Safety of Laser Hair Removal in Patients Receiving Systemic Isotretinoin for Acne Vulgaris.

BACKGROUND: A few reports on scar and keloid formation in patients receiving systemic isotretinoin have encouraged a conservative approach in which laser procedures are delayed during and 6 to 12 months after the completion of treatment. OBJECTIVE: To assess the safety of laser hair removal with alexandrite, diode, and Nd:YAG lasers in patients receiving systemic isotretinoin treatment. MATERIALS AND METHODS: Fifty-two patients who underwent laser hair removal during isotretinoin treatment were retrospectively analyzed and compared with a control group for side effects. RESULTS: There were 48 female and 4 male patients. The average isotretinoin dose was 33.7 mg/d. The average interval between the start of isotretinoin treatment and the first laser hair removal was 39.3 days. The mean number of sessions under treatment was 4.1. Three patients had temporary crusting, and 1 patient had a small area of temporary hypopigmentation. Five (9.6%) patients in the control group had crusting. The incidence of side effects was not significantly different between the 2 groups (p > .05). Neither patients in the isotretinoin group nor those in the control group experienced blistering, pigmentation, ulceration, and scar or keloid formation. CONCLUSION: Laser hair removal is a safe procedure with alexandrite, diode, and Nd:YAG lasers in patients receiving systemic isotretinoin.

A case of elephantiasis nostras verrucosa treated successfully by a new type of compressive garment.

Elephantiasis nostras verrucosa (ENV) is a clinical manifestation composed of hyperkeratotic, verrucous, and papillomatous lesions and dermal fibrosis, which complicate chronic lymphedema. There is currently no cure for ENV, however, several measures have been used to reduce lymphedema and the resultant pseudoepidermal hyperplasia. Supportive dressings and compression therapy still constitute an important part of the treatment. In this report, we present a 69-year-old male patient with ENV developed due to chronic lymphedema caused by venous insufficiency. After failure of healing with conventional two- and three-layered bandages, and elastic stockings, he was successfully treated by a new type of compression garment. We recommend this user friendly garment for prevention of frictional trauma, contact dermatitis, and secondary infection, which all may complicate compression treatments.

An Extraordinary Manifestation of Nodular Cystic Fat Necrosis.

Nodular cystic fat necrosis (NCFN) is characterized by mobile subcutaneous nodules composed of necrotic adipocytes encapsulated by fibrous tissue. The classical presentation of NCFN is solitary or multiple, up to 40, discrete nodules scattered usually on the extremities or trunk. Here, the authors present an elderly woman who developed an unusual and striking clinical picture of NCFN, two months after a fall. The patient had a large indurated plaque and subcutaneous nodule with superposing necrotic ulcers. During debridement of the ulcers, nearly 100 small nodules popped up freely along with a brownish discharge. Deep in the ulcer, the authors discovered a dislocated nail that belongs to an old hip prosthesis. Histopathological findings of the nodules were compatible with NCFN.

Is it a sarcoidal foreign-body granuloma or a cutaneous sarcoidosis on a permanent eyebrow make-up?

Permanent make-up is a kind of cosmetic tattoo in which the colorants (pigments) are deposited in dermis after piercing the skin by tiny solid needles. It may cause some adverse effects such as local inflammation, infection, and allergic reactions on the skin and even systemic adverse effects such as sarcoidal reactions. Here the case of a 34-year-old woman who has some yellowish hard shiny papules on her eyebrows after having a permanent make-up is described. The histopathological examinations of the papules are diagnosed as sarcoidal foreign-body reactions. All the laboratory investigations were in normal limits except a mild elevation in angiotensin converting enzyme or ACE level. The lesions mostly improved after topical corticosteroid treatment. Sarcoidal foreign-body reaction due to permanent make-up is discussed with this presentation.

Prevalence of Congenital Cutaneous Anomalies in 1000 Newborns and a Review of the Literature.

OBJECTIVE: There are limited reports studying on congenital cutaneous anomalies in newborns, particularly in Turkey. Some of congenital cutaneous anomalies serve as an important clue for accompanying syndromes or other medical conditions. This study aimed to determine the prevalence of congenital cutaneous anomalies in newborns and to discuss their clinical significance with a brief review of literature. STUDY DESIGN: A total of 1,000 newborns were examined by a dermatologist in a hospital-based, cross-sectional, prospective study between October 2011 and April 2012. RESULTS: We observed 11 different congenital cutaneous anomalies in 48 newborns of 1,000 (4.8%). The most commonly seen anomalies were sacral dimple, accessory nipple, acrochordon, hypospadias, open spinal dysraphism, and accessory tragus. None of the newborns with cutaneous anomalies had any association. CONCLUSIONS: Although congenital cutaneous anomalies are rare in newborns, clinicians should be aware of them as they may be in association with syndromes and other medical conditions. It is also important to give appropriately provided information to avoid parents concerns.

A favourable response to surgical intervention and hyperbaric oxygen therapy in pyoderma gangrenosum.

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterised with ulcerations. Inflammatory bowel diseases (ulcerative colitis and Crohn's disease) and haematologic diseases (leukaemia, preleukaemia and monoclonal gammopathy) have been reported in about 40-50% of PG patients in whom the treatment of the underlying disease is important for the improvement of the lesions. We herein report a colorectal adenocarcinoma patient with PG, who responded partially to topical treatments and systemic immunosuppressants and healed completely with the aid of surgical wound repair and hyperbaric oxygen therapy.

Allergic contact dermatitis mimicking angioedema due to paraphenylendiamine hypersensitivity: a case report.

Active sensitization to paraphenylendiamine (PPD) and related compounds from temporary black henna tattoos has become an epidemic in the recent years. Hair dyes also include PPD like black henna tatoos which cause allergic contact dermatitis. Skin lesions of allergic contact dermatitis from PPD are mostly seen as an exudative erythema, an erythema multiforme-like eruption or a bullous contact dermatitis. We, herein, report a 27 year-old woman with an angioedema-like reaction occurring after the first exposure to hair dye who was unaware of being previously sensitized to PPD from black henna tattoo.

The investigation of the amounts and expressions of epidermal growth factor, epidermal growth factor receptor, and epidermal growth factor receptor gene polymorphisms in acne vulgaris.

BACKGROUND: Epidermal growth factor receptor inhibitors (EGFRI) used in cancer chemotherapy cause acneiform folliculitis in 70%-100% of patients in a dose-dependent manner. Acneiform folliculitis is considered to be caused by an inflammatory process due to follicular hyperkeratosis and subsequently a set of changes both in epidermis and hair follicles as a result of epidermal growth factor receptor (EGFR) blockade. Both acne vulgaris and acneiform folliculitis due to EGFRIs show similar changes in the pilosebaceous unit. Furthermore, in both groups of patients, topical application of recombinant human epidermal growth factor (EGF) has been reported to improve the disease. AIMS: In this study, it was aimed to investigate the role of EGF and EGFR amount, expression, and EGFR gene polymorphisms in the etiopathogenesis of acne vulgaris. PATIENTS/METHODS: 156 acne vulgaris patients, within 18-25 years of age, who had 15 or more inflammatory acne lesions on dermatologic evaluation were included in this study. The absence of any known systemic or genetic disease or cancer and any systemic or topical treatment for the last 1 month were prerequisites. In the control group, 154 volunteers in the same age range who were examined at the outpatient clinic with diagnoses of melanocytic nevus, ephelid, cherry angioma, and callus and who had no more than 3 inflammatory acne lesions were recruited. The amounts of EGF and EGFR were determined by sandwich ELISA, expressions of EGF and EGFR by reverse transcriptase polymerase chain reaction; EGFR polymorphisms were examined by restriction enzyme digestion, Sanger, and high-resolution melting methods. RESULTS: The patient and control groups were compared in terms of EGFR gene polymorphisms in addition to the amount and expressions of EGF and EGFR. The amount of EGF in the serum was found to be significantly higher in the acne group. (P = .0012). There was no significant difference in other parameters studied. CONCLUSION: The results of our study showed a significant increase in the amount of EGF in the acne group. Though EGF may be incriminated in the etiopathogenesis of AV, the most likely explanation about its role may be controlling inflammation from the very first stage.

Has the COVID-19 pandemic changed attitudes and behaviors concerning cosmetic care and procedures among patients presenting to the dermatology outpatient clinic? A multicenter study with 1437 participants.

BACKGROUND: The rate of cosmetic procedures and use of skincare products is considered to be affected during the pandemic period; however, this has not been investigated yet. OBJECTIVE: To determine whether the ongoing pandemic has changed people's habits related to skincare products and cosmetic procedures. METHODS: We conducted a multicenter survey study covering both private and public hospitals. Sociodemographic characteristics and clinical diagnoses of the patients were noted by dermatologists. A survey was used to determine the type and application areas of skincare products and cosmetic procedures before and during the pandemic, whether the patients were concerned about being infected, and any change in the make-up habits of female patients. RESULTS: Of the 1437 patients, 86.7% presented to the hospital due to dermatological complaints and 13.3% for cosmetic procedures. The rate of those that did not use skincare products was 0.05% before and 0.06% during the pandemic. Of the participants, 43.2% had undergone cosmetic procedures before and 38.1% during the pandemic. For both periods, the most frequent cosmetic procedure applied was laser epilation, followed by skincare treatment and chemical peeling. While undergoing these procedures, 34.9% of the patients were concerned about contracting coronavirus. CONCLUSION: There was no significant difference in the use of skincare products and cosmetic procedures before and during the pandemic. The majority of the patients continued to undergo these procedures despite their fear of being infected. This shows that during the pandemic period, patients are concerned with their appearance and continue to undergo cosmetic procedures and pay attention to their skincare.

The efficacy and safety of high-intensity focused ultrasound on upper arm laxity treatment: Our experience with five patients.

BACKGROUND: High-intensity focused ultrasound is approved by FDA for both upper face and lower face, neck laxity and for decollete rejuvenation. It produces micro-focused thermal damage on the dermis and superficial muscular aponeurotic system layer at precise depth and with this thermal stimulus the collagen denaturation and subsequent neo-collagenosis occur. High-intensity focused ultrasound (HIFU) effects on body laxity has also been used in some studies but it has not been approved yet. AIMS: To find out the efficacy of HIFU for the treatment of upper under arm laxity. PATIENTS/METHODS: We used HIFU device with the new transducers; 13 mm depth 4 MHz and 2J for under arm laxity for 5 patients. RESULTS: All patients showed a clinical improvement according to the physicians and patients assessment scales. The side effects were mild erythema and edema during the treatment and tenderness which lasted in 10 days. We follow up our patients in a one year period, and there were no side effects. CONCLUSION: HIFU can be used for upper arm laxity treatment with the new transducers developed for body areas.

The Epidemiology of Non-Melanocytic Benign and Malignant Skin Tumors in Pediatric Patients Attending to the Dermatology Department.

BACKGROUND: Non-melanocytic skin tumors are rarely seen in pediatric patients; although they are mostly benign, they remain to be elucidated by histopathological examination. The objective of the study was to describe the epidemiology of non-melanocytic skin tumors in children attending to our dermatology department. METHOD: The histopathologic studies of all skin punch and excisional biopsies of children up to 16 years old referred to our dermatology department between January 2007 and January 2012 were reviewed retrospectively. Melanocytic tumors and cystic and infectious lesions were excluded. Age, sex, location, and histopathologic diagnosis were recorded. The skin tumors were categorized. RESULTS: A total of 4,126 skin tumors were analyzed histopathologically, and 203 of the lesions were from children up to 16 years of age. Ninety-seven of the lesions from 91 patients were non-melanocytic skin tumors. Forty-seven (51.64%) were male, 44 (48.36%) were female, and mean age was 10.55 ± 4.31 years. Malignant tumor was 1.03% (one tumor) and benign tumors were 98.97% (96 tumors) of all. The most frequent non-melanocytic skin tumor was pilomatricoma with 22 lesions (22.68%), followed by pyogenic granuloma with 18 lesions (18.54%), and nevus sebaceous with 10 (10.3%) lesions. Cutaneous leukemic infiltrate was found to be the only malignant skin tumor in the study group. The most frequently affected age group was children aged > 13 to ≤ 16 years, which included 38 patients (41.7%). The majority of lesions were on head and scalp (32 tumors, 32.96%), followed by trunk (28 tumors, 28.84%) and upper limbs (22 tumors, 22.75%). CONCLUSION: The ratio of malignant to benign skin tumors in pediatric patients is found to be small. Pilomatricoma, pyogenic granuloma and nevus sebaceous are found to be the most frequent non-melanocytic skin tumors of children. The ratio of malignant tumors is very rare.

Linear atrophoderma of Moulin on the neck.

BACKGROUND: Linear atrophoderma is a rare disease, first described by Moulin in 1992 in 5 patients. It is an acquired unilateral hyperpigmented, depressed band-like areas following the lines of Blaschko. It affects children or adolescents of both genders involving the trunk or the limbs. It is considered to be a rare cutaneous form of mosaicism. MAIN OBSERVATION: A 39-year-old woman with a 22 years history of unilateral slightly depressed hyperpigmented lesion on her neck was admitted to us. The skin texture was normal and there were no signs of induration or sclerosis. The histopathological examination revealed a normal epidermis outlined by a hyperpigmented basal layer. In the papillary dermis proliferation of superficial vessels with mild lymphocytic infiltrate and melanin-laden macrophages were present. The collagen fibres and elastic fibres were normal. The clinical and histopathological features confirmed the diagnosis of linear atrophoderma of moulin. We discussed the case according to the other cases reported in the literature. CONCLUSIONS: Approximately 28 cases of linear atrophoderma have been reported in literature. The present case has the charecteristic clinical and histopathological features of linear atrophoderma as defined by Moulin, but the localization of the lesion is unusual.