The Use of New Hematological Markers in the Diagnosis of Alopecia Areata.

INTRODUCTION: Alopecia areata (AA) is a non-cicatricial inflammatory and autoimmune hair loss disease. In recent studies, it has been reported that hematological parameters can be used as oxidative stress markers in the diagnosis of many inflammatory diseases due to their low cost and widespread use. OBJECTIVES: In this study, it was aimed to reveal the significant cut-off points of hematological inflammatory markers in AA that can guide clinicians in clinical practice and determine how many times they increase the risk of disease. METHODS: The present study is retrospective case-control type. Seventy patients with AA and seventy healthy controls were included in the study. The hematological parameters in both groups were evaluated retrospectively. RESULTS: Hemoglobulin, monocyte, platelet, monocyte high-density lipoprotein cholesterol (HDL-C) ratio (MHR), monocyte lymphocyte ratio (MLR), platelet lymphocyte ratio (PLR) were high in patients with AA, while the number of lymphocytes was low. In ROC analysis, the optimal cut-off values for the diagnosis of AA were as follows: MLR 0.216, MHR 0.010, and PLR 111.715. In regression analysis, being above the following values of MLR 0.216, MHR 0.010, and PLR 111.715 increased the risk of developing AA by 6.3, 3.8, and 2.7 times, respectively. CONCLUSIONS: It was seen that MHR and PLR, especially MLR, can significantly increase the risk of developing the disease in AA and can also be used as diagnostic markers.

Do patients with psoriasis are at higher risk for atherogenity? A case-control study.

BACKGROUND: Psoriasis is a chronic, inflammatory skin disease that is common in both adult and childhood. Patients with psoriasis are at significant risk for the development of many comorbid conditions, including cardiovascular diseases. OBJECTIVES: We aimed to investigate the cardiovascular risk status and serum lipid parameters in patients with psoriasis and to determine the risk of cardiovascular disease by atherogenic indices obtained accordingly. METHODS: This retrospective case-control study was conducted with a total of 142 individuals, 72 patients with psoriasis vulgaris and 70 healthy volunteers over the age of 18 who were admitted to the dermatology outpatient clinic. Demographic information and laboratory values were retrieved from the hospital database. Afterward, atherogenic indexes such as Atherogenic index of plasma (AIP), Castelli Risk Index I and II (CRI-I and II), and Atherogenic coefficient (AC) were calculated. RESULTS: There was a significant difference in lipid profile between the psoriasis patients and the control group. In patients with psoriasis, triglyceride level (140.09 ± 71.20 mg/dl vs. 116.10 ± 63.95, p = 0.037) was higher, while HDL level (44.34 ± 11.77 mg/dl vs. 50.31 ± 11.62, p = 0.003) was lower. Regarding atherogenic indices; AIP (0.10 ± 0.24 vs. -0.04 ± 0.27, p = 0.001), CRI-I (4.63 ± 1.40 vs. 3.94 ± 1.02, p = 0.001), CRI-II (2.98 ± 1.01 vs. 2.61 ± 0.82, p = 0.019) and AC (3.63 ± 1.40 vs.. 2.94 ± 1.02, p = 0.001) were significantly higher in patients with psoriasis. CONCLUSION: Our study shows that patients with psoriasis have higher pro-atherogenic lipid profile and atherogenic indexes at a high risk level. Patients with psoriasis have an increased risk of cardiovascular diseases.

The correlation of systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, derived neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio with disease severity in recurrent aphthous stomatitis.

BACKGROUND/AIM: To evaluate the correlation of systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) with disease severity in recurrent aphthous stomatitis (RAS). METHODS: The present retrospective cohort study was performed on patients with RAS. Patients were divided into three groups: 1) Major (n = 75), 2) Minor (n = 123), and 3) Herpetiform aphthae (n = 17). The study groups were compared in terms of demographic features, acute phase proteins, and complete blood cell count parameters. Moreover, correlation analyses were performed for the correlation of ulcer severity score (USS) with C-reactive protein (CRP), SII, erythrocyte sedimentation rate (ESR), ferritin, dNLR, NLR, and PLR. RESULTS: Significantly higher values were observed for USS, neutrophil count, ferritin, SII, NLR, and dNLR (p < 0.05 for all) in the major and herpetiform aphthae groups compared to the minor aphthae group. Positive, strong, significant correlations were observed between USS, SII, and NLR (r = 0.80 for SII, r = 0.74 for NLR and p < 0.001 for both). Positive, moderate, significant correlations were observed between USS, PLR, ESR, and CRP (r = 0.54 for PLR, r = 0.39 for ESR, r = 0.36 for CRP, and p < 0.001 for all). Positive, weak, significant correlations were observed between USS, dNLR, and ferritin (r = 0.13 and p = 0.05 for ferritin, r = 0.27 and p < 0.001 for dNLR). CONCLUSION: Higher values of SII, NLR, dNLR, and PLR were associated with disease severity in patients with RAS.

Abnormal foot angles has an association with ingrown toenail.

BACKGROUND: Onychocryptosis, frequently termed ''ingrown toenail'' is a common foot problem in routine dermatology and orthopaedic clinical practice which leads to pain and disability. Although the aetiology of ingrown toenail is not well understood various associated risk factors have been identified with the pathogenesis. MATERIAL AND METHODS: This study was a retrospective investigation of 170 patients with hallux valgus and lateral border ingrown toenail of all stages. The patients were compared with a control group. The radiologic assessment in both groups included right hallux valgus angle, left hallux valgus angle, right first and second intermetatarsal angle, and left first and second intermetatarsal angle. RESULTS: There were 121 female and 49 male patients in the case group and 68 female and 32 male in the control group. The mean age of the case group was 41.1 years and 41.1 years in the control group. A statistically significant difference was found between the case and the control groups in terms of the right hallux valgus angle variable. CONCLUSION: The abnormal hallux valgus angle and the abnormal intermetatarsal angle plays an important role in ingrown toenail aetiology. The X-rays of the feet should be performed to determine the susceptibility of the patients who are admitted to the hospital for ingrown toenail in order to prevent other toes ingrown toenail and for planning the treatment of the patients with an ingrown toenail.

Experience with oral tofacitinib in severe alopecia areata with different clinical responses.

BACKGROUND: Alopecia areata (AA) and generalized form, universalis (AU) are common causes of noncicatricial alopecia, targeting anagen hair follicles. A dominant interferon-gamma transcriptional signaling and cytotoxic T lymphocytes were accused as the main drivers of disease pathogenesis. Tofacitinib is a Janus kinase inhibitor that has been proven to interfere with the positive feedback loop between the follicular cell and the cytotoxic T lymphocytes in AA. There is an increasing number of studies reporting success with tofacitinib in AA. AIMS: We aimed to assess oral tofacitinib's safety and efficacy in 13 recalcitrant AA and AU patients. METHODS: This is a retrospective pilot study performed between 2017 and 2020. The demographic features and the treatment responses were evaluated with Severity of Alopecia Tool score changes. RESULTS: Thirteen recalcitrant alopecia areata patients (3 AA, 10 AU), aged between 17 and 49, were included in the study. The treatment duration was 3-15 months. All three AA patients responded well; however, the therapy was unsuccessful in five of ten AU patients. Relapse was observed in one of the AA and three of the AU responders. Acneiform lesions and elevation of transaminases were the major side effects. CONCLUSION: Tofacitinib seems to be more promising and thriving in the treatment of AA than AU. Starting the therapy earlier can bring more successful results. Unfortunately, even in the cases that fully respond to treatment, relapse can be observed after discontinuation of the treatment. It is essential to inform patients about this situation in reducing the frustrations that may occur later.

The utility of systemic-immune inflammation index for predicting the disease activation in patients with psoriasis.

OBJECTIVE: To evaluate the utility of systemic-immune inflammation index (SII) in the management of patients with psoriasis. METHOD: This retrospective case-control study was conducted on patients who were admitted to the dermatology outpatient clinic. Patients with psoriasis (n = 71) were compared with a age and gender-matched control group (n = 70) with other non-inflammatory dermatologic diseases. Study and control groups were compared in terms of clinical characteristics and SII values (neutrophil X platelet/lymphocyte). Afterwards, 50th percentile value (4.5) for psoriasis area severity index (PASI) was calculated for the study group. Two subgroups were formed according to PASI values: (1) PASI < 4.5 group (n = 36) and (2) PASI ≥ 4.5 (n = 35). Clinical characteristics and SII values were also compared between these two subgroups. Furthermore, SII values were compared according to the presence of scalp, joint, nail, and genital area involvement in the study group. Finally, a receiver operating characteristic (ROC) curve analysis was performed in order to assess the performance of SII in determining the activation of psoriasis in the study group. RESULTS: Significantly higher SII values were found in patients with psoriasis. PASI ≥ 4.5 subgroup and patients with nail and genital involvement had also significantly higher SII values (P < .05). A cut-off value of 575.8 was calculated with 66.7% sensitivity and 66% specificity for psoriasis activation. CONCLUSION: SII may be used for the prediction of psoriasis activation.

Comparison of the efficacy of broad-band targeted UVB phototherapy and topical psoralen with targeted UVA phototherapy in localized vitiligo.

Aim of the study is to compare efficacy of targeted broad-band UVB phototherapy and topical psoralen with targeted UVA phototherapy treatments in localized vitiligo for 3 months prospectively. The cases with symmetrical vitiligo lesions were included in the study. Broad-band targeted UVB was applied on one side and targeted UVA phototherapy with topical psoralen on the other side. Twenty-two patients who were diagnosed with localized vitiligo were enrolled in this study. These cases consisted of 6 (27.3%) females and 16 (72.7%) males aging between 17 and 69 (34.22 ± 14.15). Fifty-four lesions (27 left, 27 right) were compared for treatments. After the first month of the treatments, the sides of the lesions were compared in order to evaluate improvement. Percentages of success were 25% for targeted broad-band UVB microphototherapy and 75% for topical psoralen with targeted UVA microphototherapy. When the two treatment methods were compared with each other, a significant difference was found in terms of treatment response (P = .017). At the end of the third month, the success rates were 37.5% for targeted broad-band UVB microphototherapy and 62.5% for topical psoralen with targeted UVA microphototherapy, however a statistically significant difference was not determined between the two treatments (P > .05). Both targeted broad-band UVB phototherapy and topical psoralen with targeted UVA phototherapy provided repigmentation for localized vitiligo at the end of the third month. Our investigation shows that both treatments are safe and they provide repigmentation with a limited response.

Changing trends in dermatology practice during COVID-19 pandemic: A single tertiary center experience.

The aim of this study was to evaluate the changing trends in dermatology clinical practice at a tertiary center during the coronavirus disease 2019 (COVID-19) pandemic. This retrospective cohort study was conducted on patients who were admitted to Ufuk University Hospital with dermatologic complaints/diseases before and during the pandemic. The patients were divided into two groups: (a) the pre-pandemic period (March-May 2019) and (b) the Pandemic period (March-May 2020). Demographic features, clinical characteristics, dermatologic diseases/complaints, dermatologic procedures/interventions, hospitalization rate, and use of biologic agents were compared between the two groups. Total number of hospital admissions have decreased from 1165 to 717. Admission rates for acne, dermatophytosis, and benign neoplasm of the skin significantly lower during the pandemic period (P values were .02, .04, and .006, respectively). Contact dermatitis, acne accompanying dermatitis, cicatricial hair loss, lichen planus, and zona zoster infection rates were significantly higher (P values were .007, <.001, .009, .04, and .03, respectively). Rates of biopsy and electrocautery procedures were decreased significantly (P values were <.001 and .002, respectively). The hospitalization rate was similar between the groups (P = .51). However, the use of biologic agents significantly decreased during the pandemic period (P = .01). Updated clinical protocols should be established for the new normal period in accordance with these findings.

Efficacy of Omalizumab in Patients with Chronic Spontaneous Urticaria and Its Association with Serum IgE Levels and Eosinophil Count.

Chronic spontaneous urticaria can be treated with several drugs such as antihistamines, leukotriene antagonists, cyclosporine, doxepin, hydroxychloroquine, colchicine, and corticosteroids. However, treatment-resistant urticaria significantly reduces quality of life. In recent years, omalizumab has been considered to be an effective treatment option in treatment-resistant cases. We aimed to investigate the clinical efficacy of omalizumab in urticaria and its possible association with serum IgE levels, total eosinophil counts, and basophil percentages. Medical records of 11 patients with chronic spontaneous urticaria treated with omalizumab were reviewed retrospectively. Treatment response, urticaria activity score, serum basophil percentages, eosinophil, and IgE levels evaluated before and at the end of the therapy. Ten patients healed completely with omalizumab. One patient did not respond to therapy. No correlation was observed between serum IgE levels and treatment outcome. However, serum eosinophil levels decreased and basophil percentages increased with omalizumab treatment. Omalizumab is a safe and effective treatment choice in patients with chronic spontaneous urticaria. We suggest that omalizumab may have an effect in the treatment of urticaria through eosinophils.

Multiorgan involvement of Behçet's disease in a young woman.

Behçet's disease is a rare disorder of unknown etiology that is classified as a systemic vasculitis. The prevalence of the disease is high in countries in the Far East, Mediterranean Basin, and East Asia. Thus, it is also known as the Silk Road Disease. Behçet's disease is characterized by recurrent oral aphthous ulcers, genital sores, and ocular lesions. However, it can present with severe clinical manifestations as a result of cardiovascular system, central nervous system, and gastrointestinal tract involvement. The disease causes serious complications, morbidity, and mortality, especially in male patients with early age onset. Here we present a rare case of Behçet's disease exhibiting multiple organ involvement in a 26-year-old Caucasian female.