Evaluation of the Quality of Life and the Demographic and Clinical Characteristics of Patients With Pemphigus With Oral Mucosal Involvement: A Multicenter Observational Study.

INTRODUCTION: Pemphigus vulgaris (PV) is an autoimmune disease primarily affecting the oral mucosa. OBJECTIVES: This study aimed to determine the demographic, clinical and treatment characteristics of PV patients with oral mucosal involvement and to assess the impact on their quality of life. METHODS: We conducted a prospective observational study among 106 patients diagnosed with PV and presenting oral mucosal involvement. Demographic data, clinical and treatment characteristics, and quality of life questionnaires were recorded. RESULTS: The study included 106 patients, 55 (51.89%) were male and there was a predominance of the mucocutaneous subtype in 83 individuals (78.38%). Oral mucosa was the initial site of manifestation in 44 patients (41.51%). Bilateral buccal mucosa was the most frequently affected site. The predominant symptom reported was a burning sensation, noted in 91 patients (85.85%). Oral mucosal examination revealed erosions in 85.85% of the patients. Systemic steroids were the most commonly administered treatment, and rituximab was used in 18 patients (16.98%). A positive and significant correlation was found between pemphigus severity and Oral Health Impact Profile-14, Dermatology Life Quality Index and Dermatological Quality of Life Scale scores (P < 0.05). The presence of superficial ulcers, flaccid bullae, lesion diameter ≥1 cm, and >10 lesions were factors that markedly diminished quality of life. Complete response to treatment was noted in all patients administered rituximab. CONCLUSIONS: The most common area of involvement was bilateral buccal mucosa, and the severity of PV closely correlated with a decline in quality of life measures. These results highlight the need for careful clinical oversight of PV, taking into account its effects on patients quality of life.

Dermatoses in overweight and obese children and their relationship with insulin and skin color.

BACKGROUND/AIM: The aim of the present study was to investigate the prevalence of obesity-related dermatoses in obese children, and the association between these dermatoses and insulin resistance as well as skin color. METHODS: Obese, overweight, and normal weight children according to body mass index who were followed up and treated in the outpatient clinics were included in the study. Dermatological examinations of the participants were performed, and fasting insulin and glucose levels were checked. RESULTS: The obese and overweight children were evaluated as the patient group (70 girls, 41 boys, mean age: 12.37 ± 3.14 years). One hundred one healthy children with normal weight were determined as the control group (59 girls, 42 boys, mean age: 12.15 ± 2.43). The first five common dermatoses in the patient group when compared with the control group were keratosis pilaris (KP), striae distensae, hyperhidrosis, acanthosis nigricans (AN), and plantar hyperkeratosis. The first five dermatoses which were positively correlated with formation and insulin resistance were KP, striae distensae, AN, hyperhidrosis, and plantar hyperkeratosis. According to the Fitzpatrick skin scale, we found that the darker the skin color, the higher the probability of AN and KP (OR, 0.298; 95% CI, 0.106-0.834, p = 0.021; OR, 0.306; 95% CI, 0.117-0.796, p = 0.015, respectively). CONCLUSION: Some dermatoses associated with obesity and insulin resistance were not found in obese children, or there was no significant association. These results indicate that many skin morbidities may be prevented by preventing and treating obesity and insulin resistance in the early period.

Antifungal efficacy of pure boron on yeast and mold isolates causing superficial mycosis.

OBJECTIVE: To examine the in vitro antifungal effects of water-soluble pure elemental boron with an alkaline solution against Candida species, Trichophyton species, and Aspergillus fumigatus that cause superficial mycosis. METHODS: The study was conducted at the microbiology laboratory of Kahramanmaras Sutcu Imam University Hospital, Kahramanmaras, Turkey, from June to December 2018, and comprised fungal strains isolated from patients with superficial mycosis who visited the dermatology clinic. The in vitro antifungal effects of the boron solution at various concentrations were determined using the microbroth dilution method. Candida albicans ATTC 90028 and Candida albicans MYA 274 served as the quality control strains, while fluconazole and amphotericin B were used as comparator antifungal agents. Data was analysed using SPSS 22. RESULTS: Of the 58 strains, 28(48.3%) were Candida albicans, 9(15.5%) non-Candida albicans, 12(20.7%) Trichophyton rubrum, 4(6.9%) Trichophyton mentagrophytes, 2(3.4%) Trichophyton species and 3(5.2%) were Aspergillus fumigates. Boron at a concentration of 78.125 µg/mL inhibited the growth of Candida albicans. The 50% and 90% minimum inhibitory concentrations of the solution in non-Candida albicanswere 78.125 and 312.5 µg/mL, respectively, whereas those in Trichophyton rubrum were 312.5 and 625 µg/mL, respectively. The 50% minimum inhibitory concentration of the solution in Aspergillus fumigatus was 625 µg/mL, whereas the 90% minimum inhibitory concentration could not be determined. CONCLUSIONS: Boron is an inexpensive, non-antibiotic element with potential uses as an antifungal agent.

How are Acne Vulgaris Patients Using Oral Isotretinoin Affected by Covid-19?

Introduction: It has been reported that the use of oral isotretinoin may have positive and negative effects on the course of COVID-19 and the risk of transmission. Objectives: The purpose of our study is to evaluate how our patients that took oral isotretinoin during the pandemic were affected by COVID-19. Methods: The clinical processes of moderate-to-severe acne vulgaris patients between March 2020 and February 2021 were evaluated. Results: Of 102 moderate-to-severe acne patients, 67 were using oral isotretinoin and 35 were using a topical treatment. Of 27 patients who tested positive for COVID-19, 16 (59.3%) were using oral isotretinoin and 11 (40.7%) were using topical treatment, there was no statistical difference in the rates of COVID-19 positivity between the two groups (P = 0.412). The rates of positive tests for COVID-19 were similar between contacted patients of two groups (P = 0.391). Loss of smell/taste was lower in patients using oral isotretinoin compared to patients receiving topical treatment (46.7% and 72.7%, respectively.). Headache symptoms were less common in patients using oral isotretinoin (P = 0.047). Conclusions: The use of oral isotretinoin did not cause an increase or decrease in the risk of COVID-19 transmission. The patients using oral isotretinoin had a lower incidence of taste/smell loss and headache.

A multicentre prospective analysis of the incidence of pemphigoid diseases in Turkey.

BACKGROUND: The differentiation between the pemphigoid diseases is essential for treatment and prognosis. In Turkey, data on the incidence of these diseases are insufficient. Our aim in this study is to determine the incidence, demographics and clinical characteristics associated with diseases of the pemphigoid group. METHODS: We prospectively analysed 295 patients with pemphigoid who visited dermatology clinics of tertiary referral hospitals in 12 different regions of Turkey within a year. The diagnosis was based on clinical, histopathological, direct immunofluorescence (DIF) and serological (multivariant enzyme-linked immunosorbent assay [ELISA], indirect immunofluorescence and mosaic-based BIOCHIP) examinations. Clinical and demographic findings, aetiological factors and concomitant diseases observed in the patients were recorded. RESULTS: A total of 295 (female/male ratio: 1.7/1) patients with pemphigoid were diagnosed in 1-year period. The overall incidence rate of pemphigoid diseases was found to be 3.55 cases per million-years. The ratio of pemphigoid group diseases to pemphigus group diseases was 1.6. The most common pemphigoid type was bullous pemphigoid (BP, 93.2%). The others were epidermolysis bullosa acquisita (3.1%), pemphigoid gestationis (2.4%), linear IgA disease (1%) and mucous membrane pemphigoid (0.3%). The most common (26.8%) possible trigger of the bullous pemphigoid was gliptin derivative drugs. The most common concomitant diseases with pemphigoid were cardiovascular (27.8%) and neurological diseases (23.7%). CONCLUSIONS: This study showed that the increased frequency of bullous pemphigoid reversed the pemphigoid/pemphigus ratio in Turkey. Further studies are warranted regarding the reasons for this increase.

Evaluation of the effects of hair colouring products on the oxidative status in rats.

INTRODUCTION: Permanent hair dyes, oxidant creams, and henna are usually used for cosmetic purposes and sometimes for therapeutic expectations. The effects of these products, which are used to change hair colour and can be absorbed percutaneously on the oxidative status is not known exactly. AIM: To investigate the effects of these products, which have various contents, on the oxidative status using an in vivo rat model. MATERIAL AND METHODS: The products used for hair colouring were prepared as recommended for human use and applied to the back region of Wistar albino rats. Superoxide dismutase (SOD), malondialdehyde (MDA) and glutathione peroxidase (GSH-Px) levels were measured in serum and liver samples of rats. The Kruskal-Wallis test showed significant differences in serum SOD, aspartate aminotranspherase (AST), alanine aminotranspherase (ALT), and liver MDA levels among the study groups. RESULTS: There were statistically significant positive correlations between hepatic MDA values and AST and ALT values. Hair dyes, oxidant creams, and henna were found to have oxidative and hepatotoxic effects. Surprisingly, comparisons revealed that oxidative effect and hepatic toxicity of the oxidant cream and henna were similar. The oxidant cream was more oxidating and hepatotoxic than the hair dye. CONCLUSIONS: Knowing the facts about these products, which are easily accessible to every individual in society and are considered to be innocent, will prevent possible harm.

Omalizumab usage in chronic urticaria and atopic dermatitis: data from South-East province of Turkey.

INTRODUCTION: Omalizumab is a current treatment option for IgE-associated dermatoses, such as urticaria and atopic dermatitis. AIM: To evaluate the clinical and laboratory findings of patients with chronic urticaria and atopic dermatitis who received omalizumab. MATERIAL AND METHODS: This study was planned as a cross-sectional and retrospective one. One hundred forty-six cases were included in the study. Omalizumab at a dose of 300 mg for patients with chronic urticaria and 600 mg for patients with atopic dermatitis, was given every 4 weeks. The response to the given treatment and remission status of patients were investigated. RESULTS: Of 146 patients included in the study, 70.5% (n = 103) were female and their mean age was 42.3 ±13.8 (min.-max.: 14-85). Of the patients, 136 had chronic urticaria and 10 had atopic dermatitis. 29.9% (n = 26) of patients with chronic urticaria had a complete response to omalizumab treatment, whereas 40% (n = 4) of patients with atopic dermatitis had remission. CONCLUSIONS: The decline of complaints with different treatment schemes in different patients suggests that treatment should be designed individually and that personal biomarkers playing a role in the effectiveness of the drug are important. Patients with the high IgE and eosinophil percentages and positive autologous serum test had a better treatment response to omalizumab treatment. Meanwhile, remission was found to be more frequent in atopic dermatitis patients with omalizumab treatment compared to the patients with urticaria. It may be more appropriate to choose patients based on certain criteria to ensure cost-effectiveness in omalizumab treatment.

Effect of the Syrian Civil War on Prevalence of Cutaneous Leishmaniasis in Southeastern Anatolia, Turkey.

BACKGROUND: Cutaneous leishmaniasis (CL) is a vector-mediated skin disease, characterized by chronic wounds on the skin and caused by macrophages in protozoan parasites. It is an endemic disease in the southern and southeastern Anatolia region and is still an important public health problem in Turkey. Because of the civil war in Syria, immigrants to this region in the last 3 years have begun to more frequently present with this disease. The aim of this study was to draw attention to the dramatic increase in new cases with CL after the beginning of the civil war in Syria. MATERIAL AND METHODS: In this retrospective study, we evaluated demographic, epidemiological, and clinical features of 110 patients diagnosed with cutaneous leishmaniasis who were admitted to the Department of Dermatology at Kahramanmaras Sutcu Imam University Faculty of Medicine between January 2011 and June 2014. RESULTS: A total of 110 patients included in the study; 50 (45%) were males, and 60 (55%) were females. The age range of the study group was 1-78 years, and the infection was more prevalent in the 0-20 year age group. Of these patients, 76 (69%) were Syrian refugees living in tent camps and 34 (31%) were Turkish citizens. The majority of the cases were diagnosed between October and December. CONCLUSIONS: Immigrations to endemic regions of Turkey from neighbouring countries where CL incidence is higher may lead to large increases in case numbers. In order to decrease the risk of exposure, housing conditions of the refugees must be improved, routine health controls must be performed, effective measures must be set in place for vector control, and infected individuals must be diagnosed and treated to prevent spread of the infection.

Interrater agreement in rating of pigmented skin lesions for border irregularity.

The clinical ABCD criteria are still recommended to both physicians and laymen when checking moles. The aim of this study was to determine the level of interrater reliability and therefore objectivity in rating for one of these criteria, namely border irregularity. Five professors, five residents, five nurses, and 10 students rated a set of 54 clinical images of pigmented skin lesions for border irregularity. After a descriptive presentation, rating was again carried out on another set of 54 images. In all groups, the agreement was moderate or substantial before the presentation and increased after the presentation. An almost perfect agreement was achieved by the professors after the presentation. Although both experience and receiving information could increase the level of interrater reliability, the disagreement was usually sufficient to suggest subjectivity in rating for border irregularity.

Familial cutaneous collagenoma: new affected family with prepubertal onset.

Two siblings presented with clinical and histopathological findings of familial cutaneous collagenoma which is a rare connective tissue nevus, inherited in an autosomal-dominant pattern. A 13-year-old girl had oval-round, soft, painless papules, 5-10 mm in size and a total of 9-10 on her abdomen and flanks. Skin biopsy demonstrated dense, coarse collagen fibers in the dermis and a decrease in elastic fibers. Doppler echocardiography indicated an atrioseptal defect of the secundum type. Her 9-year-old brother was also examined; four lesions were discovered on his back but he was otherwise normal. Our cases comprise the sixth affected family to be reported in the medical published work and all lesions had appeared prepubertally.