Zeynep Demircay

Comparison of the efficacy of spironolactone versus flutamide in the treatment of hirsutism

OBJECTIVE To compare the efficacy of two antiandrogens, spironolactone and flutamide, in the treatment of hirsutism. PATIENTS, PARTICIPANTS Twenty women with idiopathic hirsutism were randomized to receive either flutamide or spironolactone. DESIGN Twenty hirsute women were recruited from patients presenting to the hirsutism clinic in Marmara University, Istanbul. Each patient underwent a complete medical and gynecological examination as well as endocrine profile, hematologic, hepatic, and renal function analyses. Hirsutism scores were determined according to the Ferriman-Gallwey scoring system. These tests were then repeated at 3, 6, and 9 months of therapy. Ten patients received 250 mg of flutamide two times per day, and 10 patients received 100 mg of spironolactone for 9 months. RESULTS Ferriman-Gallwey scores were decreased significantly in both groups at the end of 9 months. The percent of change in hirsutism scores in flutamide and spironolactone group were as follows: 26.4% and 20.9% at 3 months; 39.5% and 32.9% at 6 months; and 46.4% and 39.6% at 9 months, respectively. There was a trend toward a better response with flutamide that did not achieve significance. None of the hormonal parameters changed significantly during this period of time. Irregular bleeding was observed in five patients (50%) of the spironolactone group, whereas none of the patients in the flutamide group experienced menstrual irregularity. Conversely, dry skin and increased appetite were experienced by two patients (20%) in the flutamide group but not in the spironolactone group. CONCLUSION These data suggest that both spironolactone and flutamide were similarly effective in treatment of hirsutism, and the pure antiandrogen flutamide is a safe and effective alternative in treatment.

Therapeutic potential of azithromycin in rosacea

Background  Systemic antibiotics currently used in the treatment of rosacea are sometimes associated with uncomfortable side‐effects. Therefore, a need for an effective agent with few side‐effects and good patient compliance exists. Azithromycin, a macrolide antibiotic with prolonged mode of action, has recently been found to be an effective alternative in the treatment of inflammatory acne. We planned a study to evaluate the efficacy and safety of azithromycin in rosacea.

Chemotherapy-induced acral erythema in leukemic patients: a report of 15 cases.

Background Chemotherapy‐induced acral erythema is a distinct localized cutaneous response to certain systemic chemotherapeutic agents.

Behçet's disease in patients with chronic myelogenous leukemia: possible role of interferon-alpha treatment in the occurrence of Behçet's symptoms.

Abstract Two patients with chronic myelogenous leukemia (CML) who developed characteristic features of Behçets disease (BD) during alpha-interferon (IFN-α) treatment and another patient who had a diagnosis of BD preceding CML are presented. In the first two patients, features of BD appeared 6 months after the initiation of IFN-α treatment; they included recurrent oral aphthae, genital ulceration, arthritis, folliculitis, and a positive skin pathergy test. The third patient, however, had a diagnosis of Behçets disease 4 years before diagnosis of Philadelphia-positive CML. We prospectively examined the skin pathergy reaction in a group of patients with CML, multiple myeloma, and hairy cell leukemia both before and after IFN-α treatment and found two additional patients with CML who developed a positive skin pathergy test following IFN-α treatment.

Ocular signs, symptoms and tear function tests of papulopustular rosacea patients receiving azithromycin

Background  Tetracycline derivatives provide moderate benefit in the treatment of ocular rosacea. Recently, azithromycin has been found to be an effective alternative in the treatment of cutaneous papulopustular rosacea.

Leg ulcers and hydroxyurea: report of three cases with essential thrombocythemia.

Case 1  A 65‐year‐old woman with essential thrombocythemia (ET) had been taking oral hydroxyurea (HU), 1000 mg daily, for 7 years. Six months ago, she developed an ulcer on the outer part of her left ankle, which healed spontaneously within 2 months. She presented with a new, tender, shallow ulcer, 2 cm × 2 cm in size, at the same site. Doppler examination revealed thrombosis of the left common femoral vein and a calcified atheroma plaque of the left common femoral artery. The dosage of HU was decreased to 500 mg daily when the platelet counts were found to be within normal levels. The ulcer completely healed within 2 months with occlusive wound dressings, and has not recurred within the follow‐up period of 1 year. Case 2  A 56‐year‐old women presented with multiple, painful, leg ulcers of 1 year duration. She had been diagnosed as having ET and had been on HU therapy, 1500 mg/day, for the past 5 years. Interferon‐α‐2b was started 3 months ago, in addition to HU, which was tapered to 1000 mg daily. She had suffered from hypertension for 20 years treated with nifedipine and enalapril, and had recently been diagnosed with diabetes mellitus which was controlled by diet. Examination revealed three ulcers located on the lateral aspects of both ankles and right distal toe. Arterial and venous Doppler examinations were within normal limits. Histopathology of the ulcer revealed nonspecific changes with a mixed inflammatory cell infiltrate around dermal vessels. The ulcers completely healed within 10 weeks with topical hydrocolloid dressings. After healing, she was lost to follow‐up. A year later, it was learned that she had developed a new ulcer at her right heel, 3 months after her last visit (by phone call). This ulcer persisted for 8 months until HU was withdrawn. Case 3  A 64‐year‐old woman with ET presented with a painful leg ulcer of 6 months’ duration. She had been taking oral HU for 5 years. She had a 20‐year history of hypertension treated with lisinopril. Examination revealed a punched‐out ulcer of 2 cm × 2 cm over the right lateral malleolus ( Fig. 1 ). Doppler examination of the veins revealed insufficiency of the right greater saphenous and femoral veins. Angiography showed multiple stenoses of the right popliteal and femoral arteries. As her platelet count remained high, HU was continued. During the follow‐up period of 13 months, the ulcer showed only partial improvement with local wound care.

Isotretinoin has no negative effect on attention, executive function and mood.

Background  According to some animal data, impairments in learning and memory are seen with isotretinoin. Isotretinoin has been shown to affect human brain metabolism, but the data on human neural functions is lacking.

A case of Schamberg's disease responding dramatically to PUVA treatment

Pigmented purpuric dermatoses are a group of chronic, recurrent disorders characterized by purpuric lesions mainly involving the lower extremities. Their etiology is unknown. Treatment options are limited and none of them have proven benefit. Phototherapy has been reported to be effective in a small number of patients in the literature. We present a case of Schambergs disease showing a dramatic response to psoralen plus ultraviolet A therapy and discuss the current therapeutic options focusing mainly on phototherapy. We believe that phototherapy is a valuable alternative, especially for patients with long‐standing and widespread pigmented purpuric dermatitis.

Vitamin E does not reduce the side-effects of isotretinoin in the treatment of acne vulgaris.

Background  Isotretinoin is widely used in the treatment of severe, recalcitrant, nodular acne. Mucocutaneous side‐effects are seen in the great majority of patients and some of them have elevations in their serum lipid and liver enzyme profiles. Recently, it has been shown that addition of vitamin E decreased the toxicity of high‐dose retinoids.

Phagocytosis and oxidative burst by neutrophils in patients with recurrent furunculosis

Neutrophil phagocytosis of fluorescently labelled Staphylococcus aureus and oxidative burst by the neutrophils were assessed by flow cytometry in 22 patients with recurrent furunculosis and in 17 controls. Phagocytosis and oxidative burst were not found to be significantly different between the patients and controls. Low serum iron concentrations were demonstrated in six patients (27%). In these patients with hypoferraemia, oxidative burst was significantly lower than in the patients without hypoferraemia and in the controls. These data suggest that hypoferraemia may be an important predisposing factor in a subgroup of patients with recurrent furunculosis in impairing oxidative killing by neutrophils.