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Chronic psychological stress cause erectile dysfunction (ED). Considering recent evidence that tumor necrosis factor-α (TNF-α) levels are increased in serum of patients with ED, the present study investigated the effects of infliximab (a TNF-α blocker) on endothelial nitric oxide synthase (eNOS) and neuronal NOS (nNOS) immunoreactivity of rat penile corpus cavernosum in unpredictable chronic mild stress (UCMS). Male adult rats were randomly divided into three groups (n=8 per group): Control, UCMS and UCMS+infliximab. Control and UCMS groups received physiological saline, UCMS+infliximab group received infliximab (5 mg kg-1 per week, intraperitoneally) during 8 weeks of UCMS. UCMS and UCMS+infliximab groups were subjected to different types of stressors, which were randomly applied four to five times during this time period. After 8 weeks, penile eNOS and nNOS expressions were determined immunohistochemically. In UCMS group, nNOS and eNOS immunoreactivity was found to be decreased in penile corpus cavernosum compared with the control group. Whereas in infliximab treatment group eNOS and nNOS immunoreactivity increased compared with the UCMS group. These findings support that UCMS decreases penile constitutive NOS expression via TNF-α, which may contribute to the development of ED. Blockage of TNF-α actions may represent an alternative therapeutic approach for ED in chronic psychological stress.

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BACKGROUND: The pathogenesis of psoriasis has not been known exactly yet. Recently, it has been suggested that increased reactive oxygen species (ROS) such as nitric oxide (NO) and malondialdehyde (MDA) may play a part in the pathogenesis of various skin diseases, including psoriasis. OBJECTIVES: In this study, we aimed to investigate the role of ROS in the pathogenesis of psoriasis. METHODS: A convenience sample of 23 patients with psoriasis and 23 healthy subjects consented to participate in the study. Plasma NO and MDA levels were measured in all participants. Psoriasis area and severity index (PASI) and tissue levels of MDA on lesional and non-lesional skin regions of psoriasis patients were measured. In addition, the correlation between age, gender with plasma NO, plasma MDA and tissue MDA was assessed. RESULTS: Plasma levels of NO and MDA in psoriasis patients (135.8 µmol/L, 4.33 µmol/L, respectively) were statistically significantly higher than those in controls (33.6 µmol/L, 2.03 µmol/L, respectively). Tissue levels of MDA in lesional tissues (49.18 nmol/gr) were significantly higher than those in non-lesional tissues (28.41 nmol/gr). A significant correlation was not found between the PASI and levels of NO and MDA. In addition, a significant negative correlation was found between the plasma NO levels and age. CONCLUSION: NO and MDA levels are elevated in psoriasis patients, which may indicate that oxidative stress plays an important role in the aetiopathogenesis of psoriasis.

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BACKGROUND: It is a common opinion that expansion and darkening in melanocytic nevi may occur during pregnancy. The main problem is that whether it is a usual finding, or it is a condition that requires suspicion about melanoma. OBJECTIVES: It was aimed to find the changes that might occur in the sizes and structures of melanocytic nevi during pregnancy. METHODS: Ninety-seven nevi of the 56 pregnant women in the first trimester were evaluated in the study. The localization and size of the nevi were recorded on a standard body diagram. After clinical examination, dermoscopic analyses were applied. Pattern analyses were done, and total dermoscopy scores (TDS) were calculated by applying ABCD scoring system. All subjects were seen again during the third trimester. RESULTS: There was a statistically significant difference between the mean diameters of nevi in the first and third trimester (P = 0.001). Of nevi whose diameters increased, 10 (50.00%) were localized on the front of body, 6 (30.00%) on the face and neck, 3 (15.00%) on the legs, and 1 (5.00%) on the back. The enlargement in diameters was more significant on the front of the body, but there was no statistically significant difference. Compared according to the pattern analysis, new dot formation was observed only on the structure of six nevi during the last trimester. Four of them were localized on the front of the body. There was statistically significant increase in mean TDS in comparison between the first and third trimesters (P = 0008). CONCLUSIONS: During the pregnancy, widening in diameters and structure changes of nevi may be seen especially on the front of the body. We also think that these findings might be connected with expansion of the skin during pregnancy. Dermoscopic controls are the first choice of method to analyse the nevi since the patient may not recognize these changes.

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In this experimental study the possible effects of the acitretin on the spermatogenesis of the rats were investigated histopathologically. Thirty-nine male adult Wistar albino rats were divided into 3 groups as two experimental groups and one control group. The first group consisting 14 rats were applied orally standard dose (0.75 mg/kg/day) acitretin and the second group consisting 16 rats were applied high dose (1.5 mg/kg/day) acitretin. Acitretin was given within dimetil sulphoxide (DMSO), which was diluted with saline solution as a ratio of 1/10, in order to increase its solubility. The control group consisting 9 rats were given only saline solution including DMSO for 8 weeks. After 8 weeks of the administration, half of the rats in the first and second groups and the entire control group were sacrificed under deep ether anaesthesia and bilateral orchiectomy was made. The remaining rats were compared with the control group using a similar method at the end of 8 weeks of wash-off period. The orchiectomy materials were histopathologically evaluated under the light microscope for spermatogenesis according to parameters including spermatogenetic activity, spermatogenetic organization, seminiferous tubular diameter, interstitial Leydig cells and fibroblasts. The groups, which were evaluated at the end of the 8(th) and 16(th) weeks, were compared with the control group regarding the mentioned parameters and no statistical significance was observed among the groups. In our study it was concluded that the standard and high doses of acitretin do not have any effect on the spermatogenesis of the rats.

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AIM: To understand the role of epidermal cells in the pathogenesis of lichen amyloidosus (LA) and macular amyloidosis (MA). METHODS: We carried out immunohistochemical investigations on cytokeratins (CKs) in amyloid deposits in formalin-fixed and paraffin-embedded tissue specimens from eight persons with LA and 12 with MA. The primary antibodies of CK1-8 (AE3), CK10 (DEK-10), CK14 (LL002), CK17 (E3), CK18 (DC10), CK19 (KS19.1), CK5/6/18 (LP34) and CK8/18 (5D3) were used in the study. RESULTS: In amyloid deposits, immunoreactivity with only two monoclonal antibodies (CK1-8 and CK5/6/18) was observed in 14 cases (eight LA and six MA), confirming the hypothesis that epidermal cells participate in amyloid formation of LA and MA. COMMENTS: All of the CKs detected in amyloid deposits were basic type (type II). It seems plausible either that acidic CKs might be degraded faster than basic types in amyloidogenesis or that paraffin-embedded tissue specimens are less sensitive than frozen tissue sections. The results of our study suggest that when paraffin-embedded specimens are investigated by immunohistochemical methods, CK5 antibody is useful in the diagnosis of LA and MA.

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Anetoderma is an uncommon disorder characterized by the loss of elastic fibres in the dermis histologically and herniation of subcutaneous tissue clinically. Recent studies indicate that immunologic mechanisms may play a role in this process. Here we report a 33-year-old woman with numerous well-circumscribed, asymptomatic skin lesions in whom clinical and histopathologic features were consistent with anetoderma. Additionally, history and investigations revealed antiphospholipid syndrome and systemic lupus erythematosus. It has been speculated that immune deposits in the dermis or within the capillary walls may lead to ischaemia and subsequent degeneration of the elastic fibres.

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BACKGROUND: Lichen planus (LP) is a papulosquamous dermatosis in which immunologic mechanisms play an important role in its pathogenesis. Topical calcipotriol, which mainly stimulates differentiation and inhibits proliferation of keratinocytes, also has immunosuppressive and anti-inflammatory functions. AIM: To investigate the therapeutical effects of topical calcipotriol in LP. METHODS: A total of 18 histopathologically proved LP patients were advised to apply calcipotriol ointment twice daily to all affected skin areas except genitalia. Clinical evaluation of all patients was performed monthly and response to treatment was assessed on clinical grounds (erythematous and/or violaceous color, thickness and scale of the lesions) as partial, complete or no response. If there was no response at the end of the second month, topical calcipotriol was stopped. If there was partial clinical improvement at the end of the second month, the treatment was continued for one additional month. RESULTS: In all, 16 patients completed the study. Of the study population, 56.25% (9/16) responded to topical calcipotriol treatment which was used for a maximum of 3 months. Complete clearing of the lesions with post-inflammatory hyperpigmentation and partial improvement were obtained in 31.25% (5/16) and 25% (4/16) of the patients, respectively. No improvement was observed in 43.75% (7/16) of the patients. CONCLUSION: Topical calcipotriol can be used in the treatment of LP as a therapeutic option, although it is not the first-choice drug.

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On 17 August 1999 a devastating earthquake with a magnitude of 7.4 on the Richter scale occurred in Marmara region of Turkey and the epicentre of the earthquake was our city. In this study we aimed to determine the influence of a major earthquake on patient admittance's to the outpatient clinic of our dematology department. All the registrations of the outpatient clinic of our dermatology department in a period of 6 months after the earthquake and the same period last year were revised retrospectively and categorized into 15 subgroups. The first 3 months registrations (earthquake group 1) and the second 3 months registrations (earthquake group 2) after the earthquake were compared with those of the same periods in last year, respectively (control group 1 and control group 2). Also the earthquake group 1 was compared with the earthquake group 2. When the results were evaluated, it was seen that the incidence of infections-infestations was significantly higher in the earthquake group 1 when compared with the control group 1. When the earthquake group 2 and the control group 2 were compared with each other regarding the incidences of the skin diseases, no statistically significant difference was found. The incidences of erythematous-squamous skin diseases, pruritus and neurocutaneous dermatoses and eczemas were significantly higher in the earthquake group 2 when compared with the earthquake group 1. On the other hand, the incidences of infections-infestations and dermatoses due to physical factors were significantly lower in the earthquake group 2 when compared with the earthquake group 1. We think that the alteration in the admittance's to outpatient clinic of our dermatology department in the first 3 months after the earthquake is due to the damaged infrastructures and unhygienic life conditions and in the second 3 months is due to psychoemotional factors related to earthquake.

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A variety of drugs have been implicated to induce or trigger pemphigus. A case of pemphigus foliaceus that was probably caused by indapamide, in whom the diagnosis was based on clinical, histologic and direct immunofluorescence testing, is reported here. To the best of the authors' knowledge, this is the first reported patient with indapamide-induced pemphigus.

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Primary localized cutaneous amyloidosis (PLCA) is characterized by the deposition of amyloid in a previously apparently normal skin with the absence of other systemic or cutaneous disorder. Although ankylosing spondylitis may be associated with secondary systemic amyloidosis, no reports have been found showing the association of this disease with PLCA. In addition, the association of PLCA with autoimmune thyroiditis has not been previously reported. We report a concomitant occurrence of lichen amyloidosis, ankylosing spondylitis and autoimmune thyroiditis in a caucasian woman.

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A 30-year-old man presented with numerous papules, nodules and inflamed cysts. The lesions were located all over the body, including the scalp, except the palms and soles. His mother and one sister had had similar but less extensive lesions. Histopathology of the biopsy specimens obtained from the anterior chest wall, axillae and the back region was consistent with steatocystoma multiplex (SM). A diagnosis of steatocystoma multiplex suppurativum was made. The inflamed lesions were treated with oral isotretinoin (1 mg/kg per daily) for 6 months. At the same time, cryotherapy was used for non-suppurating lesions smaller than 2 cm. When the patient was evaluated 6 months later, cosmetic results were good. No new lesions have appeared in the subsequent 12-month follow up.

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A large number of dermatoses associated with either morphea and psoriasis have been reported. However, to the best of our knowledge there is only one report in the literature about coexistence of morphea and psoriasis. Here we report a case of morphea and psoriasis that improved with acitretin treatment. The concomitant occurrence of these two dermatoses may be explained by immunological factors or trauma. We think that the improvement of the morphea lesions may be due to an immunomodulatory effect of the drug or a decrease in collagen production by dermal fibroblasts due to retinoic acid.

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A 48-year-old white woman presented with a 2-year history of progressive facial hemiatrophy involving the right side of the chin and tongue, associated with mastigatory spasm. Neurological examination showed no abnormalities. Computed tomography and magnetic resonance imaging of the brain and electrophysiological investigations were normal. Histopathological examination of a skin biopsy specimen from the chin revealed atrophy of the subcutaneous fat with homogenization of dermal collagen fibres. Phenytoin 100 mg t.d.s. relieved the mastigatory spasm.

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It is accepted that studies evaluating histamine-induced wheal and flare reactions in the skin represent a simple and reliable method for demonstrating pharmacodynamic activity and pharmacokinetics of the H1-receptor antagonists. In this study, the effects of single oral doses of acrivastine (8 mg), loratadine (10 mg) and cetirizine (10 mg) on the histamine-induced wheal and flare reactions were compared in 60 healthy volunteers. The wheal and flare responses were produced by prick test using 1% histamine solution. Measurements were performed before the ingestion of antihistamines (baseline values) and afterwards at 15, 30, 90, 240, 360 min and 24 h. The values obtained for each antihistamine were compared with each other and with baseline values. Cetirizine was found to be superior to acrivastine and loratadine for the suppression of wheal and flare responses at 240, 360 min and 24 h (P < 0.05) and acrivastine was superior to the other two antihistamines for the suppression of flare response at 30 min (P < 0.05). Our results indicate that a single dose of cetirizine provides a more effective and long acting suppression on wheal and flare reactions in urticaria when compared to acrivastine and loratadine.

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