Divergent in situ expression of IL-31 and IL-31RA between bullous pemphigoid and pemphigus vulgaris.

Bullous pemphigoid (BP) and pemphigus vulgaris (PV) are two major autoimmune blistering skin diseases. Unlike PV, BP is accompanied by intense pruritus, suggesting possible involvement of the pruritogenic cytokine IL-31. However, the underlying mechanisms of the clinical difference between BP and PV in terms of pruritus are not fully understood. To compare the expression levels of IL-31 and its receptor IL-31RA in the lesional skin, including peripheral nerves in BP and PV patients, immunohistochemical staining for IL-31 and IL-31RA was performed in skin samples of BP and PV patients and healthy controls (HC). The IL-31RA-expressing area in epidermis and peripheral nerves was analysed using ImageJ and the percentage of positive cells for IL-31/IL-31RA in dermal infiltrating cells was manually quantified. Quantitative analyses revealed that IL-31/IL-31RA expressions in the epidermis and dermal infiltrate were significantly increased in BP compared to PV and HC. The difference between BP and PV became more obvious when advanced bullous lesions were compared. Peripheral nerves in BP lesions presented significantly higher IL-31RA expression compared to PV lesions. In conclusion, we found significantly augmented expressions of IL-31/IL-31RA in BP lesions, including peripheral nerves, in comparison to PV. These results suggest a possible contribution of IL-31/IL-31RA signalling to the difference between BP and PV in the facilitation of pruritus and local skin inflammation, raising the possibility of therapeutic targeting of the IL-31/IL-31RA pathway in BP patients.

Association between intervertebral disc degeneration and Behçet's disease.

Behçet's disease (BD) is a chronic systemic vasculitis with a wide range of clinical findings. It has both autoinflammatory and autoimmune features and manifests with recurrent inflammatory attacks involving the innate immune system. Recently, autoinflammation has started to take place in the pathogenesis of intervertebral disc degeneration. The aim of this study is to evaluate the relationship between intervertebral disc degeneration and BD. We evaluated patients with BD who suffered neck or low back pain in the last 1 year. Eighty four patients underwent musculoskeletal system examination with MRI imaging of the cervical and lumbar vertebrae, and serum levels of IL6, IL8, and TNF-α were determined. The mean age was 47.7 ± 11.5 (range 20-68) years. Cervical and/or lumbar herniation was detected in the MRI imaging of 65 (77.3%) out of 84 patients. The mean IL8 levels of the group with pain and disc herniation and the group with pain and bulging were statistically significantly higher than the other groups (p = 0.007; p = 0.045, respectively). Chronic inflammation in BD may cause disc degeneration and radicular pain to begin and progress earlier in patients.

Association between biophysical properties and anxiety in patients with sensitive skin.

BACKGROUND: Sensitive skin (SS) is a syndrome in which neurosensory disorders accompany epidermal barrier dysfunction. However, it is not yet clear how high anxiety levels affect the biophysical parameters of the skin in patients with SS. OBJECTIVES: We aimed to investigate the relationship between anxiety levels and facial neurosensitivity, the erythema index, sebum content, and sensitive skin scale scores in individuals with sensitive skin. METHODS: The study was carried out on 35 individuals with SS and 40 without SS over three months. In the study, a questionnaire to detect the presence of sensitive skin, the sensitive skin scale for sensitive skin severity, the lactic acid sting test (LAST) to show facial neurosensitivity, a Mexameter for erythema index measurement, and a Sebumeter for sebum content measurement were used. In addition, the anxiety levels of the patient and control groups were measured using the hospital anxiety and depression scale (HADS). RESULTS: While the HADS-Anxiety scores were found to be significantly higher in patients with sensitive skin, there was no significant difference in the HADS-Depression scores. Moreover, a strong positive correlation was found between the HADS-Anxiety scores and the erythema index in patients with sensitive skin. CONCLUSIONS: Sensitive skin is a disorder that can sometimes occur without any dermatological examination findings. In particular, the sensations of the patients, along with their anxiety levels, are essential parameters that should be evaluated in the approach to patients with sensitive skin.

The Impact of Isotretinoin Therapy on the Nasal Skin Thickness and Elasticity: An Ultrasonography and Elastography Based Assessment in Relation to Dose and Duration of Therapy.

BACKGROUND: This study aimed to evaluate the impact of isotretinoin therapy on the nasal skin thickness and elasticity with regard to implications for rhinoplasty METHODS: A total of 40 acne vulgaris patients (mean±SD age: 20.9 ± 3.0 years, 65.0% were females) initiating oral isotretinoin treatment (0.25 mg/kg/day, n = 16 or 0.5 mg/kg/day, n = 24) were included in this prospective 4-month isotretinoin follow-up study. Ultrasonography assessments regarding nasal skin thickness (dermis and soft tissue) and elastography were repeated at second and fourth months of treatment. RESULTS: No significant difference was noted between isotretinoin dose groups in terms of second month and fourth month nasal skin thickness (dermis and soft tissue) values measured at any region. Each dose revealed significant decrease in dermis and soft tissue thickness from baseline at any region (p ranged < 0.001 to < 0.001), while only fourth month values at nasal tip and second month values at rhinion for dermis and only fourth month values at rhinion and glabella for subcutaneous tissue significantly differed from baseline (p < 0.01 for each) in the 0.25 mg and 0.50 mg dose groups, respectively. Elastography values at fourth month of isotretinoin treatment were significantly higher than pre-treatment and second month values in both 0.25 mg (90.4 ± 20.6 vs. 59.5 ± 21.8 and 76.4 ± 22.9, p < 0.01 for each) and 0.5 mg (86.7 ± 20.6 vs. 61.8 ± 23.2 and 76.9±24, p < 0.01 for each) dose groups. CONCLUSIONS: In conclusion, our findings revealed the association of isotretinoin treatment with a significant decrease in dermis and subcutaneous soft tissue thickness measured at each anatomical landmark, regardless of the treatment dose. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Effects of anxiety and depression symptoms on oxidative stress in patients with alopecia areata.

INTRODUCTION: Increased oxidative stress (OXS) and a high prevalence of psychiatric disorders are seen in alopecia areata (AA). However, OXS and psychiatric disorders have been studied separately in AA patients. AIM: To determine the effects of anxiety and depression symptoms on OXS in AA patients. MATERIAL AND METHODS: The anxiety and depression levels of 33 AA patients and 33 normal controls (NC) were determined using the Hospital Anxiety and Depression Scale. The oxidative stress index (OSI) was calculated by measuring serum total antioxidant status (TAS) and total oxidant status (TOS) levels in AA patients and NC. RESULTS: The AA patients had higher anxiety and depression scores than NC (p < 0.001 for both). Total oxidant status (p = 0.002) and OSI (p < 0.001) values were higher, and TAS (p < 0.001) levels were lower, in patients with AA compared to NC. However, patients' anxiety and depression scores were not correlated with the TAS, TOS, or OSI values (p > 0.05). There was no significant difference in TAS, TOS, or OSI values between patients with high and low anxiety or depression scores (p > 0.05). CONCLUSIONS: These results show that OXS, anxiety, and depression scores were higher in patients with AA compared to NC. However, anxiety and depression scores were not associated with OXS in AA patients. More extensive studies should be performed to investigate the relationship between psychological status and OXS in patients with AA.

Dermatoscopic Characteristics, Lesional Capillaroscopic Features, and Histopathological Correlation of Small Plaque Parapsoriasis and Mycosis Fungoides.

INTRODUCTION: Dermatoscopy is a frequently used non-invasive diagnostic procedure. OBJECTIVES: Considering that mycosis fungoides (MF) mimics parapsoriasis clinically in early stages, we aim to determine the dermatoscopic criteria and the histopathological correlations in patients with MF and small plaque parapsoriasis (SPP). METHODS: This prospective study involved 28 patients with clinical and histopathological diagnoses of MF and 31 patients with SPP. Videodermoscopy and USB capillaroscope were used to evaluate the patients vessels at ×200 magnification. Vascularity was evaluated through microvascular density (MVD) scoring involving CD34 antibody staining. RESULTS: Fifty-nine patients were included in this study. The scores corresponding to the presence of short linear vessels, linear-curved vessels, branching linear vessels, and non- structured orange-colored areas were significantly higher in the MF patients than in the SPP patients (P < 0.05). The highest MVD (P = 0.01) scores were also higher in the MF patients than in the SPP patients. CONCLUSIONS: The SPP and early-stage MF patients differed in their MVD scores, and the findings correlated with the dermatoscopy and lesional capillaroscopy findings. Differentiating features between SPP and MF were thus identified.

Antinuclear Antibody Positivity in Patients With Hair Loss After COVID-19 Infection.

INTRODUCTION: Hair loss is one of the most common disorders after coronavirus disease 2019 (COVID-19) infection. This study aimed to investigate the relationship between COVID-19-related hair loss and antinuclear antibody (ANA) positivity and patterns. METHODS: ANA positivity and patterns were analyzed in 30 female COVID-19 patients with hair loss complaints and compared in terms of the presence of autoimmunity between patients with and without COVID-19 exhibiting hair loss. RESULTS: ANA positivity and cytoplasmic patterns were detected in 40% of the patients with COVID-19 infection and hair loss. Trichodynia and diffuse hair loss were observed in 63.3% and 53.3%, respectively. CONCLUSIONS: In patients with COVID-19-related hair loss, diffuse hair loss and ANA positivity may be related to the high antibody levels triggered by COVID-19 infection.

The clinical effect of botulinum toxin on pigmentation.

BACKGROUND: Botulinum toxin injection is a common cosmetic procedure often used to treat dynamic wrinkles, but it has also been observed to have a lightening effect on the skin. It is thought that this lightening effect develops due to muscle innervation blockage; however, the change in the amount of melanin levels has not been quantified. METHOD: Thirty-one patients who presented to the dermatology clinic of a tertiary hospital for botulinum toxin injection for wrinkle treatment were included in the study. A standard dose of botulinum toxin was injected to each patient's forehead, glabellar, and crow's feet region, and then the melanin index (MI) was measured with the Mexameter® MX 18 (Courage + Khazaka Electronic, Köln). RESULTS: After botulinum toxin treatment, a statistically significant decrease was found in the forehead and upper face MI. The upper face total baseline MI was significantly lower in the Glogau 1 group than in the Glogau 2 group (P = 0.033). The forehead 15th day MI was significantly lower in the Glogau 1 group than in the Glogau 2, 3, and 4 groups (P = 0.030). DISCUSSION: Botulinum toxin application to healthy skin for wrinkle treatment can cause facial skin lightening by reducing MI. It was also remarkable that this decrease was more pronounced in the forehead, which is a region that is particularly vulnerable to sun exposure, compared to other regions. Younger people, who are included in the Glogau type 1 group, may benefit more from this lightening effect.

Evaluation of Sleep Quality in Patients With Genital and Non-Genital Cutaneous Warts: a Prospective Controlled Study.

Introduction: Diseases affect sleep quality, and sleep quality may also affect diseases by affecting the immune system. Depending on the immune status of patients with cutaneous warts, the extent of the disease and the response to treatment may vary. Objectives: This study aimed to characterize the association between cutaneous warts and sleep quality. Methods: A prospective controlled study was conducted. Patients over 18 years with cutaneous warts were enrolled. The control subjects were healthy, age- and sex-matched people. Demographic and clinical data on the participants were gathered. The sleep quality of participants was evaluated with the Pittsburgh Sleep Quality Index (PSQI). Results: A total of 138 patients with genital or non-genital cutaneous warts (N = 59, N = 79, respectively) and 83 controls were interviewed. The average global PSQI score of the group with cutaneous warts was significantly higher than that of the control group (1.292 95% confidence interval 1.174-1.422). The rate of poor sleep quality in the patient group was higher than in the control group (odds ratio 3.835). Patients with genital warts had a significantly higher average global PSQI score than patients with non-genital warts (8.61 ± 3.63 versus. 6.98 ± 3.32). Female patients with genital warts had a significantly higher average global PSQI score than male patients with genital warts. Conclusions: Evaluation of sleep quality in patients with warts, especially in patients with genital warts, may be suggested. The management of sleep disturbances associated with cutaneous warts may help increase the quality of life of patients and may affect disease control.

Evaluation of Biopsy Results, Consultations, and Follow-Ups in Pediatric Dermatopathology.

OBJECTIVE: Since skin diseases may show atypical presentation in children, histopathological evaluation plays a more critical role. The aim of this study is to determine the diagnoses that are finalized after the histopathological evaluation, which departments are frequently consulted, and the methods of follow-up in pediatric dermatology. MATERIALS AND METHODS: This cross-sectional study was conducted on pediatric and adolescent patients whose biopsy was taken after evaluation in the pediatric dermatology outpatient clinic for 42 months. RESULTS: Of the pediatric patients whose histopathological evaluation was made, 16.7% were consulted to other departments and 70.8% were followed up in the pediatric dermatology clinic with different methods. According to the histopathological evaluation results, 91.9% of the lesions were benign, 5.6% were premalignant, and only 1.5% were malignant. Three patients (1.5%) with malignant lesions in our pediatric dermatology clinic were followed up with pediatric dermatology and pediatric hematology. In comparison, premalignant lesions of 3 patients were excised in pediatric dermatology surgery; 6 patients were excised in plastic surgery, 1 patient in pediatric surgery, and 1 patient in ophthalmology. CONCLUSION: Pediatric dermatology is a department that should have pediatric dermatopathology and pediatric dermatosurgery units in itself. It is crucial to be in the teamwork for consultations and follow-ups after histopathological examinations.

Nitric oxide synthase activity: A novel potential biomarker for predicting Alopecia areata.

BACKGROUND: Alopecia areata is a dermatological disease characterized by nonscarring type hair loss. The cause of Alopecia areata not known exactly but studies support that it has an autoimmune etiology in which oxidative stress play an important role. AIM: This study was conducted to evaluate the level of nitrosative stress in Alopecia areata and to investigate the predictive power of nitrosative stress parameters for Alopecia areata. PATIENTS/METHODS: Thirty patients diagnosed with Alopecia areata, and 30 healthy controls were included in a prospective, cross-sectional study. In both groups, nitric oxide (NO· ), peroxynitrite (ONOO- ), and nitric oxide synthase (NOS) activity as nitrosative stress markers were measured spectrophotometrically in serum samples. The predictive power of nitrosative stress parameters in Alopecia areata and control groups was compared with binary logistic regression and Receiver Operating Characteristic analysis. RESULTS: NO· , ONOO- , and NOS activity were significantly higher in patients with Alopecia areata than in the control group (p = 0.001; p < 0.001; p < 0.001, respectively). A positive correlation was found between the parameters. Significantly, binary logistic regression modeling suggested that increases in NOS (p = 0.003, OR = 1.305, 95% CI = 1.095-1.556) activity were associated with Alopecia areata. CONCLUSION: According to the data obtained from the present study, patients with Alopecia areata were exposed to potent nitrosative stress. In particular, peroxynitrite, which acts as a bridge between reactive oxygen species and reactive nitrogen species, caused the expansion of the oxidative stress cascade. Nitrosative stress might play a role in the etiopathogenesis of Alopecia areata. Nitrosative stress parameters, particularly NOS activity, may be potential markers for Alopecia areata.

Evaluation of the serum magnesium and vitamin D levels and the risk of anxiety in primary hyperhidrosis.

BACKGROUND: Excessive sweating is considered primary hyperhidrosis if it is triggered by emotional states without any thermogenic or other underlying disease from the eccrine glands. This may be due to dysfunction in the autonomic nervous system. AIMS: To investigate the relationship between Vitamin D and Mg deficiency and the risk of anxiety and depression in patients with primary hyperhidrosis. PATIENTS/METHODS: This cross-sectional, case-control study was conducted between July and October 2019. 49 primary hyperhidrosis patients in Group I and 47 age and gender matched healthy individuals in Group II were included in the study. RESULTS: The mean 25 (OH) D and Mg levels in Group I were statistically significantly lower than in Group II (p < 0.001 and p = 0.002, respectively). Statistically significant differences were found between the groups in terms of anxiety and depression (p < 0.001 and p = 0.033, respectively). There was no significant relationship between the HADS-A / HADS-D scores and the severity of primary hyperhidrosis (r = -0.131, p = 0.096; correlation coefficient = 0.232, p = 0.447). However, a significant correlation was observed between HADS-A scores and serum Mg levels (r = -0.439, p = 0.007). CONCLUSION: Anxiety and depression are common in patients with primary hyperhidrosis. As shown in this study, both anxiety and depression can be seen with low Mg levels in patients with primary hyperhidrosis. This could possibly be related to the pathological mechanism involving Vitamin D and Mg, which determines the common pathway affecting primary hyperhidrosis and anxiety/depression.

Erasmus Syndrome: A Rare Occupational Disease.

Erasmus syndrome is a rare syndrome accompanied by interstitial lung disease and scleroderma caused by silica exposure. There are a limited number of case reports in the literature. Awareness of this rare syndrome is important and occupational exposure should be questioned in patients presenting with scleroderma in our country, silica exposure is quite frequent and it should be kept in mind. Here, we report a case of a 41-year-old male patient presenting with interstitial lung disease, scleroderma, and serpiginous supravenous hypermelanosis caused by silica exposure who worked in the denim grinding for a short period of three months.

Tattoos: Demographics, Motivations, and Regret in Dermatology Patients.

Background: Tattoos are very popular in today's world. Objectives: The aim of this study was to determine the demographics, the characteristics of tattoos, motivations for getting tattoos, tattooing practices and tattoo regret. Materials and Method: This multi-centre, cross-sectional study was conducted among. 302 patients attending to the dermatology outpatient clinics and having at least one tattoo. A questionnaire form including all needed data about patients, tattoo characteristics and possible reasons for obtaining tattoos was designed and applied to all participants. Results: Of 302 patients, 140 (46,4%) were females and 162 (53,6%) were men. The mean age was28,3 ± 8,1 years (min-max, 16-62) for all study group, 53% of participants (n = 160) had at least one tattoo involving letters or number, 80 participants (26%) stated regret for at least one of their tattoos, and 34 of them (42,5%) had their unwanted tattoo removed or camouflaged with a new tattoo. The most common reason for regret was 'not liking the tattoo anymore'. The most common motivations for having tattoos were 'to feel independent', 'to feel better about himself/herself' and 'to look good'. Women had higher scores than men regarding tattoo motivations of 'to be an individual' and 'to have a beauty mark'. Conclusion: Given the rates, tattoo regret is a significant issue and as motivations differ between genders, age groups and other demographic characteristics; tattoos are not just an ink or drawing on the body, but a tool for individuals to express themselves and to construct self-identity. Tattoos have deep symbolic meanings for emotions, and they may be a clue for behavioural patterns of individuals.

Genital Ulcerative Pyoderma Gangrenosum in Behçet's Disease: A Case Report and Review of the Literature.

Behçet's disease (BD), first described by Hulusi Behcet, is a multisystemic disease characterized by recurrent oral and genital ulcerations, ocular and cutaneous lesions, arthritis and vascular disease. Pyoderma gangrenosum (PG) is a rare, chronic, sterile pustular and progressive ulcerative process of unknown cause; sometimes can participate in the differential diagnosis of Behcet's ulceration. A 33-year-old woman complained a severe genital ulcer. She had a purulent oozing and stinky ulceration on the right side of labium minor measuring 5-8 cm. A punch biopsy at ulcer margin showed that the lymphocytic panniculitis was extending to the subcutaneous fat tissue without fibrin deposition or necrotic changes in the vessel wall. Based on the clinical and histological findings, she was diagnosed as genital ulcerative PG, which occurred during the exacerbation of BD.

Epidemiology of pediatric skin diseases in the mid-western Anatolian region of Turkey.

BACKGROUND: The field of pediatric dermatology has gained importance with the increment of pediatric patients and the discrepancy of their skin diseases with the adult versions. We aimed to describe frequency and distribution of pediatric skin diseases, and the diagnostic procedures and treatments prescribed. METHODS: Cross-sectional epidemiological study. We collected data about diagnostic patterns, diagnostic methods and treatment modalities in pediatric dermatology outpatient clinic visits over 18 months. RESULTS: Infectious diseases (27.9%) and among them viral warts (17.5%) were the most prevalent diagnoses, followed by acne-acneiform diseases (19.9%) and allergic diseases (14.5%). Among the diagnostic tests histopathology was required in 5.2%, usually to diagnose inflammatory and tumoral lesions. Topical treatments (49.3%) were followed by systemic treatments (32.4%) in majority of cases. CONCLUSIONS: Viral warts were among the most common dermatoses, and preventive measures for HPV transmission should become important part of public health efforts in children.

Epidemiología de dermatosis pediátricas en la región centro-occidental de Anatolia en Turquía / Epidemiology of pediatric skin diseases in the mid-western anatolian region of Turkey

Antecedentes. El campo de la dermatología pediátrica ha ganado relevancia con el aumento de la cantidad de pacientes pediátricos y la discrepancia de las dermatosis respecto de las presentaciones en adultos. Nuestro objetivo fue describir la frecuencia y la distribución de las dermatosis pediátricas, los procedimientos de diagnóstico y los tratamientos indicados. Métodos. Estudio epidemiológico transversal. Se recolectaron datos acerca de los patrones diagnósticos, los métodos diagnósticos y las modalidades de tratamiento en las consultas ambulatorias de dermatología pediátrica a lo largo de 18 meses. Resultados. Los diagnósticos más prevalentes fueron las enfermedades infecciosas (27,9%), incluidas las verrugas virales (17,5%), seguidas de acné o enfermedades acneiformes (19,9%) y alergias (14,5%). Entre las pruebas diagnósticas, fue necesario realizar exámenes histopatológicos en el 5,2% de los casos, en general para diagnosticar lesiones inflamatorias y tumorales. En la mayoría de los casos, se emplearon tratamientos tópicos (49,3%), seguidos por tratamientos sistémicos (32,4%). Conclusiones. Las verrugas virales representaron las dermatosis más frecuentes, y es importante que la salud pública incorpore medidas preventivas contra la transmisión del VPH en los niños.

Background: The field of pediatric dermatology has gained importance with the increment of pediatric patients and the discrepancy of their skin diseases with the adult versions. We aimed to describe frequency and distribution of pediatric skin diseases, and the diagnostic procedures and treatments prescribed. Methods: Cross-sectional epidemiological study. We collected data about diagnostic patterns, diagnostic methods and treatment modalities in pediatric dermatology outpatient clinic visits over 18 months. Results: Infectious diseases (27.9%) and among them viral warts (17.5%) were the most prevalent diagnoses, followed by acne-acneiform diseases (19.9%) and allergic diseases (14.5%). Among the diagnostic tests histopathology was required in 5.2%, usually to diagnose inflammatory and tumoral lesions. Topical treatments (49.3%) were followed by systemic treatments (32.4%) in majority of cases. Conclusions: Viral warts were among the most common dermatoses, and preventive measures for HPV transmission should become important part of public health efforts in children.