An update on the use of antihistamines in managing chronic urticaria.

INTRODUCTION: Urticaria, a mast cell-mediated skin disease, manifests as acute or chronic, with the latter divided into spontaneous and inducible types and requires individualized management, including identifying triggers and comorbidities. Antihistamines, particularly the second generation group, form the mainstay of primary treatment plans consisting of dosage adjustments and/or in combination with other treatment modalities depending on underlying disease control. AREAS COVERED: A literature search was conducted using 'antihistamines,' 'urticaria,' 'pharmacogenomics,' 'genomics,' 'biomarkers' and 'treatment response' as key words. In this review, we focus on the comprehensive understanding and application of antihistamines in managing adult and adolescent patients with chronic urticaria. EXPERT OPINION: Using antihistamines to treat urticaria is set to change significantly, focusing more on personalized medicine and identifying key biomarkers to enhance treatment response prediction. These changes aim to make treatments more specific and cost-effective by avoiding unnecessary tests. Applying new approaches in everyday clinical care faces challenges like proving the biomarkers' reliability, updating current guidelines, and incorporating individualized treatments into standard procedures. Efforts should now concentrate on finding easy-to-use biomarkers, improving access to pharmacogenomics, understanding why some patients are resistant to treatment, and creating more specific treatment options based on patient needs.

Folliculitis might be associated with pathergy-positivity in patients with Behçet syndrome.

Pathergy test indicates nonspecific hyper-reactivity of the skin to aseptic trauma in Behçet syndrome (BS) and is considered as an adjunctive diagnostic test with a good specificity albeit with low sensitivity. We tested the hypothesis that a relationship exists between active clinical manifestations of BS and the pathergy-positivity when performed simultaneously. Pathergy test and detailed dermatologic examination were done in 105 BS patients (60M/45F); who were seen consecutively at the multi-disciplinary BS outpatient clinic in a single tertiary center. Information regarding demographic and clinical characteristics, pathergy test results at diagnosis, and details about treatment were obtained from patient charts. Disease activity was assessed using Behçet Disease Current Activity Form. Among 105 patients, 27 (25.7%) were pathergy-positive at the time of the study visit whereas 40.9% were pathergy-positive at the time of the diagnosis. There was no relation between pathergy test and patient age or disease duration, either. Pathergy-positivity was significantly more common in patients with folliculitis compared to those without folliculitis (40.7% vs 19.2%; P = .026). The test was also positive in all 3 patients with leg ulcers due to venous stasis. We found that among all skin-mucosa lesions only the presence of folliculitis was associated with pathergy positivity with statistical significance. It was also remarkable that the current pathergy was positive in all 3 patients with active leg ulcers but this finding warrants further studies because of the low patient numbers.

Treatment Indications of Carbon Solution-Assisted Nd: YAG Laser According to Patient Satisfaction: A Retrospective Study.

INTRODUCTION: Carbon solution-assisted Nd:YAG lasers were previously used in enlarged pores; hair removal; acne and acne scars; and facial rejuvenation. OBJECTIVES: The aim of this study is to determine the patient satisfaction for different treatment indications of carbon solution-assisted 1064 nm Nd:YAG lasers. METHODS: This is a retrospective study that included the patients who were treated with carbon solution-assisted 1064 nm Nd:YAG laser with any indication in a private dermatology practice. A pre-prepared carbon solution was applied 30 minutes before the laser treatment with the following parameters: a spot size of 8mm, fluence of 1.3 J/cm2 and a frequency of 8Hz. Patient satisfaction was assessed with GAIS. RESULTS: A total of 272 patients were included; of these 70 patients had acne lesions, 135 patients had melasma, 27 patients had post-inflammatory hyperpigmentation, 17 patients had ephelides and 23 patients had solar lentigines. The mean patient satisfaction for solar lentigo patients (4.35/5) was greater than for that of acne patients (4.26/5) which was greater than that of ephelide patients (3.94/5) which was greater than that of melasma patients (3.67/5) which was greater than that of post inflammatory hyperpigmentation patients (2.30/5) CONCLUSIONS: This study revealed that carbon solution-assisted 1064 nm Nd:YAG laser therapy is effective in the treatment of solar lentigo, acne vulgaris, ephelides and melasma. However, it fails to provide therapeutic efficacy in post inflammatory hyperpigmentation.

Factors Affecting Topical Treatment Success in Pediatric Scabies Cases: A Cross-Sectional Study.

INTRODUCTION: Scabies is a common disease that affects the pediatric population. Treatment failure and relapse occur frequently in children. OBJECTIVES: We aimed to identify the factors that affect topical treatment success in pediatric scabies patients. METHODS: A multicenter cross-sectional study was conducted from April 2022 to December 2022. Pediatric scabies cases were classified as belonging to either the treatment failure (TF) group or the treatment success (TS) group. RESULTS: We enrolled 170 patients for the study. In the TF group, the presence of symptomatic household members and referrals from physicians other than dermatologists were more common (both P < 0.001), and relapse rates and total symptom duration were higher (P = 0.007, P < 0.001, respectively). Regarding treatment agents, 5% permethrin was more commonly used in the TF group (71.1% versus 25%; P < 0.001). The proportion of patients treated with sulfur preparations was significantly higher in the TS group (60.7% versus 16.9%; P < 0.001). Misapplication of topical therapy was significantly more common in the TF group (P < 0.001), with statistically significant errors being (i) lack of treatment of close contacts (p<0,001), (ii) single application (P < 0.001), and (iii) local application (P = 0.027). A multivariate analysis revealed that TS was mainly associated with (i) the presence of atopy (odds ratio [OR] 6.12, 95% CI: 1.39-27.04), (ii) the absence of symptomatic household members (OR 6.31, 95% CI: 2.14-18.63), and (iii) presentation to a dermatologist rather than another specialist (OR 6.51, 95% CI: 2.11-20.13). The use of permethrin negatively affected treatment success (OR 0.22, 95% CI: 0.07-0.71). CONCLUSIONS: Pediatric scabies patients should be treated before other family members become infested and with topicals other than permethrin. In addition, awareness of scabies needs to be increased among non-dermatologists.

A comprehensive investigation of novel and traditional inflammatory and metabolic markers as predictive indicators in psoriasis.

BACKGROUND: Psoriasis is a chronic inflammatory and papulosquamous dermatological disorder. While previous studies have discussed certain inflammatory markers for diagnosing and monitoring psoriasis, there is an absence of comprehensive research encompassing both novel and traditional inflammatory markers, as well as metabolic markers, in relation to psoriasis. METHODS: A total of 209 individuals participated, including 54 psoriasis patients and 155 controls. Psoriasis Area Severity Index (PASI) was calculated for the patient group. Potential predictive markers for psoriasis were identified: Uric acid/HDL ratio (UHR), D-dimer/albumin ratio (DAR), fibrinogen/albumin ratio (FAR), erythrocyte sedimentation rate, CRP, WBC, HOMA-IR, and vitamin D levels. Differences between groups and correlations with PASI and each other were analyzed using the Mann-Whitney U test and Spearman correlation coefficient. RESULTS: The results indicate that the patient group exhibited statistically significantly higher levels of UHR, FAR, CRP, WBC, and HOMA-IR. Upon analyzing the correlations between PASI and the identified markers, statistically significant positive correlation with WBC and negative correlation with vitamin D were observed. The correlations of PASI with other markers did not reach statistical significance. It should be underlined that our study was conducted in a predominantly mild-to-moderate patient population. CONCLUSIONS: The absence of specificity of these markers for psoriasis limits their practical application. However, the development of new objective measures by using them in combination with specific data such as PASI will provide significant benefits in terms of disease diagnosis, follow-up, and treatment.

Skeletal Side Effects of Systemic Isotretinoin Treatment: Do They Depend on Age, Gender, Treatment Duration, Daily Dose and Isotretinoin-Naiveness?

INTRODUCTION: Systemic isotretinoin is the most effective treatment modality in acne vulgaris; however, both patients and physicians hesitate to use it due its side effects. OBJECTIVES: The aim of this study is to determine the prevalence of fatigue, myalgia and low back pain during systemic isotretinoin treatment; and to determine their relationship with age, gender, treatment duration, daily isotretinoin dose and isotretinoin-naiveness of the patient. METHODS: This is a cross sectional study including the acne vulgaris patients, aged between 13 to 40 years, who have at least received one month of oral isotretinoin treatment. Patients were questioned for side effects during their follow-up visits; a physical therapy and rehabilitation specialist further evaluated patients complaining of low back pain. RESULTS: Fatigue was reported by 4.4% of the patients, myalgia by 2.8% and low back pain by 25% of the patients; 2.2% had inflammatory and 22.8% had mechanical low back pain. None of the patients had sacroiliitis. All the side effects that were examined were found to be independent of age, gender, isotretinoin dosage (mg/kg/day), treatment duration and isotretinoin-naiveness. CONCLUSIONS: The side effects are not as common as feared; thus, patients and physicians should not hesitate to use systemic isotretinoin in indicated cases.

Demodex prevalence in mine, textile and food factory workers with dermatosis: a cross-sectional, multicenter study.

Demodex, a type of mite, lives in human hair follicles. They can multiply very quickly in some conditions and then start to irritate the skin by causing skin disorders. This study aims to investigate if working environment conditions affect the prevalence of Demodex. A cross-sectional, multicenter study was conducted with three different occupational groups: mine, textile and food factory workers (n = 102). Determined industry workers who applied to our outpatient dermatology clinics with the complaint of dermatosis in three different cities were included in the study. Demodex positivity was checked by dermoscopy. Differences between categorical variables examined with Chi-square analysis and T test was used to compare continuous variables between groups. 50% Demodex positivity was found in mine workers, 45.3% in food factory workers and 66.7% in textile manufacturing workers. A high rate of Demodex positivity was observed in all three occupational groups. Although the highest positivity rate was observed in textile manufacturing workers, no significant difference was found between the groups (p = 0.320). The overall prevalence of Demodex in female workers was statistically significantly higher than in male workers (p = 0.029). Exposure of workers to a wide variety of factors in work environments such as textile factories and the fact that women are more sensitive to external factors may have caused the prevalence of Demodex to be higher in these groups. So, a change in the work environment or the use of suitable protective equipment may benefit the treatment of diseases caused by Demodex. But, further studies are needed with larger and various industry groups to make more certain views.

Thread lifting: Does patient satisfaction change according to age, type of threads used, number of threads used and treatment area?

BACKGROUND: Aging is an inevitable process. Eyebrows, cheeks, mandible, and neck are the areas that are the most vulnerable to the aging process. The most commonly thread lifted areas of the face are the jawline, midface, eyebrows, and the neck. PATIENTS AND METHOD: In this retrospective study, patients who were treated with thread-lifting between January 2018 and April 2020 were evaluated and the following were noted: the age and gender of the patient; the type of thread used; number of threads used; treatment area; patient satisfaction; and complications. The effects of age, type of thread used, number of threads used, and treatment area on patient satisfaction were analyzed statistically. RESULTS: The relationship between age and patient satisfaction is statistically insignificant, p = 0.697. The relationship between patient satisfaction and the type of the thread used was insignificant, p = 0.533. There is no relationship between the number of threads used and patient satisfaction, p = 0.783. There is no difference in patient satisfaction between treatment areas, p = 0.930. The most commonly observed complications were edema, pain, and ecchymosis. CONCLUSION: We report that the patient satisfaction in thread-lifting is independent of the patient's age, treatment area, type of thread used, and the number of threads used. Our study is novel as it is the first study to report that the age of the patient and the thread type do not effect patient satisfaction.

A retrospective analysis of the uses of BoNT-A in daily dermatological practice.

INTRODUCTION: Botulinum toxin-A (BoNT-A) has been increasingly used in the cosmetic dermatology daily routine. The treatment areas of BoNT-A are glabellar lines, forehead wrinkles, periorbital lines (crow's feet), eyebrow lifting, perioral lines, platysmal bands, masseter hypertrophy, and hyperhidrosis. The aim of this study was to reveal the epidemiologic characteristics of the patients treated with BoNT-A and the frequencies of treatment areas. PATIENT AND METHODS: The patients were grouped into five categories: facial wrinkles, platysmal bands, masseter hypertrophy, axillary hyperhidrosis, and palmoplantar hyperhidrosis. Each patient received either onabotulinum toxin-A (diluted with 2 cc saline) or abobotulinum toxin-A (diluted with 3 cc saline) treatment. The patients' age, gender, and the total numbers of treatment received in each area were noted. SPSS version 21 was used for the statistical analysis. RESULTS: A total of 1614 patients were included: 165 (6.5%) male and 1509 (93.5%) female. There is no difference between genders in terms of treatment area (p = 0.855). The number of treatment sessions is independent of the patients' gender (p = 0.703). The mean age of the patients was 46.6 years. There is a relationship between the patients' age and treatment area (sig 0.000). There is no relationship between the number of repetitive treatments and the patients' age (p=0.081). The number of repetitive treatments is dependent to the treatment area (p < 0.001). CONCLUSION: Facial wrinkles, platysmal bands, and masseter hypertrophy are the most commonly treated areas. The treatment area is dependent on the age as platysmal bands are more commonly treated in older patients; however, no relationship between gender and treatment area was found. BoNT-A treatment for hyperhidrosis is not as commonly repeated as for that of cosmetic concerns.

Comparison of Malassezia Colonization of 'Maskne' Patients with Seborrheic Dermatitis Cases and Healthy Individuals.

Background: With the Covid-19 pandemic, the use of masks has increased the frequency of 'maskne' cases. Local physiological changes due to the use of mask have caused changes in the presence of yeasts in the environment, such as acne and seborrheic dermatitis. Objectives: The aim is to compare the differences of Malassezia species in the maskne region. Materials and Method: A total of 408 subjects wearing masks at least 4 h a day for 6 weeks or longer, compromised of 212 acne patients, 72 seborrheic dermatitis sufferers, and 124 healthy volunteers were included in this study. Swab samples were taken for Malassezia cultures from nasolabial area and their control retro auricular region. The Statistical Package for Social Sciences (SPSS) version 22 was used for the statistical analysis. Results: Malassezia species was most frequently found in the nasolabial region of the seborrheic dermatitis group. Malassezia species were more commonly isolated from the nasolabial region of acne and seborrheic dermatitis patients, compared to the retroauricular region of each patient, than the healthy subjects. The rate of M. globosa isolated from the nasolabial region was high in all groups, the isolation rate of M. restricta was low (P < 0.05). Conclusion: As Malassezia species are more commonly isolated from the nasolabial region of acne and seborrheic dermatitis patients, the increasing numbers of Malassezia species will trigger inflammation with an antibody reaction against these yeasts. Treatment of resistant acne and seborrheic dermatitis will be facilitated with the knowledge of this inflammation.

The comparison of demographics and comorbidities of female pattern hair loss according to the clinical subtype and stage.

BACKGROUND: Previous literature regarding the frequencies of each subtype of female pattern hair loss is contradictory and the subtypes have not been compared to each other in terms of their epidemiologic characteristics and relationships with comorbid diseases. OBJECTIVES: The aims of this study are to determine the frequency and the relationship with comorbidities for each subtype, and to determine the relationship of clinical stage with age and comorbid diseases. METHODS: This is a prospective cross-sectional study involving patients with a definitive diagnosis of female pattern hair loss. The age, age at the time of diagnosis, family history for androgenetic alopecia, clinical subtype, clinical stage, and comorbid conditions were noted for each patient. SPSS version 21 (IBM SPSS) was used for statistical analysis. RESULTS: Advanced stages of female pattern hair loss are related to increased age, menopausal state, and hypertension. Acne vulgaris is more prevalent in earlier stages. Hirsutism and acne vulgaris are more commonly encountered in the Ludwig and Hamilton subtypes. Hypertension is more frequent in Ludwig subtype. LIMITATIONS: The confounding effect of age on the relationship between clinical subtype and comorbid diseases. CONCLUSION: The relationship between comorbid diseases and stage in specific subtypes can guide us to the diagnosis of undiagnosed comorbid diseases.

Treatment of periorbital and perioral wrinkles with fractional Er:YAG laser: What are the effects of age, smoking, and Glogau stage?

BACKGROUND: Dynamic and static wrinkling are observed on the facial skin as a result of aging. Previously, it was showed that fractional Er:YAG laser was effective in the treatment of facial wrinkles. AIMS: The aims of this study are to determine the effects of age, Glogau stage, and smoking status on the treatment efficacy of fractional Er:YAG laser; and to compare the success of laser treatment on periorbital wrinkles with perioral wrinkles. MATERIAL/METHOD: Periorbital and perioral wrinkles of the same patient were treated with fractional Er:YAG laser (2940 nm) for 4 sessions with monthly intervals. Treatment parameters were affluence of 1.5J, a spot size of 7 mm, and a frequency of 5 Hz. Treatment efficacy was evaluated by a blinded physician evaluation scale and patient satisfaction scale 2 months after the final treatment session. RESULTS: Fifteen patients completed the study. The mean age of the patients was 42.8 years. The blinded physician evaluation of the improvement in the periorbital wrinkles decreased (P =.034) and the patient satisfaction in perioral wrinkles decreased (P =.049) with increasing age. The relationship between smoking and patient satisfaction in the treatment of periorbital wrinkles was also statistically significant (P =.014). No difference in terms of treatment efficacy was found between periorbital and perioral regions. CONCLUSION: Fractional Er:YAG laser (2940 nm) is equally successful in the treatment of periorbital and perioral wrinkles. The treatment success decreases with smoking and increasing age.

Evaluation of the alopecia areata patients on tofacitinib treatment during the COVID-19 pandemic.

Tofacitinib is a Janus Kinase 3 inhibitor that is used in the treatment of alopecia areata. We recommended our alopecia areata patients to discontinue their tofacitinib treatment during the COVID-19 pandemic for an average of 80 days. We aimed to evaluate the drug use and the SARS-CoV-2 infection status of alopecia areata patients; and the relationships of recurrence to age, gender, treatment duration, and tofacitinib discontinuation. One-hundred and ninety-one (61.4%) patients were off the drug and 120 (38.6%) were on therapy during the pandemic. The relationship between drug discontinuation due to the COVID-19 pandemic and recurrence was statistically significant (P < .001). Statistically significant relationships of age (P = .013) and treatment duration (P < .001) to recurrence were also found. The change in the SALT score differed between the patients on therapy and off therapy during the pandemic (P < .001). A significant negative correlation was found between the change in the SALT score and treatment duration: the spearman correlation test P = .018. We concluded that the patients may continue to the tofacitinib therapy during the rest of the COVID-19 pandemic if the benefit outweighed the risk.