Gülcan Saylam Kurtipek

Increased tumor necrosis factor alpha (TNF‐α) and interleukin 1 alpha (IL1‐α) levels in the lesional skin of patients with nonsegmental vitiligo

Increased tumor necrosis factor alpha (TNF-α) and interleukin 1 alpha (IL1-α) levels in the lesional skin of patients with nonsegmental vitiligo Dear Sir, Depigmentation in vitiligo is caused by melanocyte destruction. There are different hypotheses including neural, selfdestruction, and immune hypotheses to explain the pathogenesis of vitiligo There is growing evidence that cytokines are important in the depigmentation process of vitiligo. Granulocytemacrophage colony-stimulating factor (GM-CSF), endothelins, b-FGF are the mitogens for melanocytes whereas TNFα, IL1α, IL-6, TGFβ are the potent inhibitors of melanocyte growth. IL1α is remembered as one of the cytokines of inflammation, and is also known as a B-cell activating factor. It produces similar biological effects with TNF α and is produced in most inflammatory and immunological diseases. b-FGF, produced by fibroblasts and epidermal keratinocytes, is a polypeptide and is capable of promoting angiogenesis and mitogenesis through autocrine and paracrine mechanisms. The role of peripheral blood and lesional cytokine expression in patients with vitiligo has not been clarified yet. Herein we wanted to investigate the levels of cytokines in the skin and serum of vitiligo patients and to compare them with the levels in healthy controls. Six female and 18 male vitiligo patients aged (32 years ± 17 SD) were enrolled in the study after giving informed consent. Thirteen (54.2%) had symmetrical generalized, seven (29.2%) had acrofacial, and four (16.7%) had focal vitiligo. Six (25%) had progressive and 18 (75%) had stabile vitiligo (no new depigmentation had been observed for more than 3 months). Fourteen ageand sex-matched healthy volunteers consisted the control group. Samples of peripheral blood from patients and healthy volunteers were collected by venipuncture. Serum was separated and stored at −70 °C before use. Four-millimeter punch biopsies were taken in all patients from lesional skin and nonlesional skin (at least 3 cm far from lesional biopsy) and from healthy volunteers. The biopsies were frozen in liquid nitrogen (−196 °C) and preserved at −70 °C. Levels of IL1α, TNFα, and b-FGF were measured with specific ELISA kits (Biosource International, Camarillo, California, USA) according to the manufacturer’s instructions. Skin cytokines were measured as described by Lowry et al. Level of the cytokines were expressed as μmol/mg protein. Statistical analysis was carried out using spss 10.0. Differences in values of cytokine amount between lesional vs. healthy volunteers, nonlesional vs. healthy controls, serum of patients vs. serum of healthy volunteers were carried out using Mann– Whitney U-test. The parameters of lesional vs. nonlesional skin were analyzed by the Wilcoxon-signed rank test. P-value of less than 0.05 was considered to be statistically significant. The mean (± SD) values of IL1α, TNFα, b-FGF in lesional, nonlesional, healthy skin, and the serum from healthy controls and the study group are given in Table 1. The expression of IL1α and TNFα was significantly higher in lesional skin than in nonlesional skin in patients with vitiligo (P = 0.007 and P = 0.002), respectively. The exact mechanism how cytokines effect pigmentation is not fully understood. The different hypotheses are: (a) TNFα induces IL1α promoting B-cell differentiation and immunoglobulin production. (b) Cytokines such as IFNγ, TNFα, TNFβ, IL1α, and IL-6 can induce cell surface ICAM-1 on melanocytes which is necessary for leukocyte–melanocyte attachment. ICAM-1 may also induce B-cell activation, increasing autoantibody production and may cause melanocyte damage in vitiligo. (c) TNFα and IL1α also have the capacity to induce apoptosis in many cell types. (d) Melanogenesis is also inhibited by TNFα through an inhibitory effect on tyrosinase and tyrosinase related protein. Moretti et al. found increased levels of IL-6 and TNFα in the epidermis of lesional skin compared with the healthy controls. Swope et al. investigated the role of epidermal cytokines in pigmentation and found that IL1α, TNFα, and IL-6 elicited a dose-dependent decrease in the activity of the enzyme tyrosinase of cultured normal human melanocytes and also inhibited melanocyte proliferation. Ozdemir et al. demonstrated increased skin blister fluid b-FGF levels and serum levels in vitiligo patients compared with healthy controls and proposed that b-FGF plays a role in the pathogenesis of vitiligo. However,

Response to vaccination against hepatitis B in patients with Behcet's disease

Background and Aim:  Hepatitis B virus infection is an important public health problem in Turkey. Although hepatitis B vaccination is regarded as safe and effective for the general population, recommendations for hepatitis B immunization in patients with Behcets disease are not clear. The aim of the present study was to elucidate the response of patients with Behcets disease to hepatitis B vaccination and to determine whether hepatitis B vaccination has any adverse effects on the course of the disease.

Suction bullae as a complication of prolonged cupping

managed using topical steroids alone. Further UVA1 treatment has been contemplated, but there are practical problems for the patient of travelling long distances for treatment. Patient 2. A 47-year-old woman had a 7-year history of DLE, consisting of erythematous plaques affecting the face and trunk. Repeated autoimmune screens were negative. Previous unsuccessful treatments included antimalarials (hydroxychloroquine and choroquine), methotrexate, thalidomide, azathioprine, auranofin, clofazimine, isotretinoin, mycophenolate mofetil, systemic corticosteroids (oral and intravenous) and cyclophosphamide (oral and pulsed). Treatment with UVA1 was commenced using the same regimen as for patient 1. After 15 exposures (cumulative dose 81.3 J ⁄ cm), there was no improvement, and treatment was discontinued. The skin remained difficult to control with oral steroids and the patient was admitted to hospital 3 months later with an exacerbation of her skin condition. Treatment with efalizumab was commenced and further outcome is awaited. UVA1 was first shown to be effective in the New Zealand hybrid mouse model of SLE; it reduced autoantibody levels, decreased splenomegaly and prolonged survival in irradiated mice. Since then, there have been two small randomised, double-blind, crossover studies using low-dose UVA1 (6 J ⁄ cm) in mild-to-moderate SLE. In the first study, 26 patients received either UVA1 or placebo 5 times weekly for 3 weeks. UVA1 improved disease activity and was thought to have a greater beneficial effect than placebo. Resistance and sometimes exacerbation of ‘discoid LE lesions’ was noted in these SLE patients. In the second study, 11 patients received either UVA1 or placebo 5 times weekly for 3 weeks followed by a 9-week washout period. A significant improvement was detected with UVA1 but no statistical difference was seen compared with placebo. The next randomised controlled trial was the only study to show significant statistical outcome compared with placebo. Higher doses of UVA1 (12 J ⁄ cm) were used as an adjuvant therapy in 12 patients with moderate SLE, and showed that UVA1 was significantly more effective than placebo when measured by the SLE Activity Measure but not by the SLE Disease Activity Index. There is only one previous report of successful UVA1 treatment for ‘discoid lupus lesions’ in an SLE patient, by a presumed systemic action as the skin lesions were covered during treatment. Our limited experience suggests a highly variable response in DLE patients to low-dose UVA1. UVA1 for recalcitrant DLE seems reasonable based on initial use in SLE although further study in SLE is awaited. Treatment with UVA1 in DLE patients should only be continued if clear improvement is demonstrated and should be discontinued early if ineffective to prevent long-term complications of cutaneous lupus and phototherapy. Clinical trials using UVA1 in DLE patients are required to establish if there is a definite role for phototherapy in management of the condition.

The Frequency of Autoimmune Thyroid Disease in Alopecia Areata and Vitiligo Patients

Aim. Many studies demonstrated that alopecia areata (AA) and vitiligo are commonly associated with autoimmune thyroid diseases. We aimed to investigate the frequency of thyroid dysfunctions and autoimmunity related with vitiligo and AA. Material and Methods. 200 patients, 92 AA and 108 vitiligo diagnosed, were surveyed retrospectively. The control population was in reference range and from Konya, central Anatolian region of Turkey. Thyroid function tests (free T3, free T4, and TSH) and serum thyroid autoantibody (anti-TG, anti-TPO) levels were evaluated in all patients. Results. In vitiligo patients, 9 (8.3%) had elevated anti-TG levels and 16 (14.8%) had elevated anti-TPO, and in 17 patients (15.7%) TSH levels were elevated and 3 (2.8%) patients had elevated fT4 levels and 5 (4.6%) had elevated fT3 levels. Within AA patients, 2 (2.2%) had anti-TG elevation and 13 (14.1%) had anti-TPO elevation, in 7 patients (7.6%) TSH were elevated, and in 1 patient (1.1%) fT4 were elevated and 5 (5.4%) patients had elevated fT3 levels. Conclusion. In our study, impaired thyroid functions and thyroid autoantibodies in vitiligo and AA patients were identified at lower rates than the previous studies. According to results of this study there is no need for detailed examination in alopecia areata and vitiligo patients without clinical history.

Plasma‐soluble urokinase plasminogen activator receptor (suPAR) levels in Behçet's disease and correlation with disease activity

Soluble urokinase plasminogen activator receptor (suPAR), a new biomarker, is a soluble form of membrane‐bound receptors secreted from different immune cells. The aim of the present study is to determine plasma suPAR levels in Behçets disease and their correlation with disease activity.

GEOGRAPHIC TONGUE THAT RESPONDS TO THE TREATMENT OF PREGABALIN: CAN IT BE A NEW TREATMENT CHOICE?

Geographical tongue, also known as benign migratory glossitis or erythema migrans, is a benign dermatosis whose spesific etiology is not known due to the disappearance of central erythematous and filiform papillaries surrounded by a hyperkeratotic ring forming the geographical shape on the tongue. In treatment, topical corticosteroids may be recommended for symptomatic relief. Pregabalin is a drug with, GABA analog structure. Pregabalin is a drug used and investigated in epilepsy, neuropathic pain, anxiety, and sleep disorders. We reported in a patient with geographical tongue successfully treated with pregabalin. We believe that geographic tongue lesions that do not have an effective treatment option in the future may be a new and successful treatment option supported by pregabalin treated case series and prospective studies. This article is protected by copyright. All rights reserved.

What is your diagnosis 2

Yirmi yaşında erkek hasta göğüs ön duvarında 2 yıl önce başlayıp giderek artan çok sayıda kabarıklık şikayeti ile polikliniğimize başvurdu. Öz ve soygeçmişinde herhangi bir özellik yoktu. Dermatolojik muayenesinde göğüs ön yüzde deri renginde 1-3 mm çapında 7-8 adet multipl papülleri mevcuttu (Resim 1). Tanı için alınan biyopsi örneğinin histopatolojik incelemesinde retiküler dermiste düzleşmiş skuamöz epitelyum ile döşeli kist lezyonu izlenmekteydi (Resim 2a). Kist kavitesinde lameller keratinöz materyal ve kıl şaftları mevcuttu (Resim 2b).

Knowledge, Beliefs and Attitudes of Patients with Verruca Vulgaris About the Disease

Objective: The purpose of this study was to learn the opinions of the patients with nongenital verruca vulgaris about the cause, course and treatment of verruca and their sources of information. Methods: A total of 187 non-genital verruca patients over 15 years old were included in the study. Their ideas about the cause, ways of transmission and treatment, and the sources they referred for information about the disease were recorded. Results: Of the participants, 44.4% thought it was contagious, 3.2% thought it was genetically inherited and 11.8% thought that is was not a disease. Seventy six of the patients (40.6%) had no idea about the subject. When the causes of verruca was questioned, 88 patients (47.1%) replied that it is a virus, 12 patients (6.4%) thought that it was transmitted by frogs, 4 patients (2.1%) thought that it was transmitted by turtles and 83 patients (44.4%) thought that it was transmitted by other reasons. Forty five of the patients (24.1%) tried conventional treatment methods previously. Of them, 16 (35.5%) had the verruca prayed, 7 (15.5%) applied fig sap, 6 (13.4%) applied vaseline/ toothpaste, 6 (13.4%) applied acid on it, 4 (8.9%) tied it with a string, 4 (8.9%) used keratoma tape, and 2 (4.4%) cut it. Conclusion: It was determined that such a common dermatological disease is not recognized and the treatment methods are not known enough.

Widespreed Staphylococcus Folliculitis Advancing After the Usage of Epilators

Bakteriyel follikülit kıl follikülünün yüzeysel veya derin enfeksiyonudur. Stafilokokkus aureus follikülite neden olan en yaygın ajandır. Bakteriyel follikülite eğilim yaratan faktörler derinin oklüzyon, maserasyon ve aşrı hidrasyonunu içerir. Kılların traşlanması, kökünden koparılması ve parafinlenmesi, topikal kortikosteroidlerin kullanılması, sıcak ve nemli iklim ve diabetes mellitus kişilerde follikülite eğilime neden olabilir.