Evaluation of local trace element status and 8-Iso-prostaglandin F2α concentrations in patients with Tinea pedis.

BACKGROUND: Tinea pedis (TP) is an infection of the feet caused by fungi. The infectious diseases caused by dermatophytes are mainly related to the enzymes produced by these fungi. Up to the now, the local 8-iso-prostaglandin F2α (8-iso-PGF2α), concentration as oxidative stress biomarker and trace elements status have not been published in patients with TP. The aim of this study is to evaluate the relationship between oxidative stress and trace elements (Cu, Zn, Se), and to evaluate the ratios of Cu/Zn and Cu/Se in this disorder. METHODS: Forty-three consecutive patients with a diagnosis of unilateral interdigital TP were enrolled in this study. The samples were obtained by scraping the skin surface. 8-iso-PGF2α concentrations in scraping samples were determined by ELISA. In addition, the levels of Se, Zn and Cu in scraping samples were determined on flame and furnace atomic absorption spectrophotometer using Zeeman background correction. RESULTS: Oxidative stress was confirmed by the significant elevation in 8-iso-PGF2α concentrations (p < 0.05). When compared to non-lesional area, Zn and Se levels were significantly lower on lesional area, whereas Cu levels was higher on the lesional area than the non-lesional area (p < 0.05). In addition, the correlation results of this study were firstly shown that there were significant and positive correlations between Cu and 8-iso-PGF2α parameters, but negative correlations between Se-Cu; Se-8-iso-PGF2α parameters in lesional area. Furthermore, the ratios of Cu/Zn and Cu/Se were significantly higher on the lesional area than the non-lesional area (p < 0.05). According to sex and fungal subtypes, there was no significant difference in the concentrations of 8-iso-PGF2α and trace elements in patients with TP (p > 0.05). CONCLUSIONS: Our results showed that there is a possible link between oxidative stress (increased 8-iso-PGF2α concentrations) and imbalanced of trace elements status in lesional area of TP patients. The use of antifungal agents together with both Zn and Se drugs could be helpful in the both regression of disease and in shortening the duration of disease.

Clinical characteristics of haematological malignancy patients diagnosed with leukaemia cutis: Experience of a single centre.

BACKGROUND/OBJECTIVES: We evaluated the clinical characteristics of patients with haematological malignancies at our centre who were diagnosed with leukaemia cutis (LC). In addition, we describe the spectrum of other skin lesions, including, secondary skin malignancies and nonspecific benign skin lesions in haematological malignancy patients. METHODS: We defined 58 skin lesions that developed in 54 inpatients hospitalised in the Department of Haematology, Trakya University Medical Faculty, Turkey. All skin lesions that developed in inpatients between 2006 and 2012 had been evaluated by a dermatologist. The patients' clinical features, skin biopsy results and therapies were obtained from hospital files. The diagnosis of LC was based on clinical features and histopathological examinations of the skin biopsy. RESULTS: There were 11 patients with LC. Six (54.5%) had acute myeloblastic leukaemia. In nine patients (82%), LC was present at the initial presentation. Secondary skin malignancy was detected in 11 patients (five basal cell carcinoma, four Kaposi's sarcoma, one squamous cell carcinoma, one malignant melanoma); and malignancy was present in two patients (18%) at the initial presentation. Nonspecific benign skin lesions, the most frequent of which were drug eruptions, were determined in 32 of our patients. LC had a significantly higher likelihood of being present at initial presentation than other skin lesions (P < 0.01). The median survival in LC patients was quite short (4.5 months). CONCLUSIONS: LC was usually diagnosed at the initial presentation of the patient or during the early course of the disease. Having LC was a poor prognostic factor.

RESTLESS LEGS SYNDROME AND INSOMNIA FREQUENCY IN PATIENTS WITH PSORIASIS.

BACKGROUND: To assess the prevalence and severity of RLS in psoriasis patients and to investigate its effects on sleep and quality of life. METHODS: Seventy patients with psoriasis in Trakya University Medical Faculty Dermatology Department and also applied to Neurology Department in the same center and 70 volunteer controls were enrolled in the study. Severity of the Restless Legs Syndrome (RLS) was determined using International Restless Legs Syndrome Study Group (IRLSSG) criteria among the patients who have been diagnosed with RLS based on IRLSSG criteria. The presence of insomnia in patients was detected using International Classification of Sleep Disorders (ICSD-II) criteria. Additionally, to evaluate the severity of the disease and quality of life, Psoriasis Area Severity Index (PASI) and Dermatology Life Quality Index (DLQI) tests were applied to the patients with psoriasis. RESULTS: RLS frequency in patients with psoriasis was 28 (40%) compared to the control group 10 (14.2%), and the difference was statistically significant (p<0.001). IRLSSG severity scores were higher in patients with psoriasis who had insomnia secondary to RLS compared to those who did not have insomnia (p<0.001). The mean values of PASI were 7.54 +/- 6.52 in the presence of insomnia and 3.27 +/- 2.69 in the absence of insomnia. The difference was statistically significant (p<0.001). No significant difference was found in DLQI scores between patients with RLS and without RLS or between patients with and without insomnia (p>0.05). DISCUSSIONS: RLS frequency in patients with psoriasis was significantly higher than in the control group. In addition, we found that RLS is more common but RLS severity was mildly high in patients with psoriasis relative to controls. However, there was a correlation between the increase in severity of RLS with secondary insomnia patients who were diagnosed with RLS. It may be beneficial to consider RLS and insomnia for each patient diagnosed with psoriasis.

Elevated platelet-monocyte complexes in patients with psoriatic arthritis.

We evaluated platelet and endothelial activation parameters in psoriatic arthritis (PsA), a disease reported to be associated with the development of endothelial dysfunction and increased atherosclerotic complications. Twenty patients with PsA, eight psoriasis and 20 healthy controls were included into the study. The patients' clinical features and acute phase parameters were assessed. In all patients and controls, platelet-monocyte complexes (PMC), platelet-neutrophil complexes (PNC), and basal and ADP-stimulated P-selectin expression were determined with flow cytometry; soluble E-selectin (sE-selectin) and soluble CD40L (sCD40L) were determined with ELISA. Patterns of joint involvement and degrees of skin involvement in PsA patients were assessed. PMC in PsA patients were significantly higher than in the control group (p = 0.02). PNC were not significantly different among the three groups (p values > 0.05). sE-selectin levels in both PsA and psoriasis groups were significantly higher than in healthy controls (p values, respectively, <0.001 and 0.023). Basal and ADP-stimulated CD62P expression and sCD40L level were similar in all groups (p values > 0.05). Polyarticular PsA patients had significantly higher sCD40L than oligoarticular plus spondylitic PsA groups (p = 0.04). sCD40L level was higher in active PsA group than in inactive PsA group (p = 0.03). Groups with limited and extensive skin involvement did not differ significantly in the evaluated parameters. C-reactive protein (CRP) level in PsA patients correlated with sCD40L (r = 0.69, p = 0.012), basal CD62P expression (r = 0.89, p < 0.001) and ADP-stimulated CD62P expression (r = 0.73, p = 0.001). Endothelial activation might be have a role in the pathogenesis of both psoriasis and PsA. Among parameters of platelet activation, only PMC might play a role in the pathogenesis of PsA.

Oxidative stress in the blood of patients with active localized vitiligo.

OBJECTIVES: Vitiligo is an acquired skin disease characterized by white areas on the skin. The pathogenesis of the disease is still unclear. Some findings show that oxidative stress could be an important phenomenon in the pathophysiology of vitiligo. METHODS: We evaluated 16 consecutive localized vitiligo patients and 16 healthy controls of a similar age and sex distribution. We measured their indicators of oxidative stress such as catalase (CAT), superoxide dismutase (SOD), glucose 6-phosphate dehydrogenase (G6PD) in erythrocytes, and plasma malondialdehyde (MDA) by spectrophotometry. RESULTS: SOD activities and MDA levels of patients were significantly higher than controls (p < 0.001). CAT and G6PD activities of patients were significantly lower than controls (p < 0.05 and p < 0.001, respectively). CONCLUSION: Our results confirmed that oxidative stress may play an important role in the pathogenesis of vitiligo. Melanocyte damage in vitiligo might be linked to generalized oxidative stress. This study is the first report on some antioxidant parameters of localized-type vitiligo patients.

E-dermatology: emails about dermatological diseases on the Internet.

Today, it is very easy to access information for both doctors and patients thanks to the Internet. The number of websites including health information is increasing day by day. This study was targeted to retrospectively investigate the dermatological questions received by the free consultation page of the health site for IsNet customers. The patients were assessed on the aspects of age and sex. The diseases were classified by the subject of the questions emailed and on what the patient would like to learn. It was also assessed whether the patient had seen a doctor before sending the email. The responses of the dermatologist were also classified as information on the disease and the treatment. A total of 607 questions were examined. One hundred and thirteen male and 69 female patients disclosed their sexes. Also, only 208 patients stated their age and the mean age was 29.3 years. Four hundred and sixty questions were related to the emailer. The questions usually asked were about treatment and requests for comprehensive information about the disease. The diseases most frequently asked about were: acne, hair diseases, pruritus, eczema, seborrheic dermatitis, psoriasis, superficial mycoses and vitiligo. Most responses were related to general information on diagnosis and treatment options. The Internet is frequently preferred for its speed; therefore, users do not give detailed information because it is not required. These results show there are differences in the intentions of our Internet users and the aims of our health website. In order to conduct these kinds of services more efficiently, preparing special forms would be useful. These data can be beneficial in the development of e-medicine programs.

Turkish Internet users' awareness of and attitudes toward HIV/AIDS and other STDs.

OBJECTIVE: The Internet is currently used as a tool to obtain information, make conversation, and find sexual partners. The aim of this study was to investigate Turkish Internet users's awareness of and attitudes toward HIV/AIDS and other sexually transmitted diseases (STDs) by using a standard web-based questionnaire. METHOD: Our study was performed using a standard web-based questionnaire form open to all Internet users consisting of questions and statements about HIV/AIDS and other STDs. The study included 898 participants. RESULTS: The most common sources from which respondents obtained STD-related information were stated as primarily print sources, followed by the Internet. Although men and women had similar educational levels, women were more informed about HIV/AIDS (p = 0.001). People with better awareness of HIV/AIDS had more information and also had different attitudes (p = 0.001). CONCLUSION: Our study shows that Turkish Internet users lack HIV/AIDS and other STD- related awareness and have mistaken opinions. Because it is the best and the fastest communication tool of our age, the Internet should have correct orientations and should be developed in order to give people access to reliable information. Because young people increasingly use the Internet on a daily basis, this medium might be a good educational tool for HIV/AIDS and other STDs.

A case of perforating pilomatricoma.

Pilomatricoma is a rare skin neoplasm, most commonly seen in the head and neck region, and occurring in the first two decades of life. It is usually solitary and varies from 0.5 to 2 cm in diameter. Its etiology is unknown. Perforating pilomatricoma is a rare clinical variant that presents as a draining, crusted nodule or ulcer, and is reported to arise faster than the classic pilomatricoma. Herein, we report a case of 35-year-old female, who had a 4-month history of a growing mass on her leg. On physical examination, a 4-cm diameter, asymptomatic, erythematous, ulcerated mass was noted on the left anterio-lateral upper leg. The first histopathological analysis of a punch biopsy from the lesion was reported as basal cell carcinoma. Therefore, the lesion was totally excised. There were shadow cells, squamoid cells, and basaloid aggregations more prominently in the one area in the tumor. In addition, calcification, foreign body giant cells and inflammatory cells were present. Punch or excisional biopsies are preferred as a method of diagnosis for the majority of cutaneous neoplasms. If total excision is not the method of choice, multiple punch biopsies should be made from different areas in large skin tumors for correct diagnosis.

Fibroadenoma of the ectopic breast of the axilla--a case report.

Polymastia is a term that is used to describe the presence of more than two breasts in human beings. It is synonymous with supernumerary or accessory breast tissue. In the ectopic breast tissue any disease can develop that affects the normal breast, including fibroadenoma. We reported a case of fibroadenoma of the axilla in a 23-year-old woman. Differential diagnosis of an axillary mass should also include fibroadenoma in an ectopic breast tissue.

Myoid differentiation and EMA expression in fibrosarcomatous dermatofibrosarcoma protuberans.

Dermatofibrosarcoma protuberans (DFSP) is a relatively unusual, locally aggressive cutaneous tumor of intermediate malignancy. Fibrosarcomatous DFSP (FS-DFSP), a rare variant of DFSP, has a higher tendency for recurrence and metastasis. Recently, a small number of cases of another variant of FSDFSB characterized by areas of myoid differentiation have been reported. We present here a 35 yearold female patient with myoid differentiation in FS-DFSP. The tumor on the left scapular region had slowly grown over six years. Examination revealed a domeshaped, firm, nontender, violaceous dermal nodule. Histologically, it was composed of a monotonous spindle cell population arranged predominantly in a storiform pattern and to a lesser extent in a fascicular fibrosarcomatous pattern with a parallel arrangement of the cells. Immunohistochemically, the tumor cells showed diffuse expression for vimentin and CD34. In the center of the tumor areas with frequent mitosis, hypercellular and negative reactive for CD34 were seen. In addition, approximately 10% of the cells were positive for epithelial membrane antigen. Myoid differentiation was found around the blood vessels. The myoid areas were positive for smooth muscle actin and negative for desmin. It is possible that the presence of hyperplastic myofibroblasts is a reactive phenomenon to the proliferation of tumor cells. We believe that this finding around blood vessels may be present in DFSP or FS-DFSP. However, when myoid areas, myoid fascicles and myoid nodules are seen in the stroma, it may be a new morphological variant of DFSP and/or FS-DFSP.

Subungual amelanotic malignant melanoma.

We report a 61-year-old, male patient complaining from prolonged lesion on his great toe that has been previously treated surgically. Histopathological examination of toenail specimen revealed the presence of nests of atypical tumor cells that led to the diagnosis of amelanotic malignant melanoma. Four years ago, he was diagnosed as gout due to extreme erythema and edema in the same toe. He has been taken to surgical treatment and chemotherapy and is still undergoing. As this disease is seen very rarely, it can be misdiagnosed. This situation also has poor prognosis. We presented a case of subungual amelanotic melanoma, as it is rare disease, early and correct diagnosis is very important.

Oxidative Stress Biomarkers and Adenosine Deaminase over the Alopecic Area of the Patients with Alopecia Areata.

BACKGROUND: Alopecia areata (AA) is an autoimmune, T-cell mediated, and chronic inflammatory disorder. The pathological mechanisms of disease are unclear, but oxidative stress may be involved. To our knowledge, no studies have examined the oxidative stress levels or biomarkers within the lesional area and skin surface in patients with AA. Similarly, adenosine deaminase (ADA) has not been characterized in AA. AIMS: Therefore, we aimed to define ADA levels and the factors involved in oxidative stress from scalp-scrapes of patients with AA. STUDY DESIGN: Case-control study. METHOD: A total of 60 patients (30 diagnosed AA patients and 30 healthy controls) were included in the study. ADA as well as oxidative stress factors, including malondialdehyde (MDA), reduced glutathione (GSH), superoxide dismutase (SOD) and catalase (CAT) were analyzed from scalp-scrapes in both groups and quantified by spectrophotometry. RESULTS: Activities of SOD (p=0.000), CAT (p=0.033), and ADA (p=0.004) as well as levels of GSH (p=0.000) and MDA (p=0.032) in patients with AA were higher than the controls statistically significant. CONCLUSION: Based on these results, factors associated with oxidative stress were elevated in AA patient scalp-scrapes compared to controls and may have a defined role the disease pathogenesis. Alterations in the activities of antioxidant enzymes from AA patient scraping samples may be a local effect of elevated oxidative stress levels. In this disease, oxidative stress may affect not only hair follicle but also any layers of the skin.

TUR-PSO: A cross-sectional, study investigating quality of life and treatment status of psoriasis patients in Turkey.

Psoriasis is a common inflammatory disease that has a severe impact on quality of life. There is lack of data regarding epidemiological and clinical features of psoriasis patients in Turkey, a country with a population of 76 million. The aim of this study was to define the demographic and clinical characteristics, quality of life and treatment patterns of psoriasis patients in Turkey. A cross-sectional observational study was conducted at 40 centers, chosen from geographically diverse locations in Turkey. Patients diagnosed with psoriasis were assessed by investigators who were specialists of dermatology using standardized study questionnaire forms. Dermatology Life Quality Index (DLQI) and EuroQol-5 dimension (EQ-5D) forms were also filled out by each patient. 3971 psoriasis patients were included in this study. 24.2% of plaque psoriasis patients had moderate to severe psoriasis (Psoriasis Area and Severity Index, ≥10). Mean DLQI was 7.03 ± 6.02; quality of life was moderately, severely or very severely affected in 49.2% of patients. The most severely affected component of EQ-5D was anxiety/depression. Among all patients, 22.9% were not receiving any treatment, 39.8% were receiving only topical treatment, 11.5% were on phototherapy, 26.1%, were taking conventional systemic agents and 4.1% were on a biologic treatment. 31.3% of psoriasis patients with moderate to severe disease were treated with only topical agents and only 30.5% of moderate to severe psoriasis patients were receiving systemic therapy. Moderate to severe psoriasis has a considerable impact on quality of life. Treatment in Turkey of patients with moderate to severe psoriasis is insufficient.

Comparison of azelaic acid and anthralin for the therapy of patchy alopecia areata: a pilot study.

BACKGROUND: Although topical azelaic acid has been previously used for the treatment of alopecia, no controlled trials of azelaic acid for this condition have been conducted to date. OBJECTIVE: The goal of this study was to determine the efficacy, tolerability, and safety of azelaic acid treatment in patients with patchy alopecia areata (AA) in comparison with anthralin (dithranol) treatment. SUBJECTS AND METHODS: This study included 31 subjects with patchy AA who did not receive any treatment for at least 1 month prior to the study. Demographic and clinical characteristics of these subjects were recorded at baseline. Subjects were randomized to apply either 20% azelaic acid (15 subjects) or 0.5% anthralin (16 subjects) for 12 consecutive weeks. In a subsequent 8-week follow-up period no cream was applied. Two independent investigators performed an efficacy evaluation with clinical examination using a terminal hair regrowth score (RGS) with a scale ranging from 0 (inadequate response) to 2 (complete response) at week 20. Partial response was accepted as score 1. RESULTS: Both groups were well matched for the relevant demographic and clinical indicators affecting treatment response at baseline. All subjects completed the trial. At week 20 the RGS was 1.27 +/- 0.9 in the azelaic acid group versus 1.37 +/- 0.8 in the anthralin group (p > 0.05). A complete response was observed in 53.3% of cases in the azelaic acid group (8 of 15) compared with 56.2% (9 of 16) in the anthralin group (p > 0.05). No serious adverse events were observed in either group during the study. CONCLUSION: The present pilot study showed that the use of azelaic acid gave similar results to anthralin with regard to hair regrowth, and that it can be an effective topical therapy for patchy AA. More extensive trials are necessary, however, to reach a definitive conclusion.

Multiple plaques on the back: S-100 negative benign granular cell tumor.

Granular cell tumor is a rarely seen disease characterized by a gradually developing nodular lesion, which is difficult to diagnose. It has been thought to originate from Schwann cells. The tumor usually appears in the 4th-6th decades of life, more frequently in women and blacks, and has a multifocal location in 10-25% of the cases. The malignancy potential is 1-3%, with 70-74% of the cases in women. Ninety-eight percent of the cases are S-100 positive. The present paper describes an 18-year-old female patient with benign granular cell tumor. This rarely seen type of tumor was S-100 negative and has been detected in biopsies taken from multiple asymptomatic plaques and maculopapular lesions. They were 0.5-4 cm in diameter, light brown in color, and with clear contours and had been gradually growing on her back the last nine years.

Ocular surface disorders and tear function changes in nodulo-cystic acne.

The aim of this study was to investigate the ocular surface disorders and tear function changes in patients with nodulo-cystic acne. Eighty-seven patients with nodulo-cystic acne vulgaris and 50 healthy subjects were included in the study. All subjects underwent full ocular examinations. Subjective ocular complaints were recorded. Corneal staining with fluorescein, tear film break-up time (BUT), and Schirmer test were applied. Abnormal tear film BUT and abnormal Schirmer scores were significantly more common in the acne group than in the control group. The tear film BUT was abnormal in 18 (20.7%) cases in the patient group and in 2 (4%) subjects in the control group (p=0.007). The mean Schirmer score was abnormal in 7 (8%) and decreased in 18 (20.7%) acne patients, and it was decreased in only 3 (6%) control subjects (p=0.005). Corneal punctuate epithelial erosions were detected in 3 (3.4%) acne patients, but not any of the control subjects. However, the difference between the groups was not statistically significant (p=0.184). Subjective ocular complaints were present in 28 cases (32.2%) in the patient group. Five (10%) subjects in the control group had such complaints (p=0.003). Tear function tests are also significantly altered in patients with nodulo-cystic acne. Our data suggest that severe acne patients should be referred to an ophthalmologist.

A case of bathing trunk nevus studded with neurofibroma-like papules.

There is a significant association between bathing trunk nevus and neurofibromatosis. However, not all neurofibroma-like papules detected clinically in cases with bathing trunk nevus may be a neurofibromas and histopathological confirmation is essential for definition of these lesions. We report a 21 year old white male patient with a bathing trunk nevus studded with neurofibroma-like papules of melanocytic nature. Histopathological examination of both papular and flat lesions showed diffuse melanocytes with plentiful eosinophilic cytoplasm and round nuclei in the dermis. Immunohistochemistry showed strong positivity of dermal melanocytes for S-100 protein. The clinical and histopathological findings and positivity of dermal melanocytes for S-100 protein were consistent with bathing trunk melanocytic nevus.

Superoxide dismutase and myeloperoxidase activities in polymorphonuclear leukocytes in acne vulgaris.

BACKGROUND AND DESIGN: Acne vulgaris frequently occurs in the second decade of life. The pathogenesis of the disease is multifactorial and in the present study, we aimed to investigate the role of reactive oxygen species in the inflammation of acne by determining the activities of myeloperoxidase (MPO) and superoxide dismutase (SOD) in polymorphonuclear leukocytes (PMN). MATERIALS AND METHODS: Forty-three patients with acne vulgaris and 24 healthy controls were enrolled. The severity of the acne was categorized from mild (subjects with only comedonic lesions) to severe (subjects with nodulocystic lesions). SOD and MPO activities in PMN were measured spectrophotometrically. RESULTS: There was no significant difference in the activity of MPO between the patients and controls.However, SOD activity in PMN was significantly lower in the patients than in the controls (p<0.001). Nocorrelation was detected between the activities of enzymes and the severity of the disease. CONCLUSION: Propionibacterium acnes may not play a primary role in the pathogenesis of acne as a bacterium. However, the low activity of SOD in PMN may be responsible for the increased levels of superoxide anion radicals in the epidermis. New anti-acne drugs should include substances with lymphocyte stimulating and anti-oxidative properties.