Cutaneous changes in patients with chronic renal failure on hemodialysis.

CONTEXT: A number of skin diseases can be observed in chronic renal failure (CRF). Their incidence have changed in different series. OBJECTIVE: To compare the prevalence of cutaneous changes in CRF undergoing hemodialysis (HD) with healthy persons and to study the potential relationship with various parameters in the patients. MATERIALS AND METHODS: The study comprised one hundred patients with CRF under regular HD as well as one hundred healthy control subjects of matched age and sex. Both groups were subjected to full history and thorough skin examination. RESULTS: Numerous skin lesions (at least one in each patient) were detected in all patients examined. Of these patients, nail abnormalities were observed in 92%, xerosis in 87%, fungal infection in 68%, hyperpigmentation in 62%, pruritus in 51%, and paleness in 51%. The nail changes included absence of lunula (55%), half and half nail (51%), splinter hemorrhages (36%), subungual hyperkeratosis (34%), onychomycosis (31%), koilonychia (19%), and onycholysis (9%). Oral changes were oral candidiasis (50%), xerostomia (40%), angular cheilitis (27%), and ulcerative stomatitis (18%). Specific cutaneous findings such as acquired perforating dermatosis, pseudoporphyria cutanea tarda, calciphylaxis, calcinosis cutis, and nephrogenic fibrosing dermopathy were not detected in any of the patients. In our study, when the patients were evaluated on the relationship between xerosis and pruritus, pruritus was found to be significantly increased parallel to the increase in the severity of xerosis. CONCLUSIONS: Xerosis and pruritus are common problems in HD-dependent patients. The early recognition of cutaneous signs can relieve suffering and decrease morbidity.

Is "premature sebaceous hyperplasia" really a sebaceous hamartoma? Report of a case with neonatal onset.

Sebaceous hyperplasia is a common benign proliferation of the sebaceous gland. It commonly presents in middle-aged people as soft, yellow papules with central umbilication on the face, particularly on the forehead. We report a newborn with striking unilateral sebaceous hyperplasia and suggest that this may represent a unique sebaceous hamartoma rather than "premature sebaceous hyperplasia."

[Investigation of microsporidia in patients with acute and chronic urticaria]. / Akut ve Kronik Ürtikerli Hastalarda Microsporidia Pozitiflik Orani

Microsporidia species are one of the major causes of severe diarrhea especially in immunocompromised patients, however they also cause infections in immunocompetent subjects. Urticaria, which is a common dermatologic disease may be triggered by drugs, infections, foods or food additives, psychogenic factors and autoimmune, metabolic and malignant diseases. While the etiologic grounds of acute urticaria are generally identified, the etiology remains unknown in most of the chronic urticaria cases. The studies on the roles of parasitic infections in the etiology of urticaria have indicated that the most responsible protozoa are Giardia intestinalis and Blastocystis hominis. However, no data have been found in the literature concerning the relationship between Microsporidia and urticaria. The aim of this study was to investigate the presence of Microsporidia spores in the stool samples of patients diagnosed as acute or chronic urticaria in dermatology clinics and to determine the rates of positivity. All of the samples stained with modified trichrome and calcofluor staining methods were examined microscopically. The samples were accepted as positive when the spores of Microsporidia were detected by both of the staining methods. Microsporidia were detected in 26 (19.7%) of the patients and in 1 (2.8%) of the control subjects. Thus the total rate of positivity was 16% (27/168). In cases with acute/chronic urticaria, microsporidia positivity rate was found significantly higher than the control group (p= 0.028; p< 0.05). No statistically significant difference was detected between Microsporidia positivity and age or gender (p= 0.27 and p= 0.99, respectively; p> 0.05). In conclusion, Microsporidia should be taken into consideration in patients with unknown origin of urticaria. However, advanced studies are needed for supporting the relation between Microsporidia and acute/chronic urticaria.

The relationship between serum levels of total IgE, IL-18, IL-12, IFN-gamma and disease severity in children with atopic dermatitis.

Studies about the role of cytokines on the immunopathogenesis of atopic dermatitis (AD) are generally based on in vitro observations and this role has not been completely clarified yet. Serum levels of total IgE, IL-18, IL-12, IFN-gamma and the relationship between these parameters and disease severity, determined using the SCORAD index, in a group of atopic patients were investigated in this study. Serum levels of total IgE were measured by the nephelometric method and serum levels of IL-18, IL-12/p40 and IFN-gamma were measured by ELISA method. Serum levels of total IgE and IL-18 were found significantly higher in study group than in controls (P<.001). There was no statistically significant difference between patients and controls in respect of serum levels of IL-12/p40 (P = .227). A statistically significant relationship between SCORAD values and serum levels of total IgE (P < .001), IL-18 (P < .001), and IL-12/p40 (P < .001) was determined. These results show that serum levels of IL-18 can be a sensitive parameter that importantly correlates with clinical severity of AD, can play a role in the immunopathogenesis of AD, and furthermore may be used in the diagnosis and follow-up of the disease in addition to other parameters.

Pyogenic granuloma on the hand subsequent to friction blister in a hand surgeon.

A case of pyogenic granuloma in a 62-year-old hand surgeon secondary to friction blister is reported. He developed a fast growing, hypertrophic inflammatory papule consisting of exceptionally richly vascularized granular tissue. This dusky red lesion was located on the thenar part of the hand. We find no prior report of PG attributed to friction blister.

Subungual amelanotic malignant melanoma.

We report a 61-year-old, male patient complaining from prolonged lesion on his great toe that has been previously treated surgically. Histopathological examination of toenail specimen revealed the presence of nests of atypical tumor cells that led to the diagnosis of amelanotic malignant melanoma. Four years ago, he was diagnosed as gout due to extreme erythema and edema in the same toe. He has been taken to surgical treatment and chemotherapy and is still undergoing. As this disease is seen very rarely, it can be misdiagnosed. This situation also has poor prognosis. We presented a case of subungual amelanotic melanoma, as it is rare disease, early and correct diagnosis is very important.

Multiple plaques on the back: S-100 negative benign granular cell tumor.

Granular cell tumor is a rarely seen disease characterized by a gradually developing nodular lesion, which is difficult to diagnose. It has been thought to originate from Schwann cells. The tumor usually appears in the 4th-6th decades of life, more frequently in women and blacks, and has a multifocal location in 10-25% of the cases. The malignancy potential is 1-3%, with 70-74% of the cases in women. Ninety-eight percent of the cases are S-100 positive. The present paper describes an 18-year-old female patient with benign granular cell tumor. This rarely seen type of tumor was S-100 negative and has been detected in biopsies taken from multiple asymptomatic plaques and maculopapular lesions. They were 0.5-4 cm in diameter, light brown in color, and with clear contours and had been gradually growing on her back the last nine years.

Comparison of azelaic acid and anthralin for the therapy of patchy alopecia areata: a pilot study.

BACKGROUND: Although topical azelaic acid has been previously used for the treatment of alopecia, no controlled trials of azelaic acid for this condition have been conducted to date. OBJECTIVE: The goal of this study was to determine the efficacy, tolerability, and safety of azelaic acid treatment in patients with patchy alopecia areata (AA) in comparison with anthralin (dithranol) treatment. SUBJECTS AND METHODS: This study included 31 subjects with patchy AA who did not receive any treatment for at least 1 month prior to the study. Demographic and clinical characteristics of these subjects were recorded at baseline. Subjects were randomized to apply either 20% azelaic acid (15 subjects) or 0.5% anthralin (16 subjects) for 12 consecutive weeks. In a subsequent 8-week follow-up period no cream was applied. Two independent investigators performed an efficacy evaluation with clinical examination using a terminal hair regrowth score (RGS) with a scale ranging from 0 (inadequate response) to 2 (complete response) at week 20. Partial response was accepted as score 1. RESULTS: Both groups were well matched for the relevant demographic and clinical indicators affecting treatment response at baseline. All subjects completed the trial. At week 20 the RGS was 1.27 +/- 0.9 in the azelaic acid group versus 1.37 +/- 0.8 in the anthralin group (p > 0.05). A complete response was observed in 53.3% of cases in the azelaic acid group (8 of 15) compared with 56.2% (9 of 16) in the anthralin group (p > 0.05). No serious adverse events were observed in either group during the study. CONCLUSION: The present pilot study showed that the use of azelaic acid gave similar results to anthralin with regard to hair regrowth, and that it can be an effective topical therapy for patchy AA. More extensive trials are necessary, however, to reach a definitive conclusion.

Serum levels of TNF-alpha, IFN-gamma, IL-6, IL-8, IL-12, IL-17, and IL-18 in patients with active psoriasis and correlation with disease severity.

Recent progress in the understanding of psoriasis has shown that the regulation of local and systemic cytokines plays an important role in its pathogenesis. The most often used psoriasis score is the psoriasis area and severity index (PASI). A simple laboratory test from a blood sample would be an attractive, patient-independent, and observer-independent marker of disease severity. To this end, we evaluated the association of serum levels of some proinflammatory cytokines in vivo and their correlation with severity of psoriasis. The serum levels of cytokines levels were determined with the use of the ELISA method. All mean values except IL-17 levels of patients were significantly higher than those of controls. There was a significant correlation between serum levels of IFN-gamma, IL-12, IL-17, and IL-18, and severity of the disease. Psoriasis can be described as a T-cell-mediated disease, with a complex role for a variety of cytokines, which has led to the development of new immunomodulatory therapies. In this study, serum TNF-alpha, IFN-gamma, IL-6, IL-8, IL-12, and IL-18 levels were significantly higher in active psoriatic patients than in controls. Furthermore, high levels of IFN-gamma, IL-12, and IL-18 correlated with the clinical severity and activity of psoriasis, and those measurements of serum levels of these cytokines may be objective parameters for the disease severity.

Oxidative stress in patients with nongenital warts.

Comparison of oxidative stress status between subjects with or without warts is absent in the literature. In this study, we evaluated 31 consecutive patients with warts (15 female, 16 male) and 36 control cases with no evidence of disease to determine the effects of oxidative stress in patients with warts. The patients were classified according to the wart type, duration, number, and location of lesions. We measured the indicators of oxidative stress such as catalase (CAT), glucose-6-phosphate dehydrogenase (G6PD), superoxide dismutase (SOD), and malondialdehyde (MDA) in the venous blood by spectrophotometry. There was a statistically significant increase in levels of CAT, G6PD, SOD activities and MDA in the patients with warts compared to the control group (P< .05). However, we could not define a statistically significant correlation between these increased enzyme activities and MDA levels and the type, the duration, the number, and the location of lesions. We determined possible suppression of T cells during oxidative stress that might have a negative effect on the prognosis of the disease. Therefore, we propose an argument for the appropriateness to give priority to immunomodulatory treatment alternatives instead of destructive methods in patients with demonstrated oxidative stress.

Skin findings related to chronic usage of anti-epileptic drugs.

OBJECTIVE: Chronic type skin reactions are defined as unwanted effects of drugs. As there are more benign conditions, skin findings related to chronic usage of anti-epileptic drugs (AEDs) have not been studied previously. In this study, we investigate the skin findings associated with the chronic usage of AEDs. METHODS: The study was conducted in the Post, Telephone and Telegraph Training and Research Hospital between May 2002 and January 2003 during a 6-month work period. Skin lesions were first assessed individually, and then their correlations with AEDs were examined. Skin findings were then divided into skin disease groups to evaluate statistical significance. The prevalence of skin findings occurring in 62 epileptics was compared with that of an age-matched group of 33 non-epileptics. RESULTS: The rate of skin findings defined in the workgroup was 85.5%, while it was 84.8% in the control group. The most common skin findings were acneiform eruptions for both groups. There was no significant differences between the work and study group as for skin findings (p>0.05). Alopecia was the only skin condition related to AED usage and it was seen in 4 patients (6.5%) using valproate (p<0.05). None of the 11 patients with infectious skin findings were using valproate, and that was the only significant relationship between antiepileptic drugs and skin diseases (p=0.015). CONCLUSION: The inflammatory skin diseases were the most commonly seen problem in both patients and controls. The alopecia ratio with valproate usage in our patient group was similar to literature reports.

Superoxide dismutase and myeloperoxidase activities in polymorphonuclear leukocytes in acne vulgaris.

BACKGROUND AND DESIGN: Acne vulgaris frequently occurs in the second decade of life. The pathogenesis of the disease is multifactorial and in the present study, we aimed to investigate the role of reactive oxygen species in the inflammation of acne by determining the activities of myeloperoxidase (MPO) and superoxide dismutase (SOD) in polymorphonuclear leukocytes (PMN). MATERIALS AND METHODS: Forty-three patients with acne vulgaris and 24 healthy controls were enrolled. The severity of the acne was categorized from mild (subjects with only comedonic lesions) to severe (subjects with nodulocystic lesions). SOD and MPO activities in PMN were measured spectrophotometrically. RESULTS: There was no significant difference in the activity of MPO between the patients and controls.However, SOD activity in PMN was significantly lower in the patients than in the controls (p<0.001). Nocorrelation was detected between the activities of enzymes and the severity of the disease. CONCLUSION: Propionibacterium acnes may not play a primary role in the pathogenesis of acne as a bacterium. However, the low activity of SOD in PMN may be responsible for the increased levels of superoxide anion radicals in the epidermis. New anti-acne drugs should include substances with lymphocyte stimulating and anti-oxidative properties.

Ocular surface disorders and tear function changes in nodulo-cystic acne.

The aim of this study was to investigate the ocular surface disorders and tear function changes in patients with nodulo-cystic acne. Eighty-seven patients with nodulo-cystic acne vulgaris and 50 healthy subjects were included in the study. All subjects underwent full ocular examinations. Subjective ocular complaints were recorded. Corneal staining with fluorescein, tear film break-up time (BUT), and Schirmer test were applied. Abnormal tear film BUT and abnormal Schirmer scores were significantly more common in the acne group than in the control group. The tear film BUT was abnormal in 18 (20.7%) cases in the patient group and in 2 (4%) subjects in the control group (p=0.007). The mean Schirmer score was abnormal in 7 (8%) and decreased in 18 (20.7%) acne patients, and it was decreased in only 3 (6%) control subjects (p=0.005). Corneal punctuate epithelial erosions were detected in 3 (3.4%) acne patients, but not any of the control subjects. However, the difference between the groups was not statistically significant (p=0.184). Subjective ocular complaints were present in 28 cases (32.2%) in the patient group. Five (10%) subjects in the control group had such complaints (p=0.003). Tear function tests are also significantly altered in patients with nodulo-cystic acne. Our data suggest that severe acne patients should be referred to an ophthalmologist.

Skin findings related to chronic usage of anti-epileptic drugs.

OBJECTIVE: Chronic type skin reactions are defined as unwanted effects of drugs. As there are more benign conditions, skin findings related to chronic usage of anti-epileptic drugs (AEDs) have not been studied previously. In this study, we investigate the skin findings associated with the chronic usage of AEDs. METHODS: The study was conducted in the Post, Telephone and Telegraph Training and Research Hospital between May 2002 and January 2003 during a 6-month work period. Skin lesions were first assessed individually, and then their correlations with AEDs were examined. Skin findings were then divided into skin disease groups to evaluate statistical significance. The prevalence of skin findings occurring in 62 epileptics was compared with that of an age-matched group of 33 non-epileptics. RESULTS: The rate of skin findings defined in the workgroup was 85.5%, while it was 84.8% in the control group. The most common skin findings were acneiform eruptions for both groups. There were no significant differences between the work and study group for skin findings (p>0.05). Alopecia was the only skin condition related to AED usage and it was seen in 4 patients (6.5%) using valproate (p<0.05). None of the 11 patients with infectious skin findings were using valproate, and that was the only significant relationship between antiepileptic drugs and skin diseases (p=0.015). CONCLUSION: The inflammatory skin diseases were the most commonly seen problem in both patients and controls. The alopecia ratio with valproate usage in our patient group was similar to literature reports.

Oxidative stress in patients with acne vulgaris.

Acne vulgaris is one of the common dermatological diseases and its pathogenesis is multifactorial. In this study, we aim to determine the effects of oxidative stress in acne vulgaris. Forty-three consecutive acne patients and 46 controls were enrolled. The parameters of oxidative stress such as catalase (CAT), glucose-6-phosphate dehydrogenase (G6PD), superoxide dismutase (SOD), and malondialdehyde (MDA) in the venous blood of cases were measured spectrophotometrically. The values compared with control group, the relation between the severity and distribution of acne, and the correlation of each enzyme level were researched. CAT and G6PD levels in patients were found to be statistically decreased, and SOD and MDA levels were found to be statistically increased (P < .001). However, any statistical difference and correlation could not be found between the severity and distribution of lesions and the mean levels of enzymes. In addition, we found that each enzyme is correlated with one another. Our findings show that oxidative stress exists in the acne patients. It will be useful to apply at least one antioxidant featured drug along with the combined acne treatment.

A case of bathing trunk nevus studded with neurofibroma-like papules.

There is a significant association between bathing trunk nevus and neurofibromatosis. However, not all neurofibroma-like papules detected clinically in cases with bathing trunk nevus may be a neurofibromas and histopathological confirmation is essential for definition of these lesions. We report a 21 year old white male patient with a bathing trunk nevus studded with neurofibroma-like papules of melanocytic nature. Histopathological examination of both papular and flat lesions showed diffuse melanocytes with plentiful eosinophilic cytoplasm and round nuclei in the dermis. Immunohistochemistry showed strong positivity of dermal melanocytes for S-100 protein. The clinical and histopathological findings and positivity of dermal melanocytes for S-100 protein were consistent with bathing trunk melanocytic nevus.