Dermoscopic Features of Cutaneous Vasculitis.

INTRODUCTION: Dermoscopy has become widespread in the diagnosis of inflammatory skin diseases. Cutaneous vasculitis (CV) is characterized by inflammation of vessels, and a rapid and reliable technique is required for the diagnosis. OBJECTIVES: We aimed to define CV dermoscopic features and increase the diagnostic accuracy of dermoscopy with machine learning (ML) methods. METHODS: Eighty-nine patients with clinically suspected CV were included in the study. Dermoscopic images were obtained before biopsy using a polarized dermoscopy. Dermoscopic images were independently evaluated, and interobserver variability was calculated. Decision Tree, Random Forest, and K-Nearest Neighbors were used as ML classification models. RESULTS: The histopathological diagnosis of 58 patients was CV. Three patterns were observed: homogeneous pattern, mottled pattern, and meshy pattern. There was a significant difference in background color between the CV and non-CV groups (P = 0.001). The milky red and livedoid background color were specific markers in the differential diagnosis of CV (sensitivity 56.7%, specificity 96.3%, sensitivity 29.4%, specificity 99.2%, respectively). Red blotches were significantly more common in CV lesions (P = 0.038). Red dots, comma vessels, and scales were more common in the non-CV group (P = 0.002, P = 0.002, P = 0.003, respectively). Interobserver agreement was very good for both pattern (κ = 0.869) and background color analysis (κ = 0.846) (P < 0.001). According to ML classifiers, the background color and lack of scales were the most significant dermoscopic aspects of CV. CONCLUSIONS: Dermoscopy may guide as a rapid and reliable technique in CV diagnosis. High accuracy rates obtained with ML methods may increase the success of dermoscopy.

Efficacy of Topical Dapsone 5% Gel for the Treatment of Erythematotelangiectatic Rosacea: New Treatment Option With Old Drug.

INTRODUCTION: Many topical drugs are used in the treatment of erythematotelangiectatic rosacea (ETR). However, dapsone 5% gel has never been used in ETR to date. OBJECTIVES: To evaluate the efficacy of dapsone 5% gel as a new treatment option for ETR. METHODS: Thirty-five patients with ETR were included in the study. Diagnosis was made with National Rosacea Society criteria. Dapsone 5% gel was used topically twice a day for 12 weeks. Investigator Global Assessment (IGA) 4-point scale ( 0 → Clean, 1 → mild, 2 → moderate, 3 → severe, 4 → very severe), Visual Analogue Scale (VAS) and Dermatology Life Quality Index (DLQI) were used for evaluation (at baseline, 2nd, 6th, and 12th weeks). RESULTS: IGA scores among baseline (2 → 62.9%, 3 → 34.3%, 4 → 2.9%) and 2nd (1 → 14.3%, 2 → 77, 1%, 3 → 8.6%), 6th (1 → 45, 7%, 2 → 54.3%) and 12th weeks (1 → 62.9%, 2 → 37.1%) were found to be statistically significant (P < 0.001). Median VAS scores among baseline (median = 7 [5-9]) and 2nd (median=5 [3-8]), 6th (median=5 [3-6]) and 12th weeks (median = 4 [2-6]) were statistically significant (P < 0.001). Median DLQI scores among baseline (median = 8 [6-14]) and 2nd (median = 5 [3-11]), 6th (median = 5 [3-11]) and 12th weeks (median = 4 [2-9]) were statistically significant (p<0.001). Concurrent systemic disease was a risk factor for poor treatment response (P = 0.034). Mild irritation was observed in 3 patients (8.5%) during treatment. CONCLUSIONS: Dapsone 5% gel was effective and well tolerated in ETR treatment.

Internalized Stigma in Hidradenitis Suppurativa: A Multicenter Cross-Sectional Study.

BACKGROUND: Hidradenitis suppurativa (HS) causes significant physical, social, and psychological burdens. Internalized stigma, acceptance of negative attitudes and stereotypes of society regarding a person's illness, has not been studied previously in HS. OBJECTIVES: The objective of this study was to investigate the internalized stigma state of HS patients and identify the factors affecting it. METHODS: This multicenter, prospective, cross-sectional study included 731 patients. Internalized Stigma Scale (ISS), Hurley staging, Physician Global Assessment, Dermatology Life Quality Index (DLQI), Skindex-16, Beck Depression Inventory-II (BDI-II), and Visual Analog Scale (VAS)-pain score were used in the study. RESULTS: The mean ISS value (57.50 ± 16.90) was comparable to the mean ISS values of studies in visible dermatological and various psychiatric diseases. A significant correlation was found between the mean values of ISS and all disease activity scores, quality of life measures, BDI-II, and VAS-pain scores. Obesity, family history, low education and income level, vulva/scrotum involvement and being actively treated are significant and independent predictive factors for high internalized stigma in multivariate analysis. CONCLUSIONS: HS patients internalize society's negative judgements, which may create a profound negative effect on access to health care. Therefore, in addition to suppressing disease activity, addressing internalized stigma is fundamental for improving health care quality.

Real-life efficacy and drug continuation of secukinumab in treating moderate to severe plaque psoriasis in Aegean region of Turkey: a multicenter retrospective study and systematic review of the literature.

BACKGROUND: Secukinumab was demonstrated to be efficient in the treatment of moderate to severe plaque psoriasis in the phase studies. Real-life treatment experiences obtained from patients that do not meet the inclusion criteria of phase studies can provide valuable information on efficacy and safety results. Results may also differ in different ethnic populations. OBJECTIVE: To investigate short and long-term efficacy and drug continuation of secukinumab in Turkish population. METHODS: The study conducted in three tertiary care psoriasis centers. Patients' demographic characteristics and week 0 / 4th week / 12th week / 1st year PASI values were analyzed. For systematic review of the literature a PubMed search using the keywords "secukinumab and real and psoriasis" from inception to April 2021 was performed. RESULTS: Mean PASI scores improved the compared to baseline at all assessment weeks (p = 0.000). In multivariate model, we found that bioexperience have negative influence on the PASI90 response at week 4. Univariate analysis showed significant relationship only between PASI90 response rate and gender at week 12 and year 1. Approximately 85% of patients remained on secukinumab treatment at the end of one year. CONCLUSIONS: Secukinumab seems to be an effective treatment option for plaque psoriasis. According to our knowledge, this is the first study concerning about long-term efficacy and drug continuation of secukinumab from Turkey.

The use of interferon-α2a as monotherapy in stage IB patients with mycosis fungoides: A retrospective chart review of patient outcomes.

The aim of this study was to evaluate the response to IFN-α2a treatment as monotherapy in stage IB patients with mycosis fungoides (MF) in second-line therapy. Twenty-five patients with recurrent or persistent MF were included in the study. The diagnosis of MF was established according to clinical and histopathological signs. Clinical staging was made using TNMB classification. IFN-α2a as monotherapy was used as treatment. IFN-α2a was administered at a dose of 3 x 106 units thrice a week subcutaneously as initially described. According to clinical tolerance, the dose was increased every 4 weeks to 6 - 9 x 106 units. IFN-α2a was used more frequently for at least 3 months after complete remission. Treatment success was evaluated with Clinical Response (disappearance of all clinical evidence = Complete Remission [CR], ≥50% decrease in extent or severity = Partial Remission [PR], unresponsiveness to treatment = Stable Disease [SD], progression of MF = Progressive Disease [PD]). The average age was 51.3 ± 9.1. CR and PR were achieved in 11 (44%) and 12 (48%) patients, respectively. PD was observed in two (8%) patients. CR was accomplished at 16.1 ± 9.8 weeks. Recurrences were mostly observed within 1 year (10.4 ± 7.7 months). The recurrence rate was 45.4%. The mean duration of CR was 33.3 ± 7.9 months. Side effects were seen in 36% of the patients (18.2% in CR). The most common side effect was fatigue (12%). The patients received 11 different types of treatment before IFN-α2a treatment. The most frequent therapy prior to IFN-α2a treatment was narrow-band ultraviolet-B (NB-UVB) phototherapy (15 [60%] patients). CR can be achieved in a relatively short period of time in patients receiving IFN-α2a in MF. The duration of CR is reasonable. The side effects of IFN-α2a are acceptable. Therefore, IFN-α2a as monotherapy is a good option in stage IB second-line MF therapy.

Validity and reliability of the Turkish version of Psoriasis Epidemiology Screening Tool for the detection of psoriatic arthritis in patients with psoriasis.

Objectives: The Psoriasis Epidemiology Screening Tool (PEST) is a simple and useful questionnaire designed to screen arthritis in patients with psoriasis. This study aims to evaluate the validity and reliability of the PEST questionnaire in Turkish patients with psoriasis. Patients and methods: Between August 2019 and September 2019, a total of 158 adult patients with psoriasis (61 males, 68 females; mean age: 43.1±13.3 years; range, 29.8 to 56.4 years) who were not previously diagnosed with PsA were included. The testing procedure for translation and cultural adaptation was carried out according to the following steps: preparation, forward translation, reconciliation, back-translation/back-translation review, harmonization, finalization, and proofreading. Patients' demographic parameters, comorbidities, PEST, and Toronto Psoriatic Arthritis Screen (ToPAS 2) results were recorded. The patients were, then, assessed by a rheumatologist who was blinded to their PEST scores. The diagnosis of PsA was made according to the Classification criteria for Psoriatic Arthritis (CASPAR). The receiver operating characteristic (ROC) was assessed to obtain the sensitivity and specificity of the PEST questionnaire. Results: Of the patients, 42 had PsA, while 87 did not. Each parameter of PEST showed a low-high internal consistency ranging from 0.366 to 0.781. When the Question 3 was excluded, Cronbach alpha value increased to 0.866. The Cronbach alpha value of the whole scale was 0.829. The test-retest reliability of the Turkish version of PEST was determined as 0.86 for the total score (ICC=0.866 95% CI: 0.601-0.955; p<0.0001). There was a strong positive correlation between PEST and ToPAS 2 (r=0.763; p<0.001) and a moderate positive correlation between PEST and CASPAR (r=0.455; p<0.001). A cut-off value of ≥3 yielded a sensitivity of 93% and a specificity of 89% for the diagnosis of PsA with the highest Youden's index. The PEST scale was found to have a higher sensitivity, but lower specificity in the head-to-head comparison with ToPAS 2. Conclusion: The Turkish version of PEST is a reliable and valid tool for screening PsA in Turkish patients with psoriasis.

The impact of COVID-19 pandemic on psoriasis patients, and their immunosuppressive treatment: a cross-sectional multicenter study from Turkey.

BACKGROUND: Immunosuppressive therapy has been a great concern during the pandemic. This study aimed to evaluate the pandemic's impact on psoriasis patients treated with immunosuppressive drugs. MATERIAL AND METHODS: The multicenter study was conducted in 14 tertiary dermatology centers. Demographic data, treatment status, disease course, and cases of COVID-19 were evaluated in patients with psoriasis using the immunosuppressive treatment. RESULTS: Of 1827 patients included, the drug adherence rate was 68.2%. Those receiving anti-interleukin (anti-IL) drugs were more likely to continue treatment than patients receiving conventional drugs (OR = 1.50, 95% CI, 1.181-1.895, p = .001). Disease worsening rate was 24.2% and drug dose reduction increased this rate 3.26 and drug withdrawal 8.71 times. Receiving anti-TNF or anti-IL drugs was associated with less disease worsening compared to conventional drugs (p = .038, p = .032; respectively). Drug withdrawal causes were 'unable to come' (39.6%), 'COVID concern' (25.3%), and 'physician's and patient's co-decision' (17.4%). Four patients had COVID-19 infection with mild symptoms. The incidence was 0.0022% while it was 0.0025% in the general population. CONCLUSION: Our study shows that psoriasis patients using systemic immunosuppressive do not have a higher, but even lower COVID-19 risk than the general population, and treatment compliance with biological drugs is higher.

Multicenter study evaluating the impact of COVID-19 outbreak on dermatology outpatients in Turkey.

COVID-19 pandemic has a significant impact on public health, whether directly or indirectly. The first case was seen in Turkey on March 11, and the World Health Organization (WHO) declared a pandemic on March 12, 2020. The study aimed to document the effect of pandemic on dermatology outpatient clinics in Turkey. Fifteen tertiary hospitals from 13 provinces were included in the study, which was conducted between January 12 and May 12, 2020. The International Codes of Diseases (ICD-10) categories and patients' characteristics were evaluated before and after the pandemic. A total of 164 878 patients, 133 131 before and 31 747 after the pandemic, were evaluated. The daily hospital applications were found reduced by 77%. The three of the most frequent diagnoses; dermatitis, acne, and psoriasis remained unchanged after the pandemic. While the frequency of herpes zoster, scabies, urticaria, pityriasis rosea and sexually transmitted diseases increased significantly; allergic and irritant contact dermatitis decreased after the pandemic. The applications regarding cutaneous neoplasms were considerably reduced during the pandemic, and this effect was more pronounced in cities with higher COVID incidence. The pandemic caused a noteworthy reduction in the number of patients accessing dermatological care. The pandemic caused significant changes in the frequency of a wide range of dermatological diseases. The application of cutaneous neoplasms is considerably reduced after the pandemic, and this effect was more pronounced in cities where pandemics are frequent. Therefore, the pandemic has resulted on numerous impacts on many critical issues in dermatology and dermatological care.

The early and late efficacy of single-pass fractional carbondioxide laser, fractional radiofrequency, and their combination in acne scars: A prospective, split-face, single-blinded, controlled clinical study.

We investigated the effectiveness of fractional carbon dioxide laser (FCO2 ) vs fractional radiofrequency (FRF) and FCO2 vs FRF plus FCO2 combination in the treatment of acne scars. Twenty-seven patients were included. Scar severity was scored with "Echelle d'évaluation clinique des cicatrices d'acné" (ECCA) by a dermatologist blinded to treatment. FCO2 and FRF were administered to the right and left halves of the patients' faces, respectively, at the first three visits, once a month. At the fourth visit, FCO2 was administered to both sides. Last evaluation was performed 6 months after the last treatment. Mean ECCA scores for both face halves decreased gradually at each visit compared with Visit-1; however, the effect size of decrease was higher in the right half of the face and in terms of gender differences was higher in women for both sides that the difference was more pronounced for the FRF side. There was no statistically significant change in the mean VAS patient satisfaction scores in the following visits compared with Visit-2 on both halves (P > .05). Side effects were similar; but lasted longer in the FCO2 side. Both FCO2 and FRF are effective treatment methods in the treatment of atrophic acne scars. Combining FCO2 to FRF improves patient satisfaction. FRF may achieve better results in women compared with men. To our knowledge the study is unique prospective, controlled clinical study comparing the efficacy of FCO2 and FRF plus FCO2 combination treatments.

Validation of the Simple Psoriatic Arthritis Screening (SiPAS) questionnaire in a Turkish psoriatic population.

OBJECTIVES: Screening of psoriatic arthritis (PsA) in patients with psoriasis (PsO) is critical for the prevention of irreversible joint erosions, deformity, and disability. The SiPAS questionnaire is a short, simple and useful tool designed to screen PsA. This study aimed to evaluate validity of the SiPAS questionnaire in Turkish patients with PsO. MATERIALS AND METHODS: The Turkish translation of SiPAS was sent to us by the developer authors of the original index. Subjects were recruited from dermatology outpatient clinics. All patients' demographic parameters and SiPAS questionnaire results were recorded. After patients completed the questionnaire they were assessed by a rheumatologist according to standard protocol which included a complete history, detailed physical examination, laboratory tests and Classification for Psoriatic Arthritis (CASPAR) criteria. Receiver operating characteristics (ROC) were assessed to obtain sensitivity and specificity of the Turkish version of the SiPAS questionnaire. RESULTS: One hundred and thirty subjects were recruited into the study. The mean age of subjects were 43.5 years and the 55.4% of subjects were female. Of these, after rheumatologic evaluation 42 patients were diagnosed as PsA. The area under the ROC curve was 0.994 which means as excellent predictor and optimum cut-off threshold to discriminate patients diagnosed with PsA was 3 according to this ROC curve analysis. The overall sensitivity and specificity based on cut-off threshold of 3, were 97.6% and 94.3%, respectively. CONCLUSIONS: The Turkish version of the SiPAS questionnaire is a simple useful, time-saving and valid tool for screening PsA in patients diagnosed with PsO with its high sensitivity and specificity. A SiPAS score ≥3 is an indication for referral to a rheumatologist.

Potential utility of dermoscopy in the examination of ocular pigmentations.

BACKGROUND: Dermoscopy is a fundamental method in the examination of melanocytic neoplasms. Limited data exist about the dermoscopic features of ocular pigmentations (OPs). OBJECTIVES: We aimed to investigate the usefulness of dermoscopy in the examination of OPs. METHODS: Dermoscopic images of OPs of 20 consecutive patients were recorded. Impression cytology (IC) was performed to these lesions. Dermoscopic images were evaluated for specific dermoscopic structures and patterns without knowing the cytological examination results. RESULTS: Fifteen percent (3/20) of the lesions presented with suspicious cytological findings. More of the suspicious lesions had 4 colors compared to benign lesions (66.7% vs 11.8%, p=0.088). This was also determined for blue-gray (66.7% vs 11.8%, p=0.088) and white (66.7% vs 17.7%, p=0.14) colors. At least 3 structures were observed in all suspicious lesions (100%), but were observed in only in 41.2% of benign lesions (p=0.105). Besides, two-thirds of suspicious lesions had more than 4 structures, but none of the benign lesions reported this (p=0.016). Most of the benign lesions showed asymmetry in one axis (93.3%), whereas all suspicious lesions showed asymmetry in 2 axes (p=0.004). CONCLUSIONS: Dermoscopy seems to be a useful method in the evaluation of OPs. The existence of dermoscopic patterns, colors, and dermoscopic structure plurality and asymmetry raise suspicion in OPs, similarly to skin pigmentations. Dermatologists should be aware of the ocular area, and closer collaboration should be developed between dermatologists and ophthalmologists in the management of pigmented lesions.

Dermoscopic changes in melanocytic nevi covered with both opaque tape and sunscreen cream during narrowband ultraviolet B therapy.

BACKGROUND: Ultraviolet (UV) light may cause dermoscopic changes on melanocytic nevi (MN). OBJECTIVES: To investigate the effects of sunscreen cream (SSc) application on dermoscopic changes in MN during narrowband UVB (NBUVB) therapy. METHODS: Half of the randomly selected MN in each patient were covered with opaque tape and SSc [SSc(+)], and the rest were covered with only opaque tape [SSc(-)] during NBUVB treatment sessions. RESULTS: More SSc(-) MN displayed dermoscopic changes at end of NBUVB therapy compared to the start of therapy (p=0.035). The number of the MN that decreased in size and showed loss of structure was significantly higher in SSc(-) MN (p=0.04 and p=0.026, respectively). CONCLUSIONS: Sunscreen in combination with opaque tape may contribute to some dermoscopic changes in melanocytic nevi, including decrease in size and loss of structure.

[A case with scalp pruritus caused by Dermanysus gallinae (order: mesostigmata)]. / Dermanysus gallinae'nin (Takim: mesostigmata) neden oldugu saçli deride kasintili olgu.

Dermanyssus gallinae is one of the important hematophagous ectoparasite species of poultry like chicken, pigeon and wild bird species. These ectoparasites in the form of nymphs or adults who can not find their hosts are also seen in mammals and even in humans. For this reason, they are considered as important for public health. The ectoparasite causes a clinical condition named gamasoidosis among pet owners and people who live or work close to animal shelters, barns and chicken farms. Pruritus dermatitis is also caused by D.gallinae in humans and can cause false diagnosis. In this report, a case of D.gallinae which leads to severe itch in the hairy head skin was presented. A 66-year-old female patient admitted to University Hospital with complaints of "bugs in her hair and itching of the skin increasing in the evenings" that have persisted for a month. In the dermatological examination of the patient, it was noted that her hair and scalp were usual. Routine laboratory tests were normal. However, a large number of mites were found in her headscarf that she brought with her to the examination. Later, it was learned that the patient feeds chicken in her garden in the village where she lives. The collected mite samples were were kept in glass test tubes that contained glycerol and alcohol. The mites were identified as D.gallinae by morphological identification with light microscopy by using 10x, 20x and 40x magnifications. The mites were described as D.gallinae (Order: Mesostigmata, local name: poultry red mite, perch mite, poultry mite) with the morphological examination. Long-acting 1% permethrin shampoo was applied to remove the mites on the patient and during the controls, it was changed as 5% permethrin and 10% crotamiton lotion. For environmental sanitation, carbamates (such as carbolineum, trichlorfon, malathion, tetrachlorvinphos, etc.), organophosphates and acaricide insecticides with pyrethroids spraying or powder formulations were recommended. It was recommended to repair the slits and cracks where the parasite in the shelter could be stored. The patient was informed on (i) how to clean the household items with susceptible acaricides, (ii) removal of unused infected animal shelters, cages and nests from human habitat, (iii) raising of ambient temperature above 45°C, (iv) ventilation of the living spaces and (v) washing the clothes with detergent. In order to be effectively protected from the risk of infection and the detriments that are brought by this parasite, it is imperative to stay away from the hosts and the infected areas such as chicken farms, to obey the hygiene regulations, and to properly conduct the disinfestation of the shelters. In addition, it is also helpful to receive a true story from the patient, with details of contact with birds for the protection and treatment.