Dermoscopic Features of Cutaneous Vasculitis.

INTRODUCTION: Dermoscopy has become widespread in the diagnosis of inflammatory skin diseases. Cutaneous vasculitis (CV) is characterized by inflammation of vessels, and a rapid and reliable technique is required for the diagnosis. OBJECTIVES: We aimed to define CV dermoscopic features and increase the diagnostic accuracy of dermoscopy with machine learning (ML) methods. METHODS: Eighty-nine patients with clinically suspected CV were included in the study. Dermoscopic images were obtained before biopsy using a polarized dermoscopy. Dermoscopic images were independently evaluated, and interobserver variability was calculated. Decision Tree, Random Forest, and K-Nearest Neighbors were used as ML classification models. RESULTS: The histopathological diagnosis of 58 patients was CV. Three patterns were observed: homogeneous pattern, mottled pattern, and meshy pattern. There was a significant difference in background color between the CV and non-CV groups (P = 0.001). The milky red and livedoid background color were specific markers in the differential diagnosis of CV (sensitivity 56.7%, specificity 96.3%, sensitivity 29.4%, specificity 99.2%, respectively). Red blotches were significantly more common in CV lesions (P = 0.038). Red dots, comma vessels, and scales were more common in the non-CV group (P = 0.002, P = 0.002, P = 0.003, respectively). Interobserver agreement was very good for both pattern (κ = 0.869) and background color analysis (κ = 0.846) (P < 0.001). According to ML classifiers, the background color and lack of scales were the most significant dermoscopic aspects of CV. CONCLUSIONS: Dermoscopy may guide as a rapid and reliable technique in CV diagnosis. High accuracy rates obtained with ML methods may increase the success of dermoscopy.

Efficacy of Topical Dapsone 5% Gel for the Treatment of Erythematotelangiectatic Rosacea: New Treatment Option With Old Drug.

INTRODUCTION: Many topical drugs are used in the treatment of erythematotelangiectatic rosacea (ETR). However, dapsone 5% gel has never been used in ETR to date. OBJECTIVES: To evaluate the efficacy of dapsone 5% gel as a new treatment option for ETR. METHODS: Thirty-five patients with ETR were included in the study. Diagnosis was made with National Rosacea Society criteria. Dapsone 5% gel was used topically twice a day for 12 weeks. Investigator Global Assessment (IGA) 4-point scale ( 0 → Clean, 1 → mild, 2 → moderate, 3 → severe, 4 → very severe), Visual Analogue Scale (VAS) and Dermatology Life Quality Index (DLQI) were used for evaluation (at baseline, 2nd, 6th, and 12th weeks). RESULTS: IGA scores among baseline (2 → 62.9%, 3 → 34.3%, 4 → 2.9%) and 2nd (1 → 14.3%, 2 → 77, 1%, 3 → 8.6%), 6th (1 → 45, 7%, 2 → 54.3%) and 12th weeks (1 → 62.9%, 2 → 37.1%) were found to be statistically significant (P < 0.001). Median VAS scores among baseline (median = 7 [5-9]) and 2nd (median=5 [3-8]), 6th (median=5 [3-6]) and 12th weeks (median = 4 [2-6]) were statistically significant (P < 0.001). Median DLQI scores among baseline (median = 8 [6-14]) and 2nd (median = 5 [3-11]), 6th (median = 5 [3-11]) and 12th weeks (median = 4 [2-9]) were statistically significant (p<0.001). Concurrent systemic disease was a risk factor for poor treatment response (P = 0.034). Mild irritation was observed in 3 patients (8.5%) during treatment. CONCLUSIONS: Dapsone 5% gel was effective and well tolerated in ETR treatment.

Retrospective evaluation of clinical profile and comorbidities in patients with alopecia areata.

OBJECTIVE: The aim of the study was to determine the clinical profile of the patients with alopecia areata (AA) and whether or not any differences between the AA patients with and without comorbidity. METHODS: A total of 218 patients diagnosed with AA between January 1, 2016, and August 31, 2020, in our outpatient clinic were analyzed retrospectively. RESULTS: The mean age was 27.8±12.3. 61.5% of the patients were male (M/F=1.59). There were AA in 96.3%, alopecia universalis in 3.2%, and alopecia totalis in 0.5% of the patients. Most of them showed unifocal involvement (85.8%) and multifocal involvement to a smaller extent (10.5%). Number of patches was 1 in 75.2%, 2 in 16.7% and 3 or more in 8.1% of AA patients. Average disease duration was 18.1 months. Comorbid diseases were accompanying to 51.8% of the patients. Dermatological diseases were among the most common accompanying diseases (17.9%). However, hypothyroidism (12.8%) was the most frequent comorbid disease. There were thyroidal diseases in 15.1%, allergic disorders in 7.7%, psychiatric disorders in 7.3%, anemia in 5.9%, rheumatic diseases in 2.2%, other endocrine diseases in 1.8%, malignancy in 1.3%, and morbid obesity in 1.3% of the patients. Down syndrome accompanied in 0.9%. Vitamin-D deficiency (38.9%), low ferritin (13.8%), and B12 deficiency (9.6%) were also detected. Female gender (46.9 to 29.5%, p=0.008), extensive disease (p=0.085), Vitamin B12 deficiency (13.3 to 5.7%, p=0.059), and low ferritin level (20.4 to 6.7%, p=0.003) were observed more in patients with comorbidity than those without one. CONCLUSION: AA accompanies various systemic, autoimmune, and psychiatric diseases. Dermatologists need to recognize potential comorbid diseases, evaluate and manage these patients with a multidisciplinary approach to achieve a better outcome.

Familial Actinic Lichen Planus: Three Cases from the Same Family.

Actinic lichen planus (ALP) that affects sun-exposed areas of the skin is an uncommon variant of lichen planus. While ALP is commonly triggered by ultraviolet radiation exposure, genetic predisposition may also be important in the pathogenesis of the disease. Herein, we report three patients with ALP from the same family, which supports the genetic etiopathogenetic factors of ALP.

The use of interferon-α2a as monotherapy in stage IB patients with mycosis fungoides: A retrospective chart review of patient outcomes.

The aim of this study was to evaluate the response to IFN-α2a treatment as monotherapy in stage IB patients with mycosis fungoides (MF) in second-line therapy. Twenty-five patients with recurrent or persistent MF were included in the study. The diagnosis of MF was established according to clinical and histopathological signs. Clinical staging was made using TNMB classification. IFN-α2a as monotherapy was used as treatment. IFN-α2a was administered at a dose of 3 x 106 units thrice a week subcutaneously as initially described. According to clinical tolerance, the dose was increased every 4 weeks to 6 - 9 x 106 units. IFN-α2a was used more frequently for at least 3 months after complete remission. Treatment success was evaluated with Clinical Response (disappearance of all clinical evidence = Complete Remission [CR], ≥50% decrease in extent or severity = Partial Remission [PR], unresponsiveness to treatment = Stable Disease [SD], progression of MF = Progressive Disease [PD]). The average age was 51.3 ± 9.1. CR and PR were achieved in 11 (44%) and 12 (48%) patients, respectively. PD was observed in two (8%) patients. CR was accomplished at 16.1 ± 9.8 weeks. Recurrences were mostly observed within 1 year (10.4 ± 7.7 months). The recurrence rate was 45.4%. The mean duration of CR was 33.3 ± 7.9 months. Side effects were seen in 36% of the patients (18.2% in CR). The most common side effect was fatigue (12%). The patients received 11 different types of treatment before IFN-α2a treatment. The most frequent therapy prior to IFN-α2a treatment was narrow-band ultraviolet-B (NB-UVB) phototherapy (15 [60%] patients). CR can be achieved in a relatively short period of time in patients receiving IFN-α2a in MF. The duration of CR is reasonable. The side effects of IFN-α2a are acceptable. Therefore, IFN-α2a as monotherapy is a good option in stage IB second-line MF therapy.

The early and late efficacy of single-pass fractional carbondioxide laser, fractional radiofrequency, and their combination in acne scars: A prospective, split-face, single-blinded, controlled clinical study.

We investigated the effectiveness of fractional carbon dioxide laser (FCO2 ) vs fractional radiofrequency (FRF) and FCO2 vs FRF plus FCO2 combination in the treatment of acne scars. Twenty-seven patients were included. Scar severity was scored with "Echelle d'évaluation clinique des cicatrices d'acné" (ECCA) by a dermatologist blinded to treatment. FCO2 and FRF were administered to the right and left halves of the patients' faces, respectively, at the first three visits, once a month. At the fourth visit, FCO2 was administered to both sides. Last evaluation was performed 6 months after the last treatment. Mean ECCA scores for both face halves decreased gradually at each visit compared with Visit-1; however, the effect size of decrease was higher in the right half of the face and in terms of gender differences was higher in women for both sides that the difference was more pronounced for the FRF side. There was no statistically significant change in the mean VAS patient satisfaction scores in the following visits compared with Visit-2 on both halves (P > .05). Side effects were similar; but lasted longer in the FCO2 side. Both FCO2 and FRF are effective treatment methods in the treatment of atrophic acne scars. Combining FCO2 to FRF improves patient satisfaction. FRF may achieve better results in women compared with men. To our knowledge the study is unique prospective, controlled clinical study comparing the efficacy of FCO2 and FRF plus FCO2 combination treatments.