Güzin Özarmağan

HLA in alopecia areata

Abstract

Intermittent use of topical dimethyl sulfoxide in macular and papular amyloidosis

Background Severe and therapy‐resistant pruritus is the most prominent feature of macular (MA) and lichen (LA) amyloidosis that leads to further amyloid deposition by recurrent frictional trauma to the epidermis. Of the various therapeutic modalities with variable success, the most encouraging and beneficial effect has been observed with topical dimethyl sulfoxide (DMSO) therapy. In a previous study, we achieved marked clinical improvement in nine of 10 patients in a daily treatment regimen over 6–20 weeks, but relapses occurred in the post‐treatment follow‐up period. The aims of this study are to investigate whether the patients would benefit from intermittent therapy and to determine the optimal application interval of DMSO to maintain the relief of symptoms.

Topical provocation in 27 cases of cotrimoxazole-induced fixed drug eruption.

The purpose of this study was to investigate the usefulness of topical provocation in the diagnosis of cotrimoxazole‐inducedxed‐drug eruption (FDE). 27 patients with established cotrimoxazoleinduced FDE by oral provocation and 20 healthy controls were tested with drugs at increasing concentrations in white petrolatum and dimethyl sulfoxide (DMSO) both on previously involved and uninvolved skin sites. Tape‐stripping occlusive patch testing in petrolatum remained negative in 19 tested patients. Open testing with drug preparations in DMSO revealed positive results in 25 of 27 tested patients. 1 patient showed an additional positive reaction on previously uninvolved skin. Lesions on male genitalia and on face reacted to testing once with 10% or 20% of the suspected drug, whereas repeated testing with concentrations up to 50% was necessary in lesions on trunk & extremities. Open testing with drug preparations in DMSO at concentrations of 10%, 20% and 50% and pure DMSO remained negative in 20 healthy controls. The present study shows that repeated open testing with graded concentrations of the drugs up to 50% in DMSO is a reliable test method in sulfamethoxazole/trimethoprim‐induced FDE. Patients and physicians should be aware of the transient irritant reaction to DMSO that is not infrequent, so as to avoid false‐positive interpretations.

Systemic allergic dermatitis from chromium in a multivitamin/multimineral tablet.

A 43-year-old non-atopic lawyer presented with a 10-year history of recurrent vesicular eczema on his hands, wrists, feet, ankles, and lower legs mainly after wearing leather gloves, shoes, or boots. Wearing dark coloured socks worsened his foot eczema. He was aware of no other aggravating factor. Patch testing was performed with the extended European baseline series, and with series of preservatives, emulsifying excipients, fragrances, and leather including leather dyes (Brial Allergen, Greven, Germany) using IQ-Chamber® (Chemotechnique Diagnostics, Vellinge, Sweden). Using International Contact Dermatitis Research Group (ICDRG) criteria, a +++ positive reaction developed to potassium dichromate (0.5% pet.), a ++ positive reaction to cobalt chloride (1% pet.), and a + reaction to nickel sulfate (5% pet.), chromium sulfate (0.5% pet.), ammoniated mercury (1% pet.), and phenylmercuric acetate (0.01% pet.) on D2, D3, and D4. The metal and mercury compounds were of past relevance; the former having caused eczema on contact areas of metals such as eyeglass frame or wrist watch, and the latter from use of mercurochrome in the past. He had had no exposure to these for at least a year and he had never used wet cement. In spite of further avoidance of contact with metals, leather, dark coloured textiles, dyes, and a low chromate and nickel diet for the next 1 month, the lesions failed to improve. At that point, the patient reported the daily use of 1–2 multivitamin/multimineral tablets (ONE-A-DAY® Men’s, Leiner Health Products, USA, imported by Bayer Türk Kimya San. Ltd. Şti., Istanbul, Turkey) for the previous 2–3 months. The preparation contained 150 μg chromium chloride as well as 9 μg vitamin B12 (cyanocobalamin) but no nickel. Within 10 days after discontinuation of the tablets and treatment with topical corticosteroids, his eczema resolved completely. After an eczema-free interval of 3 months, systemic challenge with the multivitamin/multimineral tablets one daily orally for three consecutive days resulted in recurrence of acute vesicular eczema on previously involved sites within 2D. A flare in the previous patch test sites was not observed. The tablets were stopped again, and lesions resolved within 10D. Additional patch testing with chromium chloride could not be performed. There was no recurrence of the eczema during a 6-month follow-up.

TUR‐PSO: A cross‐sectional, study investigating quality of life and treatment status of psoriasis patients in Turkey

Psoriasis is a common inflammatory disease that has a severe impact on quality of life. There is lack of data regarding epidemiological and clinical features of psoriasis patients in Turkey, a country with a population of 76 million. The aim of this study was to define the demographic and clinical characteristics, quality of life and treatment patterns of psoriasis patients in Turkey. A cross‐sectional observational study was conducted at 40 centers, chosen from geographically diverse locations in Turkey. Patients diagnosed with psoriasis were assessed by investigators who were specialists of dermatology using standardized study questionnaire forms. Dermatology Life Quality Index (DLQI) and EuroQol‐5 dimension (EQ‐5D) forms were also filled out by each patient. 3971 psoriasis patients were included in this study. 24.2% of plaque psoriasis patients had moderate to severe psoriasis (Psoriasis Area and Severity Index, ≥10). Mean DLQI was 7.03 ± 6.02; quality of life was moderately, severely or very severely affected in 49.2% of patients. The most severely affected component of EQ‐5D was anxiety/depression. Among all patients, 22.9% were not receiving any treatment, 39.8% were receiving only topical treatment, 11.5% were on phototherapy, 26.1%, were taking conventional systemic agents and 4.1% were on a biologic treatment. 31.3% of psoriasis patients with moderate to severe disease were treated with only topical agents and only 30.5% of moderate to severe psoriasis patients were receiving systemic therapy. Moderate to severe psoriasis has a considerable impact on quality of life. Treatment in Turkey of patients with moderate to severe psoriasis is insufficient.

Reticulate acropigmentation of Kitamura: a case report.

A Turkish female patient from Eastern Anatolia is described with the clinical and histopathological features of reticulate acropigmentation of Kitamura (RAK). The brother of the patient, who has similar clinical features, refuses to give a biopsy specimen. No similar lesions are noted on the other members of the patients family. We have found the case worthwhile to report, since case reports on RAK from ethnic groups other than Japanese are still rare at present.

Sexually transmitted infections in Turkey

Turkey is a Moslem country where lay knowledge regarding sexually transmitted infections (STIs) is poor. Surveillance arrangements are limited, and frequently ignored, with the result that the true incidence of STIs is unknown. The prevalence of syphilis is definitely increasing, and probably that of the other infections is too. Modern diagnostic techniques are not widely deployed and there is little standardization of medical arrangements. However, there has been a high level of governmental involvement in HIV prevention in recent years and it is now believed that most HIV transmission in Turkey is by the heterosexual route.