Background and Design: We aimed to compare the additional impact of dapsone gel and nadifloxacin cream as adjuvant treatments with systemic isotretinoin for moderate and severe acne vulgaris.
Materials and Methods: We retrospectively compared patients with moderate-to-severe acne vulgaris who received dapsone 7.5% gel or nadifloxacin 1% cream in combination with oral isotretinoin treatment at Altunizade and Ataþehir Acýbadem Hospitals between January 2021 and October 2023. Isotretinoin treatment was administered at fixed low doses of 10-30 mg/day alongside topical treatments until the lesions resolved. Thereafter, oral isotretinoin was continued as monotherapy for an additional two months after the clearance of active lesions.
Results: A total of 74 patients, 34 in the dapsone group (24 female, 10 male) and 40 in the nadifloxacin group (21 female, 19 male), were included in the study. The time to complete clearance of active lesions and the total treatment time were significantly shorter in the dapsone group (2.68±0.18 and 5.15±0.14 months, respectively) than in the nadifloxacin group (3.43±0.15 and 5.8±1.9 months, respectively). The cumulative dose of isotretinoin was significantly lower in the dapsone group (3376.5±71.9 mg) than in the nadifloxacin group (4155±88.4 mg). Skin dryness was observed more frequently in the dapsone group (29.4% vs. 12.5%), but this difference was not statistically significant (p=0.071).
Conclusion: Topical dapsone gel may be an effective adjuvant therapy to accelerate the treatment response to oral isotretinoin and reduce the cumulative dose of isotretinoin. However, larger prospective studies are needed to determine the optimal adjuvant treatment options.

Background and Design: Demodex mites are common ectoparasites of human hair follicles, and Demodex folliculorum (D. folliculorum) and Demodex brevis live on human skin. The role of Demodex in acne vulgaris remains controversial, and there is limited information regarding the effects of systemic isotretinoin on these mites. This study aimed to determine the presence and type of Demodex in acne vulgaris patients and to investigate the impact of oral isotretinoin treatment on Demodex infestation.
Materials and Methods: This prospective study included a total of 53 patients with moderate-to-severe acne vulgaris who were scheduled to start oral isotretinoin therapy. Standardized superficial skin biopsies were obtained from lesional areas before treatment and at the third and sixth months of therapy to assess the presence of Demodex.
Results: Demodex was detected in 31 (58.49%) of the 53 patients (39 female, 14 male). D. folliculorum + Demodex brevis (n=16), D. folliculorum (n=14), and Demodex brevis (n=1) were determined. Demodex was negative in all patients at 3 and 6 months of treatment. There was no statistically significant difference between Demodex positivity and Demodex type, disease duration, acne type, or acne localization (p>0.05).
Conclusion: Demodex brevis was frequently observed along with D. folliculorum. Oral isotretinoin treatment was effective against Demodex. Systemic isotretinoin may be considered a treatment option for patients with demodicosis.

Background and Design: Trichostasis spinulosa (TS) is a common but frequently underdiagnosed dermatological condition. Dermoscopy has recently been identified as the most practical and useful noninvasive diagnostic tool. This study aimed to assess the demographic, clinical, and dermoscopic features of TS, as well as the patients’ perspectives. The objective was to increase awareness of this disease.
Materials and Methods: This was a prospective descriptive study. A total of 100 adult patients diagnosed with facial TS at a tertiary center between October 2021 and April 2023 were included. Physical and dermoscopic examinations were performed. Demographic data, reasons for admission, age at onset, subjective complaints, comorbidities, previous treatments, treatment responses, lesion location, dermoscopic findings, and patient perspectives on the disease were recorded.
Results: Ninety-nine percent of the patients presented to the clinic with other dermatological conditions. The most common age group was 18-25 years. Of the patients, 81% were female and 19% were male. When patients’ perspectives were evaluated, 67% were aware of the TS findings, 52% reported being disturbed by the lesions, and 56% requested treatment of the lesions. On dermoscopy, vellus hairs surrounded by keratotic plugs were observed in 68% of patients and black comedone-like structures in 58% of patients, together with hair tufts. The combined presence of hair tufts, vellus hairs surrounded by keratotic plugs, and black comedone-like structures was observed in 33% of the patients.
Conclusion: TS can cause cosmetic distress, particularly in young adults. TS should be considered in the differential diagnosis of treatmentresistant, comedone-like facial lesions. In most cases, a practical diagnosis can be established using a dermatoscope.

Background and Design: Systemic therapies are frequently used off-label for the treatment of atopic dermatitis (AD); however, real-world data are limited.
Materials and Methods: This study aimed to evaluate the efficacy and safety of phototherapy and systemic treatments in patients with severe AD aged <18 years using real-world data. The study, designed as a single-center retrospective observational study, evaluated patients who received at least one systemic treatment or phototherapy between 2019 and 2022. Treatment response was assessed using the Physician Global Assessment (PGA) ordinal scale.
Results: This study evaluated 30 patients and 81 treatment courses. The most common treatment was cyclosporine (CSA), administered to 25 (83.3%) patients, followed by systemic corticosteroids (SCS), administered to 18 (60%) patients (treatment course: 21 patients). Azathioprine (AZA) was used in 12 (40%) patients, methotrexate (MTX) in 7 (23.3%) patients, phototherapy in 5 (16.6%, 6 treatment courses), intravenous immunoglobulin (IVIG) in 5 (16.6%), omalizumab in three (10%), dupilumab in one (3.3%), and mycophenolate mofetil in one (3.3%). While all courses of SCS and IVIG resulted in at least a good response (PGA1 or PGA2), the rates of patients with at least a good response to CSA, AZA, MTX, and phototherapy were 92%, 66.7%, 57.1%, and 50%, respectively (p=0.001). The percentage of patients experiencing side effects was 32% (n=8) for CSA, 23.8% (n=5) for SCS, 33.3% (n=4) for AZA, 14.3% (n=1) for MTX, and 33.3% (n=2) for phototherapy. Two patients discontinued CSA treatment due to side effects: one due to nausea and the other due to impetigo and febrile seizure. None of the patients discontinued other treatments because of side effects.
Conclusion: This observational study indicates that classical immunosuppressive treatments are effective alternatives for children with severe AD without serious side effects. However, comprehensive studies involving novel treatment modalities, such as biologics and small molecules, are warranted.

Background and Design: Giant condyloma acuminata (GCA), or Buschke-Loewenstein tumor, is a rare anogenital and perianal verrucous tumor associated with human papillomavirus infection, characterized by circular, exophytic, cauliflower-like tumors commonly seen in the anogenital area. This study aimed to identify the risk factors associated with GCA among patients with condyloma acuminata (CA) at the dermatology and venereology outpatient clinic of a tertiary referral hospital in Indonesia.
Materials and Methods: This retrospective descriptive study used secondary data from the medical records of patients who visited the dermatology and venereology outpatient clinic of a tertiary referral hospital in Surakarta, Indonesia, from January 2013 to December 2022. The data were statistically analyzed using a bivariate chi-square test, and significance was set at p<0.05.
Results: Of the 2202 outpatient visits, 313 patients were diagnosed with CA, of whom 28 were diagnosed with GCA. These GCA patients were predominantly male (71.43%) and aged between 21 and 40 years (57.14%). Most subjects were high school graduates (42.9%), private employees (50%), men who have sex with men (42.86%), and human immunodeficiency virus (HIV)-reactive (67.86%). The most common predilection site was the anal region (35.71%). The duration of the disease was less than one year (53.6% of patients). The most common therapy was cryotherapy (82.14%), followed by oral cimetidine (78.57%), topical potassium hydroxide (75%), and topical trichloroacetic acid 80% (67.86%). Bivariate analysis revealed that male sex (p=0.023), sexually active age (p=0.025), high school graduation (p=0.000), employment (p=0.000), and reactive HIV (p=0.001) were the risk factors for GCA.
Conclusion: GCA is a rare disease. The risk factors for GCA include being a sexually active male, having a high school education, being employed, and being HIV-reactive.

Aquagenic syringeal acrokeratoderma (ASA) is a rare, transient skin disorder characterized by the appearance of white papules and plaques on the palms after short-term exposure to water. We report a two-year case series involving 12 patients (8 males, 4 females) aged 7 to 32 years (mean age 19.25), all diagnosed with ASA. Symptoms developed within 1-6 min of water contact and resolved spontaneously within 20-52 min. Palmar involvement was present in all cases, without lesions on the fingertips, dorsal hands, or plantar surfaces. Diagnosis was made clinically in 10 patients and histopathologically confirmed in two. Seven patients reported symptoms, including itching, burning, or hyperhidrosis, whereas five remained asymptomatic. None had relevant medication use, recent viral illness, or known genetic predisposition, such as cystic fibrosis. Topical therapies provided partial relief; however, recurrence was common during the follow-up period. This study highlights the characteristic clinical presentation of ASA, the importance of clinical recognition, and the challenges in achieving sustained treatment success.