Mualla Polat

Ocular findings in patients with psoriasis

Background  Psoriasis is a chronic inflammatory disease affecting skin, nails, and joints. Although there are not many reports in the literature, ocular findings occur in approximately 10% of patients, in mostly those who have psoriatic arthritis. In this study, we aimed to evaluate eye involvement in psoriasis patients.

Does recurrent aphthous stomatitis affect quality of life? A prospective study with 128 patients evaluating different treatment modalities

Abstract Introduction: Quality of life measures are increasingly being used in the evaluation of oral disease outcome. To date, there has been less focus on oral health-related quality of life (OHR-QoL) measures for oral diseases in dermatologic literature. Objective: To test whether patients with recurrent aphthous stomatitis (RAS) report a lower OHR-QoL than the general population and to evaluate therapeutic regimens for RAS by using OHR-QoL measures. Method: A total of 128 patients and 40 controls were enrolled. A questionnaire entitled the 14-item oral health impact profile (OHIP-14) was completed. Forty-three (33%) of the patients were followed-up and completed the OHIP-14 following treatment. Results: The median total score of patients on colchicine before treatment was 21. Following use of colchicine, the total score was 10. There was a significant difference concerning the impact of oral health following use of oral colchicine. However, no reduction of OHIP-14 scores was observed in the topical treatment group. Conclusion: When the influence of one of the most common oral diseases such as RAS on OHR-QoL was taken into consideration, OHR-QoL provides an additional dimension that may help to improve the impact of a disease on an individuals life. In relation to this, colchicine seems to be one of the most effective management strategies used in RAS.

Internalized stigma in psoriasis: A multicenter study

Internalized stigma is the adoption of negative attitudes and stereotypes of the society regarding a persons illness. It causes decreased self‐esteem and life‐satisfaction, increased depression and suicidality, and difficulty in coping with the illness. The primary aim of this study was to investigate the internalized stigma state of psoriatic patients and to identify the factors influencing internalized stigma. The secondary aim was to identify the correlation of internalized stigma with quality of life and perceived health status. This multicentre, cross‐sectional study comprised 1485 patients. There was a significant positive correlation between mean values of Psoriasis Internalized Stigma Scale (PISS) and Psoriasis Area and Severity Index, Body Surface Area, Dermatological Life Quality Index and General Health Questionnaire‐12 (P < 0.001 in all). Lower percieved health score (P = 0.001), early onset psoriasis (P = 0.016), family history of psoriasis (P = 0.0034), being illiterate (P < 0.001) and lower income level (P < 0.001) were determinants of high PISS scores. Mean PISS values were higher in erythrodermic and generalized pustular psoriasis. Involvement of scalp, face, hand, genitalia and finger nails as well as arthropathic and inverse psoriasis were also related to significantly higher PISS scores (P = 0.001). Our findings imply that psoriatic patients experience high levels of internalized stigma which are associated with psoriasis severity, involvement of visible body parts, genital area, folds or joints, poorer quality of life, negative perceptions of general health and psychological illnesses. Therefore, internalized stigma may be one of the major factors responsible from psychosocial burden of the disease.

Cardiac findings in Behçet’s patients

Behçet’s disease is a chronic multi‐system inflammatory disorder and the severity and clinical manifestations of Behçet’s patients may show geographic variation. We aimed to detect the cardiac findings in 30 Behçet’s patients and compare them with the normal population (n = 29). We used color‐doppler echocardiography and transesophageal echocardiography in combination. We calculated manually QT intervals and QT dispersion (QTd) from twelve‐lead ECG recordings. There was no E/A inversion and coronary ischemia in all patients or control group. The E velocity difference between groups was not significant. The mean A velocity was significantly lower in Behçet’s patients than normal group. The mean DT was 154.4 ± 5.8 msec in Behçet’s patients and 122.59 ± 0.96 msec in control group (P < 0.0001). The mean IVRT was 75.66 ± 1.36 msec in Behçet’s patients and 69.1 ± 0.55 msec in control group (P < 0.0001). There was no QTc time difference between the Behçet’s patients and the control group. The mean QT dispersion (QTd) interval was 45.46 ± 2.65 msec in Behçet’s patients and 31.83 ± 1.23 msec in control group (P < 0.0001). Atrial septal aneurysm, mitral valve prolapse and insufficiency, tricuspid valve insufficieny, and pulmonary hypertension frequencies in Behçet’s patients were significantly higher than in the control group. We concluded that Behçet’s cardiac involvement may effect cardiac structure and cause diastolic dysfunction, electrical instability and structural abnormalities. We also concluded that cardiac involvement in Behçet’s disease may be specific for this geographic area.

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.

Spitz nevus of the genital mucosa.

We herein report an 11-year-old girl who came to our clinic with a swelling on the genital area of 2 months duration. Dermatological examination of the patient was performed and a pigmented lesion was found on the inner surface of the labium majus of the mucosa. The lesion was well circumscribed and approximately 1 cm in diameter, with homogenous color distribution. The patient was diagnosed as Spitz nevus on the basis of clinical and histopathological findings. Our case is probably the first reported case of Spitz nevus localized to the genital mucosa in the English literature.

Inner ear involvement in Behçet's disease

OBJECTIVE To assess cochlear involvement and hearing loss in patients with Behçets disease (BD). METHOD Forty-two patients with BD and 24 sex and age matched healthy subjects were included in the study. pure-tone audiometry including high frequencies (250-16000Hz) and DPOAE were performed to all participants. Results of the audiological evaluation were compared and correlation between the audiologic status and clinical manifestations of the BD were investigated. RESULTS Bilateral sensorineural hearing loss was detected in 27 (64.3%) patients. Hearing thresholds were found to be higher in patients with BD at all of the frequencies except at 500Hz when compared to control group (p<0.05). The difference in the hearing levels tend to increase in high frequencies. Compared with control group, distortion products and SNR of the BD patients were lower in all of the tested frequencies (p<0.05) which indicates weaker outer hair cell motility. There was no correlation between the clinical manifestations and the audiological parameters. CONCLUSION Even having hearing levels within normal limits in speech frequencies, increased hearing thresholds in high frequencies and decreased signal-noise ratios (SNR) in distortion product otoacoustic emission (DPOAE) indicate a cochlear involvement in patients with BD.

Basal cell carcinoma in a bacillus Calmette-Guérin scar.

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Cellular Immune Response in Patients with Chronic Plaque Type Psoriasis: Evaluation of Serum Neopterin, Procalcitonin, Anti-Streptolysin O and C Reactive Protein Levels

Background: Psoriasis is characterized by T-cell mediated hyperproliferation of keratinocytes initiated by antigen presenting cells on the skin. Environmental factors including β hemolytic streptococcus infections and multiple genetic components may be responsible for the pathogenesis of the disease. However the antigen which initiates the immunologic reactions has not yet been known. We aimed to evaluate the relationship between streptococcal as well as other bacterial infections and psoriasis via measurement of some infection markers. Materials and methods: The study included 40 patients with exacerbations of chronic plaque type psoriasis lesions and 40 healthy individuals. Disease activity in study group was determined according to the score of psoriasis area and severity index. Antistreptolysin O, C-reactive protein, procalcitonin and neopterin levels of patients with psoriasis were compared to those of control subjects. Results: The levels of procalcitonin (p=0.002) and neopterin (p=0.001) in patients with psoriasis were significantly higher than those in control subjects. Additionally, there was significant correlation between psoriasis area and severity index scores and neopterin (p< 0.001) as well as C-reactive protein (p=0.006) levels. However ASO levels in patients with psoriasis did not differ significantly from those in control subjects (p=0.86). Conclusions: Significant increased levels of serum procalcitonin during exacerbation period of chronic plaque type psoriasis may be resulted from the presence of a bacterial antigenic stimulus and significant elevated levels of neopterin may indicate elevated cellular immune system activity following bacterial antigenic stimulation. However, absence of significant elevated antistreptolysin O levels indicates the possible role of bacterial infections in the pathogenesis of psoriasis rather than streptococcal infections.

Evaluation of clinical signs and early and late trichoscopy findings in traction alopecia patients with Fitzpatrick skin type II and III: a single-center, clinical study

Traction alopecia refers to (often permanent) hair loss caused by prolonged physical damage. No study has yet described the unique trichoscopic findings of the condition. We describe the trichoscopic findings of traction alopecia and its relationships with the duration of traction.