Can Biologic Agents Improve Treatment Success in Obese Patients With Psoriasis Vulgaris: A Retrospective Review of 320 Patients With Psoriasis Vulgaris.

INTRODUCTION: Obesity plays a major role in the development of many inflammatory disorders including psoriasis. OBJECTIVES: We aimed to demonstrate how treatment responses change according to body mass index (BMI) among patients with psoriasis. METHODS: In our study, Psoriasis Area and Severity Index (PASI) 75 and PASI 90 responses were assessed at baseline and at months 1 and 3 among patients who received TNF-α inhibitors, ustekinumab, IL-17 blockers, and IL-23 blockers. The same responses were also assessed with methotrexate and acitretin for a comparison group. Analyses were performed retrospectively. RESULTS: The study included 317 patients who received 222 biological and 95 conventional treatments. In the group with BMI ≥30, the proportion of patients who achieved PASI 75 response was 40.0% (N = 26) at month 1 and 55.4% (N = 36) at month 3. The proportion of patients who achieved PASI 90 response was 33.8% (N = 22) at month 1 and 44.6% (N = 29) at month 3 among those receiving biological agents. Improvement was significantly more difficult among obese patients. The proportion of patients who achieved PASI 75 response was 3.6% at month 1 and 25.0% (N = 7) at month 3 among patients receiving conventional systemic treatments. While the presence of joint involvement affected the success of treatment among obese patients with psoriasis, no relationships were found for smoking, the presence of concomitant psychiatric diseases, or the presence of pruritus in psoriasis. CONCLUSIONS: Biological agents were more successful in achieving PASI 75 and PASI 90 responses in both non-obese and obese individuals. Based on our study, among biological agents, IL-17 and IL-23 inhibitors may be more successful among obese individuals, but neither of them shows superiority over the other.

Does omalizumab treatment affect serum dehydroepiandrosterone sulphate levels in chronic idiopathic urticaria?

INTRODUCTION: It is known that serum dehydroepiandrosterone sulphate (DHEA-S) levels are low in patients with chronic idiopathic urticaria. AIM: In the study, the effect of the drug on the DHEA-S serum levels and its correlation with the remission and relapse times of the disease was investigated. MATERIAL AND METHODS: Fifty-seven patients with chronic idiopathic urticaria who were referred to our hospital and 20 healthy volunteers were included in the study. A subcutaneous injection of 300 mg omalizumab was administered to the patient group. Drug injections at this dose were completed (6 injections in total, one per month). Relations between serum DHEA-S levels and relapse rates, treatment response and remission duration of the patients and control group were investigated in the groups. RESULTS: Median DHEA-S value before treatment was 116.3 (21.5-448.7) µg/dl; the median DHEA-S value measured after 3 months was 98.4 (10.0-410.0) µg/dl (p = 0.003). The median DHEA-S value before treatment was 123.1 (21.5-299.6) µg/dl when the initial and 3-month DHEA-S levels of the 34 complete remission patients were compared; after 3 months the value was 100.4 (23.1-301.9) µg/dl (p = 0.021). CONCLUSIONS: This is the first study to investigate the effect of omalizumab treatment on DHEA-S levels in the treatment of chronic urticaria according to our literature review. The DHEA-S levels were found to be significantly lower after omalizumab therapy but not related to remission and relapse times.

The rapid effect of pulsed dye laser on demodex density of facial skin.

BACKGROUND: Recently, treatment with acaricides, which is aimed at reducing excessive proliferation of demodex mites, has gained popularity due to its providing a significant improvement in the symptoms of diseases, such as rosacea, seborrhoeic dermatitis, and perioral dermatitis. The effect of IPL on demodex mites was reported in skin biopsy specimens in three patients; however, to the best of our knowledge, no study exists to date, which evaluates the effect of pulsed dye laser (PDL) on demodex density (Dd) in larger patient group. We aim here in to observe the Dd before and after PDL therapy with two different skin biopsy techniques. MATERIAL AND METHODS: Thirty-one patients diagnosed with rosacea were included in the study who received PDL treatment. Dds which were measured by using both the SSSB (standardized skin surface biopsy) and CTM (cellophane tape method) techniques before and after 3 weeks of PDL therapy were evaluated. RESULTS AND DISCUSSION: The Dd of patients before PDL treatment was 13.0 (interquartile range (IQR): 5.0-28.0) and after 3 weeks of PDL treatment it was 6.0 (IQR: 3.0-12.0) with SSSB. After PDL treatment, the Dd was significantly lower than pretreatment the Dd (p = 0.002). The present study shows that PDL significantly reduced Dd in facial skin with one session.

Netherton syndrome previously misdiagnosed as hyper IgE syndrome caused by a probable mutation in SPINK5 C.

Özyurt K, Atasoy M, Ertas R, Ulas Y, Akkus MR, Kiraz A, Hennies HC. Netherton syndrome previously misdiagnosed as hyper IgE syndrome caused by a probable mutation in SPINK5 C. Turk J Pediatr 2019; 61: 604-607. Netherton syndrome (NS, MIM256500) is an autosomal recessive disorder that includes ichthyosis linearis circumflexa and a predisposition to allergies, asthma, and eczema, with hypereosinophilia, trichorrhexis invaginata, and elevated serum IgE levels. The genetic bases of Netherton syndrome are mutations in the gene SPINK5, and the Lymphoepitheial Kazal type related inhibitor, a serine protease inhibitor, is encoded by SPINK. Here a case is presented which showed a probable splice site mutation in SPINK5, which was previously unknown in databases and the literature, to point out the misdiagnosis of Hyper IgE Syndrome in the early presentation of the phenotype. This case highlights that a genetic test can be critical for identifying NS. The finding of underlying mutations contributes to the understanding of Netherton syndrome and is instrumental in indicating a specific therapy. Notably, treatment with acitretin has significantly improved both the ichthyosis linearis circumflexa and eczema in our patient.

Case Report: Nicolau syndrome due to etofenamate injection.

Nicolau syndrome, also known as embolia cutis medicomentosa, is a rare complication characterized by tissue necrosis that occurs after injection of drugs. The exact pathogenesis is uncertain, but there are several hypotheses, including direct damage to the end artery and cytotoxic effects of the drug. Severe pain in the immediate postinjection period and purplish discoloration of the skin with reticulate pigmentary pattern is characteristic of this syndrome. Diagnosis is mainly clinical and there is no standard treatment for the disease. Etofenamate is a non-steroidal anti-inflammatory drug and a non-selective cyclooxygenase inhibitor. Cutaneous adverse findings caused by etofenamate are uncommon. Herein, we present a case with diagnosis of Nicolau syndrome due to etofenamate injection, which is a rare occurrence.

Adverse Reaction to Omalizumab in Patients with Chronic Urticaria: Flare Up or Ineffectiveness?

Omalizumab is a recombinant humanized anti-Ig E monoclonal antibody used as the third line treatment of chronic spontaneous urticaria (CSU). We report four patients with severe antihistamine-resistant CSU, who developed angioedema, anaphylaxis and/or flare up of urticaria at different times following omalizumab therapy.

Pityriasis rosea: a natural history of pediatric cases in theCentral Anatolia Region of Turkey.

BACKGROUND/AIM: This study aimed to evaluate the demographic, clinical, and epidemiological features of pityriasis rosea (PR) in a cohort of 46 children in Yozgat, a city in the Central Anatolia Region of Turkey. MATERIALS AND METHODS: Forty-six children with PR were monitored at regular intervals (1, 2, 4, and 12 weeks) for 3 months from the time of diagnosis. A complete evaluation of the patient was performed at each visit. RESULTS: The average age of patients at time of diagnosis was 12 ± 3.9 years. Cases were most common in the winter (rainy, snowy months; n = 14, 31%). Fifteen patients had a medical history significant for the presence of upper respiratory tract infection, while skin PR manifestations were preceded by drug intake in a second group of 15 patients. The presence of a herald patch was observed in 78.3% of patients, most frequently on the trunk (n = 23). Pruritus occurred in 75% of patients. Median PR duration was 3 weeks (range: 1-20 weeks). CONCLUSION: The course of PR is similar in Turkish children and adults. The high prevalence of pruritus in children with PR in Turkey was also significant. Further evaluation of this finding comparing adults and children is now required.

The association of androgenetic alopecia and insulin resistance is independent of hyperandrogenemia: A case-control study.

BACKGROUND/OBJECTIVES: Androgenetic alopecia (AGA) occurs due to the effect of androgens and genetic predisposition. The association between hyperandrogenism and insulin resistance (IR) has been clearly documented. In recent years there have been reports supporting the presence of IR in AGA. The study aimed to investigate the presence of IR in women with AGA and discern whether or not it is associated with hyperandrogenism. METHODS: Overall, 77 women with AGA were included in the study. Patients with Ludwig grades I-III AGA were enrolled in the study. Blood samples were drawn for measurements of hormone profile, basal insulin and fasting blood glucose (FBG). An oral glucose tolerance test was performed on another day. IR was assessed by the homeostasis model assessment score. RESULTS: All IR parameters were significantly higher in the 75 study subjects without DM than in the control group (P < 0.05). After excluding five patients with IGT, the level of all IR parameters were still higher than in the control group (P < 0.05). Hyperandrogenemia was found in 30 (40%) patients. When this second group (n = 45) (excluding patients with hyperandrogenemia) was compared with the control group on IR, all parameters except for basal insulin were significantly higher in the second group than in the controls (P < 0.05). CONCLUSION: Our results suggest a relation between IR and AGA in female patients. We showed for the first time that the association of AGA and IR is independent of hyperandrogenemia.

Epidemiological and clinical characteristics of 7172 patients with cutaneous leishmaniasis in Sanliurfa, between 2001 and 2008.

BACKGROUND: Cutaneous leishmaniasis in Sanliurfa is still a public health problem. In this study, we report the epidemiological, clinical, and demographic properties from Sanliurfa. MATERIALS AND METHODS: 7172 patients followed up in the Sanliurfa Leishmaniasis Treatment Center between January 2001 and December 2008. RESULTS: The rates of male and female patients were 46% and 54% of the 7172 cases, respectively. The incidence of ACL showed a typical trend of an increase between November and May and a decrease in the summer. The face and extremities were the most involved parts of the body. Clinical appearance and Giemsa smear were most used diagnostic tools and intralesional pentavalent antimony compounds were the first choice of treatment. CONCLUSION: The incidence of cutaneous leishmaniasis in Sanliurfa is still low but not zero.