Emin Ozlu

Neutrophil/Lymphocyte Ratio, Serum Endocan, and Nesfatin-1 Levels in Patients with Psoriasis Vulgaris Undergoing Phototherapy Treatment.

Background Psoriasis is an autoimmune, inflammatory, and chronic disease. Recent studies have evaluated serum endocan and nesfatin-1 levels in patients with inflammatory disorders. The neutrophil-to-lymphocyte ratio (NLR) is an inflammatory marker currently used in many diseases. The aim of the present study was to evaluate NLR, serum endocan, and nesfatin-1 levels in psoriasis vulgaris before and after narrow-band ultraviolet B (NB-UVB) phototherapy treatment and compared to healthy controls. Material/Methods This study was conducted on a total of 88 cases, 39 of which had psoriasis vulgaris and 49 were healthy volunteers. Thirty-nine psoriasis vulgaris patients underwent NB-UVB phototherapy treatment for 3 months. NLR, serum endocan, and nesfatin-1 levels were measured in all psoriasis patients before and after NB-UVB phototherapy and in the control group. Results Compared with the control group, neutrophil count and NLR were significantly higher (p<0.001) in psoriasis patients before NB-UVB phototherapy. Serum endocan levels were significantly correlated with disease activity before treatment. There was no significant difference in NLR, serum endocan, and nesfatin-1 levels in psoriasis patients before and after NB-UVB phototherapy (p>0.05). Conclusions The current study shows that NLR was higher in psoriasis vulgaris patients when compared with the control group, whereas serum endocan and nesfatin-1 levels were not significantly different. In addition, NB-UVB phototherapy did not affect NLR, serum endocan, or nesfatin-1 levels. Further larger-scale studies are required on this subject.

Erythrodermic pityriasis rubra pilaris: Dramatic response to infliximab therapy

Pityriasis rubra pilaris is a chronic papulo-squamous skin disorder characterized by skin and nail involvement.[1] The exact etiology is unknown. Vitamin A deficiency, infections, trauma and impaired immune responses are among the suggested causes.[2] A variety of topical and systemic treatment options are available.[3] This case is reported due to a dramatic response obtained with infliximab therapy, when various other systemic medications failed to produce a therapeutic response.

The co-occurrence of lichen sclerosus et atrophicus and celiac disease

A 53-year-old female patient was admitted to our clinic for generalized hypo/hyper-pigmented, partially firm and sclerotic plaques with undefined borders. As the skin biopsy taken from the lesion was compatible with lichen sclerosus et atrophicus (LSA), the patient was treated with ultraviolet A1 (UVA1) treatment. Upon follow-up, she developed abdominal pain and diarrhea. Further investigation (including endoscopic and laboratory tests) showed signs consistent with celiac disease. After 30 sessions of UVA1 treatment, the skin lesions partially regressed. We present this case because the co-occurrence of LSA and celiac disease is very rare.

Comparison of TLR-2, TLR-4, and antimicrobial peptide levels in different lesions of acne vulgaris.

Abstract Context: Recent studies have shown that tolls like receptors (TLRs) and antimicrobial peptides (hBD-1, cathelicidin) play an important role in the pathogenesis of acne vulgaris (AV). Objective: To evaluate and report the expression of TLR-2, TLR-4, hBD-1 and cathelicidin in different regions of skin in AV. Participants: This study was performed in 80 patients with AV and a control group of 20 healthy individuals. Material and methods: Skin biopsies were performed from 20 papular, 20 pustular, 20 comedonal and 20 nodular lesions of patients and 20 healthy volunteers. Expression levels of TLR-2, TLR-4, hBD-1 and cathelicidin in four separate areas (epidermis, dermis, inflammation region and skin appendages) were evaluated by immunohistochemical method. Further, these parameters were compared between different skin lesions. Results: A significant difference was found between the levels of staining of TLR-2, TLR-4 and hBD-1 from the epidermis, inflammation region, dermis and skin appendages (p < 0.05). Levels of cathelicidin were different in only the inflammation region (p < 0.05). The level of TLR-2 in the epidermis with nodules was lower than the papules and comedones (p < 0.05). Levels of TLR-2 in the inflammation and dermis of the cases with papules were significantly higher when compared to pustules (p < 0.05). The levels of staining of TLR-4 in the dermis with comedones were significantly lower compared to the cases with papules (p < 005). The level of hBD-1 in the epidermis region of comedones was significantly higher compared to nodules (p < 0.05). The expression of cathelicidin in the inflammation region of comedones was significantly low (p < 0.05). Conclusion: It is thought that TLR-2, TLR-4, hBD-1 and cathelicidin play an important role in the pathogenesis of AV and in the development of different acne types. We think that, better results could be obtained in treatment of AV with different treatment options targeted in regulation of TLR-2, TLR-4, hBD-1 and cathelicidin release.

Cutaneous siderosis after intramuscular iron injections: a case report.

Abstract Skin reactions against injected or implanted foreign materials are not rare. Siderosis is a disease characterized by the accumulation of iron in various tissues. Brownish-gray discoloration of the skin can be seen as a side-effect on the injection area after the parenteral iron treatment. Here, we present cutaneous siderosis case developed after multiple intramuscular iron injection on the gluteal region for iron-deficiency anemia. Development of cutaneous siderosis after intramuscular iron injection rarely has been reported in the literature before.

An investigation of cytochrome p450 (CYP) and glutathione S‐transferase (GST) isoenzyme protein expression and related interactions with phototherapy in patients with psoriasis vulgaris

Oxidative stress may play an important role in the pathogenesis of psoriasis. Glutathione S‐transferases (GSTs) make up a group of antioxidant enzymes. Cytochrome p450 (CYP) enzymes can influence oxidation and reduction reactions. We investigated the potential effects of GST and CYP enzymes in the pathogenesis of psoriasis. The study included 32 psoriasis patients and 22 healthy subjects. Psoriasis patients were administered 20 sessions of narrowband ultraviolet B phototherapy. Expressions of GST and CYP enzymes were assessed by immunohistochemical staining. Expression levels of GSTK1, GSTM1, and GSTT1 were significantly higher in psoriasis than in control tissues (P = 0.022, P = 0.001, and P = 0.006, respectively). Pre‐ and post‐treatment expression was similar. Expression of CYP1A1 and CYP2E1 was significantly higher in pre‐ (P = 0.003 and P = 0.001, respectively) and post‐treatment (P = 0.003 and P = 0.001, respectively) psoriatic tissues than in control tissues. No significant differences in CYP1B1 levels between the study and control groups were detected before treatment (P > 0.05). However, CYP1B1 levels were higher in post‐treatment psoriatic tissue than in control tissue (P = 0.045). The significant increases in expression of GSTK1, GSTM1, and GSTT1 in psoriasis may reflect the increased activation of GST in response to excessive free radical formation from activated neutrophils or ultraviolet exposure to maintain antioxidant capacity in psoriasis. Furthermore, expressions of CYP1A1 and CYP2E1 represent important enzymatic systems in psoriasis. These findings suggest that psoriasis is an oxidative stress condition, although phototherapy does not affect these enzymatic systems. Further investigation is required.

The investigation of antimicrobial peptides expression and its related interaction with methotrexate treatment in patients with psoriasis vulgaris

Abstract Background: Psoriasis is a chronic, inflammatory and immune-mediated disease. Recently, the role of antimicrobial peptides (AMPs) such as human beta defensins (hBDs) in the pathogenesis of psoriasis has been investigated. We aimed to evaluate the expression profiles of hBD-1 and hBD-2 in psoriatic skin before and after methotrexate (MTX) therapy and to compare healthy controls. Methods: Immunohistochemical expressions of hBD-1 and hBD-2 were assessed in 16 patients with psoriasis vulgaris and 20 normal skin biopsies from healthy controls. The patients were administered a 12 week of MTX and skin biopsy samples were obtained from the lesional skin of the patients pre-/posttreatment and normal body of the healthy controls. Results: The median (range) Psoriasis Area and Severity Index (PASI) value was 21.6 (8.2–27.7) before the treatment whereas; 3.05 (1–23.4) after the treatment. hBD-1 expression in psoriasis patients was significantly higher as compared to the healthy controls before treatment (p < 0.01). No significant difference was observed between psoriasis patients and healthy controls in terms of hBD-2 expression before treatment (p > 0.05). No significant difference was observed between before–after MTX treatment in terms of hBD-1 and hBD-2 expression levels in psoriasis patients (p > 0.05). Conclusions: These findings suggest a role for hBD-1 in psoriasis pathogenesis. But MTX treatment does not affect on hBD-1 and hBD-2 expressions. Further studies are needed to assess the roles of these AMPs in psoriasis etiopathogenesis.

Effective treatment of Fox-Fordyce disease with pulsed dye laser.

Dear Sir, Fox–Fordyce disease (FFD) is a rare inflammatory disorder of apocrine sweat glands, which is clinically characterized by smooth, uniform, firm, folliculocentric, yellow skin-colored papules on apocrine gland-bearing areas (1). Etiology of FFD is still unclear, but epidemiologic data support the role of hormonal component (1, 2). FFD is a treatment-resistant disease, and no certain treatment method has been proven to be curative. Topical and intralesional glucocorticoids, topical and systemic retinoids, topical clindamycin, topical pimecrolimus cream, benzoyl peroxide, oral contraceptives, oral isotretinoin, and ablative lasers have been reported with varying efficacy portion. In recalcictrant cases, mechanical destruction or removal of the apocrine glands can be offered. Pulsed dye laser is a gold standard treatment method for vascular lesions which was first used in the treatment of telangiectatic chronic erythema in 1996 (3). Today, we can use this laser in many different indications both in vascular, inflammatory, and tumoral etiology (4, 5). Effect of this laser has not been reported in the literature before. We want to present a young female patient with Fox–Fordyce disease with good response to pulsed dye laser. A 17-year-old female patient admitted to our outpatient clinic with a 2-year history of no hair growth and no sweating on bilaterally axillar region with excessive itching. Dermatological examination revealed multiple, follicular, skin-colored, 1to 2-mm-diameter papular lesions on bilateral axillary fossa (Fig. 1). Histopathological examination revealed mild dilatation and mild fibrosis in eccrine sweat glands, perifollicular fibrosis and chronic inflammation (Fig. 2). She was diagnosed as FFD with her histological and clinical examinations and topical clobetasol propionate ointment was initiated. In second month of this therapy, no remission was detected and topical pimecrolimus was offered but she could not use this therapy because of irritation. We started pulsed dye laser application (585 nm), 6 weeks apart, with 8 J/cm and after first session both hair growth and sweating were detected, after third session itching was significantly decreased (Figs 3 and 4). We evaluated the clinical response by hair growth clinically and symptomatic decrease of pruritus. The severity of itching was evaluated with visual analog scale which was 10/10 at the beginning and we observe a slow decrease in itching after every session. Her VAS score was 9/10 after first session, 8/10 after second session, 7/10 after third session, 6/10 after fourth session, and 5/10 after fifth session. After sixth session, her itching was 3/10 and almost total remission was detected in pruritus after

A comparative study of MMP‐1, MMP‐2, and TNF‐α expression in different acne vulgaris lesions

Many inflammatory mediators and cytokines play important roles in the pathogenesis of acne vulgaris (AV). Information about the roles of these factors in the pathogenesis of the disease is limited. The purpose of this study was to evaluate levels of matrix metalloproteinase‐1 (MMP‐1), MMP‐2, and tumor necrosis factor‐α (TNF‐α) in AV lesions. We selected 80 patients who presented at our dermatology department with AV. Their lesions included papules, pustules, nodules, and comedones. Each specimen was evaluated by histopathology with hematoxylin and eosin staining, and subsequently by immunohistochemical analysis for MMP‐1, MMP‐2, and TNF‐α antibodies. A statistically significant difference between lesion groups emerged for MMP‐1 (P = 0.012) and TNF‐α (P = 0.029) scores. The MMP‐1 score was highest in nodules and lowest in comedones. The TNF‐α score was also highest in nodules but lowest in papules. We conclude that different levels of MMP expression can contribute to the development of different types of acne lesion and that the amount of TNF‐α released may contribute to lesion development. Further studies of novel treatment modalities might evaluate the different clinical types of AV.

Evaluation of Cardiovascular Risk Factors, Haematological and Biochemical Parameters, and Serum Endocan Levels in Patients with Lichen Planus.

Background and Objective: The current study aimed to evaluate cardiovascular risk factors, haematological and biochemical parameters, and serum endocan concentrations in lichen planus (LP) patients. Methods: This study was conducted with 86 cases, including 43 LP patients and 43 healthy controls. Cardiovascular risk factors, haematological and biochemical parameters, and endocan levels were evaluated. Results: The serum endocan concentrations of LP patients were not significantly different from those of the healthy controls (p > 0.05). There were no significant differences in the serum endocan levels according to classification by cardiovascular risk factors and smoking history (p > 0.05). In the LP group, white blood cell count, platelet distribution width and monocyte count/high-density lipoprotein cholesterol ratios were significantly higher when compared to the healthy controls (p < 0.05). The LP group had a lower mean platelet volume than the healthy controls (p < 0.05). Conclusions: Serum endocan levels did not change significantly in patients with LP, and there were significant differences in haematological and biochemical parameters.