Peeling skin diseases: 21 cases from Turkey and a review of the literature.

BACKGROUND: Peeling skin diseases (PSD) refer to a group of rare autosomal recessive dermatosis which are characterized by spontaneous, continual peeling of the skin. Three different clinical pictures can be distinguished: Inflammatory PSD also referred to as peeling skin syndrome (PSS) type B, non-inflammatory PSD also referred to as PSS type A, and localized forms i.e. acral type PSS. OBJECTIVE: To characterize the clinical and histopathological features of PSD in Turkey. METHODS: We retrospectively reviewed the medical records and clinical photographs of patients who were given diagnosis of PSD and conducted histopathological evaluation of skin biopsies to identify the site of cleavage. Also we evaluated the cases including age, gender, age onset, clinical and histological findings, family history, associated disorders and PSD type. RESULTS: Twenty-one patients with PSD were seen at Gulhane School of Medicine in Ankara between the years 1994 and 2010 in this retrospective study. All patients were men. Their ages were between 20 and 26 years (22.44±2.30, Mean age±SD). Of the patients, eight cases (40%) were type A, eight cases (40%) were type B, and five cases (20%) were acral type PSS. Eleven cases (52%) had parental consanguinity. Keratoderma, cheilitis, keratosis pilaris, melanonichia, clubbing, hyperhidrosis, onychodystrophy were observed in eight cases as an accompanying disorder. CONCLUSIONS: In this case series, PSD occurred rarely and also showed generally mild course of disease in Turkey and most likely related to consanguineous of marriages. Future investigations on PSD will contribute to our progressing alternative targets for pathogenesis-based therapy.

Polymerase chain reaction based detection of Mycobacterium tuberculosis complex in lupus vulgaris: a case report.

Lupus vulgaris (LV), the commonest of all forms of cutaneous tuberculosis, can affect the earlobes. Authors present a 20-year-old male patient with LV of the left earlobe initially misdiagnosed as pyoderma and treated superfluously with antibiotics at different intervals over the last 4 years in another hospital. Mycobacteria could not be seen or isolated by stained smears or conventional or radiometric culture methods from the skin biopsy specimens. Suspected clinical diagnosis of our patient was LV. This was supported by positive polymerase chain reaction assay and histological findings. The lesion was treated successfully with anti-tuberculosis chemotherapy, further confirming the diagnosis of LV.

Efficacy and safety assessment of 0.5% and 1% colchicine cream in the treatment of actinic keratoses.

BACKGROUND: Topical colchicine has been reported to be an effective treatment for actinic keratoses, but the optimal concentration has not been fully defined. OBJECTIVE: The aim of this study was to further support the beneficial effect of topical colchicine therapy for actinic keratoses, and to compare the efficacy and safety of two different concentrations of colchicine cream, 0.5% and 1%. METHODS: Sixteen patients with actinic keratoses were enrolled in this comparative randomized study. Eight patients applied 1% colchicine cream, twice daily on their lesions while the other eight were treated with a 0.5% colchicine cream for 10 days. Some patients were applied a second course of 10 days' therapy. Patients were examined before treatment and at 10 days, and followed up at 1, 2 and 6 months of treatment. Visible and palpable actinic keratoses lesions in each group were counted. Safety and efficacy were also assessed by clinical examination at each study visit. Routine laboratory tests were performed before and after treatment. RESULTS: Actinic keratoses lesions showed significant clinical improvement following treatment with 0.5% and 1% colchicine cream. Complete healing of actinic keratoses were observed in six of the eight patients in the 1% colchicine group, and in seven of the eight patients in the 0.5% colchicine group. The reduction rate in number of actinic keratoses at the end of treatment in the 1% colchicine group was 73.9% (48/65) (p < 0.001), and the reduction rate in the 0.5% colchicine group was 77.7% (52/67) in total (p < 0.001). The reduction in number of actinic keratoses (mean +/- SD) at the end of treatment was similar in the 1% colchicine group (0.7 +/- 1.3), and the 0.5% colchicine group (mean 0.6 +/- 1.7) (p > 0.05). Systemic side effects were not seen in either concentration. CONCLUSIONS: Topical colchicine is an effective and safe alternative agent. Cream containing 0.5% of colchicine is equally effective as 1% colchicine cream in the treatment of actinic keratoses.

An open, randomized, comparative study of oral fluconazole, itraconazole and terbinafine therapy in onychomycosis.

BACKGROUND/AIM: In this open, randomized and comparative study, the safety and efficacy of systemic fluconazole, itraconazole and terbinafine was investigated in 50 patients with distal subungual toenail onychomycosis diagnosed clinically and mycologically. The patients with positive mycology and also the patients with positive microscopy and negative culture were investigated. METHODS: The treatment duration was 3 months, and the follow-up period was 6 months. Patients were randomly assigned: 16 patients received 150 mg fluconazole once weekly, 18 patients received 200 mg itraconazole twice daily with meals during the first week of each month, and 16 patients received 250 mg/day terbinafine during the treatment period. RESULTS: In a clinical evaluation, at the endpoint of the follow-up period, the clinical cure rates were 81.3% (13/16) in the terbinafine group, 77.8% (14/18) in the itraconazole group, and 37.5% (6/16) in the fluconazole group. The mycological cure rates were 75% (12/16), 61.1% (11/18) and 31.2% (5/16), respectively. The overall assessment rates were 62.5% (10/16), 61.1% (11/18) and 31.2% (5/16), respectively. Statistically significant intra-group reductions from baseline symptom severity values were seen at the endpoint of treatment and at the endpoint of the follow-up period for all three treatment groups in onycholysis, subungual hyperkeratosis, affected-area percentage score and total score parameters (p < 0.001). At the endpoint of the follow-up period, statistically significant differences between the treatment groups were seen in clinical, mycological and overall assessment (p < 0.05). However, while no statistically significant difference between the terbinafine and itraconazole groups was seen, there was a clinical and statistical difference between the other groups and the fluconazole group. Treatment was not stopped for side effects such as mild gastrointestinal and central nervous system symptoms. These effects were noted in four patients in the fluconazole group (25%), five patients in the itraconazole group (27.8%), and three patients in the terbinafine group (18.75%). The clinical laboratory data on all three drug groups did not show any statistically or clinically significant intra-group changes from baseline values at the endpoint (p > 0.05). CONCLUSION: This comparative study of systemic fluconazole, itraconazole and terbinafine showed that all three drugs were effective and safe in the treatment of onychomycosis. However, fluconazole, at these doses and treatment durations, was the least effective. With regard to cost-effectiveness, side effects and the cure rates, terbinafine could be the drug of choice in the short-term treatment of toenail onychomycosis.

Follicular mucinosis responding to isotretinoin treatment.

Follicular mucinosis is a rare disorder of unknown etiology characterized by accumulation of mucin in the sebaceous glands and outer root sheaths of the hair follicles. It is divided into a primary benign type and a secondary type mostly associated with lymphomas. No effective standard therapy for follicular mucinosis is available. We describe the case of a 21-year-old Caucasian male who had papules, nodules, and erythematous plaques on his left shoulder, left arm, and right scapular region. He was diagnosed as primary benign generalized follicular mucinosis, and treated with isotretinoin. Almost complete remission was achieved in 4 months.

Preparation of polyethyleneglycol (PEG) coatings for microencapsulation of charcoal.

Polyethyleneglycols (PEGs) with their high solubility in water cannot normally be used as a coating material in aqueous solutions such as blood. A gamma-radiation procedure was therefore applied after coating charcoal granules with PEG in a non-aqueous phase, and an 80-90% insoluble polymer matrix on charcoal was obtained. PEGs with different molecular weights from 4000 to 300,000 were used for coating. The performance of this system was determined by using several test solutes, namely creatinine, uric acid, and vitamin B-12. It was observed that the pore size and structure of these membranes can be adjusted by changing the irradiation time and by using PEGs with different molecular weights. Thus, very high mass transfer rates can be achieved.

Growth of Ag nanometre-sized particles in solution: molecular dynamics simulations.

This work focuses on the growth of nanometre-sized Ag clusters in solution. Molecular dynamics simulations have been employed to gain the necessary detail on the dynamics of solute species and to study the mechanistic features of the processes governing the association of solute atoms in aggregates. Supersaturated liquid solutions of Ag in tetrachloromethane have been considered. A systematic variation of the concentration of Ag atoms in solution permitted us to show the different mechanistic scenarios responsible for the growth processes of solid Ag clusters. It is shown that such processes are limited by the thermal diffusion of solute in the solution bulk at relatively low supersaturation degrees, whereas the growth is limited by interfacial effects at relatively high supersaturation degrees.

Efeitos da hidrocinesioterapia na pressão arterial e nas medidas antropometricas em mulheres hipertensas / Hidrokinetictherapy effects in the blood pressure and on the anthropometrical measures in hypertensive women

A hiperetensao arterial e considerada problema de saude publica nao apenas em paises desenvolvidos, mas tambem no terceiro mundo, sendo um dos principais fatores de risco para a doenca cardiovascular. O propositodeste estudo foi verificar os efeitos de um programa de hidrocinesioterapia na pressao arterial e nas medidas antropometricas de mulheres hipertensas. A pressao arterial e as variaveis antropometricas foram analisadas antes e depois do programa de hidrocinesioterapia, que teve a duracao de 10 semanas. Uma sessao tipica era dividida em 4 etapas: I- Aquecimento, II- Alongamento, III- Atividades Aerobicas e IV- Relaxamento. Os dados obtidos foram analisados utilizando-se o teste Wilcoxon para amostras dependentes, nivel de significancia de (5 por cento). Verificou-se diferenca estatistica significativa pre e pos-tratamento na pressao arterial sistolica (PAS) (reducao de 5mmHg) e na pressao arterial diastolica (PAD) (reducao de 10 mmHg) (p<0,0001), porem nao houve diferenca significativa no peso corporal, na circunferencia de cintura e na circunferencia de quadril (p>0,05). Conclui-se que o programa de hidrocinesioterapia contribuiu para a reducao da PAS e da PAD, porem nao produziu modificacoes nas medidas antropometricas durante o periodo estudado