Alterations in Retinal Vascularity in Severe Psoriasis.

PURPOSE: To evaluate the changes in retinal vascularity in patients with severe psoriasis. MATERIALS AND METHODS: Patients with severe psoriasis [psoriasis area-severity index (PASI) >10] who did not get any systemic treatment in the last year and do not have any ocular diseases were included. All patients underwent detailed ophthalmological examination, including optical coherence tomography (OCT) and OCT angiography (OCTA). Vessel densities (VD) of Superficial (SCP) and deep (DCP) capillary plexus, foveal avascular zone (FAZ) diameter, central retinal thickness (CRT) were analyzed and compared with age-sex matched healthy adults. RESULTS: Fifty-three patients (13 F, 40 M) and 56 controls (16 F, 40 M) were included in the study. VD of SCP (50.4%±3.9 vs. 51.4%±3.2) and DCP (52.6%±6.4 vs. 55.4%±5.7) were lower in psoriasis group compared to controls (p < .05). Presence of psoriatic arthritis was related with an increased CRT (p = .000), larger FAZ and decreased foveal VD in SCP (p = .01, p = .02, respectively). CONCLUSION: Severe psoriasis causes a decrease in retinal blood flow and presence of psoriatic arthritis is related with decreased foveal VD.

Comparison of 1064 nm Q-switched Nd:YAG laser and Jessner peeling in melasma treatment.

Melasma is an acquired hyperpigmentation disease characterized by hyperpigmented patches in sun-exposed areas that significantly impairs life quality. Topical treatments such as hydroquinone, retinoic acid, azelaic acid, chemical peels and laser treatments are among the main treatment options. In our study, we aimed to compare the effectiveness of Jessner peeling and 1064 nm Q-switched Nd:YAG laser in melasma treatment. For this purpose, Jessner peeling was applied to 20 patients and 1064 nm Q-switched Nd: YAG laser was applied to 19 patients of 39 melasma patients who applied to the cosmetology unit of Ege University department of dermatology and venereal diseases between November 2018-March 2020. Thirty seven patients completed the study. Changes in MASI, pigment and erythema scores measured by mexameter before and after treatment were compared for two groups. A statistically significant decrease in MASI scores, pigment and erythema scores was observed in both groups with no significant difference between two groups. In conclusion, in our study, it has been shown that Jessner peeling and 1064 nm Q-switched Nd:YAG laser are equally effective in treatment of melasma.

Evaluation of platelet-rich plasma efficacy in melasma.

Platelet-rich plasma (PRP), which is widely used in many dermatologic conditions, has also been used in the treatment of melasma in recent years. The objective of this study is to determine the efficacy of PRP in melasma. Fifteen female patients with melasma participated in this study. Intradermal PRP was performed every 3 weeks for three times. We photographed all participants, performed Melasma Area and Severity Index (MASI), and measured melanin and erythema index (EI) with mexameter before every session and 1 month after the last session. Patients self-assessment of pigmentation grade (0-10) were also employed at baseline and 1 month after the last procedure. Mean MASI of the patients reduced from 10 ± 3.6 to 7.3 ± 2.5. Melanin index (MI) and EI evaluated by mexameter reduced from 256.5 ± 31 to 238.9 ± 29.9 and from 329.9 ± 53.8 to 322.7 ± 77.6, respectively. Mean patients self-assessment score (PSS) reduced from 8.3 ± 1.3 to 5 ± 1.4. Mean MASI, MI, and PSS reduction after treatment was found significant (p = .001, p = .000, p = .000). Intradermal application of PRP is an effective option for treatment of melasma. It also has other benefits like improvement in skin appearance. Because recurrence is common in melasma, depigmenting agents should be used after all procedures.

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: 11-year Demographic Clinical and Prognostic Characteristics.

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute, life-threatening, severe drug reactions. Randomized studies on these diseases are difficult to perform. Aims and Objectives: The purpose of this study was to summarize the demographic and clinical characteristics of patients with SJS and TEN in a tertiary hospital in Turkey. Materials and Methods: We evaluated the records of 33 patients with SJS and TEN who were followed in our clinic or examined between January 2008 and June 2019, retrospectively. Age, sex, time of admission to hospital, causative drug, presence of concomitant disease, skin findings, mucosal involvement, the severity-of-illness score for TEN, the medication used, antibiotic use, transfer to intensive care, development of complications, and death or discharge status were noted. Results: Of the 33 patients, 11 (33.3%) had SJS, 3 (9.1%) had SJS/TEN overlap, and 19 (57.6%) had TEN. The majority (60.6%) of the patients were female. Nineteen (57.6%) patients had one, and 13 (39.4%) had more than one suspected drug exposure in their history. The most commonly suspected drugs were antibiotics. Twelve (36.4%) patients had intensive care unit hospitalization. Ten (30.3%) patients died. Conclusion: The demographic data of our study were consistent with the literature. Similar to the literature, antibiotics were the most common reaction-causing drugs. However, antiepileptic drugs, which were more frequently reported in other studies, were identified as suspicious in only one patient. We believe that our study will contribute to the determination of characteristics of this rare disease with real-life data.

Comparison of Skin Scraping and Standard Superficial Skin Biopsy in the Laboratory Diagnosis of Scabies

Objective: Scabies is diagnosed based on the presence of burrows on the skin, Sarcoptes scabiei adult, egg, or scybala in skin scrapings. The laboratory diagnosis of scabies poses various challenges. We aimed to compare the analytical performance of skin scraping and standard superficial skin biopsy (SSSB) and to investigate the correlation with false negative results in the laboratory diagnosis of scabies. Methods: Skin scraping and SSSB were applied from July 1 to December 31, 2018 on 42 patients whose burrows were marked using dermatoscopy, as obtained from the laboratory information system. Results: The number of patients who tested positive for scabies with skin scraping was 18 (42.9%) and 24 (57.1%) with SSSB, and the difference was significant (p=0.003). Sensitivity was 42.9% for skin scraping and 57.1% for SSSB. The number of positive cases with both techniques was 15 (35.7%). The number of patients positive with only skin scraping was 3 (7.1%) and only SSSB was 9 (21.4%). Conclusion: To date, it has seemed impossible to diagnose scabies using a single clinical or laboratory test. According to our results, SSSB is an inexpensive and easy-to-apply method with high sensitivity for obtaining skin samples for scabies laboratory diagnosis.

Experience with Omalizumab for the treatment of chronic spontaneous urticaria in a tertiary center: real life experience.

PURPOSE: Chronic spontaneous urticaria (CSU) is defined as urticaria and/or angioedema that appears spontaneously due to known or unknown causes and lasts for at least 6 weeks. Omalizumab, an anti-IgE antibody that binds circulating free IgE, has recently emerged as a promising treatment for CSU, a condition which impairs patients' quality of life. We aimed to contribute real life data by reporting our experience with omalizumab in the treatment of intractable CSU. METHODS: Of 140 patients treated with omalizumab in our clinic between September 2013 and January 2018, 86 CSU patients with available current data were retrospectively evaluated in terms of sex, age, urticaria duration, urticaria activity score over 7 days (UAS7) before and after omalizumab, relapses and time to relapse, length of remission after omalizumab cessation, adverse events, and comorbidities. RESULTS: The mean age of the patients was 45.5 ± 14.3 years and 73.3% were women. Mean duration of urticaria before initiation of omalizumab therapy was 54.5 ± 67 months. All patients had used antihistamines before starting omalizumab treatment. The mean number of omalizumab doses was 11.9 ± 9.3. The mean duration of omalizumab treatment was 13.3 ± 10.4 months. Mean UAS7 score was 38.9 ± 4.1 before the start of omalizumab treatment, and 7.9 ± 10.5 after treatment. Treatment was discontinued in 10 patients (11.6%) due to nonresponse or loss of effect. Four patients (4.65%) experienced adverse events. Treatment was discontinued in 1 patient (1.16%) due to side effects. Of the 55 patients whose treatment was discontinued after their symptoms resolved, 31 (56.3%) relapsed after omalizumab cessation. Twenty-four patients (43.6%) did not relapse after omalizumab cessation. CONCLUSIONS: Our results show that omalizumab was an effective treatment for intractable CSU and did not cause any serious adverse effects other than asthenia, vertigo, and injection site reaction in four patients. These findings are relevant because they reflect real-life data.

Systemic comorbidities associated with rosacea: a multicentric retrospective observational study.

BACKGROUND: Once considered a disorder limited to the skin, rosacea is now known to be associated with systemic disorders. The aim of this study was to determine what systemic comorbidities accompany rosacea and to determine the relationship between the type, severity, and duration of rosacea, and the presence of and type of systemic comorbidities. METHODS: This retrospective multicenter study was conducted by the Turkish Society of Dermatology Acne Study Group. Thirteen dermatology clinics throughout Turkey participated in the study. A structured physician-administered questionnaire was used to collect patient demographics, clinical findings, and lifestyle data. The principal rosacea subtype, physician global assessment of severity, and duration of rosacea were recorded. Physicians recorded each participant's medical history, including current and past comorbidities, duration of any such comorbidity, and the use of medications to treat any comorbidities. RESULTS: The study included 1,195 rosacea patients and 621 controls without rosacea aged 18-85 years. As compared to the controls, more of the rosacea patients had respiratory tract, gastrointestinal system, and metabolic and hepatobiliary system disorders in a rosacea's severity- and duration-dependent manner. CONCLUSION: Clinicians must be aware of the potential for systemic comorbidities in rosacea patients, which becomes more likely as disease duration and severity increase.

Root resorption due to orthodontic treatment using self-ligating and conventional brackets : A cone-beam computed tomography study.

OBJECTIVES: Purpose of the present study was to compare external root resorption (ERR) volumetrically in maxillary incisors induced by orthodontic treatment using self-ligating brackets (Damon Q, DQ) or conventional brackets (Titanium Orthos, TO) with the help of cone-beam computed tomography (CBCT). PATIENTS AND METHODS: A sample of 32 subjects, with Angle Class I malocclusion and anterior crowding of 4-10 mm, was divided randomly into two groups: a DQ group, in which self-ligating DQ brackets with Damon archwires were used; and a TO group, in which conventional TO brackets with large Orthos archwires were applied. The study was conducted using CBCT scans taken before (T1), and near the end (9 months after the initiation of treatment; T2) of the orthodontic treatment. The extent of ERR was determined volumetrically using Mimics software. Changes in root volume were evaluated by repeated-measures analysis of variance as well as by paired and independent t-tests. RESULTS: While significant differences were found between T1 and T2 for root volume in both groups (p < 0.05), there was no difference between the groups regarding the amount (mm3 or relative change) of ERR (p > 0.05). Maxillary central and lateral incisors showed similar volume loss (p > 0.05). Furthermore, the TO group showed a higher prevalence of palatinal and proximal slanted RR compared with the DQ group (p < 0.05). CONCLUSIONS: It is not possible to suggest superiority of one bracket system over the other only considering root resorption pattern or amount. Higher incidence of slanted RR found in patients treated with the TO system warrants further research to identify possible specific causes.

Comparison of stepwise vs single-step advancement with the Functional Mandibular Advancer in Class II division 1 treatment.

OBJECTIVE: To compare two groups of subjects at the peak of the pubertal growth period treated with the Functional Mandibular Advancer (FMA; Forestadent, Pforzheim, Germany) appliance using either single-step or stepwise mandibular advancement. MATERIALS AND METHODS: This study was conducted on 34 Class II division 1 malocclusion subjects at or just before the peak phase of pubertal growth as assessed by hand-wrist radiographs. Subjects were assigned to two groups of mandibular advancement, using matched randomization. Both groups were treated with the FMA. While the mandible was advanced to a super Class I molar relation in the single-step advancement group (SSG), patients in the stepwise mandibular advancement group (SWG) had a 4-mm initial bite advancement and subsequent 2-mm advancements at bimonthly intervals. The material consisted of lateral cephalograms taken before treatment and after 10 months of FMA treatment. Data were analyzed by means paired t-tests and an independent t-test. RESULTS: There were statistically significant changes in SNB, Pg horizontal, ANB, Co-Gn, and Co-Go measurements in both groups (P < .001); these changes were greater in the SWG with the exception of Co-Go (P < .05). While significant differences were found in U1-SN, IMPA, L6 horizontal, overjet, and overbite appraisals in each group (P < .001), these changes were comparable (P > .05). CONCLUSION: Because of the higher rates of sagittal mandibular skeletal changes, FMA using stepwise advancement of the mandible might be the appliance of choice for treating Class II division 1 malocclusions.

Upper airway changes following single-step or stepwise advancement using the Functional Mandibular Advancer.

OBJECTIVES: Purpose of the present study was to determine and compare possible changes in the dimensions of the pharyngeal airway, morphology of the soft palate, and position of the tongue and hyoid bone after single-step or stepwise mandibular advancement using the Functional Mandibular Advancer (FMA). PATIENTS AND METHODS: The sample included 51 peak-pubertal Class II subjects. In all, 34 patients were allocated to two groups using matched randomization: a single-step mandibular advancement group (SSG) and a stepwise mandibular advancement group (SWG). Both groups were treated with FMA followed by fixed appliance therapy; the remaining 17 subjects who underwent only fixed appliance therapy constituted the control group (CG). The study was conducted using pre- and posttreatment lateral cephalometric radiographs. Data were analyzed by paired t test, one-way analysis of variance, and Pearson's correlation coefficient. RESULT: In the SWG and SSG, although increases in nasopharyngeal airway dimensions were not significant compared with those in the CG, enlargements in the oropharyngeal airway dimensions at the level of the soft palate tip and behind the tongue, and decreases in soft palate angulation, were significant. Tongue height increased significantly only in the SWG. Compared with the CG, while forward movement of the hyoid was more prominent in SSG and SWG, the change in the vertical movement of the hyoid was not significant. No significant difference between SWG and SSG was observed in pharyngeal airway, soft palate, tongue or hyoid measurements. CONCLUSIONS: The mode of mandibular advancement in FMA treatment did not significantly affect changes in the pharyngeal airway, soft palate, tongue, and hyoid bone.

Effective topical delivery systems for corticosteroids: dermatological and histological evaluations.

Atopic dermatitis (AD) is a chronic and relapsing skin disease with severe eczematous lesions. Long-term topical corticosteroid treatment can induce skin atrophy, hypopigmentation and transepidermal water loss (TEWL) increase. A new treatment approach was needed to reduce the risk by dermal targeting. For this purpose, Betamethasone valerate (BMV)/Diflucortolone valerate (DFV)-loaded liposomes (220-350 nm) were prepared and incorporated into chitosan gel to obtain adequate viscosity (∼13 000 cps). Drugs were localized in stratum corneum + epidermis of rat skin in ex-vivo permeation studies. The toxicity was assessed on human fibroblast cells. In point of in-vivo studies, pharmacodynamic responses, treatment efficacy and skin irritation were evaluated and compared with previously prepared nanoparticles. Liposome/nanoparticle in gel formulations produced higher paw edema inhibition in rats with respect to the commercial cream. Similar skin blanching effect with commercial creams was obtained via liposome in gels although they contain 10 times less drug. Dermatological scoring results, prognostic histological parameters and suppression of mast cell numbers showed higher treatment efficiency of liposome/nanoparticle in gel formulations in AD-induced rats. TEWL and erythema measurements confirmed these results. Overview of obtained results showed that liposomes might be an effective and safe carrier for corticosteroids in skin disease treatment.

The frequency of skin diseases among students in a university clinic.

This study was conducted to assess the frequency of dermatologic diseases in Turkish university students. University students who visited two dermatology outpatient clinics within the Ege University Health, Culture and Sports Office were included in the study. Each student was examined by two dermatologists. Questions about demographic data and information about the frequency of using the swimming pool were directed to the patients. All dermatological diseases were recorded. Patients were asked to assess and give a score for the state of their mental wellness using the visual analog scale (0-100) during the past month. Chi-square and Student t tests were used for statistical analyses. A total of 1733 individuals, 750 (43.3%) men and 983 (56.7%) women, were included in the study. The most frequently seen diseases were acne vulgaris (40.1%) and fungal diseases (17.08%), whereas the least frequently seen were parasitic skin diseases (0.46%) and vascular diseases (0.51%). The mean mental wellness score was found to be 61.03 +/- 21.34 (0-100, median: 65.00). It can be concluded that students visit university dermatology outpatient clinics frequently and the most common complaints are acne vulgaris and fungal diseases.

Efficiency of ellagic acid and arbutin in melasma: a randomized, prospective, open-label study.

The aim of this study was to compare the effectiveness of gel formulations containing arbutin, synthetic ellagic acid and plant extracts that contain ellagic acid, on patients with melasma. Thirty patients who applied to Ege University Medical Faculty, Department of Dermatology, were included in the study. A signed consent was obtained from each patient prior to study. Patients whose type of melasma was determined via Wood's lamp were randomized to groups of arbutin, synthetic ellagic acid and plant extract containing natural ellagic acid. The pigment density of patients was evaluated via Mexameter before and after the treatment. The approval of the Institutional Ethics Committee of Ege University was obtained before the study. Wilcoxon and Kruskal-Wallis tests were used in the statistical analysis. Nine of 10 patients, for whom synthetic ellagic acid was started, completed the study. A decrease in the level of melanin was determined in eight of these nine patients (P = 0.038). A significant decrease in the level of melanin was also determined in all 10 patients who used plant extract containing ellagic acid (P = 0.05). A significant response was obtained from all of 10 patients who used arbutin. The difference between pre- and post-treatment levels of melanin was statistically significant (P = 0.05). Formulations prepared with plant extracts containing ellagic acid was found effective on melasma, similar to the formulations containing synthetic ellagic acid and arbutin. This material that is not yet being used widespread commercially on melasma could be an effective alternative for treatment of melasma.