Semsettin Karaca

Clinical importance of Demodex folliculorum in patients receiving phototherapy.

Background  Patients with immunodeficiency are prone to infestation with Demodex folliculorum mites. Ultraviolet (UV) radiation can lead to immunosuppression and sebaceous gland hyperplasia. Although some cases of demodicidosis related to UV radiation exposure have been reported, no studies have been performed on the incidence of D. folliculorum and its clinical characteristics in patients receiving phototherapy.

Temperament and character profile in patients with essential hyperhidrosis.

Background/Aims: The main debates on hyperhidrosis are whether there are some personality features such as anxiety or stress, or whether the psychological symptoms are due to negative social feedback from early life. We aimed to investigate the temperament and character dimensions with a psychobiological inventory. Methods: We recruited patients with hyperhidrosis (n = 26) and chronic renal failure (n = 44) as well as healthy subjects (n = 22) from dermatology and nephrology clinics and the general population in Afyonkarahisar. All subjects were required to perform a temperament and character inventory. Results: The total novelty seeking score in hyperhidrosis was significantly lower than in controls. There was no significance in total harm avoidance scores between hyperhidrosis patients and controls. The total reward dependence and persistence scores were significantly higher in hyperhidrosis patients. The fear of uncertainty in the harm avoidance scale was found to be significantly greater in hyperhidrosis patients. Regarding character dimensions, the total score in each of the subscales self-directedness, cooperativeness and self-transcendence was found to be higher in hyperhidrosis patients. Conclusion: The higher scores of all subscales of character dimensions in hyperhidrosis patients suggest that hyperhidrosis is not related with social phobia or personality disorder.

Angiolymphoid Hyperplasia with Eosinophilia Successfully Treated with Imiquimod

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare disorder characterized by vascular proliferation, eosinophilia in peripheral blood samples and lymphocytosis. The etiology is unknown; this rare condition is generally seen in women. It often presents as multiple, grouped red nodules in the periauricular region, scalp line and neck. Numerous therapeutic approaches have been tried for ALHE including destructive techniques such as electrodesiccation, cryotherapy, surgical excision, radiotherapy or laser (argon, CO2, pulse dye). We present an ALHE case that was treated successfully by using topical imiquimod cream.

Erythrocyte Oxidant/Antioxidant Status in Essential Hyperhidrosis

Essential Hyperhidrosis is a disorder of excessive, bilateral, and relatively symmetric sweating occurring in the axillae, palms, soles, or craniofacial region without obvious etiology. Nitric oxide may play a physiological part in the production and/or excretion of sweat in skin eccrine glands. Tempol, a SOD mimetic, increases the half-life of NO and results in vasodilatation, hypotension, and reflex activation of sympathetic nervous system. Reactive oxygen species (ROS) may directly activate both central and peripheral sympathetic nervous system activity. We assessed the levels of malondialdehyde (MDA), the activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) of red blood cells in patients with essential hyperhidrosis (n = 31) compared to age-and sex-matched healthy controls (n = 28). Erythrocyte activities of SOD and level of MDA were detected significantly higher (p = 0.020, p = 0.004 and respectively) and activities of CAT and GSH-Px were significantly lower (p = 0.0001, p = 0.0001 respectively) in patients than controls. Our results support the hypothesis that oxidative damage resulting from increased ROS production along with insufficient capacity of antioxidant mechanisms may be involved in pathogenesis of EH.

Do patients with mild to moderate psoriasis really have a sedentary lifestyle

The aim of this study was to compare aerobic exercise capacity, daily physical activity, pulmonary functions, resting metabolic rate, and body composition parameters in patients with psoriasis and healthy controls. A total of 60 participants (30 [15 men, 15 women] patients with psoriasis, and 30 [15 men, 15 women] healthy controls) ranging in age from 22–57 were included in the study. Maximal aerobic capacity was determined by Astrand exercise protocol. Daily physical activity was measured with an accelerometer. Resting metabolic rate was determined with an indirect calorimeter. Pulmonary function tests were performed with a portable spirometer. Body composition was established with a bioelectric impedance analysis system. Skinfold thicknesses and body circumference measurements were carried out. Short Form 36 quality of life questionnaire was applied to all participants. In both genders, daily physical activity parameters were found to be higher in the psoriasis group compared to the control. Maximal aerobic capacity, resting metabolic rate, pulmonary function tests, body fatness, body fat distributions, and quality of life were not statistically different between patients with psoriasis and controls in males and females. We suggest that patients with psoriasis who do not have psoriatic arthritis or severe psoriasis are well in performing daily physical activities. In addition, we suggest that this lifestyle helped to prevent impairments of body fatness, body fat distributions, resting metabolic rate, pulmonary functions, and quality of life in patients with mild to moderate psoriasis.

Evaluation of myocardial perfusion and function by gated SPECT in patients with Behçet's disease.

BackgroundBehçet’s disease (BD) is a systemic multi-system vasculitis that can have a wide range of effects on the cardiovascular system.ObjectiveTo determine the existence of myocardial perfusion defects caused by coronary microvascular dysfunction in BD and to evaluate coronary arterial distribution and left ventricular systolic function by gated single-photon emission computed tomography (SPECT).MethodsThe study population consisted of 23 (15 men and 8 women) patients with BD and 20 healthy controls (12 men and 8 women). Technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) gated SPECT studies were performed at stress and rest in a 2-day protocol. Stress and rest left ventricular ejection fraction (LVEF) were calculated. Using non-gated SPECT images myocardial perfusion scores [summed stress score (SSS), summed rest score (SRS), summed difference score (SDS), and fix defect score (FDS)] and perfusion defect extent as percentage (stress, rest ischemic, and fix %LV) were determined. Using gated SPECT images, wall motion score indices (stress wall motion score indices and rest wall motion score indices) were calculated. Coronary angiography (CAG) was applied to patients with abnormal myocardial perfusion scintigraphy (MPS).ResultsThe mean ages of the BD and control groups were 39.3 ± 10.6 years and 36.2 ± 8.3 years, respectively. No statistically significant differences were observed between the two groups regarding clinical features and cardiologic findings. Abnormal MPS was found in 13 (56.5%) of the BD patients; 3 patients had non-transmural infarcts and 10 patients reversible perfusion defects. Reversible perfusion defects were also found in two controls (10.0%). When the two groups were compared regarding the gated SPECT findings, differences were determined in the following parameters; SSS, SRS, SDS, FDS, stress and rest LVEF, stress and rest %LV, and stress and rest WMSI. In the BD group, when gated SPECT results were compared between those with and without abnormal MPS, differences were determined in SSS, SRS, SDS, FDS, stress and rest %LV, and stress and rest WMSI. Epicardial coronary arteries were normal in CAG.ConclusionsMyocardial perfusion and function are disturbed owing to influenced coronary microvascularity in BD, and CAG is frequently observed to be normal. Gated SPECT is a non-invasive reliable method that simultaneously evaluates the existence, extent and severity of myocardial ischemia or infarction and the wall movements in cardio-Behçet.

Giant Proliferating Trichilemmal Tumor of the Gluteal Region

Background Proliferating trichilemmal tumors are rare cutaneous neoplasms that show features of typical pilar cysts but also show extensive epithelial proliferation, variable cytologic atypia, and mitotic activity. Proliferating trichilemmal tumors are benign lesions; however, there are numerous reports of malignant proliferating trichilemmal tumors. Objective We present a case of benign proliferating trichilemmal tumor of an 81-year-old woman that was located on the left superior gluteal region for 30 years. Methods A tumor measuring 9 × 7 cm was surgically excised with a 1 cm conservative margin of normal tissue. Results Based on the histopathologic findings of tumor, this case was diagnosed as proliferating trichilemmal tumor. The patients condition was successfully treated with total excision. Conclusions Our case is an unusual presentation of proliferating trichilemmal tumor. Physicians should be aware of this entity while differentiating cutaneous tumor located on the gluteal region.

Treatment of primary hyperhidrosis with tap water iontophoresis in paediatric patients: a retrospective analysis

Abstract Objectives: Primary hyperhidrosis is an under-recognized condition in children and adolescents. Iontophoresis is the second line of treatment for palmoplantar hyperhidrosis following topical treatment. The studies evaluating the efficacy of iontophoresis in children are limited. We aimed to investigate the efficacy and reliability of tap water iontophoresis in children with primary hyperhidrosis. Methods: Twenty-one patients aged under 18 years, who received iontophoresis for primary palmoplantar hyperhidrosis, were included in the study. In our clinic, tap water iontophoresis was administered at regular intervals, starting with five times per week and decreased to once a week on fifth week. Then maintenance sessions once a week for 6 weeks are recommended. The presence of excessive sweating was scored by visual analogue scale (VAS): “0” as continuation of excessive sweating and “10” as the absence of excessive sweating. The demographic and clinical data were collected from files. Also, patients fulfilled a questionnaire for efficacy on follow-up visit. Results: Nineteen patients completed the whole 21 sessions. The mean VAS score was 5.89 ± 1.49 at the end of the 15th session and 6.36 ± 2.06 at the end of the treatment. Side effects were well tolerated. Only seven patients were still free of excessive sweating on third months after treatment. The mean satisfaction score was 4.95 ± 2.38, as measured by VAS where 0 indicated dissatisfaction and 10 indicated high satisfaction. Conclusion: Tap water iontophoresis is an effective method of treatment for primary palmoplantar and axillary hyperhidrosis in paediatric patients. But there are still unanswered questions about the mechanism of action, ideal session intervals and protocols for maximum efficacy.

Venous Insufficiency in Patients With Toenail Onychomycosis

Onychomycosis is a common fungal infection of the toenails and can originate secondary to vascular abnormalities. The aim of this study was to evaluate the relationship between onychomycosis and venous insufficiency.

Insulin resistance in patients with post-adolescent acne.

Post‐adolescent acne has been defined as acne in a patient aged >25 years. Acne vulgaris first develops at the onset of puberty as a result of hormonal changes. During puberty, there is a transient decline in insulin sensitivity. We hypothesized that insulin resistance might persist after puberty in patients with post‐adolescent acne.