Evaluation of Healthy Lifestyle Behaviors in Psoriasis Patients.

OBJECTIVES: The purpose of our study was to compare healthy lifestyle behaviors between psoriasis patients and healthy controls. METHODS: This case-control study included 80 psoriasis patients and 80 sex- and age- matched healthy controls aged over 18. Participants completed the socio-demographic data form and the Health-Promoting Lifestyle Profile II (HPLP-II). The HPLP-II consists of 52 items and measures six components of health-promoting behavior outcomes: Nutrition, physical activity, health responsibility, spiritual growth, interpersonal relations, and stress management. Higher scores show that the individual applies the specified health behaviors at a high level. RESULTS: HPLP-II total scores were 128.3±21.1 in patient group and 132.5±22.3 in control group. Based on the scores, psoriasis patients showed a moderate level of health-promoting lifestyle, while controls showed a good level of health-promoting lifestyle. Spiritual growth score of patients (mean±SD = 25.6±4.9) was statistically lower than the controls (mean±SD = 27.3±4.5) (p=0.040). In addition, spiritual growth score and disease duration were negatively correlated in the patient group (r=-0.287, p=0.01). Furthermore, nutrition score of those with additional comorbidity was significantly higher than those with psoriasis alone in patient group (p=0.002). CONCLUSION: This is the first study to compare healthy lifestyle behaviors of psoriasis patients and healthy volunteers in Turkish population. The task of dermatologists is not only the medical treatment of psoriasis lesions but also questioning patients' lifestyle behaviors and supporting the development of healthy behaviors in patients.

The frequency of alopecia and quality of life in high-school students in rural areas (Sivrihisar, Mahmudiye, Alpu, and Beylikova) of Eskisehir.

OBJECTIVE: The aim of the present study was to determine the incidence of alopecia and related factors and the health-related quality of life (HRQoL) in high-school students in rural areas of Eskisehir. This was a cross-sectional study. METHODS: The study was performed between March 2, 2015 and April 30, 2015. A total of 1662 (74.9%) students were included in the study. The questionnaire performed for the purpose and consisted of four sections was filled out by the students themselves under supervision. The HRQoL was evaluated by Short Form-36 (SF-36). Students' hair and scalps were examined by a dermatologist. The acquired data were analyzed by SPSS 20 statistical package program. Chi-square test, Mann-Whitney U test, and logistic regression analyses were used for statistical analyses. A p value ≤0.05 was accepted as statistically significant. RESULTS: In the present study, the incidence of alopecia was found to be 37.4% (n=622). Alopecia was more frequently seen in male students who have complaints about their scalps and those with a fatty scalp. In the study group, students with alopecia had poor HRQoL in general health perception, vitality, and mental health of SF-36. CONCLUSION: There is a need to provide early diagnosis and treatment to decrease the incidence of alopecia and to improve the quality of life. Health education studies must be performed to increase the awareness of students about alopecia. Integrating hair and scalp examination into school health screening studies, steering the students who have alopecia to the dermatologists, and suggesting students who have fatty scalp regular hair washing will be appropriate.

The efficacy and safety of omalizumab in refractory chronic spontaneous urticaria: real-life experience in Turkey.

INTRODUCTION: This study used real-world data to evaluate the effectiveness and reliability of omalizumab in treating recalcitrant chronic spontaneous urticaria in Turkish patients. METHODS: Study data were collected retrospectively from eight tertiary-care hospitals in Turkey. This study included 132 patients with chronic spontaneous urticaria that were resistant to H1 antihistamine treatment in a dose up to four times the licensed dose and were treated with 300 mg/month of omalizumab for 6 months. RESULTS: The mean weekly urticarial activity score (UAS7) after omalizumab treatment improved significantly compared to the pre-treatment score (p < 0.001). Treatment response was detected primarily in the 1st and 2nd months after treatment. No significant association was observed between omalizumab's treatment effectiveness and disease-related parameters or laboratory data. The mean dermatology life quality index was 23.12 ± 6.15 before treatment and decreased to 3.55 ± 3.60 6 months after treatment (p < 0.001). No side effects were reported in 89.4% (118) of the patients. CONCLUSIONS: This study showed that UAS7 decreased significantly and quality of life improved in omalizumab-treated patients. Moreover, treatment effectiveness was mainly observed in the first 2 months after treatment. However, no association was observed between omalizumab treatment effectiveness and disease-related parameters or laboratory data.

Advanced oxidation protein products and serum total oxidant/antioxidant status levels in rosacea.

INTRODUCTION: Rosacea is a chronic, inflammatory dermatosis which develops due to the effect of genetic and environmental factors. AIM: To evaluate the oxidative stress in rosacea patients by measuring serum total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI) and advanced oxidation protein products (AOPP) levels in our study. MATERIAL AND METHODS: Our study included rosacea patients and healthy volunteers aged between 18 and 65 years. Total antioxidant status, TOS and AOPP levels were measured and OSI was calculated. RESULTS: The study included 70 rosacea patients and 30 healthy volunteers as a control group. When TAS, TOS, OSI and AOPP levels were compared between rosacea and control groups, there was no difference for OSI levels; while TAS, TOS and AOPP levels were significantly higher in the rosacea group (p = 0.151, p = 0.013, p = 0.034, p = 0.017, respectively). In the rosacea group, there was no correlation between TAS, TOS, OSI and AOPP levels and disease duration. Besides there was no difference between family history, rosacea type, symptom frequency and ocular involvement and TAS, TOS, OSI and AOPP levels in the rosacea group. CONCLUSIONS: We observed that serum TAS, TOS and AOPP levels were significantly higher in rosacea patients, but there was no significant difference among the disease activity parameters. These results can support the role of oxidative stress in the pathogenesis of rosacea.

The Evaluation of Contact Sensitivity with Standard and Cosmetic Patch Test Series in Rosacea Patients.

BACKGROUND: Rosacea is a common dermatosis characterized by erythema, telangiectasia, papules and pustules. OBJECTIVE: We aimed to evaluate contact sensitivity in the rosacea patients. METHODS: We included 65 rosacea patients and 60 healthy volunteers in the study. The patient and control groups were patch tested with European baseline series and cosmetic series. RESULTS: A positive reaction to at least 1 allergen in the European standard series was found in 32.3% of rosacea patients and 20.0% of subjects in the control group while the relevant numbers were 30.8% of rosacea patients and 10% of controls with the cosmetic series (p=0.08). In total, we found a positive reaction to at least 1 allergen in 38.5% of patients and 25.0% of controls (p=0.15). We did not find a statistically significant relationship between a positive reaction to 1 allergen in total and the gender, skin type, rosacea type, ocular involvement, age and disease duration. There were more symptoms in patients with a positive reaction to allergens (p<0.001). CONCLUSION: Contact sensitivity was detected more common in rosacea patients. Patch testing may be useful in the treatment and follow up of rosacea patients especially if symptoms such as itching, burning and stinging are present.

The efficacy and safety of phototherapy in geriatric patients: a retrospective study.

BACKGROUND: While phototherapy is a well-established treatment for many dermatoses, data from the literature regarding its use in elderly patients are quite limited. OBJECTIVE: In this study, we aimed to determine the phototherapy indications in geriatric patients and to evaluate the effectiveness and reliability of phototherapy in this group. METHODS: This study included 95 patients of 65 years of age and older who were treated in our phototherapy unit between 2006 and 2015. The data for this study were collected retrospectively from patient follow-up forms in the phototherapy unit. RESULTS: Phototherapy was administered to 28 (29.5%) patients for mycosis fungoides, 25 (26.3%) patients foplaque type psoriasis, 12 (12.6%) patients for palmoplantar psoriasis, 12 (12.6%) patients for generalized pruritus, and 18 (19%) for other dermatoses. Of the patients, 64.2% had received a narrowband UVB (NB-UVB), 21.1% oral psoralen UVA (PUVA), and 14.7% local PUVA treatment. A complete response was achieved in 76.9-85.7% of the mycosis fungoides and in 73.71-100% of the psoriasis vulgaris patients treated with NB-UVB and PUVA, respectively. All the patients with generalized pruritus were treated with NB-UVB, and 80% of these patients achieved significant improvement. The erythema rate was found to be 0.43% per session for NB-UVB treatment and 0.46% per session for PUVA treatment as a side effect. STUDY LIMITATIONS: The limitations of our study are that it was retrospective and the remission durations of the patients are not known. CONCLUSION: This study showed that phototherapy is effective and reliable in the elderly population with proper dose increases and close follow-up.

The efficacy and safety of phototherapy in geriatric patients: a retrospective study

Abstract: Background: While phototherapy is a well-established treatment for many dermatoses, data from the literature regarding its use in elderly patients are quite limited. Objective: In this study, we aimed to determine the phototherapy indications in geriatric patients and to evaluate the effectiveness and reliability of phototherapy in this group. Methods: This study included 95 patients of 65 years of age and older who were treated in our phototherapy unit between 2006 and 2015. The data for this study were collected retrospectively from patient follow-up forms in the phototherapy unit. Results: Phototherapy was administered to 28 (29.5%) patients for mycosis fungoides, 25 (26.3%) patients foplaque type psoriasis, 12 (12.6%) patients for palmoplantar psoriasis, 12 (12.6%) patients for generalized pruritus, and 18 (19%) for other dermatoses. Of the patients, 64.2% had received a narrowband UVB (NB-UVB), 21.1% oral psoralen UVA (PUVA), and 14.7% local PUVA treatment. A complete response was achieved in 76.9-85.7% of the mycosis fungoides and in 73.71-100% of the psoriasis vulgaris patients treated with NB-UVB and PUVA, respectively. All the patients with generalized pruritus were treated with NB-UVB, and 80% of these patients achieved significant improvement. The erythema rate was found to be 0.43% per session for NB-UVB treatment and 0.46% per session for PUVA treatment as a side effect. Study limitations: The limitations of our study are that it was retrospective and the remission durations of the patients are not known. Conclusion: This study showed that phototherapy is effective and reliable in the elderly population with proper dose increases and close follow-up.

The role of irisin in the relationship between psoriasis and insulin resistance.

BACKGROUND: Irisin, a hormone like myokine, is identified to the relation with insulin resistance and metabolic syndrome recently. In the literature to date, there are no studies evaluating serum irisin levels in psoriasis patients. We aimed to elucidate the pathogenesis of insulin resistance in psoriasis patients by evaluating serum irisin levels and metabolic parameters associated with insulin resistance in patients with plaque-type psoriasis vulgaris. METHODS: The study included 40 patients with moderate-to-severe chronic plaque-type psoriasis vulgaris and 37 healthy subjects. Body Mass Index (BMI) and waist circumference were measured, and serum irisin, fasting blood glucose (FBG), lipid profile, high-sensitivity CRP (hs-CRP) and insulin levels were assessed. To evaluate insulin resistance, the Homeostasis Model Assessment (HOMA-IR) and triglyceride/HDL (TG/HDL) ratio were used. RESULTS: Serum irisin and HDL levels were significantly lower in patients than the control group (P<0.001, P=0.024). Within the patient group, there was a significant negative correlation between serum irisin and serum TG, LDL, and TG/HDL levels (P=0.041, P=0.022, P=0.025), and a positive correlation with HDL levels (P=0.036). The PASI scores and serum irisin levels were significantly positively correlated. CONCLUSIONS: In conclusion, we observed that serum irisin levels were significantly lower in patients with psoriasis, and associated with serum lipid levels and disease activity in our study. These results can be interpreted that irisin is involved in the disease pathogenesis of patients with psoriasis in relation to metabolic dysregulation.

Evaluation of the effects of acne vulgaris on quality of life in Turkey by using TAQLI.

BACKGROUND: Acne vulgaris (AV) is a chronic, inflammatory skin disease that may cause various psychiatric and/or psychological problems. OBJECTIVE: In this study, we aimed to determine the effect of AV on the quality of life in the Turkish population using the Turkish Acne Quality of Life Index (TAQLI). METHODS: A total of 960 patients with AV who attended the dermatology department were included in the study. Acne severity was determined using the global acne classification system. TAQLI was used to evaluate the effect of acne on quality of life. RESULTS: The 960 patients consisted of 673 (70.1%) females and 287 (29.9%) males. There were 536 (55.8%) patients under the age of 20, 386 (40.2%) aged 20-30, and 38 (4.0%) over 30. Acne duration varied between 1 and 20 years, and the mean duration was 2.95 ± 2.53 years. The mean TAQLI value of all patients was 20.8 ± 9.5. The mean TAQLI value was statistically significantly higher in female patients, in patients with an acne duration of more than 2 years, and in those with very severe acne. However, no statistically significant difference was found between the age groups. CONCLUSION: We observed that the quality of life in patients with AV was affected, and this effect was more significant in female patients, patients with severe acne and longer acne duration. We believe that the psychiatric/psychological effects should be followed up closely in this group of patients.

Morphea in Middle Anatolia, Turkey: a 5-year single-center experience.

INTRODUCTION: Morphea, also referred to as localized scleroderma, is a rare fibrosing skin disorder of undetermined cause. AIM: We report our single-center experience with morphea. MATERIAL AND METHODS: The study included 53 patients who were diagnosed with morphea by histopathology in our department between 2010 and 2015. Study data were collected retrospectively from the records of morphea patients. RESULTS: The study included 53 patients (38 women, 15 men), and median age at onset was 39.0 (range: 8-85) years. Thirty (56.6%) patients had circumscribed morphea, 15 (28.3%) had generalized morphea, and 7 (13.2%) had linear morphea. One patient had mixed variant morphea (generalized, pansclerotic and linear morphea). ANA positivity was detected in 12 (22.6%) patients, but analysis for an association between the presence of ANA and morphea types, patients' characteristics did not reveal any significant associations. We did not observe any extracutaneous manifestations in patients during follow-up period. There were 2 of 53 patients who had concomitant autoimmune disorder including vitiligo and spondyloarthritis. Thirty (56.6%) patients received only topical treatment. The patients with clinical improvement who were treated with systemic therapy received methotrexate (26.4%), colchicine (9.4%), mycophenolate mofetil (5.7%) and prednisolone (1.9%). CONCLUSIONS: Our results related to the demographic data of the patients and morphea types were consistent with the literature. On the other hand we observed that methotrexate was mostly used as an effective treatment option for generalized morphea.

Kaposi's sarcoma concealed by stasis dermatitis in a patient with psoriasis.

Kaposi's sarcoma (KS) is a multifocal and angioproliferative neoplasm. KS may be accompanied by psoriasis; however, in most of these cases the main mechanism involves iatrogenic KS associated with the immunosuppressive drugs that are used in psoriasis treatment. In angioproliferative lesions as a result of venous insufficiency and stasis dermatitis, acroangiodermatitis (pseudo-KS) is initially considered. However, the concurrent occurrence of psoriasis, stasis dermatitis, and KS has not been previously reported. We report a case of classic-type KS in an 83-year-old man that was concealed by stasis dermatitis and accompanied by psoriasis.

Behçet disease: New aspects.

Behçet disease is currently considered an "autoinflammatory disease" triggered by infection and environmental factors in genetically predisposed individuals. Although the disease is characterized by recurrent oral and genital aphthous ulcers and ocular involvement, it can affect multiple organ systems. Complex aphthosis is characterized by recurrent oral and/or genital aphthous ulcers. It is important to evaluate the patient with complex aphthosis for Behçet disease and related systemic disorders. We discuss the etiopathogenesis, clinical features, diagnostic criteria, and treatment approaches for complex aphthosis and Behçet disease in light of the current literature.

Superimposed Segmental Manifestation of Juvenile Amyopathic Dermatomyositis in a 9-year-old Boy.

Dermatomyositis is a well-known autoimmune disorder. On the other hand, juvenile amyopathic dermatomyositis (JADM) occurs rather rarely. Here, we report an unusual case in a 9-year-old Turkish boy showing a unilateral linear inflammatory skin lesion that was followed, after 16 months, by the appearance of bilateral disseminated features JADM.

Narrowband UVB treatment increases serum 25-hydroxyvitamin D levels in patients with chronic plaque psoriasis.

The aim of this study was to investigate the effects of narrowband UVB (NB-UVB) phototherapy on serum 25-hydroxyvitamin D (25[OH]D) levels and related parameters in patients with psoriasis. Forty-nine participants with moderate to severe plaque-type psoriasis were included in this study and were treated with NB-UVB therapy 3 times weekly for 6 months or until psoriasis area and severity index (PASI) 75 was achieved. Participants' serum 25(OH)D, calcium, phosphorus, parathyroid hormone (PTH), and alkaline phosphatase (ALP) levels were measured at baseline and completion of treatment, along with PASI scores. We observed that the serum 25(OH)D levels increased after NB-UVB treatment, but the only correlation that was found was the number of sessions of NB-UVB. There was no relationship between patient age, Fitzpatrick skin type, PASI score, or maximum NB-UVB dose and serum 25(OH)D levels.

Evaluation of Cutaneous Findings in Children and Adolescents with Attention Deficit Hyperactivity Disorder: A Preliminary Study.

Attention deficit hyperactivity disorder (ADHD) is characterized by attention, concentration, mobility, and impulse control problems and is among the most frequently seen psychiatric disorders during childhood. Our aim was to evaluate cutaneous findings in children and adolescents with ADHD. In our study we found that onychophagy, traumatic skin changes, atopy and related symptoms, certain birthmarks, and acne were frequent cutaneous findings in children with ADHD. Although a limitation is the lack of a control group, ADHD is very common, and our study suggests that further studies of cutaneous findings and ADHD are warranted.

The role of oxidative stress in early-onset androgenetic alopecia.

BACKGROUND: Androgenetic alopecia (AGA) is the most common cause of alopecia in men. In the literature, although there are in vitro studies investigating the relationship between oxidative stress and AGA, any in vivo study does not exist. AIM: Our aim was to evaluate the oxidative stress status in male patients with early-onset AGA by measuring total oxidant levels (TOS), total antioxidant levels (TAS), and oxidative stress index (OSI). METHODS: Our study included 33 male patients with early-onset AGA and 30 healthy men between ages of 18 and 30 years old. TAS and TOS measurements were taken, and OSI was calculated. RESULTS: When TAS, TOS, and OSI levels were compared between patient and control groups, there was no difference for TAS level, while TOS and OSI were significantly higher in patient group. In patient group, correlation between TAS, TOS, and OSI levels and age, and disease onset age and disease duration was evaluated. Highly significant negative correlation was determined between TAS level and both age and disease duration. When TAS, TOS, and OSI levels were assessed according to AGA stage, there was no significant difference between groups, while OSI level was significantly higher in patients with family history. CONCLUSIONS: We found increased oxidative stress in younger patients with early-onset AGA. There is need for further molecular studies on the role of oxidative stress in the etiopathogenesis of AGA. We also think that topical or systemic antioxidants can be promising in treatment of AGA, especially for young patients.

Why some of the dermatologists choose to avoid carrying out minimally invasive cosmetic procedures?

BACKGROUND: Some dermatologists choose to avoid carrying out cosmetic dermatology procedures. The aim of this study is to reveal the knowledge and daily outpatient clinic applications of dermatologists in Turkey, and their problems concerning minimally invasive cosmetic procedures (MICPs). MATERIALS AND METHODS: This study was designed as a descriptive cross-sectional study. Between December 2014 and July 2015, a questionnaire was sent to dermatologists by e-mail. RESULTS: Of the 318 participant dermatologists, 233 (73.3%) were female. It was determined that 63.8% of the participants had sufficient knowledge on MICP (very good, good, and medium) while 36.2% had insufficient knowledge (little, very little, and none). About 19.9% of the patients required MICP during outpatient clinic service. The 120 dermatologists who do not apply MICP gave the following reasons: not having adequate training (50%), MICP not being profitable (28.3), not having enough time (25%), being worried about side effects and complications (14.2%), and legal problems (9.2%). CONCLUSION: It was observed that many dermatologists are interested in cosmetic dermatology, received their training on the subject through courses, have sufficient knowledge, and apply these procedures. However, it was also found out that some dermatologists do not apply MICP due to inadequate training, time, and physical constraints.

Do dermatologists have cosmetic procedures?

BACKGROUND: Current approach and ideas of dermatologists about undergoing MICPs themselves are unknown. OBJECTIVE: The aim of this study was to reveal current situation and thought of dermatologists about undergoing minimally invasive cosmetic procedures (MICPs) themselves. METHODS: This study was planned as a cross-sectional, descriptive study and performed between December 2014 and July 2015. A questionnaire comprising 11 questions was sent to dermatologists via electronic mail. RESULTS: Of the 318 dermatologists, 233 (73.3%) were female and 85 (26.7%) were male. It was established that 56 percent (n = 178) of the dermatologists underwent MICPs. There was a statistical difference between the gender and having MICPs (female = 66.1% vs. male = 28.2%; P < 0.001). They selected dermatologists (91%) as a performer and private settings (67.2%). To be young and beautiful (77%), they had MICPs after medical residency (75.3%). Physicians' experience (66.9%) was the most important criterion. Of the dermatologists who did not have MICPs were planning to have MICPs (76.4%). The most frequent reason that stopped them from having MICPs was "not need yet" (62.1%). CONCLUSION: There are some tendencies among the dermatologists while selecting a physician for the procedures. They usually have MICPs after dermatology residency to seem younger and more beautiful by an experienced dermatologist in private setting. Male Turkish dermatologists have MICPs more frequently than the general population. Their satisfaction level with MICPs is very high. Most of dermatologists who do not have MICPs are planning to have MICPs.

Methotrexate Treatment in Children with Febrile Ulceronecrotic Mucha-Habermann Disease: Case Report and Literature Review.

Febrile Ulceronecrotic Mucha-Habermann disease is a rare and potentially fatal variant of pityriasis lichenoides et varioliformis acuta and is characterized by high fever, constitutional symptoms, and acute oncet of ulceronecrotic lesions. We present an 11-year-old male with Febrile Ulceronecrotic Mucha-Habermann disease who was cured with methotrexate and review the use of methotrexate for this disorder in the pediatric age group with the relevant literature.