Important complications requiring intensive care may occur in dermatologic diseases which affect large body surface areas. Toxic epidermal necrolysis, staphylococcal scalded skin syndrome, bullous diseases, skin necrosis, gangrenous cellulitis and exfoliative dermatitis constitute the great portion of dermatologic intensive care patients. Because of the disturbances in barrier, immunologic and thermoregulatory functions of the skin, these patients lose fluid, electrolytes, protein and energy; have nutritional problems and/or severe infections. Considering these problems, such
patients should be monitorized and treated in an intensive care discipline. Here in some complications affecting survival of these patients are reviewed.

Background: The 'tin-tack' sign (TTS) is the appearance of horny processes that project from the under-surface of a crust. Although it is a well-known feature of discoid lupus erythematosus it may be also seen in other crusted lesions particularly in cutaneous leishmaniasis (CL). Objective: The purpose of this study was to determine the value of TTS in the clinical diagnosis of CL. Materials and Methods: We studied 472 patients with diseases known to have the potential of producing 'tin-tack' crusts or scales. After detection of the crusted lesions, the presence of TTS was investigated in these lesions. Results: TTS was positive in approximately 10% of the study group. The positive TTS
was a frequent finding (over 75%) in the late ulcer stage of CL. The positive TTS was found to have a poor sensitivity and negative predictive value but a high specificity and positive predictive value in diagnosis of the patients with CL. Conclusion: Although it is not disease-specific, a positive TTS may be an indicative sign of CL with a high probability in the regions where CL is endemic.

Background and Design: Chronic urticaria remains a major problem in terms of etiology and investigation. Physical stimuli and functional autoantibodies are main causes of chronic urticaria. Appropriate challenge tests to identify patient whom physical urticaria and autologous serum skin test to identify patients who have functional autoantibodies are most important tests to show the etiology of chronic urticaria. Materials and Methods: Basic blood, urine and stool examinations and appropriate challenge tests to determine physical urticaria had been performed in 88 patients with
chronic urticaria. The patients associated with angioedema were investigated for the level of C4. The patients who had cholinergic urticaria were examined for atopic dermatitis, allergic asthma, allergic rhinitis and investigated for the level of total IgE /specific IgE. The patients with cold urticaria evaluated for cryoglobulin, cold agglutinin and cryofibrinogen. Autolog serum skin test was performed in 35 patients with chronic urticaria. Results and Conclusion: Challenge tests to determine physical urticaria were positive in 73 (%83,3) of the 88 patients. Cholinergic urticaria was present in 29 (%39,72) of the 73 patients and was the most common of all the physical urticaria. Twenty- seven patients (%36,98) had physical urticaria types concurrently. Autologous serum skin test was positive in 24 (%63,15) of 35 patients with chronic urticaria. We suggest that
physical stimuli and autoimmune antibodies play the most important role in the etiopathogenesis of chronic urticaria.

Background and Design: The cause of chronic urticaria can not be determined in most cases. Though it is known that physical stimuli are mentioned etiologically in 20- 30 % of all urticarias, the recent studies have shown that this rate can increase up to 71-80 %. Since the studies to determine the cause of chronic urticaria requires too much time and costs a lot of money which may be exhausting. In this study, the rate of physical urticarias has been searched by easily applicable tests. Materials and Methods: 53 patients, who had urticaria lesions everyday in their bodies for at least last four weeks have been included to this study. The standardized tests for dermographism, pressure urticaria, cold urticaria, heat urticaria, cholinergic urticaria and aquagenic urticaria were applied to patients respectively. Results: At least one physical urticaria was found in 37 patients (69.8 %), dermographism in 28 patients (52.8 %), pressure urticaria in three patients (5.7 %),
cholinergic urticaria in two patients (3.8 %), cholinergic urticaria and dermographism in two patients (3.8 %), pressure urticaria and dermographism in one patient (1.9 %), cholinergic urticaria, heat urticaria, cold urticaria and dermographism in one patient (1.9 %) out of 53 patients with chronic urticaria were found. Aquagenic urticaria was determined in none of the patients. Conclusion: Physical urticarias, which are determined at a very high rate (70 % approximately) should be the first step of investigating the etiology of chronic urticaria according to us.

Background and Design: Chronic idiopathic urticaria (CIU) is a common disease of which pathogenesis is unclear and resistant to therapy. Recent investigations have indicated that autoimmunity plays role in nearly one third of CIU patients. The present study aimed to investigate the relationship between HLA Class I and Class II antigens and immune pathogenesis of CIU.
Materials and Methods: HLA Class I and Class II antigens were investigated in 55 patients diagnosed as CIU, utilizing two stage microlymphocytotoxicity test. Seventy one healty and genetically unrelated individuals were evaluated as control group. Results: While significant differences were not found between patient and contro groups in all HLA Class I antigens and DQ locuses of Class II HLA antigens, HLA DR13 antigens were statistically high in patient group( p=0.03). Conclusion: We assume that the presence of antigens HLA DR13 could increase the incidence of CIU and play a role in its pathogenesis.

Background and Design: Chronic idiopathic urticaria (CIU) is characterized by
urticaria attacks of longer than 6 weeks' duration with unknown etiology and is more
frequent in women and young adolescents. Since the basis of its' therapy depends
on the blockage of the effects of histamine sequestered, first generation H1 histamine
antagonists are preferred as the first option. Epicutaneous histamine test is often
used to evaluate the effects of these drugs.
Materials and Methods: In our study, a total of 60 patient (44 women, 16 men)
applied to Uluda University Medical Faculty, Dermatology Clinic between 1999-2000
years and diagnosed as CIU, aged between 15-74 years were given 180 mg/day
fexofenadine p.o. for three months. The clinical symptoms and prick test results were
evaluated before and after therapy.
Results: Significant regression in both clinical symptoms and prick test results were
detected after therapy.
Conclusion: We believe that long-term use of antihistamines as three months can
provide suppression in the symptoms and because of the suppression of histamine
response in this duration, it is necessary to stop these drugs at least 10 days before
the epicutaneous histamin test applications.

Pemphigoid gestationis (PG) is a pregnancy dermatosis which has clinical and histopathological characteristics of bullous pemphigoid. The lesions which occur during PG have a tendency to make annular, vesiculobullous groups on erythematous-urticarial bases. Although 40-60 mg/day prednisolone treatment is mostly enough to supress the new blister formation, in severe cases
immunosupressive drugs, dapsone and plasmapheresis are needed. In this report, the efficiency of plasmapharesis is evaluated in a case with postpartum PG who had severe clinical manifestations and did not respond to high dose systemic corticosteroid treatment. We stressed that plasmapheresis could be a safe and effective method as alternatively in the treatment of severe PG.

Lichen planus (LP) is an itchy, inflammatory skin disorder that involves skin and mucous membranes. Lesions characterized by reddish-violet color, thin scaly and angled papule are extremely rare in linear distribution and generally exhibit in childhood. Verrucous (hypertrophic) LP is a distinct type of LP characterized by verrucous plaques, which consists of papules. A 48-year-old male patient was diagnosed as lichen planus in his right lower extremity, which started initially in hypertrophic character and then showed linear distribution. He had also zosteriform-distributed lesions on the ipsilateral lumbar and the abdominal skin areas. It has been seen that the case was carrying both rare lesional morphology and distribution altogether and resisted to treatments.

Ichthyosis linearis circumflexa is a rare ichthyosiform dermatosis characterized by erythmatous, double-edged scaling lesions. Netherton syndrome is defined as a classical triad composed of ichthyosiform dermatosis presenting mostly as ichthyosis linearis circumflexa, various hair shaft defects and atopic manifestations. We report 2 cases of ichthyosis linearis circumflexa associated with some atopic manifestations and 1 case of Netherton syndrome. Since atopic manifestations may be associated with ichthyosis linearis circumflexa and spontaneous remission may be observed in hair abnormalities in Netherton syndrome, we think that these two dermatoses might be regarded as two ends of the same disease spectrum.

Fox-Fordyce disease is a rare and sporadic cutaneous disorder characterized by pruritic follicular papules as a result of apocrine sweat retention. The most important step in the pathogenesis of the disease is the keratinious obstruction and rupture of apocrine ducts. Herein we report a typical case of Fox-Fordyce disease and discuss the clinicopathological features of the disorder in view of the medical literature.

Carcinoma erysipelatoides (CE) is an erysipelas like condition resulting from cutaneous metastases and lymphatic dermal occlusion with metastatic cells of internal malignancies. Although, most commonly it occurs due to breast carcinoma, it may also be associated with other carcinomas such as gastric malignancy. Here, we present a 55-year-old male with CE, who has erythematous indurated plaques in the left pectoral area and associated with a gastric adenocarcinoma. This
is the first case of CE associated with gastric adenocarcinoma in the Turkish dermatological literature.

Mycophenolate mofetil is a potent immunosupressor agent, found its place in the dermatological treatment in the recent years, after it was proved to be effective in the prevention and treatment of acute renal allograft rejection. It was first used in 1975 for the treatment of psoriasis, and then considered as an effective and safe treatment modality for autoimmune bullous diseases. Clinical studies support the opinion that mycophenolate mofetil can be an alternative treatment for a spectrum of autoimmune and inflammatory skin diseases.