Retrospective Analysis of Liver Enzyme Abnormalities in Patients Prescribed Terbinafine and Itraconazole for Onychomycosis.

Introduction Onychomycosis (OM) is defined as a nail fungal infection. Its prevalence increases with advancing age. Human-to-human transmission makes it a serious public health risk. Although OM is not a life-threatening disease, it has a detrimental effect on patients' quality of life. Due to the long therapy duration and potential side effects of systemic antifungal medicines, physicians may be reluctant to treat OM orally. In this study, we aimed to evaluate the effect of terbinafine and itraconazole on liver transaminases, the side effects of these treatments, and patients' adherence to systemic treatment of OM. Methods This is a retrospective study conducted in our dermatology department (Ordu University, Ordu) between June 2020 and October 2021. Hospital records were analyzed, and patients with the diagnosis of tinea unguium (ICD code B35.1) were investigated. Patients who were prescribed terbinafine or itraconazole were included in the study. Following a clinical diagnosis of OM, the researchers first tried to confirm it through direct microscopic examination with potassium hydroxide (KOH). If the direct microscopic examination was negative but the suspicion about OM continued, confirmation was done through a fungal culture. Results This study included 735 patients, of whom 409 (55.6%) were female and 326 (44.4%) were male. The research covered all of the patients who were given one of these two medications. To find patients who could apply to other hospitals, the Turkish National Healthcare System was checked in addition to hospital information. To identify patients who could apply to other healthcare institutions, all hospitals share their data with this national healthcare system. Terbinafine was used by 433 patients (76.4%), 75 patients (13.2%), and 37 patients (6.5%), respectively, for one, two, and three months. A total of 119 patients (70.8%) took itraconazole for a month, 32 patients (19%) took it for two months, and four patients (2.33%) took it for three months. At the end of the first month, the proportion of the patients with elevated aspartate transaminase (AST) levels was 5.2% for terbinafine and 0% for itraconazole. Eighteen (8.4%) patients with terbinafine had elevated alanine aminotransferase (ALT) levels, and four patients (7.5%) who were on itraconazole treatment had high ALT levels. None of the patients reported cutaneous adverse drug reactions, gastrointestinal disturbances, or headaches due to OM treatment. Also, no patients discontinued treatment because of hepatotoxicity. Conclusion In this study, none of the patients discontinued the treatment because of hepatotoxicity. According to the results of this study, oral terbinafine and itraconazole can be used with close follow-up. Baseline and regular laboratory monitoring for AST and ALT should be done to monitor liver toxicity with terbinafine and itraconazole. Besides, we did not observe other side effects like cutaneous or cardiac side effects or drug-drug interactions.

A newly identified myokine: irisin, and its relationship with chronic spontaneous urticaria and inflammation.

Chronic spontaneous urticaria (CSU) is an important dermatological disease involving severe itchy urticaria lesions and/or angioedema. Urticaria and angioedema occur in the community at a rate of 25-30%. Many factors, such as inflammation, have been implicated in the etiology of CSU. Irisin is a newly identified adipocytokine shown by research to exhibit anti-inflammatory properties in addition to its many other effects. The aim of the study was to investigate, for the first time in the literature, the significance of serum irisin levels in patients with CSU. Seventy-eight individuals were evaluated. The study group included 44 patients diagnosed with CSU, and the control group consisted of 34 healthy individuals. Serum samples were collected, and serum irisin, Interleukin-2 (IL-2), Interleukin-3 (IL-3), Tumor Necrosis Factor-alpha (TNF-α), and Interferon-É£ (IF-É£) levels were determined using the enzyme-linked immunosorbent assay (ELISA) method. Irisin was studied for the first time in patients with CSU and exhibited a significantly higher level in the control group than in the patient group (p = 0.020). IL-2, IL-3, and IF-É£ levels were higher in the CSU group than in the control group, although the results were not statistically significant. Only TNF-α results increased significantly. Correlation analysis was applied to determine the relationships between irisin and IF-É£ and IL-3 levels. This revealed that the irisin parameter was significantly and positively correlated with IF-É£ and IL-3 in patients with CSU (r = 0.518, p = 0.016 and r = 0.536, p = 0.022, respectively). This is the first report to evaluate irisin as an inflammatory biomarker in CSU. Irisin levels in patients with CSU were low, suggesting that irisin may pay a role in the pathogenesis of CSU and may be a marker showing the severity of the disease.

Incidence and Prognosis of COVID-19 in Patients with Psoriasis: A Multicenter Prospective Study from the Eastern Black Sea Region of Turkey.

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.

Assessment of central retinal thickness, choroidal thickness, and retinal nerve fiber layer in psoriasis: a spectral-domain optical coherence tomography study.

BACKGROUND: This study aims to evaluate choroidal thickness (CT), retinal thickness, ganglion cell-inner plexiform layer (GCIPL), and retinal nerve fiber layer (RNFL) structures in psoriasis patients using optical coherence tomography (OCT). METHODS: This study included 33 psoriasis patients and 33 healthy individuals. Moreover, psoriasis patients who did not use any systemic anti-inflammatory treatment were evaluated. Retinal and choroidal images of the participants were obtained with spectral-domain OCT. Furthermore, CT was measured in the subfoveal, temporal, and nasal positions at 500-µm intervals to a distance of 1,500 µm from the foveal center. RESULTS: The mean psoriasis area and severity index (PASI) score was 5.70 (range, 2.40-9.00). No significant differences were found in subfoveal (p = 0.659), temporal, and nasal CT values in psoriasis patients compared with the control group (p > 0.05). Similarly, no statistically significant differences were found between the groups in terms of central retinal thickness, macular GCIPL, and RNFL (p > 0.05). Moreover, no significant correlation exists between the duration of psoriasis disease and PASI scores and OCT parameters (p > 0.05). CONCLUSIONS: No significant changes in CT, ganglion cell layer, RNFL, and retinal thickness values were noted in psoriasis patients with mild to moderate mean PASI score.

Skin problems related to personal protective equipment among healthcare workers during the COVID-19 pandemic (online research).

INTRODUCTION: Coronavirus disease-2019 (COVID-19) is a highly contagious infectious disease that first appeared in Wuhan, China, in December 2019. Health care workers (HCWs) are at increased risk of infection because the virus is highly contagious and can be transmitted by a variety of routes. Health care workers are required to use a variety of personal protective equipment (PPE) for prolonged hours and, as a result, they face varying degrees of cutaneous complications. METHODS: We conducted a cross-sectional online questionnaire survey to investigate skin problems caused by the use of PPE and personal hygiene measures. We developed a survey with 32 questions using Google forms and distributed it via WhatsApp and Facebook groups. RESULTS: A total of 1142 responses were obtained. Among the respondents, 88.1% reported adverse skin reactions due to PPE and personal hygiene measures. Female sex, working as a nurse, wearing PPE more than 6 h/day, and working more than 3 days/week increase the risk of PPE-related skin problems. CONCLUSION: In this study, we highlighted skin problems related to PPE and found out risk factors for PPE-related skin problems.

The relationship between rosacea and insulin resistance and metabolic syndrome.

Rosacea is a chronic inflammatory skin disease affecting the face. A positive correlation has been found between rosacea and cardiovascular diseases. We sought to investigate the relation between rosacea and metabolic syndrome (MS) and insulin resistance (IR). Between January and June 2015, a case-control study including 47 age-, gender-, and body mass index (BMI)-matched rosacea patients and 50 controls was conducted. Demographic data, clinical features of rosacea patients, anthropometric measures, laboratory findings, blood pressure levels, BMI, smoking history, alcohol consumption, sports life, family history of cardiovascular disease, and presence of MS and IR were recorded. Forty-seven rosacea patients (12 men and 35 women; age range: 35-68 years) and 50 controls (11 men and 39 women; age range: 38-78 years) were included in our study. Of 47 rosacea patients, 24 had erythematotelangiectatic type, 22 had papulopustular type, and one had phymatous type. Whereas the rate of IR was significantly higher in the rosacea group, there was no significant difference in the rate of MS between rosacea and the control group (p = 0.009 and p = 0.186, respectively). In addition, the rosacea group had significantly higher fasting blood glucose, total cholesterol, and systolic and diastolic blood pressure levels (p<0.05). Mean levels of LDL, triglyceride, total cholesterol and CRP were significantly higher than in the control group (p<0.05). Our findings suggest that there is a relationship between rosacea and IR and some parameters of cardiovascular risk factors. We recommend investigation of IR in rosacea patients.

Risk Factors for Premature Hair Graying in Young Turkish Adults.

BACKGROUND: Premature hair graying (PHG) is a common condition resulting in loss of self-esteem. Studies investigating PHG risk factors for both sexes with a large number of patients are scarce. We sought to investigate the socioclinical risk factors for PHG in young Turkish men and women and the differences between the sexes. METHODS: A cross-sectional study was conducted in 1,119 participants who answered a survey about PHG and some socioclinical characteristics between February and July 2015. The number of gray hairs, onset age of hair graying, and family history of PHG were asked about, as well as demographic characteristics, anthropometric measures, body mass index, smoking, alcohol consumption, sports life, diet, medical history, educational status, occupation, marital status, monthly income, and Fitzpatrick skin type. RESULTS: Of 1,119 participants, 315 (28.1%) had PHG and 804 did not. Maternal and paternal PHG, alcohol consumption, presence of chronic disease, educational status, hair loss, perceived stress scale (PSS) score, age, and height were significantly higher in subjects with PHG. Rates of maternal and paternal PHG were high in women with PHG, and the rate of paternal PHG was high in men with PHG. According to the multivariate ordinal regression analysis, PSS score, age, hair loss, and family history of PHG were correlated with the severity of PHG. CONCLUSION: PHG is closely related to factors causing oxidative stress, such as emotional stress, alcohol consumption, and chronic diseases in genetically predisposed men and women.