Evren Sarifakioglu

Evaluating the effects of ice application on the pain felt during botulinum toxin type-a injections: a prospective, randomized, single-blind controlled trial.

The pain felt during botulinum toxin type-A injections and the troubled and distressed treatment it induces is common and well known for the patient and the doctor applying the treatment. This problem is further intensified on the patients who have needle phobia. The effect of ice application on the treatment zone before botulinum toxin type-A treatment on the pain felt during injections is investigated. Totally, 24 patients who underwent botulinum toxin type-A treatment in upper face region for esthetic purposes are included in the study. Ice was applied 5 minutes before the injections on the right lateral orbital zones (crows feet area) of the patients, whereas on their left sides, toxin was injected without applying any ice. All the drugs were diluted by normal saline; 5 U of active botulinum toxin type-A was used in each diziem (0.1 mL). Total injection number was determined both in right and left areas as 8. Visual analog scale (VAS) was used for pain intensity and evaluation. On the side where ice was applied, the treatment was completed in 1 session and lasted shorter when compared with that of the control side. However, the average VAS values defining the pain that the patients felt in their right and left sides were found as 1.1 and 5.9, respectively. The clinical findings obtained indicated that pain is significantly reduced on the side where ice is applied. The statistical significance of the test results were evaluated by Students t test, and the difference between VAS values was found statistically significant (P = 0.000).

Evaluating Effects of Preservative-Containing Saline Solution on Pain Perception During Botulinum Toxin Type-A Injections at Different Locations: A Prospective, Single-Blinded, Randomized Controlled Trial

Pain is a side effect of botulinum toxin type-A (BTX-A) injections. The efficiency of the preservative-containing saline solution used as the “dilution solution” for controlling the pain felt during multiple injections in different areas has been investigated by a prospective, randomized, single-blinded, controlled study. A total of 93 patients were divided into three groups for the study. All the patients were given BTX-A. Of these 93 patients, 60 received injections in the upper face, 15 in the neck, and 18 in the axillary regions. The visual analog scale (VAS), a single-dimension pain intensity rating scale, was used to evaluate pain perception. The average VAS values for pain sensation experienced by the groups were 1.2 of 10 points for the upper face area in the experimental group (n = 60) and 4.5 point for the control group. In the neck region (n = 15), the respective scores were 0.6 in the experimental group and 3.9 in the control group. Finally, in the axillary region (n = 18), the respective values were 0.9 and 5.1. The authors conclude that the preservative-containing saline solution significantly decreased pain perception during BTX-A injections (p = 0.000).

Serum leptin, atherogenic lipids and glucose levels in patients with skin tags

Aim: To investigate the relationship between serum leptin, atherogenic lipid and glucose levels in patients with skin tags and healthy controls. Materials and Methods: A total of 58 patients, with at least three skin tags, aged 24 to 85 years, and 31 healthy controls aged 30 to 70 years, were examined in the present study. The subjects in all the groups were selected with statistically similar Body Mass Index (BMI). Fasting concentrations of plasma glucose, serum lipids including triglyceride, total cholesterol, and high-density lipoprotein cholesterol (HDL) and low-density lipoprotein cholesterol (LDL), HbA1c, and leptin were measured by enzyme-linked immunosorbent assay (ELISA). In addition, serum LDL level was calculated using Friedewalds formula. Results: There was no significant difference in age, sex, BMI, HbA1c, triglyceride, HDL and leptin levels between the groups. Skin tags group showed significantly higher levels of total cholesterol and LDL, when compared with the healthy controls groups (P < 0.01). In addition, regression analysis showed that leptin level was positively correlated to serum triglyceride level (r = 0.265, P = 0.044). Conclusion: Total cholesterol and LDL serum levels should be controlled in patients with skin tags. On the other hand, glucose, leptin and HbA1c serum levels may not be as important as is being considered in recent times.

Efficacy of topical pimecrolimus in the treatment of chronic vulvar pruritus: A prospective case series – a non‐controlled, open‐label study

Background: Chronic vulvar pruritus has been a most distressing physical and sociologic disorder for many patients, as well as for their physicians. Potent topical steroids are the conventional therapy for this distressing condition. Side effects or steroid resistance can be encountered. A second‐line therapy is required. Objectives: A single‐centre, non‐controlled, open‐label study was designed to assess the efficacy of topical pimecrolimus in the treatment of chronic vulvar pruritus. Methods: Fifteen married adult women with symptoms of vulvar pruritus ⩾4 months were included in the study. The patients did not have any relief with topical steroids. There were no objective physical findings. Topical pimecrolimus 1% cream (Elidel cream®, Novartis) was applied twice daily to the vulvar region. Patients were followed up 4 weeks later. After the trial was stopped, the patients remained in regular review for 3 months. Results: Thirteen patients tolerated pimecrolimus. They showed a clinical response within 2–4 weeks. Ten patients showed a complete response, three showed a partial response. After the trial had stopped, the patients with complete response were followed‐up by telephone for another 3 months, and were found to be in remission. Conclusions: We found that topical pimecrolimus provides relief for chronic vulvar pruritus. Pimecrolimus can be chosen as the second‐line therapy in patients with vulvar pruritus.

Women with scalp dysesthesia treated with pregabalin

1 Khan SA, Thomas HC, Davidson BR, et al. Cholangiocarcinoma. Lancet 2005; 366: 1303–1314. 2 Yanagi T, Matsumura T, Yoshizaki N. Cholangiocarcinoma with skin metastases. J Am Acad Dermatol 2007; 56(Suppl. 2): 58–60. 3 Reingold IM, Smith BR. Cutaneous metastases from hepatomas. Arch Dermatol 1978; 114: 1045–1046. 4 Lu CI, Wong WR, Hong HS. Distant cutaneous metastases of cholangiocarcinoma: report of two cases of a previously unreported condition. J Am Acad Dermatol 2004; 51(Suppl. 2): 108–111. 5 Dogan G, Karincaoglu Y, Karincaoglu M, et al. Scalp ulcer as first sign of cholangiocarcinoma. Am J Clin Dermatol 2006; 7: 387–389. 6 Landaluce Olavaria A, Estraviz Mateos B, Sarabia Garcia S. Cutaneous metastasis in a patient with cholangiocarcinoma. Rev Esp Enferm Dig 2007; 99: 118–119. 7 Stergiopoulos C, Kountouras J, Kapetanakis N, et al. Distant cutaneous metastasis preceding the diagnosis of ductal cholangiocarcinoma. J Eur Acad Dermatol Venereol 2009; 23: 242–243. 8 Lee WJ, Kim MS, Chang SE, et al. Multiple cutaneous metastases from hilar cholangiocarcinoma. Clin Exp Dermatol 2009; 34: 174–176.

A case of follicular mucinosis treated successfully with pimecrolimus

1 Kossard S, Rosen R. Cutaneous Bowen s disease. An analysis of 1001 cases according to age, sex and site. J Am Acad Dermatol 1992; 27: 406–10. 2 Cox NH. Body site distribution of Bowen s disease. B J Dermatol 1994; 130: 714–6. 3 Cox NH, Eedy DJ, Morton CA. Guidelines for management of Bowen s disease: 2006 update. Br J Dermatol 2007; 156: 11–21. 4 Dave R, Monk B, Mahaffey P. Treatment of Bowen s disease with carbon dioxide laser. Lasers Surg Med 2003; 32: 335. 5 Dupree MT, Kiteley RA, Weismantle K et al. Radiation therapy for Bowen s disease: lessons for lesions of the lower extremity. J Am Acad Dermatol 2001; 45: 401–4.

Nail alterations in 250 infant patients: a clinical study.

Aims  To investigate the frequency and the nature of nail alterations in infants.

Vestibular Papillomatosis: Case Report and Literature Review

Sir, The origin of vestibular papillomatosis (VP) is controversial. VP describes the condition of multiple papillae that may cover the entire surface of the vestibule (1). Our literature search for vestibular papillomatosis revealed 13 reports in gynaecological journals and only one in a dermatological journal. Furthermore, searching for vulvar squamous papillomatosis revealed 6 reports in gynaecological journals and again only one in a dermatological journal. We therefore conclude that it is worthwhile drawing the attention of dermatologists to this entity.

Isotretinoin: is there any arrhythmic effect?

Background  Oral isotretinoin is currently the most effective therapy for acne, but is associated with numerous adverse effects. To investigate the cardiac effects of isotretinoin, acne patients receiving isotretinoin for 6 months were studied.

Vulvodynia: Case Report and Review of Literature

Vulvodynia is defined as chronic vulvar burning, stinging, rawness, soreness or pain in the absence of objective clinical or laboratory findings to explain these symptoms. Vulvodynia is a chronic pain syndrome affecting up to 18% of the female population and is generally regarded as an underdiagnosed difficult to treat gynecological disorder. An increasing number of patients present with symptoms of vulvar pain, soreness, burning or irritation, which becomes chronic. Vulvodynia is a term used to describe chronic burning and/or pain in the vulva without objective clinical or laboratory findings to explain these symptoms. We present a case of vulvodynia accompanying somatoform disorder and depression.