Effectiveness of low-voltage radiofrequency in the treatment of xanthelasma palpebrarum: a pilot study of 15 cases.

BACKGROUND: Xanthelasma palpebrarum (XP) is the most common form of xanthoma, which is mostly located on the eyelids. Various treatment options are available, with certain limitations, and none of them is satisfactory. OBJECTIVES: To offer another treatment option (low-voltage radiofrequency (RF)) and to evaluate its efficacy in XP. METHODS: Fifteen patients were included in the study. The patients were examined before treatment, at the end of treatment, and 5 months later at a follow-up visit. Improvement was judged according to clinical examination by comparing before and after photographs. Electrodes from a dual-frequency 4.0-MHz RF machine were applied superficially to the lesions. The clinical scores were calculated using a 5-point scale (0=no result, 0-25%=mild, 26-50%=moderate, 51-75%=good, 76-100%=excellent). RESULTS All participants completed the study. Of these, scores of nine patients were excellent, scores of five were good, and the score of one was moderate. Statistically significant percentage improvement of the clinical scores from baseline was seen at the end (p<.05). CONCLUSION: Low-voltage RF treatment of XP is effective. If the lesions are too close to the eyes or are multiple or patched with indistinct borders, low-voltage RF can be used.

Comparison of the efficacy and tolerability of 3% diclofenac sodium gel and 5% imiquimod cream in the treatment of actinic keratosis.

BACKGROUND: Topical diclofenac and imiquimod have been reported to be effective in the treatment of actinic keratosis, but a study to compare these two drugs has not been reported yet. OBJECTIVE: To compare the efficacy and safety of topical 3% diclofenac gel plus hyaluronic acid and 5% imiquimod cream in the treatment of actinic keratosis. METHODS: Forty-nine patients with actinic keratosis were enrolled in this randomized comparative open-label study. Twenty-four patients applied 3% diclofenac gel once a daily to their lesions, while the other 25 patients were treated with a 5% imiquimod cream three times a week for 12 weeks. Patients were examined before treatment and every month of the treatment. Assessments were made by investigators according to the Investigator and the Patient Global Improvement Indices (IGII) and (PGII). RESULTS: According to the IGII results, a complete response was observed in 12% of the diclofenac group and 22% of the imiquimod group. For the PGII scores, a complete response was observed in 28% of the diclofenac group and 23% of the imiquimod group. There were no significant differences between the two groups (p > 0.05). Both treatments were well tolerated, with most adverse events related to skin. CONCLUSION: The two drugs were found to be equally effective and safe in the treatment of actinic keratosis but complete remission was very low. Therefore, topical treatments with these two drugs were not seen to be completely effective, and combined therapies and further studies are needed.

Skin problems in amputees: a descriptive study.

BACKGROUND: Skin problems are common in amputee patients. These problems may restrict the normal use of a prosthetic limb. We aimed to determine the range, incidence, causes and patterns of dermatological problems seen in a population of amputees. MATERIALS AND METHODS: One hundred and forty two amputees, were enrolled to the study. Age, sex, age at the time of amputation, level of amputation, reason for amputation, and types of prosthesis were noted. Dermatological problems were recorded. Stumps were swabbed for bacteriological and mycological examination, and patch tests were performed in suspected patients. RESULTS: Of these 142 patients, 139 (97.9%) were males and 3 (2.1%) were females. The reasons for amputation in the majority of the cases were wounds due to mine explosion (n = 114, 80.3%) and gunshot wounds (n = 19, 13.4%). The other reasons were arterial diseases, traffic accidents, congenital absence of the tibia, and vascular complication of diabetes. At least one skin problem was detected in 105 (73.9%) of 142 cases. Positive reactions to allergens have been detected in 28 (43%) of 65 cases with dermatitis. Bacterial infection was detected in 12 patients and fungal infection was detected in 4 patients. CONCLUSION: Our descriptive study shows that skin problems have a high prevalence, up to 73.9% in amputee patients. This high percentage indicates that dermatological problems are important in amputees. Early recognition and treatment of these problems can prevent the amputee's mental, social, and economic losses.

Immunohistochemical analysis of small plaque parapsoriasis: involvement of dendritic cells.

Small plaque parapsoriasis (SPP) is one of the cutaneous T-cell lymphoproliferative disorders. The aim of the present study was to show the antigenic profile of a subset of dendritic cells and lymphocytes in SPP in comparison with normal cells to provide data on the role of these two cell types in the pathogenesis of SPP. Skin biopsy specimens of lesions were obtained from 8 patients with SPP. Biopsies of the healthy skin from 9 control individuals were also analyzed. Immunohistochemistry was performed on the frozen tissue sections to reveal binding of anti-HLA Class II, anti-CD1a, anti-CD4, anti-CD8, anti-CD44, anti-CD45, and anti-CD68 monoclonal antibodies. There was a statistically significant increase in the number of CD1a(+), Langerhans cells (LCs), HLA-DR-immunoreactive and, CD1a-positive dermal dendritic cells and CD68(+) macrophages in the SPP group (p=0.008, 0.008, 0.002 and <0.0009, respectively). The number of lymphocytes positive for CD4, CD8 and CD45 was significantly higher than normal in the SPP group (p=0.015, <0.0009 and <0.0009, respectively). Our study demonstrates that both peptide- and lipid-based antigens are involved in the persistent antigenic exposure in SPP. Dendritic cells play a pivotal role in SPP by presenting antigens by both LC and dermal dendritic cells via MHC Class II and CD1a molecules. The CD68(+) macrophages are thought to be involved in the immune response in this pathology as an antigen-presenting cell.

A 2-year-old girl with Stevens--Johnson syndrome/toxic epidermal necrolysis treated with intravenous immunoglobulin.

Toxic epidermal necrolysis and Stevens-Johnson syndrome are severe skin reactions, usually to drugs, associated with a widespread destruction of the epidermis. Widespread purpuric macules and epidermal detachment of less than 10% of the body surface is indicative of Stevens-Johnson syndrome, whereas epidermal detachment between 10% and 30% is called Stevens-Johnson-toxic epidermal necrolysis overlap. Epidermal detachment involving more than 30% of the total body surface is designated as toxic epidermal necrolysis. These generalized reactions are known to occur in association with various drugs. Treatment is primarily supportive care, and there are no specific therapy regimens. Therapeutic modalities such as corticosteroids, cyclosporin, thalidomide, cyclophosphamide, and plasmapheresis, usually based on a symptomatic approach, have been tried in single patients or in small series. Intravenous immunoglobulin has recently been shown to provide rapid improvement in all three of these skin reactions. We report a 2-year-old girl who developed Stevens-Johnson syndrome-toxic epidermal necrolysis overlap after receiving ampicillin-sulbactam for an upper respiratory tract infection. She was treated successfully with a 4-day course of intravenous immunoglobulin.

Interferon-gamma in alopecia areata.

Alopecia areata is a common type of hair loss. In clinical practice most patients will present with reversible patchy hair loss whereas others may develop complete baldness. Although the etiopathogenesis of alopecia areata is poorly understood, evidence is accumulating that it can be regarded as a T-cell mediated tissue-restricted autoimmune disease of the hair follicle, especially expressing the T-helper-type 1 cytokines interleukin-1beta, interleukin-2, and interferon-gamma. The aim of the study was to compare the serum levels of interferon-gamma in patients with alopecia areata and the control group and also to investigate the difference between the localized form of the disease with the extensive forms like alopecia totalis (AT) and alopecia universalis (AU). Forty patients with alopecia areata and 20 healthy controls were enrolled in the study. Nineteen patients had localized AA (LAA) and twenty-one patients had AT, AU or AT/AU. The serum levels of interferon-y were measured using enzyme immunoassay techniques. The mean serum IFN-gamma level in AA patients (n = 40) was 14.25 +/- 8.76 pg/mL (mean +/- SD), whereas that of LAA (n = 19) or extensive (AT, AU or AT/AU) (n = 21) was 13.45 +/- 6.75 pg/mL or 14.98 +/- 10.37 pg/mL, respectively. The mean serum IFN-gamma level in controls was 9.95 +/- 2.6 pg/mL. Serum levels of IFN-gamma in patients with AA were significantly higher than those in controls (p < 0.05). Significant difference was observed in serum levels of IFN-y between patients with LAA and control group (p < 0.05). Serum levels of IFN-gamma in patients with AT, AU or AT/AU were significantly higher than those in controls (p < 0.05). There was no significant difference in levels of IFN-gamma between patients with LAA and extensive group (p > 0. 05). We conclude that the elevated serum levels of IFN-gamma may reflect the inflammatory symptoms in AA, especially in the extensive form and that control of IFN-gamma production may be important to management of this disease. And also the measurement of serum IFN-gamma in patients with AA may be useful in discriminating those likely to progress to AU from the remaining LAA, or as a prognostic indicator.