Yavuz Peksari

Contact sensitivity to standard series allergens in 1038 patients with contact dermatitis in Turkey

We planned to determine the frequency of sensitivity to European standard patch test allergens in 1038 patients with contact dermatitis. From 1992 to 2004, 1038 patients with the diagnosis of contact dermatitis were patch tested with the European standard series. Seven hundred and five patients were female (67.9%) and 333 patients were male (32.1%). A total of 336 patients (32.3%) had one or more positive patch test reactions. The most common allergens were nickel (17.6%), cobalt chloride (5.3%), potassium dichromate (4.6%), neomycin (2.4%), fragrance mix (2.1%) and balsam of Peru (2.1%). Contact sensitivity to potassium dichromate and thiuram was significantly more frequent in male patients, whereas nickel and primin sensitivity was significantly more frequent in female patients. Higher sensitivity rates for potassium dichromate, neomycin, balsam of Peru, wool alcohol, fragrance mix and primin were noted in patients over 40 years of age. Sensitivity rates of the standard series allergens were all similar in atopic patients and in non‐atopic patients. Metals, neomycin and fragrances are the leading allergens in Turkey. Although fragrances are among the most important sensitizers, sensitivity rates to fragrances and also to preservatives are much lower than the rates in Europe and the US.

Indolent Acremonium strictum infection in an immunocompetent patient

A 35‐year‐old housewife presented with an 11‐year history of a painless lesion on the right cheek, which had enlarged over the last 2 years. She had no history of travel or trauma. Various topical and systemic antimicrobial and antifungal agents, such as fluconazole, ketoconazole, sulbactam/ampicillin, and mupirocin, had been prescribed, with a probable diagnosis of pyoderma and blastomycosis, without significant benefit. Her medical history was otherwise unremarkable. Dermatologic examination revealed a well‐circumscribed, erythematous, infiltrative, 8 × 10 cm plaque covering the right cheek and a 2 × 3.5 cm vegetative, ulcerated lesion on the chin ( Fig. 1 ). There were no sinus tracts or grains.

Lupus vulgaris in a patient with systemic lupus erythematosus and persistent IgG deficiency

We present the case of a patient with juvenile onset systemic lupus erythematosus (SLE) who developed a persistent, acquired hypogammaglobulinaemia with IgG deficiency. The hypogammaglobulinaemia was probably a complication of high dose corticosteroid treatment. The serum IgG level remained subnormal despite intravenous immunoglobulin therapy. Lupus vulgaris, which developed on the nasal cartilage in this patient with SLE, is not an expected finding. This patient is probably the first reported case of SLE associated with lupus vulgaris.

Assessing the autoantibody levels in relation to disease severity and therapy response in pemphigus patients

Background: In pemphigus, autoantibodies are directed against adhesion molecules, which make the junctions between keratinocytes, and thus determining their level can reflect the disease activity. Aim: The purpose of this study is to determine the clinical significance of the autoantibody levels in pemphigus management. Materials and Methods: The clinical features of 47 pemphigus vulgaris patients were assessed and patients′ sera were investigated by indirect immunofluorescence using monkey esophagus as a substrate for autoantibody levels. Results: We found a significant correlation between antibody titers and mucosal severity scores. Initial antibody titers of the patients with at least one mucosal lesion at the end of the first month of the therapy were found significantly higher than the patients who had no mucosal lesion. With the therapy, lesions resolved earlier than the antibody titers. Conclusion: In patients with pemphigus, especially in cases who were not treated before, sera antibody levels are a valuable tool in evaluating disease severity and choosing initial treatment. In patients who had been taking any systemic treatment, it is difficult to make a relationship between antibody levels and disease severity, because therapy improves disease earlier than the antibody titers. However, estimating antibody levels can be helpful for clinicians in disease management, in reducing or ceasing treatment dosage and anticipating recurrence.