Epidemiological and clinical characteristics of malignant melanoma in Southeast Anatolia in Turkey.

INTRODUCTION: The present study aimed to establish the epidemiological and clinical characteristics of patients who were histopathologically diagnosed with malignant melanoma (MM). METHODS: The present study retrospectively analyzed the data of 78 patients who were histopathologically diagnosed with MM in Dicle University Medical Faculty, Dermatology and Medical Oncology departments between 2005 and 2014. RESULTS: The study included 78 patients in total with 44 (56.4%) male and 34 (43.6%) female. Median age of the patients was 62.50 years (range: 27 - 84 years). Of the patients, 78.2% (n = 61) had cutaneous melanoma, 8.9% had solid organ melanoma, and 2.5% had ocular and mucosal melanoma. The most common tumor localization among the patients was the lower extremities with 29.4% (n = 23). The most common histopathological type was nodular malignant melanoma with 35.8% (n = 28). Based on TNM, Clark and Breslow classifications, 26.9% (n = 21) of the patients were stage 4, 26.9% (n = 21) were Clark stage 4, and 37.1% (n = 29) were Breslow stage 4. Median overall survival in all patients was 14.9 months (95% CI 10.9 - 18.8 months). In the multivariate Cox analysis, only stage statistically significantly affecting survival [odds ratio (OR): 0.54; (95% CI 0.16-1.82, p = 0.02)]. CONCLUSION: Malignant melanoma data are also important for the optimal utilization of effective methods and healthcare resources to prevent the disease. In order to minimize MM mortality and morbidity, not only the society but also physicians from primary and secondary care hospitals should become familiar with melanoma.

Clinical and dermoscopic evaluation of cutaneous leishmaniasis.

BACKGROUND: Dermoscopy is a method to aid in the visualization of the epidermis and dermis. In recent years, the use of dermoscopy in the diagnosis of non-melanocytic lesions such as those of leishmania cutis has increased. OBJECTIVES: This study was intended to establish whether dermoscopic investigation has any diagnostic value in cutaneous leishmaniasis (CL). METHODS: Fifty-five patients diagnosed with CL at the Department of Dermatology, Faculty of Medicine, Dicle University, between February and October 2012, were included in the study. Collectively, the patients exhibited a total of 127 lesions. RESULTS: The mean ± standard deviation age of the patients was 25.7 ± 21.3 years (range: 4-86 years). Twenty-three (41.8%) patients were male, and 32 (58.2%) were female. In dermoscopy, teardrop-like structures were observed in 42.5% of the lesions. Vascular structures were detected in 115 (90.6%) lesions; no vascular structures were observed in 12 (9.4%) lesions. Branching, linear, comma-like, and polymorphic vessels were seen more commonly in lesions on the face; pin-point and hairpin-like vessels were seen more commonly in lesions on the upper extremities. CONCLUSIONS: When the findings obtained in this study were evaluated along with those reported in the literature, it became apparent that follicular plugs, also called "teardrop-like structures", seen on the face and neck may be a dermoscopic feature specific to CL. As hairpin-like vessels seen in an asymmetric radial arrangement were often observed on parts of the body other than the face, further dermoscopic studies comparing the lesions of CL with other ulcerating lesions are necessary.

Serum Cytokine Levels in Behçet's Disease.

BACKGROUND: The aim of this study is to investigate and compare the serum levels of various cytokines in patients with Behçet's Disease and healthy controls. METHODS: Thirty-five patients with Behçet's disease and 29 age and sex-matched healthy controls were included in the study. The patients were separated into groups with active and inactive disease. Serum IL-2, IL-6, IL-8, IL-10, IL-17A, and IFN-γ levels were determined using the enzyme-linked immunosorbent assay method. Cytokine levels of the two patient groups and healthy controls were compared using SPSS 15.0. RESULTS: Ten patients with active disease and 25 patients with inactive disease were present. Serum IL-8 levels of active BD patients were higher compared to inactive patients (P = 0.048) and healthy controls (P = 0.02). IL-8 levels were correlated with the duration of symptoms (r = 0.490, P = 0.003) and time passed since diagnosis (r = 0.579, P ˂ 0.001). CONCLUSION: Behçet's disease involves complex interactions of cells of the immune system, mainly T lymphocytes and neutrophils. Further studies on the cytokine profile in Behçet's disease will aid in elucidation of its pathogenesis.

Investigation of dermatology life quality index and serum prolactin and serum dehydroepiandrosterone sulphate levels in patients with chronic urticaria.

BACKGROUND: Chronic urticaria (CU) is known to be one of the most disturbing diseases which significantly affect the quality of life. Prolactin (PRL) and DHEA-S (dehydroepiandrosterone sulfate) are stress-associated hormones in chronic urticaria. OBJECTIVE: In the present study, we measured DHEA-S and prolactin levels of CU patients, compared them with healthy subjects and evaluated the association between disease status and serum levels. METHODS: Plasma DHEA-S and serum PRL concentrations were measured in 48 CU patients and 31 healthy subjects. CU activity was assessed with the use of the symptom scores recommended with EAACI/GALEN/EDF guidelines. All the patients participating in this study were evaluated by means of Dermatology Life Quality Index (DLQI). With respect to DLQI and clinical activity scores, plasma DHEA-S and serum prolactin levels were compared. RESULTS: Median plasma concentration of DHEA-S was significantly lower in CU patients as compared with healthy subjects (p = 0.026). DHEA-S levels of females were significantly lower than males (p = 0.001). Mean PRL values of the patients were higher than the controls, but not statistically significant (p = 0.619) and there was a statistically signifcant inverse correlation with DHEA-S levels (p = 0.04, r = -0.298). Therewas a significant correlation between DLQI and clinical disease activity (p < 0.001, r = 0.748). CONCLUSIONS: The exact relation of hormones to CU pathogenesis remains to be determined by further clinical studies. In addition, therapies aiming to increase DHEA-S and decrease PRL may be subject to trial in CU.

Results of patch testing in pediatric patients with plantar dermatitis and literature review.

We aimed to determine the frequency of positive patch test reactions in pediatric patients with plantar dermatitis. Children diagnosed as inflammatory dermatitis of the plantar foot were included. Demographic and clinical characteristics of the patients were recorded, and patch testing was done using the European standard series antigens. Seventeen patients (9 females, 8 males) were included in the study. Ages of the patients ranged from 4-13 years, and the median age was 7.0. Seven patients had one to three positive reactions, seven had all negative reactions, one showed angry back syndrome, and results of two could not be assessed. Dermatitis of the feet is not rare in pediatric patients, and a significant percentage of these patients will be diagnosed as allergic contact dermatitis (ACD) if detailed and appropriate patch testing is done.

Comparative study of 5% and 2.5% potassium hydroxide solution for molluscum contagiosum in children.

BACKGROUND: Molluscum contagiosum (MC) is a pediatric viral infection that is fairly contagious. Although various treatment methods are available, the presence of facial lesions limits options of therapy. AIM: We aimed to test an alternative treatment consisting of application of two different concentrations of potassium hydroxide (of KOH 5% solution and of KOH 2.5% solution) aqueous solution. METHODS: In this study we evaluated the effectiveness and side-effects of daily applications of potassium hydroxide (KOH) aqueous solution at 2.5% and 5% concentrations, twice daily in 29 children with MC. Out of a total of 29 patients with molluscum contagiosum included in the study, 13 patients in the 2.5% KOH group and 12 patients in the KOH 5% group completed the study. Families were instructed to apply potassium hydroxide twice a day. The assessment of response and side-effects were performed on days 0, 15, 30, 45 and 60 (visits were numbered 1, 2, 3, 4 and 5, respectively) and one month after. RESULTS: We had a total of 11 (44%) patients who completely recovered after the fifth visit. While eight (66.7%) of these 11 patients were in the 5% treatment group, three (23.1%) patients were in the 2.5% treatment group, and there was a statistically meaningful difference (p < 0.047). Patients with fewer lesions remitted better (p < 0.05). When number of lesions were taken into consideration, difference between the two treatment groups appeared after the fourth visit (p < 0.001). There were no statistical differences between the two groups with respect to side-effects (p = 0.682). CONCLUSIONS: Potassium hydroxide solution at a concentration of 5% was more effective than 2.5% in our patients. The treatment was well-tolerated on the face with the advantage of administration of lower concentrations. This study suggests potassium hydroxide may be a more preferable mode of treatment for molluscum contagiosum lesions on the face.

Immune mechanisms and the role of oxidative stress in intrahepatic cholestasis of pregnancy.

INTRODUCTION: The purpose of this study was to investigate levels of inflammatory cytokines such as interleukin 6 (IL-6), tumor necrosis factor α (TNF-α) and neopterin and oxidative stress status in patients with intrahepatic cholestasis of pregnancy (ICP) as well as their potential role in the pathophysiology. MATERIAL AND METHODS: Thirty patients with ICP (Group 1) and 30 healthy pregnant women (Group 2) were included in this prospective case-control study. Levels of IL-6, TNF-α and neopterin were determined in both of the groups. Total anti-oxidant status (TAS) and total oxidative stress (TOS) levels were determined by means of a fully automated Erel method. Oxidative stress index (OSI) was calculated as the ratio of TOS to TAS. RESULTS: There was no significant difference between the groups in IL-6 and TNF-α levels (p = 0.105 and p = 0.722, respectively). The mean neopterin level was significantly higher in Group 1 compared to Group 2 (2.34 ±0.77 and 1.57 ±0.38, respectively, p = 0.001). In addition, TAS, TOS and OSI levels were significantly higher in Group 1 (p = 0.004, p = 0.001 and p = 0.001, respectively) compared to Group 2. DISCUSSION: Intrahepatic cholestasis of pregnancy is an inflammatory disorder in which maternal immune reaction may play a role. Interleukin 6 and TNF-α, which are some of the markers of humoral reaction, act as an indicator of abnormal reaction rather than acute-phase reaction in ICP. Further clinical trials and supportive placental findings are needed on the role of cytokines in cellular and humoral immune reactions during the symptomatic period and delivery to better understand the role of immune mechanisms in the aetiology of ICP.

Expression of interleukin-17 in lesions of erythema multiforme may indicate a role for T helper 17 cells.

INTRODUCTION: The aim of this study was to evaluate levels of interleukin (IL)-2, IL-6, IL-8, IL-10, IL-17A and interferon γ (IFN-γ) in the serum of patients with erythema multiforme (EM) and to search for the presence of IL-17-expressing cells in lesional samples of EM. MATERIAL AND METHODS: A total of 32 patients (22 females and 10 males) diagnosed with EM of the minor or major type were included in the study. Levels of IL-2, IL-6, IL-8, IL-10, IL-17A and IFN-γ in the serum were determined and compared with healthy controls. Biopsy specimens were stained with haematoxylin and eosin (HE) and monoclonal antibodies to CD4, CD8 and IL-17 for immunohistochemical examination. RESULTS: IL-2, 6, 8 and 17A were significantly higher in the patient group (p = 0.016, p = 0.001, p = 0.004, p = 0.006, respectively) and levels of IL-10 were significantly lower than in the control group (p = 0.046). The cellular infiltrate in lesions of EM was composed mainly of CD4+ T lymphocytes. The presence of IL-17-expressing cells, at proportion of 5 to 50%, was observed in the infiltrate. CONCLUSIONS: The demonstration of IL-17-expressing cells in lesions of EM in this study has brought forth the assumption that Th17 cells may be involved in the pathogenesis of EM.

Metabolic changes and serum ghrelin level in patients with psoriasis.

Background. Serum ghrelin levels may be related to metabolic and clinical changes in patients with psoriasis. Objective. This study was performed to determine the possible effects of serum ghrelin in patients with psoriasis. Methods. The study population consisted of 25 patients with plaque psoriasis. The patients were questioned with regard to age, gender, age of onset, duration of disease, height, weight, and body mass index (BMI). In addition, fasting blood sugar, triglyceride, cholesterol levels, insulin, and ghrelin levels were measured. Results. The mean serum ghrelin level was 45.41 ± 22.41 in the psoriasis group and 29.92 ± 14.65 in the healthy control group. Serum ghrelin level was significantly higher in the psoriasis group compared with the controls (P = 0.01). The mean ghrelin level in patients with a lower PASI score was significantly higher than in those with a higher PASI score (P = 0.02). Conclusion. The present study was performed to determine the effects of ghrelin in psoriasis patients. We found a negative correlation between severity of psoriasis and ghrelin level. Larger and especially experimental studies focusing on correlation of immune system-ghrelin levels and severity of psoriasis may be valuable to clarify the etiopathogenesis of the disease.

Immunohistochemical and histopathological changes in the skin of rats after maneb application.

OBJECTIVE: To determine the immunohistochemical and histopathological changes in facial skin after exposure to maneb (manganese ethylene bisdithiocarbamate), a fungicidal dithiocarbamate pesticide. STUDY DESIGN: In the experimental group maneb was administered by inhalation to 10 male Wistar albino rats for 5 days each week for 3 weeks. As a biological control, the control group (n = 10) received distilled water by spray for the same time period. The experiment was terminated after 3 weeks. Sections of rat facial skin were examined histopathologically. RESULTS: In the experimental group, microscopic examination of facial skin revealed degeneration of the epidermis, detection of mild inflammatory reaction, and vascular dilation in the connective tissue. Hair follicles and degenerative changes were observed in the deeper parts. In the experimental group, dilation of the blood vessels in the dermis and hemorrhage were supported by an increase in CD34 expression. In addition, a reduction in the number of melanocytes (hypopigmentation) was observed in the hair follicles and epidermis, along with a decrease in the expression of CD117. CONCLUSION: Epidermal degeneration, intradermal cell infiltration, vascular changes, and reduction in the number of melanocytes in the follicle and content of cytokeratin in both the epidermis and hair follicle keratinocytes were detected after maneb application. These findings may have important implications in the association with main signaling pathways, including keratinocyte proliferation and differentiation. Disruption of these pathways may cause some dermatoses.