Salih Levent Cinar

Long-term effect of systemic isotretinoin on female fertility

Abstract Background/objective: Acne vulgaris is one of the most common diseases of the youth. Systemic isotretinoin is the only drug which acts on all of the etiopathogenic mechanisms of acne. Isotretinoin has some well-known side effects. Besides these, there is a suspicion whether it affects fertility or not. Previously, we conducted a study about isotretinoin’s effect on ovarian reserve which showed deteriorative reserve. In this study, we aimed to evaluate the long-term effects of systemic isotretinoin on female fertility. Materials and methods: Of the 82 female patients who were enrolled in the first study, 79 patients were included in this study. Twelve months after the end of systemic isotretinoin treatment, patients were reevaluated by using the same parameters which include anti-Mullerian hormone (AMH), ovarian volume (OV), antral follicle count (AFC), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, free testosterone and total testosterone. Results: The changes in the mean AMH, OV and AFC were statistically significant between the sixth and eighteenth months (the end of systemic isotretinoin treatment and 12 months treatment free). The mean AMH, OV and AFC values at the beginning and at the 18th month were statistically similar. Conclusion: The deteriorative effects of systemic isotretinoin treatment on ovarian reserve, which can be accepted as an indicator of female fertility, diminish in time.

The association of androgenetic alopecia and insulin resistance is independent of hyperandrogenemia: A case‐control study

Androgenetic alopecia (AGA) occurs due to the effect of androgens and genetic predisposition. The association between hyperandrogenism and insulin resistance (IR) has been clearly documented. In recent years there have been reports supporting the presence of IR in AGA. The study aimed to investigate the presence of IR in women with AGA and discern whether or not it is associated with hyperandrogenism.

Topical sirolimus for the treatment of angiofibromas in tuberous sclerosis

Background: The skin is one of the most affected organs in tuberous sclerosis complex and angiofibromas are seen in almost 80% of such patients. These benign tumors impose a great psycho-social burden on patients. Objective: The aim of the study was to evaluate the effectiveness and tolerability of topical sirolimus for facial angiofibromas in patients with tuberous sclerosis complex. Methods: This was a prospective, single-blinded, cross-over study which involved twelve patients. We investigated the effect and safety of topical 0.1% sirolimus, which was obtained by crushing sirolimus tablets and mixing it with petrolatum. The patients were asked to apply the cream to one side of their face, and vaseline to the other side. The effect of topical sirolimus was evaluated using the “facial angiofibroma severity index.” Results: There was a significant improvement in the redness and extension of the tumors on the sides to which the active ingredient was applied. Some side effects such as itching and irritation occurred in three patients, which were treated with topical hydrocortisone cream. Conclusion: Topical sirolimus appears to be a promising, fairly well tolerated treatment for facial angiofibromas in patients with tuberous sclerosis complex. Although its efficacy diminishes with time, repetitive usage is effective.

The effect of Helicobacter pylori eradication on psoriasis course

Background: Psoriasis is a chronic disorder which develops in genetically vulnerable individuals with the effect of environmental factors. Some medications, trauma, stress and infections can trigger the disease. In this study we aimed to evaluate the possible effect of Helicobacter pylori eradication on psoriasis course. Material and methods: 120 psoriasis patients who were seropositive for Helicobacter pylori were enrolled in the study. Eighty of the patients were given eradication therapy for H. pylori for fourteen days. Psoriasis area severity index (PASI) scores of the patients in both groups were calculated at the beginning, at the end of the eradication therapy (15th day) and at 30th day. The two groups were compared with respect to decrease in mean PASI scores. Results: There was statistically significant decrease in the mean PASI score of the treatment group in percentages, both at 15th and 30th days. But there was no significant difference between the groups in terms of PASI-50 or PASI-75 response. There was no correlation between the body mass indexes of the patients and their response to eradication therapy. Discussion and conclusion: Although there was decrease in the mean PASI scores after eradication therapy, the number of patients who had PASI-50 response was not significant. We claim that, H. pylori eradication is not effective in healing psoriasis. Correspondence to: Salih Levent Cinar, Erciyes University Medical Faculty, Department of Skin and Venereal Diseases, 38039, Talas, Kayseri, Turkey, E-mail: sleventcinar@yahoo.com

Case Report: A rare cause of oral bullae: Angina bullosa hemorrhagica

Angina bullosa hemorrhagica (ABH) is a benign disorder of the oral cavity. Clinically, oral, blood-filled blisters are seen. To give a proper diagnosis, one should rule out any other cause. We aim to present this case in order to emphasize this rare cause of oral bullae which is necessary to be differentiated from many serious dermatological and hematological disorders.

The frequency of hematuria in acne vulgaris patients during isotretinoin treatment.

Abstract Background: Systemic isotretinoin (13-cis-retinoic acid) is effective in the treatment of acne vulgaris. The most common side effects are mucocutaneous ones. Hematuria seen secondary to isotretinoin treatment is thought to be due to mucosal dryness in the urinary system. This study aims to determine the frequency of hematuria in acne vulgaris patients during isotretinoin treatment. Materials and method: Eighty-eight subjects aged 16–32 years were included in the study group and 52 subjects were in the control group. The subjects were treated for 6 months and were monitored monthly by complete urine analyzes. They were also examined each month in terms of cheilitis, xerosis, epistaxis, rectal bleeding, fatigue, myalgia, weight loss, dry eye, conjunctivitis, headache, dysuria and pollakiuria. Results: In the study group, 15 subjects (17%) had hematuria at least once during the study, and in the control group, four subjects (7.7%) had hematuria. The difference was not statistically significant (p = 0.118). Among the subjects who had hematuria, 11 of them (73.3%) were female and four of them (33.3%) were male in the study group while all the subjects with hematuria in the control group were female. Hematuria and gender did not show a statistically significant correlation. Conclusion: Hematuria was observed in 17% of the study group; this frequency rate was not different from that of the normal population. In subjects having isotretinoin treatment, if all the other reasons or disorders are excluded, one must keep in mind that hematuria may be due to isotretinoin use.

Thyroid abnormalities in paediatric patients with vitiligo: retrospective study.

Introduction The association between vitiligo and thyroid disease is not fully investigated especially in paediatric patients. Aim To determine the incidence of vitiligo and thyroid disorders in children. This is the first report from middle Anatolia and the second report from Turkey. Material and methods A retrospective chart review was performed to examine the presence of thyroid abnormalities in paediatric patients who had been admitted to the dermatology department with vitiligo. Results A total of 155 paediatric patients, including 80 (52%) male and 75 (48%) female patients were included. The mean age was 8.6 years. Non segmental vitiligo was the most common type of the disease in 140 (90%) reviewed patients, while segmental vitiligo appeared only in 15 (10%) patients. The mean onset of vitiligo was 5.6 ±0.9 years. A family history of vitiligo was found in 14 (9%) children. Thirty-four (22%) patients had thyroid function tests and/or thyroid autoantibody abnormality. All of these patients had non segmental vitiligo. It was statistically significant (p < 0.05) in types of vitiligo and thyroid disease parameters. Conclusions Our results show that it may be useful to screen thyroid in children with non segmental vitiligo.

What is the Role of Cutaneous Lymphocyte Antigen in the Pathogenesis of Behçet’s Disease: A Randomized, Prospective Double-Blinded Study

Background : Behcet’s Disease (BD) is a chronic systemic vasculitis of unknown etiology. Cutaneous lymphocyte antigen (CLA) has an important role in the migration of T cells into the inflamed skin. Objective : Our aim was to investigate the relationship between CLA+T cell and clinical activity of BD. Methods : A total of 80 Behcet patients and 20 healthy controls were involved in this study. BD patients were divided into four groups: ocular group genital ulcer group vessel/skin lesion group, inactive group. 10.000 cells in peripheral blood were used to assess the expression levels of CD3, CD4, CD8, CLA+CD4 and CLA+CD8 in lymphocytes with CLA/FITC clone HECA-452 kit. Results : Erythrocyte sedimentation rate, C-reactive protein and lymphocyte CLA+CD8 levels were found to be higher, whereas CD4/CD8 and CLA+CD4/CLA+CD8 ratios were found lower in patients with BD when compared to controls. Conclusions : CLA may be an important finding in the determination of etiopathogenesis, disease activity and prognosis of BD.

Allergic Contact Dermatitis Caused by Both Eucalyptus Oil and Spruce Oil

Infantum cold® (Sedomed Ilac Pazarlama-Konya-Turkey) is an inhalant ointment that helps to relieve nasal congestion due to upper respiratory tract infections. It contains only eucalyptus oil and spruce oil. Although many reports present allergic contact dermatitis (ACD) due to eucalyptus oil and spruce oil separately there are no cases caused by both oil. We present a case of a pediatric patient who developed an ACD secondary to application of Infantum cold®. We believe that ACD due to eucalyptus oil and spruce oil might be more common than currently described in the literature. We encourage others to test with eucalyptus oil and spruce oil if there is clinical indication.