Gamze Erfan

Distinct temperament and character profiles in first onset vitiligo but not in alopecia areata

Alopecia areata (AA) and vitiligo (V) are diseases that are correlated with psychiatric disorders before, during and after diagnosis. The Temperament and Character Inventory (TCI) is a well‐established approach for investigating personality traits in various psychosomatic diseases. The aim of this study is to compare and investigate the differences in the TCI between patients with first onset AA, patients with V and healthy controls (HC). Participants in the study included 42 patients with first onset AA, 50 adult patients with V and 60 HC who had no history or diagnoses of psychiatric or dermatological disorders. All participants were assessed with the TCI and the Dermatology Life Quality Index (DLQI). Among the temperament traits, the extravagance, disorderliness and total novelty‐seeking scores were lower, and the worry and pessimism scores were higher in patients with V compared with patients with AA and the HC. The mean score of the enlightened second nature and the total self‐directedness score of the character traits were higher in patients with V compared with patients with AA and the HC group. In the AA group, there was a negative correlation only between the reward dependence total score and the DLQI score. This study suggests that patients with first onset V have a distinct temperament, such as being unenthusiastic and unemotional, and character profiles, such as worry and pessimism, independent of their psychiatric comorbidities, and patients with AA do not have a different personality from the non‐affected population.

Decreased ovarian reserve in female Sprague-Dawley rats induced by isotretinoin (retinoic acid) exposure.

Isotretinoin is a retinoid widely used for the treatment of severe nodulocystic acne. Although it has broad side effects, there is no well-designed study about its effects on the ovary. This study investigated possible toxic effects of isotretinoin on female gonads. A total of 30 female rats were randomly divided into three equal groups according to the dose of isotretinoin they were administered: 0 mg/kg/day (group 1), 7.5 mg/kg/day (group 2) or 15 mg/kg/day (group 3). Thirty days after the treatment, the effects of isotretinoin on the ovaries were evaluated with serum anti-Müllerian hormone (AMH) concentrations, apoptosis by TUNEL assay and immunohistochemical observations by proliferating cell nuclear antigen (PCNA). The percentage of atretic follicles was calculated for each stage of folliculogenesis. The serum AMH concentrations were found to be lower in both isotretinoin groups. The percentage of atretic follicles in both isotretinoin groups was higher than the control. The number of PCNA-positive granulosa cells was decreased in the isotretinoin groups. The number of ovarian follicles with apoptotic granulosa cells was increased in the experimental groups. These data are the first to identify that exposure of isotretinoin may be responsible for decreased ovarian reserve and toxic effects on rat ovaries.

Generalized papular and sclerodermoid eruption: Scleromyxedema

Scleromyxedema (SM) is a rare chronic progressive and highly intractable cutaneous disease with unknown etiology, affecting both genders equally between 30 and 50 years. The disease is characterized with mucin deposits in the skin and/or other organs. In fact it is a clinicopathological subset of lichen myxedematosus (LM) according to a new classification. Sclerodermiform plaques and lichenoid papules are characteristic cutaneous lesions. An elevation of IgG λ (lambda) chain exists in most cases and extracutaneous involvement occurring with variable systemic findings is also detected. Generalized form is quite difficult to treat and may even be fatal. Herein, we present a male patient with typical features of generalized papular and sclerodermoid LM variety and with benign outcome by isotretinoin.

Reduced serum brain-derived neurotrophic factor in patients with first onset vitiligo

Purpose Vitiligo is an acquired pigmentary skin disease that can cause serious cosmetic problems. There have been numerous and well established studies that have demonstrated the comorbidity of various psychiatric disorders in patients with vitiligo. However, to our knowledge, there have been no studies investigating whether a psychiatric biomarker, such as brain-derived neurotrophic factor (BDNF), is associated with vitiligo. Patients and methods This study was conducted in Namık Kemal University Medical Faculty, Departments of Dermatology and Psychiatry between January 2013 and September 2014. After meeting inclusion and exclusion criteria, serum BDNF levels were assayed in 57 patients with first onset vitiligo and no known current or past psychiatric disorder and compared with BDNF levels in 58 age and sex matched healthy subjects. Results The age and female/male ratios were similar between groups. The mean values of serum BDNF were 1.57±0.97 ng/dL and 2.37±1.73 ng/dL in the vitiligo group and in the healthy control group, respectively. The mean BDNF level was significantly higher in the healthy control group compared with the vitiligo group (t=2.76, P=0.007). Conclusion This is the first study to compare serum BDNF levels between patients with vitiligo and healthy subjects. The reduced level of serum BDNF in patients with vitiligo may be directly related to the etiology of vitiligo or associated with the high percentage of psychiatric disorders in that patient population. Further studies are needed to support our preliminary results.

Precipitation and exacerbation of psoriasiform eruption due to leuprolide acetate

Dear Editor, A 44-year-old woman who had no personal or family history of psoriasis presented with a 4-week history of erythematous multiple plaques on her extremities. The patient had a history of using tamoxifen for 18 months and a single leuprolide acetate injection (Lucrin Depot-3M) following mastectomy and chemotherapy for breast cancer, which had been diagnosed 2 years prior. Skin eruption started 2 weeks after her first leuprolide acetate injection. Physical examination revealed that erythematous plaques of various sizes with scales were present on the patient’s extremities (Fig 1a), her body mass index was 29.3, and other clinical and laboratory findings were normal. Histopathologically, there was parakeratotic hyperkeratosis with irregular acanthosis, thinning of the granular layer and a neutrophilic microabscess within the stratum corneum (Fig 2). Her Psoriasis Area Severity Index (PASI) was 1.3 and the plaques were treated with topical corticosteroids and emollients for 3 weeks. According to hormonotherapy protocol, leuprolide acetate was re-administrated in the third month after the first injection, resulting in the recurrence of skin symptoms (PASI, 3.4) within 1 week. In 3 months, the eruptions were resistant to topical treatment. Despite the ongoing psoriasiform eruptions (PASI, 2.4), she was administrated a third dose. Psoriatic plaques exacerbated (PASI, 6.2) within 10 days (Fig 1b). Leuprolide acetate treatment was stopped and only tamoxifen was continued as cancer therapy. Over the next 3 months, the plaques responded to narrowband ultraviolet B phototherapy. At 1 year of follow up after treatment, the patient had no skin lesions (Fig 1c). Drugs may result in precipitation of psoriasis in people without family history or in exacerbation of pre-existing disease. Naranjo et al. proposed the use of a “probability scale” to obtain an evidence-based classification for adverse drug reactions. Our patient’s probability scale score was 6. Tsankov et al. defined five important points for the diagnosis of drug-induced or drug-aggravated psoriasis. According to these points, in our case, the psoriatic eruption started 2 weeks after the first administration of leuprolide acetate and exacerbated within 10 days after each re-administration. In none of the eruptions did the patient have any history of other drugs and clinical or laboratory findings of infection. Tamoxifen was the only drug that had been used 18 months before eruption and is still in current use. Tamoxifen and infections were not evaluated as triggering factors because of these events. Withdrawal of leuprolide acetate was followed by improvement of psoriasis and the patient had no recurrence of skin lesions at 1 year of follow up. Regulation of estrogen function is the major target for breast cancer therapy in premenopausal patients and can be manipulated by gonadotropin-releasing hormone (GnRH) analogs or Figure 2. Histopathological examination of the lesion. Parakeratotic hyperkeratosis with irregular acanthosis, thinning of the granular layer and a neutrophilic microabscess within the stratum corneum is noted (hematoxylin–eosin, original magnification 9100).

Acitretin-induced spiny follicular hyperkeratosis.

Abstract Spiny follicular hyperkeratosis (SFH) is follicular flesh-colored hyperkeratotic spicules that are linked to different situations including drug reactions. Previously suspected drugs are BRAF inhibitors and cyclosporine. We described a 51-year-old psoriasis patient with SFH who had been using acitretin.

Effect of left ventricular diastolic function of psoriasis

The objective of our study was to evaluate the diastolic left heart functions of patients with no known cardiovascular disease via tissue Doppler imaging method. 50 psoriasis patients along with 30 healthy individual controls were included in the study. When the psoriasis group was compared with the control group, a decrease in left ventricular early filling time (71.8±14.9 versus 81±13.8, P

The first case of Henoch-Schönlein purpura associated with rosuvastatin: colonic involvement coexisting with small intestine

Henoch-Schönlein purpura (HSP) is a systemic vasculitis affecting small vessels. It is the most common systemic vasculitis in children, and is rare in adults. Serious gastrointestinal complications are more common in childhood. Infections and drugs are the most prominent factors in the aetiology. Wall thickening in segments of the small intestine is commonly seen in imaging studies in gastrointestinal system (GIS) involvement. Simultaneous involvement of small intestine and colon is rare. An HSP case involving small intestine and colon in an adult patient due to the use of rosuvastatin, an antihyperlipidaemic agent, is presented, and is first of its kind reported in the literature.

Lichen nitidus presenting with trachyonychia.

Sir, Trachyonychia is a rare idiopathic dystrophy characterized by a lack of nail luster, longitudinal striations, distal splitting and excessive ridging.1 One nail or all may be affected and it may be related to autoimmune diseases such as vitiligo and alopecia areata. Histology also may differ according to the associated diseases. Lichen nitidus is a rare, asymptomatic, cutaneous eruption more prevalent among children and young adults with multiple, skin‐colored or erythematous papules of millimetric dimensions. The typical distribution of lesions includes the penis, genital area, abdomen and extremities. Nail and mucosal involvement and palmo‐plantar hyperkeratosis are rare clinical presentations of this disease.2 We found seven previously published cases of lichen nitidus with nail changes but were unable to find any previous reports of lichen nitidus with involvement of all twenty nails.

Alopesi Areata Hastalarında Nötrofil/Lenfosit Oranının ve Diğer İnflamatuar Parametrelerin Normal Popülasyon İle Karşılaştırılması

Objective: The objective of this study is to calculate the neutrophil-lymphocyte ratio (NLR) and other inflamatory paramaters like erythrocyte sedimentation rate (ECR) and C-reactive protein results (CRP) in Alopecia areata(AA) patients and determine the association between thoose laboratory values and AA. Method: 234 patients with AA and 37 healthy subjects were enrolled in the study. Number of neutrophil, lymphocyte, leucocyte, ESR and CRP were ascertained from patient’s medical records. NLR was calculated and recorded. Results: While the difference between patient and control groups in terms of value of Neutrophils, Leukocytes, Hb and Esr were found to be insignificant (p>0.05), numbers of Lymphocyte (p=0,02) and value of Crp ( P <0.001) in patients were found to be higher than those of healthy controls. Conclusion: This study demonstrates that NLR can not serve as a usuful marker for AA. And, as for CRP, larger-scale studies need to be done in order to demonstrate if it can serve as a marker or not.