Ali Murat Ceyhan

The role of helper and regulatory T cells in the pathogenesis of vitiligo

BACKGROUND Alterations in cellular immunity, including CD4(+) T and CD8(+) T lymphocytes, have been proposed in the pathogenesis of vitiligo. There is also a proposed role for cytokines in the depigmentation observed in vitiligo. However, previous reports on the role of cytokines in the pathogenesis of vitiligo have been few in number. OBJECTIVE The purpose of this investigation was to assess the role of the major cytokines produced by T-helper 1 and 2 cells as well as T-helper 17 and regulatory T cells in the pathogenesis of vitiligo. METHODS Forty patients with vitiligo and 40 age- and sex-matched healthy control subjects were enrolled in the study. Serum interleukin (IL)-4, IL-6, IL-10, IL-17, interferon-gamma, tumor necrosis factor-beta, and transforming growth factor-beta levels were detected by enzyme-linked immunosorbent assay in both groups. The correlations of serum cytokine levels with age of onset, sex, duration of disease, type and activity of vitiligo, percentage of involved body area, Koebner positivity, family history, and the presence of associated autoimmune diseases were assessed. RESULTS Serum transforming growth factor-beta levels were significantly decreased in the vitiligo group compared with the control group (P = .004). No difference was detected between the patient and control groups in mean levels of serum IL-6, IL-10, and tumor necrosis factor-beta. In the patients with vitiligo, serum IL-17 levels were positively correlated with the extent of body area involvement (rho = 0.329, P = .038). LIMITATIONS Tissue cytokines compared with those in the peripheral blood were not measured. CONCLUSION Although multiple factors have been implicated in the pathogenesis of vitiligo, reduced serum transforming growth factor-beta levels, as observed in patients in the current investigation, may contribute to enhanced cellular immunity. This may facilitate the occurrence of vitiligo by leading to diminished maturation of regulatory T cells, followed by impaired inhibition of inflammation.

Brachioradial pruritus successfully treated with gabapentin

Brachioradial pruritus (BRP) is a mysterious entity characterized by localized pruritus of the dorsolateral aspect of the arm. The precise etiology of BRP remains unknown, but sun exposure and/or cervical spine lesions seem to be triggering or at least aggravating factors. Many treatment alternatives including non‐steroidal anti‐inflammatory drugs, topical capsaicin, topical corticosteroids, photoprotection, carbamazepine and acupuncture have been used with different success rates. Recently, gabapentin, an antiepileptic agent, has been reported to be an effective therapeutic agent in BRP. Herein, we report a 64‐year‐old man with BRP who showed good response to gabapentin therapy.

A case of multiple, eruptive pyogenic granuloma developed on a region of the burned skin: can erythromycin be a treatment option?

Pyogenic granuloma (PG) is a common, acquired, benign angiomatous proliferation of the skin and mucous membranes that develops spontaneously or traumatically. PG usually occurs in children and young adults and predominantly located on neck, hands, and extremities. There are numerous theories about the pathogenesis of PG, but the etiology is not clear. Although the occurance of PG after trauma to the skin is very common, multiple lesions of PG secondary to burn are rare in the literature. In this report, we present a case of multiple, eruptive PG that developed on the burned skin of a 17-month-old boy. After oral erythromycin treatment for 8 weeks, the lesions clearly improved.

Traumatic lingual ulcer in a child: Riga–Fede disease

Riga–Fede disease RFD is an extremely rare, benign inflammatory disorder characterized by reactive, traumatic ulceration of the oral mucosa especially located on the tongue. It is most commonly associated with natal or neonatal teeth in newborns. Mucosal lesions are often caused by repetitive traumatic damage due to backward and forward motions of the tongue over the lower incisors. Failure to diagnose and treat these lesions properly may result in inadequate food intake, growth retardation and permanent lingual deformity. We report a 15‐month‐old healthy infant with tongue ulcer diagnosed as RFD based on history and clinical features.

Evaluation of serum sCD40L and homocysteine levels with subclinical atherosclerosis indicators in patients with psoriasis: a pilot study

Psoriasis is a chronic inflammatory process associated with an increased risk of cardiovascular risk factors. sCD40L has been suggested to have a possible role in the pathogenesis, of psoriasis and is known to be associated with inflammation, atherogenesis and cardiovascular events. This study investigated cardiovascular risk factors (sCD40L and homocysteine) as well as subclinical atherosclerosis indicators in psoriatic patients and control subjects. The study included 56 consecutive patients with chronic plaque‐type psoriasis and 53 age and gender matched healthy controls admitted to a university hospital. Serum sCD40L and homocysteine levels were measured by ELISA. Carotid artery intima‐media thickness and brachial artery flow mediated dilatation (FMD) measurements were determined ultrasonographically. Subjects who had a history of cardiovascular diseases and cardiovascular risk factors and receiving any systemic treatment were excluded from the study. Plasma sCD40L levels were significantly higher in psoriasis patients compared with healthy controls (1.33 ± 0.72 vs. 0.98 ± 0.70 ng/ml P = 0.012), whereas plasma homocysteine levels did not differ significantly between the two groups. FMD was significantly reduced in the psoriasis group compared to the controls (3.83 ± 5.03 vs. 8.45 ± 7.27% P = 0.0001). Multiple linear regression analyses indicated a significant association between psoriasis, sCD40L, and FMD. Psoriatic patients had higher sCD40L levels than healthy controls, which may lead to an increase in cardiovascular diseases. sCD40L may be a more reliable and early predictive marker of cardiovascular events in psoriatic patients. New treatment options that will be developed over sCD40L will benefit in prevention of psoriasis and its cardiovascular comorbidities.

Congenital giant juvenile xanthogranuloma initially masquerading as hemangioma

ejd.2011.1312 Auteur(s) : Ali Murat CEYHAN1 amuratceyhan@yahoo.com, Giray AYNALI2, Wenchieh CHEN3, Nilgun KAPUCUOGLU4 1 Department of Dermatology, Suleyman Demirel University Medical Faculty, 32100 Isparta, Turkey 2 Department of Otorhinolaryngology Suleyman Demirel University Medical Faculty, 32100 Isparta, Turkey 3 Department of Dermatology and Allergy, Technische Universitaet Muenchen, Germany 4 Department of Pathology, Suleyman Demirel University Medical Faculty, 32100 Isparta, Turkey Juvenile [...]

Transverse leukonychia (Mees’ lines) associated with docetaxel

Figure 1. Transverse white bands are clearly visible on the fingernails. Dear Editor, The nail abnormalities encountered in patients with various malignancies likely represent side-effects of many antineoplastic agents. Docetaxel is a relatively new chemotherapeutic agent of the taxane family widely used in the treatment of various malignancies including breast, ovarian, lung, head and neck cancers. Taxanes probably cause nail changes more often than other drugs. Various nail side-effects have been described in association with docetaxel. However, in our search through the English-language published work (on PubMed using the key words Mees’ lines, transverse leukonychia and docetaxel), we could not find any report of Mees’ lines associated with docetaxel. Herein, we describe a patient with metastatic non-small cell lung cancer who developed Mees’ lines after docetaxel therapy. A 46-year-old woman was referred to our clinic in February 2009 for the evaluation of the nail color changes that involved all fingernails. The clinical history revealed that, in April 2008, the patient had suffered from metastatic non-small cell lung cancer (NSCLC) (stage IV) treated with three courses of cisplatin ⁄gemcitabine and a total of 3000 cGy palliative radiotherapy for cervical vertebral metastases. Because of the disease progression in spite of the first-line chemotherapy, the patient received four courses of docetaxel 75 mg ⁄m every 3 weeks between November 2008 and January 2009. After two courses of docataxel therapy, the patient noticed white color changes on the nail plates of both hands. She also confirmed that there were no nail changes before the docetaxel treatment, and she was taking no other concomitant medication which might have caused the white bands. Physical examination at the time of admission revealed three white transverse bands, approximately 1 mm in width, on each of her fingernails (Fig. 1). The white bands did not disappear

Persistent hoarseness in a patient with pachyonychia congenita: an early sign of laryngeal involvement

A 13-month-old boy, born of a nonconsanguineous marriage, presented with extensor hyperkeratotic papules and subungual hyperkeratosis with yellow–brown discoloration of the nail plate affecting all 20 nails, developing within the first few months of life. Whitish plaques were also observed on the oral mucosa. His mother reported progressive hoarseness, especially on crying. Treatment for onychomycosis and oral candidiasis for 2 months yielded no improvement. Multiple courses of antimicrobials for presumed upper respiratory tract infection did not improve the hoarseness. There were no other known medical problems, and his growth and development were within the normal range. Natal teeth, hair abnormalities, and abnormal dentition were not found. The family history regarding other ectodermal disorders was noncontributory. On physical examination, there was subungual hyperkeratosis and yellow–brown discoloration of all the nails (Fig. 1), symmetric follicular hyperkeratotic papules on the extensor surface of the knees and elbows, and palmar blisters. Intraoral examination showed irregularly shaped whitish plaques on the dorsal tongue, palate, buccal mucosa, and both sides of the labial commissure, together with angular cheilitis (Fig. 2). Sweating was normal. A complete ophthalmologic examination (including pupil dilation) showed normal results. Potassium hydroxide (KOH) examination and fungal culture of scrapings of the nail and from the whitish mucosal plaques yielded negative findings. Laryngeal examination under general anesthesia using an endoscopic video information system revealed a slightly elevated, white, hyperkeratotic plaque of 3–4 mm in diameter that extended from the posterior commissure to the anterior interarytenoid mucosa, and two small whitish clear papules, measuring 1–2 mm in diameter, on the upper part of the left vocal cord (Fig. 3). There was no history of any problems with respiratoryobstruction. The boy was otherwisegenerally healthy with unremarkable findings on systematic examination. The results of laboratory investigation, including 1346 Figure 1 Clinical appearance of hypertrophic nail dystrophy and discoloration of the toenails

The evaluation of prevalence of fibromyalgia in patients with chronic urticaria

Background The pathophysiology of chronic idiopathic urticaria (CIU) is not fully understood; however, it has been hypothesized that a subset of people with CIU may have an autoimmune disease and that peripheral cutaneous nerve fibers may be involved in CIU. Similarly, it has been postulated that fibromyalgia syndrome (FMS) is an autoimmune disorder and may be associated with alterations of peripheral cutaneous nerve fibers. Accordingly, the present study aimed to determine whether the frequency of FMS is higher in patients with CIU. Material/Methods A total of 72 patients with CIU and 67 sex- and age-matched healthy controls were included. Urticaria activity score (UAS), fibromyalgia impact questionnaire (FIQ), tender point number, and visual analogue scale (VAS) were assessed. Results The frequency of FMS was similar between the groups (9.7% vs. 4.5%, p=0.32). However, symptom duration of FMS was significantly longer, and tender point number and FIQ were significantly higher in patients with CIU than in controls. In addition, patients with CIU had significantly higher VAS scores. UAS was significantly correlated with presence of FMS, symptom duration of FMS, tender point number, and FIQ and VAS scores. Logistic regression analysis revealed that UAS was an independent predictor of presence of FMS (β=0.34, p=0.003). Conclusions Frequency of FMS was slightly, but not significantly, higher in patients with CIU than in controls. However, symptom duration of FMS, tender point number, and FIQ and VAS scores were significantly higher in patients with CIU, and UAS reflecting severity of the disease was significantly and independently associated with presence of FMS.

A case of cutaneous leishmaniasis presenting as facial cellulitis

Figure 1. (a) Clinical appearance of erythematous lesion resembling cellulitis on the left cheek. (b) Complete healing of the facial lesion after the therapy. Dear Editor, The clinical spectrum of cutaneous leishmaniasis (CL) is very broad. It can represent a diagnostic challenge for physicians when the disease occurs in a nonendemic area where experience is limited. Given the wide variability of clinical findings, it is one of the ‘‘great imitators’’, making it necessary to consider accurate clinical, epidemiological, laboratory and histopathological criteria to make the diagnosis. This report seeks to highlight an unusual case of CL involving the face and mimicking facial cellulitis in an immunocompetent patient living in a non-endemic area. A 66-year-old woman presented to our dermatology department with redness and swelling of the left side of her face, which were reported to have started 6 months prior. The lesion started as a red papule and a few weeks later an asymptomatic swelling appeared at that site and gradually extended. Subjective symptoms, including pruritus, fever and pain, were not reported. The patient was immunocompetent and lived in a non-endemic area. She denied facial trauma, insect bites or traveling to an endemic area for CL. Her personal and family histories were not contributory, either. Due to the suspected diagnosis of facial cellulitis, she had been treated with a variety of antimicrobial agents, such as oral amoxicillinclavulanate, cefuroxime axetil for 7 days, and i.v. broad-spectrum antibiotic for 14 days. However, this treatment had not improved her condition. Dermatological examination revealed a slightly scaly, erythematous, edematous, infiltrated plaque 6 cm · 4 cm in diameter on her left cheek (Fig. 1a). No regional lymph nodes were found. Her general physical and systemic examinations were normal. Results of complete blood counts, erythrocyte sedimentation rate, C-reactive protein, blood biochemis-