Retrospective Evaluation of Ingrown Toenails in a Tertiary Reference Center.

BACKGROUND: We evaluated the clinical characteristics of ingrown toenails in one of the biggest reference centers in Turkey. METHODS: This retrospective cohort study was conducted on patients admitted to Ufuk University Hospital with ingrown toenail between January 1, 2014, and December 31, 2019. Clinical characterstics and demographic features of all of the participants were evaluated, and then the study population was divided into two groups: group 1 (patients ≤20 years old) and group 2 (patients >20 years old). These groups were compared in terms of clinical findings. RESULTS: Disease duration, body mass index, rate of medications for chronic diseases, and rate of joint diseases were significantly higher in group 2. Rates of hyperhidrosis and sudden weight gain were significantly higher in group 1 (P < .05). Severity of ingrown toenail was significantly different between groups (P = .006). Stage 1 was the most common stage in both groups, and rate of stage 3 was higher in group 1. Onycoshisis and was more common in group 1, and nail thickening was more common in group 2 (P < .05). Nail wire and aluminum chloride were the most common treatment modalities in groups 2 and 1, respectively (P < .05). Periungual edema, presence of pus, hypertrophy, and granulation were more common in group 1 (P < .05). Thin nail plate was more common in group 1, and normal and thick nail nail plates were more common in group 2 (P < .05). CONCLUSIONS: Clinical characteristics of ingrown toenail vary between younger and older populations. Thus, an individualized approach is preferred in the management of ingrown toenail for different age groups.

The correlation of systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, derived neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio with disease severity in recurrent aphthous stomatitis.

BACKGROUND/AIM: To evaluate the correlation of systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) with disease severity in recurrent aphthous stomatitis (RAS). METHODS: The present retrospective cohort study was performed on patients with RAS. Patients were divided into three groups: 1) Major (n = 75), 2) Minor (n = 123), and 3) Herpetiform aphthae (n = 17). The study groups were compared in terms of demographic features, acute phase proteins, and complete blood cell count parameters. Moreover, correlation analyses were performed for the correlation of ulcer severity score (USS) with C-reactive protein (CRP), SII, erythrocyte sedimentation rate (ESR), ferritin, dNLR, NLR, and PLR. RESULTS: Significantly higher values were observed for USS, neutrophil count, ferritin, SII, NLR, and dNLR (p < 0.05 for all) in the major and herpetiform aphthae groups compared to the minor aphthae group. Positive, strong, significant correlations were observed between USS, SII, and NLR (r = 0.80 for SII, r = 0.74 for NLR and p < 0.001 for both). Positive, moderate, significant correlations were observed between USS, PLR, ESR, and CRP (r = 0.54 for PLR, r = 0.39 for ESR, r = 0.36 for CRP, and p < 0.001 for all). Positive, weak, significant correlations were observed between USS, dNLR, and ferritin (r = 0.13 and p = 0.05 for ferritin, r = 0.27 and p < 0.001 for dNLR). CONCLUSION: Higher values of SII, NLR, dNLR, and PLR were associated with disease severity in patients with RAS.

Perspectives of dermatology specialists and residents on COVID-19 vaccines: A questionnaire-based survey.

BACKGROUND: To evaluate the perspectives of dermatology specialists and residents on coronavirus disease 2019 (COVID-19) vaccines. METHODS: Present questionnaire-based study was conducted on dermatology residents and specialists between January 5 and 20. A non-validated online questionary evaluating the attitude of the participants about the COVID-19 vaccine was performed. In the first step of the study, data related to the demographic features, all participants' clinical characteristics, and working conditions were recorded. Thereafter answers given to 12 specific questions were recorded. The study population was divided into two groups: dermatology residents (n = 138) and specialists (n = 159). Mentioned variables were compared between the two defined groups. Furthermore, a correlation analysis was performed to assess the relationship between vaccination acceptance and various study parameters. RESULTS: Majority of the cases had positive attitudes against COVID-19 vaccines. However, there were significant differences between the resident and specialist groups related to the source of information, working conditions, degree of concern, and type of vaccines. Statistically significant negative, weak correlations were observed for age and duration of medical practice (r = -.128, P = .028; r = -.132, P = .041 respectively). Statistically significant positive weak correlations were observed for chronic diseases, level of knowledge about COVID-19 vaccines, number of information sources about COVID-19, and previous COVID-19 infection (r = .133, P = .021; r = .207, P < .001; r = .335, P < .001; r = .176, P = .002 respectively). CONCLUSION: The acceptance of COVID-19 vaccination may be affected by working conditions, medical experience, level of knowledge and the presence of risk factors for severe disease among dermatology residents and specialists.

Experience with oral tofacitinib in severe alopecia areata with different clinical responses.

BACKGROUND: Alopecia areata (AA) and generalized form, universalis (AU) are common causes of noncicatricial alopecia, targeting anagen hair follicles. A dominant interferon-gamma transcriptional signaling and cytotoxic T lymphocytes were accused as the main drivers of disease pathogenesis. Tofacitinib is a Janus kinase inhibitor that has been proven to interfere with the positive feedback loop between the follicular cell and the cytotoxic T lymphocytes in AA. There is an increasing number of studies reporting success with tofacitinib in AA. AIMS: We aimed to assess oral tofacitinib's safety and efficacy in 13 recalcitrant AA and AU patients. METHODS: This is a retrospective pilot study performed between 2017 and 2020. The demographic features and the treatment responses were evaluated with Severity of Alopecia Tool score changes. RESULTS: Thirteen recalcitrant alopecia areata patients (3 AA, 10 AU), aged between 17 and 49, were included in the study. The treatment duration was 3-15 months. All three AA patients responded well; however, the therapy was unsuccessful in five of ten AU patients. Relapse was observed in one of the AA and three of the AU responders. Acneiform lesions and elevation of transaminases were the major side effects. CONCLUSION: Tofacitinib seems to be more promising and thriving in the treatment of AA than AU. Starting the therapy earlier can bring more successful results. Unfortunately, even in the cases that fully respond to treatment, relapse can be observed after discontinuation of the treatment. It is essential to inform patients about this situation in reducing the frustrations that may occur later.

Changing trends in dermatology practice during COVID-19 pandemic: A single tertiary center experience.

The aim of this study was to evaluate the changing trends in dermatology clinical practice at a tertiary center during the coronavirus disease 2019 (COVID-19) pandemic. This retrospective cohort study was conducted on patients who were admitted to Ufuk University Hospital with dermatologic complaints/diseases before and during the pandemic. The patients were divided into two groups: (a) the pre-pandemic period (March-May 2019) and (b) the Pandemic period (March-May 2020). Demographic features, clinical characteristics, dermatologic diseases/complaints, dermatologic procedures/interventions, hospitalization rate, and use of biologic agents were compared between the two groups. Total number of hospital admissions have decreased from 1165 to 717. Admission rates for acne, dermatophytosis, and benign neoplasm of the skin significantly lower during the pandemic period (P values were .02, .04, and .006, respectively). Contact dermatitis, acne accompanying dermatitis, cicatricial hair loss, lichen planus, and zona zoster infection rates were significantly higher (P values were .007, <.001, .009, .04, and .03, respectively). Rates of biopsy and electrocautery procedures were decreased significantly (P values were <.001 and .002, respectively). The hospitalization rate was similar between the groups (P = .51). However, the use of biologic agents significantly decreased during the pandemic period (P = .01). Updated clinical protocols should be established for the new normal period in accordance with these findings.

Onychomycosis Unresponsive to Antifungals: Etiology and Treatment with a New Direct Technique.

AIMS AND OBJECTIVES: The aim of this study was to identify the fungal agents causing onychomycosis that were unresponsive to antifungal treatment and to treat these cases by placing under-nail cushions with a mild keratolytic to clear the fungus-invaded tissue. MATERIALS AND METHODS: Fungal agents were identified by the matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) technique. RESULTS: Nine patients had Aspergillus spp. (7 Aspergillus niger, 2 Aspergillus flavus); four had Candida species and one had Trichophyton rubrum. All patients were free of infection at the end of treatment. CONCLUSION: As per the results, we may state that onychomycosis that is unresponsive to treatment in immunocompetent patients seems to be mostly associated with molds. Direct application of a mild keratolytic to the fungus-invaded part, e.g., the nail plate and/or nail bed and removal of fungal elements may provide a successful treatment outcome.

Isotretinoin treatment in nodulocystic acne with and without polycystic ovary syndrome: efficacy and determinants of relapse.

BACKGROUND: Isotretinoin is the most efficacious long-lasting treatment for acne; however, some factors, including polycystic ovary syndrome (PCOS), patient age, family history, and type and number of acne lesions, may lead to treatment resistance or relapse following treatment. The aim of this study was to compare the efficacy and permanence of systemic isotretinoin (SI) in nodulocystic acne patients with and without PCOS and to evaluate the factors associated with relapse during the first and second post-treatment years. METHODS AND MATERIALS: The study included 96 female patients with nodulocystic acne. SI 0.5-1 mg/kg/dl was given, with a total cumulative dose of 120-150 mg/kg. Response to treatment and relapse during the first and second post-treatment years were evaluated. RESULTS: In all, the 50 non-PCOS and 46 PCOS acne patients were similar. SI was similarly efficacious in both groups. In total, eight patients relapsed during the first post-treatment year, versus 16 during the second. Relapse during the first year was associated with the number of nodules at the start of treatment and the number of papulopustular lesions at the end of treatment, whereas PCOS, patient age, and the number of nodules at the start of treatment were associated relapse during the second year. CONCLUSION: Regardless of its association with PCOS, SI was effective in the treatment of nodulocystic acne. The factors associated with relapse during the 1(st) and 2(nd) post-treatment years differed, except for the number of nodules at the start of treatment.

Association of hypermobility and ingrown nails.

Ingrown nail (onychocryptosis) is a common condition with severe pain and various associated morbidities. Although some underlying factors are identified, its etiology remains largely unknown. Generalized joint hypermobility (GJH) is a common entity with clinical features that might prone affected individuals to ingrown nails. Herein, we investigated the incidence of GJH in patients with ingrown nails to determine possible association between hypermobility and ingrown nail formation. Patients 16-50 years of age who were undergoing treatment for ingrown nails at the dermatology clinic were consecutively enrolled into the study. Patients with known rheumatic diseases or orthopedic foot disorders were excluded. All patients were in a pain-free period at the time of examination. The control group was comprised of age- and sex-matched healthy subjects without a history of ingrown nail. Assessment of GJH was made according to Beighton criteria. Local hypermobility was evaluated by measurement of range of motion using a goniometer. Thirty-nine patients (male/female, 17/22, mean age 31.9 ± 11.3 years) and 32 healthy subjects (male/female 12/20, mean age 31.7 ± 10.4 years) were included. Patients with ingrown toe nails were more likely to have GJH compared to healthy subjects (35.9 vs. 9.4 %, p = 0.009). Toes with ingrown nails had significantly smaller maximum dorsiflexion angles (p < 0.001) compared to toes of healthy subjects. Ingrown nail formation may be associated with GJH. However, when examined locally, there is a limited range of motion in the affected toe rather than hypermobility, which could be due to the degenerative process facilitated by the hypermobility.

Evaluation of the clinical effects of isotretinoin on chronic rhinosinusitis.

OBJECTIVES: This study aims to evaluate the clinical effects of isotretinoin (13-cis-retinoic acid), a derivative of retinoic acid, on the clinical features of chronic rhinosinusitis. PATIENTS AND METHODS: The study group included 25 chronic rhinosinusitis patients (16 females, 9 males; mean age 25.2 ± 6.8 years; range 15 to 25 years) who were on isotretinoin for acne treatment, while the control group consisted of 25 chronic rhinosinusitis patients (15 females, 10 males; mean age 25.2 ± 6.8 years; range 15 to 25 years) who were not on isotretinoin treatment. The patients' symptom scores in visual analog scale (VAS), Lanza and Kennedy nasal endoscopic scores and Newman computed tomography (CT) scores were obtained in order to evaluate the their symptom, examination and radiological findings. These patients' symptom and examination results were evaluated first day, week two and at months 3-5 and 6-10. Paranasal sinus CT results were studied first day and at months 6-10. RESULTS: In the group of patients being administered isotretinoin, no significant change in the mean symptom and examination scores was detected during the acute phase (week 2), while there was a significant regression in the long-term (months 3-5 and 6-10). There was a significant regression in the mean CT score after isotretinoin therapy. In the control group no significant change was seen in any of the scores. The number of acute sinusitis attacks were significantly lower in the isotretinoin group than in the control group. No significant difference was found between the two groups in terms of the duration of the healing period of acute sinusitis attacks. CONCLUSION: We conclude that the long-term administration of isotretinoin has positive effects on the clinical results of chronic rhinosinusitis.

Long-term results of nail brace application in diabetic patients with ingrown nails.

BACKGROUND: Ingrown toe nail is a common foot problem; however, there are limited data concerning the treatment options for diabetic patients. OBJECTIVE: Because of the special attention given to avoidance of infection and ulceration of the foot in diabetics, we applied a new, simple nail device as a treatment option without any systemic treatment or surgical intervention. METHODS AND MATERIALS: We applied braces to 21 diabetic patients with ingrown toe nails. All had severe pain, erythema, and edema without suppuration or granulation tissue formation. Braces were applied until all the symptoms are cleared. We followed the patients for 2 years for the recurrence of symptoms and signs. RESULTS: All patients had immediate relief of symptoms once the brace was applied. After the dislocation of braces, 15 of 21 patients did not have any recurrences for 2 years. Six patients had recurrence of pain and ingrown nail and were willing to use the brace once more instead of having any operations. CONCLUSION: Nail brace application is a safe, simple, and inexpensive treatment option for diabetic patients with ingrown toe nails. Although there may be recurrences, patients are willing to use it for a second time as it is simple and pain free.