Şebnem Aktan

Skin Tags and Atherosclerotic Risk Factors

An association between skin tags and insulin resistance, obesity, impaired carbohydrate and lipid metabolism has been suggested. However, there still is a need for comprehensive and controlled clinical studies. We aimed to evaluate the atherogenic risk factors in patients with skin tags. Thirty‐six patients with skin tags who were admitted to the dermatology department and 22 healthy controls were included in this study. Possible subjects who were taking systemic drugs or who had a systemic disease that may be associated with lipid or carbohydrate metabolism abnormalities were excluded from the study. All the measurements were completed in 26 patients. Standard oral glucose tolerance tests were performed on the patient and control groups. Serum insulin, total cholesterol, triglyceride and HDL‐cholesterol levels were measured. LDL‐cholesterol and VLDL‐cholesterol ratios and HOMA‐IR and body mass indices were calculated. The mean levels of body mass index, HOMA‐IR, and total cholesterol were significantly higher in patients than in controls. In conclusion, skin tags may not be innocent tumoral proliferations; instead, follow‐up of such patients with regard to the development of diseases associated with atherosclerosis may be beneficial.

Comparison of topical 3% diclofenac sodium gel and 5% imiquimod cream for the treatment of actinic keratoses

Background.  There is a wide spectrum of treatments available for actinic keratosis (AK). Topical diclofenac sodium and imiquimod are two topical treatments, which are noninvasive, easily applied, well‐tolerated and effective.

Dermoscopic findings in scalp psoriasis and seborrheic dermatitis; two new signs; signet ring vessel and hidden hair.

Background: Psoriasis and seborrheic dermatitis are both chronic erythemato-squamous dermatoses that can involve the scalp. It may be difficult to differentiate these two diseases when there is isolated scalp involvement. Recently, trichoscopy is commonly used to differentiate noncicatricial alopecias including psoriasis and seborrheic dermatitis that can lead to telogen effluvium (TE). Objectives: The objective of this study is to evaluate the trichoscopic figures that may help to differentiate scalp psoriasis and seborrheic dermatitis. Materials and Methods: Thirty one with scalp psoriasis and 112 patients with seborrheic dermatitis were enrolled. Trichoscopic examinations were performed using a videodermatoscope (MoleMax 3®). Trichoscopic findings of scalp psoriasis and seborrheic dermatitis were compared with each other, with 100 healthy individuals and with other noncicatricial alopecias including female androgenetic alopecia (FAGA) (n: 138), male androgenetic alopecia (n: 63), FAGA of male pattern (FAGA.M) (n: 5), alopecia areata (39), TE (n: 22) and trichotillomania (n: 4). Results: Atypical red vessels, red dots and globules (RDG), signet ring vessels (SRV), structureless red areas and hidden hairs (HH) were statistically more common in psoriasis while twisted red loops and comma vessels (CV) in seborrheic dermatitis. RDG were considered as the characteristic videodermatoscopic figure for psoriasis and arborizing red lines and CV for seborrheic dermatitis. In comparison with previous reports, our study yielded two new trichoscopic structures supporting the diagnosis of psoriasis; HH and SRV. Besides, according to our study, CV were described for the first time in seborrheic dermatitis and considered to be specific for seborrheic dermatitis. Conclusion: This study confirmed that trichoscopy might be useful in differentiating scalp psoriasis and seborrheic dermatitis from each other and from other noncicatricial alopecia with three trichoscopic structures as HH, SRV and CV.

Scalp Dermatoscopic Findings in Androgenetic Alopecia and Their Relations with Disease Severity

Background Clinicians are searching for new methods to diagnose and predict the course of androgenetic alopecia noninvasively. Objective Our aim is to evaluate trichoscopic findings and their relations with disease severity in androgenetic alopecia. Methods The videodermatoscopic findings of 143 female and 63 male patients with androgenetic alopecia were compared with each other, with those of healthy subjects (n=100), and with those of patients with other nonscarring alopecias (n=208). Mann-Whitney U-test, χ2 analyses, and logistic regression analysis were used for statistical analysis. Results No statistically significant relation was found between trichoscopic findings and severity in male androgenetic alopecia (MAGA) on the basis of the modified Hamilton Norwood scale (among 7 degrees); however, multihair follicular unit and perifollicular pigmentation were related to low severity whereas white dots, honeycomb pattern pigmentation, and brown dots were related to high severity. On the other hand, according to the Ludwig classification, arborizing red lines were related to low severity and brown dots were related to high severity, whereas there was no difference in stages between the Ebling and Olsen classifications in female androgenetic alopecia (FAGA). In the characteristic trichoscopic findings in this study, perifollicular pigmentation was found as a normal feature of the scalp, whereas multihair follicular unit and honeycomb pigment pattern, which were previously considered as normal features, were observed to be related to androgenetic alopecia. Conclusion No relation was found between MAGA severity and trichoscopic findings, as well as between FAGA severity according to different disease severity classifications and trichoscopic findings.

Mal de Meleda: a new geographical localization in Anatolia.

Background: Mal de Meleda (MDM) is an autosomal recessive form of palmoplantar keratoderma first described on the Dalmatian island of Meleda. MDM has been observed in many other countries so that the origin of the MDM gene may be elsewhere than in Meleda. Objective: After identification of the first MDM patient during a medical visit, a study was planned to reveal other families with MDM in the Köprüçay region in Anatolia. Methods: The patient was interviewed with a questionnaire including a pedigree drawing. All the subsequent cases reported to be of MDM were visited for clinical examination and pedigree drawings. Results: Thirty-nine patients, 8 families and 2 additional cases with MDM were identified in a 50-km2 mountainous region in Köprüçay canyon in Anatolia. The prevalent clinical features were nail involvement (80%), ‘glove-and-sock’ distribution of the keratoderma (60%), edema on the hands/feet (60%), conical tapering of the fingertips (60%) and hyperhidrosis on the palms and soles (50%). Conclusion: To our knowledge, this is the largest series reported. The relationship between the patients in Meleda and those in Anatolia awaits discovery by further researches that will be carried out with the collaboration of dermatology, genetics and medical history departments.

Trichoscopic findings in alopecia areata and their relation to disease activity, severity and clinical subtype in Turkish patients

Trichoscopic studies of alopecia areata are helpful in the non‐invasive diagnosis and prediction of the course of the disease. The objective was to determine the relationship of trichoscopic findings in alopecia areata with disease activity, severity and clinical subtype in Turkish patients.

Possible triggering factors and comorbidities in newlydiagnosed autoimmune bullous diseases

BACKGROUND/AIM The distribution and the demographic, etiological, and clinical features of autoimmune bullous diseases (ABDs) vary according to geographic regions of the world. The limited number of reported studies in Turkey are mostly retrospective and generally include only pemphigus. The aim of our study was to evaluate the demographic data, clinical features, associated triggering factors, and comorbidities in patients newly diagnosed with ABDs. MATERIALS AND METHODS In this descriptive and prospective study, the demographic data, inhabited regions, smoking and drinking habits, presence of comorbidities, and specific and general potential triggering factors of ABDs considered by the patients were examined. Furthermore, the distribution of lesions and autoimmune bullous skin disorder intensity scores were recorded. RESULTS Of the total 59 ABD patients, 26 (44.1%) were diagnosed with pemphigus, 25 (42.4%) were diagnosed with pemphigoid, and 8 (13.5%) were diagnosed with dermatitis herpetiformis. Although there were some differences between the subgroups of ABDs, the onset of the disease was associated with a triggering factor (stress, foods, physical trauma, chemical agents, ultraviolet rays, medications, infections, malignancies, and pregnancy, in a decreasing frequency) in 96.6% of the patients. Autoimmune diseases, neuropsychiatric disorders, diabetes mellitus, and hypertension were found to be statistically significantly higher in the pemphigoid group compared to the pemphigus and dermatitis herpetiformis groups. CONCLUSION Evaluation of triggering factors and comorbidities before starting treatment may assist in controlling the disease more swiftly and reducing the side effects of treatment in the management of ABDs. However, to evaluate the frequency and significance of our findings in order to determine whether they are statistically significant or not, we suggest a multicenter prospective clinical trial, which would include control groups and a higher number of patients for each of the disease groups and clinical subtypes.

Klasik Tedavilere Dirençli Verrukaların Tedavisinde Asitretin: Bir Olgu Sunumu,

Toplumda oldukca yaygin olarak gorulen verrukalar ozellikle agri, fonksiyonel bozukluk ve kozmetik rahatsizlik olusturdugunda veya tedaviye direnc gosterdiginde hem hastalar hem de hekimler acisindan ciddi bir sikinti kaynagi olusturabilmektedir. Literaturde bildirilmis farkli tedavi seceneklerine ragmen henuz optimal tedavi acisindan bir gorus birligi bulunmamaktadir. Genellikle topikal tedaviler ve/veya destruktif yontemler kullanilmakla birlikte, bu tedavilerin insan papilloma virusu infeksiyonuna karsi spesifik antiviral etki gostermemesi nedeniyle her zaman basarili sonuclar alinamamaktadir. Burada ellerinde ve ayaklarinda klasik tedavilere direncli cok sayida verrukasi olan ve dort ay sureyle kullanilan 30 mg/gun asitretin tedavisine buyuk oranda yanit veren 63 yasinda bir kadin olgu sunulmaktadir

Anogenital ulcerations in a 83-year-old woman

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