Nailfold capillaroscopic changes of sleep apnea patients.

BACKGROUND: Obstructive Sleep Apnea Syndrome (OSAS) have frequent association with comorbidities and this makes it an independent risk factor for cardiovascular disease. Not only endothelial dysfunction, but also arterial stiffening, increased inflammatory mediators, oxidative stress after hypoxemia that develops due to OSAS, cause vascular pathologies in all diameters of vessels. Nail bed capillaroscopy is a simple, noninvasive, useful method to examine microcirculation and evaluate nail bed capillary abnormalities in diseases that cause vascular damage. The aim of this study is to examine microvascular changes in the nail bed of OSAS patients by capillaroscopy. METHODS: 59 OSAS patients and 60 healthy cases (totally 119) were included. One single attended polysomnography was applied with Embla N7000 series (RemLogic Eastmed, Natus); and apnea-hypopnea index (AHI), oxygen de-saturation index >4% (ODI4%), minimum oxygen saturation (SaO2 Min.), total duration of oxygen desaturation, comorbidities, body mass index (BMI), smoking habit, sleep questionnaire applications were analyzed. Nailfold capillaroscopy was performed using a digital dermoscope (Molemax II, X30) and all images were evaluated for capillary density, capillary loop enlargement, capillary tortuosity, branching vessels, micro hemorrhages, avascular areas and splinter hemorrhages. RESULTS: The prevalence rates of all capillaroscopy findings were significantly higher in the patient group (p < 0.05). There was an inverse and moderate relationship between AHI and mean saturation (p < 0.05). A statistically significant correlation was detected between the presence of hypertension (HT) and the severity of capillary tortuosity (CT) (p = 0.002), avascular area (AA) (p = 0.004), and periungual cyanosis (PUC) (p = 0.042); also between smoking habit and intensity of capillary dilatation, enlargement dilatation-enlarged giant capillaries (CELON) (p = 0.004), CT (p = 0.018) findings. Capillary distribution (CD), CELON, CT and AA findings were significantly higher in the group with low mean saturation (p < 0.05). DM was found to be significantly higher in individuals with high Epworth Sleep Scale (ESS) (p = 0.035). CONCLUSION: In this study; 1) the nail bed capillaroscopy was used to examine vascular damage in OSAS, and 2) irregularities detected in the distal nail bed specific to a disease have been mentioned for the first time. It has been shown that endothelial damage is particularly related to the severity of hypoxia. HT and smoking history causes endothelial damage independent of the severity of the disease and hypoxia. Also, ESS may be more determinant in the screening of sleep disorders in diabetic patients.

The effects of 755 nm alexandrite laser on skin dryness and pruritus.

INTRODUCTION: The alexandrite laser (AL) is a very safe and effective treatment used for unwanted hair removal with a reported success rate of 40% to 80% at 6 months and after several treatment sessions. Although a diffuse variety of side effects has been observed during laser treatment, changes in skin dryness and pruritus before and after AL epilation have not been reported yet to the best of our knowledge. AIM: To investigate the effects of 755 nm alexandrite laser on skin dryness and pruritus at the beginning and in the third and the sixth month after the treatment. MATERIAL AND METHODS: Forty three patients with Fitzpatrick skin types of II-IV aged 18-45 with leg hair were included in this prospective study. Patients were treated with 755 nm alexandrite laser with 10-12 mm spot size. According to the skin phototype, the settings of the laser were as follows: 12-22 J/cm² and pulse width of 3 ms. For self-assessment by the patient, the visual analogue scale (VAS) was used before, at the third and sixth month of the treatment as to skin dryness and pruritus. The patients were evaluated by the same dermatologist with the same VAS. The values were compared between before-at the third month, before-at the sixth month and at the third and at the sixth month of the treatment. RESULTS: Pruritus scores were statistically lower at the third month when compared with the baseline scores (p < 0.01). However, there was no difference between the third and sixth month of the treatment as to pruritus scores (p > 0.05). There was a statistically significant difference between the scores before the treatment and the scores at the third month and at the sixth month as to skin dryness (p < 0.001). However, the difference was not prominent between the third and sixth month scores of skin dryness (p > 0.05). CONCLUSIONS: To the best of our knowledge, this is the first study researching the effects of AL on pruritus and skin dryness. Further studies with larger samples and longer follow-up periods will be able to better clarify the association.

Red Cell Distribution Width and Mean Platelet Volume in Patients With Pityriasis Rosea.

BACKGROUND: Pityriasis rosea (PR) is an inflammatory skin disorder of unknown etiology. However, it is suggested to be related with the reactivation of human herpes virus 7 (HHV-7) and/or HHV-6. It is sometimes diffucult to distinguish PR from PR-like drug eruptions and other inflammatory disorders, so we need new parameters which are cheap and easy in determining PR. Red blood cell distribution width (RDW) and mean platelet volume (MPV) have been studied as inflammatory markers in recent studies. However, the RDW and MPV in PR patients have not been investigated. This is the first study investigating RDW and MPV parameters in PR. METHODS: This was a retrospective study of 127 patients and 127 healthy controls. MPV, RDW and the other laboratory tests were recorded. RESULTS: RDW levels of patients with PR were significantly lower than those of the controls (13.66 ± 2.68 and 14.00 ± 1.39, P < 0.01). The other inflammatory markers such as MPV (9.97 ± 0.99 and 10.0 ± 1.06, P = 0.7) and platelet (2.66.29 ± 62.85 and 277.41 ± 63.50, P = 0.3) were studied and statistically significant differences were not obtained. There were no significant differences found between the patient group and healthy controls in terms of hemoglobin, hematocrite, C-reactive protein (CRP), sedimentation, mean corpuscular volume (MCV), aspartate aminotransferase (AST), red blood cell (RBC), alanine aminotransferase (ALT), blood urea nitrogen (BUN), and creatinine parameters (P > 0.05). CONCLUSION: RDW can be used as a marker in diagnosing PR.

Analysis of manganese superoxide dismutase (MnSOD Ala-9Val) and glutathione peroxidase (GPx1 Pro 198 Leu) gene polymorphisms in psoriasis.

Recent studies have suggested the involvement of increased reactive oxygen species levels and decreased antioxidant system functions in psoriasis pathogenesis. In this study, we aimed to examine to investigate possible associations between the manganese superoxide dismutase (MnSOD Ala-9Val) and glutathione peroxidase (GPx1 Pro198Leu) polymorphisms and psoriasis susceptibility and disease progression in a Turkish population. The study group consisted of 100 unrelated patients with psoriasis and 167 unrelated healthy controls. Genomic DNA was extracted from peripheral leukocytes of whole blood which were obtained from all patients and control subjects. Genotyping was performed to identify MnSOD Ala-9Val and GPx1 Pro198Leu polymorphisms by a method based on PCR amplification and detection of polymorphisms with hybridization probes labeled with fluorescent dyes. Genotype and allele frequencies were compared between patients with psoriasis and 106 healthy control subjects. There was no significant difference between the MnSOD Ala-9Val single nucleotide polymorphism (SNP) genotype distributions and allele frequencies of the psoriasis patients and the control group (p = 0.99 and p = 0.89, respectively). There was also no significant difference between distributions of the genotype or allele frequencies of the GPx1 Pro198Leu SNP of the patient groups and control subjects (p = 0.99 and p = 0.96, respectively). Also, no significant difference was found between clinical severity of psoriasis and MnSOD Ala-9Val and GPx1 Pro198Leu polymorphism. This is the first report investigating the possible associations between the MnSOD Ala-9Val and GPx1 Pro198Leu polymorphisms and psoriasis susceptibility and disease progression in the Turkish population even if no significant difference was found between patient groups and control subjects. Further studies with large cohort on different populations and ethnicities will be able to better clarify the association.

Irritant nail dermatitis of chemical depilatory product presenting with koilonychia.

Chemical hair removal products are available as creams, gels, powders, aerosols and roll-ons and all of these forms work in the same way by breaking chemical bonds between sulfur atoms in the protein. Currently, the common active ingredients of these products are calcium thioglycolate, potassium thioglycolate, arsenic and sulfur minerals. Sulfur and arsenic containing products are important toxic chemicals which are mainly used for removing hair in developing countries. Irritant contact dermatitis accounts for 80% of all contact dermatitis reactions which are often occupation-related. Toluene sulfonamide, formaldehyde resin, acrylates and ethylcyanoacrylate are the most common irritants. Irritant nail dermatitis with plants has been well defined with Lobelia richardii flower, Compositae family and garlic. Although allergic dermatitis, irritant dermatitis and irritant nail dermatitis have been well demonstrated with chemicals, koilonychia is unusual presentation of irritant dermatitis. Here we describe a case of nail irritant dermatitis due to application of chemical depilatory product for hair removal presented with koilonychias. To our knowledge this is the first case of such presentation with koilonychia in the English literature.

Methylenetetrahydrofolate reductase C677T mutation in patients with alopecia areata in Turkish population.

OBJECTIVE: Methylene-tetrahydrofolate reductase (MTHFR) is a key enzyme regulating folate metabolism and it is thought to influence DNA methylation and nucleic acid synthesis. Mutations in the MTHFR gene have been associated with several autoimmune disorders in previous studies. Alopecia areata (AA) is considered to be a tissue-specific autoimmune disease as the hair follicle has been targeted and antibodies to their own hair follicle structures have been developed. Since there is a common shared pathway between AA and other autoimmune disorders, we aimed to investigate a possible association between the MTHFR gene C677T mutation and AA susceptibility in the Turkish population. METHODS: The study included 136 patients affected by AA and 130 healthy controls. Genomic DNA was isolated and genotyped using a polymerase chain reaction (PCR)-based restriction fragment length polymorphism (RFLP) assay for the MTHFR gene C677T mutation. RESULTS: The distributions of genotype and allele frequencies of MTHFR gene C677T mutation were statistically different between AA patients and the control group (p=0.036 and p=0.011, respectively). High differences were also observed when the patients and controls were compared according to CC versus CT+TT (p=0.012). CT+TT genotypes and T allele of MTHFR gene C677T mutation were found to be a susceptibility factor for AA in the Turkish population. CONCLUSION: The results suggest that MTHFR gene C677T mutation may have an effect on the risk of alopecia areata in the Turkish population. This is the first study reporting the association between the MTHFR (C677T) genotype and AA.

Association of IL-4 gene VNTR variant with deep venous thrombosis in Behçet's disease and its effect on ocular involvement.

PURPOSE: Behçet's disease (BD) is a systemic vasculitis characterized by inflammatory lesions of the urogenital mucosa, eyes, skin, central nervous system, and joints. Vein thrombosis constitutes the most frequent vascular manifestation of the disease, and may cause such ocular vascular thrombotic events as central retinal vein and central retinal artery thrombosis. Thrombosis is a serious problem, and often leads to irreversible vision loss. Previous studies have shown that genetic factors predispose individuals to BD. Several cytokine genes might play crucial roles in host susceptibility to BD and to thrombophilia. Various polymorphic regions of the interleukin-4 (IL-4) gene (-1098G and 590T) are associated with BD in the Turkish population. This study was conducted in Turkish patients with BD to determine the frequency of the IL-4 gene 70 bp variable number of tandem repeats (VNTR) variant, and its association with clinical findings. METHODS: Genomic DNA obtained from 488 individuals (238 patients with Behçet's disease and 250 healthy controls) was used in the study. Genomic DNA was isolated and genotyped using PCR assay for the IL-4 gene 70 bp VNTR polymorphism determined by using PCR with the specific primers. RESULTS: There was statistical significance between the groups regarding IL-4 genotype distribution (p<0.001, odds ratio: 2.55 [1.629-4.052], 95% confidence interval) and allele frequencies (p<0.0012.381[1.586-3.617], 95% confidence interval). When we examined IL-4 genotype frequencies according to the clinical characteristics, we observed a statistically significant association between the P2P2 genotype and deep venous thrombosis (p=0.01). Deep venous thrombosis was also associated with ocular involvement in our study group (p=0.014). CONCLUSIONS: Our findings suggest that the IL-4 gene 70 bp VNTR polymorphism is associated with susceptibility to development of BD. Deep venous thrombosis is also associated with ocular involvement in BD. The IL-4 gene could be a genetic biomarker in Behçet's disease in a Turkish study population.

Association between the methylene tetrahydrofolate reductase gene C677T mutation and colchicine unresponsiveness in Behcet's disease.

PURPOSE: Behcet's disease (BD) is a multisystemic immunoinflammatory disorder characterized by mucocutaneous, ocular, vascular, and central nervous system manifestations. The common methylene tetrahydrofolate reductase (MTHFR) gene C677T mutation is a known risk factor for thrombosis. The aim of this study was to investigate the MTHFR gene C677 mutation in patients with BD and evaluate if there was an association with clinical features, especially thrombosis, in a relatively large cohort of patients with BD. METHODS: The study included 318 patients with BD and 207 healthy controls. Genomic DNA was isolated and genotyped using PCR-based restriction fragment length polymorphism assay for the MTHFR gene C677T mutation. RESULTS: The genotype and allele frequencies of the C677T mutation showed a statistically significant difference between BD patients and controls (p=0.003 and p=0.001, respectively). There was also a significant association between C677T alteration and response to colchicine in BD patients (p=0.046). CONCLUSIONS: The results of this study showed that there was a high association between the MTHFR gene C677T mutation and BD. Stratification analysis according to clinical features for this disease did not reveal an association except response to colchicine that was shown to be influenced by the MTHFR C677T mutation.

Comparison of the 532-nm KTP and 1064-nm Nd:YAG lasers for the treatment of cherry angiomas.

BACKGROUND: Laser therapy is the treatment of choice for cherry angiomas since it is more effective and has better cosmetic results. There is no comparative study about the treatment efficacies with KTP and Nd:YAG lasers for cherry angiomas. OBJECTIVE: To compare the efficacy and side effects of 532-nm KTP and 1064-nm Nd:YAG lasers for the treatment of cherry angiomas. METHODS: Two comparable lesions of the same patient were chosen. One of them was treated with the KTP laser while the other was treated with the Nd:YAG laser. Sessions were repeated every 4 weeks until complete clearance was achieved. Side effects were evaluated using a severity scale (0 to 4). RESULTS: The number of sessions was significantly higher with the KTP than with the Nd:YAG laser (p = 0.002). Erythema, edema, pain and scar formation were higher in the Nd:YAG laser group (erythema: p = 0.001; edema: p < 0.001; pain: p < 0.001; scar: p < 0.001). The hyperpigmentation rate was statistically higher with the KTP laser (p = 0.01). CONCLUSION: Both KTP and Nd:YAG lasers were found to be effective methods. The Nd:YAG laser offered fewer treatment sessions, but a higher risk of scar formation. The KTP laser seems more advantageous, but in dark-skinned patients the Nd:YAG laser may be preferable.