Dermatologic manifestations of multisystem inflammatory syndrome in children during the COVID-19 pandemic.

OBJECTIVES: multi-system inflammatory syndrome in children (MIS-C) is an immune-mediated process that develops after infections like SARS-CoV-2. The authors aimed to reveal the mucocutaneous findings of patients diagnosed with MIS-C at presentation and evaluate the frequency of these mucocutaneous findings and their possible relationship with the severity of the disease. METHODS: A prospective study was conducted of 43 children admitted to a tertiary hospitals between January 2021 and January 2022 who met Centers for Disease Control and Prevention criteria for MIS-C. RESULTS: 43 children (25 [58.1%] male); median age, 7.5 years [range 0.5‒15 years]) met the criteria for MIS-C. The most common symptom was cutaneous rash 81.4%, followed by gastrointestinal symptoms 67.4%, oral mucosal changes 65.1%, and conjunctival hyperemia 58.1%. The most common mucosal finding was fissured lips at 27.9%, diffuse hyperemia of the oral mucosa at 18.6%, and strawberry tongue at 13.9%. Urticaria (48.8%) was the most common type of cutaneous rash in the present study's patients. The most common rash initiation sites were the trunk (32.6%) and the palmoplantar region (20.9%). The presence or absence of mucocutaneous findings was not significantly associated with disease severity. STUDY LIMITATIONS: The number of patients in the this study was small. CONCLUSIONS: The present study's prospective analysis detected mucocutaneous symptoms in almost 9 out of 10 patients in children diagnosed with MIS-C. Due to the prospective character of the present research, the authors think that the characteristic features of cutaneous and mucosal lesions the authors obtained will contribute to the literature on the diagnosis and prognosis of MIS-C.

Isotretinoin-induced inflammatory back pain and sacroiliitis in patients with moderate-to-severe acne vulgaris.

INTRODUCTION: Isotretinoin has been reported to induce inflammatory back pain (IBP) and sacroiliitis in the patients with acne vulgaris. The aim of this study is to investigate the incidence of IBP and sacroiliitis in patients receiving isotretinoin treatment compared with oral antibiotics for acne vulgaris. MATERIALS AND METHODS: A total of 201 patients with moderate-to-severe acne vulgaris who received isotretinoin (n = 100) or oral antibiotics (n = 101) were included in the study. All patients were monthly questioned for IBP symptoms during their treatment. Patients described IBP were also evaluated for sacroiliitis by c-reactive protein, sedimentation rate, HLAB27, and sacroiliac magnetic resonance imaging (MRI). Isotretinoin was discontinued in all patients diagnosed as sacroiliitis, and these patients were reevaluated after 3 months. RESULTS: IBP was observed in 21 (10.4%), and sacroiliitis was detected in 11 (11%) patients on isotretinoin treatment; in oral antibiotic group, we did not observe IBP or sacroiliitis. The incidence of IBP and sacroiliitis differed significantly between the isotretinoin and oral antibiotic groups (p < 0.0001, p = 0.02). Complete regression was observed in the great majority of patients following cessation of isotretinoin. CONCLUSIONS: Our study is the largest prospective controlled study that investigated the incidence of sacroiliitis in patients receiving isotretinoin and compared with patients using oral antibiotics.

Prevalence and Dermoscopic Patterns of Acral Melanocytic Nevi in Turkey.

Although nevi are frequently encountered in the acral region, very limited studies have reported their prevalence in specific populations. We aimed to determine the prevalence of acral nevi, their dermoscopic patterns, and evaluate patient awareness in a Turkish population. We prospectively examined 2644 patients admitted to the outpatient dermatology clinics between October 2016 and October 2017. The characteristics of the detected acral nevi and dermatoscopic images were recorded. A questionnaire of demographic characteristics was completed from all patients. Two hundred six of the 2644 patients had at least one acral nevus. Two hundred sixty nevi were examined. The general prevalence of acral nevi was 7.8%. Women were more likely to have acral nevi than men (8.7% vs. 6.3%; P=0.028). Moreover, darker-skinned patients were also had significantly more acral nevi (8.6% in skin type III-IV vs. 6.0% in skin type I-II; P<0.001). The prevalence of acral nevi was 9.4% before the age of 20, 9.5% in patients aged 20-40 years, and 4.6% after the age of 40. In addition, 51.5% of all nevi exhibited a parallel furrow, 13.5% were lattice-like, and 7.7% had a homogeneous pattern. The overall nevus awareness rate was 73.8% and was significantly higher in women at 78.3%. Our study is the first large-scale study of that showed the prevalence of acral nevi in Turkey. According to our study, the prevalence of acral nevi was higher in patients with female sex and darker skin type. We also found that the prevalence of acral nevi decreased over 40 years of age. The general awareness of nevi was higher in women.

Drug survival of biologic treatments in Turkish patients with psoriasis.

Psoriasis is a chronic, immune-mediated disease deriving from a polygenic predisposition. Treatment paradigm of the moderate to severe psoriasis has changed in the last two decades as biologics have been developed. Real-world data concerning biologics in the treatment vary from country to country. We aimed to investigate the efficacy and drug survival of biologic agents in patients treated in our clinic in Turkey. Data for 211 biologic protocols were examined for 125 patients treated with a biologic at least once for a minimum duration of 16 weeks at our department. The drug survival rate for 3 years was highest among ustekinumab (UST) users. The primary failure rate in the present study was higher among tumor necrosis factor-alpha inhibitors compared to UST (P < .0001). The higher primary failure rate was found in etanercept users and the highest secondary failure rate was observed in infliximab, while the lowest primary and secondary failure rates were determined in UST users. UST use and articular involvement emerged as significant positive predictors of drug survival in naïve patients. Our study is the first study presenting real-life data and biologic survival in the treatment of psoriasis in Turkey, and UST exhibited significantly higher drug survival scores, particularly in naive patients.

Sun-protection habits and knowledge of patients with vitiligo.

INTRODUCTION: Vitiligo is a common chronic depigmentation disease. Patients are generally advised to protect themselves from the sun. METHODS: One hundred fifty-three patients diagnosed with vitiligo and 106 healthy volunteers with no additional dermatological disease were included in the study. We evaluated the sun-protection habits of patients with vitiligo and controls, and also assessed their knowledge and attitudes toward sun exposure. RESULTS: Rates of sunscreen use, high-factor sunscreen use, and remaining in the shade were significantly higher among patients (p = 0.004, p = 0.028, p = 0.040). We found significantly higher rates of modifying vacation habits, high sun-protection factors (SPF) sunscreen use, and preferring to remain in the shade among patients using phototherapy (p = 0.016, p = 0.019, p = 0.028). We showed higher rates of modification of vacation habits, wearing sunglasses, and remaining in the shade among patients with longer disease durations (p = 0.026, p = 0.001, and p = 0.017). CONCLUSIONS: We determined higher rates of sunscreen use, high-SPF sunscreen use, and tendencies to remain in the shade in vitiligo patients compared to the general population. We also determined that disease duration and treatment with phototherapy alters sun-protection habits, but the presence of generalized disease and lesions in visible areas such as the face does not alter patients' habits.

Mycosis Fungoides: A 10-year Turkish Experience.

Mycosis fungoides is the most common primary cutaneous T cell lymphoma, characterized by erythematous patches and plaque lesions with slow progression to cutaneous tumors or extracutaneous involvements in some patients. We aimed to evaluate the clinical characteristics, treatment responses, disease courses, and mortality rates of our MF cases. The data of 100 patients with MF were retrospectively examined from medical records in our clinic between January 2005 and January 2015. Demographic and clinical characteristics of the patients, disease stage, treatment protocols, response to treatment, recurrence, progression, and mortality rates were recorded. The male to female ratio in patients was 1.2. Mean age at onset of disease was 46, and duration of disease ranged from one to 42 years. At time of diagnosis 31 patients were at stage 1A, 31 at stage 1B, 30 at stage 2A, 2 at stage 2B, 1 at stage 3, and 5 at stage 4. Stable disease was observed in 35% of patients, progression in 10%, relapse in 27%, and complete response in 28%. Large cell transformation was found in 3 patients and additional malignity in 11. Thirty-seven patients (37%) were still surviving disease-free. 10 patients had died, three of them due to disease-related conditions. The most common first-line therapy in our study was phototherapy. It was applied to 87% of patients from stage 1A. Our results are generally consistent with current literature, but disease progression and disease-specific mortality rates were significantly lower than the literature, probably due to early phototherapy.

Cosmetical treatments of connective tissue disorders.

Connective tissue disorders (CTDs) are chronic inflammatory conditions that can lead to scarring and disfiguration. Although conventional methods are often of little benefit in cutaneous manifestations, the use of cosmetic procedures is still controversial. Concerns have also been raised concerning cosmetic treatments in CTDs, and particularly regarding lasers and fillers, due to photosensitivity and potential reactivation. This article reviews the cosmetic treatment of various CTDs under three headings - lasers, fillers, and botulinum toxin.

Sun-protective behaviours of Turkish young adults.

BACKGROUND: The prevalence of skin cancers, including melanoma, has increased significantly in the past five decades. The main environmental factor implicated in their development is excessive sun exposure. Data on sun-protective behaviours in the Turkish population are very limited. OBJECTIVES: We aim to assess sun protection behaviours and the prevalence of exposure through broad participation among a young adult population in a national university in Turkey. METHODS: A multiple-choice questionnaire including 27 questions to evaluate sun protection behaviours was sent to e-mail addresses of all undergraduates. From 40 000 undergraduates, 17 769 of them were included in the study, with a response rate of 44.4%. RESULTS: Sunscreen usage was the most preferred sun protection method, used by 64% of the study population, followed by the use of sunglasses (60%), tending to remain in the shade (49%), the use of a hat (34%) and wearing long-sleeved clothing (23%). Forty-four percentage of the students used at least two methods, whereas 7% did not use any sun protection method. The prevalence rates of the use of sunscreen, sunglasses, wearing long-sleeved clothing and preferring to remain in the shade in the summer were all significantly higher among women. In addition, the prevalence rates of the use of sunscreen and preferring to remain in the shade were higher among students in the faculty of medicine. CONCLUSION: We found that when compared to the countries with the highest incidences of skin cancer, such as Australia and the United States, young adults in Turkey are protecting themselves more from the sun. This rate was even higher among women and faculty of medicine undergrads.

The prevalence of sacroiliitis in patients with acne vulgaris using isotretinoin.

BACKGROUND/OBJECTIVE: Acne vulgaris is a chronic inflammatory disease affecting the pilosebaceous unit in the skin. Isotretinoin is a synthetic vitamin A derivative regarded as the most effective agent in the treatment of acne. There have recently been increasing reports of adverse effects of isotretinoin on the skeletal system. Our aim in this study was to evaluate the rheumatic side-effects triggered by this drug, and particularly the prevalence of sacroiliitis. MATERIALS AND METHODS: A total of 73 patients receiving isotretinoin due to moderate or severe acne vulgaris were included. All patients were questioned about inflammatory low back pain and musculoskeletal pains during the treatment process. Inflammatory low back pain was evaluated using Assessment of Spondyloarthritis International Society (ASAS) criteria. Patients meeting ASAS criteria were evaluated with radiography and when necessary with sacroiliac magnetic resonance. RESULTS: The dose range for isotretinoin was between 0.4 and 0.8 mg/kg/day (mean 0.53 mg/kg/day). Treatment lasted for 6-8 months (mean 6.8 months). Lethargy was determined in 37 (50.7%) patients, myalgia in 31 (42.5%) and low back pain in 36 (49.3%). Mechanical low back pain symptoms were present in 20 of the patients describing low back pain and inflammatory low back pain in 16. Acute sacroiliitis was determined in six patients (8.2%) following a sacroiliac magnetic resonance imaging (MRI). Five (83.3%) of the patients with sacroiliitis were female and one (16.7%) was male. No statistically significant difference was determined between male and female patients in terms of prevalence of sacroiliitis (p = 0.392). CONCLUSION: The incidence of sacroiliitis in patients using isotretinoin is quite high. Patients using isotretinoin must be questioned about sacroiliitis findings and must be subjected to advanced assessment when necessary. Further studies regarding the development of sacroiliitis under isotretinoin therapy are now needed.

Assessment of demodex presence in acne-like rash associated with cetuximab.

CONTEXT: Cetuximab is an epidermal growth factor receptor inhibitor. It is frequently used in the treatment of solid tumors. However, it has a high potential to cause acne-like rash. Demodex mites, which are known to increase in number in immunosuppressive circumstances, are closely related to the acneiform lesions. OBJECTIVE: The aim of this study is to evaluate the presence of demodex mites in acne-like rash that appears under the treatment of Cetuximab. METHODS: We reviewed the medical records of patients who applied to our clinic with cetuximab induced papulopustular rashes between November 2014 and March 2016. Demodex sampling was performed by standardized skin surface biopsy (SSSB) in a total of 11 patients (eight males and three females). Infestation was defined as at least 5 living parasites/cm2 of skin. RESULTS: Upon the SSSB examination in 10 out of the 11 patients, no demodex mites were detected. Demodex mites were found in only one of the patients. This patient, in whom two dead Demodex folliculorums were found through facial sampling, was also regarded as negative since his demodex density was under the threshold limit value. CONCLUSION: In this study, it has been concluded that acne-like rash that develops under the treatment of cetuximab is not related to the presence of demodex mites. Papulopustular eruptions that develop under cetuximab treatment should not be directly correlated with the presence of demodex; first SSSB and demodex presence should be evaluated.