Biochemical and histopathologic assessment of effects of acitretin on epiphyseal growth plate in rats.

INTRODUCTION: Acitretin is a commonly used retinoid in dermatology. Although there are generally known side effects, the effects on the epiphyseal plaque and bone metabolism are not clear in the literature. AIM: To histopathologically investigate the effects on the epiphyseal plate and assess variations in bone metabolism caused by acitretin. MATERIAL AND METHODS: Three groups were formed with 10 rats in each group. The 1st group (n = 10, 5 male, 5 female) were administered 10 mg/kg/day oral acitretin solution and the 2nd group (n = 10, 5 male, 5 female) were administered 3 mg/kg/day oral acitretin solution. The control group were given normal standard feed and water. Rats were sacrificed at the end of 4 weeks. The proximal tibias were excised and histopathologically and immunohistochemically assessed. Biochemical assessment was also carried out. RESULTS: Staining with haematoxylin-eosin found reductions in the epiphyseal plate in the 1st and 2nd group compared to the control group, though this situation was not statistically significant. Immunohistochemical studies did not encounter Type II collagen in the epiphyseal bone, proliferative zone and hypertrophic zone in the control group, low dose acitretin solution group and high dose acitretin solution group. Type II collagen was not observed in osteoids and osteoblasts. Type I collagen was not observed in the hypertrophic zone and proliferative zone of any group. CONCLUSIONS: Our data show that though acitretin caused degeneration of the epiphyseal plate, it did not cause clear thinning and we identified no significant variations in bone metabolism markers.

Pemphigus in the eastern region of Turkey.

INTRODUCTION: Pemphigus refers to a group of rare autoimmune vesiculobullous diseases with high morbidity and mortality, mainly affecting the skin and the mucosae. AIM: To evaluate the incidence of pemphigus in the Eastern region of Turkey by analysing the clinical characteristics of the patients including the drugs used in the treatment and their side-effect profiles and dosing schedules, duration of treatment, length of hospital stay, and the characteristics of the lesions. MATERIAL AND METHODS: The retrospective study included 130 pemphigus patients who were admitted to the in- and out-patient dermatology clinics at the University Medical School between January 2005 and October 2017. Age, gender, length of hospital stay, localization of the lesions, initial and maintenance dosages, treatment-related complications, comorbidities, family history, and smoking status were recorded for each patient. RESULTS: The 130 patients included 62 (47.69%) men and 68 (52.31%) women, of which 73 (56.15%) patients had a smoking history. The annual incidence rate of pemphigus was 1.036/100,000 population and pemphigus vulgaris (PV) was the most common clinical subtype of pemphigus in our patients (n = 122; 93.85%). The most common side effect of the treatment was oral candidiasis, followed by Cushingoid appearance. CONCLUSIONS: The results indicated that the incidence of pemphigus is remarkably high in the Eastern region of Turkey and the associated factors including lifestyle changes should be taken into mind when considering these patients.

Cutaneous reactions caused by nitrofurazone.

INTRODUCTION: Allergic contact dermatitis (ACD) is a form of dermatitis due to type 4 hypersensitivity reaction that occurs when the skin comes into contacts with the topical product. Topical nitrofurazone is a widely used antimicrobial drug in our country which is well known to cause ACD. AIM: In this study, ACD cases with different clinical features attributed to the use of nitrofurazone were evaluated. MATERIAL AND METHODS: Patients hospitalized in our clinic between 2013 and 2017 with ACD diagnosis due to nitrofurazone were evaluated. The patient age, gender, atopy histories, clinical features, dissemination of the lesions, treatment given were reviewed. RESULTS: In a 5-year period, 58 cases were identified and their data were analysed. Twelve patients were female (21%), 46 patients were male (79%). Clinical presentations were dyshidrosiform (45%), excoriated papules and plaques (33%), combined (21%), and erythroderma in one patient. The dissemination was generalized in 34 patients, localized in 14 patients, and local spread in 10 patients. The mean hospitalization time was 7 ±3 days, and ranged from 3 to 18 days. CONCLUSIONS: There may be widespread and severe ACD due to the use of nitrofurazone. Topical nitrofurazone should not be applied on damaged skin as sensitization may develop. Patients and physicians should be aware of the ACD risk associated with topical nitrofurazone, which is also commonly used as self-medication, physicians should take a detailed history of the drug use and products containing nitrofurazone should not be used in conditions where skin integrity is not intact, whenever possible.

Clinic experience in discoid lupus erythematosus: a retrospective study of 132 cases.

INTRODUCTION: Lupus erythematosus (LE) is an autoimmune disease characterized by a broad range of cutaneous manifestations. Discoid LE (DLE) is the most common chronic manifestation of LE. Literature reviews show that there are a limited number of large-series studies investigating DLE. Additionally, there is still no consensus on the etiological factors of DLE such as sun exposure and smoking. AIM: To evaluate the clinical and demographic characteristics of patients with DLE. MATERIAL AND METHODS: The study included patients who were hospitalized in the inpatient and outpatient clinics at the Dermatology Department. Age, gender, treatment method, history of smoking, antinuclear antibody positivity, progression to systemic lupus erythematosus (SLE), photosensitivity, and laboratory findings were recorded for each patient. RESULTS: The study included 132 patients comprising 67 (50.8%) men and 65 (49.2%) women. A family history was found in 3.8%, SLE was detected in 5.3%, and photosensitivity was revealed in 50.0% of the patients. ANA positivity was found in 23.7%, a history of smoking was revealed in 61.4%, and chronic sun exposure was detected in 42.4% of the patients. CONCLUSIONS: Discoid LE, though identified long ago, remains unelucidated and there are very few studies in the literature reporting on DLE. The results indicated that smoking and chronic UV exposure are important risk factors for DLE. Moreover, although ANA positivity was high in our patients, the rate of progression to SLE was remarkably low. The results also showed that, contrary to common belief, there is no female preponderance in DLE.

Investigation of galectin-3, lipocalin 2, retinol binding protein (RBP), small dense low-density lipoprotein (sdLDL) in patients with hirsutism.

INTRODUCTION: Hirsutism is defined as excessive terminal hair in androgen-dependent areas in women. Adipose tissue is no longer regarded as a storage site for triglycerides or as a source of free fatty acids but is currently emerging as a key constituent of energy metabolism secreting numerous enzymes, cytokines, growth factors, and hormones. AIM: To evaluate serum levels of galectin-3 (Gal3), lipocalin-2 (LCN2), retinol binding protein (RBP), and small dense low-density lipoprotein (sdLDL) in patients with hirsutism and patients co-presenting with polycystic ovary syndrome (PCOS) and hirsutism. MATERIAL AND METHODS: The study included 90 patients that were divided into three groups: (I) patients with idiopathic hirsutism (IH) (n = 30), (II) PCOS patients with hirsutism (H-PCOS) (n = 30), and (III) the control group (n = 30). Informed consent was obtained from each participant. Idiopathic hirsutism was scored using the modified Ferriman-Gallwey (mFG) scoring system and the diagnosis of PCOS was established based on the modified Rotterdam criteria. Human Gal3, LCN2, RBP, and sdLDL levels were analysed using a commercially available double-antigen sandwich enzyme-linked immunosorbent assay. RESULTS: No significant difference was found between the three groups with regard to serum Gal3, LCN2, RBP, and sdLDL levels (p > 0.05). Median values were higher in the H-PCOS group than in the other two groups: body weight (median: 76.5 kg) (p < 0.001), waist circumference (median: 82.5 cm) (p = 0.001). CONCLUSIONS: No significant correlation was found between the adipokines that play a role in the aetiology of numerous diseases and some mediators of the lipid metabolism and hirsutism.

Determinants of high-risk human papillomavirus infection in anogenital warts.

INTRODUCTION: Genital warts are benign epithelial tumours caused by human papilloma viruses (HPV), and are sexually transmitted. Genotyping of genital HPV bears great clinical significance in terms of treatment planning, follow-up, and prevention strategies. AIM: To evaluate the distribution of high-risk HPV infection types in patients diagnosed with anogenital warts. MATERIAL AND METHODS: A total of 66 patients with anogenital warts were enrolled. Punch biopsy samples were obtained from the lesions of each patient. After nucleic acid purification and DNA extraction, the presence of HPV DNA was ascertained using the PCR method, followed by HPV DNA genotyping. The relationship between HPV type distribution and age, gender, clinical location, and number of sexual partners was investigated. RESULTS: Genotyping was performed and HPV genome was detected in 50 tissue samples (75.8%). Low-risk genotypes predominated with a prevalence of 62.1% (42/66). The most prevalent genotypes were HPV-6 (47%), and HPV-11 (13.6%). Other types detected included HPV-18 and HPV-3. CONCLUSIONS: Genotyping of HPV provides significant clinical information regarding this family of viruses that play a role in the aetiology of a variety of genital cancers, as some of these malignancies are now considered preventable due to recent development of vaccines. We believe that our results may provide guidance on future vaccination programs in our country.

Effects of omalizumab therapy on peripheral nerve functions: short observational study.

INTRODUCTION: Peripheral neuropathy (PN) is a common neurological condition causing symmetrical and diffuse damage in nerves. The etiology of PN includes systemic diseases, toxic exposure, medications, infections, and hereditary diseases. Omalizumab is a humanized monoclonal anti-IgE antibody that exerts its activity by binding to free IgE in circulation. AIM: To investigate the relationship between omalizumab and peripheral neuropathy. MATERIAL AND METHODS: The study included 30 patients who underwent omalizumab therapy (Xolair) due to the diagnosis of chronic urticaria. A detailed neurological and physical examination was performed in each patient both before and 3 months after the therapy. Electrophysiological examination was also performed using a Medelec Synergy instrument. RESULTS: The 30 patients included 8 (26.7%) men and 22 (73.3%) women with a mean age of 37.5 ±14.14 years. No serious side effect of the medication was detected in any patient although local wound irritation occurred in 3 (10%) patients. Moreover, no change occurred in the pre-treatment Neuropathy Symptom Score (NSS) or Neurological Disability Score (NDS) of the patients and no pathological values that could result in neuropathy were observed during motor/sensory nerve conduction. However, significant changes were detected in the sensory and motor components of the nerves with regards to pre- and post-treatment values. CONCLUSIONS: Omalizumab therapy caused no peripheral neuropathy in any of our patients but altered the latency, amplitude, and velocity values of the peripheral nerves.

No evidence for follicular keratinocyte hyperproliferation in acne lesions as compared to autologous healthy hair follicles.

Abnormal hyperkeratinization in sebaceous hair follicles has long been believed to play an important role in acne pathogenesis. Several early reports purported to provide histological evidence for hyperproliferation of keratinocytes in acne lesions by showing a higher expression of the Ki67 as well as certain keratins. The evidence is, however, not robust, and a number of methodological and technical limitations can be identified in these studies. In this study, we looked at the expression of proliferation, mitosis and apoptosis markers directly at acne skin lesions in 66 patients with acne vulgaris. Ki67 was assessed using immunohistochemistry and α-tubulin, phospho-histone H3 and cleaved-PARP with immunofluorescence microscopy. Allogenic unaffected hair follicles from the same acne patients were used as an internal control. In both acne and control hair follicles, the α-tubulin staining was universal, approaching 100% cells and showed no signs of changed assembly. Expression of cleaved-PARP-the apoptosis marker-was a rare event. Cell proliferation rate measured by the expression of Ki67 and phospho-histone H3 was virtually identical between acne and the two control groups. Our findings show the absence of increased keratinocyte proliferation in acne vulgaris. Alternative mechanisms are likely responsible for infundibular hyperkeratinization in acne pathogenesis.

The effect of isotretinoin on retinol-binding protein 4, leptin, adiponectin and insulin resistance in acne vulgaris patients.

BACKGROUND: The effect of isotretinoin (ISO) on adipokines and insulin resistance has been investigated in a few studies, and the results are conflicting. OBJECTIVE: The aim of this study was to investigate the effect of ISO treatment on insulin resistance and adipokines. METHODS: Thirty-three patients with acne vulgaris and a control group of 30 healthy volunteers were included in our study. Screening for the biochemical parameters was performed just before the initiation and after 3 months of ISO treatment. RESULTS: In the acne group, basal leptin levels were significantly lower (p = 0.003) and basal adiponectin levels significantly higher (p = 0.008) compared with the control group. After ISO treatment, leptin levels (p = 0.0005) decreased and adiponectin levels (p = 0.003) increased significantly. However, measurements of fasting blood glucose, insulin, C peptide, retinol-binding protein 4 (RBP4), homeostasis model assessment insulin resistance and BMI did not differ after ISO treatment. CONCLUSION: ISO may affect leptin and adiponectin levels. It does not, however, affect insulin resistance and RBP4 levels.

The effect of different doses of isotretinoin on pituitary hormones.

BACKGROUND: There are a limited number of studies investigating the side effects and effectiveness of various doses of isotretinoin (ISO). We have previously shown that high-dose ISO affects pituitary hormones. OBJECTIVES: To our knowledge, there is no study in the literature looking into the effects of various doses of ISO on pituitary hormones. We searched pituitary hormones in three groups of different doses in acne patients. METHODS: We included 105 acne vulgaris patients from two different centers. We divided the patients into three groups; the first group received 0.5-1 mg/kg/day, the second 0.2-0.5 mg/kg/day and the third intermittent 0.5-1 mg/kg/day (only 1 week in 1 month) ISO treatment. Blood samples were collected for biochemistry and hormone analysis, before the treatment and after 3 months. RESULTS: After 3 months of treatment with ISO, luteinizing hormone (LH) (p < 0.001), prolactin (p < 0.001), total testosterone (p < 0.001), adrenocorticotropic hormone (ACTH) (p < 0.001), cortisol (p < 0.001), insulin-like growth factor-binding protein 3 (p < 0.001), insulin-like growth factor 1 (IGF-1) (p = 0.002), growth hormone (GH) (p = 0.002) and free T3 (fT3) (p < 0.001) levels had decreased significantly. Furthermore, we split data into three different groups. Among the patients receiving intermittent-dose ISO, LH, ACTH, IGF-1, GH and fT3 measurements lost significance. Most of the significant measurements observed in the whole group were also significant among the patients receiving high-dose ISO. Additionally, dehydroepiandrosterone sulfate (p = 0.003) levels increased, and free T4 levels decreased significantly. CONCLUSIONS: ISO affects pituitary hormones at all of these three doses. The differences in pituitary hormones are more pronounced in high-dose treatment. The weakest effect was observed in the intermittent-dose group. Choosing lower doses of ISO may decrease side effects, however the effectiveness of the treatment may also be diminished. ISO, by affecting the PPARγ/RXR system, may affecting hormone systems. These changes in various hormone systems may be related to the effectiveness of ISO.

Oral isotretinoin therapy of acne patients decreases serum paraoxonase-1 activity through increasing oxidative stress.

OBJECTIVES: There are only a few earlier studies suggesting relationship between isotretinoin treatment and oxidative stress however, their results are conflicting. Therefore we aimed to concretize the influence of isotretinoin treatment on oxidant/antioxidant status together with paraoxonase-1 (PON1) activity for the first time. METHODS: The study was performed on serum samples obtained from 35 acne vulgaris patients before and after three months of isotretinoin treatment. PON1 activity, total oxidant status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI) and some routine biochemical parameters were monitored. RESULTS: Dramatically decreased PON1 activity (p < 0.001), increased TOS level and OSI value (p < 0.001 and p < 0.001; respectively) as well as slightly diminished TAC level were noted in posttreatment stage. Moreover significant increases were observed in lactate dehydrogenase and gamma glutamyl transpeptidase activities and levels of total cholesterol, low density lipoprotein cholesterol, very low density lipoprotein cholesterol, triglycerides, low density lipoprotein cholesterol/high density lipoprotein cholesterol ratio respectively (p < 0.05, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001 and p < 0.001) while marked decrease was seen in high density lipoprotein cholesterol (p < 0.01). CONCLUSION: This study revealed that decreased PON1 activity and increased oxidative stress may have a crucial role in the pathogenesis of isotretinoin's side effects. Further studies on a large number of patients are needed to verify these results.

A comparative study of histopathological findings in skin biopsies from patients with psoriasis before and after treatment with acitretin, methotrexate and phototherapy.

INTRODUCTION: Psoriasis is a chronic and inflammatory skin disease. Few studies in the literature evaluate the responses to the treatment histopathologically. OBJECTIVES: In this study, we evaluated and compared skin biopsies taken from patients with psoriasis before and after phototherapy and therapy with acitretin and methotrexate. MATERIAL AND METHODS: We included 64 patients with a diagnosis of psoriasis vulgaris in our study. We performed phototherapy on 33 patients (51.6%), while 19 patients (29.7%) were treated with methotrexate and 12 patients (18.8%) were treated with acitretin. RESULTS: All of the patients had chronic plaque psoriasis, and they had skin lesions on more than 10% of their total body surface area and a score of PASI of 7.2-21.8 (average: 12.2). The histopathological parameter scores were similar in the initial evaluations of the pre-treatment treatment groups. When the biopsy specimens of all cases were evaluated together, a significant decrease was observed in terms of parakeratosis, Munro's microabscesses, regular acanthosis, pustules of Kogoj, lymphocyte infiltration in the papillary dermis, loss of the granular layer, spongiosis, suprapapillary thinning, vascularity in the papillary dermis and neutrophile infiltration in the papillary dermis. CONCLUSION: We found in our study that conventional treatment modalities provided histopathologically significant recovery in psoriasis, but they did not have an effect on some histopathological findings. To our knowledge, it is one of the few studies to assess these parameters in psoriasis under the continuous effect of acitretin, methotrexate and phototherapy for three months. There is a need for studies with larger series to examine the histopathological effects of these treatment modalities in terms of immunopathology.

Cutaneous siderosis after intramuscular iron injections: a case report.

Skin reactions against injected or implanted foreign materials are not rare. Siderosis is a disease characterized by the accumulation of iron in various tissues. Brownish-gray discoloration of the skin can be seen as a side-effect on the injection area after the parenteral iron treatment. Here, we present cutaneous siderosis case developed after multiple intramuscular iron injection on the gluteal region for iron-deficiency anemia. Development of cutaneous siderosis after intramuscular iron injection rarely has been reported in the literature before.

Three eyelid localized cutaneous anthrax cases.

Anthrax is primarily seen in the developing countries, but it can be a worldwide medical concern due to bioterrorism threats. Palpebral anthrax is a rare form of cutaneous anthrax. Untreated cutaneous anthrax can be lethal. Patients with palpebral anthrax can develop complications including cicatrisation and ectropion. Thus, anthrax should be considered in differential diagnosis for patients presenting with preseptal cellulitis in high-risk regions. Herein, we report three anthrax cases (with different age) involving eyelids that were cured without any complications due to early diagnosis and treatment.

A case of verru plana on tattoo.

Tattoo is a popular cosmetic decoration, however several different tattoo-induced complication have been described. Several tattoo related cutaneous reactions such as allergic, granulomatous, lichenoid reactions, and infections have been reported. A 20 year-old male presented with multiple papules on the dragon shaped tattoo. The clinical and histopathological assessments were consistent with verrucas. Tattoo has become increasingly popular among young people. People interested in tattoos should be informed on its related infections and complications during and following tattooing. Herein, we present this rare tattoo induced verru plane to point out tattoo related complications and its treatments.

Assessment of the effects of antihistamine drugs on mood, sleep quality, sleepiness, and dream anxiety.

OBJECTIVE: There are limited comparative studies on classic and new-generation antihistamines that affect sleep quality and mood. The purpose of this study was to determine and compare the effects of classic and new-generation antihistamines on sleep quality, daytime sleepiness, dream anxiety, and mood. METHODS: Ninety-two patients with chronic pruritus completed study in the dermatology outpatient clinic. Treatments with regular recommended therapeutic doses were administered. The effects of antihistaminic drugs on mood, daytime sleepiness, dream anxiety, and sleep quality were assessed on the first day and 1 month after. RESULTS: Outpatients who received cetirizine and hydroxyzine treatments reported higher scores on the depression, anxiety, and fatigue sub-scales than those who received desloratadine, levocetirizine, and rupatadine. Pheniramine and rupatadine were found to be associated with daytime sleepiness and better sleep quality. UKU side effects scale scores were significantly elevated among outpatients receiving pheniramine. Classic antihistamines increased daytime sleepiness and decreased the sleep quality scores. New-generation antihistamines reduced sleep latency and dream anxiety, and increased daytime sleepiness and sleep quality. CONCLUSION: Both antihistamines, significantly increased daytime sleepiness and nocturnal sleep quality. Daytime sleepiness was significantly predicted by rupadatine and pheniramine treatment. Cetirizine and hydroxyzine, seem to have negative influences on mood states. Given the extensive use of antihistamines in clinical settings, these results should be more elaborately examined in further studies.

The effect of acitretin treatment on insulin resistance, retinol-binding protein-4, leptin, and adiponectin in psoriasis vulgaris: a noncontrolled study.

BACKGROUND/AIM: To investigate the effects of acitretin treatment on insulin resistance (IR) and adipokines, particularly retinol-binding protein (RBP)-4. METHODS: Thirty-four patients with chronic plaque psoriasis and a control group of 34 healthy volunteers were recruited in the study. Screening for the parameters was performed before starting and after 3 months of acitretin treatment in the psoriasis group. The control group was only evaluated at the beginning of the study and did not receive placebo. We could not compare our results with a placebo control group because of ethical reasons. RESULTS: Basal adiponectin (p = 0.01), insulin (p < 0.0001) levels and homeostasis model assessment (HOMA) IR (p < 0.0001) were significantly higher in psoriasis patients. After the treatment, insulin (p = 0.014), C peptide (p = 0.011), RBP-4 (p < 0.0001) levels and HOMA-IR (p = 0.008) decreased significantly. Posttreatment leptin (p = 0.036) levels were significantly lower than those of the controls. Posttreatment adiponectin (p = 0.005) and insulin (p = 0.048) levels were higher than those of the controls. CONCLUSIONS: This study showed for the first time that RBP-4 levels and IR are decreased significantly with acitretin treatment. This finding is very important in psoriasis patients because psoriasis may cause insulin resistance and diabetes. Further experimental and clinical studies are needed to clarify the effect of acitretin on adipocyte structure and behavior.

Two cases of eczematid-like purpura of Doucas and Kapetanakis responsive to narrow band ultraviolet B treatment.

Eczematid-like purpura of Doucas and Kapetanakis is a type of pigmented purpuric dermatoses (PPDs) with eczematous changes in the purpuric surface. A 10-year-old male and a 44-year-old male patients were admitted to our clinics for itching and flaking of the skin rashes. Based on the clinical and histopathological evaluations, the rashes were identified as eczematid-like PPDs of Doucas and Kapetanakis. Both patients were treated with narrow band ultraviolet B. The lesions were remarkably regressed following the treatment. These cases reported due its rarity and good response to narrow band ultraviolet B.

A case of generalized lichen nitidus successfully treated with narrow-band ultraviolet B treatment.

Lichen nitidus (LN) is a rare skin disorder presenting with multiple, small and bright papules located on the chest, abdomen, penis glans and upper extremities. It usually presents with limited involvement; however, it can present as generalized involvement. There is no consensus on treatment. Corticosteroid, astemizole, phototherapy has been used; however, the results are controversial. A 15-year-old male with clinical and histopathological diagnosis of LN was treated with narrow-band ultraviolet B (NB-UVB). The lesions completely regressed with post-inflammatory hypopigmentation on the second month of the therapy (25 sessions). We believe that NB-UVB is an effective treatment on generalized LN.

Effect of brow lifting using botulinum a toxin on upper eyelid height in patients with ptosis undergoing the frontal sling technique.

In this study, brow lifting with botulinum A toxin was performed on patients whose ptosis was corrected using the frontal sling technique, and the effects of this application on ptosis were investigated. Seven patients (with 12 eyelids) on whom the frontal sling procedure was performed using a tensor fascia lata graft were enrolled in the study. The patients underwent brow lifting using botulinum A toxin. Digital photographs of the patients were obtained before and 21 days after botulinum A injection. In digital imaging analysis, although a statistically significant elevation was detected in the eyelids and brows of the patients following botulinum A injection, it did not to lead to a significant difference in the degree of lagophthalmos. In the current study, this procedure was found to reduce the degree of ptosis without increasing the degree of lagophthalmos in patients who had previously undergone ptosis correction using the frontal sling.