Biochemical and histopathologic assessment of effects of acitretin on epiphyseal growth plate in rats.

INTRODUCTION: Acitretin is a commonly used retinoid in dermatology. Although there are generally known side effects, the effects on the epiphyseal plaque and bone metabolism are not clear in the literature. AIM: To histopathologically investigate the effects on the epiphyseal plate and assess variations in bone metabolism caused by acitretin. MATERIAL AND METHODS: Three groups were formed with 10 rats in each group. The 1st group (n = 10, 5 male, 5 female) were administered 10 mg/kg/day oral acitretin solution and the 2nd group (n = 10, 5 male, 5 female) were administered 3 mg/kg/day oral acitretin solution. The control group were given normal standard feed and water. Rats were sacrificed at the end of 4 weeks. The proximal tibias were excised and histopathologically and immunohistochemically assessed. Biochemical assessment was also carried out. RESULTS: Staining with haematoxylin-eosin found reductions in the epiphyseal plate in the 1st and 2nd group compared to the control group, though this situation was not statistically significant. Immunohistochemical studies did not encounter Type II collagen in the epiphyseal bone, proliferative zone and hypertrophic zone in the control group, low dose acitretin solution group and high dose acitretin solution group. Type II collagen was not observed in osteoids and osteoblasts. Type I collagen was not observed in the hypertrophic zone and proliferative zone of any group. CONCLUSIONS: Our data show that though acitretin caused degeneration of the epiphyseal plate, it did not cause clear thinning and we identified no significant variations in bone metabolism markers.

Evaluation of brainstem auditory evoked potentials and their relationshipwith levels of thyroid autoantibodies in patients with vitiligo.

BACKGROUND/AIM: Vitiligo is a common depigmenting disorder. The damage can also occur in similar ways to melanocytes within other organs. We evaluated the brainstem and auditory pathway functions by evaluating brainstem auditory evoked potentials (BAEPs) and whether there is any relationship between auditory functions and autoimmunity. MATERIALS AND METHODS: Forty patients with vitiligo and 20 healthy volunteers were enrolled. Thyroid functions and autoantibodies were examined and BAEP tests were assessed by a neurologist. RESULTS: Antithyroid peroxidase (anti-TPO) and antithyroglobulin (anti-TGA) antibody positivity was higher in the patient group (P < 0.05). A negative correlation was detected between anti-TPO and lead III, IV, and V latency and I-III interpeak latency (IPL) of the right ear together with lead IV latency and I-V IPL of the left ear in the patient group. When each BAEP parameter was compared between the two groups, more abnormalities were detected in the V latency and III-V IPL of the left ear together with IV and V latency of the right ear. CONCLUSION: In this study the presence of a correlation between increased anti-TGA and anti-TPO levels and BAEP parameters may be related to an autoimmune-mediated mechanism. However, further studies are needed to be performed in a large patient series.

Chemotherapy-induced acral erythema with involvement of the face and neck: A case report.

Chemotherapy-induced acral erythema (CIAE) is a cutaneous response to diverse chemotherapeutic drug administration. These drugs cause symmetrical and painful erythema of palmoplantar surfaces. Bulla formation, desquamation, and subsequent reepithelialization may occur. Commonly, the lesions slowly resolve over 7-15 days, through desquamation, followed by regeneration of the skin. Here, we described a case of CIAE, with involvement of face and neck in a patient treated for breast cancer using a number of chemotherapeutic agents. Face involvement in CIAE has not been previously reported in the literature.

Rosacea and exposure to tandoor heat: Is there an association?

BACKGROUND: Particularly in eastern and southeastern regions of Turkey, women use tandoor ovens to bake bread and as a result are exposed to excessive heat. Exposure to heat for long periods may lead to the initiation or exacerbation of rosacea. OBJECTIVES: The aim of this study was to investigate whether there is a relationship between exposure to heat from a tandoor and rosacea. METHODS: A total of 350 female patients with various dermatological diseases were included in this study. These patients were divided into two groups comprising a control group and a group of tandoor users. Subjects in both the control and tandoor-user groups were screened to identify clinical and other characteristics, and symptoms and findings of rosacea and other dermatological disorders. RESULTS: The frequency of rosacea was significantly (P < 0.001) higher and that of acne markedly (P < 0.001) lower in the tandoor-user group than in the control group. Incidences of temporary and persistent types of erythema and telangiectasia, which are considered to be among the symptoms and findings of rosacea, were also significantly (P < 0.001) higher in the tandoor-user group than the control group. Frequencies of asthma and ex-smoker status differed significantly (P < 0.001 and P < 0.002, respectively) between the tandoor-user and control groups. Furthermore, the period of exposure to tandoor heat was positively correlated with the frequency of telangiectasia (r = 0.321, P < 0.01). CONCLUSIONS: Our study revealed a strong association between exposure to tandoor heat and rosacea. Further studies including higher numbers of patients are required to confirm our results.

The relation of autologous serum and plasma skin test results with urticarial activity score, sex and age in patients with chronic urticaria.

INTRODUCTION: Some previous studies reported autoimmunity as an etiologic factor in chronic urticaria (CU), but the results of some autoimmunity tests in these studies are conflicting. AIM: To concretize whether there was any relation of autologous serum skin test (ASST) and autologous plasma skin test (APST) results with sex, age and urticarial activity score (UAS) in patients with CU. MATERIAL AND METHODS: Fifty patients with CU and twenty healthy subjects admitted to our dermatology clinic were included in the present study. The ASST and APST were applied to all individuals. RESULTS: The positiveness rates of ASST and APST were significantly higher in the patient group than controls (p = 0.027, p = 0.001, respectively). Among patients, the APST positiveness rate (72%) was significantly (p < 0.05) higher than ASST (46%). It was seen that 48% of patients with negative ASST results had positive APST. However, no patient with negative APST results had positive ASST. There were significant (p < 0.05) relations of the tests' positiveness rates with sex and old age but with UAS. The diameter of the erythematous papule was remarkably (p < 0.05) larger in APST than ASST and also significantly (p < 0.05) larger in females compared to males in both tests (p < 0.05). It was positively increased with old age (p < 0.05). CONCLUSIONS: We can suggest that APST is more sensitive than ASST in the assessment of autoimmunity in CU. A high positiveness rate of APST results may be attributed to high numbers of autoantibodies and coagulation factors present in plasma that might probably play a role in etiopathogenesis of CU.

Oral isotretinoin therapy of acne patients decreases serum paraoxonase-1 activity through increasing oxidative stress.

OBJECTIVES: There are only a few earlier studies suggesting relationship between isotretinoin treatment and oxidative stress however, their results are conflicting. Therefore we aimed to concretize the influence of isotretinoin treatment on oxidant/antioxidant status together with paraoxonase-1 (PON1) activity for the first time. METHODS: The study was performed on serum samples obtained from 35 acne vulgaris patients before and after three months of isotretinoin treatment. PON1 activity, total oxidant status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI) and some routine biochemical parameters were monitored. RESULTS: Dramatically decreased PON1 activity (p < 0.001), increased TOS level and OSI value (p < 0.001 and p < 0.001; respectively) as well as slightly diminished TAC level were noted in posttreatment stage. Moreover significant increases were observed in lactate dehydrogenase and gamma glutamyl transpeptidase activities and levels of total cholesterol, low density lipoprotein cholesterol, very low density lipoprotein cholesterol, triglycerides, low density lipoprotein cholesterol/high density lipoprotein cholesterol ratio respectively (p < 0.05, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001 and p < 0.001) while marked decrease was seen in high density lipoprotein cholesterol (p < 0.01). CONCLUSION: This study revealed that decreased PON1 activity and increased oxidative stress may have a crucial role in the pathogenesis of isotretinoin's side effects. Further studies on a large number of patients are needed to verify these results.

The efficiency of granulocyte colony-stimulating factor in hemorrhagic mucositis and febrile neutropenia resulted from methotrexate toxicity.

Methotrexate (MTX) remains one of the most frequently used anti-metabolite agents in dermatology. MTX is an analog of folate that competitively and irreversibly inhibits dihydrofolate reductase. Oral mucositis is a common side effect of chemotherapy drugs and is characterized by erythema, pain, poor oral intake, pseudomembranous destruction, open ulceration and hemorrhage of the oral mucosa. In this paper, we report a 32-year-old female with a case of mucositis due to MTX intoxication that resulted from an overdose for rheumatoid arthritis. The patient had abdominal pain, vomiting, and nausea. During follow-up, the patient's white blood cell count was found to be 0.9 × 10(9)/L (4-10 × 10(9)/L). The patient developed fever exceeding 40 °C. The patient was consulted to the hematology service. They suggested using granulocyte colony-stimulating factor for febrile neutropenia. On the fifth day of treatment, the white blood cell count reached 5.3 × 10(9)/L and the patient's fever and mucositis started to resolve. Here, we presented a case of hemorrhagic mucositis and febrile neutropenia resulted from high-dose MTX that responded very well to granulocyte colony-stimulating factor treatment and we reviewed the literature.

[Furuncle persistent to long-term antibiotic therapy in a non-tropical region: a diagnosis that must not be overlooked: furuncular cutaneous myiasis]. / Tropikal Olmayan Bölgelerde Uzun Süre Antibiyotik Tedavisine Cevap Vermeyen Fronkül: Gözden Kaçirilmamasi Gereken Bir Tani; Fronküler Kutanöz Miyazis.

We present the case of a 12-year-old boy with furuncular myiasis living in an area with continental climate. The boy was admitted to our clinic with a wound on his nape, which started as a little acne and progressed to a large wound in which pus flowed continuously. He complained of itching and was treated with penicillin, clarithromycin, terbinafine, and ibuprofen in the last 2 months, with no big success. Otherwise, the patient was healthy, and his hygienic conditions were within normal standards. The dermatologic examination revealed an off-white ulcer measuring approximately 1x2 cm in the occipital region with regular contours, elevated borders, and purulent flow, while the skin surrounding the ulcer was normal. In the course of the examination, a living larva was removed using a forceps. The ulcer and the surroundings were washed with polyvinylprolidone iodine solution, while fusidic acid pomade was topically applied. The ulcer regressed significantly after 15 days of treatment.

Phytodermatitis in eastern Turkey: a retrospective, observational study.

BACKGROUND: Plant life is extremely diverse, with a great deal of geographic and seasonal variation. Consequently, the range of reported adverse reactions is large, and there are important differences worldwide in the incidence and prevalence of these reactions. Systemic ingestion of some plants containing furocoumarins can cause erythema, edema, vesicle and bulla formation and later hyperpigmentation, after exposure to sunlight. They may at times exhibit clinical manifestations that mimic angioedema, and rarely progress to necrosis. This condition is named phyto-phototoxic reaction. OBJECTIVE: Our aim was to identify plant dermatitis such as allergic contact dermatitis, irritant contact dermatitis, and phyto-phototoxic dermatitis in eastern Turkey and to add new data to the literature. METHODS: Thirty patients diagnosed with plant dermatitis were evaluated retrospectively. The demographic and clinical characteristics of the patients (age, gender, the type of dermatitis, and the name of the causative plant) were recorded. CONCLUSIONS: A phyto-phototoxic reaction to Chenopodium album (Chenopodiaceae) developed in 12 cases. Irritant contact dermatitis developed due to Ranunculus kotschyi (Ranunculaceae) in 11 cases. The other plants studied were Malva neglecta Wallr (Malvaceae), Mandragora autumnalis (Solanaceae), Eryngium billardieri (Apiaceae), Ceratocephalus falcatus (Ranunculaceae), Ranunculus damascenus (Ranunculaceae), and Plantago lanceolata (Plantaginaceae).

Ursodeoxycholic acid induced generalized fixed drug eruption.

Fixed drug eruption (FDE) is a rare form of drug allergies that recur at the same cutaneous or mucosal site in every usage of drug. Single or multiple round, sharply demarcated and dusky red plaques appear soon after drug exposure. Ursodeoxycholic acid (UDCA: 3α,7ß-dihydroxy-5ß-cholanic acid) is used for the treatment of cholestatic liver diseases. Some side effects may be observed, such as diarrhea, dyspepsia, pruritus and headaches. We encountered only three cases of lichenoid reaction regarding the use of UDCA among previous studies. In this article, we reported a generalized FDE case related to UDCA intake in a 59-year-old male patient with cholestasis for the first time in the literature.

Comparison of efficacy of narrow band UVB therapies with UVB alone, in combination with calcipotriol, and with betamethasone and calcipotriol in vitiligo.

OBJECTIVE: The purpose of this study is to compare the efficacy of three therapies in the treatment of non-segmental vitiligo: a combination of topical calcipotriol, narrowband-ultraviolet B (NB-UVB), and betamethasone therapies; a combination of NB-UVB and topical calcipotriol; and NB-UVB alone. MATERIAL AND METHODS: Forty-five patients with non-segmental vitiligo presenting to our Dermatology clinic were recruited to participate in the study. Patients were randomly divided into three groups. For each patient the size of the depigmented areas was assessed according to the rule of nines. The first group was treated with a combination of topical calcipotriol, NB-UVB, and betamethasone therapies. The second group was treated with a combination of NB-UVB and topical calcipotriol and third group was treated with NB-UVB alone. Since the patients' vitiligo lesions had similar phototypes, all patients were started with 0.1 j/cm(2), regardless of their skin phototype. The dose of NB-UVB was increased 10% in each session and no further increment was done after reaching 2.5 j/cm(2). Treatment effectiveness was evaluated according to the percentage improvement in repigmentation. The quality of life of the patients was measured by the Dermatology Life Quality Index (DLQI). RESULTS: The patients were aged from 13 to 55 years (mean: 25.29). The duration of disease ranged from 3 months to 20 years. Family history was positive for vitiligo in 10 patients (22.2%). The percentage of recovery after treatment was 63.33% ± 7.55 in group 1, 60.67% ± 5.75 in group 2, and 46.67% ± 7.98 in group 3. There was no statistically significant difference between groups 1 and 2, and groups 2 and 3, but there was a statistically significant difference between groups 1 and 3 (p = 0.0048). CONCLUSIONS: In conclusion, NB-UVB-alone therapy and the combined therapies are effective treatment options in the treatment of vitiligo. Future studies with larger groups are warranted to confirm our results.

Cutaneous drug reactions in children: a multicentric study.

INTRODUCTION: According to studies conducted in outpatients, it is estimated that 2.5% of children who are treated with a drug will experience a cutaneous adverse drug reaction (CADR). AIM: To analyze the CADR reports involving pediatric patients recorded by three different university hospitals for describing common, serious, and interesting cutaneous drug eruption patterns. MATERIAL AND METHODS: For this purpose, the patients' data from three different universities were reviewed retrospectively. Diagnosis was based on history, clinical findings and laboratory test results. The CADRs were classified into seven categories; urticaria, angioedema, maculopapular eruption, fixed drug eruption, erythema multiforme, acute generalized exanthematous pustulosis, drug rash with eosinophilia and systemic symptoms syndrome. RESULTS: A total of 122 patients who had CADRs were enrolled in the study. The most frequently detected cutaneous drug reactions were urticaria + angioedema. Most of patients had no previous experience with the same drug and the most common causative agent of CADRs was antimicrobials. CONCLUSIONS: Since CADRs are relatively rare, the current multicentric study can provide meaningful information about the cutaneous eruption patterns of commonly used drugs.

Is TrichoScan a new diagnostic method for diffuse hair loss?

AIM: In this study, we investigated the sensitivity of TrichoScan, a computer-based phototrichogram, in the evaluation of diffuse hair loss in women and the relationship between iron deficiency anemia and hair loss. MATERIALS AND METHODS: We recruited 100 female patients with diffuse hair loss. In all of the patients, a 1-cm2 area of hair located in a temporoparietal region was shortened to 0.5 mm. The shaved scalp regions were stained with black dye. The subject then waited for 12 min. Subsequently, pictures of these regions were taken with a videodermoscope and analyzed with the TrichoScan software program. RESULTS: The ferritin levels were markedly low in these groups. The ratio of anagen was highest in the telogen effluvium (TE) mild group, followed by the TE severe group, and was lowest in the androgenetic alopecia (AGA) group (P <0.05). The ratio of telogen was markedly higher in the AGA group, and the difference was statistically significant when compared with the other 2 groups (P < 0.05). CONCLUSION: The hair analysis results with the TrichoScan software were satisfactory and the results were consistent with the clinical diagnosis. In particular, the use of TrichoScan was very successful in the differentiation between AGA and TE.

Comparison of cutaneous mastocytosis with onset in children and adults.

BACKGROUND/AIM: Mastocytosis is a heterogeneous group of diseases characterized by the abnormal infiltration of mast cells in the skin and sometimes other organs. This study aimed to compare the demographic, clinical, and histopathological findings of cutaneous mastocytosis with onset in children and in adults. MATERIALS AND METHODS: Patients diagnosed with cutaneous mastocytosis in 2 different dermatology clinics between 2007 and 2011 were included in the study. Demographic characteristics of the patients as well as localization and type of the cutaneous lesions, presence of symptoms, Darier's sign, family history, systemic involvement, and histopathological evaluations were retrospectively examined. RESULTS: Out of the 30 cases of cutaneous mastocytosis, 60% of patients were male (n = 18) and 40% were female (n = 12). Twenty-two patients had childhood-onset mastocytosis (≤15 years) and 8 patients had adult-onset mastocytosis. The onset of the disease occurred before the age of 2 years in all cases of childhood onset. Patients with adult-onset mastocytosis had statistically significantly more systemic involvement than those with childhood-onset mastocytosis (P < 0.05). CONCLUSION: Cutaneous mastocytosis is a benign disease in children without systemic involvement and is usually sporadic.

Erythrokeratodermia variabilis: Two case reports.

Erythrokeratodermia variabilis (EKV) is a rare heterogeneous skin disorder. The classical EKV first described by Mendes da Costa is characterized by two types of skin lesions: (1) figurate hyperkeratotic plaques, and (2) transient erythematous areas. Herein, we report two patients presenting with erythematous and hyperkeratotic lesions that were histopathologically diagnosed with EKV.

The effect of acitretin treatment on insulin resistance, retinol-binding protein-4, leptin, and adiponectin in psoriasis vulgaris: a noncontrolled study.

BACKGROUND/AIM: To investigate the effects of acitretin treatment on insulin resistance (IR) and adipokines, particularly retinol-binding protein (RBP)-4. METHODS: Thirty-four patients with chronic plaque psoriasis and a control group of 34 healthy volunteers were recruited in the study. Screening for the parameters was performed before starting and after 3 months of acitretin treatment in the psoriasis group. The control group was only evaluated at the beginning of the study and did not receive placebo. We could not compare our results with a placebo control group because of ethical reasons. RESULTS: Basal adiponectin (p = 0.01), insulin (p < 0.0001) levels and homeostasis model assessment (HOMA) IR (p < 0.0001) were significantly higher in psoriasis patients. After the treatment, insulin (p = 0.014), C peptide (p = 0.011), RBP-4 (p < 0.0001) levels and HOMA-IR (p = 0.008) decreased significantly. Posttreatment leptin (p = 0.036) levels were significantly lower than those of the controls. Posttreatment adiponectin (p = 0.005) and insulin (p = 0.048) levels were higher than those of the controls. CONCLUSIONS: This study showed for the first time that RBP-4 levels and IR are decreased significantly with acitretin treatment. This finding is very important in psoriasis patients because psoriasis may cause insulin resistance and diabetes. Further experimental and clinical studies are needed to clarify the effect of acitretin on adipocyte structure and behavior.

Giant molluscum contagiosum in an immunocompetent child.

Molluscum contagiosum is a skin disorder caused by DNA poxvirus and frequently seen in children. It is self-limited in immunocompetent hosts. It can present as numerous, treatment-resistant, atypical lesions in immunosuppressive patients and resistant to treatment. Atypical forms can rarely be seen in immunocompetent patients. A case of a two-year-old child with umbilicated papules on the eyelid is presented here. Laboratory investigations were unremarkable for systemic diseases, and surgical excision was successfully performed.