The changes in the hair cycle during gestation and the post-partum period.

BACKGROUND: In pregnancy, increased numbers of hair follicles remain in the anagen phase for longer periods due to hormonal changes and return to the telogen phase within 3-6 months of delivery with a sudden drop in hormone levels. This results in excessive shedding of hair known as post-partum telogen effluvium. OBJECTIVE: To determine the changes in the hair cycle during gestation and the post-partum period. METHODS: We included 116 women in this study; 28 women at the 24th week of pregnancy, 30 pregnant women at term gestation, 29 women in the 4th post-partum month, and 29 in the first post-partum year. The number of breastfeeding mothers in the post-partum period and the month in which they were examined were also recorded. The ratios of anagen and telogen were measured using Trichoscan. RESULTS: A statistically significant difference was observed between the groups in terms of the anagen and telogen ratios (P = 0.042, P = 0.042). In the inter-group comparisons, the mean anagen rate in the 4th post-partum month was significantly lower than that in the 6th and 9th month of pregnancy (P = 0.045, P = 0.038), while the average telogen rate was significantly higher (P = 0.045, P = 0.038). The mean anagen rate in the 4th post-partum month in the breastfeeding group was significantly higher than that in the non- breastfeeding group (P = 0.014), while the mean telogen rate was significantly lower (P = 0.014). There was no statistically significant difference between the two groups (the breastfeeding and non-breastfeeding groups) in terms of the mean anagen and mean telogen ratios in the first post-partum year (P = 0.385). CONCLUSION: The anagen rate increases during pregnancy and the telogen rate rises after delivery, however, there is no exaggeration in these changes in most women.

Occipital involvement in female pattern hair loss: histopathological evidences.

BACKGROUND: Female pattern hair loss (FPHL) is characterized by diffuse thinning of hair in the frontal and parietal areas of the scalp, and preservation of the frontal hairline is the norm. Hair on the occipital scalp is thought to be preserved. OBJECTIVE: To investigate whether the occipital area is involved in FPHL or whether there is a diffuse type of FPHL. METHODS: Forty female patients who had complained about hair loss for more than a year and were diagnosed with FPHL according to the Ludwig classification were included. Two punch biopsies from both the midscalp and the occiput were taken. Histological sections were prepared horizontally and stained with haematoxylin and eosin. Terminal follicles, vellus like follicles, anagen, telogen, catagen follicles, hair bulbs and telogen germinal units were counted in two sections of the upper dermis and the dermal-subcutaneous junction. If the terminal/vellus ratio was lower than 4:1, the diagnosis of androgenetic alopecia (AGA) was made. When the ratio was between four and seven to one, AGA was suspected. RESULTS: While 29 of 40 patients (72.5%) had findings consistent with AGA on the midscalp, 11 of 40 (27.5%) displayed signs of suspected AGA. Ten of 40 patients (25%) had AGA involving the occiput. CONCLUSION: The involvement of the occipital scalp is significant in FPHL. In some patients, this situation may be so apparent that clinically visible alopecia is seen. However, in other patients, it may also present only as thinning.

Comparison of various insulin sensitivity indices in psoriatic patients and their relationship with type of psoriasis.

AIM: We aimed to identify insulin resistance and its possible association with types, duration and severity of psoriasis, and to evaluate various simple insulin-sensitivity indices and beta-cell function in psoriasis. METHODS: A cross-sectional study was performed in 110 non-obese adults (18-50 years old): 70 with psoriasis (53 type I, 17 type II psoriasis) and 40 healthy individuals. Blood glucose, insulin and C-peptide levels were measured. Oral glucose tolerance test (OGTT); insulin sensitivity and beta-cell function indices derived from a single sample and OGTT were determined and compared in three groups. RESULTS: Total, type I and type II psoriatics had IGT rates of 18.6%, 13.2% and 40%, respectively. In the control group IGT was only 2.5%. Homeostasis Model Assessment (HOMA) beta cell index, fasting insulin, Raynaud index, HOMA-IR and FIRI results were higher in total, type I and type II psoriatics than in controls (P < 0.05, for all). Fasting Belfiore index, QUICKY index, ISI HOMA and FIRI(-1) results were lower in total, type I and type II psoriatics than in controls (P < 0.05, for all), and type I psoriatics had higher levels of these indices than type II psoriatics (P < 0.05, for all). CONCLUSION: Our study showed that psoriatic patients were more insulin resistant than healthy subjects and type II psoriatics were more susceptible than type I psoriatics to develop IGT. We suggest that beta-cell function and insulin sensitivity indices are useful methods for measuring insulin resistance in psoriatics. We propose that OGTT should be applied especially in type II psoriatics because of increased rate of IGT in this group.

Sildenafil citrate-aided radiotherapy for the treatment of Kaposi's sarcoma of the penis.

We report a case of classical Kaposi's sarcoma involving multiple sites of the penis in a 62-year-old male who was treated with sildenafil citrate-aided electron beam therapy, resulting in complete resolution of the lesions.

Kaposi sarcoma associated with lipoedema.

Lipoedema is a form of lipodistrophy, which consists of abnormal accumulation of fat in subcutaneous tissue of the lower limbs. It does not cause any disease and it has not been reported association with malignity. We describe a 63-year-old woman occurring of Kaposi sarcoma on the lipoedema base.

Juvenile colloid milium: a case report.

Juvenile colloid milium is extremely rare, has its onset before puberty, may be inherited, may be caused by ultraviolet light, and is thought to result from the degeneration of keratinocytes. We report a 7-year-old girl with juvenile colloid milium. To the best of our knowledge this is the first reported case in Turkey.

Atypical hemorrhagic bullous pyoderma gangrenosum.

A 55-year-old woman was seen in the Plastic and Reconstructive Surgery Clinic because of a nonhealing wound on her left leg of approximately 2 months' duration. She had an 8-month history of multiple wounds appearing on her arms and legs. The patient noted that the majority of the wounds had been treated and healed with the use of topical medications. One wound on her left leg had continued to enlarge rapidly despite topical treatments. Therefore, hyperbaric oxygen therapy had been administered for 15 sessions. No additional healing had occurred with this treatment. Skin grafting was performed on the affected area. She developed ulcers and blistering lesions at surgical and nonsurgical sites after skin grafting. The patient was referred to the Dermatology Department. Dermatologic examination revealed a deep, necrotic ulcer, 30 cm x 10 cm, with surrounding violaceous erythema on the donor area, ulceration (18 cm x 8 cm) on the graft area, a hemorrhagic bullous plaque (5 cm x 15 cm) over the right malleolus, scattered ecchymotic lesions and small hemorrhagic bullae on both legs, and small pustules around the staplers (Fig. 1a,b). Cutaneous biopsy of a new lesion revealed a focal, dense neutrophilic infiltrate, liquefaction degeneration in the center, lymphocytic and mild plasmacytic infiltration around the venules, and fibrinoid deposits in the walls and lumen of the vessels (Fig. 2a). In addition, excessive polymorphonuclear leukocytes and extravasated erythrocytes were present in the papillary and reticular dermis (Fig. 2b). The patient had a 14-year history of asthma bronchiale. Physical examination did not reveal any abnormality, except for crackling rales at the base of each lung. Laboratory examinations were within normal limits, except for the sedimentation rate (55 mm/h). Protein electrophoresis, peripheral blood smear, abdominal ultrasound, and thorax and abdominopelvic computed tomography scans were all normal. Swab cultures from the ulcers were negative. Bullous pyoderma gangrenosum was diagnosed on clinical and histopathologic grounds. Prednisolone 80 mg/day was started. Rapid epithelialization was observed within 2 months of treatment. The dose of prednisolone was gradually decreased to 20 mg/day, and was used as a maintenance dose for an additional 6 months. Complete improvement was achieved in 8 months. The patient has been followed up for approximately 1 year. There were no side effects observed during the treatment and in addition no new lesions developed at the follow-up.