Evaluation of Mean Platelet Volume in Patients With Behcet's Disease as an Indicator of Vascular Thrombosis.

BACKGROUND: Patients with Behcet's disease (BD) are recognized with increased risk for venous and/or arterial thrombosis. Thrombotic tendency of BD is not known. Vascular injury, loss and dysfunction/hyperfunction of endothelial cells are believed to play a role in thrombosis development. Injury and inflammation due to vasculitis can cause platelet response with increase in mean platelet volume (MPV) and thrombosis in BD. In this study, we aimed to compare the levels of MPV between patients with BD and healthy controls, and also show its effect on thrombosis. METHODS: One hundred patients with BD and 100 healthy controls were evaluated for MPV levels with clinical findings in age-gender matched case-control study. The variables of patients and controls were compared and correlated using chi-square, Mann-Whitney U and Spearman tests. Logistic regression analysis was used to determine independent predictors of vascular involvement and thrombosis. RESULTS: Mean MPV was significantly higher in patients with BD than healthy controls (MPV; Patients: 9.2 ± 0.9 [7.3-12.9] vs. Controls: 8.2 ± 0.6 [6.8-10.6] fl; P<0.0001). Platelets levels were lower than controls, but not significantly (236 ± 52.3 [112-451] vs. 245 ± 52.8 [141-467] x109 /L, P=0.55). Negative correlation was found between platelet count and MPV in patients (r = -0.51, P=0.01). Presence of erythema nodosum (EN) and MPV were determined as predictors for vascular involvement and thrombosis (EN: P<0.0001, OR [95% CI] = 35.4 [6.3-178.2]; MPV: P<0.0001, OR [95% CI] = 12.8 [4.1-24.3]). CONCLUSION: MPV is a simple measurement for indirect monitoring of platelet activity and thrombotic potential. MPV and EN may be independent risk factors for vascular thrombosis in BD. Patients with higher MPV levels and EN in BD, might have been pursued closely for enhancing thrombosis. We advise to check the MPV and put the patients on anticoagulation if it is high.

The association of PASI scores with CRH-R1 expression in patients with psoriasis.

Stress is a well-known triggering factor along with genetic predisposition on the onset and during the course of psoriasis by altering the cellular constituents of the immune system. In the skin, there is a local hypothalamic-pituitary-adrenal (HPA) axis which is the equivalent of the central HPA axis. Corticotropin-releasing hormone (CRH) is a major regulator of the HPA axis in response to stress. This study was planned to show the role of CRH receptor type 1 (CRH-R1) in pathogenesis of psoriasis, the relation with the severity of psoriasis, and interpersonal variance in skin biopsy specimens of the psoriasis patient. Study involved 46 patients with psoriasis and 20 healthy control subjects who were older than 18 years. The clinical sign and PASI scores of psoriasis patients were recorded. Immunohistochemically, expression of CRH-R1 was investigated in psoriatic lesions and control group skin. A statistically significant increase of the expression of CRH-R1 was found in the skin biopsies of psoriasis patients compared with the control group patients. In patients with psoriasis, there was a positive correlation between the expressions of CRH-R1 and PASI scores (p = 0.001, r = +0.572). In addition, a statistically significant increase of PASI scores was found in the intense-stained CRH-R1 group compared with the weakly stained CRH-R1 patient group. The present study has demonstrated that CRH-R1 could have a role in pathogenesis of the psoriasis and stress may increase the intensity of psoriasis.

Pyoderma vegetans associated with ulcerative colitis: a case with good response to steroids.

Pyoderma vegetans (PV) is a very rare disorder characterized by erythematous, vesiculopustular, exudative, vegetating plaques usually localized in the inguinal and axillary folds. The etiology of PV is not known, but it is often associated with bacterial infections in immunocompromised patients. Major histopathological features in PV are pseudoepitheliomatous hyperplasia and intraepidermal and subepidermal neutrophilic or eosinophilic microabscesses. It is well known that these lesions are frequently associated with inflammatory bowel diseases, such as ulcerative colitis (UC) and Crohn's disease. No standardized treatment plan is available for PV, although antibiotic treatment has often been used, with variable results. The standard first-line therapy is still systemic steroids. Herein, we report a case of PV associated with UC with unusual localization that showed a good response to systemic corticosteroid, antibiotic and sulfasalazine therapy.

Psychiatric symptoms and health-related quality of life in children and adolescents with psoriasis.

Information about the relationship between psoriasis and psychiatric morbidity and quality of life in children and adolescents is limited. We aimed to examine the symptoms of depression and anxiety and health-related quality of life levels in children and adolescents with psoriasis. Forty-eight outpatients with psoriasis aged 8 to 18 years are included in this study. Child Depression Inventory (CDI), State-Trait Anxiety Inventories for Children (STAI-C) and Pediatric Quality of Life Inventory Parent and Child Versions (PedQL-P and C) were applied to both patient and control groups. Psoriasis symptom severity was measured by the Psoriasis Area Severity Index (PASI). Both study and control groups were divided into two age groups, child (8-12 yrs) and adolescent (13-18 yrs), to exclude the effect of puberty on psychological condition. The mean CDI score was higher, and PedQL-C psychosocial and total scores were lower in the children compared with controls. Duration of psoriasis had an increasing effect on physical-health and total scores of PedQL-C in the child group and all PedQL-C scores in the entire sample. Psoriasis severity showed a negative correlation with psychosocial and total scores of PedQL-P in the adolescent group and PedQL-P physical-health scores in the entire sample. Psoriasis is related to depression and impaired quality of life in children. The depressive symptoms in children with psoriasis should not be overlooked and psychiatric assessment of these children should be provided.

A diagnostic challenge: a case of acrodermatitis enteropathica without hypozincemia and with maternal milk of low zinc level.

Acrodermatitis enteropathica is a rare and distinct form of zinc deficiency with a requirement of life-long zinc supplementation and inherited in a recessive manner. Transient nutritional zinc deficiency is also a well known condition mimicking acrodermatitis enteropathica like skin changes in preterm and term infants who are generally breastfed with a low level of zinc containing milk. Here, a 4-month-old male, term and fully breastfed acrodermatitis enteropathica case without hypozincemia and with maternal milk of low zinc level is presented.

Reduced erythrocyte deformability in active and untreated Behçet's disease patients.

OBJECTIVE: Although the etiology of Behcet's disease is not clarified yet, the vascular endothelial damage and thrombosis are prominent features of the disease. The underlying mechanisms of increased risk of thrombosis in Behcet's disease are not completely understood. It is stated that the changes in blood rheology such as erythrocyte deformability take part in the thrombosis. There are limited numbers of studies with conflicting results about the erythrocyte deformability in Behcet's disease. The previous studies were not limited to the untreated patients with active disease. METHOD: Blood samples were filtered immediately by "Imugard- leukocyte removal filter". After plasma and erythrocytes were separated by centrifugation, 10% erythrocyte suspensions were prepared with isotonic Tris NaCl buffer solution. These erythrocyte suspensions were filtered under gravitational force by "Nucleopore" to determine the filtration time. The filtration times of the erythrocyte and buffer solutions were referred as t1 and t2 respectively. Finally, deformability indices were obtained by dividing the t1 by t2. A decrease in the deformability of the erythrocytes would result in an increase in the filtration time of the erythrocyte suspension and deformability indices. RESULTS: The median deformability indices were 3.090 and 2.170 for patients and control subjects respectively and the difference was statistically significant (P = 0.000). CONCLUSION: We suggest that the decrease in erythrocyte deformability in Behcet's disease may be related to oxidative damage of erythrocytes and subsequently takes part in the development of thrombosis in Behcet's disease.

A case of subcorneal pustular dermatosis in association with monoclonal IgA gammopathy successfully treated with acitretin.

Subcorneal pustular dermatosis (SPD), or Sneddon-Wilkinson disease, is a rare, chronic, recurrent, pustular eruption. Association with several diseases is well known, mainly IgA and IgG gammopathies or myelomas. Although dapsone is often considered to be the first-line treatment, some patients fail to respond or cannot tolerate the side effects. For cases that do not respond well to this treatment, acitretin, an excellent second-line treatment, may be used. Herein, a 55-year-old woman with SPD associated with monoclonal IgA gammopathy refractory to dapsone is presented, who was successfully treated with acitretin in a short period.

Etanercept does not have an apoptosis-inducing effect on psoriatic keratinocytes.

BACKGROUND: Tumor necrosis factor-alpha is the key inflammatory cytokine in psoriasis vulgaris triggering abnormal differentiation and proliferation of keratinocytes. Etanercept as an antitumor necrosis factor-alpha agent is widely used for the treatment of psoriasis vulgaris. OBJECTIVES: To find out whether etanercept has an apoptotic effect on psoriatic keratinocytes. METHODS: Biopsies from 13 untreated chronic plaque psoriasis patients and 10 control subjects were examined in the study. Immunohistochemical staining for Ki-67 and the terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick-end labeling (TUNEL) method for the detection of apoptosis were performed. Ki-67 and TUNEL indices were calculated. RESULTS: The mean Ki-67 index of patients before treatment (34.20 +/- 10.30) was significantly higher than that of the control subjects (8.30 +/- 2.20) and of the treated patients (9.50 +/- 2.50); however, it did not differ between the treated patients and control subjects (p < 0.001, p = 0.001 and p = 0.208, respectively). Although the mean TUNEL index of patients before treatment (0.23 +/- 0.44) was significantly lower than the controls (1.1 +/- 0.99), it did not significantly differ after etanercept therapy (0.46 +/- 0.66) (p = 0.030 and p = 0.083, respectively). The mean TUNEL indices of treated patients and control subjects were not different (p = 0.131). CONCLUSION: Etanercept decreased epidermal thickness successfully without inducing apoptosis of psoriatic keratinocytes.

Mean platelet volume in psoriasis and psoriatic arthritis.

Mean platelet volume (MPV), an indicator of platelet activation, is a newly emerging risk factor for atherothrombosis. There is evidence of platelet activation in psoriasis and psoriatic arthritis (PsA). The association between psoriasis, PsA, and atherosclerosis is well documented, yet, the underlying mechanisms remain unclear. The aim of this study was to investigate the differences of MPV values in patients with psoriasis, PsA, and healthy subjects and the correlation between MPV and the clinical disease activity. A total of 106 patients with psoriasis were included in this study. The study population grouped as 48 patients with PsA (group 1) and 58 patients without PsA (group 2) and 95 healthy controls (group 3). MPV was measured in psoriasis and PsA patients. MPV values were collected from standard complete blood count samples. Clinical features and PASI scores in group 1 and 2 were also recorded. MPV in patients with psoriasis 8.7 +/- 0.9 fL was significantly higher than that of control subjects 7.3 +/- 0.8 fL (p < 0.001). There was also statistical difference between MPV levels of patients with (9.5 +/- 0.8) and without (8.0 +/- 0.7) arthritis (p < 0.001). MPV levels were positively correlated with psoriasis area and severity index score (p = 0.000, r = +0.735). MPV levels showed positive correlation with disease duration (p = 0.01, r = 0.518). MPV levels are increased in patients with psoriasis and PsA. MPV may be a marker for the severity of psoriasis. This study may confirm previous observation indicating increased platelet activation in psoriasis. Increased platelet activity could contribute to increasing the atherosclerotic risk in patients with psoriasis and PsA.

Experience with repetitive use of pimecrolimus: exploring the effective and safe use in the treatment of relapsing seborrheic dermatitis.

BACKGROUND: Seborrheic dermatitis (SD) tends to reoccur frequently, so the therapeutic agent must have a high benefit versus adverse effect ratio for long-term and repetitive uses. OBJECTIVE: To assess the efficacy and safety of retreatment with pimecrolimus in SD patients. METHODS: A total of 45 patients who had been treated previously with pimecrolimus 1% cream were retreated with the same agent using the same treatment protocol after the disease reoccurred. The first and the second treatments were compared with regard to disease severity before treatment, complete cure times, remission times and side effects. RESULTS: The median severities of the disease were 5 and 4 before the first and second treatments, respectively. Retreatment of the disease with pimecrolimus resulted in shorter cure and longer remission times. Side effects were seen only on the first day of the retreatment and an increase in erythema was seen in fewer patients. CONCLUSIONS: Retreatment of the recurrence of SD with pimecrolimus as monotherapy is an effective and safe approach in the management of the disease.

Chemical matricectomy with 10% sodium hydroxide for the treatment of ingrown toenails in people with diabetes.

BACKGROUND: Treatment of ingrown toenails using chemical matricectomy in patients with diabetes has been difficult, because delayed wound healing, wound infections, and digital ischemia can interfere with the procedure. Chemical matricectomy with 10% sodium hydroxide is an effective treatment for ingrown toenails in a normal population. OBJECTIVES: Investigation of the effectiveness and safety of chemical matricectomy with 10% sodium hydroxide solution for ingrown toenails in patients with diabetes. MATERIAL AND METHODS: Thirty patients with diabetes with 40 ingrown toenails and 30 patients without diabetes with 41 ingrown toenails were enrolled in the study. After partial avulsion of the affected edge, germinal matrix was treated for 1 minute with 10% sodium hydroxide. Patients were observed on alternate days until complete healing was achieved and followed for up to 24 months for recurrence. RESULTS: Assessment of the treatment in both groups for complete healing, postoperative pain, tissue damage, drainage, infections, and rate of recurrences revealed no statistically significant difference. CONCLUSIONS: The partial avulsion of the affected edge and the treatment of the germinal matrix for 1 minute with 10% sodium hydroxide preceded by matrix curettage is an effective and safe treatment modality for ingrown toenails in people with diabetes.

Hyperhomocysteinemia in patients with stasis dermatitis and ulcer: a novel finding with important therapeutic implications.

BACKGROUND: Although homocysteine (Hcy) has profound effects concerning vascular lesions and thrombosis, it has not previously been investigated in patients with stasis dermatitis and ulcer. OBJECTIVE: To evaluate plasma Hcy levels in patients with stasis dermatitis and ulcer. METHODS: A total of 25 patients (17 male, eight female; mean age of 36 +/- 5.97 years) with stasis dermatitis, 40 patients with stasis ulcer (27 male, 13 female; mean age of 38.5 +/- 7.96 years) and 35 healthy control individuals (25 male, 10 female; mean age of 36.9 +/- 6.49 years) were included in this study. Patients taking vitamin supplements or patients with folic acid or vitamin B12 deficiency, diabetes mellitus, chronic hepatitis, renal failure and chronic alcoholism which might affect Hcy levels were excluded from the study. RESULTS: Hcy levels were found to be elevated in patients with stasis dermatitis (p = 0.00) and stasis ulcer (p = 0.00) compared to healthy controls with a median (range) of 19.1 micromol/l (15-28), 18.98 micromol/l (15-29), and 8.1 micromol/l (5-12.2), respectively. There was no statistically significant difference in Hcy level in patients with stasis dermatitis and ulcer (p = 0.877). CONCLUSION: As hyperhomocysteinemia can be treated by selected vitamin supplementation even in patients with normal serum vitamin concentrations, ulcer formation might be prevented by lowering Hcy in the clinical stage of stasis dermatitis.

Localized hypertrichosis due to temporary henna tattoos: report of three cases.

Temporary henna tattoos have become increasingly widespread. Although reactions to henna tattoo are becoming progressively more common, only one case of a henna pseudotattoo resulting in temporary hypertrichosis has been reported so far. We report three patients who received paint-on henna tattoos on their right upper arm. Approximately 1 week later, localized hypertrichosis was observed over the same area as the tattoo, which resolved spontaneously within 3-4 months. Clinicians should be aware of this complication and it should be noted that treatment is not necessary as hypertrichosis resolves spontaneously.

[Comparison of phenol applications of different durations for the cauterization of the germinal matrix: an efficacy and safety study]. / Germinal matriks koterizasyonunda farkli fenol uygulama sürelerinin etkinlik ve güvenlik açisindan karsilastirilmasi.

OBJECTIVES: Partial nail avulsion with phenol matricectomy is one of the most widely performed procedures for the treatment of ingrowing nails. We compared phenol applications of different durations with respect to efficacy and safety. METHODS: The study included 148 ingrowing nails (grade 2-3) of 110 patients (54 males, 56 females). The patients were randomized to three groups for 1-, 2-, and 3-minute applications of phenol cauterization of the germinal matrix following surgical removal of ingrowing nails. Postoperative evaluations were made on days 2, 10, 16, 24, and 30 for pain, drainage, and tissue damage. Recurrences were recorded during a follow-up of 24 months. RESULTS: Improvements in pain, drainage, and tissue damage in each group were significant (p<0.001). Time to complete healing and durations of drainage and tissue damage were significantly shorter in patients receiving 1-minute phenol application (p<0.001), and the remaining groups did not differ in this respect. The mean duration of pain was similar in three groups. While the frequencies of pain and tissue damage were similar in three phenol groups, the number of patients having drainage on day 16 was significantly lower with 1-minute phenol application (p<0.001). All recurrences appeared in the sixth month and there was no significant difference between the three groups with respect to the recurrence rate. CONCLUSION: Our findings suggest that 1-minute phenol cauterization of the germinal matrix has a better safety profile than prolonged applications in the treatment of ingrown nails.