Suhan Gunasti

Clinical features and natural course of Behçet’s disease in 661 cases: a multicentre study

Background  Behçet’s disease (BD) is a systemic inflammatory disease with unpredictable exacerbations and remissions. The natural course of BD is not fully known.

Pemphigus in the Mediterranean region of Turkey: a study of 148 cases.

Background  The purpose of this study was to describe the epidemiological and clinical features, course, response to treatment, and prognosis of pemphigus in the Mediterranean region of Turkey.

Severe inflammatory and keloidal, allergic reaction due to para-phenylenediamine in temporary tattoos

Hair coloring with henna has been popular in Turkey for years. In recent years since the tattoos are applied by the street vendors in most of the beach places in Turkey, skin coloring with henna has also increased. Henna can be used alone or in combination with other coloring agents. Henna alone can be safe but due to additives such as para-phenylenediamine (PPD), p-toluenediamine and various essential oils, allergic contact reactions may occur. We report a 22-year-old man who developed severe inflammatory and keloidal, moderately bullous allergic reaction after henna paint-on tattoo. We did a patch test separately with these painting products (henna powder, PPD) and with the European standard series. PPD was strongly positive (+++) on day 2 and remained positive for following days. After treating with topical clobetasol-17 butyrate, resolution was obtained in two weeks. But some keloidal reaction remained.

Cutaneous leishmaniasis: new dermoscopic findings

Cutaneous leishmaniasis (CL) has a worldwide distribution. Delayed and incorrect diagnosis may cause the significant spread of this disease and consequent increases in morbidity and drug resistance.

Interrater agreement in rating of pigmented skin lesions for border irregularity.

The clinical ABCD criteria are still recommended to both physicians and laymen when checking moles. The aim of this study was to determine the level of interrater reliability and therefore objectivity in rating for one of these criteria, namely border irregularity. Five professors, five residents, five nurses, and 10 students rated a set of 54 clinical images of pigmented skin lesions for border irregularity. After a descriptive presentation, rating was again carried out on another set of 54 images. In all groups, the agreement was moderate or substantial before the presentation and increased after the presentation. An almost perfect agreement was achieved by the professors after the presentation. Although both experience and receiving information could increase the level of interrater reliability, the disagreement was usually sufficient to suggest subjectivity in rating for border irregularity.

A Family with Waardenburg Syndrome

To the Editor: Waardenburg syndrome (WS) is a rarely seen inherited disease characterized by dystopia canthorum, broad nasal root, congenital deafness, heterochromic irises, medial eyebrows, and piebald-like lesions of the skin and hair. Four types of this syndrome have been defined so far. Types I, II, and III are autosomally dominant while Type IV is autosomally recessive (1–4). The incidence of WS in the general population is around 1 in 42,000 and is responsible for 1–2% of all congenital deafness (5). Several case reports of Waardenburg syndrome have been published in different literatures (5, 6). The syndrome is characterized by an increased distance between the inner canthi with a normal interpupillary distance (dystopia canthorum), congenital deafness, heterochromic irises, white forelock and hypomelanotic macules (2–4, 7). The diagnostic criteria for WS Type I are as follows: Major criteria: Congenital sensorineural hearing loss, pigmentary disturbances of the iris (complete heterochromia iridum, partial or segmental heterochromia, hypoplastic blue eyes) hair hypopigmentation, white forelock, dystopia canthorum, affected first degree relative. Minor criteria: congenital leucoderma, synophrys or medial eyebrow flare, broad or high nasal root, hypoplasia of alae nasi, premature graying of the hair (before age 30). At least two major criteria or one major and two minor criteria are needed to confirm the diagnosis (8). We present two siblings and their two children with WS (Fig. 1). WS was found de novo in our cases and the penetrance was different in each case. The two siblings were males and their ages were 40 and 31. They The Journal of Dermatology Vol. 31: 434–436, 2004

The influence of training on the recognition of gross features of dermoscopy images.

BACKGROUND In a dermoscopic examination, besides structural components, inexperienced clinicians should also be able to recognize the gross features of the images. AIM The aim of this study is, whether or not an inexperienced clinician has problems in the recognition of gross features of the images on dermoscopic examination. METHODS Two dermatologists, of whom one was experienced in the field of dermoscopy and the other was not, examined 161 dermoscopic images of melanocytic lesions in the gross features of their borders. Inner and outer borders were defined for each lesion. Both dermatologists separately evaluated the borders of the lesions for irregularity, asymmetry, and wideness of fading. For subjective image analysis they scored each lesion by using the four-point ordinal scale. For computerized image analysis they manually marked borders with dots, by using a computer program. We used quadratic-weighted kappa for interobserver reliability assessments for subjective scores and intraclass correlation coefficients (ICC) for automatically calculated scores. RESULTS In a subjective evaluation the inexperienced observer used a higher score than the experienced observer and the kappa values were between 0.241-0.286. ICC for the automatically calculated scores were between 0.357 and 0.522. According to both the outer and the inner borders, the concordance between experienced and inexperienced observers was almost perfect in measurements of diameter, perimeter, and area (ICC scores were between 0.948 and 0.990). CONCLUSIONS An inexperienced person, in comparison with an experienced person, sees lesions in the same sizes, but in different shapes on dermoscopy. Therefore, it is advisable that making learners familiar with the borders of lesions should be included in the training on dermoscopy.