A common but not well-known cause in anal fissure development and treatment failure: Isotretinoin treatment for acne vulgaris

To investigate the underrecognized effects of isotretinoin as a cause of anal fissures (AF) and compare AF patients undergoing systemic isotretinoin treatment (SIT) and those not receiving this treatment. This study was conducted with 118 patients with newly diagnosed AF, 54 undergoing SIT (Group 1) and 64 not undergoing SIT (Group 2). The same clinical treatment modalities including first-line conservative and medical treatments during the first eight weeks, followed by interventional methods (botulinum injection or sphincterotomy) for unresponsive/recurrent cases were used for all patients. A comparative analysis was also performed. Age and body mass index (BMI) were statistically low in group 1 (p=0.003; p=0.032). Similarly, the VAS pain and Wexner constipation scores and the duration of symptoms were lower in group 1 than Group 2 (p=0.003, p<0.001, and p<0.001, respectively). Atypical fissure localization was clearly associated with group 1 (p=0.012), and although SIT did not increase the surgery rate, atypical fissures and longer symptom duration constituted the most important factors determining requirement of surgical. SIT, a very successful treatment for nodulocystic acne disease, can facilitate AF development in younger individuals with a low BMI even without significant constipation

Serum leptin, adiponektin, ghrelin, resistin levels in psoriatic patients treated with cyclosporine

Psoriasis ve obesite arasındaki ilişki yapılan bir çok çalışmada gösterilmiştir. Leptin, ghrelin, adiponektin, resistin primer olarak yağ dokusundan salgılanırlar. Yağ hücre kökenli bu hormonlar proinfilamatuvar sitokinlerin oluşumunu etkileyerek çeşitli immunolojik yanıtlara neden olurlar. Çalışmamızdaki amaç bu hormonların psoriasis vulgaris patogenezindeki rolünü ve siklosporin tedavisi ile olan ilişkilerini saptamaktı.Materyal ve Metod: PASI' sı 10'nun üzerinde olan 18 yaşının üzerinde 26 psoriasis hastası ve yaş, cinsiyet ve BMI'lar uyumlu 26 sağlıklı kontrol grubu çalışmaya alındı. Her bir hastanın yaş, cinsiyet, BMI, aile öyküsü , PASI, NAPSI değerleri kaydedildi. Hastalara 5mg/ kg/gün dozunda üç ay süre ile siklosporin tedavisi verildi. Hormonlar ELİSA yöntemiyle çalışıldı.Bulgular: Psoriasis hasta grubu ile kontrol grubu arasında serum leptin, ghrelin, adiponektin, resistin düzeyleri açısından anlamlı fark yoktu. Üç aylık siklosporin tedavisi sonrası leptin ve ghrelin düzeylerinde istatistiksel olarak anlamlı değişiklik olmazken, adiponektin ve resistin düzeylerinde istatistiksel olarak anlamlı artış saptandı. Tedavi sonrası PASI ve NAPSI değerlerinde düşme görüldü. Aile öyküsü ile leptin düzeyi arasında pozitif bir korelasyon, NAPSI ile resistin düzeyi arasında güçlü pozitif bir korelasyon, PASI ile ghrelin düzeyi arasında negatif korelasyon saptandı.Sonuç: Adiposit kökenli bu hormonların psoriasis patogenezinde rol almalarından dolayı psoriasis tedavisinde kullanılan ajanlarla da negatif veya pozitif yönde etkileşime giriyor olabilirler. Bu nedenle tedaviyle olan ilişkisini ortaya koyabilmek için diğer tedavi ajanlarını da içeren çalışmalara ihtiyaç vardır.Many studies support the relationship between psoriasis and obesity. Leptin, ghrelin, adiponeltin and resistin are secreted predominantly from adipose tissue. These adipocyte derived hormones cause immunologic response by effecting the production of inflammatuar cytokines. The aim of our study is to show the role of these hormones in psoriasis patogenesis and cyclosporine treatment.Material and methods: Twenty-six patients with psoriasis with all Psoriasis Area and Severity Index (PASI) scores over 10 and 26 healty control subjects those compatible with age, gender and Body Mass Index (BMI) were included to study. Age, gender, BMI, family history, Nail Psoriasis Severity Index (NAPSI) scores of each patient were recorded. Cyclosporin at a dose of 5 mg/kg/day was given to patients for a period of 3 months. Hormones were studied with ELISA.Results: There was no statistically significant difference in leptin, ghrelin, adiponectin and resistin levels between patients and controls. After three-month cyclosporin therapy, no significant change in both leptin and ghrelin levels were determined. However, adiponectin and resistin levels significantly increased after therapy. Decline in PASI and NAPSI scores were also observed. There was a positive correlation between family history and leptin. A strong positive correlation between NAPSI score and resistin levels was also detected. PASI score and ghrelin was negatively correlated.Conclusions: Since these adipocyte derived hormones have a part in pathogenesis of psoriasis, they could interact with the agents used in psoriasis therapy negatively or positively. Concequently, to prove the relationship between therapy and these hormones, studies including the other agents are needed

Pityriasis rosea recurrence is much higher than previously known: A prospective study

WOS: 000470074900006PubMed ID: 30848285Pityriasis rosea is a common acute exanthema of unknown aetiology, which causes severe anxiety. In this study, the demographic data of pityriasis rosea patients, who presented to our clinic between 2013 and 2017, were prospectively recorded. The patients with a confirmed pityriasis rosea diagnosis were followed up for 4 years in order to investigate the recurrence rate. Of the clinically suspected patients, having a typical history of pityriasis rosea manifestations, a herald patch, and/or secondary coloured squamous lesions, 400 were confirmed by biopsy to have pityriasis rosea. The 4-year follow-up was completed in 212 patients, of whom 136 (64.2%) were female and 76 (35.8%) were male. The recurrence rate was determined as 25.9% at the end of the 4-year follow-up period

Evaluation of lens clarity in children with atopic dermatitis: A densitometric analysis with Pentacam

The association of atopic dermatitis (AD) with a wide variety of ocular complications is known; however, there is no study in the literature that measured lens densitometry in pediatric patients with AD. This study aimed to investigate lens densitometry in children with AD. In order to examine ocular complications in AD, 31 pediatric patients (13 males, 18 females; mean age 12 ± 3 years) with AD and 20 healthy children (9 males, 11 females; mean age 12 ± 2 years), who presented to the dermatology clinic of Istanbul Medipol Mega University between December 2018 and May 2019 were included in this study. The diagnosis of AD was based on the UK Working Party's Diagnostic Criteria for AD. Patients receiving inhaler and systemic steroids were excluded from the study. All children were examined by the same dermatologist and ophthalmologist. The mean values of best-corrected visual acuity, refractive error, and axial length were similar between both groups (P >.05). The lens densitometry values of zone 1, zone 2, and zone 3, as well as the average lens densitometry measurements were found statistically significantly higher in children with AD compared to the controls (P <.05 for all). This is the first study to demonstrate an increase in treatment-independent lens densitometry in children with AD

Evaluation of the demographic and clinical findings of pediatric patients that developed acute graft-versus-host disease after allogeneic hematopoietic stem cell

Aim: Acute graft-versus-host disease (GVHD) is an complication after allogeneic hematopoietic stem cell transplantation (alloHSCT), manifesting with an erythematous maculopapular rash followed by liver disease and dysfunctions of the gastrointestinal tract. This study aimed to retrospectively investigate the demographic and clinical characteristics of pediatric patients diagnosed with acute GVHD after undergoing allo-HSCT due to various hematological diseases. Material and Methods: The study included 33 pediatric patients that underwent their first allogeneic bone marrow transplantation in the Pediatric Bone Marrow Transplant Unit between 2015 and 2018 and were consecutively diagnosed with acute GVHD in consultation with the department of dermatology. The demographic characteristics, clinical findings, donor characteristics, treatments, and survival status of each patient were recorded. Results: Between 2015 and 2018, bone marrow transplantation was performed in 150 pediatric patients, of whom 33 (22%) developed acute GVHD. Of the 33 pediatric patients, 19 (57.6%) were boys and 14 (42.4%) were girls. At the time of transplantation, the mean age of the patients was 8.5 years, and the median age was 7 years. Twenty patients (60.6%) had only skin GVHD while 13 (39.4%) had skin and gastrointestinal and/or hepatic GVHD. It was found that the rashes had appeared on average 27.4 days after allo-HSCT. Palmoplantar involvement was detected in 13 patients (39.4%), painful erosion in the oral mucosa in 11 (33%), and conjunctivitis in seven (21.2%). The factors of being a male patient, being a female donor, transplantation from unrelated donors, liver involvement, and palmoplantar involvement were found to create risk of mortality, but not significantly (respectively p=0,753;p=0,145,0,66). Five patients (15%) progressed from acute to chronic GVHD. In patients that progressed from acute to chronic had, the mean donor age was higher, the mean time from transplantation to rash was longer, and oral involvement was higher, but not significantly (respectively; p=0,596;p=0,980;p=0,193. Conclusion: In acute GVHD, the skin is the first and most involved organ; therefore, dermatologists play an important role in its diagnosis. This study is important for determining the factors affecting the decrease in progression to chronic GVHD and prolonging survival

Measurement of the serum zonulin levels in patients with acne rosacea

OBJECTIVE: Although the etiopathogenesis of acne rosacea has not yet been clearly elucidated, it has been discussed over the years that autoimmunity may play a role. Genetic and environmental factors are known to have combined effects in the background of autoimmunity, but it has recently been emphasized that an impaired intestinal barrier system is also involved in the development of the disease. Zonulin is a protein that reversibly increases intestinal permeability. This study aimed to evaluate the zonulin levels in acne rosacea. METHODS: A total of 61 individuals, 30 diagnosed with acne rosacea and 31 healthy controls, were included in this study. There was no difference between the two groups in terms of age, gender, and body mass index. Zonulin was studied using the enzyme-linked immunosorbent assay. RESULTS: The serum zonulin levels were found to be significantly higher in the patient group than in the control group (18.5 ± 2.9 ng/ml and 13.2 ± 2.7 ng/ml, respectively; p < .001). CONCLUSION: This is the first study in the literature to demonstrate that the serum zonulin levels are increased in patients with acne rosacea

Peripheral inflammatory biomarkers as predictors of recurrence in surgically-treated anogenital condylomata acuminata patients

The aim of this study was to examine the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) in patients with anogenital condylomata acuminata (CA) and their association with recurrence and squamous intraepithelial neoplasia development. We conducted a descriptive study in 95 patients that had undergone surgical treatment for CA. The descriptive data, disease characteristics, and pre-treatment peripheral inflammatory biomarkers (PIBs) were recorded retrospectively. All parameters were compared in those with recurrent and non-recurrent CA. All PIBs were significantly higher in patients with the greatest genital wart size of >2 cm in the squamous intraepithelial lesion (SIL) group. Human papillomavirus (HPV) types 16, 18, 31 and 33, known to carry high risk for anogenital cancer, were significantly related to higher SII. Greater wart size, high-grade squamous intraepithelial lesion (HSIL), and higher PLR and SII values were highly associated with recurrent disease (p = 0.003, 0.006, 0.005 and 0.000, respectively). Of all recurrences, 34.1% were explained by HSIL and increased PLR and SII values. The prediction of CA recurrence is important to determine those patients at high risk. PLR and SII can be used for risk analysis in selected patient groups

Evaluation of thiol/disulfide homeostasis in patients with pityriasis rosea

Purpose: Pityriasis rosea (PR) is a common, self-limiting, inflammatory skin disease with an acute onset. The etiology of PR is not yet clearly known but the defect in the oxidation system involved in many papulosquamous skin diseases may play a role. Thiol/disulfide homeostasis is a new marker of oxidative stress and has been studied in many diseases in recent years. The aim of this study to investigate thiol/disulfide homeostasis in PR patients. Material and methods: Thirty-four patients (18 females, 16 males; median age 26 years) that presented to the Dermatology Clinic of Istanbul Medipol Mega University Hospital between November 2017 and December 2018 and were clinically and/or histopathologically diagnosed with PR, and 30 healthy individuals (16 females, 14 males; median age 27 years) were included in the study. The serum native thiol and total thiol were measured by a novel colorimetric, automated method. The disulfide levels and disulfide/native thiol ratios were also calculated from these measured parameters. Results: There was no statistically significant difference in the serum native thiol and total thiol concentration between the PR and control groups (p = 0.711 and 0.788, respectively). Disulfide, disulfide/native thiol, and disulfide/total thiol levels were significantly higher in patients with PR (p = 0.002, 0.006 and 0.006, respectively). Conclusions: The thiol-disulfide balance shifted toward disulfide in patients with PR. This demonstrates the importance of oxidative stress in the etiopathogenesis of PR using a new marker

Demographic and clinical features of hidradenitis suppurativa in Turkey

Background The literature contains conflicting reports on the epidemiology and frequency of hidradenitis suppurativa (HS), a chronic, recurrent inflammatory disease of the apocrine glands. Objective To evaluate the clinical and demographic characteristics of HS cases in Turkey and investigate the similarities with world epidemiology. Method The records of 208 patients that presented to our polyclinics and were diagnosed with HS between June 2012 and July 2017 were retrospectively evaluated. Results Of the cases, 68.3% were male and 31.7% were female. Of the patients, 75.5% had no family history of HS, 60.6% were smokers, 39.4% were aged 20-29 years, and 36.1% were aged 30-39 years. The most commonly involved regions were the axilla (62%), groin (50.5%), and gluteus (15.9%). According to univariate analyses, male patients had higher disease stages than females (odds ratio=1.67). The patients with groin involvement, high body mass index (BMI), and low education level (0-8 years) had higher risk of severe disease stage (odds ratio=1.63, 8.91, and 1.51, respectively). The most commonly used treatment was oral antibiotics in Hurley stages I and II, and surgical intervention in Hurley III. In all 3 Hurley stages, clavulanic acid-amoxicillin combination was the mostly used systemic antibiotic (41.8%, 43.2%, and 47.8%, respectively). Conclusions This is the first epidemiological study on HS in the Turkish population, where HS shows male predominance. Male gender, low education level, absence of acne, high BMI, and groin involvement were associated with severe disease stages. Determining associated comorbidities and possible risk factors is important in progression and prevention of the disease

Discoid lupus erythematosus at the site of healed herpes zoster: Wolf's isotopic response: Case report

The term Wolf's isotopic response refers to the appearance of a new skin disease at the site of an already healed, unrelated disease. In most cases, the initial disease is herpes zoster. Different diseases may subsequently develop on the same site. The most common isotopic responses are granulomatous and lichenoid reactions, Discoid lupus erythematosus (DLE) is the most common form of cutaneous lupus erythematosus. It is a chronic inflammatory skin disease that typically manifests as erythematous, indurated, scaly plaques that have the potential to cause permanent scarring and dyspigmentation. In May 2013, the patient presented papular and vesicular eruption that appeared at first on her right face, scalp skin and spreaded to the right arm. The patient was diagnosed as herpes zoster. After two months, she developed atrophic, scaly, erythematous papules and plaques confined to the same sites and referred to our outpatient clinic. Here we report this 62-year-old-female patient with DLE due to Wolf s isotopic response