M. Ali Gürer

Behçet’s disease: an enigmatic vasculitis

Professor Hulusi Behcet, a Turkish dermatologist, gave his name to a syndrome in 1937. This syndrome is characterized by recurrent oral, genital ulceration and uveitis with an unknown etiology.1 The disease was probably recognized by Hippocrates, who lived in ancient Greece near the Turkish mainland. Many investigators tried to describe the patients with the disease. Shigeta in 1924 and Whitwell in 1934 mentioned recurrent uveitis and orogenital lesions.2,3 Today, Behcet’s disease is a more complicated entity. The disease is recognized as a chronic multisystem disorder with vasculitis as its underlying pathological process. Variable involvement of many organs and additional features were added to the disease spectrum. Although the etiology remains obscure, the main denominator in all organ systems appears to be “vasculitis.”

Skin problems of musicians.

Objective We investigated the skin problems of high level musicians in a professional orchestra. This study was prompted by our observation of violinists with skin changes.

Bilateral nipple hyperkeratosis treated successfully with topical isotretinoin

A 22‐year‐old woman presented with bilateral thickening and hyperpigmentation of her nipples since the age of 17 years. There was no history of pregnancy or oral contraceptive pill use. Isotretinoin 0.025% gel was applied twice daily and the lesions disappeared in 4 weeks. After the drug was ceased, recurrence appeared within 4 months. The same therapy, applied for 2 weeks, again cleared the problem.

Case of Mondor's disease of the abdomen (body-building induced).

A 65-year-old White man was examined in our outpatient clinic. Fifteen months ago, at the end of spring, he noticed a pruritic eruption, which was more intense on his sun-exposed skin. He did not use any continuous medication or fragances. Skin examination showed erythema with edema and scaling on the face (Fig. 1a), neck (Fig. 2a), forearms and dorsum of the hands. On his neck a clear demarcation between the exposed and the protected skin could be seen. Lymph nodes were of normal size. Light microscopy showed a eczematous dermatitis, without epidermal microabcesses or an interface dermatitis. Phototesting with UVA was able to reproduce the eruption on his back. Internal investigation ruled out visceral or lymph node enlargement. Serology for autoimmune diseases was negative. He was initially treated with systemic and topical steroids, associated with high-protection sunscreens, which improved his skin only slightly. Dihydroxycloroquine 250 mg a day was also prescribed and was ineffective. Before using systemic immunosuppressors, such as azathioprine, topical 1% pimecrolimus was prescribed twice daily associated with a potent sunscreen. This therapy controlled the disease (Figs 1b and 2b). After 3 weeks the desquamation and the edema disappeared; topical pimecrolimus was then reduced to once a day. After a further 4 weeks the treatment was reduced again to three applications a week, and maintained at this level until the end of autumn (the southern region of Brazil has a temperate climate with four well-defined seasons). Pimecrolimus is a macrolide with immunosuppressive properties, whose topical use is effective in inhibiting T-lymphocyte activity. Together with tacrolimus, the other approved substance in this group, pimecrolimus ushers in a new era in dermatological therapy, replacing in some situations corticosteroid treatment. These drugs are effective in atopic and allergic contact dermatitis, conditions mediated by T lymphocytes. The treatment of chronic actinic dermatitis is sometimes disappointing, and frequently complex systemic therapy with potential side-effects must be used. 3–5

Serum β2-microglobulin levels in psoriatic patients

β2‐Microglobulin (β2‐M) is a low molecular weight protein forming the light chain of the class I major histocompatibility complex. It is found on the cell surface of all nucleated cells. Its serum concentration is found to be increased in kidney diseases, neoplasia, AIDS, chronic inflammation and autoimmune diseases. Inflammation plays an important role in the pathogenesis of psoriasis, especially psoriatic arthritis and immunological upset is one of the most implicated factors in the etiology of the disease. In this study, the sera β2‐M levels were evaluated in cases diagnosed as psoriasis vulgaris and psoriatic arthritis, and a statistically significant increase was found in cases of psoriatic arthritis compared to those of psoriasis vulgaris and the control group.