Serum galectin-3 levels in patients with psoriasis.

INTRODUCTION: Galectin-3 is a ß-galactoside-binding lectin associated with cellular proliferation, inflammation and angiogenesis, which are the major characteristics of psoriatic skin. OBJECTIVES: To investigate serum galectin-3 levels in psoriasis patients compared with healthy controls and to study its relationship with disease characteristics. METHODS: Seventy-eight patients diagnosed with psoriasis and 78 age- and sex-matched healthy volunteers were included in the study. Serum galectin-3, IL-17, IL-6 and TNF-α levels were measured using Enzyme-linked immunosorbent assay (ELISA). RESULTS: Serum Galectin-3, IL-17, IL-6 and TNF-α levels were significantly higher in psoriasis patients compared with control group (P < .001, P = .003, P < .001 and P < .001, respectively). A cut-off value of 10 ng/mL for galectin-3 was set after receiver operating characteristic analysis. A serum galectin-3 level >10 ng/mL increased the risk of psoriasis by 14.5 times (95% CI: 6.6-32.3, P < .001) and a serum galectin-3 level >10 ng/mL predicted psoriasis with 83.3% sensitivity and 74.3% specificity. No statistically significant association was observed between serum galectin-3 concentrations and disease characteristics including disease severity, presence of psoriatic arthritis, nail involvement and psoriatic comorbidity. No statistically significant correlation was observed between serum galectin-3 level and serum IL-17, IL-6 and TNF-α levels (all three P values > .05). CONCLUSIONS: Elevated serum galectin-3 levels in psoriasis patients may indicate a possible role of galectin-3 in pathogenesis of psoriasis.

Elevated neutrophil to lymphocyte ratio as an indicator of secondary erythema nodosum, a retrospective observational study

Background/aim: Erythema nodosum (EN) is an inflammatory disorder of subcutaneous tissue. Although etiopathogenesis of the disease is unknown, many predisposing factors such as infections, systemic disease, and drugs have been identified. Neutrophil to lymphocyte ratio (NLR) has been shown to be a novel inflammatory marker in many dermatological diseases. The aim of our study is to investigate NLR in EN patients and evaluate its relation to the underlying cause of the disease. Materials and methods: Between 2014 and 2018, clinical and laboratory data of 395 patients diagnosed with EN and 395 controls were extracted from patient files. EN patients were grouped as idiopathic EN and secondary EN (EN with an identified underlying cause). Clinical and laboratory characteristics of the two groups were compared Results: NLR was elevated in EN patients compared to controls (median of 2.38 vs. 1.55, P < 0.001). Among EN patients, NLR was also elevated in patients with secondary EN. In multivariate logistic regression model NLR (> 2.11), RDW-CV (> 13.65), and CRP (> 5.5) were identified as risk factors for secondary EN (relative risks were 17.16, 2.69, and 2, respectively). Conclusion: Elevated NLR (> 2.11) may be used as a parameter to discriminate secondary EN from idiopathic EN.

The frequency of hematuria in acne vulgaris patients during isotretinoin treatment.

BACKGROUND: Systemic isotretinoin (13-cis-retinoic acid) is effective in the treatment of acne vulgaris. The most common side effects are mucocutaneous ones. Hematuria seen secondary to isotretinoin treatment is thought to be due to mucosal dryness in the urinary system. This study aims to determine the frequency of hematuria in acne vulgaris patients during isotretinoin treatment. MATERIALS AND METHOD: Eighty-eight subjects aged 16-32 years were included in the study group and 52 subjects were in the control group. The subjects were treated for 6 months and were monitored monthly by complete urine analyzes. They were also examined each month in terms of cheilitis, xerosis, epistaxis, rectal bleeding, fatigue, myalgia, weight loss, dry eye, conjunctivitis, headache, dysuria and pollakiuria. RESULTS: In the study group, 15 subjects (17%) had hematuria at least once during the study, and in the control group, four subjects (7.7%) had hematuria. The difference was not statistically significant (p = 0.118). Among the subjects who had hematuria, 11 of them (73.3%) were female and four of them (33.3%) were male in the study group while all the subjects with hematuria in the control group were female. Hematuria and gender did not show a statistically significant correlation. CONCLUSION: Hematuria was observed in 17% of the study group; this frequency rate was not different from that of the normal population. In subjects having isotretinoin treatment, if all the other reasons or disorders are excluded, one must keep in mind that hematuria may be due to isotretinoin use.

Short-term isotretinoin-induced elkonyxis and median nail dystrophy.

Elkonyxis and median nail distrophy are very rare nail fold disorders due to the damage in nail matrix and proximal nail fold. Herein, we report a patient with both elkonyxis and median nail distrophy occured two months into a treatment course of isotretinoin that is to our knowledge for the first time.

An unusual side effect of isotretinoin: retinoid dermatitis affecting external urethral meatus.

Isotretinoin (Iso) is the most effective drug against severe nodulocystic acne. As a synthetic oral retinoid, Iso exerts its actions by modulating cell growth and differentiation. Targeting all the pathophysiologic processes in acne development, Iso has been considered to be an unique drug, however it has several side effects. While chelitis, xerosis, ocular sicca, arthralgia, myalgia, headache, hyperlipidemia are the most common side effects, teratogenicity and depressive symptoms are the most concerning ones. In addition, Iso has unusual side effects which have been described for the first time in the literature. Here, we report a remarkable side effect of Iso in a 23-years-old male patient with retinoid dermatitis affecting the external uretral meatus. To our knowledge, only few cases of retinoid dermatitis in the urethral mucosa due to Iso have been reported in the literature so far.

Faun tail: a rare cutaneous marker of spinal dysraphism.

A 10-year-old girl who was admitted to the urology department with complaints of urinary incontinence was referred to our dermatology outpatient clinic because of a congenital, circumscribed, hypertrichotic area on the lumbosacral region. Cutaneous examination revealed a circumscribed area of coarse, dark terminal hair measuring 25 x 15 cm overlying the lumbosacral area with normal underlying skin (Figure 1). There were erythematous macular lesions on the superior of the hairy area. The lesion had been present since birth, and no other family member had similar lesions. Her history revealed back pain and a long history of urinary incontinence. On neurologic examination, no motor weakness or sensory changes were observed. Babinski reflex was positive on the left. Magnetic resonance imaging (MRI) findings included diastematomyelia between T12 and L1 levels and slight flattening of lumbar lordosis (Figure 2). A diagnosis of faun tail with underlying spinal dysraphism was made. There was also urinary incontinence as late sequelae of spinal dysraphism.

Comparison of Optical Coherence Tomography Angiography Findings in Patients with Behçet's Disease and Healthy Controls.

PURPOSE: To investigate optical coherence tomography angiography (OCTA) findings in patients with Behçet's disease (BD). METHODS: Ninety-four eyes of 49 patients with BD and 53 eyes of 53 healthy subjects were included. Vascular density (VD), foveal avascular zone (FAZ) area, perifoveal capillary hypoperfusion, perifoveal capillary network disorganization, and FAZ irregularity were analyzed. RESULTS: OCTA revealed retinal VD reduction and higher perifoveal capillary hypoperfusion, perifoveal capillary network disorganization and FAZ irregularity in ocular Behçet's compared to nonocular Behçet's (p = .000). However, compared to normal eyes, there was no difference between any OCTA measurements in nonocular BD patients. The mean area of FAZ was not different in any group (p = .266). In ocular Behçet, visual acuity was inversely correlated with FAZ area and FAZ irregularity. CONCLUSION: Retinal VD decreases and perifoveal microvascular network changes in ocular Behçet's. FAZ irregularity may be a more valuable marker than FAZ area for indicating ocular involvement.

Association of CYP2J2 polymorphism with susceptibility to psoriasis in Turkish population: a case-control study.

BACKGROUND: Cytochrome P450 2J2 is mostly expressed in extrahepatic tissues; it metabolizes arachidonic acid to epoxyeicosatrienoic acids, with various cardio protective and anti-inflammatory effects. CYP2J2 polymorphism has been identified as a risk factor for cardiovascular diseases, but its association with psoriasis remains unknown. OBJECTIVE: To evaluate CYP2J2 polymorphism as a risk factor for psoriasis in the Turkish population. METHODS: There were 94 patients with psoriasis and 100 age- and sex-matched healthy controls included in the study. Detailed demographic and clinical characteristics were recorded, and Psoriasis Area and Severity Index (PASI) scores were calculated for psoriasis patients. Venous blood samples were collected from all the participants and CYP2J2 50G>T (rs890293) polymorphism was analyzed using polymerase chain reaction (PCR). RESULTS: Both T allele and TT+GT genotype frequencies were increased in psoriasis vulgaris patients compared to the control group (p=0.024 and p=0.029 respectively, OR=2.82, 95% CI: 1.11-7.15) No association between CYP2J2 polymorphism and clinical features of psoriasis was identified. STUDY LIMITATIONS: A limited number of patients were included in the study. CONCLUSION: CYP2J2 50G>T (rs890293) polymorphism was associated with an increased risk for PsV in the Turkish population.

Patient characteristics in Behçet disease: a retrospective analysis of 213 Turkish patients during 2001-4.

BACKGROUND: Behçet disease (BD) is a chronic, inflammatory, multisystemic vasculitic disorder with a wide spectrum of clinical presentations. The highest prevalence is seen in Turkey. Specific diagnostic tools are yet to be discovered; thus, the diagnosis relies on physicians being acquainted with the symptoms and signs of the disease. OBJECTIVE: To investigate the epidemiologic characteristics of BD and to emphasize the typical clinical and laboratory characteristics. METHODS: This was a retrospective analysis of all the BD patients attending the Ankara Numune Education and Research Hospital throughout the years 2001-4. Diagnosis of BD was made according to the International Study Group criteria. A total of 213 patients were evaluated with respect to family history, clinical features, pathergy test, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), antistreptolysin O, and ferritin levels. When assessing disease activity, the active clinical manifestations on the day of the examination were taken into account. Correlations were analyzed between sex and age distribution, age of onset, disease duration, and family history; and between family history and age of onset, pathergy, clinical manifestations, and laboratory parameters. Correlations were also evaluated between pathergy positivity and clinical manifestations, and laboratory parameters. Correlations between activity scores and age of onset, duration, sex, family history, and laboratory data were also analyzed. RESULTS: The female : male ratio was 1.04, and the mean age of onset was 27 years. Family history did not affect age of onset or disease severity. Men presented with more active disease, and there was a weak but positive correlation between disease activity and CRP. No correlation was observed between duration and age of disease onset. The most common clinical presentations were oral aphthous lesions, genital ulcers, and skin lesions. Men more commonly presented with papulopustular lesions, pathergy positivity, and vascular, eye, and renal involvement, and women presented with arthritis/arthralgia more commonly than men. Vascular lesions, ESR, and CRP showed significant relationships with pathergy reaction. Eye involvement was not affected by age of onset. CONCLUSIONS: We believe our results indicate that the pathogenesis of BD is multifactorial. Hormonal factors seem to be of some influence, while genetic background and environmental factors seem to be the major contributors. Infections seem to be among the triggering environmental factors. Predisposing genes may affect the influence of environmental factors. Prevalence studies should be carried out periodically in those countries with a high prevalence of BD to keep up with the changing dynamics of the disease, which may also shed light on the as-yet unknown pathogenesis of BD.

Complete dermatological examination in the elderly: an exploratory study from an outpatient clinic in Turkey.

BACKGROUND: The geriatric population is growing continuously, therefore more aged patients are being admitted to dermatology clinics. Successful management of these patients requires a thorough understanding of the features of geriatric patients and prevalence of skin diseases in this group. MATERIALS AND METHODS: Patients aged 65 years and older admitted to the dermatology outpatient clinic over a 3-month period were included. Patients aged between 65 and 74 years were included in group I, and patients older than 74 years were included in group II. Demographic features of the patients were noted. Total dermatological examination was performed in each patient. Fifteen days after the first visit, the patients were phoned up to obtain information about their level of satisfaction regarding the treatments and were invited to the clinic for reexamination where their improvement levels were scored. RESULTS: A total of 209 patients were included in this study. The most common complaints were in the chronic eczema-dermatitis group. However, the most commonly detected disorders were in the chronic sun exposure group. Some severe cutaneous and noncutaneous diseases were detected incidentally at total dermatological examination. Treatment satisfaction scores of patients and improvement scores of doctor had a significantly good correlation. DISCUSSION: The study results indicated that in the management of elderly patients, social and physical evaluation should be carried out and treatment must be recommended accordingly. In all elderly patients, total dermatological examination must be performed because it may reveal some severe cutaneous or underlying noncutaneous diseases.

Allergic contact dermatitis to pure henna.

Henna is a naturally occurring brown dye made from the leaves of the tree Lawsonia inermis. The active ingredient of henna is lawsone (2-hydroxy-1, 4-naphthoquinone). It is traditionally used in Islamic and Hindu cultures as a hair coloring and as a dye for decorating the nails or making temporary skin tattoos. Actually, henna has a very low allergic potential. In most cases, allergic reactions not caused by henna, but by the chemical coloring additives that are added to henna mixtures. These additives include agents such as daiminotoluenes and diaminobenzenes. In this article, we report a case of allergic contact dermatitis from pure henna that is also used for the relief of rheumatic pain.

Assessment of Metabolic Profile and Ischemia-modified Albumin Level in Patients with Alopecia Areata: A Case-Control Study.

BACKGROUND: Alopecia areata (AA) is an autoimmune-mediated hair follicle disorder. In the literature, there is no study evaluating metabolic syndrome and levels of ischemia-modified albumin (IMA) which is proposed as an oxidative stress biomarker in patients with AA. AIMS: The aim was to investigate the presence of metabolic syndrome and the levels of IMA, small dense low-density lipoprotein (sd-LDL), and visfatin levels in AA patients. SETTINGS AND DESIGN: A hospital-based cross-sectional study was undertaken among AA patients and controls. SUBJECTS AND METHODS: Thirty-five patients with AA and 35 sex-, age-, and body mass index-matched healthy controls were enrolled. Clinical and laboratory parameters of metabolic syndrome were examined in all participants. Furthermore, IMA, sd-LDL, and visfatin levels were assessed and analyzed with regard to disease pattern, severity and extent, severity of alopecia tool score, duration, and recurrence. RESULTS: The median IMA and adjusted IMA levels were significantly increased compared with controls (P<0.05 and P=0.002, respectively). Patients with pull test positivity displayed higher levels of adjusted IMA levels (P<0.05). In AA group, there was a positive correlation between adjusted IMA and waist circumference (r=0.443, P=0.008), adjusted IMA and triglyceride levels (r=0.535, P=0.001), and adjusted IMA and sd-LDL levels (r=0.46, P<0.05). We observed no statistically significant difference in fasting blood glucose and lipid profile, sd-LDL, and visfatin levels of the patients and healthy controls. CONCLUSIONS: AA patients and controls have similar metabolic profile. Raised levels of adjusted IMA levels may be associated with antioxidant/oxidant imbalance and with risk of cardiovascular disease.

Generalized pruritus: a prospective study concerning etiology.

BACKGROUND: Generalized pruritus can often be the primary manifestation of systemic disease. OBJECTIVE: To determine how frequently generalized pruritus had a systemic etiology in an outpatient population seen in a dermatology department and whether any identifiable patient characteristics meant a systemic explanation of generalized pruritus was more likely. METHODS: A prospective controlled study of 55 patients with generalized pruritus and 41 healthy age- and sex-matched control subjects. Clinical data were collected from patients and laboratory parameters investigated in both patients and healthy control subjects to determine the frequency of systemic disease in each group. RESULTS: Of 55 patients, 12 had a systemic cause of pruritus. Pruritus was the initial symptom of systemic disease in eight of these patients. The underlying diseases included hypothyroidism, chronic lymphocytic leukemia, hepatitis C, hepatitis B, diabetes mellitus, lung cancer, uremia, and iron deficiency anemia. Of these, iron deficiency anemia was the most common cause. Compared with the control group, mean serum hemoglobin, iron, and cyanocobalamin (vitamin B(12)) levels in patients with generalized pruritus were lower. No other patient characteristics were statistically associated with systemic causes of pruritus. CONCLUSION: Generalized pruritus was the initial symptom of a systemic disease in 8 of 55 patients presenting to a dermatology outpatient clinic with this complaint. A number of underlying diseases were identified, of which the most common was iron deficiency anemia.

Acquired aquagenic papulotranslucent acrokeratoderma: report of two cases.

Aquagenic papulotranslucent acrokeratoderma (APA) is an acquired, unusual condition characterized by bilateral, symmetric, translucent-to-white papules located on the hands and feet. These lesions are accentuated following a short period of water exposure. Since its first description in 1973 as hereditary papulotranslucent acrokeratoderma, only a few cases of APA have been reported. We report two cases of teenage girls with APA. Both patients responded well to 5% salicylic acid ointment but recurrence of lesions still occurred. The close temporal proximity of presentation of these two cases may indicate that APA is not as rare as previously thought.

Prevalence of skin diseases among pediatric patients in Turkey.

The pediatric population is composed of persons under 16 years of age, and few studies are available on the dermatological diseases of this group. In the present study, data on a total of 6300 pediatric patients admitted between the years 2004-2006 were analyzed. Hospital-based patient registry records were used for data collection. The data were analyzed according to age, sex and time of admittance. A female preponderance (53%) was observed, and adolescents (12-16 years old) constituted the largest group within the patient population (47.6%). A total of 125 dermatoses were recorded. Acne vulgaris was the most prevalent dermatosis (12.4%), followed by atopic dermatitis (11.8%), contact dermatitis (11.3%), warts (9.5%), seborrheic dermatitis (4.3%) and impetigo (4.1%). Atopic dermatitis was the most frequently seen dermatosis in both infants and preschool-age children, whereas contact dermatitis was more prevalent in school-age children, and acne vulgaris was more prevalent in the adolescent group. The frequencies of some diseases showed seasonal variations. Acne vulgaris, atopic dermatitis, contact dermatitis, psoriasis, xerosis and alopecia areata were more common in winter. In contrast, insect bites, vitiligo, dyshidrotic eczema, impetigo and tinea corporis were more common in summer. Studies of the pediatric population, which constitutes the cornerstone of the community, can play an important role in determining the policies of protective medicine and public health. New studies will help us to better understand the frequency of dermatological diseases in the pediatric population according to age, gender and season, and take precautions with regard to these conditions.

Phytophotodermatitis due to Ficus carica.

The genus Ficus belongs to the Moraceae (the mulberry family). Figs can cause irritant or phototoxic reactions. Phytophotodermatitis is a common cutaneous phototoxic reaction. Contact with plant-derived phototoxic substances (furocoumarins or psoralens) followed by sunlight exposure produces the clinical lesions. Here, we present a case of phytophotodermatitis after contact with fig fruits and leaves. The vesicular dermatitis was primarily located in areas of vitiligo.

Mycosis Fungoides and Vitamin D Status: Analyses of Serum 25-Hydroxyvitamin D Levels and Single Nucleotide Polymorphisms in the Vitamin D Receptor Gene.

Various types of cancer, including melanoma and non-melanoma skin cancer, are associated with vitamin D receptor (VDR) polymorphisms. However, few studies have addressed VDR polymorphisms in patients with mycosis fungoides (MF), and previous studies have reported conflicting results. Aim of this case-control study was to assess the correlation between VDR single nucleotide polymorphisms (SNPs) Cdx2, Fok1, Apa1, Bsm1, and Taq1 and MF. Venous blood samples were collected from 41 patients with MF and 59 age- and sex-matched healthy controls. VDR genotypes of both groups were analyzed. Serum vitamin D levels of patients with MF were also analysed among varying stages and VDR genotypes. Vitamin D levels were significantly low (<30 ng/mL) in 87.9% of the patients (P<0.001). No associations were found between Apa1, Cdx2, Fok1, and Bsm1 SNPs and MF. However, Taq1 polymorphisms were higher in the healthy control group (P<0.001). Our study supports the claim that vitamin D deficiency is common in patients with MF. On the other hand, our findings suggest that Taq1 polymorphisms may be associated with decreased susceptibility to MF. Therefore, VDRs may have complex and heterogeneous effects on the pathogenesis of MF.

Visfatin and insulin levels and cigarette smoking are independent risk factors for hidradenitis suppurativa: a case-control study.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. HS has been associated with obesity, adipokine imbalance, dyslipidemia, pro-inflammation, and metabolic syndrome (MS). The aim of this study was to determine the association between HS, and serum visfatin levels (SVLs), small-dense low-density lipoprotein cholesterol (sdLDL-C), and ischemia-modified albumin (IMA), as well as the association between HS, and smoking, alcohol consumption, anthropometric measurements, blood pressures (BPs), fasting blood glucose (FBG) and lipids, inflammatory markers, homocysteine, uric acid (UA), serum insulin levels (SILs), insulin resistance (IR) and MS, so as to identify relevant risk factors for HS. This case-control study included 40 patients (M/F: 23/17) and 40 age- and gender-matched controls (M/F: 23/17). Demographic data, smoking status and alcohol consumption, personal and family medical history, previous and current treatments were noted. Anthropometric data, BPs, FBG and lipids, homocysteine, UA, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and high-sensitivity CRP (hs-CRP), hemoglobin A1c (HbA1c), SILs, SVLs, IMA and sdLDL-C were measured. Homeostasis model assessment for IR (HOMA-IR) was calculated. The associations were made by univariate and multivariate analyses. Univariate analysis showed that there was a significant association between HS and smoking, pack-years of smoking, weight, body mass index (BMI), waist circumference (WC), triglycerides (TGs), high-density lipoprotein cholesterol, very low-density lipoprotein cholesterol, SILs, CRP, hs-CRP, homocysteine, UA, ESR, HOMA-IR, SVLs, and MS. After adjusting for BMI and smoking status, the SVLs, SILs, and hs-CRP levels remained higher in the patients than in the controls (P = 0.02, P = 0.01, and P = 0.02, respectively). Multivariate analysis showed that there was a significant association between HS, and the SVLs and SILs, and smoking. Each unit increase in the SVL (P = 0.003, 95% CI 1.16-2.11) and SIL (P = 0.03, 95% CI 1.01-1.17) increased the risk of HS 1.56- and 1.09-fold, respectively. Furthermore, smoking was associated with a 14.87-fold increase in the risk of HS (P = 0.001, 95% CI 2.82-78.56). This study indicates that HS patients have higher SVLs, SILs, and hs-CRP levels than healthy controls-independent of BMI and smoking status. The SVL and SILs and smoking were independent risk factors for HS.

Vitiligo at the site of radiotherapy for nasopharyngeal carcinoma.

Cases of vitiligo following radiotherapy have been reported in patients with a history of vitiligo, possibly resulting from the Koebner phenomenon. As vitiligo in general is caused by melanocyte depletion, there is an increased radiosensitivity of this cell type in this disorder. However, vitiligo at sites of irradiation may be linked to a proposed auto-cytotoxic mechanism that may occur through inhibition of thioredoxin reductase by high extracellular calcium levels observed in keratinocytes of vitiligo patients. High levels of thioredoxin and thioredoxin reductases have been shown to protect from ionizing radiation-induced cell death. Thus, inhibition of thioredoxin reductase in vitiligo might account for the increased radiosensitivity of melanocytes in this disorder. We describe a patient who developed depigmentation at the site of radiation following radiotherapy for nasopharyngeal carcinoma. She had no history of vitiligo. Occurrence of depigmentation on the irradiated skin seemed to be related to radiation injury in our patient. Our case suggests that radiation injury to the skin can trigger vitiligo in patients who have no history of vitiligo. Thus, prior to therapy, the possibility of development of vitiligo should be taken into account for patients who are candidates for radiotherapy, even if they have no history of vitiligo.

Chronic bullous disease of childhood in a patient with acute lymphoblastic leukemia: possible induction by a drug.

Linear IgA disease is characterized by the presence of linear IgA deposits in the basement membrane zone of the skin, and circulating basement membrane zone antibodies are detected in 80% of cases. The disease occurs in both adults and children, and is designated adult linear IgA disease in the former and chronic bullous disease of childhood (CBDC) in the latter. We describe a 5-year-old boy with acute lymphoblastic leukemia in remission, in whom CBDC developed after treatment with trimethoprim/sulfamethoxazole (cotrimoxazole). To our knowledge, this is the first reported case of possible drug-induced CBDC.