Halis Bülent Taştan

Narrow-band ultraviolet B as monotherapy and in combination with topical calcipotriol in the treatment of vitiligo.

Vitiligo is a common, idiopathic, acquired, depigmenting disease characterized by loss of normal melanin pigments in the skin. The most interesting treatment methods for extensive vitiligo involve psoralen plus ultraviolet A (PUVA) therapy and ultraviolet (UV)‐B phototherapy, particularly narrow‐band UV‐B. In this randomized and comparative study, we investigated the safety and efficacy of narrow band ultraviolet B as monotherapy and in combination with topical calcipotriol in the treatment of generalized vitiligo. Of the 40 vitiligo patients enrolled in the study, 15 were treated with the calcipotriol plus narrow‐band UV‐B (NBUVB) and 25 with narrow band UV‐B alone. The patients were randomized into two NBUVB treatment groups. The first group, consisting of 24 patients (all male), received only NBUVB treatment; the second group, consisting of 13 patients (all male) applied 0.05% topical calcipotriol ointments twice daily. Both groups were irradiated with NBUVB (311 nm). In the NBUVB group, the percentage of the body surface affected was reduced from 27.21 ± 10.41% to 16.25 ± 8.54% after a mean of 30 treatment sessions. The mean repigmentation percentage was 41.6 ± 19.4%. In clinical evaluation (moderate and marked/complete response was accepted as an effective treatment), 19 patients (19/24; 79.17%) had clinically good results. In the NBUVB plus calcipotriol group, the percentage of the body surface affected was reduced from 23.35 ± 6.5% to 13.23 ± 7.05% after a mean of 30 treatment sessions. The mean repigmentation percentage was 45.01 ± 19.15%. In clinical evaluation (moderate and marked/complete response was accepted as an effective treatment), 10 patients (10/13; 76.92%) had clinically good results. Statistically significant intragroup reductions from the baseline percentage of the body surface affected were seen at the endpoint of treatment for the two treatment groups (P < 0.001). However, there was no statistically significant difference between the two treatment groups at the end of therapy with respect to the reduction of repigmentation rates (P > 0.05). The present study reconfirmed the efficacy of NBUVB phototherapy in vitiligo. It can be a therapeutic option considered in the management of patients with vitiligo. However, addition of topical calcipotriol to NBUVB did not show any advantage.

An Open, Randomized, Comparative Study of Oral Finasteride and 5% Topical Minoxidil in Male Androgenetic Alopecia

Background and Aim: Androgenetic alopecia (AGA) is undoubtedly the most common form of hair loss in males. It is a condition which may cause cosmetic and psychosocial problems in androgen-dependent cases. In this open, randomized and comparative study we evaluated the efficacy of oral finasteride and 5% topical minoxidil treatment for 12 months in 65 male patients with mild to severe AGA. Methods: We randomly assigned 40 (61.53%) patients to receive 1 mg/day oral finasteride for 12 months, and 25 (38.47%) patients applied 5% topical minoxidil solution twice daily for 12 months. Results: There were no significant differences between the 2 groups considering age, age of onset of hair loss, family history and type of hair loss (p > 0.05). In the clinical evaluation at the endpoint of treatment, the clinical cure rates (i.e. increased intensity of hair) were 80% (32/40) for the oral finasteride group and 52% (13/25) for the 5% topical minoxidil group. Encountered side effects were all mild, and there was no need to stop the treatment. In the group given oral finasteride, side effects were noted in 7 patients: 6 patients suffered from loss of libido, and 1 patient had an increase in other body hairs; irritation of the scalp was seen in 1 patient in the group administered 5% minoxidil. These adverse events disappeared as soon as the treatment was stopped. The laboratory data on both drug groups did not show any statistically or clinically significant intragroup changes from baseline values to the endpoint (p > 0.05), except the level of serum total testosterone which was increased, and free testosterone and serum prostate-specific antigen in the finasteride group which were statistically decreased from baseline values to the endpoint (p < 0.05). Conclusion: In this comparative study of systemic finasteride and topical minoxidil, it was concluded that both drugs were effective and safe in the treatment of mild to severe AGA, although oral finasteride treatment was more effective (p < 0.05). Adverse events were not considered important either, and these side effects disappeared as soon as the treatment was stopped.

An open, randomized, comparative study of oral fluconazole, itraconazole and terbinafine therapy in onychomycosis

OBJECTIVE: In this open, randomized and comparative study, the safety and efficacy of systemic fluconazole, itraconazole and terbinafine was investigated in 50 patients with distal subungual toenail onychomycosis diagnosed clinically and mycologically. The patients with positive mycology and also the patients with positive microscopy and negative culture were investigated. METHODS: The treatment duration was 3 months, and the follow-up period was 6 months. Patients were randomly assigned: 16 patients received 150 mg fluconazole once weekly, 18 patients received 200 mg itraconazole twice daily with meals during the first week of each month, and 16 patients received 250 mg/day terbinafine during the treatment period. RESULTS: In a clinical evaluation, at the endpoint of the follow-up period, the clinical cure rates were 81.3% (13/16) in the terbinafine group, 77.8% (14/18) in the itraconazole group, and 37.5% (6/16) in the fluconazole group. The mycological cure rates were 75% (12/16), 61.1% (11/18) and 31.2% (5/16), respectively. The overall assessment rates were 62.5% (10/16), 61.1% (11/18) and 31.2% (5/16), respectively. Statistically significant intra-group reductions from baseline symptom severity values were seen at the endpoint of treatment and at the endpoint of the follow-up period for all three treatment groups in onycholysis, subungual hyperkeratosis, affected-area percentage score and total score parameters (p < 0.001). At the endpoint of the follow-up period, statistically significant differences between the treatment groups were seen in clinical, mycological and overall assessment (p < 0.05). However, while no statistically significant difference between the terbinafine and itraconazole groups was seen, there was a clinical and statistical difference between the other groups and the fluconazole group. Treatment was not stopped for side effects such as mild gastrointestinal and central nervous system symptoms. These effects were noted in four patients in the fluconazole group (25%), five patients in the itraconazole group (27.8%), and three patients in the terbinafine group (18.75%). The clinical laboratory data on all three drug groups did not show any statistically or clinically significant intra-group changes from baseline values at the endpoint (p > 0.05). CONCLUSION: This comparative study of systemic fluconazole, itraconazole and terbinafine showed that all three drugs were effective and safe in the treatment of onychomycosis. However, fluconazole, at these doses and treatment durations, was the least effective. With regard to cost-effectiveness, side effects and the cure rates, terbinafine could be the drug of choice in the short-term treatment of toenail onychomycosis.

Anhidrotic ectodermal dysplasia with eruptive vellus hair cysts

A 21‐year‐old white man complained of heat intolerance, absence of sweating, and papular lesions on the forehead. Facial features included a saddle nose, prominent supraorbital edge, and frontal bossing. The scalp hair was scanty, fine, and brittle. Eyelashes and eyebrows were also thin. Subungual hyperkeratosis and dystrophic changes were observed on the finger and toe nails. Hypodontic teeth were detected on oral examination. He was otherwise healthy. Biochemical and hematologic analyses were also normal. Cutaneous examination revealed smooth and dry skin. Multiple, 4–5 mm, brown–black, comedo‐like, soft papules were observed on the forehead ( Fig. 1 ). A biopsy specimen from a papule on the forehead revealed cystic structures lined by squamous epithelium and containing laminated keratinous material and scattered obliquely and transversely cut vellus hairs ( Fig. 2 ). Topical application of 0.1% tretinoin for 2 months produced no clinical improvement.

Follicular mucinosis responding to isotretinoin treatment

Follicular mucinosis is a rare disorder of unknown etiology characterized by accumulation of mucin in the sebaceous glands and outer root sheaths of the hair follicles. It is divided into a primary benign type and a secondary type mostly associated with lymphomas. No effective standard therapy for follicular mucinosis is available. We describe the case of a 21-year-old Caucasian male who had papules, nodules, and erythematous plaques on his left shoulder, left arm, and right scapular region. He was diagnosed as primary benign generalized follicular mucinosis, and treated with isotretinoin. Almost complete remission was achieved in 4 months.

Acrokeratoelastoidosis treated with the erbium:YAG laser.

Acrokeratoelastoidosis is a rare skin disorder characterized by grouped, small, firm, translucent papules distributed on the margins of the hands and feet. We report a 21‐year‐old white patient with acrokeratoelastoidosis in whom Er:YAG laser surgery was carried out, resulting in a slight post‐treatment improvement of the disease with slight flattening of the lesions. No clinical recurrence of the lesions developed during the 6 months of follow‐up. We suggest that Er:YAG laser surgery of acrokeratoelastoidosis may be considered as a treatment option for this rare disease; however, patients should be informed of the limited clinical improvement obtained with this treatment.

Vitamin D receptor gene polymorphisms are not associated with alopecia areata

Background  It has been demonstrated that the vitamin D receptor (VDR) is strongly expressed in key structures of hair follicles, and a lack of VDR leads to alopecia. We investigated whether there was any association between VDR gene polymorphisms (BsmI, ApaI, and TaqI) and alopecia areata (AA).

Focal epithelial hyperplasia treated with interferon alpha-2a

BACKGROUND Focal epithelial hyperplasia (FEH) is an uncommon benign oral condition that occurs mainly in young individuals of certain racial groups. METHODS A 21-year-old Caucasian man presented with FEH of the oral mucosa. The patient was treated with interferon alpha-2a three times a week for 14 weeks intramuscularly (a total of 162 million units). RESULTS At 2 months after the end of therapy, the papular lesions showed partial regression. CONCLUSION This treatment modality should be used in cases with diffuse focal epithelial hyperplasia.BACKGROUND: Focal epithelial hyperplasia (FEH) is an uncommon benign oral condition that occurs mainly in young individuals of certain racial groups. METHODS: A 21-year-old Caucasian man presented with FEH of the oral mucosa. The patient was treated with interferon alpha-2a three times a week for 14 weeks intramuscularly (a total of 162 million units). RESULTS: At 2 months after the end of therapy, the papular lesions showed partial regression. CONCLUSION: This treatment modality should be used in cases with diffuse focal epithelial hyperplasia.

Norwegian scabies of the legs in a patient with paraplegia

A 54-year-old woman was admitted from a nursing home to our institution with a 2-month history of a pruritic rash unresponsive to oral antihistamines and topical menthol ⁄ camphor lotions. The patient’s medical history was consistent with paraplegia, secondary to spinal trauma that had developed after a traffic accident. Her daughter and three of the nursing home staff also complained of an intermittent, generalized itchy rash that interfered with sleep. A physical examination revealed diffuse, scaly, crusted erythematous plaques on the patient’s lower limbs and excoriated erythematous papules located on the periumbilical and periareolar region, axillae, and flexor surfaces of the wrist and hands (Fig. 1). Paralysis and sensory loss of the lower extremities were also detected. Videodermatoscopic examination of the legs at · 40 magnification (Molemax I, Derma Instruments, USA) revealed numerous triangular and jet aircraft trail structures (Fig. 1). Skin scrapings obtained from crusted lesions yielded huge numbers of mites, eggs and faecal pellets, confirming the diagnosis of Norwegian scabies (NS). Treatment was initiated with overnight and alternating use of topical 5% permethrin lotion and 6% precipitated sulphur ointment over a 2-week period. At the end of the treatment period, the patient was symptom-free, and complete resolution of the lesions was observed. Videodermoscopic examination and control skin scrapings were negative for scabies infestation. NS, or crusted scabies, is a rare and severe form of Sarcoptes scabiei infection, characterized by huge numbers of mites infesting the skin. NS is mostly seen in immunosuppressive conditions including lymphoma, leukaemia, acquired immunodeficiency syndrome and graft-vs.-host disease, and in patients undergoing treatment with immunosuppressants and topical corticosteroids. Failure of cell-mediated immune response has been considered in the pathogenesis of the disease. Neurological impairments, resulting in sensorial deficits and physical disability, such as leprosy, syringomyelia, tabes dorsalis, and cerebrovascular disease, have also been implicated in the pathogenesis of this disease. NS usually manifests as greyish, thick, crusted and scaly lesions as observed in our case. In our patient, the characteristic crusted lesions of NS were strictly confined to the lower extremities, where paraplegia and sensory loss had been detected, while an examination of the rest of the body yielded classical scabies lesions in our patient. We suggest that reduced scratching of the legs secondary to a lack of pruritus in this region, which resulted from neurological impairment, may have contributed to this phenomenon. These findings suggest that scratching may be an effective host mechanism against the development of NS infestation. Barbosa et al. reported a 26-year-old man diagnosed with NS associated with lepromatous leprosy of the upper extremities, which resulted in altered sensibility. Unlike our case, diffuse involvement of the skin with thickened and crusted lesions were observed in that patient, suggesting that a mechanism other than neurological involvement may play a role in the dissemination of NS. To the best of our knowledge, our patient is the second reported with NS associated with paraplegia. The other previously reported case experienced recurrent strokes with limb paralysis secondary to cerebrovascular disease. Recently, digital dermoscopy has been introduced as a useful tool for the in vivo diagnosis of scabies, with high sensitivity and specificity rates. The characteristic triangular structures, as observed in our case, correspond with the anterior section of the mite including the mouth part and the two pairs of front legs. A linear segment observed below the base of the triangle, with a structure resembling the condensation trail of a jet aircraft, is considered to result from small PD

Early-onset gastric carcinoma in a man with dermatopathia pigmentosa reticularis

A 15-month-old infant with no significant medical history presented with a unilateral skin eruption of 2 days’ duration. The skin lesions consisted of grouped vesicles on an erythematous base and were localized in the S2 dermatome, involving the right buttock and calf (Fig. 1). The patient was afebrile. A Tzanck smear preparation was positive for multinucleated giant cells, supporting a clinical diagnosis of herpes zoster. Immunization records indicated that the patient had received a single dose of varicella vaccine 56 days prior to presentation. The patient had not developed chicken pox prior to or after vaccination. Fourteen days after treatment with acyclovir at 30 mg/kg/day, the lesions resolved with residual hyperpigmentation. Herpes zoster can be caused by reactivation of latent varicella zoster virus in a dorsal root ganglion after varicella vaccination. Amongst vaccine recipients, herpes zoster has an incidence of 14 cases per 100,000 person-years. Several studies have shown that varicella vaccination does not increase the risk of herpes zoster in vaccinated children or in the general population. Only seven cases of herpes zoster have previously been reported in healthy young children (below 5 years) after immunization with varicella vaccine (Table 1). The interval between vaccination and the onset of infection ranges from 15 to 34 months. Our patient is currently the youngest reported case of herpes zoster, which occurred within 2 months after varicella vaccination.