The relationship between TNF-α, IL-1, IL-12, IL-17, IL-23, IL-36 expression and treatment response in psoriasis histopathologically and immunohistochemically.

AIM: There is no marker that can predict whether there is resistance to treatment in patients with psoriasis. In this study, we investigated the relationship between the staining rates of TNF-α, IL-1, IL-12, IL-17, IL-23, and IL-36 markers immunohistochemically from cutaneous biopsy and the treatment success. METHODS: The patients who were followed up in the dermatology clinic with the diagnosis of plaque-type psoriasis vulgaris and received biological treatment and previously had cutaneous biopsy were included in the study. The cutaneous biopsies of the cases that met the conditions were re-sectioned and subjected to immunohistochemical examination for TNF-α, IL-1, IL-12, IL-17, IL-23, and IL-36. RESULTS: Comparing the staining scores with psoriasis area severity index (PASI); A statistically significant positive correlation was found between PASI and TNF-α staining score (p = 0.034). A statistically significant positive correlation was found between PASI and IL-17 staining score (p = 0.004). When the staining scores and PASI response rates of psoriasis treatment were evaluated in terms of correlation; there was a positive correlation between TNF-α, IL-17, and IL-23 immunohistochemical staining rates and PASI response rates. CONCLUSIONS: In line with the data obtained from our study, we think that making immunohistochemical scoring before the biological treatment decision in psoriasis patients will be beneficial in treatment selection. In this respect, our study may open a new era in the selection of biological treatments for psoriasis.

Internalized Stigma in Hidradenitis Suppurativa: A Multicenter Cross-Sectional Study.

BACKGROUND: Hidradenitis suppurativa (HS) causes significant physical, social, and psychological burdens. Internalized stigma, acceptance of negative attitudes and stereotypes of society regarding a person's illness, has not been studied previously in HS. OBJECTIVES: The objective of this study was to investigate the internalized stigma state of HS patients and identify the factors affecting it. METHODS: This multicenter, prospective, cross-sectional study included 731 patients. Internalized Stigma Scale (ISS), Hurley staging, Physician Global Assessment, Dermatology Life Quality Index (DLQI), Skindex-16, Beck Depression Inventory-II (BDI-II), and Visual Analog Scale (VAS)-pain score were used in the study. RESULTS: The mean ISS value (57.50 ± 16.90) was comparable to the mean ISS values of studies in visible dermatological and various psychiatric diseases. A significant correlation was found between the mean values of ISS and all disease activity scores, quality of life measures, BDI-II, and VAS-pain scores. Obesity, family history, low education and income level, vulva/scrotum involvement and being actively treated are significant and independent predictive factors for high internalized stigma in multivariate analysis. CONCLUSIONS: HS patients internalize society's negative judgements, which may create a profound negative effect on access to health care. Therefore, in addition to suppressing disease activity, addressing internalized stigma is fundamental for improving health care quality.

The ocular surface findings in alopecia areata patients: clinical parameters and impression cytology.

PURPOSE: The objective of this study was to examine the effects of alopecia areata (AA) on the ocular surface and conjunctival cytology. METHODS: A total of 48 subjects were included in the present study. Twenty-three subjects were assigned to group 1 as the patient group, and 25 healthy individuals were included in group 2 as the control group. The ocular surface examination was performed, and the right eyes of all participants were included in the analysis. Both groups underwent the following tests for evaluation of ocular surface: tear break-up time (TBUT), Schirmer I test, Ocular Surface Disease Index (OSDI), and conjunctival impression cytology (CIC). Results obtained from the tests were then analyzed and compared between the groups. RESULTS: The mean TBUT value was significantly lower in Group 1 compared to Group 2 (4.96 ± 3.4 vs 10.52 ± 4.8 s) (p < 0.001). There was no significant difference between Group 1 and Group 2 in terms of the mean Schirmer I test score (p = 0.129). The mean OSDI score was higher in Group 1 compared to Group 2 (15.48 ± 10.4 vs 9.61 ± 13.4), but the difference between both groups was not statistically significant (p = 0.1). The mean CIC score was statistically significantly higher in Group 1 than in Group 2 (1.65 ± 0.7 vs 0.52 ± 0.5) (p < 0.001). CONCLUSION: The results of this study showed that AA was correlated with significant disturbances in conjunctival cytology and the tear function.

Effect of the COVID-19 pandemic on the anxiety and depression levels in patients who applied to the cosmetology unit.

The relationship between the skin and the brain is based on their origin from the same ectodermal structure, as well as being affected by similar hormones and neurotransmitters. At this point, psychodermatology forms a common field of study based on the relationship and interaction between psychiatry and dermatology. Cosmetology is a special group within dermatology, and the psychosocial needs of this group differ. In this study, it was aimed to examine the moods such as anxiety, fear and depression experienced by the patients during their application to the cosmetology unit during the COVID-19 pandemic process and to compare them with the control group. A total of 162 cases, 80 cases from the cosmetology unit meeting the specified conditions and 82 cases as the control group, were retrospectively evaluated. In all participants, the Coronavirus Anxiety Scale (CAS) scores decreased significantly compared to the beginning of the pandemic (P = .001). In the study, while depression (HAM-D) and general anxiety (HAM-A) were higher in the cosmetology group compared to the control group (P = .049 and P = .001, respectively), there was no difference in coronavirus anxiety scores (CAS) (P = .24). It should be known that patients who underwent cosmetological procedures during the pandemic period may have anxiety and depression. In this patient group, which requires a special psychodermatological approach, pandemic effects should also be considered. In patients who apply to cosmetology units during the pandemic period, attention should be paid to the relationship between surreal cosmetological process requests and their anxiety and depression state.

Demodex positive discoid lupus erythematosus: Is it a separate entity or an overlap syndrome?

Discoid lupus erythematosus (DLE) is a chronic inflammatory erythematous skin disease that can be triggered by several factors. Rosacea is another skin disease that causes facial redness and tenderness. Demodex mites have been reported in rosacea and DLE patients commonly in the literature. These two diseases can be seen concomitant, mimic each other clinically and share common possible etiologic factors. To assess demodex mite infestation in both clinical and histopathological findings in DLE patients. We retrospectively evaluated the files of 42 patients with DLE who had been diagnosed DLE based on clinical and histopathological findings between August 2018 and August 2019. Demodex positivity was detected 50% of patients (n = 21). Neutrophile percentages in the dermal and perivascular area were higher in the demodex positive patients (4.43%) than in the Demodex negative patients (2.19%). The intensity of demodex mites correlated positively with dermal neutrophile percentages. ANA was negative in 29 patients (69%) and positive in 13 patients (31%). Anti-dsDNA was negative in serology and follicular plugging was positive in histopathology in all 42 patients (100%). This was a retrospective study. DLE and rosacea share common features in etiopathogenesis and clinical presentation. Inflammation and exacerbations caused by the demodex mites may increase the clinical severity of DLE. Although the position of demodex mites in DLE etiopathogenesis is not known exactly, the presence of high demodex in DLE patients has been determined. Standard skin surface biopsy can be a routine procedure for the evaluation of DLE patients in daily clinical practice.

Gallstones at chronic spontaneous urticaria patients: A retrospective clinical study.

Chronic spontaneous urticaria (CSU) is a chronic, inflammatory skin disease can be triggered by many factors such as inflammatory process. To assess accompanying gallstone in CSU patients and to evaluate laboratory test results. We retrospectivelyscanned the files of the 108 patients with CSU who had been diagnosed CSU in September 2017-September 2019. Accompanied gallstone cases by detecting transabdominal ultrasound (TUS) or were 11 patients. Nine patients had also had cholecystectomy history. We seperated these 20 patients as Group A than the rest. WBC count is 9.38 ± 2.37 in Group A and 8.03 ± 2.04 in Group B. Platelet count was also differ between two groups significantly (Group A = 328.70 ± 85.62 × 103 /mm3 vs. Group B = 287.12 ± 72.77 × 103 /mm3 ). Neutrophil count was more in Group A (5.87 ± 1.65) than Group B (4.76 ± 1.75). Gallstone history of family was significantly higher in Group A (n = 12 positive/8 negative) than Group B. These findings were significant statistically p < .05. CSU can be associated with inflammation and gallstones. It is needed to perform further investigations to detect these relations and pathways.

The effect of smoking on the psoriasis: Is it related to nail involvement?

Psoriasis is a chronic inflammatory skin disease that negatively affects the quality of life with remissions and relapses. Smoking, which is known to accelerate the development of comorbidities that can accompany psoriasis such as atherosclerotic heart disease, metabolic syndrome, is also an independent risk factor for psoriasis. In our study, we aimed to investigate the relationship between smoking and psoriasis. The study included a total of 476 participants with 276 psoriasis patients and 200 healthy volunteers. One hundred and thirty-nine (69.5%) cases in the psoriasis group and 61 (30.5%) cases in the control group were smoking. Patients with psoriasis had more cigarette smoking than the control group (P < .001). Smoking was present in 100 cases (61%) of 164 cases with nail psoriasis and psoriatic nail was significantly more frequently observed in patients with psoriasis when smoking was present (P < .001). It was observed that systemic treatment requirements were higher in smoking psoriasis patients (P = .04). It is known that cigarette use increases in patients with psoriasis compared to the normal population, and cigarette use also increases the psoriasis area severity index (PASI). In our study, a significant relationship was found between smoking and psoriasis nail involvement first in the literature. Furthermore, the need for systemic treatment was higher in smokers.

Management of patients with Behçet's disease during the COVID-19 pandemic.

Behçet's disease is a disease characterized by chronic inflammatory vasculitis. In the clinical symptoms of Behçet's disease, many immunosuppressive and immunomodulatory drugs are used. The suspicion that drugs used in chronic disease treatments such as Behçet's disease during pandemic will increase the risk of transmission of COVID-19 disease, and that the disease may progress more lethally in these patients after the infection caused clinicians to worry. As far as we know, there is no study in the literature about the management of patients with Behçet's disease in the pandemic period. Fifty-four patients with Behçet's disease who were admitted to the dermatology outpatient clinic between 11 March and July 14, 2020 were retrospectively analyzed. In this pandemic period, 44 of 54 patients were recommended to continue their previous treatment. While the dose of medication used by 7 patients was reduced, it was decided to change the treatment of 3 patients. No life-threatening activation was observed. None of the patients developed COVID-19 disease. This article is important in terms of being the first study in the literature examining the treatment of patients with Behçet's disease during the COVID-19. In this period, we know that the treatment practices in chronic diseases change frequently daily, and in this respect, we hope that our study will provide a perspective to other dermatology clinics in terms of the treatment of Behçet's disease during the pandemic.

Evaluation of the effect of COVID-19 pandemic on dermatological diseases with dermatological quality life index.

Disease-related skin lesions have been reported in 8% to 20% of COVID-19 patients. In the literature, cutaneous symptoms associated with the disease are generally emphasized. However, there are very few studies on the effect of this new SARS-CoV-2 virus entering our lives on dermatological diseases, and none of them have used the dermatological quality of life index (DLQI). In our study, we aimed to evaluate the difficulties faced by the patients who applied to the dermatology outpatient clinic during the pandemic period and the course of their diseases with the dermatological quality of life index. The study was carried out prospectively by including dermatology patients who will apply to the outpatient clinic in June-July 2020. 282 patients were evaluated in the study. DLQI was significantly lower in the group using regular emollients (P < .001). When DLQI was compared between disease groups, it was found to be significantly different (P: .017). DLQI was found to worsen significantly compared to prepandemic studies. It was found that using moisturizer in this period helps to maintain the dermatological quality of life.

Clinical and laboratory assessment for the inflammation role in chronic spontaneous urticaria: A clinical study.

Chronic spontaneous urticaria (CSU) is triggered by unknown causes. We would like to explore the possible effect of hemogram parameters and several biochemical markers on CSU presence and also the severity of the disease. We also aimed to discuss the relationship between CSU and inflammation associated with these values. The study was planned prospectively. We selected patients already diagnosed with CSU who applied to the dermatology outpatient clinic and healthy controls. The patients and the healthy controls were tested for complete blood count, neutrophil/lymphocytes ratio and platelets/lymphocytes ratio, erythrocyte sedimentation rate, C-reactive protein, serum albumin and total bilirubin and indirect bilirubin levels. Urticaria activity score over 7 days (UAS-7) was calculated for the CSU patients. Forty patients with CSU and 55 healthy subjects were included in the study. Mean white blood cell (WBC) count is 8.37 ± 2.14 in the patients' group and 7.41 ± 2.01 in the healthy subjects group. Mean neutrophil (NEU) count is 4.88 ± 1.65 in the patients' group and 4.19 ± 1.39 in the healthy subjects group. Mean platelets (PLT) count is 308.48 ± 88.32 in the patients' group and 268.65 ± 64.80 in the healthy subjects group. We also detected positive correlations between UAS-7 score-WBC counts and UAS-7 score-NEU counts. Future studies are needed to investigate this possible relationship and confirm these results.

Evaluation of dermatology consultations in the era of COVID-19.

It has been reported that dermatology practices may be a vector for SARS-CoV-2 transmission and elective cases should be postponed during the pandemic period. In this context, studies on the change of patient profile in Dermatology outpatient clinic have been conducted. However, there was no study in the literature about dermatology consultations during the pandemic period. One hundred and forty-seven dermatology consultation cases in the era of COVID-19 pandemic between March 11, 2020 and May 4, 2020 were retrospectively evaluated. Twenty-four patients (16.3%) had suspicion and signs of COVID during consultation (fever, cough, shortness of breath, etc.). Nine (37.5%) of these patients also had accompanying COVID-19 skin lesions (two urticarial lesions, two livedo and necrosis, two maculopapular eruption, two vesicular rashes, one pseudo-chilblain). The number of cases that were suspected to have COVID-19 was statistically significantly higher in consultations requested by the emergency department and intensive care unit, while there were no suspected cases in outpatient clinic consultations (P = .001). Two (1.4%) of these patients were diagnosed with COVID-19 confirmed by PCR within 2 weeks. We acknowledge that daily practice changes frequently during this period, but still our study provides a perspective to other dermatology clinics in terms of the requested dermatology consultations during the pandemic.

Is prenatal testosterone-estrogen balance associated with psoriasis?

The etiopathogenesis of psoriasis is not understood; however, psoriasis is affected by hormones, particularly the sex steroids. The second-to-fourth digit (2D:4D) ratio, which is an indicator of prenatal sex hormone balance, has been studied in various diseases that are affected by hormones. A total of 369 individuals comprising 172 patients with psoriasis and 197 healthy volunteers were included in the study. Patients with psoriasis were divided into type-1 and type-2, according to age of onset and family history. The 2D:4D ratio of both hands was recorded for all participants. Females in the psoriasis group had a lower 2D:4D ratio in both hands compared with those in the control group, with no significant difference. Males in the psoriasis group had a higher 2D:4D ratio for both hands compared with those in the control group (P = .009 and P < .001 for the right and left hands, respectively). Further, male patients with type-1 psoriasis had a lower 2D:4D ratio compared to those with type-2 psoriasis. Our results suggest that an alteration of the estrogen-testosterone balance due to prenatal testosterone activity is an independent predisposing factor for psoriasis in males.

Effects of isotretinoin on the platelet counts and the mean platelet volume in patients with acne vulgaris.

Aim. The aim of this study was to evaluate the platelet counts and the mean platelet volume in patients who received isotretinoin for the treatment of acne vulgaris. Method. A total of 110 patients were included in this retrospective study. Complete blood count parameters were recorded prior to and three-months following the treatment. Results. Both platelet counts and the mean platelet volume were significantly decreased following the treatment. No significant differences were noted on the levels of hemoglobin, hematocrit, and white blood cell count. Conclusion. Platelet counts and mean platelet volume significantly decreased following isotretinoin treatment. Since the decrease of platelet counts and the mean platelet volume was seen concomitantly, it is concluded that the effect of isotretinoin was through the suppression of bone marrow.

Analysis of factors influencing target PASI responses and side effects of methotrexate monotherapy in plaque psoriasis: a multicenter study of 1521 patients.

Methotrexate (MTX) is commonly used as first-line systemic treatment agent in psoriasis. We aimed to evaluate the clinical characteristics and treatment responses of patients with psoriasis undergoing MTX monotherapy. Data from adult patients with plaque psoriasis who received MTX monotherapy for at least 3 months between April 2012 and April 2022 were retrospectively evaluated in 19 tertiary care centers. Our study included 722 female and 799 male patients, a total of 1521 participants. The average age of the patients was 44.3 ± 15.5 years. Mode of treatment was oral in 20.4% of patients while in 79.4% it was subcutaneous. The median treatment duration was 8 months (IQR = 5-15). The median weekly dose was 15 mg (IQR = 11-15). 1448 (95.2%) patients were taking folic acid supplementation. At week 12, 16.3% of the patients achieved PASI (Psoriasis Area and Severity Index) 90 response while at week 24, 37.3% achieved it. Logistic regression analysis for week 12 identified the following independent factors affecting PASI 90 achievement positively: median weekly MTX dose ≤ 15 mg (P = 0.011), subcutaneous administration (P = 0.005), no prior systemic treatment (< 0.001) and folic acid use (0.021). In logistic regression analysis for week 24; median weekly MTX dose ≤ 15 mg (P = 0.001), baseline PASI ≥ 10 (P < 0.001), no prior systemic treatment (P < 0.004), folic acid use (P = 0.001) and absence of comorbidities (P = 0.009) were determined as independent factors affecting the achievement of PASI 90. Adverse effects were observed in 38.8% of the patients, with nausea/vomiting (23.9%) and transaminase elevation (13%) being the most common. The most common reasons for interruptions (15.3%) and discontinuations (27.1%) of the treatment were patient related individual factors. The use of MTX as the first systemic treatment agent, at doses ≤ 15 mg/week and concurrent folic acid application are positive predictive factors for achieving the target PASI response both at weeks 12 and 24. In our study, which is one of the most comprehensive studies on MTX treatment in psoriasis, we observed that MTX is an effective and safe treatment option.

Total oxidant capacity, total antioxidant capacity, ischemic modified albumin, microRNA levels, and their relationship with psoriasis area and severity index.

Aims To examine the differences in the levels of microRNA, ischemic modified albumin (IMA), total oxidant capacity (TOC), and total antioxidant capacity (TAC) of persons with and without psoriasis and, in the case group, the relationship between these parameters and psoriasis area and severity index (PASI). Methods Blood samples were collected from patients and healthy participants to examine levels of these parameters. Results The mean serum TOC level was higher in the case group. The mean serum TAC and IMA levels were significantly lower in the case group (P <0.001). It was observed that the mean serum miR-203 and miR-146a levels were increased in psoriasis patients. It was determined that there was only a significant positive weak correlation between miR-203 and PASI (r = 0.232, P = 0.027). Limitations The small sample size, not controlling serum albumin and not evaluating the effects of the treatment agents used by the patients on oxidative and inflammatory processes. Conclusion In the case group changes in the mean serum TOC and TAC levels provide evidence that oxidative stress may play a critical role in disease pathogenesis. The increase in the mean serum miR-203 and miR-146a levels suggest the possibility of therapies targeting these microRNAs as a new option.

Selenium Disulfide-based shampoo applied for 4 weeks significantly improves dandruff and seborrheic dermatitis.

Seborrheic Dermatitis (SD) is a chronic and relapsing inflammatory condition accompanied by erythema, flaking and itching. Dandruff is a milder form of SD. Selenium disulfide (SeS2) is beneficial in both conditions. OBJECTIVES: to assess the efficacy of SeS2-based shampoo in dandruff/SD. MATERIALS & METHODS: an international, multicenter, observational study was conducted in 1407 adult subjects. SeS2- based shampoo was used 2 to 3 times per week for 4 weeks. Clinical efficacy criteria included improvement of hair, flaking, erythema and irritation on a scale from 0 to 5; investigator satisfaction was assessed at month 3 from 0 to 10. The subjects rated the impact of their hair problem (0 to 5), efficacy and satisfaction with SeS2-based shampoo at month 3. Tolerance was assessed throughout the study. RESULTS: At baseline, 68.2% had a flake severity score of 3-5, 49.9% an erythema severity score of 3-5, and 46.2% an irritation severity score of 3-5; 28.2% were bothered and 41.5% were very bothered. At study end, SD/D had at least clearly improved in 89.6% of subjects. All clinical signs had significantly (p<0.001) improved. 95.6% of subjects reported less pruritus. Significantly fewer (15.4%, p<0.0001) subjects were still bothered. The overall subject satisfaction score was 8.9±1.4; 97.6% of investigators were satisfied or very satisfied. Tolerance was good or very good in 98.8% of subjects. CONCLUSION: A SeS2-based shampoo applied 2 to 3 times per week is efficient and well tolerated in dandruff and SD.

Treatment of keratosis pilaris rubra with 577-nm pro-yellow laser.

OBJECTIVE: Keratosis pilaris rubra (KPR) is a rare group of idiopathic hereditary disorders of keratinization, and it is considered as variants of keratosis pilaris. It is characterized by a well-defined erythema and small, keratotic follicular papules that are seen on the cheeks and preauricular area. Keratosis pilaris rubra is an aesthetically distressed situation, and especially vascular erythema is the most common complaint. In recent years, pro-yellow (577 nm) laser, laser system with yellow light wavelength, has been used as an alternative for seeking more effective treatment especially in vascular lesions. However, in the literature, pro-yellow laser therapy has never been used before in keratosis pilaris rubra. Therefore, we wanted to evaluate the effectiveness of the pro-yellow laser in keratosis pilaris rubra patients. MATERIALS AND METHODS: In our study, four patients with keratosis pilaris rubra treated with pro-yellow laser in our Cosmetology Unit between December 2017 and March 2019 were evaluated. The first session was started with 20 j/cm2 and the dose increased 2 j/cm2 at each session. The dose was increased up to 26 j/cm2 , a total of four sessions (20-22-24-26 j/cm2 ) was applied in treatment. All the sessions were used in treatment scanner mode. RESULTS: Objectifying a clearance of erythema >75% was clinically evident in three patients, in the fourth patient, erythema regressed approximately 50%. There has been no recurrence of the lesions after a minimum three months follow-up. There was no permanent side effect in any patient. CONCLUSION: Pro-yellow laser is a well option for the treatment of keratosis pilaris rubra, and we think that it could be a safety choice therapy. In addition, a well tolerance to treatment and a low incidence of serious side effects make it a very reliable therapy. Further clinical studies are needed to improve our findings.

Comparison of anti-TNF and IL-inhibitors treatments in patients with psoriasis in terms of response to routine laboratory parameter dynamics.

BACKGROUND: Biological agent treatments represent a relatively new field and their effects on routine laboratory parameters are not fully known as there has been little research in the area. In our study, we aimed to evaluate the differences between the two main biological treatment groups and their effects on routine laboratory parameters. METHODS: Patients were enrolled when they had received treatment for more than six months with biological treatments between January 2013 and April 2020. The available data on routine laboratory parameters were collected by routine blood tests before the treatment, at three months, and at the final evaluation. RESULTS: When the changes in routine laboratory parameters were evaluated by treatment, it was found that the NLR and CRP values decreased statistically significantly in the anti-TNF group compared to the IL inhibitor group. In addition, strong suppression of these inflammation parameters means strong suppression of the immune system response. In addition, AST, ALT, and creatinine values were found to be statistically significantly higher in the anti-TNF group compared to the IL inhibitor group. CONCLUSIONS: In our study, anti-TNF treatments are shown to be more effective in reducing inflammation parameters while IL antagonists are safer in terms of biochemical parameters.