Melatonin Prevents UVB-Induced Skin Photoaging by Inhibiting Oxidative Damage and MMP Expression through JNK/AP-1 Signaling Pathway in Human Dermal Fibroblasts.

Exposure to ultraviolet (UV) irradiation causes damage to the skin and induces photoaging. UV irradiation stimulates production of reactive oxygen/nitrogen species, which results in activation of epidermal growth factor receptor (EGFR) and mitogen-activated protein kinases (MAPK) in fibroblasts. MAPKs are responsible for activation of activator protein-1 (AP-1), which subsequently upregulates expression of matrix metalloproteinases (MMPs). Melatonin is a potent free radical scavenger which is known to have photoprotective effects. The aim of this study is to investigate the underlying molecular mechanisms for the photoprotective effects of melatonin in UVB-irradiated primary human dermal fibroblasts (HDFs) in terms of EGFR activation, oxidative/nitrosative damage, JNK/AP-1 activation, MMP activities, and the levels of tissue inhibitors of metalloproteinase-1 (TIMP-1) and type I procollagen (PIP-C). In this study, HDFs were pretreated with 1 µM of melatonin and then irradiated with 0.1 J/cm2 of UVB. Changes in the molecules were analyzed at different time points. Melatonin inhibited UVB-induced oxidative/nitrosative stress damage by reducing malondialdehyde, the ratio of oxidized/reduced glutathione, and nitrotyrosine. Melatonin downregulated UV-induced activation of EGFR and the JNK/AP-1 signaling pathway. UVB-induced activities of MMP-1 and MMP-3 were decreased and levels of TIMP-1 and PIP-C were increased by melatonin. These findings suggest that melatonin can protect against the adverse effects of UVB radiation by inhibiting MMP-1 and MMP-3 activity and increasing TIMP-1 and PIP-C levels, probably through the suppression of oxidative/nitrosative damage, EGFR, and JNK/AP-1 activation in HDFs.

A multicentre prospective analysis of the incidence of pemphigoid diseases in Turkey.

BACKGROUND: The differentiation between the pemphigoid diseases is essential for treatment and prognosis. In Turkey, data on the incidence of these diseases are insufficient. Our aim in this study is to determine the incidence, demographics and clinical characteristics associated with diseases of the pemphigoid group. METHODS: We prospectively analysed 295 patients with pemphigoid who visited dermatology clinics of tertiary referral hospitals in 12 different regions of Turkey within a year. The diagnosis was based on clinical, histopathological, direct immunofluorescence (DIF) and serological (multivariant enzyme-linked immunosorbent assay [ELISA], indirect immunofluorescence and mosaic-based BIOCHIP) examinations. Clinical and demographic findings, aetiological factors and concomitant diseases observed in the patients were recorded. RESULTS: A total of 295 (female/male ratio: 1.7/1) patients with pemphigoid were diagnosed in 1-year period. The overall incidence rate of pemphigoid diseases was found to be 3.55 cases per million-years. The ratio of pemphigoid group diseases to pemphigus group diseases was 1.6. The most common pemphigoid type was bullous pemphigoid (BP, 93.2%). The others were epidermolysis bullosa acquisita (3.1%), pemphigoid gestationis (2.4%), linear IgA disease (1%) and mucous membrane pemphigoid (0.3%). The most common (26.8%) possible trigger of the bullous pemphigoid was gliptin derivative drugs. The most common concomitant diseases with pemphigoid were cardiovascular (27.8%) and neurological diseases (23.7%). CONCLUSIONS: This study showed that the increased frequency of bullous pemphigoid reversed the pemphigoid/pemphigus ratio in Turkey. Further studies are warranted regarding the reasons for this increase.

Quality of life, anxiety, depression, social anxiety and avoidance in patients with chronic hand eczema.

BACKGROUND: Previous studies have demonstrated that chronic hand eczema (CHE) causes negative effects on psychological status of patients. However, presence of social anxiety and avoidance has not been investigated in CHE patients. In this descriptive and prospective study, we aimed to examine the psychosocial dimensions of CHE in a more detailed manner. METHODS: 70 patients with CHE and 70 controls were participated in the study. The quality of life (QoL) was assessed with the World Health Organization QoL Questionnaire-Short Form (WHOQoL-BREF); anxiety and depression were evaluated with the Hospital Anxiety and Depression Scale (HADS); and social anxiety and avoidance were evaluated with the Liebowitz Social Anxiety Scale (LSAS). RESULTS: The physical and environmental subscale scores of the WHOQoL-BREF were significantly lower (P<0.001, P=0.041); whereas HADS-total (P=0.019), HADS-anxiety (P=0.014), LSAS-total (P=0.025), LSAS-anxiety (P=0.037) and LSAS-avoidance (P=0.029) scores were significantly higher in CHE patients compared to controls. The physical (r=-0.260, P=0.002) and social (r=0.204, P=0.016) domains of the WHOQoL-BREF scale negatively correlated with the severity of eczema, while the psychological (r=-0.363, P=0.002) and environmental (r=-0.456, P<0.001) domains negatively correlated with the extent of eczema. HADS-total (r=0.284, P=0.017) and HADS-depression (r=0.311, P=0.009) also showed positive correlations with the extent of the CHE. CONCLUSIONS: Considering that impairment in QoL may be associated with psychosocial morbidity, it is important to develop strategies to recognize and treat those psychiatric comorbidities in patients with CHE.

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.

Melatonin attenuates the detrimental effects of UVA irradiation in human dermal fibroblasts by suppressing oxidative damage and MAPK/AP-1 signal pathway in vitro.

BACKGROUND: People living in Mediterranean countries are mostly exposed to solar ultraviolet (UV) radiation that damages skin and results in photoaging which involves activation of epidermal growth factor receptor (EGFR) and downstream signal transduction through mitogen-activated protein kinases (MAPKs) in fibroblasts. Generation of reactive oxygen/nitrogen species by UV radiation is also critical for EGFR and MAPKs activation. MAPKs are responsible for activation of AP-1 subunits in the nucleus which induce matrix metalloproteinases. Melatonin, along with its metabolites, are known to be the most effective free radical scavenger and protective agent due to its ability to react with various radicals, lipophilic/hydrophilic structures. OBJECTIVES: In this study, we investigated the effects of melatonin on UVA-irradiated primary human dermal fibroblasts (HDFs) by following the alteration of molecules from cell membrane to the nucleus and oxidative/nitrosative damage status of the cells in a time-dependent manner which have not been clearly elucidated yet. METHODS: To mimic UVA dosage in Mediterranean countries, HDFs were exposed to UVA with sub-cytotoxic dosage (20 J/cm2 ) after pretreatment with melatonin (1 µmol/L) for 1 hour. Changes in the activation of the molecules and oxidative/nitrosative stress damage were analyzed at different time points. RESULTS: Our results clearly show that melatonin decreases UVA-induced oxidative/nitrosative stress damage in HDFs. It also suppresses phosphorylation of EGFR, activation of MAPK/AP-1 signal transduction pathway and production of matrix metalloproteinases in a time-dependent manner. CONCLUSION: Melatonin can be used as a protective agent for skin damage against intracellular detrimental effects of relatively high dosage of UVA irradiation.

Matrix metalloproteinase-2 and -9 activity levels increase in cutaneous lupus erythematosus lesions and correlate with disease severity.

Lupus erythematosus is a chronic autoimmune disease characterized by remissions and exacerbations. Accumulated evidence indicated that matrix metalloproteinases (MMPs) are upregulated in inflammatory cells of cutaneous lupus erythematosus (CLE); however, the activity levels of these proteases have remained uncharacterized. To elucidate the significance of MMP-2, MMP-9, and TIMP-1 in CLE pathogenesis, gelatin zymography was used to investigate pro and active levels of MMP-2 and MMP-9 in lesional and perilesional skin biopsies obtained from twenty-two CLE patients. TIMP-1 protein levels were detected by ELISA in the biopsy specimens. The correlation between biochemical parameters and clinical characteristics of the disease was also evaluated. Significantly higher levels of active MMP-2, active MMP-9, proMMP-9, active/proMMP-2, and TIMP-1 were detected in lesional skin samples. Besides, the active/proMMP-9 was elevated in female and smoking patients. Active MMP-9 levels and active/proMMP-9 were also increased in elderly patients. Active MMP-9 levels were lower in patients who had smaller total damage score. Consistently, active/proMMP-9 and active/proMMP-2 were positively correlated with CLASI. Interestingly, in hydroxychloroquine or topical corticosteroid-treated patients, MMP-2/-9 activity levels were found to be higher compared to untreated patients. These findings suggest that increased MMP-2 and MMP-9 activities may contribute to the pathogenesis of CLE and cutaneous disease severity.

Epidemiology of Pemphigus in Turkey: One-year Prospective Study of 220 Cases.

Pemphigus is a group of rare and life-threatening autoimmune blistering diseases of the skin and mucous membranes. Although they occur worldwide, their incidence shows wide geographical variation, and prospective data on the epidemiology of pemphigus are very limited. Objective of this work is to evaluate the incidence and epidemiological and clinical features of patients with pemphigus in Turkey. All patients newly diagnosed with pemphigus between June 2013 and June 2014 were prospectively enrolled in 33 dermatology departments in 20 different provinces from all seven regions of Turkey. Disease parameters including demography and clinical findings were recorded. A total of 220 patients were diagnosed with pemphigus during the 1-year period, with an annual incidence of 4.7 per million people in Turkey. Patients were predominantly women, with a male to female ratio of 1:1.41. The mean age at onset was 48.9 years. Pemphigus vulgaris (PV) was the commonest clinical subtype (n=192; 87.3%), followed by pemphigus foliaceus (n=21; 9.6%). The most common clinical subtype of PV was the mucocutaneous type (n=83; 43.2%). The mean Pemphigus Disease Area Index was 28.14±22.21 (mean ± Standard Deviation). The incidence rate of pemphigus in Turkey is similar to the countries of South-East Europe, higher than those reported for the Central and Northern European countries and lower than the countries around the Mediterranean Sea and Iran. Pemphigus is more frequent in middle-aged people and is more common in women. The most frequent subtype was PV, with a 9-fold higher incidence than pemphigus foliaceus.

Possible triggering factors and comorbidities in newly diagnosed autoimmune bullous diseases.

BACKGROUND/AIM: The distribution and the demographic, etiological, and clinical features of autoimmune bullous diseases (ABDs) vary according to geographic regions of the world. The limited number of reported studies in Turkey are mostly retrospective and generally include only pemphigus. The aim of our study was to evaluate the demographic data, clinical features, associated triggering factors, and comorbidities in patients newly diagnosed with ABDs. MATERIALS AND METHODS: In this descriptive and prospective study, the demographic data, inhabited regions, smoking and drinking habits, presence of comorbidities, and specific and general potential triggering factors of ABDs considered by the patients were examined. Furthermore, the distribution of lesions and autoimmune bullous skin disorder intensity scores were recorded. RESULTS: Of the total 59 ABD patients, 26 (44.1%) were diagnosed with pemphigus, 25 (42.4%) were diagnosed with pemphigoid, and 8 (13.5%) were diagnosed with dermatitis herpetiformis. Although there were some differences between the subgroups of ABDs, the onset of the disease was associated with a triggering factor (stress, foods, physical trauma, chemical agents, ultraviolet rays, medications, infections, malignancies, and pregnancy, in a decreasing frequency) in 96.6% of the patients. Autoimmune diseases, neuropsychiatric disorders, diabetes mellitus, and hypertension were found to be statistically significantly higher in the pemphigoid group compared to the pemphigus and dermatitis herpetiformis groups. CONCLUSION: Evaluation of triggering factors and comorbidities before starting treatment may assist in controlling the disease more swiftly and reducing the side effects of treatment in the management of ABDs. However, to evaluate the frequency and significance of our findings in order to determine whether they are statistically significant or not, we suggest a multicenter prospective clinical trial, which would include control groups and a higher number of patients for each of the disease groups and clinical subtypes.

High Prevalence of Metabolic Syndrome in Patients with Discoid Lupus Erythematosus: A Cross-Sectional, Case-Control Study.

Although it is known that systemic form of lupus erythematosus (LE) and metabolic syndrome (MetS) are frequently observed together, there are no published reports on MetS in patients with skin-restricted LE. We aimed to compare the frequencies of MetS and its components in discoid LE (DLE) with the non-DLE control group. Additionally, we intended to determine the differences of sociodemographic and clinical data of the DLE patients with MetS compared to the patients without MetS. This was a cross-sectional, case-control study, including 60 patients with DLE and 82 age- and gender-matched control subjects. In DLE group, the presence of MetS was observed as more frequent (48.3% versus 24.4%, p = 0.003), and hypertriglyceridemia (43.3% versus 22.0%, p = 0.006) and reduced HDL-cholesterol (61.7% versus 23.2%, p < 0.001) among the MetS components were found significantly higher when compared to the control group. DLE patients with MetS were at older age (50.45 ± 11.49 versus 43.06 ± 12.09, p = 0.02), and hypertension, hyperlipidemia/dyslipidemia, and cardiovascular disease histories were observed at a higher ratio when compared to the patients without MetS. Between the DLE patients with and without MetS, no significant difference was observed in terms of clinical characteristics of DLE. Moreover, further large case-control studies with follow-up periods would be required to clearly assess the impact of MetS on the clinical outcomes of DLE.

Dermoscopic findings in scalp psoriasis and seborrheic dermatitis; two new signs; signet ring vessel and hidden hair.

BACKGROUND: Psoriasis and seborrheic dermatitis are both chronic erythemato-squamous dermatoses that can involve the scalp. It may be difficult to differentiate these two diseases when there is isolated scalp involvement. Recently, trichoscopy is commonly used to differentiate noncicatricial alopecias including psoriasis and seborrheic dermatitis that can lead to telogen effluvium (TE). OBJECTIVES: The objective of this study is to evaluate the trichoscopic figures that may help to differentiate scalp psoriasis and seborrheic dermatitis. MATERIALS AND METHODS: Thirty one with scalp psoriasis and 112 patients with seborrheic dermatitis were enrolled. Trichoscopic examinations were performed using a videodermatoscope (MoleMax 3(®)). Trichoscopic findings of scalp psoriasis and seborrheic dermatitis were compared with each other, with 100 healthy individuals and with other noncicatricial alopecias including female androgenetic alopecia (FAGA) (n: 138), male androgenetic alopecia (n: 63), FAGA of male pattern (FAGA.M) (n: 5), alopecia areata (39), TE (n: 22) and trichotillomania (n: 4). RESULTS: Atypical red vessels, red dots and globules (RDG), signet ring vessels (SRV), structureless red areas and hidden hairs (HH) were statistically more common in psoriasis while twisted red loops and comma vessels (CV) in seborrheic dermatitis. RDG were considered as the characteristic videodermatoscopic figure for psoriasis and arborizing red lines and CV for seborrheic dermatitis. In comparison with previous reports, our study yielded two new trichoscopic structures supporting the diagnosis of psoriasis; HH and SRV. Besides, according to our study, CV were described for the first time in seborrheic dermatitis and considered to be specific for seborrheic dermatitis. CONCLUSION: This study confirmed that trichoscopy might be useful in differentiating scalp psoriasis and seborrheic dermatitis from each other and from other noncicatricial alopecia with three trichoscopic structures as HH, SRV and CV.

Trichoscopic findings in alopecia areata and their relation to disease activity, severity and clinical subtype in Turkish patients.

BACKGROUND/OBJECTIVE: Trichoscopic studies of alopecia areata are helpful in the non-invasive diagnosis and prediction of the course of the disease. The objective was to determine the relationship of trichoscopic findings in alopecia areata with disease activity, severity and clinical subtype in Turkish patients. METHODS: Trichoscopic examinations of 39 patients with alopecia areata were compared with 309 alopecia patients including psoriasis (n = 31), seborrhoeic dermatitis (n = 112), female androgenetic alopecia (n = 138), male androgenetic alopecia (n = 63), female androgenetic alopecia of male pattern (n = 5), telogen effluvium (n = 22) and trichotillomania (n = 4). A χ(2) test and logistic regression analysis were used for the statistical analysis. The odds ratios were calculated by cross tabulation. RESULTS: There was no relationship between the alopecia areata subtype and trichoscopic findings. On the other hand, a honeycomb hyperpigmentation pattern, cumulus-like clustered white dots, white dots and black dotted pigmentation related to severe disease, while exclamation mark hairs related to mild disease. Exclamation mark hairs were found to be related to active disease while atypical red vessels and white dots were negatively related to disease activity. CONCLUSION: In our study, further characteristic trichoscopic findings were detected in alopecia areata such as clustered white dots, multi-hair follicular unit, hidden hairs and black dotted pigmentation, in addition to previous findings. Hence, it is concluded that the identification and prediction of alopecia areata might be straightforward with the help of these new signs such as activation and severity findings.

Scalp dermatoscopic findings in androgenetic alopecia and their relations with disease severity.

BACKGROUND: Clinicians are searching for new methods to diagnose and predict the course of androgenetic alopecia noninvasively. OBJECTIVE: Our aim is to evaluate trichoscopic findings and their relations with disease severity in androgenetic alopecia. METHODS: The videodermatoscopic findings of 143 female and 63 male patients with androgenetic alopecia were compared with each other, with those of healthy subjects (n=100), and with those of patients with other nonscarring alopecias (n=208). Mann-Whitney U-test, χ(2) analyses, and logistic regression analysis were used for statistical analysis. RESULTS: No statistically significant relation was found between trichoscopic findings and severity in male androgenetic alopecia (MAGA) on the basis of the modified Hamilton Norwood scale (among 7 degrees); however, multihair follicular unit and perifollicular pigmentation were related to low severity whereas white dots, honeycomb pattern pigmentation, and brown dots were related to high severity. On the other hand, according to the Ludwig classification, arborizing red lines were related to low severity and brown dots were related to high severity, whereas there was no difference in stages between the Ebling and Olsen classifications in female androgenetic alopecia (FAGA). In the characteristic trichoscopic findings in this study, perifollicular pigmentation was found as a normal feature of the scalp, whereas multihair follicular unit and honeycomb pigment pattern, which were previously considered as normal features, were observed to be related to androgenetic alopecia. CONCLUSION: No relation was found between MAGA severity and trichoscopic findings, as well as between FAGA severity according to different disease severity classifications and trichoscopic findings.

Vitamin D receptor gene polymorphisms and haplotypes (Apa I, Bsm I, Fok I, Taq I) in Turkish psoriasis patients.

BACKGROUND: Psoriasis is an inflammatory disease characterized by increased squamous cell proliferation and impaired differentiation. Vitamin D, Calcitriol, and its analogues are successfully used for psoriasis therapy. However, it is unknown why some psoriasis patients are resistant to Vitamin D therapy. Vitamin D mediates its activity by a nuclear receptor. It is suggested that polymorphisms and haplotypes in the VDR gene may explain the differences in response to vitamin D therapy. MATERIAL/METHODS: In this study, 102 psoriasis patients and 102 healthy controls were studied for VDR gene polymorphisms. The Fok I, Bsm I, Apa I and Taq I polymorphisms were examined by PCR-RFLP, and 50 subjects received vitamin D therapy to evaluate the association between VDR gene polymorphisms and response to vitamin D therapy. Existence of cutting site is shown by capital letters, and lack was shown by lower case. The haplotypes were analysed by CHAPLIN. RESULTS: There was significant difference in allele frequency of T and genotype frequency of Tt between cases and controls (p values 0.038 and 0.04, respectively). The Aa and bb genotypes were significantly higher in early onset than late onset psoriasis (p values 0.008 and 0.04, respectively). The genotypes Ff, ff and TT are significantly different between vitamin D3 therapy responders and non-responders (p values 0.04, 0.0001, 0.009, respectively). To the best of our knowledge, this is the first report showing importance of VDR gene haplotypes in psoriasis, the significance of the Wald and LR (Likelihood Ratio) statistics (p=0,0042) suggest that FfBbAatt is a disease-susceptibility haplotype. CONCLUSIONS: Haplotype analysis is a recent and commonly used method in genetic association studies. Our results reveal a previously unidentified susceptibility haplotype and indicate that certain haplotypes are important in the resistance to vitamin D3 therapy and the onset of psoriasis. The haplotypes can give valuable data where genotypes unable to do.

A girl of Klippel-Trenaunay Weber syndrome coexistence of recurrent bloody vaginal discharge.

Klippel-Trenaunay Weber syndrome (KTWS) is the coexistence of capillary vascular malformations, varicose veins, dilated arteries and arteriovenous fistulas, soft tissue and/or bone hypertrophy. We present a girl of KTWS associated with hypertrophied left kidney, enlargement in venous structures of the left kidney, recurrent bloody vaginal discharge and angiokeratomas. A 6-year-old girl was admitted to our department with complaints of recurrent bloody vaginal discharge and swelling in the left inguinal region. Physical examination revealed hypertrophy of the left lower extremity. Vaginoscopy and cystoscopy revealed normal findings. Abdominal ultrasound revealed an enlarged left kidney. Enlargement in the venous structures of the hypertrophied left kidney was detected by abdominal magnetic resonance imaging, and arteriovenous fistulas were revealed by conventional angiography. The patient was diagnosed KTWS. Ophthalmic examination was normal. Galactosidase A (GLA) level was found to be at the lower limit of the normal range, and mutation was not detected in the GLA gene. In conclusion, we have emphasized that the girls with recurrent vaginal discharge might be KTWS. Angiokeratoma may be considered as a dermatological finding of KTWS. KTWS may also have enlarged kidney and enlargement in venous structures of the kidney in hypertrophied side.

Epidemiology of atopic dermatitis in primary schoolchildren in Turkey.

The present study aimed to investigate the prevalence of atopic dermatitis in primary schoolchildren in Denizli, Turkey, and to determine the possible risk factors for atopic dermatitis in home environment. A self-administered questionnaire was handled to the parents of 2,100 children aged 7 to 15 years, from three randomized primary schools and 1,644 (78.9%) completed and returned the questionnaire. The questionnaire included the United Kingdom Working Party diagnostic criteria and asked about conditions that could affect the course of atopic dermatitis. The prevalence of atopic dermatitis and coexisting factors that may affect the course of the disease were evaluated in 1,644 children (825 girls and 819 boys). The prevalence of atopic dermatitis was detected as 4.9%. Passive smoking, heating systems either in the house or in the child's bedroom, and the number of people living in the house had no significant effect (p > 0.005). The difference in prevalence of atopic dermatitis between developed and developing countries is striking. The determination of the factors that have an influence in this issue will probably enable us to change the course and frequency of atopic dermatitis.

Biomechanical properties of human hair with different parameters.

BACKGROUND/PURPOSE: Investigations on the mechanical properties of human hair are inadequate. This research explores the break force of anagen hair by forming criteria according to the diameter of hair, gender, age, strain, use of drugs and hair dyes and how these criteria affect the mechanical resistance of hair. METHODS: The resistances of anagen hair of 120 volunteers were investigated in our biomechanics laboratory. The relationship between the value of break force of hair and hair diameter, gender, age, strain, use of drugs and hair dyes was examined. Tensile tests were applied to each hair with a 50 N load cell device. RESULTS: The statistical evaluation demonstrated a significant difference between the break forces of hairs with different hair diameters. The hairs with a diameter of 51 mum and above had a significantly higher break force than those of 50 mum and below (P=0.000). An insignificant correlation was observed between break force and strain (P=0.554, r=-0.055) whereas the correlation between diameter and strain was statistically significant (P=0.000, r=0.361). CONCLUSION: The break force of hairs did not show any significant dependency on age, presence of hair dyes, gender and usage of drugs. Yet, a statistically significant difference was observed between the break forces of hairs when compared according to their diameters and strain. More research on the mechanical properties of human hair consistent with biological properties like protein structure, alpha keratin fibers and microfibril-matrix composite behaviors would guide dermatologists for diagnostic symptoms.

The role of essential and non-essential elements in Mal de Meleda.

Mal de Meleda (MDM) is a rare autosomal recessively inherited palmoplantar keratoderma. In 1826 Stulli described the disease on the Dalmatian island of Meleda. Hyperkeratosis involves other parts of the body such as elbows and knees, in addition to the palms and soles. Zinc deficiency is known to cause hyperkeratozis in addition to other skin changes. We studied the levels of essential and nonessential elements in blood and tissues /nail, hair, skin/ in MDM patients and healthy controls living in Köprüçay area, Turkey. The results show no significant difference in blood zinc, iron, copper, cadmium, and lead levels between MDM patients and healthy controls. The zinc and copper levels of nail and hair in MDM patients did not differ from those of healthy controls.

Quantification of female pattern hair loss: a study in a Turkish population.

Studies dealing with the relationship between the clinical staging of female pattern hair loss (FPHL) and quantitative measurements of hair parameters are limited. This study was performed to quantify Turkish women's hair characteristics in FPHL, to assess the relationship between clinical presentations of FPHL with hair density and anagen hair ratio and to compare the differences in hair parameters between FPHL and normal women, using epiluminescence microscopy combined with digital image analysis (Trichoscan). Hair density and anagen hair ratio measurements of 39 patients with FPHL were evaluated according to clinical stages and compared with those of 31 healthy volunteers. The results of digital image analysis were compared with the results of visual counting using the photomacrographs of the same images. Mid-scalp hair density and anagen ratio of the patients were detected to be significantly lower than those of the controls. The visual counting detected significant differences among the hair densities of all groups including controls, Ludwig I, and Ludwig II/III groups, while digital image analysis revealed a significant difference only between controls and Ludwig II/III groups. Thus digital image analysis was found to underestimate hair density, and the amount of underestimation demonstrated a positive correlation with hair density. In conclusion, diminished hair density seems to be the main sign in the clinical diagnosis of hair loss, although digital image analysis was found to be less competent than visual counting in detecting hair density. Thus, the increase in hair density in the assessment of various treatment modality effects may be underestimated by digital image analysis.