Bilge Bulbul Sen

Mean Platelet Volume in Recurrent Aphthous Stomatitis and Behçet Disease

Behcet disease (BD) and recurrent aphthous stomatitis (RAS) are systemic inflammatory diseases, but the exact pathogenesis of both the diseases is unknown. Mean platelet volume (MPV) is an indicator of platelet activation. The aim of this study was to investigate the MPV levels in patients with BD, RAS, and healthy participants. A total of 61 patients with BD, 60 patients with RAS, and 60 healthy controls were included in this study. The MPV levels and erythrocyte sedimentation rate in patients with BD and RAS groups were significantly higher than the control groups (P < .001). In the BD group as well as in the RAS group, the disease activity does not affect the levels of MPV. The MPV levels may be used as a cheap and feasible diagnostic marker in patients with BD and RAS. Nevertheless, the MPV does not have a predictive value in differentiating the diagnosis of BD and RAS.

Neutrophil to lymphocyte ratio as a measure of systemic inflammation in psoriasis

Abstract Objective: Psoriasis is a chronic systemic inflammatory disorder. The neutrophil to lymphocyte ratio (N/L ratio) has been used as a marker for systemic inflammatory status. In our study, we aimed to evaluate N/L ratio in patients with psoriasis. Methods: This cross-sectional study population consisted of 138 patients with psoriasis and 120 age- and sex-matched control subjects. Results: The patients had significantly higher neutrophil counts and lower lymphocyte counts than the controls. The N/L ratios and high sensitivity C reactive protein (hs-CRP) levels were also significantly higher in patients. The N/L ratios and hs-CRP levels were increasing with increasing in Psoriasis Area and Severity Index score. Furthermore, the N/L ratios and hs-CRP levels of patients were found to be positively correlated. Conclusions: Our data show that the N/L ratio to be a simple, inexpensive and easily assessable marker of systemic inflammation in patients with psoriasis.

Mean platelet volume and eosinophilia relationship in patients with bullous pemphigoid

Abstract Introduction: Bullous pemphigoid (BP) is an autoimmune skin disease that is characterized by the formation of blisters on normal or erythematous skin. In patients with BP, eosinophils are highly represented in the inflammatory infiltrate of the lesional skin and their levels are often increased in peripheral blood. It is known that eosinophils are the major intravascular source of tissue factor (TF), an initiator of the extrinsic coagulation pathway. Patients with BP are also three times more likely to develop pneumonia and pulmonary embolism than the matched controls. We hypothesized that there might be an association between the eosinophil level and mean platelet volume (MPV) in these patients. Patient and method: A total of 19 patients with BP and age–sex match 22 healthy controls were included in this study retrospectively. MPV before treatment, MPV after treatment, platelet, eosinophil count before treatment, eosinophil count after treatment, white blood cell, glucose, C reactive protein and sedimentation rate were evaluated in BP patients and the control group. Results: The MPV value (8.32 fl ± 1.8) and eosinophil count (1.03 × 103 μL−1 ± 0.36) in patients with BP was significantly higher than that of control subjects (p = 0.036) and (0.22 ×103 μL−1 ± 0.29) (p = 0.002) (p < 0.05, Mann–Whitney U-test). Conclusion: In this study high levels of MPV and eosinophil levels have been detected. MPV may be a useful indicator of the risk of vascular events. Prospective studies are needed to compare disease activity, thromboembolic events and MPV in BP patients.

Narrow-band ultraviolet B phototherapy in childhood.

Abstract Background: Narrow-band ultraviolet B (UVB) has been used for skin diseases in children. However, the use of phototherapy in childhood has limited due to the possible risk of skin cancer. The aim of this study is to evaluate the efficacy and safety of the narrow-band UVB phototherapy in children for the treatment of various skin diseases. Methods: The data of the children aged 16 years or under who were treated with narrow-band UVB in our clinic’s phototherapy unit were analyzed, retrospectively. Results: The study included 77 children (42 girls, 35 boys) aged 5–16 years (mean 12.18 ± 3.53) who were treated with a total of 81 courses of narrow-band UVB phototherapy in the last 4.5 years. The majority of patients had vitiligo (47%) and psoriasis (39%). Thirty-four (44.2%) patients showed complete response, 15 (19.5%) good response, 12 (15.6%) partial response, 5 (6.5%) poor response and 11(14.3%) no response. Acute side effects of phototherapy were observed only in 11 (14.3%) patients. Conclusions: Narrow-band UVB phototherapy is an effective and well-tolerated treatment in childhood.

Localized bullous pemphigoid occurring on surgical scars.

A 39-year-old woman presented with blisters on the old surgical scars for a month. Fifteen years ago she had undergone surgical operation due to a traffic accident. In dermatological examination, there were intact, tense bullae, located linearly along the scars on her legs [Figure 1]. Nikolsky phenomenon was negative. There were no bullae in any other mucocutaneous site. No milia were seen. Histopathological examination of the biopsy revealed subepidermal separation and bullous formation. There were abundant neutrophils and eosinophils in bullae [Figure 2]. In dermis, dilated vessels and perivascular chronic inflammatory cell infiltration and less neutrophils and eosinophils were seen. Direct immunofluorescence showed linear complement C3 deposition at the epidermal basement membrane [Figure 3]. IgG, IgA, IgM, and fibrinogen were negative. According to these signs, bullous pemphigoid (BP) was diagnosed. The patient was treated with 0.05% clobetasol propionate cream and her lesions disappeared and no new lesions were observed.

Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism in psoriasis in southern Turkey.

Background Psoriasis is a multigenic and multifactorial dermatological disease linked to cardiovascular diseases. Increased levels of homocysteine in patients with psoriasis have been demonstrated in many studies. The most frequently investigated genetic defect that plays a role in homocysteine metabolism is single point substitution (C to T) located on the 677th nucleotide of the methylenetetrahydrofolate reductase gene (MTHFR). Objective In this study, we aimed to investigate methylenetetrahydrofolate C677T polymorphism in psoriasis patients in Turkey. Methods The study included 96 patients with psoriasis and 77 controls from southern Turkey. Methylenetetrahydrofolate C677T polymorphism was analysed using the Polymerase Chain Reaction-Restriction Fragment Length Polymorphism methods. Results In the psoriasis group, 34 CC (35.4%), 46 CT (47.9%) and 16 TT (16.7%) genotypes were found, respectively; while in the control group, the figures were 39 (50.6%), 35 (45.5%), 3 (3.9%). Homozygote and heterozygote T alleles of methylenetetrahydrofolate C677T polymorphism were significantly higher in the psoriasis than in the control group (p=0.013). Conclusion We firstly found a correlation between methylenetetrahydrofolate C677T polymorphism and psoriasis among the southern Turkish population.

Assessment of left ventricular dyssynchrony in patients with psoriasis

Psoriasis is an inflammatory disorder, which has been reported to be associated with cardiovascular (CV) risks. Although increased CV risks in psoriasis are well established, there are no data about changes of contraction synchrony in psoriasis. Therefore, we aimed to study the left ventricular (LV) contraction synchrony in patients with psoriasis with narrow QRS and normal ejection fraction.

Mean platelet volume as an inflammatory indicator in behcet disease.

We read with interest the letter by Erayman and Sen regarding our article entitled ‘‘Mean Platelet Volume in Recurrent Aphthous Stomatitis and Behcet Disease.’’ Behcet disease (BD) is a chronic, multisystemic, inflammatory process with the clinical features of mucocutaneous lesions as well as ocular, vascular, articular, gastrointestinal, neurologic, urogenital, pulmonary, and cardiac involvement. Vascular involvement is an important part of BD complications. We speculated that mean platelet volume (MPV) in BD is related to vascular involvement. Furthermore, we agree that MPV is a widely used marker associated with platelet function based on inflammatory conditions. The MPV also represents platelet function, which is central to processes that are involved in coronary heart disease pathophysiology and endothelial dysfunction. The MPV might be influenced by coronary risk factors including age, obesity, smoking, diabetes mellitus, hypertension, hyperlipidemia, and metabolic syndrome. Some other recent studies have reported that an elevated MPV is linked with peripheral artery disease and stroke, all of which are related to atherosclerosis on the basis of inflammation. Additionally, some inflammatory indicators such as carotid intima–media thickness is widely accepted as a surrogate marker for atherosclerotic disease. Also, arterial stiffness indicates the viscoelastic properties of the vessel wall. It represents vascular damage and is a measure of the degree of atherosclerosis. The inflammatory markers have been shown to reflect atherosclerosis severity and cardiovascular events. In conclusion, we believe that these markers should be evaluated in patients with BD in future studies. References

Is Arterial Stiffness a Predictor of Cardiovascular Disease in All Patients With Psoriasis

We read the article by Balta et al entitled ‘‘Aortic Arterial Stiffness is a Moderate Predictor of Cardiovascular Disease in Patients With Psoriasis Vulgaris’’ with interest. They enrolled 32 patients with psoriasis vulgaris. Patients who were receiving lipid-lowering therapy, antihypertensive or antiaggregant drugs, nitrates, or long-term systemic steroids were excluded. They concluded that patients with psoriasis had higher high-sensitivity C-reactive protein (hsCRP) level and pulse wave velocity (PWV) compared with controls. In patients with psoriasis, PWV correlated positively with age, sex, body mass index, diastolic blood pressure, and hsCRP level. The PWV was not associated with psoriasis area and severity index and duration of disease. Balta et al evaluated only 32 patients with psoriasis vulgaris but several clinical types of psoriasis have been described. Additionally, the patients who received medical treatment were excluded from their study. However, in daily practice, a significant number of patients with psoriasis receive various topical or systemic treatments. Therefore, the study does not exactly represent the real-world situation. A study design including increased number of patients with different types of psoriasis who receive treatment may be more representative. Such a study may help better understand the relationship between arterial stiffness, atherosclerosis, inflammation, and psoriasis.

Nutritional anemia in reproductive age women with postadolescent acne

Abstract Context: Postadolescent acne has been defined as the presence of acne beyond the age of 25 years. Postadolescent acne affects approximately 14% of women between the ages of 25 and 50 years. Namely, postadolescent acne usually occurs in women of reproductive age. Nutritional anemia occurs from an insufficient intake of nutrients such as iron, folate and vitamin B12. It is very common in women of reproductive age. Nutritional anemia causes irritability, apathy, fatigue, depressive symptoms and difficulty in concentration. The major etiological factor in adult acne can be increased levels of emotional stress, leading to increase in adrenal androgens. Thus, nutritional anemia may aggravate the lesions of acne by affecting the emotional status in women of reproductive age. Objective: We aimed to investigate the relationship between postadolescent acne and nutritional anemia in this study. Materials and methods: The study population comprised of 52 patients with postadolescent acne and 52 healthy control subjects. Hemogram, vitamin B12, folate, serum iron, ferritin and total iron-binding capacity (TIBC) were measured. Results: No significant differences were observed between both groups in hemoglobin, vitamin B12, serum iron, ferritin and TIBC levels. Serum folate levels were significantly decreased in postadolescent acne patients (p < 0.001). There were no significant correlations between hemoglobin, vitamin B12, folate, serum iron, ferritin and TIBC levels and acne severity. Discussion and conclusion: We could not find any relationship between postadolescent acne and nutritional anemia in our study. However, serum folate levels were decreased in postadolescent acne patients. Prospective research studies are needed to clarify the role of nutrition in the pathophysiology of postadolescent acne. We think that nutritional interventions can be inexpensive, safe, easy to administer and generally acceptable to patients with postadolescent acne.