De Novo Malignancies After Kidney Transplant: Where Do We Stand and Does the Head and Neck Region Require More Caution?

OBJECTIVES: The aim of this study was to investigate the characteristics of de novo malignancies arising in kidney transplant recipients followed in a tertiary hospital in Turkey and to examine the tumors in the head and neck region as a subgroup. MATERIALS AND METHODS: Data from kidney transplant recipients treated at our institution between January 2010 and July 2022 were retrospectively analyzed in this single-center study. Data regarding malignancies were noted according to the pathologists' reports. In situ malignancies and those arising after graft loss were not evaluated. RESULTS: The study population comprised 231 patients (165 men; 71.4%) with a median follow-up of 11 years (2853 patient-years). The recipients had a higher cancer risk than the general population (standardized incidence rate = 3.04; 95% CI, 1.82-4.26). Thirty de novo malignant tumors were detected in 24 patients (10.4%). The mean age at diagnosis of cancer was 54.88 ± 11.44 years. The median time from transplant to cancer diagnosis was 11.5 years (range, 7-18.8 y). Nonmelanoma skin cancers (56.7% of all tumors) were the most common malignancies. Twenty-two lesions (73.3%) that developed in 17 patients (7.4%) were localized to the head and neck region: 15 (68.2%) were cutaneous and 7 (31.8%) were noncutaneous. The median time from transplant to head and neck cancer diagnosis was 12 years (range, 7.5-17.5 y). Mortality rate was higher in cancer patients (10 [41.7%] vs 17 [8.2%]; P < 0.01). CONCLUSIONS: The incidence of de novo malignancy in kidney transplant recipients was relatively higher compared with previous data. Nonmelanoma skin cancers were the most common type. Three-quarters of all lesions were in the head and neck region, and two-thirds were of cutaneous origin.

Effects of lipid-containing eye drops on the ocular surface and in vivo confocal microscopy findings in patients using systemic isotretinoin.

OBJECTIVE: To evaluate the effects of lipid-containing Rohto Dry Aid eye drops and sodium hyaluronate eye drops on the ocular surface and in vivo confocal microscopy (IVCM) findings in patients using systemic isotretinoin. METHODS: This retrospective study included 71 patients using systemic isotretinoin for acne vulgaris. Ocular surface and tear functions were evaluated with the tear break-up time (TBUT), corneal fluorescein staining (CFS), and the ocular surface disease index questionnaire (OSDI). Meibography was used for the staging of Meibomian gland dysfunction (MGD) while IVCM was used for the analysis of corneal micro-structural changes. The data of 36 patients using Rohto Dry Aid (the Rohto group) and 35 patients using sodium hyaluronate (the SH group) were recorded. Pre-treatment, first month and third month data were analyzed. RESULTS: Longer TBUT, lower OSDI score, and less CFS were observed in the first and third months after treatment in the Rohto group (p < 0.001). There was no significant change in TBUT and CFS in the first month (p > 0.05) in the SH group (p < 0.05) but lower TBUT and more CFS were observed in the third month. There was no significant change in the OSDI score in the SH group. There was a significant decrease in dendritic cells, activated keratocytes, and nerve tortuosity with IVCM in both groups. However, no significant difference was found between the two groups. CONCLUSION: Rohto Dry Aid, with its support of the lipid layer, is an effective and safe treatment agent that can improve both ocular surface and IVCM findings in evaporative dry eye cases with MGD.

The effectiveness of fractional carbondioxyde laser and microneedle radiofrequency on acne scars.

Acne scars lead to physical and psychological problems for young adults therefore they should be treated effectively. Fractional carbon dioxide (FCL) and radiofrequency (FRFL) lasers have been both used for acne scars. The aim of this study was to evaluate the effectivity and satisfaction of combined FCL and FRFL treatment for acne scars and evaluate effect of these treatments especially on atrophic scar types retrospectively. A total of 41 patients with acne scars who received FCL + FRFL were included in this study. Photographs of patients before treatment and 1 month following the last treatment session were scored by the other blinded clinician, according to the ECCA acne scar scoring method. A significant decrease was noted in clinical scores after the treatment. Side effects were minimal and acceptable. When comparing atrophic scars to erythematous ones laser treatment was more effective for atrophic types. In conclusion, our findings revealed that laser treatment with FCL + FRFL for acne scars is successful, effective and comfortable. These combination is more effective in atrophic type acne scars.

Diffuse large B cell lymphoma progression with skin involvement: A case report.

Diffuse large B cell lymphoma (DLBCL) constitutes the most frequent subtype of all non-Hodgkin's lymphomas. DLBCL is an aggressive disease and extranodal involvement is seen in approximately 30% of patients and most common extranodal sites are gastointestinal tract and skin. Skin involvement may be either primary or secondary. Secondary cutaneous lymphoma has a worse prognosis. The case is here reported of a 56-year old male DLBCL patient with cutaneous lesions and aggressive clinical course. The patient had no skin lesions at diagnosis and during follow up and treatment period, skin, cerebrospinal fluid and bone marrow involvement was occurred. Salvage chemotherapy and autologous stem cell transplantation was planned but the patient died before the second cycle of salvage chemotherapy. In contrast to primary cutaneous lymphoma, which tends to be more indolent, secondary skin involvement is associated with unfavourable prognosis. In conclusion it should be kept in mind that skin can be involved in lymphoma patients and in these cases, skin biopsy should be performed rapidly.

Serotonin Expression in Lichen Planus Lesions and Its Relationship with Depression/Anxiety.

BACKGROUND: Psychological factors such as stress, depression, and anxiety have been documented to contribute to the development of lesions in lichen planus (LP). OBJECTIVE: To evaluate the relationship between serotonin expression in LP lesions and depression/anxiety. METHODS: Forty patients (22 females, 18 males) with LP and 20 healthy control subjects were included in this study. The severity of LP was assessed with the palmar method (using the measurement of affected body surface area [BSA]). The depression and anxiety scores were measured with Beck's depression inventory (BDI) and Beck's anxiety inventory (BAI). The expression of serotonin was determined via immunohistochemistry in LP lesions and in the control group skin using a monoclonal antibody to serotonin. RESULTS: The skin biopsies of the LP patients had significantly higher levels of serotonin than those of the control subjects (p<0.001). In the LP patients, and there was a positive correlation between serotonin expression and LP severity (p=0.022). Based on the results from the BDI and BAI, there was a significant relationship between the severity of depression/anxiety and intensity of serotonin expression (p<0.001). CONCLUSION: Data from this study suggest that serotonin may have a possible role in the pathogenesis of LP. Further, the relationship between serotonin expression in acute cutaneous lesions and the depression/anxiety scores indicates that serotonin may be a mediator for the association of LP and depression/anxiety simultaneously. There is a need for more specific studies showing the expression of serotonin in the lichen planus to demonstrate the cause or effect.

Evaluation of Mean Platelet Volume in Patients With Behcet's Disease as an Indicator of Vascular Thrombosis.

BACKGROUND: Patients with Behcet's disease (BD) are recognized with increased risk for venous and/or arterial thrombosis. Thrombotic tendency of BD is not known. Vascular injury, loss and dysfunction/hyperfunction of endothelial cells are believed to play a role in thrombosis development. Injury and inflammation due to vasculitis can cause platelet response with increase in mean platelet volume (MPV) and thrombosis in BD. In this study, we aimed to compare the levels of MPV between patients with BD and healthy controls, and also show its effect on thrombosis. METHODS: One hundred patients with BD and 100 healthy controls were evaluated for MPV levels with clinical findings in age-gender matched case-control study. The variables of patients and controls were compared and correlated using chi-square, Mann-Whitney U and Spearman tests. Logistic regression analysis was used to determine independent predictors of vascular involvement and thrombosis. RESULTS: Mean MPV was significantly higher in patients with BD than healthy controls (MPV; Patients: 9.2 ± 0.9 [7.3-12.9] vs. Controls: 8.2 ± 0.6 [6.8-10.6] fl; P<0.0001). Platelets levels were lower than controls, but not significantly (236 ± 52.3 [112-451] vs. 245 ± 52.8 [141-467] x109 /L, P=0.55). Negative correlation was found between platelet count and MPV in patients (r = -0.51, P=0.01). Presence of erythema nodosum (EN) and MPV were determined as predictors for vascular involvement and thrombosis (EN: P<0.0001, OR [95% CI] = 35.4 [6.3-178.2]; MPV: P<0.0001, OR [95% CI] = 12.8 [4.1-24.3]). CONCLUSION: MPV is a simple measurement for indirect monitoring of platelet activity and thrombotic potential. MPV and EN may be independent risk factors for vascular thrombosis in BD. Patients with higher MPV levels and EN in BD, might have been pursued closely for enhancing thrombosis. We advise to check the MPV and put the patients on anticoagulation if it is high.

Long-Pulsed Nd: YAG Laser Treatment for Nail Psoriasis.

BACKGROUND: Psoriasis is a chronic inflammatory skin disease in which lesions display angiogenesis and increased vascularity. OBJECTIVE: The long-pulsed 1,064-nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser treats vascular lesions which suggests that it might also be used to treat nail psoriasis. METHODS: Sixteen patients (10 males and 6 females) with isolated nail psoriasis or nail with only mild cutaneous involvement were enrolled in the study. Nails were treated for 3 sessions with long-pulsed 1,064-nm Nd:YAG laser once monthly. During the course of the treatment, nail bed and matrix Nail Psoriasis Severity Index (NAPSI) scores were recorded. RESULTS: The mean baseline NAPSI score was 26 ± 7.2. The means of total NAPSI scores after the first, second, and third treatment sessions were as follows: 22 ± 6.6, 13 ± 6, and 5.7 ± 4.3, respectively. The decline in NAPSI score was statistically significant. At the end of the 3 treatment sessions, both nail bed and matrix lesions significantly responded to Nd:YAG laser treatment. CONCLUSION: The Nd:YAG laser is a promising treatment option for nail psoriasis.

Does the corticotropin-releasing hormone system play a role in the pathogenesis of lichen planus?

INTRODUCTION: Lichen planus (LP) is a chronic inflammatory disease, where the psychogenic factors seem to play an important role in the pathogenesis. AIM: To determine the expression of corticotropin-releasing hormone (CRH) receptor type 1 (CRH-R1) in LP. MATERIAL AND METHODS: Thirty-two LP patients and 17 age/gender-matched controls were included in the study. Detailed information about the disease and body surface area (BSA) covered by the lesions was recorded. Immunohistochemically, the expression of CRH-R1 was stained in the lesional skin of patients with LP and in the control group. RESULTS: The comparison of CRH-R1 expression showed a statistically significant difference between LP patients and the controls (p < 0.05). Additionally, we did not observe any correlation between BSA and staining intensity in LP patients. CONCLUSIONS: Our study showed an increase in CRH-R1 expression in LP lesions. These results support the participation of the cutaneous CRH/CRH-R1 system in the pathogenesis of LP skin lesions.

Evaluation of abdominal fat index by ultrasonography and its relationship with psoriasis and metabolic syndrome.

INTRODUCTION: Accumulating evidence indicates that psoriasis is associated with obesity and metabolic syndrome. Psoriasis and obesity share similar inflammatory mediators, and obesity may potentiate some inflammatory cytokines seen in psoriasis. Body fat distribution, particularly visceral adipose tissue (VAT), is an important factor in metabolic syndrome and atherosclerotic diseases. An association has been demonstrated between psoriasis and abdominal VAT measured by computed tomography (CT). AIM: To measure abdominal VAT noninvasively by ultrasonography (USG) in patients with psoriasis and investigated its relation to psoriasis and metabolic syndrome. MATERIAL AND METHODS: The study population consisted of 41 psoriasis patients and 41 control subjects matched for age, sex, and body mass index. The maximal preperitoneal fat thickness (Pmax) at the anterior surface of the liver and the minimal subcutaneous fat thickness (Smin) of the abdomen were measured by USG. The abdominal fat index (AFI = Pmax/Smin ratio) was calculated and the results were compared between groups. RESULTS: The rate of metabolic syndrome was significantly higher in psoriasis patients (p = 0.0018). The mean AFI was similar in both groups. AFI was not associated with psoriasis in subjects with metabolic syndrome (p = 0.495) or with Psoriasis Area and Severity Index (r = 0.123, p = 0.443). CONCLUSIONS: This is the first study to evaluate abdominal VAT by USG. Computed tomography may be more reliable than USG, but its high cost and radiation exposure are major disadvantages. Further studies are required to determine the relationships between psoriasis and VAT.

The Effect of Colchicine on Mean Platelet Volume in Behcet's Disease.

BACKGROUND: Patients with Behcet's Disease are recognized to be at an increased risk for venous and/or arterial thrombosis. Colchicine reduces the initiation and amplification of inflammation and is believed to suppress secretion of cytokines and chemokines and in vitro platelet aggregation. OBJECTIVES: To evaluate the effect of colchicine on levels of mean platelets volume, platelets, erythrocyte sedimentation rate, and C-reactive protein in patients with Behcet's Disease. METHODS: Patients with Behcet's Disease were evaluated for mean platelets volume before colchicine therapy (Group 1) and after 6-month from beginning of colchicine treatment (Group 2). RESULTS: Fifty-two subjects were evaluated. The mean age was 38.3 years and the female/male ratio was 28/24=1.16. Laboratory tests were evaluated in Group 1 and Group 2. The median level of mean platelets volume was 9.2±0.8 fl in Group 1 and 8.9±0.9 fl in Group 2. Levels of mean platelets volume was found as significant between Group 1 and 2 (p=0.001). CONCLUSIONS: Given the proposed relationship between MPV and platelet activity, MPV may serve as a surrogate essay for Behcet's response to colchicine. Colchicine might suppress platelet function and be used in vascular involvement together with immunosuppressant agents in Behcet's Disease. Further studies in large population are needed to evaluate the role of colchicine in platelet function and the effect of colchicine on thrombosis in BD.

Sex hormones in male psoriasis patients and their correlation with the Psoriasis Area and Severity Index.

Modulation of psoriasis severity by estradiol during pregnancy, menstruation and menopause has been investigated previously. The correlation between sex hormones and Psoriasis Area Severity Index (PASI) has not been studied in male psoriasis patients. We investigated serum sex hormones in male psoriasis patients compared with healthy controls and correlated these findings with PASI. Estradiol, testosterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were measured in 47 male patients with psoriasis and 20 healthy controls. Patients with psoriasis showed higher body mass index and higher serum levels of FSH and LH relative to healthy controls, although this difference was not statistically significant. However, serum levels of testosterone and estradiol were significantly different between patients with psoriasis and healthy controls. Testosterone was significantly increased in control patients and estradiol was significantly increased among psoriatic patients. A significant inverse correlation was found between estradiol and PASI. Although the role of sex hormones in the pathogenesis of psoriasis has not been demonstrated, this is the first report of an inverse correlation between estradiol and PASI in male patients.

The association of PASI scores with CRH-R1 expression in patients with psoriasis.

Stress is a well-known triggering factor along with genetic predisposition on the onset and during the course of psoriasis by altering the cellular constituents of the immune system. In the skin, there is a local hypothalamic-pituitary-adrenal (HPA) axis which is the equivalent of the central HPA axis. Corticotropin-releasing hormone (CRH) is a major regulator of the HPA axis in response to stress. This study was planned to show the role of CRH receptor type 1 (CRH-R1) in pathogenesis of psoriasis, the relation with the severity of psoriasis, and interpersonal variance in skin biopsy specimens of the psoriasis patient. Study involved 46 patients with psoriasis and 20 healthy control subjects who were older than 18 years. The clinical sign and PASI scores of psoriasis patients were recorded. Immunohistochemically, expression of CRH-R1 was investigated in psoriatic lesions and control group skin. A statistically significant increase of the expression of CRH-R1 was found in the skin biopsies of psoriasis patients compared with the control group patients. In patients with psoriasis, there was a positive correlation between the expressions of CRH-R1 and PASI scores (p = 0.001, r = +0.572). In addition, a statistically significant increase of PASI scores was found in the intense-stained CRH-R1 group compared with the weakly stained CRH-R1 patient group. The present study has demonstrated that CRH-R1 could have a role in pathogenesis of the psoriasis and stress may increase the intensity of psoriasis.

Pyoderma vegetans associated with ulcerative colitis: a case with good response to steroids.

Pyoderma vegetans (PV) is a very rare disorder characterized by erythematous, vesiculopustular, exudative, vegetating plaques usually localized in the inguinal and axillary folds. The etiology of PV is not known, but it is often associated with bacterial infections in immunocompromised patients. Major histopathological features in PV are pseudoepitheliomatous hyperplasia and intraepidermal and subepidermal neutrophilic or eosinophilic microabscesses. It is well known that these lesions are frequently associated with inflammatory bowel diseases, such as ulcerative colitis (UC) and Crohn's disease. No standardized treatment plan is available for PV, although antibiotic treatment has often been used, with variable results. The standard first-line therapy is still systemic steroids. Herein, we report a case of PV associated with UC with unusual localization that showed a good response to systemic corticosteroid, antibiotic and sulfasalazine therapy.

Reduced erythrocyte deformability in active and untreated Behçet's disease patients.

OBJECTIVE: Although the etiology of Behcet's disease is not clarified yet, the vascular endothelial damage and thrombosis are prominent features of the disease. The underlying mechanisms of increased risk of thrombosis in Behcet's disease are not completely understood. It is stated that the changes in blood rheology such as erythrocyte deformability take part in the thrombosis. There are limited numbers of studies with conflicting results about the erythrocyte deformability in Behcet's disease. The previous studies were not limited to the untreated patients with active disease. METHOD: Blood samples were filtered immediately by "Imugard- leukocyte removal filter". After plasma and erythrocytes were separated by centrifugation, 10% erythrocyte suspensions were prepared with isotonic Tris NaCl buffer solution. These erythrocyte suspensions were filtered under gravitational force by "Nucleopore" to determine the filtration time. The filtration times of the erythrocyte and buffer solutions were referred as t1 and t2 respectively. Finally, deformability indices were obtained by dividing the t1 by t2. A decrease in the deformability of the erythrocytes would result in an increase in the filtration time of the erythrocyte suspension and deformability indices. RESULTS: The median deformability indices were 3.090 and 2.170 for patients and control subjects respectively and the difference was statistically significant (P = 0.000). CONCLUSION: We suggest that the decrease in erythrocyte deformability in Behcet's disease may be related to oxidative damage of erythrocytes and subsequently takes part in the development of thrombosis in Behcet's disease.

A case of subcorneal pustular dermatosis in association with monoclonal IgA gammopathy successfully treated with acitretin.

Subcorneal pustular dermatosis (SPD), or Sneddon-Wilkinson disease, is a rare, chronic, recurrent, pustular eruption. Association with several diseases is well known, mainly IgA and IgG gammopathies or myelomas. Although dapsone is often considered to be the first-line treatment, some patients fail to respond or cannot tolerate the side effects. For cases that do not respond well to this treatment, acitretin, an excellent second-line treatment, may be used. Herein, a 55-year-old woman with SPD associated with monoclonal IgA gammopathy refractory to dapsone is presented, who was successfully treated with acitretin in a short period.

Mean platelet volume in psoriasis and psoriatic arthritis.

Mean platelet volume (MPV), an indicator of platelet activation, is a newly emerging risk factor for atherothrombosis. There is evidence of platelet activation in psoriasis and psoriatic arthritis (PsA). The association between psoriasis, PsA, and atherosclerosis is well documented, yet, the underlying mechanisms remain unclear. The aim of this study was to investigate the differences of MPV values in patients with psoriasis, PsA, and healthy subjects and the correlation between MPV and the clinical disease activity. A total of 106 patients with psoriasis were included in this study. The study population grouped as 48 patients with PsA (group 1) and 58 patients without PsA (group 2) and 95 healthy controls (group 3). MPV was measured in psoriasis and PsA patients. MPV values were collected from standard complete blood count samples. Clinical features and PASI scores in group 1 and 2 were also recorded. MPV in patients with psoriasis 8.7 +/- 0.9 fL was significantly higher than that of control subjects 7.3 +/- 0.8 fL (p < 0.001). There was also statistical difference between MPV levels of patients with (9.5 +/- 0.8) and without (8.0 +/- 0.7) arthritis (p < 0.001). MPV levels were positively correlated with psoriasis area and severity index score (p = 0.000, r = +0.735). MPV levels showed positive correlation with disease duration (p = 0.01, r = 0.518). MPV levels are increased in patients with psoriasis and PsA. MPV may be a marker for the severity of psoriasis. This study may confirm previous observation indicating increased platelet activation in psoriasis. Increased platelet activity could contribute to increasing the atherosclerotic risk in patients with psoriasis and PsA.