Mustafa Tunca

Skin problems in amputees : a descriptive study

Background  Skin problems are common in amputee patients. These problems may restrict the normal use of a prosthetic limb. We aimed to determine the range, incidence, causes and patterns of dermatological problems seen in a population of amputees.

Association of human leukocyte antigen class II alleles with pemphigus vulgaris in a Turkish population

Pemphigus vulgaris (PV) is a severe autoimmune blistering skin disorder that is strongly associated with major histocompatibility complex class II alleles. Human leukocyte antigen (HLA) subtypes vary with racial/ethnic backgrounds. The purpose of this study was to determine the association of HLA class II alleles and haplotypes with PV in Turkish patients. Twenty‐five patients with PV and 113 healthy transplant donors were genotyped for HLA class II alleles. HLA DNA typing was performed by the polymerase chain reaction/sequence specific primer method. The frequency of HLA DRB1*04 allele was 68.00% in patients compared to 30.97% in controls (P = 0.0012) and the frequency of HLA DRB1*14 allele was 32.00% in the patient group compared to 8.85% in the control group (P = 0.0054). Also, the frequency of HLA DRB1*04/DQB1*03 and HLA DRB1*14/DQB1*05 haplotypes in PV patients was significantly higher than controls (32.0% vs 6.2%, χ2 = 28.142, P < 0.001; and 16% vs 2.7%, χ2 = 15.143, P = 0.001, respectively). A preventive allele or haplotype for the manifestation of PV has not been identified in this study. Our findings suggest that HLA DRB1*04 and DRB1*14 alleles, and HLA DRB1*04/DQB1*03 and HLA DRB1*14/DQB1*05 haplotypes are genetic markers for general susceptibility to PV in the Turkish population.

Broadband targeted UVB phototherapy for localized vitiligo: a retrospective study

Phototherapy with ultraviolet B (UVB) or PUVA has been used in the treatment of vitiligo for many years. The aim of this study was to analyze retrospectively the efficacy and safety of targeted broadband UVB phototherapy in patients with localized vitiligo. Thirty‐two patients (14 male, 18 female), aged 18–65 years, were treated with Daavlin T500x High Dose Targeted Phototherapy System. Patients were treated twice or thrice weekly, totaling 20 to 60 sessions. Out of 32 total patients, only four patients (12.5%) showed visible repigmentation. In two patients, repigmentation was more than 75%. Other two patients showed mild repigmentation (less than 25%). All the lesions responsive to treatment were facial lesions. Mild adverse events recorded in 3 of 32 patients. Although safety of targeted broadband UVB phototherapy in the treatment of localized vitiligo is good, its therapeutic effectiveness is limited and depends on the locations of vitiligo lesions.

The effect of oral cyclosporine in the treatment of severe alopecia areata.

Abstract Context: Alopecia areata (AA) is a common non-scarring hair loss condition with an unpredictable and relapsing disease course. T-cell mediated autoimmune process is mainstay of the pathogenesis of AA, therefore immunosuppressive therapies are widely used in the treatment of AA. Objective: The aim of the study was to evaluate efficacy of oral cyclosporine therapy and reveal effects of prognostic factors in the treatment of severe AA. Materials and methods: We evaluated case histories of patients who were admitted to our department between December 2004 and September 2011 for the treatment of severe AA. A total of 25 patients were included in the study. Patients’ data that included sex, age, alopecia type, alopecia duration, family history, atopic history, previous treatments, treatment dosage, treatment duration, adverse events and clinical response were retrieved from patients’ records. Twelve patients had multifocal AA, nine patients had alopecia universalis and four patients had alopecia totalis. Patients were treated with 2.5–6 mg/kg/d doses of oral cyclosporine for 2–12 months. Results: The mean age of patients was 21.92 ± 3.56 (range: 19–34) years. All patients were male. The mean duration of disease was 8.3 ± 6.48 (range: 0.5–21) years. Four patients had positive family history and three patients had atopy history. Three of 25 (16%) patients discontinued treatment due to adverse events. Of remaining 22 patients, significant hair growth was observed in 10 (45.4%) patients; five patients with multifocal AA, three patients with alopecia universalis and two patients with alopecia totalis. In addition to this, six of nine patients with less than four years disease duration showed significant hair growth. But in patients with more than four years disease duration, only 4 of 13 patients showed significant hair growth. Conclusion: This study indicates that oral cyclosporine treatment may be a beneficial treatment option for severe AA. In addition to this, disease duration is an important prognostic factor that influences efficacy of oral cyclosporine treatment.

Lack of efficacy of topical imiquimod in the treatment of patchy alopecia areata

They reported a 29-year-old man with Henoch-Schönlein purpura (HSP), and skin biopsy showed leukocytoclastic vasculitis with perivascular dense neutrophilic infiltration and stomach biopsy demonstrated extravasation of erythrocytes with mononuclear cell infiltration in the stroma. He was treated with oral prednisolone, carbazochrome sodium sulfonate, tranexamic acid and ascorbic acid. Regarding the histopathological findings of HSP, vessel wall granulocytes on biopsy has been a major diagnostic criterion according to the American College of Rheumatology criteria. 2 Recently, however, EULAR/PReS (European League against Rheumatism/Pediatric Rheumatology European Society) endorsed consensus criteria for HSP included “predominant IgA deposition” in the definition of the criterion describing “biopsy”, 3 because IgA deposition is a main pathogenesis of HSP and it can differentiate HSP from hypersensitivity vasculitis (leukocytoclastic vasculitis without IgA deposits). Cutaneous manifestations of hypersensitivity vasculitis are similar to those of HSP and, abdominal pain, arthralgia and renal involvement can also be present. 3,4 However, patients with hypersensitivity vasculitis recover completely and it does not lead to chronic renal failure in children. 3,5

Vitamin D receptor gene polymorphisms are not associated with alopecia areata

Background  It has been demonstrated that the vitamin D receptor (VDR) is strongly expressed in key structures of hair follicles, and a lack of VDR leads to alopecia. We investigated whether there was any association between VDR gene polymorphisms (BsmI, ApaI, and TaqI) and alopecia areata (AA).

Topical nadifloxacin 1% cream vs. topical erythromycin 4% gel in the treatment of mild to moderate acne

Topical antibiotics are the mainstay of therapy in mild to moderate inflammatory acne. Topical erythromycin is one of the most common prescribed topical antibiotics. Nadifloxacin, another topical antibiotic for acne, was recently introduced into the market in our country. In this study, we compared the efficacies and safety of topical nadifloxacin 1% cream and erythromycin 4% gel in acne. A total of 86 patients with mild to moderate facial acne were randomized into two treatment groups. The efficacies of the drugs were assessed by lesion counts. An acne severity index (ASI) was also calculated. In both groups, there was a significant reduction in lesion counts and ASI scores beginning from the first visit at week 4. This reduction continued throughout the 12‐week study period. Both treatments were well tolerated. We conclude that when topically applied, both nadifloxacin 1% cream and erythromycin 4% gel are equally effective and safe treatments for mild to moderate facial acne.

Effects of etanercept on urine neopterin levels in patients with psoriasis in a controlled, open-label study

Neopterin is an immunological marker of cellular immune activation. Etanercept is a tumor necrosis factor‐α (TNF‐α) antagonist that decreases excessive levels of TNF‐α associated with inflammatory disease down to physiological levels. The objective of this study was to investigate urine neopterin levels in psoriatic patients treated with etanercept, to study the effect of etanercept as a TNF‐α blocker on urine neopterin levels. Urine neopterin levels and urine neopterin/creatinine ratios were measured by high‐performance liquid chromatography in 22 patients with psoriasis before and after treatment with etanercept. Results were compared with a group of 20 healthy volunteers, and 20 patients with inflammatory skin diseases as control groups. Urine neopterin levels, neopterin/creatinine ratios and Psoriasis Area and Severity Index (PASI) scores were evaluated at baseline, and the 12th and 24th week after treatment. Urine neopterin levels were significantly elevated in the psoriatic group compared with control and inflammatory skin diseases groups (P < 0.05). Urine neopterin levels were significantly reduced after etanercept treatment. Statistically we did not find any correlation between neopterin levels and PASI scores. Our findings indicate that urine neopterin concentrations may reflect the disease activity in psoriasis, and may be used as a marker for monitoring disease activity and response to treatment with etanercept in psoriatic patients.

Treatment of nail psoriasis with tumor necrosis factor-alpha blocker agents: An open-label, unblinded, comparative study

In this study, weaimed to investigate comparatively how nail psoriasis respondsto treatment with tumor necrosis factor (TNF)-a antagonistagents. A total of 28 patients were enrolled into the study withmoderate to severe nail psoriasis, who had failed to respondto, were contraindicated for, or were intolerant of other sys-temic therapies. Three patients had psoriatic nails without skinlesions who were diagnosed with peculiar clinical features. Thelocal ethics committee approved the study and writteninformed consent was obtained from all patients.Before treatment, complete blood count (CBC), routineblood tests, serological markers for hepatitis, anti-HIV anti-body, antinuclear antibody, chest radiography and purified pro-tein derivative test were checked. Routine blood tests, CBCand chest radiography were repeated every 3 months duringthe study period.Participants were randomized into three treatment groups.Patients in the etanercept group (n = 9) received 50-mg s.c.injections twice every week for the first 12 weeks, and onceevery week thereafter. Patients in the adalimumab group(n = 8) received an initial 80 mg s.c. injection, and 40 mg atweek 1, then 40 mg every other week thereafter. Patients inthe infliximab group (n = 11) received i.v. infusions (5 mg/kg) atweeks 0, 2 and 6 and every 8 weeks through to week 46.Patients were evaluated at 0, 12, 24, 36 and 48 weeks withNail Psoriasis Severity Index (NAPSI) and modified NAPSI(mNAPSI) scores.At the end of 48 weeks of treatment, NAPSI improvementswere 53.8%, 57.3% and 40.4%, and mNAPSI improvementswere 48.6%, 59.6% and 40.4% in adalimumab, etanercept andinfliximab treatment groups, respectively (Table 1). Each treat-ment group was found effective in comparison with baselineand there was no statistically significant difference betweenthe groups in terms of effectiveness. No significant side-effectswhich require cutting off the treatment were observed duringthe study, except for toxic hepatitis in one patient in the ada-limumab treatment group. Upon discontinuation of therapy,laboratory findings of this patient returned back to normalspontaneously.Kyriakou et al.

Targeted photochemotherapy in alopecia areata

Alopecia areata (AA) is a common cause of localized non‐scarring alopecia. Usage of targeted UVA after the topical application of 8‐methoxypsoralen (8‐MOP) is one of the rising treatment modalities for AA. Our aim was to assess the efficacy and safety of topical 8‐MOP plus targeted UVA phototherapy in the treatment of patchy AA.