Undesirable repigmentation in vitiligo patient receiving methotrexate therapy for the treatment of psoriasis: treatment or side effect?

Vitiligo is an acquired skin depigmentation disorder related to the destruction of melanocytes. There are a limited number of case reports and studies in current literature that show methotrexate (MTX) is effective in the treatment. A 44-year-old man presented to our clinic with a one-year history of psoriasis. On dermatological examination, there were erythematous, scaly papules and plaques on knees, elbows, gluteal area, and scalp compatible with psoriasis. In addition there was total depigmentation over the body. He had a 30-year history of vitiligo, beginning localized but progressed gradually and covered the entire body surface. Subcutaneous methotrexate 10mg weekly was started for psoriasis. On the 6th week of methotrexate treatment, he presented to our clinic with newly developed brown macules on his face. The result of the punch biopsy taken from a macule was reported as normal skin findings. Because his body was fully depigmented, his brown melanocytic macules on his face were considered as repigmentation associated with MTX treatment. His MTX treatment was stopped by patient request. On his 6-month follow-up, hypopigmentation was observed at prior repigmented macules. Methotrexate can be considered an alternative treatment for vitiligo patients when topical therapy and phototherapy are ineffective or not applicable.

More than a skin disease: stress, depression, anxiety levels, and serum neurotrophins in lichen simplex chronicus

Abstract Background: Lichen simplex chronicus is a dermatological condition due to excessive scratching, with few studies on psychoneuroimmunology. Objective: We aimed to estimate the levels of stress, depression, and anxiety, and to measure serum levels of neurotrophins in patients with lichen simplex chronicus, and to correlate these parameters with the severity of the disease and pruritus. Methods: Thirty-six patients with lichen simplex chronicus and 36 age- and sex-matched healthy controls were included. Each participant was administered the Hospital Anxiety and Depression Scale and Perceived Stress Scale questionnaires, along with a visual analog scale for pruritus. Levels of neurotrophins (brain-derived neurotrophic factor, neurotrophin-3, nerve growth factor, glial cell line-derived neurotrophic factor) were determined by ELISA assays. Results: The scores of Perceived Stress Scale-10, Hospital Anxiety and Depression Scale were statistically higher in patients (p < 0.05 for all). The serum levels of all neurotrophins were significantly lower in patients compared to healthy controls (p < 0.05 for all). Disease severity showed no correlation with all four neurotrophins. In linear regression models applied for increased visual analog scale-pruritus scores and disease severity these two variables were statistically significant predictors (p = 0.043). Study limitations: A direct causal relationship was not addressed. Conclusion: Lichen simplex chronicus patients are at risk of increased levels of stress, anxiety, depression, and present decreased levels of neurotrophins, that may suggest a role in the pathophysiology of this disorder.

More than a skin disease: stress, depression, anxiety levels, and serum neurotrophins in lichen simplex chronicus.

BACKGROUND: Lichen simplex chronicus is a dermatological condition due to excessive scratching, with few studies on psychoneuroimmunology. OBJECTIVE: We aimed to estimate the levels of stress, depression, and anxiety, and to measure serum levels of neurotrophins in patients with lichen simplex chronicus, and to correlate these parameters with the severity of the disease and pruritus. METHODS: Thirty-six patients with lichen simplex chronicus and 36 age- and sex-matched healthy controls were included. Each participant was administered the Hospital Anxiety and Depression Scale and Perceived Stress Scale questionnaires, along with a visual analog scale for pruritus. Levels of neurotrophins (brain-derived neurotrophic factor, neurotrophin-3, nerve growth factor, glial cell line-derived neurotrophic factor) were determined by ELISA assays. RESULTS: The scores of Perceived Stress Scale-10, Hospital Anxiety and Depression Scale were statistically higher in patients (p < 0.05 for all). The serum levels of all neurotrophins were significantly lower in patients compared to healthy controls (p < 0.05 for all). Disease severity showed no correlation with all four neurotrophins. In linear regression models applied for increased visual analog scale-pruritus scores and disease severity these two variables were statistically significant predictors (p = 0.043). STUDY LIMITATIONS: A direct causal relationship was not addressed. CONCLUSION: Lichen simplex chronicus patients are at risk of increased levels of stress, anxiety, depression, and present decreased levels of neurotrophins, that may suggest a role in the pathophysiology of this disorder.

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.