Comparison of efficacy and safety of fractional radiofrequency and fractional Er:YAG laser in facial and neck wrinkles: Six-year experience with 333 patients.

Lasers and other light sources are popular treatment options for facial rejuvenation in recent years. In this study, we aimed to compare the efficacy and safety of fractional radiofrequency (RF) and fractional Erbium: YAG (Er:YAG) laser for facial and neck skin wrinkles, objectively. Three hundred and thirty-three patients treated with fractional RF and fractional Er:YAG laser were evaluated by two blinded dermatologists. Fractional Er:YAG laser was more effective for the periorbital area; whereas fractional RF treatment was more effective for perioral, nasolabial and jawline areas. There was no statistically significant difference in side effects between two treatment groups. In conclusion, both modalities significantly improve skin wrinkles; however, it should be considered that there may be regional differences between the treatment outcomes of them.

Paget's Disease of the Breast in a Patient with Amyopathic Dermatomyositis.

Amyopathic dermatomyositis (AD) can be a part of paraneoplastic syndrome of an underlying malignancy. Paget's disease is a rare form of breast cancer. We present a very rare case of Paget's disease associated with AD. Paget's disease has been diagnosed in a patient with AD who is under surveillance of dermatology department. The patient has undergone central lumpectomy with removal of the nipple-areola complex and sentinel lymph node biopsy. Surgical margins after lumpectomy and sentinel node biopsy were negative. The whole breast irradiation was performed after surgery. The patient receives medical treatment for AD of which lesions regressed in 1 year during the follow-up period. This is a very rare case of Paget's disease diagnosed in a patient with AD. Female patients with dermatomyositis have been absolutely recommended to undergo screening for breast and gynaecological malignancies. AD may be an early finding of primary or recurrent malignancy of the breast.

Enhanced functional stability of plasminogen activator inhibitor-1 in patients with livedoid vasculopathy.

Livedoid vasculopathy (LV) is a chronic, recurrent, painful cutaneous disease with distinctive clinical features and an uncertain etiology. The skin lesions are recognizable by focal purpura, depigmentation and shallow ulcers. Thrombophilic conditions occur frequently in patients with LV. While no definitive treatment exists for LV, smoking cessation, antiplatelet therapy, immunosuppressive treatment, and anabolic steroids are often included in the therapeutic ladder. Recently, a possible link between LV and impaired fibrinolysis was established as cutaneous LV lesions responded to tissue plasminogen activator (t-PA) infusion suggesting that inhibition of the fibrinolysis through plasminogen activator inhibitor-1 (PAI-1) activity may determine the disease course in patients with LV. In this study, we investigated PAI-1 antigen (Ag) and activity levels in 20 patients with biopsy proven LV (mean age 26 ± 11, M/F = 7/13, median disease duration 3.5 years). All patients received antiplatelet treatment with aspirin and/or dipyrimadole and 14 patients received anabolic steroids or immunosuppressive treatment. Fasting PAI-1 Ag and activity levels were measured at 9 AM in all patients. Both Ag (34 (26) ng/ml) (median (interquartile range)) and specific activity (17 (23) IU/fmole) levels of PAI-1 were moderately elevated in LV patients compared to the controls, however, PAI-1 kinetic studies demonstrated markedly enhanced stability of PAI-1 activity in plasma from patients with LV. Specific activity at 16 h was significantly higher than expected specific activity levels (7 (11) vs. 0.07 (0.09) IU/fmole, P < 0.01). While the exact mechanism of increased stability of PAI-1 activity is not known, it may be due to post-translational modifications or increased binding affinity for a stabilizing cofactor. In conclusion, enhanced stability of PAI-1 may contribute to the pathophysiology of LV, and systemic or local treatment with PAI-1 inhibitors may offer a potential treatment alternative in patients with LV.

Marie Unna hereditary hypotrichosis: a Turkish family with loss of eyebrows and a U2HR mutation.

We report a family with Marie Unna hereditary hypotrichosis (MUHH) from Turkey. MUHH is a distinct form of scalp and body hair loss characterized by the absence or scarcity of scalp hair, eyebrows, and eyelashes at birth. Coarse wiry hair begins to grow during childhood. Around puberty, progressive hair loss occurs in the affected patients. Recently, mutations were identified in U2HR, an inhibitory upstream open reading frame in the 5'-untranslated region of the human hairless gene (HR) as the underlying cause of MUHH. We are presenting hair loss of eyebrows in a Turkish family comprising eight affected and seven unaffected individuals. The pedigree is compatible with autosomal dominant inheritance. Linkage and haplotype analyses confirmed linkage of this family to the MUHH locus at cytoband 8p21. By sequencing U2HR, we identified the mutation c.2T>C (M1T) in all affected family members. We concluded that there may be considerable clinical variations in MUHH, and that eyebrow loss is an important clue for accurate diagnosis.

Localized crossed hyperhidrosis and the coexistence of thyroid gland disease.

Hyperhidrosis is the most common type of sweat gland disorder. It may be localized or generalized. The localized type usually occurs in a symmetrical fashion over the palms, soles and armpits as a response to emotional stimuli. Another form of the localized type is idiopathic localized unilateral hyperhidrosis which is very rare and the etiopathogenesis remains unclear. Here, we report a female patient who had localized crossed hyperhidrotic areas on her body (on the left side of the scalp, face and the shoulder and on the right side of the trunk) and also had thyroid gland disease. We herein discuss this extremely rare presentation of the disease and its association with thyroid gland disease.

Iododerma following sitz bath with povidone-iodine.

A 50-year-old man developed numerous pustules and bullae on the trunk and limbs 15 days after anal fissure surgery. The clinicopathological diagnosis was iododerma induced by topical povidone-iodine sitz baths postoperatively. Complete resolution occurred within 3 weeks using systemic corticosteroids and forced diuresis.