Ozer Arican

Topical imiquimod 5% cream in external anogenital warts: a randomized, double-blind, placebo-controlled study.

The complete treatment of anogenital warts has not been obtained with any combination of methods; therefore, new methods are still under investigation. In this study the activity and side effects of imiquimod 5% cream were investigated. The study group consisted of 23 male and 11 female volunteers and the control group of 9 male and 2 female volunteers. Patients applied the cream three times a week, every other day in the evenings for a period of 12 weeks. After the treatment, patients were regularly monitored for six months for recurrences. At the end of the study, 23 (69.7%) patients (all of females and 54.5% of males) in the study group displayed a complete clearance, 9 patients displayed 50–90% clearance and 1 patient displayed less than 50% clearance. In the control group, only 1 patient displayed a complete clearance, 1 patient displayed 50–90% clearance, and the other 8 patients showed no alteration in the lesions. These results were statistically significantly different (p<0.01). In 15 patients in the study group, no side effects were reported; the most frequently seen side effects were erythema and erosion. In six patients that were observed for a period of six months, recurrences occurred. Imiquimod 5% cream is a topically applied medicament that should be considered as an effective and reliable medical option in the treatment of anogenital warts.

Comparison of azelaic acid and anthralin for the therapy of patchy alopecia areata: a pilot study.

AbstractBackground: Although topical azelaic acid has been previously used for the treatment of alopecia, no controlled trials of azelaic acid for this condition have been conducted to date. Objective: The goal of this study was to determine the efficacy, tolerability, and safety of azelaic acid treatment in patients with patchy alopecia areata (AA) in comparison with anthralin (dithranol) treatment. Subjects and methods: This study included 31 subjects with patchy AA who did not receive any treatment for at least 1 month prior to the study. Demographic and clinical characteristics of these subjects were recorded at baseline. Subjects were randomized to apply either 20% azelaic acid (15 subjects) or 0.5% anthralin (16 subjects) for 12 consecutive weeks. In a subsequent 8-week follow-up period no cream was applied. Two independent investigators performed an efficacy evaluation with clinical examination using a terminal hair regrowth score (RGS) with a scale ranging from 0 (inadequate response) to 2 (complete response) at week 20. Partial response was accepted as score 1. Results: Both groups were well matched for the relevant demographic and clinical indicators affecting treatment response at baseline. All subjects completed the trial. At week 20 the RGS was 1.27 ± 0.9 in the azelaic acid group versus 1.37 ± 0.8 in the anthralin group (p > 0.05). A complete response was observed in 53.3% of cases in the azelaic acid group (8 of 15) compared with 56.2% (9 of 16) in the anthralin group (p > 0.05). No serious adverse events were observed in either group during the study. Conclusion: The present pilot study showed that the use of azelaic acid gave similar results to anthralin with regard to hair regrowth, and that it can be an effective topical therapy for patchy AA. More extensive trials are necessary, however, to reach a definitive conclusion.

Unsuccessful treatment of extragenital lichen sclerosus with topical 1% pimecrolimus cream.

Lichen sclerosus most commonly affects the anogenital region. Spreading into the extragenital regions is rare, and its course is most commonly asymptomatic. Women have been reported to be affected 6 to 10 times more often than men. The etiology of lichen sclerosus is still unknown. The disease is characterized by ivory‐white atrophic plaques, and no treatment ensuring complete recovery is available. T‐cells are also involved in its pathogenesis. Pimecrolimus is a topical inhibitor of T‐cells. In the present paper, we present a male patient with lichen sclerosus located only in extragenital regions and report an unsuccessful outcome of treatment with pimecrolimus 1% cream administered topically twice a day for 16 weeks.

A case of perforating pilomatricoma

Pilomatricoma is a rare skin neoplasm, most commonly seen in the head and neck region, and occurring in the first two decades of life. It is usually solitary and varies from 0.5 to 2 cm in diameter. Its etiology is unknown. Perforating pilomatricoma is a rare clinical variant that presents as a draining, crusted nodule or ulcer, and is reported to arise faster than the classic pilomatricoma. Herein, we report a case of 35‐year‐old female, who had a 4‐month history of a growing mass on her leg. On physical examination, a 4‐cm diameter, asymptomatic, erythematous, ulcerated mass was noted on the left anterio‐lateral upper leg. The first histopathological analysis of a punch biopsy from the lesion was reported as basal cell carcinoma. Therefore, the lesion was totally excised. There were shadow cells, squamoid cells, and basaloid aggregations more prominently in the one area in the tumor. In addition, calcification, foreign body giant cells and inflammatory cells were present. Punch or excisional biopsies are preferred as a method of diagnosis for the majority of cutaneous neoplasms. If total excision is not the method of choice, multiple punch biopsies should be made from different areas in large skin tumors for correct diagnosis.

Role of hepatitis B and C viruses in the etiopathogenesis of vitiligo

To the Editor: Vitiligo is an acquired skin disease characterized by well-defined, milky white, depigmented macules with or without associated systemic features. Even though certain hypotheses have been put forward, the etiopathogenesis of this disease is unknown. The disease may be accompanied by human immunodeficiency virus, and the observation of cytomegalovirus particles in vitiliginous regions has also raised the topic of possible viral etiological factors (1–3). Other miscellaneous dermatological diseases such as lichen planus and chronic urticaria are also associated with Hepatitis B virus (HBV) or Hepatitis C virus (HCV) infections (4). It may, therefore, be warranted to study the association of HBV and HCV infections in patients with vitiligo. We carried out a prospective case-control study to determine whether the pathogenesis and nature of vitiligo are related to HBV and HCV infections. The frequency of HBV and HCV infections in patients with vitiligo and the effect of positivisms on the clinical course of disease were investigated in this study. One hundred and twenty-one vitiligo patients (63 female and 58 male) and 114 ageand sex-matched control subjects (60 female and 54 male) were recruited for the study. Subjects who were vaccinated or dependent on any substance, patients with liver impairment, renal failure or organ transplantation, and those receiving blood products were excluded from the study. Patients in both groups underwent HBs antigen, anti-HBc total antibody, anti-HBs antibody and anti-HCV antibody and routine biochemical analyses. Anti-HBc total and anti HBs antibodies were detected with an IM-X device obtained from Abbott Company, and HBs antigen and anti-HCV antibody were studied with a Tek-Time (microwell system) device obtained from the Organon Technica Company. The microelisa method was used in both devices. The statistical analyses were performed by chi-square, ttest, and Spearman correlation tests, and p<0.05 was accepted as statistically significant. The ages were 2–76 years in the vitiligo group (mean: 33 ± 18) and 4–72 years (mean: 30 ± 16) in the control group. The age of onset of the disease ranged between 1–75 (mean: 26 ± 17), and the total duration was between 0.1–67 (mean: 10 ± 13) years. Ninety (74%) patients were considered active due to a new lesion appearing or a growth described within the last one month in the lesion and the remaining 31 The Journal of Dermatology Vol. 31: 506–507, 2004

Multiple Plaques on the Back: S-100 Negative Benign Granular Cell Tumor

Granular cell tumor is a rarely seen disease characterized by a gradually developing nodular lesion, which is difficult to diagnose. It has been thought to originate from Schwann cells. The tumor usually appears in the 4th–6th decades of life, more frequently in women and blacks, and has a multifocal location in 10–25% of the cases. The malignancy potential is 1–3%, with 70–74% of the cases in women. Ninety‐eight percent of the cases are S‐100 positive. The present paper describes an 18‐year‐old female patient with benign granular cell tumor. This rarely seen type of tumor was S‐100 negative and has been detected in biopsies taken from multiple asymptomatic plaques and maculopapular lesions. They were 0.5–4 cm in diameter, light brown in color, and with clear contours and had been gradually growing on her back the last nine years.