Low and high body mass index in hidradenitis suppurativa patients-different subtypes?

INTRODUCTION: Overweight is a well-established risk factor for hidradenitis suppurativa (HS). In this cross-sectional study, we compare HS patients with a high body mass index (BMI) with HS patients with a low BMI to investigate differences in disease characteristics. MATERIALS AND METHOD: Patients were recruited from 17 dermatological centres from four continents. A total of 246 patients with a BMI below 25 were compared to 205 patients with a BMI of above 35. RESULTS: Patients with a high BMI suffered more severe disease (Hurley, physician global assessment, number of areas affected and patient-reported severity (PRS), P < 0.001 for all). There was no difference in smoking (P = 0.783) nor in family history (P = 0.088). In both low and high BMI patients, early onset of HS was a predictor of positive family history (P < 0.001, for each). For low BMI patients, an increase in BMI significantly increased PRS (P < 0.001). For patients with a high BMI, number of pack-years significantly increased PRS (P = 0.001). Cluster analysis of eruption patterns was location specific for low BMI patients but severity specific for high BMI patients. DISCUSSION: Patients with a low and high BMI could represent two clinically different subtypes. We suggest a non-linear relationship between BMI and impact of HS. As patients go from a low BMI patient to a high BMI patient (or from high to low), eruption patterns and risk factors may change.

Therapeutic options for palmoplantar pustulosis.

Palmoplantar pustulosis (PPP) is a common chronic and recurrent pustular dermatosis characterized by multiple sterile pustules and erythematous plaques on the palms and soles. The exact cause and pathogenesis of the disease remain unknown, and there is still debate about whether PPP is a variant of psoriasis or a distinct condition. A review of the medical literature revealed that a wide range of treatments have been used in the treatment of PPP over the years. The literature in PPP is restricted to case reports or small case series, and there is a lack of well-documented clinical studies, which makes it difficult to select an ideal therapy for the condition. The purpose of this review is to discuss the current therapy options for PPP, based on results of randomized controlled trials.

Easy to diagnose, difficult to treat: keratosis lichenoides chronica.

Keratosis lichenoides chronica (KLC) is a rare disease, with approximately 70 cases reported in the literature. The problem in this long-lasting disease is generally the treatment, not the diagnosis. In the literature, many treatments failed to show any beneficial effect. We present a 20-year-old man with KLC that was successfully treated with a combination of phototherapy, acitretin and calcipotriol ointment. The patient's lesions showed a marked improvement with this combination. To our knowledge, this is the first report of this type of combination treatment being used successfully in KLC. This approach might help reduce doses of retinoids or psoralen ultraviolet A required when these are used separately, and limit the potential toxicity of these treatments.

A retrospective analysis of treatment responses of palmoplantar psoriasis in 114 patients.

BACKGROUND: Treatment options remain unsatisfactory for patients with palmoplantar psoriasis (PP) and palmoplantar pustular psoriasis (PPP). Aim To evaluate the therapeutic responses of PP and PPP patients that were treated in our psoriasis polyclinic between 2003 and 2007. METHODS: This retrospective study comprised PP (n = 62) and PPP (n = 52) patients. Treatments were individualized according to patient compliance and associating systemic diseases. The effect of systemic treatments was grouped as follows: 'no improvement': patients unresponsive for the present treatment; 'partial improvement': < 50% decrease in severity or affected area; 'moderate improvement': 50-75% decrease in severity or affected area, and 'marked improvement': > 75% decrease of the disease compared to baseline. RESULTS: In the PP group, 17 of 62 patients showed marked improvement to topical agents, while the remaining patients required systemic agents including oral retinoids (n = 24), local psoralen plus ultraviolet A (PUVA; n = 12), methotrexate (n = 9) and cyclosporine (n = 2). Marked improvement was achieved in 53%, 45%, 47% and 100%, respectively. In these patients, two (n = 10), three (n = 5), or four (n = 5) systemic agents were used alternately. In the PPP group, 18 of 52 patients achieved marked improvement by topical agents. Patients that required systemic agents were treated with colchicum (n = 19), local PUVA (n = 8), methotrexate (n = 4), oral retinoids (n = 3) and cyclosporine (n = 2). These treatments achieved a marked improvement in 60%, 33%, 57%, 83%, and 50% of the patients, respectively. In the course of the disease, 18 patients required two and 3 patients required three systemic agents alternately. CONCLUSIONS: Although the success rates appeared to be high, the high number of patients who required multiple systemic agents emphasized the fact that localized forms of psoriasis were resistant to therapy.

The role of human herpesvirus 6, human herpesvirus 7, Epstein-Barr virus and cytomegalovirus in the aetiology of pityriasis rosea.

AIM: To identify the role of human herpesvirus 6 (HHV-6), HHV-7, Epstein-Barr virus (EBV) and cytomegalovirus (CMV) in the pathogenesis of pityriasis rosea (PR). MATERIAL: Polymerase chain reaction with specific primers for HHV-6 and HHV-7 DNA sequences was performed on the blood and tissue samples of 25 patients with PR and on the blood samples of age- and sex-matched healthy controls. HHV-6, EBV, CMV immunoglobulin M (IgM) and IgG were analysed by enzyme-linked immunosorbent assay, HHV-7 IgM and IgG were analysed by indirect immunofluorescence on the serum samples of the study population. In the patient group, the values were studied 2 weeks later again (second control). RESULTS: There were no differences between the first and second controls of the patients and healthy subjects regarding HHV-6 IgM, HHV-7 IgM, CMV IgM, EBV IgM results. There were significant differences between the first [HHV-6 DNA (2 of 25), HHV-7 DNA (6 of 25)] and second control [HHV-6 DNA (1 of 25), HHV-7 DNA (11 of 25)] of the patients for the blood samples in favour of HHV-7. PR patients showed higher amounts of HHV-6 and HHV-7 DNA positivity when compared with that of healthy subjects. HHV-7 seemed to be more important regarding tissue samples [HHV-6 DNA (7 of 25), HHV-7 DNA (12 of 25) first control, HHV-6 DNA (6 of 25), HHV-7 DNA (12 of 25) second control] as well as blood samples. CONCLUSION: Though our results failed to support a causal relationship among EBV, CMV and PR, they indicated a possible role for HHV-6 and especially HHV-7 in a group of Turkish patients but other aetiological factors may exist.

Arachidonic acid metabolites and colchicine in Behçet's disease (BD).

Vasculitis is accepted to be the basis of Behçet's disease (BD) which is a multisystem disease, and the arachidonic acid(AA) metabolites acting as balancing mediators in the organism are accepted to be responsible for the vasculitis. In this study, we examined the prostaglandin E2 (PGE2) and leukotriene C4 (LTC4) levels of the patients with BD before and after colchicine therapy. We found a statistical decrease in the PGE2 and LTC4 levels after colchicine therapy compared to the previous levels, concluding that colchicine inhibits the inflammation and the polymorphonuclear leukocyte (PML) chemotaxis by inhibiting the cyclooxygenase and lipoxygenase pathways.

Decompression for the management of onychocryptosis.

BACKGROUND: There are many therapeutic alternatives for the management of onychocryptosis. Generally in severe cases, surgical approaches are preferred. OBJECTIVE: The aim of this study was to introduce the new surgical method that treats onychocryptosis without inducing a permanent injury to the matrix. MATERIALS AND METHODS: Twenty-two patients with 30 cases of onychocryptosis were treated by unilateral soft tissue resection combined with partial nail plate avulsion technique without permanent matricectomy. RESULTS: Complete recovery was attained in 25 (83.3%) of cases. No complication was observed. CONCLUSION: The most important advantage of this method was on the nail matrix. No permanent injury is incurred on the matrix.

Natural cellular cytotoxicity in Behçet's disease.

This study evaluated the cytotoxic activity of natural killer cells in the active and inactive stages of Behçet's disease (BD) and attempted to develop a new explanation for its immunopathogenesis. Blood samples were taken from 16 BD patients and compared with 11 healthy individuals. The lymphocyte fraction was separated and diluted in RPMI-1640. Candida as a target cell (T) was mixed with lymphocytes (E) (effector cells) in ratios of T:E 1/5 and T:E 1/25. After the numbers of colonies were counted with controls, the anticandidal index (natural cytotoxicity) was calculated. Natural cytotoxicity relatively decreased in the active stage and increased in the inactive stage of BD. Although the difference between the mean value of natural cytotoxicity in the active stage and in the inactive stage was significant, the difference between the averages of active stage and the control group was insignificant. However, the difference between inactive stage and the control group was remarkable. The increase of the natural cytotoxic activity in the inactive period of the disease may play a role together with other immune mechanisms in the aetiopathogenesis of BD.

[In vitro susceptibility of dermatophyte strains to imidazole derivatives]. / Dermatofit suslarinin imidazol türevlerine karsi invitro duyarliligi.

Recently, imidazole derivatives are being successfully used for the dermatomycoses. These drugs have the strongest antimycotic activity. 44 dermatophyte strains were isolated from our out-patient with dermatomycosis. Imidazole derivatives such as isoconazole, oxiconazole, bifonazole and tioconazole were studied their efficacy on these fungal agents in vitro. 4 imidazole derivatives were effective on all of the dermatophyte strains in less than or equal to 5 micrograms/ml concentration. Whereas, there were differences in Minimal Inhibition Concentration (MIC) and MIC50 values.

When there is no single best biological agent: psoriasis and psoriatic arthritis in the same patient responding to two different biological agents.

Guidelines and treatment strategies for the new biological agents have been developed, but dermatologists continue to face difficulties in adopting these guidelines into their daily practices. We report a patient with psoriasis and psoriatic arthritis whose skin lesions responded only to efalizumab, and the arthritis to etanercept. This case shows that different biological agents may achieve different success rates even in the same patient. Each biological agent offers different advantages and disadvantages, which sometimes make it difficult to choose the single best agent for a patient. Psoriasis often becomes one of the most difficult diseases to treat and does not respond to any single antipsoriatic agent. Perhaps in the future, rotational or combination treatment with different biological treatments will be used.

The effects of calcipotriol and methylprednisolone aseponate on bcl-2, p53 and ki-67 expression in psoriasis.

OBJECTIVE: The decrease of physiological apoptosis in the psoriatic lesions is thought to be involved in the pathogenesis of psoriasis, and induction of apoptosis was shown to contribute to the regression of psoriatic hyperplasia. In the present study, we compared the effects of calcipotriol and methylprednisolone aseponate (MPA) treatments on bcl-2, p53 and ki-67 expressions in psoriatic patients in order to define a relationship between regulation of apoptosis and healing process in psoriasis. METHODS: Thirty psoriatic patients with stable and moderate chronic plaque psoriasis applied either calcipotriol or MPA ointment for 6 weeks twice daily. Evaluation of bcl-2, p53 and ki-67 positivity was performed at baseline and was repeated at sixth week for each therapy. RESULTS: The mean percentage of positive keratinocytes was 8.63 +/- 7.15% for p53, 20.66 +/- 14.45% for ki-67, and 3.74 +/- 2.83% for bcl-2 in psoriatic skin at baseline. Normal skin values were 3.27 +/- 3.21% for p53, 4.93 +/- 4.77% for ki-67, and 1.80 +/- 0.41% for bcl-2. The psoriatic skin showed higher ki-67 (P < 0.05) and bcl-2 (P < 0.05) expression rates when compared to normal skin. The p53 positivity observed in psoriatic skin and normal skin was not significantly different (P > 0.05). Following calcipotriol and MPA treatments, there was a significant reduction in p53 and ki-67 positivity accompanied by an increase in bcl-2 positivity (P < 0.05 each). No significant differences were found at sixth week between calcipotriol and MPA groups with respect to p53, ki-67 and bcl-2 positivity (P > 0.05). The post-treatment psoriatic skin showed lower expression of p53, higher expressions of ki-67 and bcl-2 when compared to normal skin (P < 0.05 each). CONCLUSION: The results of this study provide evidence that both calcipotriol and MPA decrease the p53 and ki-67 expression and increase bcl-2 expression. However, it should further be elucidated if these changes were the common behaviour of psoriatic keratinocytes to any antipsoriatic medication.

Serum interleukin 18 and tumour necrosis factor-alpha levels are increased in Behcet's disease.

Inflammation in Behcet's disease is thought to be mediated by cytokines derived from T-helper type 1 (Th1) lymphocytes. In this study, we tried to determine serum interleukin (IL)-18 and tumour necrosis factor (TNF)-alpha levels of patients with Behcet's disease. Twenty-seven patients with active Behcet's disease, and 20 healthy control subjects were included in this study. Differences between mean serum IL-18 and TNF-alpha level of patients with Behcet's disease were significantly increased when compared with the control group. A significant correlation was found between serum IL-18 and TNF-alpha levels of Behcet patients (rs = 0.627, P < 0.0001). IL-18 and TNF-alpha levels may be related to disease pathogenesis. Increased levels of IL-18 also support Th1 predominance in Behcet's disease.