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COVID-19 infection can have a poor prognosis, especially in patients with chronic diseases and those receiving immunosuppressive or immunomodulating therapies. This study aimed to investigate the severity of COVID-19 infection in patients with psoriasis and compare the infection severity for systemic treatments and comorbidities. We conducted a study in the dermatology clinics of five different centers in the Eastern Black Sea region of Turkey. Four hundred and eighty-eight patients were included, and 22.5% were confirmed as having COVID-19 infection. In our study, the frequency of hospitalization rates due to COVID-19 infection were similar (15.4%, 25.9% respectively) in patients receiving biological treatment and receiving non-biological systemic treatment (P=0.344). Hospitalization rates were higher in patients with hypertension, androgenetic alopecia, and acitretin use (P=0.043, P=0.028, P=0.040). In conclusion, current biologic treatments and non-biologic systemic treatments in patients with psoriasis did not appear to increase the risk of the severe form of COVID-19, except for acitretin.
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COVID-19 , Psoriasis , Humanos , Acitretina/efectos adversos , Acitretina/uso terapéutico , Mar Negro , COVID-19/complicaciones , COVID-19/epidemiología , Incidencia , Pronóstico , Estudios Prospectivos , Psoriasis/complicaciones , Psoriasis/epidemiología , Psoriasis/terapia , Turquía/epidemiología , Hospitalización/estadística & datos numéricosRESUMEN
INTRODUCTION: Histological changes of psoriasis include invasion of neutrophils into the epidermis and formation of Munro abscesses in the epidermis. Neutrophils are the predominant white blood cells in circulation when stimulated; they discharge the abundant myeloperoxidase (MPO) enzyme that uses hydrogen peroxide to oxidize chloride for killing ingested bacteria. AIM: To investigate the contribution of neutrophils to the pathogenesis of psoriasis at the blood and tissue levels through inducible nitric oxide synthase (iNOS) and MPO. MATERIAL AND METHODS: A total of 50 adult patients with a chronic plaque form of psoriasis and 25 healthy controls were enrolled to this study. Serum MPO and iNOS levels were measured using ELISA method. Two biopsy specimens were taken in each patient from the center of the lesion and uninvolved skin. Immunohistochemistry was performed for MPO and iNOS on both normal and psoriasis vulgaris biopsies. RESULTS: While a significant difference between serum myeloperoxidase levels were detected, a similar statistical difference between participants in the serum iNOS levels was not found. In immunohistochemistry, intensely stained leukocytes with MPO and intensely staining with iNOS in psoriatic skin was observed. CONCLUSIONS: Neutrophils in psoriasis lesions are actively producing MPO and this indirectly triggers the synthesis of iNOS. Targeting of MPO or synthesis of MPO in the lesion area may contribute to development of a new treatment option.
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BACKGROUND: Iron is an essential nutrient for mammals. Accelerated loss of nutrients through hyperproliferation and desquamation from the skin in psoriasis is known. Hepcidin is an important and recently discovered regulator of iron homeostasis. AIMS AND OBJECTIVES: The present study was undertaken to investigate the hepcidin expression in psoriasis patients. MATERIALS AND METHODS: We examined peripheral blood cell counts, serum Fe, ferritin, interleukin-6 (IL-6) and hepcidin levels using respectively automated hematology analyzer, Iron assay on the AEROSET system, chemiluminescent microparticle immunoassay with automated analyzer, and enzyme-linked immunosorbent assay. RESULTS: The independent comparison of Fe, ferritin, IL-6 and hepcidin levels in psoriasis patients and control group (healthy volunteers) revealed lower Fe and higher IL-6, hepcidin levels in psoriasis patients. No significant difference was seen in the ferritin level between the psoriasis and the control group. CONCLUSIONS: We think that studies on hepcidin expression in psoriatic plaques will contribute to our understanding the role of iron and hepcidin in the pathogenesis of psoriasis.
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INTRODUCTION: According to studies conducted in outpatients, it is estimated that 2.5% of children who are treated with a drug will experience a cutaneous adverse drug reaction (CADR). AIM: To analyze the CADR reports involving pediatric patients recorded by three different university hospitals for describing common, serious, and interesting cutaneous drug eruption patterns. MATERIAL AND METHODS: For this purpose, the patients' data from three different universities were reviewed retrospectively. Diagnosis was based on history, clinical findings and laboratory test results. The CADRs were classified into seven categories; urticaria, angioedema, maculopapular eruption, fixed drug eruption, erythema multiforme, acute generalized exanthematous pustulosis, drug rash with eosinophilia and systemic symptoms syndrome. RESULTS: A total of 122 patients who had CADRs were enrolled in the study. The most frequently detected cutaneous drug reactions were urticaria + angioedema. Most of patients had no previous experience with the same drug and the most common causative agent of CADRs was antimicrobials. CONCLUSIONS: Since CADRs are relatively rare, the current multicentric study can provide meaningful information about the cutaneous eruption patterns of commonly used drugs.
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BACKGROUND: Aplasia cutis congenita is a disorder of the skin embryonic development characterized by a defect of localized or widespread areas of skin at birth. The lesions are mostly oval, 1-3 cm in diameter, with localization on the parietal part of scalp (60%) and rarely on the face and extremities. MAIN OBSERVATIONS: Herein, we reported a case of aplasia cutis congenita termly born at 39 weeks of gestation to a 30-year-old mother with bronchial asthma attacks. She was referred for 3 punched-out punctate depressed defective lesions in 0.4 cm's diameter on the vertex covered with necrotic and hemorrhagic crusts. There was a hypertrichotic area consisting of tufts of terminal hair on the lumbosacral area over a sinus tract. Maternal perinatal drugs included aerosol salbutamol sulfate, ipratropium bromide and oral montelukast sodium for bronchial asthma. The pregnancy was firstly started as a di-chorionic, di-amniotic twin gestation, but deteriorated after the fetal resorption of the co-twin in the 20th gestational week resulting in fetus papyraceus. CONCLUSION: In multi-gestational pregnancies, the presence of the fetus papyraceus or the death of the co-twins should make the neonatologists and dermatologists be aware of the possible cutaneous defects like aplasia cutis congenita. We emphasize that the possibility of this rare entity should be kept in mind in the presence of fetus papyraceus, perinatal drug use, maternal cigarette smoke, or maternal diseases like bronchial asthma in multiple gestations.
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Psoriasis was initially considered to represent a disease of abnormal epidermal keratinocyte proliferation. Proliferation of keratinocytes is restricted by apoptotic cell death to maintain a constant thickness of epidermis. Nucleosomes are mainly released by apoptotic cells. Tumor necrosis factor-α (TNF-α) is an important factor affecting the apoptosis. In the present study, the relationship between TNF-α, nucleosome and the Psoriasis Area and Severity Index (PASI) score was investigated. The patients were divided according to PASI score into three groups (mild, moderately, severe). Serum TNF-α and nucleosome levels were measured using Enzyme-linked immunosorbent assay (ELISA) method. Our findings show a correct relationship between PASI scores and TNF-α and an inverse relationship between nucleosome and PASI score. According to the results obtained from the study, we believe that serum nucleosome levels can be used as a new indicator in follow-up of patients with psoriasis and monitoring of the effectiveness of drugs which used in the treatment of psoriasis.
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Apoptosis , Queratinocitos/patología , Nucleosomas/patología , Psoriasis/patología , Adulto , Análisis de Varianza , Biomarcadores/sangre , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Queratinocitos/inmunología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Psoriasis/sangre , Psoriasis/diagnóstico , Psoriasis/inmunología , Índice de Severidad de la Enfermedad , Factor de Necrosis Tumoral alfa/sangreRESUMEN
Leiomyoma is a benign tumour commonly encountered in the genitourinary and gastrointestinal organs in adults. Cutaneous leiomyomas are rare benign tumors arising from the arrector pili muscle of hair follicles. Cutaneous leiomyomas are more likely to occur in adults than in children. We describe a case of a 10-year-old female who presented with multiple, firm, red-brown masses on the back. A punch biopsy was performed. Under high-power examination, spindle cells with an eosinophilic cytoplasm were observed and immunohistochemical studies were performed; the cells stained strongly positive for smooth muscle actin (SMA). The patient was subsequently diagnosed with pilar leiomyoma and referred to a plastic surgeon for surgical treatment. Although cutaneous leiomyoma is a rare disorder, we identified a case of pilar leiomyoma in a young female. A careful clinical assessment led to the correct diagnosis and therapy in the present case. We propose that leiomyoma ought to be considered in the differential diagnosis of any cutaneous or mucosal mass in children.
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INTRODUCTION: Eosinophilic panniculitis is an unusual type of panniculitis characterized by a prominent infiltration of subcutaneous fat with eosinophils without an exact etiopathogenesis. To the best of our knowledge, up to now eosinophilic panniculitis has been described in only one previous case with human immunodeficiency virus disease in the literature. CASE PRESENTATION: Here we report the case of a 44-year-old Caucasian man, who is human immunodeficiency virus positive, diagnosed with eosinophilic panniculitis. A dermatological examination revealed multiple, confluent Kaposi's sarcoma-like purple colored, deep plaques and nodules on his right gluteal area and right thigh. The presence of the mixed inflammatory infiltrate of lymphocytes, macrophages, and numerous eosinophils involving both septa and lobules of the subcutis were noted on the histopathological examination. On the basis of all these clinical and histopathological findings the patient was diagnosed with eosinophilic panniculitis. He was given intravenous 60mg/day methylprednisolone for 3 consecutive days a week for 6 months. The lesions resolved almost completely after 6 months. CONCLUSION: The predominance of T helper-2 subset of T helper cells and the consequential increase in interleukin-5 cytokines accompanying peripheral eosinophilia and high serum immunoglobulin E levels may all be blamed for the development of eosinophilic panniculitis in our case study. As a result, we aim to emphasize that eosinophilic panniculitis should be kept in mind in the differential diagnosis of subcutaneous nodular lesions in patients who are human immunodeficiency virus positive. We also focus on the requirement of histopathological examination for the definitive diagnosis because the clinical features of eosinophilic panniculitis may easily be confused with Kaposi's sarcoma.
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Diagnostic and therapeutic approaches in syphilis show wide variation. The use of only one type of serologic test is insufficient for diagnosis. However, current international recommendations cannot be applied due to various reasons (cost, availability, etc.). The aim of the study was to review serologic data of syphilis patients to determine diagnostic performance of three different methods. In 117 patients suspected of having syphilis, syphilis was diagnosed serologically and clinically. Three different methods were used for detection of antibodies: Rapid Plasma Reagin (RPR), Treponemal Chemiluminescence Microparticle Enzyme Immunoassay (CMIA) and Treponema pallidum hemagglutination (TPHA). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated for the former two methods against TPHA. The sensitivity of RPR and CMIA against TPHA was 58% and 98%, respectively. The specificity of RPR and CMIA against TPHA was 0% and 100%, respectively. Automated enzyme immunoassay systems could contribute to reducing errors that depend on the person, especially while monitoring titration changes.
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Serodiagnóstico de la Sífilis/métodos , Humanos , Inmunoensayo/métodos , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: Alopecia areata (AA) is a disease characterized by patchy hair loss. Although the etiopathogenesis of AA is still unclear, it has been hypothesized that immune system dysfunction and stress are involved. The aim of this study was to evaluate possible associations between AA and depression, anxiety and serum levels of cytokines interleukin (IL)-1ß, IL-6, IL-8 and IL-10. MATERIALS AND METHODS: Forty-three patients who were diagnosed with AA were prospectively enrolled into the study. Thirty age- and sex-matched healthy individuals were included as the control group. The Hamilton Rating Scale for Depression and the Hamilton Rating Scale for Anxiety were used. For children between the ages of 7 and 16, the Children's Depression Inventories was completed. Serum levels of the cytokines IL-1 ß, IL-6, IL-8, and IL-10 were analyzed by ELISA. RESULTS: No significant differences were observed between patients and controls with respect to serum cytokine levels (p>0.05). Depression rates were found to be 50% and 30% in AA patients and controls, respectively (p<0.05). Similarly, anxiety rates were found to be 63% and 23.3% in AA patients and controls, respectively (p<0.05). CONCLUSION: Depression and anxiety were found more frequent in AA patients than healthy individuals. Therefore, when considering management therapy, an entire psychiatric evaluation should also be performed. However, no differences were found in serum cytokine levels of patients and controls.
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OBJECTIVE: This study was carried out to evaluate the frequency and seasonal characteristics of dermatological problems of juvenile outpatients in the dermatology polyclinic. MATERIAL AND METHOD: Children under the age of 17 treated in an outpatient setting in our polyclinic within a 10-year period were retrospectively evaluated. RESULTS: The study registered a total of 3244 patients, of whom 1651 (50.90%) were females, and 1593 (49.10%) were males. The largest group was infectious diseases, with 1031 patients (31.78%). This was followed by the dermatitis group with 635 patients (19.57%). The months when the number of presentations at the hospital was the highest were August and November, and the months with the lowest number of presentations were January and July. CONCLUSION: In the present study we found that the most frequent cause of hospital visits of juvenile outpatients at our polyclinic was infectious diseases and dermatitis, and that there was significant correlation between diseases and seasons.
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Estaciones del Año , Enfermedades de la Piel/epidemiología , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/tratamiento farmacológico , Turquía/epidemiologíaRESUMEN
Urticarial vasculitis (UV) is a disease characterized clinically by urticarial skin lesions and histologically by leukocytoclastic vasculitis caused by immunocomplex accumulation in post-capillary venules. Cases induced by various drugs such as cimetidine, diltiazem, potassium iodide, fluoxetine, and non-steroid inflammatory drugs have been reported in the literature. A 48-year-old female who developed pruritus and rash on her body 3 months after starting glatiramer acetate (GA) treatment for multiple sclerosis was diagnosed with UV after clinical and histopathological examination. This report presents the first case in the literature of UV induced by GA.
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Inmunosupresores/efectos adversos , Esclerosis Múltiple/tratamiento farmacológico , Péptidos/efectos adversos , Urticaria/inducido químicamente , Vasculitis Leucocitoclástica Cutánea/inducido químicamente , Femenino , Acetato de Glatiramer , Humanos , Persona de Mediana EdadRESUMEN
BACKGROUND: Molluscum contagiosum has a worldwide occurrence and its primary mode of transmission is via direct human contact including sexual means. The aim of the study was to implement a polymerase chain reaction-based assay for detection and subtyping of Molluscum contagiosum virus (MCV) in skin lesions diagnosed with molluscum contagiosum in a large regional teaching hospital in Turkey. METHODS: For this purpose, a total of 61 patients were included in the study. Randomly selected single lesion from each patient was used to extract DNA material and a specific PCR reaction amplifying 393-bp- and 575-bp-long regions from MCV genome was used in the detection. Subtyping was carried out by digestion of the amplified 575-bp product with restriction endonuclease enzyme BamHI. Both amplified and restriction enzyme digested products visualized on agarose gel electrophoresis. RESULTS: All 61 molluscum cases (100%) included in the study contained MCV genetic material as demonstrated by the presence of 393- and 575-bp-long PCR amplified products. Restriction enzyme BamHI digestion of the 575-bp-long amplicon indicated that the infecting subtype in all the cases (100%) was MCV subtype I. CONCLUSIONS: Results of this study demonstrate that subtype I is the only infecting strain dominant in our region. Because the only consecutive molluscum patients admitted to our hospital were included in the study, our data do not rule out the possibility that other genotypes might be present in the Turkish population. However, it is not unreasonable to conclude that similar trends exist in the rest of the country. Results also show that a molecular-based diagnostic assay would be feasible in cases where diagnosis was deemed necessary.
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Molusco Contagioso/diagnóstico , Molusco Contagioso/virología , Virus del Molusco Contagioso/clasificación , Virus del Molusco Contagioso/aislamiento & purificación , Adolescente , Adulto , Niño , Preescolar , ADN Viral/genética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Virus del Molusco Contagioso/genética , TurquíaRESUMEN
INTRODUCTION: One of the main problems in Behçet's disease is the lack of an original laboratory marker that can reflect clinical activity. In this study, laboratory parameters that could be used as indicators of active disease are investigated. MATERIALS AND METHODS: The study included a total of 40 patients with Behçet's disease, 25 of whom were active and 15 inactive, who applied to Firat University, Firat Medical Center Dermatology, Rheumatology, Physiotherapy, and Ophthalmology outpatient clinics and a control group composed of 30 healthy volunteers. Serum neopterin, C-reactive protein (CRP), and sedimentation rate (ESR) levels were determined in all patients and healthy controls. RESULTS: Serum neopterin, CRP, and ESR levels in active Behçet's disease patients were significantly higher than those in both the inactive group and healthy controls (p<0.001). CONCLUSIONS: It was contemplated that together with serum CRP and ESR, neopterin could be a useful laboratory parameter in patients in whom disease activation could not be determined.
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Síndrome de Behçet/diagnóstico , Proteína C-Reactiva/metabolismo , Neopterin/sangre , Adulto , Síndrome de Behçet/sangre , Biomarcadores/sangre , Sedimentación Sanguínea , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Valor Predictivo de las PruebasRESUMEN
The incidence of tuberculosis in Western countries is rising, and continued vigilance together with an awareness of its protean manifestations is essential. Cutaneous tuberculosis is a relatively rare manifestation of the disease, accounting for only 1% of extrapulmonary cases of tuberculosis and 0.14% of all reported cases of tuberculosis. A 19-year-old male patient was admitted to our clinic with skin lesions both at the front and at the back of his body. With clinical findings, histopathology, polymerase chain reaction, PA lung graph, and computerised tomography, the patient was diagnosed with metastatic tuberculosis abscess associated with lung tuberculosis and Pott's disease. Antituberculosis drugs were administered. An increased awareness of the re-emergence of cutaneous tuberculosis will allow for the proper diagnosis and management of this increasing common skin disorder.
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Tuberculosis Cutánea/patología , Tuberculosis Pulmonar/patología , Tuberculosis de la Columna Vertebral/patología , Absceso/etiología , Absceso/patología , Adulto , Antituberculosos/administración & dosificación , Humanos , Masculino , Reacción en Cadena de la Polimerasa , Tuberculosis Cutánea/tratamiento farmacológico , Tuberculosis Cutánea/etiología , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis de la Columna Vertebral/complicaciones , Tuberculosis de la Columna Vertebral/tratamiento farmacológicoRESUMEN
We investigated the prevalence and genotypic distribution of GB virus-C/hepatitis G virus (GBV-C/HGV) and TT virus (TTV) in blood donors, mentally retarded children and four groups of patients living in Eastern Anatolia, Turkey. The prevalence and genetic analysis of TTV were determined by using the primers of the UTR and ORF1 regions of TTV, respectively. Reverse transcription nested (RT-n)-PCR was used to amplify 5' UTR of GBV-C/HGV. Genotyping of HGV was carried out by PCR-based genotyping assay while RFLP was conducted to determine the genotypes of TTV. TTV DNA was detected in 118 of 410 sera tested, giving an overall prevalence of 28.7%; GBV-C/HGV-RNA was detected in only 17 cases, giving an overall prevalence of 4.1%. No significant differences were observed in the number of positive or negative tests for GBV-C/HGV and TTV according to duration of illness or mean duration of institutionalization in any of the groups studied. Although all samples from the study population belonged to genotypes 1 and 4, the most common TTV genotype is G2. In conclusion, our results indicate a low endemicity of GBV-C/HGV and TTV infection in Eastern Anatolia, Turkey. The presence of G2 strains reveals the limited genetic diversity of the GBV-C/HGV circulating in Turkey. We suggest that TTV infection of genotypes 1 and 4 is prevalent in the same region.
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Donantes de Sangre , Infecciones por Circoviridae/epidemiología , Infecciones por Flaviviridae/epidemiología , Virus GB-C/genética , Hepatitis Viral Humana/epidemiología , Discapacidad Intelectual/virología , Torque teno virus/genética , Adolescente , Adulto , Anciano , Infecciones por Circoviridae/virología , ADN Viral/genética , Femenino , Infecciones por Flaviviridae/virología , Virus GB-C/aislamiento & purificación , Genotipo , Hepatitis B Crónica/virología , Hepatitis C Crónica , Hepatitis Viral Humana/virología , Hospitales Psiquiátricos , Humanos , Lepra/virología , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Prevalencia , ARN Viral/genética , Factores de Riesgo , Esquizofrenia/virología , Torque teno virus/aislamiento & purificación , Turquía/epidemiologíaRESUMEN
Recurrent aphthous ulceration (RAU) is a common oral mucosal disorder characterized by recurrent, painful oral aphthae. Although the exact cause of RAU is not known, local trauma, microorganisms, nutritional deficiencies, hormonal changes, genetics, and immunological factors have been suggested to contribute to its pathogenesis. The aim of this study was to assess the level of lipid peroxidation and status of antioxidant vitamins in patients with RAU. Thirty patients with RAU and 20 healthy controls were recruited. Vitamins A, E, and C and malondialdehyde (MDA) levels were measured in both serum and saliva of patients with RAU and control subjects by high performance liquid chromatography. Levels of vitamins A, E and C in both fluids were significantly lower (p < 0.05 for vitamins A and E, and p < 0.005 for vitamin C, respectively) in patients with RAU than in healthy control subjects. Conversely, the levels of MDA in serum and saliva were significantly higher (p < 0.005) in patients with RAU than in the control group. Furthermore, strong and highly significant correlation was found between serum and salivary levels of vitamins A, E and C, and MDA in patients with RAU (r > or = 0.90, p < 0.0001). The present study demonstrates that the serum and saliva levels of selected antioxidant vitamins are lower, while the degree of lipid peroxidation, as judged by the MDA levels, is higher in patients with RAU than in the control subjects. This is the first to measure specific antioxidant levels in both saliva and blood in the same patients, and indicates that the non-enzymatic anti-oxidant ability is impaired in patients with RAU.