Sociodemographic, clinical, laboratory, treatment and prognostic characteristics of 156 generalized pustular psoriasis patients in Turkey: a multicentre case series.

BACKGROUND: Generalized pustular psoriasis (GPP) is a rare and severe inflammatory disease characterized by widespread and superficial sterile pustules on an erythematous background. OBJECTIVES: This multicentre study aimed to determine the clinical profile and course in a large cohort of patients with GPP. METHODS: One hundred and fifty-six GPP patients (mean age, 44.2 ± 18.7 years) who met the diagnostic criteria of the European Consensus Report of GPP were included in the study. Sociodemographic characteristics, quality of life, triggering factors of the disease, clinical, laboratory, treatment and prognostic features were evaluated. RESULTS: 61.5% of the patients were female. The rate of working at or below the minimum wage (≤$332.5/month) was 44.9%. Drugs (36.5%) were the most common trigger. While hypocalcaemia (35.7%) was the most important cause of GPP during pregnancy, systemic steroid withdrawal (20%) was the most frequently reported trigger for infantile/juvenile and mixed-type GPP (15%) (P < 0.05). Acute GPP (53.8%) was the most common clinic. Nails were affected in 43.6% of patients, and subungual yellow spots (28.2%) were the most common change. In annular GPP, fever (P < 0.001) and relapse frequency (P = 0.006) were lower than other subtypes, and the number of hospitalizations (P = 0.002) was lower than acute GPP. GPP appeared at a later age in those with a history of psoriasis (P = 0.045). DLQI score (P = 0.049) and joint involvement (P = 0.016) were also higher in this group. Infantile/juvenile GPP was observed in 16.02% of all patients, and arthritis was lower in this group (24.4 vs. 16%). GPP of pregnancy had the worst prognosis due to abortion observed in three patients. CONCLUSIONS: Recent advances in treatment have improved mortality associated with GPP, but abortion remains a significant complication. Although TNF-α inhibitors have proven efficacy in GPP, they can also trigger the disease. Mixed-type GPP is more similar to acute GPP than annular GPP with systemic manifestations and course.

Clinical characteristics, quality of life and risk factors for severity in palmoplantar pustulosis: a cross-sectional, multicentre study of 263 patients.

BACKGROUND: Palmoplantar pustulosis (PPP) is a rare, chronic, inflammatory skin disease characterized by sterile pustules on palmar or plantar areas. Data on PPP are scarce. AIM: To investigate the clinical characteristics and risk factors for disease severity in a large cohort of Turkish patients with PPP. METHODS: We conducted a cross-sectional, multicentre study of patients with PPP recruited from 21 tertiary centres across Turkey. RESULTS: In total, 263 patients (165 women, 98 men) were evaluated. Most patients (75.6%) were former or current smokers. The mean Palmoplantar Pustulosis Area and Severity Index (PPPASI) was 8.70 ± 8.06 and the mean Dermatology Life Quality Index (DLQI) score was 6.87 ± 6.08, and these scores were significantly correlated (r = 0.52, P < 0.001). Regression analysis showed that current smoking was significantly associated with increased PPPASI (P = 0.03). Coexisting psoriasis vulgaris (PsV) was reported by 70 (26.6%) patients. Male sex prevalence, PPP onset incidence, disease duration, DLQI, and prevalence of nail involvement and psoriatic arthritis (PsA) were significantly increased among patients with PPP with PsV. Of the 263 patients, 18 (6.8%) had paradoxical PPP induced by biologic therapy, and these patients had significantly increased mean DLQI and prevalence of PsA (r = 0.03, P = 0.001). CONCLUSION: Our data suggest that smoking is a risk factor for both PPP development and disease severity. Patients with PPP with PsV present distinct clinical features and patients with biologic therapy-induced paradoxical PPP have reduced quality of life and are more likely to have PsA.

Clinical and demographic features of hidradenitis suppurativa: a multicentre study of 1221 patients with an analysis of risk factors associated with disease severity.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, relapsing and debilitating inflammatory disease associated with profound morbidity. AIM: In this multicentre study, we investigated the demographic and clinical features of HS, and determined risk factors of disease severity. METHODS: In total, 1221 patients diagnosed with HS from 29 centres were enrolled, and the medical records of each patient were reviewed. RESULTS: The mean age of disease onset was 26.2 ± 10.4 years, and almost 70% (n = 849) of patients were current or former smokers. Mean disease duration was 8.9 ± 8.4 years with a delay in diagnosis of 5.8 ± 3.91 years. Just over a fifth (21%; n = 256) of patients had a family history of HS. The axillary, genital and neck regions were more frequently affected in men than in women, and the inframammary region was more frequently affected in women than in men (P < 0.05 for all). Acne (40.8%), pilonidal sinus (23.6%) and diabetes mellitus (12.6%) were the most prevalent associated diseases. Of the various therapies used, antibiotics (76.4%) were most common followed by retinoids (41.7%), surgical interventions (32.0%) and biologic agents (15.4%). Logistic regression analysis revealed that the most important determinants of disease severity were male sex (OR = 2.21) and involvement of the genitals (OR = 3.39) and inguinal region (OR = 2.25). More severe disease was associated with comorbidity, longer disease duration, longer diagnosis delay and a higher number of smoking pack-years. CONCLUSIONS: Our nationwide cohort study found demographic and clinical variation in HS, which may help broaden the understanding of HS and factors associated with disease severity.

Insulin-like growth factor-I gene polymorphism in acne vulgaris.

BACKGROUND: Acne vulgaris is a multifactorial disease of the skin. Several studies have shown that elevated levels of serum insulin-like growth factor-I (IGF-I) correlate with overproduction of sebum and acne. Recently functional relationship between IGF-I (CA) polymorphism and circulating IGF-I levels in adults has been reported. AIMS: The aim of our study was to investigate for the first time whether IGF-I (CA) polymorphism might be involved in the pathogenesis of acne or not. METHODS: We included 115 acne patients and 117 healthy subjects to the study. The clinical grade of acne was assessed based on the Global Acne Grading System. Participants were questioned about diabetes mellitus, PCOS and other systemic disease. We searched for the IGF-I (CA) 19 polymorphism in this study. The IGF-I (CA) 19 polymorphism was performed by polymerase chain reaction. RESULTS: We categorized the IGF-I (CA) 19 polymorphism area into three groups as lower than 192 bp, 192­194 bp and higher than 194 bp. We found that the frequency of genotype IGF-1 (CA) 19 gene was significantly different between control and acne patients (P = 0.0002). A significant association between IGF-I (CA) genotypes and severity of acne was found (P = 0.015). No significant difference was found between male and female patients (P > 0.05). CONCLUSIONS: Our results suggest that IGF-I (CA) 19 polymorphism may contribute to a predisposition to acne in Turkish patients.

A scientometric analysis of dermoscopy literature over the past 25 years.

BACKGROUND: Dermoscopy is a useful method allowing the non-invasive visualization of dermal and epidermal structures. OBJECTIVE: To determine the scientific output in dermoscopy between 1985 and 2009 using ISI Web of Knowledge. METHODS: The ISI Web of Knowledge was searched for articles on dermoscopy published between 1985 and 2009 using appropriate terms. Articles were characterized each year by publication type and journal type. RESULTS: The search yielded 1490 dermoscopy publications, of which 1198 (80%) appeared in dermatology journals. A cubic increase in the number of publications over time was observed (R(2) = 95.3%, P < 0.0001). Most of these publications were published in high-impact dermatologic journals, including Archives of Dermatology (209, 14%), Journal of the American Academy of Dermatology (161, 10.8%) and British Journal of Dermatology (113, 7.6%). Italy produced 29% of all articles followed by the United States with 22% and Austria with 15%. The number of dermoscopy publications associated with a given country correlated with melanoma incidence and Growth Domestic Product (GDP) per capita of that country (r = 0517 P = 0.02, and r = 0486 P = 0.03 respectively). CONCLUSION: The number of scientific publications in the field of dermoscopy has increased significantly over the past 25 years. Italy, the United States and Austria have dominated the field of dermoscopy.

Cantharidin-podophylotoxin-salicylic acid versus cryotherapy in the treatment of plantar warts: a randomized prospective study.

BACKGROUND: Plantar warts are refractory to any form of treatment. High cure rates have been reported with a topical proprietary formulation consisting of 1% cantharidin, 5% podophyllotoxin and 30% salicylic acid (CPS). However, no data exists comparing the efficacy of this formulation with another treatment. Cryotherapy is a method that is also widely used in the treatment of plantar warts. Likewise, there is no evidence that it is more effective than any topical treatment. OBJECTIVE: We aim to compare the efficacy of topical CPS and cryotherapy in the treatment of plantar warts. METHODS: Patients with plantar warts were consecutively treated with either cryotherapy or topical CPS. Both treatments were performed every 2 weeks for up to five sessions. In patients without complete clearance, the therapy was switched to the other treatment option. RESULTS: Twenty-six patients with a total of 134 warts were included. Fourteen patients were completely cleared of their warts with topical CPS, whereas only in five of 12 patients (41.7%) warts were completely cleared with cryotherapy (P=0.001). In seven patients without complete clearance, the therapy was switched to CPS. Four of these patients missed the follow-up. While the two of the remaining three patients were cleared of their warts, one patient's warts still failed to clear. CONCLUSION: Topical CPS is more effective than cryotherapy in the treatment of plantar warts.

Carpet weaving: an occupational risk for onychomycosis?

BACKGROUND: Some occupations carry a risk for fungal infections. OBJECTIVE: To investigate the prevalence of onychomycosis in carpet weavers. METHODS: Seventy-seven weavers (the mean age +/- SD = 32.97 +/- 12.38) from three factories and 77 controls (the mean age +/- SD = 38.32 +/- 12.38) were examined for onychomycosis. Samples from nails and the carpets, which were being weaved, were taken for mycological investigations. RESULTS: Direct microscopic examination of only two controls' normal-appearing nails was positive. Fungal growth was observed in the culture of four weavers' normal-appearing nails. It was watched over that most of the weavers had polished-appearing nails and were using a glue containing cyanoacrylate to restore their broken nails due to weaving. CONCLUSION: The fungal growth observed in weavers' nails has been accepted as colonization. There is no data about the presence of fungi on normal-appearing nails. So, we thought that the weavers with fungal colonization should be followed for the development of onychomycosis.

Reticulohistiocytosis: different dermatoscopic faces and a good response to methotrexate treatment.

The reticulohistiocytoses are a rare group of non-Langerhans cell histiocytic disorders. Recently, dermatoscopic features have been reported for some of the xanthomatous disorders. We report a case of diffuse cutaneous reticulohistiocytosis with 29 reticulohistiocytomas. On dermatoscopy of these lesions, we saw three typical features: a homogeneous pattern with various shades of yellow (defined previously as a 'setting-sun' pattern), brown reticular structures, and central white scar-like patches and streaks. The setting-sun pattern was most commonly seen in combination with brown reticular structures. In four lesions, brown reticular structures surrounded a central white scar-like patch resembling that of a dermatofibroma. However, the presence of the setting-sun pattern in the background gave a different hue to that of the peripheral network seen in a dermatofibroma. A marked clinical improvement was associated with 6 months of systemic methotrexate treatment. Dermatoscopy may aid in the diagnosis of xanthomatous diseases. For this patient, methotrexate was beneficial.

The comparison of Nail Psoriasis Severity Index with a less time-consuming qualitative system.

OBJECTIVE: Reliable assessment of severity in nail psoriasis is essential to document treatment responses in clinical trials and routine clinical usage. In this study the correlation between Nail Psoriasis Severity Index (NAPSI) and Cannavo's scoring system was assessed, and inter-rater correlation of NAPSI scores were evaluated. MATERIALS AND METHODS: Forty-five patients with nail psoriasis were included. Target nails were selected and graded by the first dermatologist with both scoring systems. The nails were reevaluated by the second dermatologist with NAPSI. RESULTS: The two systems were highly correlated (P < 0.001). For NAPSI inter-rater correlation was also significant (P < 0.001). CONCLUSION: Our results showed that the qualitative and quantitative evaluations of the same rater were similar. Although the qualitative scoring system of Cannavo's is less time consuming than NAPSI, to suggest this system inter-rater correlations should be evaluated.

The prevalence, aetiological agents and therapy of onychomycosis in patients with psoriasis: a prospective controlled trial.

BACKGROUND: Nail involvement morphologically resembling onychomycosis frequently accompanies psoriatic lesions. The role of psoriasis as a predisposing factor for onychomycosis and the possible influence of psoriasis on responsiveness of onychomycosis to treatment are controversial. AIM: To investigate the frequency of onychomycosis, the aetiological agents responsible for it, and the efficacy of terbinafine 250 mg/day in patients with psoriasis compared with controls in order to reveal the role of psoriatic process on fungal growth. METHODS: Over a 1-year period, 168 patients with psoriasis and 164 nonpsoriatic controls were recruited. In the case of clinically suspected of fungal infection, further mycological investigations were performed. Systemic terbinafine therapy 250 mg daily for 12 weeks was administered to the patients with onychomycosis. Patients were followed up clinically and mycologically for 24 weeks. RESULTS: Onychomycosis was diagnosed in 22 patients with psoriasis (13.1% of the psoriasis group, which constituted 28.6% of patients with suspicion of onychomycosis) and 13 controls (7.9% of control group; 40.6% of controls with suspicion of onychomycosis). The prevalence rates of onychomycosis were similar in both groups. The most commonly isolated fungi were dermatophytes in the psoriasis group and nondermatophytic moulds in controls. Dermatophytes were more common in psoriatic than control nails (P = 0.02). All patients in each group were cured at the end of the therapy. CONCLUSION: It seems that nail psoriasis constitutes a risk factor not for onychomycosis, but specifically for dermatophytic nail infections. Because of the similar therapeutic results in each group, different antifungal treatment protocols may not be needed in psoriasis. However, to confirm this, new comprehensive studies are necessary.

Improved port film quality with six megavolt linear accelerator.

This article introduces a new technique for accurate verification of therapy treatment sites with radiographs. It can be used not only on most linear accelerators, but also on cobalt treatment units, with slight variation in exposure technique. It can eliminate the poor image detail presently seen and accepted at various therapy instiutions with a new method of quality control.