The effects of sebum configuration on Demodex spp. density.

BACKGROUND/AIM: Demodex spp. are ectoparasites living in the pilosebaceous units, which feed on the host's sebum and cellular proteins. The protective barrier of the skin consists of sebum secretion, moisture, and the acid mantle. In this study, we aimed to determine the effects of skin sebum, moisture, pH levels, and sebum configuration on Demodex spp. density. MATERIALS AND METHODS: Forty-five patients who had demodicosis were enrolled in the study group, while the control group consisted of 40 subjects without demodicosis. Body fat percentage, serum triglyceride and cholesterol levels, skin sebum, moisture, and pH levels were measured. Demodex spp. density was determined with a standardized skin surface biopsy. Sebum samples were taken from the forehead and a high-performance thin-layer chromatography (HPTLC) method was performed on these samples. Subsequently, densitometric analyses were applied to the HPTLC plates. RESULTS: Demodex spp. were found on the cheeks and lived in an alkali environment. Skin sebum and moisture levels were low in all groups. The skin pH levels and cholesterol ester in the sebum configuration were determined to be significantly higher in the group with demodicosis. CONCLUSION: We suggest that Demodex spp. may use cholesterol ester in the sebum as nutriment. In other words, cholesterol ester may be a suitable growth medium for the proliferation of Demodex spp.

Investigation and analysis of a human orf outbreak among people living on the same farm.

Human orf is a viral zoonotic infection caused by Parapoxvirus. The skin lesions of human orf can be misdiagnosed as cutaneous anthrax leading to overtreatment and also fear. This study was conducted to analyze an outbreak which led to deaths among kids and lambs in the same flock, and skin lesions in some persons who were living on the same farm that were initially diagnosed as cutaneous anthrax by a practitioner. Eight patients with skin lesions and eleven persons who had no skin lesion were considered as patients and control groups, respectively. The cultures obtained from the lesions of all patients were negative for Bacillus anthracis. The diagnosis of skin lesions was done by clinical findings, histopathological examination and PCR as human orf. To be under 20 years of age, direct contact with the animals, and contact with flayed skin of sick animals were the risk factors for human orf (Odds Ratio 7.5; 95% Confidence Interval 1.02-54.54, OR 12.25; 95% CI:1.3-100.9, OR 16.67; 95% CI:1.65-148.20, respectively). Orf should be kept in mind in the differential diagnosis of skin lesions resembling anthrax. For control and prevention of orf, transmission routes should be known; good hand hygiene and other personal protective measures have to be implemented.

Evaluation of 23 cutaneous anthrax patients in eastern Anatolia, Turkey: diagnosis and risk factors.

BACKGROUND: Anthrax is a potentially fatal zoonotic disease. The diagnosis of cutaneous anthrax (CA) may be very difficult, particularly in atypical presentations and nonendemic regions. AIM: To evaluate the clinical features and diagnostic difficulties of 23 anthrax cases seen between May 2004 and September 2006. METHODS: Twenty-three patients with CA were included in this study. The diagnosis of CA was based on clinical findings and/or microbiologic procedures. RESULTS: All patients with a diagnosis of CA were followed up. One patient experienced toxemic shock. Twenty-two patients had a history of animal contact. Only one patient did not recall any history of suspicious contact. The clinical presentation of CA was typical in 20 patients (87%). Two patients were initially misdiagnosed with insect bites and one patient with angioedema. Cultures from the lesions were positive for Bacillus anthracis in seven cases (30.4%). Gram stain from the lesions revealed Gram-positive rods in eight cases (34.8%). Fifteen patients (65.2%) were diagnosed by clinical presentation and a history of contact with sick animals and/or contaminated animal products. CONCLUSION: CA is a very contagious and important infectious disease worldwide. Early and accurate diagnosis dramatically affects the prognosis of the disease. The diagnosis of CA may be difficult, especially in atypical presentations and nonendemic areas. Thus, CA should be kept in mind, especially in these situations.

Ciprofloxacin-induced urticaria and tenosynovitis: a case report.

BACKGROUND: Tendon disorders are rare events associated with fluoroquinolone congestion. Skin reactions are more frequent than tendon disorders. We reported this case as the combination of ciprofloxacin-induced urticaria and tenosynovitis has been unreported in young women. CASE: A 28-year-old woman without underlying disease developed urticarias and tendinopathy 4 days after the initiation of ciprofloxacin treatment for urinary infection. MRI of the left foot revealed increased synovial fluid surrounding the tendon of the flexor hallucis longus muscle representing tenosynovitis. Ciprofloxacin was ceased due to the possibility of ciprofloxacin-induced tendinopathy and urticaria. Complete resolution of her symptoms and findings occurred 3 days after discontinuation of ciprofloxacin without any additional treatment. CONCLUSION: Early discontinuation of fluoroquinolone therapy when tendinopathy is suspected is the basis of therapy. So, it should be kept in mind that fluoroquinolone-induced tendinopathy may occur in an otherwise healthy young patient with no risk factors and in a site other than the Achilles tendon.

Diagnostic potential of serum N-terminal pro-B-type brain natriuretic peptide level in detection of cardiac wall stress in women with polycystic ovary syndrome: a cross-sectional comparison study.

BACKGROUND: In addition to the negative effect on fertility, polycystic ovary syndrome (PCOS) has been associated with cardiac pathology. Brain natriuretic peptide (BNP) is a possible marker for cardiac risk, therefore we investigated whether N-terminal pro-B-type BNP (NT-proBNP) increases in women with PCOS compared with healthy women of comparable age and body mass index. METHODS: Thirty women with PCOS and 30 healthy women not suffering from overt cardiac disease were involved in the study. Fasting insulin and serum NT-proBNP levels were measured, and M-Mode echocardiography was performed. Insulin resistance was calculated using the homeostasis model assessment insulin resistance index (HOMA-IR). RESULTS: PCOS subjects had higher NT-proBNP levels than the control subjects (P < 0.001). Abnormal echocardiography indices were detected in 14 of the PCOS subjects (but none of the controls), including valvular heart disease in nine, diastolic dysfunction in two, right ventricular enlargement in one, right atrial enlargement in one and pulmonary hypertension in one. PCOS subjects (n = 30) showed an increased left ventricular mass (LVM) (P < 0.001) and left ventricular posterior wall thickness (LVPWT) (P = 0.006). In addition, NT-proBNP concentration was positively correlated with LVM (r = 0.587, P = 0.001) and negatively correlated with sex-hormone-binding globulin (r = -0.528, P = 0.003). There was a positive correlation between LVM and HOMA-IR (r = 0.295, P = 0.03) while LVPWT was positively correlated with fasting insulin and HOMA-IR (r = 0.335, P = 0.031 and r = 0.346, P = 0.045, respectively) in PCOS subjects (n = 30). CONCLUSION: The present study demonstrated that the level of NT-proBNP was increased in PCOS subjects with asymptomatic heart disease.

Excretion rate and composition of skin surface lipids on the foreheads of adult males with type IV hyperlipoproteinemia.

OBJECTIVES: Most of the lipids of the skin surface come from sebaceous glands secretions, called sebum. Some of the sebum lipids are synthesized by sebaceous cells while some are reportedly derived from the plasma. Role of blood lipoproteins in sebum secretion rate and composition is unclear. To this end, excretion rate and composition of skin surface lipids of normo- and type IV hyperlipoproteinemic subjects were compared. DESIGN AND METHODS: Quantitative analysis of skin surface lipids was performed by three successive sampling on left, middle, and right zones of the forehead with a sebumeter. Skin surface lipid samples for the compositional analysis were collected from the forehead, extracted into n-hexane, and analyzed by high performance thin layer chromatography (HPTLC). HPTLC plates were scanned with a densitometer for the quantification of the lipids. RESULTS: Skin surface lipids from type IV hyperlipoproteinemic subjects contained higher proportion of wax ester + cholesterol ester compared with that from normolipoproteinemic subjects. However, skin surface lipid excretion rates of normo- and hyperlipoproteinemic subjects were found to be similar. CONCLUSIONS: Plasma lipid/lipoprotein concentration may be a determinant factor in sebum lipid composition.

Is metronidazole 0.75% gel effective in the treatment of seborrhoeic dermatitis? A double-blind, placebo controlled study.

The study aimed to evaluate the effectiveness of metronidazole 0.75% gel in patients with mild and moderate seborrhoeic dermatitis. Sixty-seven patients with seborrhoeic dermatitis were enrolled. Cases were randomly treated with metronidazole 0.75% gel or placebo for four weeks and were additionally followed up for another four weeks. Patients were evaluated by scoring before the treatment, once a week during the treatment and twice after the cessation of the treatment within a 15-day interval. Furthermore, patient satisfaction and doctor global evaluation were done at the end of the treatment and of the study as well. In the metronidazole group 33 patients (median age: 26, total severity score: 15.0 +/- 11.0 (median +/- interquartile range) and in the placebo group 34 patients (median age: 26, total severity score: 13.0 +/- 7.5) were enrolled in the study. Three patients from the metronidazole group and four patients from the placebo group did not attend to follow-up visits. Erythema, scales, papule, pruritus and the total severity scores in both group decreased significantly during the treatment when compared with the basal levels (p < 0.05). There was no difference between the two groups in terms of efficacy (p > 0.05). Total severity scores were found as 7.33 +/- 1.08 and 6.43 +/- 0.93 in the metronidazole and placebo groups at the end of the treatment, respectively. After the cessation of the treatment, all scores had increased rapidly. Total severity scores were 10.40 +/- 1.54 and 11.20 +/- 1.53 in the metronidazole and placebo groups one month after the cessation of the treatment, respectively. Both metronidazole 0.75% gel and the placebo were well tolerated by the patients. In conclusion, in the treatment of seborrhoeic dermatitis, administration of metronidazole 0.75% gel is well tolerated but it is only as effective as placebo and the disease severity quickly returns to the basal levels after the cessation of treatment.

High prevalence of glucose metabolism disturbance in patients with lichen planus.

AIM: To establish the prevalence of diabetes mellitus (DM) and insulin resistance in patients with lichen planus (LP), and to examine whether diabetic status showed any relation with the type of LP. PATIENTS AND METHODS: Thirty patients with LP and 30 age, weight, and sex matched volunteers were included. Serum fasting glucose, insulin, hemoglobin A1c levels were determined, a standard oral glucose tolerance test (OGTT) was performed. RESULTS: Of patients with LP, eight (26.7%) had DM (four newly diagnosed), however, only one (3.33%) diagnosed as DM in control group (p=0.007). Six patients (20.0%) with LP and four healthy persons (13.3%) had IGT (p>0.05). Glucose metabolism disturbance (DM+IGT) was detected in 14 (46.7%) of the patients and in 5 (16.7%) of the controls (p=0.026). HbA1c, fasting serum glucose, and insulin resistance (HOMA) were statistically higher in patients compared to controls. CONCLUSION: Our finding documented that approximately one half of the patients with LP had glucose metabolism disturbance, and one fourth had DM. We believe that further studies are needed to explain this close relationship between DM and LP.

Psoriasis in childhood and adolescence: evaluation of demographic and clinical features.

BACKGROUND: The present study was aimed to define the gender ratio, familial occurrence, age of onset, precipitating factors, clinical types, nail and joint involvement of psoriasis in childhood and adolescence in Turkey. METHODS: A total of 61 children with psoriasis under 18 years old were evaluated retrospectively, for age, gender, age of disease onset, family history, concomitant disease, the clinical type of psoriasis, clinical localization, nail and joint involvement and treatment modalities. RESULTS: Of the patients, 23 (37.70%) were boys and 38 (62.30%) were girls. Mean age was 9.28 +/- 4.02 years in girls and 11.18 +/- 3.85 years in boys (9.96 +/- 4.03 years in all children). Mean age at the onset of the disease was 6.81 +/- 4.11 years in girls and 7.03 +/- 4.28 years in boys (6.89 +/- 4.14 years in all patients). In 14 (23%) cases, a positive family history was detected. The most frequent probable triggering factors were upper respiratory tract infections (14.8%) and positive throat culture for A group ss-hemolytic streptococcus (21.3%). Frequency of emotional stress and psychiatric morbidity were 54% and 9.8%, respectively. The most frequent localizations at onset were trunk (44.3%), extremities (54.0%), and scalp (36.0%). Three children (4.9%) had a history of dissemination from psoriatic diaper rash. In total, 51 (83.6%) patients presented with psoriasis vulgaris, eight (13.1%) with generalized pustular psoriasis, and the remaining two (3.3%) with erythrodermic psoriasis. CONCLUSION: The incidence of psoriasis among dermatological patients in childhood and adolescence was 3.8%. The disease tends to appear earlier in girls than boys. The authors suggested that stress and upper respiratory infections are the most important triggering factors in childhood and adolescence psoriasis.

Increased micronucleus frequencies in peripheral blood lymphocytes in women with polycystic ovary syndrome.

OBJECTIVE: We aimed to assess possible genomic instability in women with polycystic ovary syndrome (PCOS). DESIGN: The frequency of micronuclei in cultured peripheral lymphocytes was used as a biomarker of genomic instability in somatic cells. METHODS: Nineteen women, diagnosed with PCOS and 19 healthy female volunteers of corresponding ages and body-mass index (BMI) were included in the study. Micronuclei frequencies were assessed in cytokinesis-blocked lymphocytes. RESULTS: The frequency of micronucleated cells (per thousand) was 9.00 (5.00) (interquartile range in parentheses) for patient group and 3.0 (3.0) for the control group (P < 0.0001, Mann-Whitney U-test). The serum levels of follicle-stimulating hormone (FSH), estradiol, prolactin, glucose and dehydroepiandrosterone sulfate (DHEAS) and the homeostasis model of assessment of insulin resistance (HOMA-IR) were not different between the two groups (P > 0.05). Serum total testosterone, luteinizing hormone (LH) and insulin levels and hirsutism score in the PCOS group were significantly (P = 0.007, P < 0.0001, P = 0.009 and P < 0.0001 respectively) higher than those of the control group (2.3 (2.1) nmol/l vs 1.7 (0.4) nmol/l; 8.5 (5.88) mU/ml vs 4.8 (4.4) mU/ml; 6.8 (5.1) microU/ml vs 9.7 (4.2) microU/ml; 19.5 (6.5) vs 4.0 (2.5) respectively). However, the mean level of sex hormone-binding globulin (SHBG) in PCOS group was significantly (P = 0.004) lower than in control group (36.4(22.6) nmol/l vs 48.6(25.2) nmol/l respectively). CONCLUSION: These findings suggest that women with PCOS have a high incidence of genomic instability, and this condition is positively correlated with the hirsutism score, BMI, LH and serum total testosterone and insulin levels, and is negatively correlated with SHBG.

Neurofibromatosis type 1: diffusion weighted imaging findings of brain.

PURPOSE: The purposes of this study were to evaluate the differences in apparent diffusion coefficient (ADC) values between infra and supratentorial unidentified bright objects (UBOs), between UBOs and normal appearing side (NAS, contralateral regions of the UBOs and/or normal appearing region without UBOs) in the neurofibromatosis type 1 patients (NF1) and control group and also to investigate correlation between age and ADC values. METHODS: A total of 30 patients and 26 healthy controls were included. The MRI examination consisted of routine imaging and diffusion weighted imaging (DWI). Seven distinct locations (frontal, parieto-occipital and cerebellar white matter, globus pallidum, thalamus, hippocampus, and midbrain) were selected for the analysis. The ADC values were calculated directly from these automatically generated ADC maps with ROI. RESULTS: The ADC values of UBOs were significantly increased in cerebellar white matter, hippocampus, globus pallidum, midbrain, and thalamus when compared with NAS and control group. There were statistically significant differences between NAS and control group in the ADC values obtained from hippocampus and thalamus. There were statistically significant differences between supra and infratentorial UBOs in ADC values. There was a negative correlation between age and the ADC values obtained from normal appearing midbrain, hippocampus, thalamus, and globus pallidum. CONCLUSION: ADC values both in UBOs and in the normal appearing locations as hippocampus and thalamus were detected to be higher in the patients with NF1. The detection of lesions might be independent of MRI appearance in NF1, i.e. although the brain is affected, MRI appearance may be normal. Therefore, DWI and ADC values should also be utilized in the delineation of brain involvement of NF1 patients.

Proton MR spectroscopy features of normal appearing white matter in neurofibromatosis type 1.

To determine whether differences exist between neurofibromatosis type 1 (NF1) patients with or without focal lesions and healthy normal volunteers in the metabolite ratios of normal appearing white matter, 27 patients with NF1 (with parenchymal lesion, MR positive, n: 17; without parenchymal lesions, MR negative, n: 10) and 20 healthy volunteers underwent MRI and short TE (31 ms) proton MR spectroscopy (MRS). In 17 patients with parenchymal lesions, 61 focal lesions were detected by MRI. MRS was performed from normal appearing frontal and posterior parietal white matter (FWM and PWM) in NF1 and from control groups. NAA/Cr, Cho/Cr and MI/Cr ratios were calculated. Significant increase in Cho/Cr and MI/Cr ratios were found in FWM and PWM in MR negative and positive groups when compared to control group. NAA/Cr ratio in MR positive group was significantly decreased in FWM compared to control group. There were no significant differences between FWM and PWM in all metabolite ratios of MR negative group. MI/Cr ratio in MR positive group was significantly elevated in PWM compared to FWM. Metabolite changes detected by MRS could indicate demyelination and gliosis in normal appearing white matter in all NF1 patients, and additionally neuroaxonal damage in the FWM of NF1 patients with focal lesions. For that reason, in the clinical evaluation and follow-up of these patients MRS features of normal appearing white matter should be considered in addition to focal lesions.