The course of autologous serum skin test in chronic urticaria

Kronik idiopatik ürtikerli bazı hastalarda histamin salıverilmesine yol açan dolaşan otoantikorlar saptanmıştır. I Otolog serum deri testi, böyle-olguların tanısı için bir tarama testi olarak önerilmiştir. Ürtikerdeki otoimmünite-I nin çoğunlukla primer olduğu kabul edilse de sekonder bir fenomen olabileceği yönünde görüşler de vardır. i Bu çalışmada, ürtikerdeki otoimmünitenin primer mi yoksa sekonder mi olduğununun araştırılması amaçlandı. Bu amaçla kronik idiopatik ürtikerli 20 hasta (16 kadın, 4 erkek) çalışma kapsamına alındı. Bu hastalara, başvuru sırasında, iki ve altı ay sonra olmak üzere toplam üç kez otolog serum deri testi uygulandı. Başvuru sıra¬sındaki testte %25, ikincisinde %20 ve üçüncüsünde %15 hastada pozitiflik saptandı. En az bir pozitiflik gösteren 7 hasta (%35) vardı. Bunların yalnızca birinde tüm testler pozitif idi. Yalnızca ilk testi pozitif olan bir hasta olduğu gibi, yalnızca son testi pozitif olan bir hasta da vardı. Bu bulgular, kronik ürtikerdeki otoimmünitenin bazı olgularda primer, bazı olgularda ise sekonder olabileceği şeklinde yorumlandı.Circulating autoantibodies causing histamine release are detected in some patients with chronic idiopathic urticaria. The autologous serum skin test (ASST) is suggested as a screening method to diagnose such patients. Autoimmunity in urticaria is generally accepted to occur primarily whereas some authors believe it to be a seconder phenomenon. The aim of this study was to determine whether autoimmunity in urticaria is primary or secondary. Materials and Methods: For this purpose autologous serum skin test in 20 patients (16 women and 4 men) was used. Autologous serum was performed to the patiens for three different times; at the beginning, at the second and at the sixth month. Results: The ASST was found to be positive in 25% in 20% and in 15% of patients; at the beginning, at the second month and at the sixth month, respectively. At least one positive test was observed in 7 patients (35%). In only 1 of 7 patients, all tests were positive. Initial test was positive for only one patient and last test was also positive for another patient. Conclusion: These results explain that autoimmunity in chronic urticaria could be either primer or seconder in some patients

Variables affecting interpretation of skin prick test results

Background: Both performer-and device-dependent variabilities have been reported in sizes of wheal responses to skin prick tests. Objective: We aimed to evaluate whether or not variabilities in sizes of wheal responses influence the final interpretation of skin prick tests; in other words, the decision on whether or not there is an allergy to a given antigen. Methods: Skin prick tests with positive and negative controls and extracts of Dermatophagoides farinae and Dermatophagoides pteronyssinus were done for 69 patients by two different persons, using two different puncturing devices-disposable 22-gauge hypodermic needles and metal lancets. Results: Among four different skin prick tests, the average coefficients of variation in sizes of wheal responses were near to or higher than 20% for all of them. On the other hand, in the final interpretation of results, kappa values indicated substantial or almost perfect agreements between these tests. However, the frequency of establishing allergy to the house dust mites widely ranged in these tests (20.8-35.8% for D. farinae and 20.8-28.3% for D. pteronyssinus). Limitations: The conduction of the study in a single center and the comparisons of results of only two performers. Conclusion: We feel that variabilities in sizes of wheal responses of skin prick test can influence its categorical results

Diagnostic values of KOH examination, histological examination, and culture for onychomycosis: a latent class analysis

Background In the absence of a real gold standard, comparative studies are still done on diagnostic methods for onychomycosis. There are only a few attempts using latent class analysis to determine the value of polymerase chain reaction in comparison to conventional methods. We aimed to determine the value of histological examination in such a way for the diagnosis of onychomycosis. Methods Potassium hydroxide mount (KOH), culture and histological examination with periodic acid-Schiff (PAS), and Gomori's methenamine silver (GMS) stains were done in 106 patients having clinically suspected toenail onychomycosis. Results KOH was positive in 74% of the patients; culture in 14%; PAS in 30%; and GMS in 66%. According to the results of the latent class analysis, culture and PAS were highly specific but poorly sensitive; KOH, highly sensitive but poorly specific; and GMS, both highly sensitive and specific. Conclusions Based on these results, we have proposed KOH as a screening test and GMS as a confirmatory test for the diagnosis of onychomycosis in our own practice. However, since positivity rates of different diagnostic methods vary widely in different centers, it is more suitable that every center should determine their own diagnostic strategy by evaluating their own results with latent class analysis.Research Fund of Cukurova University Project TSA-2015-503

The Value of Etiological Tests and Skin Biopsy in the Management of Prurigo Simplex Subacuta

It has been emphasized that prurigo simplex subacuta may be associated with various disorders and may be clinically confused with dermatitis herpetiformis. Aim of the study was to evaluate the value of our set of tests for finding possible associations and for the aforementioned differential diagnosis. Rates of implementations and abnormal results in our set of tests, including skin prick test, skin biopsy, complete blood count, blood chemistry panel, and psychiatric evaluation were analyzed retrospectively between the years of 2010 and 2015 in 130 patients clinically diagnosed with prurigo simplex subacuta. The set of tests was implemented completely in 43.8% patients and with only a single missing test in 31.5% of the patients. The least implemented procedure was psychiatric evaluation (66.9%). The most commonly found issues were psychiatric abnormalities (55.2% of 87 psychiatrically evaluated patients) and atopy (53.8% of 104 skin prick tested patients). The most common finding suggestive of internal diseases was hyperglycemia (25.4% of 130 patients). It was a striking result that hematological malignancies were suspected upon complete blood count and peripheral blood smear and confirmed by further investigations in 4 of 102 patients. Dermatitis herpetiformis was diagnosed in 2 of 120 skin biopsied patients. Because of the substantial rate of implementation, the high frequencies of psychiatric abnormalities and atopy, and detection of hematological malignancies and dermatitis herpetiformis even in just a few patients, we recommend our set of tests for patients clinically diagnosed as prurigo simplex subacuta

Successive Potassium Hydroxide Testing for Improved Diagnosis of Tinea Pedis

In this study, we investigated the role of successive potassium hydroxide (KOH) tests for the diagnosis of tinea pedis with different clinical presentations. The study included 135 patients with 200 lesions that were clinically suspicious for tinea pedis. Three samples of skin scrapings were taken from each lesion in the same session and were examined using a KOH test. This study offers an inexpensive, rapid, and useful technique for the daily practice of clinicians and mycologists managing patients with clinically suspected tinea pedis

Granulomatous disorders

Almost all granulomatous skin disorders can cause red lesions on the face. Such disorders may include many bacterial, fungal, or parasitic infections, noninfectious inflammatory disorders, foreign body reactions, and even neoplasms. Clinically, they usually present with papules, plaques, nodules, and/or abscesses, which may ulcerate. It may be helpful in their differential diagnosis to define certain clinical patterns, such as multiple and discrete papules, necrotic or umbilicated papules or nodules, annular plaques, vegetative plaques or tumors, verrucous plaques or tumors, abscesses and/or sinuses, and lymphocutaneous pattern. Some disorders, such as sarcoidosis, can cause a wide variety of lesions. We accept that cutaneous leishmaniasis is also among such great imitators. (C) 2014 Elsevier Inc. All rights reserved