Assessing the autoantibody levels in relation to disease severity and therapy response in pemphigus patients.

BACKGROUND: In pemphigus, autoantibodies are directed against adhesion molecules, which make the junctions between keratinocytes, and thus determining their level can reflect the disease activity. AIM: The purpose of this study is to determine the clinical significance of the autoantibody levels in pemphigus management. MATERIALS AND METHODS: The clinical features of 47 pemphigus vulgaris patients were assessed and patients' sera were investigated by indirect immunofluorescence using monkey esophagus as a substrate for autoantibody levels. RESULTS: We found a significant correlation between antibody titers and mucosal severity scores. Initial antibody titers of the patients with at least one mucosal lesion at the end of the first month of the therapy were found significantly higher than the patients who had no mucosal lesion. With the therapy, lesions resolved earlier than the antibody titers. CONCLUSION: In patients with pemphigus, especially in cases who were not treated before, sera antibody levels are a valuable tool in evaluating disease severity and choosing initial treatment. In patients who had been taking any systemic treatment, it is difficult to make a relationship between antibody levels and disease severity, because therapy improves disease earlier than the antibody titers. However, estimating antibody levels can be helpful for clinicians in disease management, in reducing or ceasing treatment dosage and anticipating recurrence.

Mycosis fungoides in a patient with ankylosing spondylitis during infliximab therapy.

Immunosuppressive therapies, in particular cyclosporine, are known to induce the development of lymphoproliferative malignancies. In general, the lymphomas that occur in the setting of impaired immune function are B cell non-Hodgkin's lymphomas, often large cell lymphomas. Mycosis fungoides (MF) is the most common form of cutaneous T cell lymphomas, which can require persistent antigen and superantigen stimulation by way of chronic immunosuppression and HIV. Tumor necrosis factor antagonists, which are novel immunomodulatory agents, might produce significant adverse effects, including an increased risk of malignancy. Currently available data do not show whether these agents were the proximate cause of the reported lymphomas. We present a 32-year-old male with ankylosing spondylitis treated with infliximab who developed MF during the second year of therapy.

Comparison of phenol and sodium hydroxide chemical matricectomies for the treatment of ingrowing toenails.

OBJECTIVE: Chemical matricectomy is performed mainly by two agents: phenol and sodium hydroxide. Both agents have excellent cure rates, but there are no data about the comparison of postoperative healing periods. This study was designed to compare the postoperative morbidity rates of sodium hydroxide and phenol matricectomies. MATERIALS AND METHODS: Forty-six patients with 154 ingrowing nail sides were treated with either sodium hydroxide or phenol matricectomy. In the postoperative period, the patients were evaluated for the duration and severity of pain, drainage, and peripheral tissue destruction; complete healing periods; and overall success rates. RESULTS: The incidence of pain was higher in the sodium hydroxide group on the first visit, on the second day, but all patients became pain-free after that. The incidence and duration of drainage and peripheral tissue destruction was significantly higher in the phenol group. The mean period for complete recovery was 10.8 days in the sodium hydroxide group, whereas it was 18.02 days in the phenol group. The overall success rates in the sodium hydroxide and phenol groups were found to be 95.1 and 95.8%, respectively. CONCLUSION: Both sodium hydroxide and phenol are effective agents giving high success rates, but sodium hydroxide causes less postoperative morbidity and provides faster recovery.

Can specific vessel-based papulopustular lesions of Behçet's disease be differentiated from nonspecific follicular-based lesions clinically?

BACKGROUND: Although papulopustular lesions are one of the diagnostic criteria for Behçet's disease, controversy exists as to the nature of these lesions. Specific vessel-based papulopustular lesions as well as nonspecific follicular lesions may be seen in patients with Behçet's disease. Some authors suggest that papulopustular lesions should be considered a positive criterion only if they exhibit a vessel-based neutrophilic reaction. OBJECTIVE: [corrected] To determine whether specific vessel-based papulopustular lesions can be differentiated clinically from nonspecific follicular lesions in patients with Behçet's disease. METHODS: Twenty-three papulopustular lesions in 20 patients with Behçet's disease were initially examined clinically by two dermatologists blind to each other's diagnosis. Biopsies taken from these lesions were examined by a pathologist unaware of the patient data. RESULTS: Leukocytoclastic vasculitis or perivascular infiltration was observed in 10 lesions, perifollicular and perivascular infiltration was noted in nine lesions, and perifollicular inflammation was seen in four biopsy specimens. Most of the lesions interpreted clinically as specific papulopustular lesions of Behçet's disease had predominantly perivascular infiltration or leukocytoclastic vasculitis; however, three papulopustular lesions evaluated by both observers as specific papulopustular lesions had only perifollicular inflammation, and one lesion diagnosed clinically as a nonspecific follicular eruption revealed perivascular neutrophilic reaction. Interobserver variance was noted in three papulopustular lesions. CONCLUSIONS: Clinical examination may not be sufficient to predict the dermatopathologic pattern in all lesions. Papulopustular lesions with no specific clinical and histopathologic features may create problems in the diagnosis of Behçet's disease.

Sodium hydroxide chemical matricectomy for the treatment of ingrown toenails: comparison of three different application periods.

OBJECTIVE: Sodium hydroxide matricectomy is a successful method for the treatment of ingrown toenails. This study was designed to evaluate the optimal sodium hydroxide application period providing high success rates with minimal postoperative morbidity. MATERIALS AND METHODS: Sixty-six patients with 225 ingrown nail edges were treated in three groups receiving 30-second, 1-minute, and 2-minute applications of sodium hydroxide. Each patient was reviewed postoperatively for pain, drainage, and tissue damage. The median long-term follow-up period was 14 months. RESULTS: The success rate of the therapy was 70.9% in the first group, 92.7% in the second group, and 94.4% in the third group. In all groups, about half of the patients experienced minimal pain within 48 hours following the operation, but only in the third group, 20% of the patients had minimal pain, which continued about 1 week. Drainage and tissue damage were minimal or mild in all groups and disappeared within 3 weeks in the first and second groups but were prolonged to 6 weeks in the third group. CONCLUSION: The success rate of 30-second application is significantly lower than 1-minute and 2-minute applications. Although the success rates of the latter two procedures are similar, the prolonged healing time is the disadvantage of the 2-minute application. We conclude that 1-minute application of 10% sodium hydroxide is simple, safe, and highly effective for the treatment of ingrown nails.

Congenital malalignment of the great toenails in a pair of monozygotic twins.

Congenital malalignment of the great toenails is the lateral deviation of the long axis of nail growth relative to the distal phalanx. The nails grow slowly, with thickening, curving, and transverse ridging. We describe a pair of 3-year-old monozygotic female twins with congenital malalignment of the great toenails complicated by ingrowing and paronychia. Although there are a few cases without any family history, congenital malalignment is believed to be inherited through an autosomal-dominant gene of variable expression. This report provides further evidence of the heritability of the disease.

Contact sensitivity to standard series allergens in 1038 patients with contact dermatitis in Turkey.

We planned to determine the frequency of sensitivity to European standard patch test allergens in 1038 patients with contact dermatitis. From 1992 to 2004, 1038 patients with the diagnosis of contact dermatitis were patch tested with the European standard series. Seven hundred and five patients were female (67.9%) and 333 patients were male (32.1%). A total of 336 patients (32.3%) had one or more positive patch test reactions. The most common allergens were nickel (17.6%), cobalt chloride (5.3%), potassium dichromate (4.6%), neomycin (2.4%), fragrance mix (2.1%) and balsam of Peru (2.1%). Contact sensitivity to potassium dichromate and thiuram was significantly more frequent in male patients, whereas nickel and primin sensitivity was significantly more frequent in female patients. Higher sensitivity rates for potassium dichromate, neomycin, balsam of Peru, wool alcohol, fragrance mix and primin were noted in patients over 40 years of age. Sensitivity rates of the standard series allergens were all similar in atopic patients and in non-atopic patients. Metals, neomycin and fragrances are the leading allergens in Turkey. Although fragrances are among the most important sensitizers, sensitivity rates to fragrances and also to preservatives are much lower than the rates in Europe and the US.

Contact sensitivity to preservatives in Turkey.

This study was designed to evaluate the frequency of contact sensitivity to 14 common preservatives among patients with contact dermatitis in Turkey. From 2000 to 2004, 308 patients with the diagnosis of contact dermatitis were patch tested in the Department of Dermatology, Ankara University School of Medicine. All patients were patch tested with European standard series. In addition to the four preservatives included in the standard series, patients were also tested with DMDM hydantoin, imidazolidinyl urea, bromonitropropane diol, diazolidinyl urea, thimerosal, propylene glycol, chlorocresol, chloroxylenol, methyldibromoglutaronitrile/phenoxyethanol (MDBGN/PE) and benzalkonium chloride. Out of the 308 patients suspected of having contact dermatitis, 23 patients were found to have positive reactions to one or more preservatives. Preservatives that were the most frequent cause of positive reactions were thimerosal (1.6%), benzalkonium chloride (1.6%), formaldehyde (1.3%) and MDBGN/PE (0.9%). In our study, 65% of the positive reactions were caused by allergens not present in the standard series, such as thimerosal, benzalkonium chloride and MDBGN/PE. Although thimerosal caused a high rate of contact sensitivity, it may not be considered as an important allergen, because clinical relevance could not be found in any of the patients.

Treatment of Basal Cell Carcinoma Located in the Head and Neck Region with Intralesional Interferon alpha-2a : Evaluation of Long-Term Follow-Up Results.

OBJECTIVE: Intralesional injections of interferon have been reported to provide successful results in the treatment of basal cell carcinoma. However, there are only a few reports describing the long-term efficacy of this therapy. The aim of our study was to evaluate the efficacy and long-term results of interferon alpha-2a (IFNalpha-2a) in the treatment of basal cell carcinoma. METHODS: Twenty dermatopathologically proven basal cell carcinoma lesions were treated with intralesional IFNalpha-2a injections three times weekly for 3 weeks. The dose per injection was 1.5 x 10(6)IU if the lesion was <2cm in diameter and 3.0 x 10(6) IU if it was >/=2cm. Eight weeks after the last injection, the lesion sites were rebiopsied and all cases were reevaluated both clinically and dermatopathologically. Patients with complete cure were followed up for 7 years to determine the long-term results. RESULTS: Eleven lesions (55%) showed complete clinical and dermatopathological remission, six lesions (30%) showed partial remission, and two lesions (10%) showed no response. One lesion (5%) increased in size during the treatment. No serious adverse effects were observed. During the follow-up period there was only one recurrence, at the fifth year. CONCLUSION: Treatment with intralesional IFNalpha-2a was shown to be an effective therapeutic option for basal cell carcinoma, with low recurrence rates in long-term follow-up.

Epithelioid sarcoma metastatic to the tongue: a rare entity.

Epithelioid sarcoma (ES) typically arises as a firm nodule on the extremities of young men. The tumor is remarkable for diagnostic difficulties both clinically and histopathologically resulting in a high frequency of initial misdiagnosis. ES is also known to have a high rate of recurrence and high rate of metastasis predominantly to the lymph nodes, lungs, and scalp. Herein, the second case of ES with metastasis to the tongue is reported.

A 15-year-old boy with Rubinstein-Taybi syndrome associated with severe congenital malalignment of the toenails.

Rubinstein-Taybi syndrome (RTS) is a well-known disorder characterized by growth and mental retardation, typical facial features, short stature, and broad thumbs and toes. Although several cutaneous manifestations are observed in these patients, they are not diagnostic and are usually considered to be coincidental. Congenital malalignment of the great toenails is a very rare disorder that is characterized by lateral deviation of the nail plate along its longitudinal axis. The nail plate grows into the lateral nail fold resulting in pain and infection. It is usually present at birth or begins in early childhood. We report a patient with characteristic manifestations of RTS and congenital malalignment of the great toenails. The association of these two entities has not been reported previously.

Chemical matricectomy with 10% sodium hydroxide for the treatment of ingrowing toenails.

BACKGROUND: In the last decades, phenol cauterization has been widely used with high success rates for the treatment of ingrowing toenails. However, unpredictable tissue damage and prolonged healing time are the disadvantages of this technique. Sodium hydroxide is an alternative chemical agent that causes less tissue damage. OBJECTIVE: In this study, long-term results and postoperative morbidity of two sodium hydroxide chemical matricectomy procedures carried out by different application times have been investigated. METHODS: A total of 156 partial chemical matricectomy procedures were performed with 10% sodium hydroxide in 60 patients divided into two groups. The first group (80 nail sides) received a 2-minute application of sodium hydroxide, whereas the second group (76 nail sides) received a combination of curettage of the lateral matrix area and 1-minute application of sodium hydroxide. Postoperative pain, drainage, and tissue damage were evaluated 2 days after the operation and at three more visits with weekly intervals. Long-term success rates of the methods were evaluated on the 6th month and at a further visit with a mean time of 16.83+/-2.18 months (range, 13 to 20). RESULTS: Partial matricectomy with 10% sodium hydroxide was found to be 100% successful in both of the groups (P>0.05). Postoperative pain and tissue damage were either absent or minimal in the great majority of the patients with no statistical difference between the two groups (P>0.05). On the 2nd day, more patients in the first group experienced mild drainage than the patients in the second group (P=0.001), but in the following control visits, this difference disappeared. CONCLUSION: Matricectomy with 10% sodium hydroxide, either applied for 2 minutes or 1 minute combined with curettage, is equally effective in the treatment of ingrowing toenails with high success rates and minimal postoperative morbidity.

Multifocal papillomavirus epithelial hyperplasia: successful treatment with CO2 laser therapy combined with interferon alpha-2b.

Human papilloma virus (HPV) infections of the oral mucosa presents with various clinical and histopathologic features in relation with the causative HPV type and chronicity and the extent of the infection.1 The entity is known by several names based on histopathologic variations such as focal epithelial hyperplasia, oral florid papillomatosis, verrucous hyperplasia, oral florid verrucosis, and Ackerman's tumor. In recent years, the term multifocal papillomavirus epithelial hyperplasia (MPVEH) has been proposed to define the variant that usually occurs in childhood and is characterized by diffuse confluent papillomatous lesions in the oral mucosa.1 Despite the lesions' benign appearance, early diagnosis and therapy of MPVEH is essential because of its high capacity for progression and its tendency for malign degeneration.

Comparative evaluation of Type 1 latex hypersensitivity in patients with chronic urticaria, rubber factory workers and healthy control subjects.

Latex hypersensitivity manifests itself most commonly with contact urticaria. In this study, we investigated the frequency of latex hypersensitivity as a possible aetiological factor in patients with chronic urticaria (CU) and compared latex hypersensitivity of CU patients (n = 50) with that of rubber factory workers (n = 50) and healthy controls (n = 50). Prick test with latex and fruit extracts and determination of latex-specific immunoglobulin E (IgE) were performed. As a risk factor, contact dermatitis due to rubber additives was tested by patch test. Latex hypersensitivity was detected in 14% of CU patients, 12% of rubber factory workers and 12% of healthy controls (P > 0.05). Positive patch test with rubber additives was detected in 6% of CU and 4% of rubber factory workers. 3 of 7 CU patients had sensitivity to fruits in addition to latex hypersensitivity. In 1 patient with CU, the clinical complaints were found to be related to latex hypersensitivity. These findings suggest that the frequency of latex hypersensitivity in CU patients is no higher than that in healthy individuals. However, CU patients should be carefully asked about latex allergy, as we demonstrated that 1 of the CU patients had undiagnosed symptomatic latex allergy.

HLA-class 1 and class 2 antigens in Turkish patients with pemphigus.

BACKGROUND: Pemphigus is an autoimmune disease which is more frequently seen in certain ethnic groups such as Jews. It is thought that exogenous factors may induce pemphigus in genetically predisposed individuals. Recent reports on HLA antigens indicate an increased frequency of HLA-class II antigens particularly HLA-DR4 among Jewish patients. Herein we investigated the antigen frequencies of HLA-A, B, C, HLA-DR and DQ in Turkish patients with pemphigus. METHODS: HLA class I and II antigens were typed by microdroplet lymphocyte cytotoxicity test in 33 patients with pemphigus and 100 healthy individuals. RESULTS: HLA-B35, B44, CW4, DR4, DR14, DQ8 and DQ4 antigens were significantly high in the study group whereas HLA-DR11, DQ7 and DQ2 antigens were high among the controls. The most striking differences were observed in HLA class II antigens. HLA DR14-DQ8 and HLA B35-DR14 haplotypes were the most frequently observed ones in the study group. CONCLUSIONS: We postulate that HLA-B35, B44, CW4, DR4, DR14, DQ4 and DQ8 antigens may be responsible for susceptibility to pemphigus while HLA-DR11, DQ7 and DQ2 antigens may have a protective role in the Turkish population.

The evaluation of the sociodemographic and clinical features of Turkish psoriasis patients.

BACKGROUND: Psoriasis is a common, chronic and recurrent, inflammatory disease of the skin. With no sociodemographic psoriasis data available in Turkey, we decided to investigate the clinical features and distribution of this disease in our country. METHODS: The records of 329 patients with psoriasis were retrospectively reviewed. RESULTS: Psoriasis constituted 1.3% of the total dermatological disorders. Sixty-one per cent of the patients were female, and 39% were male. The mean age at onset of disease was 25 +/- 16 years in females, and 28 +/- 15 years in males. Family history was positive 30% of the patients. A positive family history was observed in 25% of the females and 37% of the males. 312 cases (95%) had psoriasis vulgaris, 17 cases (5%) had pustular psoriasis. Of the patients with psoriasis vulgaris, 212 (68%) had plaque, 73 (23%) guttate, 18 (6%) palmoplantar, 9 (3%) inverse type. The mean and median PASI score were 3.7 +/- 3.8 & 2.7 for females, 5.4 +/- 6.1 & 3.5 for males, respectively. 1.5% of patients had psoriatic arthropathy. Nail changes were seen in 54 (16%) of the cases. The various nail involvement types observed in descending frequency were: pitting (13%), subungual hyperkeratoses (7%), onycholysis (2%), discoloration (1.5%), oily spot (1%) and splinter hemorrhages (0.3%). CONCLUSIONS: The prevalence of psoriasis in Turkey is similar to numbers reported in South America and Germany. Females were predominant, and the mean age of onset was lower in women. Positive family history was more frequent in males. Plaque type psoriasis was the most common presentation. The difference between mean PASI scores of female and male patients was not statistically significant. Psoriatic arthritis was extremely rare in Turkish psoriasis patients. Pitting was the most common abnormality of the nails.

The results of the conformity studies in 60 states in Turkey

In Turkey the continuing existance of the leprosy stigma force the patients to hide their disease. So some of the patients have applied each time with different addresses to keep themselves secret.On the other hand the neglicence of the local official organisations prevents the deletion of the patients from the records who are lost, died or misdiagnosed.