Comparison of Histopathological Findings in Psoriasis According to the Lesion Location From Biopsy.

ABSTRACT: The aim of this study was to investigate whether the histopathological findings of psoriasis varied by the biopsied lesion location. Age, gender, age at disease onset, lesion locations, presence or absence of a preliminary diagnosis of psoriasis, and histopathological findings of 307 patients were recorded. The sections prepared from the patients' paraffin blocks were reexamined microscopically, the severity of the observed findings was graded, and various histopathological features were recorded. The female-to-male ratio was 1.2 to 1. Family history for psoriasis was positive in 30% of patients. A clinically preliminary diagnosis of psoriasis was present in 232 patients. The most common histopathological features included hyperkeratosis, parakeratosis, Munro/Kogoj microabscesses, suprapapillary thinning-hypogranulosis, and vascular dilation-capillary proliferation. Hyperkeratosis was least common in the trunk. A linear and moderately strong correlation was found between the histopathological findings of inflammation, capillary proliferation, and suprapapillary thinning. For the first time, the clinical and demographic features of psoriasis are evaluated and the severity of the histopathological findings is compared by the biopsied lesion location in a large number of patients.

COVID-19 and dermatology

Background/aim: Sars-CoV-2 virus infection (COVID-19) was observed in China in the last months of 2019. In the period following, this infection spread all over the world. In March 2020 the World Health Organization announced the existence of a pandemic. The aim of this manuscript is to investigate skin diseases associated with COVID-19 under three main headings: skin problems related to personal protective equipment and personal hygiene measures, skin findings observed in SARS-CoV-2 virus infections, and skin findings due to COVID-19 treatment agents. Materials and methods: In PubMed, Google Scholar databases, skin lesions related to personal protective equipment and personal hygiene measures, skin findings observed in SARS-CoV-2 virus infections and skin findings due to COVID-19 treatment agents subjects are searched in detail. Results: Pressure injury, contact dermatitis, itching, pressure urticaria, exacerbation of preexisting skin diseases, and new skin lesion occurrence/new skin disease occurrence may be due to personal protective equipment. Skin problems related to personal hygiene measures could include itching, dryness, and contact dermatitis. Skin findings may also be observed in SARS-CoV-2 virus infections. The incidence of skin lesions due to COVID-19 was reported to be between 0.2% and 29%. Many skin lesions including maculopapular, urticarial, vesicular, chilblain-like, thrombotic/ischemic, etc. are observed in COVID-19 patients. Some authors have stated that there is an absence of SARS-CoV-2 virus infection-specific skin findings. However, in asymptomatic or presymptomatic COVID-19 patients in particular, skin lesions can lead to the diagnosis of COVID-19. In addition, skin lesions may occur due to COVID-19 treatment agents. Conclusion: Many skin lesions may appear as a result of COVID-19. Even in the absence of a COVID-19 diagnosis, skin findings should be evaluated carefully in this pandemic period.

Investigation of Enthesopathy with Ultrasonography and Comparison with Skin Findings in Asymptomatic Psoriatic Patients.

BACKGROUND: Joint involvement associated with psoriasis is referred to as psoriatic arthritis. A late diagnosis of psoriatic arthritis may cause a variety of morbidities; therefore, an early diagnosis and treatment of psoriatic arthritis are required. Asymptomatic psoriatic arthritis has been found in 8-70% of patients with psoriasis using imaging techniques. OBJECTIVE: To investigate joint and enthesis regions by ultrasonography in patients with psoriasis without inflammatory joint symptoms to detect subclinical psoriatic arthritis. METHODS: We included 50 psoriasis patients and 30 healthy control subjects without joint complaint in this study. Twelve joint regions of all subjects in each group were examined by ultrasonography. RESULTS: The presence of any pathological ultrasonography finding (30%) was higher but did not significantly differ in psoriasis patients compared with the control group (13.33%; p > 0.05). CONCLUSION: Although statistically not significant, the pathological ultrasonography findings were approximately twofold more common in patients with psoriasis compared with the control group. Therefore, the development of psoriatic arthritis in patients with psoriasis should be more closely followed.

Number and size of acquired melanocytic nevi and affecting risk factors in cases admitted to the dermatology clinic.

INTRODUCTION: The size and number of acquired melanocytic nevi (AMN) and presence of dysplastic nevi are the leading risk factors that should be recognized in the development of malignant melanoma. AIM: To evaluate AMN and risk factors in the development of AMN in all age groups admitted to a dermatology outpatient clinic. MATERIAL AND METHODS: Four hundred and twelve patients who were admitted to the dermatology outpatient clinic for any dermatological symptom and who accepted to participate in the study were randomly included in the study. For each case, background-family history and dermatological findings were recorded. All AMN observed in the patients were dermatoscopically examined. RESULTS: The presence of more than 50 nevi was significantly higher in males, in individuals who had a history of sunburn and smokers. The number of nevi that were 5 mm and below was found to be higher in individuals who regularly sunbathed their face/body, in individuals using sunscreen, in individuals who had a history of sunburn, smokers and alcohol users. The number of nevi that were above 5 mm was higher in smokers. The total dermatoscopy score between 4.75 and 5.45 was found to be higher in individuals who had more than 50 nevi, in individuals exposed to more than one chemical substance and in alcohol users. CONCLUSIONS: When determining the patient's risk factors, factors such as the patient's sunbathing habits and chemical substance exposure features should be taken into consideration besides the number and size of nevi.

Associations of rs4810485 and rs1883832 polymorphisms of CD40 gene with susceptibility and clinical findings of Behçet's disease.

There are evidences that besides geographic tendency, interactions between genetic and environmental factors play an essential role in the pathogenesis of Behçet's disease (BD). In this study, we have evaluated the associations between rs4810485 and rs1883832 single nucleotide polymorphism (SNP)s of CD40 gene with the susceptibility and clinical findings of BD. Two hundred and eighty-five patients with BD and 225 age-matched healthy controls were enrolled in this study. The clinical findings of patients were noted. The distributions of genotypes, alleles, combined genotypes and haplotypes of these two SNPs in BD patients were compared with those in healthy controls. In further evaluation, we evaluated the patients with and without any of clinical findings with regarding to distribution of genotypes and alleles of these two SNPs. There was no significant difference concerning frequencies of genotypes, alleles, combined genotypes and haplotypes of rs4810485 and rs1883832 between patients and controls (p > 0.05 for all). Frequency of GT genotype of CD40 rs4810485 polymorphism was found to be significantly higher in patients with skin lesions (p < 0.05, OR 1.65, 95 % CI 1.02-2.64). Also, we have found significantly higher frequencies of CC genotype and C allele of CD40 rs1883832 polymorphism in patients with genital ulcers (p < 0.05 for both, OR 2.30, 95 % CI 1.07-4.94 and OR 1.78, 95 % CI 1.06-2.97, respectively). However, these significances were disappeared after Bonferroni correction. We suggest that differences in the expression levels of CD40 because of different genotypes of these two SNPs may take part in the development of skin lesions or genital ulcers in patients with BD.

Mucocutaneous warts in Middle Anatolia, Turkey: clinical presentations and therapeutic approaches.

INTRODUCTION: Viral warts are common skin condition caused by the human papilloma virus. AIM: To determine the clinical features of warts and therapeutic approaches to warts and compare them with the literature. MATERIAL AND METHODS: A cross-sectional survey was conducted on 362 consecutive patients presenting to a dermatology clinic in Ankara, Middle Anatolia, Turkey. Age, gender, anatomic localization, clinical types, number of warts, and medical therapy histories were recorded. RESULTS: In our study 139 (38.4%) children and 223 (61.6%) adults had warts. Warts were seen in 191 men, and 171 women. The mean age was 24.7 ±13.5. In all groups the incidence and the number of warts were higher in men. Clinical types of warts were vulgar, anogenital, plantar, verruca plana, filiform, and mosaic. Thirty-six (9.9%) of 362 cases had more than one type. The locations of warts were as follows extremities (n = 233, 64.4%), anogenital (n = 86, 23.7%) and head and neck (n = 73, 20.2%). The incidence of anogenital warts was statistically higher in men than women (p < 0.05). Topical medical treatment was the first choice (n = 60, 57.1%). CONCLUSIONS: In our study, the incidence and the number of warts were higher in men, which is different than in previous reports. The anogenital wart (AW) was ranked second in all types of warts. According to this finding, we can say that the frequency of AW has been increased in Turkey. To our knowledge recently there have been no studies investigating the clinical features of viral warts in all ages in the literature.

Serological test results of sexually transmitted diseases in patients with condyloma acuminata.

INTRODUCTION: Human papillomavirus (HPV) is one of the most common causes of sexually transmitted diseases (STD). The incidence of condyloma acuminata (CA) has increased in recent years. AIM: To determine demographical features and serological test results of STD in patients with CA. MATERIAL AND METHODS: A cross-sectional survey was conducted on 94 patients presenting to a dermatology clinic in Ankara, Middle Anatolia, Turkey. Dermatological examinations were made and the patients completed a questionnaire which consisted of questions about their marital status, partners and condom use. In all cases, VDRL/RPR, anti-HIV, HBsAg, anti-HCV and in 57 cases - HSV type 1-2 IgM and IgG were studied. If the value of VDRL or RPR was positive, TPHA was conducted. RESULTS: In our study, 83 men and 11 women had CA. We could not analyze whether our cases had multiple partners and a habit of condom use as some of the patients did not answer questions about their sexual life. We observed VDRL and TPHA positivity in 3 (3.1%) cases, none of those cases had clinical findings of syphilis and they denied using any therapy for syphilis. HBsAg positivity was found in 3 cases. No anti-HIV and anti-HCV antibody positivity was detected. CONCLUSIONS: The seroprevalence of HBsAg in our study was similar to that of the general population of Turkey. But as we found positive syphilis serology in 3 patients, we suggest that syphilis serology should be investigated in patients with CA.

Patch test results of the dental personnel with contact dermatitis.

OBJECTIVES: Dental personnel have high risk of occupational contact dermatitis. The aim of this study is to detect the materials which cause contact sensitization and the frequency of contact dermatitis by using patch tests with European standard series and dental screening series in dental personnel. METHODS: Between August 2008 and July 2009, 461 dental personnel working in Ankara (Turkey) were examined and age, gender, previous history of dermatitis, area of the skin affected and clinical diagnosis were noted. About 198 (43%) of the dental personnel were diagnosed contact dermatitis. Sixty-five of the dental personnel accepted to be patch tested. RESULTS: Dental technicians, dentists and dental nurses constitute 69.2%, 24.6% and 6.2% of patch tested 65 patients, respectively. Positive reactions to at least one allergen were detected with European standard series at 20% and with dental series at 10.8% among the dental personnel. The most common allergens were nickel sulfate (12.3%), acrylates (6.1%) and para-tertiary-butylphenol-formaldehyde resin (4.6%). The most common acrylate was ethyleneglycol dimethacrylate (3.1%). CONCLUSIONS: We believe our study will be helpful to dermatologists about frequency of contact dermatitis among dental personnel and allergens that cause contact sensitivity for developing new methods to protect the personnel in dentistry against sensitization.

DD genotype of ACE gene I/D polymorphism is associated with Behcet disease in a Turkish population.

Behcet's disease (BD) is a chronic, multi-systemic and inflammatory disorder. The local renin-angiotensin system (RAS) in the vessel wall plays a role in the endothelial control and contributes to inflammatory processes. Angiotensin-converting enzyme (ACE) is the regulatory component of the RAS. This study was conducted in Turkish patients with BD to determine the frequency of I/D polymorphism genotypes of ACE gene. Genomic DNA obtained from 566 persons (266 patients with BD and 300 healthy controls). ACE gene I/D polymorphism genotypes were determined using polymerase chain reaction using I and D allele-specific primers. There was statistically significant difference between the groups with respect to genotype distribution (p < 0.001). This study is the largest study in Turkish population that ACE gene I/D polymorphism investigated in BD. As a result of this study, ACE gene I/D polymorphism DD genotype could be a genetic marker in BD in Turkish study population.

Association between the methylene tetrahydrofolate reductase gene C677T mutation and colchicine unresponsiveness in Behcet's disease.

PURPOSE: Behcet's disease (BD) is a multisystemic immunoinflammatory disorder characterized by mucocutaneous, ocular, vascular, and central nervous system manifestations. The common methylene tetrahydrofolate reductase (MTHFR) gene C677T mutation is a known risk factor for thrombosis. The aim of this study was to investigate the MTHFR gene C677 mutation in patients with BD and evaluate if there was an association with clinical features, especially thrombosis, in a relatively large cohort of patients with BD. METHODS: The study included 318 patients with BD and 207 healthy controls. Genomic DNA was isolated and genotyped using PCR-based restriction fragment length polymorphism assay for the MTHFR gene C677T mutation. RESULTS: The genotype and allele frequencies of the C677T mutation showed a statistically significant difference between BD patients and controls (p=0.003 and p=0.001, respectively). There was also a significant association between C677T alteration and response to colchicine in BD patients (p=0.046). CONCLUSIONS: The results of this study showed that there was a high association between the MTHFR gene C677T mutation and BD. Stratification analysis according to clinical features for this disease did not reveal an association except response to colchicine that was shown to be influenced by the MTHFR C677T mutation.

Patch Test Results to European Baseline Series in Turkey: A Prospective and Multicenter Study.

BACKGROUND: Patch testing with the European Baseline Series (EBS) is an essential diagnostic tool for the assessment of allergic contact dermatitis. OBJECTIVE: The aims of the study were to describe the most common contact allergens identified with patch testing in Turkey and to establish the distribution of contact allergens among different regions in Turkey. PATIENTS AND METHODS: Twelve centers consisting of tertiary health care institutions were included in the study. A total of 1169 patients were patch tested with the EBS from 2015 to 2017. RESULTS: A total of 596 patients (51.0%) had 1 or more positive patch test reactions to the EBS. A total of 30.2% (n = 353) of those tested had clinical relevance. Contact sensitivity was more common in young patients. The most common 10 allergens were nickel sulfate (20.4%), followed by textile dye mix (8.6%), cobalt chloride (8.3%), potassium dichromate (8.0%), p-phenylenediamine base (4.5%), balsam of Peru (4.3%), methylchloroisothiazolinone/methylisothiazolinone (3.8%), thiuram mix (3.6%), fragrance mix I (3.0%), and methylisothiazolinone (2.9%). CONCLUSIONS: This study provides a comprehensive profile of patch test results with the EBS in Turkey. An ongoing decrease in contact allergy to methylchloroisothiazolinone/methylisothiazolinone and methylisothiazolinone was observed. Textile dye mix and p-phenylenediamine are beginning to pose a new risk in Turkey.

A case with an indolent course of subcutaneous panniculitis-like T-cell lymphoma demonstrating Epstein-Barr virus positivity and simulating dermatitis artefacta.

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare form of cytotoxic T-cell lymphoma. The disease has a poor prognosis in patients with the complication of hemophagocytic syndrome, especially in those with Epstein-Barr virus (EBV) positivity. A 20-year-old woman presented with multiple, itchy, purplish nodules and excoriations on both of her upper limbs. The histopathologic, immunohistochemical staining, and clonal T-cell receptor gene rearrangement examinations of skin lesions revealed the diagnosis of SPTCL. In situ hybridization performed for EBV was positive. There were no findings suggesting systemic involvement of SPTCL, or hemophagocytic syndrome. The lesions improved with systemic corticosteroid therapy and radiotherapy, with no recurrence. We present a patient with a protracted course of SPTCL in whom EBV positivity was demonstrated. This apparent conflict may be explained by geographic and ethnic variations in EBV infection. Further studies may shed light on the real relationship between EBV-RNA and the course of SPTCL.

An uncommon presentation of the co-existence of morphea and vitiligo in a patient with chronic hepatitis B virus infection: is there a possible association with autoimmunity?

A 30-year-old man presented with indurated violaceous plaques all over his body that had been present for 7 months. The patient had also had vitiligo for 3.5 years, and hepatitis B virus (HBV) infection and cirrhosis for a 2-year period. Histopathologic examination of the indurated plaques confirmed the diagnosis of morphea. Localized scleroderma and vitiligo have only rarely been reported to occur simultaneously. Although the etiologies of vitiligo and morphea are both uncertain, their association with autoimmune diseases favors an autoimmune hypothesis. Both vitiligo and morphea might have appeared coincidentally. However, this association could be significant because it may be related to the presence of HBV and alterations in the immune system that are caused by this virus. Therefore, this rare combination of vitiligo and morphea in a patient with chronic HBV infection warrants attention because it suggests a possible immunologic association, which may merit future study.

Autoimmune thyroid disorders in patients with psoriasis.

A few studies have shown a high prevalence of thyroid autoimmunity in patients with psoriatic arthritis. However, thyroid autoimmunity has not been investigated in patients with psoriasis who do not have psoriatic arthritis. We aimed to investigate thyroid autoimmunity in patients with psoriasis. The study included 105 consecutive patients with psoriasis who did not have psoriatic arthritis and a sex and age matching control group consisting of 96 patients with tinea pedis. All of the patients with psoriasis were examined dermatologically and PASI scores were calculated for each patient. Free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), antithyroglobulin (AbTG), and antithyroidperoxidase antibody (AbTPO) levels were measured in all of the subjects. The levels of TSH, FT3, FT4, AbTG and AbTPO and ultrasonographic findings of thyroid gland were compared statistically between psoriasis and control groups. Also, the levels of TSH, FT3, FT4, AbTG and AbTPO of psoriasis patients were compared with PASI scores. Mann-Whitney U test was used as statistical method. The mean age of patients with psoriasis was 40.54 +/- 16.91 years. 56 patients were female, 49 were male. The levels FT4 were found to be significantly increased in the patient group. But levels of AbTPO and AbTG were not statistically different between the two groups. The patients who had thyroiditis plus nodules in thyroid ultrasonography had statistically longer disease periods. This is the first study that investigated autoimmune thyroid disorders in patients with psoriasis who did not have arthritis. We believed that thyroid autoimmunity in patients with psoriasis was no different from that found in healthy individuals.

Risk factors for pressure ulcers.

BACKGROUND: Pressure ulcers (PrUs) remain a common problem in all healthcare settings. The aim of this study was to assess the presence of risk factors in patients with PrUs. METHODS: The study included 32 immobilized inpatients with PrUs and 30 immobilized inpatients without PrUs as a control group, who were being followed up at the Ankara Physical Therapy and Rehabilitation Hospital, Ankara, Turkey. Patients were given physical examinations and assessed for medical history, as well as for associated diseases, the duration of PrUs, the presence of stool and urinary incontinence, the use of pressure-reducing bed surface, and change of position. Routine biochemical and hematologic blood examinations were performed in all of the patients involved in the study. RESULTS: When risk factors for PrUs were assessed, 81.2% of the patients with PrUs had stool and urine incontinence, 46.8% had been smoking, 46.8% had hypoalbuminemia, 15.6% had been drinking alcohol, and 9.3% had diabetes; 18.7% had been using a pressure-reducing bed surface before the ulcer appeared, and 40.6% started to use a pressure-reducing bed surface after the ulceration occurred; and 59.3% were repositioned periodically. PrUs were found to develop earlier in patients who were smoking and who had anemia. A significant relation also was found between the grade of the ulcer and the frequency of change of position in bed. Smoking and urinary/stool incontinence were found to be significantly present more frequently in the patient group than the control group. Stool incontinence and the absence of the use of a pressure-reducing bed were also found to be risk factors in the patient group when compared with the control group. CONCLUSIONS: The authors believe that stool and urinary incontinence, smoking, anemia, not using a pressure-reducing bed surface, and infrequent change of position in bed are considerable risk factors for the development of PrUs. Immobilized patients should be assessed for these risk factors, and measures should be taken to prevent PrU development.

Sarcoidosis involving the lacrimal, submandibular, and parotid glands with panda sign.

Sarcoidosis is a granulomatous inflammation of unknown origin that varies in severity and distribution. We present a case of sarcoidosis with involvement of the skin, lacrimal, parotid, and submandibular glands. The patient had been previously misdiagnosed as having angioedema and allergic contact dermatitis; he had the rare finding of panda sign on gallium scintigraphy.

A case of granulomatous rosacea successfully treated with pimecrolimus cream.

A 43-year-old male attended with lesions on his face that had been present for 3 months. On dermatological examination, multiple papules and pustules were seen on the forehead, nose, bilateral cheeks and lower eyelids. The patient used systemic clindamycin and doxycycline and topical benzoyl peroxide therapies, but the lesions did not regress. Routine laboratory tests were normal. Histopathological examination of the lesions confirmed the diagnosis of granulomatous rosacea. Pimecrolimus cream 1% was applied to the lesions. The regression of lesions began in the first month and complete improvement was observed at the end of the fourth month of therapy. Rosacea is a chronic, inflammatory skin disorder characterized by remissions and relapses. Although it is known that the disease is a treatable disorder, it may be resistant to standard therapies and there is a need for new therapy alternatives in some patients. We present a case of granulomatous rosacea successfully treated with pimecrolimus cream and believe that pimecrolimus may be a good alternative for the treatment of granulomatous rosacea.

Pediatric skin disorders encountered in a dermatology outpatient clinic in Turkey.

This study documents the spectrum and frequency of skin disorders in a total of 2370 children encountered in a dermatology outpatient clinic in Turkey. Infectious skin diseases were most frequently observed (27.6%) followed by, eczemas (17.9%), acne (14,5%), papulosquamous diseases (6.9%), hair diseases (4.1%), pigmentation disorders (3.8%), generalized pruritus (2.8%), urticaria (2.7%), and insect bite (2.3%). Epidemiologic data are useful in planning of the health care and taking preventive measures to decrease the prevalence of skin disorders in children.