BACKGROUNDVitiligo is an acquired pigmentary skin disorder that affects 0.5% to 2.0% of the population.OBJECTIVEPatients' knowledge, opinions, and attitudes about vitiligo were evaluated.METHODSThe team conducted a cross-sectional, descriptive, prospective study between June 2014 and May 2015. The study included 100 patients aged over 12 years who were diagnosed with vitiligo. A questionnaire including items on knowledge, opinions, and beliefs about vitiligo and the Illness Perception Questionnaire (IPQ) were filled out by the patients, and the results were analyzed.RESULTSIn total, 100 (58 female, 42 male) patients were included in the study. Of them, 74% knew the name of their disease, 90% thought that vitiligo was not contagious, 48% reported that they obtained information on the disease from a doctor, and 69% believed they had adequate information on vitiligo. Eighty percent reported no negative effects from vitiligo on relationships with friends or family. It was believed that stress, excessive sun exposure, and heredity were causes of vitiligo, according to 84%, 37%, and 22% of the patients, respectively. Thirty-six patients (36%) believed that their illness was a serious disease and 35% deemed that it did not have a major impact on their lives.CONCLUSIONSOur results show that vitiligo patients were generally highly aware of their condition. The disease did not negatively affect patient opinions or attitudes about vitiligo. The authors believe that improving patient-physician communication will impact positively on the course of the disease.

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We present a case of in-transit metastasis in a nonimmunosuppressed patient with a primary cutaneous squamous cell carcinoma.

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Conflicts of interest:None declared.To the Editor, Methotrexate (Mtx) is an immunosuppressive and antimitotic agent that terminates deoxyribonucleic acid (DNA) synthesis by inhibiting the enzyme dihydrofolate reductase. The spectrum of clinical usage and the side effects are quite common. Reactivation of radiation dermatitis, generalized maculopapular rash, stomatitis, and exacerbation of acne lesions can be associated with the use of Mtx (1). Phototoxicity is a direct tissue damage that is caused by phototoxic agents and UV light via inflammatory mediators (2).Sunburn reactivation is a rare and specific UV recall dermatitis that is seen in patients previously suffering from sunburn (3). This phenomenon is quite different from other cytotoxic drug-induced radiation recall dermatitis. Low dose Mtx given to psoriasis patients does not appear to cause this recall reaction. This may be a time-and doserelated reaction (1). Some points will be emphasized in this paper to avoid this side effect.A 45-year-old male who was receiving Mtx treatment for psoriasis developed an erythematous, painful, and edematous rash on the chest, abdomen, and extremities. He went to the shore for swimming and sunbathing on Sunday and had a moderate erythema on sun-exposed areas. Three days after sunbathing, he took 16 tablets of Mtx (2.5 mg tablets, a total of 40 mg) by mistake, even though he was prescribed to take 10 mg a week. Twentyfour hours after receiving high-dose Mtx, the patient noticed burning and increased redness on his skin at sites where he had sun-induced erythema previously. The dermatologic examination revealed erythema on the sunexposed areas of his upper back, chest, arms, and legs. There was erythematous to violaceous and edematous plaques with hyperemia and pain in involved skin areas (Fig. 1a, b). Patient was hospitalized, and Mtx therapy is ceased. It was revealed from the patient's history that he has been taking Mtx 40 mg/week since 6 weeks, and his psoriasis was in remission. Complete blood count and biochemical values were in normal range. Histopathological examination revealed epidermal spongiosis, intraepidermal apopitotic keratinocytes, and vesiculation, which was consistent with phototoxic reaction. Symptomatic treatment with wet dressings and antihistaminics resulted in a rapid resolution of the lesions. He was free of psoriasis lesions when he was discharged from the hospital but had recurrence after 6 weeks.Mtx is an antimitotic and immunosuppressive agent used for the treatment of cancer, psoriasis, and rheumatologic disorders. The well-known side effects include mucosal ulceration, hepatotoxicity, pulmonary fibrosis, myelosuppression, alopecia, and renal toxicity (1).