Subclinical atherosclerosis in patients with hidradenitis suppurativa treated with TNF inhibitors.

BACKGROUND: Hidradenitis suppurativa (HS) is an independent risk factor for the development of subclinical atherosclerosis. Tumour necrosis factor (TNF) inhibitors are effective for the treatment of recalcitrant moderate-to-severe HS. However, the effect of treatment with TNF inhibitors on subclinical atherosclerosis in HS patients has not been previously investigated. OBJECTIVES: In this study, we aimed to assess changes in biochemical parameters (fasting blood glucose and lipid levels) and carotid intima-media thickness (CIMT) values in Hurley stage II and III HS patients undergoing treatment with TNF inhibitors. METHODS: This was a single center prospective study including 30 patients with Hurley stage II and III HS and 30 healthy controls (HCs). Baseline values of biochemical parameters and CIMT were compared to the values recorded after at least 6 months of TNF inhibitor therapy. RESULTS: CIMT values of the HS patients significantly exceeded those of HCs (for right p = 0.011 and for left p = 0.017). After at least 6 months of TNF inhibitor therapy, there was a statistically significant decrease in fasting blood glucose (p = 0.001), whereas total cholesterol levels significantly increased (p = 0.001). CIMT values also significantly increased (for right p = 0.02 and for left p = 0.01). STUDY LIMITATIONS AND CONCLUSIONS: Small sample size is limitation of the current study. Our study shows that patients with Hurley stage II and III HS undergoing TNF inhibitor therapy are under risk for progression of subclinical atherosclerosis.

The comparison of demographics and comorbidities of female pattern hair loss according to the clinical subtype and stage.

BACKGROUND: Previous literature regarding the frequencies of each subtype of female pattern hair loss is contradictory and the subtypes have not been compared to each other in terms of their epidemiologic characteristics and relationships with comorbid diseases. OBJECTIVES: The aims of this study are to determine the frequency and the relationship with comorbidities for each subtype, and to determine the relationship of clinical stage with age and comorbid diseases. METHODS: This is a prospective cross-sectional study involving patients with a definitive diagnosis of female pattern hair loss. The age, age at the time of diagnosis, family history for androgenetic alopecia, clinical subtype, clinical stage, and comorbid conditions were noted for each patient. SPSS version 21 (IBM SPSS) was used for statistical analysis. RESULTS: Advanced stages of female pattern hair loss are related to increased age, menopausal state, and hypertension. Acne vulgaris is more prevalent in earlier stages. Hirsutism and acne vulgaris are more commonly encountered in the Ludwig and Hamilton subtypes. Hypertension is more frequent in Ludwig subtype. LIMITATIONS: The confounding effect of age on the relationship between clinical subtype and comorbid diseases. CONCLUSION: The relationship between comorbid diseases and stage in specific subtypes can guide us to the diagnosis of undiagnosed comorbid diseases.

Evaluation of the alopecia areata patients on tofacitinib treatment during the COVID-19 pandemic.

Tofacitinib is a Janus Kinase 3 inhibitor that is used in the treatment of alopecia areata. We recommended our alopecia areata patients to discontinue their tofacitinib treatment during the COVID-19 pandemic for an average of 80 days. We aimed to evaluate the drug use and the SARS-CoV-2 infection status of alopecia areata patients; and the relationships of recurrence to age, gender, treatment duration, and tofacitinib discontinuation. One-hundred and ninety-one (61.4%) patients were off the drug and 120 (38.6%) were on therapy during the pandemic. The relationship between drug discontinuation due to the COVID-19 pandemic and recurrence was statistically significant (P < .001). Statistically significant relationships of age (P = .013) and treatment duration (P < .001) to recurrence were also found. The change in the SALT score differed between the patients on therapy and off therapy during the pandemic (P < .001). A significant negative correlation was found between the change in the SALT score and treatment duration: the spearman correlation test P = .018. We concluded that the patients may continue to the tofacitinib therapy during the rest of the COVID-19 pandemic if the benefit outweighed the risk.

Can rituximab be used in the treatment of pemphigus vulgaris during the COVID-19 pandemic?

Rituximab is a monoclonal antibody that targets CD20, a B-lymphocyte antigen; that leads to a decline in the B-cell counts for at least a year. The patients who have received rituximab treatment in the previous 5 years with the diagnosis of pemphigus group of diseases at Cerrahpasa Medical Faculty were questioned for COVID-19 infection. A total of 48 patients were included in this study; only one male patient had COVID-19 infection which had a mild course. There is no significant difference in the total number of lymphocytes between patients who have received rituximab within the previous 5 years or last year. The number of lymphocytes is independent of the number of courses of rituximab treatment received. Therefore, we suggest that all pemphigus patients who have received rituximab treatment within the previous 5 years should be careful of the preventive measures against the COVID-19 infection irrespective of the number of treatment courses or the number of years which has passed since the treatment. The disease course was mild in the only infected patient. Thus, rituximab may be used in the treatment of pemphigus vulgaris during the COVID-19 pandemic if its use is necessary.

Evaluation of the changes in sebum, moisturization and elasticity in acne vulgaris patients receiving systemic isotretinoin treatment.

AIM: The aim of this study was to determine the change in facial skin sebum, hydration and elasticity of acne vulgaris patients after being treated with systemic isotretinoin. METHOD: Patients who were diagnosed with acne vulgaris and who received systemic isotretinoin treatment for 6 months in Cerrahpasa Medical Faculty Department of Dermatology between June 2012 and May 2017 were included in this study. The sebum, hydration and elasticity of the skin were measured non-invasively with a device called "Soft Plus Skin Analyses System" before treatment and 6 months after treatment. The relationship between the pre-treatment and post-treatment values were evaluated statistically. 35 adult patients (20 female, 15 male) who were diagnosed with acne vulgaris and who received systemic isotretinoin treatment for 6 months. RESULTS: The pre-treatment sebum value for both sexes ranged between 5 and 100 and the mean value was calculated as 75.8 ± 28.0. The post-treatment sebum values ranged between 1 and 98 and the mean value was calculated as 48.4 ± 31.8. The difference between the pre-treatment and post-treatment values was statistically significant, p < 0.001. The decline in sebum value after treatment was 36%. The pre-treatment hydration values ranged between 9 and 77.5 and the mean was 34.6 ± 14.6. The post treatment hydration values ranged between 4.8 and 100 and the mean was calculated as 62.4 ± 28.6. The difference between the pre-treatment and post-treatment hydration values were statistically significant, p < 0.001. The post-treatment increase in hydration was 79%. The pre-treatment skin elasticity ranged between 28 and 50; the mean was 40.4 ± 5.5. The post-treatment elasticity values ranged between 20 and 50; and the mean was 37.5 ± 8.2. However, the difference was not statistically significant (p = 0.1). CONCLUSION: With this study, it was concluded that, systemic isotretion leads to a 36% decline in skin sebum values and a 79% increase in the skin hydration. However, the change in skin elasticity was not statistically significant. Furthermore, the changes in sebum and skin hydration did not lead to a change in skin elasticity.

Treatment of alopecia areata with 2940-nm fractional erbium:yttrium-aluminum-garnet laser.

Various laser therapies have been used for the treatment of alopecia areata (AA). Enhanced hair regrowth was reported with the use of ablative fractional 2940-nm erbium:yttrium-aluminum-garnet (Er:YAG) laser in a murine model. However, clinical effectiveness of fractional Er:YAG laser for hair disorders has not been investigated in human studies. The aim of our study was to assess the effectiveness of 2940-nm fractional Er:YAG laser in the treatment of chronic AA that is unresponsive to conventional therapies. Twenty-five AA patients underwent three sessions, each 4 to 6 weeks apart, of fractional Er:YAG laser. Clinical evaluation was done at baseline and 1 month post-treatment (follow-up) by photographic assessment. Subjective evaluation by patient satisfaction score was also performed. Photographic evaluation of the patients revealed a mean percent change in SALT score of 17.4 ± 3.5% at follow-up. A total of 16 patients who were treated for patchy AA of the scalp showed 27.8 ± 31.3% regrowth. Five patients who were treated for AA of the beard had 39 ± 34.2% regrowth. Fractional Er:YAG laser might be a therapeutic alternative for patients with patchy AA of the scalp and beard that is unresponsive to conventional therapies.

Inpatient dermatology consultations during COVID 19 pandemic in a tertiary referral center.

Since the COVID-19 infection first appeared in December 2019, patient profile of outpatient and inpatient clinics has changed. Various cutaneous findings associated with COVID-19 have been reported in the literature. The main objective of this study was to describe and analyze the profile of the consultations requested from dermatology department during the COVID pandemic. Retrospective, cohort study. In this study, we observed the dermatology consultations of the hospitalized patients over a period of 2 months, corresponding to the peak of COVID outbreak in a tertiary care hospital in Turkey. We reviewed the inpatient dermatology consult database retrospectively. Both pediatric and adult dermatology inpatient consultations were evaluated. A total of 166 inpatient dermatology consultations were requested from dermatology department during March-May, 2020. The mean age of the patients was 53.12 (1-89) years. Almost 32.5% (n = 54) of dermatology consultations were requested from the COVID wards and the COVID intensive care unit. The second most common consultations were requested from internal medicine departments (n = 46, 27.7%). The most common indications for the consultations were cutaneous infections (36%), followed by inflammatory disorders (32%), and urticaria (11%). Dermatology consultations have an essential role on the management of hospitalized patients, especially at that pandemic time. Careful dermatological examination improves diagnostic accuracy in skin disorders and skin manifestations of COVID-19 infection that provides an early diagnosis and treatment, helps to improve the quality of the patient care and management.

Erythroderma: A clinicopathological study of 47 cases from 2018 to 2020.

Erythroderma, or exfoliative dermatitis, is an inflammatory disorder characterized by erythema and scaling, affecting most of the skin surface. It may be a result of many different causes such as previous dermatoses (psoriasis, eczema, atopic dermatitis [AD], pityriasis rubra pilaris, and pemphigus foliaceous), drug reactions, malignancies (mycosis fungoides [MF], Sézary syndrome, adult T cell leukemia/lymphoma), infections, and idiopathic disorders. Regardless of the etiology, the clinical appearance of erythroderma is similar in all patients. The most prominent physical examination findings in almost all patients are diffuse erythema and scaling. In a 2-year period, 47 patients who were hospitalized and treated in our department were included in the study. We classified patients into seven subgroups: psoriasis, AD, drug-induced erythroderma, MF, pityriasis rubra pilaris, bullous pemphigoid, and polymorphous light eruption. All patients had a biopsy during the acute stage and diagnoses were histopathologically confirmed. Some patients had multiple biopsies for histopathological confirmation. In our study, the majority of the patients were men over the age of 54. The most common etiological cause of erythroderma is psoriasis. We aim to analyze clinical, laboratory, and histopathological findings of erythrodermic inpatients prospectively in Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty between January 2018 and 2020.

Alendronate induced subacute cutaneous lupus erythematosus successfully treated with intravenous immunoglobulin.

The subacute cutaneous lupus erythematosus (SCLE) is a distinct subtype of lupus erythematosus (LE) representing specific clinical and serological features. Almost 20%-30% of the cases with SCLE are predicted to associated with medications. Thiazide diuretics, terbinafine, antiepileptic, and proton pump inhibitors are the best-known drugs to induce drug-related SCLE. Herein we want to present a 65-year-old female with alendronate induced SCLE, resistant to classical therapies, and respond well to intravenous immunoglobulin (IVIG), suggesting that IVIG could be an alternative treatment in patients resistant to classical treatment protocols.

Cutaneous manifestations in hospitalized patients diagnosed as COVID-19.

Cutaneous manifestations of COVID-19 disease have not yet been fully described. To describe cutaneous manifestations of COVID-19 disease in hospitalized patients. We examined the cutaneous manifestations of 210 hospitalized patients. Cutaneous findings were observed during COVID-19 infection in 52 of the patients. Lesions may be classified as erythematous scaly rash (32.7%), maculopapular rash (23%), urticarial lesions (13.5%), petechial purpuric rash (7.7%), necrosis (7.7%), enanthema and apthous stomatitis (5.8%), vesicular rash (5.8%), pernio (1.9%), and pruritus (1.9%). Cutaneous manifestations were observed statistically significantly more in certain age groups: patients of 55 to 64 and 65 to 74 years of age complained of more cutaneous manifestations than the other age groups. As for gender, there was no significant difference between male and female patients in terms of cutaneus findings. The relationship between comorbidity and dermatological finding status was statistically significant. The relationship increases linearly according to the comorbidities. According to the statistical results, the patients who were hospitalized in the intensive care unit had a higher risk of having cutaneous findings due to COVID-19 infection. With this study, we may highlight the importance of overlooked dermatological findings in patients that are hospitalized.

Relationship between fecal calprotectin level and disease activity in patients with hidradenitis suppurativa.

BACKGROUND: Hidradenitis suppurativa is a chronic, inflammatory, recurrent disease with recurrent abscesses, and sinus tract formation leading to scarring. Calprotectin has immunomodulatory, antimicrobial, and antiproliferative properties and is a calcium-binding protein primarily found in the neutrophil cytoplasm. In recent years, a significant relationship between the activity of various diseases and the level of calprotectin has led to the conclusion that there may be a similar relationship in hidradenitis suppurativa. OBJECTIVE: To determine the relationship between disease activity and fecal calprotectin levels in patients with hidradenitis suppurativa. METHODS: Fifty patients with hidradenitis suppurativa (case group) who present to the Dermatology and Venerology Department between December 6, 2017, and April 6, 2018, and 36 healthy volunteers (control group) were enrolled in our study. Fecal calprotectin levels we requantitatively calculated using enzyme-linked immunosorbent assay. RESULTS: In patients with active hidradenitis suppurativa, the level of stool calprotectin was higher than that of patientsin remission, and this difference was statistically significant (p < .001). There was no statistically significant correlation between disease stage and fecal calprotectin levels in patients with hidradenitis suppurativa (p = .14). Age, sex, smoking and alcohol use, anti-TNF-α treatment, and fecal calprotectin levels were not significantly correlated. In our study, fecal calprotectin levels in patients with active hidradenitis suppurativa were higher than inpatients in remission (p < .001). CONCLUSION: Fecal calprotectin can beused as a marker of disease activity in hidradenitis suppurativa.

Retrospective Analysis of the Effect of Comorbid Atopic Dermatitis on the Treatment Response to Topical Immunotherapy in Pediatric Alopecia Areata Patients.

INTRODUCTION: Alopecia areata is an organ-specific autoimmune disease. In addition, treatment options are limited in pediatric patients. Topical immunotherapy treatment may be preferred, especially in pediatric patients with severe and/or refractory alopecia areata. OBJECTIVES: In this study, it was aimed to examine the effect of atopic dermatitis, which is one of the poor prognostic factors in pediatric alopecia areata, on topical immunotherapy treatment. METHODS: The data of patients aged 18 years and younger who received at least 20 sessions of topical immunotherapy with the diagnosis of alopecia areata in our clinic between January 2018 and December 2020 were analyzed. RESULTS: A total of 139 patients were included in the study. The mean age of the patients was 10.29 years, 67 (48.20%) of the patients were female, 72 (51.80%) were male, 24 (17.26%) of the patients had mild disease, 115 of them (82.73%) had severe disease. Atopic dermatitis accompanying alopecia areata was detected in 38 of the patients. Inadequate response was obtained in 60 (43.17%) patients and adequate response was obtained in 79 (56.83%) patients with topical immunotherapy treatment. In addition, the presence of atopic dermatitis in the patient group with inadequate response to treatment was found to be statistically significantly higher than the patient group with adequate response to treatment. CONCLUSIONS: Topical immunotherapy treatment was found to be effective in 56.83% of pediatric alopecia areata patients included in the study. Our study showed that questioning pediatric alopecia areata patients for atopic dermatitis before topical immunotherapy treatment can predict the response to treatment.

Evaluation of quality of life scores and family impact scales in pediatric patients with alopecia areata: a cross-sectional cohort study.

BACKGROUND: There are a limited number of studies evaluating the effects of alopecia areata (AA) on the health-related quality of life (HRQoL) of pediatric patients and their families. This study aimed to assess the HRQoL of pediatric patients with AA and their parents. MATERIALS AND METHODS: This single-center cross-sectional cohort study included 72 pediatric patients diagnosed with AA. The study was conducted between December 2020 and December 2021 in the dermatology department of a single tertiary center in Turkey. The HRQoL index of the pediatric patients was assessed with the Children's Dermatology Life Quality Index (CDLQI). At the same time, their parents, who were primarily involved in the disease process, were evaluated using the Dermatological Family Impact Scale (DeFIS). An ordinal logistic regression model was used to detect predictors for CDLQI severity. RESULTS: The mean ± SD CDLQI of the pediatric patients who participated in our study was 8.4 ± 5.3, corresponding to moderate impairment. The highest impairment in CDLQI was observed in the symptoms and feelings domain, while the slightest impairment was observed in the domain of personal relationships (P < 0.001). There was a statistically significant positive correlation between the Severity of Alopecia Tool (SALT) score and all CDLQI domains, and the most substantial relationship was with the leisure domain (r = 0.78, P < 0.001). DeFIS scores of female patients were substantially higher than males (25.3 ± 8.6 vs. 17.6 ± 9, P = 0.001). CONCLUSION: Our study supports that AA is a disease that significantly impacts the HRQoL of affected children and their families.

Relationship of psoriatic arthritis with nail and scalp involvement in Turkish psoriasis patients: Multicentered cross-sectional study.

Psoriasis is a common multisystem inflammatory disease, and arthritis is an essential component of the disorder, requiring early diagnosis and prompt treatment for successful management. In this study, we aimed to investigate the relationship between nail and scalp involvement and other covariates with psoriatic arthritis (PsA). This cross-sectional study, conducted from June 2021 through December 2021, included 763 patients from 11 different centers in Turkey. The severity of involvement was evaluated using psoriasis area severity index (PASI), nail psoriasis severity index (NAPSI), and psoriasis scalp severity index (PSSI) scores. Predictors for PsA were evaluated using univariate and multivariate logistic regression models. PsA (n = 155, 21.5%) was significantly more common in patients having a family history of psoriasis (43.2% vs 30.9%, P = .004), nail involvement (68.4% vs 52.3%, P < .001), and coexistence of nail and scalp involvement (53.7% vs 39.6%, P = .002). Furthermore, patients with PsA had considerably higher PASI (7 vs 5.6, P = .006), NAPSI (5 vs 2, P < .001), and PSSI scores (7 vs 4, P = .002) and longer disease duration (months) (126 vs 108, P = .009). In multivariate analysis, female gender [OR: 3.01, 95% CI (1.861-4.880), P < .001], nail involvement [OR: 2.06, 95% CI (1.293-3.302), P = .002)], and body mass index (BMI) [OR: 1.06, 95% CI (1.017-1.100), P = .005] were identified as independent predictors for PsA. Female gender, nail involvement, and high BMI are significant predictors for PsA and warrant detailed rheumatological assessment. Notably, being female is the strongest predictor of increased risk of PsA in our survey. Scalp involvement appears not to be associated with PsA. Also, the presence of PsA seems related to a more severe skin involvement phenotype.

Comparative study of the efficacy of fractional Er: YAG 2940 nm laser and Q-switched Nd: YAG 1064 nm laser in keratosis pilaris.

BACKGROUND: Keratosis pilaris is a common keratinization disorder of the extensor surfaces of the proximal extremities. Various treatment modalities reduce symptoms, but their efficacy is limited. AIMS: The aim of this study is to compare the efficiency of Q-Switched Nd: YAG laser and fractional Er: YAG laser. MATERIAL/METHOD: The lesions in both arms were randomly divided into areas A and B. Fractional Er: YAG 2940 nm laser performed to area A 1.5 J/cm2 , spot size 7 mm, frequency 3 Hz and three passes and Q-Switched Nd: YAG 1064 nm laser performed to Area B, 4-6 J/cm2 spot size 4 mm, 8 Hz frequency, and as a single pass. Both lasers were performed in 4 sessions at 3-week intervals. The global improvement scale evaluated treatment responses in dyspigmentation and skin texture. RESULTS: Twenty patients completed the study, and the mean age of a total of 20 patients was 22.9. There was no significant difference in dyspigmentation and skin texture with global improvement scale between Area A and Area B, respectively (p = 0.078, p = 0.638). In addition, there was no significant difference between patient satisfaction levels after treatment in Area A and Area B (p = 0.868). CONCLUSION: The efficiency of the fractional Er: YAG 2940 nm laser was found equal to the Q-switched Nd: YAG 1064 nm laser. Fractional Er: YAG 2940 nm laser may be a new treatment option in the treatment of keratosis pilaris.

The Association between the Number of Follicular Stelae and Severity and Treatment Response of Alopecia Areata Cases: A Retrospective Study.

Background: Alopecia areata (AA) is an autoimmune disease characterized by peribulbar lymphocytic infiltration, follicular miniaturization, catagen/telogen follicles, and increased follicular stelae (streamers) in skin biopsies. Objectives: Our aim was to assess the number of follicular stelae of patients with AA and to evaluate their association with clinical type and severity and treatment response of AA. Materials and Methods: Histopathologic features including number of follicular stelae were recorded in skin biopsies taken from lesions of AA in 142 patients who attended our dermatology clinic from 2011 to 2017. Results: There was a statistically significant correlation between the patient age and the number of follicular stelae (P = 0.001). There was a statistically significant correlation between the severity of disease and the number of follicular stelae (P = 0.005). AA subtypes (0%-25% scalp hair loss) had a significantly lower number of follicular stelae than 75%-100% scalp hair loss and alopecia universalis (7.92 ± 4.21 vs. 13.23 ± 7.28). There was no statistically significant correlation between the treatment response and the number of follicular stelae (P = 0.75). Conclusion: Our results showed that number of follicular stelae varied among AA clinical types and correlated with severity. This study was the first to evaluate the correlation between the number of follicular stelae and severity of AA.

Association of alopecia with self-esteem in children and adolescents.

OBJECTIVES: Hair is important for individuals due to its cosmetic functions and its anatomical and physiological features. Hair loss in children significantly affects their social and psychological well-being and may lead to significant psychological distress in those not benefiting from medical and/or traditional therapies. Accordingly, the aim of the present study was to evaluate the self-esteem in children and adolescents with alopecia areata. METHODS: This comparative study included children and adolescents with the diagnosis of alopecia and age- and sex-matched healthy controls. Self-esteem was evaluated by the Rosenberg Self-Esteem Scale (RSES). RESULTS: The study included 64 patients with alopecia (M/F, 32/32; mean age, 12.2 ± 3.0 years) and 60 healthy controls (M/F, 30/30; mean age, 12.0 ± 3.0 years). Age (p=0.64) and sex (p=1.0) distributions were similar between the groups. Of the patients, 35 had alopecia areata, 21 had alopecia universalis, and eight had alopecia totalis. The RSES score of patients was significantly higher than that of the controls (median [interquartile range], 1 [0-2] and 1 [0-1], respectively; p=0.008). The distribution of the participants according to the level of self-esteem (low, moderate, and high) based on the RSES scores revealed that, the proportion of patients with low and moderate self-esteem were significantly higher as compared with controls (p=0.001). The diagnostic subtype and sex did not affect the distribution of self-esteem scores in both groups. CONCLUSIONS: Hair loss is a significant factor affecting self-esteem of children and adolescents. Deteriorations in self-esteem may progress to psychological comorbidities if not approached, diagnosed, and treated timely and efficiently.