Gokhan Okan

Nicolau syndrome and perforator vessels: a new viewpoint for an old problem

Nicolau syndrome is rare cutaneous adverse reaction following injection of various drugs. The disease has been associated with almost all classes of medications, such as nonsteroidal anti-inflammatory drugs, local anesthetics, corticosteroids, antibiotics, vitamin B complexes, antihistamines, and vaccines. The most severe cases of this complication occur after injection of nonsteroidal anti-inflammatory drugs. Subcutaneous injection is an important factor in the pathogenesis of the syndrome. We report a case of Nicolau syndrome resulting from intramuscular injection of diclofenac and discuss some precautions to prevent this complication.

The effects of a high glycerin content hydrogel premolded mask dressing on post-laser resurfacing wounds.

Abstract Background: Laser resurfacing for the rejuvenation of facial skin remains a popular cosmetic procedure. Postoperative care for laser resurfacing is important to optimize healing, reduce pain and minimize complications. Objective: To compare the efficacy of the new dressing against placebo (Vaseline® cream) after Er:YAG laser resurfacing. Methods: Fifteen patients between 45 and 72 years of age with facial wrinkles were enrolled in the study. Patients underwent full-face Er:YAG procedures. The wounds were then dressed: one side of the face was treated with Vaseline and the other with a hydrogel dressing. Erythema, edema, pigmentation, average time of re-epithelization, pain score, itching, clinical evaluation of infection, crust formation and acidity were documented. Results: The hydrogel dressing decreased postoperative morbidity. The site treated by hydrogel showed a shorter epithelial healing time than the Vaseline site. The dressing relieved the immediate pain of facial resurfacing as well as preventing crust formation and itching. Conclusion: A hydrogel dressing is a better and suitable alternative to the open technique to manage post-laser wound healing.

Serum Visfatin, Fetuin-A, and Pentraxin 3 Levels in Patients With Psoriasis and Their Relation to Disease Severity.

Psoriasis is a chronic immune‐mediated inflammatory skin disease associated with increase of some pro‐inflammatory mediators. We wanted to investigate whether there is a relationship between psoriasis and visfatin, fetuin‐A and pentraxin 3 (PTX3)—pro‐inflammatory mediators implicated in the development of insulin resistance (IR), metabolic syndrome, and atherosclerosis.

The Effect of Long-Pulsed Nd:YAG Laser for the Treatment of Onychomycosis

BACKGROUND Topical onychomycosis therapies are usually inadequate, and patient compliance to systemic therapies is poor. Recently, interest in laser therapy for the treatment of onychomycosis has increased. We sought to investigate the efficacy of long-pulsed Nd:YAG laser therapy for onychomycosis. METHODS Thirty patients with mycologically confirmed onychomycosis received long-pulsed 1064-nm Nd:YAG laser therapy, moving the beam in a spiral pattern over the whole nail plate two times, with a 1-minute pause between passes. Laser therapy was performed with a spot diameter of 4 mm at a speed of 25 mm/sec once weekly for 4 weeks using fluencies ranging from 40 to 60 J/cm2, depending on the thickness of the nail plate. Patients were evaluated in terms of clinical improvement and mycologic cure. RESULTS Thirty patients started and 15 completed the study. Mycologic cure was achieved in nine patients (60%), of whom eight (89%) were infected with Trichophyton sp. Complete clinical improvement was achieved in seven patients (47%), all of whom were infected with Trichophyton sp. Mycologic cure was not achieved in one of two patients infected with Epidermophyton or in either patient in whom the agent was Candida or Aspergillus; complete clinical improvement did not occur in any of these patients. No serious adverse events were observed. CONCLUSIONS Based on these results, long-pulsed Nd:YAG laser can be used as an effective treatment for onychomycosis, but further studies are needed to draw firmer conclusions.

Azathioprine-induced liver injury in a patient with multiple autoimmune syndrome

Abstract Extraintestinal manifestations are frequent in patients with ulcerative colitis. They are most commonly associated with active bowel disease but can also occur prior to bowel disease or during a period of remission. The disease often requires long-term therapy. The tolerability of drugs is essential for the comprehensive management of patients. Azathioprine is considered an indispensable drug for the treatment of severe ulcerative colitis patients. It is used to prevent relapse or to treat patients who are refractory to corticosteroids. We report a patient who had alopecia areata, vitiligo, recurrent episcleritis, ulcerative colitis and azathioprine-induced liver injury, and review the related literature.

G-231A and G+70C polymorphisms of endothelin receptor type-A gene could affect the psoriasis area and severity index score and endothelin 1 levels

Background: The etiopathogenesis of psoriasis has not been clearly elucidated although the role of chronic inflammation, imbalance between pro- and anti-inflammatory cytokines, and many immunological events have been established. Endothelin 1 (EDN1) and endothelin receptor type-A (EDNRA) are implicated in the inflammatory process. The relationships between EDN1 and EDNRA polymorphisms with several diseases have been found. Aims and Objectives: This study examined the possible association of EDN1 (G5665T and T-1370G) and EDNRA (G-231A and G + 70C) single nucleotide polymorphisms (SNPs) with the occurence of psoriasis, and evaluated the relationship between genotypes and clinical/laboratory manifestation of psoriasis. Materials and Methods: We analyzed genotype and allele distributions of the above-mentioned polymorphisms in 151 patients with psoriasis and 152 healthy controls by real-time PCR combined with melting curve analysis. Results: We did not find significant differences in the genotype and allele distributions of EDN1 T-1370G, EDNRA G-231A, and EDNRA G+70C polymorphisms between patients with psoriasis and healthy controls. Psoriasis area and severity index (PASI) score of EDNRA –231 polymorphic A allele carrying subjects (AA and AA + AG) was higher than that of wild homozygotes (P = 0.044 and P = 0.027, respectively). In addition, EDN1 levels in EDNRA+70 polymorphic C allele carriers (CC + CG) were elevated when compared with GG genotype; however, the difference was at borderline significance (P = 0.05). Conclusion: Although there were no associations between studied polymorphisms and psoriasis susceptibility, the PASI score and EDN1 levels seem to be affected by EDNRA G-231A and G + 70C polymorphisms.