Occipital involvement in female pattern hair loss: histopathological evidences.

BACKGROUND: Female pattern hair loss (FPHL) is characterized by diffuse thinning of hair in the frontal and parietal areas of the scalp, and preservation of the frontal hairline is the norm. Hair on the occipital scalp is thought to be preserved. OBJECTIVE: To investigate whether the occipital area is involved in FPHL or whether there is a diffuse type of FPHL. METHODS: Forty female patients who had complained about hair loss for more than a year and were diagnosed with FPHL according to the Ludwig classification were included. Two punch biopsies from both the midscalp and the occiput were taken. Histological sections were prepared horizontally and stained with haematoxylin and eosin. Terminal follicles, vellus like follicles, anagen, telogen, catagen follicles, hair bulbs and telogen germinal units were counted in two sections of the upper dermis and the dermal-subcutaneous junction. If the terminal/vellus ratio was lower than 4:1, the diagnosis of androgenetic alopecia (AGA) was made. When the ratio was between four and seven to one, AGA was suspected. RESULTS: While 29 of 40 patients (72.5%) had findings consistent with AGA on the midscalp, 11 of 40 (27.5%) displayed signs of suspected AGA. Ten of 40 patients (25%) had AGA involving the occiput. CONCLUSION: The involvement of the occipital scalp is significant in FPHL. In some patients, this situation may be so apparent that clinically visible alopecia is seen. However, in other patients, it may also present only as thinning.

Cutaneous lesions in Turkish neonates born in a teaching hospital.

BACKGROUND: The neonatal period is regarded as the first 4 weeks of extrauterine life. In the literature, there are numerous articles about the skin findings in neonates and the results of these studies show differences according to races and environmental factors. AIMS: Our objective was to evaluate the skin lesions seen in neonates delivered in our hospital and to determine their relationship to gender, gestational age and route of delivery. METHODS: Newborns delivered at the Obstetrics Clinics of our hospital between November 2007 and April 2008 were included in this study. Dermatologic examination was performed and relationship between the 10 most common skin findings and gender, gestational age and route of delivery were statistically evaluated. RESULTS: A total of 572 newborns were examined for the presence of skin lesions. Most common skin findings were Epstein pearls (58.76%), sebaceous hyperlasia (48.45%) and xerosis (31.29%). Milia and sebaceous hyperplasia in girls, desquamation and xerosis in preterms, Epstein pearls, sebaceous hyperplasia and desquamation in vaginally delivered babies were found to be more frequent and the differences were statistically significant. CONCLUSION: We found that 90.7% of the neonates had one or more cutaneous lesions. Maturity and type of delivery of the babies were important factors in their causation. In Turkey, this study is the first study performed on the skin lesions seen during the neonatal period. With this study, we want to increase the awareness about the skin findings in neonates.

Adherence to treatment in patients with psoriasis vulgaris: Turkish experience.

BACKGROUND: Treatment adherence has been an important issue in therapies of chronic diseases such as psoriasis vulgaris. There are a few studies on treatment adherence in psoriasis patients in literature. OBJECTIVE: The goal of this study is to show treatment adherence and the factors that affect it in psoriasis patients in Turkish population. METHODS: A total of 109 patients with psoriasis vulgaris were enrolled in an 8-week study. A standard questionnaire was completed by the patients. 'Psoriasis Area and Severity Index' and 'Dermatology life quality index' scores and treatment regimens of patients were recorded. At the end of the 8-week therapy, treatment adherence scores were calculated by using self-reported data given by the patients. The level of satisfaction and reasons for missing treatment were recorded. RESULTS: One hundred three patients (44 men, 59 women) completed the study. The overall rate of treatment adherence was 75%. Single or divorced patients had a significantly higher mean adherence than married ones. There was a significant correlation between adherence and education level. The average level of satisfaction was 44.3%, and the adherence of satisfied patients was statistically more significant than that of the unsatisfied patients. The major two reasons for non-adherence to the therapy were being busy (25.45%) and fed up (21.81%). CONCLUSION: In the present study, we found that marital status, education and satisfaction level were important for treatment adherence. We suggest that further studies with different contributing factors consisting of social, cultural and psychological effects may be useful for treatment adherence in psoriasis patients.

Narrowband UVB phototherapy for early-stage mycosis fungoides: evaluation of clinical and histopathological changes.

BACKGROUND: Early-stage (IA, IB, IIA) mycosis fungoides (MF) has long been treated with various agents including topical potent steroids, nitrogen mustard, carmustine, oral psoralen plus UVA (PUVA), broadband UVB, electron-beam radiotherapy, interferon-alpha and retinoids. However, each of these modalities is associated with various side-effects. Narrowband UVB (NB-UVB) therapy has the same effect but is safer to use than the other methods. OBJECTIVE: Our purpose in this prospective study was to determine the effects of NB-UVB in early-stage MF both clinically and histopathologically. MATERIALS AND METHODS: Twenty-three patients (20 men, three women, aged 27-78 years) with clinically and histologically confirmed MF were enrolled. Patients received NB-UVB therapy three times a week. Clinical and histological responses, cumulative doses, total number of treatments, side-effects and duration of remission period were noted. RESULTS: Six patients had stage IA MF, 15 patients stage IB and two patients stage IIA. Eighteen patients had patch stage and five patients had plaque stage histopathologically. All of the patients in the patch group had a complete response (CR). In the plaque group, three patients (60%) had a CR and two (40%) had partial (PR) or no clinical response (NR). The clinical response between patch and plaque groups was statistically significant. Regarding the histopathological findings, 17 (94.4%) had complete clearing and only one (5.6%) patient had a partial improvement in the patch group. In the plaque group, one (20%) patient had complete clearing and four (80%) patients had partial or no improvement. The difference between the two groups was statistically significant. In the patch group, the mean cumulative dose was 90.15 J/cm(2) and the mean number of treatments was 35.33. In the plaque group, the mean cumulative dose was 90.67 J/cm(2) and the mean total number of treatments was 39.40. The differences were not statistically significant, either between the mean cumulative dose or the mean number of treatments. The mean duration of follow-up was 10.87 months (range 1-25 months). Only one of the patients had a relapse. CONCLUSIONS: NB-UVB therapy for patients with early-stage MF is an effective and safe treatment with the effect lasting for months. We suggest that clinical clearance correlates with histological improvement except for patients in the plaque stage.

Comparison of various insulin sensitivity indices in psoriatic patients and their relationship with type of psoriasis.

AIM: We aimed to identify insulin resistance and its possible association with types, duration and severity of psoriasis, and to evaluate various simple insulin-sensitivity indices and beta-cell function in psoriasis. METHODS: A cross-sectional study was performed in 110 non-obese adults (18-50 years old): 70 with psoriasis (53 type I, 17 type II psoriasis) and 40 healthy individuals. Blood glucose, insulin and C-peptide levels were measured. Oral glucose tolerance test (OGTT); insulin sensitivity and beta-cell function indices derived from a single sample and OGTT were determined and compared in three groups. RESULTS: Total, type I and type II psoriatics had IGT rates of 18.6%, 13.2% and 40%, respectively. In the control group IGT was only 2.5%. Homeostasis Model Assessment (HOMA) beta cell index, fasting insulin, Raynaud index, HOMA-IR and FIRI results were higher in total, type I and type II psoriatics than in controls (P < 0.05, for all). Fasting Belfiore index, QUICKY index, ISI HOMA and FIRI(-1) results were lower in total, type I and type II psoriatics than in controls (P < 0.05, for all), and type I psoriatics had higher levels of these indices than type II psoriatics (P < 0.05, for all). CONCLUSION: Our study showed that psoriatic patients were more insulin resistant than healthy subjects and type II psoriatics were more susceptible than type I psoriatics to develop IGT. We suggest that beta-cell function and insulin sensitivity indices are useful methods for measuring insulin resistance in psoriatics. We propose that OGTT should be applied especially in type II psoriatics because of increased rate of IGT in this group.

Sildenafil citrate-aided radiotherapy for the treatment of Kaposi's sarcoma of the penis.

We report a case of classical Kaposi's sarcoma involving multiple sites of the penis in a 62-year-old male who was treated with sildenafil citrate-aided electron beam therapy, resulting in complete resolution of the lesions.

Kaposi sarcoma associated with lipoedema.

Lipoedema is a form of lipodistrophy, which consists of abnormal accumulation of fat in subcutaneous tissue of the lower limbs. It does not cause any disease and it has not been reported association with malignity. We describe a 63-year-old woman occurring of Kaposi sarcoma on the lipoedema base.

Juvenile colloid milium: a case report.

Juvenile colloid milium is extremely rare, has its onset before puberty, may be inherited, may be caused by ultraviolet light, and is thought to result from the degeneration of keratinocytes. We report a 7-year-old girl with juvenile colloid milium. To the best of our knowledge this is the first reported case in Turkey.

Unusual localization of multiple myxoid (mucous) cysts of toes.

Myxoid cysts of fingers and toes are observed frequently on the lateral or dorsal aspects of the distal digits. They are usually solitary nodules. Both subungual localization and multiplicity are quite rare. We present a 74-year-old woman with digital subungual mucous cysts located on all toes.

Atypical hemorrhagic bullous pyoderma gangrenosum.

A 55-year-old woman was seen in the Plastic and Reconstructive Surgery Clinic because of a nonhealing wound on her left leg of approximately 2 months' duration. She had an 8-month history of multiple wounds appearing on her arms and legs. The patient noted that the majority of the wounds had been treated and healed with the use of topical medications. One wound on her left leg had continued to enlarge rapidly despite topical treatments. Therefore, hyperbaric oxygen therapy had been administered for 15 sessions. No additional healing had occurred with this treatment. Skin grafting was performed on the affected area. She developed ulcers and blistering lesions at surgical and nonsurgical sites after skin grafting. The patient was referred to the Dermatology Department. Dermatologic examination revealed a deep, necrotic ulcer, 30 cm x 10 cm, with surrounding violaceous erythema on the donor area, ulceration (18 cm x 8 cm) on the graft area, a hemorrhagic bullous plaque (5 cm x 15 cm) over the right malleolus, scattered ecchymotic lesions and small hemorrhagic bullae on both legs, and small pustules around the staplers (Fig. 1a,b). Cutaneous biopsy of a new lesion revealed a focal, dense neutrophilic infiltrate, liquefaction degeneration in the center, lymphocytic and mild plasmacytic infiltration around the venules, and fibrinoid deposits in the walls and lumen of the vessels (Fig. 2a). In addition, excessive polymorphonuclear leukocytes and extravasated erythrocytes were present in the papillary and reticular dermis (Fig. 2b). The patient had a 14-year history of asthma bronchiale. Physical examination did not reveal any abnormality, except for crackling rales at the base of each lung. Laboratory examinations were within normal limits, except for the sedimentation rate (55 mm/h). Protein electrophoresis, peripheral blood smear, abdominal ultrasound, and thorax and abdominopelvic computed tomography scans were all normal. Swab cultures from the ulcers were negative. Bullous pyoderma gangrenosum was diagnosed on clinical and histopathologic grounds. Prednisolone 80 mg/day was started. Rapid epithelialization was observed within 2 months of treatment. The dose of prednisolone was gradually decreased to 20 mg/day, and was used as a maintenance dose for an additional 6 months. Complete improvement was achieved in 8 months. The patient has been followed up for approximately 1 year. There were no side effects observed during the treatment and in addition no new lesions developed at the follow-up.