Assessing Public Awareness and Perception of Teledermatology Via Survey.

INTRODUCTION: Teledermatology represents an alternative medical approach allowing for the remote assessment of a patient's clinical information without the need for face-to-face consultations. OBJECTIVES: This study aims to gauge the public's awareness and perception of teledermatology. METHODS: This research employed a cross-sectional observational design. Data collection was executed using an online survey. Sociodemographic attributes of all participants, such as age, gender, and occupation, were recorded. The survey, designed using Google Forms, comprised two sections: demographic information (5 questions) and queries related to teledermatology (10 questions). Questions and options in the survey were reviewed and revised by two dermatologists to eliminate potential misunderstandings, grammar, and other errors. Power analysis indicated a requirement of a minimum of 527 participants, given a 0.05 margin of error, 98% confidence level, and 0.50 response distribution. RESULTS: A total of 873 individuals completed the survey- 47.7% were male and 52.3% were female. Students made up 48.1% of the participants, while 22.6% were civil servants. The Marmara Region had the highest participation rate at 47.7%. Remarkably, 41.9% of participants were unfamiliar with the term "teledermatology". However, 57.2% expressed a preference for consultations via teledermatology. Furthermore, 63.7% mentioned facing challenges when attempting to communicate with dermatologists for skin-related concerns. A notable 71.6% supported the formal implementation of teledermatology in our country. CONCLUSIONS: Our survey highlighted a limited awareness of teledermatology among participants, yet a majority showed a preference for teledermatology consultations. For a comprehensive understanding of public knowledge and perception towards teledermatology, more extensive, multicentric studies are necessary.

The relationship between seborrheic dermatitis and body composition parameters.

OBJECTIVE: Seborrheic dermatitis (SD) is a chronic, recurrent inflammatory skin disease characterized by clinically scaly patches. It is known that skin diseases with chronic inflammation are associated with comorbid conditions such as metabolic syndrome, obesity, cardiovascular diseases (CVD) and diabetes. In recent years, there are studies investigating the relationship of SD with metabolic syndrome, hypertension, obesity and nutritional factors. However, there is no study evaluating body composition parameters in SD patients. In the light of this information, it was aimed to evaluate the relationship between SD and body composition parameters. METHODS: The study was conducted on a total of 78 participants, including 39 SD patients over the age of 18 and 39 age- and gender-matched control patients, who applied to the University Faculty of Medicine Dermatology outpatient clinic. Body composition parameters were measured for each participant with the Tanita MC 580 Body Analyzer. In addition, SD area severity index (SDASI) was calculated in the SD patient group. These parameters were compared between the case and control groups. RESULTS: There was no significant difference concerning height (p=0.208), weight (p=0.309), body mass index (p=0.762), fat mass (p=0.092), metabolic age (p=0.916), body density (p=0.180), mineral (p=0.699), visceral adiposity (p=0.401), protein (p=0.665), and other body composition parameters, between the case and control groups. There was only positive correlation between SDASI and height (p=0.026) and protein (0.016) value. CONCLUSION: SD may be associated with obesity, metabolic syndrome, insulin resistance, and CVD, but the results are unclear and further studies are needed.

The effect of COVID-19 on development of hair and nail disorders: a Turkish multicenter, controlled study.

BACKGROUND: A broad spectrum of skin diseases, including hair and nails, can be directly or indirectly triggered by COVID-19. It is aimed to examine the type and frequency of hair and nail disorders after COVID-19 infection. METHODS: This is a multicenter study conducted on consecutive 2171 post-COVID-19 patients. Patients who developed hair and nail disorders and did not develop hair and nail disorders were recruited as subject and control groups. The type and frequency of hair and nail disorders were examined. RESULTS: The rate of the previous admission in hospital due to COVID-19 was statistically significantly more common in patients who developed hair loss after getting infected with COVID-19 (P < 0.001). Telogen effluvium (85%) was the most common hair loss type followed by worsening of androgenetic alopecia (7%) after COVID-19 infection. The mean stress scores during and after getting infected with COVID-19 were 6.88 ± 2.77 and 3.64 ± 3.04, respectively, in the hair loss group and were 5.77 ± 3.18 and 2.81 ± 2.84, respectively, in the control group (P < 0.001, P < 0.001). The frequency of recurrent COVID-19 was statistically significantly higher in men with severe androgenetic alopecia (Grades 4-7 HNS) (P = 0.012; Odds ratio: 2.931 [1.222-7.027]). The most common nail disorders were leukonychia, onycholysis, Beau's lines, onychomadesis, and onychoschisis, respectively. The symptoms of COVID-19 were statistically significantly more common in patients having nail disorders after getting infected with COVID-19 when compared to the control group (P < 0.05). CONCLUSION: The development of both nail and hair disorders after COVID-19 seems to be related to a history of severe COVID-19.

Evaluation of plasma zonulin level and its relationship with inflammatory cytokines in patients with vitiligo.

BACKGROUND: It has been proven that there is an increase in intestinal permeability in some autoimmune diseases. In our study, we purposed to assess intestinal permeability in vitiligo disease by looking at zonulin levels. At the same time, we aimed to examine the correlation of inflammatory cytokines and lipopolysaccharide (LPS) levels with zonulin. METHODS: Forty-one patients and 41 healthy participants were involved in our study. Blood samples were taken from all patients and controls, and the levels of zonulin, tumor necrosis factor (TNF)-α, interleukin (IL)-6 and LPS were examined. RESULTS: The mean of zonulin in the patient group was found to be statistically higher than the control group (p < 0.05). A positive correlation was found between zonulin level and IL-6, TNF-α, and LPS levels (p < 0.05). TNF-α and LPS levels in the vitiligo group were significantly higher than in the control group, but there was no such significance in terms of IL-6 levels. CONCLUSION: We think that serum zonulin level increases and intestinal permeability increases in vitiligo disease.

Evaluation of serum TWEAK, TRAIL, and oxidative stress markers in rosacea patients.

BACKGROUND: Rosacea is a chronic inflammatory skin disease of unknown pathogenesis. TWEAK and TRAIL are two cytokines thought to have a role in the pathogenesis of some inflammatory and autoimmune diseases. AIMS: The purpose of this study was to examine TWEAK and TRAIL serum levels and oxidative stress markers in patients with rosacea. MATERIAL AND METHOD: Forty rosacea patients and 40 sex- and age-matched healthy controls were involved in the study. Serum TWEAK and TRAIL levels were evaluated with ELISA kits. Serum total antioxidant status, total oxidant status, total thiol, native thiol, disulfide levels were evaluated, and oxidative stress index was computed. RESULTS: Serum levels of TWEAK, TRAIL, and oxidative stress markers did not differ statistically in the patients and controls. Both TWEAK and TRAIL levels in the patients were detected to be statistically higher in male than in female. CONCLUSION: TWEAK and TRAIL may not have a systemic effect in rosacea, unlike other inflammatory diseases. More studies are needed to investigate the role of TWEAK and TRAIL in rosacea.

Platelet rich plasma application by dermapen microneedling and intradermal point-by-point injection methods, and their comparison with clinical findings and trichoscan in patients with androgenetic alopecia.

Androgenetic alopecia (AGA) is a progressive hair loss disease that occurs with the effect of androgens and genetic predisposition. Hair thinning and hair loss affect people's self-confidence and self-image more than is thought. In these patients, platelet rich plasma (PRP) treatment is used in addition to the limited medical treatments available. However, there is a lack of standardization for the application method of PRP treatment in the literature. The number of studies in which objective data and hair analysis parameters were revealed to demonstrate the effectiveness of PRP treatment is also very limited. In this study, it was aimed to show the efficacy of PRP treatment with trichoscan data in AGA patients and to compare dermapen-mediated microneedling and point-by-point technique injection application methods. The study was conducted with 62 male AGA patients, aged between 18 and 55 years, who applied to the University Faculty of Medicine, Department of Dermatology, and ranged from Norwood-Hamilton Stage II-V. The patients were randomly divided into two groups and one group was given microneedling with a dermapen, an electrical device that makes automatic needling, and the other group was given manual injection with point-by-point technique with a 30-gauge needle. Before the first treatment, each patient underwent a trichoscan hair analysis evaluation. A total of four sessions of PRP treatment were performed, as three sessions at 2-week intervals and the fourth session 1 month after the last session. The mean age of the cases was 33.13 ± 6.36. According to Norwood-Hamilton staging, stage III was detected with the highest rate of 46% (29). Hair pulling test became significantly negative after treatment (p < 0.05). Statistically significant differences were found in trichoscan analysis parameters for hair count, hair density, terminal hair count, and terminal hair density in both groups compared to pretreatment (p < 0.05). Between the groups, a statistically significant difference was found between the averages of anagen hair, telogen hair, and hair length in the dermapen treated group compared to the group treated with the point-by-point technique. In our study, the efficacy of PRP treatment for AGA patients was demonstrated by trichoscan parameters. Among the PRP application methods, dermapen-mediated application was found to be superior to the point-by-point technique in terms of anagen, telogen, and average hair length parameters.

Dermatological signs in liver transplant recipients.

BACKGROUND: In recent years, the number of liver transplantations for advanced-stage liver diseases has considerably increased and the patients have a wide range of dermatologic manifestations. AIM: This study aims to reveal cutaneous, mucosal, and nail lesions in liver transplant recipients in quite large patient series. PATIENTS/METHODS: The study included 520 patients in the Inonu University Liver Transplantation Institute. New and followed-up patients attended to the study between May and October 2019. The patients were examined by a dermatologist, and their data were recorded. RESULTS: The study included 163 female and 357 male patients with the main age of 44.20 ± 18.18 (range: 1-83 years), and 465 livers (89.4%) were taken from live donors, while 54 livers (10.4%) were taken from cadavers. A total of 314 (60.4%) patients had dermatophyte infections, 174 (33.4%) patients had pathological nail changes, and 427 (82.1%) patients had oral mucosal lesions. Graft-versus-host disease (GVHD) developed in 9 (1.73%) patients after the transplantation, and 5 patients died of GVHD. Four patients had cutaneous malignancies. CONCLUSIONS: Tumoral and nontumoral dermatological diseases may be encountered following the transplantation depending on underlying liver disease, immunosuppressive treatment, the graft itself, or any primary cutaneous disease. Liver transplantation recipients require a multidisciplinary clinical approach, and dermatological care must be an integral part of this approach.

Evaluation of the effect of 577-nm pro-yellow laser on demodex intensity.

The skin disease of the pilosebaceous unit created by demodex mites is called demodicosis. Recently, it has been brought to the agenda that laser therapies can be effective in reducing the intensity of demodex parasite. With this study, we aimed to evaluate the effect of pro-yellow laser applied to the face on the intensity of demodex parasite. Twenty-five patients who had referred to the dermatology polyclinic with a complaint of rash on the face and who had been given proyellow laser therapy during the past year were included in the study. Average pre-laser therapy demodex number per cm2 was 3.9 ± 5.0, while average post-therapy demodex number per cm2 was 2.6 ± 4.9 (p = .117). The 577-nm pro-yellow laser caused a change in demodex density. We found that the number of demodex following laser therapy decreased in some patients, while it increased in some others.

Comparison of patients' diagnoses in a dermatology outpatient clinic during the COVID-19 pandemic period and pre-pandemic period.

AIM: In this study, we compared the current diagnoses of patients admitted to the dermatology outpatient clinic with the diagnoses during the non-pandemic period, and we examined the effect of COVID-19 on the patient profile. METHODS: Diagnoses were compared by examining the patient files of the 3-month period when the pandemic was influential in our country and the 2-week non-pandemic period corresponding to the same season a year ago. The outpatient diagnoses in the first month and the last month of the 3-month pandemic period were also compared. RESULTS: During the 3-month pandemic process, the most common reasons for applying to the outpatient clinic were acne, urticaria, psoriasis, and allergic/irritant contact dermatitis. Urticaria, psoriasis, allergic/irritant contact dermatitis, scabies, liken planus, mycosis fungoides, zona zoster, recurrent aphthous stomatitis and polymorph light eruption were statistically more common in the pandemic period. Moreover, acne, other eczematous dermatities, verruca, androgenic alopecia, and melanocytic nevus diagnoses were found to decrease statistically during the pandemic period when compared with the non-pandemic period. CONCLUSION: Unlike other studies, the present study evaluated the patient diagnoses during the pandemic period and the period a year before and discussed the possible reasons for the changes in patient profiles.

The efficacy of a single-session pro-yellow laser in the treatment of facial telangiectasia.

Facial telangiectasia (FT) is a condition in which small dilated vessels visibly protrude on the surface of the skin. The aim of this study was to evaluate the efficacy and safety of a single-session pro-yellow laser in the treatment of FT and spider angioma (SA) to compare it with a limited number of studies conducted on this subject. In this pilot study, we reviewed 41 patients who admitted to our dermatology clinic with FT and SA and were treated by using pro-yellow laser. The efficacy of the treatment was evaluated using the recorded clinical information and digital camera images. The improvement was graded as complete (90-100%), very good (75-89%), good (50-74%), moderate (25-49%), and weak (< 25%). Of the 41 patients included in the study, 37 (90.2%) had FT and four (9.8%) had SA. Twenty-two patients were female and 19 were male. Pro-yellow laser therapy was generally well tolerated by patients, and minimal pain occurred during the application. In 1-month follow-up, good, very good, or complete recovery was achieved in 51.4% of the FT patients. The new pro-yellow laser only has a yellow light wavelength. Its unique wavelength at 577-nm yellow light is ideal for vascular lesions. In this study, 51.4% of the patients with FT achieved good, very good, or complete improvement after a single session of 577-nm pro-yellow laser, and complete improvement was achieved in all the four patients with SA.

Fragmented QRS complexes are associated with subclinical left ventricular dysfunction in patients with Behcet's disease: Four-dimensional speckle tracking echocardiography.

BACKGROUND: Behcet's disease (BD) is a chronic systemic inflammatory disease in which early detection of cardiac involvement is essential. The aim of this study was to assess the left ventricular (LV) functions in BD patients using four-dimensional (4D) speckle tracking echocardiography (STE) and to test the correlation between LV dysfunction and the presence of QRS fragmentation. METHODS: This cross-sectional study included 64 Behcet's patients and 48 healthy volunteers. The BD group was divided into two subgroups depending on the presence (fQRS+) or absence (fQRS-) of fragmented QRS (fQRS). In both groups, left ventricular global area strain (LV-GAS), global radial strain (GRS), global longitudinal strain (GLS), and global circumferential strain (GCS) were obtained with 4D echocardiography. RESULTS: GAS, GRS, GLS, and GCS values were significantly different in Behcet's patients and in healthy volunteers. GLS and GAS values were lower in the fQRS+ than in the fQRS- group (-15.8 ± 1.8 and -17.9 ± 1.6, P = .001 vs -25.0 ± 3.1 and -29.2 ± 4.2, P < .001, respectively). The duration of disease was longer in fQRS+ than in fQRS- patients (120.8 ± 67.4 vs 71.0 ± 40.5, P < .001). Multiple linear regression analysis showed that fQRS and disease duration were independent predictors of LV-GAS. CONCLUSIONS: Four-dimensional STE may be helpful for the prediction of early cardiac dysfunction in patients with BD. The presence of fQRS may be an indicator of subclinical LV dysfunction.

Evaluation of the relationship between androgenetic alopecia and blood groups and Rhesus factor.

BACKGROUND/AIM: Androgenetic alopecia (AGA) is the most common type of hair loss. Androgens and genetic factors are responsible for pathogenesis. Blood groups are genetic markers that are used to identify human gene variation. The aim of this study was to evaluate the blood group distribution in patients with AGA and to compare it with healthy population. MATERIALS AND METHODS: A total of 207 patients diagnosed with AGA in dermatology clinic and whose blood group records were available, between 2010 and 2019, were included in the study. Six hundred forty two healthy individuals who matched with the patient group in terms of age and sex, who attending to the family medicine outpatient clinic of our hospital in order to learn their blood groups were included as the control group. RESULTS: When the results were compared, no statistically significant difference was found between the two groups (P Ëƒ .05). CONCLUSION: We could not find any relationship between AGA and blood groups. However, in order to determine this relationship more clearly, further multicentre studies including more cases and investigating subgroups of the cases are needed.

Views and experiences of dermatologists in Turkey about teledermatology during the COVID-19 pandemic.

BACKGROUND: Teledermatology is an alternative medical science that allows evaluation of patient's clinical information over a distance without requiring face-to-face examination. Due to COVID-19, social distancing has become important these days, and teledermatology can help physicians and patients in overcoming the barriers of accessing health care. AIM: In this study, we aim to evaluate how dermatologists in our country have viewed and experienced teledermatology during the pandemic through surveys. PATIENTS/METHODS: The study was carried out by using an online survey for evaluating the teledermatology experiences of dermatologists in Turkey and how they have viewed teledermatology during the 2-month pandemic period and the 2-month prepandemic period. RESULTS: The number of patients evaluated with teledermatology methods was found to be significantly higher in the pandemic period when compared with the prepandemic period. The rates of using video calls with mobile phone and online video calls were found to be significantly higher in the pandemic period when compared with the prepandemic period. CONCLUSION: Our study results show that the teledermatology method had a higher rate of usage compared to before the pandemic.

Intravascular lymphoma presenting with paraneoplastic syndrome.

Intravascular lymphomatosis (IVL) is a rare type of B-cell non-Hodgkin lymphoma (BCNHL), which can mimic many other diseases. Fever, neurological symptoms, and skin findings are the most frequent clinical findings. Intravascular lymphomatosis may be associated with genetic factors and infection with human immunodeficiency virus (HIV), human herpesvirus 8 (HHV-8), human T-lymphotropic virus 1 (HTLV1), Epstein-Barr virus (EBV), and hepatitis B virus (HBV). A 50-year-old man was hospitalized with recalcitrant hyponatremia of unknown cause. He had also telangiectatic, indurated, slightly erythematous plaques on his trunk for the last 10 days. His past medical history was unremarkable, although he was a carrier of hepatitis B. Multiple skin biopsies were performed and were considered to be diagnostic of IVL. The hyponatremia was unresponsive to water restriction and hypertonic solution support but it resolved with B cell directed chemotherapy. A final diagnosis was made as syndrome of inappropriate antidiuretic hormone (SIADH) in the setting of IVL. This case had a relatively early diagnosis with just 10-days of skin lesions. Intravascular lymphomatosis is a very rare disease and is usually difficult to diagnose. An even more uncommon presentation is IVL complicated by a paraneoplastic syndrome. There are prior reported cases of SIADH in the setting of IVL. However, this case underscores the importance of evaluating patients with SIADH for potential IVL.

Recurrent angiolymphoid hyperplasia with eosinophilia during several pregnancies.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare, benign vascular tumor. Although its etiology is not clearly known, infection, hormonal factors, and trauma are the suspected reasons. There are few cases considered to be related to pregnancy described in the literature. Granulomas are rarely seen in the histopathology and only four patients with granulomas have been described. Herein, we will present a 28-year-old woman who has been pregnant three times; in every pregnancy, she developed pink nodular lesions on the back of her ear. In the first two pregnancies, the lesions had appeared during the pregnancy and regressed completely in the postpartum period. In her third pregnancy, the condition emerged again and lasted 1.5 years after birth of her child. Histopathology exhibited ALHE with granulomas. Although the relationship between ALHE and pregnancy is already known, there are few cutaneous ALHE cases associated with pregnancy reported in the literature. This association is further supported by this case having recurrent ALHE during each pregnancy period. Also, the presence of naked granuloma in histopathology, unlike most of the cases, contributes to the current histopathological data.

Investigation of monocyte HDL ratio as an indicator of inflammation and complete blood count parameters in patients with acne vulgaris.

AIMS: Acne vulgaris is a common inflammatory skin disease that affects the pilosebaceous unit. Increased sebum production, hyperkeratosis in follicular infundibulum, inflammation and Propionibacterium acnes are among aetiological factors. Complete blood count (CBC) parameters are used as diagnosis biomarkers for many diseases related with inflammatory processes. Although monocyte/HDL ratio (MHR) has been defined as an inflammatory marker recently, we did not come across any studies about MHR in acne, which is known to be an inflammatory disease. The present study was conducted to compare CBC parameters and MHR levels in acne vulgaris patients and healthy controls (HCs). METHODS: Sixty-five acne vulgaris patients followed in our clinic between January 2018 and December 2019 and 36 HCs matching in terms of age and sex were included in the study. Patients and HCs were compared in terms of CBC parameters [neutrophil, monocyte, platelet, lymphocyte, neutrophil/lymphocyte (NLR), monocyte/lymphocyte (MLR), platelet/lymphocyte (PLR)], HDL and MHR ratio. RESULTS: When compared with the HCs, acne vulgaris patients had statistically significantly higher neutrophil, NLR ratio and HDL (P = .042, P = .011 and P = .014, respectively). No statistically significant difference was found between acne vulgaris patients and the HCs in terms of other CBC parameters and MHR ratio (P > .05). CONCLUSIONS: We believe that prospective studies consisting of large patient series are needed to understand whether CBC parameters and MHR ratio can be used as an inflammatory marker in acne vulgaris patients.