Ömer Çalka

Cutaneous anthrax in Eastern Turkey: a review of 85 cases

Background.  Anthrax is a zoonotic disease diminishing worldwide. Although a very rare disease in developed countries, anthrax is still endemic in developing countries.

Oesophageal involvement during attacks in pemphigus vulgaris patients.

Background.  Pemphigus vulgaris (PV) is a rare autoimmune bullous skin disorder characterized by frequent involvement of the mucous membranes, usually beginning at the mouth.

The Effect of Acitretin Treatment on Insulin Resistance, Retinol-Binding Protein-4, Leptin, and Adiponectin in Psoriasis Vulgaris: A Noncontrolled Study

Background/Aim: To investigate the effects of acitretin treatment on insulin resistance (IR) and adipokines, particularly retinol-binding protein (RBP)-4. Methods: Thirty-four patients with chronic plaque psoriasis and a control group of 34 healthy volunteers were recruited in the study. Screening for the parameters was performed before starting and after 3 months of acitretin treatment in the psoriasis group. The control group was only evaluated at the beginning of the study and did not receive placebo. We could not compare our results with a placebo control group because of ethical reasons. Results: Basal adiponectin (p = 0.01), insulin (p < 0.0001) levels and homeostasis model assessment (HOMA) IR (p < 0.0001) were significantly higher in psoriasis patients. After the treatment, insulin (p = 0.014), C peptide (p = 0.011), RBP-4 (p < 0.0001) levels and HOMA-IR (p = 0.008) decreased significantly. Posttreatment leptin (p = 0.036) levels were significantly lower than those of the controls. Posttreatment adiponectin (p = 0.005) and insulin (p = 0.048) levels were higher than those of the controls. Conclusions: This study showed for the first time that RBP-4 levels and IR are decreased significantly with acitretin treatment. This finding is very important in psoriasis patients because psoriasis may cause insulin resistance and diabetes. Further experimental and clinical studies are needed to clarify the effect of acitretin on adipocyte structure and behavior.

Phytodermatitis from Ranunculus damascenus

Keywords: Ranunculaceae; Ranunculus damascenus; ranunculin; anemonin; protoanemonin; phytodermatitis; herbal remedies; toxic; vesicant; plants; irritant

The use of complementary and alternative medicine among dermatology outpatients in Eastern Turkey

Introduction: Over the past decade, complementary and alternative medicine (CAM) has become increasingly popular around the world. Objectives: In this study, we aim to investigate how frequently CAM is used and the types of CAM methods used for dermatological disease in Eastern Turkey. Materials and methods: We recruited 1610 patients from our clinic for this study. The sociodemographic features and the CAM methods were investigated with a survey. Results: The most common dermatological disorders included contact dermatitis (21.4%), acne vulgaris (17.5%), fungal infections (10.9%), eczema (6.3%), and warts (5.7%). The ratio of patients using at least one CAM method was 43.7% and that of those using two or more CAM methods was 20.8%. The most commonly used CAM methods were those using henna, cologne, moisturizing cream, prayer, and herbal therapy. Some patients were found to use some interesting and unusual CAM methods, such as putting out a cigarette over the skin on the back for anthrax, applying raw meat for furuncle, using fuel oil and nitric acid for contact dermatitis. Conclusions: CAM methods are commonly used in our population. CAM methods often cause adverse reactions that may alter diagnostic skin findings and interfere with the efficacy of other medical therapies. Therefore, physicians should ask their patients about the use of CAM methods while collecting patient history. Physicians have a critical role in preventing improper use of CAM. In addition, further investigations into the efficacy, benefits, and risks of CAM methods should be carried out for better insight into those CAM methods.

Report of an Infant with Noma (Cancrum Oris)

Noma (cancrum oris) is an infectious disease that destroys the oro‐facial tissues and other neighboring structures in its fulminating course. The starting point of the disease is acute ulcero‐necrotic gingivitis, which results in an extensive gangrenous plaque destroying all of the soft tissues of the face. It predominantly affects children aged 2–16 years and is primarily seen in areas where the socioeconomic standards are low and there is poor hygiene, as in developing countries. We discuss possible predisposing factors in cancrum oris such as malnutrition, infectious diseases, HIV infection, and immune compromise conditions. Poverty is the most important risk factor. We report the case of a 6‐month‐old child with noma and review the characteristic features of this disease.

Cutaneous drug reactions in children: a multicentric study.

Introduction According to studies conducted in outpatients, it is estimated that 2.5% of children who are treated with a drug will experience a cutaneous adverse drug reaction (CADR). Aim To analyze the CADR reports involving pediatric patients recorded by three different university hospitals for describing common, serious, and interesting cutaneous drug eruption patterns. Material and methods For this purpose, the patients’ data from three different universities were reviewed retrospectively. Diagnosis was based on history, clinical findings and laboratory test results. The CADRs were classified into seven categories; urticaria, angioedema, maculopapular eruption, fixed drug eruption, erythema multiforme, acute generalized exanthematous pustulosis, drug rash with eosinophilia and systemic symptoms syndrome. Results A total of 122 patients who had CADRs were enrolled in the study. The most frequently detected cutaneous drug reactions were urticaria + angioedema. Most of patients had no previous experience with the same drug and the most common causative agent of CADRs was antimicrobials. Conclusions Since CADRs are relatively rare, the current multicentric study can provide meaningful information about the cutaneous eruption patterns of commonly used drugs.

Histiocytoid Sweet syndrome

Histiocytoid Sweet syndrome Requana et al., in 2005, was the first to describe histiocytoid Sweet syndrome (HSS) as a variant of acute febrile neutrophilic dermatosis. They described 41 patients with a variant of SS exhibiting histiocytoid mononuclear cells in histopathological assessments. Although the clinical presentations were similar to typical SS, histologically those cases demonstrated a dense dermal infiltrate of mononuclear cells with large, slightly eccentric, elongated, kidney-shaped, basophilic nuclei that immunohistochemically stained with CD15, CD43, CD45, CD68, MAC386, HAM56, and lysosyme. Of these 41 patients, six had associated hematologic or visceral malignancies. Later, Chow et al. reported six cases of HSS and panniculitides. In addition, HSS associated with Crohn’s disease without presenting bone marrow dysplasia or immaturity has been reported. Moreover, drug-related HSS has been reported in two cases. A 29-year-old woman came to our clinic with a oneweek history of fever, ocular hyperemia, and erythematous swelling over her face and arms. She was eight weeks pregnant. Her medical history and family history were unremarkable. The physical examination demonstrated several painful, erythematous papules and plaques on her face, neck, arms, and extensor surfaces of the hands (Fig. 1a,b). The eye examination revealed hyperemia and conjunctivitis. No cervical lympadenopathy or hepatosplenomegaly was detected. Laboratory studies showed elevated white blood cells of 12,400/mm with 93% predominantly with neutrophils; elevated total IgE of 194 iu/ml (0–100); elevated erythrocyte sedimentation rate of 57 mm/h (normal, 1–20 mm/h); and elevated C-reactive protein level measuring 39.4 mg/l (normal, 0–5 mg/l). The routine biochemical test and peripheral blood smear were normal. The histopathological examination of the skin biopsy from the arm showed that basket-weave orthokeratosis, acanthosis, dermal perivascular mixed infiltrates composed of mainly histiocytoid mononuclear cells and mild edema in papillary dermis (Fig. 2a). The immunohistochemical staining confirmed that most dermal infiltrating cells were CD68 positive (Fig. 2b). Further positive immunostaining of myeloperoxidase indicated that these histiocytoid cells were indeed granulocytes (Fig. 2c). The patient was diagnosed with HSS based on clinical and histopathological findings. She was treated with topical steroid cream (mometasone furoate) due to her pregnancy. The plaques were completely resolved within three weeks. The routine histiocyte markers such as CD68/KP1, lysosyme, and MAC 387 stain both histiocytes and myeloid cells. To differentiate myeloid lineage, more specific staining techniques, including myeloperoxidase, neutrophil elastase, and T-cell intracellular antigen 1 should be performed. Myeloperoxidase is the main component of primary granules in myeloid cells serving as a reliable marker for myeloid cells, both early and mature forms. The appearance of myeloperoxidase precedes that of neutrophil elastase during myeloid cell differentiation. In HSS, the lesions may be caused by immature myeloperoxidase positive myeloid cells being released from the bone marrow during the early phase of the disease, and these immature myeloid cells may be replaced by more mature, segmented, neutrophils in the later phase. In our case, although clinical findings were suggestive of SS, the 80 (a)

A case of irritant contact dermatitis with leech

Medicinal leeches are invertebrated parasites that have been used for medical purposes for centuries as one of the traditional treatment methods. Medicinal leeches are used for wound and flap healing in the plastic and reconstructive surgery, in the treatment of venous insufficiency, varicosities, hemorrhoids, and in many other diseases. However, due to medicinal leech therapy (hirudotherapy) complications such as anaphylaxis, local allergic reactions, anemia, and mucosal synechiae can occur. In this article, we report a case of an irritant contact dermatitis in a patient who experienced severe redness and itching after applying leeches for the relief of head and neck pain. Leeches are being used widely in some regions in the world and if people are informed about the leeches, it may be helpful in preventing complications that may occur.

Visual evoked potential findings in Behcet's disease without neurological manifestations.

Behçets disease (BD) is a chronic, recurrent multisystem inflammatory disorder firstly described by Turkish dermatologist Dr. Hulusi Behçet in 1937. The classic triad consists of recurrent oral and genital ulcerations and uveitis. The article presents the value of visual evoked potential findings of a series of 44 patients with BD without neurological manifestations seen at the Medical Hospital in Neurology and Dermatology clinics over the past 8 years. The mean latency value of positive peak P100 in BD patients was significantly delayed compared to that of control subjects (patientss mean: 105.6 ms in right eye and 107.7 ms in left eye; control subjects mean: 101.4 ms in right eye and 101.7 ms in left eye).