Melih Akyol

Non-Acne Dermatologic Indications for Systemic Isotretinoin

Systemic isotretinoin has been used to treat severe acne vulgaris for 20 years. However, isotretinoin also represents a potentially useful choice of drugs in many dermatologic diseases other than acne vulgaris. Diseases such as psoriasis, pityriasis rubra pilaris, condylomata accuminata, skin cancers, rosacea, hidradenitis suppurativa, granuloma annulare, lupus erythematosus and lichen planus have been shown to respond to the immunomodulatory, anti-inflammatory and antitumor activities of the drug. Isotretinoin also helps prevent skin cancers such as basal cell carcinoma or squamous cell carcinoma. A combination of systemic isotretinoin and interferon-α-2a may provide a more potent effect than isotretinoin alone in the prevention and treatment of skin cancers.Systemic isotretinoin may be considered as an alternative drug in some dermatologic diseases unresponsive to conventional treatment modalities. However, randomized clinical trials aimed at determining the role of systemic isotretinoin therapy in dermatologic diseases other than acne vulgaris are required.

Kangal Hot Spring with Fish and Psoriais Treatment

The effect of “Kangal Hot Spring with Fish” in the treatment of psoriasis is investigated. The study was carried out on 87 patients with psoriasis vulgaris and the patients were evaluated by a dermatologist for 21 days. The evaluation of the disease was performed using PASI (Psoriasis Area and Severity Index) scores. Recurrences were investigated in the patient population, who had been previously treated in the same hot spring. The first examination scores were significantly higher than the scores of the 3, 6, 9, 12, 15 and 21 days after treatment (p<0.01). Longer remission periods, when compared to the topical corticosteroid treatment, expressed by the 35 patients previously treated in hot spring (p<0.01). Spa therapy under observation of a dermatologist may be effective and useful for psoriasis vulgaris patients.

P300 in Behcet's patients without neurological manifestations.

OBJECTIVE Behcets disease is the association of recurrent aphthous stomatitis with genital ulceration and eye disease. Neurologic involvement patterns include meningomyelitis, a brain stem syndrome, pyramidal and extrapyramidal abnormality and stroke. In the present study, subclinical involvement was investigated by using P300 in Behcets patients without neurological manifestation. METHODS Fifteen patients and 15 healthy volunteers were accepted for the study. P300 from vertex (Cz) electrode sites of the 10-20 system using electrodes and motor response time were recorded. RESULTS Patients had significantly prolonged latencies of P300 as compared to normal controls (p=0.013) but no significant differences in amplitude (p=1.000). Patients showed a significantly delayed motor response time than controls (p=0.006). Nine patients (60%) had P300 latency and eight patients (53.3%) had motor response time values exceeding the mean of controls by two standard deviations. CONCLUSION The findings suggest that the P300 measures and motor response time may reflect subclinical neurologic involvement in Behcets disease.

Granuloma annulare associated with prostate carcinoma

Granuloma annulare occurs as an idiopathic and benign condition, although it may be associated with some neoplasms. We describe a 60‐year‐old man with granuloma annulare on dorsal hands who developed prostate carcinoma. To the best of our knowledge, this is the first case report of granuloma annulare with prostate carcinoma. Granuloma annulare, especially in older age groups, may be classified as a sign of various carcinomas.

A case with Listeria meningitis during administration of mycophenolate mofetil for pemphigus vulgaris.

© 2007 The Authors 1447 JEADV 2007, 21, 1413–1450 Journal compilation

A Case of Acrodermatitis Enteropathica

Acrodermatitis enteropathica is a rare hereditary disorder affecting zinc metabolism that is characterized by dermatitis, alopecia, gastrointestinal disturbances, eye infections, and growth failure. We report a 17‐month‐old girl with acrodermatitis enteropathica. Physical examination showed a cutaneous eruption consisting of vesiculobullous and psoriasiform skin lesions symmetrically distributed in the perioral, acral, and perineal areas. Her plasma zinc level was decreased (75 μg/dl), but within the normal range (60.00–135.00 μg/dl). The patient was given zinc sulfate 50 mg/day. At the end of two months, she had significantly improved.

Sneddon's Syndrome and Antithrombin III

Sneddons syndrome, an uncommon disorder, is characterized by multiple cerebrovascular accidents along with ideopathic livedo reticularis. In this article, two cases who had increased amounts of antithrombin III and were diagnosed with Sneddons syndrome are presented.

Prevalence of common and atypical melanocytic nevi in Turkish children

The incidence of malignant melanoma is increasing rapidly in the white population of the world. Therefore, it is necessary to know the etiological factors of malignant melanoma and to take preventive measures in high-risk groups in different populations. This study aimed to estimate the prevalence of common melanocytic nevi (CMN) and atypical melanocytic nevi (AMN) and to identify some phenotypic factors (eye and hair color, skin type), gender, and age associated with CMN and AMN presence in primary school children in a Turkish population. In this study, 1491 children aged from 7-15 were examined. Brown-black discrete lesions of two millimeters or larger, with the exceptions of solar lentigo and ephelides, were counted as CMN. The CMN prevalence was 73.85%, and the AMN prevalence was 3.45%. The numbers of CMN and AMN were found to be higher in boys than in girls. While more CMN were present in the head and neck areas than in other anatomic regions, the number of AMN was higher on the ventral and dorsal trunk. Our study provides evidence for a significant relationship between specific characteristics, including skin type, age, gender and the number of CMN in our population. However, CMN is more frequent in children having a lighter skin type, and its number increases with age. The results of our study and further studies which take sun-exposure characteristics and pigmentary factors into account, may facilitate the determination of the other factors affecting nevus production and the development of further strategies for following and preventing cutaneous melanoma in our geographical area.

Habituation of auditory event-related potentials in patients with Behcet's disease.

Behcet’s disease is a progressive and/or relapsing-remitting multisystem inflammatory disorder. Involvement of the central nervous system occurs in 10%–29% of cases with Behcet’s disease. The aim of the present study was to assess the effect of repetitive auditory stimulations on event-related potentials (ERP) in patients with Behcet’s without neurologic manifestations. The study was performed in 14 patients with Behcet’s disease and 14 healthy volunteers. ERPs were recorded from Fz, Cz and Pz. The auditory ERPs test was continued until 20 artefact-free rare tones were averaged, which was accepted as one trial block. After six blocks were obtained in a sequential manner, the test was completed. According to the results of the present study, P300 latency changed in different manners over trial blocks in the two groups. P300 latency values showed a progressive increase in the controls; however this was not determined in the Behcet’s group. Thus, habituation was not observed in the patient group. Because of the lack of habituation related to P300 latency, it may be thought that there is an insidious pathologic process in Behcet’s disease without neurologic manifestation.

Metabolic syndrome may be an important comorbidity in patients with seborrheic dermatitis

Introduction Seborrheic dermatitis is a chronic inflammatory skin disease. One of the components of metabolic syndrome is inflammation, and many inflammatory cytokines play a critical role in the disease. The aim of this study is to investigate metabolic syndrome and to evaluate the relationship between the parameters of the disease and disease severity in patients with seborrheic dermatitis. Material and methods Forty-seven patients with seborrheic dermatitis and 36 healthy controls were included in the study. The parameters of metabolic syndrome were recorded in both groups. In the patient group, disease severity was determined with the seborrheic dermatitis area and severity index (SDASI). All the venous blood samples were taken at 8 a.m. after 10 h of fasting. Results High-density lipoprotein (HDL) levels in the patient group were statistically significantly lower than in the controls. There was no significant difference between groups according to other parameters. In terms of history of metabolic disease in first degree relatives (diabetes mellitus, cardiovascular disease, and dyslipidaemia), 78.7% of those in the patient group (n = 37) and 55.6% of those in the control group (n = 20) had a history of metabolic disease in their families, and the difference between the patient and control groups was found to be statistically significant (p < 0.05). There was a significant correlation between disease severity and plasma HDL levels (p = 0.033, r = –0.312). Conclusions The presence of seborrheic dermatitis may be a predictive factor for metabolic syndrome.