Evaluation of hirsutism and hormonal parameters in acne vulgaris patients treated with isotretinoin.

BACKGROUND: Although the effect of isotretinoin use on hormonal changes in acne pathogenesis is not fully known, there are limited studies on its effects on the development of hirsutism. In this study, it was aimed to evaluate the effect of isotretinoin use on hirsutism and hormonal parameters in patients with acne vulgaris. METHODS: In this study, 30 female acne patients and 30 healthy females were evaluated prospectively. Menstrual irregularity, LH, FSH, prolactin, progesterone, 17-OH progesterone, oestradiol, total testosterone, DHEA-S, insulin, glucose, TSH levels, Ferriman-Gallwey (FG) score and ultrasonography (USG) findings of control group and patient group were recorded. RESULTS: Pre-treatment progesterone (P = .007) and oestradiol (P = .001) levels of the patients were statistically lower than the control group. In the patient group, menstrual irregularity (P < 001) and FG hirsutism score at the third month of treatment were significantly higher than before treatment. In 10% of the patients, there were abnormal findings on pelvic USG in the third month of treatment. CONCLUSION: In our study, it could not be revealed that isotretinoin has a significant effect on pituitary, adrenal hormones and insulin resistance. We found that 3 months of isotretinoin treatment caused an increase in menstrual irregularity and FG hirsutism score.

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.

Assessment of HLA-A, HLA-DR, and HLA-DQ alleles in patients with pemphigus vulgaris from eastern of Turkey.

BACKGROUND: Pemphigus vulgaris (PV) is a chronic progressive autoimmune bullous disease caused by the interaction of pathogenic factors, genetic, and environmental factors. HLA alleles, which are considered as protective factors against disease or predisposing factors, may be different in various populations and ethnic groups. AIMS: The purpose of this study is to examine the HLA-A, HLA-DR, and HLA-DQ alleles in patients that are diagnosed with PV in and around eastern of Turkey and to determine the alleles that create predisposition to disease or protect against the disease. PATIENTS/METHODS: Thirty patients diagnosed as PV with clinical, histopathological, and immunofluorescence findings and 30 healthy subjects were included in this study. The HLA-A, HLA-DR, and HLA-DQ typology in the DNA samples that were obtained from the blood samples of the groups was performed by using the PCR-SSP low-resolution gene panels. RESULTS: The HLA-A*03 allele was found to be significantly higher in patient group than the control group (P-value: .020). HLA-DRB1*04 and HLA-DRB1*14 alleles in PV patients were found to be significantly higher than the control group (P-value = .000). CONCLUSION: It was concluded that the HLA-DRB1*03, HLADQB1*02, and HLA-DQB1*06 alleles in and around eastern of Turkey showed protective effects against pemphigus vulgaris. It was also concluded that the HLA-A*03, HLA-DRB1*04, HLA-DRB1*14, HLA-DRB4, HLA-DQB1*03, and HLA-DQB1*05 alleles could cause predisposition to the disease.

Expressions of glutathione S-transferase alpha, mu, pi, and theta in the skin samples of patients with acne rosacea.

BACKGROUND: Data point to the importance of oxidative stress in rosacea. Glutathione S-transferases (GSTs) have substantial roles in a wide variety of oxidative stress-related conditions. AIM: To evaluate the immunohistochemical staining characteristics of GST alpha (GSTA), mu (GSTM), pi (GSTP), and theta (GSTT) in patients with rosacea. PATIENTS/METHODS: The study included 23 women and 7 men with rosacea (mean ± SD age 49 ± 11 year) and 15 healthy control subjects (10 women, 5 men; mean ± SD age 47.86 ± 10.88 year). For each patient, the average disease duration, disease subtype, ocular involvement, and severity score were recorded. A 3-mm punch biopsy was taken from the facial skin of each patient and control. Expression of GST isoenzymes was analyzed immunohistochemically. RESULTS: Expressions of GSTM1, GSTP1, and GSTT1 were significantly elevated in patients with rosacea compared to those in the control group (P = .0001, P = .0002, P < .0001, respectively). In the rosacea group, GSTT1 expression was significantly stronger than GSTP1 and GSTA1 expressions (P = .019, P < .0001, respectively). There were no significant associations between expressions of GST isoenzymes and gender, age, average duration of illness, disease subtype, ocular involvement, or severity score in the patient group (all P > .05). CONCLUSIONS: In rosacea, the significant increase of GSTT1, GSTP1, and GSTM1 expressions might result from activation of GST as an outcome of extreme free radical generation from triggered neutrophils or ultraviolet vulnerability. These findings support the relevance of oxidant stress in the pathogenesis of rosacea.

Immunohistochemical evaluation of the effect of acitretin and systemic steroid treatments on Ki-67, Bcl-2, and COX-2 levels in cutaneous lichen planus patients.

BACKGROUND: Lichen planus (LP) is an inflammatory disease that affects skin, hair follicles, mucous membranes, and nails. Ki-67 is an antigen associated with the proliferation of cells in all stages of cell cycle except G0. Bcl-2 is a protooncogene that protects cells from apoptosis. COX-2 is an antiapoptotic protein that increases in inflammation. The infiltration of T cells in LP seems to be responsible in the apoptosis of the basal keratinocytes. OBJECTIVE: The purpose of this study was to investigate the effects of prednisolone and acitretin treatments on Ki-67, Bcl-2, and COX-2 expression and apoptosis in patients with LP and the role of Ki-67, Bcl-2, and COX-2 proteins in LP. METHODS: Fifty-eight patients with clinically and histopathologically diagnosed LP who had not been treated with systemic treatment before and 15 healthy volunteers were evaluated prospectively. Pretreatment and posttreatment biopsies were immunohistochemically stained with Ki-67, Bcl-2, and COX-2. The percentage of the stained cells were calculated and recorded. RESULTS: Although the percentage of staining with Ki-67 and Bcl-2 after treatment with prednisolone and acitretin decreased significantly (P < 0.05) in both groups, there was no significant difference between groups (P > 0.05). COX-2 decreased but was not statistically significant. CONCLUSIONS: With this study in cutaneous lichen planus, prednisolone and acitretin treatments reduced Bcl-2 and Ki-67 levels and did not effect COX-2 levels. It should be clarified whether these results can be obtained with any treatment effective in cutaneous lichen planus.

Internalized stigma in psoriasis: A multicenter study.

Internalized stigma is the adoption of negative attitudes and stereotypes of the society regarding a person's illness. It causes decreased self-esteem and life-satisfaction, increased depression and suicidality, and difficulty in coping with the illness. The primary aim of this study was to investigate the internalized stigma state of psoriatic patients and to identify the factors influencing internalized stigma. The secondary aim was to identify the correlation of internalized stigma with quality of life and perceived health status. This multicentre, cross-sectional study comprised 1485 patients. There was a significant positive correlation between mean values of Psoriasis Internalized Stigma Scale (PISS) and Psoriasis Area and Severity Index, Body Surface Area, Dermatological Life Quality Index and General Health Questionnaire-12 (P < 0.001 in all). Lower percieved health score (P = 0.001), early onset psoriasis (P = 0.016), family history of psoriasis (P = 0.0034), being illiterate (P < 0.001) and lower income level (P < 0.001) were determinants of high PISS scores. Mean PISS values were higher in erythrodermic and generalized pustular psoriasis. Involvement of scalp, face, hand, genitalia and finger nails as well as arthropathic and inverse psoriasis were also related to significantly higher PISS scores (P = 0.001). Our findings imply that psoriatic patients experience high levels of internalized stigma which are associated with psoriasis severity, involvement of visible body parts, genital area, folds or joints, poorer quality of life, negative perceptions of general health and psychological illnesses. Therefore, internalized stigma may be one of the major factors responsible from psychosocial burden of the disease.

Evaluation of brainstem auditory evoked potentials and their relationshipwith levels of thyroid autoantibodies in patients with vitiligo.

BACKGROUND/AIM: Vitiligo is a common depigmenting disorder. The damage can also occur in similar ways to melanocytes within other organs. We evaluated the brainstem and auditory pathway functions by evaluating brainstem auditory evoked potentials (BAEPs) and whether there is any relationship between auditory functions and autoimmunity. MATERIALS AND METHODS: Forty patients with vitiligo and 20 healthy volunteers were enrolled. Thyroid functions and autoantibodies were examined and BAEP tests were assessed by a neurologist. RESULTS: Antithyroid peroxidase (anti-TPO) and antithyroglobulin (anti-TGA) antibody positivity was higher in the patient group (P < 0.05). A negative correlation was detected between anti-TPO and lead III, IV, and V latency and I-III interpeak latency (IPL) of the right ear together with lead IV latency and I-V IPL of the left ear in the patient group. When each BAEP parameter was compared between the two groups, more abnormalities were detected in the V latency and III-V IPL of the left ear together with IV and V latency of the right ear. CONCLUSION: In this study the presence of a correlation between increased anti-TGA and anti-TPO levels and BAEP parameters may be related to an autoimmune-mediated mechanism. However, further studies are needed to be performed in a large patient series.

Comparison of cutaneous mastocytosis with onset in children and adults.

BACKGROUND/AIM: Mastocytosis is a heterogeneous group of diseases characterized by the abnormal infiltration of mast cells in the skin and sometimes other organs. This study aimed to compare the demographic, clinical, and histopathological findings of cutaneous mastocytosis with onset in children and in adults. MATERIALS AND METHODS: Patients diagnosed with cutaneous mastocytosis in 2 different dermatology clinics between 2007 and 2011 were included in the study. Demographic characteristics of the patients as well as localization and type of the cutaneous lesions, presence of symptoms, Darier's sign, family history, systemic involvement, and histopathological evaluations were retrospectively examined. RESULTS: Out of the 30 cases of cutaneous mastocytosis, 60% of patients were male (n = 18) and 40% were female (n = 12). Twenty-two patients had childhood-onset mastocytosis (≤15 years) and 8 patients had adult-onset mastocytosis. The onset of the disease occurred before the age of 2 years in all cases of childhood onset. Patients with adult-onset mastocytosis had statistically significantly more systemic involvement than those with childhood-onset mastocytosis (P < 0.05). CONCLUSION: Cutaneous mastocytosis is a benign disease in children without systemic involvement and is usually sporadic.

Comparison of efficacy of narrow band UVB therapies with UVB alone, in combination with calcipotriol, and with betamethasone and calcipotriol in vitiligo.

OBJECTIVE: The purpose of this study is to compare the efficacy of three therapies in the treatment of non-segmental vitiligo: a combination of topical calcipotriol, narrowband-ultraviolet B (NB-UVB), and betamethasone therapies; a combination of NB-UVB and topical calcipotriol; and NB-UVB alone. MATERIAL AND METHODS: Forty-five patients with non-segmental vitiligo presenting to our Dermatology clinic were recruited to participate in the study. Patients were randomly divided into three groups. For each patient the size of the depigmented areas was assessed according to the rule of nines. The first group was treated with a combination of topical calcipotriol, NB-UVB, and betamethasone therapies. The second group was treated with a combination of NB-UVB and topical calcipotriol and third group was treated with NB-UVB alone. Since the patients' vitiligo lesions had similar phototypes, all patients were started with 0.1 j/cm(2), regardless of their skin phototype. The dose of NB-UVB was increased 10% in each session and no further increment was done after reaching 2.5 j/cm(2). Treatment effectiveness was evaluated according to the percentage improvement in repigmentation. The quality of life of the patients was measured by the Dermatology Life Quality Index (DLQI). RESULTS: The patients were aged from 13 to 55 years (mean: 25.29). The duration of disease ranged from 3 months to 20 years. Family history was positive for vitiligo in 10 patients (22.2%). The percentage of recovery after treatment was 63.33% ± 7.55 in group 1, 60.67% ± 5.75 in group 2, and 46.67% ± 7.98 in group 3. There was no statistically significant difference between groups 1 and 2, and groups 2 and 3, but there was a statistically significant difference between groups 1 and 3 (p = 0.0048). CONCLUSIONS: In conclusion, NB-UVB-alone therapy and the combined therapies are effective treatment options in the treatment of vitiligo. Future studies with larger groups are warranted to confirm our results.

The effects of retinoids on secondary wound healing: biometrical and histopathological study in rats.

OBJECTIVE: A wound healing is a complex process, and the role of retinoids in this process is debated and controversial. In this study, the effect of topical tretinoin and oral acitretin on wound healing process was investigated in full-thickness skin lesions on rat model. METHOD: A circular full-thickness wound was created by 6 mm punch biopsy on the back side of 32 male rats. The rats were seperated into four equal. The first group was assigned as a control group and was observed with no treatment. The second group was administered dexpanthenol once a day over wound area. In the third group, 0.1% tretinoin cream was applied daily. In the fourth group, 2.5 mg/kg/day acitretin was given daily. Additionally, the biopsies were taken from wounds for the histopathologic examination. RESULTS: The complete recovery time was remarkably longer in the tretionin group than the control group and the dexpantenol group (p < 0.05). The average complete recovery time was significantly longer in the acitretin group than the control and dexpanthenol groups whereas it was statistically shorter in the acitrein group than the tretionin group (p < 0.05). CONCLUSION: Based on our findings, topical tretinoin and oral acitretin can delay secondary wound healing, epithelization and angiogenesis.

Does isotretinoin therapy have any effects on electrocardiography, heart rate and blood pressure?

BACKGROUND: Isotretinoin therapy is associated with numerous adverse effects of various systems. Although some cases have been reported, cardiac side effects are rare following isotretinoin treatment. OBJECTIVE: To investigate the effects of isotretinoin on the cardiovascular system. METHODS: Seventy patients with acne vulgaris were enrolled in the study. The patients were treated with a dose of 0.5-1.0 mg/kg per day of isotretinoin. Screening for biochemical and hematologic parameters, heart rate, blood pressure and electrocardiographic parameters were done before treatment and after 3 months of isotretinoin treatment. RESULTS: Heart rate, systolic/diastolic tension and electrocardiographic parameters (P-wave duration and QTc duration) were not statistically different before compared with after treatment. CONCLUSION: As far as we know, there is no study researching the effect of isotretinoin on P- and QT-wave measurements in the literature. We found that isotretinoin did not affect P- and QT-wave measurement. Further studies with longer periods of follow-up are needed to understand the effect of isotretinoin on the cardiovascular system.