Cytochrome P450 polymorphisms in patients with Behcet's disease

OBJECTIVES

Although the etiopathogenesis of Behcet's disease (BD) remains unknown, increased neutrophil functions such as chemotaxis, phagocytosis and excessive production of reactive oxygen species, including superoxide anion, may be responsible for the oxidative tissue damage observed in BD. Cytochrome P-450 are a multigene family of enzymes involved in the detoxification and occasional activation of a wide variety of chemicals. Our aim was to investigate CYP2C9 and CYP2C19 polymorphisms in patients with BD.

METHODS

Sixty-two subjects with BD and 107 healthy control subjects were enrolled in the study. Polymorphisms of CYP2C9 and CYP2C19 were performed by real-time PCR with a LightCycler instrument. We researched associations between CYP polymorphisms and BD.

RESULTS

The frequencies of wild-type and heterozygous CYP2C19*2 genotypes were 66.1% and 33.9% in the patients and 83.2% and 16.8% in the controls, respectively. There was a 2.53-fold increased risk of Behcet's disease in individuals with the CYP2C19*2 heterozygous genotype (OR = 2.53; 95% CI, 1.22-5.25) when compared with the control group. But the CYP2C9*2, CYP2C9*3 and CYP2C19*3 gene polymorphisms were not related to an increased risk of developing BD.

CONCLUSIONS

We observed that patients with BD presented with a higher prevalence of the heterozygous CYP2C19*2 genotype. Hereditary deficiencies of this enzyme activity may lead to an imbalance between pro- and antioxidant systems, resulting in the formation of excessive reactive oxygen species.

Cerebriform intradermal nevus

Cerebriform intradermal nevus is a rare form of cutis verticis gyrata. Clinically it manifests as a scalp deformity resembling the surface of the brain, with cerebriform morphologic characteristics. Degeneration into malignant melanoma has been reported. Herein, a cerebriform intradermal nevus of the scalp in a 7-year-old girl is reported. The clinical and histopathologic presentations of cerebriform intradermal nevus are described and the therapeutic possibilities discussed.

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.

A high prevalence of parvovirus B19 DNA in patients with psoriasis

Psoriasis is a common inflammatory skin disease. Infectious models are considered to be of pathophysiological importance in psoriasis. The immunological profile of stable psoriasis plaques suggests that viral antigens may be important. Human parvovirus B19 (PVB19) is a single-stranded DNA virus that causes various clinical symptoms. Several case reports have suggested associations between PVB19 infection and various chronic autoimmune and dermatologic diseases. There has so far been no information regarding the role of PVB19 in psoriasis, except psoriatic arthritis. In this report, to investigate the role of PVB19 in psoriasis, we analyzed PVB19 DNA of peripheral blood from psoriatic patients (n = 47) in comparison with blood donors (n = 20). We also determined the presence of anti-PVB19 IgG and IgM antibodies by using enzyme-linked immunosorbent assay (ELISA). We found that the presence of PVB19 DNA in patients with psoriasis (38%) was significantly higher than in controls (0%, P < 0.01). Anti-PVB19 IgG antibodies were detected in 79% of the cases while only 6% had anti-PVB19 IgM antibodies. PVB19 DNA presence was associated with seropositivity for anti-PVB19 IgG (P < 0.05) but not with IgM antibodies, indicating subclinical activation of latent infection. No correlation was found between the presence of PVB19 DNA and a patient's age, sex, type of psoriasis, or psoriasis area and severity index. The data demonstrated a statistically significant association between psoriasis and PVB19. Therefore, we suggest that PVB19 infection may be of pathophysiological importance in psoriasis.

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.

Apolipoprotein E polymorphism and lipoprotein compositions in normolipidaemic xanthelasma patients

BACKGROUND

Apolipoprotein E (apoE) phenotypes and lipoprotein compositions in xanthelasma patients have been reported in different series.

OBJECTIVE

To investigate the apoE polymorphism and lipoprotein compositions in xanthelasma patients by using rapid polymerase chain reaction, and searched for an association between apoE polymorphism and the lipoprotein levels in xanthelasma patients.

DESIGN

ApoE polymorphism and the different types of serum lipoproteins were studied in 25 patients with xanthelasma and compared with 27 normal subjects.

RESULTS

All of patients were found to be normolipidaemic. The patients had significantly higher concentrations of total cholesterol and apolipoprotein B, and lower concentrations of apolipoprotein A. There was no difference in serum triglyceride, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol concentrations. The distribution of apoE genotypes and alleles was the same in both groups.

CONCLUSIONS

The apoB, apoA and cholesterol levels did show statistically significant differences in the direction of an increased risk of atherosclerosis. Patients with xanthelasma demonstrated slight differentiations in the apoE polymorphism and metabolism of lipoproteins that require further clarifications.

Eruptive vellus hair cysts: an effective extraction technique for treatment and diagnosis

BACKGROUND

Eruptive vellus hair cysts are uncommon developmental anomalies of vellus hair follicles that are observed in young patients. Two patients were evaluated for asymptomatic flesh-coloured papules appearing on the chest, abdomen and axillae. Lesions of both patients were diagnosed histologically as eruptive vellus hair cyst, which is a disorder with no standard treatment option.

OBJECTIVE

To introduce an alternative treatment and diagnostic technique for eruptive vellus hair cysts and to evaluate this technique's effectiveness histopathologically.

MATERIALS AND METHODS

We treated the lesions by using cautery and a standard dissecting forceps under topical anaesthesia. After puncturing the overlying skin in the centre using the sharp-tipped cautery point, we grasped the base of the cyst using a standard dissecting forceps and we extracted the cysts out. In patient 1, extracted cysts were sent for histopathological examination; in patient 2, microscopic examination of the extracted material was performed in potassium hydroxide preparations.

RESULTS

Over 150 cysts were extracted with this technique in two patients. The technique was simple, quick and tolerated well. No lesion recurrence was observed after 4 months. On histopathological examination, extracted cysts were observed to have cyst walls. In patient 2, the diagnosis was made within minutes by microscopic examination of the potassium hydroxide preparations of the extracted material.

CONCLUSION

Our extraction technique is a simple and effective treatment option for these cysts. It can be regarded as curative since the cyst walls were also extracted. Microscopic examination of the potassium hydroxide preparation of the extracted cysts suggests that this technique can also be used as a simple diagnostic procedure.

Superficial basal cell carcinoma of the scalp mimicking seborrhoeic dermatitis

Superficial basal cell carcinomas (BCC) comprise 9% to 11% of BCC, and are commonly found on the trunk or limbs. We report a case of a superficial BCC on the scalp that was misdiagnosed and treated as seborrhoeic dermatitis. Any erythematous plaque-type lesion of long duration must have superficial BCC considered in the differential diagnosis.

Recurrent herpes labialis during isotretinoin therapy: is there a role for photosensitivity?

Isotretinoin (13-cis-retinoic acid) is one of the synthetic retinoids derived from vitamin A. Vitamin A derivatives demonstrate virucidal activity, both in vivo and in vitro. Isotretinoin has been used for the treatment of recurrent herpes simplex with encouraging results. However, we present a case with frequent attacks of herpes labialis during isotretinoin therapy for acne, who had a marked decrease in frequency of recurrences following strict use of sunscreens.

Familial eruptive dermatofibromas in atopic dermatitis

Multiple eruptive dermatofibromas (MEDF) are rare and their aetiology is unknown. More than half of the patients with MEDF have underlying diseases, and more than 80% of the underlying diseases are immune mediated. Familial cases suggesting a genetic cause have also been reported. We report a case of familial eruptive dermatofibromas associated with atopic dermatitis, possibly caused by both hereditary factors and compromised immunity.

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.

The changes in expression of ICAM-3, Ki-67, PCNA, and CD31 in psoriatic lesions before and after methotrexate treatment

Although the effectiveness of methotrexate (MTX) in the treatment of psoriasis is very well established, the mechanism of action is poorly understood. It was suggested that the therapeutic effect of MTX in psoriasis might be mediated by inhibition of adhesion molecule expression. The aim of our study was to investigate the different effects of MTX treatment on cell proliferation, inflammatory infiltrate, adhesion molecules, and angiogenesis in psoriasis, and to clarify the mechanism by which MTX exerts its therapeutic effects. Clinical response, the morpho-phenotypic changes, epidermal thickness, and mitosis count were analyzed and the expression of CD31 and ICAM-3, proliferative markers such as Ki-67, PCNA, were evaluated by immunohistochemical techniques in lesional psoriatic epidermis, before and after the treatment with MTX in ten patients. In posttreatment biopsies a decrease in the degree of epidermal hyperplasia and a significant reduction in the severity of the inflammatory infiltrate (P<0.05) were observed. In addition, CD31 and ICAM-3 expression was significantly decreased on dermal cellular infiltrate, (respectively; P<0.05, P<0.01). Ki67 and PCNA expression were suppressed concurrently in about 90% of cases (P<0.01). We suggest that MTX may have an inhibitory effect on an initial integral component of the pathways that lead to psoriasis. Immunopharmacologic intervention in adhesion event has the potential to improve psoriasis. Inhibition of revascularization may be another mechanism of action of MTX.

Idiopathic guttate hypomelanosis: idiopathic or ultraviolet induced?

Idiopathic guttate hypomelanosis (IGH) is a common but often unrecognized skin disease with obscure etiopathogenesis. As the lesions mostly develop on the exposed parts of the extremities, ultraviolet has been hypothesized to induce these lesions. However, previous statistical studies did not confirm any association between ultraviolet and IGH. We describe a 72-year-old woman with mycosis fungoides in whom widespread IGH occurred during narrow band ultraviolet B (UVB) therapy. The lesion development in the trunk following narrow band UVB therapy suggests that these lesions may not be idiopathic and they may be associated with UV exposure although controversy exist in the literature. This case is particular as it reveals strong evidence on this relationship.

A simple open comedone extraction technique for Favre-Racouchot disease

Favre-Racouchot disease (FRD) is a common disease characterized by solar elastosis and large open comedones and cysts. This disorder mainly affects elderly Caucasian men who have had a great deal of exposure to the sun. Patients having FRD continuously develop numerous large open comedones that could cause a cosmetic problem. We performed a simple and effective extraction technique for these open comedones using a standard dissecting forceps. This technique is well tolerated and no complications were observed. We suggest this comedone extraction technique as a simple alternative treatment for this common cosmetic problem.

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.

Celecoxib-induced photoallergic drug eruption

Photoallergic dermatitis is caused by a photosensitizing substance plus sunlight exposure in a sensitized person. If the photosensitizer is delivered internally, it is called a photoallergic drug reaction. Celecoxib is a new generation non-steroidal anti-inflammatory drug and sulfonamide derivative. We report a photoallergic drug eruption associated with the introduction of celecoxib. To our knowledge, this is the first report of photoallergic drug reaction associated with celecoxib.

Treatment of lichen planopilaris with mycophenolate mofetil

Mycophenolate mofetil (MMF) is an immunosuppressive drug that has recently been used to treat autoimmune and inflammatory skin diseases. We report the first case of lichen planopilaris (LPP) successfully treated with MMF. The treatment of our patient demonstrates a novel therapeutic option for patients with LPP; MMF treatment may be preferable to azathioprine treatment because MMF has a safer adverse-effect profile. Larger studies must be performed to establish the risk-benefit ratio of various therapeutic dosages of MMF for these patients.

Plasma reactive oxygen species activity and antioxidant potential levels in rosacea patients: correlation with seropositivity to Helicobacter pylori

BACKGROUND

Recent studies have suggested that there might be an etiologic role for Helicobacter pylori (HP) in rosacea. HP is a Gram-negative bacterium that colonizes the gastric mucosa, increases the generation of reactive oxygen species (ROS), and decreases plasma antioxidants such as ascorbic acid.

AIM

To investigate plasma ROS activities and antioxidant status, and their relationship with HP infection, in rosacea patients.

METHODS

Twenty-nine rosacea patients and 20 age- and sex-matched healthy controls were examined for specific immunoglobulin G (IgG) and IgM against HP, plasma malondialdehyde (MDA), and antioxidant potential (AOP) levels.

RESULTS

Compared with controls, the seropositivity of HP for IgM was significantly higher (P = 0.03) and the seropositivity of HP for IgG was significantly lower (P = 0.0001) in patients with rosacea. Plasma MDA levels were higher (P = 0.0001) and AOP levels were lower (P = 0.019) in patients than in controls, regardless of the severity of the disease. Plasma MDA and AOP levels were not affected by the seropositivity of HP for IgM and/or IgG in either group.

CONCLUSION

Our results suggest that rosacea is an oxidative stress condition, as reflected by the increased ROS activity and decreased AOP, regardless of HP infection.

Apolipoprotein E gene polymorphism and serum lipids in patients with superficial fungal disease

Superficial mycosis, including dermatophytic infections, tinea versicolor, and cutaneous candidiasis is mostly limited to the outer layers of the skin, nails, and mucous membranes. In this study, Apolipoprotein E (ApoE) polymorphism and lipoprotein cholesterol concentrations were compared between 42 patients with superficial fungal disease and 27 control subjects. Both the patients and controls were found to be normolipemic. The patients with superficial fungal disease had significantly higher concentrations of high-density cholesterol (HDL) compared to the control group (p=0.0462). However, there was no difference in the serum triglyceride, low-density lipoprotein (LDL) and very low-density lipoprotein (VLDL) cholesterol concentrations. A significantly higher incidence of heterozygosity E2/3 was found in the patients (p=0.0228), and significantly lower incidence of homozygosity E3/3 in all patients, and those with candidiasis and dermatophytosis (p=0.0139, 0.0194 and 0.0337, respectively) compared to the control group. The E3/4 genotype differences between patients and controls were not statistically significant. There were slight differences in the allele frequencies between the two groups, but these did not reach statistically significant levels. It was concluded that the presence of apoE2/3 genotype, high HDL-cholesterol levels and the absence of apoE3/3 genotype can be regarded as risk factors for superficial fungal disease, especially dermatophytosis.

Giant recurrent pyogenic granuloma on the face with satellitosis responsive to systemic steroids

Pyogenic granuloma is a common benign skin tumour. However, giant recurrent pyogenic granuloma with satellitosis is relatively rare. We present a 52-year-old man who had recurrent gigantic pyogenic granuloma with satellitosis responsive to systemic steroids. Our case of recurrent pyogenic granuloma is interesting because of its clinical presentation, recurrence following surgical excision and its steroid responsiveness. Systemic steroids may be effective in treating recurrent giant pyogenic granulomas during their high-proliferation phase.

Oxidant / antioxidant status in patients with psoriasis

Psoriasis is a common, chronic inflammatory skin disease with unknown etiology. Recently it has been suggested that increased ROS production and deficient function of antioxidant systems activities may be involved in the pathogenesis of the disease. Although there are several studies investigating oxidant/antioxidant systems in psoriatic patients, the data obtained from these studies is not concordant. In this study, superoxide dismutase (SOD) enzyme activity, and malondialdehyde (MDA) and antioxidant potential (AOP) levels in thirty-five patients with psoriasis were investigated and compared with those of twenty-four control subjects. Clinical severity of the disease was determined according to the Psoriasis Area and Severity Index (PASI) scores in the patients. Plasma SOD activity and MDA levels were significantly higher (p=0.012 and p=0.005 respectively), whereas AOP levels were lower, in patients than controls (p=0.001). There was no correlation between PASI scores and plasma SOD, MDA, and AOP levels. Our findings may provide some evidence for a potential role of increased ROS production and decreased antioxidant activity in psoriasis.

Extra-Fine Insulin Syringe Needle: An Excellent Instrument for the Evacuation of Subungual Hematoma

BACKGROUND

The most commonly used treatment method for subungual hematoma is nail trephining, which has some disadvantages.

OBJECTIVE

To introduce a very simple and well-tolerated treatment technique for this common problem.

METHODS

We used an extra-fine, 29-gauge insulin syringe for evacuation. We inserted the needle very close to the nail plate to minimize pain. We drained the blood from the hyponychium under the nail plate using this extra-fine needle.

RESULTS

The technique described herein is very fast and simple, and the patients tolerate it well. It is particularly successful for the treatment of smaller subungual hematomas of the second, third, and fourth toenails, in which the trephining is harder.

CONCLUSION

For these reasons, we suggest this technique as a practical alternative to the traditional nail trephining methods.

Oxidant/antioxidant status in patients with recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is recognized as one of the most common oral mucosal diseases worldwide. The aim of this study was to determine the oxidant/antioxidant status in erythrocyte and plasma samples from patients with RAS in comparison with healthy controls. Twenty-two patients with RAS and 23 healthy controls were recruited. Superoxide dismutase, glutathione peroxidase (GSHPx) and catalase (CAT) activities, and malondialdehyde (MDA) and antioxidant potential (AOP) levels were measured in plasma and erythrocytes from patient with RAS and controls. We found decreased CAT and GSHPx activities and AOP levels in the erythrocytes, and decreased AOP and increased MDA plasma levels in patients with RAS in comparison with control subjects. In summary, this study demonstrated that enzymatic and nonenzymatic antioxidant defence systems are impaired in patients with RAS.

Bone mineral density in patients with Behçet's disease

Behçet's disease is a complex, multisystemic, inflammatory disorder characterized clinically by recurrent oral and genital ulcerations as well as uveitis, sometimes leading to blindness. The etiology and pathogenesis of this syndrome remain obscure. However, various factors are suspected, including genetic propensity, infectious precipitants, and immunological abnormalities. Considering the chronicity and unclear etiology of the disease, we conducted a prospective investigation of a possible alteration in the bone mineral density of affected persons. Thirty-five patients (18 males and 17 females, mean age 38.02+/-7.93 years) diagnosed with Behçet's disease and 33 sex- and age-matched healthy controls (14 males and 19 females, mean age 40.06+/-7.66 years) were seen on an outpatient basis, and bone densitometry measurements were done from June 2000 to December 2002 at the Mersin University Hospital in Turkey. Postmenopausal women with Behçet's disease and patients receiving oral corticosteroid therapy were excluded from the study. The mean disease duration was 6.68+/-7.05 years. Bone mineral density was measured with dual X-ray absorptiometry at the lumbar spine and right femur. The mean Z scores of the patient and control groups were -0.50+/-1.06 and -0.13+/-0.92 at the lumbar spine, respectively, and 0.38+/-1.07 and 0.45+/-1.20 at the right femur, respectively. No significant differences in bone mineral density values were detected in the groups at either the lumbar (P = 0.15) or right femur (P = 0.82) site. Body mass index and disease duration did not influence bone mineral density, and age had a positive correlation with bone mineral density in patients with Behçet's disease. In conclusion, although it is difficult to draw definite conclusions due to the relatively small sample size, our study confirms that bone mineral density in Behçet's disease was not lower than in healthy subjects.

The prevalence of pediculosis capitis in schoolchildren in Mersin, Turkey

BACKGROUND

Pediculosis capitis is an endemic parasitosis affecting many countries of the world. The aim of this study was to investigate the incidence of head lice infestation in Mersin, Turkey.

METHODS

A total of 5318 elementary schoolchildren, aged 8-16 years, were examined for the presence of Pediculus capitis. If any evidence of head lice was detected, such as live or dead eggs, or nits, the child was considered to be infected. The following details were recorded for each child: age, sex, family size, monthly income, number of siblings, parents' education, presence or absence of social security of the family, pet (cat or dog) ownership, and frequency of hair washing (per week). The chi-squared test and logistic regression analysis were performed to analyze the results.

RESULTS

Pediculosis capitis was detected in 360 (6.8%) children. The prevalence of infestation was significantly higher in girls (13.3%) than in boys (1.1%) (chi2 = 313.2, d.f. = 1, P = 0.000). Children aged 8-9 years exhibited a significantly lower prevalence rate than those aged 10-11 years and those aged 12 years and above. The following variables were found to be statistically significantly related to pediculosis capitis: sex, age, father's education level, and pet ownership (cat or dog).

CONCLUSIONS

Our results show that the prevalence of pediculosis capitis is not very high in Mersin, Turkey, and is observed in all schools regardless of the socio-economic and personal hygiene status of the children.

Bullous erythema ab igne

Erythema ab igne is a localized, cutaneous condition, consisting of reticulate hyperpigmentation, dusky erythema, epidermal atrophy, and telangiectasia, all the result of repeated exposures to heat. We describe a patient with a bullous form of erythema ab igne: bullae and crusts within a localized area of reticular, brown, macular pigmentation on the lateral side of the left leg, an area that had repeated close exposure to an electrical heater over the previous 3 months. We believe that bullous erythema ab igne, something rarely reported in the literature, should be considered a well-defined variant of erythema ab igne; it may be more common than the literature suggests.

Surgical approach to benign small papular and dome-shaped melanocytic naevi on the face

Patients frequently request removal of benign papular and dome-shaped naevi for cosmetic or functional reasons. Melanocytic naevi can be removed by elliptical, round, punch or shave excision or destroyed using electrodessication or cryotherapy. Total elliptical excision is probably the most widely used method of removal. If malignancy is suspected, adequate specimens for histological interpretation are required. When malignancy is not suspected, the cosmetic result becomes the first priority. Smaller incisions minimize tissue trauma and so give cosmetically superior results. Round excision has been recommended for the removal of moles but has not been widely practised. Round excision and punch excision may be better alternatives than conventional fusiform excision of benign dome-shaped or papular naevi of the face, as more tissue is preserved. Shave excision of naevi may be preferable to elliptical excision in sites where the incidence of hypertrophic scarring is high, as preservation of some thickness of the dermis may result in a more acceptable scar or even avoid a scar entirely. Expedient and simple surgery with excellent cosmetic results can be accomplished by the use of punches. Cryotherapy with cutting or curetting and electrodesiccation combined with shaving have been described. Round excision may be a better alternative to conventional fusiform or shave excision of benign papular or dome-shape nevus of the face because it leaves an almost imperceptible scar. In this technique, less skin is excised and histopathological examination can be done.

An effective extraction technique for the treatment of closed macrocomedones

BACKGROUND

Closed macrocomedones are unsightly lesions that may be resistant to medical treatments and comedone extractors. Light cautery has been used to treat macrocomedones, which are 1 to 3 mm in size; however, its success in larger and chronic lesions is limited.

OBJECTIVE

To introduce an alternative treatment technique for this neglected problem.

METHODS

We treated these lesions by using cautery and standard dissecting forceps. After puncturing the macrocomedones in the center using the sharp-tipped cautery point, we grasped the base of the comedone using standard dissecting forceps and squeezed and pulled out the contents.

RESULTS

Twelve patients were treated with this technique, all of whom tolerated the procedure well and judged the cosmetics results as very good.

CONCLUSION

We recommend this procedure for patients who have closed macrocomedones larger than 3 mm in size, although it is an effective treatment for macrocomedones of any size.

Neutrophilic dermatosis of the hands (localized Sweet's syndrome) in association with chronic hepatitis C and sarcoidosis

We report a case of recurrent localized Sweet's syndrome (SS) with pulmonary sarcoidosis and hepatitis C virus infection. Hepatitis C may be the triggering factor for both Sweet's syndrome and sarcoidosis through stimulation of T helper 1 immune responses involved in the pathogenesis of both diseases.

Severe erythema nodosum due to Behçet's disease responsive to erythromycin

A patient with severe erythema nodosum due to Behçet's disease is reported on here. Erythema nodosum lesions did not respond to classical treatments; however, they cleared after erythromycin treatment, which was prescribed for the treatment of coincidental erythrasma. Erythromycin treatment appears to be an effective treatment option in erythema nodosum. The hypothetical anti-inflammatory effects of erythromycin, besides its antibiotic properties, are reviewed and discussed to explain such a clinical improvement.