Cutaneous findings in patients with acromegaly and its relationship with concomitant endocrinopathies.

OBJECTIVES: Skin changes in acromegaly are often the first sign of the disease. The aim of this study was to describe the cutaneous findings in patients with acromegaly. In addition, a secondary aim was to investigate the possible association of these findings with remission status and concomitant endocrinopathies. DESIGN, PATIENTS, AND MEASUREMENTS: In this prospective multicenter study, 278 patients over the age of 18 years with acromegaly who were followed up in 14 different tertiary healthcare institutions were included. These patients, who were followed up by the Endocrinology Department, were then referred to a dermatologist for dermatological examination. The frequency of skin lesions was investigated by detailed dermatologic examination. Dermatological diagnosis is reached by clinical, dermatological and/or dermoscopic examination, and rarely skin punch biopsy examinations in suspicious cases. The possible association of the skin findings between remitted and nonremitted patients and with concomitant endocrinopathies were evaluated. RESULTS: The most common skin findings in patients with acromegaly in our study were skin tags (52.5%), cherry angiomas (47.4%), seborrhoea (37%), varicose veins (33%), acneiform lesions (28.8%), hyperhidrosis (26.9%) and hypertrichosis (18.3%). Hypertrichosis was significantly more prevalent in patients nonremitted (p: .001), while xerosis cutis was significantly more prevalent in patients remitted (p: .001). The frequency of diabetes mellitus and hypothyroidism was significantly higher in patients with varicose veins and seborrhoeic keratosis than those without. Additionally, the coexistence of hypothyroidism, hyperthyroidism and galactorrhea was significantly higher in patients with Cherry angioma than in those without Cherry angioma (p-values: .024, .034 and .027, respectively). The frequency of hypogonadism in those with xerosis cutis was significantly higher than in those without (p: .035). CONCLUSIONS: Cutaneous androgenization findings such as skin tag, seborrhoea, acne and acanthosis nigricans are common in patients with acromegaly. Clinicians should be aware that skin findings associated with insulin resistance may develop in these patients. It can be said that the remission state in acromegaly has no curative effect on cutaneous findings. Only patients in remission were less likely to have hypertrichosis. This may allow earlier review of the follow-up and treatment of acromegaly patients presenting with complaints of hypertrichosis. Additionally, it can be said that patients with skin findings such as cherry angioma may be predisposed to a second endocrinopathy, especially hypothyroidism. Including dermatology in a multidisciplinary perspective in acromegaly patient management would be beneficial to detect cutaneous findings earlier.

Cutaneous reactions after COVID-19 vaccination in Turkey: A multicenter study.

OBJECTIVES: In this study covering all of Turkey, we aimed to define cutaneous and systemic adverse reactions in our patient population after COVID-19 vaccination with the Sinovac/CoronaVac (inactivated SARS-CoV-2) and Pfizer/BioNTech (BNT162b2) vaccines. METHODS: This prospective, cross-sectional study included individuals presenting to the dermatology or emergency outpatient clinics of a total of 19 centers after having been vaccinated with the COVID-19 vaccines. Systemic, local injection site, and non-local cutaneous reactions after vaccination were identified, and their rates were determined. RESULTS: Of the 2290 individuals vaccinated between April 15 and July 15, 2021, 2097 (91.6%) received the CoronaVac vaccine and 183 (8%) BioNTech. Systemic reactions were observed at a rate of 31.0% after the first CoronaVac dose, 31.1% after the second CoronaVac dose, 46.4% after the first BioNTech dose, and 46.2% after the second BioNTech dose. Local injection site reactions were detected at a rate of 35.6% after the first CoronaVac dose, 35.7% after the second CoronaVac dose, 86.9% after the first BioNTech dose, and 94.1% after the second BioNTech dose. A total of 133 non-local cutaneous reactions were identified after the CoronaVac vaccine (2.9% after the first dose and 3.5% after the second dose), with the most common being urticaria/angioedema, pityriasis rosea, herpes zoster, and maculopapular rash. After BioNTech, 39 non-local cutaneous reactions were observed to have developed (24.8% after the first dose and 5% after the second dose), and the most common were herpes zoster, delayed large local reaction, pityriasis rosea, and urticaria/angioedema in order of frequency. Existing autoimmune diseases were triggered in 2.1% of the patients vaccinated with CoronaVac and 8.2% of those vaccinated with BioNTech. CONCLUSIONS: There are no comprehensive data on cutaneous adverse reactions specific to the CoronaVac vaccine. We determined the frequency of adverse reactions from the dermatologist's point of view after CoronaVac and BioNTech vaccination and identified a wide spectrum of non-local cutaneous reactions. Our data show that CoronaVac is associated with less harmful reactions while BioNTech may result in more serious reactions, such as herpes zoster, anaphylaxis, and triggering of autoimmunity. However, most of these reactions were self-limiting or required little therapeutic intervention.

Dermoscopy of dermatofibromas: A new perspective.

AIM: In dermoscopic studies on dermatofibromas, some publications divide the appearance of lesions into standardised patterns, and some publications classify the clinical appearance of the lesions by comparing them with existing dermatological lesions. This study aims to re-evaluate the dermoscopic findings and patterns of dermatofibromas from a different perspective. MATERIALS AND METHODS: In this study, 142 lesions of 72 patients were evaluated dermoscopically and their patterns were schematised. RESULTS: In our study, a total of 15 patterns consisting of main and sub-patterns were created. The most common patterns we detected were pattern 1 (1a: 13.4%, 1b: 8.5%), pattern 8 (8a: 10.6%, 8b: 4.2%) and pattern 2 (2a: 9.2%, 2b: 4.2%), respectively. CONCLUSION: Patterns of DFs were reclassified while preserving basic patterns. We think that the new sub-patterns and schematisation with this study can contribute to a better understanding of DFs.

Evaluation of corneal densitometry changes in patients with lichen planus.

PURPOSE: To investigate the corneal topography and densitometry changes in patients with lichen planus (LP). METHODS: Anterior segment parameters and corneal densitometry of patients with LP and age- and gender-matched individuals with healthy eyes were evaluated using Scheimpflug corneal topography. A 12 mm corneal area was divided into 4 annular zones and 3 regions-in-depth anterior, central and posterior-for densitometry evaluation. RESULTS: The study included 45 patients with LP and 50 individuals with healthy eyes. The two groups were similar in age and gender, and they showed no significant differences in anterior segment corneal topography parameters. Schirmer's I test results were significantly lower in the patients with LP than in the control group (P Ë‚ .001). The total corneal densitometry was higher in patients with LP than in the control group (P = .030). The anterior, central and posterior corneal densitometry in the 0-2 mm and 2-6 mm annular zones was higher in the LP group than in the control group. Correlation analysis between disease duration and corneal densitometry values showed a strong positive correlation in the anterior segment and a moderate positive correlation in the central and posterior segments (r = 0.632, P Ë‚ .001; r = 0.572, P Ë‚ .001; and r = 0.562, P Ë‚ .001, respectively). CONCLUSIONS: Corneal densitometry values were higher in patients with LP than in individuals with healthy eyes, even if the patients had a clinically transparent cornea. More studies are needed to evaluate the changes that may occur in corneal transparency in patients with LP and other autoimmune dermatologic diseases that may affect the eye.

The effect of secukinumab treatment on inflammatory parameters in patients with psoriasis: A multicentre restrospective study.

AIM: Psoriasis is a common chronic inflammatory disease of the skin with remission and relapses. The aim of this study was to investigate the change in inflammatory parameters such as neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and mean platelet volume (MPV) in patients receiving secukinumab treatment for psoriasis vulgaris (PV). MATERIALS AND METHODS: In this retrospective study, we evaluated the laboratory results of 40 patients who were followed up with a diagnosis of PV and received secukinumab treatment in three different dermatology clinics between July 2018 and September 2019. RESULTS: Neutrophil count and leukocyte count were significantly decreased after secukinumab treatment. (P < .001) There was no statistically significant difference between lymphocyte count, platelet count, MPV, NLR and PLR values before treatment and at the 4th month of treatment (P values .230, .065, .110, .915 and .365, respectively). CONCLUSION: In conclusion, it can be concluded that parameters such as NLR, PLR and MPV are not suitable parameters for monitoring the effects of secukinumab treatment on inflammation.

Atypical and unusual morphological variants of cutaneous leishmaniasis.

OBJECTIVE: Cutaneous leishmaniasis (CL) is a skin disease characterised by prolonged nodulo-ulcerative lesions of the skin that heals with atrophic scar. Clinical features of CL vary depending on the type of parasite and host immune resistance. The aim of this study was to investigate the clinical features of atypical and unusual morphological variants of CL patients diagnosed in our clinic. MATERIALS AND METHODS: In this prospective study, 27 CL patients with atypical clinical features among 486 patients admitted to our clinic between July 2018 and September 2019 and diagnosed as CL by slit-skin smear examination or histopathological examination were included. RESULTS: Of 27 patients, 15 (55.5%) were male and 12 (44.5%) were female. The mean age of the patients was 25.8 ± 7.62 years. Seven (25.9%) patients had lupoid lesions, five (18.6%) patients had eczematoid lesions, four (14.8%) patients had lip lesions, three (11.1%) patients had erysipelas-like lesions, two (7.4%) patients had eyelid lesions, two (7.4%) patients had sporotrichoid lesions, two (7.4%) patients had verrucous lesions, one (3.7%) patient had psoriasiform lesion and one (3.7%) patient had paronychial lesion. CONCLUSION: In conclusion, rare clinical forms of CL are presented in this study. It should be kept in mind that CL may have very different clinical features and should be considered in the differential diagnosis of eczema, psoriasis, erysipelas, sporotrichosis, paronychia and verrucous lesions.

Effect of isotretinoin (13-cis-retinoic acid) on levels of soluble VEGF receptors (sVEGFR1, sVEGFR2, sVEGFR3) in patients with acne vulgaris.

BACKGROUND/AIM: The effect of isotretinoin on soluble VEGFRs has not been previously investigated. This study evaluate the effects of isotretinoin (13-cis-retinoic acid) on soluble VEGFR1 (sVEGFR1), soluble VEGFR2 (sVEGFR2) and soluble VEGFR3 (sVEGFR3). METHODS: The study included 38 patients (28 females, 10 males) receiving systemic isotretinoin treatment and 38 healthy individuals (28 females, 10 males) with similar age and gender characteristics. The blood samples of the patient group at third months and blood samples of the control group were compared in terms of sVEGFR1, sVEGFR2 and sVEGFR3 concentrations. RESULTS: It was significant that sVEGFR1 was low and sVEGFR3 was high in patients receiving isotretinoin (p: .038, p: .021, respectively). There was no significant change in sVEGFR2 levels between the groups (p: .519). CONCLUSIONS: We think that the effect of isotretinoin on sVEGFR1, sVEGFR2 and sVEGFR3 may be secondary to its effects on the VEGF family. However, after clarifying the effect of isotretinoin on the VEGF family, we think that it can be used in some tumors and vascular diseases.

Evaluation of inflammatory parameters in patients with cutaneous leishmaniasis.

Cutaneous leishmaniasis (CL) is a vector-borne parasitic disease characterized by various skin lesions that can cause deformities when healed. Our aim in this study is to show the utility of parameters such as neutrophil/lymphocyte ratio (NLR), thrombocyte/lymphocyte ratio (TLR), and mean thrombocyte volume (MTV) as auxiliary laboratory methods in CL patients. About 107 patients who were admitted to our dermatological and venereal diseases outpatient clinic between January 2018 and January 2019 and were diagnosed with CL by microscopic examination and 74 healthy individuals were included in the study. There were no significant differences between the patient and control group in terms of neutrophil counts, leukocyte counts, platelet counts, and NLR values (P values: .271, .053, .263, and .459, respectively). When the TLR and MTV values of patients with CL and those of the healthy controls were compared, it was found that TLR and MTV values were statistically higher in patients with CL (P values of .010 and .044, respectively). Based on these data, NLR was not considered to be a suitable parameter for demonstrating inflammation in CL patients, but TLR and MTV were held to be an appropriate parameter for demonstrating inflammation in CL patients. In addition, we think that the increase in MTV and TLR, can be used as an auxiliary laboratory test in the diagnosis of CL disease.

Premature or nevoid sebaceous hyperplasia? Two case reports of a rare disease.

Early or familial cases of sebaceous hyperplasia (SH) with multiple lesions, thought to be associated with genetic predisposition, have been reported in young individuals. Rarely reported variants include the giant, diffuse, zosteriform, and/or linear (nevoid) form. However, premature SH, defined as benign proliferation of sebaceous glands that occurs during or after puberty, is histologically similar to SH. Whether the definitions of nevoid SH or premature SH are the same remains unclear. We report two sporadic cases of premature SH.

Isotretinoin does not alter VEGF-A and VEGF-C levels: do retinoids behave differently in dose-dependent and/or in vivo/in vitro conditions?

BACKGROUND: It is seen that various forms of retinoids have different results on VEGF-A and VEGF-C levels when tested at different dosages, in different diseases and under different conditions such as in vivo or in vitro. OBJECTIVE: To evaluate the effects of isotretinoin on VEGF-A and VEGF-C levels in humans. METHODS: Blood samples at the third month of the patient group and blood samples of the control group were compared in terms of VEGF-A and VEGF-C concentrations. RESULTS: No statistically significant difference was observed between the patient group and the control group in terms of VEGF-A and VEGF-C levels. LIMITATIONS: Most of the patients discontinued treatment and could not reach the required number, the study was converted to case-control. CONCLUSIONS: We think that 0.5 mg/kg/day isotretinoin has no effect on blood concentrations of VEGF-A and VEGF-C in humans. Therefore, there is a need for studies using isotretinoin in different doses and durations in humans in order to better evaluate its effects.

Retinal nerve fiber layer, retinal pigment epithelium, and choroidal thickness in vitiligo patients.

BACKGROUND: Vitiligo is one of the common pigmentary disorders affecting the ocular structures. AIM: To determine the retinal nerve fiber layer (RNFL), retinal pigment epithelium (RPE), and choroidal thickness (CT) in vitiligo patients and to evaluate the relationship between choroidal thickness and vitiligo subtypes. METHODS: The right eyes of 106 participants (51 vitiligo, 55 nonvitiligo) were included in the study. All of the participants underwent detailed eye examinations and spectral-domain optical coherence tomography (SD-OCT) examinations. CT was measured manually with enhanced depth imaging optical coherence tomography (Edi-OCT) (subfoveal [SubF], nasal n500 µm [N1], n1500 µm [N2]), and temporal (t500 µm [T1], t1500 µm [T2]). RESULTS: In vitiligo patients, CT values were significantly lower in the SubF, N1, N2, T1, and T2 areas compared to the control group (P = .001, P = .011, P = .002, P = .005, P Ë‚ .001, respectively). Periorbital involvement did not affect CT (P = .355, P = .746, P = .443, P = .633, P = .558, respectively). However, in patients with periorbital region involvement, the CT was significantly reduced if the lesion had a universal character (P Ë‚ .001, P = .001, P = .011, P Ë‚ .001, P = .002, respectively). It was observed that RPE thickness decreased in vitiligo, but this difference was not statistically significant (P = .140). RNFL thickness was unaffected in all quadrants. A positive correlation (r = .286, r = .280, respectively) was observed between the Vitiligo Area Severity Index (VASI) and age and disease duration. A negative correlation (r = -.360, r = -.316, r = -.315, r = -.313, respectively) was found in the CT of the SubF, N1, N2, T1, and T2 areas. CONCLUSION: Vitiligo patients should be closely monitored for possible posterior ocular segment disorders.

Low dose of isotretinoin: A comprehensive review.

Isotretinoin is a first-generation retinoid initially approved for the treatment of severe cases of acne vulgaris (nodulocystic acne). Because of its broad anti-inflammatory and immunomodulatory properties, it has been used beyond its initial approval in a myriad of other indications. Adverse effects of isotretinoin vary from xerosis to teratogenicity. Herein, we reviewed the literature, through date-unlimited PubMed search, from inception till December 2019, using the following search terms: "low-dose isotretinoin" and "dermatology," "isotretinoin and safety," "isotretinoin, off-label uses," "isotretinoin and male fertility," "isotretinoin, iPLEDGE system," aiming to deliver a therapeutic update relevant to clinical practice. All English-language articles were considered with no limitation based on the articles' type. Low-dose isotretinoin is not limited to old and novel dermatological conditions, but also showed promising results in the field of infertility and safety in the field of gastroenterology. We also highlight on the safety profile of the drug and experts' recommendations to enhance safety measures to decrease fetal risk while on isotretinoin.