Yavuz Harmanyeri

Inflammation and Hypercoagulable State in Adult Psoriatic Men

Hyperhomocysteinaemia is a well-known risk factor for cardiovascular disease and plays a role in atherothrombosis. Psoriasis is a common chronic and recurrent inflammatory skin disease associated with increased thrombosis. The aim of this study was to examine serum homocysteine levels and their relationships with inflammatory and atherothrombotic markers in psoriasis. Twenty patients with mild or moderate psoriasis and 20 age-matched healthy men were included in this study. Patients with acquired hyperhomocysteinaemia were excluded from both groups. The inflammation markers, mean platelet volume, C-reactive protein and ceruloplasmin levels, were significantly increased in the study group compared with the control group. In the study group there was decreased antithrombin III and total homocysteine levels, for haemostatic parameters. Folic acid levels, cardiovascular risk factors, endothelial inflammation markers and blood coagulation factors demonstrated significant correlations. Folic acid levels correlated inversely with homocysteine and positively with fibrinogen levels. In conclusion, increased homocysteine concentration and inflammation markers may play a role in the atherothrombotic state in psoriasis.

Antistreptococcal treatment of guttate psoriasis: a controlled study

Background  The role of streptococcal infection in the initiation of guttate psoriasis is well‐recognized. But the treatment results with oral erythromycin and phenoxymethylpenicillin are conflicting.

Evaluation of patients with symptomatic dermographism

Background  Dermographism or ‘simple’ dermographism, which has been noted in about 1.5% to 5% of healthy individuals, is regarded as a normal physiological phenomenon. However, in symptomatic dermographism (SD), even light pressure or rubbing from clothes may provoke widespread weal‐and‐flare reactions with itching and burning. It is one of the dermatologic diseases that negatively impacts quality of life.

Intralesional alfa-2a interferon therapy for basal cell carcinoma.

Basal cell carcinoma (BCC) is an epithelial tumour of the skin that arises from basal cells of the epidermis and its appendages. There are some therapeutic models for BCC, and one of these is intralesional interferon. Thirteen patients with histopathologically-proven BCC on their faces or trunk were treated with intralesional interferon alfa-2a. Only 2 of 13 patients required surgery due to insufficient improvement. All the others were completely cured in 12 to 36 weeks. We concluded that intralesional interferon therapy of sufficient dose and duration for noduloulcerative and superficial BCC is an encouraging alternative to surgery and other treatment models.

Intradermal antigen tests and the Koebner phenomenon in psoriasis

Background Psoriasis is one of several dermatologic conditions in which nonspecific irritation may elicit the disease where it was not previously present. In this study we aimed to assess the cutaneous cellular immune reaction with intradermal antigen tests and the relation between Koebners phenomenon and intradermal antigens.

Acquired unilateral nevoid telangiectasia syndrome.

We describe a man with acquired unilateral nevoid telangiectasia syndrome, in whom no underlying disease, alcohol abuse or physiological conditions causing hormonal changes are demonstrable. To our knowledge, this is the first case of acquired unilateral nevoid telangiectasia syndrome seen in a healthy adult male and not associated with a hyperestrogenaemic state and estrogen receptor abnormality. This case report casts doubt on the commonly held view that unilateral nevoid telangiectasia syndrome is an estrogen-sensitive nevoid anomaly.

Atopy patch test reactivity to house dust mites in patients with scabies

It is well known that the house dust and the scabies mitesare related phylogenetically. We therefore performedatopy patch tests with house dust mite antigens (Dermato-phagoides pteronyssinus (Dp) and/or Dermatophagoidesfarinae (Df)) in scabies patients without atopy and healthycontrols. We studied 25 men with active scabies and 25healthy controls. Skin prick tests with standardized housedust mite extract were performed for all patients andcontrols. An intradermal test procedure was carried out inskin prick test-negative patients, and for controls showingpositive atopy patch test to Dp and/or Df. While atopypatch tests were performed directly in all healthy controls,patients with scabies were first treated and on the nextday, atopy patch tests were performed. Twenty-two of 25patients with scabies (88%) had skin prick test and/orintradermal test positivity against house dust mites,whereas 17/25 patients (68%) had atopy patch testpositivity against house dust mites (Dp and/or Df).There was no statistically significant difference betweenskin prick test and/or intradermal test positivity and atopypatch test positivity in a regression analysis (p50.222).The only statistically significant correlation was betweenatopy patch test positivity and the extent of scabiesinvolvement (pv0.05). Only few of the healthy controlshad positive tests. In this study, we have shown that apositive atopy patch test to house dust mite antigens is notspecific for patients with atopic dermatitis, but also occursin scabies patients without a history of atopic dermatitis.

Phacomatosis spilorosea (phacomatosis pigmentovascularis type IIIb).

Phacomatosis pigmentovascularis is a rare combination of melanocytic lesions and capillary malformations associated with defects of various organs including the nervous system and eyes. A 20-year-old otherwise healthy Caucasian man presented with a lifelong history of irregular pigmented and reddish patches on the skin of the head and neck, trunk and upper limbs. There was no family history of similar lesions. On examination there were multiple giant naevus spilus of the macular type bilaterally on the face, on the right side of the neck, right upper chest and most of the right upper limb (Figs 1,2). A pale pink giant telangiectatic naevus (naevus roseus) was present on the left side of the chest extending to the left arm (Fig. 3). A similar but smaller lesion was localized to the left lateral lumbar region and

A case of coumarin necrosis with penile and pedal involvement

A 57‐year‐old male patient with advanced adenocarcinoma of the lung, who was administered oral anticoagulant therapy because of pulmonary embolism, developed coumarin necrosis confined to the penis and feet. To our knowledge, this patient showing acral involvement is the seventh case of coumarin‐induced penile necrosis reported to date.

Unilateral vocal cord paralysis in a patient with Behçet's disease

Editor Behçet’s disease (BD) is a chronic, relapsing vascular inflammatory disease of unknown origin, involving the nervous system in a group of patients. Central nervous system involvement of BD is well recognized. However, manifestation of the disease on peripheral nervous system has rarely been observed. A case of BD with unilateral vocal cord paralysis is reported in this article. A 21-year-old man was admitted to the outpatient clinic of the dermatology department with complaints of oral ulcerations. Past medical history revealed that he had been diagnosed of BD 2 years earlier, based on the findings of oral apthous lesions, genital ulcerations and papulopustular lesions. He had been treated with colchicine and aspirin in the first 2 months and no other medications since then. Initial dermatological examination revealed two small ulcerations of oral mucosa and scrotal scar formation with papulopustular lesions, with a positive pathergy test. Routine physical examination of the patient was normal except for hoarseness. He stated that his dysphonia had started concurrently with his Behcet’s symptoms. Endoscopic laryngoscopy revealed unilateral vocal cord paralysis on the right side (fig. 1). Besides oral ulcers, extensive pharyngeal ulcers were observed in otolaryngological examination. Laboratory analyses, which were done for investigation, were all found normal or negative. There was no organic pathology like tumour or granulomatous lesions on computerized tomography (CT) scan and/or magnetic resonance imaging (MRI) of the cervical region and brain. No pathologies of the mediastinal or pulmonary structures were observed. Neurology consultation revealed no cranial parenchymal tissue involvement related to neuro-Behçet’s disease. The results of the brainstem auditory evoked potentials (BAEP) test were normal. The patient did not consent to a laryngeal electromyography. All pathologies that could potentially cause vocal cord paralysis were carefully reviewed and eliminated. The aphthous lesions were cleared with topical treatment; however, his dysphonia did not change during this period. Rare cases of neuro-Behçet and peripheral nervous involvement have also been reported. Although the mechanisms of peripheral nervous involvement in BD are not fully understood, it is thought to be attributable to vasculitis of the vasa nervorum or the side-effects of medications used in BD such as colchicine. In the present case, there was no pathology detected and shown above is the level of bulbus in cranial CT, MRI and BAEP. Paralysis of the recurrent laryngeal nerve causes vocal cord fixation on paramedian position on the affected side as it was in our case. In any pathology occurring above the branching of the recurrens nerve from the vagus nerve, severe motor dysfunctions such as difficulty in swallowing and breathing due to pharyngeal and laryngeal paralysis, and autonomic dysfunctions of the respiratory and gastrointestinal system would be observed. No such complaints were observed in our case. Idiopathic vocal cord paralysis is not a rarity. However, concurrent occurrence of BD symptoms and n. recurrens palsy and lack of evidence for any potential causes for this condition made us believe that this case was an isolated peripheral nerve involvement due to BD. To our knowledge, this is the second report documenting recurrent laryngeal nerve palsy due to BD.