Comparison of the efficacy of broad-band targeted UVB phototherapy and topical psoralen with targeted UVA phototherapy in localized vitiligo.

Aim of the study is to compare efficacy of targeted broad-band UVB phototherapy and topical psoralen with targeted UVA phototherapy treatments in localized vitiligo for 3 months prospectively. The cases with symmetrical vitiligo lesions were included in the study. Broad-band targeted UVB was applied on one side and targeted UVA phototherapy with topical psoralen on the other side. Twenty-two patients who were diagnosed with localized vitiligo were enrolled in this study. These cases consisted of 6 (27.3%) females and 16 (72.7%) males aging between 17 and 69 (34.22 ± 14.15). Fifty-four lesions (27 left, 27 right) were compared for treatments. After the first month of the treatments, the sides of the lesions were compared in order to evaluate improvement. Percentages of success were 25% for targeted broad-band UVB microphototherapy and 75% for topical psoralen with targeted UVA microphototherapy. When the two treatment methods were compared with each other, a significant difference was found in terms of treatment response (P = .017). At the end of the third month, the success rates were 37.5% for targeted broad-band UVB microphototherapy and 62.5% for topical psoralen with targeted UVA microphototherapy, however a statistically significant difference was not determined between the two treatments (P > .05). Both targeted broad-band UVB phototherapy and topical psoralen with targeted UVA phototherapy provided repigmentation for localized vitiligo at the end of the third month. Our investigation shows that both treatments are safe and they provide repigmentation with a limited response.

Internalized Stigma in Pediatric Psoriasis: A Comparative Multicenter Study.

BACKGROUND: Internalized stigma, adoption of negative attitudes and stereotypes of the society regarding persons' illness, has not been studied previously in pediatric psoriasis patients. OBJECTIVE: We aimed to investigate the internalized stigma in pediatric psoriasis patients and to determine differences according to factors affecting internalized stigma compared to adult psoriasis patients. METHODS: This multicenter, cross-sectional, comparative study included 125 pediatric (55 female, 70 male; mean age±standard deviation [SD], 14.59±2.87 years) and 1,235 adult psoriasis patients (577 female, 658 male; mean age±SD, 43.3±13.7 years). Psoriasis Internalized Stigma Scale (PISS), Dermatology Life Quality Index (DLQI), Perceived Health Status (PHS), and the General Health Questionnaire (GHQ)-12 were the scales used in the study. RESULTS: The mean PISS was 58.48±14.9 in pediatric group. When PISS subscales of groups were compared, the pediatric group had significantly higher stigma resistance (p=0.01) whereas adult group had higher scores of alienation (p=0.01) and stereotype endorsement (p=0.04). There was a strong correlation between mean values of PISS and DLQI (r=0.423, p=0.001). High internalized stigma scores had no relation to either the severity or localization of disease in pediatric group. However, poor PHS (p=0.007) and low-income levels (p=0.03) in both groups, and body mass index (r=0.181, p=0.04) in the pediatric group were related to high PISS scores. CONCLUSION: Internalized stigma in pediatric patients is as high as adults and is related to poor quality of life, general health, and psychological illnesses. Unlike adults, internalized stigma was mainly determined by psoriasis per se, rather than disease severity or involvement of visible body parts, genitalia or folds.

Internalized stigma in psoriasis: A multicenter study.

Internalized stigma is the adoption of negative attitudes and stereotypes of the society regarding a person's illness. It causes decreased self-esteem and life-satisfaction, increased depression and suicidality, and difficulty in coping with the illness. The primary aim of this study was to investigate the internalized stigma state of psoriatic patients and to identify the factors influencing internalized stigma. The secondary aim was to identify the correlation of internalized stigma with quality of life and perceived health status. This multicentre, cross-sectional study comprised 1485 patients. There was a significant positive correlation between mean values of Psoriasis Internalized Stigma Scale (PISS) and Psoriasis Area and Severity Index, Body Surface Area, Dermatological Life Quality Index and General Health Questionnaire-12 (P < 0.001 in all). Lower percieved health score (P = 0.001), early onset psoriasis (P = 0.016), family history of psoriasis (P = 0.0034), being illiterate (P < 0.001) and lower income level (P < 0.001) were determinants of high PISS scores. Mean PISS values were higher in erythrodermic and generalized pustular psoriasis. Involvement of scalp, face, hand, genitalia and finger nails as well as arthropathic and inverse psoriasis were also related to significantly higher PISS scores (P = 0.001). Our findings imply that psoriatic patients experience high levels of internalized stigma which are associated with psoriasis severity, involvement of visible body parts, genital area, folds or joints, poorer quality of life, negative perceptions of general health and psychological illnesses. Therefore, internalized stigma may be one of the major factors responsible from psychosocial burden of the disease.

Narrow band ultraviolet-B versus Goeckerman therapy for psoriasis with and without acitretin: A retrospective study.

BACKGROUND: Narrow band ultraviolet-B (NB-UVB) is now one of the most widely used modalities in the treatment of psoriasis. However, despite its high efficacy, conventional Goeckerman treatment has fallen out of favor in recent years and some institutions are now using NBUVB with coal tar as their regimen. OBJECTIVE: To evaluate the efficacy of NB-UVB, Goeckerman therapy and the effect of addition of retinoid to the treatment regimen in the treatment of psoriasis,. PATIENTS AND METHODS: A retrospective analysis of 65 patients who underwent 81 courses of treatment in our department was undertaken. The efficacy of NB-UVB and Goeckerman therapy individually, and in combination with acitretin was assessed. Data were analysed to evaluate the contribution of acitretin to these modalities. RESULTS: PASI-75 responses in the NB-UVB, retinoid+NB-UVB (re-NB), Goeckerman and retinoid+Goeckerman (re-Goeckerman) groups were achieved for 12 of 31 patients (39%), 13 of 21 patients (62%), 15 of 17 patients (88%) and 10 of 12 patients, respectively. The addition of acitretin to both modalities reduced both the number of sessions and the cumulative ultraviolet-B dose delivered. LIMITATIONS: This is a retrospective study, the patients were not randomized and the number of patients in the treatment groups were dissimilar. CONCLUSION: Goeckerman therapy is more effective than NB-UVB phototherapy. Although the addition of acitretin to both NB-UVB and Goeckerman therapy did not contribute to treatment outcomes in terms of PASI-75 responses, it enabled a reduction in UV exposures and enhanced efficacy.

Treatment of lipoid proteinosis with ablative Er:YAG laser resurfacing.

Lipoid proteinosis (LP) is a rare autosomal recessive genodermatosis characterized by deposition of amorphous hyaline material in different parts of the body, especially the skin and mucous membranes. Disfiguring lesions predominantly affect facial appearance. There is no curative therapy and treatment options are limited to symptomatic approaches. Facial disfigurement in this disease may have an huge negative effect on the patients' psychology and quality of life. With this regard, the patients may benefit very much from symptomatic treatments. Four patients with LP were treated with Er:YAG laser to ablate disfiguring lesions on the face. Patients were followed up for 14 months to 2 years. We obtained favorable clinical and aesthetic results in all cases with Er:YAG laser treatment and did not observe any recurrences during the follow-up. Depending on our observations Er-YAG laser can be accepted as an effective tool for dermal accumulations and scars of LP with precise ablation capability and favorable esthetic results.

An open, comparative study of 10% potassium hydroxide solution versus salicylic and lactic acid combination in the treatment of molluscum contagiosum in children.

OBJECTIVES: To evaluate and compare the safety and efficacy of 10% potassium hydroxide (KOH) solution and salicylic and lactic acid (SAL + LAC) combination in the treatment of molluscum contagiosum (MC). MATERIAL AND METHODS: 26 patients with MC randomized into two treatment groups. 12 patients treated with 10% KOH solution and 14 patients treated with SAL + LAC combination for 6 weeks. Parents of patients were instructed to apply medication once daily only to lesions at study onset. Assessment of response of the treated lesions and side effects was performed at 2, 4 and 6 weeks of the treatment. Newly acquired lesions were not included in the study. RESULTS: At the end of therapy, 83.3% (n = 10) of KOH group demonstrated complete remission and 16.7% (n = 2) of them showed partial remission; four patients (33%) developed new lesions during the study. All the patients in the SAL + LAC combination group (100%) demonstrated complete remission of study entry lesions at the end of 6 weeks with five patients (35%) acquiring new lesions during the study. Minor side effects were observed in two groups. CONCLUSIONS: 10% KOH solution and SAL + LAC combination were found to be equally effective in the treatment of MC in children.

[A case of cutaneous leishmaniasis caused by Leishmania infantum in a non-endemic province (Ankara) of Turkey]. / Ülkemizin Endemik Olmayan Bir Ilinde (Ankara) Saptanan Leishmania infantum'a Bagli Bir Kütanöz Leysmanyazis Olgusu.

Southeastern Anatolia and the Mediterranean regions of Turkey are known as endemic areas for cutaneous leishmaniasis (CL). In this report, a 64 years-old male patient with CL caused by Leishmania infantum has been presented. The patient who was inhabiting in Ankara (Central Anatolia region, Turkey) complained from a lesion on his right ring finger for the last six months. He has a cat and has been engaged with gardening. Overall, he was healthy with the exception of hypertension and glucose intolerance. The patient had not left Ankara since the last seven months, however, he had previously been to the Aegean coast during his summer holiday. The examination of the 4th phalanx of his right hand revealed the presence of a 3 x 3 cm erythematous, slightly swollen lesion, at the center of which 1.5 x 1.5 cm ulcerative area covered with a hemorrhagic crust, was detected. Neither axillary or cervical lymphadenopathy, nor hepatosplenomegaly could be observed. The routine examinations, including complete blood count, serum biochemistry, chest X-ray and abdominal ultrasonography were within normal limits. Giemsa stained smears prepared from aspiration of the lesion revealed amastigote-like organisms and leishmania promastigotes were grown in NNN media. PCR amplification of the specimen indicated the presence of a positive DNA band of 420 bp specific for Leishmania spp. The serum sample of the patient revealed positivity for leishmaniasis by the rapid rK39 test and immunofluorescence antibody (IFAT) test. The organism was identified as L.infantum by PCR-RFLP applied to the cultivated organism. The examination of his cat's serum for leishmaniasis by IFAT and PCR, were negative. The exact way of transmission had not been confirmed for the patient. However, when long incubation period of CL was considered, the transmission might probably occurred during his summer stay in the Aegean coast. This case was presented to withdraw attention to a delayed diagnosis of CL which developed in a non-endemic area and which was due to L.infantum instead of the more common L.tropica species.

Efficacy and safety of non-laser, targeted UVB phototherapy alone and in combination with psoralen gel or calcipotriol ointment in the treatment of localized, chronic, plaque-type psoriasis.

BACKGROUND: Topical drugs enhance the therapeutic effects of ultraviolet (UV)-based therapy for psoriasis. However, their efficacy has yet to be established in a clinical trial. OBJECTIVES: This study aimed to compare the efficacy of targeted microphototherapy alone and in combination with psoralen or calcipotriol in the treatment of plaque-type psoriasis. METHODS: Thirty individuals, affected by plaque-type psoriasis, were treated with targeted narrowband UVB phototherapy alone (Group 1), in combination with psoralen gel (Group 2), or in combination with calcipotriol ointment (Group 3) three times per week based on predetermined minimal erythema doses for 10 weeks. RESULTS: All patients in each group completed the study. The percentages of improvement in Psoriasis Area and Severity Index (PASI) and Psoriasis Severity Index (PSI) scores were 33.9% and 38.3% in Group 1, 29.9% and 29.8% in Group 2, and 67.2% and 59% in Group 3, respectively. There was no statistically significant difference in improvement between Groups 1 and 2 (P > 0.05). Outcomes in Group 3 were found to be superior compared with those in the other groups. CONCLUSIONS: The addition of calcipotriol ointment in targeted phototherapy enhances the therapeutic effects of phototherapy in the treatment of plaque-type psoriasis.

Mometasone cream versus pimecrolimus cream for the treatment of childhood localized vitiligo.

BACKGROUND: With regard to the lack of effective treatment modalities for childhood localized vitiligo, the search for newer therapeutic agents continues. OBJECTIVE: To conduct an open, comparative trial to evaluate the clinical efficacy and safety of topical mometasone cream and pimecrolimus cream in the treatment of childhood vitiligo. METHODS: Fifty patients with childhood vitiligo were included in the study. Patients were treated for 3 months either with mometasone cream (0.1%) once daily or with pimecrolimus cream (1%) twice daily. RESULTS: Forty patients, 20 from each group, completed the study. The two drugs were found to be statistically significantly effective for diminishing lesion size (Z = 3.070,p = 0.002 andZ = 3.845,p < 0.001, respectively). There were no statistical differences between the two drugs:Z = 1.427,p = 0.154 (mometasone non-inferiority to pimecrolimus). The mean repigmentation rate was 65% in the mometasone group and 42% in the pimecrolimus group at the end of therapy. Atrophy, telangiectasia and erythema were observed in two patients (10%) in the mometasone cream group and a burning sensation and pruritus were observed in two patients (10%) in the pimecrolimus cream group; drop-out was not related to the observed adverse effects. CONCLUSION: Mometasone cream was found to be effective in the treatment of vitiligo on any part of the body. Pimecrolimus was not effective on the body except for the face in childhood localized vitiligo.

An open, randomized, prospective, comparative study of topical pimecrolimus 1% cream and topical ketoconazole 2% cream in the treatment of seborrheic dermatitis.

BACKGROUND: Seborrheic dermatitis (SD) is a chronic inflammatory disorder that mainly affects the seborrheic region. While ketoconazole is often used, pimecrolimus has been used successfully in SD. OBJECTIVE: To compare the efficacy and tolerability of pimecrolimus in comparison with ketoconazole in the treatment of SD. METHODS: A total of 48 patients with SD were included in the study. Patients were randomized into two groups: 23 and 25 patients in the pimecrolimus and ketoconazole groups, respectively. Clinical measures were assessed by erythema, scaling and infiltration, which were evaluated using a four-point scale (0 to 3) at 2, 6, and 12 weeks. RESULTS: Of these 48 patients, 38 completed the study (18 and 20 patients in the pimecrolimus and ketoconazole groups, respectively). The mean percentage decrease in clinical severity scores from baseline to the last follow-up period was 86.2% and 86.1% in the pimecrolimus and ketoconazole groups, respectively. Both pimecrolimus and ketoconazole were effective in SD. Differences between the two groups were not statistically significant. Side effects were observed more frequently with pimecrolimus than with ketoconazole and this difference was statistically significant. CONCLUSION: Our study showed that pimecrolimus had a comparable efficacy profile with that of ketoconazole, but side effects appeared more frequently in the pimecrolimus group than in the ketoconazole group.

An open, randomized, controlled, comparative study of the combined effect of intralesional triamcinolone acetonide and onion extract gel and intralesional triamcinolone acetonide alone in the treatment of hypertrophic scars and keloids.

BACKGROUND: Various treatment regimens have been used in scars. The literature offers little consensus about appropriate therapy. OBJECTIVE: To compare intralesional triamcinolone acetonide (TAC) alone or combined with onion extract in keloidal and hypertrophic scars. MATERIALS AND METHODS: Fourteen patients were treated with intralesional TAC and onion extract gel, and 13 patients were treated with intralesional TAC alone. Findings were recorded and graded at each visit (weeks 0, 4, 12, and 20). The scores before treatment and at week 20 were compared. RESULTS: Twenty-seven patients [17 men (63%) and 10 women (37%) aged 15 to 73 (average age 28.1 +/- 11.7)] were enrolled in the study. At baseline, the difference in the two treatment groups was not statistically significant (p>.05). At week 20, there was statistically significant improvement in both treatment groups (p<.05). TAC with onion extract was more effective than TAC alone in terms of pain-sensitiveness, itching, and elevation but not in erythema and induration. Treatment was well tolerated, without any adverse effect. CONCLUSION: Treatment with intralesional TAC and onion extract and TAC alone were effective. Combined with onion extract gel, intralesional TAC appears to be superior to TAC alone in the treatment of keloids and hypertrophic scars.

Adapalene gel 0.1% in the treatment of infantile acne: an open clinical study.

Infantile acne is an uncommon condition in pediatric age. We determined the efficacy and safety of adapalene gel 0.1% in the treatment of infantile acne. Twelve patients were enrolled for adapalene gel 0.1% application once daily over a 16-week treatment period. Efficacy evaluation included counting the inflammatory and noninflammatory lesions by the physician and global evaluation of the improvement. After 16 weeks all patients were followed up for a 1-year period. The time of clearance of the infantile acne lesions was 3 months in four (33%) patients and 4 months in eight (67%) patients (median 3.4 months). Adapalene gel produced reductions in noninflammatory and inflammatory lesions counts. Limited side effects were observed and none of them required stopping the therapy. No patient was left with scarring. Three patients were showed mild lesions in the 1-year follow-up period. Adapalene gel 0.1% was found to be a highly effective and safe drug in the treatment of mild-to-moderate infantile acne.

Skin problems in amputees: a descriptive study.

BACKGROUND: Skin problems are common in amputee patients. These problems may restrict the normal use of a prosthetic limb. We aimed to determine the range, incidence, causes and patterns of dermatological problems seen in a population of amputees. MATERIALS AND METHODS: One hundred and forty two amputees, were enrolled to the study. Age, sex, age at the time of amputation, level of amputation, reason for amputation, and types of prosthesis were noted. Dermatological problems were recorded. Stumps were swabbed for bacteriological and mycological examination, and patch tests were performed in suspected patients. RESULTS: Of these 142 patients, 139 (97.9%) were males and 3 (2.1%) were females. The reasons for amputation in the majority of the cases were wounds due to mine explosion (n = 114, 80.3%) and gunshot wounds (n = 19, 13.4%). The other reasons were arterial diseases, traffic accidents, congenital absence of the tibia, and vascular complication of diabetes. At least one skin problem was detected in 105 (73.9%) of 142 cases. Positive reactions to allergens have been detected in 28 (43%) of 65 cases with dermatitis. Bacterial infection was detected in 12 patients and fungal infection was detected in 4 patients. CONCLUSION: Our descriptive study shows that skin problems have a high prevalence, up to 73.9% in amputee patients. This high percentage indicates that dermatological problems are important in amputees. Early recognition and treatment of these problems can prevent the amputee's mental, social, and economic losses.

Efficacy and safety of serial glycolic acid peels and a topical regimen in the treatment of recalcitrant melasma.

Melasma is a common acquired disorder of facial hyperpigmentation. In this study we investigated the efficacy and safety of a combined treatment regimen including serial glycolic acid peels, topical azelaic acid cream and adapalene gel in the treatment of recalcitrant melasma. Twenty-eight patients with recalcitrant melasma were enrolled in a prospective, randomized, controlled trial lasting 20 weeks. The patients of the group receiving chemical peels underwent serial glycolic acid peels in combination with topical azelaic acid 20% cream (b.i.d.) and adapalene 0.1% gel (q.i.d., applied at night). The control group received only topical treatment including topical azelaic acid and adapalene. The clinical improvement was assessed with the Melasma Area Severity Index (MASI) at baseline and monthly during the 20-week treatment period. The results showed a prominent decrease in MASI scores at the end of the treatment in both groups, although the results were better in the group receiving chemical peels (P=0.048). All patients tolerated the topical agents well with minimal irritation observed in the first few weeks of the therapy. Three patients in the glycolic acid peel group developed a mild-degree postinflammatory hyperpigmentation with total clearance at the end of the treatment period. Therefore, the present study suggests that combined treatment with serial glycolic acid peels, azelaic acid cream and adapalene gel should be considered as an effective and safe therapy in recalcitrant melasma.

Bullous eosinophilic cellulitis succession with eosinophilic pustular folliculitis without eosinophilia.

Eosinophilic cellulitis is characterized clinically by an acute dermatitis resembling cellulitis with unknown etiology. Eosinophilic pustular folliculitis is also a rare inflammatory dermatosis characterized by recurrent crops of erythematous follicular papulopustules that coalesce to form annular plaques with unclear etiopathogenesis. We describe a 20-year-old white male who had vesiculobullous and plaque-like lesions on the hands and feet and was diagnosed with bullous eosinophilic cellulitis clinically and histologically without any etiological agents. Following therapy with oral corticosteroid and oral tetracycline capsules, the lesions disappeared. After a 2-month asymptomatic period, the patient developed pruritic follicular papules and pustules on the lower and upper extremities and upper back. Stool examination revealed Gierdia intestinalis eggs. The patient had complete clearance with treatment of ornidazol for 2 weeks and indomethacin for 2 months. This is the first report of bullous eosinophilic cellulitis coexisting with eosinophilic pustular folliculitis without eosinophilia in the English published work.

Linear and whorled nevoid hypermelanosis.

Linear and whorled nevoid hypermelanosis (LWNH) is a rare skin condition characterized by swirls and whorls of hyperpigmented macules in a reticulate pattern along Blaschko's lines; approximately 40 cases have been reported in the English language literature. We report a case of LWNH occurring in a 20-year-old man with widespread involvement over the trunk, face, upper limbs, and genitalia in association with scoliosis. A small hyperpigmented area on the abdomen was treated with a medium-depth chemical peel regimen using 70 percent glycolic acid and 35 percent trichloroacetic acid with no benefit. This is the first report of LWNH treated with medium-depth chemical peel.