Androgenetic alopecia

Androgenetik alopesi; genetik predispozisyonu olan kişilerde androjenlerin etkisi ile ortaya çıkan, her iki cinste de görülebilen ve saç kaybı ile seyreden bir hastalıktır. Günümüzde saç dökülmeleri kişilerin yaşam kalitesini etkilemekte ve tedavisi konusunda değişik yöntemler arayışı ortaya çıkmaktadır. Özellikle fizyolojik bir süreç olarak kabul edilen de saç dökülmesi progressif bir seyir izlediği için kişilerin yaşamlarında etkili olmaktadır. Bu yazıda nin etyopatogenezi, klinik özellikleri, tedavideki son gelişmeler ve hastalığın yaşam kalitesi üzerine etkileri literatür bilgileri gözden geçirilerek derlenmiştir.Androgenetic alopecia is an androgen-dependent hair loss of the scalp in genetically predisposed male and female patients. Nowadays hair shedding has an effect on life quality of the individuals and there is a need of various therapy modalities for hair loss in recent years. Although androgenetic alopecia is accepted as a physiological process, as it has a progressive course, predominantly this type of alopecia influences life style of the patients. In this report the etiopathogenesis, clinical features, the effects on quality of life and recent advances in therapy of androgenetic alopecia is reviewed with the relevant literature

Four cases of anticonvulsant hypersensitivity syndrome

Fenitoin, karbamazepin, fenobarbital ve primidon gibi aromatik antiepileptik ilaçlarla olusan antikonvülzan hipersensitivite sendromu (AHS) akut, yasamı tehdit edici, multisistemik bir ilaç reaksiyonudur.En önemli klinik bulgular ates, hafif morbiliform döküntünden Stevens-Johnson sendromuna kadar degisen cilt döküntüleri ve lenfadenopatidir. Eozinofili, mononükleozis benzeri atipik lenfositoz gibi hematolojik anormalliklerin yanı sıra hepatit, nefrit ve pnömoni gibi iç organ tutulumu ile beraber olabilir. Morbiliform makülopapüler erüpsiyon en sık görülen deri bulgusudur. Bu yazıda dört AHS olgusunun klinik bulguları degerlendirilerek, bu sendromun karakteristik klinik özelliklerini vurgulamak amaçlanmıstır. Serimizde bulunan AHS tanısı almıs, yasları 17-64 yas arasında degisen 4 erkek olgunun epilepsi, psikiyatrik hastalık, trigeminal nevraji ve subdural hematom operasyonu sonrası antikonvülzan ilaç kullanımı mevcuttu. Olgulardan 2'sinde karbamazepin, diger 2'sinde ise difenilhidantoin ve okskarbazepin birlikte kullanılmıstı. Bulgular ilaç tedavilerinin baslanmasından veya ilaç degistirilmesinden 1-1.5 ay sonra, 3 olguda eritrodermi, 1 olguda Stevens-Johnson sendromu olarak ortaya çıkmıstı. Olguların hepsinde ates yüksekligi, 2'sinde lenfadenopati ve 1'inde hepatosplenomegali mevcuttu. Laboratuvar bulgularından lökositoz 3 hastada, eritrosit sedimentasyon hızında artıs 3 hastada, üre ve kreatinin yüksekligi 1 hastada mevcutken, tüm hastalarda karaciger enzimlerinde yükselme saptandı. Tedavi ve takipleri yapılan hastaların eritrodermi tablosunda olan biri hariç hepsinde 1-5 ay sonrasında iyilesme gözlendi.Anticonvulsant hypersensitivity syndrome (AHS) that occurs with aromatic antiepileptic drugs such as phenytoin, carbamazepine, phenobarbital and primidone is an acute, life threatening multisystemic drug reaction. Most important clinical signs are fever, skin eruptions ranging from mild morbiliform eruption to Stevens- Johnson syndrome and lymphadenopathy. Beside hematological abnormalities such as eosinophilia, mononucleosis like atypic lymphocytosis, internal organ involvements including hepatitis, nephritis and pneumonia can be seen. Morbiliform maculopapular eruption is the most frequent skin sign. In this article we aimed to present 4 patients withAHS and emphasize the characteristic clinical features of this syndrome. In our series 4 male patients with AHS, between ages 17 and 64, had been treated with anticonvulsant drugs after epilepsy, psychiatric disease, trigeminal neuralgia and operation of a subdural hematoma. The causative agents were carbamazepine in 2 patients, diphenylhidantoin and oxcarbazepine in the others. Erythroderma in 3 patients and Stevens-Johnson syndrome in the 4th patient had developed after 1-1,5 months following initiation or alteration of anticonvulsant therapy. Fever, was observed in 4 patients, lymphadenopathy in 2 patients and hepatosplenomegaly in one patient. Laboratory evaluation showed leucocytosis in 3, increase in erythrocyte sedimentation rate in 3, elevated blood urea nitrogen and creatinin levels in 1 and elevated liver enzymes in all patients. Except one case with erythroderma, all cases improved within 1-5 months

İnvestigation of knowledge about sun effects, skin cancer and sun protection behaviour among doctors in Adnan Menderes Hospital

Amaç: Tüm dünyada deri kanseri insidansındaki artıs, günese maruziyetteki artıs ile paralel seyretmektedir. Bu çalısmanın amacı Adnan Menderes Üniversitesi Hastanesinde çalısan hekimlerin günesten korunma davranıslarını, günesin derideki zararlı etkileri ve deri kanseri etyopatogenezi konusunda bilgi düzeylerini arastırmaktır. Yöntem: Kesitsel tipteki çalısma için 26 soru içeren bir anket formu hazırlandı ve 158'si uzman hekim ve 172'si uzmanlıkögrencisi olmak üzere toplam 330 hekimden anketleri yanıtlamaları istendi. Bulgular: Anketler 196 hekim tarafından yanıtlandı. Çalısma popülasyonunun yas ortalaması 34.1±7.1'di, %51.5'i kadın, %48.5'i erkekti. Gölgede kalma, ögle saatlerinde dısarı çıkmama, gözlük kullanımı hekimlerin en sık kullandıgı ilk 3 günesten korunma yöntemiydi. “Genellikle” ya da “her zaman” günesten koruyucu ürün kullanımı ise 4. sırada yer alan bir yöntemdi (%56). Kadınlar erkeklere göre daha sıklıkla günesten koruyucu ürün kullanmaktaydı. Günesin etkileri ve deri kanserleri konusunda 9 soruya verilen dogru yanıtların ortalaması 5.4±1.4 idi. Günesin immünsupresif etkisi %8.7 hekim tarafından, koyu renk giysilerin açık renklilere göre günesten daha iyi koruyucu oldugu ise %15.3'ü tarafından bilinmisti. Günese duyarlı deri tipine sahip ve günesin derideki etkileri, deri kanserleri ve korunma yollarına iliskin bilgi seviyesi yüksek hekimler daha sıklıkla günesten korunma yöntemlerine basvurduklarını belirtmislerdi (p<0.05). Sonuç: Arastırmanın yapıldıgı hastanede çalısan hekimlerin deri kanserleri konusundaki bilgi düzeyleri ve günesten korunma davranısları yeterli degildir. Günesin derideki zararlı etkileri ve deri kanserlerinin engellenmesi konusunda halkı egitmek temel olarak dermatologların görevi olsa da, tüm hekimlerin bu göreve katkıda bulunması gerekmektedir. Bu nedenle hekimlerin günesin derideki etkileri, deri kanserleri ve korunma yolları konusunda bilgi düzeylerinin gelistirilmesine ihtiyaç vardır.Objective: The increase of skin cancer incidence all over the world on recent years is in parallel with the increase in sun exposure. The purpose of this study was to investigate sun protection behaviour and knowledge about harmful effects of the sun on skin and skin cancer ethiopathogenesis among doctors working in Adnan Menderes University Hospital. Methods: Aquestionnaire containing 26 questions was prepared for the cross-sectional designed study and given to 330 doctors to be answered (158 specialists and 172 residents). Results: 196 doctors answered the questionnaire. Mean age was 34.1±7.1, 51.5% of the study population were women and 48.5% were men. Staying under the shade, not going out in midday, use of sunglasses were among the first three methods of sun protection practiced by the doctors. Use of sun protection product most of the time or everytime was in the 4th place (56%). Women stated more frequent use of sun protection product than men. Mean number of correct answers given to 9 questions about sun effects and skin cancer was 5.4±1.4. Immunsuppresive effect of the sun was known by 8.7% and better sun protection offered by clothes with dark colour was known by 15.3%. Doctors with sun sensitive phenotype and who had given more correct answers stated more frequent use of sun protection (p<0.05). Conclusion: Doctors working in this hospital do not have sufficient knowledge about skin cancers and the optimal mode of sun protection. Public education for harmful effects of sun and prevention of skin cancer is mainly the duty of dermatologists but all doctors should have some input for this purpose. Therefore, we believe that there is a need for improvement about knowledge of all doctors for effects of the sun on skin, skin cancer and means of sun protection

Schamberg’s disease

Pigmente purpurik dermatozlar grubunda yer alan Schamberg hastalığı nedeni bilinmeyen, erkeklerde kadınlara oranla daha sık görüldüğü bildirilen ancak popülasyonda görülme sıklığı ile ilgili verilerin yetersiz olduğu bir hastalıktır. Bu yazıda; iki yıllık bir süre içinde polikliniğimize dermatolojik inceleme için başvuran 12353 hastadan Schamberg hastalığı tanısı alan Schamberg hastalığı tanısı almış 7 olgumuzun klinik ve histopatolojik özellikleri irdelenmiştir. Erkeklerde daha sık görüldüğü bildirilmesine rağmen bizim hastalarımızın %71,4 ünü kadın hastaların oluşturduğu gözlenmiştir. Schamberg hastalığı sıklığını %0.056 olarak saptamakla beraber, hastalığın asemptomatik olması nedeni ile bu oranın daha yüksek olabileceğini düşünmekteyiz.A variant of chronic pigmented purpura, Schamberg s disease has been reported as affecting predominantly elderly men. Data as to the incidence of the disease, however, is limited. In this report, the clinical and histopathological findings of the patients with Schamberg’s disease among 12353 patients who were seen at our department in a period of two years, were evaluated. Although Schamberg’s disease has been reported as affecting predominantly elderly men, of the 7 patients in our series, 71.4% were female patients. As the disease is asymptomatic, we suggested that the prevalance of Schamberg’s disease could be higher than the value we had found

Behcet's disease experience in aydin: retrospective evaluation of 67 patients

We aimed to investigate the demographical and clinical features of patients with Behçet's disease followed up inAdnan Menderes University Medical Faculty, Dermatology Department. Sixtyseven patients who fullfilled the diagnostic criteria of the International Study Group for Behçet's Disease were included to the study. Patients records were investigated and analysed by using SPSS 14 programme. Patient's age range was between 16-61, mean age was 35.7±10.5 and male/female ratio was 1.48:1. The mean age at the first symptom of the disease was 27.1±9.3, and mean age of the diagnosis of Behçet's disease was 32.4±9.6. Oral ulcers (100.0%) and genital ulcers (97.0%) were the most common findings of the disease. These were followed by papulopustular lesions (72.3%), pathergy positivity (50.8%) erythema nodosum (38.8%), articular involvement (23.9%), eye involvement (21.5%) and thrombophlebitis (9.1%). Thrombophlebitis was seen significantly more frequently in male patients than females (p=0.03). The data of patients with Behçet's disease who were followed up in a Dermatology clinic in Aydin were presented as a one centered study. Major findings were mucocutaneous ones and none of the patients had the severe involvement of the Behçet's disease.Bu çalısmada Adnan Menderes Üniversitesi Tıp Fakültesi Dermatoloji AD'da izlenen Behçet hastalarının demografik ve klinik özelliklerinin belirlenmesi amaçlandı. Çalısmaya uluslararası Behçet hastalıgı tanı kriterlerini dolduran 67 hasta dahil edildi. Hastaların dosya bilgileri incelendi ve veriler SPSS 14 programı kullanılarak analiz edildi. Yasları 16 ile 61 arasında degisen hastaların yas ortalaması 35.7±10.5'ti ve erkek/kadın oranı 1.48:1 idi. Hastalıgın ilk semptomunun baslama yası ortalaması 27.1±9.3, Behçet hastalıgı tanısını alma yası ortalaması 32.4±9.6'ydı. Oral ülserler (%100) ve genital ülserler (%97.0) hastalıgın en sık bulguları idi. Bunları papülopüstüler döküntü (%72.3), paterji pozitifligi (%50.8) eritema nodozum (%38.8), eklem tutulumu (%23.9), göz tutulumu (%21.5) ve tromboflebit (%9.1) izledi. Tromboflebit anlamlı olarak erkeklerde daha fazla görüldü (p=0.03). Aydın'da tek merkezli olarak Dermatoloji kliniginde izlenen Behçet hastalarının verileri sunuldu. Mukokutanöz bulguların ön planda oldugu hastaların hiçbirinde siddetli tutulum izlenmedi

Comparison of narrow band uvb and retinoid narrow band uvb therapies in patients with psoriasis

AMAÇ: Psoriazis vulgaris, kronik seyirli, inflamatuar bir deri hastalığıdır. Hastalık günlük yaşam kalitesini olumsuz etkileyebildiğinden, etkin ve hızlı biçimde tedavi edilmesi önemlidir. Kombinasyon tedavileri bu amaca hizmet edebilmektedir. Bu çalısmada amacımız psoriazis vulgariste dar bantUVB(dbUVB) ve asitretin-dar bant UVB(re-dbUVB) kombinasyon tedavilerinin etkinliklerinin karşılaştırılmasıdır. GEREÇ ve YÖNTEM: Çalısmaya dbUVB ve asitretin kullanımı için kontrendikasyonu olmayan plak tip psoriazis vulğaris hastaları alındı ve hastalar 4 ay süreyle Psoriazis Alan Siddet Indeksi (PASI) skorları ve tedavi yan etkileri açısından izlendi. BULGULAR: Çalısmaya 17'si erkek, 5'i kadın 22 hasta dahil edildi. Hastaların yaşları 31 ile 61 arasında değişmekte olup yaş ortalaması 45.9±15.7 idi. Hastaların 11'i dbUVB, 11'i re-dbUVB tedavileri aldı. Birinci ve 2. ayda re-dbUVB alan grupta PASI'deki azalma (sırasıyla %83.4 (%34.3-%86.4), %89.3 (%85.3-%96.7)), dbUVB alan grubunkinden %29.6 (%27.0-%74.0) %74.4 (%35.9-%88.8)) anlamlı olarak yüksek bulundu (p=0.006, p=0.033). Ancak 3. ve 4. aylarda re-dbUVB grubunda PASI'deki azalma, dbUVB grubundan anlamlı farklılık göstermedi. Çalışmamızda psoriazis vulgariste asitretin-dbUVB kombinasyon tedavisi ile, dbUVB tedavisiyle karşılastırıldığında 4 ay sonunda tedavi etkinliklerinin farklılık göstermediği, ancak ilk 2 ayda alınan yanıtta redbUVB kombinasyonu ile daha iyi sonuç alındığı saptandı. Asitretin ile eklenen yan etkiler hafifti ve hastalar tarafından iyi tolere edildi. SONUÇ: Hızlı yanıta ihtiyaç duyulan plak tip psoriazisli hastalarda, kısa sürede iyi yanıt alınması nedeniyle redbUVBkombinasyon tedavisinin verilmesi, dbUVB'ye tercih edilebilir.OBJECTIVE: Psoriasis vulgaris is a chronic, inflammatory skin disease. Since the disease can worsen the quality of life, it is important to give both effective and also rapid acting therapies. Combination therapies could provide such benefits.Aim of this study was to compare the effectiveness of the narrow band UVB (nbUVB) and acitretin and narrow bandUVBcombination therapies (re-nbUVB) in psoriasis vulgaris. MATERIALS and METHODS: Plaque type psoriasis patients who have no contraindication for nbUVB and acitretin use were included to the study and followed up for 4 months for changes in Psoriasis Area and Severity Index (PASI) scores and side effects. RESULTS: Seventeen men and 5 women, a total of 22 patients were included. Age range was between 31 to 61, mean age was 45.9±15.7. Eleven patients received nbUVB and 11 patients received re-nbUVB combination therapy. In the first and the second months, the decrease in PASI in re-nbUVB group {83.4% (34.3%-86.4%), 89.3% (85.3%-96.7%) respectively}were higher than nbUVB group {29.6% (27.0%-74.0%) , 74.4% (35.9%- 88.8%); p=0.006 and p=0.033}. In the 3rd and the 4th months, decreases in PASI in re-nbUVB group were not significantly different than the nbUVB group. Response to acitretin-nbUVB combination therapy and nbUVB therapy were not different at the end of the 4 months of therapy. On the other hand, in first 2 months, re-nbUVB combination was more effective for decreasing PASI scores. Additional side effects of acitretin were minor and well-tolerated by the patients. CONCLUSION: In patients who were in need of rapid response, re-nbUVB combination therapy may be preferred tonbUVBin order to get good results in a short period of time

Evaluation of skin barrier functions in patients with breast cancer-related lymphedema: Measurement of stratum corneum hydration, sebum level, and transepidermal water loss

Background and Design: Skin barrier function in patients with breast cancer-related lymphedema (BCRL) has rarely been evaluated. This study aimed to investigate transepidermal water loss (TEWL), stratum corneum hydration (SCH), and sebum level (SL) on the skin of the lymphedema arm in comparison to the skin of the healthy contralateral arm in BCRL patients. Materials and Methods: This cross-sectional study included 40 female patients with unilateral BCRL. TEWL, SCH, and SL were measured using Tewameter®, Corneometer®, and Sebumeter®, respectively. Measurements were taken in each patient's lymphedema arms and healthy contralateral arm. The volar/dorsal regions of the forearm and the dorsal region of the upper arm were determined as measurement sites. Results: In all three measurement areas, there was no significant difference in SCH or SL between the skin of the lymphedema arm and the skin of the healthy contralateral arm. TEWL was significantly higher on the skin of the lymphedema arm than on the healthy arm for the volar forearm regions (p=0.007). However, there was no significant difference in TEWL between the skin of the lymphedema arm and the skin of the healthy contralateral arm in the dorsal forearm or dorsal upper arm region. Conclusion: This study showed that there was no difference in skin barrier functions in the lymphedema arm compared with the healthy contralateral arm, except for higher TEWL in the skin of the volar forearm region of the lymphedema arm in BCRL patients. The detection of changes in skin barrier function in BCRL patients may help in the regulation of optimal skin care of these patients' lymphedema arms

Subcorneal pustular dermatosis: an atypical case report

Subkorneal püstüler dermatoz; tekrarlayıcı özellikteki püstüler erüpsiyonlar ve histopatolojik olarak çok sayıda nötrofil içeren subkorneal yerleşimli püstüller ile karakterize, seyrek görülen kronik bir dermatozdur. Nedeni bilinmeyen hastalık; özellikle karın, aksilla ve kasıklarda yerleşen, bilateral ve simetrik, annüler veya serpiginöz plaklar ile seyreder. Bu yazıda; karakteristik histopatolojik bulgular gösteren ve bir yıldır yayılım göstermeden tek bir plak ile seyreden 54 yaşında erkek s olgusu, atipik klinik özellikler izlenmesi nedeni ile, 100 mg/gün dapson sağaltımı sonuçları ile birlikte sunulmuştur.Subcorneal pustular dermatosis is an uncommon and chronic disease with unknown etiology, characterized by recurrent pustular eruption and subcorneal pustules that contain abundant neutrophils histopathologically. Annular or serpiginous plaques are observed symmetrically with a predilection of axilla, abdomen and groins. We describe a 54-year old male patient with an atypical solitary non-spreading plaque, showing characteristic features of subcorneal pustular dermatosis histopathologically and present the results of 100 mg/d dapson treatment

Patient use of complementary and alternative medicine for psoriasis vulgaris and factors believed to trigger the disease: A multicenter cross-sectional study with 1621 patients

Introduction: Due to the chronic recurrent nature of psoriasis vulgaris (PV) and lack of definitive treatment for the disease, patients often resort to alternative treatments. Physicians seem to have low awareness of this issue. Objectives: To elicit the perceptions of 1,621 PV patients on complementary and alternative medicine (CAM) and examine factors reported to worsen PV. Methods: The patients sociodemographic characteristics, Psoriasis Area Severity Index (PASI), Dermatology Life Quality Index (DLQI), disease duration, and severity were recorded, and the patients CAM use was questioned in detail. The patients were also asked about factors that worsened PV and their experiences with a gluten-free diet. Results: Of the patients, 56.51% had used CAM. The mean age, illness duration, PASI scores and DLQI of those using CAM were significantly higher. CAM use was significantly higher in those with facial, genital involvement, and arthralgia/arthritis. The patients mostly referred to CAM when PV became severe (46.4%). Of the CAM users, 45.52% used herbal topicals. The physicians of 67.03% did not inquire whether they used CAM. Of the participants, 37.73% considered that stress worsened their disease. Gluten-free diet did not affect PV symptoms in 52.22%. Conclusions: Patients CAM use is often overlooked by dermatologists. Our results showed that more than half the patients used CAM and did not share this information with their physicians. Therefore, the awareness of physicians should be increased and patients should be asked about the use of CAM and directed to the appropriate medical treatment options by physicians

Habits of using social media and the internet in psoriasis patients

Introduction: Psoriasis significantly affects the patients quality of life, which often leads patients to seek online information about this disease. Objectives: To explore the habits of patients with psoriasis related to their use of social media (SM) and the internet to obtain information about their disease. Methods: 1,520 patients completed the survey and the Dermatology Life Quality Index (DLQI) questionnaire. The Psoriasis Area Severity Index scores (PASI) and clinical data of the patients were recorded by their physicians. Results: Of the 1,114 patients that reported using SM and internet, 48.38% regularly and 31.14% sometimes resorted to obtain information about psoriasis. The use of SM and internet for psoriasis was statistically significantly higher among young people (P = 0.000), those with university or higher education (P = 0.009), higher DLQI (P = 0.000) and PASI (P = 0.011) scores, facial (P = 0.050), scalp (P = 0.032), hand (P = 0.048), genital (P = 0.001) and inverse (P = 0.000) involvement, and arthralgia/arthritis (P = 0.006). The participants mostly used the Google (86%) and Facebook (41%). More than half of the participants (62.8%) expected dermatologists to inform society that psoriasis is not contagious. Conclusions: Internet and SM being widely available and offering substantial information to be easily accessed make it very attractive for patients to use these platforms to investigate diseases, including psoriasis. If what is presented on SM conflicts with what the physician says, patients mostly trust the latter, but at the same time, they tend not to share the results of their online inquiries with their physicians