The relationship between sleep quality and chronotype differences and urticaria severity in patients with chronic spontaneous urticaria.

INTRODUCTION: Chronic spontaneous urticaria (CSU) is characterized by persistent or recurrent pruritic lesions that last more than 6 weeks. Patients with CSU may experience sleep disturbances, particularly due to itching. Biological rhythms (chronotypes) are categorized as morningness, intermediate, and eveningness types. This study evaluates the relationship between sleep quality, chronotype, and disease severity in CSU patients. METHODS: The study included 53 CSU patients and 50 healthy controls. A sociodemographic data form was completed, and the disease severity was determined utilizing the Urticaria Activity Score over 7 days (UAS7). The Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI), and Pittsburgh Sleep Quality Index (PSQI) scales as well as the Morningness-Eveningness Scale (MEQ) were applied to the participants. RESULTS: The CSU group had a significantly higher body mass index (BMI) than that of the healthy control group. In terms of sleep and chronotype scales, compared to the control group, the CSU group had higher ISI scores as well as subscale scores on the PSQI subscales, with the exception of habitual sleep efficiency and total PSQI scores. There was no difference between MEQ scores. In the correlation analysis, the UAS7 and PSQI total scores were found to be correlated, whereas in the logistic regression analysis the estimated relative risk of BMI and PSQI total score for CSU was found to be 1.13 and 1.45, respectively. CONCLUSIONS: When dealing with CSU patients, it is necessary to conduct a sleep quality assessment as part of a holistic evaluation.

Can chronic spontaneous urticarial produce symptoms of neuropathic pain?

Abstract Background Chronic spontaneous urticaria (CSU) is a condition that is associated with recurrent pruritic hives and/or angioedema lasting for more than 6 weeks and is known to affect 1% of the population. Neuropathic pain can be defined as abnormal pain in the peripheral or central nervous system following injury and results from dysfunctions in the peripheral or central nervous system without peripheral nociceptor stimulation. Histamine appears in the pathogenesis of both the CSU and diseases of the neuropathic pain spectrum. Objective To evaluate the symptoms of neuropathic pain in patients with CSU using scales. Method Fifty-one patients with CSU and 47 sex- and age-matched healthy controls were included in the study. Results The results of the short-form McGill Pain Questionnaire revealed the scores in the sensory and affective domains, Visual Analogue Scale (VAS) scores and pain indices to be significantly higher in the patient group (p < 0.05 for all cases), while the overall pain assessment and sensory assessment based on the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale were also significantly higher in the patient group. Based on the assumption that scores of > 12 indicated neuropathy, 27 (53%) of the patients in the patient group and 8 (17%) in the control group were found to have neuropathy (p < 0.05). Study limitations Cross-sectional study, small patient sample and use of self-reported scales. Conclusion In addition to itching, patients with CSU should be aware of the potential for the association of neuropathic pain. In this chronic disease that is known to affect the quality of life, using an integrated approach with the patients and identifying accompanying problems are as important as treating the dermatological disorder.

Effect of systemic isotretinoin therapy on semen parameters.

PURPOSE: Vitamin A has multiple functions in the human body, being involved in growth, epithelial differentiation, vision, immune function and reproduction. While normal spermatogenesis is influenced by several factors, it requires vitamin A. Systemic isotretinoin is a vitamin A derivative that is used in the treatment of many dermatological diseases, especially acne vulgaris (AV). There is limited research on the changes in semen parameters after systemic isotretinoin therapy in humans. Our study investigates the presence of varicoceles in patients undergoing systemic isotretinoin therapy for AV and examines whether there were any changes in the semen parameters before and after treatment. METHODS: Included in the study were 46 men patients who were scheduled for systemic isotretinoin therapy for AV. Before treatment, the patients underwent a physical examination and ultrasonography for varicoceles assessment. The patients underwent spermiogram before treatment and after 6 months of treatment. The spermiogram assessments included semen volume, sperm concentration, total sperm count, progressive motility, viability and sperm morphology. RESULTS: After treatment, there was an increase in semen volume, sperm concentration, total sperm count, progressive motility and vitality from the pre-treatment values, but a deterioration in the sperm morphology (p < .05). Comparing patients with and without varicoceles revealed more changes in semen parameters after treatment in those with varicoceles. There was a statistically significant difference in sperm concentration (p < .001). CONCLUSIONS: Systemic isotretinoin therapy negatively affects sperm morphology, but has positive effect on other semen parameters, and these changes in semen parameters occur more frequently in patients with varicoceles.KEY MESSAGESAcne vulgaris is a very common disease and systemic isotretinoin is used as the most effective agent in its treatment.Systemic isotretinoin positively affects semen parameters except sperm morphology.Changes in semen parameters are more common in patients with varicocele.

Can chronic spontaneous urticarial produce symptoms of neuropathic pain?

BACKGROUND: Chronic spontaneous urticaria (CSU) is a condition that is associated with recurrent pruritic hives and/or angioedema lasting for more than 6 weeks and is known to affect 1% of the population. Neuropathic pain can be defined as abnormal pain in the peripheral or central nervous system following injury and results from dysfunctions in the peripheral or central nervous system without peripheral nociceptor stimulation. Histamine appears in the pathogenesis of both the CSU and diseases of the neuropathic pain spectrum. OBJECTIVE: To evaluate the symptoms of neuropathic pain in patients with CSU using scales. METHOD: Fifty-one patients with CSU and 47 sex- and age-matched healthy controls were included in the study. RESULTS: The results of the short-form McGill Pain Questionnaire revealed the scores in the sensory and affective domains, Visual Analogue Scale (VAS) scores and pain indices to be significantly higher in the patient group (p < 0.05 for all cases), while the overall pain assessment and sensory assessment based on the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale were also significantly higher in the patient group. Based on the assumption that scores of > 12 indicated neuropathy, 27 (53%) of the patients in the patient group and 8 (17%) in the control group were found to have neuropathy (p < 0.05). STUDY LIMITATIONS: Cross-sectional study, small patient sample and use of self-reported scales. CONCLUSION: In addition to itching, patients with CSU should be aware of the potential for the association of neuropathic pain. In this chronic disease that is known to affect the quality of life, using an integrated approach with the patients and identifying accompanying problems are as important as treating the dermatological disorder.

Psoriasis and Its Relationship With Somatosensory Amplification, Health Anxiety, and Depression.

Objective The present study investigates the relationship between psoriasis and diseases such as health anxiety, depression, and somatosensory amplification. Methods The participating patients (n=117, including 60 psoriasis patients and 57 controls) filled out the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Somatosensory Amplification Scale (SSAS), and Health Anxiety Inventory (HAI) questionnaires. Results The mean scores from SSAS, HAI, and BDI were significantly higher in the psoriasis group than in the control group (p<0.05 in all comparisons). When the group medians of BAI were evaluated, the differences were not statistically significant, although BAI medians were higher in the patient group. Furthermore, a moderate correlation was found between the involvement of specific areas (especially the scalp and face) and SSAS scores. Conclusion Patients with psoriasis score highly in depression, health anxiety, and somatosensory amplification, and there was a moderate correlation between specific body area involvement (especially the scalp and face) and SSAS score. The results of this study seem to indicate that psychiatric assessment and treatment approaches should be included in the treatment of such chronic skin diseases as psoriasis that follow a life-long remission and relapse pattern.

A very rare localization of a rare disease: palmar lichen nitidus

Abstract Lichen nitidus is an uncommon lichenoid dermatosis that could be defined as multiple, separated, shiny, pinpoint, pale to skin-colored papules. Palmoplantar lichen nitidus is a quite rare variant of lichen nitidus. It is hard to make a diagnosis of palmar lichen nitidus when there are no lesions elsewhere on the body. There are some dermoscopic features defined for both palmoplantar and non-palmoplantar lichen nitidus that might be useful to facilitate the diagnosis before histopathological examination. Herein, we report a case of a 24-year-old man diagnosed with isolated palmar lichen nitidus with dermoscopic features and histopathological confirmation.

A very rare localization of a rare disease: palmar lichen nitidus.

Lichen nitidus is an uncommon lichenoid dermatosis that could be defined as multiple, separated, shiny, pinpoint, pale to skin-colored papules. Palmoplantar lichen nitidus is a quite rare variant of lichen nitidus. It is hard to make a diagnosis of palmar lichen nitidus when there are no lesions elsewhere on the body. There are some dermoscopic features defined for both palmoplantar and non-palmoplantar lichen nitidus that might be useful to facilitate the diagnosis before histopathological examination. Herein, we report a case of a 24-year-old man diagnosed with isolated palmar lichen nitidus with dermoscopic features and histopathological confirmation.

The Relationship of Acne With Somatosensory Amplification, Health Anxiety, and Depression Levels.

Objective The objective of this study is to evaluate the somatosensory amplification, as well as anxiety and depression levels in acne vulgaris (AV) patients, and to examine their relationship with disease severity. Methods Sociodemographic form, Global Acne Grading System (GAGS), Somatosensory Amplification Scale (SSAS), Health Anxiety Inventory (HAI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) were applied to the patient group. All scales, except GAGS, were also applied to the healthy controls. Results All psychiatric scale scores of acne patients were higher than those of the control group. Moreover, the patient group had significantly higher SSAS, BDI scores, HAI total scores, and subscales of hypersensitivity to somatic symptoms and anxiety compared to the healthy controls. A positive but weak correlation was found between all scale scores. In patients with AV, no correlation was found between acne severity, age, disease duration, and all scale scores. Conclusion A significant relationship was found between somatosensory amplification, depression, and health anxiety in acne patients, independent of global acne severity, age, and disease duration. More successful acne treatment and patient management will be possible with an interdisciplinary approach that includes both psychiatry and dermatology.

A case of pediatric psoriasis achieving remission after allogenic bone marrow transplantation.

BACKGROUND: Psoriasis is an inflammatory skin disease in which the cells and molecules of innate and adaptive immunity are involved in the pathogenesis. Aplastic anemia is a bone marrow deficiency syndrome that is characterized by an extreme reduction in the number of blood cells as a result of failure in hematopoiesis. Allogenic hematopoietic stem cell transplantation is a promising treatment for Aplastic Anemia and it is important to note that other comorbid diseases like psoriasis- since both have some common pathogenetic mechanisims- might achieve remission after treatment. CASE: We present a 12-years-old male patient who underwent bone marrow transplantation for aplastic anemia and his psoriasis vulgaris lesions completely regressed. The final follow-up visit on day 150 also revealed no sign of the pre-transplantation skin and scalp lesions. CONCLUSIONS: This is the first case of pediatric psoriasis together with aplastic anemia that achieved complete remission of psoriasis after bone marrow transplantation. Our case report needs to be supported by prospective studies involving larger patient populations.

Noninvasive assessment of subclinical atherosclerosis in patients with rosacea.

BACKGROUND: Rosacea is a chronic, inflammatory cutaneous disorder that is characterized by remissions and relapses that commonly occur in patients over the age of 30 years. There have been many studies in literature evaluating the relationship between cardiovascular disease and psoriasis, which is a chronic inflammatory disease; however, there have been very few studies to date evaluating the relationship between rosacea and cardiovascular disease risk. METHODS: The study included 52 consecutive rosacea patients and 52 healthy controls matched for age, gender and Body Mass Index. Demographic data, anthropometric measurements, lipid parameters, C-reactive protein (CRP), epicardial fat thickness (EFT) and carotid intima-media thickness (CIMT) were recorded. RESULTS: The main finding of the present study is the significantly higher EFT (P˂0.001) and CIMT (P˂0.001) values identified in patients with rosacea than in the control group and CRP (P=0.004), total cholesterol (P=0.003) and low-density lipoprotein (P=0.004) levels were also significantly higher in the rosacea group. EFT was significantly correlated with CIMT in the rosacea group (P=0.041). Total cholesterol (OR=1.032, P=0.017), CIMT (OR=7.391, P˂0.001) and EFT (OR=3.959, P=0.036) were independently associated with rosacea. CONCLUSIONS: Clinicians should be aware of the risk of cardiovascular disease when presenting with conditions involving persistent subclinical inflammation, as in the case of rosacea. EFT and CIMT measurements, which are noninvasive, easily accessible and cheap, can be useful to determine cardiovascular risk in rosacea patients.

Difficulties in emotion regulation and quality of life in patients with acne.

BACKGROUND: The psychological factors associated with the impairment of the quality of life (QoL) in acne vulgaris have not been fully elucidated, yet. The aim of the present study was to evaluate the performance of the difficulties in emotion regulation (DER) in predicting the QoL of patients with acne vulgaris and to examine the relationship between acne vulgaris and common psychopathologies, such as anxiety and depression. METHODS: A total of 141 patients were administered the difficulties in emotion regulation scale (DERS-Brief Form) (DERS-16), Hospital Anxiety and Depression Scale (HADS), and Acne Quality of Life (AQOL) Scale, while the control group including 102 participants was administered all scales other than the AQOL. RESULTS: The patients with acne vulgaris had significantly higher DERS scores than the control group. DER were found to predict quality of life more than acne severity. A strong positive correlation was found between the DERS and anxiety and depressive symptoms. There was no significant correlation between the acne severity and HADS and DERS scores, although only a weak correlation was found with the AQOL scores. The duration of acne showed no correlation with any of the variables. CONCLUSIONS: Our study results showed the relationship between the DER and acne vulgaris. The ignorance of this relationship while evaluating patients with acne may result in anxiety and depression symptoms and impairment in the QoL in the future. Hence, psychopathologies should be considered in acne treatment and patients should gain the ability of regulating their emotions through appropriate therapeutic approaches.

Evaluation of Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio in patients with Behçet's disease.

OBJECTIVE: Behçet's disease (BD), a multisystemic inflammatory disorder, has been associated with a number of cardiovascular dysfunctions, including ventricular arrhythmias and sudden cardiac death. The mechanism of increased ventricular arrhythmias in BD remains uncertain. The aim of the present study was to assess the ventricular repolarization by using the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio as candidate markers of ventricular arrhythmias in patients with BD. METHODS: A total of 42 patients (mean age: 42.71±10.99 years) with BD and 50 sex- and age-matched healthy volunteers (mean age: 39.24±11.32 years) as the control group were evaluated. The risk of ventricular arrhythmia was evaluated by calculating the electrocardiographic, the Tp-e interval, and the QT, QTc, Tp e/QT, and Tp-e/QTc ratios. RESULTS: QTmax (p=0.005), QTcmax (p=0.015), QTmin (p=0.011), and QTcmin (p=0.024) were statistically significantly higher in the BD group than in the control group. The Tp-e, cTp-e, Tp-e/QT, and Tp-e/QTc ratios were also significantly higher in patients with BD than in the control group (80.26±4.55 and 74.74±6.47, respectively, p<0.001; 88.23±6.36 and 82.68±7.81, respectively, p<0.001; 0.21±0.01 and 0.20±0.01, respectively, p=0.008; and 0.19±0.01 and 0.18±0.01, respectively, p=0.01). Positive correlations were found between Tp-e/QTc ratio and disease duration (r=0.382, p=0.013). CONCLUSION: Our study showed that the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio, which are evaluated electrocardiographically in patients with BD, have been prolonged compared with normal healthy individuals. A positive correlation was determined between disease duration and Tp-e/QTc ratio. These results may be indicative of an early subclinical cardiac involvement in patients with BD, considering the duration of the disease. Therefore, these patients should be more closely screened for ventricular arrhythmias.

Patient with Mal de Meleda in whom a Novel Gene Mutation was Identified.

Mal de Meleda, also known as keratoderma palmoplantaris transgrediens, is a rare type of autosomal recessive palmoplantar keratoderma. A 19-year-old male presented with a congenital yellowish discoloration and thickening of both palms and soles of the feet. His family history revealed that there was no consanguinity between the mother and the father and that the patient had three healthy brothers. The second- and third-degree relatives, five females and one male, also exhibited similar skin findings. From the isolated DNA samples, the extrinsic regions of the SLURP1 gene were screened using the sequence analysis and the Sanger sequencing was performed with the 3130 Sequence Analyzer. Results of this analysis show that a p.Arg 96 Pro (R96P) (c.287 CGA>CCA) homozygous missense point mutation was detected on the SLURP 1 (a secreted toxin-like mammalian lymphocyte antigen 6/urokinase-type plasminogen activator receptor-related protein 1) gene of the patients, while heterozygous p.Arg 96 Pro (R96P) (c.287 CGA>CCA) mutation was detected in the mother, father, and brothers. Our search of the Human Genome Mutation Database and previous literature revealed no reports of this mutation in mal de Meleda. We report this case due to the identification of a novel gene mutation in a patient with mal de Meleda, a palmoplantar keratoderma.

The polymorphism rs4696480 in the TLR2 gene is associated with psoriasis patients in the Turkish population.

BACKGROUND: Toll-like receptors (TLRs) have an important role in the host defense. Recent studies demonstrated that TLR polymorphisms might have a role in the pathogenesis of psoriasis vulgaris. The aim of this study was to indicate whether TLR2 rs11938228 and rs4696480 were associated with susceptibility to psoriasis in the Turkish population. METHODS: This case-control study included 140 psoriasis patients and 250 controls. Genotyping of 2 rs11938228 and rs4696480 SNPs of TLR2 were determined using LightSNiP Kit (Roche Diagnostic, GmBH, Mannheim, Germany). RESULTS: Our results demonstrated that the TLR2-rs4696480 AA genotype seemed to have a higher risk for psoriasis [crude 95% CI: 1.495-4.514, and p < 0.001, adjusted 95% CI: 1.349-4.292, and p = 0.003] while as TLR2-rs11938228 polymorphism has not shown any significant association with the risk of psoriasis [p > 0.005]. There was no statistically significant difference between the mean age, gender, onset age, and PASI level and genotypes for rs11938228 and rs4696480 polymorphisms (p > 0.05). CONCLUSIONS: The SNP rs4696480 of TLR2 may have significant effects on the heritability of psoriasis in the Turkish population.

Evaluation of Toll-like receptor expression profile in patients with psoriasis vulgaris.

TLRs are thought to play a role in the pathophysiology of such dermatological diseases as leprosy, acne and psoriasis. The study included 20 patients with plaque psoriasis, as well as 20 healthy age- and gender-matched control subjects. Real-time polymerase chain reaction evaluation was made of the messenger RNA expression of TLRs 1-10 in lesional tissue and peripheral blood mononuclear cell samples in psoriasis patients. TLR 3, 5, 6, 7, 9 and 10 lesional tissue mRNA expressions were increased significantly when compared to the expression levels in the PBMCs of the same patients (p = 0.0082, p = 0.0176, p = 0.0239, p = 0.0261, p = 0.0223, p = 0.0206). A comparison of the TLR expression in the PBMCs of healthy subjects and the PBMCs of patients with psoriasis showed a significant increase in the TLR 1, 8 and 10 mRNA expressions in the patient group (p < 0.0001, p < 0.0001, p = 0.0035). The TLR 5 mRNA expression was significantly higher in the control group than in the patient group (p = 0.0037). To the best of our knowledge, this is the first study in literature to evaluate mRNA TLR expression levels in the lesional tissue and PBMCs of patients with psoriasis.

Sleep disorders in patients with psoriasis: a cross-sectional study using non-polysomnographical methods.

BACKGROUND: Psoriasis is a chronic inflammatory skin disease which can cause sleep disturbances due to the disease itself or due to its complications. In this study, we aimed to analyze the array of sleep disturbances caused by psoriasis and to evaluate the interaction between the quality of sleep and the duration and severity of psoriasis. METHODS: Study subjects included 60 patients with plaque psoriasis and 60 sex- and age-matched controls. The Psoriasis Area and Severity Index (PASI) was used to evaluate severity of disease. Body mass index (BMI), medication usage, and duration of disease were recorded. All subjects completed the Epworth Sleepiness Scale (EES), Pittsburgh Sleep Quality Index (PSQI), insomnia severity index (ISI), Berlin-sleep apnea questionnaire, and questions based on criteria of the International Restless Legs Syndrome Study Group indicating the presence of restless legs syndrome (RLS). RESULTS: There were statistically significant and clinically relevant differences between the patients and controls regarding day-time sleepiness (ESS 5.3 vs 4.1, p = 0.037), sleep quality (PSQI 14.4 vs 4.9, p < 0.001), insomnia (ISI 19.7 vs 14.4, p < 0.001), sleep apnea (high risk 30% vs 7%, p = 0.01), and RLS (high risk 32% vs 0%, p < 0.001). CONCLUSIONS: Patients with psoriasis experience poor sleep quality and are at markedly increased risk for insomnia, obstructive sleep apnea, and restless legs syndrome. These findings suggest the importance of evaluating patients with psoriasis for conditions that affect sleep. The study results further suggest that simple screening tools may be useful for this task.

A case of aquagenic syringeal acrokeratoderma with involvement of periungual area of the hand.

Gürel G, Sahin S, Çölgeçen E. A case of aquagenic syringeal acrokeratoderma with involvement of periungual area of the hand. Turk J Pediatr 2018; 60: 762-764. Aquagenic syringeal acrokeratoderma (ASA) is a rare form of palmoplantar keratoderma occurring after short-term contact with water. Although ASA usually involves the palmar region, there are also several cases with the involvement of dorsum of hand and sole of the feet. We described 15-year old girl who had white keratodermic plaques observed on the flexor side of distal phalanxes especially the periungual area after a 10 min contact with water. Our patient represents a rare case of ASA with the involvement of periungual region of the fingers.