Sibel Alper

Efficiency of ellagic acid and arbutin in melasma: A randomized, prospective, open-label study

The aim of this study was to compare the effectiveness of gel formulations containing arbutin, synthetic ellagic acid and plant extracts that contain ellagic acid, on patients with melasma. Thirty patients who applied to Ege University Medical Faculty, Department of Dermatology, were included in the study. A signed consent was obtained from each patient prior to study. Patients whose type of melasma was determined via Woods lamp were randomized to groups of arbutin, synthetic ellagic acid and plant extract containing natural ellagic acid. The pigment density of patients was evaluated via Mexameter before and after the treatment. The approval of the Institutional Ethics Committee of Ege University was obtained before the study. Wilcoxon and Kruskal–Wallis tests were used in the statistical analysis. Nine of 10 patients, for whom synthetic ellagic acid was started, completed the study. A decrease in the level of melanin was determined in eight of these nine patients (P = 0.038). A significant decrease in the level of melanin was also determined in all 10 patients who used plant extract containing ellagic acid (P = 0.05). A significant response was obtained from all of 10 patients who used arbutin. The difference between pre‐ and post‐treatment levels of melanin was statistically significant (P = 0.05). Formulations prepared with plant extracts containing ellagic acid was found effective on melasma, similar to the formulations containing synthetic ellagic acid and arbutin. This material that is not yet being used widespread commercially on melasma could be an effective alternative for treatment of melasma.

Association between IL4 (–590), ACE (I)/(D), CCR5 (Δ32), CTLA4 (+49) and IL1-RN (VNTR in intron 2) gene polymorphisms and vitiligo

Vitiligo is a common skin disorder characterized by patterned depigmentation, because of a decrease of melanin pigment resulting from apparent melanocyte loss. The aim of this study was to investigate interleukin 4 (IL4), Angiotensin Converting Enzyme (ACE), C-C Chemocine Receptor 5 (CCR5), Cytotoxic T Lymphocyte-associated Antigen Receptor 4 (CTLA4) and Interleukin 1 Receptor Antagonist (IL1-RN) gene polymorphisms in 48 Turkish vitiligo patients and 50 healthy controls. Polymorphisms for the genes ACE insertion(I)/deletion(D), CCR5 (Delta32), IL1-RN (VNTR in intron 2) were detected by PCR methods. IL4 (-590) and CTLA4 (+49) gene polymorphisms were typed using PCR-RFLP methods. No significant differences in either the genotype distribution or allele frequencies of IL4, CCR5 and ACE gene polymorphisms were observed. GG genotype and G allele in CTLA4 genes were found to be significantly higher in vitiligo patients compared to the controls. (0.002, 0.000). CTLA4 (AA) and IL1-RN (1/5) genotypes and 5 allele frequency in the IL1-RN gene were found to be significantly lower in vitiligo patients compared to healthy controls (p: 0.014, 0.015, 0.016, respectively). As a conclusion, CTLA4 and IL1-RN genes might play roles in the genetic etiology of vitiligo.

Non‐Melanoma Skin Cancers between the Years of 1990 and 1999 in Izmir, Turkey: Demographic and Clinicopathological Characteristics

The incidence of nonmelanoma skin cancers (NMSCs) has been rapidly increasing in epidemic proportions all over the world. The purpose was to evaluate the demographic and clinico‐pathological patterns of skin cancers in Izmir, a region with high ultraviolet light exposure. The study was retrospective and hospital‐based. The data related to all NMSC patients registered from January 1, 1990, to December 31, 1999, in the Dermatology Department of Ege University Medical School in Izmir, were collected and analyzed according to the personal statistics, anatomic location, dimensions of the lesion and clinical and histopathological type of skin cancer. A total number of 2,879 patients, aged between 20 and 96 years, were included in the study; among them 1,633 were men and 1,246 were women. The mean age of the patient population was 62.81 years, with a standard deviation of 12.50 years. Among the tumour patients, there were 2,062 basal cell carcinomas (BCCs), 746 squamous cell carcinomas (SCCs) and 71 both BCC and SCC; the total number of lesions was 3,186 (2,339 BCCs, 847 SCCs). Of all the NMSC lesions studied, the highest percentage (46.6%) were located on the face. For the BCCs, the most frequent histopathological subtype was the solid pattern (50.74%). The mean male: female ratios for SCC and BCC lesions were 2.86 and 1.01, respectively. Nodular and ulcerative forms (69.8%) were the most commonly found clinical types. Of all NMSCs, 78.4% had diameters in the 11 to 20 mm. BCC is the most common type of skin cancer diagnosed in our region. Among the NMSC patients, farming was the most widespread and risky job. The majority of SCC tumors were observed mostly in men 60 years old or above. This is the first comprehensive description of NMSCs in our region.

Skin diseases in Turkish renal transplant recipients.

Background  Organ transplant recipients are predisposed to a variety of cutaneous complications due to immunosuppressive therapy. We aimed to determine the prevalence and the clinical spectrum of skin diseases in renal transplant recipients (RTRs).

Is it necessary to have routine blood tests in patients treated with isotretinoin

Objectives: Several side effects can be observed from isotretinoin use, which has been used in acne therapy for years. In this study, the side effects of isotretinoin on skin and mucosa, blood test changes and their relation with total dose were investigated in patients who used equal doses of isotretinoin. Materials and methods: A total of 91 outpatients with acne vulgaris (57 females and 34 males; age range 17–28 years, mean 21±2.19 years) were enrolled in this study. Skin and mucosal findings and pre‐ and post‐treatment blood tests and their correlation with the total dose were investigated. Students t‐test and the Mann–Whitney U‐test were used in the statistical analyses. Results: In all, 89 out of 91 patients completed the study. Cholesterol (p = 0.00), triglyceride (p = 0.00) and low density lipoprotein (LDL) (p = 0.001) levels were found to be significantly elevated. But these values were not over the double of the upper limits. No correlations were found among the total dose and the skin and mucosal changes as well as the blood test results. Conclusion: It is concluded that examination of cholesterol, triglyceride and LDL‐cholesterol should be performed monthly if the initial blood tests are close to the upper limits; otherwise, examinations at 2‐ or 3‐month intervals are sufficient, which would save unnecessary costs.

Interleukin-1 receptor antagonist and tumour necrosis factor-alpha gene polymorphisms in Turkish patients with allergic contact dermatitis.

Background: It has been shown that the family of interleukin‐1 receptor antagonist (IL‐1 RA) and tumour necrosis factor‐alpha (TNFα) genes are polymorphic and related to some inflammatory diseases. Allergic contact dermatitis is the classic presentation of delayed‐type hypersensitivity responses to exogenous agents. A number of genes playing role in inflammatory response may be associated with allergic contact dermatitis.

TUR‐PSO: A cross‐sectional, study investigating quality of life and treatment status of psoriasis patients in Turkey

Psoriasis is a common inflammatory disease that has a severe impact on quality of life. There is lack of data regarding epidemiological and clinical features of psoriasis patients in Turkey, a country with a population of 76 million. The aim of this study was to define the demographic and clinical characteristics, quality of life and treatment patterns of psoriasis patients in Turkey. A cross‐sectional observational study was conducted at 40 centers, chosen from geographically diverse locations in Turkey. Patients diagnosed with psoriasis were assessed by investigators who were specialists of dermatology using standardized study questionnaire forms. Dermatology Life Quality Index (DLQI) and EuroQol‐5 dimension (EQ‐5D) forms were also filled out by each patient. 3971 psoriasis patients were included in this study. 24.2% of plaque psoriasis patients had moderate to severe psoriasis (Psoriasis Area and Severity Index, ≥10). Mean DLQI was 7.03 ± 6.02; quality of life was moderately, severely or very severely affected in 49.2% of patients. The most severely affected component of EQ‐5D was anxiety/depression. Among all patients, 22.9% were not receiving any treatment, 39.8% were receiving only topical treatment, 11.5% were on phototherapy, 26.1%, were taking conventional systemic agents and 4.1% were on a biologic treatment. 31.3% of psoriasis patients with moderate to severe disease were treated with only topical agents and only 30.5% of moderate to severe psoriasis patients were receiving systemic therapy. Moderate to severe psoriasis has a considerable impact on quality of life. Treatment in Turkey of patients with moderate to severe psoriasis is insufficient.

Autoantibodies Other than Antineutrophil Cytoplasmic Antibodies Are Not Positive in Patients with Psoriasis Vulgaris

There is a great deal of evidences that a link may exist between psoriasis and autoimmunity. In this study, thirty‐six patients with psoriasis vulgaris and twenty healthy controls were screened for antinuclear antibody (ANA), anti‐ds‐DNA antibodies, anti‐SSA (anti‐Ro), anti‐SSB (anti‐La), anti‐Scl‐70, anti‐Jo‐1, rheumatoid factor (RF), C3 and C4 levels, IgG and IgM anti‐cardiolipin antibodies (aCL) and anti‐neutrophil cytoplasmic antibodies (pANCA and cANCA) in order to determine the role of autoimmunity in the pathogenesis. In addition, the MPO‐ANCA test was performed on pANCA‐positive patients. In ANA screening, one patient showed 1/80 granular positivity. No positive results were obtained from either the study or control groups for anti‐dsDNA, anti‐SSA, anti‐SSB, anti‐Scl‐70, or anti‐Jo‐1 determinations. For RF, 5.8% of the patients had positive values. Both C3 and C4 levels were found to be significantly elevated in psoriasis patients compared to healthy controls (p<0.001). IgG‐aCL and IgM‐aCL positivity was not significantly different between the two group. pANCA was positive in 33.3% of the patients and a significant difference was observed between study and control groups (p<0.05). MPO‐ANCA was negative in all the pANCA‐positive patients. In conclusion, only serum C3 and C4 levels and pANCA determinations showed significant differences when compared to healthy controls. Our findings may be evidence of associations between autoimmunity and psoriasis vulgaris. However, more detailed studies in this field need to be done to determine the relationship between them.

The Turkish guideline for the diagnosis and management of atopic dermatitis-2018

Address for Correspondence/Yazışma Adresi: Özlem Su MD, Bezmialem Vakıf University Faculty of Medicine, Department of Dermato-Venereology, İstanbul, Turkey Phone: +90 533 353 77 55 E-mail: ozlemsu@atlas.net.tr Received/Geliş Tarihi: 01.01.2018 Accepted/Kabul Tarihi: 19.02.2018 ORCID ID: orcid.org/0000-0002-1140-9261 Ege University Faculty of Medicine, Department of Dermato-Venereology, İzmir, Turkey *Bezmialem Vakıf University Faculty of Medicine, Department of Dermato-Venereology, İstanbul, Turkey **Koç University Faculty of Medicine, Department of Dermato-Venereology, İstanbul, Turkey ***Uludağ University Faculty of Medicine, Department of Dermato-Venereology, Bursa, Turkey ****Medeniyet University Faculty of Medicine, Department of Dermato-Venereology, İstanbul, Turkey *****Kocaeli University Faculty of Medicine, Department of Dermato-Venereology, Kocaeli, Turkey ******Erciyes University Faculty of Medicine, Department of Dermato-Venereology, Kayseri, Turkey