Orhan Ozgoztasi

The significance of Demodex folliculorum density in rosacea

Background Demodex folliculorum has been reported in rosacea in a number of clinical studies. As the Demodex mite is also present in many healthy individuals, it has been suggested that the mite may have a pathogenic role only when it is present in high densities. Moreover, some authors have proposed that a mite density above 5/cm2 may be a criterion for the diagnosis of inflammatory rosacea. In this study, the possible role of D.u2003folliculorum and the importance of mite density in rosacea were investigated using a skin surface biopsy technique.BACKGROUNDnDemodex folliculorum has been reported in rosacea in a number of clinical studies. As the Demodex mite is also present in many healthy individuals, it has been suggested that the mite may have a pathogenic role only when it is present in high densities. Moreover, some authors have proposed that a mite density above 5/cm2 may be a criterion for the diagnosis of inflammatory rosacea. In this study, the possible role of D. folliculorum and the importance of mite density in rosacea were investigated using a skin surface biopsy technique.nnnMETHODSnThirty-eight patients with rosacea and 38 age-and-sex-matched healthy subjects entered the study. With the skin surface biopsy technique, we obtained samples from three facial sites. We then determined the mite positivities, the mean mite counts in both study groups, the mean mite densities at each facial site and in the rosacea subgroups, and the mite densities above 5/cm2.nnnRESULTSnThe mean mite count in the rosacea group (6,684) was significantly higher than that in controls (2,868; p < 0.05). The cheek was the most frequently and heavily infested facial region. Ten rosacea patients and five normal subjects had mite densities over 5/cm2; the difference was not statistically significant (p > 0.05).nnnCONCLUSIONSnRosacea is a disease of multifactorial origin, and individual properties may modify the severity of the inflammatory response to Demodex. We suggest that a certain mite density is not an appropriate criterion in the diagnosis of the disease; nevertheless, large numbers of D. folliculorum may have an important role in the pathogenesis of rosacea, together with other triggering factors.

A randomized clinical trial of topical paromomycin versus oral ketoconazole for treating cutaneous leishmaniasis in Turkey

An open-labeled, randomized clinical trial to evaluate the efficacy of paromomycin ointment as compared with ketoconazole was conducted on seventy-two patients of both sexes and different ages with the confirmed diagnosis of cutaneous leishmaniasis (CL). All patients had a complete clinical evaluation for other diseases. Patients were excluded if they were pregnant or nursing or if they had serious concomitant diseases. Patients were divided randomly into two treatment groups: in the first group 40 patients were treated with an ointment containing 15% paromomycin sulfate and 12% methylbenzothonium chloride in white soft paraffin (labeled as p-ointment by El-On1) twice daily for 15 days. Treated lesions were left uncovered. The second group consisted of 32 patients who received ketoconazole 400 mg/day orally for 30 days. This dosage was reduced to 200 mg/day for patients below 12 years of age. In all cases the diagnosis was based on positive smear and/or culture. Direct smears were prepared from the exudate obtained by a small incision made at the edge of the lesion with a sterile surgical blade or lancet and stained using the Giemsa method for leishmania bodies (Fig 1). In smear negative and suspected cases aspirates taken by puncturing the lesions were inoculated onto NNN (Novy, McNeal, Nicolle) medium for culture. The cultures were incubated at 28 degrees C and the development of motile promastigotes was observed. Clinical and parasitological evaluations of the patients were performed at the end of the treatment period and 4 weeks post-treatment. A cure was defined as complete healing and disappearance of the lesion or reversible hypopigmentation at the site of lesion. Incomplete or partial improvement was defined as a reduction in the size of a lesion and the absence of parasites on smear or culture. A treatment failure was defined as the absence of any changes in the lesion and persistence of parasites on smear or culture.

The prevalence of hepatitis C virus infection in patients with lichen planus in Gaziantep region of Turkey

The purpose of this case–control study was to investigate the association between lichen planus (LP) and hepatitis C virus (HCV) infection in Gaziantep region of Turkey. Seventy-three patients with LP and a control group of patients (n: 73) with a dermatological disorder other than LP were detected for HCV infection using a third generation enzyme-linked immunosorbent assay (ELISA). A serological positivity for HCV was found in five of LP patients (6.84%), whereas it was positive for only one patient of the control group (1.36%). A statistically significant difference was found between LP and control groups (p < 0.05). We conclude that the coexistence of the two diseases is probably more than coincidental.

Role of oxidative stress in the pathogenesis of vitiligo with special emphasis on the antioxidant action of narrowband ultraviolet B phototherapy

Objectives To evaluate the role of oxidative stress in the pathogenesis of vitiligo and the effect of narrowband (NB) ultraviolet (UV) B phototherapy on oxidative stress markers. Methods Patients with vitiligo and healthy control subjects were included in the study. Patients in the vitiligo group were treated with an NB-UVB regimen (3u2009×u2009weekly for 6 months). Erythrocyte superoxide dismutase activity (SOD), erythrocyte malonyldialdehyde (MDA) and erythrocyte glutathione peroxidase activity (GSH-Px) levels were assessed in all participants at baseline, and after NB-UVB phototherapy in patients with vitiligo. Results A total of 24 patients with vitiligo and 27 control subjects were included in the study. Before treatment, erythrocyte MDA levels were significantly higher, and SOD and GSH-Px levels were significantly lower, in patients with vitiligo compared with controls. NB-UVB phototherapy was associated with a significant reduction in MDA levels and a significant increase in GSH-Px levels, compared with baseline, in patients with vitiligo. Conclusion NB-UVB phototherapy may relieve oxidative stress in patients with vitiligo by reversing the oxidant–antioxidant imbalance that is considered to play a role in the pathogenesis of this disease.

Extensive inflammatory nevus comedonicus involving half of the body.

Nevus comedonicus is an uncommon variant of adnexal hamartoma without known cause. It usually occurs on the face, neck and chest and appears as groups of closely arranged dilated follicular openings with keratin plugs. We report extensive inflammatory nevus comedonicus in a 14‐year‐old boy involving half of his body, limited by the midline, with suppuration and residual scarring. The lesions first appeared at 3 years of age and worsened at the start of puberty. The clinical features, etiopathology, histopathology and treatment options of nevus comedonicus are briefly reviewed in the light of the literature.

Facial linear focal elastosis: a case report

Background u2002Linear focal elastosis is an uncommon disorder that clinically shows band‐like stria and a histological focal increase in elastic fibers. The disorder preferentially affects men after the age of 60 years and occurs on the lower back. The pathogenesis of linear focal elastosis is still somewhat of an enigma.

A case of adult colloid milium with chronic sun exposure.

A 57‐year‐old woman presented with a sudden onset of skin‐colored papules, mainly on the forehead ( Fig. 1 ), around the eyes, and on the dorsum of the hands ( Fig. 2 ). The papules had grown in number and size over 1 month. The papules were discrete, shiny, and dome‐shaped, varying in size between 1 and 5 mm. The patient was a farmer and had commonly been exposed to UV radiation in her work in the fields for a period of more than 45 years. She was fair‐skinned and admitted that she was reluctant to use sun protection during her outdoor work. No lesions were observed on the covered areas of the body. The diagnosis was uncertain and clinical differential diagnoses were those of primary cutaneous amyloidosis, senile sebaceous hyperplasia, adult colloid milium (ACM), and papular mucinosis.

Citalopram-induced photopigmentation.

Citalopram is one of the newer and most potent selective serotonin re‐uptake inhibitor (SSRI) drugs. It has a well‐established antidepressive action with a favorable adverse event profile. We present a fifty‐year‐old woman with diffuse photopigmentation who had been diagnosed as suffering from depression. The patient was given citalopram (40 mg/day) for her psychiatric condition and diffuse photopigmentation was noted thereafter. To our knowledge, such an adverse event has not been reported previously.

Serum concentrations of interleukin-2 and tumour necrosis factor-α under cyclosporine versus acitretin treatment in plaque-type psoriasis.

Objective A prospective, randomized clinical study to compare the short-term effects of cyclosporin and acitretin on psoriasis severity, and serum interleukin (IL)-2 and tumour necrosis factor (TNF)-α concentrations. Methods Patients with moderate-to-severe plaque-type psoriasis were randomly assigned to receive either 3u2009mg/kg per day cyclosporine or 0.3–0.5u2009mg/kg per day acitretin for 8 weeks. Disease severity (psoriasis area severity index [PASI] score) and serum IL-2 and TNF-α concentrations were determined before and after treatment. Results PASI scores and serum IL-2 and TNF-α concentrations were significantly decreased after treatment with either cyclosporine (nu2009=u200921) or acitretin (nu2009=u200925). There were no statistically significant between-group differences in any parameter. Conclusions Acitretin and cyclosporine are equally effective in the treatment of moderate-to-severe plaque-type psoriasis.

Genotyping Leishmania promastigotes isolated from patients with cutaneous leishmaniasis in south-eastern Turkey

Objective Cutaneous leishmaniasis (CL) is a significant disease in south-eastern Anatolia because it is prevalent among Syrian refugees. We identified the causative Leishmania species in CL patients using molecular methods. Methods Novy–MacNeal–Nicolle medium was inoculated with aspirated fluid from suspected CL lesions and tested for amastigotes with Giemsa staining. PCR amplified the internal transcribed spacer 1 (ITS1) of the Leishmania genome in cultures containing Leishmania promastigotes from 100 patients, which were genotyped with a restriction fragment length polymorphism (RFLP) analysis. A phylogenetic tree was constructed from ITS1 sequences of 95 culture fluid samples from these patients. Results Leishmania amastigotes were detected in 92% of cultures with growth. Leishmania promastigotes were typed as Leishmania tropica with both PCR–RFLP and sequencing. Conclusions Identification of L. tropica as the causative agent of CL in our region allows the clinical course to be predicted, and guides treatment decisions and preventive measures.