Mehmet Karakaş

Clonal outbreak of Trichophyton tonsurans tinea capitis gladiatorum among wrestlers in Adana, Turkey.

Tinea capitis gladiatorum and tinea corporis gladiatorum caused by the anthropophilic dermatophyte Trichophyton tonsurans are well-known clinical entities in individuals involved in combat sports, e.g., wrestlers and judo practitioners. We present an outbreak of Trichophyton tonsurans tinea capitis gladiatorum among wrestlers at a boarding school in Adana, Turkey. Fourteen of the 29 wrestlers examined (48.3%) harbored the pathogen, including eight asymptomatic scalp carriers, five with tinea capitis superficialis, and one asymptomatic trunk carrier. Dermatophytes were isolated from samples of the neck (1), nape (1), trunk (3) and inguinal area (2) in four of the five tinea capitis cases. A total of five inanimate objects, i.e., two wrestling mats, two pillowcases, and one sheet were also found to be positive for T. tonsurans. Mixed-marker strain typing examining 24 sequence variations in 12 gene loci confirmed that the outbreak was caused by a single strain of T. tonsurans.

Diabetes and Hepatitis frequency in 140 lichen planus cases in Çukurova Region

The aim of the present study was to determine the Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and diabetes mellitus (DM) frequencies in lichen planus (LP) cases in our region. We performed a retrospective review of records from all cases that were diagnosed with LP at the our department between 1997 and 2002. The results were compared with the control group (any type of dermatosis other than LP). The 260 LP cases included 108 (41.5%) males and 152 (58.5%) females aged between 5 and 78 years. The clinical distribution of the lesions were 127 (48.8%) with skin lesions and 133 (51.2%) with oral mucosal lesions. The duration of disease ranged from 1 to 240 months. In 140 of 260 LP cases, hepatitis serology and pre‐prandial blood glucose were examined. We found HBV positivity in 24 (17.1%) cases, Anti‐HCV positivity in 7 (5%) cases, and DM in 22 (15.7%) cases. The control group included 116 (41.4%) males and 164 (58.6%) females. Their ages ranged between 10 and 82 years. In this group, we found HBV positivity in 20 (7.1%), Anti‐HCV positivity in 4 (1.4%), and DM in 20 (7.1%) cases. We believe that the co‐association of LP with HCV is significant and this co‐association ratio indicates variance depending on clinical attributes of the lesions and racial characteristics of the patients. Although we found co‐associations between HBV and LP or DM and LP, we believe that further studies are necessary to determine if they are significant.

Cutaneous id reactions: A comprehensive review of clinical manifestations, epidemiology, etiology, and management

Id reactions are a type of secondary inflammatory reaction that develops from a remote localized immunological insult. To date, id reactions caused by various fungal, bacterial, viral, and parasitic infections have been reported. Superficial fungal infections, especially tinea pedis, are the most common cause of id reactions. Id reactions exhibit multiple clinical presentations, including localized or widespread vesicular lesions, maculopapular or scarlatiniform eruptions, erythema nodosum, erythema multiforme, erythema annulare centrifugum, Sweet’s syndrome, guttate psoriasis, and autoimmune bullous disease. The mechanisms underlying id reactions vary depending on the type of clinical presentation. The most important aspect of therapy involves the identification and adequate treatment of the underlying infection or dermatitis. This review comprehensively discusses the current state of the field concerning cutaneous id reactions, including diagnostic criteria, clinical presentations, underlying infectious conditions, etiologic agents, immunologic characteristics, histopathologic findings, and management strategies.

Unilateral Nevoid Telangiectasia

Unilateral nevoid telangiectasia is a cutaneous condition consisting of congenital or acquired patches of superficial telangiectases in a unilateral linear distribution. Unilateral nevoid telangiectasia has been associated with elevations of blood estrogen levels and/or an increased number of estrogen receptors in the involved skin. We present a hepatitis‐B carrier case with unilateral nevoid telangiectasia on the face and the right side of the neck; she had normal blood estrogen and a normal number of estrogen receptors in the involved skin.

Lichen Striatus Following HBV Vaccination

Lichen striatus (LS) was initially described in 1941 by Senear and Caro (1). Clinically, LS is characterized by the sudden development of small, red-brownish, slightly elevated and scaling papules as continuous or interrupted erythematous linear bands on one of the extremities (2). Lesions usually involve the arms or legs, but other sites such as the face or trunk may be affected as well. They usually resolve spontaneously in 6 to 24 months. Some cases of LS show a bizarre pattern of a v on the spine or an s on the abdomen, which might suggest a distribution along Blaschko’s lines (2). Most cases involve only the skin; nevertheless, nails may also be involved with skin or alone (3). In the pathogenesis of LS, an autoimmune response, atopy, genetic predisposition, viral infection, locus minoris resistentiae, and BCG vaccination have been held responsible. Nevertheless, the etiology of LS is still obscure (4). We describe a 36-year old man whose lichen striatus developed after HBV vaccination, following the pattern of Blaschko’s lines. The lesions had appeared over a twomonth period beginning 2 months after HBV vaccination [Hepatitis B Vaccine (Recombinant)] and were slightly itchy. His past medical and family history was not remarkable, except for the HBV vaccination, and he was otherwise healthy. On skin examination, he had interrupted linear streaks of slightly pigmented, brownish, flattopped, slightly elevated and scaling papules distribution on the right side of his abdomen following the characteristic Sshape pattern of Blaschko’s lines (Fig. 1). There were no lesions observed on the scalp, nails, oral mucosa, and any other body site. Other examination findings were normal. The results of laboratory tests, including complete blood count, blood biochemistry, creatinine kinase, antinuclear antibody test, anti-DNA, chest X-ray, and abdominal ultrasound, were either normal or negative. Antibody (anti-HBs) was positive, but hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), hepatitis B e antibody (anti-Hbe), hepatitis B core antibody (anti-HBc), and hepatitis C virus antibody (anti-HCV) were negative. A skin biopsy from the lesion was consistent with LS. It demonstrated hyperkeratosis, parakeratosis, spongiosis, exocytosis, dyskeratotic keratinocytes in the epidermis, focal band-like lymphocytic infiltrates, and periadnexal lymphocytic infiltrates in the The Journal of Dermatology Vol. 32: 506–508, 2005

Epidemiology of pityriasis versicolor in Adana, Turkey

Pityriasis versicolor is a common superficial mycoses of the skin. It is now recognized that the causative organisms of this infection are different species of Malassezia. The aim of this study was to determine the distribution of Malassezia species in patients with pityriasis versicolor in Adana, Turkey. In total, 97 patients positive for Malassezia elements, namely, yeast cells and short hyphae in microscopic examination, were included in the study. All samples were inoculated in plates containing modified Dixons medium. However, only 44 of the patients (45.4%) showed Malassezia spp. in culture. Malassezia globosa (47.7%) was the most commonly isolated species followed by Malassezia furfur (36.4%) and Malassezia slooffiae (15.9%). Mixed Malassezia species were not isolated. In conclusion, M. globosa was found to be the predominant PV isolate in Adana, Turkey.

Gianotti–Crosti syndrome in a child following hepatitis B virus vaccination

Gianotti–Crosti syndrome is self‐limited, characterized by papular eruption with a symmetrical distribution on the limbs and face of children, and a dermatosis of unknown etiology. However, there are many suggested factors such as a number of diseases (viral or bacterial) and vaccination. We report a case of Gianotti‐Crosti syndrome that had developed 3 weeks after the hepatitis B virus vaccination.

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.

Bacillary Angiomatosis in an Immunocompetent Child with a Grafted Traumatic Wound

Bacillary angiomatosis is an infectious disease which usually develops in immunocompromised patients. Contact with cats is implicated in its pathogenesis. We report a seven‐year‐old immunocompetent boy with bacillary angiomatosis without a history of direct contact with cats. The clinical diagnosis of bacillary angiomatosis was made following histopathological examination of a biopsy sample from the infected facial wound, in the vicinity of which angiomatous lesions had developed. Surprisingly, similar lesions also appeared at the donor site of the skin graft which was grafted on the facial wound. This case demonstrates that bacillary angiomatosis may also be seen in immunocompetent patients and that it may contaminate wounds without the intermediary of cats.

Electrophysiological findings in neurofibromatosis type 1.

Neurofibromatosis type 1 (NF1) is a common, autosomal dominant neurocutaneous disorder in which any organ system, including the skin, skeleton and nervous system can be affected. In this study, we compared the electrophysiological and magnetic resonance imaging (MRI) findings in patients with NF1. Thirty-nine adolescent and adult patients (23 women and 16 men) diagnosed with NF1 with a mean age of 25.8±10 years (10-56) were included in this study. We collected data in the form of the results of neurological examinations, multimodal evoked potentials (EPs; brainstem auditory evoked potentials, BAEPs; somatosensory evoked potentials, SEPs; and visual evoked potentials, VEPs), cerebral/orbital/spinal MRIs, and electroneuromyography (ENMG). Twenty (51.3%) patients showed abnormal VEPs, 14 (35.9%) showed abnormal SEPs, and six (15.4%) showed abnormal BAEPs. All evoked potentials were abnormal in four (10.3%) cases. These electrophysiological findings occurred primarily in the absence of any clinical sign related to the affected system. MRI revealed pathologic findings in 26 of 39 patients, and these were not always correlated with visual, auditory, or somatosensory pathway abnormalities. ENMG showed polyneuropathy in two of 33 patients who underwent ENMG. Our study showed that MRI and electrophysiological abnormalities may be found in most patients with NF1, even in the absence of associated clinical symptoms or signs. Electrophysiological testing is helpful for monitoring the subclinical involvement of the central and peripheral nervous systems in patients with NF1.