The investigation of the amounts and expressions of epidermal growth factor, epidermal growth factor receptor, and epidermal growth factor receptor gene polymorphisms in acne vulgaris.

BACKGROUND: Epidermal growth factor receptor inhibitors (EGFRI) used in cancer chemotherapy cause acneiform folliculitis in 70%-100% of patients in a dose-dependent manner. Acneiform folliculitis is considered to be caused by an inflammatory process due to follicular hyperkeratosis and subsequently a set of changes both in epidermis and hair follicles as a result of epidermal growth factor receptor (EGFR) blockade. Both acne vulgaris and acneiform folliculitis due to EGFRIs show similar changes in the pilosebaceous unit. Furthermore, in both groups of patients, topical application of recombinant human epidermal growth factor (EGF) has been reported to improve the disease. AIMS: In this study, it was aimed to investigate the role of EGF and EGFR amount, expression, and EGFR gene polymorphisms in the etiopathogenesis of acne vulgaris. PATIENTS/METHODS: 156 acne vulgaris patients, within 18-25 years of age, who had 15 or more inflammatory acne lesions on dermatologic evaluation were included in this study. The absence of any known systemic or genetic disease or cancer and any systemic or topical treatment for the last 1 month were prerequisites. In the control group, 154 volunteers in the same age range who were examined at the outpatient clinic with diagnoses of melanocytic nevus, ephelid, cherry angioma, and callus and who had no more than 3 inflammatory acne lesions were recruited. The amounts of EGF and EGFR were determined by sandwich ELISA, expressions of EGF and EGFR by reverse transcriptase polymerase chain reaction; EGFR polymorphisms were examined by restriction enzyme digestion, Sanger, and high-resolution melting methods. RESULTS: The patient and control groups were compared in terms of EGFR gene polymorphisms in addition to the amount and expressions of EGF and EGFR. The amount of EGF in the serum was found to be significantly higher in the acne group. (P = .0012). There was no significant difference in other parameters studied. CONCLUSION: The results of our study showed a significant increase in the amount of EGF in the acne group. Though EGF may be incriminated in the etiopathogenesis of AV, the most likely explanation about its role may be controlling inflammation from the very first stage.

Association of Leukotrichia in Vitiligo and Asp148Glu Polymorphism of Apurinic/Apyrimidinic Endonuclease 1.

BACKGROUND: Oxidative stress and increased DNA damage have been implicated in the etiopathogenesis of vitiligo. Oxidative DNA damage is mainly repaired by the base excision repair (BER) pathway. AIM: We sought to determine whether polymorphisms in DNA repair genes may have a role in the pathogenesis of vitiligo. MATERIALS AND METHODS: We conducted a study including 100 patients with vitiligo and age- and sex-matched 193 control subjects to examine the role of single-nucleotide polymorphisms of BER genes, human 8-oxoG DNA N-glycosylase 1 (codon 326), apurinic/apyrimidinic endonuclease 1 (APE1) (codon 148), and X-ray repair cross-complementing group 1 (codon 399) as risk factors for vitiligo. These polymorphisms were determined by quantitative real-time polymerase chain reaction and melting curve analysis. RESULTS: No significant association was observed between the variant alleles of studied genes and vitiligo. CONCLUSION: However, we showed that the presence of APE1 148Glu variant allele is associated with leukotrichia. This preliminary study suggests that APE1 (codon 148) polymorphism may play a role in vitiligo pathogenesis.

The Evaluation of Endothelin-1 and Endothelin Receptor Type A Gene Polymorphisms in Patients with Vitiligo.

BACKGROUND: Endothelin-1 (EDN1) and EDN receptor type A (EDNRA) are implicated in melanocyte functions. AIM AND OBJECTIVES: This study examines the role of EDN1 (G5665T and T-1370G) and EDNRA (C + 70G and G-231A) polymorphisms as a risk factor for vitiligo, and evaluates the relationship between genotypes and clinical characteristics of vitiligo patients. MATERIALS AND METHODS: We analyzed genotype/allele distributions of EDN1 and EDNRA polymorphisms in 100 patients with vitiligo and 185 healthy controls by real-time polymerase chain reaction. RESULTS: There was no notable risk for vitiligo afflicted by studied polymorphisms. However, the presence of EDNRA +70 variant G allele was found to be related with decreased risk for development of generalized type of vitiligo (odds ratio [OR]: 0.42, 95% confidence interval [CI] = 0.21-0.86, pcorr = 0.03) and showed protective effect against associated diseases seen in vitiligo (OR: 0.49, 95% CI = 0.27-0.88, pcorr = 0.034). Haplotype analysis demonstrated a strong (disequilibrium coefficient = 0.73, r (2) = 0.405) linkage disequilibrium between EDN1 G5665T and T-1370G polymorphisms. The EDN1 5665/-1330 TT haplotype was over represented significantly in controls than in patients (P = 0.04). CONCLUSION: The studied polymorphisms do not seem to be a major risk for vitiligo. Haplotype analysis denoting protective effects against vitiligo may indicate an indirect interaction in the course of vitiligo. In addition, EDNRA + 70 polymorphism is protective against generalized type of vitiligo and associated diseases.

Hepatitis C and hepatitis B virus infections in the etiopathogenesis of pemphigus.

BACKGROUND: Previous studies have shown that some viral infections may be triggers for autoimmune diseases. The role of viral infections in the etiopathogenesis of pemphigus has also been investigated. OBJECTIVES: To investigate the relationship between pemphigus and the hepatitis B and C virus infections. METHODS: This retrospective study included 62 patients with pemphigus and 50 healthy controls of matching ages and genders. The control group included relatives who accompanied the orthopedic patients to the hospital but had no history of systemic and/or autoimmune diseases. RESULTS: The group of patients with pemphigus was composed of 43 (69.3%) females and 19 (29.7%) males, and the mean age was 48.08 ± 15.38. The hepatitis C virus antibody was negative in all of the patients. Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), or both, were studied in 44 of the 62 patients. Two (4.3%) of these patients were positive for HBsAg and found to have HBV infection. Fourteen of them were HBsAb positive. Two (4%) of the 50 control subjects showed hepatitis C virus antibody positivity, while only 1 (2%) patient with pemphigus displayed HBsAg positivity. There was no statistically significant difference between the two groups for hepatitis B and C virus infections. CONCLUSIONS: This study does not support an association between pemphigus and hepatitis B and/or C virus infections.

Hepatitis C and hepatitis B virus infections in the etiopathogenesis of pemphigus

BACKGROUND: Previous studies have shown that some viral infections may be triggers for autoimmune diseases. The role of viral infections in the etiopathogenesis of pemphigus has also been investigated. OBJECTIVES: To investigate the relationship between pemphigus and the hepatitis B and C virus infections. METHODS: This retrospective study included 62 patients with pemphigus and 50 healthy controls of matching ages and genders. The control group included relatives who accompanied the orthopedic patients to the hospital but had no history of systemic and/or autoimmune diseases. RESULTS: The group of patients with pemphigus was composed of 43 (69.3%) females and 19 (29.7%) males, and the mean age was 48.08 ± 15.38. The hepatitis C virus antibody was negative in all of the patients. Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), or both, were studied in 44 of the 62 patients. Two (4.3%) of these patients were positive for HBsAg and found to have HBV infection. Fourteen of them were HBsAb positive. Two (4%) of the 50 control subjects showed hepatitis C virus antibody positivity, while only 1 (2%) patient with pemphigus displayed HBsAg positivity. There was no statistically significant difference between the two groups for hepatitis B and C virus infections. CONCLUSIONS: This study does not support an association between pemphigus and hepatitis B and/or C virus infections. .

Arborizing vessels under dermoscopy: a case of cellular neurothekeoma instead of basal cell carcinoma.

Neurothekeoma is a slow-growing, benign tumor of nerve sheath origin. Herein we present a 62-year-old female who presented with a 5-month history of a nodule that had shown a slight enlargement. She had a diagnosis of non-Hodgkin lymphoma for 10 years for which she had received multiple sessions of chemotherapy and radiotherapy. Cutaneous examination showed a well-defined, firm, 2 cm, pink-red nodule of the right supraclavicular area, which showed thick and arborizing vessels under dermoscopy. A diagnosis of cellular neurothekeoma was made after histopathologic examination with immunohistochemistry. Thick and arborizing vessels have been described as the dermoscopic hallmark of nodular and cystic basal cell carcinoma. In the past, hydradenoma and intraepidermal poroma have been defined as dermoscopic mimics of basal cell carcinoma because of the characteristic appearance of arborizing vessels. With this report a neurogenic tumor has been added to this list.

Characteristics of fever, etiologic factors, antibiotic use and prognosis in febrile dermatology inpatients.

BACKGROUND: Generally, fever is observed in >30% of hospitalized patients. However, little is known about fever in dermatology inpatients. OBJECTIVES: The aim of this study was to investigate and document the incidence, characteristics, and etiologic factors of fever in febrile dermatology inpatients and to describe the practice of antibiotic use and prognosis in the same group. METHODS: The medical records for 928 inpatients were retrospectively analyzed. RESULTS: The incidence of fever was found to be 16.2%. Mean length of hospital stay was found to be longer in febrile patients. Of the 176 febrile episodes, 79 (44.9%) occurred in patients without infections, 43 (24.4%) in patients with community-acquired infections, 25 (14.2%) in patients with healthcare-associated infections, 18 (10.2%) in patients classified with fever of non-infectious/infectious causes, and 11 (6.3%) in a group for whom the etiologic factors of fever were undetermined. Antibiotic treatment was started in 36.2% of febrile inpatients. The overall mortality rate was 0.6%. CONCLUSIONS: This is the first study to investigate febrile episodes in dermatology inpatients. Fever is a frequently encountered symptom in dermatology inpatients. Febrile episodes resulted from mostly non-infectious entities, mainly consisting of inflammatory dermatologic disorders. Antibiotics were ordered in a higher percentage of patients in the febrile group. Dermatologists started prophylactic or empiric antibiotic therapy in febrile patients with non-infectious or inflammatory diagnoses on the assumption that these patients had an increased risk for infection as a result of impaired skin integrity and use of immunosuppressive drug therapy. The overall mortality rate was very low in the study group of dermatology inpatients.

Sclerosing cellular blue nevus simulating melanoma.

Sclerosing blue nevus is an uncommon variant of common blue nevus and shows an amorphous blue appearance at the edges with a hypopigmented center. Herein we present a 48-year-old female with sclerosing cellular blue nevus with extraordinary clinical and dermoscopic features simulating melanoma. The association of a whitish scarlike area with a pigmented dot pattern prominent throughout the lesion was unusual for a sclerosing cellular blue nevus. Besides pattern asymmetry, polychromasia and linear irregular vessels increased the mimicry. This case illustrates the importance of surgical excision and histopathological examination.

Analysis of vitamin D receptor gene polymorphisms in vitiligo.

BACKGROUND: Vitiligo is a progressive depigmenting disorder characterized by the loss of functional melanocytes from the epidermis. The etiopathogenesis of vitiligo is still unclear. Vitamin D has both stimulatory and protective effects on melanocytes and acts through its nuclear vitamin D receptor (VDR) on target cells. AIM: The aim of this study was to investigate the association between VDR gene polymorphisms and susceptibility to vitiligo. METHODS: 98 patients with vitiligo and 216 age- and sex-matched controls recruited from dermatology outpatients attending the same department were included in the study. Genomic DNA was extracted from peripheral blood leukocytes using a DNA isolation kit. The VDR polymorphisms of BsmI, ApaI, TaqI, FokI and Cdx2 were investigated by rapid capillary PCR with melting curve analysis. Differences in genotype distributions and allele frequencies in vitiligo cases versus controls were compared for statistical significance using χ(2) test. RESULTS: Subjects with TaqI polymorphism had a 2.23-fold increased risk of developing vitiligo. Furthermore, a haplotype analysis showed that BsmI/ApaI/TaqI/FokI/Cdx2 GCCCG was significantly overrepresented in the vitiligo patients in comparison with controls (p = 0.031). CONCLUSION: This study showed that VDR TaqI gene polymorphism and the haplotype BsmI/ApaI/ TaqI/FokI/Cdx2 GCCCG may be considered as novel risk factors in vitiligo.

Clinicopathological consistency in skin disorders: a retrospective study of 3949 pathological reports.

BACKGROUND: Although the clinicopathological approach plays an important role in skin disorder diagnoses, few studies have evaluated the consistency between clinical and histopathological diagnoses of skin disorders. OBJECTIVE: We sought to investigate the consistency, and factors affecting consistency, between clinical diagnoses and pathological diagnoses in patients with skin disorders referred for biopsy by dermatologists. METHODS: We retrospectively examined 3949 pathological reports of biopsy specimens, between 1999 and 2008. The relationships between clinical and pathological diagnoses were studied in 4 groups, namely: (1) definite pathological diagnoses consistent with the clinical diagnoses, (2) descriptive pathological diagnoses consistent with the clinical diagnoses, (3) definite pathological diagnoses inconsistent with the clinical diagnoses, and (4) descriptive pathological diagnoses inconsistent with the clinical diagnoses. The first two groups show consistency, whereas the latter two groups show inconsistency between the diagnoses. RESULTS: The pathological diagnoses were consistent with the clinical diagnoses in 3034 biopsy reports (76.8%), and they were inconsistent in 915 reports (23.2%). In all types of skin disorders, clinicopathological consistency was higher in patients with sufficient clinical descriptive information. No correlation was observed between clinicopathological consistency and biopsy type, number of clinical diagnoses, or specifying the location of disease. Disease duration was shorter in the biopsy reports showing clinicopathological consistency. Moreover, a statistically significant increase was found in clinicopathological consistency for inflammatory dermatoses, when pathologists evaluated the specimens with clinical diagnoses, in comparison with blind evaluation. LIMITATIONS: The retrospective nature of the study might have resulted in a loss of data. CONCLUSION: In a dermatology clinic setting, providing sufficient clinical descriptive information for pathology requisition forms increases the probability of making an accurate diagnosis.

Canine scabies in humans: a case report and review of the literature.

BACKGROUND: Sarcoptes scabiei causes mange in many domestic and wild mammals, and it has been reported to be transmitted from animals to humans. Canine scabies is known to infest humans, as well. CASE REPORT: We report a 27-year-old woman who presented with severe pruritic papules on the trunk and arms. The patient reported that she had just bought a puppy which was also itchy. Direct microscopy from the dog showed scabies mites. The patient was treated by 5% permethrin which accomplished full recovery. DISCUSSION: Canine scabies in humans is a challenging disease to diagnose since mites are hard to find on skin scrapings of dogs and the burrows that are the hallmark of scabies are absent. Dermatological examination of the lesions in our patient did not show any burrows or a specific dermoscopic image of scabies. Instead, we observed curvilinear crusts on most of the papules. CONCLUSION: To our knowledge, dermoscopic appearance of canine scabies in humans has not been described before. We think this special pattern of excoriations is the result of superficially dug tunnels that had been torn leaving vacant curved linear remnants behind, and this may provide a good support for the diagnosis of canine scabies contributing to the spectrum of entodermoscopy.

HHV-8 positive Kaposi sarcoma in a patient with end-stage renal disease undergoing hemodialysis: no regressive effect of captopril.

Human herpesvirus 8 (HHV-8) has been associated with Kaposi sarcoma (KS) in renal transplant recipients. On the other hand, there are only a few reported cases of KS in patients with end stage renal failure receiving hemodialysis. Here, we report a case of HHV-8 positive, disseminated KS, in a 70-year-old man with renal failure, receiving hemodialysis for 7 months. The KS lesions had begun to develop almost at the same time with the onset of dialysis. The patient had been on captopril therapy since the diagnosis of renal failure. Captopril has been reported to inhibit angiogenesis, and by this way, to reduce tumor growth. However, in our patient, the lesions had developed under the treatment of captopril, and showed no evidence of regression after withdrawal of the drug.