Evaluation of fecal calprotectin as a marker of gastrointestinal inflammation in rosacea: A case-control study.

A higher incidence of gastrointestinal diseases has been well established in patients with rosacea. However, no screening tool has been introduced for gastrointestinal disease development in rosacea. Fecal calprotectin (FC) is a calcium-binding protein, mainly derived from polymorpho-nuclear cells, such as neutrophils. It has been established as a marker of gastrointestinal inflammation. The aim of the present study was to evaluate FC levels in patients with rosacea without any gastrointestinal diseases. A prospective, case-control study was planned to investigate the relationship between rosacea and gastrointestinal involvement by evaluating FC levels and the Gastrointestinal Symptom Rating Scale (GSRS). A total of 47 patients with rosacea and 39 healthy control subjects were included in the study. The FC levels were statistically significantly higher in rosacea group than in the control group (65.96 ± 58.86 ng/mL vs 31.99 ± 20.12 ng/mL, P = .026, respectively). A statistically significant difference was also observed in GSRS values between the patient and the control groups (30.26 ± 12.48 vs 22.62 ± 7.64, P = .001, respectively). A positive correlation was noted between FC levels and the values of GSRS in the study group (r: 0.354; P = .001) and in the rosacea group (r = 0.392, P = .006). The measurement of FC may be useful in the early detection of gastrointestinal system diseases that may accompany rosacea and may provide a pathway to develop treatment strategies targeting both skin and intestinal mucosa.

Evaluation of epicardial fat thickness and the ankle-brachial index in patients with rosacea: A case-control study.

BACKGROUND: Recent data suggest that rosacea is related to cardiovascular diseases (CVD) due to its inflammatory nature and immune dysregulation. AIM: The aim of this study was to evaluate the values of epicardial fat thickness (EFT) and the ankle-brachial index (ABI) in patients with rosacea, as indicators of subclinical atherosclerosis and CVD risk. METHODS: This prospective case-control study was carried out on 62 participants, including 31 rosacea patients and 31 controls. The values of EFT and ABI were measured in all subjects. RESULTS: The mean thickness of EFT was statistically higher in rosacea patients (0.54 ± 0.12 mm) than in the controls (0.39 ± 0.05 mm) (P < 0.01). ABI was not significantly different between the subjects with rosacea and the comparison group (1.02 ± 0.1 vs 0.98 ± 0.07; P = 0.131). A total of 29% of the rosacea patients had mitral valve insufficiency (MVI), while 3.2% of the control group had MVI (P = 0.006). A mild degree of tricuspid valve insufficiency (TVI) was present in 45.2% of the rosacea patients, while 19.4% of the controls had TVI (P = 0.03). CONCLUSION: Rosacea may be associated with subclinical cardiac dysfunction. EFT measurements in rosacea patients can provide early detection of possible subclinical cardiovascular diseases, which can be life-extending in rosacea. However, further studies with larger sample sizes are required to confirm the present findings.

Cutaneous manifestations in pediatric oncology patients.

BACKGROUND/OBJECTIVES: Oncology patients present with various skin manifestations related to primary disease and treatments. Although these skin toxicities are well described in adults, studies of pediatric oncology patients are limited. The objective of this study was to evaluate the cutaneous findings in pediatric oncology patients receiving chemotherapy. METHODS: In this prospective cohort study conducted from December 2018 to March 2020, all pediatric oncology patients were examined and patients who had a dermatologic finding at any point during their treatments were recorded. Dermatologic examinations were performed by the same dermatologists, and biopsy and microbiologic tests were performed according to clinical need. Patients were grouped according to their oncologic diagnoses and types of chemotherapies. RESULTS: A total of 80 patients with a mean age of 9.1 ± 5.0 years were included in the study. Seventy-five (93.7%) of them developed a dermatologic manifestation during the study period. Most of the patients had hematologic malignancies (n = 48, 60%). Antimetabolites were the most frequently used class of chemotherapeutic agents. Anagen effluvium was the most common dermatologic finding (61.3%, n = 49), followed by inflammatory dermatoses (51.2%, n = 41, most commonly diaper dermatitis in 33 patients), xerosis (35%, n = 28), and nail changes (20%, n = 16, most commonly nail pigmentation in seven patients). Mucositis was seen in 13 (16.2%) patients. Five patients (6.2%) had drug-induced cutaneous hyperpigmentation, and five (6.2%) had toxic erythema of chemotherapy. The highest percentage of xerosis (45.4%) was detected in patients using antitumor antibiotics, whereas inflammatory dermatoses were observed more in patients using antimetabolites (48.6% of patients using antimetabolites), and pigmentation changes were more frequently detected in patients using alkylating agents. CONCLUSION: Identification, diagnosis, and treatment of these reactions are important to dermatologists and oncologists so that appropriate management may be provided to pediatric oncology patients.

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.

Evaluation of the adverse effects of biological agents used in the treatment of psoriasis: A multicenter retrospective cohort study.

The objective was to reveal and compare the adverse effects of infliximab, etanercept, adalimumab, ustekinumab and secukinumab, and determine possible risk factors. The follow-up files and computer-based records of patients with psoriasis were retrospectively screened between January 2007 and September 2019. The five biological agents were compared in terms of their adverse effects, and factors that might be related to these effects were explored. While there was no statistically significant difference between the agents in terms of the rate of serious adverse effects, when all the adverse effects were evaluated together, the highest rate was seen in the use of infliximab and the lowest in secukinumab (P = .001). The rates of adverse effects and related drug discontinuation were higher in the use of anti-TNF agents compared to interleukin inhibitors (P = .004 and P = .012, respectively). The agent with the highest drug discontinuation rate due to adverse effects was infliximab while the least discontinued agent was ustekinumab (P = .036). There were more side effects with anti-TNF than interleukin inhibitors, but the serious adverse effect rate was similar in both groups. The incidence of certain adverse effects increases depending on age, number of comorbidities, biological agent and its group, concomitant systemic therapy, and use of multiple agents.

[Dermatomyositis presenting with low back pain]. / Bel agrisi ile basvuran dermatomiyozit olgusu.

Dermatomyositis (DM) is a rare connective tissue disease characterized by skin lesions and inflammatory changes observed in muscle biopsy findings. A definitive diagnosis of DM requires a characteristic rash in addition to proximal muscle weakness and muscle enzyme level elevation. DM is twice as common in women as men, with an age of onset of approximately 50 years. This case report describes a 29-year-old patient with low back pain and proximal muscle weakness in the legs diagnosed as lumbar disc herniation who was then referred by the neurosurgery department to our clinic. A physical examination revealed the characteristic skin lesions for dermatomyositis. Needle electromyography and a skin biopsy were performed, and corticosteroid treatment was initiated. In misdiagnosed patients, fatty infiltration in the muscles may cause irreversible weakness and gait disturbance. Early suppression of inflammation is important and can yield a dramatic response to treatment.

Psychopathology among individuals seeking minimally invasive cosmetic procedures.

OBJECTIVES: In recent years, so many people want to alter their physical appearance with the purpose of raising their social and psychological well-being and the demand for minimally invasive cosmetic procedures (MICPs) has continued to rise. Our study aims to investigate the psychological profile of people seeking cosmetic procedures. STUDY DESIGN: The present observational cross-sectional study was conducted with a sample of 54 participants seeking cosmetic procedures (botulinum toxin injections, soft tissue filler injection, mesotherapy, platelet-rich plasma, and dermaroller treatments). Those patients were compared to the control group, who did not have any kind of cosmetic procedure (including cosmetic surgery) before and who did not want to have any of these procedures. METHODS: The research volunteers were invited to complete the demographic questionnaire (e.g., age, gender and history of procedures) as well as psychological scales. Psychological scales includes the validated and reliable The Brief Symptom Inventory (BSI), Automatic Thoughts Scale (ATS), and Social Adaptation Self-Evaluation Scale (SASS). RESULTS: Users of MICP were mostly female (n = 46, 85%) and had some high school education or higher and showed higher scores on General Severity Index (P = .013), anxiety (P = .018), depression (P = .004), interpersonal sensitivity (P = .008) of BSI and also higher on ATS (P = .022) and lower on SASS (P = .001) scores that mean less social adaptation. There was a statistically positive correlation between age and GSI, anxiety, depression, interpersonal sensitivity, somatization scores of BSI, and negative correlations between SASS scores and age and number of past procedures. CONCLUSION: Our study findings highlight the importance of understanding individuals' psychological symptoms who are seeking cosmetic procedures.

Bullous Pyoderma Gangrenosum With Subungual Involvement Associated With Ulcerative Colitis.

Pyoderma gangrenosum (PG) is a rare inflammatory and ulcerative skin disease of unknown etiology characterized by neutrophilic infiltration of the dermis, mainly affecting the lower extremities. Bullous PG is a rare variant of this disease, usually associated with hematologic disorders. Here, we report a case of pathergy-positive bullous PG with subungual involvement associated with ulcerative colitis.

Zosteriform Collagen Nevus in an Infant.

Connective tissue nevi (CTN) are dermal hamartomas characterized by an imbalance in the amount and distribution of the normal components of the extracellular dermal matrix, specifically collagen, elastin, and/or proteoglicans. The term "CTN" was first mentioned by Lewandowsky in 1921 (1), although it was not accepted until the review by Gutmann in 1926 (2). Classification of CTN was established by Uitto et al. (3) in 1980 according to clinical, genetic, and histopathological features. But this classification did not include zosteriform nevi. The more recent Pierard and Lapiere (4) classification seems to be a more suitable method of classification for zosteriform nevi. They classified CTN into two groups: (1) reticular and (2) adventitial. Zosteriform nevus is a rare form of reticular CTN that is diagnosed according to its clinical distribution. Here we report a collagen nevus in an infant that followed a zosteriform pattern. An 8-month-old girl presented with flesh-colored plaques on the right buttock in a zosteriform distribution, which had been present since birth. The plaques appeared to be well-defined cobblestone-like nodules on palpation (Figure 1). Systemic examination, laboratory tests and radiologic examinations did not reveal any abnormalities. The patient had no associated disease and no history of similar skin findings among family members. A skin punch biopsy was performed from one of the nodules. The histopathologic examination showed significantly increased density of thickened collagen fibers in the lower dermis and subcutaneous tissue. Verhoeff-van Gieson and orcein stains demonstrated the presence of dense collagen fibers with diminished elastic fibers (Figure 2). Four subtypes of collagen tissue nevus have been described: (I) familial cutaneous collagenoma, (II) shagreen patches in tuberous sclerosis, (III) eruptive collagenoma, (IV) and isolated collagenoma (5). Isolated collagenoma with lack of family history is fairly rare. It is sporadic, localized to only one body region, and not associated with any disease. In confluent plaques it has the appearance of "peau de chagrin" or a cobblestone-like pattern. The reported presentations include paving stone nevi, plantar fibromatosis, papulolinear lesions, and zosteriform lesions (5). Zosteriform distribution is an extremely rare variety of connective tissue nevus. Steiner (6) was the first to describe the condition in 1944, in a 5-year-old girl who presented with nevi in a zosteriform distribution. The histopathology of the lesion revealed an abnormality in both collagen and elastin fibers. Only 11 other cases have been reported as zosteriform CTN in dermatological literature. To the best of our knowledge, only 3 collagen nevi in a zosteriform distribution have been previously described in the literature. De et al. (7) described the first case in a 25-year-old man presenting a collagen tissue nevus with zosteriform distribution located over the lower back. Subsequently, Kumari et al. (8) described the second case in a 20-year-old man presenting a large, flesh-colored, well-defined plaque in a zosteriform distribution on his right buttock since birth. Topal et al. (9) reported another case of a 10-year-old boy with a zosteriform collagen tissue nevus on his right arm as sclerotic papules and plaques. Clinically, zosteriform CTN has similar morphology and distribution to nevus lipomatosus superficialis (NLS) or segmental neurofibromatosis. The latter differential possibility needs to be excluded due to its association with gliomas. The histopathologic findings of NLS make it easy to differentiate from zosteriform CTN. The peculiar finding of ectopic fat in the dermis is considered to be almost pathognomonic of NLS (10). In conclusion, the zosteriform distribution of CTN is very rare, especially in the variety with collagen predominance. As the lesion remains asymptomatic, with only cosmetic effects, the condition needs no specific treatment. The present case is a rare type of isolated collagenoma with zosteriform distribution presenting over the right buttock with no associated abnormalities and family history.

Pyoderma Vegetans Misdiagnosed as Verrucous Carcinoma.

Pyoderma vegetans, a rare disorder of the skin, is considered a highly specific marker for inflammatory bowel disease, especially ulcerative colitis. It is clinically characterized by large verrucous plaques with elevated borders and multiple pustules. Here, the authors report the case of a 33-year-old man who was misdiagnosed as having verrucous carcinoma for 4 years.

Prevalence of Congenital Cutaneous Anomalies in 1000 Newborns and a Review of the Literature.

OBJECTIVE: There are limited reports studying on congenital cutaneous anomalies in newborns, particularly in Turkey. Some of congenital cutaneous anomalies serve as an important clue for accompanying syndromes or other medical conditions. This study aimed to determine the prevalence of congenital cutaneous anomalies in newborns and to discuss their clinical significance with a brief review of literature. STUDY DESIGN: A total of 1,000 newborns were examined by a dermatologist in a hospital-based, cross-sectional, prospective study between October 2011 and April 2012. RESULTS: We observed 11 different congenital cutaneous anomalies in 48 newborns of 1,000 (4.8%). The most commonly seen anomalies were sacral dimple, accessory nipple, acrochordon, hypospadias, open spinal dysraphism, and accessory tragus. None of the newborns with cutaneous anomalies had any association. CONCLUSIONS: Although congenital cutaneous anomalies are rare in newborns, clinicians should be aware of them as they may be in association with syndromes and other medical conditions. It is also important to give appropriately provided information to avoid parents concerns.

The Epidemiology of Non-Melanocytic Benign and Malignant Skin Tumors in Pediatric Patients Attending to the Dermatology Department.

BACKGROUND: Non-melanocytic skin tumors are rarely seen in pediatric patients; although they are mostly benign, they remain to be elucidated by histopathological examination. The objective of the study was to describe the epidemiology of non-melanocytic skin tumors in children attending to our dermatology department. METHOD: The histopathologic studies of all skin punch and excisional biopsies of children up to 16 years old referred to our dermatology department between January 2007 and January 2012 were reviewed retrospectively. Melanocytic tumors and cystic and infectious lesions were excluded. Age, sex, location, and histopathologic diagnosis were recorded. The skin tumors were categorized. RESULTS: A total of 4,126 skin tumors were analyzed histopathologically, and 203 of the lesions were from children up to 16 years of age. Ninety-seven of the lesions from 91 patients were non-melanocytic skin tumors. Forty-seven (51.64%) were male, 44 (48.36%) were female, and mean age was 10.55 ± 4.31 years. Malignant tumor was 1.03% (one tumor) and benign tumors were 98.97% (96 tumors) of all. The most frequent non-melanocytic skin tumor was pilomatricoma with 22 lesions (22.68%), followed by pyogenic granuloma with 18 lesions (18.54%), and nevus sebaceous with 10 (10.3%) lesions. Cutaneous leukemic infiltrate was found to be the only malignant skin tumor in the study group. The most frequently affected age group was children aged > 13 to ≤ 16 years, which included 38 patients (41.7%). The majority of lesions were on head and scalp (32 tumors, 32.96%), followed by trunk (28 tumors, 28.84%) and upper limbs (22 tumors, 22.75%). CONCLUSION: The ratio of malignant to benign skin tumors in pediatric patients is found to be small. Pilomatricoma, pyogenic granuloma and nevus sebaceous are found to be the most frequent non-melanocytic skin tumors of children. The ratio of malignant tumors is very rare.

Narrow-band ultraviolet B phototherapy in patients with psoriasis: for which types of psoriasis is it more effective?

Narrow-band ultraviolet B phototherapy with Philips TL-01 lamps is being used increasingly in the treatment of psoriasis. However, the effectiveness of phototherapy with narrow-band ultraviolet B in different clinical types of psoriasis vulgaris has not yet been evaluated in the literature. In the present study, we aimed to determine the efficacy and safety of narrow-band ultraviolet B therapy for different clinical forms of psoriasis vulgaris in our patient population. In this open study, 53 patients with psoriasis vulgaris, skin types II--IV, were enrolled. The patients were classified as guttate, nummular, plaque, or mixed according to their predominant morphological lesions. Evaluation of therapeutic efficacy was performed by comparing their Psoriasis Area and Severity Index (PASI) scores before and after treatment. The cumulative dose and the number of treatments were also calculated. Side effects were noted during the therapy. With respect to the different types of psoriasis, reductions of the PASI were not significantly different (p>0.05). The mean cumulative dose and total sessions in the plaque-type group were greater than those in the guttate and nummular groups (p<0.01, p<0.05). Complete clearing was observed in all patients in the guttate-type group, but the result was not statistically significant (p=0.064). Side effects were reported in five (11%) patients. During the 12 months follow-up period, there were no statistically significant differences in the relapse of the disease among the psoriasis groups (p=0.317). In conclusion, we found that the efficacy of narrow-band ultraviolet B therapy in patients with psoriasis decreased as the predominant lesion size enlarged. Before considering narrow-band ultraviolet B therapy for psoriasis, assessment of lesion size may be useful. Combination therapies may be more effective than phototherapy alone if the patient has predominantly large plaques.