Meltem Önder

Clinical features and natural course of Behçet’s disease in 661 cases: a multicentre study

Background  Behçet’s disease (BD) is a systemic inflammatory disease with unpredictable exacerbations and remissions. The natural course of BD is not fully known.

The multiple faces of Behçet’s disease and its aetiological factors

Behçet’s disease (BD) is a chronic, inflammatory multisystemic condition of unknown aetiology. It is clinically characterized by recurrent orogenital ulcerations and skin eruptions; ocular manifestations; arthritis; vasculitis and in some cases neurological and large vessel involvement. Aetiology has not been defined, but genetic, environmental, viral, bacterial and immunological factors have been proposed as causative agents. Treatment includes colchicine, thalidomide, steroids and immunosuppressive agents and it is based on the severity of systemic manifestations, such as central nervous system involvement, arterial aneurysms and thrombosis of the major veins. Mortality is related to major system involvement. In this article the different clinical features, the multiple faces of BD and a list of currently suspected aetiological factors of the disease are discussed, and treatment modalities summarized.

Serum interleukin 18 and tumour necrosis factor‐α levels are increased in Behcet's disease

Inflammation in Behcets disease is thought to be mediated by cytokines derived from T‐helper type 1 (Th1) lymphocytes. In this study, we tried to determine serum interleukin (IL)‐18 and tumour necrosis factor (TNF)‐α levels of patients with Behcets disease. Twenty‐seven patients with active Behcets disease, and 20 healthy control subjects were included in this study. Differences between mean serum IL‐18 and TNF‐α level of patients with Behcets disease were significantly increased when compared with the control group. A significant correlation was found between serum IL‐18 and TNF‐α levels of Behcet patients (rs = 0.627, P < 0.0001). IL‐18 and TNF‐α levels may be related to disease pathogenesis. Increased levels of IL‐18 also support Th1 predominance in Behcets disease.

Depression, Anxiety Levels and General Psychological Profile in Behçet’s Disease

Background: Behçet’s disease (BD) is a multisystem disease with unknown etiology. Until today, the role of emotional stress and the real incidence of psychiatric symptoms in this disease have not been clarified yet. Objective: In this study, we aimed to evaluate the general psychological profile of the patients diagnosed as having BD as well as their depression and anxiety levels in order to investigate the psychiatric aspects of this disease. Material and Methods: Twenty-three patients with BD and 17 patients with chronic plaque-type psoriasis who made up the control group were examined by the Beck Depression (BDI), Beck Anxiety (BAI) and Brief Symptom Inventories (BSI). Results: The mean BDI score of the BD group was 11.69 ± 6.93, and the corresponding value was 9.11 ± 7.34 for the psoriasis group. The mean BAI score of the BD group was 21.39 + 13.68 and this level was 12.41 ± 10.70 for psoriasis patients. The mean BSI score of the BD group was 61.30 ± 43.66 and it was 30.41 ± 28.77 for the control group. The mean BDI, BAI and BSI scores of the patients diagnosed as having BD were significantly higher than those of the control group (F = 0.234, F = 0.508, F = 0.549 and p < 0.05). Conclusion: BDI, BAI and BSI scales are useful to evaluate the psychiatric aspects of BD. The results of our study revealed that the collaboration of a dermatologist and psychiatrist is essential for the follow-up of patients with BD.

Reliability of Web-based teledermatology consultations

We studied the reliability of teledermatology diagnoses made using a Web-based system. Clinical photographs and information relating to 125 patients were placed on a Web server. Three dermatologists made the most likely diagnosis via a Web interface. The reference diagnosis was made in a face-to-face consultation with a fourth dermatologist; where appropriate it was confirmed histologically. The teledermatologists were correct in 57% of cases when viewing the images alone. Their diagnostic accuracy improved to 70% when additional clinical information was available. The rate of agreement between the teledermatologists ranged from 44% to 70% (kappa= 0.22–0.32). Seventy-seven per cent of the patients were correctly diagnosed by at least two dermatologists when clinical information was provided. A Web-based system appears to be reliable for teledermatology. A single well trained teledermatologist may give better results than a group of less well trained clinicians.

Patch test results in a Turkish paediatric population

Allergic contact dermatitis is increasing in childhood. In children, population‐based patch test studies point to different contact sensitizers and reflect the variations in the exposure to certain allergens among different countries. Our aim is to show common contact allergens in a paediatric population in Turkey. Contact dermatitis and identifying the suspected allergen in children are important as sensitization occurring during childhood may cause a susceptibility to the contact dermatitis later in their life.

Depression and anxiety in patients with Behçet's disease compared with that in patients with psoriasis

Background  Behçets disease (BD) is a chronic, episodic disease with an often devastating course. The aim of this study was to evaluate the depression and anxiety levels in patients with BD and to compare them with those in patients with psoriasis.

Nitric oxide levels in Behçet's disease.

Behçets disease(BD) is a chronic multisystemic disorder which is characterized by a relapsing systemic inflammatory process. In certain inflammatory conditions such as rheumatoid arthritis, over production of nitric oxide (NO) could damage host cells and tissues, either directly and/or following reaction with other free radicals, such as superoxide anion to form species including peroxynitrite or hydroxyl radicals. Excessive superoxide radical production and impaired antioxidant mechanism in both the neutrophils and plasma of patients with BD have been reported. Our study was designed to investigate the role of NO in BD. NO is an extremely unstable molecule and rapidly converted in vivo and in vitro to nitrate () and nitrite (). For this reason serum and have been used as an index of NO generation. We measured serum nitrate + nitrite levels, by using an enzymatic one‐step methodology based on the reduction of nitrate to nitrite by nitrate reductase from Aspergillus species, in the presence of β‐NADPH. When compared to healthy controls, serum nitrate + nitrite levels were found to be higher in active periods of BD patients (P < 0.01). It was concluded that increased NO production in patients with BD might have critical biological activities relevant to vasculitic events in the active period of disease.

A new indication of botulinum toxin: Leiomyoma-related pain

Cutaneous leiomyomas are benign neoplasms with smooth muscle differentiation. They are painful tumors of the skin. Nearly 90% of patients report lesion-associated pain, characteristically precipitated by cold or trauma. In the published literature, surgical excision and pharmacologic agents such as analgesics, nifedipine, phenoxybenzamine hydrochloride, gabapentin, and doxazosin have been used in the treatment of leiomyomas with varying degrees of success. Herein we report the use of botulinum toxin for the relief of pain in leiomyomas. The use of botulinum toxin provided a decrease in the amount of analgesic use in our patient. Our experience showed that botulinum toxin might offer a new therapeutic approach for leiomyoma by reducing the intensity and the frequency of the pain. Botulinum toxin has no known systemic adverse effects, and can be combined with other treatments without concern for drug interactions. Like any other medication, aside from its actual pharmacologic effect, botulinum toxin may have had a placebo effect in our patient.

Behçet’s disease: an enigmatic vasculitis

Professor Hulusi Behcet, a Turkish dermatologist, gave his name to a syndrome in 1937. This syndrome is characterized by recurrent oral, genital ulceration and uveitis with an unknown etiology.1 The disease was probably recognized by Hippocrates, who lived in ancient Greece near the Turkish mainland. Many investigators tried to describe the patients with the disease. Shigeta in 1924 and Whitwell in 1934 mentioned recurrent uveitis and orogenital lesions.2,3 Today, Behcet’s disease is a more complicated entity. The disease is recognized as a chronic multisystem disorder with vasculitis as its underlying pathological process. Variable involvement of many organs and additional features were added to the disease spectrum. Although the etiology remains obscure, the main denominator in all organ systems appears to be “vasculitis.”