Experience with oral tofacitinib in severe alopecia areata with different clinical responses.

BACKGROUND: Alopecia areata (AA) and generalized form, universalis (AU) are common causes of noncicatricial alopecia, targeting anagen hair follicles. A dominant interferon-gamma transcriptional signaling and cytotoxic T lymphocytes were accused as the main drivers of disease pathogenesis. Tofacitinib is a Janus kinase inhibitor that has been proven to interfere with the positive feedback loop between the follicular cell and the cytotoxic T lymphocytes in AA. There is an increasing number of studies reporting success with tofacitinib in AA. AIMS: We aimed to assess oral tofacitinib's safety and efficacy in 13 recalcitrant AA and AU patients. METHODS: This is a retrospective pilot study performed between 2017 and 2020. The demographic features and the treatment responses were evaluated with Severity of Alopecia Tool score changes. RESULTS: Thirteen recalcitrant alopecia areata patients (3 AA, 10 AU), aged between 17 and 49, were included in the study. The treatment duration was 3-15 months. All three AA patients responded well; however, the therapy was unsuccessful in five of ten AU patients. Relapse was observed in one of the AA and three of the AU responders. Acneiform lesions and elevation of transaminases were the major side effects. CONCLUSION: Tofacitinib seems to be more promising and thriving in the treatment of AA than AU. Starting the therapy earlier can bring more successful results. Unfortunately, even in the cases that fully respond to treatment, relapse can be observed after discontinuation of the treatment. It is essential to inform patients about this situation in reducing the frustrations that may occur later.

Efficacy of Omalizumab in Patients with Chronic Spontaneous Urticaria and Its Association with Serum IgE Levels and Eosinophil Count.

Chronic spontaneous urticaria can be treated with several drugs such as antihistamines, leukotriene antagonists, cyclosporine, doxepin, hydroxychloroquine, colchicine, and corticosteroids. However, treatment-resistant urticaria significantly reduces quality of life. In recent years, omalizumab has been considered to be an effective treatment option in treatment-resistant cases. We aimed to investigate the clinical efficacy of omalizumab in urticaria and its possible association with serum IgE levels, total eosinophil counts, and basophil percentages. Medical records of 11 patients with chronic spontaneous urticaria treated with omalizumab were reviewed retrospectively. Treatment response, urticaria activity score, serum basophil percentages, eosinophil, and IgE levels evaluated before and at the end of the therapy. Ten patients healed completely with omalizumab. One patient did not respond to therapy. No correlation was observed between serum IgE levels and treatment outcome. However, serum eosinophil levels decreased and basophil percentages increased with omalizumab treatment. Omalizumab is a safe and effective treatment choice in patients with chronic spontaneous urticaria. We suggest that omalizumab may have an effect in the treatment of urticaria through eosinophils.

Onychomycosis Unresponsive to Antifungals: Etiology and Treatment with a New Direct Technique.

AIMS AND OBJECTIVES: The aim of this study was to identify the fungal agents causing onychomycosis that were unresponsive to antifungal treatment and to treat these cases by placing under-nail cushions with a mild keratolytic to clear the fungus-invaded tissue. MATERIALS AND METHODS: Fungal agents were identified by the matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) technique. RESULTS: Nine patients had Aspergillus spp. (7 Aspergillus niger, 2 Aspergillus flavus); four had Candida species and one had Trichophyton rubrum. All patients were free of infection at the end of treatment. CONCLUSION: As per the results, we may state that onychomycosis that is unresponsive to treatment in immunocompetent patients seems to be mostly associated with molds. Direct application of a mild keratolytic to the fungus-invaded part, e.g., the nail plate and/or nail bed and removal of fungal elements may provide a successful treatment outcome.

Multiorgan involvement of Behçet's disease in a young woman.

Behçet's disease is a rare disorder of unknown etiology that is classified as a systemic vasculitis. The prevalence of the disease is high in countries in the Far East, Mediterranean Basin, and East Asia. Thus, it is also known as the Silk Road Disease. Behçet's disease is characterized by recurrent oral aphthous ulcers, genital sores, and ocular lesions. However, it can present with severe clinical manifestations as a result of cardiovascular system, central nervous system, and gastrointestinal tract involvement. The disease causes serious complications, morbidity, and mortality, especially in male patients with early age onset. Here we present a rare case of Behçet's disease exhibiting multiple organ involvement in a 26-year-old Caucasian female.

The long-term effect of oral isotretinoin therapy on macula ganglion cell complex thickness.

PURPOSE: To evaluate the long-term effect of oral isotretinoin therapy on macula ganglion cell complex (GCC) thickness by spectral domain optical coherence tomography (SD-OCT). MATERIALS AND METHODS: Newly diagnosed cystic acne patients who received low dose for a long time systemic isotretinoin therapy were included in this study. Thorough ophthalmic evaluation and GCC thickness analysis by using SD-OCT were performed at baseline, and at 1, 3, 6, and 12 months of treatment. RESULTS: Forty-eight eyes of 24 patients (15 females, 9 males) were included in the study. The mean age of patients was 19.37 ± 2.74 years (range 14-25 years). The full ophthalmologic examination was normal in all eyes before treatment. During the treatment there were no change in visual acuity, refractive error, intraocular pressure and tear break-up time. The mean GCC thicknesses were 81.45 ± 4.91, 81.45 ± 5.12, 81.81 ± 4.68, 81.87 ± 4.91 and 81.64 ± 5.09 µm at pretreatment and at 1, 3, 6, and 12 months of treatment, respectively (p = 0.803). CONCLUSION: One-year systemic use of isotretinoin had no significant effect on the thickness of macula ganglion cell. Macular ganglion cell analysis is useful for determining and following the toxic effects of systemic drugs on the retina. However, it is more rational to consider it as an adjunct to electrophysiological testing rather than used alone.