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.

Case Report: A rare cause of oral bullae: Angina bullosa hemorrhagica.

Angina bullosa hemorrhagica (ABH) is a benign disorder of the oral cavity. Clinically, oral, blood-filled blisters are seen. To give a proper diagnosis, one should rule out any other cause. We aim to present this case in order to emphasize this rare cause of oral bullae which is necessary to be differentiated from many serious dermatological and hematological disorders.

Epidemiology of Pemphigus in Turkey: One-year Prospective Study of 220 Cases.

Pemphigus is a group of rare and life-threatening autoimmune blistering diseases of the skin and mucous membranes. Although they occur worldwide, their incidence shows wide geographical variation, and prospective data on the epidemiology of pemphigus are very limited. Objective of this work is to evaluate the incidence and epidemiological and clinical features of patients with pemphigus in Turkey. All patients newly diagnosed with pemphigus between June 2013 and June 2014 were prospectively enrolled in 33 dermatology departments in 20 different provinces from all seven regions of Turkey. Disease parameters including demography and clinical findings were recorded. A total of 220 patients were diagnosed with pemphigus during the 1-year period, with an annual incidence of 4.7 per million people in Turkey. Patients were predominantly women, with a male to female ratio of 1:1.41. The mean age at onset was 48.9 years. Pemphigus vulgaris (PV) was the commonest clinical subtype (n=192; 87.3%), followed by pemphigus foliaceus (n=21; 9.6%). The most common clinical subtype of PV was the mucocutaneous type (n=83; 43.2%). The mean Pemphigus Disease Area Index was 28.14±22.21 (mean ± Standard Deviation). The incidence rate of pemphigus in Turkey is similar to the countries of South-East Europe, higher than those reported for the Central and Northern European countries and lower than the countries around the Mediterranean Sea and Iran. Pemphigus is more frequent in middle-aged people and is more common in women. The most frequent subtype was PV, with a 9-fold higher incidence than pemphigus foliaceus.

Is acne a sign of androgen excess disorder or not?

OBJECTIVE: Acne is not solely a cosmetic problem. The clinical importance of acne in the estimation of androgen excess disorders is controversial. Recently, the Amsterdam ESHRE/ASRM-sponsored third PCOS Consensus Workshop Group suggested that acne is not commonly associated with hyperandrogenemia and therefore should not be regarded as evidence of hyperandrogenemia. Our aim was to investigate whether acne is a sign of androgen excess disorder or not. STUDY DESIGN: This is a cross sectional study that was performed in a university hospital involving 207 women, aged between 18 and 45 years, suffering mainly from acne. The women were assigned as polycystic ovary syndrome (PCOS), idiopathic hirsutism (IH), idiopathic hyperandrogenemia (IHA). Women with acne associated with any of the androgen excess disorders mentioned above were named as hyperandrogenemia associated acne (HAA). Women with acne but without hirsutism and hyperandrogenemia and having ovulatory cycles were named as "isolated acne". Serum luteinizing hormone, follicle stimulating hormone, estradiol, progesterone, 17-hydroxyprogesterone, dehydroepiandrosterone-sulfate (DHEAS), androstenedione, total testosterone and lipid levels were measured. RESULTS: Acne score was similar between the women with isolated acne and HAA. The most common cause for acne was PCOS and only 28% of the women had isolated acne. 114 (55%) women had at least one raised serum androgen level. CONCLUSIONS: In this study, 72% of acneic women had clinical and/or biochemical hyperandrogenemia. In contrast to the suggestion of ESHRE/ASRM-sponsored third PCOS Consensus Workshop Group, our data indicate that the presence of androgen excess disorders should be evaluated in women presenting with acne.

Long-term effect of systemic isotretinoin on female fertility.

BACKGROUND/OBJECTIVE: Acne vulgaris is one of the most common diseases of the youth. Systemic isotretinoin is the only drug which acts on all of the etiopathogenic mechanisms of acne. Isotretinoin has some well-known side effects. Besides these, there is a suspicion whether it affects fertility or not. Previously, we conducted a study about isotretinoin's effect on ovarian reserve which showed deteriorative reserve. In this study, we aimed to evaluate the long-term effects of systemic isotretinoin on female fertility. MATERIALS AND METHODS: Of the 82 female patients who were enrolled in the first study, 79 patients were included in this study. Twelve months after the end of systemic isotretinoin treatment, patients were reevaluated by using the same parameters which include anti-Mullerian hormone (AMH), ovarian volume (OV), antral follicle count (AFC), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, free testosterone and total testosterone. RESULTS: The changes in the mean AMH, OV and AFC were statistically significant between the sixth and eighteenth months (the end of systemic isotretinoin treatment and 12 months treatment free). The mean AMH, OV and AFC values at the beginning and at the 18th month were statistically similar. CONCLUSION: The deteriorative effects of systemic isotretinoin treatment on ovarian reserve, which can be accepted as an indicator of female fertility, diminish in time.

Topical sirolimus for the treatment of angiofibromas in tuberous sclerosis.

BACKGROUND: The skin is one of the most affected organs in tuberous sclerosis complex and angiofibromas are seen in almost 80% of such patients. These benign tumors impose a great psycho-social burden on patients. OBJECTIVE: The aim of the study was to evaluate the effectiveness and tolerability of topical sirolimus for facial angiofibromas in patients with tuberous sclerosis complex. METHODS: This was a prospective, single-blinded, cross-over study which involved twelve patients. We investigated the effect and safety of topical 0.1% sirolimus, which was obtained by crushing sirolimus tablets and mixing it with petrolatum. The patients were asked to apply the cream to one side of their face, and vaseline to the other side. The effect of topical sirolimus was evaluated using the "facial angiofibroma severity index." RESULTS: There was a significant improvement in the redness and extension of the tumors on the sides to which the active ingredient was applied. Some side effects such as itching and irritation occurred in three patients, which were treated with topical hydrocortisone cream. CONCLUSION: Topical sirolimus appears to be a promising, fairly well tolerated treatment for facial angiofibromas in patients with tuberous sclerosis complex. Although its efficacy diminishes with time, repetitive usage is effective.

The association of androgenetic alopecia and insulin resistance is independent of hyperandrogenemia: A case-control study.

BACKGROUND/OBJECTIVES: Androgenetic alopecia (AGA) occurs due to the effect of androgens and genetic predisposition. The association between hyperandrogenism and insulin resistance (IR) has been clearly documented. In recent years there have been reports supporting the presence of IR in AGA. The study aimed to investigate the presence of IR in women with AGA and discern whether or not it is associated with hyperandrogenism. METHODS: Overall, 77 women with AGA were included in the study. Patients with Ludwig grades I-III AGA were enrolled in the study. Blood samples were drawn for measurements of hormone profile, basal insulin and fasting blood glucose (FBG). An oral glucose tolerance test was performed on another day. IR was assessed by the homeostasis model assessment score. RESULTS: All IR parameters were significantly higher in the 75 study subjects without DM than in the control group (P < 0.05). After excluding five patients with IGT, the level of all IR parameters were still higher than in the control group (P < 0.05). Hyperandrogenemia was found in 30 (40%) patients. When this second group (n = 45) (excluding patients with hyperandrogenemia) was compared with the control group on IR, all parameters except for basal insulin were significantly higher in the second group than in the controls (P < 0.05). CONCLUSION: Our results suggest a relation between IR and AGA in female patients. We showed for the first time that the association of AGA and IR is independent of hyperandrogenemia.

The prevalence of Behçet's disease in a city in Central Anatolia in Turkey.

BACKGROUND: The prevalence of Behçet's disease (BD) is much higher in countries along the ancient Silk Route, extending from Japan to Mediterranean countries including Turkey, than in northern Europe and the USA. OBJECTIVES: The present study aimed to investigate the prevalence of BD in Kayseri, a city in Central Anatolia in Turkey. METHODS: This study investigated cross-sectional prevalences of BD in individuals aged >10 years in Kayseri, Turkey, in two stages. The first stage aimed to identify individuals with recurrent oral ulcers (ROUs) through home visits, and the second stage aimed to further examine those with ROUs for the presence of other BD-related manifestations under hospital conditions. The study was conducted using the criteria defined by the International Study Group for Behçet's Disease. The sample size was determined to be 4697 with an expected sampling error of 5.5 per 10,000, with a 95% confidence interval. A standard questionnaire was administered to a total of 5218 individuals. RESULTS: A history of ROU was recorded in 470 (9.0%) of the 5218 residents, and a previous diagnosis of BD was recorded in nine individuals. The prevalence rate of BD was estimated as 17 cases per 10,000 population in Kayseri, Turkey. CONCLUSIONS: The present study contributes towards estimations of prevalences of BD in Turkey and towards raising public awareness about the disease. It also supports previous studies that have reported the world's highest prevalences of BD in Turkey.

Focal epithelial hyperplasia in a Turkish family.

Focal epithelial hyperplasia (FEH) is a benign proliferative condition that is more frequently found in children of certain ethnic groups. Human papillomavirus (HPV) 13 and 32 genotypes has been consistently detected in these lesions. In this study a daughter, mother and father had FEH, and HPV 13 was shown by sequence analysis in the lesions of these patients. Cryotherapy was applied to the lesions and the lesions improved, but did not recover properly. In conclusion, HPV genotyping should be performed in FEH cases.

The Treatment of Recurrent Urothelial Tumors of the Upper Urinary System and at Urostomy Site following Radical Cystectomy with Intraureteral Bacillus Calmette-Guérin and Cryotherapy.

Urinary bladder carcinoma is the second most common cancer of the urinary system. The recurrence rate in the upper urinary system (UUS) for urothelial cancers is around 3% following radical cystectomy. The followup generally consists of imaging studies and urinary cytology, although there are no prospective data on the frequency, the mode, and the duration of followup. In patients carefully selected according to risk factors, kidney-sparing minimally invasive methods (ureteroscopic procedures, percutaneous approach, and local drug instillation) appear as contemporary alternatives for low-grade and low-stage primary UUS. In this paper, we present the patient who underwent radical cystectomy with urinary diversion ureterocutaneostomy, was diagnosed with widespread bilateral UUS tumors and recurrent tumor at the urostomy site at active followup, for which he was given local Bacillus Calmette-Guérin (BCG) and cryotherapy, and was followed by disease-free for 2 years thereafter.

Accidental benzalkonium chloride (zephiran) injection.

We report a case of an accidental injection of benzalkonium chloride (zephiran) instead of a local anesthetic agent during a tooth extraction. The sudden development of chin and neck swelling led to dyspnea and the patient lost consciousness. She was sent to an emergency clinic by her dentist immediately. After medical treatment for 20 days, the necrotic tissue was debrided and a gingival sulcoplasty was performed. Healing was uneventful.

Baboon syndrome and segmental vitiligo coexistence.

The baboon syndrome is a form of systemic contact dermatitis with skin eruptions in the area of the buttocks and major flexures. Inhalation of mercury vapor causes this rare but distinctive eruption. Broken thermometers are the usual sources of exposure. We hereby present a 14-year-old boy diagnosed with baboon syndrome coexistence with vitiligo, due to broken thermometers. In our case, it was interesting that erythematous eruptions were more evident on the vitiliginous side of the trunk. To our knowledge, there have been no reports in the literature of baboon syndrome and vitiligo coexistence.

Prevalence of cutaneous findings in hospitalized neonates: a prospective observational study.

OBJECTIVE: To determine the frequency of physiologic and pathologic skin findings in the newborns hospitalized in our Newborn Unit. METHODS: All of newborn infants hospitalized in the Newborn Unit of Erciyes University Medical School Hospital in Central Anatolia, Turkey from February 1 to November 30, 2003, were included prospectively in the study. A questionnaire regarding maternal gestational history, maternal and family history was administered to the parents of each child. All skin lesions were recorded and mapped on a body chart. RESULTS: Of the 816 newborns, parents of 650 gave informed consent. Only 28 (4.3%) of the infants had no dermatologic examination findings. The most common 10 diagnoses were: xerosis/desquamation 257 (39.5%), sebaceous hyperplasia 207 (31.8%), transient toxic erythema 201 (30.9%), salmon patch 125 (19.2%), Mongolian spot 86 (13.2%), cutis marmorata 69 (10.6%), suction bulla 67 (10.3%), miliaria 55 (8.5%), hypertrichosis 51 (7.8%), and dermatitis (irritant, seborrheic, or diaper) 14 (2.1%). CONCLUSIONS: This study confirms that skin changes in the newborn are common, particularly desquamation, sebaceous hyperplasia, and transient toxic erythema.

Patients with vulval pruritus: patch test results.

BACKGROUND: Persistent vulval pruritus is a frequent problem and patients may not show signs of a primary vulval dermatosis. Allergic contact sensitivity is an important factor in such patients but may also occur as a secondary event in women with vulval dermatoses. OBJECTIVES: We aim to describe women with vulval pruritus who were evaluated for vulval dermatoses. We patch tested to help define or exclude allergens. METHODS: In a 3-year period, 50 women with vulval pruritus were examined for existence of vulval dermatosis. All the patients were patch tested to the European Baseline Series, medicaments, preservatives, vehicles, cosmetics and products they routinely used. RESULTS: Ages of the patients ranged from 22 to 62 years (mean 39.9 +/- 9 years) and duration of the diseases ranged from 0.5-360 months (mean 56.1 +/- 65.6 months). 52% of the women had at least 1 positive patch test. 8 patients (16%) had 1 or more relevant allergic positive reactions. The relevant allergens were usually cosmetics, preservatives and medicaments. CONCLUSIONS: Women with vulval pruritus were patch tested to help define or rule our allergens. Contact allergy incidence in these patients is high. The relevant allergens were usually cosmetics, preservatives and medicaments.

Isotretinoin-induced agranulocytosis.

Isotretinoin is used to treat a spectrum of dermatologic conditions. The present article reports the case of a 15-year-old female patient who exhibited agranulocytosis after the initiation of isotretinoin administration. Agranulocytosis is a rare but life-threatening side effect of isotretinoin use, and clinicians must be aware of agranulocytosis.

Different seizure types and skin lesions in oculocerebrorenal syndrome of Lowe.

Oculocerebrorenal syndrome of Lowe is an X-linked recessive disorder localized to Xq24-26.1. The phenotypic features of this disorder are Fanconi-type renal failure, mental retardation, and various eye abnormalities. Seizures may accompany the disease, and the skin-related findings are poorly defined. This case of a 9-year-old patient, diagnosed as having and followed for oculocerebrorenal syndrome of Lowe, has been presented for his seizures, which were initially myoclonic but subsequently atonic, and for his skin findings, understood to be trichoepithelioma, cystic in nature, and stemming from mature hair follicles. In monitoring the disease, the manifestation of the seizures as atonic seizures accompanied by focally initiated secondary generalized epileptic discharges is a finding previously undefined in oculocerebrorenal syndrome of Lowe. Moreover, the presence of dermal findings of a cystic nature is reported in few cases of this syndrome. In this rare syndrome, it is necessary to be aware of the presence of atonic seizures, which have an association with the progression of the disease that has not been previously reported in the literature, and of the cystic dermal lesions as part of the syndrome.

The effect of budesonide mouthwash on oral chronic graft versus host disease.

Oral chronic graft versus host disease (cGVHD) is common and a major cause of morbidity and loss of quality of life in long term survivors. Cyclosporine with prednisone remains the first line therapy for oral manifestations of cGVHD. However, even with routine administration of systemic agents, many patients with oral manifestations of cGVHD do not have resolution of their disease and may benefit from incorporation of local therapy. Budesonide is a highly potent steroid which has minimal systemic side effects and being used for oral cGVHD. We designed a retrospective study to compare treatment results of patients with oral cGVHD who received topical budesonide in addition to systemic therapy that consists of combined prednisone and cyclosporine (Group A, n = 12), with the treatment results of patients who were administered the same systemic therapy alone (Group B, n = 11) to determine whether budesonide mouthwash had any advantage on response rates. Three mg topical budesonide/10 ml saline was used 3-4 times a day for up to 6 months in group A. Diagnosis, clinical staging, and treatment response scoring for cGVHD were performed according to National Institutes of Health (NIH) consensus criteria. At the baseline examination, there were no statistically significant differences in terms of median oral cGVHD examination scores between two groups. After treatment, there was statistically significant decrease in median oral cGVHD examination scores compared to baseline (P < 0.001 and 0.021), and significant differences were found between two groups (P < 0.032). Overall response rate was 83% and 36% for group A and B, respectively (P = 0.036). However, no statistically significant differences were found between median pain scores of two groups before and after treatment (P = 0.740 and P = 0.091). No major systemic side effects and oral candidiasis were observed in two groups of patients. We concluded that topical budesonide might be added to systemic therapy to obtain better response rates in patients with oral cGHVD.

Terbinafine versus itraconazole and fluconazole in the treatment of Vulvovaginal candidiasis.

Vulvovaginal candidiasis is one of the most frequent infections of the female genital tract with a high incidence. Although numerous antimycotical agents are available for treatment of yeast vaginitis, there are few comparative data on the in vivo and in vitro activity of these drugs. The aim of this open, randomized, and comparative study was to determine in vivo and in vitro effectiveness of the 3 systemic antifungal agents: terbinafine and 2 azoles (itraconazole and fluconazole) in the treatment of patients with Vulvovaginal candidiasis. A total of 44 patients who had signs and symptoms of Vulvovaginal candidiasis were recruited for the study. Patients were randomly assigned to 3 groups: terbinafine 500 mg/d orally was used for 7 days, itraconazole 200 mg/d orally was used for 7 days, and fluconazole 150 mg orally was used as a single dose. Both clinical and mycologic examinations were performed for posttreatment assessment at week 4. This study revealed a clinical cure rate 33.3% for terbinafine, 60% for itraconazole, and 66.6% for fluconazole (P>0.05). Mycologic cure rates were 33.3%, 10%, and 66.6% respectively (P<0.05). Overall cure rates were 33.3%, 10%, and 53.3% (P>0.05). Terbinafine could be an alternative treatment option in Vulvovaginal candidiasis because there were no significant differences in the clinical and overall cure rates among 3 antifungal agents. However, terbinafine could not be suggested as a first-line treatment in Vulvovaginal candidiasis. Systemic use of terbinafine in larger numbers of cases may give more information about the effectiveness of this drug in the treatment of patients with vulvovaginal candidiasis.

Clinical features of Behçet's disease in children.

BACKGROUND: Behçet's disease (BD) is a systemic inflammatory vasculitis of young adults with unknown etiology. OBJECTIVE: The aim of this study was to determine the clinical features and outcome of BD in childhood. PATIENTS AND METHODS: Seventeen patients with BD within a pediatric age group were studied since 1997. RESULTS: Boys : girls ratio was 12:5. Familial cases were very frequent (45%). Oral aphthous ulcers were present in all patients (100%), genital aphthous ulcers were present in 16 (94%), ocular lesions in 4 (24%), erythema nodosum in 3 (18%), papulopustules in 8 (47%), joint symptoms in 13 (76%), mild gastrointestinal symptoms in 2 (12%), neurological involvement in 2 (12%), positive pathergy reactions in 13 (76%), and thrombophlebitis in 1 (6%). We used colchicine, systemic corticosteroids, cyclosporine, nonsteroidal anti-inflammatory drugs, sulfasalazine, and topical agents for the treatment of children with BD. CONCLUSION: The findings of BD in children are similar as in adults, but the frequency of familial cases is significantly higher.

Rosacea fulminans in pregnancy: case report and review of the literature.

Rosacea fulminans is a rare disease of unknown cause which occurs exclusively in women years after adolescence. Although the etiology is unknown, immunologic, hormonal, and vascular factors have been suggested. When rosacea fulminans occurs during pregnancy and in women taking oral contraceptive pills, hormonal factors may be a trigger. Rosacea fulminans is localized specifically to the face, with the chin, cheeks, and forehead bearing the brunt of the attack. A dull red, cyanotic erythema of all involved facial areas, extending beyond the inflammatory nodules, is typical. We present the case of a 31-year-old pregnant woman who had rosacea fulminans during the first trimester of her second pregnancy. She had multiple erythematous papules, pustules, nodules, and purulent discharging cysts on the face. Conventional therapeutic approaches with systemic corticosteroids were associated with clear improvement within 2 months, and subsequently only 0.75% metronidazole topical cream was used during the second trimester.