Gonca Boztepe

No additional effect of topical calcipotriol on narrow-band UVB phototherapy in patients with generalized vitiligo.

Background/Purpose: There is no definite cure for vitiligo; however, treatment responses with photobiological modalities are quite acceptable. Of all these, narrow‐band UVB phototherapy was proposed rather recently. Calcipotriol has been shown to have stimulating activity on melanogenesis besides immunomodulatory and anti‐inflammatory effects. This study was performed to determine whether adding topical calcipotriol to narrow‐band UVB phototherapy enhances the efficacy of treatment.

Cutaneous mastocytosis : demographic aspects and clinical features of 55 patients

Background  Mastocytosis is a rare, heterogeneous group of disorder with abnormal increase of mast cells in one or more organ systems.

Munich Method of Micrographic Surgery for Basal Cell Carcinomas: 5-year Recurrence Rates with Life-table Analysis

The aim of this study was to find the recurrence rates of basal cell carcinomas treated with micrographic surgery in the Department of Dermatology, University of Regensburg. From 1992 to 1997, 261 basal cell carcinomas (178 primary and 83 recurrent) have been treated. The mean duration of follow-up was 5 years (range 1-9). Data were analysed by life-table analysis. Eleven basal cell carcinomas (6 primary and 5 recurrent) recurred. The 5-year recurrence rates were 3.3% for primary and 7.3% for recurrent basal cell carcinomas. Our results are comparable with previously published data from Europe but seem higher than those reported in the USA. Use of different statistical methods to report the recurrence rates mainly accounts for the discrepancy among studies. For a better comparison among studies on recurrence rates, a standard statistical method should be used, and we support the idea that life-table analysis provides the best approximation of the true recurrence rates.

The effect of maintenance narrow-band ultraviolet B therapy on the duration of remission for psoriasis: a prospective randomized clinical trial

Background  Narrow‐band (311 nm) UVB is an effective treatment modality for moderate to severe psoriasis. The effect of maintenance narrow‐band UVB on the duration of remission is unknown.

A case of lupus vulgaris successfully treated with antituberculous therapy despite negative PCR and culture

A 14-year-old boy presented with a pink firm plaque with well-defined borders in the right infra-orbital skin area. On diascopy, the infiltrate exhibited a typical apple-jelly appearance. No acid-fast bacilli could be demonstrated. A polymerase chain reaction (PCR) assay did not reveal the presence of mycobacteria in a lesional biopsy sample. Culture of biopsied tissue on Loewenstein-Jensen medium was negative. Although the tuberculosis culture and PCR did not confirm tuberculosis, a diagnosis of lupus vulgaris was made considering the clinical and histopathological findings. After a 9-month antituberculous therapy, the lesion disappeared. We believe that a diagnosis of lupus vulgaris still depends more on clinical and histopathological findings than on tuberculosis culture or PCR.

Sweet's syndrome and erythema nodosum: a companionship or a spectrum?--a case report with review of the literature.

A 47-year-old woman presented to the emergency department with an eruption of 4 days’ duration. The eruption started on the face, neck, and hands. Later, lesions appeared on the arms and legs, accompanied by arthralgia. She had a 9-day history of an upper respiratory tract infection for which she was prescribed levofloxacin and acetaminophen. She recalled that she had also used dipyrone during the prodromal phase of the infection. In addition, she had suffered from vitiligo for 20 years, together with hypertension, hyperlipidemia, and fibromyalgia. Dermatologic examination revealed the following: on the face, ears, and ‘V’ region and back of the neck, erythematous and highly edematous papules and plaques, some of which were pseudovesicular (Fig. 1); at the extensor surfaces of the arms, erythematous, pustular papules and plaques with some dusky red centers, resembling target lesions; at the dorsal and palmar surfaces of the hands, painful, highly edematous plaques, some of which were also targetoid, and multiple separate tiny pustules; at the anterior aspects of the legs, 10–20 pale, erythematous, painful, indurated nodules (Fig. 2), accompanied by similar lesions on the sides of the thighs and on the dorsum of the left foot. All other aspects of the dermatologic examination, including the oral mucosa, scalp, and nails, were normal, except for the depigmented macules and patches on the dorsal surfaces of the hands and volar surfaces of the wrists, which were consistent with vitiligo. The rest of the physical examination was normal. There was no lymphadenopathy. The liver function tests were normal. She had leukocytosis [20.6 · 10/L; normal, (4–10) · 10/L], with a neutrophilic predominance of 78% in the peripheral smear, and an elevated C-reactive protein level (5.35 mg/ dL; normal, 0–0.8 mg/dL) and sedimentation rate (96 mm/h; normal, 0–20 mm/h). She had anemia with a hemoglobin level of 10 g/dL (normal, > 12 g/dL for females). She was hospitalized and systemic corticosteroid therapy was initiated with the clinical diagnosis of Sweet’s syndrome. All samples, including an excisional skin biopsy obtained from one of the lesions on the leg and punch biopsies taken from the neck and from one of the

Prurigo pigmentosa successfully treated with low-dose isotretinoin.

Background/Aims: Prurigo pigmentosa (PP) is an uncommon inflammatory disease with pruritic reddish papules, papulovesicules or vesicules that are symmetrically localized on the trunk and nape, accompanied by reticular hyperpigmentation. Currently available therapeutic options seem somewhat unsatisfying. Herein, we report an 18-year-old female with PP successfully treated with low-dose isotretinoin. Methods: The patient presented with a symmetrical pruritic eruption on the lateral sides of her trunk with erythematous papules on a hyperpigmented background. Based on the typical clinical and associated histological findings, the patient was diagnosed as PP and a treatment with low-dose isotretinoin 0.3 mg/kg/day (20 mg/day) was started. Results: After a total of 3 months of 20 mg/day isotretinoin therapy, all erythematous macules and papules resolved and the residual pigmentation had almost disappeared. Conclusion: Low-dose isotretinoin is not only adequate for the improvement of erythematous lesions, it also helps resolve the reticular hyperpigmentation of PP. Further studies are needed to observe the efficacy of isotretinoin in the treatment of PP.

Narrowband ultraviolet-B phototherapy in pityriasis lichenoides chronica

Background: Current knowledge about the efficacy of narrowband UVB therapy for the treatment of pityriasis lichenoides is limited. Objective: The aim of this study was to investigate the efficacy of narrowband UVB therapy for the treatment of pityriasis lichenoides chronica (PLC). Methods: Data were retrospectively collected following a review of patient phototherapy and medical charts, and telephone interviews were performed for follow-up information. Results: The study included 25 patients (14 male, 11 female) with a mean age of 34 ± 13 years. Diagnosis was confirmed by histopathological examination in 92% (n = 23) of the patients. The median duration of the disease was 24 months (range: 2–192 months). The median number of sessions until response was 25 (8 weeks) (range: 9–77 sessions), with a median cumulative dose of 15 J/cm² (range: 2–158 J/cm²). Complete response and partial response were achieved in 48% and 44% of the patients, respectively, while 8% of the patients achieved no response. In those patients for whom follow-up data were available (n = 17), 10 (58%) relapsed within a median of 9.5 months (range: 1–44 months). Conclusions: Our results suggest that narrowband UVB is an effective and well-tolerated treatment option for PLC.

Acute generalized exanthematous pustulosis induced by bleomycin and confirmed by patch testing

Acute generalized exanthematous pustulosis is a potentially severe disease caused by drugs in about 90% of cases. To the best of our knowledge, acute generalized exanthematous pustulosis following use of bleomycin has not been previously reported. Here we report a case of acute generalized exanthematous pustulosis induced by bleomycin, which was confirmed by patch testing.

Testicular mixed germ cell tumor metastasizing to skin as choriocarcinoma

XXX Correspondence Testicular mixed germ cell tumor metastasizing to skin as choriocarcinoma Choriocarcinoma is a malignant growth of trophoblastic cells. In males, up to 40% of all testicular neoplasms contain elements of choriocarcinoma which is the most aggressive component with a high metastatic potential. Although it has a high potency for distant spread, cutaneous metastasis is uncommon and despite aggressive chemotherapy and surgery, skin metastases are associated with poor prognosis. A 23-year-old white male presented to our hospital with the complaints of dyspnea and chest pain. Fifteen days prior, a radical orchiectomy had been performed for a tumor in his left testis at another medical center. Removed tumor was a mixed germ cell tumor composed of classic type seminoma and teratoma. No other germ cell component was present. During his work-up in our hospital, multiple metastases to the lungs, brain, and retroperitoneum were identified. Seven days after his admission, three isolated lesions on the skin were noted: one was located on the vertex of the scalp, in the form of an erythematous, hemorrhagic, crusted nodule measuring 0.6 × 0.8 cm (Fig. 1a). The other two lesions which were violaceous to red, firm, dome-shaped infiltrative nodules, both 1 cm in diameter were located on the trunk (on the left midclavicular line and at the interscapular region) (Fig. 1b). A skin punch biopsy from one of them revealed metastasis in the form of pure choriocarcinoma. The tissue was hemorrhagic and necrotic in the center (Fig. 2). Trophoblastic cells were distributed all over the dermis singly or in small groups. While some were surrounding the necrotic region, some were dissecting the collagen bundles. Most of the cells displayed synyctiotrophoblastic morphology, and strong pancytokeratin and β-hCG expressions (Fig. 3). Despite the administration of multiple courses of different chemotherapy protocols, patient died with multiorgan failure at the 17th month after the initial detection of cutaneous metastases. Cutaneous metastasis in the form of choriocarcinoma from a testicular germ cell tumor is very rare. To the best of our knowledge, only 10 cases have been reported in the literature. Seven of these patients had pure choriocarcinoma of the testis. Other patients had mixed germ cell tumors like the case presented here. Clinical findings vary depending on whether choriocarcinoma is a part of a mixed germ cell tumor or is a pure disease. For pure choriocarcinoma, cutaneous lesions may be the presenting symptom. On the other hand, mixed germ cell tumors usually present with testicular enlargement, pain or distant metastases. In our case, the primary tumor was a mixed germ cell tumor consisting of seminoma and mature teratoma, which had multiple metastases to lungs, brain, retroperitoneum, and additionally to the skin. Compared to visceral organs, such as lung and liver, skin is a relatively uncommon site for metastatic spread of an internal malignancy, thus the clinical diagnosis of cutaneous metastases is often challenging. One good aid for the diagnosis is the knowledge of the existence of a primary malignancy. Cutaneous metastases of testicular germ cell tumors are usually violaceous to red, hemorrhagic, infiltrative subcutaneous nodules located on the trunk, back, head, and scalp. With this clinical presentation, metastasis from choriocarcinoma may be confused with vascular lesions, such as pyogenic granuloma, hemangioma, and Kaposi’s sarcoma. Histopathology of the choriocarcinoma is an admixture of two distinct populations of cells, syncytiotrophoblasts, and cytotrophoblasts arranged in cords and islands, and associated with variable amounts of hemorrhage and necrosis. Positive immunohistochemical staining for β-hCG confirms the diagnosis. Our case is interesting beacuse the primary testis tumor contained only teratoma and seminoma, on the other hand choriocarcinomatous component first appeared in the retroperitoneal metastasis and, cutaneous metastasis was pure choriocarcinoma. Since germ cells are totipotent, they may undergo differentiation in any direction, trophoblastic or somatic, either in the primary lesion or in the areas of metastases. The present case clearly illustrates that testicular mixed germ cell tumors can produce skin metastases which might be composed only of their choriocarcinomatous component.