Mustafa Turhan Şahin

Cross validation of the turkish version of dermatology life quality index

Background  The aim of this study was to test the linguistic validation of the Turkish version of the Dermatology Life Quality Index (DLQI) for Turkish speaking dermatology patients.

A Comparison of Dermoscopic Features among Lentigo Senilis/Initial Seborrheic Keratosis, Seborrheic Keratosis, Lentigo Maligna and Lentigo Maligna Melanoma on the Face

Clinical differentiation of facial lentigo senilis/initial seborrheic keratosis (LS/ISK), seborrheic keratosis (SK), lentigo maligna (LM), and lentigo maligna melanoma (LMM) can be difficult. Dermoscopy improves the diagnoses in pigmented skin lesions (PSLs), but it is not helpful for the sun‐exposed face because of the flat rete ridges without network‐derived features. Therefore, development of new diagnostic criteria for this particular localization is a current issue of dermatology. In this retrospective study, dermoscopic slides of facial pigmented skin lesions of 66 patients referred to two clinics in Turkey were evaluated. Our aim was to determine the reliability of dermoscopy in the differentiation of these entities. The facial PSLs of 66 patients (34 males and 32 females) (median age: 58.2) were photographed with a Dermaphot (Heine, Hersching, Germany) over a five year period from November of 1995 to May of 2000. All of the dermoscopic slides were analysed according to 27 dermoscopic criteria developed by Schiffner et al. This data set contained 22 histologically proven malignant (14 LM, 8 early LMM) and 44 benign (18 SK, 26 LS/ISK) PSLs. In general, asymmetric pigmented follicular openings, dark streaks, slate‐gray streaks, dark globules, slate‐gray globules, dark dots, dark rhomboidal structures, light brown rhomboidal structures, dark homogeneous areas and dark pseudonetworks were statistically significant for malignant growth. On the other hand, milia‐like cysts, pseudofollicular openings, cerebriform structures, light brown globules, light brown dots, light brown homogeneous areas, yellow opaque homogeneous areas, and light brown pseudonetworks were statistically significant for benign growth. This research emphasizes that dermoscopic features on the face differ from criteria used in other locations of the body. Analysis of the data suggests that dermoscopy can be used in the differentiation of LS/ISK, SK, LM and LMM from each other.

Chronic actinic damage of facial skin.

Chronic actinic damage of the skin manifests itself as extrinsic skin aging (photoaging) and photocarcinogenesis. During the last decade, substantial progress has been made in understanding cellular and molecular mechanisms of photoaging. DNA photodamage and ultraviolet-generated reactive oxygen species are the initial events that lead to most of the typical histologic and clinical manifestations of chronic photodamage of the skin. Chronic actinic damage affects all layers of the skin. Keratinocytes, melanocytes, fibroblasts, and endothelial cells are altered by ultraviolet radiation and can result in numerous changes in human skin, particularly the skin of fair-skinned individuals. These changes include actinic keratosis, thickening and wrinkling, elastosis, telengiectasia, solar comedones, diffuse or mottled hyperpigmentation, and skin cancers. There are many options in the treatment of changes caused by chronic actinic damage. The most effective measure of prevention of the photoaging and photocarcinogenesis is sun protection.

Two therapeutic challenges: facial vitiligo successfully treated with 1% pimecrolimus cream and 0.005% calcipotriol cream.

© 2008 The Authors JEADV 2009, 23 , 70–110 Journal compilation

Psoriatic plaque erosion: a rare side effect of methotrexate

© 2008 The Authors JEADV 2009, 23, 317–368 Journal compilation

Inguinal keratotic Basal cell carcinoma mimicking giant solitary trichoepithelioma.

Keratotic basal cell carcinoma may not only clinically but also histologically share more or less the same features with giant solitary trichoepithelioma. It can be difficult to distinguish these two entities from each other, even for an experienced dermatopathologist. We present an unusual case of inguinal keratotic basal cell carcinoma mimicking giant solitary trichoepithelioma in a 56‐year‐old woman with a finger‐like tumor of 20 years duration. The patient presented with an asymptomatic, skin colored, firm, nonulcerative, nodular lesion. Scanty mitotic activity and apoptotic cells were the histopathologic findings against basal cell carcinoma, whereas absence of papillary mesenchymal bodies, presence of peritumoral lacunae detected only around the solid areas, and accumulation of amyloid‐like hyalinized material were the findings in favor of basal cell carcinoma. This case illustrates that keratotic basal cell carcinoma must be taken into account in the differential diagnosis of inguinally located solitary, polypoid masses, especially giant solitary trichoepithelioma.

Inappropriate Treatments at Beauty Centers: A Case Report of Burns Caused by Hot Wax Stripping

To the Editor: Isotretinoin (13-cis-retinoic acid) is very effective in the treatment of severe, recalcitrant cystic acne unresponsive to antibacterial agents (1), but the treatment has a number of common side-effects. These appear to be dose related and are largely cutaneous. They include cheilitis, conjunctivitis, dryness of mucous membranes, epistaxis, desquamation of hands and feet, pruritus, myalgia, arthralgia, lethargy, and alopecia (2). Atrophy and skin fragility also occur during isotretinoin therapy. Avoidance of dermabrasion for at least six months after the completion of isotretinoin therapy is recommended (3). A 22-year-old girl came to our outpatient clinic with a 5-year history of cystic acne. (From her history) She had received several topical and systemic acne therapies. She had been prescribed isotretinoin at the dosage of 0.5 mg/kg/day for two months. During the second month of treatment, she removed her excess facial hair by hot wax stripping at a beauty center (where cosmetic applications are performed without dermatologists). The day after hot wax stripping, she developed severe erythema and edema on her chin and cheeks. On dermatological examination, we observed erythema, edema, and erosions on her face where the wax epilation had been applied (Figs. 1, 2, 3). We applied sunscreen (SPF 30), topical dexpanthenol, and fucidic acid to her face. Clinical improvement was observed on the tenth day of the treatment, and her injuries healed without scarring. In our case, the patient’s skin had become sensitive to thermal injury because of the skin fragility due to isotretinoin treatment; therefore, a first degree burn developed as a result of the application of a hot wax epilation on her face. Holmes and Thomson reported a case of a 39-year-old woman who developed linear erosions beneath each eyebrow after cosmetic waxing of her eyebrow while taking isotretinoin 1 mg/kg per day (4). Goldberg The Journal of Dermatology Vol. 31: 854–855, 2004