Hamdi R. Memisoglu

Pemphigus in the Mediterranean region of Turkey: a study of 148 cases.

Background  The purpose of this study was to describe the epidemiological and clinical features, course, response to treatment, and prognosis of pemphigus in the Mediterranean region of Turkey.

Clinical features, epidemiology, and efficacy and safety of intralesional antimony treatment of cutaneous leishmaniasis: Recent experience in Turkey

A total of 1,030 patients, 40.2% men and 59.8% women, identified during the period of October 1998 to November 2002 as having cutaneous leishmaniasis (CL), were studied; 1,431 lesions were identified in the 1,030 patients. One lesion was present in 80.7% of the patients. The size of the lesions (longest axis) was 13.6 mm (standard, 12.1 mm; range 3–150 mm). Most of the lesions were of the papular type (51.2%), although several atypical clinical presentations of CL were observed. The duration of the disease ranged between 1 and 72 mo (mean duration, 10.8 mo). The clinical suspicion of CL was confirmed by the observation of amastigotes on lesion tissue samples stained by Giemsa. The test was positive in 851 of 1,030 patients (82.6%). Intralesional meglumine antimonate solution (85 mg Sb/ml, 0.2–1 ml, depending on the size of the lesion) weekly until complete cure or up to 20 wk was used for first-line therapy of 890 patients (86.4%). We found that this regimen of intralesional Sb has an efficacy of 97.2% with a low relapse rate of 3.9% and no serious adverse side effects.

The anticonvulsant hypersensitivity syndrome.

Background The anticonvulsant hypersensitivity syndrome is a potentially fatal multisystemic reaction to anticonvulsant medications.

Manifestation of cellulitis after saphenous venectomy for coronary bypass surgery

A few cases of onset of cellulitis after saphenous venectomy for coronary by‐pass surgery were first reported by Baddour and Bisno in 1982. We reviewed the clinical characteristics of 31 subjects followed up in our department following onset of manifestations of cellulitis after saphenous venectomy for coronary by‐pass surgery. In all the subjects the cellulitis originated at the scar of the saphenous venectomy, and most presented ill‐defined, mildly erythematous, slightly oedematous lesions. Mycologically confirmed tinea pedis was found in 25 subjects. All the patients responded well to penicillins or cephalosporins.

Oral fluconazole in the treatment of tinea versicolor.

This study was designed to assess the efficacy, tolerability, and safety of oral fluconazole given at 300 mg once weekly for two weeks in the treatment of tinea versicolor. Enrolled into the study were 44 subjects with tinea versicolor, provisionally confirmed by the detection of fungal hyphae in KOH wet mounts and Woods lamp examination. Four subjects were classified as dropouts because no information was obtained from them after the baseline visit. Subjects were treated for two weeks orally with fluconazole 300 mg weekly and followed at the 1st, 2nd, 4th and 12th weeks of treatment. The study included 40 subjects (26 males and 14 females, mean age 29 years, range 19–48 years). At the week 4 visit, 30 (75%) patients showed a complete cure and 31 (77.5%) patients showed mycologic cure. Ten (25%) patients had no significant response to therapy. At the final follow‐up visit (week 12), none of the patients showing complete or mycologic cures exhibited a recurrence. No adverse effects were observed in any of the patients treated. We believe that, due to the low incidence of side effects, shorter treatment duration, and increased adaptation of the patients, fluconazole can be used in the treatment of tinea versicolor with confidence.

Uncommon presentation of cutaneous leishmaniasis as eczema‐like eruption

To the Editor: Although cutaneous leishmaniasis (CL) usually causes ulcerated papules or nodules, it has various atypical forms, such as plaque, impetiginized, hyperkeratotic, warty, zosteriform, erysipeloid sporotrichoid and eczematoid types [ 1 , 2 ] . Therefore, CL should be included in the differential diagnosis of cases presenting various types of skin problems, especially in regions where CL is endemic. We describe a patient with CL, clinically resembling allergic contact dermatitis. A 31-year old man was admitted with pruntic erythematous, edematous, exudative and partly lichenified plaques 15-20 cm in diameter on the dorsal surfaces of his left hand and left foot (Fig. 1). These lesions had been present for 2.5 years. He had also suffered from hemophilia since birth and psoriasis for 2 years. The case was diagnosed clinically as allergic contact dermatitis. Since there was no response to administration of topical and systemic cortisone, a biopsy was obtained. Histopathological findings were focal parakeratosis. Munros microabscesses, focal hypergranulosis, slight spongiosis, acanthosis, papillomatosis, erythrocyte extravasation in the upper dermis, and a diffuse infiltration composed of histocytes, lymphocytes and plasma cells throughout the entire dermis (Fig. 2). Abundant intraand extra-cellular parasites were seen in the dermal infiltrate. Similar bodies were also detected in the spongiotic areas of the epidermis. Diagnosis of CL was confirmed by demonstration of amastigotes in Giemsa-stained thin smears of scrapped materials and by growth of promastigotes in cultures of aspirated materials on NNN medium. Leishmanin skin test was strongly positive. Results of erythrocyte sedimentation rate, complete blood counts, blood chemistry and urine analysis; counts of Pan-T, Pan-B, CD4 and CD8 positive cells in peripheral blood; and blood levels of immunoglobulins were within normal ranges. ELISA tests for antiH IV-I and I1 antibodies were negative. Courses of intravenous sodium stibogluconate ( 10 mgkg per day for 2 weeks) were repeated three times with intervals of 2 4 weeks. The third course was combined with oral ketoconazole (400 mg per day for 6 weeks). After this treatment, the lesions healed both clinically and histopathologically. There was no recurrence in the follow-up period of 9 months. The incidence of the eczematoid form of CL has been reported to be 2.3% [ l ] or 2.4% [2] in studies from Iran. We think that CL should be included in the differential diagnosis of recalcitrant eczematous eruptions especially in regions where CL is epidemic or endemic, such as our region [3]. Development of eczematous lesions in CL may be explained both by cell-mediated hypersensitivity and by invasion of parasites in the epidermis, as seen in other cutaneous infections or infestations. For example, vesiculobullous lesions of tinea pedis are usually associated with a severe cell-mediated hypersensitivity to fungal elements [4] and some vesicles of scabies may develop around the mite, Sarcoptes scabiei, which

A case of bacillary angiomatosis presenting as leg ulcers

We report a 32‐year‐old immunocompetent man who had multiple leg ulcers caused by bacillary angiomatosis without a history of direct contact with cats. Bacillary angiomatosis should be kept in mind in the differential diagnosis of leg ulcers in cases of unknown aetiology.