Narrowband ultraviolet B phototherapy for pityriasis lichenoides: A real-life experience.

INTRODUCTION: Pityriasis lichenoides (PL) is a papulosquamous disease affecting both children and adults, for which narrowband-UVB (NB-UVB) phototherapy is regarded as a commonly used treatment option. The aim of this study was to investigate the efficacy of NB-UVB phototherapy in the management of PL and to compare response rates in pediatric and adult age groups. MATERIALS AND METHODS: This observational, retrospective study included 20 PL patients (12 pityriasis lichenoides chronica; PLC, 8 pityriasis lichenoides et varioliformis acuta; PLEVA) who failed to respond to other treatment modalities. The data for this study were collected retrospectively from patient follow-up forms in the phototherapy unit. RESULTS: A complete response (CR) was obtained in all pediatric patients with PL, while 53.8% of adult patients had achieved CR. The mean cumulative dose required to achieve the CR was higher in pediatric patients than adult patients with PL (p < .05). The CR was achieved in 6 (75%) of 8 PLEVA patients, while 8 (66.7%) of 12 PLC patients had reached to CR. The mean number of exposures for patients with PLC to achieve a CR was higher than patients with PLEVA (p < .05). Erythema was the most common adverse effect during phototherapy particularly in 5 (35.7%) of the patients with PL who had achieved CR. CONCLUSIONS: NB-UVB is an effective and well-tolerated treatment option for PL especially in diffuse types. A higher response can be obtained in children with higher cumulative dose. Patients with PLC may require more exposures for CR than patients with PLEVA.

Epidemiological characteristics of different types of adult acne in Turkey: a prospective, controlled, multicenter study.

INTRODUCTION: Acne occurring in adults over the age of 25 years is known as acne tarda or adult acne. Three types of adult acne are recognized: persistent, late-onset, and recurrent acne. Most studies do not compare the characteristics between the three variants. In addition, little is known about adult acne in males. This study describes the epidemiological factors of adult acne and investigates certain triggering factors by sex and different types of adult acne. METHODS: A multicenter, prospective, descriptive study was conducted. Patients with adult acne and an acne-free control group were compared regarding medical history, family history, smoking and drinking habits, and dietary factors. In addition, triggering and prognostic factors were investigated by sex and three different types of acne: persistent, late-onset, and recurrent acne. RESULTS: The participants included 944 (88.56%) female and 122 (11.44%) male patients with adult acne, and 709 (73.85%) female and 251 (26.15%) male control patients. The consumption of crackers, chocolate, and pasta was significantly more common in the acne group than in the control group (p = 0.017, 0.002, and 0.040, respectively). Male patients with adult acne had a significantly longer disease duration than female patients with adult acne (p = 0.024). The most common type of acne was recurrent acne, followed by persistent and late-onset acne. Among patients with persistent acne, 14.5% had polycystic ovary syndrome (PCOS), whereas 12.2% of patients with recurrent acne and 11.1% of patients with late-onset acne had PCOS. Severe acne was more common in the persistent acne type (28.13%). The cheek (59.90%) was the most common involvement area, and stress (55.23%) was the most common triggering factor regardless of sex. CONCLUSIONS: Although adult female and male patents with adult acne share similar triggering factors, the involvement areas can differ, which may indicate the additional hormonal etiology of female adult acne. Further epidemiological studies on adult acne in both sexes may illuminate the pathogenesis of the disease, thus making possible the development of new treatment strategies.

Tattoos: Demographics, Motivations, and Regret in Dermatology Patients.

Background: Tattoos are very popular in today's world. Objectives: The aim of this study was to determine the demographics, the characteristics of tattoos, motivations for getting tattoos, tattooing practices and tattoo regret. Materials and Method: This multi-centre, cross-sectional study was conducted among. 302 patients attending to the dermatology outpatient clinics and having at least one tattoo. A questionnaire form including all needed data about patients, tattoo characteristics and possible reasons for obtaining tattoos was designed and applied to all participants. Results: Of 302 patients, 140 (46,4%) were females and 162 (53,6%) were men. The mean age was28,3 ± 8,1 years (min-max, 16-62) for all study group, 53% of participants (n = 160) had at least one tattoo involving letters or number, 80 participants (26%) stated regret for at least one of their tattoos, and 34 of them (42,5%) had their unwanted tattoo removed or camouflaged with a new tattoo. The most common reason for regret was 'not liking the tattoo anymore'. The most common motivations for having tattoos were 'to feel independent', 'to feel better about himself/herself' and 'to look good'. Women had higher scores than men regarding tattoo motivations of 'to be an individual' and 'to have a beauty mark'. Conclusion: Given the rates, tattoo regret is a significant issue and as motivations differ between genders, age groups and other demographic characteristics; tattoos are not just an ink or drawing on the body, but a tool for individuals to express themselves and to construct self-identity. Tattoos have deep symbolic meanings for emotions, and they may be a clue for behavioural patterns of individuals.

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.

Prevalence of onychophagia and its relation to stress and quality of life.

INTRODUCTION: Onychophagia is defined as putting one's fingers into the mouth and biting the nails. We sought to evaluate the prevalence of onychophagia in university and high school students and its relation to sociodemographic factors, perceived stress, and quality of life. METHODS: A total of 3,475 students were included in the study. A questionnaire including sociodemographic characteristics, items about onychophagia, the Perceived Stress Scale (PSS), and the European Health Impact Scale were used. RESULTS: The prevalence of onychophagia among university students was 17.6%, and among high school students it was 29.2%. In university students with onychophagia, the median score on the PSS was higher than the median score of students without onychophagia. In high school students, the median score on the PSS was 28.2 for students without onychophagia and 28.0 for students with onychophagia; the difference was not significant. The median scores on the quality of life scale for both university and high school students with onychophagia were lower than the mean score of students without onychophagia. CONCLUSIONS: Onychophagia is a common problem in the general population with a multidimensional etiology. It has dermatological, dental, and psychiatric consequences and comorbidities, and so a multidisciplinary approach is necessary for the prevention and treatment of onychophagia.

European Standard Series Patch Test Results in Contact Dermatitis Patients in a Tertiary Care Hospital.

OBJECTIVES: Sensitization of allergens varies among societies and also it is influenced by various factors, such as age and gender. It may even change over the years. In this study, we aimed to evaluate the patch test results in patients with contact dermatitis (CD) in our center. METHODS: European standard series patch test results of patients with CD between 2017 and 2018 were evaluated retrospectively. RESULTS: Of the 135 patients, 65 (48.1%) were males, 70 (51.9%) were females. The mean age of patients was 41.43±14.26 (11-78) years. In 78 (57.8%) patients, a positive reaction against at least one allergen was detected. The most common allergens were nickel sulfate (27.4%), potassium dichromate (14.8%), cobalt chloride (11.9%), textile dye mix (8.1%), fragrance mix i, ii (6.7%) and balsam of Peru (4.4%). The sensitization of nickel sulfate was higher in females and sensitization of cobalt chloride and potassium dichromate in males (p=0.03, 0.05, 0.03, respectively). In the multivariate logistic regression analysis, age was independently related to a positive reaction against at least one allergen. CONCLUSION: Nickel sulfate, potassium dichromate, cobalt chloride and textile dye mix were the most common allergens. Legal regulations should be made to decrease exposure to allergens.

Anxiety Sensitivity and Quality of Life in Patients with Acne.

BACKGROUND: Anxiety sensitivity (AS) is a continuous fundamental fear and defined as extreme fear of anxiety sensations and symptoms. High AS can cause tendency to anxiety disorders. There are many studies evaluating the anxiety in patients with acne; however, AS has not been investigated. OBJECTIVE: We aimed to investigate AS in patients with acne. METHODS: Two hundred and fourteen acne patients and 117 healthy control subjects, aged older than 16 years were enrolled in the study. Severity of acne was evaluated by Global Acne Grading System. The acne patients and healthy controls were asked to complete the anxiety sensitivity index-3 (ASI-3), the Beck anxiety inventory (BAI) and the Turkish version of acne quality of life index. RESULTS: Anxiety and AS levels in acne patients were significantly higher than healthy controls (p<0.001). Quality of life was impaired in acne patients. Quality of life was negatively correlated with anxiety and AS levels in acne patients (p=0.014, p=0.019, respectively). There was no correlation between quality of life and disease severity (p=0.556) and also there was no correlation between psychiatric scale scores (ASI-3, BAI) and disease severity (p=0.147, p=0.871, respectively). CONCLUSION: To our knowledge, our study is the first to report that AS is high in acne patients. Clinically, our results suggest that there might be a relationship between AS and acne. We conclude that further studies are needed in order to clarify the relationship between acne and AS and to investigate the efficacy of cognitive behavioral treatments in acne patients.

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.

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.

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.

A rare variant of pilomatricoma: pseudobullous pilomatricoma.

Pilomatricoma (PM; calcifying epithelioma of Malherbe) is a benign tumor originating from the matrix of the hair follicles. Clinical types of the tumor are familial, perforating, multinodular, exophytic, anetodermic, and giant PM. The bullous type is seen only in 3 to 6% of cases. Because the bullous areas detected in PM are filled with lymphatic liquid, some authors use the term pseudobulla. This report presents a 26-year-old female patient that was diagnosed with pseudobullous PM based on clinical, radiologic, and histopathological findings, and the pathogenesis of the bullous appearance of PM is reviewed from the literature.