Sedat Özçelik

Non-Acne Dermatologic Indications for Systemic Isotretinoin

Systemic isotretinoin has been used to treat severe acne vulgaris for 20 years. However, isotretinoin also represents a potentially useful choice of drugs in many dermatologic diseases other than acne vulgaris. Diseases such as psoriasis, pityriasis rubra pilaris, condylomata accuminata, skin cancers, rosacea, hidradenitis suppurativa, granuloma annulare, lupus erythematosus and lichen planus have been shown to respond to the immunomodulatory, anti-inflammatory and antitumor activities of the drug. Isotretinoin also helps prevent skin cancers such as basal cell carcinoma or squamous cell carcinoma. A combination of systemic isotretinoin and interferon-α-2a may provide a more potent effect than isotretinoin alone in the prevention and treatment of skin cancers.Systemic isotretinoin may be considered as an alternative drug in some dermatologic diseases unresponsive to conventional treatment modalities. However, randomized clinical trials aimed at determining the role of systemic isotretinoin therapy in dermatologic diseases other than acne vulgaris are required.

Kangal Hot Spring with Fish and Psoriais Treatment

The effect of “Kangal Hot Spring with Fish” in the treatment of psoriasis is investigated. The study was carried out on 87 patients with psoriasis vulgaris and the patients were evaluated by a dermatologist for 21 days. The evaluation of the disease was performed using PASI (Psoriasis Area and Severity Index) scores. Recurrences were investigated in the patient population, who had been previously treated in the same hot spring. The first examination scores were significantly higher than the scores of the 3, 6, 9, 12, 15 and 21 days after treatment (p<0.01). Longer remission periods, when compared to the topical corticosteroid treatment, expressed by the 35 patients previously treated in hot spring (p<0.01). Spa therapy under observation of a dermatologist may be effective and useful for psoriasis vulgaris patients.

A case with Listeria meningitis during administration of mycophenolate mofetil for pemphigus vulgaris.

© 2007 The Authors 1447 JEADV 2007, 21, 1413–1450 Journal compilation

Prevalence of common and atypical melanocytic nevi in Turkish children

The incidence of malignant melanoma is increasing rapidly in the white population of the world. Therefore, it is necessary to know the etiological factors of malignant melanoma and to take preventive measures in high-risk groups in different populations. This study aimed to estimate the prevalence of common melanocytic nevi (CMN) and atypical melanocytic nevi (AMN) and to identify some phenotypic factors (eye and hair color, skin type), gender, and age associated with CMN and AMN presence in primary school children in a Turkish population. In this study, 1491 children aged from 7-15 were examined. Brown-black discrete lesions of two millimeters or larger, with the exceptions of solar lentigo and ephelides, were counted as CMN. The CMN prevalence was 73.85%, and the AMN prevalence was 3.45%. The numbers of CMN and AMN were found to be higher in boys than in girls. While more CMN were present in the head and neck areas than in other anatomic regions, the number of AMN was higher on the ventral and dorsal trunk. Our study provides evidence for a significant relationship between specific characteristics, including skin type, age, gender and the number of CMN in our population. However, CMN is more frequent in children having a lighter skin type, and its number increases with age. The results of our study and further studies which take sun-exposure characteristics and pigmentary factors into account, may facilitate the determination of the other factors affecting nevus production and the development of further strategies for following and preventing cutaneous melanoma in our geographical area.

Metabolic syndrome may be an important comorbidity in patients with seborrheic dermatitis

Introduction Seborrheic dermatitis is a chronic inflammatory skin disease. One of the components of metabolic syndrome is inflammation, and many inflammatory cytokines play a critical role in the disease. The aim of this study is to investigate metabolic syndrome and to evaluate the relationship between the parameters of the disease and disease severity in patients with seborrheic dermatitis. Material and methods Forty-seven patients with seborrheic dermatitis and 36 healthy controls were included in the study. The parameters of metabolic syndrome were recorded in both groups. In the patient group, disease severity was determined with the seborrheic dermatitis area and severity index (SDASI). All the venous blood samples were taken at 8 a.m. after 10 h of fasting. Results High-density lipoprotein (HDL) levels in the patient group were statistically significantly lower than in the controls. There was no significant difference between groups according to other parameters. In terms of history of metabolic disease in first degree relatives (diabetes mellitus, cardiovascular disease, and dyslipidaemia), 78.7% of those in the patient group (n = 37) and 55.6% of those in the control group (n = 20) had a history of metabolic disease in their families, and the difference between the patient and control groups was found to be statistically significant (p < 0.05). There was a significant correlation between disease severity and plasma HDL levels (p = 0.033, r = –0.312). Conclusions The presence of seborrheic dermatitis may be a predictive factor for metabolic syndrome.

Delayed habituation in Behcet's disease

BACKGROUND The autonomic nervous system in Behcets patients may be affected due to various reasons. This entity may be detected with the measurement of the electrodermal activities, heart rate variability and pupillometric methods. Habituation is one of the implicit forms of learning and memory and the loss of habituation can reveal pathological changes in the synaptic regions. AIM To determine whether there is a functional decrease in the synaptic effectiveness (habituation) of the pathways to sympathetic neurons that had been repeatedly activated in Behcets. MATERIALS AND METHODS Twelve patients with Behcets disease and 12 healthy controls were included in the study. Sympathetic skin potential (SSP) records were taken at normal room temperature in a quiet place within a Faraday cage. Sixteen square wave single shock impulses (duration: 1200 ms, strength: 5 mA) were applied on each case. RESULTS After the 1st stimulus, the SSP amplitudes were lower in the patients compared to the controls (P<0.001, t value=7.69). There was no significant differences among the SSP amplitudes after the 13th impulse in the patients (P>0.05). Whereas there was no significant differences among the SSP amplitudes after the 9th impulse in the controls (P>0.05). The habituation rate of the SSP after consecutive impulses was slowest in the patients compared to controls (P<0.001, t value=12.39). CONCLUSIONS There is a delayed habituation in Behcets disease and that may due to pathologic changes with vasculitis through their peripheral nerves.

Lichen simplex chronicus after herpes zoster.

To the Editor: A 57-year-old Turkish male was admitted to our clinic with pain and tenderness on the right area of his neck and right scapula. Clinically, the patient was diagnosed with herpes zoster and was administered systemic antiviral treatment with acylovir. Two weeks after treatment, the lesions had cleared dramatically, but our patient has started to complain about severe pruritus in the same area. One week later violeceous, shiny papules and plaques appeared (Fig. 1). His sensation and motor functions were normal. Laboratory tests, including a full blood count and renal and liver functions, were normal. The patient was suspected of having lichen simplex chronicus, and the diagnosis was established by a biopsy taken from a papular lesion. Histopathologic examination showed hyperkeratosis, acanthosis, and elongation of the rete ridges in the epidermis. There was a superficial perivascular lymphocytic infiltration and collagen bundles in the dermis. He has responded to topical corticosteroids and systemic antihistaminic treatment. Discussion: Several cutaneous reactions have been described in dermatomes affected by herpes zoster (1-3). Cutaneous reactions occurring after herpes zoster are variable, and their pathogenesis remains unclear. Probably, minute amounts of viral proteins are responsible for these reactions. In addition, other immunological, neural or vascular factors may also playa part in the development of such cutaneous lesions (2). Lichen simplex chronicus is an unusual complication of herpes zoster; only one case was apparently previously reported (3). The sensations of itch and pain share the same neuroanatomical substrate. Itching is Letter to the Editor

Increased expressed emotion in patients with psoriasis

Aim of the study: The aim of this study was to determine whether patients with psoriasis are affected by expressed emotion in their family environment. Material and methods: Participants included 62 patients with psoriasis and 83 healthy controls and their biological parent, wife or husband, or adult child as a key relative. Sociodemographic data were recorded. Psoriasis area severity index was used to evaluate psoriasis severity. Hamilton depression and anxiety scales and the Expressed Emotion Questionnaire form were used to evaluate depression, anxiety, and expressed emotion. Results: The levels of expressed emotion and its subgroups in the patient group were higher than in the group of healthy controls (p < 0.05). Gender, disease duration, disease severity, and key relatives did not affect the levels of expressed emotion (LEEtotal) in the patients with psoriasis (p > 0.05). The LEEtotal of those with low educational level in the patient group was statistically significantly higher than those with higher educational level (p < 0.05). There was no correlation between the presence depression or anxiety and expressed emotion (p > 0.05). There was a negative correlation between age and the levels of expressed emotion in the patient group (p < 0.05). There was a negative correlation between age and intrusiveness in healthy controls (p < 0.05). Conclusions: Although decreasing with age, expression of emotion in patients with psoriasis is high, and psychosocial support should be provided to these patients.

Bir yaşlanma modeli olarak Caenorhabditis elegans bireylerinde kalsinörin inhibisyonu ile ortaya çıkan değişiklikler

Mustafa Tosun, Sibel Berksoy Hayta, Melih Akyol, Sedat Özçelik 1 Dermatology Department, Sivas Numune Hospital, Sivas, Turkey 2 Cumhuriyet University School of Medicine, Dermatology Department, Sivas, Turkey Corresponding author: Mustafa Tosun, Dermatology Department, Sivas Numune Hospital, Sivas, Turkey E-mail: doktor699@hotmail.com Received/Accepted: September 05, 2015 / September 06, 2017 Conflict of interest: There is not a conflict of interest.

Supression of sweating in palmar hyperhydrosis with 5% strontium chloride hexahydrate.

A 18-year-old boy who complained palmoplantar hyperhydrosis was admitted to our clinic. He had hyperhydrosis for 3 years. He had been used some topical medications and antiperspirants, including aluminium chlorohydrate. He expressed that he used a topical product composed of strontium chloride hexahydrate (VR Nocicept dysesthesia cream, Gelişim M€ uh. Ltd. Şti, Sivas, Turkey) to calm his pruritus due to insect bite on his hand and that this product decreased his palmar hyperhydrosis. To test the effect of strontium chloride hexahydrate (Sigma) on sweating, we made an iodine-starch test in our patient. His right hand in tap water and his left hand in a solution with 5% strontium chloride hexahydrate were kept for 15 minutes and iodine-starch test was made. A decrease of sweating on the hands treated 5% strontium chloride hexahydrate was detected (FIG. 1). The case was invited once again to make a gravimetric test for his hyperhydrosis. Gravimetric test was made after 15 minutes’ rest in sitting position in standardized temperature (24–25 C) and humidity 15–17%. After drying the surface, a preweighed filter paper was applied to the palms and plantars for a period of 1 minute. The paper was then weighed and the rate of sweat production was calculated in mg/min (1). Gravimetric intensity of sweating in this case prior to any topical application was 82 and 73 mg/min for right and left palms (respectively) and 67 and 55 mg/min right and left plantars (respectively). We recommended him to use a topical preparation including 5% strontium chloride hexahydrate (VR Nocicept dysesthesia cream) twice a day for 2 weeks period. Eight hours after the last use of topical preparation, gravimetric test was carried out again. The intensity of sweating was 30 and 33 mg/min for right and left palms, respectively, and 35 and 28 mg/min for right and left plantars, respectively. Strontium salts (e.g., chloride, nitrate) block the activation of cutaneous type C nociceptors and can effectively suppress sensory irritation and pruritus (2). Depending on their effects, strontium chloride hexahydrate (VR Nocicept dysesthesia cream) can be used in dermatological diseases accompanied by pruritus and irritation as an adjunctive therapy agent. Topical aluminium chloride hexahydrate is a well-established therapy for hyperhidrosis and the mechanism of action of aluminum chloride hexahydrate is the blockage of the distal acrosyringium, which leads to functional and structural degeneration of the Address correspondence and reprint requests to: Melih Akyol, MD, Dermatology Department, Cumhuriyet University School of Medicine, 58140 Sivas, Turkey, or e-mail: melakyol@gmail.com