Ozlem Karabudak

Inflammation and Hypercoagulable State in Adult Psoriatic Men

Hyperhomocysteinaemia is a well-known risk factor for cardiovascular disease and plays a role in atherothrombosis. Psoriasis is a common chronic and recurrent inflammatory skin disease associated with increased thrombosis. The aim of this study was to examine serum homocysteine levels and their relationships with inflammatory and atherothrombotic markers in psoriasis. Twenty patients with mild or moderate psoriasis and 20 age-matched healthy men were included in this study. Patients with acquired hyperhomocysteinaemia were excluded from both groups. The inflammation markers, mean platelet volume, C-reactive protein and ceruloplasmin levels, were significantly increased in the study group compared with the control group. In the study group there was decreased antithrombin III and total homocysteine levels, for haemostatic parameters. Folic acid levels, cardiovascular risk factors, endothelial inflammation markers and blood coagulation factors demonstrated significant correlations. Folic acid levels correlated inversely with homocysteine and positively with fibrinogen levels. In conclusion, increased homocysteine concentration and inflammation markers may play a role in the atherothrombotic state in psoriasis.

Antistreptococcal treatment of guttate psoriasis: a controlled study

Background  The role of streptococcal infection in the initiation of guttate psoriasis is well‐recognized. But the treatment results with oral erythromycin and phenoxymethylpenicillin are conflicting.

Acquired unilateral nevoid telangiectasia syndrome.

We describe a man with acquired unilateral nevoid telangiectasia syndrome, in whom no underlying disease, alcohol abuse or physiological conditions causing hormonal changes are demonstrable. To our knowledge, this is the first case of acquired unilateral nevoid telangiectasia syndrome seen in a healthy adult male and not associated with a hyperestrogenaemic state and estrogen receptor abnormality. This case report casts doubt on the commonly held view that unilateral nevoid telangiectasia syndrome is an estrogen-sensitive nevoid anomaly.

Eosinophilic cellulitis presented with semicircular pattern.

Eosinophilic cellulitis (Wells’ syndrome) is a rare condition of unknown etiology and pathogenesis. It is characterized by erythematous plaques and a histological picture of dermal eosinophilic infiltration with “flame figures”. The typical clinical presentation of eosinophilic cellulitis is mildly pruritic cellulite‐like plaques. Urticarial, vesiculo‐bullous, nodular and papulonodular variants were also reported. Herein, we describe a patient with annular and semicircular manifestations of eosinophilic cellulitis. It was treated successfully with low‐dose cyclosporine A treatment.

Histologic evidence of new collagen formation using a Q-switched Nd:YAG laser in periorbital rhytids.

Objectives: Non‐ablative laser treatment has been used for improving dermal toning. Laser application to dermis causes new collagen formation in terms of wound healing. We aimed to study mainly histological changes in skin after the use of a Q‐switched Nd:YAG laser in non‐ablative treatment of wrinkles. Methods: The laser was adjusted to a fluency of 7 J/cm2 with a spot size of 3 mm and a pulse rate of 10 Hz to treat periorbital wrinkled areas. None of the patients had received filling materials, botulinum toxin injections or any dermabrasion procedures. All laser sessions were held every 15 days for a total of six sessions and all patients were photographed before treatment and then 2 months after the last treatment. Histological examinations were performed before laser treatment and 1 month after the final treatment. Results: Four of eight individuals showed clinical improvement. The histological proportion of collagen fibers was measured by using the Samba method. An increase in the mean optical densities (MOD) of collagen fibers compared with baselines was statistically significant in all patients (p<0.05). Conclusion: The 1064‐nm Q‐switched Nd:YAG lasers appear to be safe and efficient for non‐ablative remodeling of periorbital wrinkles.

Are port-wine stain and pneumosinus dilatans associated? A controlled study

The first case demonstrating the association of a port wine stain with pneumosinus dilatans was reported in 2003 by Dogan B et al. The current study is an extension of that case report, attempting to demonstrate that the association of pneumosinus dilatans and port wine stain is clinically significant and warrants clinical evaluation in patients with port wine stains. We aimed to evaluate the patients with or without facial port wine stains if they had pneumosinus dilatans. Twenty-three patients with port-wine stains, and 20 controls without port wine stains were compared. Facial CT scan were performed on each of the 43 subjects and analysed for radiological evidence of pneumosinus dilatans. A grading system was used to assess the extent of sinus enlargement noted on CT. Statistical analysis was also done. Ten out of 20 controls had minimal enlargement, 22 out of 23 patients with a port-wine stain had minimal to marked enlargement. The differences of having pneumosinus dilatans or not and the severity of enlargement between controls and patients were statistically significant (p=0.001; p=0.00001 respectively) This study showed that the association of port wine stain and pneumosinus dilatans was not a coincidence and the diminished density of peristructural nerves might be the common cause of these two pathological conditions, especially when they are together.

The significance of histopathologic patterns in positive tuberculin skin test site

Backgrounds:  The histologic features of tuberculin skin test site is not uniform. It may be related to status of tuberculosis.

Dermatitis herpetiformis and vitiligo.

Dermatitis herpetiformis (DH) is a rare immunobullous disorder of the skin that is associated with gluten hypersensitivity. Subepidermal IgA-type antibody deposition against tissue transglutaminase leads to dense neutrophilic microabscess and eventually into vesicles in dermal papillae, which may occasionally merge into bullae. Being a subepidermal vesiculobullous disorder, DH is frequently associated with postinflammatory pigmentary changes, particularly hypopigmentation. However, the association of DH with true vitiligo is extremely rare. Here, we report a 21-year-old male with vitiligo and comorbid DH, and review the literature. This new case had severely pruritic, papular and papulovesicular lesions that were localized symmetrically and partly confined to the pre-existing vitiliginous areas. The skin biopsy specimen taken from an erythematous papule on the elbow showed characteristic findings of DH and vitiligo. Direct immunofluorescence microscopy of the perilesional skin revealed granular IgA deposition of dermal papillae. There are only 10 reports in the literature of DH and vitiligo comorbidity.

Phacomatosis spilorosea (phacomatosis pigmentovascularis type IIIb).

Phacomatosis pigmentovascularis is a rare combination of melanocytic lesions and capillary malformations associated with defects of various organs including the nervous system and eyes. A 20-year-old otherwise healthy Caucasian man presented with a lifelong history of irregular pigmented and reddish patches on the skin of the head and neck, trunk and upper limbs. There was no family history of similar lesions. On examination there were multiple giant naevus spilus of the macular type bilaterally on the face, on the right side of the neck, right upper chest and most of the right upper limb (Figs 1,2). A pale pink giant telangiectatic naevus (naevus roseus) was present on the left side of the chest extending to the left arm (Fig. 3). A similar but smaller lesion was localized to the left lateral lumbar region and

ANGIOLYMPHOID HYPERPLASIA WITH EOSINOPHILIA: ATYPICAL APPEAREANCE IN AN OLDER PATIENT

We describe a 76-year-old man presenting with a chronic, non-healing ulcer of six-year duration on his left zygomatic area. The skin biopsy specimen taken from the lesion, showed increased vascular proliferation, edematous endothelial cells in the dermal blood vessels and perivascular eosinophilic/lymphocytic infiltration. The routine and specific blood tests were unremarkable. On the basis of these features, the patient was diagnosed as having angiolymphoid hyperplasia with eosinophilia (ALHE). We present the case because of its rarity in older people, atypical clinical appearance; and stress the consideration of ALHE in the differential diagnosis of chronic non-healing superficial ulcers confined to face and neck.