Pelin Ekmekçi

Chemical matricectomy with phenol for the treatment of ingrowing toenail : A review of the literature and follow-up of 172 treated patients

There are many options for the treatment of ingrowing toenail, ranging from simple conservative approaches to extensive surgical procedures. Although conservative treatment modalities are helpful in patients with stage 1 disease, stage 2 and 3 ingrowing toenails are best treated surgically. The aim of this study was to evaluate the efficacy of chemical matricectomy with phenol for the treatment of ingrowing toenail. A total of 350 phenol ablations were performed on 172 patients with stage 2 and 3 disease. Each patient was reviewed weekly until full wound healing was achieved and afterwards, to assess the long-term efficacy of the treatment, they were followed up for a mean period of 25 months. The healing period after the operation ranged from 2 to 4 weeks and no postoperative complications were seen. Only two recurrences (0.57%) were observed, after 9 and 17 months, respectively, and nail spikes had developed in only two toes (0.57%). The success rate was found to be 98.8%. We conclude that phenol cauterization is an excellent surgical method for the treatment of ingrowing toenail because of its simplicity, low morbidity and high success rate.

Multifocal papillomavirus epithelial hyperplasia: successful treatment with CO2 laser therapy combined with interferon alpha-2b

Human papilloma virus (HPV) infections of the oral mucosa presents with various clinical and histopathologic features in relation with the causative HPV type and chronicity and the extent of the infection. 1 The entity is known by several names based on histopathologic variations such as focal epithelial hyperplasia, oral florid papillomatosis, verrucous hyperplasia, oral florid verrucosis, and Ackermans tumor. 2–4 In recent years, the term multifocal papillomavirus epithelial hyperplasia (MPVEH) has been proposed to define the variant that usually occurs in childhood and is characterized by diffuse confluent papillomatous lesions in the oral mucosa. 1 Despite the lesions’ benign appearance, early diagnosis and therapy of MPVEH is essential because of its high capacity for progression and its tendency for malign degeneration. 5–7

Clinical manifestations of cutaneous graft-versus-host disease after allogeneic haematopoietic cell transplantation: long-term follow-up results in a single Turkish centre.

The aim of this study was to evaluate the clinical manifestations of cutaneous graft-versus-host disease (GVHD) developed after allogeneic haematopoietic cell transplantation. In all, 67 patients were evaluated: 49 patients developed acute GVHD, 17 patients developed de novo chronic GVHD and 29 developed secondary chronic (15 limited, 14 progressive) GVHD following acute cutaneous GVHD. Of the 46 patients with chronic GVHD, lichenoid lesions were observed in 32 and sclerodermoid lesions were observed in 12. In four patients with sclerodermoid cutaneous GVHD, these lesions occurred after a lichenoid phase. Oral lesions were present in 61% of the patients and six of them had only oral mucosal involvement without any skin lesions. Nail lesions were observed in 31% of the patients. During the follow-up period 15 patients with GVHD died and in 7 of them the cause of death was related to chronic GVHD. In conclusion, GVHD has a wide spectrum of cutaneous manifestations, which can be used as an important tool for the early diagnosis of the disease.

Lumbosacral Vascular Malformation: A Hallmark for Occult Spinal Dysraphism

Introduction Port-wine strains are congenital vascular malformations that are found in 0.3–0.5% of all newborns [1, 2]. Even though most of the port-wine stains are cause for cosmetic concern only, haemangiomas and port-wine stains in special locations can be associated with underlying abnormalities. Sturge-Weber syndrome and KlippelTrenaunay-Weber syndrome are both well-known syndromes in which a naevus flammeus may be associated with vascular malformations of the ipsilateral meninges and the cerebral cortex or bone and soft tissue hypertrophy, respectively [1]. In 1915, Cobb [3] described an angioma of the spinal cord associated with a naevus of the port-wine variety of the same metamere. In 1986, Goldberg et al. [4] described 5 infants with sacral haemangiomas that were associated with multiple neurologic, gastro-intestinal, urologic and skeletal anomalies such as imperforate anus, renal anomaly, abnormal genitalia, rectoscrotal, rectoperineal or rectovaginal fistulas, skin tags, bony deformity of the sacrum and lipomeningomyelocele. This report indicated that lumbosacral haemangiomas and port-wine stains, like other cutaneous lesions centred over the midline, may be associated with underlying abnormalities. Albright et al. [5] reported 7 infants with lumbar haemangiomas, in whom underlying tethered cords were detected and pointed to the strong association of these two conditions. We report an additional case of a vascular malformation in the lumbosacral region associated with an underlying occult spinal dysraphism that emphasizes the importance of vascular malformations in the diagnosis of spinal malformations.

Simultaneous onset of chronic graft versus host disease and alopecia areata following allogeneic haematopoietic cell transplantation.

Sir, Chronic graft versus host disease (cGVHD) is a systemic complication that occurs after allogeneic haematopoietic stem cell or solid organ transplantation. Its incidence after allogeneic haematopoietic cell transplantation ranges between 27% and 72% (1). The immune system itself is a major target for cGVHD and the development of dysfunction may lead to autoimmune disorders. The association of vitiligo, myasthenia gravis, thrombocytopenia, autoimmune haemolytic anemia and polymyositis with cGVHD has been reported previously (2 – 6). We present three patients with alopecia areata (AA) occurring during the course of cGVHD. To the best of our knowledge, such an association has not been reported previously.

Hyperkeratosis of the nipple associated with chronic graft versus host disease after allogeneic haematopoietic cell transplantation.

Sir, Hyperkeratosis of the nipple and the areola (HNA) is a rare, benign condition characterized by asymptomatic hyperkeratosis and hyperpigmentation affecting the nipples and/or the areolae mammae (1 – 3). It may be idiopathic or associated with diseases such as ichthyosis, acanthosis nigricans, Darier’s disease or endocrinopathies. A few cases have also been reported related to internal malignancies, cutaneous T-cell lymphoma, or use of drugs (oestrogen and spironolactone) (4 – 7). We report here a case of HNA that developed during chronic cutaneous graft versus host disease (GVHD) following allogeneic peripheral blood stem cell transplantation.

Congenital malalignment of the great toenails in a pair of monozygotic twins.

Congenital malalignment of the great toenails is the lateral deviation of the long axis of nail growth relative to the distal phalanx. The nails grow slowly, with thickening, curving, and transverse ridging. We describe a pair of 3-year-old monozygotic female twins with congenital malalignment of the great toenails complicated by ingrowing and paronychia. Although there are a few cases without any family history, congenital malalignment is believed to be inherited through an autosomal-dominant gene of variable expression. This report provides further evidence of the heritability of the disease.

Is Long Term Observation of Patients with Recurrent Aphthous Stomatitis Necessary

Behcet’s disease is a chronic inflammatory disorder effecting many organ systems1,2. Clinical manifestations of Behcet’s disease may occur concurrently or subsequently. Generally oral aphthous lesions are the initial symptoms of Behcet’s disease and other manifestations occur subsequently within varying periods during the course of the disease3,4. However, it is a great dilemma to predict if patients presenting only with recurrent aphthous stomatitis will indeed develop Behcet’s disease in the future or not5—6.