Murat Orhan Oztas

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.

The role of free oxygen radicals in the aetiopathogenesis of rosacea

Summary A possible link between superoxide dismutase activity and malondialdehyde level with the clinical manifestations of rosacea was investigated. We found differences in superoxide dismutase activities between mild rosacea (stages I and II) and severe involvement (stage III) groups, as well as between disease and control groups that were statistically significant (P < 0.05). In the mild involvement group (stages I and II), the superoxide dismutase activity was higher than in the control group (P < 0.05), while the malondialdehyde levels did not differ from the control. In the severe involvement group (stage III), the superoxide dismutase activity was lower than in the control group (P < 0.05), and this was coupled to a raised level of malondialdehyde (P < 0.05). These findings clearly show that in the mild involvement phase of rosacea patients, superoxide dismutase activity was stimulated to protect the skin against reactive oxygen species so that the malondialdehyde levels were maintained. In contrast, in more severe disease, due to a decrease in the capacity of the antioxidant defence system, the malondialdehyde levels were increased. These findings support the ‘antioxidant system defect hypothesis’ in rosacea patients.

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.

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.

Skin problems of musicians.

Objective We investigated the skin problems of high level musicians in a professional orchestra. This study was prompted by our observation of violinists with skin changes.

Treatment of Idiopathic Pyoderma Gangrenosum with Infliximab: Induction Dosing Regimen or On-Demand Therapy?

Pyoderma gangrenosum is an ulcerative skin disease of unknown origin. Recently tumor necrosis factor α inhibitors have been gaining attention in the treatment of recalcitrant pyoderma gangrenosum. However, there is a lack of an optimal dosing strategy in the published literature about the treatment of idiopathic pyoderma gangrenosum, and this is responsible for substantially different treatment strategies. Therefore, it is necessary to report experiences in this patient population in order to develop an optimal dosing strategy and to clarify whether regularly scheduled or on-demand therapy is suitable for idiopathic pyoderma gangrenosum. Herein we report a recalcitrant case of an idiopathic pyoderma gangrenosum treated successfully with a dosing regimen similar to the one that has been used in psoriasis. By doing so, we were capable of controlling the disease and improving the quality of life in our patient.

Isotretinoin-induced nail fragility and onycholysis

A 23 year old woman who presented with severe acne had been treated with 40 mg/day isotretinoin. On her monthly control, severe cheilitis and bilateral toe nail onycholysis were observed. It is well known that systemic retinoids have several side effects. Although dystropic nail, paronichia-like changes, median nail dystrophy have previously been reported with isotretinoin therapy, onycholysis is rare. In this report, we describe a case with isotretinoin induced nail fragility and onycholysis.A 23 year old woman who presented with severe acne had been treated with 40 mg/day isotretinoin. On her monthly control, severe cheilitis and bilateral toe nail onycholysis were observed. It is well known that systemic retinoids have several side effects. Although dystropic nail, paronichia-like changes, median nail dystrophy have previously been reported with isotretinoin therapy, onycholysis is rare. In this report, we describe a case with isotretinoin induced nail fragility and onycholysis.A 23 year old woman who presented with severe acne had been treated with 40 mg/day isotretinoin. On her monthly control, severe cheilitis and bilateral toe nail onycholysis were observed. It is well known that systemic retinoids have several side effects. Although dystropic nail, paronichia-like changes, median nail dystrophy have previously been reported with isotretinoin therapy, onycholysis is rare. In this report, we describe a case with isotretinoin induced nail fragility and onycholysis.

Bonbon toffee sign: a new dermatoscopic feature for sebaceous hyperplasia

Introduction  Sebaceous hyperplasia is a benign proliferation of the sebaceous gland. In this study, we tried to define the dermatoscopic features of sebaceous hyperplasia, which will help to minimize misdiagnoses.

Dermoscopic features of accessory nipples

Case 1  A 27‐year‐old woman presented with a 6 × 6 mm, soft, pink–brown papule located on the right axilla ( Fig. 1 ). Dermoscopic examination showed a central scar‐like white‐colored area, a cleft‐like appearance in the central area, and a fine pigment network in the periphery of the lesion ( Fig. 2 ).

Vitiligo and multiple sclerosis in a patient treated with interferon beta-1a: a case report.

Dear Sir, Interferon (IFN) beta-1a is an approved immunomodulating treatment for relapsing-remitting multiple sclerosis. Subcutaneous injections were given three times weekly. The most frequent side effects of IFN beta-1a are inflammatory reactions at the injections sites (72%) and flu-like symptoms (69%) [1]. It has been reported that IFN-alfa therapy induce vitiligo or make it worse [2,3]. However, the development of vitiligo in response to IFN-beta treatment has not been reported. Although the mechanism for interferoninduced vitiligo is not known, it is believed that IFN-alfa causes vitiligo via induction of antimelanocyte autoantibodies or activation of cytotoxic T cells [2]. It has been stated that vitiligo lesions completely resolved after discontinuation of IFN-alfa treatment [4]; however, Seckin et al. stated that the lesions did not resolve after the cessation of treatment and new lesions continued to evolve despite of withdrawal of treatment [2]. We present the case of a 33-year-old female patient who developed vitiligo lesions after receiving 22 mcg of subcutaneous recombinant IFN beta-1a therapy three times weekly for relapsing-remitting multiple sclerosis. Her baseline value of the complete blood count, biochemical test, ferritin, vitamin B12, folate, homocysteine levels and thyroid function tests were with in normal limits. Her blood vasculitis marker, brucella agglutination, VDRL, angiotensin converting enzyme and Borrelia Burgdorferi, hepatitis markers, anti-human immunodeficiency virus antibody were negative. She tolerated the therapy well, and no concurrent steroid treatment was given. After 2 years of therapy, she developed depigmented patches on the dorsal aspects of her hands (Fig. 1). The patient gave permission for the publication of the photographs. The therapy was continued despite these skin lesions. Twenty-two months after the appearance of first skin lesions, new depigmented patches occurred on periorificial areas and on chin (Fig. 2). After the appearance of vitiligo lesions on the perioral region and the chin, the laboratory evaluation of the patient was repeated. The free T3 and free T4 levels were normal, whereas the TSH values were above the normal limits (12.97 IU/ml; normal range, 0.35–4.94 IU/ml). She was treated with 0.05% Clobetasone butyrate for the lesions on the periorofacial and chin region, and with 0.05% Clobetasol 17-propionate for the lesions on the both dorsum of the hands. No improvement was observed after the treatment of topical corticosteroid for 1.5 months; there was no any progression in that period also. She was planning to become pregnant; so her IFN beta-1a treatment was terminated and there was a mild decrease in the dimensions of the lesions at the 45th day follow-up. She was treated with levothyroxine 50 mcg/day for hypothyroidism. The free T3 and free T4 levels were normal, while the TSH level was still high (8.27 IU/ml) at 3rd month. The TSH level became in normal limit at the fourth months. The vitiligo lesions significantly improved 3 months post-cessation of IFN beta-1a and were stable in follow-up 6 months. Figure 1 Depigmented patches on the dorsal aspects of both hands.