Controversies in Polycystic Ovary Syndrome

Polycystic ovarian syndrome (PCOS) is the most common endocrinopathy that affects women from puberty to whole reproductive life. Diagnosis and treatment of PCOS is not clear. Polycystic ovary syndrome is a multisystem disease that involves dermatologist examining patients with clinical hyperandrogenism and/or biochemical signs of hyperandrogenism; gynecologist examines patients with oligo-ovulation or infertility. The management of PCOS should be tailored to each woman’s specific symptoms, fertility-related implications, and metabolic disorders. Pharmacologic treatment is not necessary for all patients with PCOS, also lifestyle changes like exercise, weight loss, and diet are effective for treatment. Lifestyle changes are often recommended as first-line treatment for PCOS to benefit general health. Topical nonhormonal therapies and laser hair removal may be effective for cutaneous symptoms like acne, hirsutism, and androgenetic alopecia in the PCOS population and are useful first-line agents. Some pharmacological agents (anti-androgens) are used to control the dermatological symptoms of hyperandrogenism. Metformin is useful for metabolic and glycemic anomalies and for the treatment of menstrual irregularities, but less effective than antiandrogens for the treatment of both hirsutism and acne. The aim of this study is to talk about unclear topics in PCOS and multidisciplinary approach to patients

Trichotillomania and Traction Alopecia

Trichotillomania and traction alopecia are chronic habitual disorders characterized by repetitive pulling of hair that results in alopecia. They are commonly observed in children and adolescents but may present in adults due to occupational or traditional behavioral patterns. Trichotillomania (hair‐pulling disorder) has been described more than a century ago, but we still have very limited data about its etiology and treatment. It is classified under the obsessive‐compulsive and related disorders along with hoarding disorder, skin‐picking disorder (excoriation) and body dysmorphic disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5; American Psychiatric Association, May 2013). Traction alopecia is defined as loss of hair caused by repetitive or continuous and prolonged tension applied to the hair, usually on the scalp periphery and associated with mechanical traction of hair due to occupational behavioral patterns such as ballerinas or traditional behavioral patterns of hairstyles that cause tension. We aim to overview the clinical and diagnostic features of trichotillomania and traction alopecia and review the therapeutic options of these disorders in this chapter

Clinical course of psoriasis patients that discontinued biologics during the COVID-19 pandemic

BackgroundSince psoriasis is a chronic disease, it is not recommended to discontinue the treatment agents used. However, in real life, the treatment of psoriasis patients may be interrupted for various reasons. During the pandemic period, the treatment of many patients was also interrupted. ObjectivesTo evaluate relapse and clinical worsening in psoriasis patients whose biological therapy was interrupted during the pandemic and reveal associated factors. MethodsThe study included patients aged >= 18 years, who were followed up with moderate and severe chronic psoriasis controlled by the last biological agent [Psoriasis Area Severity Index (PASI) 75 response achieved] but had to discontinue their treatment during the pandemic. The patients' demographic and clinical characteristics, clinical course after the discontinuation of these agents, presence of clinical worsening, and relapse were evaluated. Risk factors were analyzed with the logistic regression analysis. ResultsThe study included 169 patients, with a mean age of 47.3 +/- 14.5 (18-87) years. The mean biologics-free time was 18.2 +/- 12.3 (2-56) weeks. Clinical worsening was detected in 41.4% and relapse in 48.5% of the patients. The significant risk factors for clinical worsening and relapse in both univariate and multivariate analyses were alcohol use during the biologics-free period, total time off biologics, and the presence of an additional triggering factor. The use of secukinumab and ustekinumab was found to be a protective factor against clinical worsening in multivariate analyses. ConclusionAs the biologics-free period is prolonged, the likelihood of clinical worsening and relapse increases, therefore, we do not recommend discontinuing biological agents

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

Papulosquamous Annular Diseases

Papulosquamous diseases represent a commonly encountered group of cutaneous disorders in dermatology. Lesions can present with papules and plaques in various configurations, including annular forms. Some of these disorders are expected to appear in annular configurations, such as pityriasis rosea and subcorneal pustular dermatosis. Others may either begin as or even progress to annular configurations, including psoriasis vulgaris, seborrheic dermatitis, and nummular dermatitis. We have reviewed common papulosquamous diseases that can present with annular lesions, which includes psoriasis vulgaris, pityriasis rosea, subcorneal pustular dermatosis, contact dermatitis, seborrheic dermatitis, and nummular dermatitis. For each disorder, we have discussed the details of presentation and differential diseases to be considered

Is cutaneous microbiota a player in disease pathogenesis? Comparison of cutaneous microbiota in psoriasis and seborrheic dermatitis with scalp involvement

Background: Knowledge about cutaneous microbiota in psoriasis vulgaris and seborrheic dermatitis is limited, and a comparison of microbiota in the two diseases was not yet previously undertaken. Aims/Objectives: This study aimed to compare the scalp lesional and non-lesional microbiota in psoriasis vulgaris and seborrheic dermatitis with that in a healthy control group. Methods: Fifty samples were taken with sterile swabs from patients’ and controls’ scalps, and 16S rRNA gene sequencing analyses were performed. Results: Alpha and beta diversity analyses showed that bacterial load and diversity were significantly increased in psoriasis vulgaris and seborrheic dermatitis lesions compared to the controls. As phyla, Actinobacteria decreased and Firmicutes increased, while as genera, Propionibacterium decreased; Staphylococcus, Streptococcus, Aquabacterium, Neisseria and Azospirillum increased in lesions of both diseases. Specifically, Mycobacterium, Finegoldia, Haemophilus and Ezakiella increased in psoriasis vulgaris and Enhydrobacter, Micromonospora and Leptotrichia increased in seborrheic dermatitis lesions. Mycobacterium, Ezakiella and Peptoniphilus density were higher in psoriasis vulgaris compared to seborrheic dermatitis lesions. The bacterial diversity and load values of non-lesional scalp in psoriasis vulgaris and seborrheic dermatitis lay between those of lesional areas and controls. Limitations: The small sample size is the main limitation of this study. Conclusion: Higher bacterial diversity was detected in lesions of both psoriasis and seborrheic dermatitis compared to the controls, but similar alterations were observed when the two diseases were compared. Although these differences could be a result rather than a cause of the two diseases, there is a need to analyze all members of the microbiota and microbiota-host interactions. © 2022 Indian Journal of Dermatology, Venereology and Leprology - Published by Scientific Scholar

Clinical course of psoriasis patients that discontinued biologics during the COVID-19 pandemic

BackgroundSince psoriasis is a chronic disease, it is not recommended to discontinue the treatment agents used. However, in real life, the treatment of psoriasis patients may be interrupted for various reasons. During the pandemic period, the treatment of many patients was also interrupted. ObjectivesTo evaluate relapse and clinical worsening in psoriasis patients whose biological therapy was interrupted during the pandemic and reveal associated factors. MethodsThe study included patients aged >= 18 years, who were followed up with moderate and severe chronic psoriasis controlled by the last biological agent [Psoriasis Area Severity Index (PASI) 75 response achieved] but had to discontinue their treatment during the pandemic. The patients' demographic and clinical characteristics, clinical course after the discontinuation of these agents, presence of clinical worsening, and relapse were evaluated. Risk factors were analyzed with the logistic regression analysis. ResultsThe study included 169 patients, with a mean age of 47.3 +/- 14.5 (18-87) years. The mean biologics-free time was 18.2 +/- 12.3 (2-56) weeks. Clinical worsening was detected in 41.4% and relapse in 48.5% of the patients. The significant risk factors for clinical worsening and relapse in both univariate and multivariate analyses were alcohol use during the biologics-free period, total time off biologics, and the presence of an additional triggering factor. The use of secukinumab and ustekinumab was found to be a protective factor against clinical worsening in multivariate analyses. ConclusionAs the biologics-free period is prolonged, the likelihood of clinical worsening and relapse increases, therefore, we do not recommend discontinuing biological agents

Drug survival and predictor factors for discontinuation of methotrexate in psoriasis: A real-life multicenter study

Background Drug survival is useful to evaluate long-term drug performance in daily practice. The aim of this study was to evaluate drug survival for methotrexate (MTX) monotherapy in patients with plaque-type psoriasis. Methods We reviewed 3,512 follow-up charts of patients with psoriasis at five tertiary referral centers between January 2012 and January 2020. We analyzed baseline data and treatment outcomes of patients under MTX monotherapy. Drug survival was analyzed using Kaplan-Meier and Cox regression analyses. Results Patients with psoriasis who were treated with MTX monotherapy were enrolled (N = 649). The median duration of drug survival was 15 months (95% CI: 13.2-16.8). The overall drug survival rate was 54.7%, 17.4%, and 8% after 1, 3, and 5 years, respectively. The main reasons for discontinuation were adverse effects (n = 209, 32.2%) and inefficacy (n = 105, 15.6%). Based on multivariate Cox regression analysis, the presence of nausea/vomiting (HR: 2.01, 95% CI: 1.49-2.71; P = 15 mg/weekly were positive predictors for drug survival (HR: 0.72, 95% CI: 0.54-0.95; P = 0.02). Conclusions The average drug survival of MTX was 15 months. MTX is still the first-line treatment of moderate-to-severe plaque psoriasis, as highlighted in guidelines. To prevent premature discontinuation, physicians need to look at the response time of at least 16-24 weeks, especially when a stepwise dose increment is used. The presence of nausea/vomiting seemed to be associated with an approximately twofold risk of discontinuation