Ozlem Ozbagcivan

Possible Triggering Effect of Influenza Vaccination on Psoriasis.

Psoriasis is a chronic, recurrent, immune-mediated inflammatory disease and it can be provoked or exacerbated by a variety of different environmental factors, particularly infections and drugs. In addition, a possible association between vaccination and the new onset and/or exacerbation of psoriasis has been reported by a number of different authors. The aim of this study is to investigate the effects of influenza vaccination on patients with psoriasis. Here, we report the findings from 43 patients suffering from psoriasis (clinical phenotypes as mixed guttate/plaque lesions, palmoplantar or scalp psoriasis) whose diseases had been triggered after influenza vaccination applied in the 2009-2010 season. The short time intervals between vaccination and psoriasis flares in our patients and the lack of other possible triggers suggest that influenza vaccinations may have provocative effects on psoriasis. However, further large and controlled studies need to be carried out to confirm this relationship.

High Prevalence of Metabolic Syndrome in Patients with Discoid Lupus Erythematosus: A Cross-Sectional, Case-Control Study

Although it is known that systemic form of lupus erythematosus (LE) and metabolic syndrome (MetS) are frequently observed together, there are no published reports on MetS in patients with skin-restricted LE. We aimed to compare the frequencies of MetS and its components in discoid LE (DLE) with the non-DLE control group. Additionally, we intended to determine the differences of sociodemographic and clinical data of the DLE patients with MetS compared to the patients without MetS. This was a cross-sectional, case-control study, including 60 patients with DLE and 82 age- and gender-matched control subjects. In DLE group, the presence of MetS was observed as more frequent (48.3% versus 24.4%, p = 0.003), and hypertriglyceridemia (43.3% versus 22.0%, p = 0.006) and reduced HDL-cholesterol (61.7% versus 23.2%, p < 0.001) among the MetS components were found significantly higher when compared to the control group. DLE patients with MetS were at older age (50.45 ± 11.49 versus 43.06 ± 12.09, p = 0.02), and hypertension, hyperlipidemia/dyslipidemia, and cardiovascular disease histories were observed at a higher ratio when compared to the patients without MetS. Between the DLE patients with and without MetS, no significant difference was observed in terms of clinical characteristics of DLE. Moreover, further large case-control studies with follow-up periods would be required to clearly assess the impact of MetS on the clinical outcomes of DLE.

Lichen planus after rabies vaccination.

explored. Diagnostic imaging such as lymphoscintigraphy, lymphangiography, or magnetic imaging can be done to define the lymphatic anatomy and sites of chylous leak. Therapeutic strategies such as diet modification with mediumchain triglyceride diet control and compression garments may be helpful in some patients. If suspicions of cellulitis or lymphangitis arise, a course of antibiotics may prove beneficial. Lastly, surgical interventions should be considered for patients with low operative risks but with significant morbidity due to CCR, such as malnutrition. Options include lymphatic resection and sclerotherapy. Currently, there is little evidence to establish efficacy of individual treatment options. While most physicians adopt a stepladder approach in managing CCR, i.e., surgery upon failure of conservative management, no clear treatment threshold has been defined between conservative and surgical options. Further studies will be helpful in this regard.

Influence of demographic and clinical characteristics of actinic keratosis patients on illness perceptions and readiness to increase sun protection behaviours: an exploratory study

There are no data comprehensively investigating the key beliefs and sun protection behaviours in patients with actinic keratosis (AK). Our aim was to determine and correlate the AK perceptions and readiness to increase sun protection (RISP) behaviours.

An interstitial granulomatous pattern in scleromyxedema with dermato-neuro syndrome.

Editor Scleromyxedema belongs to the spectrum of cutaneous mucinoses and is characterized by a generalized papular sclerodermoid eruption associated with monoclonal gammopathy in the absence of thyroid disease. Typically, it affects middle-aged individuals and has a chronic progressive course. Here, we present a rare case of granulomatous scleromyxedema complicated by fatal neurological manifestations. A 50-year-old woman presented with a 2-year history of numerous nonitchy, waxy, papular eruptions over the whole body. Her medical history showed inadequate response to previous systemic corticosteroid, hydroxychloroquine and colchicine therapies. Additionally, she reported breathing problems and reduced physical fitness. On physical examination, she showed monomorphic, flesh-colored and firm papules from 2 to 3 mm in diameter on the face, body and extremities. She also had a leonine face and sclerodactyly due to induration and infiltration of the skin (Fig. 1). Further examination revealed proximal sensorimotor polyneuropathy, restrictive pulmonary disease and pericardial effusion. Routine laboratory investigations including thyroid function tests were within normal ranges, except for hypochromic microcytic anaemia. Repeated serum and urine electrophoresis showed a persistent IgG k monoclonal gammopathy and bone marrow evaluation revealed involvement by abnormal monoclonal lambda-producing CD38 positive neoplastic plasma cell infiltration. The bone marrow plasma cells were 40 %. Multiple skin biopsies were taken for histopathological examination. All specimens revealed an intact, orthokeratotic and slightly acanthotic epidermis and ‘busy’ dermis due to increased number of histiocytes. These histiocytes were admixed with small number of eosinophils and scattered between dermal collagen fibres in interstitial fashion (Fig. 2a). There were no changes in elastic tissue but there was mucinous degeneration in dermal collagen stained with Alcian blue (Fig. 2b). There were giant cells in dermal infiltrate and the histiocytes were positive for CD68 immunostaining (Fig. 2c). After a short period of time, she was transferred to the intensive care unit as a result of progressive deterioration of the disease with fever, convulsions, lethargy and then evolving into coma. Her course was complicated by pulmonary oedema and Stenotrophomonas maltophilia sepsis. She died 2 months later

Urticaria and angioedema as possible reactions of omalizumab

Dear editor; A 55-year-old man presented to our clinic with a 16-year history of chronic spontaneous urticaria (CSU). Given the poor response to H1-antihistamines at high doses alone or in combination with montelukast, he had started to receive omalizumab four months ago (300 mg/SC/every fourth week). He was referred to our clinic because of the exacerbation of his urticaria after this therapy. On physical examination, we detected the continuous eruption of short-lived hives on his body and extremities. He had no angioedema. His urticaria activity score-7 (UAS-7) was 14 in the preceding week. Complete blood count, liver, renal, and thyroid function tests, erythrocyte sedimentation rate, C3-C4 complement levels, and urine analysis were normal. Anti-thyroid and antinuclear antibodies, tests for human immunodeficiency, hepatitis B and C viruses, and stool examinations for parasitic infections were negative. Serum IgE level was 196 IU/mL (normal 0–87), and C-reactive protein (CRP) value was 2.2mg/L (normal<5 mg/L). His chest x-ray and abdominal ultrasonography were normal. Twenty-eight days after the last dose, we administered the fifth dose of omalizumab (300mg/SC) because of the ongoing symptoms. We also thought that the previous exacerbations should not be omalizumab-related. No acute reaction was observed following the administration, but an exaggeration of the urticaria and swelling of the lips and tongue were observed after about 12 hours (Figure 1). The CRP value measured in this period was 10.8mg/L. He was treated with antihistamines and systemic corticosteroids, but the UAS-7 was increased to 39 over the first week (Table 1). In the following period, the patient did not accept the diagnostic tests planned to determine the sensitizing compound of omalizumab. 304 Letters

Blocking or enhancing effects of some basic emollients in UVA penetration

Background Topical agents used in combination with phototherapy or photochemotherapy may have both blocking or enhancing effects in ultraviolet rays. Objective In this in vivo study, the effects of topical petrolatum, basis cream, glycerine, and olive oil on the transmission of ultraviolet A radiation were investigated. Methods A test was performed to determine the minimal phototoxic dose on 29 volunteers with only psoralen plus ultraviolet A (PUVA) and then the same test was repeated with white petrolatum, basis cream, glycerine, olive oil, and sunscreen (0.3cc/25cm2). The effects of each agent on the minimal phototoxic dose were determined after 72 h. Results When compared to pure PUVA, there was a statistically significant increase in the mean minimal phototoxic dose values by the application of white petrolatum (P = 0.011), but there was no significant increase or decrease in the mean minimal phototoxic dose values after the application of basis cream (P = 0.326), glycerine (P = 0.611) or olive oil (P = 0.799). Study limitations Low number of patients Conclusion The application of white petrolatum, which has a blocking effect, and also of basis cream immediately before PUVA therapy should not be recommended. Although we specify that glycerine and maybe olive oil can be used before photochemotherapy, there is a need for further research in larger series.BACKGROUND Topical agents used in combination with phototherapy or photochemotherapy may have both blocking or enhancing effects in ultraviolet rays. OBJECTIVE In this in vivo study, the effects of topical petrolatum, basis cream, glycerine, and olive oil on the transmission of ultraviolet A radiation were investigated. METHODS A test was performed to determine the minimal phototoxic dose on 29 volunteers with only psoralen plus ultraviolet A (PUVA) and then the same test was repeated with white petrolatum, basis cream, glycerine, olive oil, and sunscreen (0.3cc/25cm2). The effects of each agent on the minimal phototoxic dose were determined after 72 h. RESULTS When compared to pure PUVA, there was a statistically significant increase in the mean minimal phototoxic dose values by the application of white petrolatum (P = 0.011), but there was no significant increase or decrease in the mean minimal phototoxic dose values after the application of basis cream (P = 0.326), glycerine (P = 0.611) or olive oil (P = 0.799). STUDY LIMITATIONS Low number of patients CONCLUSION:: The application of white petrolatum, which has a blocking effect, and also of basis cream immediately before PUVA therapy should not be recommended. Although we specify that glycerine and maybe olive oil can be used before photochemotherapy, there is a need for further research in larger series.

Xerosis cutis and associated co-factors in women with prurigo nodularis

BACKGROUND Current data regarding the associated factors of prurigo nodularis are still uncertain, except for atopic predisposition. OBJECTIVES The purposes of this study were to (1) determine the frequencies of xerosis and other accompanying diseases of female patients with prurigo nodularis; (2) compare the demographic, clinical and accompanying disease characteristics by grouping these patients according to whether they have associated xerosis (who were subsequently subgrouped as atopic or non-atopic) or not. METHODS In this retrospective descriptive study, 80 females with PN were categorized according to the accompanying diseases (dermatological, systemic, neurological, psychogenic, mixed, or undetermined origin). RESULTS A total of 45 associated co-factors including dermatological in 63 (78.8%), systemic in 57 (71.3%), psychological in 33 (41.3%) and neurological co-factors in 14 (17.5%) of all patients with prurigo nodularis were detected. Xerosis was observed in 48 (60%) patients (non-atopic co-factors in 66.7% of them). The ratio of patients with mixed co-factors, dermatological+systemic co-factors and dermatological+systemic+psychological co-factors were found to be significantly higher in patients with xerosis compared to those without xerosis. STUDY LIMITATIONS Our study has certain limitations such as the absence of an age-matched control group, absence of follow-up data and the fact that the diagnosis of xerosis has not been based on objective methods. CONCLUSIONS Xerosis has been identified in more than half of the patients with PN and it has been determined that in most patients xerosis is associated especially with diabetes mellitus and other conditions related to prurigo nodularis.Background Current data regarding the associated factors of prurigo nodularis are still uncertain, except for atopic predisposition. Objectives The purposes of this study were to (1) determine the frequencies of xerosis and other accompanying diseases of female patients with prurigo nodularis; (2) compare the demographic, clinical and accompanying disease characteristics by grouping these patients according to whether they have associated xerosis (who were subsequently subgrouped as atopic or non-atopic) or not. Methods In this retrospective descriptive study, 80 females with PN were categorized according to the accompanying diseases (dermatological, systemic, neurological, psychogenic, mixed, or undetermined origin). Results A total of 45 associated co-factors including dermatological in 63 (78.8%), systemic in 57 (71.3%), psychological in 33 (41.3%) and neurological co-factors in 14 (17.5%) of all patients with prurigo nodularis were detected. Xerosis was observed in 48 (60%) patients (non-atopic co-factors in 66.7% of them). The ratio of patients with mixed co-factors, dermatological+systemic co-factors and dermatological+systemic+psychological co-factors were found to be significantly higher in patients with xerosis compared to those without xerosis. Study limitations Our study has certain limitations such as the absence of an age-matched control group, absence of follow-up data and the fact that the diagnosis of xerosis has not been based on objective methods. Conclusions Xerosis has been identified in more than half of the patients with PN and it has been determined that in most patients xerosis is associated especially with diabetes mellitus and other conditions related to prurigo nodularis.

Examination of the Microbial Spectrum in the Etiology of Erythema Nodosum: A Retrospective Descriptive Study

Even though infections are the most common cause of erythema nodosum (EN), only certain microorganisms take the great interest such as streptococci in knowledge. Our aim was to examine the frequency and type of infections in EN, to determine the characteristics of patients with an infectious etiology, and to discuss the role of these microbes in EN pathology in the context of their interactions with humans. Charts of 81 patients with EN who were seen between 2003 and 2017 were retrospectively reviewed. Identified etiological factors were classified into three groups: infectious, noninfectious, and idiopathic. While there were no significant demographic and clinical differences between the infectious and idiopathic groups, systemic symptoms (p = 0.034) and the number of EN lesions (p = 0.016) were significantly lower; the mean erythrocyte sedimentation rate was significantly higher (p = 0.049), but the mean aspartate aminotransferase value was significantly lower in the infectious group compared to the noninfectious group (p = 0.019). Besides streptococci, many other microbes, including the ones living on and inside us, were identified in the etiology of EN. There is a need for large-scale prospective studies involving control groups for a better understanding of the microbial immunopathology of EN.

Investigation of the relationship between dermoscopic features and histopathological prognostic indicators in patients with cutaneous melanoma

Türkderm-Deri Hastalıkları ve Frengi Arşivi Dergisi, Galenos Yayınevi tarafından basılmıştır. Turkderm-Archives of the Turkish Dermatology and Venerology, published by Galenos Publishing. Background and Design: Dermoscopy has an important role in the diagnosis of melanoma nowadays. Dermoscopic findings of melanoma had been associated with Breslow thickness and invasion status in previous studies but the relationship between dermatoscopic findings and other histopathological prognostic indicators has not been investigated until today. In this study, our aim is to investigate the relationship between dermatoscopic findings and histopathologic prognostic indicators such as Breslow thickness, invasion status, mitotic rate, lymphovascular invasion (LVI), ulceration and regression in patients who had been diagnosed with melanoma due to their clinical, dermatoscopic and histopatological findings. Materials and Methods: Dermoscopic and histopathological findings of 47 cases of melanoma who applied to our clinic between the years 2000 and 2014 were evaluated. The relationship between the dermoscopic findings which had been reported to be observed in melanomas in previous research and the histopathologic prognostic indicators such as Breslow thickness, invasion status, mitotic rate, lymphovascular invasion, ulceration and regression were investigated. Results: Irregular dots/globules, atypical pigment network, multifocal hypopigmentation, radial streaks and moth-eaten borders have been associated with good prognostic indicators whereas comedo like openings, regular blotch, exophytic papillary structures, dotted, glomerular, lineer irregular vessels, pink/red and blue/gray colors were associated with poor prognostic indicators. Additionally some dermatoscopic findings which are more observed in benign lesions such as multiple milia-like cysts, comedo like openings, moth-eaten borders, regular blotch, exophytic papillary structures and finger print areas have been observed in melanomas in our study. Amaç: Günümüzde dermoskopi melanom tanısında önemli bir yere sahiptir. Literatürde melanomun dermoskopik bulguları daha çok Breslow kalınlığı ve invazyon durumu ile ilişkilendirilmiş olup diğer histopatolojik prognostik belirteçlerle ilişkisi araştırılmamıştır. Bu çalışmadaki amacımız klinik, dermoskopik ve histopatolojik olarak melanom tanısı almış olan olgularda Breslow kalınlığı, invazyon durumu, mitoz oranı, lenfovasküler invazyon, ülserasyon ve regresyon durumları ile dermoskopik bulgular arasındaki ilişkiyi araştırmaktır. Gereç ve Yöntem: Araştırmamızda 2000-2014 tarihleri arasında polikliniğimize başvuran toplam 47 melanom olgusunun dermoskopik ve histopatolojik bulguları değerlendirilmiştir. Daha önceki araştırmalarda melanomlarda gözlendiği bildirilmiş olan dermoskopik bulguların varlığı ile Breslow kalınlığı, invazyon düzeyi, mitoz oranları, lenfovasküler invazyon (LVİ), ülserasyon ve regresyon durumları arasındaki ilişki araştırılmıştır. Bulgular: Araştırmamızda düzensiz nokta yapısı/globüller, atipik pigment ağı, multifokal hipopigmentasyon, ışınsal uzantılar ve güve yeniği kenar yapısı gibi dermoskopik bulguların iyi prognostik belirteçler ile birliktelik gösterdiği; komedon benzeri açıklıklar, düzenli leke, ekzofitik papiller yapılar, noktasal, glomerüler, lineer düzensiz damarlar ile pembe/kırmızı ve mavi/gri renklerin ise kötü prognostik belirteçler ile birliktelik gösterdiği belirlenmiştir. Ayrıca araştırmamızdaki melanomlarda, daha çok benign lezyonlarda gözlenen multipl milyum benzeri kistler, komedon benzeri açıklıklar, güve yeniği kenarlar, düzenli leke, ekzofitik papiller yapılar ve parmak izi benzeri alanlar gibi dermoskopik bulgular da gözlenmiştir. Sonuç: Araştırmamızda birçok dermoskopik bulgunun histopatolojik prognostik belirteçler ile istatistiksel olarak anlamlı birliktelik gösterdiği belirlenmiştir. Retrospektif özellikte olan bu çalışmada olgu sayısı sınırlı olmakla birlikte, literatürde benzer bir çalışmanın olmaması nedeniyle sonuçlarımızın ileride yapılacak araştırmalar için bir basamak oluşturabileceğini düşünmekteyiz. (Türk derm 2015; 49: 200-7) Anahtar Kelimeler: Melanom, dermoskopi, prognostik belirteçler