Zafer Turkoglu

Significant improvement in ulcerative necrobiosis lipoidica with hydroxychloroquine

infiltrate with a variable amount of lymphocytes, histiocytes, and even eosinophils. In individuals of advanced age, it may beassociatedwithsignsofarteriosclerosis. Skin manifestations are uncommon. They consist of ischemia and necrosis, resulting from a total or partial reduction in the blood supply to the territory irrigated by the affected artery. In milder cases, there can be alopecia, hyperpigmentation, and sensitivity on the skull. Cases with an initial diagnosis of herpeszosterhavebeenreported. The first two cases of scalp necrosis as a manifestation of temporal arteritis were described by Cooke et al. in the 1940s. Since then, only 26 cases have been reported in the literature. Patients with scalp necrosis are older, with a greater risk of visual alterations and gangrene of the tongue, andaworseprognosis. This is a severe disease, especially because of the complications; however, most cases are now reversible and the mortalityrate is low.

A case of livedoid vasculopathy associated with factor V Leiden mutation : Successful treatment with oral warfarin

Livedoid vasculopathy is characterized by painful purpuric lesions on the extremities which frequently ulcerate and heal with atrophic scarring. It has been considered to be a vasculitic process but now there has been increasing evidence that abnormal coagulation plays a major role in the pathogenesis of this rare disorder. We report the case of a 19‐year‐old male who had been suffering from recurrent painful ulcerations on both lower legs with atrophic scars for 4 years. A biopsy specimen revealed vasculopathy, and laboratory studies showed resistance to activated protein C with factor V Leiden mutation. Treatment with oral warfarin led to rapid improvement of the lesions.

The evaluation of thyroid diseases in patients with pemphigus vulgaris.

Background. Thyroid disorders may affect all of the organ systems of the body and they are also highly associated with a wide variety of skin disorders. The aim of this study was to investigate the prevalence of thyroid function abnormalities and thyroid autoimmunity in patients with pemphigus vulgaris (PV) and to determine the association between thyroid disorders and clinical involvement and systemic corticosteroid treatment in patients with PV. Methods. The study consisted of eighty patients with PV and eighty healthy individuals. Thyroid functions (fT3, fT4, and TSH) and thyroid autoimmunity (anti-thyroid peroxidase (anti-TPO), and anti-thyroglobulin (anti-Tg) antibodies) were investigated in both groups. Primary thyroid disease (PTD) was diagnosed with one or more of the following diagnostic criteria: (i) positive antithyroid antibodies, (ii) primary thyroid function abnormalities. Results. Significant changes in the serum thyroid profile were found in 16% (13/80) of the PV group and 5% (4/80) of the control group. Positive titers of antithyroid antibodies (anti-TPO and anti-Tg) were observed in 7 patients (9%) with PV and one in the control group (1,2%). Hashimoto thyroiditis was diagnosed in 9% of PV patients and it was found to be more prevalent in the mucosal form of PV. PTD was found in 13 of (%16) PV patients which was significantly high compared to controls. PTD was not found to be associated with systemic corticosteroid use. Free T3 levels were significantly lower in PV group compared to the control group and free T4 levels were significantly higher in PV group compared to the controls. Conclusions. PV may exist together with autoimmune thyroid diseases especially Hashimoto thyroiditis and primer thyroid diseases. Laboratory work-up for thyroid function tests and thyroid autoantibodies should be performed to determine underlying thyroid diseases in patients with PV.

Treatment of pediatric molluscum contagiosum with 10% potassium hydroxide solution

Background: Molluscum contagiosum (MC) is a common cutaneous viral infection of the skin that is frequently seen in children. Although lesions can resolve spontaneously, treatment is mandatory because of the psychological effect of widespread lesions in children. Potassium hydroxide (KOH) is a strong alkali that has been used by dermatologists for a long time in identifying the fungal infections from skin scrapings. Aims: We evaluated 40 children with MC for the safety and efficacy of treatment with topical 10% KOH aqueous solution. Methods: Parents were instructed to apply a 10% KOH aqueous solution, twice daily, with a cotton stick to all lesions. Treatment was continued till the lesions showed signs of inflammation or superficial ulceration. Assessments of response and side effects were performed at the end of week 2, week 4, week 8 and week 12. Results: We found complete clearance of lesions in 37 (92.5%) patients receiving topical 10%KOH solution after a mean period of four weeks. Three children dropped out of the study; two children reported severe stinging of the lesions and discontinued the treatment; the other patient developed hypopigmentation during the treatment. Local side effects were observed in 12 children (32.4%). Conclusion: Even though 10% KOH solution is associated with some local side effects, it is a safe, effective, inexpensive and noninvasive alternative treatment of MC in children.

Ear, nose and throat involvement in patients with pemphigus vulgaris: correlation with severity, phenotype and disease activity

Background  Pemphigus vulgaris (PV) is the most common clinical form of pemphigus that is characterized by easily ruptured or loose bulla formation on skin and/or mucosa. The frequency of the ear, nose and throat involvement of PV is not clearly defined.

Whitish papules on the palm.

A 21‐year‐old woman presented with a 1‐month history of whitish bubbling of the palms after brief exposure to water. The symptoms arose within 3–5 min after immersion in water, as a white sponge‐like appearance, and resolved after a variable drying period. She was otherwise healthy and did not complain of hyperhidrosis. There was no family history of similar lesions. Physical examination revealed a healthy appearance of the palms; however, 5 min after immersion of the hands in warm water, the central part of the left palm became swollen and tiny white papules with dilated puncta appeared. The right palm also showed similar changes. These asymptomatic papules with a tendency to coalesce became more prominent with prolonged exposure ( Figs 1 and 2 ). The lesions resolved completely approximately 30 min after removal of the hands from water. A biopsy taken from the lesional skin revealed dilatation of intraepidermal eccrine ducts and a spongy appearance in the corneal layer ( Fig. 3 ). A diagnosis of aquagenic syringeal palmar keratoderma was made on the basis of these clinical and histopathologic findings. A short course of treatment with topical aluminum chloride resulted in a remarkable response in 1 week. She had no recurrence after 1 year.

Vulvar pruritus caused by syringoma of the vulva

A 20-year-old woman presented with a 1.5-year history of pruritic papules on her vulva. There was no past history of eczema or contact sensitization. Cutaneous examination revealed multiple, 1-3 mm sized, skin-colored papules, distributed bilaterally over the labia majora (Fig. i). No other similar lesions were detected on the rest of the body. Histological examination of the lesion showed a tumoral lesion containing ductal structures formed by epithelial cells some of which were clear cytoplasm embedded in fibrotic stroma (Fig. 2). This appearance was diagnostic of a syringoma.

Autologous whole blood and autologous serum injections are equally effective as placebo injections in reducing disease activity in patients with chronic spontaneous urticaria: a placebo controlled, randomized, single-blind study

Abstract Background: Recent demonstration of circulating anti-IgG antibodies towards IgE and its receptor (FcϵRI) has led to an interest in inducing tolerance to circulating histamine-releasing factors with autologous blood injections as a treatment option in chronic spontaneous urticaria (CU). The aim of the study was to assess the efficacy of autologous whole blood (AWB) and autologous serum (AS) injections in patients with CU compared to placebo. Methods: A total of 88 CU patients with (+) autologous serum skin test (ASST) (59) and (-) ASST (29) were randomized into three parallel subgroups and were treated with weekly injections of AWB, AS or placebo for 10 weeks. Clinical assessments included urticaria activity score (UAS) and dermatology life quality index. Results: In ASST (+) patients, the percentages of patients with >30% improvement in UAS and DLQI were 85% and 90% in AWB group, 65% and 65% in AS group and 79% and 90% in placebo group, respectively. In ASST (-) patients, these figures were 67% and 89% in the AWB group, 80% and 80% in the AS group and 60% and 70% in the placebo group. The intergroup difference for complete subsidence was not statistically significant. Conclusions: Even though we could not show a better efficacy than placebo, autohemotherapy resulted in a marked decrease in disease activity and improvement in quality of life scores in CU patients.

Treatment of childhood mycosis fungoides with narrow-band phototherapy

46 Correspondence Treatment of childhood mycosis fungoides with narrow-band phototherapy Mycosis fungoides (MF) is a form of cutaneous T-cell lymphoma, usually arising in mid to late adulthood. 1 It is rarely described in children. 2,3 The most common presentation of MF diagnosed during childhood and adolescence is limited or generalized patch-stage disease without lymph node enlargement or with histologically negative nodes. 3,4 Herein, we present a patch-stage MF case in a Turkish girl who was treated successfully with narrow-band phototherapy. A 4-year-old girl is presented with disseminated asymptomatic hyperpigmented macules on her trunk. The lesions were first identified at the age of 18 months and further developed despite treatment with topical corticosteroids. Upon physical examination, she had erythematous, slightly scaly, irregularly bordered macules and patches of size 2–10 cm in diameter on her abdomen, flank, and left thigh. Sensation was normal and the lesions were not palpable (Figs 1 and 2). The result of a potassium hydroxide examination of the scale was negative. The histopathologic examination results revealed lymphocytes with darkly stained nuclei, either single or grouped, with extension along the dermo-epidermal junction and a bandlike infiltrate of large lymphocytes in papillary dermis (Fig. 3). Systemic examination and laboratory findings were found to be normal. Neither lymphadenopathy nor organomegaly were detected on clinical examination. According to the TNM (tumor, node, metastases) classification, the patient was in stage 1A (patch/plaques < 10% body surface area with no palpable lymph nodes). She received narrowband ultraviolet B (UVB) three times a week and had clinical and histological remission after a total of 30 sessions (total = 27 J/cm 2 ) over 2.5 months. She was then maintained on a regimen of once weekly for 5 months.

Intertriginous bullous morphea: A clue for the pathogenesis?

Bullae occurring in lesions of morphea are uncommon. The cause of bullae formation in morphea is multifactorial, although lymphatic obstruction from the sclerodermatous process is considered the likeliest cause. Bullous morphea may be confused clinically with lichen sclerosus et atrophicus since both diseases may cause bullae in sclerodermatous plaques. A 69-year-old woman presented with a history of generalized morphea diagnosed 9 years earlier; and a 1-month history of pruritic bullae on her inframammary folds, axillary regions, lower abdomen, upper extremities and inguinal folds. Physical examination revealed multiple erythematous erosions, hemorrhagic vesicles and eroded bullae with slight scale or crusts overlying hypopigmented, indurated, shiny plaques. Skin biopsy revealed prominent edema in the papillary dermis, resulting in bulla formation and thickening of collagen fibers within the dermis. Direct immunofluorescence was negative. According to histologic and clinical features, the diagnosis of bullous morphea was established.