Ferdi Öztürk

Toll-like receptors and skin

Toll‐like receptors are important pattern recognition receptors which have key roles in both innate and adaptive immune responses. They are strongly associated with the pathogenesis of inflammatory and autoimmune diseases. Furthermore, Toll‐like receptors have also been implicated in the pathogenesis of several skin diseases such as skin infections, psoriasis, acne vulgaris, lichen planus, Behçet’s disease, leprosy, syphilis, Lyme disease, atopic dermatitis and allergic contact dermatitis, mycosis fungoides, non‐melanoma skin cancers and melanoma. In this manuscript, the structure and functions of Toll‐like receptors in immune responses, their impact on skin diseases and recent advances on therapeutic usage have been reviewed.

Sexual dysfunction in female patients with neurodermatitis.

Neurodermatitis is a chronic disease affecting the patients psychosocial status and quality of life. It is associated with a variety of psychologic problems, including demoralization, depression, anxiety, obsessive-compulsive disorder, and sleep disturbances. Coexistence of sexual dysfunction, especially in women, with several systemic diseases has gained interest in recent years. In this study, we evaluated sexual function in female patients with neurodermatitis. We enrolled 89 women (43 patients, 46 controls) in the study. Quality of life was assessed with the Dermatology Life Quality Index (DLQI), and the Female Sexual Function Index (FSFI) was used to determine sexual function. Individuals with psychiatric disorders and/or those using antidepressants were excluded. The total DLQI score was 11.95 ± 5.65 in patients with neurodermatitis. The total FSFI score was significantly lower in patients compared with healthy controls (22.76 ± 5.31 and 28.83 ± 3.50, respectively; P = .001). Domain scores of FSFI (desire, arousal, lubrication, orgasm, and satisfaction) except pain were significantly lower in patients with neurodermatitis (P = .001). The pain score was also lower in patients than controls, but the difference was not statistically significant (P = .073). Neurodermatitis may be associated with sexual dysfunction, and patients with neurodermatitis should be evaluated with regard to sexual function to provide a better quality of life.

Hyperbaric oxygen therapy for the management of chronic wounds

Wound healing is actually a complex, precisely coordinated interaction between inflammatory cells and mediators, establishing significant overlap between the phases of wound healing. Chronic wounds are defined as wounds that do not follow the well-defined stepwise process of physiologic healing. The true incidence and economic impact of chronic wounds are difficult to assess because of the wide range of causative diseases and available treatment options. Despite multiple simultaneous and sequential therapeutic approaches, chronic wounds are highly resistant to treatment and are often indolent or even slowly progressive. Hyperbaric oxygen therapy (HBOT) has been explored as a treatment modality for chronic wounds because of its potential to promote healing and reduce bioburden in the wound bed. Multiple potential beneficial effects for wound healing have been demonstrated in various laboratory studies and experimental animal models. In this manuscript, HBOT, its mechanism of action, adverse effects and usage in diabetic and nondiabetic chronic wounds have been reviewed.

Psoriatic uveitis responding to adalimumab therapy

References 1 Zillikens D. Autoimmune bullous diseases. In: Burgdorf WHC, Plewig G, Wolff HH, Landthaler M, eds. BraunFalco’s Dermatology, 3rd edn. Berlin: Springer, 2009: 641–668. 2 Czernik A, Toosi S, Bystryn JC, et al. Intravenous immunoglobulin in the treatment of autoimmune bullous dermatoses: an update. Autoimmunity 2012; 45: 111– 118. 3 Kreuter A, Harati A, Breuckmann F, et al. Intravenous immunoglobulin in the treatment of persistent pemphigoid gestationis. J Am Acad Dermatol 2004; 51: 1027–1028. 4 Doiron P, Pratt M. Antepartum intravenous immunoglobulin therapy in refractory pemphigoid gestationis: case report and literature review. J Cutan Med Surg 2010; 14: 189–192. 5 Rodrigues CDS, Filipe P, Solana MDM, et al. Persistent herpes gestationis treated with high-dose intravenous immunoglobulin. Acta Derm Venereol 2007; 87: 184–186. 6 Hern S, Harman K, Bhogal BS, et al. A severe persistent case of pemphigoid gestationis treated with intravenous immunoglobulins and cyclosporin. Clin Exp Dermatol 1998; 23: 185–188. 7 Gan DCC, Welsh B, Webster M. Successful treatment of a severe persistent case of pemphigoid gestationis with antepartum and postpartum intravenous immunoglobulin followed by azathioprine. Austr J Dermatol 2012; 53: 66–69.

Wound healing: a new approach to the topical wound care

Cutaneous wound healing is a complex and well-coordinated interaction between inflammatory cells and mediators, establishing significant overlap between the phases of wound healing. Wound healing is divided into three major phases: inflammatory phase, proliferative phase, and remodeling phase. Unlike the acute wound, the nonhealing wound is arrested in one of the phases of healing, typically the inflammatory phase. A systematic approach to the management of the chronic nonhealing wound emphasizes three important elements of wound bed preparation in chronic wounds: debridement, moisture, and countering bacterial colonization and infection. In this article, wound-healing process and new approaches to the topical wound care have been reviewed.

Psoriatic plaque erosion: a rare side effect of methotrexate

© 2008 The Authors JEADV 2009, 23, 317–368 Journal compilation

Terra firma–forme dermatosis

Terra firma–forme dermatosis (TFFD) is an uncommon disorder of keratinization with an unknown etiology in which patients present with dirt-like lesions that are resistant to washing. A 6-year old girl presented with the complaint of an asymptomatic brownish black dirt-like eruption on her body. Her parents reported no response to washing with soap and water. Dermatologic examination revealed brown hyperpigmented patches on the trunk and abdominal region. TFFD was suspected, and isopropyl alcohol was applied to the patient’s lesions. All lesions completely disappeared after rubbing with alcohol. Terra firma–forme dermatosis is a relatively recently described entity that is much more common than might be expected when surveying the medical literature. With the very few reports found in the literature about TFFD, we believe that an increased awareness of this entity among primary care physicians would help decrease unnecessary worries or medical procedures, since TFFD lesions simply resolve by rubbing with isopropyl alcohol.

Primary cutaneous anaplastic CD30+ large-cell lymphoma that completely regressed after incisional skin biopsy

We describe a 48-year-old woman with three erythematous nodules localized on the left forearm, with 2 months evolution. Histological and immunohistochemical examination revealed a CD30+ large-cell lymphoma. Systemic involvement was not detected. The tumor regressed spontaneously within a week, after the incisional skin biopsy. In control skin biopsy, there was not any histological feature of lymphoma. No reactivation or any symptom of systemic disease was observed during the 10-month follow-up period.

Giant eccrine porocarcinoma in an unusual location

Sir, Eccrine porocarcinoma, also known as malignant eccrine poroma, is an extremely rare type of skin cancer arising from the intraepidermal ductal portion of eccrine sweat glands.1,2 Lesions of eccrine porocarcinoma occur on the lower extremities in 60% of cases. Typically, these tumors arise in midlife occurring equally in males and females and have been observed in all races. They are characterized clinically as firm asymptomatic nodules, erythematous to violaceous in color and are usually <2 cm in size.3 The differential diagnosis of the disease includes basal cell and squamous cell carcinoma, pyogenic granuloma, nevus, verruca vulgaris and melanoma. Dermoscopy should be of value in the differential diagnosis of these lesions. If there is suspicion of eccrine porocarcinoma, the biopsy of choice should be excisional. A local recurrence rate after wide excision of 20%, a distant metastasis rate of 12% and a mortality rate of >50% have been reported with this tumor. Early diagnosis of this tumor is essential to ensure a benign course.4

Malignant acanthosis nigricans associated with ileocecal adenocarcinoma.

Malignant acanthosis nigricans (MAN) is a cutaneous sign of internal malignancy, usually an adenocarcinoma. With this report, we aim to present a rare case of concomitant colon cancer and acanthosis nigricans (AN). A 62-year-old woman with hyperpigmentation, velvety cutaneous thickening and verrucous excrescences involving the axillary, inframammar, and inguinal regions with a history of 10 years is presented. Hyperpigmentation and thickening existed also on the nape, umbilicus, and periorbital regions. Histopathological findings of skin lesions were consistent with AN. Computed tomography of the abdomen revealed cecal wall thickening and multiple enlarged lymph nodes in pericolic fat tissue. The tumor was resected surgically and the diagnosis of poor differentiated adenocarcinoma of the colon with lymphatic metastasis was established. Although MAN is mostly reported in the course of abdominal malignancies, this is a very rare case report of MAN associated with adenocarcinoma of the colon.