Keratosis Pilaris Atrophicans Faciei: A Case Treated with 585 nm Diode Laser, a Novel Fractional Solid-State.

Keratosis pilaris atrophicans faciei (KPAF) is a rare, hereditary, follicular disorder categorized in the atrophicans subtypes of keratosis pilaris (KP). Nowadays it can be treated with light and laser devices. Lasers with wavelengths <600 nm, especially pulsed dye laser (PDL), are effective for treatments of KPAF. Here, we present a case with KPAF treated with 585 nm diode laser, a kind of laser system functioning with differential wavelength modified optically pumped semiconductor (D-WMOPS) technology. Our case is the first patient reported to have been treated with this laser technology in the literature.

Risankizumab for the Treatment of the Patients with Moderate to Severe Plaque Psoriasis During a 24-Week Period: Real-Life Experience.

Introduction: Several authors have reported their experiences in real-world clinical practice, confirming the therapeutic efficacy of risankizumab in plaque psoriasis. We aimed to reflect our experience with risankizumab treatment in patients with psoriasis. Materials and Methods: Patients who presented to the dermatology outpatient clinics of two tertiary care centers between November 2021 and August 2022, diagnosed with psoriasis and treated with risankizumab, constituted the target population. Data including gender, age, weight, type of psoriasis, affected body sites, disease duration, previous treatments, duration of risankizumab treatment, psoriasis area and severity index scores, comorbidities, the reasons for drug discontinuation, adverse effects, and the patients' naïve or non-naïve status were obtained from electronic patient folders. Results: Overall, 120 cases were included. While 73 (60.8%) cases were male, 47 (39.2%) were female. Eighty-six (68.3%) of all cases were biologic non-naive. A total of 49 patients (40.8%) had comorbidities. No significant correlations existed between biologic-naïve or non-naïve status, comorbidity status, and the PASI 75-90-100 responses. Conclusion: Risankizumab is an effective treatment option for both biologic naive or non-naive patients with or without comorbidities. However, long-term studies, including more extensive patient series, are needed to validate its efficacy and safety in real-life clinical settings.

Effectiveness and safety of ustekinumab for the treatment of psoriasis; six years of clinical experience.

BACKGROUND: This work aimed to investigate the long-term clinical experience with ustekinumab in cases with psoriasis. MATERIALS AND METHODS: This retrospective cohort research group consisted of cases who presented to the dermatology outpatient clinics between January 2015 and January 2021, diagnosed with psoriasis, and were treated with ustekinumab. Data including gender, age, weight, disease duration, naïve and non-naïve status, psoriasis type, duration of medication, comorbidities, psoriasis area and severity index scores, the causes of treatment discontinuation, and previous treatments were retrospectively reviewed and analyzed. RESULTS: 160 cases with psoriasis were treated with ustekinumab during the research period. Twenty-four patients were excluded. Among 136 cases, 84 (61.8%) were male and 52 (38.2%) were female. We determined 80.55% of the non-naïve cases responded to ustekinumab. CONCLUSION: Ustekinumab can be a suitable treatment option for non-naïve and resistant patients. Our data suggest the positive effect persists in cases with favorable responses to the first or second dose of ustekinumab. Also, we determined male cases gave more rapid and more robust responses than female cases, and patients were more willing about continuing the treatment.

Real-life efficacy and drug continuation of secukinumab in treating moderate to severe plaque psoriasis in Aegean region of Turkey: a multicenter retrospective study and systematic review of the literature.

BACKGROUND: Secukinumab was demonstrated to be efficient in the treatment of moderate to severe plaque psoriasis in the phase studies. Real-life treatment experiences obtained from patients that do not meet the inclusion criteria of phase studies can provide valuable information on efficacy and safety results. Results may also differ in different ethnic populations. OBJECTIVE: To investigate short and long-term efficacy and drug continuation of secukinumab in Turkish population. METHODS: The study conducted in three tertiary care psoriasis centers. Patients' demographic characteristics and week 0 / 4th week / 12th week / 1st year PASI values were analyzed. For systematic review of the literature a PubMed search using the keywords "secukinumab and real and psoriasis" from inception to April 2021 was performed. RESULTS: Mean PASI scores improved the compared to baseline at all assessment weeks (p = 0.000). In multivariate model, we found that bioexperience have negative influence on the PASI90 response at week 4. Univariate analysis showed significant relationship only between PASI90 response rate and gender at week 12 and year 1. Approximately 85% of patients remained on secukinumab treatment at the end of one year. CONCLUSIONS: Secukinumab seems to be an effective treatment option for plaque psoriasis. According to our knowledge, this is the first study concerning about long-term efficacy and drug continuation of secukinumab from Turkey.

Ixekizumab for the treatment of the patients with moderate to severe plaque psoriasis: Clinical data from a real-world experience.

Real-life data about any particular treatment is very helpful for clinicians, particularly when managing a chronic disease such as psoriasis. In our study, we aimed to reflect our clinical experience during 48 weeks with an IL-17 antagonist ixekizumab. This study was designed as a retrospective multi-center study. Four tertiary referral centers participated into the study. The patients who did not present to the clinics for 3rd month follow-up were excluded. Data including gender, age, weight, type of psoriasis, additional sites on the body, disease duration, previous treatments, duration of medication of ixekizumab, psoriasis area and severity index scores, previous treatments, and comorbidities, the reasons for drug discontinuation, adverse effects and the patients' naïve or non-naïve status were retrieved from electronic patient folders. Although 267 patients met the inclusion criteria, 28 patients were excluded since they did not present to the clinic for 3rd month follow-up so 239 cases were included mmüne research. We determined significant correlations between naive and non-naive cases about getting PASI 75 and PASI 90 responses for all cases (p = 0.005 and p = 0.028, respectively) and between comorbid and non-comorbid cases about getting PASI 90 and PASI 100 responses for all cases (p = 0.021 and p = 0.029, respectively). When we investigate as female and male patients separately, non-comorbid female cases can achieve PASI 100 response significantly easier than comorbid female patients (p = 0.019). Clinicians can use ixekizumab safely mmüne treatment of their patients with psoriasis and get PASI 75-90-100 responses quickly. Ixekizumab is more effective for naive cases but it may also be a treatment option for biologic experienced patients. The ratio of PASI 75-90-100 responses are better in non-comorbid cases than comorbid patients nevertheless ixekizumab is a quite effective agent mmüne treatment of comorbid cases.

The impact of COVID-19 pandemic on psoriasis patients, and their immunosuppressive treatment: a cross-sectional multicenter study from Turkey.

BACKGROUND: Immunosuppressive therapy has been a great concern during the pandemic. This study aimed to evaluate the pandemic's impact on psoriasis patients treated with immunosuppressive drugs. MATERIAL AND METHODS: The multicenter study was conducted in 14 tertiary dermatology centers. Demographic data, treatment status, disease course, and cases of COVID-19 were evaluated in patients with psoriasis using the immunosuppressive treatment. RESULTS: Of 1827 patients included, the drug adherence rate was 68.2%. Those receiving anti-interleukin (anti-IL) drugs were more likely to continue treatment than patients receiving conventional drugs (OR = 1.50, 95% CI, 1.181-1.895, p = .001). Disease worsening rate was 24.2% and drug dose reduction increased this rate 3.26 and drug withdrawal 8.71 times. Receiving anti-TNF or anti-IL drugs was associated with less disease worsening compared to conventional drugs (p = .038, p = .032; respectively). Drug withdrawal causes were 'unable to come' (39.6%), 'COVID concern' (25.3%), and 'physician's and patient's co-decision' (17.4%). Four patients had COVID-19 infection with mild symptoms. The incidence was 0.0022% while it was 0.0025% in the general population. CONCLUSION: Our study shows that psoriasis patients using systemic immunosuppressive do not have a higher, but even lower COVID-19 risk than the general population, and treatment compliance with biological drugs is higher.

Multicenter study evaluating the impact of COVID-19 outbreak on dermatology outpatients in Turkey.

COVID-19 pandemic has a significant impact on public health, whether directly or indirectly. The first case was seen in Turkey on March 11, and the World Health Organization (WHO) declared a pandemic on March 12, 2020. The study aimed to document the effect of pandemic on dermatology outpatient clinics in Turkey. Fifteen tertiary hospitals from 13 provinces were included in the study, which was conducted between January 12 and May 12, 2020. The International Codes of Diseases (ICD-10) categories and patients' characteristics were evaluated before and after the pandemic. A total of 164 878 patients, 133 131 before and 31 747 after the pandemic, were evaluated. The daily hospital applications were found reduced by 77%. The three of the most frequent diagnoses; dermatitis, acne, and psoriasis remained unchanged after the pandemic. While the frequency of herpes zoster, scabies, urticaria, pityriasis rosea and sexually transmitted diseases increased significantly; allergic and irritant contact dermatitis decreased after the pandemic. The applications regarding cutaneous neoplasms were considerably reduced during the pandemic, and this effect was more pronounced in cities with higher COVID incidence. The pandemic caused a noteworthy reduction in the number of patients accessing dermatological care. The pandemic caused significant changes in the frequency of a wide range of dermatological diseases. The application of cutaneous neoplasms is considerably reduced after the pandemic, and this effect was more pronounced in cities where pandemics are frequent. Therefore, the pandemic has resulted on numerous impacts on many critical issues in dermatology and dermatological care.

Epidemiology of Pemphigus in Turkey: One-year Prospective Study of 220 Cases.

Pemphigus is a group of rare and life-threatening autoimmune blistering diseases of the skin and mucous membranes. Although they occur worldwide, their incidence shows wide geographical variation, and prospective data on the epidemiology of pemphigus are very limited. Objective of this work is to evaluate the incidence and epidemiological and clinical features of patients with pemphigus in Turkey. All patients newly diagnosed with pemphigus between June 2013 and June 2014 were prospectively enrolled in 33 dermatology departments in 20 different provinces from all seven regions of Turkey. Disease parameters including demography and clinical findings were recorded. A total of 220 patients were diagnosed with pemphigus during the 1-year period, with an annual incidence of 4.7 per million people in Turkey. Patients were predominantly women, with a male to female ratio of 1:1.41. The mean age at onset was 48.9 years. Pemphigus vulgaris (PV) was the commonest clinical subtype (n=192; 87.3%), followed by pemphigus foliaceus (n=21; 9.6%). The most common clinical subtype of PV was the mucocutaneous type (n=83; 43.2%). The mean Pemphigus Disease Area Index was 28.14±22.21 (mean ± Standard Deviation). The incidence rate of pemphigus in Turkey is similar to the countries of South-East Europe, higher than those reported for the Central and Northern European countries and lower than the countries around the Mediterranean Sea and Iran. Pemphigus is more frequent in middle-aged people and is more common in women. The most frequent subtype was PV, with a 9-fold higher incidence than pemphigus foliaceus.

Impaired Pulmonary Function in Patients with Psoriasis.

BACKGROUND: Psoriasis is associated with chronic obstructive pulmonary disease. There is no study on the spirometric pulmonary function testing in patients with psoriasis. OBJECTIVE: The aim of this study was to compare the spirometric parameters in patients with psoriasis and controls. METHODS: Ninety-six patients with psoriasis and 60 sex- and age-matched control subjects were included in this study. Spirometric pulmonary function testing, including percent forced vital capacity (FVC%), percent forced expiratory volume in the 1st second (FEV1%), forced expiratory flow at 25-75% of FVC (FEF25-75%), and FEV1/FVC ratio, was performed in all study subjects. RESULTS: The mean FEV1/FVC ratio and FEF25-75% were significantly lower in the psoriasis patients than in the controls (82.4 ± 6.3 vs. 90.7 ± 10.7, p < 0.001, and 86.7 ± 24.2 vs. 94.8 ± 23.0, p = 0.04, respectively). Both FEV1/FVC ratio and FEF25-75% were significantly associated with the presence of psoriasis (p < 0.001 and p = 0.029, respectively). CONCLUSION: Psoriasis patients had lower mean FEV1/FVC ratios and FEF25-75%, compared with the control subjects. FEV1/FVC and FEF25-75% are independently associated with the presence of psoriasis.

Inflammatory linear verrucous epidermal nevus with genital involvement.

An 18-year-old woman was admitted to our clinic complaining of pruritic lesions on her inguinal and genital areas that had been present since birth. She had previously used topical steroids and a combination of topical steroids and calcipotriol for approximately 6 months; however, the treatment was unsuccessful. Her medical history was unremarkable. On dermatologic examination, mild erythematous, lichenified, and verrucous papules occurring in a linear pattern on the right inguinal area and on the region extending from the right labium majus to the perianal area were noted (Figure). Additionally, an erythematous area with central erosion surrounded by maceration was noted on the intergluteal area. Two separate punch biopsy samples were obtained from the erythematous, lichenified, verrucous, papular lesion on the inguinal area and from the erythematous, eroded, macerated lesion on the intergluteal area. Histopathological examination of both biopsy specimens revealed a thin orthokeratotic layer and scattered parakeratotic layers, as well as papillomatosis and acanthosis of the epidermis with a slight hyperpigmentation of the basal layer. A mild, perivascular, chronic inflammatory cell infiltration was noted in the dermis. Based on the clinical and histopathological findings, the patient was considered to have inflammatory linear verrucous epidermal nevus, and cryotherapy was initiated. At the 2-week follow-up after the first application, it was observed that the itching complaint decreased substantially and the eroded lesions in the intergluteal area were re-epithelialized. On clinical follow-up, no improvement was observed in the papular component of the lesion after 4 sessions of cryotherapy. The patient voluntarily discontinued the follow-up after 4 sessions of cryotherapy.

The co-existence of vulvar lichen sclerosus, ulcerated calcinosis cutis, and dermatomyositis: coincidence or immunological mechanism?

Calcinosis cutis is a condition characterized by the deposition of calcium salts in the skin and subcutaneous tissues, and patients suffering from it encounter various connective tissue disorders, such as dermatomyositis (DM), scleroderma, and systemic lupus erythematosus. Although calcinosis cutis is frequently accompanied by juvenile dermatomyositis, rare cases have been reported in adult patients with DM. On the other hand, lichen sclerosus (LS) is a chronic inflammatory disease of the skin and mucosal surfaces. In the present report, we present a rare case of a 71-year-old patient with DM accompanied by ulcerated calcinosis cutis and vulvar LS.

Increased amount of visceral fat in patients with psoriasis contributes to metabolic syndrome.

BACKGROUND: Psoriasis is associated with obesity and metabolic syndrome. Metabolic syndrome is associated with visceral fat accumulation. There is no study on the accumulation of visceral fat in patients with psoriasis. OBJECTIVE: The aim of this study was to compare the visceral fat accumulation in patients with psoriasis and controls. SUBJECTS AND METHODS: 46 patients with psoriasis and 46 sex- and age-matched control patients were included in this study. The abdominal fat area [visceral fat area (VFA), subcutaneous fat area (SFA) and total fat area (TFA)] at the level of the umbilicus was evaluated by computed tomography. RESULTS: The mean VFA value and VFA/SFA ratio of the psoriasis patients were significantly higher compared with the control patients (123.4 +/- 80.3 vs. 81.2 +/- 59.8 cm(2) and 0.734 +/- 0.593 vs. 0.491 +/- 0.336; p = 0.005 and p = 0.017, respectively). Fasting blood sugar levels were also found to be significantly higher in psoriasis patients, compared with the control patients (101.8 +/- 43.5 vs. 83.4 +/- 9.1 mg/dl; p = 0.005). Multiple linear regression analysis indicated that waist-to-hip ratio, age, body weight, the presence of psoriasis and metabolic syndrome were significantly associated with VFA. CONCLUSION: Psoriasis patients had a higher amount of VFA, compared with the control patients.

Sulfasalazine-induced hypersensitivity syndrome in a 15-year-old boy associated with human herpesvirus-6 reactivation.

Drug-induced hypersensitivity syndrome (DIHS) is characterized by high fever, facial edema, diffuse maculopapular eruption, and multiorgan involvement. Human herpesvirus (HHV)-6 reactivation is an accepted criterion for the diagnosis of DIHS and has prognostic importance. We report a 15-year-old boy with juvenile rheumatoid arthritis who developed DIHS due to sulfasalazine, associated with reactivation of HHV-6.

Coexistence of acral syringomas and multiple trichoepitheliomas on the face.

BACKGROUND: An extremely rare variant of syringoma is an acral form, which affects the upper extremities as an isolated finding. The acral syringomas may also be associated with syringomas on the feet or usual distribution around the eyelids. Of the eight previously documented cases of acral syringomas, all were located on the dorsal aspect of the upper extremities (fingers, hand, wrist, or forearm) dominantly. OBJECTIVE: We report a 41-year-old woman who presented with multiple flesh-colored to reddish brown papules on the inner aspect of the forearms and many pearly, small papules on the periorbital regions. RESULTS: The clinical picture and histopathology indicated the coexistence of acral syringomas and multiple trichoepitheliomas on the face. CONCLUSION: To the best of our knowledge, this is the first case of acral syringomas coexisting with multiple trichoepitheliomas.

High prevalence of Staphylococcus aureus cultivation and superantigen production in patients with psoriasis.

The aim of this study was to evaluate the association of Staphylococcal enterotoxins (se) a through e, exfoliative toxin (et) a and b, toxin and toxic shock syndrome toxin (tst) and mecA with psoriasis. We also investigated the distribution of Staphylococcus aureus (S. aureus) in the skin and nares. Fifty consecutive patients with chronic plaque-type psoriasis and 50 sex- and age-matched healthy controls were included in this study. There was a statistical difference in cultivation of S. aureus between lesional (64%) and non-lesional skin (14%) in patients with psoriasis (p = 0.037). S. aureus was cultivated from the nares in 25 (50%) of 50 patients with psoriasis and in 17 (34%) of 50 healthy controls (p > 0.05). In psoriasis patients, 31 (96.8%) out of the 32 strains isolated from the lesional skin and 3 (42.3%) out of the 7 strains isolated from the non-lesional skin were toxigenic (p = 0.01). Isolated strains from the nares were toxigenic in 96% (24/25) for patients with psoriasis and in 41.2% (7/17) for healthy controls, respectively (p = 0.006). Patients with cultivation-positive in lesional skin had a significantly higher PASI score than patients who were cultivation-negative in lesional skin (8.28 +/- 3.97 vs. 5.89 +/- 2.98, p = 0.031). Our results confirm that S. aureus colonization and its toxigenic-strains are associated with psoriasis. According to our findings, non-classical superantigens such as methicillin resistance gene (mecA), see and etb may also be associated with psoriasis.

DLQI scores in patients with keloids and hypertrophic scars: a prospective case control study.

BACKGROUND: Keloids and hypertrophic scars (HTS) can cause functional impairment and psychosocial burdens, both of which affects quality of life (QoL). Our aim was to compare Dermatology Life Quality Index (DLQI) scores in patients with keloids and HTS to those of psoriasis patients and normal controls. PATIENTS AND METHODS: Forty-eight consecutive patients with keloids and HTS and 48 with psoriasis vulgaris attending our dermatology outpatient clinic, as well as 48 sex- and age-matched healthy controls completed the DLQI. RESULTS: Total DLQI scores of patients with keloids and HTS (7.79 +/- 5.10) and psoriasis (8.73 +/- 5.63) were comparable and significantly higher than that of healthy controls (0.58 +/- 0.77). No significant difference were found between patients with psoriasis and patients with keloids and HTS in terms of the total DLQI scores and the subscale scores (p > 0.05) except "treatment" (p < 0.05) sub-scale scores which were higher in psoriasis. CONCLUSIONS: The QoL of patients with keloids and HTS is impaired as much as that of those with psoriasis. The DLQI questionnaire is a reliable and valid instrument for assessing the QoL in patients with keloids and HTS.

Vesicular pityriasis rosea: an atypical presentation.

Pityriasis rosea (PR) is an acute, self-limited papulosquamous dermatosis localized on the trunk and extremities. PR is seen most frequently in adolescents and young adults. Many atypical forms of the disease have been reported in the literature. We report a rare atypical type of PR with vesicles on the erythematous macules and plaques.

Widespread, chronic, and fluconazole-resistant Trichophyton rubrum infection in an immunocompetent patient.

Chronic, widespread and invasive cutaneous dermatophytoses due to Trichopyhton rubrum are common in immunocompromised patients. In immunocompetent individuals, however, chronic widespread dermatophytoses are more often associated with onychomycosis and tinea pedis. We describe a 54-year-old immunocompetent female who presented with a 2-year history of extensive erythematous and hyper-pigmented scaly plaques involving the abdominal, gluteal and crural regions without concomitant tinea pedis, tinea manus or onychomycosis. The diagnosis was made by mycological examination including culture. The pathogen identified was T. rubrum. The patient had a history of resistance to systemic fluconazole and topical ketoconazole. After an 8-week therapy period with systemic itraconazole and sertaconazole nitrate cream, a near-complete clearing of all lesions was observed. Trichophyton rubrum may thus present atypical aspects in immmunocompetent patients.