An Evaluation of Anxiety Disorder and Emotion Regulation Difficulty in Children and Adolescents with Alopecia Areata.

Context: The relationship between alopecia areata (AA) and emotion regulation difficulty has not yet been fully explained. Aims: The aim of the study was to investigate the levels of anxiety and emotion regulation difficulty in children diagnosed with AA. Settings and Design: This case-control study was done in the university setting. Methods: Behavioral tests measuring anxiety and emotion regulation difficulties, and the measures assessing AA severity were applied to 32 AA patients consulted at Dermatology Clinic of Yozgat Bozok University. A control group was formed of 36 healthy children. Statistical Analysis Used: Kolmogorov-Smirnov normality test, Mann-Whitney U test and Pearson's and Fisher's Chi-square tests and Spearman's correlation test. Results: Evaluation was made of a total of 68 subjects (32 patients, 36 healthy subjects). The Difficulties in Emotion Regulation Scale (DERS)-total score and the DERS-clarity subscore were statistically significantly higher in the control group than in the patient group (P = 0.021, P = 0.003, respectively). No significant difference was determined between the two groups in respect of anxiety levels. No correlation was determined between disease severity and the scales. It was determined that as disease duration increased, so the DERS-non-acceptance subscale score increased, and with an increase in age, the SAI score of the AA patients increased. The DERS-impulse subscale score was seen to be statistically significantly higher in the boys with AA than in girls (P = 0.030). Conclusions: The results of this study showed that a visible, chronic, recurrent disease such as AA is not always seen with high psychiatric comorbidity and that together with the presence of the disease, patient age and disease duration are also important. It can be considered that AA may have been affected by the location, time and conditions of the study.

Have Skin Biopsy Results in Adults Been Affected in the COVID-19 Pandemic?

The purpose of this study was to assess how skin biopsy results from adults, which occupy an important place in dermatological practice, have been affected by the COVID-19 pandemic. Adult patients aged over 18 presenting to the dermatology clinical of a tertiary hospital between March 12, 2019 and March 11, 2020, and between March 12, 2020 and March 11, 2021, from whom skin biopsies had been taken and who had undergone pathological examination were included in the study. Pre-COVID-19 pandemic data were compared with post-pandemic data. No significant difference was determined between the two periods in terms of age, sex, type of biopsy, preliminary diagnosis numbers, or clinicopathological correlation (P>0.05). The diseases most frequently diagnosed through biopsy before the pandemic were psoriasis (13.7%), pseudopelade of Brocq (6.8%), and fibroepithelial polyp (5.5%), compared with psoriasis (9.4%), basal cell carcinoma (BCC) (6.3%), lichen planus (6.3%), and urticarial vasculitis (6.3%) during the pandemic. Diagnoses of BCC and urticarial vasculitis were significantly elevated after the COVID-19 pandemic (P<0.05), while no periodic difference was observed in other diagnoses. A rise in the incidence of various diseases, such as urticarial vasculitis, may be indicative of a risk of asymptomatic COVID-19. Further polymerase chain reaction and/or antibody-based investigations should be carried out in order to establish whether dermatological diseases are associated with asymptomatic COVID-19 cases. Determining the clinical and histopathological aspects of COVID-19, which can progress with various cutaneous findings, will be useful in the early diagnosis and treatment of this novel and life-threatening disease.

Acne in pregnancy: A prospective multicenter, cross-sectional study of 295 patients in Turkey.

BACKGROUND: There are only a few studies on acne in pregnancy. This study was aimed to investigate the demographic, clinical, and familial characteristics of acne in pregnancy, triggering factors including endocrine diseases, and association of these findings with acne in different trimesters of pregnancy. METHODS: Pregnant women aged 18 years and older with acne at any stage of pregnancy were consecutively interviewed at the participating centers during the study period from 2016 to 2019. Acne severity was evaluated using the Comprehensive Acne Severity Scale. RESULTS: A total of 295 pregnant women with acne were included, with 167 (56.6%) patients showing mild, 87 (29.5%) moderate, six (12.2%) severe, and five (1.7%) very severe acne. Truncal acne was significantly higher in the third trimester than in the other stages (P < 0.001). Onset of acne before pregnancy, prepubertal, pubertal or adult onset, or acne history in previous pregnancies did not influence acne severity in pregnancy. Women with irregular menstruation before pregnancy, polycystic ovary syndrome, hirsutism, and higher body weight index tended to show severe acne in pregnancy. CONCLUSIONS: Severe acne during pregnancy is generally uncommon, while severity of facial acne, truncal acne, and hirsutism is higher in the third trimester than in other trimesters. Acne in pregnancy shares many characteristics with female adult acne. Substantial changes in different kinds of hormones play a more complex role in acne during pregnancy, but the pathogenesis remains to be determined.

Patient with Mal de Meleda in whom a Novel Gene Mutation was Identified.

Mal de Meleda, also known as keratoderma palmoplantaris transgrediens, is a rare type of autosomal recessive palmoplantar keratoderma. A 19-year-old male presented with a congenital yellowish discoloration and thickening of both palms and soles of the feet. His family history revealed that there was no consanguinity between the mother and the father and that the patient had three healthy brothers. The second- and third-degree relatives, five females and one male, also exhibited similar skin findings. From the isolated DNA samples, the extrinsic regions of the SLURP1 gene were screened using the sequence analysis and the Sanger sequencing was performed with the 3130 Sequence Analyzer. Results of this analysis show that a p.Arg 96 Pro (R96P) (c.287 CGA>CCA) homozygous missense point mutation was detected on the SLURP 1 (a secreted toxin-like mammalian lymphocyte antigen 6/urokinase-type plasminogen activator receptor-related protein 1) gene of the patients, while heterozygous p.Arg 96 Pro (R96P) (c.287 CGA>CCA) mutation was detected in the mother, father, and brothers. Our search of the Human Genome Mutation Database and previous literature revealed no reports of this mutation in mal de Meleda. We report this case due to the identification of a novel gene mutation in a patient with mal de Meleda, a palmoplantar keratoderma.

The effect of personal, familial, and environmental characteristics on acne vulgaris: a prospective, multicenter, case controlled study.

BACKGROUND: There are only a few studies about epidemiological features of acne vulgaris in the literature. The aim of this study was to analyze demographic, clinical, familial and environmental characteristics of acne, the role of diet and aggravating factors and association of these factors with acne severity. METHODS: Patients with a diagnosis of mild-moderate to severe acne were consecutively interviewed at the participating centers during the study period. RESULTS: A total of 3826 patients and 759 control patients were involved in this study. Mild acne was the most common type of acne, and most of the lesions were localized on face followed by the trunk. The severity of acne was worse in patients who had a positive family history of acne. The most common triggering factor was psychological stress. We found a positive correlation with chocolate, bread, green tea, milk, white sugar, ripe banana, ice cream, apple, orange, and red meat consumption. As we compare the acne severity according to geographical features we detected mild- moderate acne was more common in Mediterranean region and severe acne was more common in East Anatolian region. Family history positivity was more common in Aegean region and least common in Central Anatolian region. There was statistically significant relationship as we compare acne severity and dietary factors such as chocolate, dairy products such as milk, sunflower seed consumption within the geographical regions. CONCLUSIONS: This study presents the demographic and clinical characteristics of acne patients in Asian and the European parts of Turkey. We believe that this study will provide a useful overview of acne in Turkey.

A case of aquagenic syringeal acrokeratoderma with involvement of periungual area of the hand.

Gürel G, Sahin S, Çölgeçen E. A case of aquagenic syringeal acrokeratoderma with involvement of periungual area of the hand. Turk J Pediatr 2018; 60: 762-764. Aquagenic syringeal acrokeratoderma (ASA) is a rare form of palmoplantar keratoderma occurring after short-term contact with water. Although ASA usually involves the palmar region, there are also several cases with the involvement of dorsum of hand and sole of the feet. We described 15-year old girl who had white keratodermic plaques observed on the flexor side of distal phalanxes especially the periungual area after a 10 min contact with water. Our patient represents a rare case of ASA with the involvement of periungual region of the fingers.

Pityriasis rosea-like eruption induced by isotretinoin.

Pityriasis rosea is a common, self-limited and inflammatory skin disease. The etiology is not clearly known. Viral agents, autoimmunity, psychogenic factors and drugs have all been suggested as risk factors. Isotretinoin is usually used in the treatment of resistant, nodulocytic acne. We present a case of pityriasis rosea-like eruption induced by isotretinoin. To our knowledge, this is the second clinical case of pityriasis rosea-like eruption induced by isotretinoin.

Personality traits and common psychiatric conditions in patients with seborrheic dermatitis

Abstract Background Seborrheic dermatitis is a skin disease in which psychological factors play a central role in its onset, exacerbation and remission. Objective The aim of this study was to investigate personality traits and common psychiatric conditions in patients with SD. Methods Outpatients who were admitted to the Bozok School of Medicine Department of Dermatology complaining of SD and who volunteered for study were included. Symptom Checklist 90 – Revised (SCL-90-R) and Eysenck Personality Questionnaire – Revised Short Form (EPQ-RSF) were administered before treatment to 50 patients who fulfilled the criteria for inclusion in the study. Results compiled from the 50 subjects were compared to a control group that was comprised of 50 healthy volunteers. Results Of the 50 patients that were included in the study, 25 were female and 25 were male. The Global Symptom Index (GSI; Z = -6.96, P < 0.001), Somatization (Z = -6.59, P < 0.001), Depression (Z = -7.11, P < 0.001), and Anxiety (Z = -6.64, P < 0.001) subscales of the SCL-90-R were evaluated. Statistically significantly higher scores were obtained from patients with SD in comparison with the control group on all of these subscales. In addition, the EPQ-RSF Neuroticism subscale was statistically significantly higher (Z = -4.99, P < 0.001) in patients with SD. Discussion Our results showed that common psychiatric conditions are considerably frequent in SD patients. More importantly, neurotic personality characteristics were much more frequent in these patients. These findings suggest SD to be a psychosomatic disorder that requires a multi-disciplinary approach.

Dermatological Findings in Turkish Paediatric Haematology-Oncology Patients.

OBJECTIVE: Diagnoses of skin, mucosae, hair and nail manifestations in malignant diseases are often challenging because of life-threatening drug reactions, opportunistic infections or skin involvement of primary processes. Description of morphology, configuration and distribution of lesions is important in order to differentiate the self-healing eruptions from serious side effects of chemotherapy. There are case reports from Turkey including dermatological manifestations of malignancies and case series in adult patients but there are no published large group studies assessing all manifestations in children. The aim of this study was to evaluate the morphological features of dermatological findings in children with haemato-oncological diseases. MATERIALS AND METHODS: The study was performed at the Erciyes University, Faculty of Medicine Pediatric Hematology-Oncology Clinic, Turkey. Three dermatologists daily consulted all patients admitted to the clinic during a one-year period. RESULTS: The study group comprised of 157 children (79 female/78 male) aged 1-16 years (mean 7.19±4.63). Detailed dermatological examinations were performed, including oral-genital mucosae, hair and nails. Thorough skin examination revealed that 70% of the patients exhibited at least one dermatological finding. Generalized xerosis and hyperpigmentation were the most common findings among patients undergoing chemotherapy (24.19%). Multiple nevi on at least 10 covered areas were very frequent among patients undergoing long-term chemotherapy (18.47%). Three were identified as dysplastic nevus, but malignant transformation was not observed during the one-year study period. CONCLUSION: Regular dermatological consultation may help resolve the diagnostic and therapeutic problems in paediatric haemato-oncology clinics.

Effects of topical acne treatment on the ocular surface in patients with acne vulgaris.

PURPOSE: To assess the ocular side effects during topical retinoid-antibiotic combination treatment in patients with facial acne vulgaris. METHODS: Forty-three patients applying topical isotretinoin+erythromycin combination (isotrexin gel, GlaxoSmithKline) once daily for the treatment of acne vulgaris were enrolled. Full ophthalmologic examination, Schirmer test (with topical anesthesia), fluorescein break-up time (BUT), corneal fluorescein staining and tear osmolarity measurement with the TearLab system (TearLab Corporation) were carried out before and at the end of the first month of the treatment. For evaluation of symptoms participants completed the ocular surface disease index (OSDI) questionnaire at each visit. RESULTS: The mean age of the patients was 23.16±3.03 (18-30) years. Mean tear osmolarity increased significantly from 282.09±8.95 mOsm/L at baseline to 300.39±16.65 mOsm/L after the treatment (p<0.001). BUT decreased from an average of 11.93±1.12s at baseline to 6.65±3.03s at the end of the first month (p<0.001). The OSDI score worsened significantly (5.41±3.65 vs 21.53±12.95, p<0.001) and punctate epitheliopathy was seen in 51% of eyes after the treatment. The average Schirmer values were 13.09±1.90 and 12.41±2.44mm/5min before and at the end of the first month of the treatment, respectively (p=0.117). CONCLUSIONS: The findings of this study indicate that topical retinoid-antibiotic combination treatment causes significant signs and symptoms of dry eye. Patients receiving topical treatment for acne should be evaluated regularly to ensure the timely detection and treatment of pathologic signs on the ocular surface.

The Relation of Androgenetic Alopecia Severity with Epicardial Fat Thickness.

BACKGROUND: Androgenetic alopecia (AGA) is the most commonly encountered baldness pattern in men. Epicardial fat tissue is found on the cardiac surface between the myocardium and visceral pericardium. Both AGA and epicardial fat thickness (EFT) are related to coronary artery disease, which is also reflected by an increase in carotid intima media thickness (CIMT). OBJECTIVE: The purpose of this study was to investigate the relation of AGA severity with EFT. METHODS: One hundred twenty-six male patients with AGA aged 18 to 55 years without histories of chronic disease were enrolled. Subjects were divided into three groups (mild, moderate, and severe) on the basis of the Hamilton baldness scale as modified by Norwood. Maximum EFT was measured at end-systole on the midventricular free wall of the right ventricle. CIMT was also recorded for all patients. RESULTS: The groups did not have statistically significant differences with respect to age, height, weight, body mass index, left ventricular ejection fraction, or left atrial diameter (p>0.05 for all comparisons), but the severe group had a higher EFT compared with the moderate (p<0.001; z score, -7.040) and mild groups (p<0.001; z score, -6.667). The moderate group also had higher EFT than the mild group (p<0.001; z score, -5.931). Mean CIMT value in the severe group was significantly higher compared with the value in the other groups. CONCLUSION: The study showed that subjects in advanced stages of AGA had increased EFT, which was measured via echocardiography.

Cognitive Impairment in Patients with Psoriasis: A Cross-Sectional Study Using the Montreal Cognitive Assessment.

BACKGROUND: Psoriasis is a multisystem chronic inflammatory disorder that is thought to be associated with cognitive impairment. AIMS: We aimed to investigate cognitive performance using the Montreal Cognitive Assessment (MoCA) in patients with psoriasis. METHODS: In total, 77 patients with psoriasis and 83 age- and sex-matched control subjects were enrolled in this prospective cross-sectional study. Physical and/or histopathological findings were used to diagnose psoriasis vulgaris, and patients with psoriasis were evaluated according to disease characteristics, including duration, severity, onset age, medical treatment, and cosmetic involvement. All participants provided sociodemographic data and completed the Beck Depression Inventory. Cognitive functions were evaluated using the MoCA tool. RESULTS: The MoCA scores were significantly lower in the psoriasis group than in the control group (p = 0.004). More psoriasis patients than control subjects presented with deficits in visuospatial domain (p = 0.037) and executive functioning (p = 0.010). In the multivariate model, the presence of psoriasis (odds ratio [OR] 3.64; 95 % confidence interval [CI] 1.65-8.02; p = 0.001), education level (3.74; 95 % CI 1.65-8.48; p = 0.002), and area of residence (3.56; 95 % CI 1.61-7.87; p = 0.002) were found to be independently associated with cognitive impairment in patients with psoriasis and control subjects. On the other hand, no correlations were observed between disease characteristics and cognitive impairment in patients with psoriasis vulgaris (p > 0.05). CONCLUSIONS: The results suggest that psoriasis patients might have early or subtle cognitive impairment, including visuospatial domain and executive functioning.

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 effect of systemic isotretinoin treatment on skin biophysicalparameters among patients with acne vulgaris.

BACKGROUND/AIM: Systemic isotretinoin has been widely considered an effective and safe medical treatment for severe and refractory acne for nearly 3 decades. However, it also appears to cause undesirable cutaneous side effects. The aim of this study was to prospectively measure biophysical parameters of skin function among patients with acne vulgaris before and after 3 months of isotretinoin therapy, including pH, temperature, sebum content, skin hydration, and transepidermal water loss. MATERIALS AND METHODS: The study cohort consisted of 19 patients with acne vulgaris. Noninvasive methods were used to measure the biophysical characteristics of forehead skin. All measurements were repeated following the completion of 3 months of systemic isotretinoin treatment. RESULTS: Biophysical skin parameter measurements after 3 months of isotretinoin therapy revealed a decrease in the severity of seborrhea. However, the skin was dry, indicting a decrease in stratum corneum hydration. An increase in skin temperature was also determined. CONCLUSION: Treatment with systemic isotretinoin reduces sebum secretion and stratum corneum hydration and increases skin temperature, suggesting that isotretinoin may partially improve the biophysical characteristics of the skin among patients with acne vulgaris.

A clinical evaluation of skin disorders of lower limb amputation sites.

Amputee patients commonly experience skin problems that may result in social, mental, and economic difficulties. The purpose of this study was to evaluate the incidence of dermatological disorders and identify potential causes and symptomatic patterns among a population of lower limb amputees. Seventy lower limb amputees were enrolled. Complete examinations were performed by a dermatologist, who diagnosed and documented any skin disorders observed and recorded demographic characteristics of each patient. Mycological and bacteriological swabs were collected from the skin at the amputation site for culture analysis. In patients with suspected disease, patch tests were performed. Of the 70 patients, 58 (82.9%) were male and 12 (17.1%) female. Vascular insufficiency due to diabetes (n = 38, 54.3%) and trauma (n = 16, 22.9%) were the most common reasons for amputation. Skin problems were observed in 49 (70%) cases, and positive allergen reactions occurred in 16 (45.7%) of the 35 contact dermatitis cases. Fungal infection occurred in two patients and bacterial infection in seven. Seventy percent of the lower limb amputee patients in this cohort exhibited skin problems. This high percentage indicates that skin problems may reduce patients' quality of life. A multidisciplinary approach to the treatment of patients who have undergone amputation and early recognition and treatment of symptoms are therefore of critical importance.

Evaluation of etiological factors in patients with chronic urticaria.

In the last few decades, increasing understanding of the pathomechanisms involved in chronic urticaria has highlighted the heterogeneity of different subtypes, and chronic urticaria is now classified as chronic spontaneous urticaria and inducible urticaria. Although many factors are thought to be involved in chronic urticaria, the etiology is yet to be clarified. The purpose of this study was to investigate etiological factors in patients with chronic urticaria. Five hundred patients with chronic urticaria, 351 women and 149 men, were studied for etiological factors. The autologous serum skin test was performed on 197 patients. Provocation testing for physical urticaria was performed on 354 patients. Patients with acute urticaria were excluded from the study. We determined at least one focus of infection that might be involved in the etiology of the disease in 18.8% of cases. Patients with infections were treated, and symptoms resolved after treatment in six cases (5.3%). Autologous serum skin tests were positive in 125 patients (63.5%). Provocation tests for physical urticaria were positive in 131 (37%) patients with urticaria. We suggest that physical stimuli and autoantibodies play an important role in the etiopathogenesis of urticaria.

Personality traits and common psychiatric conditions in adult patients with acne vulgaris.

BACKGROUND: We believe that instances of neuroticism and common psychiatric disorders are higher in adults with acne vulgaris than the normal population. OBJECTIVE: Instances of acne in adults have been increasing in frequency in recent years. The aim of this study was to investigate personality traits and common psychiatric conditions in patients with adult acne vulgaris. METHODS: Patients who visited the dermatology outpatient clinic at Bozok University Medical School with a complaint of acne and who volunteered for this study were included. The Symptom Checklist 90-Revised (SCL 90-R) Global Symptom Index (GSI), somatization, depression, and anxiety subscales and the Eysenck Personality Questionnaire-Revised Short Form (EPQ-RSF) were administered to 40 patients who fulfilled the inclusion criteria before treatment. The results were compared with those of a control group. RESULTS: Of the 40 patients included in this study, 34 were female and 6 were male. The GSI and the somatization, depression, and anxiety subscales of the SCL 90-R were evaluated. Patients with adult acne had statistically significant higher scores than the control group on all of these subscales. In addition, patients with adult acne had statistically significantly higher scores on the neuroticism subscale of the EPQ-RSF. CONCLUSION: Our results show that common psychiatric conditions are frequent in adult patients with acne. More importantly, neurotic personality characteristics are observed more frequently in these patients. These findings suggest that acne in adults is a disorder that has both medical and psychosomatic characteristics and requires a multi-disciplinary approach.

The prevalence of Behçet's disease in a city in Central Anatolia in Turkey.

BACKGROUND: The prevalence of Behçet's disease (BD) is much higher in countries along the ancient Silk Route, extending from Japan to Mediterranean countries including Turkey, than in northern Europe and the USA. OBJECTIVES: The present study aimed to investigate the prevalence of BD in Kayseri, a city in Central Anatolia in Turkey. METHODS: This study investigated cross-sectional prevalences of BD in individuals aged >10 years in Kayseri, Turkey, in two stages. The first stage aimed to identify individuals with recurrent oral ulcers (ROUs) through home visits, and the second stage aimed to further examine those with ROUs for the presence of other BD-related manifestations under hospital conditions. The study was conducted using the criteria defined by the International Study Group for Behçet's Disease. The sample size was determined to be 4697 with an expected sampling error of 5.5 per 10,000, with a 95% confidence interval. A standard questionnaire was administered to a total of 5218 individuals. RESULTS: A history of ROU was recorded in 470 (9.0%) of the 5218 residents, and a previous diagnosis of BD was recorded in nine individuals. The prevalence rate of BD was estimated as 17 cases per 10,000 population in Kayseri, Turkey. CONCLUSIONS: The present study contributes towards estimations of prevalences of BD in Turkey and towards raising public awareness about the disease. It also supports previous studies that have reported the world's highest prevalences of BD in Turkey.

Serum Th1, Th2 and Th17 cytokine profiles and alpha-enolase levels in recurrent aphthous stomatitis.

BACKGROUND: All aspects of aetiopathogenesis of recurrent aphthous stomatitis (RAS) have not been elucidated. RAS and Behçet's disease (BD) have clinical and immunological characteristics in common. Although T17 cytokines and alpha-enolase have been shown to play effective roles in BD and many other autoinflammatory diseases recently, their roles in RAS have not been studied extensively. In the present study, we investigated levels of several Th1, Th2 and Th17 pathways related cytokines and alpha-enolase to elucidate pathogenesis of RAS and to obtain data about possible treatment alternatives for the condition. METHODS: Serum interleukin-1, interleukin-13, interleukin-17, interleukin-18, interferon gamma and alpha-enolase levels in 24 patients with RAS, 30 patients with BD and 20 healthy controls were measured. RESULTS: Serum interleukin-1, interleukin-13, interleukin-17, interleukin-18, interferon gamma and alpha-enolase levels were higher in patients with RAS and patients with BD than in healthy controls (P < 0.005). CONCLUSION: Like Th1 and Th2 cells, Th17 cells were found to be effective in pathogenesis of RAS. In addition, alpha-enolase, the levels of which were high, may play an important role in etio-pathogenesis of RAS. Further studies to be designed in the light of these findings are required to shed light on pathogenesis and treatment of the condition.