Gulsum Gencoglan

Therapeutic Hotline: Treatment of prurigo nodularis and lichen simplex chronicus with gabapentin

Psychocutaneous conditions are frequently encountered in dermatology practice. Prurigo nodularis and lichen simplex chronicus are two frustrating conditions that are classified in this category. They are often refractory to classical treatment with topical corticosteroids and antihistamines. Severe, generalized exacerbations require systemic therapy. Phototherapy, erythromycine, retinoids, cyclosporine, azathiopurine, naltrexone, and psychopharmacologic agents (pimozide, selective serotonin reuptake inhibitor antidepressants) were tried with some success. Here five cases with lichen simplex chronicus and four cases with prurigo nodularis, who responded well to gabapentin, are presented.

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.

The molecular mechanism of etanercept, an anti-tumour necrosis factor-a receptor-fusion protein, in the treatment of acute generalized exanthematous pustulosis

Introduction: Acute generalized exanthematous pustulosis (AGEP) is one of the severe adverse cutaneous drug reactions. In its pathophysiology, releasing of tumour necrosis factor-alpha (TNF-α) is very important. Therefore, treatment with an anti-TNF-α receptor-fusion protein, such as etanercept, may be effective. Objective: To present a case and evaluate the molecular mechanism of etanercept in the treatment of AGEP. Case: A 53-year-old woman with multiple disseminated pustules and a rash on the upper part of her back, which was progressively worsening and spreading to approximately 60–70% of the skin on her back, and fever (38.7°C), was admitted to our department. After etanercept treatment, all the symptoms were rapidly improved and the patients skin practically cleared within 5 days. Biopsy samples taken from this patient with AGEP before and after etanercept treatment were stained immunohistochemically with p53 and bcl-2 antibodies and also an apoptosis detection kit. Results: In epidermis, increasing p53 expression-related apoptosis and decreasing bcl-2 expression was detected. However, after etanercept treatment, p53 expression-related apoptosis decreased and bcl-2 expression increased. Conclusion: Because TNF-α stimulated inflammation and also p53-related apoptosis occurs in AGEP, a TNF-α blocking agent such as etanercept may be effective for quick treatment.

Expression of Nuclear Factor Kappa B and Survivin in Psoriasis

Background and Objective. Suppression of apoptosis has been proposed as a mechanism responsible for epidermal thickness in psoriasis. Survivin is a member of the inhibitor of apoptosis family. Nuclear factor kappa B (NF-κB) is one of the transcriptional factors that regulate many genes affecting apoptosis. The aim of this study was to determine survivin and NF-κB expressions in psoriasis in comparison with normal epidermis. Patients and Methods. Immunohistochemical expressions of survivin and NF-κB were investigated in 41 psoriatic and 21 normal skin samples. Results. Diffuse nuclear survivin expression in all epidermal layers was seen in all of the psoriatic samples. NF-κB expression in different epidermal locations was seen in all of the psoriatic samples. Nuclear staining was positive in 40 psoriasis samples. Similar survivin and NF-κB expressions were observed in normal skin samples. Conclusion. Since similar expressions are seen in both normal and psoriatic epidermis, no important roles for survivin and NF-κB can be attributed in epidermal proliferation and thickness seen in psoriasis.

Psoriatic uveitis responding to adalimumab therapy

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PYOGENIC GRANULOMA IN TWO CHILDREN SUCCESSFULLY TREATED WITH IMIQUIMOD 5% CREAM

Abstract:  Pyogenic granulomas are sometimes difficult to treat in children, especially very young children in whom surgical procedures may be difficult. Here, we present two children with pyogenic granuloma who were successfully treated by topical imiquimod cream with excellent results.

Trichilemmal cyst with homogeneous blue pigmentation on dermoscopy.

A 61‐year‐old woman was referred to our dermoscopy unit for a pigmented lesion that had been present on her left arm for 8 years. The patient did not notice any enlargement or change in colour. On dermoscopy, homogeneous blue pigmentation was seen. The lesion was excised with the pre‐operative diagnosis of melanoma, blue naevus and dermatofibroma. Histopathological examination showed a trichilemmal cyst in the mid‐dermis. Although homogeneous blue pigmentation on dermoscopy is the hallmark of blue naevus, it may be seen in metastatic melanoma and exceptionally in hemosiderotic and cellular types of dermatofibroma. Trichilemmal cyst should be borne in mind also in the dermoscopic differential diagnosis.

Hypopyon-like features: new dermoscopic criteria in the differential diagnosis of cutaneous lymphangioma circumscriptum and haemangiomas?

Background  Lymphangiomas are congenital malformations of the lymphatic system characterized by clusters of translucent vesicles. Dermoscopically, yellow and bluish lacunea according to the lymphatic or haematic content were described previously, but it is difficult to distinguish them from haemangioma.

Nonmelanoma Skin Cancer of the Head and Neck: Clinical Evaluation and Histopathology

Clinical and histopathologic features of nonmelanoma skin cancer, physical examination, and diagnostic methods (biopsy, dermoscopy, confocal microscopy) are summarized. A diagnostic algorithm provides a useful summarization of differential diagnosis of basal cell carcinoma, actinic keratosis, Bowens disease, and squamous cell carcinoma.

Effects of isotretinoin on spermatogenesis of rats

Background: The results of studies on the effects of retinoids on spermatogenesis are controversial. Objectives: We evaluated time- and dose-dependent effects of isotretinoin on spermatogenic activity by apoptosis, cyclin D1, E2F, p53 expressions, and Johnsen’s scores. Methods: The rats were divided into three groups. In the 1st group (n = 18), 1 mg/mL/day and in the 2nd group (n = 18) 2 mg/mL/day isotretinoin were administered for 21 days. Flower oil was given to the 3rd (n = 6) control group. On the 7th (groups 1a and 2a), 14th (groups 1b and 2b), and 21st (groups 1c and 2c) days, six rats from the 1st group and six rats from the 2nd group were sacrificed and bilateral orchiectomy was done. Results: The number of cyclin D1 and E2F-positive cells decreased nonsignificantly parallel to days in the 1st group, whereas there was a statistically significant decrease in the 2nd group for the same cells. The p53-positive cells in groups 1c and 2c were increased significantly. Conclusions: Further studies on the effects of retinoids on spermatogenesis should be conducted. It may be wise to administer contraception to male patients, especially during high-dose and long-term retinoid therapy.