Cicatricial Alopecias

Primary cicatricial alopecias (PCA) are a rare group of disorders in which the hair follicle is the main target of destructive inflammation resulting in irreversible hair loss with scarring of affected lesions. Inflammation may predominantly involve lymphocytes or neutrophils. Cicatricial alopecias that mainly involve lymphocytic inflammation include lichen planopilaris, discoid lupus erythematosus, pseudopelade (Brocq), central centrifugal alopecia, alopecia mucinosa, and keratosis follicularis spinulosa decalvans. Cicatricial alopecias that are due to predominantly neutrophilic inflammation include folliculitis decalvans and dissecting cellulitis of the scalp. Acne keloidalis, acne necrotica, and erosive pustular dermatosis are cicatricial alopecias with a mixed inflammatory infiltrate

Increased P-wave dispersion in patients with newly diagnosed lichen planus

OBJECTIVE: Lichen planus is a chronic inflammatory autoimmune mucocutaneous disease. Recent research has emphasized the strong association between inflammation and both P-wave dispersion and dyslipidemia. The difference between the maximum and minimum P-wave durations on an electrocardiogram is defined as P-wave dispersion. The prolongation of P-wave dispersion has been demonstrated to be an independent risk factor for developing atrial fibrillation. The aim of this study was to investigate P-wave dispersion in patients with lichen planus. METHODS: Fifty-eight patients with lichen planus and 37 age- and gender-matched healthy controls were included in this study. We obtained electrocardiographic recordings from all participants and used them to calculate the P-wave variables. We also assessed the levels of highly sensitive C-reactive protein, which is an inflammatory marker, and the lipid levels for each group. The results were reported as the means ± standard deviations and percentages. RESULTS: The P-wave dispersion was significantly higher in lichen planus patients than in the control group. Additionally, highly sensitive C-reactive protein, LDL cholesterol, and triglyceride levels were significantly higher in lichen planus patients compared to the controls. There was a significant positive correlation between highly sensitive C-reactive protein and P-wave dispersion (r = 0.549,

Epidemiology of pemphigus in Turkey: One-year prospective study of 220 cases

Pemphigus is a group of rare and life-threatening autoimmune blistering diseases of the skin and mucous membranes. Although they occur worldwide, their incidence shows wide geographical variation, and prospective data on the epidemiology of pemphigus are very limited. Objective of this work is to evaluate the incidence and epidemiological and clinical features of patients with pemphigus in Turkey. All patients newly diagnosed with pemphigus between June 2013 and June 2014 were prospectively enrolled in 33 dermatology departments in 20 different provinces from all seven regions of Turkey. Disease parameters including demography and clinical findings were recorded. A total of 220 patients were diagnosed with pemphigus during the 1-year period, with an annual incidence of 4.7 per million people in Turkey. Patients were predominantly women, with a male to female ratio of 1:1.41. The mean age at onset was 48.9 years. Pemphigus vulgaris (PV) was the commonest clinical subtype (n=192; 87.3%), followed by pemphigus foliaceus (n=21; 9.6%). The most common clinical subtype of PV was the mucocutaneous type (n=83; 43.2%). The mean Pemphigus Disease Area Index was 28.14±22.21 (mean ± Standard Deviation).  The incidence rate of pemphigus in Turkey is similar to the countries of South-East Europe, higher than those reported for the Central and Northern European countries and lower than the countries around the Mediterranean Sea and Iran. Pemphigus is more frequent in middle-aged people and is more common in women. The most frequent subtype was PV, with a 9-fold higher incidence than pemphigus foliaceus.   </p

Recurrent candidal intertrigo: challenges and solutions

WOS: 000430340000001PubMed: 29713190Intertrigo is a common inflammatory dermatosis of opposing skin surfaces that can be caused by a variety of infectious agents, most notably candida, under the effect of mechanical and environmental factors. Symptoms such as pain and itching significantly decrease quality of life, leading to high morbidity. A multitude of predisposing factors, particularly obesity, diabetes mellitus, and immunosuppressive conditions facilitate both the occurrence and recurrence of the disease. the diagnosis of candidal intertrigo is usually based on clinical appearance. However, a range of laboratory studies from simple tests to advanced methods can be carried out to confirm the diagnosis. Such tests are especially useful in treatment-resistant or recurrent cases for establishing a differential diagnosis. the first and key step of management is identification and correction of predisposing factors. Patients should be encouraged to lose weight, followed up properly after endocrinologic treatment and intestinal colonization or peri-orificial infections should be medically managed, especially in recurrent and resistant cases. Medical treatment of candidal intertrigo usually requires topical administration of nystatin and azole group antifungals. in this context, it is also possible to use magistral remedies safely and effectively. in case of predisposing immunosuppressive conditions or generalized infections, novel systemic agents with higher potency may be required

Erythrokeratodermia variabilis: Two case reports

Erythrokeratodermia variabilis (EKV) is a rare heterogeneous skin disorder. The classical EKV first described by Mendes da Costa is characterized by two types of skin lesions: (1) figurate hyperkeratotic plaques, and (2) transient erythematous areas. Herein, we report two patients presenting with erythematous and hyperkeratotic lesions that were histopathologically diagnosed with EKV

Effect of low-dose acitretin treatment on pituitary hormones in psoriasis vulgaris: A retrospective study

Background: It has been reported that retinoids may lead to hormonal alterations. Aim: In this retrospective study, we aimed to study the effect of acitretin on pituitary hormones in psoriasis patients. Methods: Out of 50 patients intended to be studied, blood samples of 43 patients could be tested before and after 3 months of acitretin therapy (0.2 to 0.5 mg/kg/day). Results: Patients mean ± standard deviation ages and female/male ratio were 46 ± 17 years and 19/24, respectively. After treatment with acitretin, gamma-glutamyltransferase, alkaline phosphatase, total cholesterol and triglyceride levels increased significantly (P < 0.05). After treatment, total protein, free thyroxine (T4) levels decreased significantly (P < 0.05). No significant differences were observed between before–after acitretin treatment regarding pituitary hormone levels in psoriasis patients (P > 0.05). Limitations: The retrospective nature of the study, inability to retest blood samples of 7 patients at 3 months post treatment, low dose and short duration of acitretin treatment were limitations of this study. Conclusion: This study showed that pituitary hormones were not affected except free T4 (thyroid hormone) by acitretin treatment. Further experimental and clinical studies are needed to clarify the effect of acitretin on pituitary hormones

Alopecia areata different view; Heavy metals

Background: Alopecia areata (AA) is a noncicatricial alopecia affecting any hair-bearing area. Although AA is considered to be an autoimmune disease, oxidative stress has been shown to be an important factor in the etiology of AA. Trace elements are highly essential for humans since they form the building blocks of large molecules, function as the cofactors of enzymes, and have some key biological functions. The aim of this study was to investigate serum levels of heavy metals like iron (Fe), zinc (Zn), manganese (Mn), copper (Cu), magnesium (Mg), cobalt (Co), cadmium (Cd), and lead (Pb) in patients with AA. Materials and Methods: The study included a patient group of 30 with AA and a control group of 31 healthy individuals. Serum levels of heavy metals were measured using atomic absorption spectrophotometry. Results: The 30 patients included 17 (56.7%) men and 13 (43.3%) women with a mean age of 33.8 (range, 19–48) years. Serum Zn and Mn levels were significantly lower and serum Cd, Fe, Mg, Pb, Co, and Cu levels were significantly higher in the patient group compared to that of the control group (P < 0.05 for all). Conclusion: The results indicated that low levels of Zn and Mn are associated with AA while other metals were normal. So Zn supplementation may have some beneficial effect in AA while Fe prescription is fruitless

Evaluation of 62 bullous pemphigoid patients

Bullous pemphigoid (BP) is an acquired autoimmune disease often manifesting with subepidermal bullae. Autoantibodies against hemidesmosomes constitute the main cause of BP. In this study, we aimed to evaluate the clinical and histopathological characteristics of BP patients and to discuss them in light of the studies conducted in Turkey and around the world. The retrospective study included 62 patients that were diagnosed with BP in our clinic between 2005 and 2017. Diagnosis of BP was established based on clinical, histopathological, and DIF microscopy findings. Age, gender, duration of disease, presence of pruritus, peripheral eosinophilia, significant histopathological findings, history of smoking, and family history were recorded for each patient. Patients under 18 years of age were excluded from the study. The 62 patients comprised 24 (38.7%) men and 38 (61.3%) women with a median age of 72.0 years. The male-to-female ratio was 1.5. The median age at disease onset was 67.0 (range, 50-75) years and the median duration of disease was 1.0 (0.5-3.0) years. Of the 62 patients, 35 (56.5%) had a history of smoking and mucosal involvement was found in 27 (43.5%) patients. BP is a disease of the elderly and more common in women than in men. Oral mucosa should be an integral part of the physical examination in BP patients. Pruritus is a significant clinical symptom and eosinophilia is an important laboratory marker in the diagnosis of BP, particularly in patients with difficult diagnosis. [Med-Science 2019; 8(2.000): 426-9

Assessment of heavy metal and trace element levels in patients with telogen effluvium

Background: Despite a multitude of studies, etiology of primary chronic telogen effluvium (TE) remains incompletely understood. Essential heavy metals are associated with beneficial effects in humans as well as in other living organisms. However, they may lead to toxic effects when the exposure exceeds the higher tolerable limits. We wanted to assess the heavy metal and trace element levels in patients with chronic TE. Materials and Methods: A total of 40 subjects with chronic TE were included in the study, and 30 healthy women served as control. General and dermatological examinations were taken up in all individuals. Those patients with positive hair pull test were evaluated with the help of a trichogram. The presence of >20% telogen hair as documented by trichogram was a requirement for the study inclusion. UNICAM-929 spectrophotometry device was used for determining serum trace element and heavy metal concentrations. Results: In spite of an absence of significant differences in terms of average Zn concentration, weight, or height between patients and controls, significant differences were noted for Cd, Fe, Mg, Mn, Pb, Co, and Cu (P<0.05). Conclusion: Our results suggest that heavy metals may play a causative role in the development of chronic TE. However, contrary to previous reports, zinc did not appear to play an important etiological role, while these patients had elevated serum iron levels

Evaluation of brainstem auditory evoked potentials and their relationship with levels of thyroid autoantibodies in patients with vitiligo

Background/aim: Vitiligo is a common depigmenting disorder. The damage can also occur in similar ways to melanocytes within other organs. We evaluated the brainstem and auditory pathway functions by evaluating brainstem auditory evoked potentials (BAEPs) and whether there is any relationship between auditory functions and autoimmunity. Materials and methods: Forty patients with vitiligo and 20 healthy volunteers were enrolled. Thyroid functions and autoantibodies were examined and BAEP tests were assessed by a neurologist. Results: Antithyroid peroxidase (anti-TPO) and antithyroglobulin (anti-TGA) antibody positivity was higher in the patient group (P < 0.05). A negative correlation was detected between anti-TPO and lead III, IV, and V latency and I-III interpeak latency (IPL) of the right ear together with lead IV latency and I-V IPL of the left ear in the patient group. When each BAEP parameter was compared between the two groups, more abnormalities were detected in the V latency and III-V IPL of the left ear together with IV and V latency of the right ear. Conclusion: In this study the presence of a correlation between increased anti-TGA and anti-TPO levels and BAEP parameters may be related to an autoimmune-mediated mechanism. However, further studies are needed to be performed in a large patient series