Successful treatment of generalised discoid lupus erythematosus with imiquimod cream 5%: A case report and review of the literature

Discoid lupus erythematosus (DLE) is the most common form of chronic cutaneous lupus erythematosus and tends to heal with scarring, hair loss and pigmentary changes if treatment is not initiated in the early phase of the disease. Classic DLE lesions are initially red-purple macules, papules or small plaques that rapidly acquire a hyperkeratotic appearance. Only a minority of the patients with DLE progress to develop systemic lupus erythematosus (SLE). A small percentage of patients with SLE have concomitant DLE. However, generalised DLE is more frequently associated with systemic involvement than classic DLE. The diagnosis of DLE is usually based on clinical features, although in some cases histopathologic examination may be required to confirm the diagnosis. Standard therapy for cutaneous lupus includes broad-spectrum sunscreens, topical and intralesional glucocorticoids and antimalarial agents. A 63-year-old man presented with erythematous scaly patches that he had had on his face for approximately eight months. Although it was mainly his face that was affected, lesions were also noted on his scalp, neck, chest, shoulder, upper arms and trunk. Histopathologic examination verified the diagnosis of DLE. No systemic involvement was detected through laboratory examinations or consultations with the other departments. Imiquimod cream 5% was applied three times a week, every other week. After 24 applications over a period of two months an almost complete improvement was achieved. Topical imiquimod may, then, be an alternative treatment for generalised DLE

Proliferative actinic keratosis: An invasive squamous cell carcinoma or not?

Actinic keratoses have variants that differ clinically and pathologically. Proliferative actinic keratoses (PAK) are known to be resistant against standard therapies and to create a tendency for the development of invasive squamous cell carcinoma (SCC). This study retrospectively reviewed the medical records of 50 patients with 51 PAK lesions. Fifty patients (40 male, 10 female) with a mean age of 68.5 were included in the study. Thirty-two (63%) PAK lesions were clinically selected for total excision but only 27 of them could be totally excised. Among the excised lesions, 13 were reported to be PAK, 13 were SCC, and 1 was keratoacanthoma. There was no significant difference between the PAK and SCC groups. Overall, the groups with excised and unexcised lesions were statistically similar with respect to age, sex, lesion duration, localization, size, and surface features, but induration was more common in the SCC group. The mean follow-up time was 19.7 and 17.0 months in the PAK and SCC group, respectively. In conclusion, 25% (13/51) of lesions diagnosed as PAK were invasive SCC, which is of clinical and histopathological significance. Our results suggest that the definition of PAK should be histopathologically revised and that total excisional biopsy instead of punch biopsy should be considered, especially for lesions with a proliferative appearance. </p

Epidemiology of pemphigus in Turkey: One-year prospective study of 220 cases

Pemphigus is a group of rare and life-threatening autoimmune blistering diseases of the skin and mucous membranes. Although they occur worldwide, their incidence shows wide geographical variation, and prospective data on the epidemiology of pemphigus are very limited. Objective of this work is to evaluate the incidence and epidemiological and clinical features of patients with pemphigus in Turkey. All patients newly diagnosed with pemphigus between June 2013 and June 2014 were prospectively enrolled in 33 dermatology departments in 20 different provinces from all seven regions of Turkey. Disease parameters including demography and clinical findings were recorded. A total of 220 patients were diagnosed with pemphigus during the 1-year period, with an annual incidence of 4.7 per million people in Turkey. Patients were predominantly women, with a male to female ratio of 1:1.41. The mean age at onset was 48.9 years. Pemphigus vulgaris (PV) was the commonest clinical subtype (n=192; 87.3%), followed by pemphigus foliaceus (n=21; 9.6%). The most common clinical subtype of PV was the mucocutaneous type (n=83; 43.2%). The mean Pemphigus Disease Area Index was 28.14±22.21 (mean ± Standard Deviation).  The incidence rate of pemphigus in Turkey is similar to the countries of South-East Europe, higher than those reported for the Central and Northern European countries and lower than the countries around the Mediterranean Sea and Iran. Pemphigus is more frequent in middle-aged people and is more common in women. The most frequent subtype was PV, with a 9-fold higher incidence than pemphigus foliaceus.   </p

Cutaneous leishmaniasis in Sanliurfa: epidemiologic and clinical features of the last four years (1997-2000)

Background Sanliurfa is located in south-east Anatolia, the region with the largest focus of anthroponotic cutaneous leishmaniasis (CL) in Turkey. The present study was designed to determine the epidemiological and clinical patterns of cases of CL in the Sanliurfa area over a period of 4 years (1997-2000)

Reactive nitrogen and oxygen intermediates in patients with cutaneous leishmaniasis

The metabolisms of reactive nitrogen and oxygen intermediates (RNI and ROI) in patients with cutaneous leishmaniasis (CL) were investigated and compared with those of healthy subjects. To determine RNI metabolism, nitrite plus nitrate concentrations were measured spectrophotometrically. Nitrite concentration in plasma was determined directly by the Griess method. Nitrate levels in plasma were measured after reduction into nitrite by using copper-cadmium-zinc. ROI metabolism was evaluated by measuring erythrocyte superoxide dismutase, catalase and glutathione peroxidase activities. Plasma nitrite plus nitrate levels and erythrocyte superoxide dismutase activity were higher in the patient group than healthy subjects (p&lt;0.01). In contrast, erythrocyte catalase and glutathione peroxidase activities were lower (p&lt;0.05, p&lt;0.01, respectively). ROI metabolism was altered in relation to hydrogen peroxide elevation in patients with CL. These alterations in ROI enable nitric oxide (NO) to amplify its leishmanicidal effect. The determination of ROI and RNI in patients with CL may be a useful tool to evaluate effector mechanisms of NO and clinical manifestations

Comparison of efficacy of chemical peeling with 25% trichloroacetic acid and 0.1% retinoic acid for facial rejuvenation

Introduction : Skin aging is a problem which negatively affects the psyche of the person, social relations, as well as work life and health and which compels the patients to find appropriate treatment methods. Numerous treatment methods have been developed in order to delay aging and to reduce the aging effects in addition to having a younger, healthier and more beautiful facial appearance. Aim : To compare the efficiency, cosmetic results and possible adverse effects of the peeling treatment with 25% trichloroacetic acid (TCA) and 0.1% retinoic acid for facial rejuvenation in patients presenting with skin aging. Material and methods: Fifty female patients in total presenting with medium and advanced degree skin aging were subject to this study. Two separate treatment groups were formed; the first group underwent chemical skin treatment with 25% TCA while the other group was applied with 0.1% retinoic acid treatment. Following the 4 months’ treatment the patients were controlled three times in total for post lesional hypopigmentation, hyperpigmentation, scars, skin irritation and other possible changes per month. The pretreatment and first follow-up visit, and final control images were comparatively evaluated by three observers via specific software. Results : The healing rates of the group subject to retinoic acid were statistically higher (p < 0.05) compared to patients in the TCA group in the final follow-up visit following the treatment according to the first and second observers. On the other hand, according to the third observer, patients applied with retinoic acid presented with higher healing rates compared to those treated with TCA, however; this rate was not statistically significant (p > 0.05). The frequency of TCA- and retinoic acid-associated adverse effects was similar in both groups (p > 0.05). As a result of both treatments, a reduction in the quality of life scores as well as a pronounced recovery (p = 0.001) in the quality of life of those patients with skin aging was observed. Conclusions : The photo aging treatment option with 0.1% retinoic acid is cheaper and more feasible for patients compared to 25% TCA, and it is also as reliable and effective as TCA

Vestibular papillomatosis: An important differential diagnosis of vulvar papillomas

Most authors believe that vestibular papillomatosis (VP) is an anatomical variant of the vestibular mucosa. But VP is sometimes misdiagnosed as genital warts and this can lead to aggressive investigations, therapy, and anxiety in patients. We present a patient with VP. Dermoscopy and reflectance confocal microscopy (RCM) were performed to differentiate VP from other papilomatous diseases of the vulva

A collision tumor: Reflectance confocal microscopy features and correlation between dermoscopy and histopathology

Coexistence of two types of malignant neoplasms, called 'a collision tumor,' is relatively uncommon. Basal cell carcinomas (BCCs) are known to coexist with other cutaneous lesions, but the collision of BCC with malignant melanoma is rare. We report a rare case of BCC with underlying lentigo maligna melanoma, focusing on dermoscopic and reflectance confocal microscopic (RCM) findings and their correlation with histopathology. RCM and dermoscopy seem to offer important clues to increase clinical suspicion of collision tumors and improve clinical diagnosis

Vestibular papillomatosis: An important differential diagnosis of vulvar papillomas

Most authors believe that vestibular papillomatosis (VP) is an anatomical variant of the vestibular mucosa. But VP is sometimes misdiagnosed as genital warts and this can lead to aggressive investigations, therapy, and anxiety in patients. We present a patient with VP. Dermoscopy and reflectance confocal microscopy (RCM) were performed to differentiate VP from other papilomatous diseases of the vulva

Adenosine Deaminase Activities in Sera, Lymphocytes and Granulocytes in Patients with Cutaneous Leishmaniasis

Adenosine deaminase (ADA) activities in sera, lymphocytes and granulocytes in patients with cutaneous leishmaniasis were investigated and compared with control groups. Fifty patients and 50 healthy individuals were studied. The clinical diagnosis was parasitologically confirmed by culture and Giemsa stain. ADA activities were measured by colorimetric method. Serum ADA activities 37.80 ± 11.90, 18.28 ± 6.08 IU/L (p&lt;0.0001), lymphocyte specific ADA activities 14.90 ± 7.42, 8.38 ± 7.42 U/mg protein (p = 0.04), granulocyte specific ADA activities 1.15 ± 0.73 , 1.09 ± 0.67 U/mg protein ( p&gt;0.05) were found in patients and control groups, respectively. ADA activity increases in some infectious diseases were cell mediated immune mechanisms are dominant. In cutaneous leishmaniasis, lymphokine-mediated macrophage activity is the main effector mechanism. Increase in serum and lymphocyte ADA activities in patients with cutaneous leishmaniasis may be dependent on and reflects the increase in phagocytic activity of macrophages and maturation of T-lymphocytes