The etiology of notalgia paresthetica: a descriptive study of 117 patients.

BACKGROUND: Notalgia paresthetica (NP) is a neuropathic itching condition unilaterally localized in the midscapular area. It is a common but an underdiagnosed disease, and only a few studies investigating NP etiology with a limited number of patients have been reported in the literature. OBJECTIVE: We aimed to evaluate the demographic, clinical, histopathological, neurological, and radiological findings of NP patients and investigate correlations between them and symptoms of NP to elucidate the etiology of NP. METHODS: One hundred and seventeen consecutive patients diagnosed with NP were included and assessed in a multidisciplinary and prospective manner. We recorded demographic and clinical data and obtained a skin biopsy from the pruritic or hyperpigmented region. Pruritus severity was assessed by visual analogue scale (VAS). All patients were evaluated neurologically with magnetic resonance imaging. RESULTS: The mean age of the patients was 47.08 ± 12.28 years. The disease was more common in females (87.2%). Statistical analysis revealed that VAS scores were independent of the age, gender, and skin type of the patient. We found no significant difference in VAS scores between NP patients with or without comorbidities. Vertebral pathologies detected by MRI and amyloid deposition revealed in histopathology were not among the main factors affecting VAS scores. STUDY LIMITATION: Since consecutive patients enrolled into the study, we could not include equal number of male and female patients. CONCLUSION: We found no correlation between symptom severity and findings from neurological and histopathological evaluations. Further microneurological studies should be carried out to elucidate the etiology of NP.

Reduced ocular surface disease index (OSDI) scores in patients with isotretinoin treatment.

To evaluate the changes in ocular surface and functions of tear-film in patients treated with systemic isotretinoin, to assess diagnostic performance of ocular surface disease index (OSDI) test in the dry eye conditions in association with the use of isotretinoin, and to determine the correlation between all tear-film function tests, OSDI and the dose and duration of isotretinoin administration. One hundred and twenty eyes of 60 subjects treated with oral isotretinoin were enrolled. All patients underwent ophthalmic examination at the baseline and another examination during the course of treatment. Biomicroscopic ophthalmic examination of the meibomian glands, non-anesthetized Schirmer test, and tear film break-up time (BUT) were performed. Subjective ocular complaints were scored with an OSDI questionnaire. Average Schirmer scores were not significantly changed by isotretinoin treatment. There were significant differences in the average OSDI score, the average meibomian gland disease (MGD) grade and average BUT value of both eyes during the treatment compared with baseline values (p < 0.01). There was a statistically significant inverse correlation between MGD grade and BUT value. There was no significant correlation between BUT value, OSDI score, Schirmer score, MGD grade, the total and divided dose of isotretinoin and the duration of treatment. The follow-up time was 4.01 ± 1.3 months (range 1.5-6 months). Systemic isotretinoin treatment can cause alterations in the tear film and dry eye symptoms. The OSDI test can be used as a diagnostic test for patients receiving systemic isotretinoin treatment.

A preliminary study of the contribution of telemicroscopy to the diagnosis and management of skin tumours in teledermatology.

Dermatology images can be acquired using a miniature handheld digital microscope at magnifications of 10- to 30-fold. We investigated the contribution of telemicroscopy to the reliability and accuracy of teledermatology for skin tumours. In a retrospective study of the reliability of diagnosis and management plans, two dermatologists compared teledermatology with face-to-face assessment. We also measured the accuracy of diagnosis by comparing teledermatology with histopathological examination. Two dermatologists evaluated the clinical images and information for 120 randomly sorted cases and recorded a diagnosis and a management plan for each case. Two months later, the same dermatologists re-evaluated the cases and suggested a new diagnosis and management plan for each case. The reliability of teledermatology diagnosis was not significantly different from face-to-face examination; it was significantly increased with the addition of microscopic images (P < 0.001). The reliability of teledermatology management plans was not significantly different from face-to-face examination; it was significantly increased with the addition of the microscopic images (P < 0.001). The accuracy of teledermatology was significantly increased with microscopic images (P = 0.05). Telemicroscopy appears to be a useful adjunct to teledermatology with a digital camera. Future studies with different magnifications should be performed to detect the optimum magnification for telemicroscopy.

Treatment of melasma with a depigmentation cream determined with colorimetry.

BACKGROUND: Melasma is a pigmentary disorder often recalcitrant to treatment. Few studies have objectively evaluated the efficacy of treatment colorimetrically. AIM: To evaluate the safety and efficacy of a depigmentation cream, including mainly glycolic acid and Rumex occidentalis. METHOD: Twenty-seven patients applied the cream twice daily for the first 3 months and twice weekly for the following 3 months. L*, C* and h* values of the target lesions and the perilesional area were analyzed at baseline, 12 and 24 weeks colorimetrically. The physician and patient evaluated the clinical response rate. These results were compared statistically between the lesional and perilesional area. RESULTS: There was a significant difference between 0-12, 0-24 (L*, C* and h* values) and 12-24 weeks (L* value) (p <0.001). For C* and h* values, the difference was not significant between 12 and 24 weeks (p = 0.464 and 0.151, respectively). Statistical significance was detected only between 3 and 6 months for C* value (p < 0.05) for the lesional and the perilesional areas. Clinical response rate was significant (p < 0.05). CONCLUSION: Our depigmentation cream is a moderate effective agent, well tolerated and can be considered as an alternative treatment of melasma. Twice-daily application may enhance the efficacy of treatment instead of twice-weekly application in the maintenance period.