Comparison of tretinoin 0.05% cream and 3% alcohol-based salicylic acid preparation in the treatment of acne vulgaris.

BACKGROUND: No single effective topical treatment is available for treating all pathogenic factors causing acne vulgaris (AV). Salicylic acid (SA), tretinoin (all-TRA) and clindamycin phosphate (CDP) are known to to be effective agents depending on their comedolytic and anti-inflammatory properties. OBJECTIVE: To compare the efficacy and tolerability of SA and CDP combination (SA+CDP) with all-TRA and CDP (all-TRA+CDP) in patients with mild to moderate facial AV. METHODS: Forty-six patients aged between 18 and 35 years were enrolled in a 12-week prospective, single-blind, randomized and comparative clinical study. Efficacy was assessed by lesion counts, global improvement, quality of life index and measurement of skin barrier functions. Local side effects were also evaluated. RESULTS: Both combinations were effective in reducing total lesion (TL), inflammatory lesion (IL) and non-inflammatory lesion (NIL) counts and showed significant global improvement as evaluated by the investigator. At the end of the study, there was no significant difference between the two groups in terms of all lesion counts. In addition, TL counts decreased faster in the all-TRA+CDP group compared with those in the SA+CDP group, with a significant difference between the two groups occurring as early as 2 weeks. Safety evaluations demonstrated that the incidence of mild to moderate side effects generally peaked at week 2 and declined gradually thereafter. Both combinations did not have an effect on stratum corneum hydration, although skin sebum values decreased with SA+CDP treatment. CONCLUSIONS: Combination of SA+CDP and all-TRA+CDP was effective in decreasing lesion counts and well tolerated with minimal local cutaneous reactions in patients with mild to moderate AV.

Comparison of weekly and daily incremental protocols of narrowband ultraviolet B phototherapy for psoriasis.

BACKGROUND: Different protocols have been used for narrowband ultraviolet B (UVB) therapy, commonly used in the treatment of psoriasis; however, more effective and reliable protocols are still required. OBJECTIVE: The aim of this study was to compare the weekly and daily dose increment protocols of narrowband UVB phototherapy in psoriasis patients. METHODS: Thirty patients with plaque psoriasis underwent narrowband UVB treatment three times a week and 15 patients selected consecutively among these patients underwent a weekly (once in three treatments) dose increment whereas the remaining 15 patients underwent a daily dose increment. Patients were monitored for 10 weeks and evaluated by the Psoriasis Area Severity Index (PASI). RESULTS: When the two groups were evaluated according to median PASI scores prior to the treatment and during 10 weeks of treatment, there was no statistically significant difference between the groups (P > 0.05). During the treatment lasting for 10 weeks, four patients in the group with a weekly dose increment and three patients in the group with a daily dose increment recovered and no statistically significant difference was detected between the groups (P > 0.05). The groups were also evaluated according to the median cumulative dose. The median cumulative dose was higher in the group with a daily dose increment and the difference between the groups was statistically significant (P = 0.002). CONCLUSION: The application of daily dose increments was no better than that of weekly dose increments in narrowband UVB treatment for psoriasis. Therefore, although our results may need to be supported by large-series studies, we conclude that application of weekly dose increments with a lower cumulative dose having the same efficacy is preferred in narrowband UVB treatment of psoriasis.

Lack of TP53 mutations in a case of porokeratosis palmaris, plantaris et disseminata.

A 73-year-old man with porokeratosis palmaris, plantaris et disseminata is presented. He had punctate, guttate and annular hyperkeratotic papular lesions widespread on his body with thorn-like hyperkeratosis on the palms and soles. Lesional skin did not show mutations of TP53 exons 5-6, 7, 8.

Evidence for Borrelia burgdorferi in morphea and lichen sclerosus.

BACKGROUND: Borrelia burgdorferi (Bb) infection has been implicated in the development of morphea and lichen sclerosus; however, conflicting results have been reported with different investigational methods from different regions. We looked for evidence of Bb in patients with morphea and lichen sclerosus by polymerase chain reaction (PCR) analysis of of skin biopsy samples. METHODS: Formalin-fixed, paraffin-embedded skin biopsy samples from 10 patients with morphea and 12 patients with lichen sclerosus were investigated by PCR analysis for the presence of Bb. RESULTS: The presence of Bb DNA was demonstrated in three of 10 patients with morphea and six of 12 patients with lichen sclerosus by nested PCR. CONCLUSIONS: The data obtained in this study suggest that Bb may play a role in the etiopathogenesis of both morphea and lichen sclerosus at least in the western parts of Turkey.

Heart rate variability, late potentials and QT dispersion as markers of myocardial involvement in patients with Behçet's disease.

BACKGROUND: Myocardial involvement in Behçet's disease has been reported to be relatively rare. OBJECTIVE: To evaluate myocardial involvement noninvasively in patients with Behçet's disease by measuring signal-averaged electrocardiography (SAECG), QT dispersion and heart rate variability (HRV). PATIENTS AND METHODS: The study group comprised 28 eligible patients (16 male, mean age 37+/-13 years) of 33 patients with Behçet's disease, and 25 age- and sex-matched control subjects. RESULTS: The echocardiographic left ventricular measurements were within normal limits and similar in both groups except the E/A ratio, which was significantly lower in patients with the disease than in control patients. Minimal pericardial effusion was detected in four patients. Considering the SAECG recordings, values of root mean square voltage in the last 40 ms were 30+/-18 microV and 38+/-18 microV in patients with Behçet's disease and in the control group, respectively. The number of cases with a value less than 20 microV was seven (25%) and one (4%) in the same groups, respectively. Both QT dispersion and the corrected QT interval dispersion were significantly increased in patients with Behçet's disease compared with the control patients (50.2+/-16.6 versus 20.4+/-18.8, P<0.01). Although all HRV measures appeared to be decreased in the Behçet's group, only the standard deviation of all filtered RR intervals in the entire 24 h ECG recordings and the percentage of differences between adjacent filtered RR intervals that are greater than 50 ms for the whole analysis values differed significantly between the groups (P<0.05). No significant difference was observed in frequency domain parameters. In the Holter ECG recording, grade 2 or greater premature ventricular complexes were observed in seven patients from the Behçet's group (25%) but in only one subject from the control group (4%) (P<0.05). CONCLUSIONS: Patients with Behçet's disease appeared to have significantly increased QT dispersion, a left ventricular diastolic dysfunction pattern in echocardiography, a high incidence of positive late potentials and more complex ventricular arrhythmias, suggesting myocardial involvement and the existence of an arrhythmogenic substrate, whereas the HRV measures do not suggest a clear autonomic abnormality in Behçet's disease.

Anetoderma secondary to generalized granuloma annulare.

Anetoderma is a rare disorder of cutaneous atrophy with loss of dermal elastic tissue. Secondary anetoderma is seen after a variety of dermatoses. We describe a 33-year-old woman with secondary anetoderma after generalized granuloma annulare lesions that were most pronounced on sun-exposed areas.

Cutis laxa acquisita: is there any association with Borrelia burgdorferi?

We report the first case of an acquired form of generalized cutis laxa which has positive serology and a positive polymerase chain reaction (PCR) result for lyme borreliosis. A 44-year-old man complained of excessively loose skin for four years and had no family history of any skin disease. Dermatological examination showed lax and wrinkled skin all over the body (especially on the cheeks and the intertriginous areas). Positive serology for lyme borreliosis and the presence of Borrelia burgdorferi DNA which was demonstrated by nested PCR in this acquired form of cutis laxa is interesting since it has not been reported in literature previously.

Acrodermatitis enteropathica with Pseudomonas aeruginosa sepsis.

Acrodermatitis enteropathica is characterized by eczematous and scaly plaques on the face, scalp, acral, and anogenital regions. In addition to typical lesions, unusual prominent vesiculobullous lesions are also described. We report a full-term, 9-month-old boy who has acrodermatitis enteropathica and Pseudomonas sepsis. In this patient there were clinical findings of sepsis and eczematous vesiculobullous lesions on the periorificial and acral areas. Serum zinc level was extremely low. Pseudomonas aeruginosa was identified in cultures of blood and fluid which was aspirated from the bullous lesions. After oral zinc sulfate and intravenous antibiotic treatment his condition improved within 2 weeks.