Başak Yalçin

Serum interleukin-8 as a serologic marker of activity in Behçet's disease.

Background  Immune dysregulation has been shown to be one of the major aspects of the yet unknown pathogenesis of Behçets disease. Interleukin‐8 (IL‐8), a major chemokine with pivotal effects concerning leukocytes and endothelial cells, has been found to be elevated in patients with Behçets disease.

Generalized pruritus: a prospective study concerning etiology.

AbstractBackground:Generalized pruritus can often be the primary manifestation of systemic disease. Objective:To determine how frequently generalized pruritus had a systemic etiology in an outpatient population seen in a dermatology department and whether any identifiable patient characteristics meant a systemic explanation of generalized pruritus was more likely. Methods:A prospective controlled study of 55 patients with generalized pruritus and 41 healthy age- and sex-matched control subjects. Clinical data were collected from patients and laboratory parameters investigated in both patients and healthy control subjects to determine the frequency of systemic disease in each group. Results: Of 55 patients, 12 had a systemic cause of pruritus. Pruritus was the initial symptom of systemic disease in eight of these patients. The underlying diseases included hypothyroidism, chronic lymphocytic leukemia, hepatitis C, hepatitis B, diabetes mellitus, lung cancer, uremia, and iron deficiency anemia. Of these, iron deficiency anemia was the most common cause. Compared with the control group, mean serum hemoglobin, iron, and cyanocobalamin (vitamin B12) levels in patients with generalized pruritus were lower. No other patient characteristics were statistically associated with systemic causes of pruritus. Conclusion:Generalized pruritus was the initial symptom of a systemic disease in 8 of 55 patients presenting to a dermatology outpatient clinic with this complaint. A number of underlying diseases were identified, of which the most common was iron deficiency anemia.

Patient characteristics in Behçet disease: a retrospective analysis of 213 Turkish patients during 2001-4.

AbstractBackground: Behçet disease (BD) is a chronic, inflammatory, multisystemic vasculitic disorder with a wide spectrum of clinical presentations. The highest prevalence is seen in Turkey. Specific diagnostic tools are yet to be discovered; thus, the diagnosis relies on physicians being acquainted with the symptoms and signs of the disease. Objective: To investigate the epidemiologic characteristics of BD and to emphasize the typical clinical and laboratory characteristics. Methods: This was a retrospective analysis of all the BD patients attending the Ankara Numune Education and Research Hospital throughout the years 2001–4. Diagnosis of BD was made according to the International Study Group criteria. A total of 213 patients were evaluated with respect to family history, clinical features, pathergy test, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), antistreptolysin O, and ferritin levels. When assessing disease activity, the active clinical manifestations on the day of the examination were taken into account. Correlations were analyzed between sex and age distribution, age of onset, disease duration, and family history; and between family history and age of onset, pathergy, clinical manifestations, and laboratory parameters. Correlations were also evaluated between pathergy positivity and clinical manifestations, and laboratory parameters. Correlations between activity scores and age of onset, duration, sex, family history, and laboratory data were also analyzed. Results: The female : male ratio was 1.04, and the mean age of onset was 27 years. Family history did not affect age of onset or disease severity. Men presented with more active disease, and there was a weak but positive correlation between disease activity and CRP. No correlation was observed between duration and age of disease onset. The most common clinical presentations were oral aphthous lesions, genital ulcers, and skin lesions. Men more commonly presented with papulopustular lesions, pathergy positivity, and vascular, eye, and renal involvement, and women presented with arthritis/arthralgia more commonly than men. Vascular lesions, ESR, and CRP showed significant relationships with pathergy reaction. Eye involvement was not affected by age of onset. Conclusions: We believe our results indicate that the pathogenesis of BD is multifactorial. Hormonal factors seem to be of some influence, while genetic background and environmental factors seem to be the major contributors. Infections seem to be among the triggering environmental factors. Predisposing genes may affect the influence of environmental factors. Prevalence studies should be carried out periodically in those countries with a high prevalence ofBDto keep up with the changing dynamics of the disease, which may also shed light on the as-yet unknown pathogenesis of BD.

Complete Dermatological Examination in the Elderly: An Exploratory Study from an Outpatient Clinic in Turkey

Background: The geriatric population isgrowing continuously, therefore more aged patients are being admitted to dermatology clinics. Successful management of these patients requires a thorough understanding of the features of geriatric patients and prevalence of skin diseases in this group. Materials and Methods: Patients aged 65 years and older admitted to the dermatology outpatient clinic over a 3-month period were included. Patients aged between 65 and 74 years were included in group I, and patients older than 74 years were included in group II. Demographic features of the patients were noted. Total dermatological examination was performed in each patient. Fifteen days after the first visit, the patients were phoned up to obtain information about their level of satisfaction regarding the treatments and were invited to the clinic for reexamination where their improvement levels were scored. Results: A total of 209 patients were included in this study. The most common complaints were in the chronic eczema-dermatitis group. However, the most commonly detected disorders were in the chronic sun exposure group. Some severe cutaneous and noncutaneous diseases were detected incidentally at total dermatological examination. Treatment satisfaction scores of patients and improvement scores of doctor had a significantly good correlation. Discussion: The study results indicated that in the management of elderly patients, social and physical evaluation should be carried out and treatment must be recommended accordingly. In all elderly patients, total dermatological examination must be performed because it may reveal some severe cutaneous or underlying noncutaneous diseases.

Internalized stigma in psoriasis: A multicenter study

Internalized stigma is the adoption of negative attitudes and stereotypes of the society regarding a persons illness. It causes decreased self‐esteem and life‐satisfaction, increased depression and suicidality, and difficulty in coping with the illness. The primary aim of this study was to investigate the internalized stigma state of psoriatic patients and to identify the factors influencing internalized stigma. The secondary aim was to identify the correlation of internalized stigma with quality of life and perceived health status. This multicentre, cross‐sectional study comprised 1485 patients. There was a significant positive correlation between mean values of Psoriasis Internalized Stigma Scale (PISS) and Psoriasis Area and Severity Index, Body Surface Area, Dermatological Life Quality Index and General Health Questionnaire‐12 (P < 0.001 in all). Lower percieved health score (P = 0.001), early onset psoriasis (P = 0.016), family history of psoriasis (P = 0.0034), being illiterate (P < 0.001) and lower income level (P < 0.001) were determinants of high PISS scores. Mean PISS values were higher in erythrodermic and generalized pustular psoriasis. Involvement of scalp, face, hand, genitalia and finger nails as well as arthropathic and inverse psoriasis were also related to significantly higher PISS scores (P = 0.001). Our findings imply that psoriatic patients experience high levels of internalized stigma which are associated with psoriasis severity, involvement of visible body parts, genital area, folds or joints, poorer quality of life, negative perceptions of general health and psychological illnesses. Therefore, internalized stigma may be one of the major factors responsible from psychosocial burden of the disease.

PUVA Treatment for Alopecia areata

Background: PUVA has been suggested as an alternative treatment modality for resistant, diffuse alopecia areata (AA). However, there are conflicting reports on its efficacy. Objective: The aim of this study was to investigate the efficacy of PUVA treatment of AA in a Turkish population. Methods: Twenty-four patients (15 female and 9 male) suffering from extensive AA for more than 1 year were included in a retrospective study. PUVA was administered to the whole body 3 times a week. Only 75–100% hair regrowth was defined as cosmetically acceptable. Results: Excellent hair regrowth was achieved in 37.5% of the patients. The therapeutic efficiency was not related to age and sex of the patients, duration and extent of the disease (p <0.05). Conclusion: PUVA can be an alternative therapy for patients with extensive AA independently of the duration of disease.

Increased Expression of Segmental Neurofibromatosis with Bronchoalveolar Lung Carcinoma

Segmental neurofibromatosis, neurofibromatosis 5 (NF5), a special and infrequent form of neurofibromatosis, is characterized by café-au-lait (CAL) spots, freckling and neurofibromas limited to a unilateral segment. Special eye lesions of neurofibromatosis such as Lisch nodules and optic glioma are not present in NF5. The median age at onset is 28 years, and it appears not to be inherited [1]. The etiology and genetic implications of NF5 are not known. The most likely explanation is a somatic mutation that is propagated by mitosis to involve one dermatome or somatic mosaicism accompanied by gonadal mosaicism [2]. To our knowledge, no extraneural tumor associated with NF5 or no NF5 presenting as paraneoplastic disease has been reported before. We report a patient with bronchoalveolar carcinoma of the lung together with late-onset NF5 which presented as paraneoplastic NF5. A 75-year-old female patient was admitted to our hospital with a 3-year history of numerous soft nodules on her back and on the lower extremities for the last 2 months. In clinical examination she had numerous soft papules and nodules predominantly on her left upper back, left axilla, left lower leg and left plantar area. Since some of the lesions were mimicking skin tags clinically, a skin biopsy was performed. The diagnosis of neurofibroma was verified histopathologically. On the left thigh and patellar area multiple lentiginous macules and 2 CAL spots were noted which had been present since birth and early childhood. Other body areas including axillary and inguinal areas were free of lentiginous macules and CAL spots. No Lisch nodules or optic gliomas in the eyes and no skeleton abnormalities were detected. Her family history for neurofibromatosis was unremarkable. In her medical history, she was described as a nonsmoker and as having bronchoalveolar carcinoma in her left lung lower lobe diagnosed and surgically treated 3 years previously. The diagnosis of bronchoalveolar carcinoma had preceded the appearance of the skin nodules by 3 months. Complete blood count, full biochemical examination, urine analysis and computerized tomography of the abdomen were unremarkable. In computerized tomography of the thorax there were changes related to previous lobectomy without any signs of tumoral recurrence or metastasis. There is an increased incidence of specific cancers in NF patients. These include malignant peripheral nerve sheath tumor and Triton tumor, malignant glioma and extraneural malignancies such as pheochromocytoma, carcinoid tumor, rhabdomyosarcoma and juvenile chronic myeloid leukemia [3]. Only a few cases of lung cancers in neurofibromatosis 1 have been reported up to now. They include mostly adenocarcinomas, and 1 large cell tumor and 1 primary pulmonary sarcoma [4–6]. In NF5, only 2 cases of malignant peripheral nerve sheath tumors were reported [7]. No extraneural malignancies have been reported before. This is the first case of an extraneural malignancy in an NF5 patient. In the literature we have not found any neurofibromatosis presenting as a paraneoplastic skin disease. However, in the present case, the concomitant appearance of bronchoalveolar lung cancer and unusual very late onset NF5 does not seem to be coincidental. The acute and eruptive development of neurofibromas together with bronchoalveolar carcinoma suggests a paraneoplastic process accelerating the occurrence of neurofibromatosis rather than a simple coincidence in this patient with occult NF5. The factors promoting the development of neurofibromas are not clear. It has been reported that in urticaria pigmentosa cases mast cells might play a causative role in the development of neurofibroma and neurofibroma-like lesions [8]. Similarly in this case, some tumorigenic factors secreted by bronchoalveolar carcinoma cells may be responsible for the development or acceleration of neurofibromas in this patient.

Multiple nodular plexiform neurofibromas in a neurofibromatosis 1 family: a familial tendency? A case report and review of the literature

An 18-year-old male patient was admitted to the hospital with multiple, painful nodules on his arms, legs and scalp. He first noticed them 8 years ago. Since then, they had increased in size and number. On physical examination multiple, firm, painful nodules of diameter 0.7–2 cm were observed on the flexor areas of his arms and legs and on his scalp in a linear, beaded pattern. He also had multiple large hyperpigmented cafe au lait (CAL) macules distributed all over his body and freckles in the axillae (Fig. 1). He did not have any cutaneous or subcutaneous neurofibromas. Lisch nodules were observed on ophthalmic examination. He also had scoliosis. In laboratory examinations, complete blood count and peripheral smear and serum blood chemistry were within normal limits. Computed tomography of the cranium and ultrasound of the abdomen were also unrevealing. One of the lesions was excised and histopathological examination was consistent with neurofibroma. The diagnosis of neurofibromatosis 1 (NF1) with multiple nodular plexiform neurofibromas was established. Family history revealed that, in addition to our patient, six other family members were affected. They were admitted to the clinic and, after a detailed history of their diseases was taken, they were examined carefully. His 40-year-old

Contact dermatitis due to Allivum sativum and Ranunculus illyricus: two cases

Plants are of relevance to dermatology for both their adverse and beneficial effects on skin and skin disorders respectively. Virtually all cultures worldwide have relied historically, or continue to rely on medicinal plants for medical care. As alternative herbal remedies are becoming more widely used there is an increase in phytocontact dermatitis. Here we document two patients who developed contact dermatitis due to Allivum sativum, and Ranunculus illyricus after applying to the skin in order to relieve the rheumatological joint pain.

Acquired aquagenic papulotranslucent acrokeratoderma: report of two cases.

Aquagenic papulotranslucent acrokeratoderma (APA) is an acquired, unusual condition characterized by bilateral, symmetric, translucent-to-white papules located on the hands and feet. These lesions are accentuated following a short period of water exposure. Since its first description in 1973 as hereditary papulotranslucent acrokeratoderma, only a few cases of APA have been reported. We report two cases of teenage girls with APA. Both patients responded well to 5% salicylic acid ointment but recurrence of lesions still occurred. The close temporal proximity of presentation of these two cases may indicate that APA is not as rare as previously thought.