Emine Tamer

Prevalence of skin diseases among pediatric patients in Turkey

The pediatric population is composed of persons under 16 years of age, and few studies are available on the dermatological diseases of this group. In the present study, data on a total of 6300 pediatric patients admitted between the years 2004–2006 were analyzed. Hospital‐based patient registry records were used for data collection. The data were analyzed according to age, sex and time of admittance. A female preponderance (53%) was observed, and adolescents (12–16 years old) constituted the largest group within the patient population (47.6%). A total of 125 dermatoses were recorded. Acne vulgaris was the most prevalent dermatosis (12.4%), followed by atopic dermatitis (11.8%), contact dermatitis (11.3%), warts (9.5%), seborrheic dermatitis (4.3%) and impetigo (4.1%). Atopic dermatitis was the most frequently seen dermatosis in both infants and preschool‐age children, whereas contact dermatitis was more prevalent in school‐age children, and acne vulgaris was more prevalent in the adolescent group. The frequencies of some diseases showed seasonal variations. Acne vulgaris, atopic dermatitis, contact dermatitis, psoriasis, xerosis and alopecia areata were more common in winter. In contrast, insect bites, vitiligo, dyshidrotic eczema, impetigo and tinea corporis were more common in summer. Studies of the pediatric population, which constitutes the cornerstone of the community, can play an important role in determining the policies of protective medicine and public health. New studies will help us to better understand the frequency of dermatological diseases in the pediatric population according to age, gender and season, and take precautions with regard to these conditions.

Comparison of nickel patch test reactivity in phases of the menstrual cycle

Background In earlier studies, it has been shown that severity of some diseases varies with menstrual cycle. Severity of skin diseases such as atopic dermatitis, lupus erythematosus, infections due to herpes virus, urticaria and acne were also reported to increase in the premenstrual phase. Effect of estradiol on the cellular immune system was investigated and it was found to depress the cellular immune response. In our study, we investigated whether nickel patch test reactivity was different during phases of the menstrual cycle and whether there was an increase in sensitivity to nickel during the premenstrual cycle in nickel‐sensitive women.

Flare-up of pustular psoriasis with fluoxetine: possibility of a serotoninergic influence?

In this article, we report two cases of pustular psoriasis flaring up after fluoxetine administration. A 21-year-old male patient with localized pustular psoriasis became erythrodermic following commencement of fluoxetine. Even though the lesions were unresponsive to cyclosporine A (Cyc A) treatment, dramatic resolution was observed with discontinuation of fluoxetine. A 44-year-old female patient with pustular psoriasis who was on Cyc A and acitretin therapy was given fluoxetine for her psychiatric symptoms. In the following 5 days, her lesions flared. Owing to previous experience, fluoxetin was stopped. Her lesions improved dramatically in the following 3 days. Exacerbation of psoriasis with antidepressant therapy has been rarely described. An extensive review of the literature revealed four such cases, all of which were seen after the use of selective serotonin reuptake inhibitors (SSRI). A serotoninergic influence in the etiopathogenesis of psoriasis may be possible together with a pharmacogenetic difference in the drug metabolism of these patients. Considering the two patients we presented and the patients previously reported in the literature, aggravation of pustular psoriasis by SSRI should be borne in mind.

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.

Evaluation of serum uric acid levels in psoriasis vulgaris

BACKGROUND/AIM Psoriasis has been accepted as a systemic disease and it is known to be associated with various disorders including metabolic syndrome. High serum uric acid levels are also associated with the components of metabolic syndrome. In this study, we aimed to determine serum uric acid levels in patients with psoriasis and the association of uric acid levels with disease activity by taking the presence of metabolic syndrome criteria into account, since it is one of the most important factors that affect serum uric acid levels. MATERIALS AND METHODS In this cross-sectional study, we evaluated 70 psoriasis patients and 70 healthy individuals who were matched with the patients according to the presence of metabolic syndrome. We evaluated the demographic features, levels of serum uric acid, Psoriasis Area Severity Index (PASI) scores, presence of psoriatic arthritis, nail involvement, and metabolic syndrome criteria of the patients. RESULTS Serum uric acid levels of psoriasis patients were significantly higher than those of controls. There was a positive correlation between PASI scores and serum uric acid levels of the patients. CONCLUSION As hyperuricemia had a close relationship with psoriasis and PASI scores, we suggest monitoring patients with psoriasis for serum uric acid levels during treatment and follow-up.

Demographic characteristics and risk factors in Turkish patients with anogenital warts

Anogenital warts (AGW) are one of the most common sexually transmitted diseases worldwide. The determination of groups vulnerable to contracting anogenital warts (AGW) leads to the development of policies for disease control and of prevention programs. The aim of our study was to investigate the demographical features and risk factors of Turkish patients with AGW. This study included 200 patients with AGW and 200 healthy individuals as a control group. The age, gender, education and marital status, age of first sexual intercourse, number of sexual partners, sexual orientation, and smoking status were recorded in both groups. In this study, 88% of the patients were male, and 12% were female. The mean age of the patients was 35.21±0.77 years, and the majority of patients were below 35 years old (63%). Furthermore, 46.0% of the patients were educated at the university level, and 33.5% had graduated high school. No significant differences were found based on sexual orientation or condoms between the patient and control groups. In the patient group, the mean age of first sexual intercourse was significantly earlier, and the number of single individuals and sexual partners were significantly higher. Also, 61% of the patients were current smokers, which was significantly higher than the control group. The duration of smoking and the duration of AGW were found to be correlated. All patients were tested for anti-HIV antibodies, and only one patient was found to be infected. AGW were more common in patients younger than 35 years old, among men, and among those who had graduated from high school or university. Early age of first sexual intercourse, a high number of sexual partners, being single, and smoking were also risk factors for the development of anogenital warts.

A case of breast carcinoma presenting as carcinoma en cuirasse

Cutaneous metastases of internal malignities, constitute 2% of all skin tumors and is important in detecting undiagnosed malignancies and relapses of inadequately treated malignancies [1]. Carcinoma en cuirasse is a rare and unique form of cutaneous metastases, in which the cutaneous metastases cause lymphatic blockage and eventual thickening of chest wall skin, dermal and subcutaneous tissue fibrosis, resulting in armor-like wrapping of the trunk [2]. It generally occurs months to years after the diagnosis of primary cancer. However, rarely it may be the primary symptom of cancer [3].