Psychiatric Symptoms in Patients with Alopecia Areata

WOS: 000298725800009Background and Design: Alopecia areata is a chronic inflammatory disease characterized by sudden hair loss. Existing evidence suggests that alopecia areata may be associated with personality traits altering the susceptibility to stress and psychiatric conditions associated with stress. The aim of this study was to compare the intensity of depressive and anxiety symptoms and the level of alexithymia in patients with alopecia areata and healthy control subjects. Materials and methods: Fifty patients with the diagnosis of alopecia areata and 30 healthy volunteers were compared in terms of scores of Beck depression inventory, Beck anxiety inventory, and Toronto alexithymia scale. Results: There were no statistically significant differences between alopecia areata cases and healthy controls regarding intensity of anxiety and level of alexythimia (p=0.053 and p=0.120, respectively). The intensity of depressive symptoms exhibited by alopecia areata patients was found to be significantly higher than that in healthy controls (p=0.010) and there was no statistically significant relationship between intensity of depressive symptoms and duration of the current alopecia areata episode (p=0.873). Conclusion: It is suggested that psychiatric evaluation should also be performed in all alopecia areata cases during the clinical follow-up period. (Turkderm 2011; 45: 203-5

Investigation of tinea pedis and toenail onychomycosis prevalence in patients with psoriasis

Psöriaziste onikomikoz prevalansına ilişkin çelişkili veriler bulunmaktadır. Bu çalışmada, psöriazisli hasta ve kontrol grubunda onikomikoz ve tinea pedis prevalansının araştırılması amaçlanmıştır. Çalışmaya, hastanemiz dermatoloji anabilim dalı polikliniğinde psöriazis tanısı ile izlenen 60 olgu (27'si erkek, 33'ü kadın; yaş ortalaması: 40.8 ± 17.6 yıl) ile psöriazis dışı nedenlerle izlenen 60 kontrol birey (27'si erkek, 33'ü kadın; yaş ortalaması: 42.8 ± 17.3 yıl) dahil edilmiştir. Normal görünümde veya mantar enfeksiyonu ile uyumlu klinik bulguları olan ayak tırnağı ve ayak parmak arası kazıntı örnekleri direkt mikroskobik olarak ve mantar kültürü ile incelenmiştir. Psöriazisli hastaların 5'inde onikomikoz, 1 'inde tinea pedis olmak üzere toplam 6 olguda (%10), kontrol grubunun ise 5'inde onikomikoz, 3'ünde tinea pedis olmak üzere toplam 8 olguda (%13.3) ayak dermatofitozu saptanmıştır (p> 0.05). Psöriazisli hasta ve kontrol gruplarında etken olarak yalnızca dermatofitlerden Trichophyton rubrum (%75) ve Trichophyton inter-digitale (%25) izole edilmiştir. Psöriazis grubunda onikomikozun erkeklerde daha baskın olarak saptandığı izlenmiştir (p= 0.01). Psöriazisli olgularda klinik olarak hem distero-lateral subungual onikomikoz (DLSO) hem de total distrofik onikomikoz gözlenirken, kontrol grubunda yalnızca DLSO saptanmıştır. Psöriazisli hastaların tırnaklarında rastlanılan en tipik bulgunun çukurlaşma olduğu belirlenmiştir (p= 0.04). Ayak dermatofitozunun bulaşında ortak duş alanlarının kullanımın kolaylaştırıcı bir etmen olduğu saptanmıştır (p= 0.04). Çalışmamızda elde edilen veriler, tırnağın mantar enfeksiyonlarında psöriazisin kolaylaştırıcı bir etmen olmadığını göstermekle birlikte, psöriatik tırnaklarda onikomikozun önemli bir sorun olması nedeniyle ayırıcı tanıda mikolojik incelemelerin yapılmasının yararlı olacağı açıktır. Sonuç olarak, halen önemli bir halk sağlığı sorunu olan dermatomikozların önlenmesinde, iyi ayak bakımı ve duş alanlarında çıplak ayakla yürünmemesi gibi konularda olguların eğitiminin büyük önem taşıyacağı düşüncesindeyiz.The data about the prevalence of onychomycosis in patients with psoriasis is contradictory. In this study, we investigated the prevalence of onychomycosis and tinea pedis in patients with psoriasis compared to control group. A total of 60 patients with psoriasis (27 male, 33 female; mean age: 40.8 + 17.6 years) and 60 subjects without psoriasis (27 male, 33 female; mean age: 42.8 ± 17.3 years) who were admitted to dermatology outpatient clinics of our hospital were included to the study. Scrapinqs from both normal and abnormal toenails as well as toewebs were examined using microscopy and fungal culture. Foot dermatomycosis was diagnosed in 6 (5 onychomycosis and 1 tinea pedis) patients with psoriasis (10%) and in 8 (5 onychomycosis and 3 tinea pedis) control subjects (13.3%) (p> 0.05). The only dermatophyte fungi isolated in both patients with psoriasis and control group were Trichophyton rubrum (75%) and Trichophyton interdigitale (25%). Onychomycosis was more predominant in male psoriatic patients (p= 0.01). Both distero-lateral subungual onychomycosis (DLSO) and total dystrophic onychomycosis were detected in patients with psoriasis, however, DLSO, was the only clinical type in the control group. Pitting is the most typical lesions in nails in patients with psoriasis (p= 0.04). The use of common showers play a role in transmission of foot dermatomycosis (p= 0.04). In this study, psoriasis was not found as a risk factor for onychomycosis. However, onychomycosis is a major problem in psoriatic nails, and mycological methods would be useful in differential diagnosis. Since dermatomycosis is still an important public health problem, it may be controlled by education of the patient about proper foot hygiene and avoiding walking barefooted in shower areas

Cutaneous leishmaniasis: new dermoscopic findings

Background Cutaneous leishmaniasis (CL) has a worldwide distribution. Delayed and incorrect diagnosis may cause the significant spread of this disease and consequent increases in morbidity and drug resistance. Objectives We aimed to determine dermoscopic features of CL that may help to improve the accuracy of clinical diagnosis of the disease. Methods A total of 145 lesions in 102 patients were evaluated dermoscopically. Following the diagnosis of CL, all lesions were evaluated by experienced dermoscopists. Results A total of 51 papules, 40 nodulo-ulcerative lesions, 31 plaques, and 23 nodules were evaluated by dermoscopy. Generalized erythema appeared in all lesions (100%), yellow tears in 58 lesions, both crust and ulcer in 51 lesions, white starburst-like patterns in 27 lesions, ovoid salmon-colored structures in 19 lesions, and a perilesional hypopigmented halo pattern in four lesions. Various vascular structures were present in 126 lesions. The most common vascular structure observed was an irregular linear pattern in 78 lesions, followed by a tree-like pattern in 53 lesions. The rest of the vascular structures included hairpin vessels in 25 lesions, glomerulus-like vessels in 24 lesions, dotted vessels in 23 lesions, comma-shaped vessels in six lesions, and polymorphous/atypical vessels in four lesions. We did not identify the types of parasite involved. Conclusions Yellow tears, white starburst-like patterns and salmon-colored ovoid structures seem to appear specifically in CL lesions. In geographical areas in which CL is common, dermoscopy may be utilized as a useful diagnostic tool that is practical and non-invasive

Tümör Nekrosis Faktor-Alfa inhibitörü Kullanımına Bağlı Olarak Gelişen Psöriazis: Olgu Serisi ve Literatürün Gözden Geçirilmesi

Tümör nekrozis faktor-alfa (TNF-alfa) inhibitörleri psöriazisin tedavisinde etkili olmasına rağmen TNF-alfa inhibitörleri ile tedavi edilen çeşitli romatizmal hastalıklarda psöriazisin indüklenebildiği bildirilmektedir. Bu olgu serisinde hastaların birinde iki farklı TNF-alfa inhibitörü kullanımına bağlı olmak üzere dört hastada ilaca bağlı olarak gelişen psöriazis vakaları sunulmaktadır. Vaka 1: Ankilozan spondilit tanısıyla takip edilen ve infliksimab tedavisi başlanan 31 yaşında erkek hastada tedavinin 2.haftasında ekstremitelerde eritemli skuamlı lezyonlar gelişti. İki ay sonra tekrar başlanan etanersept tedavisinin 1.ayında ise saçlı deride yoğun olmak üzere tüm gövde ve ekstremitelerde psöriatik lezyonlar gelişti. Vaka 2: Romatoid artritli 53 yaşında bayan hastada etanersept tedavisinin 2.ayında her iki ayak bileği çevresinde eritemli skuamlı lezyonlar oluştu. Vaka 3: Ankilozan spondilitli 34 yaşında bayan hastada infliksimab tedavisinin 10.ayında her iki elinde palmar psöriatik lezyonlar gelişti. Vaka 4: Ankilozan spondilit tanısıyla takip edilen 40 yaşında bayan hastada infliksimab tedavisinin 2.yılında el ve ayaklarında püstüler lezyonlar gelişti. Hastaların hiçbirinde psöriazis için aile öyküsü yoktu. Vakaların üçünde psöriazis tanısı histopatolojik olarak doğrulandı. Romatoid artrit, ankilozan spondilit ve diğer spondiloartritlerde TNF-alfa inhibitörü kullanımına bağlı olarak psöriazis indüklenebilmektedir. En fazla püstüler form ile plak tipi psöriazis görülmekte ve palmoplantar dağılıma rastlanmaktadırAlthough tumor necrosis factor-alpha (TNF-_) antagonists are shown to be effective in the treatment of psoriasis, induction of psoriatic skin lesions have been seen in patients with different rheumatic conditions who were treated with TNF-_ antagonists. In this case series, we report four cases that developed psoriatic lesions; in one of the cases, psoriasis was associated with two different TNF-_ antagonists. Case 1: A 31-year-old man with ankylosing spondylitis developed erythematous and squamous lesions on his extremities in the 2nd week of infliximab treatment. Two months later he began to receive etanercept, and psoriatic skin lesions developed on the entire trunk and extremities, and predominantly on the scalp after one month. Case 2: A 53-year-old female with rheumatoid arthritis developed psoriatic skin lesions in the ankle region after two months' treatment with etanercept. Case 3: A 34-year-old female with ankylosing spondylitis developed psoriatic lesions on her palms after 10 months' treatment with infliximab. Case 4: A 40-year-old female with ankylosing spondylitis developed pustular lesions on her palms and soles after two years' treatment with infliximab. The patients had no personal or family history of psoriasis. The diagnosis of psoriasis was confirmed by skin biopsy in three of the cases. Psoriatic skin lesions can be induced as a result of treatment with TNF-_ antagonists in patients with rheumatoid arthritis, ankylosing spondylitis and other spondyloarthropathies. The most common form is plaque or pustular pattern with palmoplantar distributio