Sevil Alan

The relation of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume with the presence and severity of Behçet's syndrome.

Behçets syndrome (BS) is associated with chronic inflammation and endothelial dysfunction. Although there have been extensive investigations on neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and mean platelet volume (MPV) in many diseases, their roles in BS is unclear. The purpose of the present study was to evaluate NLR, PLR, and MPV levels in BS patients and explore their clinical significance. The study included 254 patients with BS and 173 healthy individuals. Age, sex, age of onset, duration of disease, smoking, Behçet activity score, total white blood counts, neutrophil, platelet, and T lymphocyte counts of the patients were recorded. White blood cell (WBC), neutrophil, platelet, NLR, and PLR were significantly higher in patients with BS when compared with healthy controls (all p < 0.001). Lymphocyte counts and MPVs of the BS group were not statistically different from healthy controls (all p > 0.05). In the BS group, PLR and MPV were significantly different among the three severity groups (p = 0.037 and p = 0.016, respectively). We showed that any laboratory markers were not associated with joint, eye, central nervous system, large vessel, or gastrointestinal involvement in BS. NLR was shown to be an independent factor for BS by multivariate analysis. We suggest that NLR can be considered to be a diagnostic criterion of BS given the support of the findings from larger prospective studies.

The divergent roles of growth differentiation factor-15 (GDF-15) in benign and malignant skin pathologies

GDF-15 (Growth Differentiation Factor-15) is a member of the transforming growth factor β (TGF-β) superfamily. GDF-15 is not only involved in cancer development, progression, angiogenesis and metastasis, but also controls stress responses, bone formation, hematopoietic development, adipose tissue function and cardiovascular diseases. GDF-15, which is regulated by p53, has shown antitumorigenic and proapoptotic activities in vivo and in vitro. Also, GDF-15 is involved in skin biology and histamine-induced melanogenesis; it is overexpressed in melanoma cells and is associated with depth of tumor invasion and metastasis. GDF-15 level is increased in patients with systemic sclerosis and is related with the degree of skin sclerosis and intensity of pulmonary fibrosis. In the future, GDF-15 may be a potential target for therapy in benign disorders with skin fibrosis and malignant lesions of the skin.

Could Topical Minoxidil Cause Non-Arteritic Anterior Ischemic Optic Neuropathy?

Minoxidil hair formulation is commonly used for the treatment of male or female androgenic alopecia. Minoxidil is a Health Canada and US FDA-approved medication for hair loss in men and women. The drug is marketed as 2% and 5% topical solutions. This over-the-counter product is considered safe, but should be used with caution. Furthermore, minoxidil is an orally active vasodilator for treatment of severe hypertension. Typical side effects of minoxidil are faster heart rate, augmented heart function and stroke volume (which can be associated with reduced vascular resistance upon baroflex stimulus), retained sodium and water and abnormal hair growth. The most common adverse reactions of the topical formulation are limited to irritant and allergic contact dermatitis on the scalp. Herein, we report a non-arteritic anterior ischemic optic neuropathy caused by topical 5% minoxidil treatment that was resolved after discontinuation of minoxidil.

Temperament and character profiles of patients with chronic idiopathic urticaria

Introduction Psychosocial factors have been implicated as being important in the onset and/or exacerbation of urticaria. Aim To examine both personality factors of patients with chronic idiopathic urticaria (CIU) and the correlations between illness duration, severity of itching, urticaria activity score (UAS) and temperament-character dimensions. Material and methods A total number of 70 CIU patients and 60 healthy individuals were included in the study. The Temperament and Character Inventory (TCI) was administered individually. The relationship between UAS, illness duration and severity of pruritus and TCI subscales were evaluated. Results The CIU group had significantly higher scores of novelty seeking and lower scores of cooperativeness, reward dependence and self-directedness than the control group. Conclusions The current study shows that CIU patients have distinctive temperament and character dimensions when compared with the control group. We suggest that evaluation and treatment of CIU should also include psychosomatic approaches in clinical practice.

Cutaneous thrombosis as the presenting finding of paroxysmal nocturnal haemoglobinuria

A 24-year-old woman with a previous history of sagittal vein thrombosis and a 5-year history of Budd–Chiari syndrome had been treated by anticoagulation and insertion of a transjugular intrahepatic portosystemic shunt. She presented to our emergency department with the recent onset of a painful skin rash following a nonspecific febrile illness (top). Inherited thrombophilia and disseminated intravascular coagulation were ruled out. A normocytic anaemia without schistocytes and a mild thrombocytopenia were detected. Blood and urine cultures were negative. Urinalysis showed urobilinogenuria without haemoglobinuria. Lactate dehydrogenase activity was twice normal. Screening for a paroxysmal nocturnal haemoglobinuria (PNH) clone was performed by multiparameter flow cytometry for CD14, CD15, CD24, CD64 and FLAER (fluorescein-labelled proaerolysin): 98% of both neutrophils and monocytes were abnormal. Skin biopsy showed fibrin thrombi in the capillaries, necrosis and haemorrhagic infarction (bottom). A diagnosis of cutaneous thrombosis secondary to PNH was made. She was treated empirically with antibiotics, methylprednisolone and low molecular weight heparin. However, some of the lesions expanded and ulcerated. After compassionate use approval, four doses of eculizumab were given. Despite this therapy, she remained prothrombotic over the next weeks and portal vein thrombosis developed. Unfortunately, she died due to sepsis, secondary to skin ulceration, and liver failure.

Evaluation of clinico-epidemiological and histopathological features of pityriasis rosea.

Introduction Pityriasis rosea is a sudden-onset and self limiting disease with specific skin rash. The exact etiology is still not clear. Aim To determine epidemiological, etiological, clinical and histopathological features in pityriasis rosea (PR). Material and methods Fifty two patients (older than 18 years) with PR were included in this study. Patients were examined for epidemiological and etiological features. Biopsy specimens obtained from secondary eruptions were histopathologically evaluated with hematoxylin-eosine and immunohistochemically evaluated with CD3 and CD20 monoclonal antibodies. Results Age range of patients was 18–53, mean age was 29.3 ±9.5 and women-to-men ratio was 1.08/1. Thirty-nine (75%) patients had a history of wearing new clothes, 27 (51.9%) patients had a history of recent respiratory tract infection, 15 (28.8%) patients had a history of recent gastrointestinal infection. Eczematous changes were detected in biopsy materials by histopathological evaluation, and cellular infiltrate was positively stained with pan T-cell marker CD3 and negatively stained with B lymphocyte marker CD20 in all biopsy materials in immunohistochemical examination. Conclusions In our study, frequency of pre-disease infection and prodromal symptoms history were determined to be higher than the results of similar studies in the literature. These higher results suggest that PR may be delayed-type hypersensitivity to an infectious factor. However, positive staining of all biopsy materials with pan T lymphocyte marker CD3 supports the association with cellular immunity. We believe that more extensive studies are needed on this issue.

Neutrophil/Lymphocyte Ratio, Platelet/Lymphocyte Ratio and Mean Platelet Volume in Behçet Disease Patients with and without Ocular Involvement

Objective: To evaluate the relationship between neutrophil/lymphocyte ratio (NLR), mean platelet volume (MPV), and platelet/lymphocyte ratio (PLR) and risk of ocular involvement in Behçet Disease (BD). Material and Methods: This prospective randomised study included 45 patients with ocular BD (Group1), and 86 patients with BD without ocular involvement (Group2) and 90 control subjects. The NLR, MPV, PLR and other laboratory tests were evaluated in the groups. Results: A significant difference was found in NLR and PLR values between patients with BD (n=131) and control subjects (n=90) (p<0.001). No statistically significant difference in laboratory parameters was found in BD group without ocular involvement when compared with ocular BD group, except MPV level. There was a positive correlation between MPV and activation of ocular BD (p<0.001). In the receiver-operating characteristic analysis, MPV cut off point was 8.80 and predicted the presence of active ocular BD with 66.7% sensitivity and 60.4% specificity. HLA-B51 positivity is higher in patients with ocular BD than BD without ocular involvement (p<0.001). Conclusion: Our results show that increased NLR and PLR levels may predict BD. Although NLR, and PLR are higher in BD patients, no differences were found when comparing patients with and without ocular involvement. The MPV may be a simple, inexpensive, and convenient diagnostic marker of active ocular BD.

Is There an Association between Restless Legs Syndrome and Urticaria

Restless legs syndrome (RLS) is a disease characterized by the urge to move the legs and sleep disturbances. Similarly, chronic spontaneous urticaria (CSU) is a dermatological disease characterized by pruritus and sleep disorders. In this study, we aimed to determine the prevalence and severity of RLS in patients with chronic spontaneous urticaria (CSU) and to compare the quality of sleep of patients with and without RLS in the CSU group using the Pittsburgh Sleep Quality Index. A total of 130 patients with CSU and 100 healthy controls were included in this study. The frequency of RLS, frequency of sleep disturbances, and average score of RLS in patients with CSU were statistically significantly higher than control groups (respectively P = 0.008, P = 0.009, P = 0.004). Subjective sleep quality, sleep latency and habitual sleep efficiency scores in patients with RLS were statistically significantly higher than patients without RLS (respectively P = 0.016, P = 0.007, P = 0.035). We claimed that pruritus of urticaria may decrease the quality of sleep in patients with RLS and it may trigger and worsen the restless legs syndrome. Furthermore, RLS and CSU may share a common etiology.

The Comorbidity of Morphea, Raynaud's Phenomenon and Sarcoidosis: Case Report

106 arcoidosis is a multi-systemic disease which is characterized by noncaseating granulomas and usually affected lungs and intrathoracic lymph nodes. Sarcoidosis may present with three different clinical manifestations; asymptomatic sarcoidosis, sarcoidosis with non-specific symptoms and sarcoidosis with symptoms associated with specific organ involvement. Approximately 30-50% of patients are asymptomatic at the time of diagnosis and usually detected with routine chest radiography. Sarcoidosis, which is not clear whether it is an autoimmune disease or not, can be accompanied with autoimmune diseases. The Comorbidity of Morphea, Raynauds Phenomenon and Sarcoidosis: Case Report