[Phylotyping and Determining the Antimicrobial Susceptibility of Cutibacterium acnes Isolated from Patients with Acne Vulgaris]. / Akne Vulgarisli Hastalardan Üretilen Cutibacterium acnes Izolatlarinin Filotiplendirilmesi ve Antimikrobiyallere Duyarlilik Durumlarinin Belirlenmesi.

Cutibacterium acnes (formerly known as Propionibacterium acnes), obligate anaerobic gram-positive diphtheroid, is a member of normal skin microbiota and frequently isolated from acne lesions and also in various infections as an opportunist pathogen. Within the last decade, distinct phylogroups of C.acnes have been discovered, and specific strains associated with human disease were defined. Increasing resistance to antimicrobials used in the treatment of C.acnes infections has been reported. Resistance rates vary among isolates from different geographic locations. However, knowledge about the antimicrobial susceptibility patterns of C.acnes is limited in Turkey. Determining the phylotypes of C.acnes isolates and providing antimicrobial susceptibility data will be very useful in understanding the pathogenesis of the disease, preventing the development of resistance, and applying rational and effective empirical treatment. The aim of this study was to determine the phylotypes and antimicrobial susceptibility patterns of C.acnes and to investigate the relationship among C.acnes phylotypes, the severity of acne and the antimicrobial resistance. C.acnes isolates cultivated from the acne lesions of 57 patients who admitted to the dermatology outpatient clinic of our university hospital and from the skin of 62 healthy control group in a six-month period were included in the study. The acne lesions on the face and chest/upper back were given a score according to the Global acne grading system (GAGS) for describing the severity of acne. The severity was graded as mild if the score was 1-18, moderate with scores from 19 to 30, severe with scores from 31 to 38, and as very severe if the score is more than 39. The isolates were identified by using matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) . Phylotype analysis was performed by polymerase chain reaction (PCR) using specific primers. The minimum inhibitory concentrations (MICs) of clindamycin, erythromycin, azithromycin, tetracycline and doxycycline were determined by agar dilution technique recommended by Clinical and Laboratory Standards Institute (CLSI) for anaerobic bacteria. The majority of the isolates (patient; n= 47, control; n= 47) in both of the patient and control groups were phylotype IA, followed by type IB and type II, respectively and no type III C.acnes was detected. There was no correlation between acne severity and bacterial phylotypes. The resistance rates of clindamycin, erythromycin, azithromycin, tetracycline and doxycycline were found to be 22.8%, 29.8%, 35.2%, 3.5% and 5.3% in the acne patients group, respectively, whereas in the control group the incidence of resistance to these antimicrobials was 11.3%, 21%, 38.7%, 1.6% and 1.6%, respectively. There was no significant difference in antimicrobial resistance between the patient and control groups, except erythromycin (p= 0.043, Fisher's exact) as well as no relationship was found between antimicrobial resistance and phylotypes in both of the groups. The number of isolates, resistant to two or more antimicrobials, was higher in the patients with acne. C.acnes isolates were highly resistant to clindamycin, erythromycin and azithromycin. Type IA constituted the majority of the phylotypes. There was no significant relationship between C.acnes phylotype, antimicrobial resistance and acne severity.

Social Anxiety and Quality of Life in Vitiligo and Acne Patients with Facial Involvement: A Cross-Sectional Controlled Study.

BACKGROUND: Vitiligo and acne vulgaris, commonly affecting the face, have significant psychological effects and impair the quality of life of the affected individuals. Because of their negative effect on physical appearance, these conditions may act as a potential barrier to social relationships and cause social anxiety. OBJECTIVE: The objective of the study was to investigate the social anxiety, quality of life, anxiety, and depression levels of acne and vitiligo patients with facial involvement and compare these levels with healthy controls. METHODS: Thirty-seven vitiligo and 37 acne patients, aged older than 18 years, with facial involvement and 74 age- and sex-matched healthy control subjects were included in the study. The patients and healthy controls were asked to complete the Liebowitz Social Anxiety Scale, the Hospital Anxiety and Depression Scale, and the Dermatology Life Quality Index. Disease severity was evaluated both objectively by the physician and subjectively by the patients using a visual analog scale. RESULTS: Social anxiety, depression, and anxiety levels of vitiligo and acne patients were significantly higher than healthy controls (p < 0.05). Quality of life was impaired in both patient groups (Dermatology Life Quality Index scores for vitiligo: 5.6 ± 5.1; acne: 6.4 ± 6.2). There was no correlation between psychiatric scale scores and disease severity. Quality of life was negatively correlated with social anxiety and depression levels in both patient groups in our study. CONCLUSION: Vitiligo and acne patients had higher levels of social anxiety, anxiety, and depression compared with healthy control subjects. Considering that increased psychosocial morbidity was regardless of age, sex, and disease severity and was correlated with quality of life impairment, evaluation of the psychosocial morbidity, in particular social anxiety, may be valuable in all vitiligo and acne patients.

Predictive factors for acne flare during isotretinoin treatment.

Flare of acne is common at the beginning of isotretinoin treatment. However, severe flare is rare. Multiple comedones, male gender and young age are reported as promoting factors. However, detailed information is still limited. Our aim was to investigate the incidence, types and course of acne flare and the predictive factors for its occurrence. 244 patients were enrolled. Acne grade was defined according to global acne grading system (GAGS) score. Flare was classified according to the increase in number of inflammatory nodules and treatment requirements of the patients. Risk factors (age, sex, duration of acne, basal acne grade, baseline numbers of comedones, papule-pustules, nodules, hyperandrogenism, and presence of sinuses) were investigated. 161 patients completed the study. 79 patients (32%) had facial and/or truncal flare. Flare was mild in 18% (n = 44), moderate in 10% (n = 24), and severe in 4.5% (n = 11) of the patients. For severe flare, male sex, severe acne, GAGS cut-off score greater than 28, presence of more than 44 facial comedones and 2 facial nodules and presence of truncal nodules were found to be predictive. Recognizing predictive factors for severe flare may help to take early precautions and to prevent severe flares which may result with permanent scars.

Patient's perspective: an important issue not to be overlooked in assessing acne severity.

Acne has significant negative effects on an individual's psychosocial functions. There is not always a correlation between the severity of acne and its impact on quality of life. Our objective was to evaluate the correlation between quality of life scales and both the physician's and patient's assessments of acne severity and to find out which quality of life scale is more sensitive to changes in acne severity by using generic and acne specific scales. One hundred and twenty acne patients were enrolled. The physician's assessment of acne severity was made by means of Global Acne Grading System. Patients evaluated their acne severity on a 10-point Likert-type scale. Quality of life was measured by the Turkish version of Acne Quality of Life (AQOL) scale and Short Form-36 (SF-36). One hundred and seven patients answered the questions of the AQOL scale completely and were included in the statistical analysis. The AQOL scale did not correlate with the physician's assessment of acne severity whereas there was a correlation between patients' self assessments and AQOL scale. No correlation was found between SF-36 and either the physician's or patients' own assessments. Assessment of acne should not be limited to objective acne severity measures but also include patients' self assessments and acne specific quality of life scales. These measures, which provide a better understanding of patients' perception of severity, are important tools when taking treatment decisions.

A case of Schamberg's disease responding dramatically to PUVA treatment.

Pigmented purpuric dermatoses are a group of chronic, recurrent disorders characterized by purpuric lesions mainly involving the lower extremities. Their etiology is unknown. Treatment options are limited and none of them have proven benefit. Phototherapy has been reported to be effective in a small number of patients in the literature. We present a case of Schamberg's disease showing a dramatic response to psoralen plus ultraviolet A therapy and discuss the current therapeutic options focusing mainly on phototherapy. We believe that phototherapy is a valuable alternative, especially for patients with long-standing and widespread pigmented purpuric dermatitis.

Prevention of chronic furunculosis with low-dose azithromycin.

BACKGROUND: Chronic furunculosis is a recurrent staphylococcal abscess of the hair follicle. Besides ensuring personal hygiene, the management consists of long-term treatment with topical and systemic antibiotics. OBJECTIVE: An open-labeled, prospective study was conducted to assess the clinical and in vitro efficacy of azithromycin in the long-term suppressive treatment of chronic furunculosis. METHODS: Patients with a history of three or more episodes of furuncles were assigned to receive 12 weeks of suppressive treatment with azithromycin at a weekly dosage of 500 mg. In vitro susceptibility of azithromycin was evaluated with E-test. The primary efficacy parameter was complete absence of furuncles during the 3 months of azithromycin treatment. The secondary efficacy parameter was further absence of furuncles during the 3-month follow-up period. RESULTS: At the end of 3 months of therapy, azithromycin was found to be effective in 19 (79.2%) of 24 patients; 18 of these patients remained in remission during the 3 months of follow-up. All of the strains were methicillin-sensitive. The results of the E-test showed that 15 of 18 strains (83.3%) were susceptible to azithromycin. CONCLUSION: The results of this study indicate that azithromycin is an effective and safe alternative in the treatment of chronic furunculosis caused by methicillin-sensitive Staphylococcus aureus.

Generalized pruritus treated with narrowband UVB.

BACKGROUND: Narrowband UVB phototherapy has been increasingly used in a variety of dermatological diseases. We planned to evaluate its efficacy in generalized pruritus in this prospective study. METHODS: Forty-six patients were included and then divided into two groups: group 1 and group 2 consisted of patients with uremic pruritus and "idiopathic pruritus", respectively. Phototherapy was given three times a week. Efficacy assessments were made by means of visual analog scale (VAS) and pruritus grading score. RESULTS: Thirty-five patients completed the treatment. Mean VAS decreased from 8.2 +/- 1.5 to 3.6 +/- 3 in group 1 and from 7.1 +/- 2.3 to 2.3 +/- 2.8 in group 2 (P < 0.0001). Mean percentage of change in VAS was 54.2% (95% CI 32.6-75.9) and 67.9% (95% CI 53.8-81.9) in group 1 and group 2, respectively. Mean number of treatments was 22 in both groups. Mean cumulative UVB dose was 24,540 mJ/cm(2) and 20,801 mJ/cm(2) in group 1 and group 2, respectively. CONCLUSION: Narrowband UVB is an effective and well-tolerated treatment option for patients with generalized pruritus.

[Enzyme activities of dermatophytes isolated from different clinical samples by ApiZYM method]. / Ce,itli klinik orneklerden izole edilen dermatofitlerin enzim aktivitelerinin ApiZYM yöntemiyle tayini.

Dermatophytes' enzymes may have a role in chronic superficial infections. In this study it was planned to investigate the possible relationship between the enzymatic activities of the dermatophytes and acute or chronic course of the infections. Dermatophytes were isolated from 58 (72%) out of 81 patients with superficial infections. The infections were divided into two groups as acute (< or = 6 weeks) or chronic (> 6 weeks). Isolated fungi were identified by the classical methods and ApiZYM method. ApiZYM exhibits 19 different enzymatic activities. From 11 acute cases; five Epidermophyton floccosum, three Trichophyton rubrum, two Microsporum canis and one Trichophyton mentagrophytes strains were isolated. Of the 47 chronic cases, 96% was due to T. rubrum and 4% due to T. mentagrophytes. Production of alkaline phosphatase, leucine arylamidase and beta-glucosidase enzymes were detected in all tested strains. There was no difference between the enzymatic activities of acute and chronic cases. Alpha-mannosidase activity was detected in all of the species isolated from acute cases whereas none of the chronic cases were positive (P < 0.001). The results of this study suggest that alpha-mannosidase activity may play a role in both cutaneous inflammatory response caused by dermatophytes and the chronicity of the lesions.

Vitamin E does not reduce the side-effects of isotretinoin in the treatment of acne vulgaris.

BACKGROUND: Isotretinoin is widely used in the treatment of severe, recalcitrant, nodular acne. Mucocutaneous side-effects are seen in the great majority of patients and some of them have elevations in their serum lipid and liver enzyme profiles. Recently, it has been shown that addition of vitamin E decreased the toxicity of high-dose retinoids. OBJECTIVE: The purpose of this investigator-blinded, randomized study was to assess whether vitamin E would reduce the side-effects of isotretinoin in the treatment of acne vulgaris. METHODS: Eighty two patients were randomly assigned to one of two treatment groups with isotretinoin (1 mg/kg/day) alone or combined with vitamin E (800 IU/day). The treatment duration was 16 weeks. Mucocutaneous side-effects such as facial erythema, facial dryness, cheilitis and serum lipid and liver enzyme profiles were assessed. RESULTS: There was no difference in the incidence and severity of side-effects related to isotretinoin between the two treatment groups. CONCLUSION: Eight hundred IU/day vitamin E did not improve the side-effects of 1 mg/kg/day of isotretinoin in the treatment of acne vulgaris.

Therapeutic potential of azithromycin in rosacea.

BACKGROUND: Systemic antibiotics currently used in the treatment of rosacea are sometimes associated with uncomfortable side-effects. Therefore, a need for an effective agent with few side-effects and good patient compliance exists. Azithromycin, a macrolide antibiotic with prolonged mode of action, has recently been found to be an effective alternative in the treatment of inflammatory acne. We planned a study to evaluate the efficacy and safety of azithromycin in rosacea. METHODS: An open-labeled study was performed in a population of 18 patients, with Plewig-Kligman stage 2 rosacea. Patients were given oral azithromycin for 12 weeks in decreasing doses. RESULTS: Fourteen subjects completed the trial. The treatment produced therapeutic benefits with regard to total scores as well as inflammatory lesion scores. At the end of 12 weeks, there was a 75% decrease in total scores (P < 0.001) and an 89% decrease in inflammatory lesion scores compared with basal values. Improvement continued during the 4 weeks after treatment. Adverse effects were minimal and well tolerated in most patients. CONCLUSION: Azithromycin is a promising agent in the treatment of rosacea with its few side-effects and good patient compliance.

Leg ulcers and hydroxyurea: report of three cases with essential thrombocythemia.

CASE 1: A 65-year-old woman with essential thrombocythemia (ET) had been taking oral hydroxyurea (HU), 1,000 mg daily, for 7 years. Six months ago, she developed an ulcer on the outer part of her left ankle, which healed spontaneously within 2 months. She presented with a new, tender, shallow ulcer, 2 cm x 2 cm in size, at the same site. Doppler examination revealed thrombosis of the left common femoral vein and a calcified atheroma plaque of the left common femoral artery. The dosage of HU was decreased to 500 mg daily when the platelet counts were found to be within normal levels. The ulcer completely healed within 2 months with occlusive wound dressings, and has not recurred within the follow-up period of 1 year. CASE 2: A 56-year-old women presented with multiple, painful, leg ulcers of 1 year duration. She had been diagnosed as having ET and had been on HU therapy, 1,500 mg/day, for the past 5 years. Interferon-alpha-2b was started 3 months ago, in addition to HU, which was tapered to 1,000 mg daily. She had suffered from hypertension for 20 years treated with nifedipine and enalapril, and had recently been diagnosed with diabetes mellitus which was controlled by diet. Examination revealed three ulcers located on the lateral aspects of both ankles and right distal toe. Arterial and venous Doppler examinations were within normal limits. Histopathology of the ulcer revealed nonspecific changes with a mixed inflammatory cell infiltrate around dermal vessels. The ulcers completely healed within 10 weeks with topical hydrocolloid dressings. After healing, she was lost to follow-up. A year later, it was learned that she had developed a new ulcer at her right heel, 3 months after her last visit (by phone call). This ulcer persisted for 8 months until HU was withdrawn. CASE 3: A 64-year-old woman with ET presented with a painful leg ulcer of 6 months' duration. She had been taking oral HU for 5 years. She had a 20-year history of hypertension treated with lisinopril. Examination revealed a punched-out ulcer of 2 cm x 2 cm over the right lateral malleolus. Doppler examination of the veins revealed insufficiency of the right greater saphenous and femoral veins. Angiography showed multiple stenoses of the right popliteal and femoral arteries. As her platelet count remained high, HU was continued. During the follow-up period of 13 months, the ulcer showed only partial improvement with local wound care.