Assessment of thyroid disorders in patients with rosacea: a large case-control study

Abstract Background: The frequency of autoimmune diseases and thyroid cancer has been increasingly reported in association with rosacea. However, studies investigating thyroid diseases in rosacea are scarce with conflicting results. Objective: To investigate the relationship between thyroid disorders and rosacea. Methods: A large case-control study on ageand gender-matched 2091 rosacea patients and 9572 controls was conducted. Rosacea patients using the rosacea-specific ICD codes were compiled from the hospital records. Additionally, all participants were evaluated in terms of the presence of hypothyroidism and hyperthyroidism. Conditional logistic regression analysis was used to compute case-control odds ratios (OR) with 95% confidence intervals. Results: The analysis comprehended 2091 rosacea patients (1546 female, 545 male; mean 48.73 ± 14.53 years) and 9572 controls (7009 female, 2563 male; mean 48.73 ± 15.1 years). Whereas the rate of hypothyroidism was significantly higher in rosacea patients (OR = 1.3, 95% CI 1.13-1.49, p < 0.001), there was no significant difference in the rate of hyperthyroidism between the groups (OR = 1.12, 95% CI 0.81-1.53, p = 0.497). Stratification for gender revealed a significant association between hypothyroidism and rosacea in females (OR = 1.27, 95% CI 1.1-1.47, p = 0.002) and males (OR = 1.58, 95% CI 1.04-2.4, p = 0.032). The frequency of hypothyroidism in rosacea patients increased towards the age range of 40-49 and then decreased, parallel with the hypothyroidism frequency of the study population. Study limitations: Different subtypes and severities of rosacea were not distinguished. Conclusions: Hypothyroidism may be a comorbidity of rosacea and investigation for hypothyroidism may be appropriate when evaluating rosacea patients.

Association of amyloidosis cutis dyschromica and familial Mediterranean fever.

Amyloidosis cutis dyschromica is a rare type of primary cutaneous amyloidosis characterized by reticulate hyper-pigmentation with discrete hypopigmented macules. Up to date, about 50 cases of amyloidosis cutis dyschromica have been reported and the majority are familial cases of Asian ethnicity. Various diseases, particularly autoimmune diseases such as systemic sclerosis and systemic lupus erythematosus, have been associated with amyloidosis cutis dyschromica. Herein, we report a case of amyloidosis cutis dyschromica accompanying familial Mediterranean fever with a delayed diagnosis of 40 years. To the best of our knowledge, this is the first report of the association of amyloidosis cutis dyschromica and familial mediterranean fever.

Deferasirox-induced urticarial vasculitis in a patient with myelodysplastic syndrome.

Deferasirox is an iron chelator agent used in the treatment of diseases with iron overload, such as thalassemia and myelodysplastic syndrome. Although the majority of adverse reactions of deferasirox involve gastrointestinal symptoms and increase in serum creatinine and transaminases, skin rashes, such as maculopapular and urticarial eruptions, have also been reported. This study reports a case of myelodysplastic syndrome with urticarial vasculitis due to deferasirox therapy. Drug eruption was been confirmed by means of a challenge test, together with histopathological and clinical findings. To the best of our knowledge, we report the first case of deferasirox-induced urticarial vasculitis. Physicians should be aware of the possibility of urticarial vasculitis on deferasirox therapy and the fact that the discontinuation of the drug generally results in improvement.

Thickness of carotid intima and epicardial fat in rosacea: a cross-sectional study

Abstract: Background: Rosacea is a chronic facial skin disease associated with excessive inflammatory response to various triggers. Although some studies have supported the increased risk of cardiovascular diseases in rosacea, it has not been completely accepted. Objective: We aimed to investigate epicardial fat thickness and carotid intima-media thickness as cardiovascular risk predictors in rosacea patients. Methods: We conducted a cross-sectional study including 40 rosacea patients and 40 controls. Demographic data, epicardial fat thickness, carotid intima-media thickness, lipid parameters, biochemical parameters, presence of insulin resistance, and presence of metabolic syndrome of the participants were recorded. Results: Forty rosacea patients (31 female and 9 male) and 40 controls (30 female and 10 male) were enrolled in the study. Rosacea patients had significantly higher epicardial fat thickness and carotid intima-media thickness volumes than controls (P<0.001). In the multivariate logistic regression analysis, epicardial fat thickness was independently related to presence of rosacea (P<0.001, OR=13.31). In the multiple linear regression analysis, the epicardial fat thickness was independently associated with rosacea (β= 0.47, P<0.001), carotid intima-media thickness (β= 0.36, P<0.001), and systolic blood pressure (β=0.19, P=0.015) and the carotid intima-media thickness was independently associated with epicardial fat thickness (β= 0.6, P<0.001). The epicardial fat thickness levels were correlated with carotid intima-media thickness (r=0.63, P<0.001), LDL (r=0.23, P=0.037), systolic blood pressure (r=0.45, P<0.001), and diastolic blood pressure levels (r=0.37, P=0.001). The carotid intima-media thickness levels were correlated with epicardial fat thickness (r=0.63, P<0.001), systolic blood pressure (r=0.04, P<0.001), and diastolic blood pressure levels (r=0.27, P=0.016). Study limitations: The small number of participants. Conclusions: Examination and follow-up of rosacea patients for cardiovascular diseases may be recommended practices.

Thickness of carotid intima and epicardial fat in rosacea: a cross-sectional study.

BACKGROUND: Rosacea is a chronic facial skin disease associated with excessive inflammatory response to various triggers. Although some studies have supported the increased risk of cardiovascular diseases in rosacea, it has not been completely accepted. OBJECTIVE: We aimed to investigate epicardial fat thickness and carotid intima-media thickness as cardiovascular risk predictors in rosacea patients. METHODS: We conducted a cross-sectional study including 40 rosacea patients and 40 controls. Demographic data, epicardial fat thickness, carotid intima-media thickness, lipid parameters, biochemical parameters, presence of insulin resistance, and presence of metabolic syndrome of the participants were recorded. RESULTS: Forty rosacea patients (31 female and 9 male) and 40 controls (30 female and 10 male) were enrolled in the study. Rosacea patients had significantly higher epicardial fat thickness and carotid intima-media thickness volumes than controls (P<0.001). In the multivariate logistic regression analysis, epicardial fat thickness was independently related to presence of rosacea (P<0.001, OR=13.31). In the multiple linear regression analysis, the epicardial fat thickness was independently associated with rosacea (ß= 0.47, P<0.001), carotid intima-media thickness (ß= 0.36, P<0.001), and systolic blood pressure (ß=0.19, P=0.015) and the carotid intima-media thickness was independently associated with epicardial fat thickness (ß= 0.6, P<0.001). The epicardial fat thickness levels were correlated with carotid intima-media thickness (r=0.63, P<0.001), LDL (r=0.23, P=0.037), systolic blood pressure (r=0.45, P<0.001), and diastolic blood pressure levels (r=0.37, P=0.001). The carotid intima-media thickness levels were correlated with epicardial fat thickness (r=0.63, P<0.001), systolic blood pressure (r=0.04, P<0.001), and diastolic blood pressure levels (r=0.27, P=0.016). STUDY LIMITATIONS: The small number of participants. CONCLUSIONS: Examination and follow-up of rosacea patients for cardiovascular diseases may be recommended practices.

Deferasirox-induced urticarial vasculitis in a patient with myelodysplastic syndrome

Abstract Deferasirox is an iron chelator agent used in the treatment of diseases with iron overload, such as thalassemia and myelodysplastic syndrome. Although the majority of adverse reactions of deferasirox involve gastrointestinal symptoms and increase in serum creatinine and transaminases, skin rashes, such as maculopapular and urticarial eruptions, have also been reported. This study reports a case of myelodysplastic syndrome with urticarial vasculitis due to deferasirox therapy. Drug eruption was been confirmed by means of a challenge test, together with histopathological and clinical findings. To the best of our knowledge, we report the first case of deferasirox-induced urticarial vasculitis. Physicians should be aware of the possibility of urticarial vasculitis on deferasirox therapy and the fact that the discontinuation of the drug generally results in improvement.

Association of amyloidosis cutis dyschromica and familial Mediterranean fever

Abstract: Amyloidosis cutis dyschromica is a rare type of primary cutaneous amyloidosis characterized by reticulate hyper-pigmentation with discrete hypopigmented macules. Up to date, about 50 cases of amyloidosis cutis dyschromica have been reported and the majority are familial cases of Asian ethnicity. Various diseases, particularly autoimmune diseases such as systemic sclerosis and systemic lupus erythematosus, have been associated with amyloidosis cutis dyschromica. Herein, we report a case of amyloidosis cutis dyschromica accompanying familial Mediterranean fever with a delayed diagnosis of 40 years. To the best of our knowledge, this is the first report of the association of amyloidosis cutis dyschromica and familial mediterranean fever.

Widespread cutaneous metastasis from ovarian serous adenocarcinoma.

Cutaneous metastasis can be rarely first manifestation of internal cancers; these usually develop with advanced stage malignancies. Cutaneous metastasis of ovarian cancer is rare and the majority of are seen around the pelvic region compatible with the localization of the primary ovarian tumor. Herein, we report a patient with ovarian cancer with widespread and distant cutaneous metastases showing multiple nodules and ulcers.

The correlation between cutaneous IgM deposition and renal involvement in adult patients with Henoch-Schönlein purpura.

BACKGROUND: Henoch-Schönlein purpura (HSP) is a systemic and immune complex-related leukocytoclastic vasculitis. A positive correlation has been found between IgM deposition along with IgA in skin lesions diagnosed by direct immunofluorescence (DIF) and renal involvement with HSP. OBJECTIVES: We sought to investigate the relationship between the systemic associations of the disease and the severity of the skin lesions, as well as the immune deposition findings of the lesional skin provided by DIF in patients with HSP. MATERIALS & METHODS: Between 2001 and 2012, 47 patients with HSP were investigated at our dermatology clinic. Epidemiologic data, laboratory findings, localizations of the palpable purpura, existence of bulla or necrosis in the skin lesions, accompanying systemic involvement, and DIF findings of skin biopsy specimens were recorded. RESULTS: Of the 47 patients 22 were men and 25 were women (age range 16-88 years, mean 42.2). Among all cases with skin involvement, we found 22 (46.8%) articular involvement, 20 (42.6%) renal involvement and 12 (25.5%) gastrointestinal tract involvement. The frequency of bulla and/or necrosis in the skin lesions was significantly high in patients with gastrointestinal and renal involvement (p<0.05). The risk of renal involvement was significantly high in patients whose DIF examination revealed IgM deposition (p<0.05). No association was found between systemic involvement and IgG, complement 3 (C3) and fibrinogen deposition. CONCLUSION: Patients with HSP, having bullous and/or necrotic lesions and whose skin DIF investigations reveal IgM deposition along with IgA, should be surveyed for the risk of renal involvement.