Evaluation of the quality of life in patients with arsenic keratosis.

BACKGROUND: Chronic exposure to inorganic arsenic is an important public health problem and leads to hyperpigmentation, hyperkeratosis, Bowen's disease and non-melanoma skin cancers in humans. Arsenic keratosis is the most common skin change that is associated with arsenic exposure. It may be an indicator of arsenic induced health hazards. OBJECTIVE: To determine the needs of patients with arsenic keratosis by evaluating the impact of disease on the quality of life with respect to treatment and provide rehabilitation services. METHODS: A total of 47 subjects with arsenic hyperkeratosis, were enrolled in this crossover study. The demographics, smoking status and the presence of chronic diseases diagnosed by the physician were recorded. Weight and height of the subjects were measured and BMI was calculated. The patients were asked to respond the visual analogue scale and EuroQoL-5D scales for assessing the pain and quality of life impairment associated with arsenic hyperkeratosis. RESULTS: In the study group, moderate to severe problems were reported in 78.7% of patients for pain/uncomfortable condition domains and in 91.5% in anxiety/depression domains. Lower quality of life was reported in those with associated chronic disorders, at an advanced age, in thin patients and in those with severe lesions. CONCLUSION: According to our knowledge, our study is the first one measuring the quality of life in patients with arsenic keratosis in the literature. By this study, we tried to underline the guidance of health services to be developed towards the needs of patients and the need for the development of new health policies by determining the requirements of these patients.

A Case of Brucellosis with Recurrent Attacks of Vasculitis.

Brucellosis is a zoonosis that affects several organs or systems. Skin involvement is nonspecific and it is reported to range between 0,4 and 17% of the patients with brucellosis. Here, we defined a 36-year-old female patient presented to our clinic with a clinical picture of recurrent attacks of vasculitis due to brucellosis for the first time. Skin involvement and vasculitic lesions as a finding of skin involvement are nonspecific in brucellosis. Therefore, in the regions like Turkey where brucellosis is endemic, brucellosis should be kept in mind necessarily in the differential diagnosis of vasculitis.

A case of scar sarcoidosis developing in an old scar area on the forehead.

Sarcoidosis is a multisystem disease characterized by noncaseating granuloma development. Scar sarcoidosis is a rare cutaneous form of sarcoidosis developing on previous cutaneous scar areas. The lesions may be solitary or occur along with systemic disease. We present the case of a female patient that developed cutaneous sarcoidosis in an old scar area on the forehead that was acquired 30 years ago due to injuries from a fall. Histopathological examinations of the excisional scar biopsy revealed non-necrotizing, noncaseating granulomatous inflammatory structures comprised of epithelioid cells and Langhans giant cells with lymphocytic infiltration within the reticular dermis consistent with sarcoidosis. High-resolution CT revealed bilateral mediastinal lymphadenopathy. Patients with inflammatory skin lesions at the sites of preexisting scars should be investigated for sarcoidosis. Histopathological examination of skin biopsy specimens usually provides the correct and final diagnosis.

Assessment of arsenic levels in body samples and chronic exposure in people using water with a high concentration of arsenic: a field study in Kutahya.

OBJECTIVE: This study aimed to evaluate the prevalence of skin lesions, which is a health effect of chronic arsenic (As) exposure, and determine the hair/blood arsenic concentrations of people living in Kutahya villages who are using and drinking tap water with a high concentration of arsenic. MATERIALS AND METHODS: A total of 303 people were included in the present cross-sectional study. A prepared questionnaire form was used to collect the participants' information and environmental history. Skin examination was performed on all participants. Hair, blood and water samples were analyzed using atomic absorption spectroscopy. The cumulative arsenic index (CAI) was calculated for all participants. RESULTS: Villages were divided into two groups according to the arsenic level (<20 µg/L, Group I; >20 µg/L, Group II) in their water. The prevalence of skin lesions, hair and blood arsenic level, and CAI were found to be higher in the Group II participants. There was a positive association between body arsenic levels and CAI in the participants of each group. CONCLUSIONS: The number of skin lesions and arsenic concentrations in body samples were found to increase with the water arsenic level and exposure time. We hope that sharing this study's results with local administrators will help accelerate the rehabilitation of water sources in Kutahya.

Activated protein C resistance and its correlation with thrombophlebitis in Behçet's disease.

Patients with Behçet's disease (BD) have been recognized to be at an increased risk of thrombosis and thrombotic complications have been reported in 12%-40% of patients. The precise pathogenetic mechanisms underlying the thrombotic tendency of BD are not known. In recent researches, it is reported that procoagulant mutations might play a role in thrombotic process in BD patients. We aimed to evaluate the frequency of activated protein C resistance (APCR) in our BD patients and to investigate the association between thrombophlebitis and APCR. The study included 116 patients with BD who fulfilled the International Study Group criteria and 70 healthy individuals as a control group. APCR levels were measured by the clotting method. APCR levels were 129.63 ± 39.70 and 152.26 ± 22.62 in BD patients and control group, respectively (P<0.01). APCR was found in 47.4% and 8.6% of BD patients and control group, respectively (P<0.01). There was no statistically significant difference regarding APCR levels between patients with thrombophlebitis and without thrombophlebitis (46.4% vs. 48.3%). We found the frequency of APCR to be increased in BD patients with or without thrombophlebitis. The lack of association between thrombophlebitis and APCR in our series of BD patients suggests that some factors like endothelial abnormalities other than thrombophilia play a major role in the pathogenesis of thrombosis in BD.