Serum, saliva, and gingival tissue human ß-defensin levels in relation to retinoic acid use.

BACKGROUND: Retinoic acid is an active derivative of vitamin A and regulates the differentiation, proliferation, and antimicrobial peptide expression profiles of human cells. The aim of the present study was to analyze the effect of systemic retinoic acid use on serum, saliva, and gingival tissue levels of human ß-defensin (hBD)-1, hBD-2, and hBD-3. METHODS: A total of 69 participants (34 systemic retinoic acid users and 35 healthy controls) were enrolled in this study. Plaque index, probing pocket depth, bleeding on probing (BOP), and clinical attachment loss were measured. Saliva and serum hBD-1, hBD-2, and hBD-3 levels were quantified by enzyme-linked immunosorbent assay. Gingival tissue hBD-1, hBD-2, and hBD-3 levels were determined by immunohistochemistry. A univariate general linear model was used in adjusted comparisons of hBD1, hBD-2, and hBD-3. P values of < 0.05 were considered statistically significant. RESULTS: Reduced salivary levels of hBD-2 (P = 0.042), but not hBD-1 or hBD-3, were detected in systemic retinoic acid users compared to non-user controls. There was a significant difference in the adjusted (for BOP%) salivary hBD-2 concentrations between retinoic acid and control groups (P = 0.031). No difference was observed in serum or tissue levels of hBD-1, hBD-2, or hBD-3 between the two study groups. CONCLUSION: Systemic retinoic acid use was associated with suppressed salivary hBD-2 level, which was independent of gingival inflammation.

Acral manifestations of fungal infections.

Fungal infections, which are named according to the body site involved, can affect any skin area, the fingernails, or the toenails. Numerous fungal agents are responsible for both superficial and deep fungal diseases. Dermatophytes and Candida spp are the most common causative organisms on the surface of the hands, feet, and nails of patients with superficial fungal diseases; however, although deep fungal infections of the skin are less common compared with superficial fungal diseases, their incidence is increasing worldwide due to cross-border travel. Most superficial fungal diseases are diagnosed clinically, but sometimes direct microscopic examination with potassium hydroxide and fungal culture may be necessary for diagnosis, especially in patients suspected of having tinea incognito. In cases of superficial fungal infections except for onychomycosis and tinea incognito, topical treatments are usually sufficient and effective, but systemic treatments may be required in recalcitrant cases. Deep fungal diseases may resemble each other clinically; therefore, the organism must be identified with laboratory methods and should be treated for a long period. We review the most important clinical, diagnostic, and therapeutic aspects of fungal diseases. This paper covers fungal problems encountered both in hospitals and in general practice.

Treatment of Phthiriasis Palpebrarum and Crab Louse: Petrolatum Jelly and 1% Permethrin Shampoo.

Phthiriasis palpebrarum is an uncommon cause of blepharoconjunctivitis in which Pthirus pubis infest the eyelashes. We report a case of unilateral phthiriasis palpebrarum with crab louse. A 45-year-old man presented with conjunctival hyperaemia and moderate itching associated with irritation, and crusty excretions of the eyelashes in the left eye. Careful slit-lamp examination revealed many lice and nits in left eye and mild conjunctival hyperaemia. No abnormality was found in the right eye. On dermatologic examination, only one louse was found at the pubic area. The patient was treated effectively with petrolatum jelly (Vaseline) and 1% permethrin shampoo (Kwellada 1% shampoo). At the end of the first week no louse or nit was present on eyelashes and pubic area.

Pseudo-Kaposi sarcoma (acroangiodermatitis): occurring after bullous erysipelas.

Pseudo-Kaposi sarcoma is a benign reactive vascular proliferative disorder, which can be seen at any age. It occurs when the chronic venous pressure changes result in vascular proliferation in the upper and mid dermis. This disease is divided into two subtypes: the most frequent subtype is the Mali type and seen in early ages. The Mali type is seen in chronic venous insufficiency and in those patients with arteriovenous shunts. The rare subtype is the Stewart-Bluefarb type. This disease must be distinguished from Kaposi sarcoma because of their clinical resemblance. Herein, we present a patient with pseudo-Kaposi sarcoma, which developed after bullous erysipelas.

Precancerous lesions of oral mucosa.

Precancerous lesions of oral mucosa, known as potentially malignant disorders in recent years, are consists of a group of diseases, which should be diagnosed in the early stage. Oral leukoplakia, oral submucous fibrosis, and oral erythroplakia are the most common oral mucosal diseases that have a very high malignant transformation rate. Oral lichen planus is one of the potentially malignant disorders that may be seen in six different subtypes including papular, reticular, plaque-like, atrophic, erosive, and bullous type, clinically. Atrophic and erosive subtypes have the greater increased malignant transformation risk compared to another subtypes. Although there are various etiological studies, the etiology of almost all these diseases is not fully understood. Geographically, etiologic factors may vary. The most frequently reported possible factors are tobacco use, alcohol drinking, chewing of betel quid containing areca nut, and solar rays. Early diagnosis is very important and can be lifesaving, because in late stages, they may be progressed to severe dysplasia and even carcinoma in situ and/or squamous cell carcinoma. For most diseases, treatment results are not satisfactory in spite of miscellaneous therapies. While at the forefront of surgical intervention, topical and systemic treatment alternatives such as corticosteroids, calcineurin inhibitors, and retinoids are widely used.

Evaluation of body composition parameters in patients with psoriasis.

BACKGROUND: Body composition parameters, such as weight, body mass index (BMI), and visceral fat rating, have been found to be associated with psoriasis. However, the associations of these parameters with psoriasis have not been demonstrated clearly. OBJECTIVES: This study aimed to evaluate body composition parameters in patients with psoriasis. METHODS: The relationships between the various body composition parameters and psoriasis were retrospectively examined in 242 patients with plaque psoriasis (119 women, 123 men) over a 2-year period during 2010-2012. In addition, the correlations between body composition parameters and Psoriasis Area and Severity Index (PASI) score were evaluated in treated and untreated patients with psoriasis. Patients were divided into two groups according to whether or not they had received systemic therapy within the previous three months. Body composition values were measured using the Tanita SC-330 Body Composition Analyzer(®). RESULTS: Statistically significant differences were recorded in terms of weight (kg), body fat percentage, fat mass (kg), total body water (TBW) percentage, metabolic age, visceral fat rating, BMI, and degree of obesity among treated and untreated patients and control subjects. Differences in fat-free mass (FFM) (kg), muscle mass (kg), TBW (kg), and bone mass (kg) were found to be close to the limit for significance. The treated and untreated groups showed no significant differences in any of the parameters evaluated. The correlations between PASI score and the various parameters provided some evidence for such relationships. CONCLUSIONS: The present study provides evidence of a relationship between some body composition parameters and the occurrence of psoriasis. We suggest that body composition parameters should be analyzed not only in obese psoriasis patients but in all psoriasis patients upon their first diagnosis. Systemic therapy does not appear to cause any changes in body composition parameters.

A dystrophic calcinosis cutis case treated with CO2 laser.

Calcinosis cutis is the deposition of insoluble calcium salts within cutaneous tissue. It may be divided into four major subtypes: dystrophic, metastatic, idiopathic, and iatrogenic. The most common subtype is dystrophic calcinosis cutis. It can occur as a result of local tissue injury. We herein present a child with dystrophic calcinosis cutis developed following trauma and successfully treated with CO2 laser.

Evaluation of effectiveness of cryotherapy on the treatment of cutaneous Kaposi's sarcoma.

OBJECTIVE: Kaposi's sarcoma (KS) is a vascular tumor that affects the skin and other organs. Several therapeutic options are available, but the optimal therapy is unclear. The aim of this study was to determine the effectiveness and safety of cryotherapy in the treatment of KS. MATERIALS AND METHODS: Thirty patients were evaluated. Cryotherapy was applied using liquid nitrogen. Each treatment consisted of two freeze-thaw cycles, with freezing times ranging from 15 to 40 seconds per cycle. RESULTS: One hundred twenty-five lesions were treated in an average of 3.2 sessions. Complete response was observed in 19 (63%) of the 30 patients after cryotherapy treatment with no recurrence. The subjects tolerated cryotherapy well. Blistering occurred frequently, but local pain was limited. There were no secondary infections. CONCLUSION: Liquid nitrogen cryotherapy is safe and cost-efficient and can be readily adopted as an effective primary therapy for cutaneous KS lesions that respond slowly or show incomplete cosmetic improvement after systemic therapies.

Comparison of effectiveness of electrocautery and cryotherapy in partial matrixectomy after partial nail extraction in the treatment of ingrown nails.

OBJECTIVE: To determine an effective mode of therapy of ingrown nail using two different methods. METHODS: Patients with the diagnosis of stage 2 or 3 ingrown nails were included and divided into two groups. In the first group, partial matrixectomy was performed using electrocautery after partial nail extraction; in the second group, partial matrixectomy using cryotherapy was performed after partial nail extraction. RESULTS: The study included 53 patients with ingrown nails. Patient ages ranged from 11 to 79 years (median 31.8 ± 16.9). No relapse was observed in 96.2% of the patients after a follow-up period of 3-12 months (n = 51). Matrixectomy in 71.7% (n = 38) of patients was successful. Matrixectomy using electrocautery was successful in 18 of 29 patients. Matrixectomy using cryotherapy was successful in 20 of 24 patients. CONCLUSIONS: Matrixectomy should be added to the treatment of ingrown nails. There was no significant difference between electrocautery and cryotherapy in terms of relapse. In patients with advanced stages of ingrown nails, partial nail extraction combined with matrixectomy using cryotherapy is an effective method of treatment.

Evaluation of effectiveness of erbium:yttrium-aluminum-garnet laser on atrophic facial acne scars with 22-MHz digital ultrasonography in a Turkish population.

Scar formation due to acne is a common problem among the young population and significantly affects their quality of life. The aim of this study was to evaluate the efficacy of erbium:yttrium-aluminum-garnet (Er:YAG) laser resurfacing for acne scars and to objectively demonstrate the altering of collagen density in the dermis by 22-MHz digital ultrasonography. Twenty-one patients, aged 19-55 years, with facial acne scars were treated with Er:YAG laser. The results of the laser resurfacing were evaluated for the degree of clinical improvement, alteration of the collagen density by 22-MHz digital ultrasonography and any adverse effects at 3 months. At 3 months after the treatment, good (in 12 patients) and near total (in four patients) clinical improvement was noted in most of the patients compared to baseline. Overall treatment results were 76% (both near total and good) in 16 patients. By ultrasonographic evaluation, the average density of dermal collagen (total density/number of patients) of 21 patients was 32.714 (right cheek) and 32.142 (left cheek) before laser facial resurfacing. At the third month after treatment, the average density of dermal collagen of 21 patients was 36.380 (right cheek) and 38.809 (left cheek). In conclusion, Er:YAG laser skin resurfacing was found to be a safe and effective treatment modality for treatment of atrophic facial acne scars. As public demand grows for less invasive modalities to approach clinical diagnosis and evaluation, digital ultrasonography seems to provide an easy and confidential method for collagen density evaluation.