Internalized Stigma in Hidradenitis Suppurativa: A Multicenter Cross-Sectional Study.

BACKGROUND: Hidradenitis suppurativa (HS) causes significant physical, social, and psychological burdens. Internalized stigma, acceptance of negative attitudes and stereotypes of society regarding a person's illness, has not been studied previously in HS. OBJECTIVES: The objective of this study was to investigate the internalized stigma state of HS patients and identify the factors affecting it. METHODS: This multicenter, prospective, cross-sectional study included 731 patients. Internalized Stigma Scale (ISS), Hurley staging, Physician Global Assessment, Dermatology Life Quality Index (DLQI), Skindex-16, Beck Depression Inventory-II (BDI-II), and Visual Analog Scale (VAS)-pain score were used in the study. RESULTS: The mean ISS value (57.50 ± 16.90) was comparable to the mean ISS values of studies in visible dermatological and various psychiatric diseases. A significant correlation was found between the mean values of ISS and all disease activity scores, quality of life measures, BDI-II, and VAS-pain scores. Obesity, family history, low education and income level, vulva/scrotum involvement and being actively treated are significant and independent predictive factors for high internalized stigma in multivariate analysis. CONCLUSIONS: HS patients internalize society's negative judgements, which may create a profound negative effect on access to health care. Therefore, in addition to suppressing disease activity, addressing internalized stigma is fundamental for improving health care quality.

SARS-CoV-2 vaccination-induced cutaneous vasculitis: Report of two new cases and literature review.

Currently the most powerful tool in combating the COVID-19 pandemic is vaccination against SARS-CoV-2. A growing percentage of the world's population is being vaccinated. Various vaccines are worldwide on the market. Several adverse reactions have been reported as a part of post-marketing surveillance of COVID-19 vaccines. Among the possible adverse events, cutaneous vasculitis has occasionally been reported. We present a narrative review on cutaneous vasculitis related to COVID-19-vaccination to summarize clinical findings, histopathology, treatment and outcome. We searched for "COVID vaccine", "COVID vaccination" AND "cutaneous vasculitis" in PUBMED. Articles in English have been selected, from inception to December 2021, and analyzed for patient's characteristics, type of vaccine, time of appearance of cutaneous vasculitis and clinico-histopathologic type. Treatment and outcome have also been considered in this narrative review. Two new unpublished cases of ours were added. Cutaneous vasculitis is a rare adverse event to COVID-19 vaccination. It has been observed with mRNA and adenovirus-vector vaccines. IgA vasculitis, lymphocytic and ANCA-associated vasculitis, leukocytoclastic and urticarial vasculitis have been reported. This adverse event can occur after first or second shot. Most cases run a mild to moderate course. Cornerstone of medical treatment are systemic corticosteroids. Complete remission could be achieved in most patients. Vasculitis may not be considered as a contraindication of vaccination, being uncommonly reported and shows a favorable prognosis. The benefit of the vaccination remains high especially for immunocompromised patients. COVID-vaccine induced vasculitis is important in the differential diagnosis of purpuric and vasculitis disorders.

Dapsone for the treatment of acne vulgaris: do the risks outweigh the benefits?

Dapsone is a "4,4'-diamino diphenyl sulfone" compound and an aniline derivative from synthetic sulphones. Sulphonamides were first used in humans as antimicrobial agents to treat streptococcal infections. Dapsone derived from sulphonamides was first used in the treatment of leprosy in 1940. Today, Dapsone treatment is among the treatment options for many dermatological diseases. Acne vulgaris is a chronic inflammatory disease, which causes scar formation and changed pigmentation. Acne affects 85% of teenagers, but can occur at any age and can last into adulthood and even lifelong. Through its antimicrobial, anti-inflammatory, and antioxidant effects, dapsone treatment (local or systemic) can also be used in the treatment of acne. Dapsone treatment can cause a variety of side effects that can be categorized as pharmacological, dose-related, allergic, or idiosyncratic reactions. In this review article, the risks and benefits of using dapsone treatment in acne vulgaris will be evaluated in light of the literature.

Effect of the COVID-19 pandemic on the anxiety and depression levels in patients who applied to the cosmetology unit.

The relationship between the skin and the brain is based on their origin from the same ectodermal structure, as well as being affected by similar hormones and neurotransmitters. At this point, psychodermatology forms a common field of study based on the relationship and interaction between psychiatry and dermatology. Cosmetology is a special group within dermatology, and the psychosocial needs of this group differ. In this study, it was aimed to examine the moods such as anxiety, fear and depression experienced by the patients during their application to the cosmetology unit during the COVID-19 pandemic process and to compare them with the control group. A total of 162 cases, 80 cases from the cosmetology unit meeting the specified conditions and 82 cases as the control group, were retrospectively evaluated. In all participants, the Coronavirus Anxiety Scale (CAS) scores decreased significantly compared to the beginning of the pandemic (P = .001). In the study, while depression (HAM-D) and general anxiety (HAM-A) were higher in the cosmetology group compared to the control group (P = .049 and P = .001, respectively), there was no difference in coronavirus anxiety scores (CAS) (P = .24). It should be known that patients who underwent cosmetological procedures during the pandemic period may have anxiety and depression. In this patient group, which requires a special psychodermatological approach, pandemic effects should also be considered. In patients who apply to cosmetology units during the pandemic period, attention should be paid to the relationship between surreal cosmetological process requests and their anxiety and depression state.

Histopathological comparison of pathergy positive and negative areas of newly diagnosed Behçet patients.

BACKGROUND: Behcet's disease is an inflammatory vasculitis, and pathergy reaction is a compulsory element of the diagnostic criteria. In the literature, there is no study comparing the histopathology of negative pathergy tests and positive pathergy tests in newly diagnosed Behcet's patients. The primary goal was to investigate the frequency of vasculitis, which is an important finding of Behcet's disease, in pathergy histopathology. METHODS: The histopathology of patients with positive and negative pathergy tests revealed vasculitis or vasculopathy. In histopathology, neutrophils, lymphocytes, eosinophils, and mast cells in the perivascular area were counted and recorded as a percentage. RESULTS: Of the 88 Behcet's patients who participated in the study, 45 were female and 43 were male. The rate of vasculitis in the histopathology of those who were positive for the pathergy test was not statistically different than those of those with negative pathergy tests (P = .14). In our study, although the relationship between the male gender and uveitis was significant at the border, and the relationship between pathergy positivity and uveitis was not found to be significant, a significant relationship was found between vasculitis in histopathology and uveitis (P = .023). CONCLUSIONS: Based on the results of our study, we think that a pathergy test of histopathology will contribute to the clinical diagnostic evaluation in cases with suspicious clinical pathergy tests and especially in cases with negative pathergy tests.

Relationship between acanthosis nigricans, acrochordon and metabolic syndrome in patients with lichen planus.

AIM: In the literature, there are no data examining the association with lichen planus with acanthosis nigricans and acrochordon, which are skin findings of metabolic syndrome (MS). MATERIALS: A total of 108 lichen planus (LP) patients, age and sex-matched 109 controls, 217 patients in total were prospectively included in the study. RESULTS: Metabolic Syndrome was found in 55 (50.9%) of 108 patients with lichen planus and 36.7% in the control group. The frequency of MS in the lichen planus group was found to be significantly higher than that in the control group (P = .03). The incidence of acanthosis nigricans (AN) was statistically higher in the LP group (P = .009). In addition, while 38 of 47 AN patients in the LP group had MS, 17 of 61 patients without AN had MS, and the presence of MS was found significantly higher in LP patients with AN (p˂0.001). The incidence of acrochordon was statistically higher in the LP group (P = .03). In addition, while 43 of 62 patients with acrochordon in the LP group had MS, 12 of 46 patients without acrochordon had MS, and the presence of MS was found significantly higher in patients with LP with acrochordon (P Ë‚ .001). CONCLUSION: In our study, it was found that skin findings such as AN and acrochordon increased in patients with lichen planus. This increase was also observed in lichen planus patients with metabolic syndrome. Therefore, the association of acanthosis nigricans and acrochordon may be a predictive of metabolic syndrome in patients with lichen planus admitted to the dermatology outpatient clinic.

The clinics of HHV-6 infection in COVID-19 pandemic: Pityriasis rosea and Kawasaki disease.

A new type of coronavirus family (SARS-CoV-2), which can be found in humans and animals, with many varieties and clinical symptoms, was first seen in Wuhan, China in late 2019, under the name novel Coronavirus Disease 2019 (COVID-19). In the literature, cutaneous symptoms related to the disease are generally emphasized. However, it is not yet known whether this new SARS-CoV-2 virus, which has entered our lives, plays a role in the etiopathogenesis of dermatological diseases. The patients who were admitted to the dermatology outpatient clinic between 1 April and 15 May 2019, and on 1 April and 15 May 2020 were retrospectively analyzed by searching the hospital automation system and patient files. The reason for the same months to be included in the study was to exclude seasonal effects on the diseases. After pandemic, the number of patients with Pityriasis rosea and Kawasaki disease increased significantly in patients who applied to the dermatology outpatient clinic. Our study is the first study showing Pityriasis rosea increase during the pandemic period. We think that this increase is related to HHV-6 reactivation. Herein, we wanted to draw attention to two diseases in which Human Herpes 6 (HHV-6) was accused in etiopathogenesis: Kawasaki disease and Pityriasis rosea.

Evaluation of the effect of COVID-19 pandemic on dermatological diseases with dermatological quality life index.

Disease-related skin lesions have been reported in 8% to 20% of COVID-19 patients. In the literature, cutaneous symptoms associated with the disease are generally emphasized. However, there are very few studies on the effect of this new SARS-CoV-2 virus entering our lives on dermatological diseases, and none of them have used the dermatological quality of life index (DLQI). In our study, we aimed to evaluate the difficulties faced by the patients who applied to the dermatology outpatient clinic during the pandemic period and the course of their diseases with the dermatological quality of life index. The study was carried out prospectively by including dermatology patients who will apply to the outpatient clinic in June-July 2020. 282 patients were evaluated in the study. DLQI was significantly lower in the group using regular emollients (P < .001). When DLQI was compared between disease groups, it was found to be significantly different (P: .017). DLQI was found to worsen significantly compared to prepandemic studies. It was found that using moisturizer in this period helps to maintain the dermatological quality of life.

Clinical and laboratory assessment for the inflammation role in chronic spontaneous urticaria: A clinical study.

Chronic spontaneous urticaria (CSU) is triggered by unknown causes. We would like to explore the possible effect of hemogram parameters and several biochemical markers on CSU presence and also the severity of the disease. We also aimed to discuss the relationship between CSU and inflammation associated with these values. The study was planned prospectively. We selected patients already diagnosed with CSU who applied to the dermatology outpatient clinic and healthy controls. The patients and the healthy controls were tested for complete blood count, neutrophil/lymphocytes ratio and platelets/lymphocytes ratio, erythrocyte sedimentation rate, C-reactive protein, serum albumin and total bilirubin and indirect bilirubin levels. Urticaria activity score over 7 days (UAS-7) was calculated for the CSU patients. Forty patients with CSU and 55 healthy subjects were included in the study. Mean white blood cell (WBC) count is 8.37 ± 2.14 in the patients' group and 7.41 ± 2.01 in the healthy subjects group. Mean neutrophil (NEU) count is 4.88 ± 1.65 in the patients' group and 4.19 ± 1.39 in the healthy subjects group. Mean platelets (PLT) count is 308.48 ± 88.32 in the patients' group and 268.65 ± 64.80 in the healthy subjects group. We also detected positive correlations between UAS-7 score-WBC counts and UAS-7 score-NEU counts. Future studies are needed to investigate this possible relationship and confirm these results.

The effect of smoking on the psoriasis: Is it related to nail involvement?

Psoriasis is a chronic inflammatory skin disease that negatively affects the quality of life with remissions and relapses. Smoking, which is known to accelerate the development of comorbidities that can accompany psoriasis such as atherosclerotic heart disease, metabolic syndrome, is also an independent risk factor for psoriasis. In our study, we aimed to investigate the relationship between smoking and psoriasis. The study included a total of 476 participants with 276 psoriasis patients and 200 healthy volunteers. One hundred and thirty-nine (69.5%) cases in the psoriasis group and 61 (30.5%) cases in the control group were smoking. Patients with psoriasis had more cigarette smoking than the control group (P < .001). Smoking was present in 100 cases (61%) of 164 cases with nail psoriasis and psoriatic nail was significantly more frequently observed in patients with psoriasis when smoking was present (P < .001). It was observed that systemic treatment requirements were higher in smoking psoriasis patients (P = .04). It is known that cigarette use increases in patients with psoriasis compared to the normal population, and cigarette use also increases the psoriasis area severity index (PASI). In our study, a significant relationship was found between smoking and psoriasis nail involvement first in the literature. Furthermore, the need for systemic treatment was higher in smokers.

Evaluation of dermatology consultations in the era of COVID-19.

It has been reported that dermatology practices may be a vector for SARS-CoV-2 transmission and elective cases should be postponed during the pandemic period. In this context, studies on the change of patient profile in Dermatology outpatient clinic have been conducted. However, there was no study in the literature about dermatology consultations during the pandemic period. One hundred and forty-seven dermatology consultation cases in the era of COVID-19 pandemic between March 11, 2020 and May 4, 2020 were retrospectively evaluated. Twenty-four patients (16.3%) had suspicion and signs of COVID during consultation (fever, cough, shortness of breath, etc.). Nine (37.5%) of these patients also had accompanying COVID-19 skin lesions (two urticarial lesions, two livedo and necrosis, two maculopapular eruption, two vesicular rashes, one pseudo-chilblain). The number of cases that were suspected to have COVID-19 was statistically significantly higher in consultations requested by the emergency department and intensive care unit, while there were no suspected cases in outpatient clinic consultations (P = .001). Two (1.4%) of these patients were diagnosed with COVID-19 confirmed by PCR within 2 weeks. We acknowledge that daily practice changes frequently during this period, but still our study provides a perspective to other dermatology clinics in terms of the requested dermatology consultations during the pandemic.

Demodex prevalence in mine, textile and food factory workers with dermatosis: a cross-sectional, multicenter study.

Demodex, a type of mite, lives in human hair follicles. They can multiply very quickly in some conditions and then start to irritate the skin by causing skin disorders. This study aims to investigate if working environment conditions affect the prevalence of Demodex. A cross-sectional, multicenter study was conducted with three different occupational groups: mine, textile and food factory workers (n = 102). Determined industry workers who applied to our outpatient dermatology clinics with the complaint of dermatosis in three different cities were included in the study. Demodex positivity was checked by dermoscopy. Differences between categorical variables examined with Chi-square analysis and T test was used to compare continuous variables between groups. 50% Demodex positivity was found in mine workers, 45.3% in food factory workers and 66.7% in textile manufacturing workers. A high rate of Demodex positivity was observed in all three occupational groups. Although the highest positivity rate was observed in textile manufacturing workers, no significant difference was found between the groups (p = 0.320). The overall prevalence of Demodex in female workers was statistically significantly higher than in male workers (p = 0.029). Exposure of workers to a wide variety of factors in work environments such as textile factories and the fact that women are more sensitive to external factors may have caused the prevalence of Demodex to be higher in these groups. So, a change in the work environment or the use of suitable protective equipment may benefit the treatment of diseases caused by Demodex. But, further studies are needed with larger and various industry groups to make more certain views.

The effect of COVID-19 on development of hair and nail disorders: a Turkish multicenter, controlled study.

BACKGROUND: A broad spectrum of skin diseases, including hair and nails, can be directly or indirectly triggered by COVID-19. It is aimed to examine the type and frequency of hair and nail disorders after COVID-19 infection. METHODS: This is a multicenter study conducted on consecutive 2171 post-COVID-19 patients. Patients who developed hair and nail disorders and did not develop hair and nail disorders were recruited as subject and control groups. The type and frequency of hair and nail disorders were examined. RESULTS: The rate of the previous admission in hospital due to COVID-19 was statistically significantly more common in patients who developed hair loss after getting infected with COVID-19 (P < 0.001). Telogen effluvium (85%) was the most common hair loss type followed by worsening of androgenetic alopecia (7%) after COVID-19 infection. The mean stress scores during and after getting infected with COVID-19 were 6.88 ± 2.77 and 3.64 ± 3.04, respectively, in the hair loss group and were 5.77 ± 3.18 and 2.81 ± 2.84, respectively, in the control group (P < 0.001, P < 0.001). The frequency of recurrent COVID-19 was statistically significantly higher in men with severe androgenetic alopecia (Grades 4-7 HNS) (P = 0.012; Odds ratio: 2.931 [1.222-7.027]). The most common nail disorders were leukonychia, onycholysis, Beau's lines, onychomadesis, and onychoschisis, respectively. The symptoms of COVID-19 were statistically significantly more common in patients having nail disorders after getting infected with COVID-19 when compared to the control group (P < 0.05). CONCLUSION: The development of both nail and hair disorders after COVID-19 seems to be related to a history of severe COVID-19.

Treatment of keratosis pilaris rubra with 577-nm pro-yellow laser.

OBJECTIVE: Keratosis pilaris rubra (KPR) is a rare group of idiopathic hereditary disorders of keratinization, and it is considered as variants of keratosis pilaris. It is characterized by a well-defined erythema and small, keratotic follicular papules that are seen on the cheeks and preauricular area. Keratosis pilaris rubra is an aesthetically distressed situation, and especially vascular erythema is the most common complaint. In recent years, pro-yellow (577 nm) laser, laser system with yellow light wavelength, has been used as an alternative for seeking more effective treatment especially in vascular lesions. However, in the literature, pro-yellow laser therapy has never been used before in keratosis pilaris rubra. Therefore, we wanted to evaluate the effectiveness of the pro-yellow laser in keratosis pilaris rubra patients. MATERIALS AND METHODS: In our study, four patients with keratosis pilaris rubra treated with pro-yellow laser in our Cosmetology Unit between December 2017 and March 2019 were evaluated. The first session was started with 20 j/cm2 and the dose increased 2 j/cm2 at each session. The dose was increased up to 26 j/cm2 , a total of four sessions (20-22-24-26 j/cm2 ) was applied in treatment. All the sessions were used in treatment scanner mode. RESULTS: Objectifying a clearance of erythema >75% was clinically evident in three patients, in the fourth patient, erythema regressed approximately 50%. There has been no recurrence of the lesions after a minimum three months follow-up. There was no permanent side effect in any patient. CONCLUSION: Pro-yellow laser is a well option for the treatment of keratosis pilaris rubra, and we think that it could be a safety choice therapy. In addition, a well tolerance to treatment and a low incidence of serious side effects make it a very reliable therapy. Further clinical studies are needed to improve our findings.

Does omalizumab use in chronic spontaneous urticaria results in improvement in sexual functions?

BACKGROUND: Chronic spontaneous urticaria (CSU) is a disease that can affect the patient's quality of life (QoL), sexual functions, and mood. OBJECTIVE: We planned a retrospective study to investigate the effects of omalizumab use in CSU patients on sexual function. We also aimed to evaluate the sexual function, quality of life (QoL), and mood of CSU patients compared to the control group consisting of idiopathic pruritus patients. METHODS: A review of patients' records with CSU attending the dermatology outpatient clinic from January 2020 to June 2020 was done. Urticaria activation score (UAS7), Beck depression inventory (BDI), Dermatology life quality index (DLQI), female sexual function index (FSFI) to female participants, and the international index of erectile function (IIEF) to male participants were used to assess the impact of the disease on patients' life. The obtained data were analyzed by using SPSS software. RESULTS: Each one of the mean UAS, BDI, and DLQI score values decreased significantly in weeks in omalizumab group patients. IIEF score in male patients and FSFI score in female patients also increased in weeks in omalizumab group patients. CONCLUSIONS: Omalizumab can play an effective role in enhancing the sexual function of CSU patients in addition to improving their DLQI.