Serkan Yazici

Methotrexate for the treatment of generalized lichen planus.

Lichen planus (LP) is a common pruritic, inflammatory disease that may involve the skin, mucous membranes, nails, and hair follicles.Topical treatments are associated with a good response in limited lesions but in patients with widespread disease, these treatments are usually unsatisfactory. Systemic corticosteroids have long been the treatment of choice for generalized LP but their use is limited in several conditions like old age, systemic diseases such as diabetes mellitus and osteoporosis. Additionally, despite the good results with corticosteroids, recurrence is quite common and sometimes leads to long-term use of such medications. Other systemic treatments that have been tried in cutaneous LP with variable response rates include oral retinoids, azathioprine, Tetracycline, cyclosporine, mycophenolate mofetil, thalidomide, low molecular weight heparin, PUVA or UVB, metronidazol, and biologic agents 1-15. A treatment with a good response rate and safety comparable to corticosteroids but with a lower recurrence rate can be a very good substitute for systemic corticosteroids, especially in old ages and patients with systemic diseases. Methotrexate (MTX) inhibits the action of Dihydrofolate reductase which is a necessary enzyme in the synthesis of Iran J Dermatol 2011; 14: 131-135 Received: September 7,2011 Accepted: December 3, 2011

Clinical experience with systemic cyclosporine A treatment in severe childhood psoriasis

Abstract Background: Severe forms of psoriasis including erythrodermic or pustular psoriasis, which require a more aggressive therapeutic approach such as phototherapy or systemic therapies, are rarely seen. Systemic toxicity and long-term safety of these agents are serious concerns in children. Objective: We report our experience on the efficacy and safety of cyclosporine A treatment in 22 patients of childhood psoriasis. Methods: We retrospectively analyzed the records of all patients less than 18 years of age treated with systemic cyclosporine A therapy at our clinic between January 2000 and March 2009. Demographic features as well as other relevant data including previous therapies, the dosage and duration of cyclosporine A therapy, response to treatment and side effects were retrieved from the patients’ records. Results: A total of 22 children were treated with systemic cyclosporine A therapy. Seventeen patients were found to be excellent responders. The mean therapeutic dosage of cyclosporine A was 3.47 ± 0.62 mg/kg/day. The mean duration of cyclosporine A therapy was 5.68 ± 3.29 months. The median time to total clearance of the lesions was 4.0 weeks. Conclusion: We conclude that cyclosporine A therapy is equally effective and safe in pediatric psoriasis patients as in adults.

Iododerma following topical povidone-iodine application

Abstract A 43-year-old male patient presented with two well-demarcated, elevated plaques, measuring 4 cm in diameter, with yellow-black crusts over it that appeared 3 d earlier. With the help of history, physical examination and histopathological features, the patient was diagnosed with iododerma secondary to topical povidone-iodine use. Iododerma develops frequently after oral or intravenous but rarely after topical use of iodine. Its pathogenesis is not well-known though it is widely believed that it is a delayed hypersensitivity reaction.

Flow Cytometric Analysis of T, B, and NK Cells Antigens in Patients with Mycosis Fungoides.

We retrospectively analyzed the clinicopathological correlation and prognostic value of cell surface antigens expressed by peripheral blood mononuclear cells in patients with mycosis fungoides (MF). 121 consecutive MF patients were included in this study. All patients had peripheral blood flow cytometry as part of their first visit. TNMB and histopathological staging of the cases were retrospectively performed in accordance with International Society for Cutaneous Lymphomas/European Organization of Research and Treatment of Cancer (ISCL/EORTC) criteria at the time of flow cytometry sampling. To determine prognostic value of cell surface antigens, cases were divided into two groups as stable and progressive disease. 17 flow cytometric analyses of 17 parapsoriasis (PP) and 11 analyses of 11 benign erythrodermic patients were included as control groups. Fluorescent labeled monoclonal antibodies were used to detect cell surface antigens: T cells (CD3+, CD4+, CD8+, TCRαβ +, TCRγδ +, CD7+, CD4+CD7+, CD4+CD7−, and CD71+), B cells (HLA-DR+, CD19+, and HLA-DR+CD19+), NKT cells (CD3+CD16+CD56+), and NK cells (CD3−CD16+CD56+). The mean value of all cell surface antigens was not statistically significant between parapsoriasis and MF groups. Along with an increase in cases of MF stage statistically significant difference was found between the mean values of cell surface antigens. Flow cytometric analysis of peripheral blood cell surface antigens in patients with mycosis fungoides may contribute to predicting disease stage and progression.

A Rare Reason for Uvular Angioedema: Ecbalium elaterium.

Dear Editor: Ecbalium elaterium, a rare cause of uvular angioedema Ecbalium elaterium or squirting cucumber, is a plant species that belongs to the Cucurbitaceae family and grows in Mediterranean region. The root and fruit of this plant have been used in traditional medicine since ancient times. The fruit juice of E. elaterium has been used in the Anatolia region for inflammatory diseases like rhinosinusitis because of its potent cathartic, analgesic, and anti-inflammatory effects1. However, it may cause allergic, toxic, and systemic adverse reactions in some users. We present a case who developed uvular angioedema after applying a few drops of the fresh fruit juice of E. elaterium into his nostrils to cure his chronic rhinosinusitis. A 36-year-old male patient applied to the emergency service with complaints of burning sensation, sore throat, and difficulty in breathing. It was learned that due to recurrence of his rhinosinusitis in spite of repeated medical treatment, he applied two drops of fresh fruit juice of E. elaterium plant into his nostrils without diluting it. His symptoms began in about 10~20 minutes. When applying the same treatment on two prior occasions, he had experienced no similar symptoms. The medical and family histories were unremarkable, and he had no history of drug use. Erythema and edema were observed in uvula and soft palate and other physical examination findings were normal (Fig. 1a). On laboratory examination, complete blood count and blood biochemistry were within normal limits. In the light of the history, physical examination and laboratory findings, E. elaterium-induced angioedema was diagnosed for the patient. The patients symptoms regressed with standard angioedema treatment in the next few hours. Fig. 1 (a) Erythema and edema on the uvula. (b) The fruit of Ecbalium elaterium. Rhinosinusitis is one of the most common medical problems throughout the world. Long periods of antibiotics, surgical or supportive treatment methods are the usual treatment. However, none of these approaches have been found successful long term2. This leads people to search for alternative treatment methods as in our case. The fruit of E. elaterium is ovoid, fleshy, pale green in color, approximately 3 cm in length, and the surface is covered with hairs (Fig. 1b). Elaterium is the fluid obtained from the fruit of E. elaterium. The most known active component of elaterium is elaterin. Elaterin is a cathartic agent with potent hydragogue effect, and for this reason it has been used in traditional medicine. Another component of elaterium is cucurbitacine B which is a derivative of triperten and acts as an active anti-inflammatory agent1. It has been reported that besides chronic rhinosinusitis, elaterium is also used in the treatment of diseases considered to be inflammatory like rheumatism and infections3. An experimental study conducted by Uslu et al.4 investigated the anti-inflammatory effect of aqueous extracts of E. elaterium used topically in treatment of rhinosinusitis, showing that E. elaterium extracts reduce inflammation considerably in rabbits suffering from rhinosinusitis compared with the control group. Elaterin and cucurbitacins may cause allergic reactions, direct toxic reactions or systemic side effects. Uvular angioedema, which is one of the most prevalent adverse reactions, manifests as sore throat, hoarseness, and dyspnea. It may progress and lead to complete airway obstruction if treatment is delayed5. Uvular edema may either be an immunoglobulin E (IgE)-mediated allergic reaction or may result from direct toxic effect. Since no reaction developed in earlier uses of undiluted form of elaterium, the uvular edema in our case was considered to be an IgE-mediated hypersensitivity reaction resulting from earlier sensitizations. In their series with 42 cases where allergic edema developed due to the use of E. elaterium, Kloutsos et al.6 have reported that the edema was most frequently observed in uvula and 39 cases had a history of allergic reaction. The patient reported here had no history of allergy. Eken et al.7 have reported a case with nasal mucosa necrosis caused by direct toxic effect of E. elaterium. One case who developed renal failure after systemic intake of the plant has also been reported in literature8. Although the effect of E. elaterium on rhinosinusitis has been demonstrated experimentally, care must be taken in using herbal treatments for which therapeutic doses, effects and side effects are not fully understood, since using undiluted forms may cause serious adverse reactions.

Retrospective Analysis of 91 Kaposi’s Sarcoma Cases: A Single-Center Experience and Review of the Literature

Background: Kaposi’s sarcoma (KS) is a multifocal angioproliferative tumor involving primarily the skin. Objective: The aim of this study was to describe the clinical, demographic, histopathological characteristics, treatment modalities, and outcome of 91 KS patients, and compare them with other contemporary research. Methods: Medical records of 91 KS patients followed between January 2005 and September 2017 were evaluated retrospectively. Results: Most of our patients were male (male-to-female ratio was 4.05). The median age at diagnosis was 69 years (range, 6–93 years). The duration of the lesions varied between 3 and 25 years. The lower extremities were the most commonly involved area (51.6%). Of the 91 patients, classic type KS was seen in 75 patients. Radiotherapy was used successfully in approximately half of our patients. Recurrence was observed in approximately one third of the patients. All KS patients in this study except 1 were classic KS. Conclusion: The clinical and demographic characteristics of our patients were compatible with the previous literature suggesting that KS is a tumor that tends to be limited to the skin. Close follow-up of patients is important to monitor for recurrence. This is the largest report from Turkey to date.

Treatment of Lichen planopilaris: Methotrexate or Cyclosporine A therapy?

Abstract Background: Because of irreversible outcome of the lichen planopilaris (LPP), systemic therapy should be used in early inflammatory stages of the disease, without allowing the irreversible scar formation and permanent hair loss. Objective: We assessed the efficacy and safety of methotrexate (MTX) and cyclosporine A (CsA) in the management of recalcitrant, extensive LPP and compared their efficacy and safety profile. Methods: We retrospectively analysed the 16 LPP cases treated with either CsA or MTX therapy. Clinical improvement was defined as the absence of reported symptoms, lack of progression and reduction in erythema and follicular hyperkeratosis found in SIAscopic images. Results: A total of 16 patients received either CsA (six cases) or MTX (10 cases) therapy. The dosage of CsA was between 3 and 5 mg/kg/day. The initial dosage of MTX was 10–15 mg/wk and tapered gradually. The clinical improvement was demonstrated significantly at SIAscopic images taken at the third months of therapy. Conclusions: Our observations suggest that both MTX and CsA therapies provide similar clinical efficacy at the end of first month of therapy with dosages used in psoriasis therapy. MTX was found to be better tolerated in this study.

The efficacy of narrowband UVB treatment in pediatricvitiligo: a retrospective analysis of 26 cases

BACKGROUND/AIM Narrowband UVB (Nb UVB) treatment is commonly used for the management of psoriasis and atopic dermatitis, and is less often used for vitiligo in children. The aim of this study was to evaluate the efficacy and short-term safety of Nb UVB phototherapy in children diagnosed with vitiligo retrospectively. MATERIALS AND METHODS A total of 26 patients younger than 18 years with the diagnosis of vitiligo and managed with Nb UVB phototherapy as documented in archive records were evaluated. Clinical response was assessed according to repigmentation of the lesions: good response when there was more than 75% repigmentation, moderate response when there was 25%-74% repigmentation, poor response when repigmentation was less than 24%, and unresponsive when there was no pigmentation and new lesions occurred. RESULTS A total of 26 patients received Nb UVB treatment; 14 were girls and 12 were boys. The age at onset of the disease varied between 2 and 18 years, with a mean age of onset of 10.07 ± 4.53 years. Repigmentation rate of >75% was detected in 45.4% of cases. CONCLUSION Nb UVB phototherapy seems to be a well-tolerated effective and safe treatment option in children, especially those unresponsive to topical treatment and those with widespread lesions. However, long-term risks such as photocarcinogenesis and photoaging should kept in mind.

Retrospective analysis of the forty-six patients with bullous pemphigoid followed-up in our clinic

Türkderm-Deri Hastalıkları ve Frengi Arşivi Dergisi, Galenos Yayınevi tarafından basılmıştır. Turkderm-Archives of the Turkish Dermatology and Venerology, published by Galenos Publishing. Background and Design: Bullous pemphigoid (BP) is an autoimmune disease characterised by widespread itchy plaques and subepithelial blisterings and usually affects the elderly population. Due to the chronic nature of the disease, to prevent the side effects of chronic steroid treatment, adjuvant immunosuppressive (mycophenolate mofetil, azathioprine, methotrexate) and anti-inflammatory (tetracycline, nicotinamide, dapsone) agents may be used. In this study, we retrospectively evaluated the clinical and demographic characteristics and applied treatments of 46 patients with the diagnosis of BP and compared with literature data. Materials and Methods: We retrospectively evaluated the records of 46 patients who received clinical and histopathological diagnosis of BP and followed up in our clinic between 2006 and 2013. Results: Of the 46 patients, 22 were female and 24 male. The mean age of onset was 69.54 years (range: 18-105). The duration of the lesion ranged from 1 week to 10 months with a median duration of 8 weeks. The most frequent comorbid chronic disease was hypertension detected in 28 (60.8%) patients. Only four patients had a history of malignancy before the onset of the disease. Nineteen patients (42%) used more than 5 agents for comorbid diseases. Thirty-two patients (69.5%) used systemic corticosteroids alone and ten (22%) patients needed additional adjuvant therapies. Conclusion: BP is a major cause of morbidity in the elderly population receiving multiple drug treatment. To avoid the side effects of steroid therapy, especially in patients with severe disease, short-term use of additional immunosuppressive agents appears to be safe and effective.