Skin-homing T-cell responses associated with Demodex infestation and rosacea.

AIMS: Our aim was to investigate the skin-homing T-cell immune responses triggered in patients with Demodex infestation and/or rosacea. METHODS: Collected whole blood samples were divided into four groups: control subjects; nonrosacea patients with Demodex infestation (Demodex group); papulopustular rosacea (PPR) patients without Demodex infestation (Rosacea group); and PPR patients with Demodex infestation (Rosacea/Demodex group). Following ex vivo activation, skin-homing CLA+CD4+ T-cell subset levels were monitored by flow cytometry. RESULTS: When compared with control subjects, among skin-homing CD4+ T-cell subsets analysed, Demodex patients had higher TH 9 and Treg cell levels; Rosacea subjects displayed elevated TH 1 cell levels; and Rosacea/Demodex patients exhibited increased frequencies of TH 9 and TH 22 cells. In contrast to Rosacea subjects, Rosacea/Demodex group members displayed higher TH 2 cell levels; and when compared with Demodex groups, they had higher TH 1 and TH 2 but lower Treg cell levels. Demodex group members also exhibited higher Treg but lower TH 1 and TH 22 levels than Rosacea/Demodex group subjects. CONCLUSIONS: The skin-homing T-cell responses associated with Demodex infestation and rosacea formation seem to influence each other. The present as well as future studies could contribute to the development of effective treatment strategies for demodicosis and rosacea.

Comparison of pigmentary side effects of taxanes and anthracyclines: an onychoscopic evaluation.

BACKGROUND: Taxanes and anthracyclines are considered as fundamental drugs for the treatment of a broad range of cancers. They have several side effects, which may limit their usage. Drug-induced nail pigmentation (DHNP) has been reported as one of the most striking dermatological side effect of both taxanes and doxorubicin. OBJECTIVE: This study aimed to evaluate and compare pigmentary side effects of taxanes and doxorubicin with the help of onychoscopy. METHODS: Forty-one consecutive patients (30 women, 11 men) with a diagnosis of cancer (16 gastric cancer, 25 breast cancer) were prospectively enrolled in a period of six months. Patients were categorized according to the chemotherapy regimens they had been administered: docetaxel received group [docetaxel (60 mg/m2, day 1), cisplatin (60 mg/m2, day 1) and fluorouracil (500 mg/m2, days 1-5) every 3 weeks], paclitaxel received group [paclitaxel (80-175 mg/m2) every 21 days with or without trastuzumab/zoledronic acid] and doxorubicin received group [doxorubicin 50-60 mg/m2 and cyclophosphamide 600-750 mg/m2 every 21 days]. All the patients were asked whether they had diabetes mellitus (DM) and peripheral neuropathy. At the 16 weeks of chemotherapy, for each patient, all fingernails and toenails were evaluated in clinical and dermoscopic examinations for nail pigmentation. Dermoscopic examination was performed using a videodermatoscope. Descriptive statistics were computed for means, standard deviations, and frequencies. Chi-square test or Fisher's exact tests were used for the statistical analysis, with a significance threshold of p < 0.05. RESULTS: 34.1% of the patients (14/41) demonstrated clinical signs of nail pigmentation. Nail pigmentation was observed in 4 of 13 patients (30.8%), who had received doxorubicin; 10 of 28 patients (35.7%), who had received taxanes (docetaxel and paclitaxel). There was no statistically significant relationship between the nail pigmentation and the type of the chemotherapeutic regimen administered (Fisher's exact test, p = 1.000). In addition, no statistically significant results were observed between nail pigmentation and DM (Fisher's exact test, p = 0.393), and nail pigmentation and peripheral neuropathy (Fisher's exact test, p = 1.000). CONCLUSIONS: DHNP may cause considerable distress to patients. Dermoscopy is a noninvasive imaging method that increases diagnostic accuracy of both pigmented and nonpigmented lesions. Typical dermoscopic features of DHNP consist of a homogeneous brownish-gray coloration of the background with thin, longitudinal, gray lines, which allow the examiner to clearly make the correct diagnosis. Further studies are needed to assess both clinical and dermoscopical findings of DHNP.

A study of dermoscopic features of nail psoriasis.

INTRODUCTION: Dermoscopy is a non-invasive imaging method that enables the evaluation of pigmented and non-pigmented skin lesions. More recently, dermoscopy has been recognized as an effective tool in the diagnosis of nail diseases. AIM: To evaluate the dermoscopic features of nail psoriasis and to assess the relationship between these features and disease severity. MATERIAL AND METHODS: A total of 67 patients with clinically evident nail psoriasis (14 women, 53 men) were prospectively enrolled. Following a thorough clinical examination, patients were graded according to the Nail Psoriasis Severity Index and physician's global assessment score. A dermoscopic examination of all fingernails and toenails was performed using a videodermatoscope. Mann-Whitney U and χ2 tests were used for statistical analysis, with a significance threshold of p < 0.05. RESULTS: The most frequently observed dermoscopic features were splinter haemorrhage (73.1%), pitting (58.2%), distal onycholysis (55.2%), dilated hyponychial capillaries (35.8%) and the pseudo-fiber sign (34.3%). The pseudo-fiber sign, dilated hyponychial capillaries, nail plate thickening and crumbling, subungual hyperkeratosis, transverse grooves, trachyonychia, pitting and salmon patches were positively associated with disease severity. CONCLUSIONS: The pseudo-fiber sign described in this study appears to be a novel dermoscopic feature of nail psoriasis. We have demonstrated positive associations between a number of dermoscopic manifestations and disease severity. Further studies are required to support the present findings.

Contact sensitisation in patients with chronic leg ulcers.

The aim of our study is to identify the allergens in patients with leg ulcers who have contact dermatitis surrounding the skin of the ulcer and compare them with a control group consisting of patients with lower extremity contact dermatitis. A total of 40 patients with chronic leg ulcers (CLU) and contact dermatitis around the skin of ulcer were included in the study. As a control group, 20 patients with contact dermatitis of lower extremity without leg ulcers were included. The patient and control groups were patch tested with 37 allergens of the European Standard Series. Of the 40 patients, 31 (77·5%) had positivity to one or more allergens, and 10 (50%) of the control group patients had positivity to one or more allergens. The number of patients who had positivity to at least one allergen was significantly higher in the patient group (P < 0·05). Positivity to the balsam of Peru and benzocaine was significantly higher in the patient group than that in the control group (P < 0·05). Contact sensitisation to benzocaine and balsam of Peru was found to be associated with the presence of CLU. The efficacy of therapy in patients with leg ulcers might be increased by avoiding these allergens.

A case of generalized allergic contact dermatitis after laser tattoo removal.

Tattoos are popular body decorations mainly done for cosmetic purposes. Regarded as a form of self-expression, tattoos reflect the character of the person wearing it. However, as tatoos are persistent visual markings on the body, frequently misperceived by the others causing tattooed to seek removal. Today most of the tattoos can be successfully treated with laser ablation. Here we present a case of generalized allergic contact dermatitis after laser tattoo removal which is a rare adverse reaction of laser tattoo removal.

A case of Graham-Little-Piccardi-Lasseur syndrome.

Graham-Little-Piccardi-Lasseur Syndrome (GLPLS) is a variant of lichen planopilaris, which is characterized by progressive cicatricial alopecia of scalp, non-cicatricial alopecia of axillae and pubic regions, and keratosis pilaris-like follicular papules over trunk and extremities. GLPLS is a disease of unknown etiology. However, recent reports support a central role for a T-cell-mediated immune response in the pathogenesis of GLPLS. Besides, although GLPLS is believed to occur sporadically, a genetic predisposition also has been implicated in the pathogenesis. On the other hand, GLPLS typically affects middle-aged women, particularly of the postmenopausal age group. A diagnosis of GLPLS is generally apparent with the presence of characteristic findings in a postmenopausal woman. Herein, we report a case of GLPLS in a 75-year-old woman with the typical triad of alopecia of the scalp, non-cicatricial alopecia of axillae and pubis, and a follicular keratotic eruption on the trunk.

Etiopathogenetic factors, thyroid functions and thyroid autoimmunity in melasma patients.

INTRODUCTION: Melasma is a common chronic, acquired pigmentation disorder with a significant impact on the quality of life of patients. AIM: To investigate the etiopathogenetic factors, thyroid functions and thyroid autoimmunity in patients with melasma. MATERIAL AND METHODS: Forty-five women with melasma and 45 age-matched healthy women were included in the study group. A detailed history was taken from the patients including triggering factors of melasma. Serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), anti-thyroglobulin (AbTG) and anti-thyroid peroxidase (Ab-TPO) were measured and thyroid ultrasonography was performed for each subject. RESULTS: In 26.7% of patients, pregnancy, in 17.8%, oral contraceptive use and in 13.3%, intense sunlight exposure were the triggering factors. 17.8% of patients had a family history of melasma. FT4, TSH and AbTG levels were significantly higher in the patient group. CONCLUSIONS: The results suggest that a combination of factors including pregnancy, oral contraceptive use, sunlight and genetic factors often trigger melasma. Thyroid hormones and thyroid autoimmunity may also play a role in the pathogenesis which needs to be proven by further studies.

Assessment of Tear Functions in Patients with Acne Rosacea without Meibomian Gland Dysfunction.

Purpose: To evaluate the results of tear functions in acne rosacea. Methods: This prospective study includes 64 eyes of 32 acne rosacea patients without blepharitis and meibomian gland dysfunction and 90 eyes of 45 patients as control group. Tear functions of all were evaluated with ocular surface disease index (OSDI) questionnaire, and measurements of tear osmolarity were performed by using TearLab, Schirmer I tests without anesthesia and fluorescein tear break-up time (TBUT). Results: The mean Schirmer test result was 12.53 ± 6.54 in study group and 16.21 + 7.52 mm/5 min in control group (p = 0.28). The mean TBUT in study group was 8.21 ± 4.01 and in control group was 18.03 ± 6.45 s (p = 0.02). Mean tear osmolarity in study group was 304.77 ± 15.59and in control group was 275.23 + 28.52 mOsms/L (p = 0.03). Mean OSDI score in study group was 27.51 ± 16.73 and was 18.15 ± 7.05 in control group (p = 0.38). Conclusions: Our study demonstrated lower dry eye tests before the appearance of clinical signs of meibomian gland disease in acne rosacea.

Chronic bullous disease of childhood in a patient with acute lymphoblastic leukemia: possible induction by a drug.

Linear IgA disease is characterized by the presence of linear IgA deposits in the basement membrane zone of the skin, and circulating basement membrane zone antibodies are detected in 80% of cases. The disease occurs in both adults and children, and is designated adult linear IgA disease in the former and chronic bullous disease of childhood (CBDC) in the latter. We describe a 5-year-old boy with acute lymphoblastic leukemia in remission, in whom CBDC developed after treatment with trimethoprim/sulfamethoxazole (cotrimoxazole). To our knowledge, this is the first reported case of possible drug-induced CBDC.

Punctate palmoplantar keratoderma (Brauer-Buschke-Fischer syndrome).

Punctate palmoplantar keratoderma (PPPK) is a rare entity with an estimated prevalence rate of about 1.17 per 100,000. The exact etiology of the disorder is not known but a dual influence of genetic and environmental factors may trigger the disease. We report the case of a 70-year-old male patient with punctate palmoplantar keratodermic lesions for more than 40 years. Histopathologic examination revealed a hyperkeratotic epidermis without columns of parakeratosis or elastorhexis. On electron microscopy, the basal cells of the epidermis were found to have enlarged nucleoli and abundant tonofilaments, with keratohyalin-like granules confined to the upper part of the stratum spinosum, findings that were consistent with PPPK. Topical keratolytic agents were used with little success. Patients with PPPK and their next of kin should be investigated for possible associated malignancies.

Evaluation of serum uric acid levels in psoriasis vulgaris.

BACKGROUND/AIM: Psoriasis has been accepted as a systemic disease and it is known to be associated with various disorders including metabolic syndrome. High serum uric acid levels are also associated with the components of metabolic syndrome. In this study, we aimed to determine serum uric acid levels in patients with psoriasis and the association of uric acid levels with disease activity by taking the presence of metabolic syndrome criteria into account, since it is one of the most important factors that affect serum uric acid levels. MATERIALS AND METHODS: In this cross-sectional study, we evaluated 70 psoriasis patients and 70 healthy individuals who were matched with the patients according to the presence of metabolic syndrome. We evaluated the demographic features, levels of serum uric acid, Psoriasis Area Severity Index (PASI) scores, presence of psoriatic arthritis, nail involvement, and metabolic syndrome criteria of the patients. RESULTS: Serum uric acid levels of psoriasis patients were significantly higher than those of controls. There was a positive correlation between PASI scores and serum uric acid levels of the patients. CONCLUSION: As hyperuricemia had a close relationship with psoriasis and PASI scores, we suggest monitoring patients with psoriasis for serum uric acid levels during treatment and follow-up.

Demographic characteristics and risk factors in Turkish patients with anogenital warts.

Anogenital warts (AGW) are one of the most common sexually transmitted diseases worldwide. The determination of groups vulnerable to contracting anogenital warts (AGW) leads to the development of policies for disease control and of prevention programs. The aim of our study was to investigate the demographical features and risk factors of Turkish patients with AGW. This study included 200 patients with AGW and 200 healthy individuals as a control group. The age, gender, education and marital status, age of first sexual intercourse, number of sexual partners, sexual orientation, and smoking status were recorded in both groups. In this study, 88% of the patients were male, and 12% were female. The mean age of the patients was 35.21±0.77 years, and the majority of patients were below 35 years old (63%). Furthermore, 46.0% of the patients were educated at the university level, and 33.5% had graduated high school. No significant differences were found based on sexual orientation or condoms between the patient and control groups. In the patient group, the mean age of first sexual intercourse was significantly earlier, and the number of single individuals and sexual partners were significantly higher. Also, 61% of the patients were current smokers, which was significantly higher than the control group. The duration of smoking and the duration of AGW were found to be correlated. All patients were tested for anti-HIV antibodies, and only one patient was found to be infected. AGW were more common in patients younger than 35 years old, among men, and among those who had graduated from high school or university. Early age of first sexual intercourse, a high number of sexual partners, being single, and smoking were also risk factors for the development of anogenital warts.

Dermoscopic Findings in Patients with Pigmented Purpuric Dermatoses.

Pigmented purpuric dermatoses (PPD) are a group of chronic and relapsing cutaneous disorders characterized by a distinct purpuric rash. The diagnosis is made with clinical and histopathological findings. Dermoscopy has rarely been used in the diagnosis of PPD. The aim of our study is to describe the dermoscopic findings in patients with PPD. Eighteen patients who were clinically and histopathologically diagnosed with PPD were studied prospectively. The type and duration of PPD, associated diseases, and medication history of the patients were noted. Dermoscopic examination was performed in all of the patients. Four of the patients were women and 14 of them were men. 16 (88.8%) of them had Shamberg's disease, 1 of them had lichen aureus, and 1 had purpura annularis telangiectoides. Dermoscopic examination revealed multiple irregular red dots, globules and/or patches and brown-coppery coloration on the background in all of the patients, a network of interconnected brown lines in 8, linear vessels in 9, brown dots in 3, grey dots in 3, twisted red loops in 5, comma-like vessels in 2, and red lacunae in 1 patient. The dermoscopic examination of PPD might improve the accuracy of clinical diagnosis.

Specialists are not qualified enough to recognize and define dermatologic diseases.

Dermatology is a specific branch of medicine which includes dermatologic manifestations of systemic underlying diseases as well as primary cutaneous diseases. In this study, specialists' abilities of defining and diagnosing dermatologic diseases were assessed. 381 hospitalized patients who were referred to the Dermatology Clinic were reviewed via electronic medical charts. 121 of the clinicians (31.2%) made a dermatologic definition when referring their patients to dermatology. 136 of the the clinicians (35.1%) made a pre-diagnosis for their patients' dermatologic condition of which 90 (66,2%) were correct and 46 (33,8%) were non-relevant. Internists wrote a definitive dermatologic examination note significantly more often than surgeons (P=0.03). However, there was not a significant difference between internists and surgeons when we compared the ratio of correct and complete dermatologic definitions of patient condition (P=0.503). There was also no difference between surgeons and internists in terms of making a pre-diagnosis, making a correct diagnosis, and making a wrong diagnosis (P>0.05 for each comparison). In conclusion, dermatologic consultations are crucial and necessary for the improvement of patient care and treatment. Specialists lack basic skills to recognize and define dermatologic conditions they are confronted with.

A case of trichotillomania with recently defined trichoscopic findings.

Trichotillomania (TTM) is an impulse control disorder characterized by repetitive behavior of hair pulling resulting in secondary alopecia. It is among the psychocutaneous diseases known to be associated with psychiatric comorbidity, social, and functional impairment. Although most of the time, an experienced dermatologist easily recognizes the key features of TTM, a history and physical examination alone might not be enough to make a definitive diagnosis. As an effective noninvasive technique for the evaluation of scalp and hair diseases, trichoscopy also has proven to be a valuable tool in the diagnosis of TTM. Currently, new trichoscopic findings of TTM have been described. Here, we report a case of TTM with recently defined trichoscopic features.

Prevalence of metabolic syndrome in Behçet disease: a case-control study in Turkey.

BACKGROUND: Chronic inflammatory diseases such as psoriasis, rheumatoid arthritis, and inflammatory bowel diseases have been reported to be associated with the development of metabolic syndrome (MetS), which is characterized by central obesity, elevated triglycerides (TG), reduced high-density lipoproteins (HDL), impaired fasting blood glucose (FBG), and hypertension. Behçet disease (BD) is a chronic, immuno-inflammatory disease with multisystemic involvement. OBJECTIVE: The aim of this study was to investigate the prevalence and risk factors for MetS in patients with BD. METHODS: All patients had BD according to the criteria of the International Study Group. Diagnosis of MetS was established according to National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Mean waist circumference, body mass index (BMI), FBG, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), total cholesterol, HDL, very low-density lipoprotein (VLDL), low-density lipoprotein (LDL), TG, systolic BP, and diastolic BP were measured and analyzed. RESULTS: A total of 86 patients and 72 healthy controls were included. MetS was detected in 35.4 % of patients and 20 % of controls (p = 0.04). Patients with BD had a 2.67-fold higher risk for MetS than healthy controls (p < 0.05). Significant risk factors for developing MetS according to multivariate analyses were BD, age, and BMI. Age at onset of the disease, duration of disease, BMI, gastrointestinal system involvement, and neurological involvement were correlated with increased MetS risk (p < 0.05). MetS tended to increase with age and the duration of the disease and was higher in women under the age of 40 years compared with healthy controls in the same age group. CONCLUSION: All BD patients should be closely monitored for hypertension, hyperlipidemia, and diabetes mellitus to avoid MetS development.