Tülin Akan

Kindler syndrome: absence of definite ultrastructural feature.

Kindler syndrome is characterized by congenital blister formation, photosensitivity, poikiloderma, and cutaneous atrophy in later life. There are few reports about the ultrastructural features of this syndrome, but still there is no consensus about the basic disease. Here we report a case of Kindler syndrome with ultrastructural findings.

Comparative study of the efficacy and tolerability of 4 weeks of terbinafine therapy with 8 weeks of griseofulvin therapy in children with tinea capitis

Background: Ringworm of the scalp is a dermatophyte infection prevalent in pre-school and school-aged children. Tinea capitis is one of the few superficial fungal infections that does not adequately respond to topical treatment and requires 6-8 weeks of oral antifungal therapy. The aim of this double-blind study was to compare the efficacy and tolerability of terbinafine therapy with griseofulvin therapy in children with mycologically proven tinea capitis. METHODS: In a randomized, double-blind study, efficacy and tolerability of terbinafine given orally once daily for 4 weeks were compared with those of griseofulvin given orally once daily for 8 weeks. A total of 78 subjects were enrolled (39 in the terbinafine group, and 39 in the griseofulvin group). Among these, 7 subjects in the terbinafine group and 4 subjects in the griseofulvin group dropped out. The study included 67 subjects (32 in the terbinafine group and 35 in the griseofulvin group) and the mean age was 7.0 years (range 2-13 years) in the te...

A resistant case of pemphigus gestationis successfully treated with intravenous immunoglobulin plus cyclosporine

erythematosus Editor, A 44-year-old woman was admitted to our hospital with a 3-year history of generalized progressive erythematosquamous skin lesions. This condition had been diagnosed elsewhere as pemphigus erythematosus. Treatment with oral methylprednisolone at 80 mg per day was administered and achieved a good response. However, when the corticosteroids were slowly withdrawn, the condition relapsed, and the patient became very nervous and distressed about her facial lesions. Subsequently, she developed phobic anxiety and avoided facial cleaning and any outdoor activity. The lesions had begun as dark yellow papules on the forehead and had gradually increased to involve the whole face and scalp. Physical examination revealed thick, dark brown crusts covering most of the subjects face and red macules with purulent fluid on the cheeks (Fig. 1). A skin biopsy and direct immunofluorescence confirmed the diagnosis of pemphigus erythematosus. Anti-Dsg1 immunoglobulin G (IgG) antibodies were detected by enzyme-linked immunosorbent assay (ELISA) (120 U/ml). The patient was treated with prednisone 60 mg per day for seven days. However, when the adherent crust was removed using 0.9% normal saline, the underlying skin was found to be almost normal (Fig. 2). We tapered the dose of prednisone to 40 mg per day. There was no relapse of the skin lesions. Cutaneous dirt-adherent disease (CDAD) is a rare psychogenic dermatosis that occurs mainly in young Japanese and Chinese women. Its psychological pathogenesis remains largely unclear. To our knowledge, this is the first case of CDAD on a base of pemphigus to be reported. The skin lesions of CDAD can be confused with the oozing and crusts of pemphigus, which may lead to an erroneous diagnosis of severe pemphigus and an inappropriate increase in the dose of corticosteroid.

Long-term follow-up of early mycosis fungoides patients treated with narrowband ultraviolet B phototherapy

Background: Narrowband ultraviolet B (UVB) provides complete response (CR) in 54–91% of early mycosis fungoides (MF) patients. Data concerning relapse rate and relapse-free interval after discontinuation of therapy need clarification. The purpose of this study was to evaluate the relapse rate and the relapse-free intervals of early MF patients after achieving complete response with narrowband UVB phototherapy. Methods: Retrospective evaluation of data, which belong to early MF patients treated with narrowband UVB phototherapy between May 2000 and July 2010, and followed-up until May 2012 in a single institution, for the occurrence of relapse and the time to relapse. Results: Of 31 patients, who were followed-up for a mean of 56.5 ± 30.2 months (median 55 months, range 20–120 months), relapse was observed in 11 (35.5%) patients, within a mean of 28.8 ± 18.2 months (median 33 months, range 4–59 months), whereas 20 (64.5%) patients stayed relapse-free for a mean of 54.2 ± 28.8 months (median 55.5 months, range 20–119 months). Patients received maintenance phototherapy with a median duration of 12 months (range 1–30 months) after achieving complete response. Conclusion: Results indicate that narrowband UVB phototherapy may induce low relapse rates and long relapse-free intervals for early MF.

Comparison of Growth Hormone Receptor, IGF-1R and IGFBP-3 Between Tumoral and Non-Tumoral Areas in Non-Melanoma Skin Cancers Melanositik Olmayan Deri Kanserlerinde Tümöral ve Peritümöral Alanlardaki Büyüme Hormonu Reseptörü, İnsülin Benzeri Büyüme Faktörü-1 Reseptörü ve İnsülin Benzeri Büyüme Faktörü Bağlayici Protein-3'ün Karşilaştirilmasi

Abstract Objective: A relationship between the pathogenesis of some cancers and growth hormone, insulin-like growth factor-1 and insulin-like growth factors binding protein-3 has been shown. Our aim was to evaluate the expression of growth hormone receptor, insulin-like growth factor-1 receptor and insulin-like growth factors binding protein-3 in actinic keratosis, basal cell carcinoma and squamous cell carcinoma, and to compare the expression patterns of tumoral areas with normal epidermis and skin appendages. Material and Method: The formalin-fixed, paraffin-embedded tissues of 40 patients which were diagnosed as 15 actinic keratosis, 15 basal cell carcinoma and 15 squamous cell carcinoma were analyzed for growth hormone receptor, insulin-like growth factor-1 receptor and insulin-like growth factors binding protein-3 with the immunohistochemical method using the streptavidin-biotin-peroxidase technique. Results: There was no difference between tumoral areas of actinic keratosis, basal cell carcinoma and squamous cell carcinoma in expression of growth hormone receptor and insulin-like growth factors binding protein-3 (P>0.05). However, a significantly higher expression of insulin-like growth factor-1 receptor was observed in tumoral areas of squamous cell carcinoma (P<0.01). In basal cell carcinoma, a significantly lower intensity of immunostaining with growth hormone receptor, insulin-like growth factor-1 receptor and insulin-like growth factors binding protein-3 in tumoral areas than skin appendages was seen (P <0.01). In squamous cell carcinoma, higher expressions of growth hormone receptor, insulin-like growth factor-1 receptor and insulin-like growth factors binding protein-3 in tumoral areas than peritumoral epidermis was found (P =0.06, P <0.01 and P =0.02, respectively). Conclusion: Our study points out that, growth hormone receptor, insulin-like growth factor-1 receptor and insulin-like growth factors binding protein-3 have a role in the pathogenesis of non-melanoma skin cancers, especially squamous cell carcinoma. Öz Amac: Buyume hormonu, insulin benzeri buyume faktoru-1 ve insulin benzeri buyume faktoru bağlayıcı protein-3 bazı kanserlerin patogenezi ile ilişkili bulunmuştur. Aktinik keratoz, bazal hucreli karsinom veya skuamoz hucreli karsinomda buyume hormon reseptoru, insulin benzeri buyume faktoru-1 reseptoru ve insulin benzeri buyume faktoru bağlayıcı protein-3 ekspresyonunun belirlenmesi ve tumoral alanların ekspresyon ozelliklerinin normal epidermis ve deri ekleriyle karşılaştırılması amaclandı. Gerec ve Yontem: Kırk hastaya ait formaldehitle fikse edilmiş, parafine gomulmuş aktinik keratoz (n=15), bazal hucreli karsinom (n=15) ve skuamoz hucreli karsinom (n=15) tanısı almış doku ornekleri streptavidin- biotin-peroksidaz tekniği kullanılarak immunohistokimyasal metodla buyume hormon reseptoru, insulin benzeri buyume faktoru-1 reseptoru ve insulin benzeri buyume faktoru bağlayıcı protein-3 varlığı acısından incelendi. Bulgular: Calışmamızda, aktinik keratoz, bazal hucreli karsinom ve skuamoz hucreli karsinomun tumoral alanları arasında buyume hormon reseptoru ve insulin benzeri buyume faktoru bağlayıcı protein-3 ekspresyonu acısından anlamlı fark bulunmazken (P>0.05); insulin benzeri buyume faktoru-1 reseptoru ile skuamoz hucreli karsinomda tumoral alanlarda anlamlı olarak daha fazla ekspresyon izlendi (P<0.01). Bazal hucreli karsinomda buyume hormon reseptoru, insulin benzeri buyume faktoru-1 reseptoru ve insulin benzeri buyume faktoru bağlayıcı protein-3 ile tumoral alanların deri eklerinden anlamlı olarak daha az şiddette boyandığı goruldu (P<0.01). Skuamoz hucreli karsinomda tumoral alan buyume hormon reseptoru, insulin benzeri buyume faktoru-1 reseptoru ve insulin benzeri buyume faktoru bağlayıcı protein-3 ile peritumoral epidermisten daha fazla şiddette boyanma gosterdi (sırasıyla P=0.06, P <0.01 ve P =0.02). Sonuc: Calışmamız buyume hormon reseptoru, insulin benzeri buyume faktoru-1 reseptoru ve insulin benzeri buyume faktoru bağlayıcı protein-3’un melanositik olmayan deri kanserlerinde ve ozellikle skuamoz hucreli karsinomda patogenezde rolu bulunduğunu gostermektedir.