A diagnostic challenge: a case of acrodermatitis enteropathica without hypozincemia and with maternal milk of low zinc level.

Acrodermatitis enteropathica is a rare and distinct form of zinc deficiency with a requirement of life-long zinc supplementation and inherited in a recessive manner. Transient nutritional zinc deficiency is also a well known condition mimicking acrodermatitis enteropathica like skin changes in preterm and term infants who are generally breastfed with a low level of zinc containing milk. Here, a 4-month-old male, term and fully breastfed acrodermatitis enteropathica case without hypozincemia and with maternal milk of low zinc level is presented.

Reduced erythrocyte deformability in active and untreated Behçet's disease patients.

OBJECTIVE: Although the etiology of Behcet's disease is not clarified yet, the vascular endothelial damage and thrombosis are prominent features of the disease. The underlying mechanisms of increased risk of thrombosis in Behcet's disease are not completely understood. It is stated that the changes in blood rheology such as erythrocyte deformability take part in the thrombosis. There are limited numbers of studies with conflicting results about the erythrocyte deformability in Behcet's disease. The previous studies were not limited to the untreated patients with active disease. METHOD: Blood samples were filtered immediately by "Imugard- leukocyte removal filter". After plasma and erythrocytes were separated by centrifugation, 10% erythrocyte suspensions were prepared with isotonic Tris NaCl buffer solution. These erythrocyte suspensions were filtered under gravitational force by "Nucleopore" to determine the filtration time. The filtration times of the erythrocyte and buffer solutions were referred as t1 and t2 respectively. Finally, deformability indices were obtained by dividing the t1 by t2. A decrease in the deformability of the erythrocytes would result in an increase in the filtration time of the erythrocyte suspension and deformability indices. RESULTS: The median deformability indices were 3.090 and 2.170 for patients and control subjects respectively and the difference was statistically significant (P = 0.000). CONCLUSION: We suggest that the decrease in erythrocyte deformability in Behcet's disease may be related to oxidative damage of erythrocytes and subsequently takes part in the development of thrombosis in Behcet's disease.

Etanercept does not have an apoptosis-inducing effect on psoriatic keratinocytes.

BACKGROUND: Tumor necrosis factor-alpha is the key inflammatory cytokine in psoriasis vulgaris triggering abnormal differentiation and proliferation of keratinocytes. Etanercept as an antitumor necrosis factor-alpha agent is widely used for the treatment of psoriasis vulgaris. OBJECTIVES: To find out whether etanercept has an apoptotic effect on psoriatic keratinocytes. METHODS: Biopsies from 13 untreated chronic plaque psoriasis patients and 10 control subjects were examined in the study. Immunohistochemical staining for Ki-67 and the terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick-end labeling (TUNEL) method for the detection of apoptosis were performed. Ki-67 and TUNEL indices were calculated. RESULTS: The mean Ki-67 index of patients before treatment (34.20 +/- 10.30) was significantly higher than that of the control subjects (8.30 +/- 2.20) and of the treated patients (9.50 +/- 2.50); however, it did not differ between the treated patients and control subjects (p < 0.001, p = 0.001 and p = 0.208, respectively). Although the mean TUNEL index of patients before treatment (0.23 +/- 0.44) was significantly lower than the controls (1.1 +/- 0.99), it did not significantly differ after etanercept therapy (0.46 +/- 0.66) (p = 0.030 and p = 0.083, respectively). The mean TUNEL indices of treated patients and control subjects were not different (p = 0.131). CONCLUSION: Etanercept decreased epidermal thickness successfully without inducing apoptosis of psoriatic keratinocytes.

Experience with repetitive use of pimecrolimus: exploring the effective and safe use in the treatment of relapsing seborrheic dermatitis.

BACKGROUND: Seborrheic dermatitis (SD) tends to reoccur frequently, so the therapeutic agent must have a high benefit versus adverse effect ratio for long-term and repetitive uses. OBJECTIVE: To assess the efficacy and safety of retreatment with pimecrolimus in SD patients. METHODS: A total of 45 patients who had been treated previously with pimecrolimus 1% cream were retreated with the same agent using the same treatment protocol after the disease reoccurred. The first and the second treatments were compared with regard to disease severity before treatment, complete cure times, remission times and side effects. RESULTS: The median severities of the disease were 5 and 4 before the first and second treatments, respectively. Retreatment of the disease with pimecrolimus resulted in shorter cure and longer remission times. Side effects were seen only on the first day of the retreatment and an increase in erythema was seen in fewer patients. CONCLUSIONS: Retreatment of the recurrence of SD with pimecrolimus as monotherapy is an effective and safe approach in the management of the disease.

Chemical matricectomy with 10% sodium hydroxide for the treatment of ingrown toenails in people with diabetes.

BACKGROUND: Treatment of ingrown toenails using chemical matricectomy in patients with diabetes has been difficult, because delayed wound healing, wound infections, and digital ischemia can interfere with the procedure. Chemical matricectomy with 10% sodium hydroxide is an effective treatment for ingrown toenails in a normal population. OBJECTIVES: Investigation of the effectiveness and safety of chemical matricectomy with 10% sodium hydroxide solution for ingrown toenails in patients with diabetes. MATERIAL AND METHODS: Thirty patients with diabetes with 40 ingrown toenails and 30 patients without diabetes with 41 ingrown toenails were enrolled in the study. After partial avulsion of the affected edge, germinal matrix was treated for 1 minute with 10% sodium hydroxide. Patients were observed on alternate days until complete healing was achieved and followed for up to 24 months for recurrence. RESULTS: Assessment of the treatment in both groups for complete healing, postoperative pain, tissue damage, drainage, infections, and rate of recurrences revealed no statistically significant difference. CONCLUSIONS: The partial avulsion of the affected edge and the treatment of the germinal matrix for 1 minute with 10% sodium hydroxide preceded by matrix curettage is an effective and safe treatment modality for ingrown toenails in people with diabetes.

[Comparison of phenol applications of different durations for the cauterization of the germinal matrix: an efficacy and safety study]. / Germinal matriks koterizasyonunda farkli fenol uygulama sürelerinin etkinlik ve güvenlik açisindan karsilastirilmasi.

OBJECTIVES: Partial nail avulsion with phenol matricectomy is one of the most widely performed procedures for the treatment of ingrowing nails. We compared phenol applications of different durations with respect to efficacy and safety. METHODS: The study included 148 ingrowing nails (grade 2-3) of 110 patients (54 males, 56 females). The patients were randomized to three groups for 1-, 2-, and 3-minute applications of phenol cauterization of the germinal matrix following surgical removal of ingrowing nails. Postoperative evaluations were made on days 2, 10, 16, 24, and 30 for pain, drainage, and tissue damage. Recurrences were recorded during a follow-up of 24 months. RESULTS: Improvements in pain, drainage, and tissue damage in each group were significant (p<0.001). Time to complete healing and durations of drainage and tissue damage were significantly shorter in patients receiving 1-minute phenol application (p<0.001), and the remaining groups did not differ in this respect. The mean duration of pain was similar in three groups. While the frequencies of pain and tissue damage were similar in three phenol groups, the number of patients having drainage on day 16 was significantly lower with 1-minute phenol application (p<0.001). All recurrences appeared in the sixth month and there was no significant difference between the three groups with respect to the recurrence rate. CONCLUSION: Our findings suggest that 1-minute phenol cauterization of the germinal matrix has a better safety profile than prolonged applications in the treatment of ingrown nails.

Treatment of acrodermatitis continua with topical 8-methoxypsoralen plus local narrowband ultraviolet B phototherapy.

Treatment of acrodermatitis continua of Hallopeau (ACH) is known to be difficult. A 24-year-old man presented with an 11-year history of recurrent flares of painful pustular and scaly lesions on the distal portion of his fingers and toes, with persistent nail dystrophy. Based on the clinical and histopathological findings, ACH was diagnosed. The patient was treated with topical 8-methoxypsoralen (8-MOP) without occlusion, plus local narrowband ultraviolet B (NB-UVB) phototherapy. The patient did not use any other medication between sessions except topical emollients. Ten weeks later, when the patient had received 20 sessions, almost all the lesions had cleared. We report the first case of ACH which successfully responded to treatment with 8-MOP/NB-UVB.

Insight into pimecrolimus experience in seborrheic dermatitis: close follow-up with exact mean cure and remission times and side-effect profile.

BACKGROUND: Pimecrolimus was found to be effective for the treatment of seborrheic dermatitis in several studies and its off-label use is increasing gradually. OBJECTIVES: This study was conducted to obtain more detailed information concerning the daily use of pimecrolimus in seborrheic dermatitis and it also aims to contribute to data for the future construction of guidelines. METHODS: A total of 52 patients with seborrheic dermatitis enrolled in the study. Pimecrolimus 1% cream was applied twice daily. The mean cure and remission times, detailed responses of each clinical finding and side effects were investigated. RESULTS: The mean cure and mean remission times were 13.34 and 47.98 days, respectively. Disease severity improved by 50% in between the third and seventh days. Pruritus responded first to pimecrolimus. The drug was equally effective for erythema and scaling. The most frequent side effect was the burning-tingling sensation. After the seventh day of the study, there was no side effect. CONCLUSIONS: Pimecrolimus applications for the treatment of seborrheic dermatitis provide a complete cure in a short period of time and a sustained symptom-free period with low and self-limited side effects.