Serap Gunes Bilgili

Serum holotranscobalamine, vitamin B12, folic acid and homocysteine levels in patients with vitiligo

Few studies have investigated the role of vitamin B12 metabolism in vitiligo. We tested the hypothesis that vitamin B12 and folate metabolism might have an influence on the pathogenesis of vitiligo. Full blood count and levels of folic acid, vitamin B12, homocysteine and holotranscobalamine were examined for 69 patients with vitiligo and 52 controls. The vitiligo group had higher levels of homocysteine (P < 0.01) and haemoglobin (P < 0.01) levels, and lower levels of vitamin B12 (P < 0.01) and holotranscobalamine (P < 0.0001) than the control group. Folic acid levels were similar for both groups. In a risk analysis, hyperhomocysteinaemia (≥ 15 μmol/L, P < 0.01) and vitamin B12 deficiency (< 200 pg/mL, P < 0.01) were significant risk factors for vitiligo. Patients with holotranscobalamine levels in the lowest quartile had an increased risk for co‐occurrence of vitiligo (P < 0.005). Vitamin B12 deficiency and hyperhomocysteinaemia may share a common genetic background with vitiligo.

Cutaneous anthrax in Eastern Turkey: a review of 85 cases

Background.  Anthrax is a zoonotic disease diminishing worldwide. Although a very rare disease in developed countries, anthrax is still endemic in developing countries.

The Effect of Acitretin Treatment on Insulin Resistance, Retinol-Binding Protein-4, Leptin, and Adiponectin in Psoriasis Vulgaris: A Noncontrolled Study

Background/Aim: To investigate the effects of acitretin treatment on insulin resistance (IR) and adipokines, particularly retinol-binding protein (RBP)-4. Methods: Thirty-four patients with chronic plaque psoriasis and a control group of 34 healthy volunteers were recruited in the study. Screening for the parameters was performed before starting and after 3 months of acitretin treatment in the psoriasis group. The control group was only evaluated at the beginning of the study and did not receive placebo. We could not compare our results with a placebo control group because of ethical reasons. Results: Basal adiponectin (p = 0.01), insulin (p < 0.0001) levels and homeostasis model assessment (HOMA) IR (p < 0.0001) were significantly higher in psoriasis patients. After the treatment, insulin (p = 0.014), C peptide (p = 0.011), RBP-4 (p < 0.0001) levels and HOMA-IR (p = 0.008) decreased significantly. Posttreatment leptin (p = 0.036) levels were significantly lower than those of the controls. Posttreatment adiponectin (p = 0.005) and insulin (p = 0.048) levels were higher than those of the controls. Conclusions: This study showed for the first time that RBP-4 levels and IR are decreased significantly with acitretin treatment. This finding is very important in psoriasis patients because psoriasis may cause insulin resistance and diabetes. Further experimental and clinical studies are needed to clarify the effect of acitretin on adipocyte structure and behavior.

Assessment of the serum paraoxonase activity and oxidant/ antioxidant status in patients with recurrent aphthous stomatitis

Several studies have indicated that recurrent aphthous stomatitis (RAS) is associated with oxidative stress. The aim of this study was to investigate serum paraoxonase (PON) activity and oxidant/antioxidant status in patients with RAS.

The use of complementary and alternative medicine among dermatology outpatients in Eastern Turkey

Introduction: Over the past decade, complementary and alternative medicine (CAM) has become increasingly popular around the world. Objectives: In this study, we aim to investigate how frequently CAM is used and the types of CAM methods used for dermatological disease in Eastern Turkey. Materials and methods: We recruited 1610 patients from our clinic for this study. The sociodemographic features and the CAM methods were investigated with a survey. Results: The most common dermatological disorders included contact dermatitis (21.4%), acne vulgaris (17.5%), fungal infections (10.9%), eczema (6.3%), and warts (5.7%). The ratio of patients using at least one CAM method was 43.7% and that of those using two or more CAM methods was 20.8%. The most commonly used CAM methods were those using henna, cologne, moisturizing cream, prayer, and herbal therapy. Some patients were found to use some interesting and unusual CAM methods, such as putting out a cigarette over the skin on the back for anthrax, applying raw meat for furuncle, using fuel oil and nitric acid for contact dermatitis. Conclusions: CAM methods are commonly used in our population. CAM methods often cause adverse reactions that may alter diagnostic skin findings and interfere with the efficacy of other medical therapies. Therefore, physicians should ask their patients about the use of CAM methods while collecting patient history. Physicians have a critical role in preventing improper use of CAM. In addition, further investigations into the efficacy, benefits, and risks of CAM methods should be carried out for better insight into those CAM methods.

Sneddon syndrome associated with Protein S deficiency

Sneddon syndrome (SS) is rare, arterio-occlusive disorder characterized by generalized livedo racemosa of the skin and various central nervous symptoms due to occlusion of medium-sized arteries of unknown. Seizure, cognitive impairment, hypertension, and history of repetitive miscarriages are the other symptoms seen in this disease. Livedo racemosa involves persisting irreversible skin lesions red or blue in color with irregular margins. Usually, SS occurs in women of childbearing age. Protein S deficiency is an inherited or acquired disorder associated with an increased risk of thrombosis. We present a 33-year-old woman with SS with diffuse livedo racemosa, recurrent cerebrovascular diseases, migraine-type headache, sinus vein thrombosis, and protein S deficiency. Protein S deficiency and with Sneddon syndrome rarely encountered in the literature.

Assessment of the effects of antihistamine drugs on mood, sleep quality, sleepiness, and dream anxiety

Abstract Objective. There are limited comparative studies on classic and new-generation antihistamines that affect sleep quality and mood. The purpose of this study was to determine and compare the effects of classic and new-generation antihistamines on sleep quality, daytime sleepiness, dream anxiety, and mood. Methods. Ninety-two patients with chronic pruritus completed study in the dermatology outpatient clinic. Treatments with regular recommended therapeutic doses were administered. The effects of antihistaminic drugs on mood, daytime sleepiness, dream anxiety, and sleep quality were assessed on the first day and 1 month after. Results. Outpatients who received cetirizine and hydroxyzine treatments reported higher scores on the depression, anxiety, and fatigue sub-scales than those who received desloratadine, levocetirizine, and rupatadine. Pheniramine and rupatadine were found to be associated with daytime sleepiness and better sleep quality. UKU side effects scale scores were significantly elevated among outpatients receiving pheniramine. Classic antihistamines increased daytime sleepiness and decreased the sleep quality scores. New-generation antihistamines reduced sleep latency and dream anxiety, and increased daytime sleepiness and sleep quality. Conclusion. Both antihistamines, significantly increased daytime sleepiness and nocturnal sleep quality. Daytime sleepiness was significantly predicted by rupadatine and pheniramine treatment. Cetirizine and hydroxyzine, seem to have negative influences on mood states. Given the extensive use of antihistamines in clinical settings, these results should be more elaborately examined in further studies.

Histiocytoid Sweet syndrome

Histiocytoid Sweet syndrome Requana et al., in 2005, was the first to describe histiocytoid Sweet syndrome (HSS) as a variant of acute febrile neutrophilic dermatosis. They described 41 patients with a variant of SS exhibiting histiocytoid mononuclear cells in histopathological assessments. Although the clinical presentations were similar to typical SS, histologically those cases demonstrated a dense dermal infiltrate of mononuclear cells with large, slightly eccentric, elongated, kidney-shaped, basophilic nuclei that immunohistochemically stained with CD15, CD43, CD45, CD68, MAC386, HAM56, and lysosyme. Of these 41 patients, six had associated hematologic or visceral malignancies. Later, Chow et al. reported six cases of HSS and panniculitides. In addition, HSS associated with Crohn’s disease without presenting bone marrow dysplasia or immaturity has been reported. Moreover, drug-related HSS has been reported in two cases. A 29-year-old woman came to our clinic with a oneweek history of fever, ocular hyperemia, and erythematous swelling over her face and arms. She was eight weeks pregnant. Her medical history and family history were unremarkable. The physical examination demonstrated several painful, erythematous papules and plaques on her face, neck, arms, and extensor surfaces of the hands (Fig. 1a,b). The eye examination revealed hyperemia and conjunctivitis. No cervical lympadenopathy or hepatosplenomegaly was detected. Laboratory studies showed elevated white blood cells of 12,400/mm with 93% predominantly with neutrophils; elevated total IgE of 194 iu/ml (0–100); elevated erythrocyte sedimentation rate of 57 mm/h (normal, 1–20 mm/h); and elevated C-reactive protein level measuring 39.4 mg/l (normal, 0–5 mg/l). The routine biochemical test and peripheral blood smear were normal. The histopathological examination of the skin biopsy from the arm showed that basket-weave orthokeratosis, acanthosis, dermal perivascular mixed infiltrates composed of mainly histiocytoid mononuclear cells and mild edema in papillary dermis (Fig. 2a). The immunohistochemical staining confirmed that most dermal infiltrating cells were CD68 positive (Fig. 2b). Further positive immunostaining of myeloperoxidase indicated that these histiocytoid cells were indeed granulocytes (Fig. 2c). The patient was diagnosed with HSS based on clinical and histopathological findings. She was treated with topical steroid cream (mometasone furoate) due to her pregnancy. The plaques were completely resolved within three weeks. The routine histiocyte markers such as CD68/KP1, lysosyme, and MAC 387 stain both histiocytes and myeloid cells. To differentiate myeloid lineage, more specific staining techniques, including myeloperoxidase, neutrophil elastase, and T-cell intracellular antigen 1 should be performed. Myeloperoxidase is the main component of primary granules in myeloid cells serving as a reliable marker for myeloid cells, both early and mature forms. The appearance of myeloperoxidase precedes that of neutrophil elastase during myeloid cell differentiation. In HSS, the lesions may be caused by immature myeloperoxidase positive myeloid cells being released from the bone marrow during the early phase of the disease, and these immature myeloid cells may be replaced by more mature, segmented, neutrophils in the later phase. In our case, although clinical findings were suggestive of SS, the 80 (a)

Visual evoked potential findings in Behcet's disease without neurological manifestations.

Behçets disease (BD) is a chronic, recurrent multisystem inflammatory disorder firstly described by Turkish dermatologist Dr. Hulusi Behçet in 1937. The classic triad consists of recurrent oral and genital ulcerations and uveitis. The article presents the value of visual evoked potential findings of a series of 44 patients with BD without neurological manifestations seen at the Medical Hospital in Neurology and Dermatology clinics over the past 8 years. The mean latency value of positive peak P100 in BD patients was significantly delayed compared to that of control subjects (patientss mean: 105.6 ms in right eye and 107.7 ms in left eye; control subjects mean: 101.4 ms in right eye and 101.7 ms in left eye).

Two cases of eczematid‐like purpura of Doucas and Kapetanakis responsive to narrow band ultraviolet B treatment

Eczematid‐like purpura of Doucas and Kapetanakis is a type of pigmented purpuric dermatoses (PPDs) with eczematous changes in the purpuric surface. A 10‐year‐old male and a 44‐year‐old male patients were admitted to our clinics for itching and flaking of the skin rashes. Based on the clinical and histopathological evaluations, the rashes were identified as eczematid‐like PPDs of Doucas and Kapetanakis. Both patients were treated with narrow band ultraviolet B. The lesions were remarkably regressed following the treatment. These cases reported due its rarity and good response to narrow band ultraviolet B.