Infantile Eosinophilic Pustular Folliculitis: A Case Report.

BACKGROUND: Infantile eosinophilic pustular folliculitis (I-EPF) is a rare disease characterized by pruritic vesicles and sterile pustules on the erythematous surface of the scalp and facial localization, usually seen in the neonatal period. It is essential to show the presence of dense eosinophils in the diagnosis of pustules. Histopathological examination of the hair follicles by eosinophils infiltration is determined. AIM: Here, we reported a 5-month-old baby boy diagnosed infantile eosinophilic pustular folliculitis. PATIENT: A 5-month-old baby boy was consulted to our polyclinic by his family because of pustules on the scalp, face, and neck developing in two week after birth. In dermatological examination, the pustular lesions of 1-2 mm in diameter on the scalp, face, and neck on an erythematous background were determined. RESULTS: There was no growth in the culture taken from the pustule. In the laboratory tests of the patient; upon detection of eosinophilia in the hemogram. The eosinophil count at the patient's first admission was 1.48 K/µl. (0.05 0.50). Eosinophil count was 0.02 K/µl after treatment. It was decreased. The patient was evaluated for other pustular dermatoses. In the differential diagnosis of the patient; causing bacterial/non-bacterial pustulosis were included. Bacterial culture was negative. CONCLUSION: Eosinophilic folliculitis defines as a group of papulopustular diseases with unknown etiology characterized histologically by eosinophilic infiltrates. First, Ofuji reported a female patient with recurrent follicular pustules and peripheral eosinophilia as a variant of folliculitis in 1965. Its etiopathogenesis is not clearly known. In the differential diagnosis of EPF includes the other pustular lesions of the newborn such as erythematoxicum neonatarum, transient neonatal pustular dermatosis, infantile acropustulosis, scabies, dermatophytosis, and langerhans cell histiocytosis. Treatment options includes topical corticosteroids and calcineurin inhibitors, antihistamines, systemic antibacterial and anti-inflammatory agents, and dapson.

Pyoderma gangrenosum with thymoma and myasthenia gravis: A case report.

Pyoderma gangrenosum (PG) is a rare, neutrophilic dermatosis which is characterized by painful, necrotic ulcer with violaceous border that heals with cribriform scar. Although the etiopathogenesis of PG is not known exactly, it can be triggered by many factors such as genetics, autoimmune, pathergy phenomenon, drugs, and paraneoplastic. It is frequently associated with autoimmune pathogenesis such as inflammatory bowel disease and rheumatologic disease. It can also be associated with hematological or solid organ malignancies, and then, it is called paraneoplastic PG. The association of PG with myasthenia gravis and thymoma has not been previously reported. In our case, these three diseases with a common paraneoplastic pathogenesis were seen together and the coexistence of the three diseases is rare. Treatment of PG should be decided according to the severity, spread of the lesions, concomitant disease, medical condition, and tolerance of the patient. The purpose of treatment is to control the lesions and related diseases for a long time with minimal side effects. Mycophenolate mofetil treatment was used safely and successfully for both generalized MG and PG in our case.

Successful treatment of delayed pressure urticaria with 300 mg of omalizumab every 14 days.

Delayed pressure urticaria is a rare form of chronic inducible urticaria characterized by erythematous-painful plaques that develop in areas of the skin exposed to prolonged pressure. Its treatment is very difficult, and its response to antihistamines is variable. Cases of delayed pressure urticaria, which have been completely controlled with the use of omalizumab in recent years, have been reported.

Assessment of ADMA, IMA, and Vitamin A and E Levels in Patients with Acne Vulgaris.

BACKGROUND: Acne vulgaris is a common skin disease in adolescents known to be associated with oxidative stress. However, the number of studies in which oxidative stress and antioxidants are evaluated together is limited. AIMS: In this study, we aimed to investigate L-arginine/nitric oxide (NO) pathway metabolites, ischemia-modified albumin (IMA), and vitamin A and E levels in patients with acne and its association with disease severity. PATIENTS/METHODS: Ninety patients with acne and 30 healthy adults were included in the study. The serum levels ofL-arjinin, L-arginine metabolites, IMA, and vitamins A and E measured in the patient and control groups. RESULTS: Asymmetric dimethylarginine (ADMA), LNG -monomethyl-L-arginine (L-NMMA) and symmetric dimethylarginine (SDMA), and IMA levels were significantly higher in the patients with acne than in the control group (P Ë‚ .05). The L-arginine/ADMA ratio and citrulline and vitamin A levels were significantly lower in patients with acne than those of the controls (P Ë‚ .05). ADMA and IMA plasma levels were increased in parallel with the disease severity (P Ë‚ .05). L-arginine/ADMA ratio, L-arginine, citrulline, and vitamin A plasma levels decreased as the disease became severe (P Ë‚ .05). Although L-arginine and vitamin E levels were lower in the patient group compared to the control group, the difference was not statistically significant (P Ëƒ .05). CONCLUSION: These results suggest that IMA and L-arginine-NO pathway associated with ischemia and oxidative stress may play an important role in the pathogenesis and progression of acne vulgaris.

The effects of isotretinoin therapy on the biliary system.

The aim of the present study was to investigate the potential effects of isotretinoin on the biliary system in patients with acne vulgaris receiving isotretinoin therapy. This was a preliminary retrospective study involving 40 patients with severe acne vulgaris who attended the dermatology clinic and were administered different doses (20 or 30 mg/day) of isotretinoin. Serum levels of AST, ALT, ALP, GGT, total bilirubin, direct bilirubin, and indirect bilirubin at the beginning and at the first month of therapy were scanned, recorded, and statistically analyzed. Total and indirect bilirubin levels at the first month of treatment in 30 patients, receiving isotretinoin at a dose of 20 mg/day, were significantly lower compared to the baseline values (p = .02 and p = .03, respectively), whereas AST and GGT serum levels were significantly higher (p = .003 and p = .006 respectively). No significant reduction in total and indirect bilirubin levels was detectable at the first month of treatment in 10 patients receiving isotretinoin at a dose of 30 mg/day; however, AST, ALP, and GGT levels were significantly elevated in these patients (p = .023; p = .004; and p = .001, respectively). To our knowledge, there is no previous study investigating the effects of isotretinoin on the biliary system, and, therefore, the present study is a preliminary one. Our findings implicate that low dose (20 mg/day) isotretinoin therapy can potentially reduce total and indirect bilirubin levels. Long-term, large-scale, prospective studies with patients receiving different doses of isotretinoin may provide more reliable information regarding the bilirubin lowering effects of isotretinoin and optimum dosing for achieving this clinical effect.

Plasma-soluble urokinase plasminogen activator receptor (suPAR) levels in Behçet's disease and correlation with disease activity.

BACKGROUND: Soluble urokinase plasminogen activator receptor (suPAR), a new biomarker, is a soluble form of membrane-bound receptors secreted from different immune cells. The aim of the present study is to determine plasma suPAR levels in Behçet's disease and their correlation with disease activity. METHODS: Thirty Behçet's disease patients determined according to the International Study Group criteria for Behçet's disease diagnosis and 41 healthy subjects were included in the present study. Micro-enzyme-linked immunosorbent assay was employed to obtain quantitative data. Data of both groups were statistically analyzed. RESULTS: The comparison of C-reactive protein and suPAR plasma levels of the control and Behçet's disease group revealed statistically significant differences (respectively, P = 0.003 < 0.05 and P = 0.020 < 0.05). However, plasma suPAR levels related with disease activity revealed no statistically significant differences (P > 0.05). CONCLUSION: The present study is the first study analyzing suPAR levels in Behçet's disease patients and their correlation with disease activity. However, further prospective studies with larger patient series using suPAR as a new plasma biomarker are required to diagnose and monitor Behcet's disease and to support the findings of the present study.

Resolution of Cutaneous Sarcoidosis Following Topical Application of Ganoderma lucidum (Reishi Mushroom).

Ganoderma lucidum (reishi mushroom) has been used in traditional Chinese and Japanese medicine as a herbal remedy for over 2000 years. Studies have shown that G. lucidum has anti-allergic, anti-oxidant, anti-tumor, anti-viral, and anti-inflammatory properties. A review of the literature revealed that there were no studies examining the use of G. lucidum for the treatment of skin diseases. Here, we report the case of a 44-year-old male patient who used soap enriched with G. lucidum and goat's milk for 3 days in treating annular cutaneous sarcoidosis. The patient showed almost complete regression of the lesions.

The Frequency of Autoimmune Thyroid Disease in Alopecia Areata and Vitiligo Patients.

AIM: Many studies demonstrated that alopecia areata (AA) and vitiligo are commonly associated with autoimmune thyroid diseases. We aimed to investigate the frequency of thyroid dysfunctions and autoimmunity related with vitiligo and AA. MATERIAL AND METHODS: 200 patients, 92 AA and 108 vitiligo diagnosed, were surveyed retrospectively. The control population was in reference range and from Konya, central Anatolian region of Turkey. Thyroid function tests (free T3, free T4, and TSH) and serum thyroid autoantibody (anti-TG, anti-TPO) levels were evaluated in all patients. RESULTS: In vitiligo patients, 9 (8.3%) had elevated anti-TG levels and 16 (14.8%) had elevated anti-TPO, and in 17 patients (15.7%) TSH levels were elevated and 3 (2.8%) patients had elevated fT4 levels and 5 (4.6%) had elevated fT3 levels. Within AA patients, 2 (2.2%) had anti-TG elevation and 13 (14.1%) had anti-TPO elevation, in 7 patients (7.6%) TSH were elevated, and in 1 patient (1.1%) fT4 were elevated and 5 (5.4%) patients had elevated fT3 levels. CONCLUSION: In our study, impaired thyroid functions and thyroid autoantibodies in vitiligo and AA patients were identified at lower rates than the previous studies. According to results of this study there is no need for detailed examination in alopecia areata and vitiligo patients without clinical history.

Frequency of metabolic syndrome in patients with knuckle pads.

Knuckle pads are hyperkeratotic, benign skin lesions that we commonly observe in obese patients. There is no study that investigates the association between metabolic syndrome (MetS) and knuckle pads. We aimed to investigate the frequency of MetS in patients with knuckle pads. Forty-seven patients with knuckle pads and 46 age- and sex-matched controls were enrolled. The presence of MetS was evaluated according to National Cholesterol Education Program-Adult Treatment Panel III criteria. In the patient group, waist circumference (P < 0.01), body mass index (BMI; P < 0.01), and systolic (P < 0.01) and diastolic blood pressure (P < 0.01) were higher than controls, and most of the patients had a history of hypertension (P < 0.01). The presence of MetS was found in 66% of the patients with knuckle pads and in 52.2% of the controls (P = 0.25). In the patient group, compared with controls, more patients had blood pressure above reference values or were on antihypertensive therapy (70.2% and 43.5%, P = 0.017, respectively), and had greater waist circumference value (93.6% and 76.1%, P = 0.038, respectively). The presence of the other three criteria were similar in both groups. Although we found similar MetS frequency in both groups, patients with knuckle pads should be examined for the presence of MetS components, especially abdominal obesity and hypertension.