomas. The use of botulinum toxin provided a decrease in the amount of analgesic use in our patient. Our experience showed that botulinum toxin might offer a new therapeutic approach for leiomyoma by reducing the intensity and the frequency of the pain. Botulinum toxin has no known systemic adverse effects, and can be combined with other treatments without concern for drug interactions. Like any other medication, aside from its actual pharmacologic effect, botulinum toxin may have had a placebo effect in our patient.

Treatment of Idiopathic Pyoderma Gangrenosum with Infliximab: Induction Dosing Regimen or On-Demand Therapy?

Pyoderma gangrenosum is an ulcerative skin disease of unknown origin. Recently tumor necrosis factor α inhibitors have been gaining attention in the treatment of recalcitrant pyoderma gangrenosum. However, there is a lack of an optimal dosing strategy in the published literature about the treatment of idiopathic pyoderma gangrenosum, and this is responsible for substantially different treatment strategies. Therefore, it is necessary to report experiences in this patient population in order to develop an optimal dosing strategy and to clarify whether regularly scheduled or on-demand therapy is suitable for idiopathic pyoderma gangrenosum. Herein we report a recalcitrant case of an idiopathic pyoderma gangrenosum treated successfully with a dosing regimen similar to the one that has been used in psoriasis. By doing so, we were capable of controlling the disease and improving the quality of life in our patient.

Therapeutic options for palmoplantar pustulosis

Palmoplantar pustulosis (PPP) is a common chronic and recurrent pustular dermatosis characterized by multiple sterile pustules and erythematous plaques on the palms and soles. The exact cause and pathogenesis of the disease remain unknown, and there is still debate about whether PPP is a variant of psoriasis or a distinct condition. A review of the medical literature revealed that a wide range of treatments have been used in the treatment of PPP over the years. The literature in PPP is restricted to case reports or small case series, and there is a lack of well‐documented clinical studies, which makes it difficult to select an ideal therapy for the condition. The purpose of this review is to discuss the current therapy options for PPP, based on results of randomized controlled trials.

Salivary Epidermal Growth Factor Levels in Behçet’s Disease and Recurrent Aphthous Stomatitis

Background: Epidermal growth factor (EGF) in saliva is cytoprotective against injuries and contributes to the maintenance of the integrity of the gastrointestinal mucosa. Low salivary EGF levels have been observed in patients with various forms of oral mucosal disease. Objective: Our aim wasto determine whether salivary EGF is low in patients with recurrent aphthous stomatitis (RAS) or those with Behçet’s disease (BD) when compared with healthy controls. Methods: The study population consisted of 33 BD and 16 RAS patients and 60 healthy controls. Measurement of EGF concentration in human saliva was performed with an enzyme-linked immunosorbent assay using an antibody-coated solid phase. Results: The mean salivary EGF levels (±SD) of active (with oral ulceration) and inactive stages (absence of oral ulceration) of BD (1,939.7 ± 1,561.5 and 2,305.7 ± 1,481.6 pg/ml, respectively) and RAS patients (1,650.5 ± 704.7 and 1,069.9 ± 539.2 pg/ml, respectively) were both lower than those of the healthy controls (2,758.7 ± 1,657.9 pg/ml) (p < 0.05 for each). Conclusions: BD and RAS patients have reduced salivary EGF levels even in the absence of oral ulcerations. EGF could be involved in the pathogenesis of BD and RAS by disturbing the mucosal integrity that may result in a susceptibility to the development of oral ulcers in these diseases.

Lack of efficacy of etanercept in acrodermatitis continua of Hallopeau

A 40‐year‐old man was referred to our department in January 2000 with persistent, scaly, pustular and tender plaques on the distal portion of the digits. He first noted pustulation around the nail, which was followed by scaling and crust formation, and subsequently led to nail dystrophy. Earlier treatment had included topical antibiotics, antimycotics, and corticosteroids, as well as systemic antibiotics, without any success. His past medical history was otherwise unremarkable. Post‐traumatic fingertip amputation of the third finger of the right hand was repaired with a full‐thickness skin graft. On dermatologic examination, there was a severe erythematosquamous, psoriasiform, pustular eruption surrounded by a hyperemic area affecting the terminal phalanges of nine of the 10 digits. The skin of the graft was intact. Examination of the digits revealed anonychia of six of the 10 fingernails ( Fig. 1 ) The rest of the physical examination was normal. Clinical and histologic findings led to the diagnosis of acrodermatitis continua of Hallopeau (ACH). X‐Rays of both hands showed osteolysis of two of the 10 terminal phalanges.

Easy to diagnose, difficult to treat: keratosis lichenoides chronica

Keratosis lichenoides chronica (KLC) is a rare disease, with approximately 70 cases reported in the literature. The problem in this long‐lasting disease is generally the treatment, not the diagnosis. In the literature, many treatments failed to show any beneficial effect. We present a 20‐year‐old man with KLC that was successfully treated with a combination of phototherapy, acitretin and calcipotriol ointment. The patient’s lesions showed a marked improvement with this combination. To our knowledge, this is the first report of this type of combination treatment being used successfully in KLC. This approach might help reduce doses of retinoids or psoralen ultraviolet A required when these are used separately, and limit the potential toxicity of these treatments.

Transient reactive papulotranslucent acrokeratoderma in a 50-year-old woman: case report and review of the literature.

A 50-year-old woman who presented with intermittent symmetric edema and wrinkling of the palms after soaking in water was found to have transient reactive papulotranslucent acrokeratoderma (TRPA). This is the oldest patient ever reported to have this condition. The patient was advised to avoid water exposure as much as possible and to wear gloves. Topical treatment with 5% salicylic acid in Vaseline? also provided some relief.TRPA presents with translucent, white, confluent papules that become evident on the palms after 3–5 minutes’ exposure to water (the so-called ‘hand-in-the-bucket’ sign) and resolve within a short time after drying. It is a rare disorder with fewer than 40 cases having been reported in the world literature. The disease is seen mostly in female patients, with ages ranging from 6 to 44 years prior to our case in a 50-year-old woman. The most common histologic findings are hyperkeratosis and dilated eccrine ostia. The etiopathogenesis of the disease remains unknown but a transitory structural or functional alteration of components of the stratum corneum or aberration of the sweat duct have been considered. TRPA has been reported in patients with cystic fibrosis and more recently, in patients taking selective cyclo-oxygenase-2 inhibitors. Therefore, the pathogenesis of the condition appears to be related to increased water absorption as a result of an increased epidermal sodium level. Treatment with barrier creams such as hydrophilic petrolatum, glycerin emollients, 5–20% salicylic acid in Vaseline®, 10% urea cream, and 12% ammonium lactate cream have been reported. Cases with associated hyperhidrosis respond well to aluminum chloride-containing products.

When there is no single best biological agent: psoriasis and psoriatic arthritis in the same patient responding to two different biological agents

Guidelines and treatment strategies for the new biological agents have been developed, but dermatologists continue to face difficulties in adopting these guidelines into their daily practices. We report a patient with psoriasis and psoriatic arthritis whose skin lesions responded only to efalizumab, and the arthritis to etanercept. This case shows that different biological agents may achieve different success rates even in the same patient. Each biological agent offers different advantages and disadvantages, which sometimes make it difficult to choose the single best agent for a patient. Psoriasis often becomes one of the most difficult diseases to treat and does not respond to any single antipsoriatic agent. Perhaps in the future, rotational or combination treatment with different biological treatments will be used.