Zeynep Topkarci

Lipoid proteinosis: a case series from Istanbul.

Background  Lipoid proteinosis (LP) is a very rare genodermatosis. The literature on LP consists of case reports only. As we have observed 14 LP patients belonging to nine different families in the last 15 years in our practice, we decided to review all reported Turkish LP patients in this 15‐year period, and noted 37 diagnosed cases. The reasons for this relatively large number of cases, the clinical features of the patients, and the associations of LP with other clinical conditions are described in this article.

Systemic allergic dermatitis from chromium in a multivitamin/multimineral tablet.

A 43-year-old non-atopic lawyer presented with a 10-year history of recurrent vesicular eczema on his hands, wrists, feet, ankles, and lower legs mainly after wearing leather gloves, shoes, or boots. Wearing dark coloured socks worsened his foot eczema. He was aware of no other aggravating factor. Patch testing was performed with the extended European baseline series, and with series of preservatives, emulsifying excipients, fragrances, and leather including leather dyes (Brial Allergen, Greven, Germany) using IQ-Chamber® (Chemotechnique Diagnostics, Vellinge, Sweden). Using International Contact Dermatitis Research Group (ICDRG) criteria, a +++ positive reaction developed to potassium dichromate (0.5% pet.), a ++ positive reaction to cobalt chloride (1% pet.), and a + reaction to nickel sulfate (5% pet.), chromium sulfate (0.5% pet.), ammoniated mercury (1% pet.), and phenylmercuric acetate (0.01% pet.) on D2, D3, and D4. The metal and mercury compounds were of past relevance; the former having caused eczema on contact areas of metals such as eyeglass frame or wrist watch, and the latter from use of mercurochrome in the past. He had had no exposure to these for at least a year and he had never used wet cement. In spite of further avoidance of contact with metals, leather, dark coloured textiles, dyes, and a low chromate and nickel diet for the next 1 month, the lesions failed to improve. At that point, the patient reported the daily use of 1–2 multivitamin/multimineral tablets (ONE-A-DAY® Men’s, Leiner Health Products, USA, imported by Bayer Türk Kimya San. Ltd. Şti., Istanbul, Turkey) for the previous 2–3 months. The preparation contained 150 μg chromium chloride as well as 9 μg vitamin B12 (cyanocobalamin) but no nickel. Within 10 days after discontinuation of the tablets and treatment with topical corticosteroids, his eczema resolved completely. After an eczema-free interval of 3 months, systemic challenge with the multivitamin/multimineral tablets one daily orally for three consecutive days resulted in recurrence of acute vesicular eczema on previously involved sites within 2D. A flare in the previous patch test sites was not observed. The tablets were stopped again, and lesions resolved within 10D. Additional patch testing with chromium chloride could not be performed. There was no recurrence of the eczema during a 6-month follow-up.

Allergic contact cheilitis from a lipstick misdiagnosed as herpes labialis: Subsequent worsening due to Zovirax® contact allergy

A 29‐year‐old Turkish woman with allergic contact cheilitis from a lipstick was misdiagnosed as herpes labialis and subsequently worsened with the application of Zovirax® cream. Patch tests were positive to Zovirax® cream, propylene glycol, the patients favourite lipstick and propyl gallate. No reaction was seen with Zovirax® ophthalmic ointment and Zovirax® tablet. The propylene glycol component of the Zovirax® cream and the propyl gallate component of the lipstick were regarded as the responsible contact sensitizers. The differential diagnosis was challenging due to concomitant contact sensitization with these agents.

Is there a relation between clinical disease activity and acute phase response in Behcet's disease?

The aim of this study was to evaluate a possible relation between clinical disease activity determined by a scale validated and most widely used acute phase response parameters in patients with Behcets Disease (BD). One hundred patients with BD were included in this study. The demographic properties including age, sex, and disease durations were recorded. BD Current Activity Form (BDCAF), which scores the history of clinical features that have been present during the four weeks prior to the day of assessment, was used for the evaluation of disease activity. Erythrocyte sedimentation rate (ESR) and C‐reactive protein (CRP) levels were evaluated as acute phase response. The independent samples t test and Pearsons correlation test were performed for the statistical analysis. There were 60 male and 40 female patients with an age range of 19–51 years. The disease durations of the patients were between 12 and 240 months. In the comparison of the laboratory parameters of the patients with or without the components of BDCAF, we found significantly higher levels of ESR and CRP in patients with erythema and arthralgia‐arthritis versus without these involvements. There were significant positive correlations between ESR‐CRP levels and patients perception of disease activity (P = 0.012 and P < 0.05, respectively), clinicians overall perception of disease activity (P < 0.005), and total BDCAF score (P = 0.008 and P < 0.000, respectively). In conclusion, the presence of a newly‐developed erythema nodosum, superficial thrombophlebitis, or joint involvement may be associated with higher levels of ESR and CRP. Also, correlations between these indices and general disease activity scores may contribute the overall disease activity perception in BD.

Airborne allergic contact dermatitis caused by a henna stone

Henna stone is a lesser-known commercially available material used to obtain black henna paste (1). In some countries, including Turkey, local herb sellers sell it as ‘natural stone’, a so-called natural source for black henna. The stone has to be crushed into powder first, and then mixed with water, hydrogen peroxide and, sometimes, natural henna to obtain black henna paste for the purpose of hair dyeing or, mainly, temporary tattooing (1). We herein present a unique case; a teenager who developed an unusual airborne contact dermatitis while trying to crush a henna stone outdoors on a windy day.

Annular Erythematous Patches as the Presenting Sign of Extranodal Natural Killer/T-Cell Lymphoma

Extranodal natural killer/T-cell lymphoma (ENKTL) is a distinct type of lymphoma strongly associated with Epstein-Barr virus (EBV) infection and showing an aggressive course [1]. It usually presents as a localized disease in the upper aerodigestive tract, from the nasal cavity to the hypopharynx [2,3], but it may rapidly extend to the neighboring tissues and disseminate to various organs such as the small intestine, epiglottis, testes, adrenal gland, kidneys, and breasts [4,5]. As nasal/upper aerodigestive tract involvement may only cause nonspecific symptoms in the early period, diagnosis may be initially established based upon skin lesions [6]. We present two ENKTL patients with unusual dermatological findings.

Management of keratoacanthoma in patients with xeroderma pigmentosum: a challenge for clinicians

terized by chemotactic activity for T cells and macrophages, which suggests that IFN-b might induce or exacerbate psoriasis by stimulating the infiltration of both adaptive and innate immune cells. In addition, a recent study showed that IFN-b directly exacerbates Th17-mediated inflammatory diseases. In this case, nivolumab may have accelerated the Th17 reaction jointly suppressed by PD-1 and IFN-b and thus exacerbated psoriasis vulgaris.

Assessment of quality of life in Turkish children with psoriasis and their caregivers

The effect of pediatric psoriasis on quality of life has been demonstrated, but data regarding its influence on caregiver quality of life are scarce. The objective was to investigate how psoriasis affects quality of life of children and their caregivers.