İnci Mevlitoğlu

The levels of depression, anxiety and quality of life in patients with chronic idiopathic urticaria

Background  Chronic idiopathic urticaria (CIU) is associated with severely impaired quality of life (QoL).

Treatment of Chronic Urticaria with Narrowband Ultraviolet B Phototherapy : a Randomized Controlled Trial

Data regarding narrowband ultraviolet B (NB-UVB) phototherapy in patients with chronic urticaria is limited. The aim of this open, controlled study was to determine whether NB-UVB is effective in treating urticaria in combination with antihistamin. A total of 81 patients with chronic urticaria were recruited, 48 of whom were randomized into the NB-UVB plus antihistamine group. The control group (n = 33) received only antihistamine. Patients were assessed using the urticaria activity score and a visual analogue score (VAS). The 2 groups were evaluated at the same time-points: at treatment sessions 10 and 20 and at follow-up 3 months post-treatment. The reduction in urticaria activity score and VAS was statistically significant (p < 0.05 for both groups). When comparing the groups, the mean urticaria activity score was significantly lower in the NB-UVB group at session 10 (22.6 vs. 27.3) and session 20 (17.4 vs. 20.7). Statistically significant differences were also noted in VAS between the 2 groups (p < 0.01) at 3 months post-treatment. We conclude that NB-UVB may be an effective complementary treatment for patients with chronic urticaria.

A randomized comparison of acitretin-narrow-band TL-01 phototherapy and acitretin-psoralen plus ultraviolet A for psoriasis.

The combination of retinoids with phototherapy enhances the efficacy of phototherapy and reduces the cumulative ultraviolet dose and duration of the therapy needed to treat chronic plaque psoriasis. Although TL-01 phototherapy has been used widely, there are few data about the effectiveness of the combination of acitretin with TL-01 in treatment of the disease. The aim of this study was to compare acitretin-narrow-band TL-01 phototherapy with acitretin-psoralen plus ultraviolet A (acitretin-PUVA) in psoriasis. We studied 60 patients with moderate to severe plaque psoriasis who were randomly allocated to three times weekly treatment acitretin-narrow-band TL-01 or acitretin-PUVA. The efficacy of treatments was assessed using the Psoriasis Area and Severity Index by a blinded observer. Clearance of psoriasis was achieved in 56.6% of patients treated with acitretin-narrow-band TL-01 and in 63.3% of those treated with acitretin-PUVA. All of these patients remained clear of psoriasis 3 months after finishing the treatments. Mucocutaneous side-effects, such as dry lips and mouth, were the most common complaints in both groups. In conclusion, acitretin-narrow-band TL-01 is an effective and well-tolerated treatment for moderate to severe plaque psoriasis, with a therapeutic effect equal to that of acitretin-PUVA.

Treatment of plaque-type localized scleroderma with retinoic acid and ultraviolet A plus the photosensitizer psoralen: a case series

© 2007 The Authors 519 JEADV 2008, 22, 499–527 Journal compilation

Assessment of ischaemia-modified albumin level in patients with psoriasis

Background.  Ischaemia‐modified albumin (IMA) is increased in diseases associated with oxidative stress, as detected using the albumin cobalt‐binding test. Oxidative stress plays an important role in the development of psoriasis.

Generalized idiopathic acanthosis nigricans treated with acitretin

Generalized idiopathic acanthosis nigricans is a rare form of acanthosis nigricans. This form may be familial or nonfamilial and begins at birth or in early childhood. We report an 18‐year‐old boy with generalized idiopathic acanthosis nigricans who has no family history of acanthosis nigricans. The patient was treated with oral acitretin. Acitretin has been reported rarely as a therapeutic retinoid agent in the disease to date.

Patch test results in patients with progressive pigmented purpuric dermatosis

Editor Pigmented purpuric dermatoses are chronic and relapsing disorders characterized by a symmetrical rash of petechial and pigmentary macules confined to the lower limbs. 1–5 The patch test results had present relevance in some case reports related to progressive pigmented purpuric dermatosis (PPPD). 6,7 We tested the hypothesis that contact allergy plays a role in PPPD. Patch tests were carried out with the European Standard Series including 23 ‘type IV’ substances. The patch tests were applied to unaffected skin of the upper back and then positive patch test allergens were applied to the lesion site. Incriminated allergen was eliminated in patch test-positive patients and they were evaluated after 1 month. During this period, any systemic or topical treatments were not given to the patients. Twenty-two patients with PPPD were enrolled in the study and were patch tested. One patient’s test result could not be evaluated because of back erythema and oedema. Male-to-female ratio was 13 : 9. The ages ranged between 23 and 64 years (average, 48 years). The average duration of the skin disease was 10 months (range, 3–24 months). In all patients, the lower extremities were the main affected sites. In total, 23 reactions, as shown in Table 1, were recorded in PPPD patients. Patch tests were positive in 12 of 22 patients (54%), although none of the patients had actual signs of contact dermatitis. The positive patch test results persisted until the day 7 reading in 6 patients. Of the 12 patients with positive reactions, 3 (25%) reacted to only one allergen, 6 (50%) to two, and 3 (25%) to four allergens. None of the patients had a purpuric response to patch tests. Four allergens were applied to the lesion site (legs) of the patch test-positive patients. Of the 12 patients with positive reactions, allergic reaction to nickel sulphate, fragrance mix, Disperse Blue 106 and formaldehyde resins were recorded positive in 2 (22%), 4 (44%), 2 (22%) and 1 patients, respectively. Clinically test areas revealed oedema and erythema. However, petechiae were not recorded in any test areas. Four patients whose patch test was positive at the usual site and at the lesion site cleared after elimination of the allergen. While clearing was complete in three patients, one patient showed partial clearing. There has been little data on the relationship between contact allergens and PPPD and the underlying mechanisms are unknown. PPPD might have been suggestive of a pigmented purpuric contact dermatitis triggered by determined test series. Up till now, some cases of purpuric contact dermatitis have been reported to be related to azo dyes, para -phenylenediamine, black rubber chemicals, cobalt, benzoyl peroxide, epoxy resin, methylmethacrylate and eutectic mixture of local anaesthetics. 6 The allergens triggering the allergic reaction in our series were nickel sulphate, fragrance mix, Disperse Blue 106 and formaldehyde resins. Vascular damage and erythrocyte extravasation in PPPD may be secondary to localized cell-mediated immunological events. In our series, allergens may indicate a possible role in the pathogenesis of the PPPD, which may be acting directly through cell-mediated immune reactions inducing lymphocytic capillaritis, the characteristic pathological feature in the pigmented purpuric dermatosis. The importance of alternative patch testing modalities related to the applying sites was shown and it was speculated that only patch testing at the lesion site made an aetiologic relation possible. 6 However, patch tests performed on the back, as in our case series, have revealed the positive patch testing correlation between the usual site and the lesion site. And also, four patients cleared after elimination of the allergen. This result supports the evidence that both patch testing at the usual site and the lesion site may give a correct aetiologic relationship between an allergen and PPPD.

Acitretin narrow-band TL-01 phototherapy but not etanercept treatment improves a localized inflammatory linear verrucous epidermal naevus with concomitant psoriasis

remodeling of the peptidergic innervation of murine skin, and hair growth modulation by neuropeptides. J Invest Dermatol 2001; 116: 236–245. 5 Rossi R, Del Bianco E, Isolani D et al. Possible involvement of neuropeptidergic sensory nerves in alopecia areata. Neuroreport 1997; 24: 8: 1135–1138. 6 Kawana S, Liang Z, Nagano M, Suzuki H. Role of substance P in stressderived degranulation of dermal mast cells in mice. J Dermatol Sci 2006; 42: 47–54. 7 Siebenhaar F, Sharov AA, Peters EM et al. Substance P as an immunomodulatory neuropeptide in a mouse model for autoimmune hair loss (Alopecia Areata). J Invest Dermatol 2007; 127: 1489–1497. 8 Groves N. Capsaicin bats. 500 Dermatol Times 2002; 23: 43. 9 Bodó E, Bı́ró T, Telek A et al. A hot new twist to hair biology. Involvement of vanilloid receptor-1 (VR1/TRPV1) signaling in human hair growth control. Am J Pathol 2005; 166: 985–998.

Terra Firma Forme disease.

1 Glaiberman CB, Towbin RB, Boal DK. Giant mycotic aneurysm of the internal carotid artery in a child: endovascular treatment. Pediatr. Radiol. 2003; 33: 211–5. 2 Kato T, Oto K, Endo T et al. Microbial extracranial aneurysm of the internal carotid artery: complication of cervical lymphadenitis. Ann. Otol. Rhinol. Laryngol. 1999; 108: 314–7. 3 Beningfield A, Nehus E, Chen AY et al. Pseudoaneurysm of the internal carotid artery after retropharyngeal abscess. Otolaryngol. Head Neck Surg. 2006; 134: 338–9.

Remitting seronegative symmetrical synovitis with pitting edema in a patient with Kaposi sarcoma.

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is characterized by symmetrical synovitis, negative test for rheumatoid factors (RF), and marked pitting edema of the dorsum of the hands. RS3PE may be the initial manifestation of different rheumatic diseases of elderly patients and also may present as a paraneoplastic condition. Paraneoplastic RS3PE is associated with several solid tumors and hematological malignancies. We report a case of Kaposi sarcoma presenting as RS3PE.