The Relationship of Serum Trimethylamine N-Oxide Levels with Carotid Intima-Media Thickness and Disease Activity in Psoriasis Patients.

INTRODUCTION: Psoriasis is an inflammatory disease that can cause cardiovascular comorbidities. Some recent studies have indicated that impaired gut microbiota and metabolites may be associated with inflammatory diseases. OBJECTIVES: In this study, the relationship between serum trimethylamine n-oxide (TMAO, a gut bacterial metabolite) level and carotid intima-media thickness (CIMT) and disease severity in psoriasis patients was investigated. METHODS: Age- and gender-matched 73 patients and 72 healthy controls were included in the study. In both groups serum trimethylamine n-oxide(TMAO), oxidized low-density lipoprotein (ox-LDL), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride, total cholesterol, high-sensitivity C-reactive protein (hs-CRP), creatinine, aspartate aminotransferase (AST) and alanine aminotransferase(ALT) levels were recorded and the carotid intima-media thickness (CIMT) was measured by B-mode ultrasonography by a cardiologist. RESULTS: TMAO, hs-CRP, oxidized-LDL, triglyceride and CIMT levels were statistically higher in the patient group. HDL levels were statistically higher in the control group. There was no significant difference between the two groups in terms of total cholesterol and LDL-C levels. In partial correlation analyzes in the patient group, positive correlations were observed between TMAO and CIMT, LDL-C and total cholesterol levels. Linear regression analysis showed that TMAO levels positively predicted CIMT levels. CONCLUSIONS: This study confirmed that psoriasis is a risk factor for the development of cardiovascular disease and that elevated serum TMAO levels in these patients indicate the presence of intestinal dysbiosis. Furthermore, TMAO levels were found to be a predictor of the risk of developing cardiovascular disease in psoriasis patients.

A Rare Cutaneous Hamartomatous Adnexal Tumor: Trichofolliculoma.

Introduction: Trichofolliculoma is a very rare, benign hamartomatous skin adnexal tumor originating from the hair follicle. The tumor which presents as a papule or nodule is usually observed on the scalp and face. Case Presentation: We report the case of a 49-year-old female who presented with a solitary papule on the nose. The lesion which was observed macroscopically and dermoscopically compatible with trichofolliculoma was completely removed by punch biopsy. The diagnosis of trichofolliculoma was confirmed histopathologically, and no recurrence was observed in the follow-up. Conclusion: Trichofolliculomas can macroscopically mimic some skin cancers such as basal cell carcinoma and sebaceous carcinoma. Awareness of its typical clinical and dermoscopic features facilitates diagnosis and prevents aggressive surgical intervention.

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.

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.