Evaluation of the relationship between Demodex infestation and obesity in rosacea patients.

BACKGROUND: The changes in the skin caused by obesity may predispose patients with rosacea to Demodex infestation (DI). Besides, identifying predisposing factors in these patients is important for initial treatment plan. AIMS: The main purpose of this study is to determine the relationship between DI and obesity in patients with rosacea. METHODS: Sociodemographic characteristics, body mass index, and clinical features of 130 rosacea patients were recorded. Demodex density was measured by noninvasive standard skin biopsy, and a determination of ≥5/cm2 mites was regarded as positive for DI. Patients with a BMI of 30 and above were categorized as the obese group, and those with a BMI below 30 were classified as the nonobese group. Moreover, patients were divided according to DI into positive and negative. These groups were compared with each other. RESULTS: Upon comparing the patients with and without obesity, it was noted that the obese patients had significantly higher rates of erythematotelangiectatic type rosacea, rosacea severity, and flushing complaints. Furthermore, results show that the DI was significantly more common in obese patients. The most determinant factors for predicting DI in rosacea patients were papulopustular type rosacea, obesity, and rosacea severity, respectively. CONCLUSIONS: In this study, DI was found to be more common in obese patients with rosacea. Besides, obesity was found to be one of the most determining factors in detecting DI in patients with rosacea.

Evaluation of the serum C-reactive protein-albumin ratio and its relationship with disease severity IN alopecia areata: A prospective case-control study.

BACKGROUND: Alopecia areata (AA) is an autoimmune and inflammatory disease characterized by localized or diffuse non-scarring hair loss. The serum C-reactive protein (CRP)/albumin ratio (CAR) is a novel inflammatory marker and a significant prognostic indicator in several diseases. AIM: We aimed to explore CAR in AA patients and healthy controls and analyze the possible correlation between CAR and disease severity. METHOD: The present study was conducted with 65 eligible AA patients and 65 age- and gender-matched healthy controls. Disease severity was analyzed based on the Severity of Alopecia Tool (SALT) score. The CAR score was calculated by dividing serum CRP by the albumin content in both patient and healthy control groups. FINDINGS: 56.9% of the patients were male and 43.1% were female, and the mean age was 31.93 ± 9.67. The patient group' mean CAR level (0.42 ± 0.3) was statistically higher than that of the healthy controls (0.07 ± 0.04), (p < 0.05). There were positive correlations between disease severity, CAR (r = 0.65; p < 0.01), and CRP (r = 0.66; p < 0.01), while the correlation between disease severity and albumin was negative (r = -0.56; p < 0.01). In the receiver operating characteristic analysis conducted on disease severity, the area under the curve was 0.16 for albumin, 0.92 for CRP, and 0.95 for CAR. The optimum CAR for AA severity was 0.38 with 87% sensitivity and 92% specificity. CONCLUSION: In the study, we determined that the CAR was higher in AA patients when compared to the control group, and the elevation was associated with disease severity. The present study findings demonstrated that alopecia areata was associated with systemic inflammation, and CAR is a useful inflammatory marker in AA patients.

COVID-19 and Inflammatory Markers.

Coronavirus disease-2019 (COVID-19) causes mild illness to serious infection with lung involvement, thrombosis, and other complications potentially resulting in fatal outcomes. Recognised inflammatory biomarkers play important roles in managing patients with COVID-19; for example, diagnosis, follow-up, assessment of treatment response, and risk stratification. Inflammatory markers in COVID-19 disease were analysed in two categories. Well-known inflammatory markers include complete blood count, C-reactive protein, albumin, cytokines, and erythrocyte sedimentation rate. Asymmetric dimethylarginine, endocan, pentraxin 3, serum amyloid A, soluble urokinase plasminogen activator receptor, total oxidant status and total antioxidant status, and galectin-3 are considered among the emerging inflammatory markers. This brief narrative review assesses the relationship between these inflammatory markers and COVID-19 infection.

The Relation Between C-Reactive Protein-Albumin Ratio and Carotid Intima-Media Thickness in Psoriasis.

Psoriasis vulgaris is associated with an increased risk of atherosclerosis. The C-Reactive Protein-to-Albumin Ratio (CAR) has received increasing attention as an independent prognostic factor for inflammatory diseases. The carotid intima-media thickness (cIMT) is a predictor of atherosclerosis. We assessed the correlation between CAR and cIMT in patients with psoriasis vulgaris. We enrolled 147 participants (72 with psoriasis vulgaris and 75 controls). Disease severity was assessed using the "Psoriasis Area Severity Index (PASI)." Patient and control groups were similar with regard to gender, age, and body mass index (BMI). cIMT was measured in both the left and the right common carotid arteries. CAR values were higher in patients with psoriasis compared with controls (0.93 (0.06-4.32) vs 0.51 (0.10-2.99), p < .001). The patients with psoriasis had a significantly greater cIMT compared with control subjects. (0.53 (0.42-0.65) vs 0.50 (0.41-0.65) mm, p = .03). PASI scores were positively correlated with CAR values (r = 0.532, p < .001). A positive correlation between cIMT and CAR was found in patients with psoriasis vulgaris (r = 0.463, p < .001). CAR is an easily derived reproducible marker that could prove useful for assessing the inflammatory status of patients with psoriasis in clinical practice. CAR may also prove useful as a cardiovascular risk marker in these patients.

Endocan: a new marker of endothelial function.

PURPOSE OF REVIEW: To consider the role of endocan as an inflammatory marker in cardiovascular diseases. RECENT FINDINGS: Endocan, an endothelial inflammatory marker, is associated with cardiovascular disease. SUMMARY: Vascular endothelial inflammation plays a key role in the pathogenesis of inflammatory and cardiovascular diseases by influencing thrombogenesis, tumour invasion and secretion of bioactive mediators. We discuss the role of endocan mainly in the context of cardiology.

Analysis of 3702 patients with acne vulgaris and concomitant comorbidities in Turkey: a multi-centered, prospective, controlled study.

BACKGROUND: Acne vulgaris is a chronic inflammatory skin disease that affects the pilosebaceous unit. Although it is considered to be a skin-limited disease, different clinical studies have recently been published in which the disease is accompanied by systemic symptoms. In this study, systemic comorbidities accompanying acne vulgaris and the relationship between existing comorbidities and disease severity are investigated. METHODS: This prospective multicenter study was conducted by the Turkish Society of Dermatology Acne Study Group. Twelve dermatology clinics and 14 clinicians throughout Turkey participated in the study. A structured physician-administered questionnaire was used to collect patient demographics, clinical findings, and lifestyle data. Physicians recorded each participant's medical history, including current and past comorbidities, duration of any comorbidity, smoking, and drinking. Body mass index (BMI) was calculated. RESULTS: There were 3022 patients in the adolescent acne group and 897 in the control group. The incidence of nonmigraine headache in adolescents with acne was significantly higher than in the nonacne group (P = 0.019). There were 680 patients in the postadolescent acne group and 545 in the control group. In the postadolescent group, incidence of metabolic disease was lower than the control group (P = 0.003). In the postadolescent group, premenstrual syndrome (P < 0.001) and PCOS (P = 0.007) were more common than the control group. CONCLUSIONS: In this study, we observed that acne vulgaris does not cause systemic comorbidities. There is also a need for new studies involving a large number of patients to illuminate systemic diseases accompanying acne vulgaris.

Nocardiosis in a patient with pemphigus foliaceus treated with rituximab.

Rituximab is a chimeric human/murine monoclonal anti-CD20 antibody. This agent is an effective therapeutic option in severe types of pemphigus. However, rituximab may cause opportunistic infections if used in immunosuppressed patients. We reported a case of diffuse Nocardia infection following rituximab treatment in pemphigus foliaceus. Rheumatoid arthritis protocol applied in our patient. Rituximab was used at a dose of 1000 mg every 2 weeks. Because the disease was not adequately controlled, rituximab treatment was administered six times every 15 days. One week after the sixth dose of the rituximab, she presented lassitude and multiple palpable masses in soft tissue of the upper extremity. Thereafter, the aspirate culture of the abscess on the left shoulder was taken and confirmed to be disseminated nocardiosis. She was treated with linezolid and meropenem for 1 month; however, amikacin was added because the patient did not respond adequately to linezolid and meropenem therapy. The patient died of cardiac arrest because of her comorbidities. In this case, prolonged administration of rituximab therapy may have caused the development of nocardiosis. Therefore, all patients should have a sensible balance of risk and benefit, considering the use of rituximab.

The effect of personal, familial, and environmental characteristics on acne vulgaris: a prospective, multicenter, case controlled study.

BACKGROUND: There are only a few studies about epidemiological features of acne vulgaris in the literature. The aim of this study was to analyze demographic, clinical, familial and environmental characteristics of acne, the role of diet and aggravating factors and association of these factors with acne severity. METHODS: Patients with a diagnosis of mild-moderate to severe acne were consecutively interviewed at the participating centers during the study period. RESULTS: A total of 3826 patients and 759 control patients were involved in this study. Mild acne was the most common type of acne, and most of the lesions were localized on face followed by the trunk. The severity of acne was worse in patients who had a positive family history of acne. The most common triggering factor was psychological stress. We found a positive correlation with chocolate, bread, green tea, milk, white sugar, ripe banana, ice cream, apple, orange, and red meat consumption. As we compare the acne severity according to geographical features we detected mild- moderate acne was more common in Mediterranean region and severe acne was more common in East Anatolian region. Family history positivity was more common in Aegean region and least common in Central Anatolian region. There was statistically significant relationship as we compare acne severity and dietary factors such as chocolate, dairy products such as milk, sunflower seed consumption within the geographical regions. CONCLUSIONS: This study presents the demographic and clinical characteristics of acne patients in Asian and the European parts of Turkey. We believe that this study will provide a useful overview of acne in Turkey.

Systemic comorbidities associated with rosacea: a multicentric retrospective observational study.

BACKGROUND: Once considered a disorder limited to the skin, rosacea is now known to be associated with systemic disorders. The aim of this study was to determine what systemic comorbidities accompany rosacea and to determine the relationship between the type, severity, and duration of rosacea, and the presence of and type of systemic comorbidities. METHODS: This retrospective multicenter study was conducted by the Turkish Society of Dermatology Acne Study Group. Thirteen dermatology clinics throughout Turkey participated in the study. A structured physician-administered questionnaire was used to collect patient demographics, clinical findings, and lifestyle data. The principal rosacea subtype, physician global assessment of severity, and duration of rosacea were recorded. Physicians recorded each participant's medical history, including current and past comorbidities, duration of any such comorbidity, and the use of medications to treat any comorbidities. RESULTS: The study included 1,195 rosacea patients and 621 controls without rosacea aged 18-85 years. As compared to the controls, more of the rosacea patients had respiratory tract, gastrointestinal system, and metabolic and hepatobiliary system disorders in a rosacea's severity- and duration-dependent manner. CONCLUSION: Clinicians must be aware of the potential for systemic comorbidities in rosacea patients, which becomes more likely as disease duration and severity increase.

Prevalence and epidemiology of tinea pedis and toenail onychomycosis and antifungal susceptibility of the causative agents in patients with type 2 diabetes in Turkey.

BACKGROUND: Diabetes patients are particularly susceptible to fungal infections because their vascular and immunological systems are compromised. OBJECTIVES: The present study aimed to determine prevalences of tinea pedis and onychomycosis, factors predisposing to their development, and antifungal susceptibilities of causative fungal species against fluconazole, itraconazole, and terbinafine in patients with type 2 diabetes mellitus (DM). METHODS: Study groups were defined according to hemoglobin A1C rates of ≥6.5% for the diabetes group and ≤5.7% for control subjects. A total of 600 diabetes subjects and 152 control subjects were evaluated. Rates of onychomycosis and tinea pedis in diabetes patients, and associations with age, gender, blood glucose level, duration of diabetes and serum lipid profile were investigated, as were the distribution and antifungal susceptibility of agents isolated. RESULTS: Patients with onychomycosis and/or tinea pedis numbered 85 in the diabetes group and nine in the control group (P = 0.006). The development of onychomycosis or tinea pedis was significantly related to increasing age and male gender. Although the most common agents were dermatophytes, non-dermatophyte fungal isolates were not uncommon. Terbinafine was the most effective drug against dermatophytes but was invalid for non-dermatophyte isolates by in vitro antifungal susceptibility testing. CONCLUSIONS: The development of onychomycosis or tinea pedis was significantly related to type 2 DM, increasing age, and male gender. The most common isolate was Trichophyton rubrum. The isolation and identification of the fungus is important to the effective management of tinea pedis and onychomycosis in diabetes patients because non-dermatophyte fungi can cause these infections.

Nail changes in patients with inflammatory bowel diseases.

BACKGROUND/AIM: Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine. To our knowledge, no studies to date pertain to the profile of nail changes in IBD, except for onychomycosis. We aimed to study the frequency and pattern of nail changes among patients with IBD and evaluate their potential relationships with several parameters in IBD. MATERIALS AND METHODS: The study included 73 patients with IBD and 51 healthy control subjects. Nails of both groups were examined for changes with regard to color, striations, texture, curvature of nail plates, dystrophy of nail plates, and pigmentation. Mycological examinations were performed when onychomycosis was suspected. RESULTS: Nail changes were statistically higher in patients with IBD than in the control group (P = 0.001). The presence of onychomycosis was significantly more common in patients with IBD (P = 0.041). Subungual hyperkeratosis and brownish discoloration of the nail were the most common findings in patients with IBD. CONCLUSION: Our study is the first report showing all nail changes in IBD. Further studies with more subjects are needed to reveal more detailed information about nail changes in IBD.

Are patients with lichen planus really prone to urolithiasis? Lichen planus and urolithiasis.

PURPOSE: to investigate whether patients with lichen planus (LP) are really prone to urolithiasis or not. PATIENTS AND METHODS: We performed a prospective analysis of 40 patients diagnosed with lichen planus (LP) (group I), and 40 volunteers did not have LP before (group II). Participants were all checked for urolithiasis by radiological investigations. Blood samples were analyzed for biochemistry parameters including calcium and uric acid. 24-h urine samples were analyzed to investigate oxalate, citrate calcium, uric acid, magnesium, sodium and creatinine. RESULTS: Men/women ratio and mean age were similar between group I and II (p>0.05). A presence or history of urolithiasis was detected in 8 (20%) and 2 (%5) patients in group I and II, respectively (p<0.05). Hypocitraturia was the most common anomaly with 35% (n:14) in group I. The rate of hypocitraturia in group II was 12.5% (n:5) and the difference was statistically significantly different (p=0.036). In group I, hyperuricosuria and hyperoxaluria followed with rates of 27.5% (n:11) and 25% (n:10), respectively. The rate of hyperuricosuria and hyperoxaluria were both 5% (n:2) in group II and the differences were significant (p<0.05). Hyperuricemia was another importante finding in the patients with LP. It was detected in 13 (32.5%) patients in group I and in 1 (2.5%) participant in group II (p=0.001). CONCLUSION: According to our results, metabolic disorders of urolithiasis were highly detected in the patients with LP. However, similar to the etiology of LP, the exact reasons for these metabolic abnormalities in LP remain a mystery.

Are patients with lichen planus really prone to urolithiasis? Lichen planus and urolithiasis

ABSTRACT Purpose to investigate whether patients with lichen planus (LP) are really prone to urolithiasis or not. Patients and Methods We performed a prospective analysis of 40 patients diagnosed with lichen planus (LP) (group I), and 40 volunteers did not have LP before (group II). Participants were all checked for urolithiasis by radiological investigations. Blood samples were analyzed for biochemistry parameters including calcium and uric acid. 24-h urine samples were analyzed to investigate oxalate, citrate calcium, uric acid, magnesium, sodium and creatinine. Results Men/women ratio and mean age were similar between group I and II (p>0.05). A presence or history of urolithiasis was detected in 8 (20%) and 2 (%5) patients in group I and II, respectively (p<0.05). Hypocitraturia was the most common anomaly with 35% (n:14) in group I. The rate of hypocitraturia in group II was 12.5% (n:5) and the difference was statistically significantly different (p=0.036). In group I, hyperuricosuria and hyperoxaluria followed with rates of 27.5% (n:11) and 25% (n:10), respectively. The rate of hyperuricosuria and hyperoxaluria were both 5% (n:2) in group II and the differences were significant (p<0.05). Hyperuricemia was another important finding in the patients with LP. It was detected in 13 (32.5%) patients in group I and in 1 (2.5%) participant in group II (p=0.001). Conclusion According to our results, metabolic disorders of urolithiasis were highly detected in the patients with LP. However, similar to the etiology of LP, the exact reasons for these metabolic abnormalities in LP remain a mystery.

Behçet's disease and risk of vascular events.

PURPOSE OF REVIEW: We discuss the relationship between several factors and the risk of vascular events in patients with Behçet's disease. RECENT FINDINGS: Behçet's disease, a systemic, chronic relapsing vasculitis, is mainly seen in the Mediterranean area and is typically characterized by recurrent oro-genital ulcers, ocular inflammation, and skin manifestations, including articular, vascular, gastroenteric, and neurological involvement. It is a chronic inflammatory disease with relapses and remissions. The prognosis varies. Behçet's disease can cause venous or arterial lesions. Vascular involvement contributes to the mortality and morbidity associated with Behçet's disease. SUMMARY: The cause of thrombosis or vascular events in Behçet's disease remains incompletely understood; several factors have been studied with conflicting results. Vasculitis is considered to underlie several clinical manifestations of Behçet's disease.

General psychiatric symptoms, quality of sleep, and coping strategies in patients with psoriasis vulgaris.

BACKGROUND: Psoriasis is a common dermatological disorder with psychiatric comorbidity. Psoriasis is associated with a variety of psychological problems, including poor self-esteem, sexual dysfunction, sleep disturbances, anxiety, depression, and suicidal ideation. OBJECTIVES: We aimed to investigate general psychiatric symptoms, quality of sleep, and coping strategies in patients with psoriasis vulgaris. METHODS: A total of 79 subjects (37 patients with psoriasis vulgaris and 42 control subjects) were enrolled in the study. Coping strategies were measured using the Coping Orientations to Problems Experienced (COPE) Scale. General psychopathological status was assessed using the Symptom Checklist-90-R (SCL90R), and sleep quality and disturbances were assessed using the Pittsburgh Sleep Quality Index (PSQI). RESULTS: The mean age of the patients was 39.18 ± 16.85 years. The mean age of control subjects was 39.33 ± 11.61 years. The mean score on the Psoriasis Area and Severity Index (PASI) was 7.56 ± 3.66. There were no significant differences in scores on the SCL90R and COPE subscales between the patient and control groups. However, significant differences between the groups emerged on the PSQI subscales for subjective sleep quality and habitual sleep efficiency (Z = -1.964, P = 0.049, and Z = -2.452, P = 0.014, respectively). CONCLUSIONS: The present study found no significant differences in general psychiatric symptoms and coping strategies between the psoriasis patients and the control group, by contrast with findings reported elsewhere in the literature. We think that the low PASI scores of our patients, which indicate the low severity of disease in the present group, is the main reason for this finding. However, sleep quality is lower in psoriasis vulgaris patients than in healthy controls. This may be associated with the itch and pain caused by lesions. Further experimental studies are required to explain these findings.