The effect of isotretinoin on insulin resistance and adipocytokine levels in acne vulgaris patients

Background/aim: Recent data draw attention to the effect of body composition, insulin resistance, and adipocytokines to acne vulgaris (AV) development. The aim of this study was to assess the association of AV with insulin resistance and adipocytokine levels and to evaluate the effect of isotretinoin on insulin resistance and adipocytokine levels. Materials and methods: In 29 AV patients and 29 healthy volunteers, body mass index (BMI) and body fat mass (BFM), lipid, adiponectin, leptin, resistin, retinol binding protein-4 (RBP4), and insulin levels were measured and insulin resistance was assessed by HOMA-IR index in serum samples taken twice from patients before and after isotretinoin treatment. Results: In AV patients, pretreatment HOMA-IR and adipocytokine levels were not found to correlate with disease severity. With five months of isotretinoin treatment, higher HOMA-IR values were found (P = 0.028). Isotretinoin therapy maintained lower mean resistin levels (P = 0.016), higher mean RBP4 levels (P = 0.040), but not affected the mean adiponectin and leptin levels (P = 0.113, P = 0.125, respectively). Conclusions: All data suggests that five months of isotretinoin therapy in AV patients causes insulin resistance and the increase in in-sulin resistance is not dependent on age, BMI, BFM, and lipid levels of these patients.

Method for facilitating the application of digital tourniquets.

The authors have indicated no significant interests with commercial supporters.

Hidradenitis suppurativa: importance of early treatment; efficient treatment with electrosurgery.

BACKGROUND: Hidradenitis suppurativa is a challenging condition, both for the physicians and for the patients. Many surgical and medical approaches with different success rates have been undertaken. Early and appropriate intervention is a factor that significantly increases the success rate of the treatment of the disease. OBJECTIVE: This study was conducted to evaluate the efficiency of electrosurgery treatment in early hidradenitis suppurativa. MATERIALS AND METHODS: This study comprised 12 patients aged between 29 and 38 years (mean, 34 years) with a diagnosis of hidradenitis suppurativa Grade I (n=9) or Grade II (n=3). A surgical method consisted of excision of the areas with nodules and sinuses, up to the level of subcutaneous fat tissue, and leaving the surgical defect for secondary healing. RESULTS: All patients completed the study. In 10 of 12 (83%) patients, 26 of 30 (86%) lesions, cure was observed in a mean of 16 days (range 15 to 21 days). Four lesions in 2 patients with Grade II became infected and required a short course of antibiotic therapy. CONCLUSION: Electrosurgery will decrease the need for other systemic treatments, owing to its high cure rates. Our results showed that electrosurgery should be considered a top alternative in the treatment algorithm of hidradenitis suppurativa.

Silicone gel sheeting for the management and prevention of onychocryptosis.

BACKGROUND: Onychocryptosis, commonly referred to as ingrown nails, has many therapeutic alternatives for its management. Although mild cases can be treated conservatively, in severe cases, surgical treatment is preferred. Silicone gel sheeting is found to be effective in the treatment of hypertrophic scars and keloids. OBJECTIVE: To document the effectiveness of silicone gel sheeting in the management of patients with onychocryptosis and in the prevention of the recurrences by breaking the devil's circle, which usually took place after the surgical procedures used in the treatment of the onychocryptosis. METHODS: Fourteen patients were enrolled in the study. Entry criteria required the presence of slight (2 patients), moderate (2 patients), or severe (10 patients) onychocryptosis. The simple technique used in the study was the excision of the one-quarter part of the lesional side of the nail plate without excising the granulation tissue. After 24 hours, the silicone was placed on the granulation tissue and the exposed nail bed. Silicone gel sheet was bandaged loosely without applying any pressure. Patients entering the study were given detailed instructions in applying and using the gel for 12 hours during the daytime. The study lasted for 14 months and was composed of a treatment period of 4 months and a follow-up period of 10 months. The patients were evaluated every 2 weeks in the first month and then monthly. The change in thickness of granulation tissue was evaluated by comparing them with the baseline photographs and those taken at each visit. RESULTS: The management and prevention of onychocryptosis were achieved in 12 of 14 patients (85.71%). The silicone gel sheeting treatment was well tolerated except for an occasional transient exudation, which was resolved when the treatment was withdrawn. CONCLUSION: The results show that the new method that we used for the treatment of onychocryptosis is successful in reducing the thickness of the hypertrophic nail fold and prevents the recurrence of the condition during the regrowth of the nail plate by breaking the devil's circle. The advantage of this method is that it is not destructive to the nail matrix and the adjacent tissue.