Mukadder Koçak

Permethrin 5% Cream versus Metronidazole 0.75% Gel for the Treatment of Papulopustular Rosacea

Background: Permethrin 5% cream used against human ectoparasites suggests that it may be effective in papulopustular rosacea. Methods: This study included 63 patients diagnosed as having papulopustular rosacea based on the clinical and histological findings. Patients were randomly assigned into permethrin (n = 23), metronidazole (n = 20) and placebo (n = 20) groups. Scores of erythema, telangiectasia, edema and rhinophyma and the numbers of papules, pustules, inflammatory nodules and Demodex folliculorum were determined. Twenty-three patients were given permethrin 5% cream (Zalvor 5% skin cream®), 20 patients metronidazole 0.75% gel (Roza gel®) and 20 patients placebo cream (Basis cream®), in packages looking identical to those of metronidazole and permethrin creams, and were recommended to apply them to their faces twice a day. All patients were also given SPF 20 cream for protection against sunlight. Two months of treatment were planned, and the patients were invited to the clinic for fortnightly controls. Scores of erythema, telangiectasia, edema and rhinophyma and the numbers of papules, pustules, inflammatory nodules and D. folliculorum were recorded at each visit. The mean scores of erythema and the mean numbers of papules, pustules and D. folliculorum were determined at baseline and on days 15, 30, 45 and 60. Side effects were also detected. Results: The effect of permethrin 5% cream on D. folliculorum was superior to that of metronidazole 0.75% gel. The effect of permethrin 5% cream on erythema and papules was found to be more effective than placebo and as effective as metronidazole 0.75% gel. However, it had no effect on telangiectasia, rhinophyma and pustules. Conclusion: It can be concluded that the application of permethrin 5% cream twice daily for 2 months can be as effective and reliable as metronidazole in the treatment of rosacea and a greater benefit can be gained when it is combined with other systemic and/or topical treatments.

Increased tumor necrosis factor alpha (TNF‐α) and interleukin 1 alpha (IL1‐α) levels in the lesional skin of patients with nonsegmental vitiligo

Increased tumor necrosis factor alpha (TNF-α) and interleukin 1 alpha (IL1-α) levels in the lesional skin of patients with nonsegmental vitiligo Dear Sir, Depigmentation in vitiligo is caused by melanocyte destruction. There are different hypotheses including neural, selfdestruction, and immune hypotheses to explain the pathogenesis of vitiligo There is growing evidence that cytokines are important in the depigmentation process of vitiligo. Granulocytemacrophage colony-stimulating factor (GM-CSF), endothelins, b-FGF are the mitogens for melanocytes whereas TNFα, IL1α, IL-6, TGFβ are the potent inhibitors of melanocyte growth. IL1α is remembered as one of the cytokines of inflammation, and is also known as a B-cell activating factor. It produces similar biological effects with TNF α and is produced in most inflammatory and immunological diseases. b-FGF, produced by fibroblasts and epidermal keratinocytes, is a polypeptide and is capable of promoting angiogenesis and mitogenesis through autocrine and paracrine mechanisms. The role of peripheral blood and lesional cytokine expression in patients with vitiligo has not been clarified yet. Herein we wanted to investigate the levels of cytokines in the skin and serum of vitiligo patients and to compare them with the levels in healthy controls. Six female and 18 male vitiligo patients aged (32 years ± 17 SD) were enrolled in the study after giving informed consent. Thirteen (54.2%) had symmetrical generalized, seven (29.2%) had acrofacial, and four (16.7%) had focal vitiligo. Six (25%) had progressive and 18 (75%) had stabile vitiligo (no new depigmentation had been observed for more than 3 months). Fourteen ageand sex-matched healthy volunteers consisted the control group. Samples of peripheral blood from patients and healthy volunteers were collected by venipuncture. Serum was separated and stored at −70 °C before use. Four-millimeter punch biopsies were taken in all patients from lesional skin and nonlesional skin (at least 3 cm far from lesional biopsy) and from healthy volunteers. The biopsies were frozen in liquid nitrogen (−196 °C) and preserved at −70 °C. Levels of IL1α, TNFα, and b-FGF were measured with specific ELISA kits (Biosource International, Camarillo, California, USA) according to the manufacturer’s instructions. Skin cytokines were measured as described by Lowry et al. Level of the cytokines were expressed as μmol/mg protein. Statistical analysis was carried out using spss 10.0. Differences in values of cytokine amount between lesional vs. healthy volunteers, nonlesional vs. healthy controls, serum of patients vs. serum of healthy volunteers were carried out using Mann– Whitney U-test. The parameters of lesional vs. nonlesional skin were analyzed by the Wilcoxon-signed rank test. P-value of less than 0.05 was considered to be statistically significant. The mean (± SD) values of IL1α, TNFα, b-FGF in lesional, nonlesional, healthy skin, and the serum from healthy controls and the study group are given in Table 1. The expression of IL1α and TNFα was significantly higher in lesional skin than in nonlesional skin in patients with vitiligo (P = 0.007 and P = 0.002), respectively. The exact mechanism how cytokines effect pigmentation is not fully understood. The different hypotheses are: (a) TNFα induces IL1α promoting B-cell differentiation and immunoglobulin production. (b) Cytokines such as IFNγ, TNFα, TNFβ, IL1α, and IL-6 can induce cell surface ICAM-1 on melanocytes which is necessary for leukocyte–melanocyte attachment. ICAM-1 may also induce B-cell activation, increasing autoantibody production and may cause melanocyte damage in vitiligo. (c) TNFα and IL1α also have the capacity to induce apoptosis in many cell types. (d) Melanogenesis is also inhibited by TNFα through an inhibitory effect on tyrosinase and tyrosinase related protein. Moretti et al. found increased levels of IL-6 and TNFα in the epidermis of lesional skin compared with the healthy controls. Swope et al. investigated the role of epidermal cytokines in pigmentation and found that IL1α, TNFα, and IL-6 elicited a dose-dependent decrease in the activity of the enzyme tyrosinase of cultured normal human melanocytes and also inhibited melanocyte proliferation. Ozdemir et al. demonstrated increased skin blister fluid b-FGF levels and serum levels in vitiligo patients compared with healthy controls and proposed that b-FGF plays a role in the pathogenesis of vitiligo. However,

Examination of Bcl-2, Bcl-X and bax protein expression in psoriasis

Background  Psoriasis is an inflammatory skin disease characterized by epidermal hyperplasia and greatly accelerated epidermal turnover. The blockage of normal apoptotic process in the epidermis is one of the factors implicated in the pathogenesis of psoriasis.

Detection of human herpesvirus 7 in pityriasis rosea by nested PCR.

Background Clinical presentation, immunologic, light microscopic, and electron microscopic studies suggest a viral etiology for pityriasis rosea (PR).

Executive dysfunctions and depression in Behçet's disease without explicit neurological involvement.

Abstract  This study aims to assess the executive functions and depression status in patients with Behçet’s disease without explicit neurological involvement and to evaluate cognitive functions in this group of patients independent of accompanying depression. In the present study, 30 patients with Behçet’s disease in the non‐active phase of their illness and 30 healthy volunteers were included. In the evaluation of depression levels, Beck Depression Inventory was employed. The executive functions of the patients were evaluated by Wisconsin Card Sorting Test (WCST) and Stroop Test (ST). Beck Depression Inventory scores measured in the Behçet’s disease group, in which no clinically serious depression was observed, were higher than the control group. Then, it was observed that the scores of neuropsychological tests of the Behçet’s disease group were found to be significantly lower, especially in WCST, while significant relations were revealed between Beck Depression Inventory scores and WCST, ST scores. The authors’ findings suggest that there may be factors other than depression causing executive impairment in patients with Behçet’s disease without explicit neurological symptoms. Executive dysfunctions may occur in association with mild depressive states due to chronic disease stress or silent and/or future neurological involvement of Behçet’s disease, especially in the frontal lobes.

Peripheral Neuropathy in Behçet's Disease

Behçets disease (BD) is a multisystem disorder. Since its first description, the involvement of many organ‐systems has been studied. However, the involvement of the peripheric nervous system has not been well documented yet. Twenty‐six patients involved in the study were without prominent complaints of neuropathic symptoms. They were surveyed through the outpatient clinic of the department of dermatology. Each patient filled out a total neuropathy score (TNS) questionaire after their neurologic exam. A neurology specialist conducted the electrophysiological study. Our results were noteworthy because this complication was present without significant complaint. We hypothesized that the nerve dysfunction or peripheral neuropathy of BD is an axonal type of distal polyneuropathy and predominantly involves the lower extremities. We did not find a predominant motor or sensory nerve involvement. This complication is mentioned and reported rarely in BD.

A case of porokeratotic eccrine ostial and dermal duct naevus of late onset

We describe the case of a 21‐year‐old man with an 8‐year history of porokeratotic eccrine ostial and dermal duct naevus (PEODDN) of late onset. The patient had pruritic, keratotic papules on the dorsal surface of his left hand, bilaterally on his palms and multiple yellowish lesions on the plantar surface of his feet. On histopathological examination cornoid lamella‐like parakeratotic columns above eccrine sweat ducts were observed. The acrosyringium was also dilated. The lesions were refractory to treatment with salicylic acid in petrolatum and acitretin for 2 months. This entity should be taken into consideration in the differential diagnosis of linear keratotic cutaneous eruptions.

The Effect of Behçet's Disease on Sexual Function and Psychiatric Status of Premenopausal Women

INTRODUCTION Little is known about the relationship between Behçets disease (BD) and female sexual dysfunction (FSD). AIMS The aims were to evaluate the prevalence of FSD in premenopausal BD patients and to compare hormonal and psychiatric conditions to healthy subjects. METHODS A total of 71 married women with BD and 63 healthy married women between 18 and 44 years old were enrolled into the study. After evaluating detailed history and physical examination, serum steroid hormone levels were measured. Presence of genital ulcerations in physical examination and any medical treatment were recorded in patients. All subjects were asked to complete the Female Sexual Function Index (FSFI) for sexual status and Beck Depression Inventory (BDI) for psychiatric assessment. MAIN OUTCOMES MEASURES FSFI and BDI scores and serum sex steroid hormone levels were measured in women with BD and healthy controls. RESULTS The mean BDI score of patients was significantly greater than that for controls (P = 0.001), and there was a statistically significant difference between BDI scores (Pearson chi2 = 19.109, P = 0.001). FSD was found in 34 patients with BD (47.9%) and in 11 controls (17.5%). A statistically significant difference was found between the two groups (Pearson chi2 = 13.855, P = 0.001). While the most common sexual problem in the patients with BD was diminished arousal (n = 49, 69.0%), diminished desire was found in 32 patients (45.1%) and lubrication problems in 36 patients (50.7%). There was a statistically significant negative correlation between BDI and FSFI score in BD patients. On the contrary, there was no relationship between FSFI and presence of genital ulcerations. CONCLUSION FSD is more common in BD patients than in healthy subjects. We conclude that depressive mood according to the BDI scale correlates with the sexual status of BD patients, and this may be because of the depressive effect of BD as a chronic disease.

Associations between human leukocyte antigens and leprosy in the Turkish population

Summary Leprosy is a chronic infection caused by an intracellular microorganism. Genetic predisposition to both disease susceptibility and to host immunological response has been postulated for many years. The aim of this study was to determine whether there is HLA‐linked susceptibility to leprosy and its different types. HLA‐class I (A, B, C) and II (DR, DQ) antigen frequencies in 80 patients with leprosy (35 borderline lepromatous, 25 lepromatous, 15 borderline tuberculoid, five tuberculoid) were compared with those in 120 healthy individuals. HLA‐class I antigens A9, A10, A32, B5, B21, Bw4, Bw6, Cw1, Cw2 and HLA‐class II antigens DR9, DR10, DRw52, DQ1, DQ3 were found to be significantly more frequent in patients with leprosy, whereas HLA‐class I antigens A3, B44, B49 and HLA‐class II antigen DQ5 were so in controls. However, there was no significant difference in HLA‐class I and II antigen frequencies between subtypes of leprosy. HLA‐A null antigen was found to have weak expression in patients with leprosy. In conclusion, factors other than HLA‐class I and class II antigens may have a more critical role in the pathophysiology of leprosy infection in man.

Focal acral hyperkeratosis: A rare cutaneous disorder within the spectrum of costa acrokeratoelastoidosis

Abstract:  Acrokeratoelastoidosis and focal acral hyperkeratosis share similar clinical features and identical histologic epidermal alterations. These disorders are distinguished solely on the basis of the absence of elastorrhexis in the latter. We present a case of focal acral hyperkeratosis in a 9‐year‐old girl. The lesions consisted of translucent polygonal papules clustered on the thenar regions of the palms and over the metacarpophalangeal and interphalangeal joints. Histopathologic examination revealed orthohyperkeratosis within focal clavus‐like depressions of the epidermis and prominent hypergranulosis. There was no evidence of alterations in elastic tissue. The clinicopathologic distinction between focal acral hyperkeratosis and acrokeratoelastoidosis is blurred. There is enough evidence to consider the former as a histologic variant of Costa acrokeratoelastoidosis syndrome, and a better nomenclature for this disorder would be “acrokeratoelastoidosis without elastorrhexis.”