Is the effect of smoking on rosacea still somewhat of a mystery?

CONTEXT: Rosacea is an inflammatory skin disease with a chronic course. In the past, the association between rosacea and smoking was examined only in a few studies. OBJECTIVE: The objective of this study is to investigate the prevalence and the influence of smoking in rosacea patients. MATERIALS AND METHODS: This prospective cross-sectional study includes 200 rosacea patients and 200 age- and gender-matched rosacea-free controls. Using National Rosacea Society Expert Committee classification, we divided patients into three subgroups as having erythematotelangiectatic (ETR), papulopustular (PPR), and phymatous rosacea (PhR). Demographic data, risk factors, and smoking habits were recorded. RESULTS: In multivariate analysis, the prevalence of smoking was significantly higher (66%) among patients compared with controls. ETR subtype (43.5%) was found to be significantly higher among active smokers (p < 0.001). Considering the risk factors, caffeine intake and alcohol consumption could not be evaluated because of their never or rarely intake. Whereas rates of photosensitive skin type and positive family history were significantly prominent in ETR patients (p < 0.001). While PhR was mostly detected in men who are very old, a significant tendency was found to develop ETR in women. CONCLUSION: While a significantly increased risk of developing rosacea among smokers was observed in this study, ETR seems to be the disease of active smokers. Further studies are required for better understanding of the association between rosacea and smoking.

Reticular erythematous mucinosis on the midline of the back.

We report the case of a 51-year-old man who presented with reticular macular erythema and erythematous plaques on the midline of the back of 10 years' duration that seemed to worsen on exposure to sunlight. Based on the clinical and histopathologic findings, a diagnosis of reticular erythematous mucinosis (REM) was made. The patient was treated with hydroxychloroquine 400 mg daily and the lesions resolved by the end of the second week of therapy.

Impact of functional pruritus compared with mild psoriasis on quality of life: a cross-sectional questionnaire study in Turkey.

BACKGROUND: Functional pruritus (FP) is a type of chronic pruritus that is a somatoform disease in nature, triggered by psychogenic factors. Psoriasis is a chronic, inflammatory, and pruritic skin disease that causes significant cosmetic problems and psychological distress. OBJECTIVE: In this study, we aimed to investigate the effects of functional pruritus on quality of life and to compare these with the effects of mild psoriasis. METHODS: A total of 73 patients (40 with psoriasis and 33 with FP) were enrolled into the study. All the participants were asked to complete the Dermatology Life Quality Index (DLQI) and World Health Organization (WHO) Quality of Life, short form, Turkish version (WHOQOL-BREF-TR). Pruritus severity was evaluated subjectively with a visual analog scale (VAS) in both groups, and psoriasis severity was evaluated with the Psoriasis Area and Severity Index. Patients' age, gender, educational status, duration of disease, and medications were recorded. RESULTS: There was no significant difference in quality of life between the two groups. VAS values were significantly higher in the FP group. A negative correlation was found between age and the physical domain on the WHOQOL-BREF-TR, and also between the psychological domain on the WHOQOL-BREF-TR and the duration of the disease in FP patients. In psoriasis patients, a negative correlation was found between age and DLQI scores. CONCLUSION: FP has a negative impact on quality of life that is comparable to that of mild psoriasis. It seems that the visibility of psoriatic lesions and the cosmetic concerns in psoriasis patients do not result in a more severely impaired quality of life than in patients with FP.

A favourable response to surgical intervention and hyperbaric oxygen therapy in pyoderma gangrenosum.

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterised with ulcerations. Inflammatory bowel diseases (ulcerative colitis and Crohn's disease) and haematologic diseases (leukaemia, preleukaemia and monoclonal gammopathy) have been reported in about 40-50% of PG patients in whom the treatment of the underlying disease is important for the improvement of the lesions. We herein report a colorectal adenocarcinoma patient with PG, who responded partially to topical treatments and systemic immunosuppressants and healed completely with the aid of surgical wound repair and hyperbaric oxygen therapy.

Sexual dysfunction in men suffering from genital warts.

INTRODUCTION: Human papillomavirus (HPV) infection can present clinically as genital warts (GWs) in both males and females. Much less is known about the psychosexual consequences of GW, and the studies on patients in this group are still quite limited. AIMS: The aim of this study was to test two hypotheses: (i) sexual dysfunction (SD) is likely to occur in male patients suffering from GWs; (ii) if male SD exists, it may be associated with depression or anxiety. METHODS: This was a pilot study with a prospective cross-sectional design. Male patients with GW (N for patient group = 116) were compared with male control cases (N for control group = 71) using the Arizona Sexual Experience Scale (ASEX), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). The participants were evaluated by a dermatologist and a psychiatrist, respectively. MAIN OUTCOME MEASURES: The associations between sexual dysfunction, depression, and anxiety among the participants were examined. RESULTS: There was no difference between the groups in terms of sociodemographic changes. Sexual dysfunction was found to be significantly more common in the patients than controls (P = 0.000 < 0.001). When the subscores of ASEX were evaluated, they were found to be statistically significant between the two groups (P = 0.000 < 0.001). BDI and BAI scores were statistically higher in the patient group than in controls, and there was a positive correlation between BDI and BAI scores with ASEX total and subscores (P = 0.000 < 0.001). CONCLUSIONS: Male patients with GW have higher rates of sexual dysfunction, depression, and anxiety when compared with the normal population. Men suffering from GW should be evaluated for possible sexual problems, besides depression and anxiety.

Pemphigoid gestationis with postpartum flare-up: a case report.

BACKGROUND: Pemphigoid gestationis (PG), also known as herpes gestationis, is an uncommon autoimmune blistering disease that almost always occurs in the third trimester of pregnancy. The sudden emergence of the disease, its clinical appearance and the course create great stress on the pregnant woman and the fetus. The disease has been associated with premature delivery and small-for-gestational-age infants. Corticosteroids remain the mainstay of therapy. CASE: A pregnant woman presented with a diffuse blistering and intensely pruritic urticarial plaques that occurred periumbilically and spread to the rest of the body. We report a well-documented case of PG and an overview of the current understanding of the disease. CONCLUSION: A multidisciplinary approach for diagnosis, treatment and course of the disease from both dermatologic and gynecologic viewpoints is suggested.

"Turkey ear" as a cutaneous maniestation of tuberculosis.

Lupus vulgaris is the most common morphological variant of cutaneous tuberculosis. Classical lupus lesions are often seen in the head and neck region. Turkey ear is a clinically descriptive term, previously being used for the earlobe with reddish indurated plaque lesions, which recently can be a sign for lupus vulgaris. A 65-year-old man presented with lupus vulgaris of the earlobe. The diagnosis was confirmed by conventional laboratory investigations and the patient showed well response to antituberculous therapy. This is the second reported case of "turkey ear" as a manifestation of cutaneous tuberculosis.

Variable clinical presentations of Classic Kaposi Sarcoma in Turkish patients.

BACKGROUND: Kaposi sarcoma (KS) is a vascular neoplasm with multicentric cutanenous and extracutaneous involvements, which was first described by Moriz Kaposi in 1872. Since then, different epidemiological clinical and histopathological variants of this neoplasm have been identified. Classic Kaposi sarcoma (CKS) is one of four main clinico-epidemiologiologic variants. characteristics of the disease. MATERIALS AND METHODS: Four Turkish inpatients with CKS were evaluated in the study. All medical history and clinical data were noted. A screening immunodeficiency workup were performed for all patients. HHV-8 immunofluorescence testing on the specimens and ELISA test for human immunodeficiency virus (HIV 1 and 2) were performed. Pulmonary X ray graphies and computurized tomography (CT) scan were applied. Stage of the tumor was determined, in each case, according to the classification system proposed by Brambilla et al in 2003. RESULTS: All patients are positive for HHV-8. They were all immunocompetent and negative for HIV1 and HIV2. The first patient was unusual for morphological presentation of several verrucoid lesions that was evaluated as verrucoid KS. He was considered stage IB CKS. The patient 2 was a young man and the course of KS seemed unexpectedly aggressive for CKS. His clinical appearence seemed us to be a patient with AIDSassociated KS. The patient was evaluated as stage IVB CKS. Our third patient had also prominent lymphedema associated with bluish discoloration on the toes and fingers, suggesting a diagnosis of peripheral vascular disorder. He was diagnosed as stage IIIB CKS. The fourth case was interesting for very extensive lesions involving big sized plaques and also the existence of mucosal lesion. The patient was diagnosed as stage IVB CKS. CONCLUSIONS: It seems that the reports of exceptional cases of KS are accumulating. Data from various cases should be collected and perhaps, novel clinical classifications should be considered.

Allergic contact dermatitis mimicking angioedema due to paraphenylendiamine hypersensitivity: a case report.

Active sensitization to paraphenylendiamine (PPD) and related compounds from temporary black henna tattoos has become an epidemic in the recent years. Hair dyes also include PPD like black henna tatoos which cause allergic contact dermatitis. Skin lesions of allergic contact dermatitis from PPD are mostly seen as an exudative erythema, an erythema multiforme-like eruption or a bullous contact dermatitis. We, herein, report a 27 year-old woman with an angioedema-like reaction occurring after the first exposure to hair dye who was unaware of being previously sensitized to PPD from black henna tattoo.

Linear atrophoderma of Moulin on the neck.

BACKGROUND: Linear atrophoderma is a rare disease, first described by Moulin in 1992 in 5 patients. It is an acquired unilateral hyperpigmented, depressed band-like areas following the lines of Blaschko. It affects children or adolescents of both genders involving the trunk or the limbs. It is considered to be a rare cutaneous form of mosaicism. MAIN OBSERVATION: A 39-year-old woman with a 22 years history of unilateral slightly depressed hyperpigmented lesion on her neck was admitted to us. The skin texture was normal and there were no signs of induration or sclerosis. The histopathological examination revealed a normal epidermis outlined by a hyperpigmented basal layer. In the papillary dermis proliferation of superficial vessels with mild lymphocytic infiltrate and melanin-laden macrophages were present. The collagen fibres and elastic fibres were normal. The clinical and histopathological features confirmed the diagnosis of linear atrophoderma of moulin. We discussed the case according to the other cases reported in the literature. CONCLUSIONS: Approximately 28 cases of linear atrophoderma have been reported in literature. The present case has the charecteristic clinical and histopathological features of linear atrophoderma as defined by Moulin, but the localization of the lesion is unusual.

Do eating disorders accompany metabolic syndrome in psoriasis patients? Results of a preliminary study.

BACKGROUND: Metabolic syndrome (MBS) has been reported as a frequent comorbidity in psoriatic patients. The main pathogenesis is considered to be inflammation in this association. MBS has been investigated in eating disorders as well. While psoriasis has some psychiatric comorbidities, the link between psoriasis, MBS, and eating disorders (EDs) is unknown. METHODS: The study was designed as a cross-sectional, randomized, and controlled trial. A total of 100 patients with psoriasis were included in the study. Sociodemographic data, clinical subtype of psoriasis, Psoriasis Area and Severity Index (PASI) scores, and associated diseases were registered for each patient. The criteria for diagnosis of MBS developed by the International Diabetes Foundation (IDF) was used. These are central obesity (waist circumference ≥94 cm in men or ≥80 cm in women), plus two of the following: elevated triglycerides (≥150 mg/dL), reduced high-desity lipoprotein cholesterol (>40 mg/dL for men; >50 mg/dL for women), elevated blood pressure (≥130 mmHg systolic or ≥85 mmHg diastolic), and elevated fasting blood glucose (≥100 mg/dL). Additionally, the Eating Attitude Test (EAT), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI), and psychiatric interview were performed for all patients. RESULTS: There were 45 female and 55 male patients, aged between 18 and 85 years old (median 41.12 ± 16.01). MBS was present in 31% of the patients with psoriasis. There was no correlation between the severity of psoriasis and MBS. EAT scores were ≥30 in 7/100 patients. Four out of 31 patients with MBS (12.9%) had ED and 3/69 patients were without MBS (4.3%). Mean ED scores were compared statistically and the difference was significant (EAT = 17.9 ± 9.558 and 11.5 ± 7.204, P < 0.001). CONCLUSION: Defining risk factors leading to comorbidities is important in psoriasis. EDs seem to have an impact on the development of MBS in psoriasis. Establishment and treatment of EDs in patients with psoriasis may prevent the onset of MBS and other comorbidities due to MBS.