Osman Köse

Keloids and hypertrophic scars: are they two different sides of the same coin?

Keloids and hypertrophic scars are different forms of excessive dermal fibrosis thought to be caused by regulation of cellularity increase and decrease during the wound-healing process in predisposed individuals. Differences between keloids and hypertrophic scars include distinct clinical features, histologic evidence, and cellular function in response to molecular events. Keloids and hypertrophic scars are the results of increased fibroblast density and extracellular matrix substances. Interactions between epidermal keratinocytes and dermal fibroblasts play an important role in regulating tissue homeostasis and processing scar formation. Keloids and hypertrophic scars are the two different stages of the same process that is based on separate clinical and histochemical entities. The aim of this review is to provide updated information regarding similarities and differences between keloids and hypertrophic scars as two different sides of the same coin. This article will also enable the dermatologist to better understand fundamental biology of the scarring.

Comparison of the efficacy and tolerability of 3% diclofenac sodium gel and 5% imiquimod cream in the treatment of actinic keratosis

Background: Topical diclofenac and imiquimod have been reported to be effective in the treatment of actinic keratosis, but a study to compare these two drugs has not been reported yet. Objective: To compare the efficacy and safety of topical 3% diclofenac gel plus hyaluronic acid and 5% imiquimod cream in the treatment of actinic keratosis. Methods: Forty‐nine patients with actinic keratosis were enrolled in this randomized comparative open‐label study. Twenty‐four patients applied 3% diclofenac gel once a daily to their lesions, while the other 25 patients were treated with a 5% imiquimod cream three times a week for 12 weeks. Patients were examined before treatment and every month of the treatment. Assessments were made by investigators according to the Investigator and the Patient Global Improvement Indices (IGII) and (PGII). Results: According to the IGII results, a complete response was observed in 12% of the diclofenac group and 22% of the imiquimod group. For the PGII scores, a complete response was observed in 28% of the diclofenac group and 23% of the imiquimod group. There were no significant differences between the two groups (p>0.05). Both treatments were well tolerated, with most adverse events related to skin. Conclusion: The two drugs were found to be equally effective and safe in the treatment of actinic keratosis but complete remission was very low. Therefore, topical treatments with these two drugs were not seen to be completely effective, and combined therapies and further studies are needed.

Mometasone cream versus pimecrolimus cream for the treatment of childhood localized vitiligo

Abstract Background: With regard to the lack of effective treatment modalities for childhood localized vitiligo, the search for newer therapeutic agents continues.Objective: To conduct an open, comparative trial to evaluate the clinical efficacy and safety of topical mometasone cream and pimecrolimus cream in the treatment of childhood vitiligo.Methods: Fifty patients with childhood vitiligo were included in the study. Patients were treated for 3 months either with mometasone cream (0.1%) once daily or with pimecrolimus cream (1%) twice daily.Results: Forty patients, 20 from each group, completed the study. The two drugs were found to be statistically significantly effective for diminishing lesion size (Z = 3.070,p = 0.002 andZ = 3.845,p < 0.001, respectively). There were no statistical differences between the two drugs:Z = 1.427,p = 0.154 (mometasone non-inferiority to pimecrolimus). The mean repigmentation rate was 65% in the mometasone group and 42% in the pimecrolimus group at the end of therapy. Atrophy, telangiectasia and erythema were observed in two patients (10%) in the mometasone cream group and a burning sensation and pruritus were observed in two patients (10%) in the pimecrolimus cream group; drop-out was not related to the observed adverse effects.Conclusion: Mometasone cream was found to be effective in the treatment of vitiligo on any part of the body. Pimecrolimus was not effective on the body except for the face in childhood localized vitiligo.

An open, comparative study of 10% potassium hydroxide solution versus salicylic and lactic acid combination in the treatment of molluscum contagiosum in children

Abstract Objectives: To evaluate and compare the safety and efficacy of 10% potassium hydroxide (KOH) solution and salicylic and lactic acid (SAL + LAC) combination in the treatment of molluscum contagiosum (MC). Material and methods: 26 patients with MC randomized into two treatment groups. 12 patients treated with 10% KOH solution and 14 patients treated with SAL + LAC combination for 6 weeks. Parents of patients were instructed to apply medication once daily only to lesions at study onset. Assessment of response of the treated lesions and side effects was performed at 2, 4 and 6 weeks of the treatment. Newly acquired lesions were not included in the study. Results: At the end of therapy, 83.3% (n = 10) of KOH group demonstrated complete remission and 16.7% (n = 2) of them showed partial remission; four patients (33%) developed new lesions during the study. All the patients in the SAL + LAC combination group (100%) demonstrated complete remission of study entry lesions at the end of 6 weeks with five patients (35%) acquiring new lesions during the study. Minor side effects were observed in two groups. Conclusions: 10% KOH solution and SAL + LAC combination were found to be equally effective in the treatment of MC in children.

Expression of cytokeratins, adhesion and activation molecules in oral ulcers of Behçet's disease.

Background.  Behçets disease (BD) is a multisystemic inflammatory disorder of which oral aphthous ulceration is a major feature.

Pulse methylprednisolone therapy for the treatment of extensive alopecia areata

Background: Since the mainstay of pathogenesis depends on autoimmune process, systemic steroids are widely used in the treatment of alopecia with various side effects. To avoid side effects of long-term steroid treatment, pulse methylprednisolone therapy appears to be a safe treatment option. Objective: The aim was to determine the effect of pulse methylprednisolone therapy for the treatment of adult alopecia areata. Methods: Demographical features of all patients were recorded before the treatment. Patients received methylprednisolone 500 mg intravenously for 3 consecutive days every month for 3 months. Patients were followed up for 3 months. Treatment responses were defined by complete regrowth (100%), significant regrowth (>50%) and minimal regrowth (<50%). Results: Totally 15 patients were enrolled in this study. At the end of the study, two patients had significant regrowth and one patient had minimal regrowth in multifocal alopecia areata (n = 4); one patient had significant regrowth and one patient had minimal regrowth in alopecia universalis (n = 8); three patients had no regrowth in alopecia totalis (n = 3). Conclusions: The study suggests that pulse methylprednisolone therapy might be a therapeutic option for severe multifocal alopecia areata. However, in alopecia totalis or universalis, treatment results are unsatisfactory.

Effectiveness of Low-Voltage Radiofrequency in the Treatment of Xanthelasma Palpebrarum: A Pilot Study of 15 Cases

BACKGROUND Xanthelasma palpebrarum (XP) is the most common form of xanthoma, which is mostly located on the eyelids. Various treatment options are available, with certain limitations, and none of them is satisfactory. OBJECTIVES To offer another treatment option (low‐voltage radiofrequency (RF)) and to evaluate its efficacy in XP. METHODS Fifteen patients were included in the study. The patients were examined before treatment, at the end of treatment, and 5 months later at a follow‐up visit. Improvement was judged according to clinical examination by comparing before and after photographs. Electrodes from a dual‐frequency 4.0‐MHz RF machine were applied superficially to the lesions. The clinical scores were calculated using a 5‐point scale (0=no result, 0–25%=mild, 26–50%=moderate, 51–75%=good, 76–100%=excellent). RESULTS All participants completed the study. Of these, scores of nine patients were excellent, scores of five were good, and the score of one was moderate. Statistically significant percentage improvement of the clinical scores from baseline was seen at the end (p<.05). CONCLUSION Low‐voltage RF treatment of XP is effective. If the lesions are too close to the eyes or are multiple or patched with indistinct borders, low‐voltage RF can be used. &NA; The authors have indicated no significant interest with commercial supporters.

Effıcacy of the Carbon Dıoxıde Fractıonal Laser ın the Treatment of Compound and Dermal Facıal Nevı Usıng wıth Dermatoscopıc Follow-up

Abstract Background: Surgical excision for nevi can produce scar formation. Treatment of compound and dermal nevi, especially on the face, can be challenging. Objectives: The study objectives included an assessment of the efficacy and safety of the CO2 fractional laser for removing compound and dermal nevi and usefulness of dermoscopy for the monitoring of the nevus. Methods: We performed a retrospective review of 330 patients with 684 facial nevi. CO2 fractional laser was performed at 2-month intervals until complete clearance occurred. The global assessment scale (GAS) scores were used to assess the overall results. Results: Five-hundred fifty-four nevi (81%) were successfully treated in one session. Eighty-nine (13%) and 34 (5%) required second and third sessions, respectively. Only seven (1%) required >3sessions. At the end of one year, patients’ (87%) and physicians’ (85%) GAS scores were rated as excellent and good, respectively. At the one year follow-up, fibrosis in 20 patients (3%), recurrences in 15 (2%), dimples in 12 (2%), scars in 12 (2%), hyperpigmentation in 8 (1.5%), and hypopigmentation in 6 (1%) were observed as side effects. Conclusions: CO2 laser produced excellent cosmetic results, led to high patient satisfaction, and could be easily performed. Dermoscopy can be helpful for long-term follow-up.

Giant Mongolian Macules with Bilateral Ocular Involvement: Case Report and Review

Dermal melanocytosis is characterized by the presence of spindle-shaped melanocytes in the dermis. The most common form is Mongolian spots. A 15-month-old girl from Azerbaijan had a systematized dark blue-gray hyperpigmentation on her shoulder, back and extremities. The hyperpigmentation was also found on both sclera and choroidal areas, without any other facial involvement. On histopathological examination, dense melanocytes were found on the intermediate and deep dermis. Her physical and mental development was normal. This association of blue macules and involvement of both sclerae does not represent a distinct entity and cannot be categorized as an example of nevus of Ota.