Hakan Turan

Methotrexate for the treatment of generalized lichen planus.

Lichen planus (LP) is a common pruritic, inflammatory disease that may involve the skin, mucous membranes, nails, and hair follicles.Topical treatments are associated with a good response in limited lesions but in patients with widespread disease, these treatments are usually unsatisfactory. Systemic corticosteroids have long been the treatment of choice for generalized LP but their use is limited in several conditions like old age, systemic diseases such as diabetes mellitus and osteoporosis. Additionally, despite the good results with corticosteroids, recurrence is quite common and sometimes leads to long-term use of such medications. Other systemic treatments that have been tried in cutaneous LP with variable response rates include oral retinoids, azathioprine, Tetracycline, cyclosporine, mycophenolate mofetil, thalidomide, low molecular weight heparin, PUVA or UVB, metronidazol, and biologic agents 1-15. A treatment with a good response rate and safety comparable to corticosteroids but with a lower recurrence rate can be a very good substitute for systemic corticosteroids, especially in old ages and patients with systemic diseases. Methotrexate (MTX) inhibits the action of Dihydrofolate reductase which is a necessary enzyme in the synthesis of Iran J Dermatol 2011; 14: 131-135 Received: September 7,2011 Accepted: December 3, 2011

Miliary osteoma cutis of the face: treatment with the needle microincision-extirpation method.

Multiple miliary osteoma cutis of the face represents primary extra‐skeletal bone formation that arises within the skin of the face. Multiple miliary osteoma cutis of the face is a rare complication of chronic inflammatory acne vulgaris and has invasive and non‐invasive treatment alternatives different from acne vulgaris. Invasive techniques should be simple, easy, and inexpensive, with minimal risk of scarring and pigmentation. We used a needle microincision‐extirpation technique in a patient with multiple miliary osteoma cutis unresponsive to non‐invasive treatment modalities. Skin overlying the papules was incised with a needle and then the calcificated papules were extirpated by using a small curettage device. Lesions were left to secondary healing. Results were quite good and cosmetically acceptable.

Nail Psoriasis Successfully Treated with Intralesional Methotrexate: Case Report

Psoriasis is a common, chronic disease which affects nearly 3% of the population. The lifetime incidence of nail involvement increases up to 80–90% for psoriatic patients. Nail psoriasis is considered a significant social problem. Many topical agents have been used for psoriatic nails with various side effects and some benefits; management is currently inconclusive. Methotrexate (MTX) is a folic acid analog, which irreversibly binds to dehydrofolate reductase and blocks deoxyribonucleic acid synthesis. It is considered a potential treatment option for rapidly growing cells and has an anti-inflammatory effect through inhibition of the polyamine pathway in autoimmune diseases. Intralesional MTX has been used successfully for various indications. We present a case successfully treated with low-dose intralesional MTX with no observed side effects in a 26-year-old female psoriatic patient suffering from nail dystrophy. In contrast, conventional topical and systemic therapies have various side effects, which limit their use. We conclude that intralesional MTX injection seems to be a safe and effective treatment option for nail psoriasis; however, large controlled studies are needed.

Narrowband UVB (311 nm, TL01) phototherapy for pityriasis lichenoides

Background/purpose: Narrowband (NB) UVB (NB‐UVB) phototherapy has recently demonstrated high levels of efficacy and tolerability in a variety of skin diseases. The purpose of the present study was to assess the efficacy of NB‐UVB phototherapy in the management of pityriasis lichenoides (PL).

Allergic contact dermatitis to para-phenylenediamine in a tattoo: a case report

It is highly popular among children and young adults to have temporary henna tattoos on their bodies in different colors and figures. Henna is a greenish natural powder obtained from the flowers and dry leaves of Lawsonia alba plant and its allergenicity is very low. Henna is also used in combination with other coloring substances such as para-phenylenediamine in order to darken the color and create a permanent tattoo effect. Para-phenylenediamine is a substance with high allergenicity potential and may cause serious allergic reactions. Here, we aimed to draw attention to the potential harms of para-phenylenediamine containing temporary tattoos by presenting a child patient who developed allergic contact dermatitis after having a scorpion-shaped temporary tattoo on his forearm.

Polyurethane toilet seat contact dermatitis.

Abstract:  Polyurethane chemicals are produced by the reaction of isocyanates and they may cause allergic contact dermatitis or precipitate asthma attacks. Contact dermatitis to polyurethane toilet seat has not been reported before. Herein we present a case of allergic contact dermatitis to polyurethane toilet seat.

Dermal absorption and toxicity of alpha amanitin in mice

Abstract The fungus Amanita phalloides is known to contain two main groups of toxins: amanitins and phallotoxins. The amanitins group effectively blocks the RNA polymerase II enzyme found in eukaryotic cells. As alpha amanitin has a lethal effect on the majority of eukaryotic cells, it can be valuable as an antiparasitic or antifungal drug. It can be used externally against ectoparasites. It is critical that percutaneous applications of the alpha amanitin toxin are not harmful to the recipient. In this study, the absorption and the toxicity of percutaneous and intraperitoneal (ip) applications of 1 mg/kg alpha amanitin to mice were compared. Potential skin, liver and kidney toxicities were investigated through pathological examination. HPLC analysis was used to determine the amount of the toxin. No toxicity or toxin were found in the skin, liver, or kidneys of the mice in the control group. Interestingly, the percutaneous application group also showed no toxicity, and the toxin was not present in this group. After 24 h, Councilman-like bodies and pyknotic cells were observed in the mice in which alpha amanitin was applied intraperitoneally, demonstrating the presence of toxicity. Peak levels of alpha amanitin (µg/mL) in the liver, kidney, and blood in the ip application group were measured at 3.3 (6 h), 0.2 (6 h) and 1.2 (1 h), respectively. The results demonstrated that the toxin was not absorbed through the skin of the mice and that the percutaneous application of alpha amanitin did not have any toxic effects. Thus, alpha amanitin may be administered percutaneously for therapeutic purposes.

Adult‐onset Langerhans cell histiocytosis confined to the skin

890 JEADV 2006, 20, 868–902

Profuse erythema multiforme induced by chlorambucil

Dear Editor, Purine analogs replaced alkylating agents as the standard first-line agents for chronic lymphocytic leukemia (CLL); however, chlorambucil is still being used in some of selected patients, particularly who are not candidates for more aggressive therapies due to poor performance status or co-morbid diseases. Although myelosuppression is being the most common toxicity of chlorambucil therapy, rare but serious complications such as allergic skin reactions may also occur. In this paper, we report a CLL patient who developed profuse erythema multiforme (EM) induced by chlorambucil. A 69-year-old woman had history of B cell CLL (Rai stage IV) diagnosis since 2002. She did not respond well to fludarabine therapy or to CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone). After four cycles of CHOP therapy, the patient developed severe pneumonia. Therefore, CHOP therapy was discontinued. Four months later, during off-therapy, she presented with night sweats, malaise, and progressively increasing white blood cell count (WBC). At that time, her physical examination revealed pale appearance, multiple palpable lymph nodes, splenomegaly (13 cm), and hepatomegaly (5 cm). Peripheral blood picture showed: Hb 9.5 g/dl, WBC 125×10/l, and a platelet count of 58×10/l. Chlorambucil at a dose of 8 mg/day was commenced. Two weeks later, she was admitted to the hospital complaining of skin eruptions for the last 10 days. There was no preceding history of viral illness or vaccination. Her history revealed that the skin eruptions developed on the fourth day of chlorambucil therapy, which was then discontinued. On physical examination, several target lesions with a central blister and surrounding purplish dark erythema on the face, trunk, and extremities were observed (Fig. 1). Histopathological evaluation of lesions was compatible with EM. Blood cultures for bacteria were negative. Prednisone (1.5 mg/kg/day) was commenced promptly. However, 8 days later, she died due to development of pneumonia before the resolution of her skin lesions. EM is an acute, self-limited skin disease characterized by the abrupt onset of symmetrical fixed red papules, some of which evolve into target lesions [1]. EM may occur in patients of all ages, particularly in adolescents and young adults [2]. Although many precipitating factors have been defined in EM, viral and bacterial infections and medicaments are the usual culprits. Nonetheless, chlorambucilassociated allergic skin reactions are very rare [3, 4]. Autoimmune disorders are well-known complications of CLL that may be observed either at presentation or during the course of the disease [5]. However, it is most likely that our patient has developed EM induced by chlorambucil, as: Ann Hematol (2007) 86:539–540 DOI 10.1007/s00277-007-0273-y

Acquired bilateral nevoid telangiectasia syndrome with gastrointestinal involvement

ejd.2011.1404 Auteur(s) : Aysegul Turan1 draysegulgocer@yahoo.com, Hayriye Saricaoglu1, Emel Bulbul Baskan1, Murat Keskin2, Saduman Balaban Adim3, Hakan Turan4, Sukran Tunali1 1 Uludag University Medical Faculty, Dermatology Department, Bursa, Turkey 2 Uludag University Medical Faculty, Gastroenterology Department, Bursa, Turkey 3 Uludag University Medical Faculty, Pathology Department, Bursa, Turkey 4 Duzce University Medical Faculty, Dermatology Department, Duzce, Turkey Unilateral nevoid telangiectasia [...]