Biologic therapy increases Demodex density in psoriasis patients.

BACKGROUND: Demodex density is known to increase in various immunosuppressive conditions. The relationship between biologic therapy and Demodex density remains unknown. We aimed to investigate whether the density of Demodex mites is higher in psoriasis patients treated with biologic agents compared to treatment-naive or topically treated patients. METHODS: A cross-sectional study was conducted, comparing psoriasis patients receiving biologic therapy (n = 34) with controls (n = 33). Demodex density was assessed using the standardized skin surface biopsy technique (SSSB). Statistical analysis was performed to compare the densities and prevalence of demodicosis between the two groups. RESULTS: Demodex density was significantly higher in the biologic therapy group compared to the control group on the right cheek (7.29 vs. 0.12/cm2; P = 0.001), left cheek (8.15 vs. 0.24/cm2; P = 0.002), and whole face (average of all four regions: 5.50 vs. 0.80/cm2; P = 0.001). The prevalence of demodicosis was significantly higher in the biologic therapy group on the forehead (35.3% vs. 12.1%; P = 0.043), right cheek (41.2% vs. 0%; P < 0.001), and left cheek (44.1% vs. 0%; P < 0.001). The frequency of cases with demodicosis in at least one localization was higher in the biological therapy group compared to the control group (61.8% vs. 15.2%; P < 0.001). CONCLUSIONS: Psoriasis patients receiving biologic therapy had a higher Demodex density and prevalence of demodicosis compared to controls. Biologics may lead to an increase in Demodex density by blocking specific cytokines, such as interleukin-17 and tumor necrosis factor-α, which play a role in immunity against Demodex. Further research is needed to explore the impact of different biological agents on Demodex density.

Epidemiological characteristics of different types of adult acne in Turkey: a prospective, controlled, multicenter study.

INTRODUCTION: Acne occurring in adults over the age of 25 years is known as acne tarda or adult acne. Three types of adult acne are recognized: persistent, late-onset, and recurrent acne. Most studies do not compare the characteristics between the three variants. In addition, little is known about adult acne in males. This study describes the epidemiological factors of adult acne and investigates certain triggering factors by sex and different types of adult acne. METHODS: A multicenter, prospective, descriptive study was conducted. Patients with adult acne and an acne-free control group were compared regarding medical history, family history, smoking and drinking habits, and dietary factors. In addition, triggering and prognostic factors were investigated by sex and three different types of acne: persistent, late-onset, and recurrent acne. RESULTS: The participants included 944 (88.56%) female and 122 (11.44%) male patients with adult acne, and 709 (73.85%) female and 251 (26.15%) male control patients. The consumption of crackers, chocolate, and pasta was significantly more common in the acne group than in the control group (p = 0.017, 0.002, and 0.040, respectively). Male patients with adult acne had a significantly longer disease duration than female patients with adult acne (p = 0.024). The most common type of acne was recurrent acne, followed by persistent and late-onset acne. Among patients with persistent acne, 14.5% had polycystic ovary syndrome (PCOS), whereas 12.2% of patients with recurrent acne and 11.1% of patients with late-onset acne had PCOS. Severe acne was more common in the persistent acne type (28.13%). The cheek (59.90%) was the most common involvement area, and stress (55.23%) was the most common triggering factor regardless of sex. CONCLUSIONS: Although adult female and male patents with adult acne share similar triggering factors, the involvement areas can differ, which may indicate the additional hormonal etiology of female adult acne. Further epidemiological studies on adult acne in both sexes may illuminate the pathogenesis of the disease, thus making possible the development of new treatment strategies.

Antibacterial activity of Calendula officinalis and Echinacea purpurea extracts against the causal agent of tomatoes' bacterial canker: Clavibacter michiganensis subsp. michiganensis / Actividad antibacteriana de los extractos de Calendula officinalis y Echinacea purpurea contra el agente causal del cancro bacteriano del tomate: Clavibacter michiganensis subsp. Michiganensis

We aimed to investigate the effects of Calendula officinalis and Echinacea purpurea extracts in terms of growth parameters, antibacterial activity and phenolic profile in tomato infected by Clavibacter michiganensis subsp. michiganensis (CmmT7). A significant difference was observed in E. purpuraextract, indicating the highest effects on plant height (27.25 cm), fresh plant weight (28.45 cm), root length (24.42 cm), and root weight (6.74 g) (p<0.05). Moreover, Calendula officinalis and Echinacea purpurea extracts showed significant inhibitory activity against CmmT7 (p<0.05). Among phenolic compounds, the only chlorogenic acid amounts were varied in the tomato seedlings leaves with C. officinalis extract (K3) + CmmT7, E. purpurea extract (E3) + CmmT7 and CmmT7 (p<0.01). Moreover, chlorogenic acid amount was approximately 9 times higher than in CmmT7-treated leaves when compared to control. The results showed that application of the extracts of these plants had a significant influence on bacterial canker and growth parameters.

Nuestro objetivo fue investigar los efectos de los extractos de Calendula officinalis y Echinacea purpurea en términos de parámetros de crecimiento, actividad antibacteriana y perfil fenólico en tomate infectado por Clavibacter michiganensis subsp. michiganensis (CmmT7). Se observó una diferencia significativa en el extracto de E. purpura, que indica los mayores efectos sobre la altura de la planta (27,25 cm), el peso de la planta fresca(28,45 cm), la longitud de la raíz (24,42 cm) y el peso de la raíz (6,74 g) (p<0,05). Además, los extractos de Calendula officinalis y Echinacea purpurea mostraron una actividad inhibidora significativa contra CmmT7 (p<0,05). Entre los compuestos fenólicos, las únicas cantidades de ácido clorogénico se variaron en las hojas de las plántulas de tomate con extracto de C. officinalis (K3) CmmT7, extracto de E. purpurea(E3) CmmT7 y CmmT7 (p<0.01). Además, la cantidad de ácido clorogénico fue aproximadamente 9 veces mayor que en las hojas tratadas con CmmT7 en comparación con el control. Los resultados mostraron que la aplicación de los extractos de estas plantas tuvo una influencia significativa sobre el cancro bacteriano y los parámetros de crecimiento.

The impact of COVID-19 in patients with psoriasis: A multicenter study in Istanbul.

There is widespread concern about treatment of psoriasis in COVID-19 pandemic. We aimed to evaluate the epidemiological data, clinical characteristics, treatment features of the psoriasis patients during the pandemic period. We conducted a study in dermatology clinics of seven different tertiary centers. All adult psoriasis patients who were followed up between 11 March 2020 and 28 June 2020, were phone called or questioned in their visit to their follow-up clinics. A semistructured questionnaire was applied and patients' demographics and disease characteristics were recorded. Of 1322 patients, 52.4% were male, and 47.6% were female. According to the questionnaire responses, 964 (72.9%) of these patients could not communicate with their physician during this period, remained 358 (27.1%) patients contacted the physician by phone, email, or hospital visit. From the patients diagnosed as probable/confirmed COVID-19, 14 were female, and 9 were male. Nine of 23 (39.1%) patients were using biologic treatment. There was no statistically significant difference in terms of hospitalization from COVID-19 between the patients using biologics (n = 9) and those who did not (n = 14) (P = 1.00). No mortality was observed among them. Obesity, smoking, age, and accompanying psoriatic arthritis were not among the risk factors affecting the frequency of COVID-19. We only encountered an increased risk in diabetic patients. Also, an exacerbation of psoriasis was observed with the infection. No difference was found in patients with psoriasis in terms of COVID-19 infection in patients who use biologics and those who don't.

Topical polyphenol treatment of sacrococcygeal pilonidal sinus disease: use of ultrasonography to evaluate response to treatment - clinical case series study.

INTRODUCTION: Sacrococcygeal pilonidal sinus disease (SPSD) is a common disorder and encountered more frequently in hairy young males after puberty. AIM: To assess effectiveness of topical polyphenol treatment of SPSD by using physical examination and ultrasonography (USG). MATERIAL AND METHODS: Fourteen patients with SPSD diagnosis were treated by natural polyphenol products and were retrospectively included in this study. All of the patients were assessed by superficial ultrasonography before and after treatment. Demographic and clinical information of the patients was obtained from medical records. RESULTS: Patients were aged 18-45 years and the median disease duration was 2 years. The most common findings in physical examination were sinus openings and subcutaneous nodules and the most common ultrasonographic findings were abscess/cyst formation and presence of fistula at the pre-treatment visit. All of the patients applied topical polyphenols for a median period of 3 months. Topical polyphenol treatment was effective in 92.9% of patients. Follow-up examinations at 18.3 months post-treatment revealed that 12 (85.7%) patients were free of disease. Control physical examination and ultrasonographic assessment were completely normal in 11 (78.6%) patients. CONCLUSIONS: Topical polyphenol therapy is a promising alternative treatment for SPSD and its effectiveness can be objectively evaluated by ultrasonography. It is advised that topical polyphenols should be tried first in every young and active patient with SPSD. Majority of these patients can avoid demanding and expensive alternative treatment methods such as complex surgical procedures. This topical therapy method makes surgical SPSD a dermatologically treatable disease.

Systemic Retinoids and Scar Dehiscence.

Systemic retinoids such as isotretinoin and acitretin are associated with numerous side effects but are therapeutically valuable in dermatological practice. Several studies have reported the wound-healing effects of treatment with concurrent systemic retinoids in addition to surgical treatments. Herein, we describe two patients with scar dehiscence that developed after initiation of systemic retinoid treatment following cutaneous surgery. In Case 1, isotretinoin was thought to decrease collagen production to a greater degree than did degradation during the wound remodeling phase, which resulted in wound dehiscence. In Case 2, acitretin was thought to decrease fibroblast proliferation and collagen production during the proliferation phase of wound healing, which resulted in wound dehiscence. Based on the two presented cases, it is advisable to postpone systemic retinoid treatment for 6 months to 1 year following cutaneous surgery, located especially in cosmetically important sites.

Effectiveness of non-ablative three dimensional (3D) skin rejuvenation: a retrospective study involving 46 patients.

BACKGROUND: Three dimensional (3D) skin rejuvenation is proposed to be effective for all skin layers. The aim of this concept is to treat sun spots with broad-band pulse light; large pores, fine lines and vascular lesions with a long-pulsed 1064 nm neodymium-yttrium-aluminum-garnet (Nd:YAG) laser system and skin ptosis and laxity with a 1100-1800 nm infrared light source. OBJECTIVE: In this study, 46 patients treated with the 3D skin rejuvenation procedure were retrospectively evaluated to assess the effectiveness of the 3D procedure according to both patient and doctor satisfaction. METHODS: The 3D procedure was carried out over the course of five sessions with 15 day intervals between sessions. Results were judged by an experienced laser dermatologist both by direct patient examination and by comparison of "before" and "after" photographs. Results were ranked into five categories ranging from 0 to 4. At the final control, the patients were also asked to rate their satisfaction with the procedure in five categories, ranging from 0 to 4. RESULTS: All of our patients showed improvement, with an overall patient satisfaction score of 2.65. Female patients were more satisfied than male patients. Patient and doctor satisfaction scores were generally correlated. CONCLUSIONS: Our clinical results indicate that the 3D procedure is an effective nonsurgical skin rejuvenation method.

Effectiveness of topical use of natural polyphenols for the treatment of sacrococcygeal pilonidal sinus disease: a retrospective study including 192 patients.

Sacrococcygeal pilonidal sinus disease (SPSD) is a common disorder. None of the current treatment methods seems to be the ideal treatment for SPSD. In this study, we evaluated the effectiveness of polyphenols produced from the components of natural organic matter in soil in the treatment of SPSD. One hundred and ninety two patients with SPSD who used topical polyphenols for the treatment of their disease were studied retrospectively. Information on the characteristics of patients and treatment and results of treatment were obtained from the patient files and/or by telephone surveys. The median duration for total treatment was 12 weeks and the mean follow up period was 22 months. One hundred and sixty six (86.5%) patients got benefit from the treatment. Fifty one (26.6%) patients had minor temporary side effects. In 64 (33.3%) patients SPSD relapsed. Patients were able to continue their normal daily activities during the treatment period and there was no loss of work days. Locally applied natural polyphenols are one step in the direction of finding an ideal treatment of SPSD. They are easy to apply, cheap, safe and associated with a low risk of complications. Their use was not associated with time off work, unnecessary hospital stay or any anatomical distortion of the natal cleft.

Confetti-like macular atrophy: A new entity?

Anetoderma, is characterized by herniated atrophic macules clinically and by decreased to absent dermal elastic fibers histopathologically. Atrophoderma is characterized by depressed, atrophic, pigmented patches clinically and by thickened and homogenized dermal collagen bundles with absence of elastolysis histopathologically. Atrophoderma elastolyticum discretum describes lesions that are reminiscent of atrophoderma clinically but they are compatible with anetoderma histopathologically. A 34-year-old female patient presented with diffuse, hypopigmented, atrophic, shiny macules on the upper limbs and upper trunk. Histopathological examination revealed an atrophic epidermis with disorganized, hyalinized and coarse collagen bundles in the middle and lower dermis. Elastic fiber loss and fragmentation were detected in the upper dermis. The other patient was a 42-year-old female patient. She applied with diffuse, hypopigmented, shiny, atrophic macules on the upper limbs and upper trunk. Histopathological examination revealed findings that were similar to those of the first case but there was near complete loss of elastic fibers throughout the whole thickness of dermis. Our cases did not show depressed or herniated atrophic macules clinically but the macules were at the same level with the surrounding healthy skin. Histopathological findings in these cases showed the histopathological features of both atrophoderma and anetoderma. These two cases are interesting because they may represent a clinicopathological entity which has not been described before.

Clinical experience in the treatment of different vascular lesions using a neodymium-doped yttrium aluminum garnet laser.

BACKGROUND: A neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has been used with good results for the treatment of various vascular lesions. OBJECTIVE: To report our experience with a variable long-pulsed Nd:YAG laser for the treatment of different vascular lesions. MATERIALS AND METHODS: One hundred ten patients with different vascular skin lesions were included. Patients were examined before the treatment; 1 week after each treatment session; and 1, 2, and 3 months after the last treatment session. Improvement was judged according to clinical examination of the patients and by comparing pre- and post-treatment photographs. Results were graded in four groups using percentage resolution (0-25%, 26-50%, 51-75%, and 76-100%. RESULTS: One hundred five patients (19 port wine stains, 48 telangiectasias, 25 hemangiomas, and 13 other vascular lesions) completed the study; 71.5% of patients showed greater than 50% improvement. Good to excellent (more than 50%) results were achieved in 63.2% of patients with port wine stain, 80.0% of patients with hemangioma, 66.7% of patients with telangiectasia, and 84.6% of patients with other vascular lesions; 71.5% of all patients were very satisfied or satisfied with the results. CONCLUSION: A variable long-pulsed Nd:YAG laser was found to be effective in the treatment of different vascular lesions ranging from easy to difficult to treat. The authors have indicated no significant interest with commercial supporters.

A new experimental delayed wound healing model in rabbits.

Chronic wounds pose important problems in clinical practice and their treatment is difficult and costly. Here we describe a new delayed wound healing animal model. Fifteen male New Zealand rabbits were used in this study. A horizontal incision 4 cm in length was made on the dorsal part of the torso and pure skin flaps were raised in front of and behind this incision. This exposed the panniculus carnosus layer and it was resected. Skin flaps were returned to their places and sutured. After a 3 week period of healing third degree burn injury was inflicted using hot metal plates both on the healed flaps and at the same location on the opposite side. Scar samples were sent for histopathological examination after healing. The wounds on the panniculectomy side healed in an average of 43.20 days but on the control side they healed in an average of 32.80 days (p < 0.05). Wound healing was slower and scars were broader and more irregular on the panniculectomy side. In our new model, addition of panniculectomy to full thickness burn injury significantly delayed wound healing with a decrease in scar quality. This is a simple, economic and effective animal model to study delayed wound healing.

Report of two angiokeratoma of Fordyce cases treated with a 1064 nm long-pulsed Nd:YAG laser.

Various laser treatment modalities for angiokeratomas have been reported in the literature. A 60-year-old male patient presented for the treatment of multiple angiokeratomas of the scrotum and a 56-year-old female patient presented for the treatment of vulvar angiokeratomas. A 1064 nm long-pulsed Nd:YAG laser was used to treat the patients' lesions. The patients received two laser treatment sessions at an interval of 2 months. Nd:YAG laser treatment yielded successful results in the treatment of our patients' scrotal and vulvar angiokeratomas following two application sessions. We suggest that a long-pulsed Nd:YAG laser is a safe and effective method for the treatment of angiokeratoma of Fordyce.

Lateral foldplasty with or without partial matricectomy for the management of ingrown toenails.

BACKGROUND: Ingrown toenails are common and lead to significant morbidity. OBJECTIVE: This retrospective study was aimed at evaluation of our new surgical technique of lateral foldplasty with limited lateral matrix resection in some cases for the management of ingrown toenails with regard to recurrence rates, spicule formation, local infection, partial flap necrosis, and cosmetic outcome. METHODS & MATERIALS: Thirty-two patients with 52 ingrown nails were included in this study. Lateral foldplasty procedure alone was preferred for the surgical treatment of 18 ingrown toenails of mild to moderate severity. Lateral foldplasty with limited lateral matrix resection was performed in 34 ingrown nails in patients with broad nail plates or for moderate to severe cases with significant granulation tissue formation. RESULTS: Relapse rate, local infection rate, and partial flap necrosis rate were very low. Spicule formation was not observed. The cosmetic appearance of the nail did not disturb any patient treated with this procedure. CONCLUSION: The lateral foldplasty procedure alone or combined with limited lateral matrix resection is a cheap, simple, and satisfactory technique for the treatment of ingrown toenails with a low risk of relapse. This technique also has good cosmetic results.

Basal cell carcinoma in Turkey.

Basal cell carcinoma (BCC) is the most common form of cancer in Caucasians. This study was undertaken to define clinical features of BCC treated by surgical excision in Turkish patients. One-hundred and ninety-eight patients with 216 BCC, all treated by surgical excision, were studied prospectively. Age and sex distribution, personal and family history, skin type, site and size of the lesions, clinical type of the lesions, status of surgical margins and incidence of recurrence were analyzed. The male to female ratio was 9:10, and the average age of the patients was 64.5 years. Of the tumors, 91.5% occurred on the head and neck. There was also personal and/or family history of cancer in 24.8% of our cases. Of all BCC treated, 83.8% had a noduloulcerative clinical appearance. The vast majority of our patients were Fitzpatrick type 3 (53.0%) and type 2 (41.5%). There were seven recurrences after follow-up periods varying between 3 months and 2 years. In conclusion, clinical characteristics of BCC in Turkish patients have both similarities and differences compared with other countries.

Basal cell carcinoma in Turkey.

Basal cell carcinoma (BCC) is the most common form of cancer in Caucasians. This study was undertaken to define the clinical features of BCC treated by surgical excision in Turkish patients. A group of 198 patients with 216 BCCs, all treated by surgical excision, were studied prospectively. The age and sex distribution, personal and family histories of the patients, skin type, sites and sizes of the lesions, clinical types of the lesions, status of the surgical margins, and incidences of recurrence were analyzed. The male to female ratio was 0.9, and the average age of the patients was 64.5 years. Of the tumors, 91.5% occurred on the head and neck. There were also personal and/or family histories of cancer in 24.8% of our cases. Of all BCCs treated, 83.8% had a noduloulcerative clinical appearance. The vast majority of our patients were Fitzpatrick type 3 (53.0%) and type 2 (41.5%). There were seven recurrences after follow-up periods varying between three months and two years. In conclusion, the clinical characteristics of BCC in Turkish patients have both similarities and differences compared to those of other countries.

Incidental idiopathic calcinosis cutis in a rhytidectomy patient.

Calcinosis cutis, deposition of insoluble calcium salts in cutaneous tissues, is an uncommon disorder. This condition can be classified as metastatic, dystrophic, idiopathic, and iatrogenic based on the pathogenesis of the deposition. Whereas dystrophic calcinosis cutis is a fairly common condition, idiopathic cases are very rare. Distinct cutaneous anatomic areas, the vulva, scrotum, penis, and breast, have been reported to develop this disorder. Nevertheless, our case who had idiopathic calcinosis cutis in her neck may be a proof that this condition is not confined to genitals or the breasts and can be seen all over the skin.