The increase in neglected cutaneous leishmaniasis in Gaziantep province of Turkey after mass human migration.

Outbreaks of Cutaneous Leishmaniasis (CL) due to war-related factors have been reported in different areas in Turkey and Syria. CL has become the most serious of the infectious diseases which have been reported in Gaziantep in southeast Turkey, during the last three years due to the influx of Syrian refugees. The present research involves an analytical cross-sectional epidemiological study of CL cases diagnosed in the Gaziantep Leishmaniasis Diagnosis and Treatment Center. The patient demographic data, the location of the lesions, the number of the lesions, the duration of the lesions, and the treatment of the lesions are included. The diagnosis of CL was made by microscopic examination of smears in all cases, and 81.1% (900/1110) of which were found to be positive. Out of 900 CL patients, 93.8% (845/900) were Syrian citizens and 6.2% (55/900) were Turkish citizens. The disease was more frequent in females with 53.5% (482/900) and in the age group between 0-20 years with 68.3% (615/900). Distribution of lesions in the body showed that the face was the most affected location with 37% (333/900), and the generation time of lesions was 0-6 months with 71.2% (641/900). 94.7% (852/900) of the CL patients healed without relapse, and 5.3% (48/900) of the CL patients relapsed. CL patients have re-emerged in Gaziantep, located in the southeast of Turkey, as a result of Syrian refugees. The increase in CL frequency is alarming and requires control and prevention measures in highly infected areas including this region.

Clinical practice guidelines for the diagnosis and treatment of cutaneous leishmaniasis in Turkey.

BACKGROUND: Cutaneous leishmaniasis (CL) is a vector-born parasitic disease characterized by various skin lesions that cause disfiguration if healed spontaneously. Although CL has been endemic for many years in the southern regions of Turkey, an increasing incidence in nonendemic regions is being observed due to returning travelers and, more recently, due to Syrian refugees. Thus far, a limited number of national guidelines have been proposed, but no common Turkish consensus has emerged. OBJECTIVES: The aim of this study was to develop diagnostic and therapeutic guidelines for the management of CL in Turkey. METHODS: This guideline is a consensus text prepared by 18 experienced CL specialists who have been working for many years in areas where the disease is endemic. The Delphi method was used to determine expert group consensus. Initially, a comprehensive list of items about CL was identified, and consensus was built from feedback provided by expert participants from the preceding rounds. RESULTS: Evidence-based and expert-based recommendations through diagnostic and therapeutic algorithms according to local availability and conditions are outlined. CONCLUSION: Because CL can mimic many other skin diseases, early diagnosis and early treatment are very important to prevent complications and spread of the disease. The fastest and easiest diagnostic method is the leishmanial smear. The most common treatment is the use of local or systemic pentavalent antimony compounds.

Genotyping Leishmania promastigotes isolated from patients with cutaneous leishmaniasis in south-eastern Turkey.

Objective Cutaneous leishmaniasis (CL) is a significant disease in south-eastern Anatolia because it is prevalent among Syrian refugees. We identified the causative Leishmania species in CL patients using molecular methods. Methods Novy-MacNeal-Nicolle medium was inoculated with aspirated fluid from suspected CL lesions and tested for amastigotes with Giemsa staining. PCR amplified the internal transcribed spacer 1 (ITS1) of the Leishmania genome in cultures containing Leishmania promastigotes from 100 patients, which were genotyped with a restriction fragment length polymorphism (RFLP) analysis. A phylogenetic tree was constructed from ITS1 sequences of 95 culture fluid samples from these patients. Results Leishmania amastigotes were detected in 92% of cultures with growth. Leishmania promastigotes were typed as Leishmania tropica with both PCR-RFLP and sequencing. Conclusions Identification of L. tropica as the causative agent of CL in our region allows the clinical course to be predicted, and guides treatment decisions and preventive measures.

[The Assesment of Cutaneous Leishmaniasis Patients Admiting to Gaziantep University of Medicine Faculty Leishmaniasis Diagnosis and Treatment Center]. / Gaziantep Üniversitesi Tip Fakültesi Leishmaniasis Tani ve Tedavi Merkezine Basvuran Kutanöz Leishmaniasis Olgularinin Degerlendirilmesi.

OBJECTIVE: Cutaneous Leishmaniasis (CL) is a curable clinical condition characterized by atrophic scars caused by the Leishmania species of protozoan parasites. In the period following the beginning of the Syrian Civil War, there has been a dramatic increase in number of CL cases in Gaziantep. The aim of this study was to evaluate the epidemiological characteristics of CL patients admitted to Gaziantep University of Medicine Faculty Leishmaniasis diagnosis and treatment center in Gaziantep. METHODS: Within the context of this study, a total of 635 CL patients admitted between 01 April 2013 and 01 April 2014 to the Leishmaniasis diagnosis and treatment center of the Gaziantep were evaluated retrospectively. Patient data regarding age, sex, the location of lesions, the number of lesions, the duration of the lesions, and the months in which the lesions appeared were recorded and statistically analyzed. RESULTS: Of these patients, 67 (10.6%) were Turkish citizens, while 568 (89.4%) were Syrian citizens. In addition, 299 (47.1%) of the patients were female, while 336 (52.9%) were male. The large majority of the cases were between 5-9 (n=140, 22%) and 10-19 (n=168, 26.5%) years of age; 66% of all cases were below 20 years of age. An evaluation of the distribution of cases according to the months revealed that the lowest number of cases occurred in the months of July (n=14, 2.2%) and August (n=13, 2.0%), while the highest number of cases occurred in the months of January (n=122, 19.2%) and February (n=106, 16.7%). CONCLUSION: Cutaneous Leishmaniasis is a condition that affects individuals of all ages and genders. It is thus necessary to conduct regular health screenings for Cutaneous Leishmaniasis, and to inform and educate vulnerable communities and the society in general regarding this condition.

Serum concentrations of interleukin-2 and tumour necrosis factor-α under cyclosporine versus acitretin treatment in plaque-type psoriasis.

OBJECTIVE: A prospective, randomized clinical study to compare the short-term effects of cyclosporin and acitretin on psoriasis severity, and serum interleukin (IL)-2 and tumour necrosis factor (TNF)-α concentrations. METHODS: Patients with moderate-to-severe plaque-type psoriasis were randomly assigned to receive either 3 mg/kg per day cyclosporine or 0.3-0.5 mg/kg per day acitretin for 8 weeks. Disease severity (psoriasis area severity index [PASI] score) and serum IL-2 and TNF-α concentrations were determined before and after treatment. RESULTS: PASI scores and serum IL-2 and TNF-α concentrations were significantly decreased after treatment with either cyclosporine (n = 21) or acitretin (n = 25). There were no statistically significant between-group differences in any parameter. CONCLUSIONS: Acitretin and cyclosporine are equally effective in the treatment of moderate-to-severe plaque-type psoriasis.

Role of oxidative stress in the pathogenesis of vitiligo with special emphasis on the antioxidant action of narrowband ultraviolet B phototherapy.

OBJECTIVES: To evaluate the role of oxidative stress in the pathogenesis of vitiligo and the effect of narrowband (NB) ultraviolet (UV) B phototherapy on oxidative stress markers. METHODS: Patients with vitiligo and healthy control subjects were included in the study. Patients in the vitiligo group were treated with an NB-UVB regimen (3 × weekly for 6 months). Erythrocyte superoxide dismutase activity (SOD), erythrocyte malonyldialdehyde (MDA) and erythrocyte glutathione peroxidase activity (GSH-Px) levels were assessed in all participants at baseline, and after NB-UVB phototherapy in patients with vitiligo. RESULTS: A total of 24 patients with vitiligo and 27 control subjects were included in the study. Before treatment, erythrocyte MDA levels were significantly higher, and SOD and GSH-Px levels were significantly lower, in patients with vitiligo compared with controls. NB-UVB phototherapy was associated with a significant reduction in MDA levels and a significant increase in GSH-Px levels, compared with baseline, in patients with vitiligo. CONCLUSION: NB-UVB phototherapy may relieve oxidative stress in patients with vitiligo by reversing the oxidant-antioxidant imbalance that is considered to play a role in the pathogenesis of this disease.

Extensive inflammatory nevus comedonicus involving half of the body.

Nevus comedonicus is an uncommon variant of adnexal hamartoma without known cause. It usually occurs on the face, neck and chest and appears as groups of closely arranged dilated follicular openings with keratin plugs. We report extensive inflammatory nevus comedonicus in a 14-year-old boy involving half of his body, limited by the midline, with suppuration and residual scarring. The lesions first appeared at 3 years of age and worsened at the start of puberty. The clinical features, etiopathology, histopathology and treatment options of nevus comedonicus are briefly reviewed in the light of the literature.

Facial linear focal elastosis: a case report.

BACKGROUND: Linear focal elastosis is an uncommon disorder that clinically shows band-like stria and a histological focal increase in elastic fibers. The disorder preferentially affects men after the age of 60 years and occurs on the lower back. The pathogenesis of linear focal elastosis is still somewhat of an enigma. METHOD: A 50-year-old farmer presented with an unusual linear lesion on the left side of his chin. The patient was frequently exposed to sun because of fieldwork for a period of more than 40 years. RESULTS: Skin biopsy specimen revealed a massive abnormal collagen deposition extending from the subpapillary dermis to the lower dermis with numerous wavy bundles of fibers. Elastin van Gieson stain for elastic fibers showed that abnormal elastic fibers were increased within a massive abnormal collagen deposition. Diagnosis of facial linear focal elastosis was made after clinicopathological correlation. CONCLUSION: Facial involvement of linear focal elastosis has not been reported previously in the literature. It has been suggested that sunlight has a minor role in the development of elastotic change in linear focal elastosis. However, our patient was a farmer and was exposed to sunlight frequently for a period of more than 40 years, suggesting that ultraviolet radiation may play a role in the pathogenesis of linear focal elastosis.