Muhterem Polat

Prevalence of skin diseases among pediatric patients in Turkey

The pediatric population is composed of persons under 16 years of age, and few studies are available on the dermatological diseases of this group. In the present study, data on a total of 6300 pediatric patients admitted between the years 2004–2006 were analyzed. Hospital‐based patient registry records were used for data collection. The data were analyzed according to age, sex and time of admittance. A female preponderance (53%) was observed, and adolescents (12–16 years old) constituted the largest group within the patient population (47.6%). A total of 125 dermatoses were recorded. Acne vulgaris was the most prevalent dermatosis (12.4%), followed by atopic dermatitis (11.8%), contact dermatitis (11.3%), warts (9.5%), seborrheic dermatitis (4.3%) and impetigo (4.1%). Atopic dermatitis was the most frequently seen dermatosis in both infants and preschool‐age children, whereas contact dermatitis was more prevalent in school‐age children, and acne vulgaris was more prevalent in the adolescent group. The frequencies of some diseases showed seasonal variations. Acne vulgaris, atopic dermatitis, contact dermatitis, psoriasis, xerosis and alopecia areata were more common in winter. In contrast, insect bites, vitiligo, dyshidrotic eczema, impetigo and tinea corporis were more common in summer. Studies of the pediatric population, which constitutes the cornerstone of the community, can play an important role in determining the policies of protective medicine and public health. New studies will help us to better understand the frequency of dermatological diseases in the pediatric population according to age, gender and season, and take precautions with regard to these conditions.

Generalized pruritus: a prospective study concerning etiology.

AbstractBackground:Generalized pruritus can often be the primary manifestation of systemic disease. Objective:To determine how frequently generalized pruritus had a systemic etiology in an outpatient population seen in a dermatology department and whether any identifiable patient characteristics meant a systemic explanation of generalized pruritus was more likely. Methods:A prospective controlled study of 55 patients with generalized pruritus and 41 healthy age- and sex-matched control subjects. Clinical data were collected from patients and laboratory parameters investigated in both patients and healthy control subjects to determine the frequency of systemic disease in each group. Results: Of 55 patients, 12 had a systemic cause of pruritus. Pruritus was the initial symptom of systemic disease in eight of these patients. The underlying diseases included hypothyroidism, chronic lymphocytic leukemia, hepatitis C, hepatitis B, diabetes mellitus, lung cancer, uremia, and iron deficiency anemia. Of these, iron deficiency anemia was the most common cause. Compared with the control group, mean serum hemoglobin, iron, and cyanocobalamin (vitamin B12) levels in patients with generalized pruritus were lower. No other patient characteristics were statistically associated with systemic causes of pruritus. Conclusion:Generalized pruritus was the initial symptom of a systemic disease in 8 of 55 patients presenting to a dermatology outpatient clinic with this complaint. A number of underlying diseases were identified, of which the most common was iron deficiency anemia.

Chronic Bullous Disease of Childhood in a Patient with Acute Lymphoblastic Leukemia : Possible Induction by a Drug

Linear IgA disease is characterized by the presence of linear IgA deposits in the basement membrane zone of the skin, and circulating basement membrane zone antibodies are detected in 80% of cases. The disease occurs in both adults and children, and is designated adult linear IgA disease in the former and chronic bullous disease of childhood (CBDC) in the latter. We describe a 5-year-old boy with acute lymphoblastic leukemia in remission, in whom CBDC developed after treatment with trimethoprim/sulfamethoxazole (cotrimoxazole). To our knowledge, this is the first reported case of possible drug-induced CBDC.

Complete Dermatological Examination in the Elderly: An Exploratory Study from an Outpatient Clinic in Turkey

Background: The geriatric population isgrowing continuously, therefore more aged patients are being admitted to dermatology clinics. Successful management of these patients requires a thorough understanding of the features of geriatric patients and prevalence of skin diseases in this group. Materials and Methods: Patients aged 65 years and older admitted to the dermatology outpatient clinic over a 3-month period were included. Patients aged between 65 and 74 years were included in group I, and patients older than 74 years were included in group II. Demographic features of the patients were noted. Total dermatological examination was performed in each patient. Fifteen days after the first visit, the patients were phoned up to obtain information about their level of satisfaction regarding the treatments and were invited to the clinic for reexamination where their improvement levels were scored. Results: A total of 209 patients were included in this study. The most common complaints were in the chronic eczema-dermatitis group. However, the most commonly detected disorders were in the chronic sun exposure group. Some severe cutaneous and noncutaneous diseases were detected incidentally at total dermatological examination. Treatment satisfaction scores of patients and improvement scores of doctor had a significantly good correlation. Discussion: The study results indicated that in the management of elderly patients, social and physical evaluation should be carried out and treatment must be recommended accordingly. In all elderly patients, total dermatological examination must be performed because it may reveal some severe cutaneous or underlying noncutaneous diseases.

Flare-up of pustular psoriasis with fluoxetine: possibility of a serotoninergic influence?

In this article, we report two cases of pustular psoriasis flaring up after fluoxetine administration. A 21-year-old male patient with localized pustular psoriasis became erythrodermic following commencement of fluoxetine. Even though the lesions were unresponsive to cyclosporine A (Cyc A) treatment, dramatic resolution was observed with discontinuation of fluoxetine. A 44-year-old female patient with pustular psoriasis who was on Cyc A and acitretin therapy was given fluoxetine for her psychiatric symptoms. In the following 5 days, her lesions flared. Owing to previous experience, fluoxetin was stopped. Her lesions improved dramatically in the following 3 days. Exacerbation of psoriasis with antidepressant therapy has been rarely described. An extensive review of the literature revealed four such cases, all of which were seen after the use of selective serotonin reuptake inhibitors (SSRI). A serotoninergic influence in the etiopathogenesis of psoriasis may be possible together with a pharmacogenetic difference in the drug metabolism of these patients. Considering the two patients we presented and the patients previously reported in the literature, aggravation of pustular psoriasis by SSRI should be borne in mind.

Neurofibromatosis 1/Noonan Syndrome Associated with Hashimoto's Thyroiditis and Vitiligo

Neurofibromatosis 1 (NF1) is an autosomal dominant disease which predominantly involves the skin and the nervous system. The cardinal features of NF1 include neurofibromas, cafe-au-lait spots, axillary and inguinal freckling, eye abnormalities comprising Lisch nodules, optic glioma and osseous lesions and learning disabilities (1). Noonan syndrome (NS), is a genetic disorder whose prevelance is estimated to be 1 in 1000 or 2500 live births. It is characterized by unusual triangular-shaped face, hypertelorism, down-slanting eyes, ptosis, strabismus, amblyopia, refractive errors, low-set ears with thickened helices, high nasal bridge, webbed neck, congenital heart disease (dysplastic/stenotic pulmonic valve, hypertrophic cardiomyopathy), short stature and chest deformities (pectus carinatum/excavatum, scoliosis) (2). Vitiligo, characterized by depigmented macules and patches on the skin, has been commonly reported as a component of multiple autoimmune syndromes and in association with autoimmune thyroid disease such as Hashimoto’s thyroiditis and Graves’ disease (3). Although NF1 has been seen in relation with various autoimmune diseases, coexistence with either Hashimoto’s disease or vitiligo has not been reported previously. Here we report a case with established NF1/NS who also has a diagnosis of vitiligo and Hashimoto’s disease.CASE REPORTA 20-year-old female patient was admitted to the hos-pital with hyperpigmented skin patches that had been present since birth and tumoral formations on her skin that had recently increased in number. She had also developed hypopigmented patches on her knees and elbows 4 years previously. Her family history revealed that her mother and father were second degree relatives (maternal cousins) and one of her cousins had similar skin lesions. On her physical examination she was 145 cm tall. She had scoliosis in her thoracic vertebrae and a short webbed neck. Her face was triangular with a prominent forehead and a small chin (Fig. 1a). Her ears were small and low-set with thickened helices (Fig. 1b). Her eyes were down-slanting and ptotic. Her dermatological examination revealed bilateral axillary freckling, several hyperpigmented macules and patches between 1 and 5 cm in diameter which were consis-tent with cafe-au-lait spots. She had large patches of depigmentation between 5 and 10 cm in diameter on the knees and elbows consistent with vitiligo (Fig. 1c). Skin biopsy confirmed the diagnosis of vitiligo. On laboratory examination, karyotype analyses revealed normal female with 46 XX. Complete blood count, se-rum and urine biochemistry were within normal limits. Thyroid stimulating hormone was 2.06 µIU/ml (normal range 0.35–4.95); T3 was 172 ng/dl (normal range 95–190); and T4 was 7.54 µg/dl (normal range 5–11). Antithyroid peroxidase level was 528 IU/ml (normal range 0–100 IU/ml) and antithyroglobulin was 442 IU/ml (normal range 0–100 IU/ml). The thyroid gland was firm on palpation and ultrasonography revealed a diffuse mildly enlarged gland. Abdominopelvic ultra-

Caspase-9 expression is increased in endothelial cells of active Behçet's disease patients

Background  Behçets disease is a multisystem disease of unknown etiology. Caspase‐9 is responsible for initiating the caspase activation cascade during apoptosis. The aim of this study was to examine caspase‐9 expression in both endothelial and perivascular infiltrates of patients with active Behçets disease.

Plasma homocysteine level is elevated in patients on isotretinoin therapy for cystic acne: A prospective controlled study

Purpose: Isotretinoin (Iso) has marked side effects. Homocysteine (Hcy) metabolizes in the liver, requiring folate and vitamin B12. Elevated blood levels of Hcy have been linked to an increased risk of premature coronary artery disease (CAD). In this study, we evaluated Hcy levels, vitamin B12, and folate in patients on Iso treatment for cystic acne (CA). Methods: Seventy‐four patients with CA were included to the study group. Blood levels of Hcy, vitamin B12, and folate were assessed before and after 45 days of Iso therapy. The control group consisting of 80 individuals were tested once. Results: Hcy levels were statistically significantly increased in patients on Iso treatment. Vitamins were unaltered, while lipids and liver enzymes increased statistically significantly. Conclusion: Hcy levels are elevated in patients on Iso treatment for CA. It may be due to either the inhibition of cystathionine‐β‐synthase, an enzyme required in the metabolism of Hcy, by the drug and/or the liver dysfunction. Daily supplementation with vitamin B12 and folate, which are the cofactors of the enzymatic reactions involved in Hcy metabolism, can lower plasma levels of Hcy, so it is recommended to take these vitamins in case of deficiency along with Iso to prevent premature occlusive vascular disease.

Contact dermatitis due to Allivum sativum and Ranunculus illyricus: two cases

Plants are of relevance to dermatology for both their adverse and beneficial effects on skin and skin disorders respectively. Virtually all cultures worldwide have relied historically, or continue to rely on medicinal plants for medical care. As alternative herbal remedies are becoming more widely used there is an increase in phytocontact dermatitis. Here we document two patients who developed contact dermatitis due to Allivum sativum, and Ranunculus illyricus after applying to the skin in order to relieve the rheumatological joint pain.

Punctate Palmoplantar Keratoderma (Brauer-Buschke-Fischer Syndrome)

Punctate palmoplantar keratoderma (PPPK) is a rare entity with an estimated prevalence rate of about 1.17 per 100 000. The exact etiology of the disorder is not known but a dual influence of genetic and environmental factors may trigger the disease. We report the case of a 70-year-old male patient with punctate palmoplantar keratodermic lesions for more than 40 years. Histopathologic examination revealed a hyperkeratotic epidermis without columns of parakeratosis or elastorhexis. On electron microscopy, the basal cells of the epidermis were found to have enlarged nucleoli and abundant tonofilaments, with keratohyalin-like granules confined to the upper part of the stratum spinosum, findings that were consistent with PPPK. Topical keratolytic agents were used with little success. Patients with PPPK and their next of kin should be investigated for possible associated malignancies.