Zennure Takci

The association between Interleukin (IL)-4 gene intron 3 VNTR polymorphism and alopecia areata (AA) in Turkish population.

OBJECTIVE Alopecia areata (AA) is hypothesized to be an organ-specific autoimmune disease of hair follicles mediated by T cells. As immunological and genetic factors have been implicated in the pathogenesis of AA, the purpose of the present study was to investigate possible associations between the functional Interleukin (IL)-4 gene intron 3 VNTR polymorphism and AA susceptibility and disease progression in Turkish population. METHODS The study group consisted of 116 unrelated patients with AA and 125 unrelated healthy controls. Genomic DNA was isolated and IL-4 gene 70 bp VNTR polymorphism determined by using polymerase chain reaction (PCR) with specific primers. RESULTS No association was observed between AA patients and controls according to genotype distribution (p=0.051). The allele distribution of IL-4 gene intron 3 VNTR polymorphism was statistically different between AA patients and control group (p=0.026). The frequency of P1 allele in patients was significantly higher than that in the control group. When the P2P2 genotype was compared with P1P2+P1P1 genotypes, a statistically significant difference was observed between patients and controls (p=0.036). Intron 3 VNTR polymorphism in the IL-4 gene was found to be associated with AA susceptibility in Turkish population. CONCLUSION The results suggest that IL-4 VNTR polymorphism in the intron 3 region may be a risk factor for the development of AA among Turkish population. This is the first to report that intron 3 VNTR polymorphism in the IL-4 gene is associated with AA susceptibility.

The Effect of Acitretin Treatment on Insulin Resistance, Retinol-Binding Protein-4, Leptin, and Adiponectin in Psoriasis Vulgaris: A Noncontrolled Study

Background/Aim: To investigate the effects of acitretin treatment on insulin resistance (IR) and adipokines, particularly retinol-binding protein (RBP)-4. Methods: Thirty-four patients with chronic plaque psoriasis and a control group of 34 healthy volunteers were recruited in the study. Screening for the parameters was performed before starting and after 3 months of acitretin treatment in the psoriasis group. The control group was only evaluated at the beginning of the study and did not receive placebo. We could not compare our results with a placebo control group because of ethical reasons. Results: Basal adiponectin (p = 0.01), insulin (p < 0.0001) levels and homeostasis model assessment (HOMA) IR (p < 0.0001) were significantly higher in psoriasis patients. After the treatment, insulin (p = 0.014), C peptide (p = 0.011), RBP-4 (p < 0.0001) levels and HOMA-IR (p = 0.008) decreased significantly. Posttreatment leptin (p = 0.036) levels were significantly lower than those of the controls. Posttreatment adiponectin (p = 0.005) and insulin (p = 0.048) levels were higher than those of the controls. Conclusions: This study showed for the first time that RBP-4 levels and IR are decreased significantly with acitretin treatment. This finding is very important in psoriasis patients because psoriasis may cause insulin resistance and diabetes. Further experimental and clinical studies are needed to clarify the effect of acitretin on adipocyte structure and behavior.

Assessment of the serum paraoxonase activity and oxidant/ antioxidant status in patients with recurrent aphthous stomatitis

Several studies have indicated that recurrent aphthous stomatitis (RAS) is associated with oxidative stress. The aim of this study was to investigate serum paraoxonase (PON) activity and oxidant/antioxidant status in patients with RAS.

Decreased serum paraoxonase and arylesterase activities in patients with rosacea

Recent evidence suggests that oxidative stress may be an important phenomenon in the pathophysiology of rosacea. Paraoxonase‐1 (PON1) is an antioxidant enzyme with three activities: paraoxonase, arylesterase and dyazoxonase. In this study, we evaluated serum paraoxonase and arylesterase activities, and serum lipid hydroperoxide (LOOH) levels in patients with rosacea in comparison to healthy controls.

Evaluation of serum vitamins A and E and zinc levels according to the severity of acne vulgaris

Abstract Background: Although hyperseborrhea, follicular hyperkeratinization, Propionibacterium acnes colonization and inflammation are found to be responsible in the pathogenesis of acne, the exact mechanisms are unknown. Vitamin A and E are basic antioxidants vital for health. Zinc is also an essential element for human. But these parameters of the effects on skin are not fully understood. We aimed to evaluate plasma levels of vitamin A, E and zinc in acne patients in relation to the severity of the disease. Material and method: There were 94 acne patients who were referred to our clinic, all new diagnosed, and 56 age and sex matched healthy volunteers as control group. All patients are assessed according to Global Acne Grading System and grouped as mild, moderate, severe and very severe. Acne patients further grouped as group 1 consist of patients with mild to moderate disease; and group 2 consist of patients with severe to very severe acne. The patients with the controls and group 1 with group 2 was compared. Results: The level of vitamin E, vitamin A and zinc were significantly lower than the control group (Table 1,p < 0.001). When the patient group is compared among each other there was no statistically significant difference for plasma vitamin A levels between group 1 and 2 whereas vitamin E and zinc levels were significantly low in group 2 than group 1. Thus there was a negative correlation between acne severity and vitamin E and zinc levels. Conclusion: Our study marks the importance of diet in patients with acne. We offer supportive dietary measures with foods rich in vitamin A and E and zinc in the acne prophylaxis and treatment. Supportive treatment with these vitamins and zinc in severe acne may lead to satisfactory results.

Isotretinoin modestly increases platelet count in acne patients

Isotretinoin (ISO) has been used over 25 years for the treatment of severe acne, and it affects nearly all the etiopathogenetic aspects of this disease (1,2). ISO side effects involve several organ systems, most commonly mucocutaneous, and can cause dyslipidemia and liver enzyme elevation (1,3). Thrombocytopenia, agranulocytosis and leukopenia have been associated with ISO in several case reports (3), but a previous study found that no abnormalities were found in hemoglobin, white blood cell and platelet counts and the researchers suggested not to measure these parameters in patients treated with ISO (4). In this study, we aimed to investigate the possible effect of ISO on blood cell counts. Seventy patients with moderate to severe nodulocystic acne, who had therapeutic failure with topical remedies and tetracyclines (47 females, 23 males, age: 21.5 ± 4.8 years) from November 2010 to June 2011, were included. ISO therapy was initiated at a dose of 0.5–0.75 mg/kg body weight. The drug was administered twice daily with a meal for at least 5 months. Screening for complete blood count was done just before initiation and after 3 months of ISO treatment. Complete blood count was performed by an automated COULTER LH 780 Hematology Analyzer (Beckman Coulter, Inc., Miami, FL, USA). A Wilcoxon signed-rank test was used for analysis of data with skew variability; significance was defined as p < 0.05. Platelet counts 3 months into treatment (274.4 ± 62.8) were higher than baseline counts (252.4 ± 59, p < 0.0001). Posttreatment hemoglobin, hematocrit and white blood cell counts did not change (Table I). We found a modest rise in platelet count associated with ISO treatment. Several studies with other retinoids investigated platelet counts before and after treatment. All-trans retinoic acid (ATRA) stimulates megakaryopoiesis of progenitor cell line MEG-01 cells (5). The resulting megakaryocytes stayed viable for more than 3 weeks. Retinoic acid enhances the generation of hematopoietic progenitors from human embryonic stem cell-derived hemato-vascular precursors (6). ATRA in patients with myelodysplastic syndrome increased both absolute neutrophil counts and platelet counts in 3 out of 15 patients (7). In a Phase I clinical trial of 13-cis-retinoic acid (13-cRA) in patients with myelodysplastic syndromes, 5 out of 15 patients showed an increase in platelet counts (8). This effect does not appear to be of clinical importance in acne patients and our findings confirm that following blood counts is not necessary during ISO treatment of acne.

A pediculid case: autosensitization dermatitis caused by pediculosis capitis.

Pediculosis capitis is a worldwide infestation caused by Pediculus humanus capitis ectoparasite that only lives on the hairs of the scalp. As a result of severe itching excoriation, secondary bacterial infection, cervical and occipital lymphadenopathy are seen frequently where, sometimes bite reaction, viral exanthema mimicking hypersensitivity eruption and conjunctivitis may occur. Hereby, with the presentation of a quite rarely seen pediculid case, characterized with common autosensitization dermatitis as an -id reaction to pediculosis capitis, the importance of exploring the source of the infection and/or infestation on the patients who have presented with generalized pruritic maculopapular eruption, is emphasized.

The Effect of Different Doses of Isotretinoin on Pituitary Hormones

Background: There are a limited number of studies investigating the side effects and effectiveness of various doses of isotretinoin (ISO). We have previously shown that high-dose ISO affects pituitary hormones. Objectives: To our knowledge, there is no study in the literature looking into the effects of various doses of ISO on pituitary hormones. We searched pituitary hormones in three groups of different doses in acne patients. Methods: We included 105 acne vulgaris patients from two different centers. We divided the patients into three groups; the first group received 0.5-1 mg/kg/day, the second 0.2-0.5 mg/kg/day and the third intermittent 0.5-1 mg/kg/day (only 1 week in 1 month) ISO treatment. Blood samples were collected for biochemistry and hormone analysis, before the treatment and after 3 months. Results: After 3 months of treatment with ISO, luteinizing hormone (LH) (p < 0.001), prolactin (p < 0.001), total testosterone (p < 0.001), adrenocorticotropic hormone (ACTH) (p < 0.001), cortisol (p < 0.001), insulin-like growth factor-binding protein 3 (p < 0.001), insulin-like growth factor 1 (IGF-1) (p = 0.002), growth hormone (GH) (p = 0.002) and free T3 (fT3) (p < 0.001) levels had decreased significantly. Furthermore, we split data into three different groups. Among the patients receiving intermittent-dose ISO, LH, ACTH, IGF-1, GH and fT3 measurements lost significance. Most of the significant measurements observed in the whole group were also significant among the patients receiving high-dose ISO. Additionally, dehydroepiandrosterone sulfate (p = 0.003) levels increased, and free T4 levels decreased significantly. Conclusions: ISO affects pituitary hormones at all of these three doses. The differences in pituitary hormones are more pronounced in high-dose treatment. The weakest effect was observed in the intermittent-dose group. Choosing lower doses of ISO may decrease side effects, however the effectiveness of the treatment may also be diminished. ISO, by affecting the PPARγ/RXR system, may affecting hormone systems. These changes in various hormone systems may be related to the effectiveness of ISO.

Serum holotranscobalamine, vitamin B12, folic acid and homocysteine levels in alopecia areata patients

Alopecia areata has been associated with many autoimmune diseases. There is a common belief that the prevalance of pernicious anemia is increased in patients with alopecia areata. In this study, we sought to investigate vitamin B12, folate and homocysteine metabolism in alopecia areata. We measured holotranscobalamine (holoTC), vitamin B12, folate and homocysteine levels in 75 patients with alopecia areata and 54 controls. We did not find any significant differences in these parameters between these groups. We think that alopecia areata may not be associated with vitamin B12 deficiency. The co-occurence of pernicious anemia and alopecia areata in rare autoimmune syndromes, may not justify routine measurements of these parameters in alopecia areata patients.

Nail discoloration due to tinzaparin sodium

Tinzaparin sodium is a low molecular weight heparin formed by the enzymatic degradation of porcine unfractionated heparin, and is effective in the prevention and treatment of thromboembolic disease. We report a 31-year-old female patient with a history of recurrent pregnancy loss due to thrombophilia, who developed nail discoloration after 8 weeks of tinzaparin sodium therapy. No other pigmentation was found elsewhere on the skin, mucous membranes, teeth, or sclerae. To our knowledge, nail pigmentation following tinzaparin sodium therapy is an unknown side effect and has not been reported previously in the English literature.