Ülker Gül

Clinical aspects of epidermodysplasia verruciformis and review of the literature

Background  Epidermodysplasia verruciformis (EV), is an unusual genodermatosis characterized by persistent human papilloma virus infection with an autosomal recessive inheritance pattern. Clinically, it is characterized by flat wart‐like lesions, scaly hypo‐ and hyperpigmented macules and/or patches, which resemble pityriasis versicolor, and development of early beginning nonmelanoma cutaneous carcinomas.

Skin findings in thyroid diseases

BACKGROUND In cases of thyroid diseases, many of the symptoms arise on the skin. In this study, we aimed to detect and compare the skin findings and accompanying dermatoses of patients with thyroid diseases. MATERIALS AND METHODS 220 patients with thyroid diseases, who did not have any medical cure, and 90 healthy individuals as a control group attended our study. All of the cases were examined, and the skin findings and/or dermatoses were recorded. The skin findings in the patients and the control group were compared statistically. RESULTS Among 220 cases, in 125 (56.8%) skin findings were detected. The most frequently observed skin findings were chronic urticaria (6.8%), vitiligo (6.8%), diffuse alopecia (6%), acne vulgaris (5%) and acne rosacea (3.6%). No significant difference was detected statistically between the patients and control group in terms of skin findings. When compared for the presence of each dermatosis, chronic urticaria, vitiligo and pruritus were found to be significantly higher in the patient group with thyroid diseases than in the control group. In terms of the presence of skin findings, no statistical difference was detected between autoimmune hyperthyroidism and non-autoimmune hyperthyroidism, between autoimmune hypothyroidism and non-autoimmune hypothyroidism, or between autoimmune euthyroidism and non-autoimmune euthyroidism. Chronic urticaria, vitiligo, and diffuse alopecia were found to be significantly higher in patients with autoimmune thyroid diseases than in the control group. Vitiligo and diffuse alopecia were found to be higher in autoimmune hyperthyroidism patients than in the control group. Vitiligo was found to be significantly higher in autoimmune hypothyroidism patients than in the control group. CONCLUSION To our knowledge, no report investigating the skin findings among thyroid diseases exists in literature. We believe this study would provide data for further studies.

Homocysteine, vitamin B12 and folic acid levels in psoriasis patients

Background  Hyperhomocysteinaemia is a risk factor for atherosclerotic cardiovascular disease, stroke, peripheral arterial occlusive disease and venous thrombosis. An association between psoriasis and cardiovascular diseases has been reported.

Risk factors for pressure ulcers.

BACKGROUND: Pressure ulcers (PrUs) remain a common problem in all healthcare settings. The aim of this study was to assess the presence of risk factors in patients with PrUs. METHODS: The study included 32 immobilized inpatients with PrUs and 30 immobilized inpatients without PrUs as a control group, who were being followed up at the Ankara Physical Therapy and Rehabilitation Hospital, Ankara, Turkey. Patients were given physical examinations and assessed for medical history, as well as for associated diseases, the duration of PrUs, the presence of stool and urinary incontinence, the use of pressure-reducing bed surface, and change of position. Routine biochemical and hematologic blood examinations were performed in all of the patients involved in the study. RESULTS: When risk factors for PrUs were assessed, 81.2% of the patients with PrUs had stool and urine incontinence, 46.8% had been smoking, 46.8% had hypoalbuminemia, 15.6% had been drinking alcohol, and 9.3% had diabetes; 18.7% had been using a pressure-reducing bed surface before the ulcer appeared, and 40.6% started to use a pressure-reducing bed surface after the ulceration occurred; and 59.3% were repositioned periodically. PrUs were found to develop earlier in patients who were smoking and who had anemia. A significant relation also was found between the grade of the ulcer and the frequency of change of position in bed. Smoking and urinary/stool incontinence were found to be significantly present more frequently in the patient group than the control group. Stool incontinence and the absence of the use of a pressure-reducing bed were also found to be risk factors in the patient group when compared with the control group. CONCLUSIONS: The authors believe that stool and urinary incontinence, smoking, anemia, not using a pressure-reducing bed surface, and infrequent change of position in bed are considerable risk factors for the development of PrUs. Immobilized patients should be assessed for these risk factors, and measures should be taken to prevent PrU development.

Squamous cell carcinoma developing on burn scar.

Background:It is estimated that 2% of burn scars undergo malignant transformation. Squamous cell carcinoma (SCC) is the most common type of cancer that develops. Materials and Methods:We report a retrospective study, which consists of 510 patients who have 570 cases of tumors of SCC. We examined SCCs developing on burn scars retrospectively among 570 cases, and we found that 36 cases had SCC developing on burn scars. The records of those 36 cases were analyzed in terms of age, sex, latent period between burn and carcinoma, anatomic localization of the carcinoma, and the presence of metastases. These findings were compared with the SCC group that did not have burn history. Results:The number of SCC developing on burn scars among the 570 cases was 36 (6.31%), 15 of which were women (41.66%) and 21 were men (58.33%). The average age was 46.77 years. The average latent period between burn and the development of carcinoma was found to be 32.22 years. It should be mentioned that the burn scar carcinoma group was younger. In addition, burn scar carcinoma was more likely to localize on lower extremities and metastasize (P < 0.001). Conclusion:Having high aggressive features, the suspicion of development of SCC in burn scar should be kept in mind, so patients with burn scar must be followed periodically.

A case of generalized discoid lupus erythematosus: Successful treatment with Imiquimod cream 5%

Discoid lupus erythematosus (DLE) is the most common form of chronic cutaneous lupus erythematosus. Classic DLE lesions begin as red-purple macules, papules, or small plaques and rapidly develop a hyperkeratotic surface. Most patients with untreated classic DLE lesions suffer indolent progression to large areas of cutaneous dystrophy and scarring alopecia that can be psychosocially devastating. A 44-year-old male patient presented to the clinic with erythematous scaly patches that began on his nose 1 y before. His face was most affected, however, lesions were also noted on his scalp, ears, and limbs. Histopathologic examination verified a diagnosis of DLE. Laboratory examinations and consultations revealed no signs of systemic involvement. Imiquimod cream 5% was applied to the lesions once a day 3 times a week. After 20 applications, entire lesions regressed significantly. Imiquimod cream 5% may represent an alternative treatment method for patients with DLE.

Detection of contact hypersensitivity to corticosteroids in allergic contact dermatitis patients who do not respond to topical corticosteroids

The delayed hypersensitivity development against topical corticosteroids which are used in allergic contact dermatitis (ACD) treatment is an important clinical problem. In our study, 41 ACD patients who did not show any response to topical corticosteroid treatment were patch tested with corticosteroid series and the commercial preparations of corticosteroids and their vehicles. In corticosteroid series, there were budesonide, bethametasone‐17‐valerate, triamcinolone acetonide, tixocortol pivalate, alclomethasone‐17‐21‐dipropionate, clobetasole‐17‐propionate, dexamethasone‐21‐phosphate disodium and hydrocortisone‐17‐butyrate. We detected positive reaction to corticosteroids in 9 of our cases (22%) (5 single and 4 multiple). The sensitivity was mostly produced by tixocortol pivalate (6 patients). This was followed by triamcinolone acetonide (2 patients) budesonide (2 patients), alclomethasone dipropionate (2 patients), dexamethasone 21 phosphate disodium (2 patients) and betamethasone‐17‐valerate (1 patient). As a result, it should not be forgotten that the corticosteroids used to treat ACD patients may cause ACD themselves. In ACD patients who did not respond to corticosteroid treatment, routinely applying patch test with corticosteroids should be helpful in directing the treatment.

Autoimmune thyroid disorders in patients with psoriasis

A few studies have shown a high prevalence of thyroid autoimmunity in patients with psoriatic arthritis. However, thyroid autoimmunity has not been investigated in patients with psoriasis who do not have psoriatic arthritis. We aimed to investigate thyroid autoimmunity in patients with psoriasis. The study included 105 consecutive patients with psoriasis who did not have psoriatic arthritis and a sex and age matching control group consisting of 96 patients with tinea pedis. All of the patients with psoriasis were examined dermatologically and PASI scores were calculated for each patient. Free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), antithyroglobulin (AbTG), and antithyroidperoxidase antibody (AbTPO) levels were measured in all of the subjects. The levels of TSH, FT3, FT4, AbTG and AbTPO and ultrasonographic findings of thyroid gland were compared statistically between psoriasis and control groups. Also, the levels of TSH, FT3, FT4, AbTG and AbTPO of psoriasis patients were compared with PASI scores. Mann-Whitney U test was used as statistical method. The mean age of patients with psoriasis was 40.54 +/- 16.91 years. 56 patients were female, 49 were male. The levels FT4 were found to be significantly increased in the patient group. But levels of AbTPO and AbTG were not statistically different between the two groups. The patients who had thyroiditis plus nodules in thyroid ultrasonography had statistically longer disease periods. This is the first study that investigated autoimmune thyroid disorders in patients with psoriasis who did not have arthritis. We believed that thyroid autoimmunity in patients with psoriasis was no different from that found in healthy individuals.

Cutaneous manifestations in patients positive for anti-hepatitis C virus antibodies.

Cutaneous diseases can indicate the presence of hepatitis C virus (HCV) infection. The aim of this study was to analyse the frequency of cutaneous findings in HCV infection and HCV RNA positive cases in Turkey. Fifty consecutive patients positive for anti-HCV antibodies,negative controls, and patients positive and negative for HCV RNA were examined for any cutaneous findings that could be associated with HCV infection. The risk of infected patients developing cutaneous finding was higher than for non-infected individuals. Only pruritus showed a statistically significant difference in separate assessment of cutaneous symptoms. There were no differences in cutaneous findings in HCV RNA positive and negative cases. The risk of developing a dermatological finding, especially pruritus, was increased in HCV infection.However, because the number of patients in this study was too low to allow statistical evaluation of the prevalence of dermatological symptoms and diseases, multicentre studies including large numbers of patients are needed.

Skin findings in newborns and their relationship with maternal factors: observational research.

Background Cutaneous lesions are commonly seen in the newborn period and exhibit inconsistency from the skin lesions of an adult. Objective The present study was carried out with an aim to determine the frequency of physiologic and pathologic cutaneous findings in newborns. Methods Typically, 1234 newborns were included in this study. A questionnaire about maternal gestational history, maternal and family history was issued to the parents of each newborn. The presence of cutaneous lesions was recorded. Results Overall, 642 (52%) of the newborns were male and 592 (48%) were female. Typically, 831 newborns (67.3%) had at least one cutaneous lesion. The prevalence of genital hyperpigmentation and milia was significantly higher in males. In premature newborns, the pervasiveness of cutis marmorata and genital hyperpigmentation was found to be significantly higher. Caput succedaneum, transient neonatal pustular melanosis and cyanosis appeared predominantly in vaginally born infants. Erythema toxicum neonatorum was seen in infants, who were born by cesarean section. The predominance of Mongolian spots and erythema toxicum neonatorum were significantly higher in the newborns of the multiparous mothers; however, caput succedaneum was significantly higher in newborns of the primiparous mothers. Conclusion A number of studies about neonatal dermatoses have been carried out involving different methods in various countries. We consider that our study may be useful in literature, as it has been carried out involving large number of maternal parameters.