Geriatric patients in management of pigmented lesions: Should follow-up be recommended? [Pi·gmente lezyon degerlendi·ri·lmesi·nde geri·atri·k hasta: İzlem öneri·lmeli· mi·?]

Introduction: Dermatological follow-up is essential in management of pigmented lesions. Elderly people may have poor compliance to follow-up schedules because of immobilization and general health problems. In this study, we aimed to determine the general features of geriatric patients admitted to dermoscopy unit and evaluate their compliance both to follow-up and surgical recommendations. Materials and Method: All patients aged 65 years and over, who admitted to the dermoscopy unit between January 2003 and May 2008, were included in the study. Medical records of the patients were reviewed and age and gender of the patients, pigmented lesions and their localizations, and compliance to the follow-up schedule and surgical recommendations were evaluated retrospectively. Results: A total of 193 geriatric patients constituted 6.4% of 3016 patients admitted to dermoscopy unit in the same period. A total of 242 lesions were detected (158 of them were benign and 84 of them were premalignant/malignant). The most common lesions were seborrheic keratoses (27.3%), melanoma (17.8%), and melanocytic nevi (15.3%). A total of 130 patients (67.7%) were invited for follow-up and 29 of them (22.3%) were able to attend. A surgical procedure was recommended to a total of 99 patients (51.6%) in whom 82 (82.8%) followed the recommendations. Conclusion: Since the compliance may be difficult, it is recommended to consider the elderly as a special group and to avoid inviting them for follow-up if possible

The effectiveness of hydroxychloroquine in treatment of actinic granuloma: Case report [Aktinik granülomda hidroksiklorokinin etkinligi]

A 35-year-old male patient presented with elevated, erythematous, itchy lesions on the neck and left cheek. On dermatologic examination; centrally faded, infiltrated, erythematous, annular plaques on the neck, and cheeks were observed. Histopathologic examination revealed collagen bands surrounded by epithelioid histiocytes and foreign body type giant cells together with granulomatous inflammatory infiltrate which included elastolysis in their central area. Based on the clinical and histopathological features the patient was diagnosed as "actinic granuloma" and treatment including hydroxychloroquine was given. After a month of treatment prominent resolution was obtained, hydroxychloroquine was maintained for another three months and ceased. Actinic granuloma is an uncommon disease characterized by centrally atrophic, annular plaques distributed on sun-exposed areas. There is no an evidence-based guideline for the management of the disease. Different therapies such as topical and intralesional steroids, retinoids, cyclosporine, methotrexate, antimalarial agents have been used with various successes in the literature. Here, we report a case of actinic granuloma who has been treated successfully with hydroxychloroquine. Copyright © 2010 by Türkiye Klinikleri