Efficiency of KTP laser for verrucae vulgaris and plantaris: A retrospective analysis.

BACKGROUND: Verrucae are benign proliferations caused by human papillomavirus. Treatment is needed for pain, bleeding, contagiousness, and cosmetically. AIMS: The aim of this study is to evaluate the effectiveness of KTP laser treatment in verrucae, as well as side effects and recurrence rates. PATIENTS AND METHODS: Patients who had Verrucae vulgaris (V. vulgaris) and Verrucae plantaris (V. plantaris) previously treated with KTP laser were scanned for their eligibility. Twenty-nine patients who met the inclusion criteria were included. There was complete recovery in 24 patients (82.8%) and partial recovery in two patients (6.9%). Three patients (10.3%) were unresponsive to treatment after six sessions (no recovery). Two patients had mild pain during the application, and 65.4% of the patients had complete cosmetic recovery at the 3rd month follow-up. RESULTS: As a result, we found that the standard KTP laser can be an effective option for both types of verrucae. CONCLUSIONS: We think KTP laser treatment can be preferred for verrucae treatment.

Evaluation of supratrochlear artery depth and course variations by Doppler ultrasonography along the glabellar frown lines for safer filler injections.

PURPOSE: Hyaluronic acid (HA) injection is a popular nonsurgical, rejuvenating procedure to treat glabellar frown lines, which has devastating complications such as blindness and skin necrosis due to the arterial occlusion of supratrochlear artery (STA). Therefore, when injecting into the frown lines, knowledge of the STA's depth and plane is necessary to prevent possible adverse events. The aim of this study was to identify the depths of STA in the area of the frown lines in order to maximize safety during filler injections. METHODS: Supratrochlear artery depth measurements were performed at the level of eyebrow and at the level of 1.5 cm above the eyebrow. Superficial duplex Doppler ultrasonography was performed of 71 cases. RESULTS: In the eyebrow level, the epidermis-artery distance (EAD) is between 1,8 and 5.9 mm, and the artery-periost distance (APD) is between 0.7 and 3.7 mm. In the 1.5 cm superior level of the eyebrow, the EAD is between 1.8 and 5.1 mm and the APD is between 0.6 and 3.8 mm. There was no significant difference between the depth measurements of the right and left STA. At the eyebrow level, APD is greater in men than in women. As the body mass index increases, the EAD and APD depth increases. EAD depth increases with increasing age. CONCLUSIONS: Based on the findings of this study, safe filler injections to correct the glabellar frown lines can be possible with intradermal injections just below the ryhtide. In the glabellar region, subcutaneous and supraperiosteal injections seems to be risky.

The place of B-mode ultrasonography, shear-wave elastography, and superb microvascular imaging in the pre-diagnosis of androgenetic alopecia.

PURPOSE: Androgenetic alopecia (AGA) is the most common cause of hair loss in males. Physical examination and history are the most important examinations in diagnosis of the disease. As yet, there is no diagnostic method to be able to determine which individuals will develop AGA. Shear-wave elastography (SWE) is a novel diagnostic tool, which can evaluate tissue stiffness. Superb microvascular imaging (SMI) can determine low flow in microvessels. The aim of the current study was to determine whether or not AGA would develop in individuals with normal hair and a family history of AGA using B-mode US, SMI, and SWE. METHODS: The study included 26 patients clinically diagnosed with AGA and a control group of 26 volunteers. RESULTS: Thickness with the distance from the epidermis to the calvarium (ECD) on the hairline and cranial subcutaneous tissue thickness (CSTD) were determined to be statistically significantly thinner in the AGA group than in the control group (p < 0.0001). For the differentiation of the AGA patients, the cutoff value was determined to be 5.5 mm for ECD and 4.05 mm for CSTD. The cranial epidermis-dermis (CED) stiffness values both as meter/second (m/s) and kilopascals (kPa) were statistically significantly lower in the AGA patients than in the control group (p < 0.0001). The cutoff values were 6.075 as m/s and 104.4 as kPa. CONCLUSIONS: The results of this study demonstrated that differentiation could be made of individuals before the development of AGA from normal healthy individuals with CSTD measurement on B-mode US and CED stiffness measurement on SWE.

Evaluation of facial artery course variations and depth by Doppler ultrasonography.

BACKGROUND: As deep nasolabial folds (NLF) are associated with facial aging, there is an increasing demand for esthetic correction with filler injections. Understanding the anatomy of the angular artery (AA) and facial artery (FA) around the NLF region is essential for ensuring the safety of dermal filler injections into the NLF. The purpose of this study was to provide detailed vascular anatomical information on the course and depth of AA and FA around NLF using Doppler ultrasound on live cases. METHODS: FA was observed from the origin level adjacent to the mandible corpus to the end of its terminal branch AA in 168 hemifaces of 84 cases with Doppler ultrasonography. RESULTS: We made a classification of the FA course based on the NLF. The minimum and maximum depths of the FA along its course were measured in 84 cases. The results showed that its course may be highly superficial (2.5 mm at the mandibular origin, 3.7 mm at the cheilion, 3.7 mm at the nasal ala) or it may follow a very deep course near the periosteum (15.0 mm at the mandibular origin, 18.7 mm at the cheilion, 23.5 mm at the nasal ala). FA depth was varied between 5.98 mm and 6.62 mm at the mandibular origin, between 8.36 mm and 9.20 mm at the cheilion, between 9.52 mm and 10.51 mm at the nasal ala at a 95% confidence interval. CONCLUSIONS: This study suggests that there is no absolutely safe depth or region for nasolabial fold filler injections.

Long pulse 1,064-nm neodymium-doped yttrium aluminum garnet laser in aesthetic dermatology.

Long pulse 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser is a very versatile laser due to its deep penetration and absorption by hemoglobin, melanin, and water, which has gained increasing popularity over recent years for the treatment of leg veins and permanent hair removal as well as skin rejuvenation. The long-pulse Nd:YAG laser was appointed as treatment of choice for the treatment of 0.5-3.0 mm deoxygenated, unsightly leg veins. Hair removal is another application of long pulse Nd:YAG lasers, and decreased light absorption by melanin at 1,064 nm reduces the risk of pigmentary side effects, which makes long pulse Nd:YAG laser the safest laser in darker skin types. The long pulse Nd:YAG lasers are also being employed for skin rejuvenation based on their ability to heat dermal water and stimulate collagen production. We have reviewed the parameters of Nd:YAG laser and shared our experiences in these indications that may be useful for good clinical response with minimal side effects.

Epidemiology of Pemphigus in Turkey: One-year Prospective Study of 220 Cases.

Pemphigus is a group of rare and life-threatening autoimmune blistering diseases of the skin and mucous membranes. Although they occur worldwide, their incidence shows wide geographical variation, and prospective data on the epidemiology of pemphigus are very limited. Objective of this work is to evaluate the incidence and epidemiological and clinical features of patients with pemphigus in Turkey. All patients newly diagnosed with pemphigus between June 2013 and June 2014 were prospectively enrolled in 33 dermatology departments in 20 different provinces from all seven regions of Turkey. Disease parameters including demography and clinical findings were recorded. A total of 220 patients were diagnosed with pemphigus during the 1-year period, with an annual incidence of 4.7 per million people in Turkey. Patients were predominantly women, with a male to female ratio of 1:1.41. The mean age at onset was 48.9 years. Pemphigus vulgaris (PV) was the commonest clinical subtype (n=192; 87.3%), followed by pemphigus foliaceus (n=21; 9.6%). The most common clinical subtype of PV was the mucocutaneous type (n=83; 43.2%). The mean Pemphigus Disease Area Index was 28.14±22.21 (mean ± Standard Deviation). The incidence rate of pemphigus in Turkey is similar to the countries of South-East Europe, higher than those reported for the Central and Northern European countries and lower than the countries around the Mediterranean Sea and Iran. Pemphigus is more frequent in middle-aged people and is more common in women. The most frequent subtype was PV, with a 9-fold higher incidence than pemphigus foliaceus.

The Effectiveness of Matrix Cauterization With Bichloracetic Acid in the Treatment of Ingrown Toenails.

BACKGROUND: Chemical matricectomy is performed mainly by 2 agents, phenol and sodium hydroxide. Chemical matricectomy with phenol has a low recurrence rate and good cosmetic results, but it produces extensive tissue destruction and can result in drainage and a delayed healing time. These adverse effects have brought forward the use of chemical agents such as sodium hydroxide and trichloroacetic acid for matricectomy. OBJECTIVE: This prospective study aimed mainly to evaluate the efficacy of partial nail avulsion and selective chemical cauterization of the matrix using 90% bichloracetic acid (BCA) in the treatment of the ingrown nails. MATERIALS AND METHODS: A total of 30 patients with 58 ingrown toenail edges were included in this study. All of the patients underwent chemical matricectomy with 90% BCA after partial nail avulsion. Adverse effects such as postoperative pain and drainage were minimal in most of the patients. RESULTS: One patient who underwent matricectomy had recurrence in a single nail edge (1.8%) at the 12th month of the follow-up. No recurrence was observed in 29 patients during mean follow-up period. This was considered to be statistically significant (p < .001). CONCLUSION: This is the first study to use BCA for the treatment of ingrown toenail. Partial nail avulsion followed by BCA matricectomy is a safe, simple, and effective method with low rates of postoperative morbidity and high rates of success. Therefore, partial nail avulsion and BCA matricectomy can be used as an alternative treatment method for the treatment of ingrown toenails.

Microchimerism in alopecia areata.

BACKGROUND: Autoimmunity is the main etiopathogenetic factor in alopecia areata. Microchimerism is the existence of allogeneic DNA in a living creature. There are variable studies investigating the role of microchimerism on the etiopathogenesis of autoimmune diseases. To our knowledge, no report has investigated the relationship between microchimerism and alopecia areata. OBJECTIVE: We aimed to investigate the possible role of microchimerism on alopecia areata. METHODS: We analyzed SRY gene levels as indicators of fetal microchimerism in our patient group. The patients were 29 women with alopecia areata, over 18 years old, who had visited our clinic between 2010 and 2013. Patients were divided into two groups; group 1 consisted of 14 patients having a son and group 2, 15 patients either nulliparous or having a daughter. RESULTS: Seventeen of 29 patients (58.6%) and four of 103 controls (3.9%) showed presence of an SRY gene. The difference between the patient and control groups was statistically significant (P < 0.001). CONCLUSION: As a result of our study, microchimerism may be associated with the etiopathogenesis of alopecia areata. However, we think there is a need for a larger series of studies to support this hypothesis.

The effectiveness of matrix cauterization with trichloroacetic acid in the treatment of ingrown toenails.

Ingrown toenail is an often painful clinical condition that usually affects the big toe. Chemical matricectomy with phenol has a low recurrence rate and good cosmetic results. However, it produces extensive tissue destruction that can result in drainage and delayed healing. Alternatives such as sodium hydroxide and trichloroacetic acid (TCA) have therefore come into vogue. A total of 39 patients with 56 ingrown toenail edges underwent chemical matricectomy with 90% TCA after partial nail avulsion. In most of the patients, adverse effects such as postoperative pain and drainage were minimal. One patient who underwent matricectomy had recurrence in a single nail edge (1.8%) at 12 months follow-up. No recurrence was observed among 38 patients during the mean follow-up period. This was considered to be statistically significant (P < 0.001). Partial nail avulsion followed by TCA matricectomy is a safe, simple, and effective method with low rates of postoperative morbidity and high rates of success.

Genetics of Behçet's Disease.

Behçet's disease (BD) is a systemic inflammatory disorder characterized mainly by recurrent oral and genital ulcers and eye involvement. Although the pathogenesis remains poorly understood, a variety of studies have demonstrated that genetic predisposition is a major factor in disease susceptibility. Peculiar geographical distribution of BD along the ancient Silk Road has been regarded as evidence supporting genetic influence. The observed aggregation of BD in families of patients with BD is also supportive for a genetic component in its etiology. HLA-B51 (B510101 subtype) is the most strongly associated genetic marker for BD in countries on the Silk Road. In recent years, several genome-wide association studies and genetic polymorphism studies have also found new genetic associations with BD, which may have a supplementary role in disease susceptibility and/or severity. The author reviewed the HLA and non-HLA genetic association studies.

CD4+CD25+ Treg cells in patients with toenail onychomycosis.

The essential role played by CD25+CD4+ regulatory T (Treg) cells in the control of immunity against some pathogens such as Helicobacter pylori is now well established. But their role in cutaneous fungal infections is still unknown. Onychomycosis is the chronic fungal infection of the nails, which is very common. The aim of this study was to evaluate possible relationship of CD4+CD25+ Treg cells and onychomycosis. Peripheral blood samples were investigated for CD4+CD25+ Treg cells using flow cytometry analysis in 43 toenail onychomycosis patients and in 30 healthy controls. We have found that onychomycosis patients had a higher expression of CD25+CD4+ Treg cells than controls, with values of 8.45 +/- 4.47% versus 4.64 +/- 1.59%, respectively (P = 0.001). The results of this study suggests that increased numbers of CD4+CD25+ Treg cells may play a role in failure of clearance of dermatophytes from skin by preventing the protective inflammation which is leading to development of onychomycosis. Accordingly, we address the possibility that CD4+CD25+ Treg cells may play a role in immune pathogenesis of other superficial fungal infections.

GSTM1 and GSTT1 null genotypes as possible heritable factors of rosacea.

PURPOSE: Rosacea might be related to an increased activity of reactive oxygen species (ROS) and deficient function of the antioxidant system. Glutathione S-transferases (GSTs) play a primer role in cellular defense against electrophilic chemical species and radical oxygen species. We hypothesized that increased ROS activity or decreased antioxidant potential, possibly induced by GST gene polymorphism, might have a pathogenic role in rosacea. METHODS: The study group consisted of 45 patients with rosacea and 100 control subjects. DNA samples were isolated from blood samples using high pure polymerase chain reaction (PCR) Template preparation Kit. The GSTM1, GSTT1, and P1 polymorphisms were detected using a real-time PCR and fluorescence resonance energy transfer with a Light-Cycler Instrument. Associations between specific genotypes and the development of rosacea were examined using logistic regression analyses to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: GSTM1 and GSTT1 null genotypes were found to be statistically different from control (P=0.005, P=0.009, respectively), and associated with an increased risk of rosacea (OR [95% CI]: 2.84 [1.37-5.89]; OR [95% CI]: 2.68 [1.27-5.67], respectively). There was a statistically significant relationship between both null combination of the GSTM1 and GSTT1 genotype polymorphisms and rosacea (P=0.003, OR [95% CI]: 4.18 [1.57-11.13]). There were no statistically significant differences between patient and control groups for the GSTP1 Ile/Ile, Ile/Val, and Val/Val genotypes (P>0.05). CONCLUSION: We demonstrated a significant association between the GSTT1 and/or GSTM1 null genotypes and rosacea. However, the potential role of GSTs as markers of susceptibility to rosacea needs further studies in larger patient groups.

Lack of association with TNF-alpha-308 promoter polymorphism in patients with vitiligo.

Vitiligo is an acquired depigmentary disorder of the skin, characterized by incomplete penetrance, multiple susceptibility loci and genetic heterogeneity. An immunologic hypothesis is currently advanced as a possible pathogenesis of vitiligo. The cytokines have an important role in pathogenesis of autoimmunity in which tumor necrosis factor-alpha (TNF-alpha), a paracrine inhibitor of melanocytes, is especially important. Several single-nucleotide polymorphisms (SNP) have been identified in the human TNF gene promoter. The polymorphism at position -308 (TNF-308), which involves substituting G for A and designing the AA genotype, leads to a higher rate of TNF gene transcription than the wild-type GG genotype in in vitro expression studies. It has also been linked to increased susceptibility to several chronic metabolic, degenerative, inflammatory and autoimmune diseases. Therefore, we investigated the TNF-alpha-308 SNP in patients with vitiligo. We examined 61 patients with vitiligo. Healthy age-, ethnically- and sex-matched individuals (n = 123) served as controls. Polymerase chain reaction amplification was used for analysis of the polymorphism at position -308 in promoter of TNF-alpha gene. We found that the distribution of TNF-alpha genotypes in vitiligo patients did not differ from that in control subjects (P > 0.05). Moreover, there was no association between TNF-alpha genotypes and types of vitiligo. In conclusion, we suggest that TNF-alpha-308 SNP is not a genetic risk factor for vitiligo susceptibility.

Relationship between ABO blood groups and skin cancers.

Studies of associations between various cancers and the ABO blood groups have shown elevated relative risks for some categories of disease. To date, no report has evaluated the relationship between the ABO blood groups and the skin cancers. To investigate this association, we conducted a retrospective study of premalignant and malignant tumors diagnosed in Turkey. All tumors were histologically confirmed. Blood information was obtained for 98 individuals with premalignant and malignant skin tumors, and the distribution of ABO and Rh blood type for cases was compared with that of 419 healthy blood donors from the same geographic area. Although patients with blood group A were higher, group 0 lower than in controls, the differences were not significant. The distribution of Rh factor, blood group B and AB among cases and controls also did not differ significantly. We found a significant relationship between age and skin cancer (p=0.0001). Old patients had 1.238 times higher risk for skin cancer. Further studies in larger series on blood group antigens are needed to elucidate the relationship between these antigens and skin cancer.

Apolipoprotein E polymorphism and lipoprotein compositions in patients with Behçet's disease.

BACKGROUND: Behçet's disease (BD) is a multisystemic disease of unknown etiology characterized by chronic relapsing oral-genital ulcers and uveitis. Some abnormalities in lipoprotein metabolism have been described in patients with BD. METHODS: In this study, apolipoprotein E (apo E) polymorphism and lipoprotein cholesterol concentrations in 30 patients with BD were compared with those of 27 control subjects. RESULTS: Both patients and controls were found to be normolipidemic. Patients with BD had significantly higher concentrations of high-density lipoprotein (HDL) cholesterol than those of controls (P < 0.05); however, there was no difference in serum triglyceride, low-density lipoprotein (LDL) and very low-density lipoprotein (VLDL) cholesterol concentrations. The distribution of apo E genotypes and alleles was the same in both groups. There were slight differences in allele frequency between the groups, but this was not statistically significant. CONCLUSIONS: The high HDL cholesterol levels observed in our patients were not related to abnormalities in apo E alleles.

Round excision of small, benign, papular and dome-shaped melanocytic nevi on the face.

BACKGROUND: Patients frequently request the removal of benign, papular and dome-shaped nevi for cosmetic or functional reasons. Total excision is probably the most widely used method of removal. AIM: To introduce the round excision technique for the treatment of benign, papular and dome-shaped nevi on the face. METHODS: In a prospective study, 36 benign, papular or dome-shaped nevi of all types were removed by the round excision technique. The lesions were circumscribed with a number 15 scalpel blade, 2 mm beyond the limits, with incision to the full depth of the dermis, and removed by cutting horizontally at the maximum depth of the circular incision. Histologic examinations were performed for all specimens. RESULTS: Complete removal of nevi was achieved in all patients with excellent or good cosmetic results. Of the 36 nevi, 24 were intradermal and 12 were compound nevi. Dog-ear formation was observed in only one patient. CONCLUSION: Round excision may be a better alternative to conventional fusiform or shave excision of benign, dome-shaped or papular nevi of the face.