Efficacy of botulinum toxin for treating a gummy smile.

INTRODUCTION: This study was conducted to investigate the efficacy of botulinum toxin applied to the different muscles of patients who have excessive gingival display and to evaluate the return to baseline gingival exposure value. METHODS: Twenty-eight patients who had a gummy smile of more than 2 mm were randomly divided into 2 groups. Botulinum toxin was administered equally to the left and right of the levator labii superioris alaeque nasi muscle of group 1 and the orbicularis oris site of group 2. Photographs were taken, and measurements were taken before injection and at 3 days, 15 days, 1 month, 4 months, 5 months, and 6 months after injection. The visual analogue scale was used to assess the level of satisfaction. RESULTS: The average amount of visible gingiva in group 1 was 4.92 mm at the beginning of the treatment and 1.92 mm on the 15th day. In group 2, the average amount of visible gingiva was 4.58 mm at the beginning of treatment and 2.16 mm on the 15th day. In both treatment groups, it was determined that the measurements on the sixth month did not return to their initial values. The decrease in gingival appearances in group 1 was greater than in group 2. There was no significant difference between the groups in terms of return to baseline gingival exposure value. In both groups, it was seen that the increase in satisfaction in patients was high. CONCLUSIONS: For gummy smile correction, botulinum toxin injection is thought to be an alternative method because it is effective and conservative and has high patient satisfaction.

The risk of hepatotoxicity during long-term and low-dose flutamide treatment in hirsutism.

OBJECTIVE: Flutamide is an effective drug in treatment of hirsutism. Hepatotoxicity occasionally may occur with therapeutic doses (750-1500 mg/day), 3 months after initiation of treatment. Monitoring of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels is recommended to obviate serious hepatotoxicity. MATERIALS AND METHODS: Two hundred and fourteen patients with mean age of 20.9+/-2.34 years suffering from hirsutism were included in the study. Of these 214 women, 117 had diagnosis of polycystic ovarian syndrome (PCOS), and 97 had diagnosis of idiopathic hirsutism. Thirty age-matched (mean age 20.3+/-2.0 years) normal women without signs of hirsutism and with normal menstrual cycle served as control group. Hirsutism was assessed using modified Ferriman-Gallwey method at the beginning and at the end of the treatment. Serum levels of luteinizing hormone (LH), follicle stimulant hormone (FSH), prolactin (PRL), estradiol (E2), androstenodion (A), testosterone (T), dehydrotestosterone (DHT), dehydroepiandrosterone sulfate (DHEAS), dehydroepiandrosterone (DHEA), 17-hydroxyprogesterone (17-P), sex hormone binding protein (SHBG), and ACTH were measured. Pelvic ultrasonography was performed for diagnosis of PCOS. Fifty-seven patients with PCOS (group 1) were given flutamide 125 mg/day + oral contraceptive. Sixty patients with PCOS (group 2) were given flutamide 250 mg/day + oral contraceptive. Forty-seven patients with IH (group 3) were given flutamide 125 mg/day alone, and 50 patients with IH (group 4) were given flutamide 250 mg alone. Thirty women in control group (group 5) were given placebo only. ALT and AST levels were measured in the beginning of the treatment, and repeated after 3, 6, 9 and 12 months. RESULTS: No incidence of increase in AST or ALT levels (>or= 45 U/L) was observed in any of the groups. No evidence of hepatotoxicity in any of the 214 hyperandrogenic women was observed on low-dose flutamide for 1 year. CONCLUSION: We conclude that flutamide in a dosage of 125 or 250 mg daily is a safe drug in the long-term treatment of hirsutism. The follow-up of patients receiving flutamide can be done by monitoring AST or ALT levels for hepatotoxicity.

Low-dose and short-term cyclosporine treatment in patients with chronic idiopathic urticaria: a clinical and immunological evaluation.

The present study aimed to evaluate the effectiveness of 2.5 mg/kg/day cyclosporin (CsA) treatment in patients with severe chronic idiopathic urticaria (CIU) and the impact of CsA treatment on several cytokines involved in the etiopathogenesis of CIU. Twenty-seven CIU patients and 24 healthy control subjects were included in the study. The autologous serum skin test (ASST) for autoantibodies and urticaria activity scoring (UAS) were measured for the evaluation of the clinical severity and the response to therapy, and the serum levels of interleukin (IL)-6, IL-8, IL-2 receptor, IL-1beta, tumor necrosis factor (TNF)-alpha and IL-5 were measured. The mean UAS score was 32.07 +/- 7.05 and 6.22 +/- 3.84 before and after CsA treatment, respectively. The serum IL-2 receptor, TNF-alpha and IL-5 levels of patients before CsA treatment were statistically higher than those of the control group (P = 0.001), and after 4 weeks of CsA therapy the mean IL-2R, TNF-alpha and IL-5 levels were significantly decreased. The data from this study demonstrate that CsA therapy is efficient and safe for CIU patients. Increase in clinical efficacy and marked decreases in serum cytokine levels suggest that inhibition of cytokine generation is involved in the action of the drug in this clinical setting.

The prevalance, epidemiology and risk factors for onychomycosis in hemodialysis patients.

BACKGROUND: Onychomycosis has a high prevalance among immunocompromised patients such as diabetics and hemodialysis patients. In the present study, we aimed to investigate the prevalence of onychomycosis among hemodialysis patients with and without diabetes mellitus, and to find out the factors likely to be associated with the development of onychomycosis among hemodialysis patients. METHODS: One hundred and nine hemodialysis patients were enrolled. Fifty-seven of hemodialysis patients had the diagnosis of diabetes mellitus. Nail scrapings were obtained from 76 patients who had dystrophic nail changes. Samples were examined with 20% potassium hydroxide solution and all of the samples were inoculated on Saboraud's dextrose agar, potateus dextrose agar and mycobiotic agar. Diagnosis of onychomycosis was based on the presence of both positive clinical signs and positive potassium hydroxide test. RESULTS: Onychomycosis was diagnosed in 26.6% of hemodialysis patients. Diabetes mellitus was present in 68.9% of patients with onychomycosis. Toenail scraping cultures were reported to be positive in 19.7% of patients with dystrophic nail changes. Logistic regression analysis revealed that the presence of diabetes mellitus and the mean duration of hemodialysis were the significant predictors associated with the development of onychomycosis. CONCLUSION: The prevalence of dystrophic nail changes and onychomycosis is increased among hemodialysis patients. The dialysis duration and the presence of diabetes mellitus are the independent risk factors associated with the development of onychomycosis in uraemic patients.

Cutaneous manifestations in brucellosis: a prospective study.

Brucellosis remains an important public health problem in Turkey, just as it is in other regions of the world. This study was conducted to determine the types and rates of cutaneous lesions that occur in patients with brucellosis. Brucellosis was diagnosed by standard tube agglutination testing for Brucella antibodies at a titer of 1/160 or higher in the presence of compatible clinical findings. A total of 140 patients who had been given a diagnosis of brucellosis were prospectively observed in the dermatology clinic. Of these patients, 102 (72.9%) were female, with a mean age of 44.11+/-18.22 y, and 38 (27.1%) were male, with a mean age of 46.44+/-14.58 y. The duration of symptoms was less than 2 mo (acute) in 75 patients (53.5%), from 2 to 12 mo (subacute) in 30 patients (21.4%), and longer than 12 mo (chronic) in 35 patients (25.0%). Cutaneous findings related to brucellosis were observed in 8 (5.71%) of the 140 cases. Maculopapular eruptions were observed in 2 patients (25%), erythema nodosum-like lesions in 2 (25%), psoriasiform lesions in 1 (12.5%), palmar erythema in 1 (12.5%), malar eruption in 1 (12.5%), and palmar eczema in 1 (12.5%). The investigators concluded that although cutaneous findings encountered in brucellosis are generally not specific to this disease, the presence of these findings may be useful in diagnosing brucellosis in persons who live in, or used to live in, endemic regions.

Investigation of interleukin-12, interleukin-17 and interleukin-23 receptor gene polymorphisms in alopecia areata.

OBJECTIVE: To investigate the distribution of interleukin (IL)-12 (IL12; 1188A/C), IL17 (A7488G) and IL-23 receptor (IL23R; +2199A/C) gene polymorphisms in patients with alopecia areata. METHODS: Patients with alopecia areata and healthy controls were enrolled in this case-control study. Genotyping of the IL12 (1188A/C), IL17 (A7488G) and IL23R (+2199A/C) polymorphisms was undertaken. Genotype frequencies were compared between the two groups. RESULTS: The study enrolled 100 patients with alopecia areata and 71 control subjects. No significant differences were found in the frequencies for the IL12 and IL23R gene polymorphisms between the patient and control groups. The IL17 GG genotype was significantly more common and the IL17 GA genotype was significantly less common in patients with alopecia areata compared with controls, but only 10% of patients had the GG genotype. CONCLUSION: The IL17 GG genotype was associated with susceptibility for alopecia areata, but this genotype was only present in a small number of patients. The IL12 and IL23R gene polymorphisms were not found to have a significant association with alopecia areata.

Familial cutis tricolor: a possible example of paradominant inheritance.

Cutis tricolor is a recently described skin disorder characterized by the coexistence of congenital hyper- and hypopigmented macules adjacent to each other on a background of normal skin. It has been considered to represent an example of didymosis (twin spotting), which is a particular form of loss of heterozygosity. Cutis tricolor may occur as a cutaneous feature of various multisystem birth defects. We report two sisters with cutis tricolor. One of them had, in addition, unilateral hypoplasia of the breast. This familial occurrence of cutis tricolor may best be explained by the concept of paradominant inheritance. 2003.

Segmental lentiginosis with ipsilateral nevus depigmentosus: another example of twin spotting?

We report a patient with unilateral lentiginosis and ipsilateral nevus depigmentosus. She had no other cutaneous or extracutaneous abnormalities. The coexistence of segmental lentiginosis and nevus depigmentosus may be explained as a twin-spot phenomenon.

Clinical and laboratory parameters associated with metabolic syndrome in Turkish patients with psoriasis.

OBJECTIVES: To assess clinical and laboratory parameters associated with metabolic syndrome in Turkish patients with moderate or severe plaque-type psoriasis and nonpsoriatic controls. METHODS: Patients with moderate or severe plaque psoriasis (patient group) or with nonpsoriatic dermatological disease (controls) were included. Waist circumference, weight, height and arterial blood pressure were measured, together with fasting blood glucose, triglyceride, high density lipoprotein (HDL), fibrinogen, homocysteine and adiponectin levels. Metabolic syndrome was diagnosed using National Cholesterol Education Program-Adult Treatment Panel III criteria. RESULTS: Out of 90 patients (50 with psoriasis; 40 controls), metabolic syndrome was more frequent in the patient group than in controls. In terms of metabolic syndrome parameters, only hypertension was more frequent in patients with psoriasis compared with controls. There was no statistically significant difference between the patient and control groups for obesity, hypertriglyceridaemia, HDL levels or hyperglycaemia. Fibrinogen levels were increased and adiponectin levels were decreased in the psoriasis group. No between-group difference in homocysteine levels was found. CONCLUSION: In this small study, metabolic syndrome was found to be more frequently identified in Turkish patients with psoriasis than in controls; metabolic syndrome could lead to increased cardiovascular disease risk in patients with moderate to severe psoriasis.

Role of oxidative stress in the pathogenesis of vitiligo with special emphasis on the antioxidant action of narrowband ultraviolet B phototherapy.

OBJECTIVES: To evaluate the role of oxidative stress in the pathogenesis of vitiligo and the effect of narrowband (NB) ultraviolet (UV) B phototherapy on oxidative stress markers. METHODS: Patients with vitiligo and healthy control subjects were included in the study. Patients in the vitiligo group were treated with an NB-UVB regimen (3 × weekly for 6 months). Erythrocyte superoxide dismutase activity (SOD), erythrocyte malonyldialdehyde (MDA) and erythrocyte glutathione peroxidase activity (GSH-Px) levels were assessed in all participants at baseline, and after NB-UVB phototherapy in patients with vitiligo. RESULTS: A total of 24 patients with vitiligo and 27 control subjects were included in the study. Before treatment, erythrocyte MDA levels were significantly higher, and SOD and GSH-Px levels were significantly lower, in patients with vitiligo compared with controls. NB-UVB phototherapy was associated with a significant reduction in MDA levels and a significant increase in GSH-Px levels, compared with baseline, in patients with vitiligo. CONCLUSION: NB-UVB phototherapy may relieve oxidative stress in patients with vitiligo by reversing the oxidant-antioxidant imbalance that is considered to play a role in the pathogenesis of this disease.

Serum concentrations of interleukin-2 and tumour necrosis factor-α under cyclosporine versus acitretin treatment in plaque-type psoriasis.

OBJECTIVE: A prospective, randomized clinical study to compare the short-term effects of cyclosporin and acitretin on psoriasis severity, and serum interleukin (IL)-2 and tumour necrosis factor (TNF)-α concentrations. METHODS: Patients with moderate-to-severe plaque-type psoriasis were randomly assigned to receive either 3 mg/kg per day cyclosporine or 0.3-0.5 mg/kg per day acitretin for 8 weeks. Disease severity (psoriasis area severity index [PASI] score) and serum IL-2 and TNF-α concentrations were determined before and after treatment. RESULTS: PASI scores and serum IL-2 and TNF-α concentrations were significantly decreased after treatment with either cyclosporine (n = 21) or acitretin (n = 25). There were no statistically significant between-group differences in any parameter. CONCLUSIONS: Acitretin and cyclosporine are equally effective in the treatment of moderate-to-severe plaque-type psoriasis.

Association of serotonin transporter gene-linked polymorphic region and variable number of tandem repeat polymorphism of the serotonin transporter gene in lichen simplex chronicus patients with psychiatric status.

BACKGROUND: The serotonin (5-hydroxytryptamine; 5-HT) is a key neurotransmitter in the central nervous system and a responsible mediator for the itch. Dysregulation of serotonergic pathways has been implicated in the pathogenesis of many complex neuropsychiatric diseases. OBJECTIVES: The purpose of this study was to evaluate the relationship between lichen simplex chronicus and dysfunction and serotonin transporter (5-HTT) gene polymorphism. METHODS: Thirty-nine patients with lichen simplex chronicus and 61 healthy control subjects were examined. RESULTS: The results for the patients and control subjects were not significantly different (P > 0.05) in long/long (L/L) and long/short (L/S) genotypes of 5-HTT gene-linked polymorphic region (HTTLPR) polymorphism, but short/short S/S genotype was lower in lichen simplex chronicus patients (17.9%) than in controls (42.6%). This difference was statistically significant (P = 0.028). The results for the patients and control subjects were not significantly different in 12/12, 10/12 and 10/10 genotypes of variable number of tandem repeat (VNTR) polymorphism (P > 0.05). Beck depression inventory (BDI) scores and symptom checklist-90-revised (SCL-90) psychotic subscale were overrepresented significantly in the 12/12 genotypes than 10/12 genotypes. State and Trait Anxiety Inventory tests (STAI-I and -II) point averages were not statistically significant (P > 0.05) CONCLUSION: S/S genotypes of HTTLPR polymorphism in the 5-HTT gene may be related to lichen simplex chronicus and that patients who have 12/12 genotypes of VNTR polymorphism may be affected psychiatrically.

[Detection of cutaneous leishmaniasis cases in Hatay and surrounding areas]. / Hatay ve çevresinde saptanan kutanöz leishmaniasis olgulari.

Leishmaniasis; is a disease that is transmitted by infected sand flies when they suck the blood of mammals. Cutaneous leishmaniasis (CL), which is given such names as the Antep boil in Turkey, is mostly seen on the skin and sometimes on the mucosa and heals with a recessed scar. Between June 2003 and October 2005, 55 patients with skin lesions presented at the parasitology laboratory of the Mustafa Kemal University Medical Faculty for the detection of CL. Microscopic examination showed Leishmania amastigotes in 40 patients who were given a diagnosis of CL. Thirteen patients were men (32.5%) and 27, women (67.5%). The most frequent age range was 0-20 (57.0%). The lesions were mostly found on the face in 27 (67.5%) patients and on the hands and feet in 13 (32.5%). Fourteen patients (35.0%) had 2 or more lesions. The duration of the lesions was from a minimum of 1 month to a maximum of 3 years. The patients were mostly from Iskenderun/Kirikhan, Iskenderun/Arsus Serinyol, Altinözü, Samandag Antakya, Harbiye and they were farmers. Cutaneous leishmaniasis was more often detected during the May-June period. Some patients came to our laboratory from regions that had not reported CL before. Therefore, we think that CL has been increasing in Hatay and its surroundings.

Hydatid disease with atypical localization: 4 cases report.

Hydatid disease caused by Echinococcus often manifests as slowly growing cystic mass and mainly affects the liver or lung and rarely other parts of the body such as brain, heart, bone and muscle. Cyst may be single or multiple, uni-or multiloculated. In this paper 4 hydatic cases, multiple and atypically localized are presented. Of the 4 cases, 2 were known to suffer from hydatid disease, having had a hepatic cyst removal previously. Thus, when faced with a hydatid cyst in any part of the body, it is preferable to examine other parts of the body by radiological imaging methods.