Anti-Inflammatory Effect of Cinnamaldehyde in a Mouse Model of 2,4-Dinitrofluorobenzene-Induced Atopic Dermatitis.

Background: This study aims to investigate the anti-inflammatory effects of cinnamaldehyde in atopic dermatitis (AD) in the mouse model. Materials and Methods: Twenty-four mice were divided into four groups: Group A (control), group B [AD with no treatment (AD + NoTre)], group C [AD with corticosteroids (AD + Cort)] and group D [AD with cinnamaldehyde (AD + Cin)]. 2,4-dinitrofluorobenzene was used to form the AD model. Topical corticosteroid was applied to group C, and oral cinnamaldehyde was administered to group D. Dorsal skin biopsies were evaluated immunohistochemically with interleukin (IL)-25, IL-33, thymic stromal lymphopoietin and caspase-3. Results: Epithelial thicknesses were significantly higher in group B-D mice compared to group A (P = 0.002, 0.009, 0.004, respectively). Significantly, higher staining with IL-25 was observed in group B (AD + NoTre) and group D (AD + Cin) than in group A (control) (P = 0.003, 0.002, respectively). However, no significant difference was observed between group D (AD + Cin) and group B (AD + NoTre). All three groups (B-D) had significantly higher staining in terms of diffuseness of IL-33 compared to group A (control) (P = 0.002, 0.002, 0.002, respectively). Caspase-3 staining was significantly lower in group D (AD + Cin) than in group B (AD + NoTre) (P = 0.003, 0.002, respectively). Moreover, caspase-3 staining intensity was significantly lower in group D (AD + Cin) than in group C (AD + Cort) (P = 0.002). Conclusions: Our study demonstrated that IL-33, IL-25 and caspase-3 have a role in the pathogenesis of AD. Furthermore, cinnamaldehyde reduced caspase-3 activity more than topical corticosteroids and anti-inflammatory effects might be investigated in AD therapy with future studies.

Epidemiological characteristics of different types of adult acne in Turkey: a prospective, controlled, multicenter study.

INTRODUCTION: Acne occurring in adults over the age of 25 years is known as acne tarda or adult acne. Three types of adult acne are recognized: persistent, late-onset, and recurrent acne. Most studies do not compare the characteristics between the three variants. In addition, little is known about adult acne in males. This study describes the epidemiological factors of adult acne and investigates certain triggering factors by sex and different types of adult acne. METHODS: A multicenter, prospective, descriptive study was conducted. Patients with adult acne and an acne-free control group were compared regarding medical history, family history, smoking and drinking habits, and dietary factors. In addition, triggering and prognostic factors were investigated by sex and three different types of acne: persistent, late-onset, and recurrent acne. RESULTS: The participants included 944 (88.56%) female and 122 (11.44%) male patients with adult acne, and 709 (73.85%) female and 251 (26.15%) male control patients. The consumption of crackers, chocolate, and pasta was significantly more common in the acne group than in the control group (p = 0.017, 0.002, and 0.040, respectively). Male patients with adult acne had a significantly longer disease duration than female patients with adult acne (p = 0.024). The most common type of acne was recurrent acne, followed by persistent and late-onset acne. Among patients with persistent acne, 14.5% had polycystic ovary syndrome (PCOS), whereas 12.2% of patients with recurrent acne and 11.1% of patients with late-onset acne had PCOS. Severe acne was more common in the persistent acne type (28.13%). The cheek (59.90%) was the most common involvement area, and stress (55.23%) was the most common triggering factor regardless of sex. CONCLUSIONS: Although adult female and male patents with adult acne share similar triggering factors, the involvement areas can differ, which may indicate the additional hormonal etiology of female adult acne. Further epidemiological studies on adult acne in both sexes may illuminate the pathogenesis of the disease, thus making possible the development of new treatment strategies.

Evaluation of subclinical atherosclerosis in rosacea patients by flow-mediated dilatation method.

BACKGROUND: Rosacea may contribute to the development of cardiovascular (CV) diseases by causing endothelial dysfunction (ED), which is known to be the initial step of atherosclerosis, due to its inflammatory features. OBJECTIVE: This study aimed to assess ED in rosacea patients using the flow-mediated dilatation (=dilation) (FMD) method. METHODS: Seventy-three rosacea patients and 73 age, gender-matched healthy volunteers were enrolled. Individuals with cardiac risk factors, pregnant, and lactating women were excluded. Demographic, clinical data and anthropometric measurements were recorded. FMD measurement was performed ultrasonographically by a cardiologist. Systolic and diastolic blood pressures (BP) were measured and hemogram, erythrocyte sedimentation rate (ESR), C-Reactive Protein (CRP), total cholesterol, triglyceride, low-density lipoprotein (LDL), high-density lipoprotein (HDL), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV), and fasting blood glucose values were assessed. RESULTS: The FMD value was statistically lower in rosacea patients compared with healthy controls (p = 0.000). Metabolic syndrome, systolic and diastolic BPs, and plasma NLR were higher in the rosacea group (p = 0.009, p = 0.000, p = 0.000, p = 0.000, respectively). According to the multivariate linear regression analysis, rosacea type significantly predicted FMD. CONCLUSIONS: Rosacea is not only a disease limited to the skin, but it may also have systemic involvement. A significant difference was found between FMD values measured in between the case and control groups, suggesting rosacea may have an atherogenic effect. Possible cardiac risks should be considered in rosacea patients, and further evaluation could be warranted.

A Proposal for the Etiopathogenesis of Acquired Cold Urticaria: Role of Substance P, Angiotensin-Converting Enzyme and Mast Cell Chymase.

Background: The etiopathogenesis and cold stimulation mechanism are not fully understood in cold urticaria (CU). Substance P (SP) is released from skin neurons as a result of cold stimulation. It causes mast cell degranulation and therefore causes mast cell chymase (MCC) release. Angiotensin-converting enzyme (ACE) plays a role in removing SP from the environment. ACE also catalyses the conversion of angiotensin I (AT1) to angiotensin II (AT2), like MCC. This study aims to investigate the role of SP, ACE and MCC in the pathogenesis of CU. Methods: Patients with acquired CU were included in the study. Two punch biopsies were taken from the urticaria plaque resulting from the stimulation and the intact skin without lesions. The samples were evaluated histopathologically. All samples were stained immunohistochemically with SP, ACE and MCC antibodies. Results: The number of patients included in the study was 21. In the plaque lesion, the presence of dermal neutrophil and eosinophil, neutrophil in the vascular lumen were found to be statistically significantly higher than intact tissue (p = 0.046, P = 0.014, P = 0.014). Strong positive staining was detected in the full thickness of the epidermis, vascular endothelial cells, eccrine and sebaceous glands with ACE. MCC was statistically significantly higher in lesional skin than lesion-free skin samples (p < 0.001). Conclusions: Mast cell maintains its central role in CU pathogenesis. SP, which causes neurogenic inflammation, may not be detected due to its rapid destruction in the tissue. Strong staining of ACE, which takes part in the local renin-angiotensin-aldosterone (RAS) system in the skin, should be documented quantitatively.

Amiodarone-induced cutaneous leukocytoclastic vasculitis: a case report and a review of the literature.

Amiodarone can be used in a variety of arrhythmias. Given its widespread use, the probability of clinicians encountering its cutaneous adverse effects is high. A few cases of amiodarone-induced cutaneous vasculitis were reported in the literature, probably because it is underdiagnosed in clinical practice. Indeed, amiodarone-related cutaneous reactions may present a wide range of manifestations and are sometimes difficult to diagnose. Herein, we report a case with a sizeable necrotic ulcer on the left lower leg shortly after amiodarone exposure. A rigorous diagnostic study was performed before concluding the diagnosis of amiodarone-induced cutaneous vasculitis, which showed the histopathological features of leukocytoclastic vasculitis. The lesion was almost completely healed by the third month of discontinuation of amiodarone. We did a literature search and found seven cases which were reported as leukocytoclastic or lymphocytic vasculitis. We reviewed previous cases and presented our case in comparison to prior cases.

Effectiveness of FastFung agar in the isolation of Malassezia furfur from skin samples.

BACKGROUND: Lipophilic basidiomycetous yeasts of the Malassezia genus can cause various skin diseases, such as seborrheic dermatitis, pityriasis versicolor, folliculitis and atopic dermatitis, and even life-threatening fungemia in newborns and immunocompromised individuals. Routine mycological media used in clinical practice do not contain sufficient lipid ingredients required for the growth of Malassezia species. A recently developed medium, FastFung agar, is promising for culturing fastidious fungal species. METHODS: In this study, we compared FastFung agar and mDixon agar for culturing Malassezia species from nasolabial fold and retroauricular specimens of 83 healthy individuals and 187 and 57 patients with acne vulgaris and seborrheic dermatitis, respectively. RESULTS: Malassezia species were identified using conventional tests and matrix-assisted laser desorption/ionisation mass spectrometry. In total, 96 of 654 samples (14.6%) contained Malassezia species. The total isolation rate was significantly higher in patients with seborrheic dermatitis (40.4%) than in healthy volunteers (21.7%; p < .05), and the rate of M. furfur isolation was significantly higher for patients with acne vulgaris (13.9%) and seborrheic dermatitis (24.6%) than for healthy individuals (1.5%; p < .05). FastFung agar was superior to mDixon agar in M. furfur isolation (p = .004) but showed similar performance in the case of non-M. furfur species (p > .05). Among cultured Malassezia species, perfect agreement between mDixon agar and FastFung agar was found only for M. globosa (κ = 0.90). CONCLUSION: Our results indicate that FastFung agar favours the growth of Malassezia species and should be useful in clinical mycology laboratories.

Are irisin levels associated with inflammation and insulin resistance in patients with moderate-to-severe psoriasis?

BACKGROUND: A wide variety of effects of irisin, as a myokine and adipokine, have been reported. Although there are some clues about its role in the modulation of immune response in the pathogenesis of immune-mediated diseases such as psoriasis, it has not yet been clearly elucidated. The aim of the present study is to investigate the relationship of irisin levels with inflammation and insulin resistance in patients with psoriasis. METHODS: This study was conducted in patients with moderate-to-severe psoriasis and healthy subjects who were admitted to Haseki Training and Research Hospital. In addition to routine laboratory analyses, hs-CRP, insulin, irisin, adiponectin, and leptin levels were measured. The association between irisin levels and study variables was assessed using univariate and multivariate analyses. RESULTS: A total of 42 non-diabetic patients with moderate-to-severe psoriasis and 43 healthy subjects were enrolled. The mean irisin, waist circumference, insulin, insulin resistance, and hs-CRP, and frequency of metabolic syndrome were significantly higher in psoriasis patients than healthy controls. Psoriasis and control groups were similar in terms of adiponectin, leptin, and Body Mass Index levels. Also, hs-CRP levels were positively and strongly correlated with irisin, adiponectin, and leptin levels. The median irisin level was 2.15 µg/mL. In the binary logistic regression analysis, CRP level (OR=1.14, 95% CI 1.005-1.29, P=0.042) and a BMI>30 kg/m2 (OR=5.9, 95% CI 1.02-34.4, P=0.048) were independent predictors of a higher irisin level. CONCLUSIONS: This study demonstrates that serum irisin levels are higher in patients with moderate-to-severe psoriasis than in healthy subjects. Irisin seems to be associated with inflammation, as measured by hs-CRP. More comprehensive studies are needed to clarify the effect of irisin, on immune-modulate response in patients with psoriasis.

Comparison of Malassezia Colonization of 'Maskne' Patients with Seborrheic Dermatitis Cases and Healthy Individuals.

Background: With the Covid-19 pandemic, the use of masks has increased the frequency of 'maskne' cases. Local physiological changes due to the use of mask have caused changes in the presence of yeasts in the environment, such as acne and seborrheic dermatitis. Objectives: The aim is to compare the differences of Malassezia species in the maskne region. Materials and Method: A total of 408 subjects wearing masks at least 4 h a day for 6 weeks or longer, compromised of 212 acne patients, 72 seborrheic dermatitis sufferers, and 124 healthy volunteers were included in this study. Swab samples were taken for Malassezia cultures from nasolabial area and their control retro auricular region. The Statistical Package for Social Sciences (SPSS) version 22 was used for the statistical analysis. Results: Malassezia species was most frequently found in the nasolabial region of the seborrheic dermatitis group. Malassezia species were more commonly isolated from the nasolabial region of acne and seborrheic dermatitis patients, compared to the retroauricular region of each patient, than the healthy subjects. The rate of M. globosa isolated from the nasolabial region was high in all groups, the isolation rate of M. restricta was low (P < 0.05). Conclusion: As Malassezia species are more commonly isolated from the nasolabial region of acne and seborrheic dermatitis patients, the increasing numbers of Malassezia species will trigger inflammation with an antibody reaction against these yeasts. Treatment of resistant acne and seborrheic dermatitis will be facilitated with the knowledge of this inflammation.

Could "Islets of Sparing" Be a Clue for Neutral Lipid Storage Disease with Ichthyosis in Patients with Congenital Ichthyosiform Erythroderma?

The prevalent form of ichthyosis in neutral lipid storage disease (NLSDI) is nonbullous congenital ichthyosiform erythroderma (CIE) characterized by fine, whitish scales on erythematous skin over the whole body. Here, we report a late-diagnosed, 25-year-old woman with NLSDI presenting with diffuse erythema and fine whitish scales throughout the body with patches of apparently normal skin, "islets of sparing" on her lower extremities. We observed that the size of the normal skin islets changed with time, and even the entire lower extremity was covered with erythema and desquamation like the rest of the body. Frozen section histopathological examinations were made from lesional skin and normal-looking skin; no difference was observed in terms of lipid accumulation. The only noticeable difference was the thickness of the keratin layer. In CIE patients, observation of patches of apparently normal skin or "islets of sparing" might be a clue for NLSDI to be distinguished from other CIE conditions.

Dermatology outpatient clinic outcomes after COVID-19 outbreak: What is new normal?

Coronavirus disease-2019 (COVID-19), which emerged in late 2019 and caused a pandemic, has significantly affected outpatient admissions to dermatology outpatient clinics. There have been changes in the number and composition of the patients who applied to the outpatient clinics. The dermatology outpatient clinic applications have dramatically decreased due to restrictions and prohibitions, and active participation of dermatologists in the field immediately after the pandemic. The composition of the diagnoses has also altered for reasons such as excessive use of hygiene products and types of protective equipment usage related to COVID-19. Intensive precautions have been taken in the first 3 months of the pandemic (March, April, and May). As of 12 May, controlled socialization started with new regulations. This period has been called "the normalization process." This study aims to evaluate the changes of the patients admitted to dermatology outpatient clinics within the normalization process. Despite the increasing number of COVID-19 patients and related deaths in the whole country with the new normal, the admissions to dermatology outpatient clinics have increased. During this period, acne and related diseases, pigmentation disorders, and viral skin infections had increased; dermatoses, xerosis cutis, and superficial fungal infections had reduced. It seems that nonurgent dermatological complaints affect the quality of life of patients and cause the need for an application. Although restrictions reduce these numbers, measures should be taken to protect patients and society during the ongoing pandemic.

Pigmented purpuric dermatosis: Ten years of experience in a tertiary hospital and awareness of mycosis fungoides in differential diagnosis.

BACKGROUND: Pigmented purpuric dermatoses (PPD) can clinically mimic many diseases. Histopathology provides a definitive diagnosis. The aim of the study is to reveal the features of patients with PPD and to determine the disease frequency in the differential diagnosis, especially mycosis fungoides (MF). METHODS: We retrospectively reviewed records of patients with PPD admitted to our hospital from January 2010 to May 2019. We studied the histopathological features of 127 patients, and performed pattern analysis on cases with a confirmed histopathologic diagnosis of PPD. Among the cases presenting with clinical features of PPD, but displaying different histopathological diagnoses, we focused on MF and tried to clarify the features of PPD-like MF. RESULTS: Overall, 389 patients were admitted to our hospital with PPD symptoms. Of them, 262 patients were diagnosed clinically and a histopathological examination was performed in 127 patients. Of 127, 87 were diagnosed with PPD, and in the remaining 40, non-specific features (9.4%), vasculitis (6.2%), pityriasis rosea (4.7%), MF (3.9%), suspected-MF (1.5%), and other dermatoses (%5.5) were detected. The biopsy findings of two patients showed PPD, but during follow-up, the diagnosis of MF was established. CONCLUSIONS: MF should be included in the differential diagnosis of PPD cases presenting with longstanding and widespread involvement.

Case of Olmsted Syndrome with Essential Thrombocytosis Misdiagnosed as Acrodermatitis Enteropathica.

Olmsted syndrome is a rare genodermatosis. Palmoplantar keratoderma and periorificial keratodermic plaques are the most important clinical findings. Additional findings associated with a large number of systems may accompany such as teeth, nail deformities, alopecia, mental retardation, and bone-joint anomalies. Therefore, it is difficult to make a differential diagnosis from other palmoplantar keratodermas. It also needs to be differentiated from acrodermatitis enteropathica because of periorificial plaques. The absence of regression in lesions with zinc treatment excludes this disease. We present here an Olmsted syndrome case with essential thrombocytosis for the first time.

Systemic isotretinoin treatment in a renal transplant patient developing sebaceous hyperplasia due to cyclosporine.

Sebaceous hyperplasia (SH) is a benign tumor with telangiectasia on it, yellowish or skin-colored, with papulosis. Besides genetic factors, aging, ultraviolet rays, sex hormones, calcineurin inhibitors, such as cyclosporin, tacrolimus and systemic steroids, play a role in the development of sebaceous hyperplasia. Cyclosporin is widely used in organ transplant patients. Acne, keratosis pilaris, sebaceous hyperplasia and epidermoid cysts, which are rare side effects, are frequently seen in renal transplant patients and it is suggested that the pilosebaceous unit develops as a result of occlusion with keratinous material. It is thought that cyclosporine causes these side effects by increasing the secretion of sebum and 5-alpha reductase enzyme activity. In this case study, wepresent here a 36-year-old female patient who had been on cyclosporine treatment for 25 years and had a large number of yellowish, umblike papules on her face for 20 years. She had been diagnosed with cyclosporin triggered by clinical and histopathological findings. The patient was started on 40 mg/day (0.6 mg/kg/day) systemic isotretinoin treatment, and after two months treatment, the patient had almost complete regression of the lesions. Systemic isotretinoin is effective and easy to treat treatment for patients with multiple lesions, especially when compared to other treatments. In addition, all of the cases reported in the literature are male, and this report presents the first female transplant patient with SH, which is induced by cyclosporine use.

Desmoplastic Melanoma as a Diagnostic Pitfall.

Dear Editor, Desmoplastic melanoma (DM) is a rare histological subtype of melanoma, usually presenting as a slowly-growing, amelanotic, discoid, and/or firm lesion composed of spindle cells with abundant collagen (1). It is more common on sun-exposed areas, especially on head and neck in elderly patients (2). Regional lymph node involvement is reported to be less frequent than in other cutaneous melanomas (3). Desmoplastic melanoma can clinically mimic a wide spectrum of benign and malignant lesions, including Bowen's disease, desmoplastic nevus, basal cell carcinoma, squamous cell carcinoma, lentigo maligna, dermatofibrosarcoma protuberans, peripheral nerve sheath tumors, cysts, or hypertrophic/keloid scars (4). Regarding its appearance, at the time of diagnosis DM frequently presents as advanced lesions with deep infiltration. A 60-year-old man presented with an one-year history of an asymptomatic, erythematous, well-defined plaque in the right lumbar region (Figure 1). Dermatological examination revealed a 5×5 cm, pink/red infiltrated plaque accompanied by a 6 mm dark-brown melanocytic lesion. Dermoscopically, atypical vascular structures in the form of linear, irregular, and dotted vessels, milky-red areas, and atypical pigment network, and streaks were observed near the melanocytic lesion (Figure 2). A 4 mm punch biopsy was performed on the erythematous plaque next to the melanocytic lesion, and a dermal-based, paucicellular proliferation of atypical spindle cells without melanin in a sclerotic stroma was found histologically (Figure 3, a). Immunohistochemically, dermal spindle cells were stained with S-100 and HMB45 antibodies (Figure 3, b). The patient was histologically diagnosed with melanoma, of the desmoplastic subtype. The lesion was totally excised with 2 cm clear margins. A diagnosis of nonulcerated nodular melanoma with a Breslow thickness of 4 mm and a mitotic index 1/mm2 was established. Sentinel lymph node biopsy revealed no metastases. No systemic metastases were detected in PET-CT scanning and cranial magnetic resonance imaging. The patient remained under follow-up and has been free of any local recurrence or primary or systemic metastasis for 3 years. Dermoscopic characteristics of DM are not well known, probably due to it not being considered a melanocytic lesion. Debarbieux et al. first reported the dermoscopic features of desmoplastic melanoma in six cases (5). They found that only half of the cases presented one classical feature of a melanocytic lesion, whereas the other cases were diagnosed based on the presence of figures of regression such as white scar-like and "peppering", multiple (>4) color, and melanoma-related vascular patterns (five out of six) such as linear-irregular vessels and milky-red areas (5). In the largest DM case series, Jaime et al. reported that all DM featured at least 1 melanoma-specific structure, with atypical vascular structures being the most common (6). Similarly, in our patient dermoscopy showed an atypical pigment network and streaks, atypical vascular structures, and milky-red areas, which is predictive for melanoma. We reported this case to serve as a reminder to consider desmoplastic melanoma in the differential diagnosis of pink tumoral lesions despite its rarity and atypical localization.

Nineteen-year retrospective evaluation of pemphigus in a single dermatology centre in Istanbul, Turkey.

INTRODUCTION: Pemphigus is an autoimmune intra-epidermal bullous disease of the skin and mucosae. AIM: To retrospectively evaluate the course, prognosis and clinical features of pemphigus. MATERIAL AND METHODS: The files of 196 pemphigus patients admitted to our clinic between December 1995 and December 2014 were collected and analysed. RESULTS: The male to female ratio among patients was 1 : 1.88. Pemphigus vulgaris (PV) was the most common clinical variant observed in 175 (89.3%) of the patients, followed by pemphigus foliaceus (PF) in 14 (7.1%) of the patients. The mean patient age at disease onset was 50 years. PV presented itself as skin lesions in 55 (31.4%) of the patients and as oral mucosa lesions in 120 (68.6%) of the patients. Complete remission and treatment withdrawal were obtained in 112 (57.1%) of the patients, for a mean period of 2.91 ±2.66 years (range: 4 months to 13 years). The mortality rate was 6%, and relapse occurred in 16 (14.3%) of the patients for a mean relapse period of 2.15 ±1.88 years (range: 6 months to 7 years). Mucocutaneous pemphigus (MCP) was the major clinical pattern observed in 96 (49%) of the patients. CONCLUSIONS: Within our study population, pemphigus predominately affected females, and the most common clinical variant was PV, a subtype that frequently occurs in middle-aged individuals. MCP was the most common clinical pattern. Although MCP and higher doses of corticosteroids were needed to control pemphigus, they did not seem to influence the prognosis.

Evaluation of the relationship between Behcet's disease and cardiovascular disorders through metabolic function and copeptin.

INTRODUCTION: Behcet's disease (BD) is a chronic inflammatory and multisystem vasculitis. Cardiac involvement is one of the major complications of BD. Cardiac involvement is sporadic in terms of its specific relationship to mortality. How to identify and follow up on cardiac-related complications in BD patients has yet to be determined. AIM: The aim of our study is to assess cardiovascular diseases in BD patients by measuring metabolic function and copeptin levels and comparing these to a healthy control group. Knowing the specific metabolic functions that are negatively affected by BD will help doctors determine which functions need to be more closely monitored in BD patients. Our study is the first study in the available literature that evaluates copeptin in BD patients. MATERIAL AND METHODS: A control group of 58 healthy volunteers, including 32 females and 26 males (average age: 39.8 ±10.3 years, range: 18-50 years), was formed to compare with 84 BD patients (average age: 40.5 ±11 years, range: 21-63 years), including 39 females and 45 males. Diastolic and systolic blood pressure, height, weight, body mass index (BMI), and waistline were measured for both groups. All study patients were also given hemograms, and fasting blood sugar (FBS), uric acid, lipid profile, insulin, C-reactive protein (CRP), and copeptin levels were measured. An ELISA Kit was used to measure copeptin. RESULTS: FBS, CRP, and insulin levels were significantly higher in the patient group (p < 0.001, p = 0.004, and p = 0.038, respectively). Patients who had had the disease for more than 10 years had higher BMIs, total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride (TG) levels (p = 0.034, p = 0.004, p = 0.016, and p = 0.045, respectively). Additionally, CRP levels were found to be higher in long-term patients and patients with active lesions. Diastolic blood pressure and waist circumference were also higher in the BD group. Patients who had active lesions had significantly higher diastolic blood pressure (p = 0.047). There were no statistically significant differences in copeptin levels between BD and control groups. CONCLUSIONS: Cardiovascular involvement rarely contributes to the high mortality rate of BD patients. There were meaningful elevations in metabolic markers identified when BD and cardiovascular disease risk was assessed with metabolic parameters. The cardiac disease risk should be closely followed using metabolic functions, particularly in long-term BD patients with vascular involvement.

Multifactorial Painful Leg Ulcers Due to Hyperhomocysteinemia, Plasminogen Activator Inhibitor-1 4G/5G Heterozygote Gene Mutation, and Beta Thalassemia Minor: A Case Report.

Leg ulcers may occur due to many autoimmune, hereditary, inflammatory, and infectious causes including venous, arterial, and neuropathic ulcers. Hyperhomocysteinemia is a metabolic disorder caused by various enzyme defects in methionine metabolism. The most common cause is methylenetetrahydrofolatreductase (MTHFR) enzyme gene mutations. Hyperhomocysteinemia is an independent risk factor for deep vein thrombosis and peripheral arterial disease. The effects of endothelial cell damage on smooth muscle hypertrophy, platelet aggregation, coagulation, and fibrinolysis cause atherogenesis and thrombosis, leading to venous and arterial lower extremity ulcers. In this article, we report the case of a 47-year-old male patient who was admitted to our clinic due to painful leg ulcers that started 1 year ago. He had a history of vena cava inferior thrombosis, deep vein thrombosis, and 40 pack-year smoking. Histopathological examination of punch biopsy taken from ulcerative lesion showed intense inflammatory infiltration in the middle dermis, erythrocyte extravasation, leukocytoclasia, and thrombus formation in a small diameter venule lumen. There were nonspecific findings in direct immunofluorescence examination. He was found as having MTHFR C677T homozygote and plasminogen activator inhibitor-1 4G/5G heterozygote gene mutation with high homocysteine level of 22.90 µmol/L, and he was diagnosed as hyperhomocysteinemia. He was recommended to quit smoking because it triggered thrombosis in hyperhomocysteinemia. Herein, we present a case of hyperhomocysteinemia due to MTHFR mutation, which is one of the rare hereditary thrombophilia causes.

Coexistence of morphea and granuloma annulare: a rare case report

ABSTRACT CONTEXT: Localized scleroderma (morphea) is characterized by fibrosis of skin and subcutaneous tissue. Granuloma annulare is a relatively common disease that is characterized by dermal papules and arciform plaques. CASE REPORT: Here, we present the case of a 42-year-old woman who developed granuloma annulare on the dorsum of her feet and abdominal region, and morphea on the anterior side of her lower limbs. We also discuss the etiological and pathogenetic processes that may cause the rare coexistence of these two diseases. CONCLUSION: Only a few cases in the literature have described coexistence of morphea and granuloma annulare.

Coexistence of morphea and granuloma annulare: a rare case report.

CONTEXT: Localized scleroderma (morphea) is characterized by fibrosis of skin and subcutaneous tissue. Granuloma annulare is a relatively common disease that is characterized by dermal papules and arciform plaques. CASE REPORT: Here, we present the case of a 42-year-old woman who developed granuloma annulare on the dorsum of her feet and abdominal region, and morphea on the anterior side of her lower limbs. We also discuss the etiological and pathogenetic processes that may cause the rare coexistence of these two diseases. CONCLUSION: Only a few cases in the literature have described coexistence of morphea and granuloma annulare.