Gülbahar Saraç

Treatment of erythematotelangiectatic rosacea, facial erythema, and facial telangiectasia with a 577-nm pro-yellow laser: a case series

Various lasers have been used for the treatment of erythematotelangiectatic rosacea (ETR), facial erythema (FE), and facial telangiectasias (FT). The assessment of the treatments of all of these conditions with a 577-nm pro-yellow laser has not been reported yet. The aim of this work was to assess the efficacy and safety of the 577-nm pro-yellow laser in ETR, FE, and FT. Forty patients suffering from ETR, FE, and FT (25 female and 15 male) were enrolled in this study. All of the patients were treated with 577-nm pro-yellow laser (QuadroStarPRO YELLOW® Asclepion Laser Technologies, Germany) at 4-week intervals, for one to four sessions. The assessment of the treatment was made based on the digital photographs and the percentage of fading of the erythema and telangiectasias in the lesions. Significant clinical improvement (80–100%) was observed in the first or second sessions of the treatment in FE and ETR patients and in second and fourth sessions of the treatment in FT patients. The treatment was very well tolerated. No side effect was observed except for a few patients who had mild to moderate erythema fading away in 12–24xa0h. This case series has shown that the pro-yellow laser is a very effective, safe, and well-tolerated treatment for ETR, FE, and FT.

Management of complications of vitamin E injections into the face

Dear Editor, Filler applications can be performed by specialists and even by other doctors who are not trained in this field or the personnel who are nonpractitioners (Kamouna et al., 2015). Besides clinically approved filler materials, some unofficial materials with unknown ingredients sold on the Internet might be also used. The adverse effects due to the injections of vitamin E have been frequently encountered in the literature, recently. A 33-year-old woman has attended to our outpatient clinic with the complaint of red, painful, indurated lesions on her face. She had injected vitamin E gel into the zygomatic region of her own face. After 2 months, there were three nodules, which were 2–4 cm in size, erythematous, indurated, and painful at palpation in both zygomatic regions. There were also 2 cm sized erythema and induration on both eyelids (Figure 1). A punch biopsy from the lesion revealed superficial and deep dermal perivascular, interstitial, and periappendiceal lymphohistiocytic infiltrate beneath the minimally hyperkeratotic epidermis. Telangiectatic capillary vessels were present in the superficial and middle portions of the dermis. The patient was evaluated as having a severe inflammatory reaction due to vitamin E injections. She was treated with systemic 0.5 mg/kg/day methylprednisolone, 1.5 mg/day colchicine, and 200 mg/day doxycycline. Additionally, the combination of 8 mg of steroid, 300 mg of clindamycin, and 50 mg of 5-fluorouracil was applied as 0.3 ml intralesional injections at 1 cm intervals. There were no any complications such as atrophy and telangiectasias due to the intralesional injections. The steroid dose was gradually tapered to zero over the ensuing 3 months. After 3-month treatment, there was approximately 80% regression in the size of the lesions (Figure 2). The most common reactions due to foreign material injections are sclerodermoid reactions, subcutaneous infiltration, edema, hyperpigmentation, and deformation. Also, hepatosplenomegaly, acute kidney failure, disseminated lipogranuloma, and sudden death cases possibly caused by dissemination of the materials via hematologic or lymphatic routes are reported (Kamouna et al., 2015; Rollins, Reiber, Guinee, & Lie, 1997). In our case, we think that there has been a hematologic or lymphatic dissemination, too, because she had the similar reaction also on her eyelids, which were uninjected. The most frequent adverse effect due to lipid and vitamin injection is sclerosis lipogranuloma. In sclerosis lipogranuloma, fibrotic and granulomatous changes occur in subcutaneous fat

The Effect of Skin Sebum, pH, and Moisture on Demodex Infestation in Acne Vulgaris and Rosacea Patients

OBJECTIVEnAcne vulgaris is an inflammatory disease involving the pilosebaceous unit. Rosacea is a chronic inflammatory skin disease that affects the face in particular. This study aimed to determine if skin sebum, pH, and moisture affect the number of Demodex spp. in acne vulgaris and rosacea patients.nnnMETHODSnThis study focused on 30 patients each with acne vulgaris and rosacea. As a control group, 60 healthy individuals were included.nnnRESULTSnIn acne vulgaris patients, when compared to those with Demodex mite more than 5 /cm2 in each area, less than 5/cm2 were found to be oily, acidic, dry or very dry. However, there was no significant difference in moisture value. In patients with rosacea, the skin was acidic and dry in patients those with more than 5/cm2 Demodex mites when compared to those with demodex mite less than 5 /cm2 in patients in each of the right cheek and nose areas. There was no difference in skin oil level.nnnCONCLUSIONnThe oily, acidic, dry, and very dry skin of the acne vulgaris patients and the oily, acidic, and very dry skin of the rosacea patients are factors facilitating the development of Demodex ssp.

Darier Hastalığında Fatal Herpes Simpleks Virüs Enfeksiyonu

Darier disease is an autosomal dominant disorder characterized by small, hyperkeratotic papules localised on the trunk especially in the seborrheic regions. Vegetation and infections in the intertriginous areas are common in this disease while treatment is not usually satisfying. While the urea or lactic acid containing moisturizers, topical steroids, and topical retinoids are used in mild cases, systemic retinoids are preferred in severe cases. Kaposi varicelliform eruption caused by herpes simplex virus is rare but a well-defined complication. Clinical findings of this viral infection, which are usually uncommon, may delay diagnosis and treatment. Here, we report the case of a patient with Darier’s disease treated with corticosteroids who later developed fatal herpes simplex virus infection despite the aciclovir therapyDarier Hastaligi, otozomal dominant kalitimla gecen, klinik olarak govdede ve ozellikle seboreik alanlarda lokalize, kucuk, hiperkeratotik papullerle karakterize bir hastaliktir. Hastalikta intertriginoz alanlarda vejetasyon ve infeksiyonlar siktir. Tedavisi genellikle tatmin edici degildir. Hafif olgularda ure veya laktik asit iceren nemlendiriciler, topikal steroidler, topikal retinoidler kullanilirken, siddetli olgularda sistemik retinoidler tercih edilir. Herpes simpleks virusunun neden oldugu Kaposinin variselliform erupsiyonu hastaligin nadir gorulen fakat iyi tanimlanmis bir komplikasyonudur. Bu viral enfeksiyonun alisilmisin disindaki klinik bulgulari, siklikla tanida ve tedavinin verilmesinde gecikmelere neden olabilir. Burada kortikosteroid tedavisi alan bir Darier hastasinda takipleri esnasinda gelisen ve asiklovir tedavisine ragmen fatal seyreden, herpes simpleks virus enfeksiyonu sunulmaktadir.