Elastography findings in acne scar patients who were treated with microneedling.

BACKGROUND: Acne scar (AS) is a frequent sequela in patients with acne. In addition to advanced treatment methods, microneedling (MN) is still used as an effective option in the treatment of AS. However, similar to most diseases in dermatology, there is no objective tool to determine the severity of AS and to evaluate the treatment outcome. OBJECTIVES: In the current study, we aimed to evaluate skin elasticity in AS patients who have undergone MN therapy. Furthermore, other purposes were to determine the relationships between the history of isotretinoin use, demographic data, and changes in skin elasticity. METHODS: In order to evaluate the skin elasticity of 20 patients with AS, shear wave elastography (SWE) was performed before and after MN treatment. The physician's clinical assessment was evaluated with quantitative AS severity scale. In order to show that SWE is a consistent method, three repeated measurements were performed on 24 healthy participants. RESULTS: A significant increase was found between the shear-wave velocity (SWV) values that were measured baseline and after treatment in the patient group (P = 0.033). In the control group, there was no significant difference between the three repeated measurements (P > 0.05). A statistically significant decrease was also detected in the AS severity scores (P < 0.005). CONCLUSIONS: In AS patients who underwent MN treatment, a significant increase was found in skin elasticity compared to the baseline. We argued that SWE is a method that can be useful to evaluate skin elasticity before and after similar cosmetic procedures and dermatological diseases.

Is botulinum toxin a cause or a cure for headaches?

BACKGROUND: Botulinum toxin is used in the treatment of headache as well as cosmetic indications. In recent years, headache cases have been encountered after botulinum toxin injections for cosmetic purposes. However, no clinical studies have been conducted on this seemingly paradoxical issue. OBJECTIVE: In our study, the aim was to evaluate the frequency of occurrence of headache and its clinical features in patients who had undergone botulinum toxin application for cosmetic purposes. METHODS: A total of 186 patients who were treated with onabotulinum toxin A for cosmetic purposes in our clinic between January 2019 and January 2021 were retrospectively screened, and the clinical and demographic characteristics of the patients who reported headache complaints were examined. RESULTS: Headache was reported in 19 (10.2%) of the 186 patients included in the study. Of the 19 patients who reported headaches, 17 (89.4%) had the onset of the complaint within the first 24 h, the complaint was resolved within the first 3 days in 16 (84.2%), and 12 (63.1%) reported spontaneous regression without the need for painkillers. The rate of development of headache complaints after the procedure was found to be statistically significantly higher in patients diagnosed with hypertension (p = 0.000) and patients treated for bunny line (p = 0.016). Ten patients (52.6%) described constant, 17 patients (89.5%) had diffuse, and 11 patients (57.9%) had throbbing-type headaches. CONCLUSION: Botulinum toxin application causes diffuse, constant, throbbing-type headaches that start in the early period and ends within a short time without the need for treatment.

Investigation of skin self-examination and sunscreen use in adolescents in northern Cyprus.

INTRODUCTION: Regular skin self-examination (SSE) is very important for the early diagnosis of malignant melanoma (MM). Since sun exposure is the most important trigger factor for the development of skin cancers, effective and regular sun protection is the main preventive method. AIM: To investigate the awareness of SSE, risky nevus and sun protection of the adolescents in the Turkish Republic of Northern Cyprus (TRNC). MATERIAL AND METHODS: The data used within this research were obtained from questionnaires administered to volunteer high school students in the TRNC. RESULTS: 39.8% of the participants included in the study stated that they conducted SSE. All the participants who said they conducted SSE reported that they performed a face exam. The body regions that the participants did not examine were the scalp (47.7%), foot (36.9%), back (35.4%) and genital area (35.4%). The features of the nevus perceived by the participants as risk factors included rapid growth, bleeding and itching. While 74% of respondents said they used sunscreen products, only 9% of users reported using them every day. CONCLUSIONS: In the TRNC where the exposure to the sun is high, young people perform skin examinations at high rates in order to monitor their nevi. Nevertheless, the results of this research show that hard-to-reach areas are neglected.

A case of lipomembranous panniculitis with a dramatic response to the treatment of venous insufficiency.

Lipomembranous panniculitis (LP) is a peculiar type of fat necrosis and is reported with various clinical conditions, mostly with peripheral vascular diseases. Here, a case of a 57-year-old woman with a painful erythematous swelling of the right leg in association with venous insufficiency has been reported. Although LP is frequently associated with venous insufficiency, to the best of our knowledge, this is the first report on the beneficial effect of venous insufficiency treatment in LP.

Systemic Isotretinoin Treatment and Pregnancy: A Longitudinal Cohort Study from Turkey.

OBJECTIVE: Isotretinoin is known to be the most effective treatment of severe and persistent acne. However, one of the most important adverse effects of this drug is known to be teratogenicity. In this regard, tests are administered before initiating the treatment, to assure that an unknown pregnancy is not present and accordingly, patients are advised to take contraceptive precautions during their systemic isotretinoin treatments. On the contrary, many cases of unwanted pregnancies and relevant abortuses have been reported all over the world. In the Turkish literature, only a few reports have been identified about foetal exposure to isotretinoin. MATERIALS AND METHODS: In this respect, a study was carried out on fifty-seven female patients, aiming to fulfil the gap of information mentioned above. Female patients, with ages ranging between 14 and 35 years, were recruited to the study and they were administered isotretinoin treatments (cumulative dose of 120 mg/kg) for an average period of 6 months. The patients were followed up during and after the treatment for a total period of 18 months. RESULTS: As a result, it has been observed that none of the patients got pregnant during the treatment period and relevantly, no abortuses or foetal abnormalities were recorded. Moreover, none of the patients got pregnant 12 months after the termination of the treatment. Additionally, the socio-demographic analysis of the patients indicates that most of the patients were single and 81% of the patients were sexually inactive. CONCLUSION: Our findings suggest that the low reportage of teratogenicity due to isotretinoin usage in Turkey could be due to several reasons, such as the sociocultural profile of the female patients undertaking the isotretinoin treatment, and strict adherence to contraceptive methods, and/or underreporting of teratogenic incidents due to lack of studies held in cooperation with obstetricians.

Facial and Periorbital Cellulitis due to Skin Peeling with Jet Stream by an Unauthorized Person.

Technologies and devices for cosmetic procedures are developing with each passing day. However, increased and unauthorized use of such emerging technologies may also lead to increases in unexpected results and complications as well. Here, we report a case of facial cellulitis after a "beauty parlor" session of skin cleaning with jet stream peeling device in 19-year old female patient for the first time. Complications due to improper and unauthorized use of jet stream peeling devices may also cause doubts about the safety and impair the reputation of the technology as well. In order to avoid irreversible complications, local authorities should follow the technology and update the regulations where the dermatologists should take an active role.

Hidroa vacciniforme.

Hidroa vacciniforme is a rare chronic photodermatosis with unknown cause in which lesions appear with exposure to sun. Early diagnosis and treatment of this disease which is characterized with recurrent vesicles and bullae on areas which are exposed to sun including the face and distal parts of the extremities is important, since it recovers by leaving scar. Here, a six-year old girl who presented to our clinic with eruptions on the face for three years and who was diagnosed with hidroa vacciniforme was presented in accompaniment of current information because of the rarity of the disease.

Knowledge, attitudes and behaviour towards sexually transmitted diseases in Turkish Cypriot adolescents.

BACKGROUND: The incidence of sexually transmitted diseases (STDs) is increasing among adolescents all around the world. There may be differences in knowledge and attitudes among different cultures and ethnic populations. The aim of this study is to determine knowledge, attitudes and behaviour of Turkish Cypriot adolescents related to STDs. OBJECTIVES: To assess knowledge of STDs, attitudes towards sexual behaviour and STDs among the secondary school students. METHODS: A cross sectional study, with a sample size of 423 students, was conducted by using a semi-structured questionnaire. Simple random sampling method was applied during the selection of the sample. RESULTS: The mean age of all participants was 15.61 +/- 1.22, 211 (49.88%) of them were male and 212 (50.12%) female. The majority of students (91.25%) stated that they had some knowledge about STDs; hovewer, 8.75% of the participants did not have any knowledge at all. Most of them, 42.32% described school as a source of information on STDs, nonetheless, only 7.57% of the group cited health care professionals as the information source. The majority of students (97.64%) has never been treated for STDs. Among 423 applicants, 93.14% indicated that they would have appreciated information about STDs during the high school years. CONCLUSIONS: There is a general understanding that the students are willing to participate and are in need of seminars that will be held about STDs during high school attendance. Furthermore, awareness raising educational events on this matter should be reviewed and revised in order to come up with more powerful ways of fighting against STDs transmission in this young population group of Turkish Cypriot (TC) community.

Effect of isotretinoin on prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT).

Patients with severe acne may need elective/urgent surgical interventions during treatment with isotretinoin and it is critical for the surgeon to consider the possible effects of this medication on coagulation systems. The aim of this study is to determine the changes in prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT) during isotretinoin treatment. PT, aPTT, and INR values of 51 severe acne patients were evaluated during routine pre-treatment biochemical analysis. Only patients with normal values were included in the study. The results of before and after 1 month treatment were compared statistically. There were no statistically significant change in mean alanine aminotranferease (ALT), aspartate aminotransferase (AST), PT, and INR values after treatment. A significant increase in aPTT was detected. The INR values, which are more trusted and safe, showed no difference. Isotretinoin seems to have no effect on these coagulation parameters.

Magnesium sulfate protects fetal skin from intrauterine ischemia reperfusion injury.

Intrauterine ischemia-reperfusion (I/R) injury in fetus occurs with multifactorial pathogenesis and results with multiorgan injury including skin. Magnesium has widespread use in obstetric practice. Inn addition to magnesium's tocolytic and neuroprotective properties, it also has free radical reducing effects. The aim of the present study was to demonstrate whether magnesium sulfate could have protective effect on fetal rat skin in intrauterine ischemia-reperfusion (I/R) injury. Fetal skin ischemia was induced by clamping the utero-ovarian arteries bilaterally for 30 min, and reperfusion was achieved by removing the clamps for 60 min in 19-day pregnant rats. Magnesium Sulfate (MgSO(4)) was given to pregnant rats 20 min before I/R injury at the dose of 600 mg/kg in magnesium treatment group. No ischemia reperfusion was applied to control and sham-operated groups. Lipid peroxidation from the skin tissues was determined as thiobarbituric acid reactive substances (TBARS). Myeloperoxidase (MPO) activity was determined for neutrophil activation. The results showed that the levels of TBARS and MPO increased significantly in the fetal rat skin after I/R injury compared to control group. Levels of TBARS and MPO were significantly lower than those of I/R group in Magnesium-treated group. In conclusion, intrauterine ischemia-reperfusion may produce considerable fetal skin injury. Increased TBARS and MPO activity can be inhibited by magnesium treatment. This suggests that magnesium treatment may have protective effect on fetal rat skin in intrauterine I/R injury.

Plantar pitted keratolysis: a study from non-risk groups.

Pitted keratolysis is an acquired, superficial bacterial infection of the skin which is characterized by typical malodor and pits in the hyperkeratotic areas of the soles. It is more common in barefooted people in tropical areas, or those who have to wear occlusive shoes, such as soldiers, sailors and athletes. In this study, we evaluated 41 patients who had been diagnosed with plantar pitted keratolysis. The patients were of high socioeconomic status, were office-workers, and most had a university degree. Malodor and plantar hyperhydrosis were the most frequently reported symptoms. The weight-bearing metatarsal parts of the feet were those most affected. Almost half the women in the study gave a history of regular pedicure and foot care in a spa salon. Mean treatment duration was 19 days. All patients were informed about the etiology of the disease, predisposing factors and preventive methods. Recurrences were observed in only 17% of patients during the one year follow-up period. This study emphasizes that even malodorous feet among non-risk city dwellers may be a sign of plantar pitted keratolysis. A study of the real incidence of the disease in a large population-based series is needed.

Faun tail nevus and spinal dysraphism: cosmetic improvement with alexandrite laser epilation.

Faun-tail presents as an abnormal lumbosacral hypertrischosis and may be associated with spinal dysrasphism. In addition to the problems due to spinal anomalies, patient's physico-social life may also be affected. Here, we report a case of 13 years old female patient with Faun-tail in association with sypinal dysraphism, in which cosmetic improvement was achieved with the help of Alexandrite laser. Alexandrite laser can be the method of choice for permanent hair removal method due to its safe, effective and easy to apply properties.

Managing the blue man: multiple traumas involving a paint-carrying truck.

INTRODUCTION: This report describes the difficulty in evaluating a patient with multiple traumas because he was covered with paint poured from a truck in a car accident. Cleansing with paint thinner and isotonic saline solution was necessary. CASE REPORT: A 29-year-old male patient was admitted to the emergency department following the collision of his car with a paint-carrying truck. His head, face, neck and hands were covered with a cyan-blue oil paint, and bloody "paint mud" covered all frontal and occipital areas of the scalp. Abdominal guarding was identified. A rapid cleansing with normal saline solution (0.9% NaCl) was attempted in order to expose the lesions of the patient, but it had no effect on the drying paint. The patient's scalp, face and neck were cleaned with paint thinner (60% toluene). The patient was then diagnosed as having a maxillofacial fracture and underwent surgery for open reduction and rigid fixation by plastic and reconstructive surgeons. Thinner was not used for the eyes for fear of further chemical injury. Normal saline removed corneal and conjunctival paint remnants but proved ineffective for cleansing of the eyelids and eyelashes. CONCLUSION: Removal of the paint from the skin and the eyes was a prerequisite for the evaluation of the underlying structures. It is difficult to find a cleansing material that can be used effectively and safely in different parts of the body.

Depilatory cream vs. shaving: does it influence recurrences of genital warts?

Genital warts are common infections caused by human papilloma viruses (HPV). Although the diagnosis is straight forward and many different treatment choices are present, recurrences are almost inevitable. There are many factors influencing recurrences such as immunity, HPV types, sexual partnership, and hygiene. Hair removal methods may be an issue in recurrence. In this retrospective study, the recurrence rate of genital warts in 50 patients using depilatory creams or shaving as a regular hair removal method before and after treatment by electrocauterization were evaluated. Both methods showed no difference in recurrence rates. Therefore, no depilatory method can be advised as decreasing genital recurrence of genital warts.

Autoimmune progesterone dermatitis.

Autoimmune progesterone dermatitis (APD) is an uncommon cutaneous disorder characterized by exacerbations during the luteal phase of the menstrual cycle. We describe a 27-year-old woman with a recurrent skin eruption for 3 years. She had no history of exposure to synthetic progesterones. At each menses, the patient developed scaly, erythematous maculopapular lesions over the face. Intradermal skin test reaction to progesterone was positive. Progesterone sensitivity was also demonstrated by challenge test with intramuscular progesterone acetate. These features were consistent with the diagnosis of APD. Our patient was treated successfully with conjugated estrogen for 6 months. At one year follow-up, the patient had had no recurrence of facial eruption.