İbrahim Halil Yavuz

Assessment of heavy metal and trace element levels in patients with telogen effluvium

Background: Despite a multitude of studies, etiology of primary chronic telogen effluvium (TE) remains incompletely understood. Essential heavy metals are associated with beneficial effects in humans as well as in other living organisms. However, they may lead to toxic effects when the exposure exceeds the higher tolerable limits. We wanted to assess the heavy metal and trace element levels in patients with chronic TE. Materials and Methods: A total of 40 subjects with chronic TE were included in the study, and 30 healthy women served as control. General and dermatological examinations were taken up in all individuals. Those patients with positive hair pull test were evaluated with the help of a trichogram. The presence of >20% telogen hair as documented by trichogram was a requirement for the study inclusion. UNICAM-929 spectrophotometry device was used for determining serum trace element and heavy metal concentrations. Results: In spite of an absence of significant differences in terms of average Zn concentration, weight, or height between patients and controls, significant differences were noted for Cd, Fe, Mg, Mn, Pb, Co, and Cu (P<0.05). Conclusion: Our results suggest that heavy metals may play a causative role in the development of chronic TE. However, contrary to previous reports, zinc did not appear to play an important etiological role, while these patients had elevated serum iron levels.

Erythema Multiforme; Sixty Six Case Series with Review of Literature

Erythema multiforme (EM) is an acute, selflimited, and sometimes recurrent skin disease considered to be a hypersensitivity reaction associated with certain medications and infections (1). EM has recently been recognized as a distinct disease differentiated from the Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) (2). However, epidemiological data on EM are limited mainly due to the acute course of the disease and the lack of a universally accepted classification system. Nevertheless, accumulating evidence indicates that the prevalence of EM is less than 1% and the disease mostly affects women between 20 and 40 years of age (3).

Clinic experience in discoid lupus erythematosus: a retrospective study of 132 cases

Introduction Lupus erythematosus (LE) is an autoimmune disease characterized by a broad range of cutaneous manifestations. Discoid LE (DLE) is the most common chronic manifestation of LE. Literature reviews show that there are a limited number of large-series studies investigating DLE. Additionally, there is still no consensus on the etiological factors of DLE such as sun exposure and smoking. Aim To evaluate the clinical and demographic characteristics of patients with DLE. Material and methods The study included patients who were hospitalized in the inpatient and outpatient clinics at the Dermatology Department. Age, gender, treatment method, history of smoking, antinuclear antibody positivity, progression to systemic lupus erythematosus (SLE), photosensitivity, and laboratory findings were recorded for each patient. Results The study included 132 patients comprising 67 (50.8%) men and 65 (49.2%) women. A family history was found in 3.8%, SLE was detected in 5.3%, and photosensitivity was revealed in 50.0% of the patients. ANA positivity was found in 23.7%, a history of smoking was revealed in 61.4%, and chronic sun exposure was detected in 42.4% of the patients. Conclusions Discoid LE, though identified long ago, remains unelucidated and there are very few studies in the literature reporting on DLE. The results indicated that smoking and chronic UV exposure are important risk factors for DLE. Moreover, although ANA positivity was high in our patients, the rate of progression to SLE was remarkably low. The results also showed that, contrary to common belief, there is no female preponderance in DLE.

Effects of omalizumab therapy on peripheral nerve functions: short observational study

Introduction Peripheral neuropathy (PN) is a common neurological condition causing symmetrical and diffuse damage in nerves. The etiology of PN includes systemic diseases, toxic exposure, medications, infections, and hereditary diseases. Omalizumab is a humanized monoclonal anti-IgE antibody that exerts its activity by binding to free IgE in circulation. Aim To investigate the relationship between omalizumab and peripheral neuropathy. Material and methods The study included 30 patients who underwent omalizumab therapy (Xolair) due to the diagnosis of chronic urticaria. A detailed neurological and physical examination was performed in each patient both before and 3 months after the therapy. Electrophysiological examination was also performed using a Medelec Synergy instrument. Results The 30 patients included 8 (26.7%) men and 22 (73.3%) women with a mean age of 37.5 ±14.14 years. No serious side effect of the medication was detected in any patient although local wound irritation occurred in 3 (10%) patients. Moreover, no change occurred in the pre-treatment Neuropathy Symptom Score (NSS) or Neurological Disability Score (NDS) of the patients and no pathological values that could result in neuropathy were observed during motor/sensory nerve conduction. However, significant changes were detected in the sensory and motor components of the nerves with regards to pre- and post-treatment values. Conclusions Omalizumab therapy caused no peripheral neuropathy in any of our patients but altered the latency, amplitude, and velocity values of the peripheral nerves.

Wiskott–Aldrich syndrome: Two case reports with a novel mutation

ABSTRACT Background: The Wiskott–Aldrich syndrome (WAS) is X-linked recessive disorder associated with microplatelet thrombocytopenia, eczema, infections, and an increased risk of autoimmunity and lymphoid neoplasia. The originally described features of WAS include susceptibility to infections, microthrombocytopenia, and eczema. Aim: In this case report, we present our experience about two cases diagnosed with a new mutation. Methods: We report phenotypical and laboratory description of two cases with WAS. Results: We, for the first time, detected a new hemizygote mutation of WAS gene (NM_000377.2 p.M393lfs*102 (c.1178dupT)) in two patients. The first case was an 11-month-old boy presenting with complaints of recurrent soft tissue infection, ear infection, anemia, and thrombocytopenia with a low platelet volume. The second case was a 2-month-old boy presenting with thrombocytopenia and a low platelet volume. Both cases were the first-degree relatives: they were cousins and their mothers were sisters. Conclusion: Herein, we report two cases of WAS and a new gene mutation which would disrupt the WAS protein function within the Polyproline (PPP) domain. This report adds to the growing number of mutations which cause complex clinical manifestations associated with WAS.

Assessment of Melanoma Risk in Acquired Melanocytic Nevi Using Digital Dermoscopic and 3-Point Checklist Score

Melanocytic nevi are benign melanocyte proliferations. They are well demarcated macula or papilla that may have the same color with the skin or may have reddish-brown, brown, or black color. Melanocytic nevi may be congenital or acquired. In white race, almost every individual have approximately 20 nevi on average (1). In a typical life cycle melanocytic nevi develop after infancy, reach a peak number in the second and third decades of life, and disappear in the seventh to ninth decades of life. In individuals with advanced age, these lesions are rare and should raise a suspicion (2,3). Even if completely ordinary, an increased number of nevi is associated with an increased risk of melanoma. Of all melanomas, nearly 25% develop on a background of melanocytic nevi. However, it is impossible to foretell which nevi will pose an increased risk and removal of all melanocytic nevi is unfeasible (1-4). Dermoscopy and histological examination form the basis of the diagnosis and follow up of melanocytic nevi. A number of different computer software have been developed to be used in combination with digital dermoscopy to acquire, interpret, and store clinical and dermoscopic images. In a patient with multiple atypical nevi, it may not be possible to completely rule out a suspicious melanoma based on clinical or dermoscopic examination, despite a low level of clinical suspicion. In such cases, rather than relying on the physician’s memory or clinical photographs, which are frequently difficult to use or retrieve, it may be more plausible to use serial dermoscopic images, since they allow comparison, calculation of dermoscopic scores, and effectively document the alterations (3,5,6). In this study, ABSTRACT

Atypically Located Orf Developing After a Lamb Bite: A Pediatric Case

Orf is a zoonosis that is transmitted to humans from bovines and is caused by the Parapoxvirus. They are papulonodular lesions that heal spontaneously. It is mostly seen in occupational groups that have a lot of contact with animals. The most common places the infection settles in are the hands and the face. It can be seen as single or multiple lesions. Diagnosis is mostly through the clinical signs and the patient’s history. In this article we present a 10-year-old female orf case that developed the infection in the ear one week after she was bitten by a lamb. From the history of the patient we learned that she had no prior complaints similar to the current infection. On dermatological examination, there was a 1 cm violet erythematous nodule surrounded by yellow crusts on the left ear lobe. We presented the case because of the atypical location of the lesion and to provide updated knowledge about orf.