Isotretinoin treatment in nodulocystic acne with and without polycystic ovary syndrome: efficacy and determinants of relapse

Background Isotretinoin is the most efficacious long-lasting treatment for acne; however, some factors, including polycystic ovary syndrome (PCOS), patient age, family history, and type and number of acne lesions, may lead to treatment resistance or relapse following treatment. The aim of this study was to compare the efficacy and permanence of systemic isotretinoin (SI) in nodulocystic acne patients with and without PCOS and to evaluate the factors associated with relapse during the first and second post-treatment years. Methods and Materials The study included 96 female patients with nodulocystic acne. SI 0.5-1 mg/kg/dl was given, with a total cumulative dose of 120–150 mg/kg. Response to treatment and relapse during the first and second post-treatment years were evaluated. Results In all, the 50 non-PCOS and 46 PCOS acne patients were similar. SI was similarly efficacious in both groups. In total, eight patients relapsed during the first post-treatment year, versus 16 during the second. Relapse during the first year was associated with the number of nodules at the start of treatment and the number of papulopustular lesions at the end of treatment, whereas PCOS, patient age, and the number of nodules at the start of treatment were associated relapse during the second year. Conclusion Regardless of its association with PCOS, SI was effective in the treatment of nodulocystic acne. The factors associated with relapse during the 1st and 2nd posttreatment years differed, except for the number of nodules at the start of treatment

A cutoff value for the systemic immune-inflammation index in determining activity of Behcet disease

Background Behcet disease (BD) is an immune-mediated vasculitis-like syndrome characterized by recurrent aphthous lesions and various systemic manifestations. Inflammatory markers may be useful to assess disease severity. The Systemic Immune-Inflammation Index (SII) (neutrophils x platelets/lymphocytes) has been widely used in oncology since 2014, with promising results. Aim To assess the efficiency of the SII in determining activity of BD. Methods This retrospective cohort study was conducted on patients with BD who were admitted to the outpatient clinic of the Department of Dermatology and Venereology, Ufuk University Hospital, between 1 January 2010 and 31 December 2019. Patients were divided into two groups based on their disease status upon admission: (i) active BD (n = 103), and (ii) inactive BD (n = 63). Clinical characteristics, demographic features, type of medications, full blood count parameters, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ferritin and SII were compared between the groups. Furthermore, receiver operating characteristic curve analysis was performed to assess the performance of the SII in determining disease severity upon admission to hospital. Results Higher numbers of white blood cells, platelets and neutrophils, greater red cell distribution width, higher levels of ESR, CRP and ferritin, and higher SII were observed in the active disease group (P 552 x 10(3)/mm(3)) at the initial evaluation of the patients

Multiorgan involvement of Behcet's disease in a young woman

Behcet's disease is a rare disorder of unknown etiology that is classified as a systemic vasculitis. The prevalence of the disease is high in countries in the Far East, Mediterranean Basin, and East Asia. Thus, it is also known as the Silk Road Disease. Behcet's disease is characterized by recurrent oral aphthous ulcers, genital sores, and ocular lesions. However, it can present with severe clinical manifestations as a result of cardiovascular system, central nervous system, and gastrointestinal tract involvement. The disease causes serious complications, morbidity, and mortality, especially in male patients with early age onset. Here we present a rare case of Behcet's disease exhibiting multiple organ involvement in a 26-year-old Caucasian female

The utility of immunoglobulin A/complement 3 and immunoglobulin G/immunoglobulin M ratios in the assessment of disease activation in patients with Behcet disease

Objective: Pathogenesis of Behc¸et disease (BD) has not yet been clearly revealed and there is no ideal test for the estimation of disease activation at present. This study aimed to assess the efficiencies of IgG/IgM and IgA/C3 ratios in determining activation of BD. Method: This retrospective cohort study consisted of 140 patients with BD. Patients were divided into two groups: (1) active BD (n ¼ 89) and (2) inactive BD (n ¼ 51) and were compared in terms of demo graphic features, clinical characteristics and laboratory test results. IgA/C3 and IgG/IgM ratios were compared according to organ system involvement; receiver operating characteristic (ROC) curve ana lysis was performed in order to assess the performance of IgA/C3 and IgG/IgM ratios in determining patient disease status. Results: Significantly higher levels of erythrocyte sedimentation rate, C-reactive protein, IgA, G, C4, IgA/C3, IgG/IgM ratios (p ¼ .007 for IgA and p < .001 for others) and significantly lower levels of IgM and C3 were observed in patients with active BD (p < .001). The IgG/IgM ratio was significantly higher in patients with vascular involvement (p ¼ .017) and the IgA/C3 ratio was significantly higher in patients with arthritis (p ¼ .007). Cut-off values of 0.019 (70.8% sensitivity, 62% specificity) and 7.08 (84.3% sensitivity, 80% specificity) were determined for IgA/C3 and IgG/IgM ratios, respectively. Conclusion: IgA/C3 and IgG/IgM ratios may be used as additional parameters for the assessment of BD status

A Case of Multiple Myeloma Diagnosed by Skin Lesions

Multiple myeloma, being a malignant proliferation of plasma cells in the bone marrow, has clinical spectrum varying from monoclonal gammopathy with unknown significance to plasma cell leukemia. The presenting symptoms have usually been bone pain, pathologic fractures or repeating infections. In patients with multiple myeloma, amyloid depositions may be seen in the skin. This form, defined as primary systemic amyloidosis, is characterized by light-chain amyloid fibril depositions. Our case applied with multiple, asymptomatic, yellowish papules localized on the face, trunk, oral and genital mucosa, gradually increasing during the last two years. He had no complaints, except for slight weight loss. In routine tests, the patient had no pathological laboratory findings, except high C-reactive protein levels. Further research revealed histopathologic and immunohistochemical findings consistent with amyloidosis. Upon these results, immunoglobulin G levels were measured and found high, and in protein electrophoresis, IgG monoclonal gammopathy was determined. The diagnosis of multiple myeloma is made by bone marrow biopsy. This patient is presented for being an asymptomatic case diagnosed by skin findings of amyloidosis

Association of hypermobility and ingrown nails

Ingrown nail (onychocryptosis) is a common condition with severe pain and various associated morbidities. Although some underlying factors are identified, its etiology remains largely unknown. Generalized joint hypermobility (GJH) is a common entity with clinical features that might prone affected individuals to ingrown nails. Herein, we investigated the incidence of GJH in patients with ingrown nails to determine possible association between hypermobility and ingrown nail formation. Patients 16–50 years of age who were undergoing treatment for ingrown nails at the dermatology clinic were consecutively enrolled into the study. Patients with known rheumatic diseases or orthopedic foot disorders were excluded. All patients were in a pain-free period at the time of examination. The control group was comprised of age- and sex-matched healthy subjects without a history of ingrown nail. Assessment of GJH was made according to Beighton criteria. Local hypermobility was evaluated by measurement of range of motion using a goniometer. Thirty-nine patients (male/female, 17/22, mean age 31.9±11.3 years) and 32 healthy subjects (male/female 12/20, mean age 31.7± 10.4 years) were included. Patients with ingrown toe nails were more likely to have GJH compared to healthy subjects (35.9 vs. 9.4 %, p00.009). Toes with ingrown nails had significantly smaller maximum dorsiflexion angles (p< 0.001) compared to toes of healthy subjects. Ingrown nail formation may be associated with GJH. However, when examined locally, there is a limited range of motion in the affected toe rather than hypermobility, which could be due to the degenerative process facilitated by the hypermobility

Experience with oral tofacitinib in severe alopecia areata with different clinical responses

Background: Alopecia areata (AA) and generalized form, universalis (AU) are common causes of noncicatricial alopecia, targeting anagen hair follicles. A dominant interferon-gamma transcriptional signaling and cytotoxic T lymphocytes were accused as the main drivers of disease pathogenesis. Tofacitinib is a Janus kinase inhibitor that has been proven to interfere with the positive feedback loop between the follicular cell and the cytotoxic T lymphocytes in AA. There is an increasing number of studies reporting success with tofacitinib in AA. Aims: We aimed to assess oral tofacitinib's safety and efficacy in 13 recalcitrant AA and AU patients. Methods: This is a retrospective pilot study performed between 2017 and 2020. The demographic features and the treatment responses were evaluated with Severity of Alopecia Tool score changes. Results: Thirteen recalcitrant alopecia areata patients (3 AA, 10 AU), aged between 17 and 49, were included in the study. The treatment duration was 3-15 months. All three AA patients responded well; however, the therapy was unsuccessful in five of ten AU patients. Relapse was observed in one of the AA and three of the AU responders. Acneiform lesions and elevation of transaminases were the major side effects. Conclusion: Tofacitinib seems to be more promising and thriving in the treatment of AA than AU. Starting the therapy earlier can bring more successful results. Unfortunately, even in the cases that fully respond to treatment, relapse can be observed after discontinuation of the treatment. It is essential to inform patients about this situation in reducing the frustrations that may occur later

Alopesi areata, vitiligo ve sağlıklı kontrollerde otolog serum deri testi pozitifliği

Background and Design: Autologous serum skin test (ASST), the best in-vivo test displaying in vitro basophil histamin releasing activity, is used in the diagnosis of chronic autoimmune urticaria. Besides, it is cheap and is easy to perform. It has been found that in ASST-positive chronic urticaria patients, autoimmune thyroid disease especially and other autoimmune diseases were more common and the level of autoimmune markers were higher compared to others. Autoimmunity is accused in the pathogenesis of alopecia areata and vitiligo. In this study, we assessed ASST results in healthy controls and those with autoimmune diseases, and aimed to explore the effects of thyroid autoantibodies and other factors in ASST positivity. Materials and Methods: ASST was administered to 51 patients with alopecia areata, 53 patients with vitiligo and 51 healthy controls, and thyroid function tests and thyroid autoantibodies (anti-Tg, anti-TPO) were assessed. Results: ASST was positive in 64.7% of patients with in alopecia areata, 64.2% of those with vitiligo and in 45.1% of controls. There was no statistically significant difference between the groups in terms of ASST positivity. We observed that ASST positivity had no relationship with age, anti-Tg, anti-TPO and the presence of one or both autoantibody positivity. It was seen that the frequency of ASST positivity was higher in females than in men in all groups, but it was statistically significant in alopecia areata group only. Among the all study groups, the frequency of ASST positivity was statistically significantly higher in females than in men.Conclusion: The high rates of ASST positivity in individuals with alopecia areata and vitiligo as well as in healthy control, indicate that ASST positivity does not solely exist in chronic urticaria patients. With logical regression analysis, it was shown that, having alopecia areata and being female significantly increase the risk of having ASST positivity. Therefore, we assume that ASST positivity might indicate the autoimmune etiology for alopecia areata and susceptibility to autoimmune diseases in female gender

Alopesi areata, vitiligo ve sağlıklı kontrollerde otolog serum deri testi pozitifliği

Background and Design: Autologous serum skin test (ASST), the best in-vivo test displaying in vitro basophil histamin releasing activity, is used in the diagnosis of chronic autoimmune urticaria. Besides, it is cheap and is easy to perform. It has been found that in ASST-positive chronic urticaria patients, autoimmune thyroid disease especially and other autoimmune diseases were more common and the level of autoimmune markers were higher compared to others. Autoimmunity is accused in the pathogenesis of alopecia areata and vitiligo. In this study, we assessed ASST results in healthy controls and those with autoimmune diseases, and aimed to explore the effects of thyroid autoantibodies and other factors in ASST positivity. Materials and Methods: ASST was administered to 51 patients with alopecia areata, 53 patients with vitiligo and 51 healthy controls, and thyroid function tests and thyroid autoantibodies (anti-Tg, anti-TPO) were assessed. Results: ASST was positive in 64.7% of patients with in alopecia areata, 64.2% of those with vitiligo and in 45.1% of controls. There was no statistically significant difference between the groups in terms of ASST positivity. We observed that ASST positivity had no relationship with age, anti-Tg, anti-TPO and the presence of one or both autoantibody positivity. It was seen that the frequency of ASST positivity was higher in females than in men in all groups, but it was statistically significant in alopecia areata group only. Among the all study groups, the frequency of ASST positivity was statistically significantly higher in females than in men.Conclusion: The high rates of ASST positivity in individuals with alopecia areata and vitiligo as well as in healthy control, indicate that ASST positivity does not solely exist in chronic urticaria patients. With logical regression analysis, it was shown that, having alopecia areata and being female significantly increase the risk of having ASST positivity. Therefore, we assume that ASST positivity might indicate the autoimmune etiology for alopecia areata and susceptibility to autoimmune diseases in female gender

Efficacy of nail brace treatment for ingrown nails

have been defined for treatment of ingrown nails. In this study we aimed to evaluate the efficacy of nail brace treatment which is a cheap conservative treatment, recurrence percentages after nail brace treatment and risk factors for recurrence. Material and Method: Thirty-two female and 19 male patients with the complaint of ingrown nail aged 14-73 with a total of 73 nails are included to the study. Silver nitrate has been applied every 3-7 days to patients with granulation tissue. Nail brace application has been stopped in patients with granulation tissue once the granulation tissue has subsided and complaints have subsided, in patients without granulation tissue as their complaint was over during weekly controls in first month and monthly controls thereafter. Results: Ninety-eight point six percent of patients having ingrown nail (72/73) benefited from brace treatment. In 12 nails out of 71, recurrence has been established, in 59 nails follow-up without recurrence continues. Two nails have not been reached for followup after the first 3 month relief. Assessing patients treated with nail brace for recurrence, no significant difference was detected between recurrent and non-recurrent groups according to stage of ingrown nail, presence of granulation tissue, nail thickness, angle of nail curve, age, gender, presence of hyperhydrosis, duration of treatment and total force applied. Conclusion: Nail brace application has been found effective for pain relief and as treatment in patients with ingrown nails and no statistically significant predictive factor has been found in terms of recurrence after treatment