Sexual quality of life in female patients with acne.

Acne is a common skin disease which can have a negative psychosocial impact on quality of life. Sexual health is an important part of overall health and little is known about the effects of acne on individual sexuality. We aimed to assess the sexual quality of life and general quality of life in female patients with acne and compare to those without acne. Sixty female participants with acne and age-matched 40 female controls were enrolled in the study and asked to complete the Sexual Quality of Life-Female Questionnaire and the Short Form-36 Health Survey. Acne severity was evaluated objectively by the Global Acne Grading System and subjectively by the Visual Analogue Scale. Participants reported a significantly worse sexual quality of life and had significantly decreased scores on the quality of life scales of Bodily Pain, General Perception of Health and the Physical Component Summary when compared to controls. Neither the sexual quality of life nor the quality of life was correlated with objective and subjective acne severity and duration of acne. Acne can negatively affect sexual quality of life in female patients as well as differentdimensions of quality of life. The sexual quality of life should be considered while evaluating acne in women irrespective of its severity.

Dermatological aspects of synthetic cannabinoid addiction.

CONTEXT: Synthetic cannabinoids (SCs) have recently become one of the most abused substances among young population and have caused severe health consequences in our country and worldwide. OBJECTIVE: The aim of this study was to investigate sociodemographic and dermatological findings in SC addicts. MATERIALS AND METHODS: A total of 136 SC users who applied to our hospital's Substance Dependence Center outpatient clinic and diagnosed with drug addiction according to DSM-4 criteria between September 2014 and September 2015 were enrolled to our study. Patients were evaluated by dermatologist and psychiatrist with sociodemographic and clinical data sheets. Data were obtained by direct conversation with patients, clinical examination findings, and laboratory tests, if necessary. RESULTS: Of 136 patients, 12 (8.8%) were female and 124 (91.2%) were male, aged between 17 and 53 with mean age of 25.8 ± 9.2. Most common use way of SC was smoking and patients majorly used opiates before SC. The majority of the patients enrolled to our study were low-educated and almost 50% did not have a regular job. The most frequent dermatologic complaints were periorbital darkening, hallowed-cheeks and premature aging, hair loss and gray hair, and acnes, whereas most frequent dermatologic examination findings were artifact lesions such as blade scars and tobacco scars-stains, tattoos, and acnes. DISCUSSION AND CONCLUSIONS: Given the increased prevalence of SC use in our country and around the world, dermatologists should continue to familiarize themselves with the common mucocutaneous markers of this substance use. Awareness of signs of SCs use will facilitate earlier diagnose, intervention, and directed treatment.

[An alternative biphasic nutrient medium for the diagnosis of cutaneous leishmaniasis]. / Kutanöz leysmanyazis tanisinda alternatif bifazik nutrient besiyeri.

Cutaneous leishmaniasis (CL) caused by the Leishmania spp. parasites, is a disease characterized by nodulo-ulcerative lesions in the skin. CL is transmitted to humans by infected sandflies during blood sucking, and is endemic in about 98 countries over the world. The demonstration of amastigotes via microscopic examination, and the growth of promastigotes in NNN (Novy-MacNeal-Nicolle) medium are gold standard methods for laboratory diagnosis. The aim of this study was to compare the biphasic NNN medium that is frequently used in routine laboratories with the biphasic nutrient medium that can be prepared easily in microbiology laboratories, for the growth of promastigotes. In the study, the aspiration fluid sample was used as clinical sample which was obtained from the skin lesion of a 47-year-old female patient admitted to Izmir Katip Celebi Ataturk Education and Research Hospital dermatology outpatient clinic and pre-diagnosed as CL. The aspirate sample taken from the lesion was evaluated with microscopy, cultivation in two different media and real-time polymerase chain reaction (Rt-PCR) methods. In microscopic examination Leishmania amastigotes were observed in Giemsa-stained smears prepared from the aspiration fluid. In Rt-PCR performed by using specific primers and probes targeting ITS1 region of Leishmania parasite, a melting-curve compatible with L.tropica was detected. For cultivation, triple inoculations of the aspirate sample into NNN (NNN + RPMI 1640 + 10% fetal calf serum) and nutrient media (nutrient agar + nutrient broth + 10% fetal calf serum) were used. The cultures were incubated at 27°C for 10 days, and the number of propagated promastigotes were counted on the third, seventh and tenth days. The growth of Leishmania promastigotes was detected in both media on the third day. The number of promastigotes grown in NNN medium on the third, seventh and tenth days were 105/ml, 106/ml and 108/ml, respectively. Those values in nutrient medium were 106/ml, 107/ml and 108/ml on the third, seventh and tenth days, respectively. Although the number of promastigotes on the third and seventh days were higher in nutrient medium than NNN medium, the number of cultivated promastigotes were equal on the tenth day. As a result, nutrient medium is considered to have an impact in the diagnosis of CL, by providing an alternative to the routine medium used and can readily be available in microbiology and parasitology laboratories with long shelf-life. It was concluded that biphasic nutrient medium could be used as a supplementary medium for diagnosis in laboratories in the absence of NNN medium or can not be provided.

Clinical practice trends in cryosurgery: a retrospective study of cutaneous lesions.

INTRODUCTION: Cryosurgery is an alternative treatment for many benign, premalignant, and malignant lesions of the skin. AIM: To review the indications of cryosurgery for cutaneous lesions. MATERIAL AND METHODS: The retrospective study was based on the assessment of medical records of 1031 dermatology patients who had cryosurgery. RESULTS: One thousand two hundred and forty-four sessions of cryosurgery were applied to the total of 1031 patients. Of the 1031 patients, the most frequent indication for cryosurgery was common warts which were present in 535 (61.59%) patients, followed by anogenital warts in 119 (11.54%) patients, callosity in 81 (7.85%) patients, actinic keratosis in 77 (7.46%) patients, molluscum contagiosum in 35 (3.39%) patients, and other benign or malignant skin lesions. CONCLUSIONS: Cryosurgery is still a valuable treatment of choice in various benign, premalignant, and malignant skin diseases but seems to be underused for indications other than viral warts.

An uncommon cause of laser burns: the problem may be the use of gel.

Laser hair removal is the most common procedure which is usually performed on patient's demands. Even though they are usually safe and well tolerated, with the widespread use both expected and unexpected side effects can be seen. Recognizing the source of side effects is an important issue for the laser operator. In recent years, a new laser technology has been introduced to aid in pain and other side effects in laser applications. Diode laser systems are produced for this technology. The major disadvantage with this laser is the gel application during procedure. We herein report a women while on her second session for laser hair-removal procedure with a 808-nm diode laser, complicated with an epidermal burn reaction due to accumulated debris on the guide.

Tumoral melanosis in an adolescent after trauma: a clinicopathological dilemma.

Tumoral melanosis (TM) is a histologic term used to indicate a nodular accumulation of melanophages in the dermis clinically presenting as a pigmented lesion. It is usually associated with regression of melanoma and nonmelanoma melanocytic pigmented lesions. We present the case of a 16-year-old girl with a suspicious pigmented macule on her right knee that appeared after trauma. The lesion was completely excised and diagnosed as TM.

A case of septal panniculitis secondary to interferon treatment.

The most common side effects of interferon-beta therapy following subcutaneous administration include pain, inflammation and induration at the injection site, which occur in approximately 20-60% of patients. Besides, transient injection-site erythema is frequently seen in beta-interferon therapy. Less frequent reactions at injection sites include vascular thrombosis, mucinosis, dermal and systemic sclerosis, necrosis, and ulceration. Here, we report a 44-year-old case diagnosed with multiple sclerosis, who developed pain and swelling following interferon-beta 1a treatment after an improperly administered intramuscular injection; and with this case report, we would like to draw attention to septal panniculitis, a serious drug complication, that develops following interferon-beta 1a treatment after an improperly administered intramuscular injection.

Treatment of primary hyperhidrosis with tap water iontophoresis in paediatric patients: a retrospective analysis.

OBJECTIVES: Primary hyperhidrosis is an under-recognized condition in children and adolescents. Iontophoresis is the second line of treatment for palmoplantar hyperhidrosis following topical treatment. The studies evaluating the efficacy of iontophoresis in children are limited. We aimed to investigate the efficacy and reliability of tap water iontophoresis in children with primary hyperhidrosis. METHODS: Twenty-one patients aged under 18 years, who received iontophoresis for primary palmoplantar hyperhidrosis, were included in the study. In our clinic, tap water iontophoresis was administered at regular intervals, starting with five times per week and decreased to once a week on fifth week. Then maintenance sessions once a week for 6 weeks are recommended. The presence of excessive sweating was scored by visual analogue scale (VAS): "0" as continuation of excessive sweating and "10" as the absence of excessive sweating. The demographic and clinical data were collected from files. Also, patients fulfilled a questionnaire for efficacy on follow-up visit. RESULTS: Nineteen patients completed the whole 21 sessions. The mean VAS score was 5.89 ± 1.49 at the end of the 15th session and 6.36 ± 2.06 at the end of the treatment. Side effects were well tolerated. Only seven patients were still free of excessive sweating on third months after treatment. The mean satisfaction score was 4.95 ± 2.38, as measured by VAS where 0 indicated dissatisfaction and 10 indicated high satisfaction. CONCLUSION: Tap water iontophoresis is an effective method of treatment for primary palmoplantar and axillary hyperhidrosis in paediatric patients. But there are still unanswered questions about the mechanism of action, ideal session intervals and protocols for maximum efficacy.

Erythroderma secondary to gliclazide: a case report.

Erythroderma is generalized exfoliative dermatitis, which involves more than 90% of the patient's skin. The most common cause of erythroderma is exacerbation of an underlying skin disease, malignancies or drug reaction. There is a long list of drugs responsible for erythroderma such as antiepileptics, sulfonamides, antibiotics, and angiotensin converting enzyme (ACE) inhibitors. We herein report a case of erythroderma due to gliclazide usage which is also proved by histopathologic examination and patch test. We could not find any case report of gliclazide, an oral antidiabetic, as a cause erythroderma in the literature.

Does pernio cause nail dystrophy?

Pernio is an abnormal inflammatory response to moisture and cold. It is characterized with inflammatory, erythema or violet, painful or itchy cutaneous lesions affecting distal extremities, particularly the fingers and toes. It is more common in women. A literature search showed no reports of nail deformities due to pernio. Here, we present a pernio case who developed nail deformities after extended exposure to cold, if combined with other facilitating factors.

Might psoriasis be a risk factor for obstructive sleep apnea syndrome?

BACKGROUND: It is believed that psoriasis is a chronic systemic inflammatory disease. Obstructive sleep apnea syndrome (OSAS) is a disease influencing all systems and characterized by intermittent partial or complete obstruction of the upper respiratory tract during sleep. In our study, we aimed to investigate the frequency of OSAS in patients previously diagnosed with psoriasis in order to investigate a potential association between chronic inflammation psoriasis and OSAS. METHODS: Thirty-three patients diagnosed with psoriasis by biopsy were enrolled into the study. Demographics of patients, Psoriasis Area Severity Index (PASI), Dermatology Life Quality Index (DLQI), and Epworth Sleepiness Scale were examined. All patients underwent polysomnography. RESULTS: OSAS was determined in 18 of 33 patients with psoriasis (54.5 %). Eleven of the 18 patients had mild, 2 had moderate, and 5 had severe OSAS. Mean age was significantly higher in the OSAS group in comparison with non-OSAS group (54.4 ± 15.5 vs 39.4 ± 11.8, respectively, p < 0.05). Mean PASI was higher in the OSAS group in comparison with that of non-OSAS group, and the difference was not significant, although mean DLQI was lower (p > 0.05). It is believed that this was caused by the small patient population. CONCLUSION: We detected that the frequency of OSAS in patients with psoriasis was much higher than that in the normal population. Though OSAS is not easy to diagnose without detailed testing, it should be investigated in psoriatic patients with long disease duration and high PASI score, and patients refractory to conventional systemic treatment. Physicians treating patients with psoriatic disease should incorporate this life-altering comorbidity into their assessment of disease and selection of treatment.

Evaluation of myocardial perfusion and function by gated SPECT in patients with Behçet's disease.

BACKGROUND: Behçet's disease (BD) is a systemic multi-system vasculitis that can have a wide range of effects on the cardiovascular system. OBJECTIVE: To determine the existence of myocardial perfusion defects caused by coronary microvascular dysfunction in BD and to evaluate coronary arterial distribution and left ventricular systolic function by gated single-photon emission computed tomography (SPECT). METHODS: The study population consisted of 23 (15 men and 8 women) patients with BD and 20 healthy controls (12 men and 8 women). Technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) gated SPECT studies were performed at stress and rest in a 2-day protocol. Stress and rest left ventricular ejection fraction (LVEF) were calculated. Using non-gated SPECT images myocardial perfusion scores [summed stress score (SSS), summed rest score (SRS), summed difference score (SDS), and fix defect score (FDS)] and perfusion defect extent as percentage (stress, rest ischemic, and fix %LV) were determined. Using gated SPECT images, wall motion score indices (stress wall motion score indices and rest wall motion score indices) were calculated. Coronary angiography (CAG) was applied to patients with abnormal myocardial perfusion scintigraphy (MPS). RESULTS: The mean ages of the BD and control groups were 39.3 +/- 10.6 years and 36.2 +/- 8.3 years, respectively. No statistically significant differences were observed between the two groups regarding clinical features and cardiologic findings. Abnormal MPS was found in 13 (56.5%) of the BD patients; 3 patients had non-transmural infarcts and 10 patients reversible perfusion defects. Reversible perfusion defects were also found in two controls (10.0%). When the two groups were compared regarding the gated SPECT findings, differences were determined in the following parameters; SSS, SRS, SDS, FDS, stress and rest LVEF, stress and rest %LV, and stress and rest WMSI. In the BD group, when gated SPECT results were compared between those with and without abnormal MPS, differences were determined in SSS, SRS, SDS, FDS, stress and rest %LV, and stress and rest WMSI. Epicardial coronary arteries were normal in CAG. CONCLUSIONS: Myocardial perfusion and function are disturbed owing to influenced coronary microvascularity in BD, and CAG is frequently observed to be normal. Gated SPECT is a non-invasive reliable method that simultaneously evaluates the existence, extent and severity of myocardial ischemia or infarction and the wall movements in cardio-Behçet.

Etiology of foot intertrigo in the District of Afyonkarahisar, Turkey: a bacteriologic and mycologic study.

BACKGROUND: Foot intertrigo, occurring in the interdigital space, is mostly caused initially by dermatophytes and yeasts and less frequently by gram-negative and gram-positive bacteria. With time, a "complex" may develop in the setting of moisture and maceration that contains multiple fungal and bacterial organisms. METHODS: We examined and sampled 84 patients with toe web intertrigo for bacteriologic and mycologic studies. RESULTS: In the culture media, the prominent isolated pathogens as single agents were coagulase-negative staphylococci in 17.9% of patients, which is assessed as contamination from skin flora; Pseudomonas aeruginosa in 16.7%; dermatophytes, Corynebacterium minutissimum, and Staphylococcus aureus each in 11.9%; beta-hemolytic streptococcus in 2.4%; and Proteus mirabilis in 1.2%. However, we recovered double pathogens from patients with foot intertrigo as mixed infection in 19 patients (22.6%). The most common predisposing factors were exposure to spa pools and ablutions. CONCLUSIONS: Several pathogens and factors might play a role in toe web infections. Therefore, clinical and microbiologic studies are suggested to assist in the selection of appropriate treatment and the prevention of important complications of toe web infections.

Angiolymphoid hyperplasia with eosinophilia successfully treated with imiquimod. A case report.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare disorder characterized by vascular proliferation, eosinophilia in peripheral blood samples and lymphocytosis. The etiology is unknown; this rare condition is generally seen in women. It often presents as multiple, grouped red nodules in the periauricular region, scalp line and neck. Numerous therapeutic approaches have been tried for ALHE including destructive techniques such as electrodesiccation, cryotherapy, surgical excision, radiotherapy or laser (argon, CO(2), pulse dye). We present an ALHE case that was treated successfully by using topical imiquimod cream.

Incidence of atopic stigmata and prick test results in patients with asthma, allergic rhinitis and conjunctivitis.

Allergic diseases are part of the 'modern lifestyle' and their incidence is still increasing. Cutaneous markers (stigmata) usually provide valuable clues for the diagnosis of atopic diseases. This study evaluated the prevalence of the four major and twenty-one minor criteria of Hanifin and Rajka in a total of 246 patients with mucosal allergies (99 asthma, 108 allergic rhinitis, and 39 allergic conjunctivitis). The two most prevalent major criteria were history of atopic diseases and pruritus. The most prevalent three minor criteria were periorbital darkening, influence of environmental factors and xerosis. The most common prick test-positive allergens were grass and mite allergens. Despite evidence for a high co-morbidity between atopic diseases, in daily clinical practise diagnostic and therapeutic procedures generally focus on the most predominant disease. We concluded that it may be important to screen subjects with mucosal allergies for the presence of major and minor cutaneous stigmata. Screening for cutaneous manifestations and subsequent treatment might further enhance the quality of life of these patients.

Frequency of body dysmorphic disorder among patients with complaints of hair loss.

BACKGROUND: Body dysmorphic disorder (BDD) is a psychiatric condition in which a disabling preoccupation with a non-existent or slight defect in appearance is the main symptom. Hair concerns are frequent in patients with BDD. OBJECTIVES: The purpose of this study was to determine the prevalence of BDD among patients with complaints of hair loss. METHODS: A validated BDD questionnaire (BDDQ) was administered to 150 patients with complaints of hair loss and 150 control subjects who were selected from among general dermatology (GD) patients. Standard statistical tests were performed (descriptive analysis, chi-squared tests, non-parametric tests). Differences that achieved a P-value of <0.05 were considered statistically significant. RESULTS: Among patients with complaints of hair loss, 42 of 142 subjects retained in the study (29.6%; 31 females and 11 males) were diagnosed with BDD. Furthermore, 25.6% of female patients and 52.4% of male patients were diagnosed with BDD (P = 0.013). Hair concerns were more common in males than in females (P < 0.05). In the GD group, four control subjects (2.7%, all female) were diagnosed with BDD; all of their concerns focused on the body and acne. CONCLUSIONS: The incidence of BDD is about 10 times higher in patients with complaints of hair loss than it is in GD patients and is higher in males. Awareness of the condition and the referral of selected patients to mental health professionals is crucial.

The Impact of Inflammatory and Infectious Diseases of Vulvar on Quality of Life.

OBJECTIVES: This study aimed to evaluate the effects of vulvar dermatoses (VD) and vulvar infections (VE) on anxiety, depression scores, general, and dermatological quality of life (QOL) of women. METHODS: We conducted a cross-sectional survey on patients diagnosed with VD and VE. All patients were assessed using a sociodemographic form, Skindex-29 scale, World Health Organization QOL (WHOQOL) BREF scale, Hamilton anxiety rating scale (HAM-A), Hamilton depression rating scale (HAM-D). RESULTS: HAM-A score was significantly higher in the VD group than in the control group. Based on age groups, all subscales of Skindex-29 were found to be higher in women > 50 years. For women with severe pruritus, the symptom subscale was higher in patients with skin involvement and the function and emotion subscales were higher in patients with and emotion subscales were higher in patients with mucosal involvement. CONCLUSIONS: We found that VD was particularly significantly associated with decreased QOL.

Phytodermatitis caused by Ceratocephalus falcatus (Ranunculacea).

Ceratocephalus falcatus is a member of Ranunculacea family that forms part of the flora of the Sinanpasa and Dinar regions of Afyon city in Turkey. Ceratocephalus falcatus has laxative properties and has been used for treating hemorrhoids, rheumatismal diseases and wounds. Here, a case of phytodermatitis caused by this remedy used for relieving knee pain is presented. This plant should be kept in mind when a case of phytodermatitis with vesicles or bullae presents at clinics.

Antifungal susceptibilities of dermatophytic agents isolated from clinical specimens.

The aim of this study was to investigate the susceptibility to four antifungal agents: ketoconazole, terbinafine, itraconazole and fluconazole, of the different species of dermatophyte strains isolated from clinical specimens. A total of 128 specimens were collected from toe nail, foot, inguinal region, trunk, hands and head. The dermatophytes tested included Trichophyton rubrum 108 (84.4%), Trichophyton mentagrophytes 11 (8.6%), Epidermophyton floccosum 5 (3.9%), Microsporum canis 2 (1.5%) and Trichophyton tonsurans 2 (1.5%). The mean minimum inhibitory concentrations (MIC) for the five species of dermatophytes ranged between 0.09-1.12 microg/mL for ketoconazole, 0.04-0.27 microg/mL for terbinafine, 0.08-0.43 microg/mL for itraconazole and 16.18-24.0 microg/mL for fluconazole. In vitro analysis of antifungal activity of these agents would also allow for the comparison between different systemic antifungals, which in turn may clarify the reasons for the lack of clinical response or serve as an effective therapy for patients with chronic infection.

Amyloidosis cutis dyschromica: a case treated with acitretin.

We report a case of amyloidosis cutis dyschromica with diffuse postinflammatory-type hypo- and hyperpigmentation all over the body. The diagnosis was confirmed with routine light microscopic and immunohistochemical staining methods. The patient was treated with acitretin with a good response.