Patient Use of Complementary and Alternative Medicine for Psoriasis Vulgaris and Factors Believed to Trigger the Disease: a Multicenter Cross-Sectional Study With 1621 Patients.

Introduction: Due to the chronic recurrent nature of psoriasis vulgaris (PV) and lack of definitive treatment for the disease, patients often resort to alternative treatments. Physicians seem to have low awareness of this issue. Objectives: To elicit the perceptions of 1,621 PV patients on complementary and alternative medicine (CAM) and examine factors reported to worsen PV. Methods: The patients sociodemographic characteristics, Psoriasis Area Severity Index (PASI), Dermatology Life Quality Index (DLQI), disease duration, and severity were recorded, and the patients CAM use was questioned in detail. The patients were also asked about factors that worsened PV and their experiences with a gluten-free diet. Results: Of the patients, 56.51% had used CAM. The mean age, illness duration, PASI scores and DLQI of those using CAM were significantly higher. CAM use was significantly higher in those with facial, genital involvement, and arthralgia/arthritis. The patients mostly referred to CAM when PV became severe (46.4%). Of the CAM users, 45.52% used herbal topicals. The physicians of 67.03% did not inquire whether they used CAM. Of the participants, 37.73% considered that stress worsened their disease. Gluten-free diet did not affect PV symptoms in 52.22%. Conclusions: Patients CAM use is often overlooked by dermatologists. Our results showed that more than half the patients used CAM and did not share this information with their physicians. Therefore, the awareness of physicians should be increased and patients should be asked about the use of CAM and directed to the appropriate medical treatment options by physicians.

Habits of Using Social Media and the Internet in Psoriasis Patients.

Introduction: Psoriasis significantly affects the patients quality of life, which often leads patients to seek online information about this disease. Objectives: To explore the habits of patients with psoriasis related to their use of social media (SM) and the internet to obtain information about their disease. Methods: 1,520 patients completed the survey and the Dermatology Life Quality Index (DLQI) questionnaire. The Psoriasis Area Severity Index scores (PASI) and clinical data of the patients were recorded by their physicians. Results: Of the 1,114 patients that reported using SM and internet, 48.38% regularly and 31.14% sometimes resorted to obtain information about psoriasis. The use of SM and internet for psoriasis was statistically significantly higher among young people (P = 0.000), those with university or higher education (P = 0.009), higher DLQI (P = 0.000) and PASI (P = 0.011) scores, facial (P = 0.050), scalp (P = 0.032), hand (P = 0.048), genital (P = 0.001) and inverse (P = 0.000) involvement, and arthralgia/arthritis (P = 0.006). The participants mostly used the Google (86%) and Facebook (41%). More than half of the participants (62.8%) expected dermatologists to inform society that psoriasis is not contagious. Conclusions: Internet and SM being widely available and offering substantial information to be easily accessed make it very attractive for patients to use these platforms to investigate diseases, including psoriasis. If what is presented on SM conflicts with what the physician says, patients mostly trust the latter, but at the same time, they tend not to share the results of their online inquiries with their physicians.

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.

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.

Reflectance confocal microscopic findings in a case of huge dermatofibrosarcoma protuberans.

Dermatofibrosarcoma protuberans is a slowly progressive, locally aggressive fibroblastic tumor which can be misdiagnosed in the early stage. Reflectance confocal microscopic features of dermatofibrosarcoma protuberans has been scarcely described in the literature. We described the dermoscopic and reflectance confocal microscopic findings of 12â€¯× 15 cm sized tumoral lesion of 45-year-old man.

Development of a New Incontinence Containment Product and an Investigation of Its Effect on Perineal Dermatitis in Patients With Fecal Incontinence: A Pilot Study in Women.

Research related to the design and development of new incontinence containment products for women is scarce. PURPOSE: The purpose of this 2-part study was to 1) develop a new incontinence containment product for fecal incontinence and 2) examine the effect of this new product on the occurrence of incontinence-associated dermatitis (IAD). METHODS: In part 1, a new incontinence containment product was designed, developed, and trialed among 10 healthy female volunteers. The product was comprised of a double layer of polypropylene nonwoven fabric and 100% cotton interlock fabric with a 3-ply 100% cotton interlock fabric added into the perianal section. Participants wore the product for 8 hours and were asked to defecate into the product and evaluate its comfort, ability to contain liquids and protect privacy, any personal allergic reaction, and air permeability. In part 2, after any product modifications, 12 bedridden women treated in the neurology unit of a hospital in western Turkey who had an indwelling urinary catheter and fecal incontinence and who did not have diabetes mellitus, a darkly pigmented area in the perianal area, pressure injury, or erythema were randomized to 2 groups (study product and control, a premium adult diaper) and monitored for 8 days for the development and severity of perineal dermatitis (scored from 0 [no erythema] to 4 [broken, abraded skin]) using a skin assessment tool. Any type of erythema was considered IAD. Skin care (cleansing with a washcloth and water) was provided daily and after each defecation to all study participants. Data were collected via paper-and-pencil completion of the perineal skin integrity assessment and patient observation forms and entered into and analyzed by a computerized statistical program. Fisher's exact test and the chi-squared test were used to analyze the difference in IAD incidence and severity between the 2 groups, and the Mann Whitney U test was used to detect differences in the number and consistency of defecations. RESULTS: No statistically significant differences were noted among the characteristics of the 12 participants (6 in each group) except for age; patients in the study product group were significantly older (70.66 ± 10.36 vs 52.20 ± 16.78 years; P <.05. Four (4) patients in the study group exhibited 13 areas of perineal dermatitis (degree 1 = 6 areas; degree 2 = 6 areas; degree 3 = 1 area; and degree 4 = 0); 1 patient in the control group had 4 areas with degree 1. CONCLUSION: This prototype product is not sufficient to be used in clinical practice in patients with fecal incontinence, but further study in a larger population is warranted..

Pemphigoid Diseases as a Sign of Active Psoriasis: A Case Report and Brief Review.

BACKGROUND: Overlap of bullous pemphigoid (BP) with chronic psoriatic plaques (CPP) is a common condition. However, the association of BP with pustular psoriasis (PP) is uncommon. Moreover, perilesional erythema and pustular lesions on CPP are accepted as a sign of unstable psoriasis. Unstable psoriasis could be triggered by certain irritant topical treatments against psoriasis. These chemical agents could also induce a localized pattern of generalized PP. Here, we describe BP and PP collision in unstable CPP. OBJECTIVE: By this observation we suggest that BP could be a sign of active psoriasis. Presumably, psoriasis-induced BP is an inflammation activity-dependent condition. METHODS: This study is a case report and literature review. RESULTS: The dramatic response of bullo-pustular lesions to short-term methotrexate (MTX) treatment suggests the rule of 'no psoriasis, no BP'. Presumably, MTX supressed the active inflammation of CPP and BP disappeared following CPP control. CONCLUSION: BP can be a sign of active psoriasis in the present case.

Long-term Follow-up of Positive Surgical Margins in Basal Cell Carcinoma of the Face.

BACKGROUND: Basal cell carcinoma (BCC) in central facial locations and tumors with positive margins are at a higher risk of recurrence. The most effective treatment is total excision, which includes an adequate pathological margin. OBJECTIVE: To evaluate the outcome of the patients who underwent surgery for BCCs of the head and neck and of those who had positive surgical margins where Mohs surgery is not available. METHODS: This study was conducted at Ege University Medical School between 2004 and 2014. One hundred thirty patients with 154 BCC who underwent surgical excision were included. In the histopathologic report, the existence of positive margin, BCC subtype, localization of the tumor, and distance of margins to the tumor were evaluated. RESULTS: Twenty-three lesions (14.9%) of 22 patients revealed positive surgical margins. Six patients (26.1%) had recurrences on the surgical site. The BCC subtypes of recurrent patients were reported to be multifocal superficial in 2 (33.3%), infiltrative (16.7%) in 1, and micronodular (50%) in 3. CONCLUSION: Patients with superficial multifocal or micronodular tumors should undergo reoperation because of high recurrence rates.

Follicular mucinosis and follicular mycosis fungoides: clinicopathological evaluation of seven cases.

OBJECTIVE: Follicular mucinosis is a disease characterized by follicular degeneration and mucin accumulation. It can be seen in mycosis fungoides, although idiopathic or forms associated with other diseases are also known. Follicular mycosis fungoides is a type of mycosis fungoides with different clinicopathological and prognostic features. MATERIAL AND METHOD: Seven cases with follicular centered lesions and multiple biopsies (2-6) were included. Cases were evaluated according to their clinical, histological and immunophenotypical features and follow-up data. RESULTS: All cases were male, and the mean age was 40.3 (range 18-61). Clinical complaints were follicular prominence, erythema and alopecia at head and neck, trunk, and lower limbs. Follicular mucinosis (6/7), and dermal lymphoid infiltration showing minimal-intensive folliculotropism accompanied by eosinophils was seen. Lymphoid infiltration was composed of small-medium sized cells, with scattered hyperchromatic nuclei in six cases. In one case there was only minimal cytological atypia. Intense folliculotropism of atypical lymphocytes and dense dermal infiltration without follicular mucinosis was seen in one case. Local and/or systemic treatments were applied and partial remission was achieved histologically. In three cases new and increasing lesions were seen. Density of infiltration and atypia were increased. CONCLUSION: The findings supported the opinion that follicular mucinosis is an important finding seen in mycosis fungoides. There can be important differences concerning the amount of infiltration and degree of atypia. In cases where the density of infiltration associated with follicular mucinosis is not diagnostic for MF, there can be progression over time. Long-term follow up is necessary in such cases where the differential diagnosis is difficult.

Adverse cutaneous drug reactions among hospitalized patients: five year surveillance.

CONTEXT: Cutaneous Adverse Drug Reactions (CADRs) are observed in 2-3% of hospitalized patients. The clinical presentation of the CADRs varies among different populations. OBJECTIVE: To study the CADRs in hospitalized patients and their outcome. MATERIALS AND METHODS: Patients hospitalized at our department between 2005 May and 2010 May were retrospectively reviewed for the diagnosis of CADRs. RESULTS: A total of 94 patients (3.3%) were diagnosed with CADR among 2801 hospitalized patients. Of them, 56 patients were female (59.6%) and 38 patients were male (40.4%). The culprit drugs were antibiotics (24.5%), non-steroid anti-inflammatory drugs (NSAID) (22.4%), anticonvulsants (13.8%), antihypertensive agents (8.5%), paracetamol with or without pseudoephedrine or phenylephrine (6.4%), intravenous contrasts (3.2%), terbinafine (2.1%), biologic agents (2.1%) and various other medications (17.0%). The most common clinical type of CADRs was morbilliform exanthemas in 59.6% of the patients, followed by erythroderma (6.4%), drug reactions with eosinophilia and systemic symptoms (6.4%), lichenoid drug reaction (5.3%), urticaria and angioedema (4.3%), acute generalized exanthematous pustulosis (4.3%), drug-induced vasculitis (3.2%), drug induced psoriasis (2.1%), Stevens-Johnson syndrome/toxic epidermal necrolysis overlap (2.1%), psoriasiform drug reaction (2.1%). Fixed drug reaction, erythema multiforme, bullous drug reaction, drug induced panniculitis were observed in one each. No deaths occurred on the follow-up. Fever was observed in 35.1% of the patients. Eosinophilia was present in 51.1% of them. Latency period ranged between 0-15 days in 59 patients (62.8%), 15-30 days in 19 patients (20.2%), 30-90 days in 13 patients (13.8%), 90-120 days in three of them (3.2%). The latency for anticonvulsant drugs was statistically longer than the other group of drugs (p: 0.027). DISCUSSION AND CONCLUSIONS: CADRs were more common in women and most of them were caused by antimicrobial agents followed by NSAIDs and anticonvulsants. Latency period of anticonvulsants were longer than the other groups.

Exanthematous drug eruption due to valsartan.

OBJECTIVE: Valsartan is an angiotensin II receptor blocker (ARB) used for treatment of hypertension. The well-known adverse effects of valsartan are dizziness, headache and cough. Valsartan-related cutaneous side effects have been reported previously in a limited number of case reports. MATERIALS AND METHODS: A 47-year-old man admitted with diffuse, itchy erythematous maculopapular eruption all over the body. He has been taking 160 mg valsartan daily for 10 days before onset of the eruption. On the third day of valsartan therapy, erythema had appeared over the face and spread throughout the whole body within a week. Histopathologic examination of the lesions showed lymphocyte exocytosis, spongiosis, necrotic keratinocytes in the epidermis, and mixed inflammatory cell infiltrates including perivascular eosinophils in the dermis. The patient was diagnosed as drug reaction due to valsartan with historical, clinical and histopathologic features. DISCUSSION AND CONCLUSION: Most common antihypertensive agents including diuretics, beta blockers, calcium-channel blockers, angiotensin-converting enzyme inhibitors have many cutaneous side effects. However, there are a few reports about the cutaneous side effects of ARBs. Physicians should be aware of the cutaneous side effects of this commonly used agent and valsartan should be considered as a triggering factor of an exanthematous drug reactions.

Generalized pustular eruptions due to terbinafine.

Terbinafine, a widely used antifungal agent, may rarely cause cutaneous side effects with an incidence of 2.7%. Generalized pustular eruptions are quite uncommon but severe adverse cutaneous reactions of terbinafine have been reported. The main pustular eruptions due to terbinafine include acute generalized exanthematous pustulosis and drug induced pustular psoriasis. In this report, two cases of acute generalized exanthematous pustulosis and one case of generalized pustular psoriasis triggered with terbinafine are presented.

Retrospective analysis of results of short-term low dose interferon-α-2b combined with PUVA in the treatment of early stage mycosis fungoides.

Early-stage mycosis fungoides (MF) can be treated with different regimens such as oral photo-chemotherapy (Psoralen and UVA-PUVA). There have been some studies showing the effectiveness of combination of interferon (IFN) with PUVA. In this study, we aimed to evaluate retrospectively the patients with early-stage MF treated with IFN + PUVA. Six patients with the diagnosis of early stage (Ia-IIa) MF between June 2003 and May 2005 were enrolled in this study. IFN combined with PUVA was started and followed by IFN maintenance in complete response (CR) patients. Patients achieving CR were followed up at monthly intervals until relapse. Interferon-α-2b was administered at a dose of 3 MU 3 times a week and PUVA was applied 3 times a week. There were 4 female and 2 male patients, aged 32-75 years (mean 54.3 years). Four patients were at stage Ia, one patient at Ib and one patient at stage IIa according to TNM staging. Four of 6 patients (66%) achieved CR and 2 of 6 (33%) achieved partial response (PR). No grade 3-4 side effects due to IFN were detected, and no progression was observed during the treatment. All patients have been under treatment as planned. Low dose of IFN-α-2b plus PUVA was found to be successful in achieving excellent clinical responses in patients with early-stage MF. This treatment modality was very well tolerated.

Psoriasiform contact dermatitis due to propolis in a beekeeper.

BACKGROUND: More than 250 cases of allergic contact dermatitis due to propolis have been described. A few of these occurred in beekeepers. OBJECTIVE: To describe a case of psoriasiform dermatitis caused by propolis in a beekeeper who thought that his lesions were related to honeybee stings. METHODS: A 45-year-old beekeeper experienced hand dermatitis for the past 5 years. He believed that the lesions occurred and worsened when he was stung by honeybees. He was prescribed topical corticosteroids several times, but because he was stung frequently, the drugs never helped control the lesions. In the past few years, he frequently had contact with propolis during honey collection, but he denied the role of propolis because he was wearing gloves while handling the beehives. For diagnostic evaluation, skin biopsy, skin prick tests (SPTs), identification of specific IgE antibodies, and atopic patch tests were performed. RESULTS: Skin biopsy showed psoriasiform contact dermatitis. Results of SPTs to honeybee and serum specific IgE for Apis mellifera remained negative. Results of the atopic patch test performed using A mellifera SPT material were also negative in the first 20 minutes and on the second and third days. However, propolis showed a positive erythematopapular reaction on day 2. The patient never again worked as a beekeeper, and neither did he, as far as he knew, use any medical or cosmetic products that contained propolis. His hand lesions improved almost completely. CONCLUSION: Dermatitis due to propolis should never be disregarded in beekeepers, and every effort should be put forth to make a correct diagnosis and to convince the patients of the cause.

Porokeratosis of Mibelli: successful treatment with cryosurgery.

Porokeratosis of Mibelli, a disorder of keratinization, should be treated because of the possibility of development of malignant epithelial tumors on the porokeratotic lesions. Liquid nitrogen cryosurgery is considered to be particularly useful in the treatment of precancerous and benign skin lesions. We aimed to evaluate the efficiency of this method in the treatment of porokeratosis of Mibelli. Eight patients with 20 porokeratotic lesions were treated with spray cryosurgery. Each lesion was frozen for 30 seconds with a spray tip after the keratotic borders were removed conically by sharp dissection. Eighteen of the 20 lesions were healed successfully with slight atrophy in one session. One more session was necessary for the other two lesions. Liquid nitrogen cryosurgery may be considered superior to other destructive methods in the treatment of porokeratosis of Mibelli, with advantages such as simplicity, high cure rates, low cost, short treatment period, and few complications.

T cell subpopulations and IL-2R in vitiligo.

Immunological alterations have been implicated in the etiopathogenesis of vitiligo. The aim of this study was to determine peripheral lymphocyte subpopulations and interleukin-2 receptor (IL-2R) in patients with vitiligo. Forty-five vitiligo patients (24 female, 21 male) and 34 healthy controls (11 female, 23 male) were included into the study. Eight (17.8%) of the patients had the segmental type, and 37 (82.2%) had generalized vitiligo. The disease was active in 25 (55.6%) patients; the other 20 (44.4%) patients had static vitiligo. Flow cytometry was used to determine the percentages of total T-lymphocytes, B-lymphocytes, helper/inducer T cells, suppressor/cytotoxic T cells, natural killer (NK) cells, activated T cells and interleukin-2 receptor (IL-2R) with the use of CD3, CD19, CD4, CD8, CD16, HLA-DR and CD25 monoclonal antibodies, respectively. The mean value of helper T cells showed a significant difference (p=0.01) between the two groups with the value being 32.5% in patients and 38.1% in control subjects. CD4/CD8 was significantly lower in vitiligo patients (p=0.04). There was also a statistically significant difference in the mean percentage of activated T cells between vitiligo patients and control subjects (4.7 and 8.1, respectively; p=0.001). No statistically significant differences were found when the values were compared between segmental and generalized vitiligo patients, or between active and static cases. In conclusion, T helper/inducer cells, CD4/CD8 ratio and activated (HLA-DR+) T cells are decreased in vitiligo patients, suggesting a role for changes in cellular immunity.

Non-melanoma skin cancers between the years of 1990 and 1999 in Izmir, Turkey: demographic and clinicopathological characteristics.

The incidence of nonmelanoma skin cancers (NMSCs) has been rapidly increasing in epidemic proportions all over the world. The purpose was to evaluate the demographic and clinico-pathological patterns of skin cancers in Izmir, a region with high ultraviolet light exposure. The study was retrospective and hospital-based. The data related to all NMSC patients registered from January 1, 1990, to December 31, 1999, in the Dermatology Department of Ege University Medical School in Izmir, were collected and analyzed according to the personal statistics, anatomic location, dimensions of the lesion and clinical and histopathological type of skin cancer. A total number of 2,879 patients, aged between 20 and 96 years, were included in the study; among them 1,633 were men and 1,246 were women. The mean age of the patient population was 62.81 years, with a standard deviation of 12.50 years. Among the tumour patients, there were 2,062 basal cell carcinomas (BCCs), 746 squamous cell carcinomas (SCCs) and 71 both BCC and SCC; the total number of lesions was 3,186 (2,339 BCCs, 847 SCCs). Of all the NMSC lesions studied, the highest percentage (46.6%) were located on the face. For the BCCs, the most frequent histopathological subtype was the solid pattern (50.74%). The mean male: female ratios for SCC and BCC lesions were 2.86 and 1.01, respectively. Nodular and ulcerative forms (69.8%) were the most commonly found clinical types. Of all NMSCs, 78.4% had diameters in the 11 to 20 mm. BCC is the most common type of skin cancer diagnosed in our region. Among the NMSC patients, farming was the most widespread and risky job. The majority of SCC tumors were observed mostly in men 60 years old or above. This is the first comprehensive description of NMSCs in our region.