The Psychosocial Impact of Chronic Facial Dermatoses in Adults.

INTRODUCTION: Skin diseases have negative psychological and social consequences, especially when they are chronic and affect a visible area of the body, such as the face. OBJECTIVES: The purpose of this study is to investigate and compare the psychosocial impact of three common chronic dermatoses of the face: acne, rosacea, and seborrheic dermatitis. METHODS: The Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), and Social Appearance Anxiety Scale (SAAS) were used to compare acne, rosacea, and seborrheic dermatitis patients and healthy controls. The relationships between DLQI, HADS, and SAAS results were investigated, as well as their associations with disease duration and severity. RESULTS: The study included 166 acne patients, 134 rosacea patients, 120 seborrheic dermatitis patients, and 124 controls. The patient groups had significantly higher DLQI, HADS, and SAAS scores than the control group. Rosacea patients had the highest DLQI and SAAS scores, as well as the highest anxiety prevalence. Patients with seborrheic dermatitis had the highest rate of depression. The DLQI, HADS, and SAAS results were moderately correlated with each other, but their relationship with disease duration and severity was insignificant or weak at best. CONCLUSIONS: Chronic facial dermatoses have a detrimental impact on mood and quality of life. Although patients with acne, rosacea, and seborrheic dermatitis have distinct lesions, the outcomes in terms of quality of life, anxiety, and depression are largely similar. Furthermore, these patients report similar levels of social anxiety as a result of their overall appearance.

Dermatopathological Correlation of Clinically Challenging Cutaneous Lesions: a Single Center Experience of 2184 Cases.

Introduction: Although a trained eye can easily identify typical skin lesions, histopathological examination and clinicopathological correlation are critical in challenging cases. Objectives: The primary objective is to organize the final diagnoses reached following clinicopathological consensus in clinically challenging cutaneous lesions, identifying the most common diagnostic scenarios encountered by dermatopathologists and discussing their diverse differentials submitted by clinicians. The secondary objective is to investigate how the case profile and clinician decision-making processes evolved during the COVID-19 pandemic. Methods: Skin and mucosa samples collected by the dermatology department between 2016 and 2020 were classified based on pathology reports. For frequent diagnoses, preliminary diagnoses stated by clinicians on pathology requisition forms were reviewed. The years preceding and following the first nationally reported COVID-19 case were compared to investigate the pandemic's impact on the distribution of dermatology and dermatopathology cases. Results: One thousand nine hundred and eighty-nine reports were classified into 4 major categories: inflammatory (49.8%), neoplastic (30.1%), other diseases (7.1%), and non-diagnostic (12.8%). We further classified inflammatory diseases based on major tissue reaction patterns and neoplasms based on cell origin. We analyzed the leading diagnoses in each category, discussed their differential diagnoses, and provided clinicians with clues to reduce errors in practice. Following the pandemic, the overall number of pathology reports and patient admissions dropped dramatically, with significant changes in case profiles. Conclusions: We presented and discussed the frequently encountered confounding cases to sketch the diagnostic landscape. In the authors' experience, clinicopathological correlation can increase the rate of reaching the diagnosis by up to 75.3%.

Tissue expression of glutathione S transferase isoenzymes in vitiligo.

The association of glutathione S-transferase (GST) enzymes with vitiligo is inconclusive. To evaluate tissue expressions of GST isoenzymes in vitiligo patients and to compare these expressions with healthy controls, we used 26 active depigmented patches on the trunk of vitiligo patients and 20 healthy sex and age matched controls. Punch biopsies were taken from the lesioned or normal skin. Tissue expression of GST isoenzymes were analyzed immunohistochemically. Tissue expression of GSTT1, GSTA1 and GSTP1 was significantly higher in the patient group than controls. Tissue expression of GSTM1 was not significantly different between the two groups. The increased tissue expression of GSTT1, GSTA1 and GSTP1 may represent a response to excess free radical formation in vitiligo and may support the role of oxidative stress in the pathogenesis of vitiligo.

Analysis of 3702 patients with acne vulgaris and concomitant comorbidities in Turkey: a multi-centered, prospective, controlled study.

BACKGROUND: Acne vulgaris is a chronic inflammatory skin disease that affects the pilosebaceous unit. Although it is considered to be a skin-limited disease, different clinical studies have recently been published in which the disease is accompanied by systemic symptoms. In this study, systemic comorbidities accompanying acne vulgaris and the relationship between existing comorbidities and disease severity are investigated. METHODS: This prospective multicenter study was conducted by the Turkish Society of Dermatology Acne Study Group. Twelve dermatology clinics and 14 clinicians throughout Turkey participated in the study. A structured physician-administered questionnaire was used to collect patient demographics, clinical findings, and lifestyle data. Physicians recorded each participant's medical history, including current and past comorbidities, duration of any comorbidity, smoking, and drinking. Body mass index (BMI) was calculated. RESULTS: There were 3022 patients in the adolescent acne group and 897 in the control group. The incidence of nonmigraine headache in adolescents with acne was significantly higher than in the nonacne group (P = 0.019). There were 680 patients in the postadolescent acne group and 545 in the control group. In the postadolescent group, incidence of metabolic disease was lower than the control group (P = 0.003). In the postadolescent group, premenstrual syndrome (P < 0.001) and PCOS (P = 0.007) were more common than the control group. CONCLUSIONS: In this study, we observed that acne vulgaris does not cause systemic comorbidities. There is also a need for new studies involving a large number of patients to illuminate systemic diseases accompanying acne vulgaris.

Correlation study between clinical classification and disability index in a holistic evaluation of acne severity and impact in Turkey.

BACKGROUND: This study provides a comparison between disease severity observed by inspectors and the disease burden assessed by patients is scanty in acne study. METHODS: In a multicenter prospective hospital-based study, modified Comprehensive Acne Severity Scale (mCASS) and Cardiff Acne Disability Index (CADI) were employed to grade disease severity and to determine the quality of life, respectively. The average of the mCASS and CADI scores, with range at 0-25, was termed as Acne Severity and Impact Grading System (ASIG). RESULTS: In 1331 evaluated patients (mean: 21,51±4,93 years), including 306 men and 1025 women, an overall significant, positive correlation was found between ASIG and mCASS (r=0.862), or CADI (r=0.686), respectively (P=0.001 each). Adult women with back acne and adolescent with décolleté expressed greater concern (higher CADI) than the clinical severity (lower mCASS). The overall prevalence of acne in décolleté area, including neck, was 32.3%. CONCLUSIONS: Discrepancies in the acne severity between self-perception and objective evaluation exist in certain subgroups of patients. Décolleté acne deserves special attention in clinical assessment.

Introduction of a novel quantitative scoring system for acanthosis nigricans and its validation in a pilot study.

Inconsistent data exist regarding the diagnostic value of acanthosis nigricans (AN) or skin tags as clinical markers for obesity or diabetes. In an outpatient department-based prospective study, we designed a scoring for AN severity (SCANS) to evaluate AN and skin tags, their correlation with obesity or diabetes. Quantification of AN in six anatomic sites, in consideration of the affected skin surface areas, texture changes, number of skin tags, leads to a total severity score between 0 and 46. Among 336 adult patients (aged ≥18 years) with AN, a higher BMI was associated with AN (r = 0.299, P < .001), but not with diabetes (P = .43), as compared with 243 age- and sex-matched controls without AN. Among nondiabetics, AN scores were significantly correlated with waist circumference (r = 0.131, P = .024) and total cholesterol levels (r = 0.155, P = .04). Skin tags alone in the absence of AN were not associated with obesity (P = .333) or diabetes (P = .164). The total AN scores were positively correlated with the presence of skin tags (r = 0.132, P < .001), and the involvement of anterior neck (r = 0.668, P < .001) and axilla (r = 0.793, P < .001). Knuckles and groins were unaffected in our series. Our results indicate that combination of AN with skin tags can be used as clinical marker for obesity, but not for diabetes. Large-scale studies on patients of different ethnic background are required to further validate our proposed scoring.

Acne in pregnancy: A prospective multicenter, cross-sectional study of 295 patients in Turkey.

BACKGROUND: There are only a few studies on acne in pregnancy. This study was aimed to investigate the demographic, clinical, and familial characteristics of acne in pregnancy, triggering factors including endocrine diseases, and association of these findings with acne in different trimesters of pregnancy. METHODS: Pregnant women aged 18 years and older with acne at any stage of pregnancy were consecutively interviewed at the participating centers during the study period from 2016 to 2019. Acne severity was evaluated using the Comprehensive Acne Severity Scale. RESULTS: A total of 295 pregnant women with acne were included, with 167 (56.6%) patients showing mild, 87 (29.5%) moderate, six (12.2%) severe, and five (1.7%) very severe acne. Truncal acne was significantly higher in the third trimester than in the other stages (P < 0.001). Onset of acne before pregnancy, prepubertal, pubertal or adult onset, or acne history in previous pregnancies did not influence acne severity in pregnancy. Women with irregular menstruation before pregnancy, polycystic ovary syndrome, hirsutism, and higher body weight index tended to show severe acne in pregnancy. CONCLUSIONS: Severe acne during pregnancy is generally uncommon, while severity of facial acne, truncal acne, and hirsutism is higher in the third trimester than in other trimesters. Acne in pregnancy shares many characteristics with female adult acne. Substantial changes in different kinds of hormones play a more complex role in acne during pregnancy, but the pathogenesis remains to be determined.

Nineteen-year retrospective evaluation of pemphigus in a single dermatology centre in Istanbul, Turkey.

INTRODUCTION: Pemphigus is an autoimmune intra-epidermal bullous disease of the skin and mucosae. AIM: To retrospectively evaluate the course, prognosis and clinical features of pemphigus. MATERIAL AND METHODS: The files of 196 pemphigus patients admitted to our clinic between December 1995 and December 2014 were collected and analysed. RESULTS: The male to female ratio among patients was 1 : 1.88. Pemphigus vulgaris (PV) was the most common clinical variant observed in 175 (89.3%) of the patients, followed by pemphigus foliaceus (PF) in 14 (7.1%) of the patients. The mean patient age at disease onset was 50 years. PV presented itself as skin lesions in 55 (31.4%) of the patients and as oral mucosa lesions in 120 (68.6%) of the patients. Complete remission and treatment withdrawal were obtained in 112 (57.1%) of the patients, for a mean period of 2.91 ±2.66 years (range: 4 months to 13 years). The mortality rate was 6%, and relapse occurred in 16 (14.3%) of the patients for a mean relapse period of 2.15 ±1.88 years (range: 6 months to 7 years). Mucocutaneous pemphigus (MCP) was the major clinical pattern observed in 96 (49%) of the patients. CONCLUSIONS: Within our study population, pemphigus predominately affected females, and the most common clinical variant was PV, a subtype that frequently occurs in middle-aged individuals. MCP was the most common clinical pattern. Although MCP and higher doses of corticosteroids were needed to control pemphigus, they did not seem to influence the prognosis.

Alteration of tissue expression of human beta defensin-1 and human beta defensin-2 in psoriasis vulgaris following phototherapy.

We compared the expression profiles of antimicrobial peptides (AMPs) in psoriatic skin before and after narrow band ultraviolet B (nb-UVB) phototherapy and compared the levels to healthy controls. We studied 15 male and 12 female patients with psoriasis vulgaris, and 11 female and nine male control individuals. The patient group was treated with 24-36 sessions of nb-UVB phototherapy. Immunohistochemical staining for human beta defensin 1 (hBD-1) and human beta defensin 2 (hBD-2) expression of lesioned and control skin was performed prior to and following phototherapy. After phototherapy, the psoriatic area and severity index (PASI) decreased significantly in the treated patients compared to controls. The hBD-1 level was significantly higher in psoriasis patients than healthy controls. We found no statistically significant difference in hBD-1 and hBD 2 levels before and after phototherapy in the patient group. Although hBD-1 plays a role in psoriasis, levels of human beta defensin 1 and 2 are not affected significantly by phototherapy.

Effects of Different Doses of Systemic Isotretinoin on Eyes: A Histopathological and Immunohistochemical Study in Rats.

PURPOSE: To evaluate ocular side effects associated with systemic isotretinoin histopathologically. METHODS: In this multicenter study, a total of 15 male and 15 female rats were randomly divided into 3 equal groups according to the oral dose of isotretinoin they were administered: 0 mg/kg/d (group A), 7.5 mg/kg/d (group B), and 15 mg/kg/d (group C). Biopsy specimens were taken from the globe conjunctiva, cornea, and eyelid conjunctiva. Expression levels of human beta-defensin-1, human beta-defensin-2, toll-like receptor (TLR)-2, and TLR-4 were evaluated by immunohistochemical methods. RESULTS: The number of goblet cells in eyelid conjunctiva was significantly lower in group B than that in group A and group C (P = 0.002). The sizes of meibomian gland acini were significantly smaller in group B and group C than those in group A (P < 0.001). Fibrosis of eyelid conjunctiva was significantly higher in group C and group B than that in group A (P = 0.002). The levels of staining of TLR-4 in the cornea with group B were significantly lower compared with group C (P = 0.035). CONCLUSIONS: Our study suggests that isotretinoin in the early period affects eyelid conjunctiva and meibomian glands without affecting the globe conjunctiva and cornea. Occurrence of the initial symptoms of isotretinoin on the eyelids, especially on the meibomian glands, suggests that the symptoms of patients occur because of evaporative dry eye.

Evaluation of ocular findings in patients with lichen planus.

INTRODUCTION: Lichen planus (LP) is a chronic, inflammatory disease of unknown etiology. AIM: To evaluate the tear functions and the retinal and choroidal thickness (CT) in patients with LP. MATERIAL AND METHODS: In total, 33 patients and 30 healthy controls were enrolled. All participants were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer 1 test (with anesthesia), tear break-up time (TBUT) test, intraocular pressure (IOP), axial length (AL), and central corneal thickness (CCT). The measurements of retinal thickness (RT) and CT were obtained by spectral domain optical coherence tomography. RESULTS: No significant difference was observed between the groups in IOP, AL, CCT, or RT (p > 0.05 in each group). There was a significant difference in the Schirmer 1 test, TBUT, and OSDI questionnaire (p < 0.05 in each group). Choroidal thickness in LP patients was thinner than that in the controls (p = 0.001 in each location). There was a moderate negative correlation between the disease duration and Schirmer 1 test, TBUT, and subfoveal CT (r = -0.426, r = -0.555, r = -0.637; p = 0.001, p = 0.001, p = 0.001, respectively). There was a moderate negative correlation between the oral mucosal involvement and Schirmer 1 test, TBUT, and subfoveal CT (r = -0.345, r = -0.392, r = -0.467; p = 0.006, p = 0.001, p = 0.001, respectively). There was a positive correlation between disease duration, oral mucosal involvement and OSDI score (r = 0.717, r = 0.345; p = 0.001, p = 0.006, respectively). CONCLUSIONS: Lichen planus may influence tear function tests and may cause dry eye. Patients with LP had lower CT values than healthy controls. Further studies are needed to clarify the effect of LP on the eyes.

Morphea secondary to interferon beta1b injection: a case and review of the literature.

Interferon beta (IFNß) is a drug used successfully in the treatment of multiple sclerosis (MS). Although IFNß is a safe and well-tolerated drug, dermatological side effects are common. The most common dermatological adverse effect is a local reaction at the injection site. It may also cause inflammatory and immune-mediated dermatological side effects. However, morphea induced by IFNß1b injection is very rare.

Effect of low-dose acitretin treatment on pituitary hormones in psoriasis vulgaris: A retrospective study.

BACKGROUND: It has been reported that retinoids may lead to hormonal alterations. AIM: In this retrospective study, we aimed to study the effect of acitretin on pituitary hormones in psoriasis patients. METHODS: Out of 50 patients intended to be studied, blood samples of 43 patients could be tested before and after 3 months of acitretin therapy (0.2 to 0.5 mg/kg/day). RESULTS: Patients mean ± standard deviation ages and female/male ratio were 46 ± 17 years and 19/24, respectively. After treatment with acitretin, gamma-glutamyltransferase, alkaline phosphatase, total cholesterol and triglyceride levels increased significantly (P < 0.05). After treatment, total protein, free thyroxine (T4) levels decreased significantly (P < 0.05). No significant differences were observed between before-after acitretin treatment regarding pituitary hormone levels in psoriasis patients (P > 0.05). LIMITATIONS: The retrospective nature of the study, inability to retest blood samples of 7 patients at 3 months post treatment, low dose and short duration of acitretin treatment were limitations of this study. CONCLUSION: This study showed that pituitary hormones were not affected except free T4 (thyroid hormone) by acitretin treatment. Further experimental and clinical studies are needed to clarify the effect of acitretin on pituitary hormones.

The rapid effect of pulsed dye laser on demodex density of facial skin.

BACKGROUND: Recently, treatment with acaricides, which is aimed at reducing excessive proliferation of demodex mites, has gained popularity due to its providing a significant improvement in the symptoms of diseases, such as rosacea, seborrhoeic dermatitis, and perioral dermatitis. The effect of IPL on demodex mites was reported in skin biopsy specimens in three patients; however, to the best of our knowledge, no study exists to date, which evaluates the effect of pulsed dye laser (PDL) on demodex density (Dd) in larger patient group. We aim here in to observe the Dd before and after PDL therapy with two different skin biopsy techniques. MATERIAL AND METHODS: Thirty-one patients diagnosed with rosacea were included in the study who received PDL treatment. Dds which were measured by using both the SSSB (standardized skin surface biopsy) and CTM (cellophane tape method) techniques before and after 3 weeks of PDL therapy were evaluated. RESULTS AND DISCUSSION: The Dd of patients before PDL treatment was 13.0 (interquartile range (IQR): 5.0-28.0) and after 3 weeks of PDL treatment it was 6.0 (IQR: 3.0-12.0) with SSSB. After PDL treatment, the Dd was significantly lower than pretreatment the Dd (p = 0.002). The present study shows that PDL significantly reduced Dd in facial skin with one session.

Evaluation of platelet parameters and neutrophil/lymphocyte ratio during omalizumab treatment in patients with severe chronic spontaneous urticaria

Background/aim: Spontaneous wheals and/or angioedema lasting longer than six weeks are described as chronic spontaneous urticaria (CSU). Omalizumab is used for the treatment of antihistamine-resistant CSU. The neutrophil­lymphocyte ratio (NLR), platelet­ lymphocyte ratio (PLR), mean platelet volume (MPV), and platelet distribution width (PDW) are considered important indicators of inflammation and platelet activation in chronic diseases. We aimed to determine the NLR, PLR, MPV, and PDW levels in patients with CSU compared with healthy controls. We also aimed to investigate the effects of omalizumab therapy on these parameters in CSU patients. Materials and methods: This hospital-based, retrospective study included 143 patients with CSU and 132 healthy controls with a mean age of 40.0 ± 13.17 and 42.0 ± 16.34, respectively. Patients with equal or higher-than-baseline UAS scores at week 12 of omalizumab treatment were considered nonresponders, others were considered responders. We analyzed the neutrophils, lymphocytes, platelet counts, NLR, PLR, MPV, and PDW before, during, and after omalizumab treatment and compared the results with those of healthy controls. Results: CSU patients presented higher baseline MPV (P = 0.035) and lower baseline PDW values (P < 0.001) than healthy controls. There were statistically significant increases in the MPV (P < 0.001), MPV/platelet count (P = 0.005), and PDW (P = 0.003) and there was a statistically significant decrease in the NLR (P = 0.018) during omalizumab treatment. The percent increase of MPV was low in nonresponders (P = 0.009). Nonresponders had lower PDW values than responders (P = 0.040). Conclusion: The increase in the MPV and PDW may be due to platelet activation during omalizumab treatment. The decrease in the NLR may be regarded as an antiinflammatory effect of omalizumab. The effect of omalizumab on platelet and inflammatory markers may be used to discriminate the responders from nonresponders.

Comparison of cutaneous manifestations in diabetic and nondiabetic obese patients: A prospective, controlled study.

OBJECTIVE: Obesity is known to be a risk factor for many diseases including dermatological problems. Here, we aimed to determine the cutaneous manifestations in obese patients and the frequency of the accompanying dermatoses and to investigate the effect of diabetes mellitus in obese patients on cutaneous manifestations compared with the control group. METHODS: Our study included a total of 600 adults: 450 obese volunteers and 150 healthy volunteers. The number of diabetic obese patients was 138 (30%), whereas that of nondiabetic obese patients was 312 (70%). A detailed dermatological examination was performed for each case, and accompanying dermatoses were compared. RESULTS: The mean body mass index (BMI) in the obese patients and control group was 37.22 kg/m2 and 22.23 kg/m2, respectively. The most common dermatoses in the obese patients were, according to their frequency: striae distensae (291 patients, 64.7%), acrochordon (236 patients, 52.4%), acanthosis nigricans (213 patients, 47.3%), plantar hyperkeratosis (209 patients, 46.4%), and venous insufficiency (202 patients, 44.9%). Although hirsutism was more frequently observed in the nondiabetic obese group than in the diabetic obese group, stasis dermatitis was less frequently observed (p<0.05). CONCLUSION: We found that many dermatoses are more frequently observed in the obese patients than in the controls. We observed that the effect of obesity on skin is different from that of diabetes mellitus and that cutaneous manifestations of obesity occur more frequently. More extensive, comprehensive, and advanced studies on this subject are required.

Behçet Disease: New Developments in the Etiopathogenesis of an Old Silk Road Disease.

Behçet disease (BD) is a systemic inflammatory disorder that affects the skin, mucosa, eyes, joints, blood vessels, brain, and gastrointestinal tract. The etiopathogenesis of BD has not yet been fully elucidated, but disorganized immune responses against the stimuli of environmental triggering factors have been considered to play a major role in the pathogenesis of the disease in individuals with genetic susceptibility. Human leukocyte antigen (HLA)-B*51 is known to be the main factor involved in genetic susceptibility to BD. Among the environmental factors, infectious agents in particular are thought to be important. Immunological abnormalities could thus be the cornerstone in the development of BD. Along with cytokines that play a role in disease pathogenesis, numerous other cytokines have been recently identified or have been the focus of recent studies. This contribution sheds light on the etiopathogenesis and immunology of BD in relation to the current literature.

Evaluation of oxidative stress via protein expression of glutathione S-transferase and cytochrome p450 (CYP450) isoenzymes in psoriasis vulgaris patients treated with methotrexate.

INTRODUCTION: Oxidative stress is the imbalance between oxidant-antioxidant systems and may play a major role in the psoriasis pathogenesis. Cytochrome (CYP) is a family of enzymes that are responsible for the metabolism of various endogenous and exogenous substances such as drug metabolism. Most importantly, the antioxidant system is the glutathione S-transferases (GST), which decrease oxidative stress by reducing oxidative products. AIM: We aimed to evaluate the expressions of isoenzymes of GST and CYP families and the beneficial role of metotrexate (MTX) in this process. MATERIAL AND METHODS: This study included 21 patients with psoriasis and 22 healthy subjects. We treated all the patients with 10-15 mg/week of MTX for minimum 12 weeks. Expressions of GST and CYP enzymes were assessed by immunohistochemical staining. RESULTS: GSTK1, GSTM1 and GSTT1 expressions were significantly higher in the psoriasis tissues than in the control tissues (p < 0.05; p < 0.05; p < 0.05, respectively). In the psoriasis patients, GSTO1 expression was similar the control group. CYP1B1 and CYP2E1 expressions were significantly higher in the pre-treatment and post-treatment psoriasis tissues than in the control tissues (p < 0.05; p < 0.05; p < 0.05; p < 0.05, respectively). CONCLUSION: We found a significant increase in the tissue levels of, either expression of GST, or CYP, which has important role in drug metabolism and oxidative stress. MTX treatment resulted in marked clinical improvement, yet we found that MTX did not have any significant effect on these parameters. CYP2E1 is especially the most important enzyme for MTX metabolism since it is the primarily responsible of the toxic metabolism of various drugs. The other experimental studies involving greater number of patients and other different drug are needed to enlighten the role of oxidant and antioxidant systems and the other possible mechanisms for the pathogenesis of psoriasis.

Cutaneous manifestations of diabetes mellitus and the metabolic syndrome.

Metabolic diseases are commonly encountered in the Western world. Cutaneous manifestations are common in metabolic disorders, such as diabetes mellitus (DM) and the metabolic syndrome (MetS), and metabolic diseases may manifest with specific skin findings. MetS and DM share a common mechanism in their etiopathogenesis. As a result, the skin findings associated with these two diseases partially overlap. Several skin findings in DM and MetS may be the first clinical features of the disease, and early diagnosis facilitates treatment, thereby helping in preventing long-term complications. In this review, MetS and skin manifestations associated with DM are discussed.