Sociodemographic, clinical, laboratory, treatment and prognostic characteristics of 156 generalized pustular psoriasis patients in Turkey: a multicentre case series.

BACKGROUND: Generalized pustular psoriasis (GPP) is a rare and severe inflammatory disease characterized by widespread and superficial sterile pustules on an erythematous background. OBJECTIVES: This multicentre study aimed to determine the clinical profile and course in a large cohort of patients with GPP. METHODS: One hundred and fifty-six GPP patients (mean age, 44.2 ± 18.7 years) who met the diagnostic criteria of the European Consensus Report of GPP were included in the study. Sociodemographic characteristics, quality of life, triggering factors of the disease, clinical, laboratory, treatment and prognostic features were evaluated. RESULTS: 61.5% of the patients were female. The rate of working at or below the minimum wage (≤$332.5/month) was 44.9%. Drugs (36.5%) were the most common trigger. While hypocalcaemia (35.7%) was the most important cause of GPP during pregnancy, systemic steroid withdrawal (20%) was the most frequently reported trigger for infantile/juvenile and mixed-type GPP (15%) (P < 0.05). Acute GPP (53.8%) was the most common clinic. Nails were affected in 43.6% of patients, and subungual yellow spots (28.2%) were the most common change. In annular GPP, fever (P < 0.001) and relapse frequency (P = 0.006) were lower than other subtypes, and the number of hospitalizations (P = 0.002) was lower than acute GPP. GPP appeared at a later age in those with a history of psoriasis (P = 0.045). DLQI score (P = 0.049) and joint involvement (P = 0.016) were also higher in this group. Infantile/juvenile GPP was observed in 16.02% of all patients, and arthritis was lower in this group (24.4 vs. 16%). GPP of pregnancy had the worst prognosis due to abortion observed in three patients. CONCLUSIONS: Recent advances in treatment have improved mortality associated with GPP, but abortion remains a significant complication. Although TNF-α inhibitors have proven efficacy in GPP, they can also trigger the disease. Mixed-type GPP is more similar to acute GPP than annular GPP with systemic manifestations and course.

Malignant Melanoma and Atypical Fibroxanthoma: An Unusual Collision Tumour

ABSTRACT Two different neoplasms in the same biopsy material, called collision tumour, were studied. These tumours are rarely seen in the skin. We report the case of a 79-year-old female with a collision tumour composed of amelanotic malignant melanoma and atypical fibroxanthoma of the face. The histological and immunopathological features observed are discussed.

Clinical and demographic features of hidradenitis suppurativa: a multicentre study of 1221 patients with an analysis of risk factors associated with disease severity.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, relapsing and debilitating inflammatory disease associated with profound morbidity. AIM: In this multicentre study, we investigated the demographic and clinical features of HS, and determined risk factors of disease severity. METHODS: In total, 1221 patients diagnosed with HS from 29 centres were enrolled, and the medical records of each patient were reviewed. RESULTS: The mean age of disease onset was 26.2 ± 10.4 years, and almost 70% (n = 849) of patients were current or former smokers. Mean disease duration was 8.9 ± 8.4 years with a delay in diagnosis of 5.8 ± 3.91 years. Just over a fifth (21%; n = 256) of patients had a family history of HS. The axillary, genital and neck regions were more frequently affected in men than in women, and the inframammary region was more frequently affected in women than in men (P < 0.05 for all). Acne (40.8%), pilonidal sinus (23.6%) and diabetes mellitus (12.6%) were the most prevalent associated diseases. Of the various therapies used, antibiotics (76.4%) were most common followed by retinoids (41.7%), surgical interventions (32.0%) and biologic agents (15.4%). Logistic regression analysis revealed that the most important determinants of disease severity were male sex (OR = 2.21) and involvement of the genitals (OR = 3.39) and inguinal region (OR = 2.25). More severe disease was associated with comorbidity, longer disease duration, longer diagnosis delay and a higher number of smoking pack-years. CONCLUSIONS: Our nationwide cohort study found demographic and clinical variation in HS, which may help broaden the understanding of HS and factors associated with disease severity.

Sexual Dysfunction in Male Patients With Behçet's Disease.

INTRODUCTION: The purpose of this study was to evaluate sexual dysfunction in male patients with Behçet's Disease in comparison to healthy control subjects. MATERIAL AND METHODS: Seventy-two sexually active male patients with Behçet's Disease and 62 healthy control subjects were included in this study. Patients' demographic and clinical characteristics were noted. Sexual function was assessed by means of the International Index of Erectile Function scoring system. In addition, disease-related quality of life was measured by means of the Nottingham Health Profile, and anxiety and depression levels were assessed by means of the Hospital Anxiety and Depression Scale. RESULTS: Patients with Behçet's Disease scored significantly lower in each of the 5 parameters of International Index of Erectile Function (p < 0.001) and significantly higher in Hospital Anxiety and Depression Scale compared to healthy control subjects (p < 0.001). International Index of Erectile Function scores correlated with age, duration of disease and Hospital Anxiety and Depression Scale and Nottingham Health Profile scores in patients with Behçet's Disease (p < 0.05). CONCLUSION: Sexual function is impaired in male patients with Behçet's Disease, which might be associated by age, duration of disease, psychological status and quality of life.

Effects of hyperbaric oxygen therapy on rat facial skin.

INTRODUCTION: We used immunohistochemistry to investigate the histopathologic effects of hyperbaric oxygen (HBO) on the facial skin of rats. MATERIAL AND METHODS: Rats in the HBO group (n = 6) were placed in a 20 L HBO chamber at 2.5 atmospheres absolute at 25-26°C with 100% oxygen for 90 min/day for 7 days. Following euthanasia, sections of facial skin were removed for examination. RESULTS: Epidermal hyperplasia and degeneration, basal-cell hypertrophy, subepithelial fibrosis, and increased connective tissue were observed in the HBO group. E-cadherin expression was reduced in the epidermis, hair follicles, and sebaceous glands in HBO-treated rats relative to control animals. HBO treatment was associated with vimentin immunoreactivity in fibroblasts, endothelial cells, and the bulbus pilorum of a subset of hair follicles. It also resulted in increased type IV collagen expression within the connective tissue in the hair follicles and sebaceous glands. CONCLUSION: The HBO group demonstrated epidermal hyperplasia and degeneration, basal-cell hypertrophy, and subepithelial fibrosis. In addition, HBO decreased E-cadherin expression, which suggests that HBO may impair intracellular adhesion. Expression of vimentin and type IV collagen was also observed in the dermis. Increased connective tissue, hemorrhage, and mononuclear cell infiltration were observed in the dermis of HBO-treated animals. Thus, HBO has effects on the structures of the epidermis and dermis.

Evaluation of orbital arteries with colour Doppler ultrasonography in patients with psoriasis.

AIM: To evaluate the blood flow in arteries of the orbit in patients with psoriasis. METHODS: In total, 30 patients with psoriasis and 30 healthy control subjects were recruited to the study. Standard ophthalmic evaluation, fundus examination and retrobulbar colour Doppler ultrasonography assessment were performed. The ophthalmic, posterior ciliary and central arteries were evaluated, and peak systolic blood flow velocity, end diastolic velocity, resistance index and pulsatility index were measured. Results of the measurements were compared between the two study groups. RESULTS: There were significant differences in blood flow parameters of the orbital arteries between the psoriasis group and the control group. CONCLUSIONS: The haemodynamics of the orbit might be affected in patients with psoriasis.

Seroprevalence of IgG anti-Toxocara canis antibodies and anti-Fasciola sp. antibodies in patients with urticaria.

AIMS: Chronic urticaria (CU) is defined by recurrent episodes occurring at least twice a week for 6 weeks and generally characterized by the rapid appearance of wheals and/or angioedema and may be associated with parasitic infections. We aimed to investigate the seroprevalance of Toxocara canis and Fasciola species in patients with CU. MATERIALS AND METHODS: We included 55 patients (in age 16-55) with urticaria admitted in study. As a control group we recruited 30 healthy volunteers they had no history of urticaria, rhinitis, asthma, atopic eczema/dermatitis syndrome (AEDS), or other relevant diseases. IgG antibodies to Toxocara canis and Fasciola species were investigated by ELISA method. RESULTS: In a total of 55 patients (mean age: 31.85 ± 8.92), 8 patients (14.5%) were positive for IgG antibodies to Toxocara canis. Among seropositive patients (mean age: 38.62 ± 12.46) 6 patients were female. No patient was positive for Fasciola by ELISA. Six of Toxocara canis seropositive cases were frequently visited or lived in rural areas and had contact with pets. CONCLUSIONS: Patients with urticaria, should be tested for Toxocara canis and treated with anthelminthic drugs in endemics areas for toxocariasis.

Oxidative stress index may play a key role in patients with pemphigus vulgaris.

BACKGROUND: Increased reactive oxygen species (ROS) and lipid peroxidation are seen in many dermatologic disorders, including atopic dermatitis, psoriasis, vitiligo, acne vulgaris, pemphigus vulgaris (PV), lichen planus and alopecia areata. In PV, the increased production of ROS from activated neutrophils reduces the concentrations of antioxidant vitamins and enzymes. OBJECTIVE: The present study aims to determine the oxidative stress index (OSI) by studying serum total oxidant capacity (TOC), lipid hydroperoxide (LOOH) and total antioxidant capacity (TAC) in PV patients. METHODS: The study included 27 PV patients and a control group consisting of 24 healthy volunteers. Serum TOC, LOOH and TAC levels were examined and OSI was measured in the PV patients and the control group. RESULTS: TOC (P = 0.001) and LOOH (P = 0.001) levels as well as OSI (P = 0.001) were found higher in the PV patients, relative to the control group. Serum TAS (P = 0.221) did not differ between groups. Serum TOC, LOOH and TAC levels and OSI in PV patients with mucosal involvement were not different than those in mucocutaneous PV patients. CONCLUSION: Serum TOC and LOOH levels and OSI were higher in the PV patients, in comparison with the control group. Serum TAC level was not different.