Selma Emre

Internalized stigma in psoriasis: A multicenter study

Internalized stigma is the adoption of negative attitudes and stereotypes of the society regarding a persons illness. It causes decreased self‐esteem and life‐satisfaction, increased depression and suicidality, and difficulty in coping with the illness. The primary aim of this study was to investigate the internalized stigma state of psoriatic patients and to identify the factors influencing internalized stigma. The secondary aim was to identify the correlation of internalized stigma with quality of life and perceived health status. This multicentre, cross‐sectional study comprised 1485 patients. There was a significant positive correlation between mean values of Psoriasis Internalized Stigma Scale (PISS) and Psoriasis Area and Severity Index, Body Surface Area, Dermatological Life Quality Index and General Health Questionnaire‐12 (P < 0.001 in all). Lower percieved health score (P = 0.001), early onset psoriasis (P = 0.016), family history of psoriasis (P = 0.0034), being illiterate (P < 0.001) and lower income level (P < 0.001) were determinants of high PISS scores. Mean PISS values were higher in erythrodermic and generalized pustular psoriasis. Involvement of scalp, face, hand, genitalia and finger nails as well as arthropathic and inverse psoriasis were also related to significantly higher PISS scores (P = 0.001). Our findings imply that psoriatic patients experience high levels of internalized stigma which are associated with psoriasis severity, involvement of visible body parts, genital area, folds or joints, poorer quality of life, negative perceptions of general health and psychological illnesses. Therefore, internalized stigma may be one of the major factors responsible from psychosocial burden of the disease.

Evaluation of total oxidant and antioxidant status in localized and generalized vitiligo

Vitiligo is an acquired depigmentation disorder, and oxidative stress is suggested to have a major role in its aetiopathogenesis.

Clinicopathological features of 25 patients with acquired perforating dermatosis

BACKGROUND Acquired perforating dermatosis (APD) is a rare group of skin disorders characterized by transepidermal elimination of dermal tissue material. There are only a few studies of APD. OBJECTIVE We aimed to review the clinicopathologic features of patients with APD and evaluate the outcomes of treatments. MATERIAL AND METHODS The medical records of 25 patients who were clinically and histopathologically diagnosed as having APD between 2006 and 2013 were retrospectively reviewed. The histopathologic sections and the results of elastic, trichrome and periodic acid Shiff (PAS) staining were evaluated. RESULTS Of the patients, 17 (68%) had ARPC, 7 (28%) had perforating folliculitis, 1 (4%) had Kyrles disease. Male/female ratio was 1.3. The mean age was 51.8 ± 12.8 years. The disease duration ranged between 15 days and 96 months. Diabetes mellitus was the most common disease associated with APD (48%). The walls of vessels were PAS positive in the lesions of 6 of 13 diabetic patients. After various treatments, almost all lesions regressed in 15 (60%) patients. CONCLUSION Acquired perforating dermatosis may present with various clinical features and is mostly associated with diabetes mellitus. Diabetes mellitus may be involved in the pathogenesis of APD via microangiopathy and other mechanisms.

Pili annulati with fragility: Electron microscopic findings of a case.

Pili annulati (PA) is typically characterized by shinny beads seen along the hair shaft. PA is accepted to belong to the classification of hair shaft abnormalities without fragility. Herein, we described a 14-year-old, fair skin with dark-haired girl diagnosed as PA with fragility which was demonstrated by weathering features in electron microscopic examinations. The patient had shinny beaded, easily breakable hairs since the age of four. A few broken hairs were observed by a light pull test. Transmitted light microscopy revealed periodic dark bands in the hair shaft. These dark bands disappeared after application of 10% aqueous potassium hydroxide. Multiple cavities within hair shaft and severe cuticular damages representing the weathering pattern were observed in electron microscopic examinations. All these findings were found to be consistent with presence of fragility in PA. This case provides evidences of fragile hair structure of PA which may be due to pathological cavities within hair shafts.

High frequency of hypertrichosis after cast application.

Background: Hypertrichosis following cast application is commonly observed after removing casts, due to an unknown mechanism. Objective: To determine the frequency and associated demographic and clinical risk factors of postcast hypertrichosis in patients who underwent cast application for bone fractures. Methods: The study included 117 patients (50 females, 67 males, age range: 3–91 years). Demographic information of each patient (age, gender, fracture localization, type of cast, cast duration and pruritus) was recorded. After removing the cast, the presence of hypertrichosis, contact dermatitis and lymphedema of the cast area was evaluated. Demographic and clinical features of the patients were analyzed to determine the risk factors for postcast hypertrichosis. Results: Postcast hypertrichosis was detected in 34.2% of patients. Patients with hypertrichosis were younger than those without hypertrichosis (p = 0.015). Duration of cast application, session of cast application, presence of lymphedema, contact dermatitis and pruritus between patients with hypertrichosis and without hypertrichosis were similar (p > 0.05). Age was the only parameter independently associated with developing postcast hypertrichosis (OR: 0.97, 95% CI: 0.95–0.99; p = 0.008). The frequency of hypertrichosis peaked significantly between 12 and 25 years (p = 0.026). Conclusion: A significant number of patients with cast application developed hypertrichosis. Patient age was closely associated with postcast hypertrichosis.

The weeks and the cumulative doses of the first adverse events related to oral isotretinoin in acne patients: analysis of 300 patients

Abstract Background: The purpose of our study is to find out in which weeks and in which cumulative doses the side effects emerge and to study whether or not there is a significant variance between the observed period and doses of the emergent side effects of the patients taking the daily doses of below and above 0.5 mg/kg. Methods: Patients were started treatment with doses of 0.25–1 mg/kg isotretinoin, and a form was given to the patients to mark which probable side effects occurred in which weeks and called for weekly follow-up for the first 2 months. Results: The median of the complaints of emerged side effects such as chellitis, dry face and facial erythema, photobia and nyctalopia was in less than 4 weeks. When the doses taken below and above 0.5 mg/kg are compared, the side effects observed to have differences between both the week they occurred and the cumulative doses are xerosis, dry face, exacerbation of acnes, nervousness, and somnolence. Conclusions: We believe that knowing which weeks the side effects are observed first, warning about the side effects that may especially occur in the first 4 weeks, and ensuring some measures are taken before the side effects are observed will increase the success of patient compatibility and management of side effects.

Dynamic thiol/disulfide homeostasis and effects of smoking on homeostasis parameters in patients with psoriasis

Abstract Purpose: Recently, increased reactive oxygen species (ROS), reduced antioxidant capacity, and oxidative stress have been suggested in the pathogenesis of psoriasis. The aim of this study to evaluate the thiol/disulfide homeostasis in patients with psoriasis. Materials and methods: Ninety patients with psoriasis who did not receive any systemic treatment in the last six  months were included in the study. Seventy-six age and gender-matched healthy volunteers served as control group. Thiol/disulfide homeostasis was measured in venous blood samples obtained from patient and control groups. Results: Native thiol and total thiol levels were significantly higher in patients than in control group. When thiol/disulfide hemostasis parameters and clinical and demographic characteristics were compared, a negative correlation was detected between native thiol and total thiol with age. The levels of total thiols had also negative correlation with PASI and duration of the disease. When we divided the patients into smokers and non-smokers, native thiol and total thiol levels were significantly higher in smokers than in controls, whereas native thiol and total thiol levels were comparable in non-smoker patients and controls. Conclusions: Thiol/disulfide balance shifted towards thiol in psoriasis patients and this may be responsible for increased keratinocyte proliferation in the pathogenesis of psoriasis.

Ornidazole-induced fixed drug reaction on sole: case report and review of the literature

Abstract Background: Fixed drug eruption (FDE) is a special variant of drug reaction seen on skin or mucous membrane, and typically recurs at the same location. Ornidazole-induced FDE cases have been reported extremely rare. Case: The 48-year-old female patient was diagnosed for ornidazole-induced fixed drug reaction on the sole. The patient’s history revealed that the lesion occurred for the third time in the last 6 months and she was administered ornidazole tablet 3 times by the gynecologist for genitourinary tract infection. Conclusion: This report presents a case of fixed drug reaction located at the sole induced by ornidazole use and a literature review.

Focal epithelial hyperplasia associated with human papillomavirus 13 and common human leukocyte antigen alleles in a Turkish family.

Focal epithelial hyperplasia (FEH) is a rare and benign papillomatous disease of the oral cavity, which is closely associated with human papillomavirus (HPV) type 13 and 32. Genetic susceptibility to HPV infections are supported by recent studies involving the human leukocyte antigen system (HLA). In this report, we aimed to determine the clinicopathological features of a Turkish family with FEH and to detect the shared HLA DR and DQ types.

Evaluation of dermatological consultations of patients treated in intensive care unit.

Background: Skin disorders which require treatment are a common development in patients treated in intensive care units (ICUs). There are very few prospective studies about skin complications in adult ICUs. Objective: The aim of this study is to evaluate skin disorders in ICU-treated adult patients who were consulted for dermatological problems. Methods: Eighty-two of 591 patients admitted to ICUs who were consulted for dermatological problems were included in the study. The correlation between skin complications and associated comorbidities, age, gender and ICU length of stay were analyzed. Results: Ninety dermatological complications were observed. Cutaneous drug reactions were significantly more frequent in female patients than males (p = 0.020). Candidal intertrigo was more frequent in diabetic patients than in nondiabetic patients (p = 0.042). Conclusion: Patients in ICUs may develop various skin disorders that need to be evaluated by dermatological consultations. Clinical features of the patients, especially gender and comorbidities, may predispose skin complications.