Development of a quality of life scale for vitiligo.

BACKGROUND: No vitiligo-specific quality of life scale exists. OBJECTIVE: To develop a reliable and valid quality of life scale for vitiligo patients. METHODS: The content was derived from in-depth interviews with vitiligo patients. The internal consistency, test-retest reliability and validity of the scale, VLQI (Vitiligo Life Quality Index), were evaluated. RESULTS: Internal consistency was high with 30 patients and then with 183 patients (Cronbach's α 0.92 and 0.91). Test-retest scores were correlated (r = 0.86, p < 0.001). There was no difference between the test and retest scores (p > 0.05). VLQI was correlated with DLQI (Dermatology Life Quality Index) (r = 0.77, p < 0.001) and with the perceived severity by the patients (r = 0.57, p < 0.001). There was a significant relationship between the VLQI and the extent of the disease (p = 0.015). Factor analysis revealed six subscales. CONCLUSION: The VLQI is a valid and reliable instrument assessing quality of life of vitiligo patients.

Microleakage and Marginal Integrity of Ormocer/Methacrylate-Based Bulk-Fill Resin Restorations in MOD Cavities: SEM and Stereomicroscopic Evaluation.

This in vitro study aimed to compare the microleakage and marginal integrity of methacrylate/ormocer-based bulk-fill composite (BFC) restorations used in cervical marginal relocation with two different layering thicknesses in mesio-occlusal-distal (MOD) cavities exposed to thermo-mechanical loading. Standard MOD cavities were prepared in 60 mandibular molars and assigned into three groups: x-tra fil/AF + x-tra base/XB, Tetric N-Ceram Bulk Fill/TNB + Tetric N-Flow Bulk Fill/TFB, and Admira Fusion x-tra/AFX + Admira Fusion x-base/AFB. Each group was further divided into two subgroups (2 mm and 4 mm) based on the thickness of flowable BFCs (n = 10). The specimens were subjected to thermo-mechanical loading (240,000 cycles) and immersed in 0.2% methylene blue. Following mesiodistal sectioning, the specimens were examined under stereomicroscope (×25) and scored (0-3) for microleakage. Marginal integrity was examined using a scanning electron microscope (SEM). Descriptive statistical methods and the chi-square test were used to evaluate the data (p < 0.05). While there was no statistically significant difference in gingival cement microleakage in the XB and AFB specimens with a 4 mm thickness, microleakage was significantly increased in the TFB specimen (p = 0.604, 0.481, 0.018 respectively). A significantly higher amount of score 0 coronal microleakage was detected in the AFX2 mm + AFB4 mm compared to the TNB2 mm + TFB4 mm (p = 0.039). The SEM examination demonstrated better marginal integrity in groups with 2 mm thick flowable BFCs. Ormocer and methacrylate-based materials can be used in marginal relocation with thin layers.

Leukemic vasculitis: an unusual manifestation of leukemia cutis.

Leukemia cutis is frequently observed as papules, nodules, and plaques, but unusual clinical manifestations rarely occur. We report a 64-year-old woman with acute myeloid leukemia M1 who presented with erythematous papules and vesiculobullous lesions limited to the arms, hands, and neck in addition to purpuric papules on the legs. Because of the symmetric distal involvement and vesiculobullous nature of the skin lesions, the differential diagnosis included erythema multiforme and vasculitis. However, a skin biopsy specimen revealed infiltration with a striking predominance of blast cells in the dermis. These cells were also observed within the walls of the venules along with fibrin. Leukemia cutis associated with vasculitis was diagnosed. A few blast cells can be observed in many reactive dermatoses in patients with leukemia. However, in this patient a predominance of blast cells in the dermis and infiltration of vessel walls by these cells favored leukemic vasculitis.

Topical 8-methoxypsoralen increases the efficacy of narrowband ultraviolet B in psoriasis.

BACKGROUND: A combination of oral psoralen with narrowband ultraviolet B (UVB), defined as 'psoralen-narrowband UVB', was shown to have a superior efficacy than UVB alone and even a comparable efficacy to psoralen and ultraviolet A in psoriasis. OBJECTIVE: To find out whether topical psoralen-narrowband UVB provides any additional benefit to narrowband UVB alone in psoriasis. METHODS: Nineteen patients with plaque psoriasis were included. Phototherapy was given three times per week. Two symmetrical lesions were selected as target lesions. In the first 12 sessions of phototherapy, the target lesion on one side was treated with 1% 8-methoxypsoralen (MOP) gel 30 min before UVB radiation whereas the target lesion on the other side served as a control. Target lesion scores were assessed at baseline, third, sixth, ninth and 12th sessions. Side effects were recorded. RESULTS: Sixteen patients completed the study. Target lesion scores decreased significantly on both sides (P<0.0001). The mean percentage of decreases was greater on the 8-MOP-applied sides compared with the control sides for all assessments, but the difference was statistically significant only at the ninth session (37.7% vs. 58.6%, P=0.043). Pigmentation was frequently seen in 8-MOP gel-applied lesions. CONCLUSION: Topical 8-MOP gel plus narrowband UVB has greater efficacy than narrowband UVB alone in psoriasis.

Patient's perspective: an important issue not to be overlooked in assessing acne severity.

Acne has significant negative effects on an individual's psychosocial functions. There is not always a correlation between the severity of acne and its impact on quality of life. Our objective was to evaluate the correlation between quality of life scales and both the physician's and patient's assessments of acne severity and to find out which quality of life scale is more sensitive to changes in acne severity by using generic and acne specific scales. One hundred and twenty acne patients were enrolled. The physician's assessment of acne severity was made by means of Global Acne Grading System. Patients evaluated their acne severity on a 10-point Likert-type scale. Quality of life was measured by the Turkish version of Acne Quality of Life (AQOL) scale and Short Form-36 (SF-36). One hundred and seven patients answered the questions of the AQOL scale completely and were included in the statistical analysis. The AQOL scale did not correlate with the physician's assessment of acne severity whereas there was a correlation between patients' self assessments and AQOL scale. No correlation was found between SF-36 and either the physician's or patients' own assessments. Assessment of acne should not be limited to objective acne severity measures but also include patients' self assessments and acne specific quality of life scales. These measures, which provide a better understanding of patients' perception of severity, are important tools when taking treatment decisions.

A case of Schamberg's disease responding dramatically to PUVA treatment.

Pigmented purpuric dermatoses are a group of chronic, recurrent disorders characterized by purpuric lesions mainly involving the lower extremities. Their etiology is unknown. Treatment options are limited and none of them have proven benefit. Phototherapy has been reported to be effective in a small number of patients in the literature. We present a case of Schamberg's disease showing a dramatic response to psoralen plus ultraviolet A therapy and discuss the current therapeutic options focusing mainly on phototherapy. We believe that phototherapy is a valuable alternative, especially for patients with long-standing and widespread pigmented purpuric dermatitis.

Combined surgical-orthodontic rehabilitation of cleidocranial dysplasia: 5 years follow-up.

Cleidocranial dysplasia (CD) is an autosomal dominant syndrome which is characterized by several skeletal malformations such as non-closed fontanelles, skeletal abnormalities of the maxilla and mandible and absence of clavicles. Mid-facial hypoplasia and mandibular prognathism are mostly seen jaw abnormalities in CD. In this study, the combined orthodontic-surgical treatment of a patient with CD with class III malocclusion and multiple unerupted primary and deciduous teeth is presented.