Epidemiology of pemphigus in the western region of Turkey: retrospective analysis of 87 patients.

BACKGROUND: Pemphigus is a worldwide disease and varies in its clinical profile and epidemiology in different regions of the world. The disease is rare and few epidemiological data are available. OBJECTIVE: The purpose of this study was to evaluate the epidemiologic, clinical, and therapeutic features of pemphigus in the western region of Turkey. METHODS: We retrospectively investigated a total of 87 patients with pemphigus. The parameters including age at diagnosis, sex, diagnostic delay, diagnostic methods, hospitalizations, distribution of skin lesions, duration and dose of therapy, side effects, and duration of follow-up were evaluated. RESULTS: The mean age at the onset was 48 years. The average annual incidence of the disease was seven new patients and estimated annual incidence rate was 0.18 per 100,000 inhabitants. The male-to-female ratio was 1/1.64. All patients were treated with systemic corticosteroids. The mean initial dose was 100 mg prednisolone equivalent. Thirty-three (37.9%) patients received azathioprine as adjuvant therapy. The mean time to control the disease activity was 23 days in our study group. Ten patients (11.5%) were in clinical remission without treatment, 41 patients (47.1%) were on low dose steroid (≤ 10 mg daily), and 28 (32.2%) were using > 10 mg/day corticosteroid at the end of the study period. CONCLUSION: Pemphigus vulgaris (PV) is the most common clinical subtype in the western part of Turkey. The disease is more frequent in the fifth decade of life and has a female predominance in our region. The patients with both oral mucosa and skin involvement need higher corticosteroid dose, more time to control the disease activity and longer hospitalization time when compared with the patients with oral mucosa involvement alone.

A case of recurrent impetigo herpetiformis treated with systemic corticosteroids and narrowband UVB.

Impetigo herpetiformis is a rare pustular eruption with usual onset during the third trimester of pregnancy. The disease tends to remit after delivery, but may recur in subsequent pregnancies. Here we present a recurrent case of impetigo herpetiformis with earlier onset and poor response to corticosteroids in the subsequent pregnancy. She had widespread, erythematosquamous patches with tiny superficial pustules in the third trimester of her first pregnancy. Histopathological and clinical findings were consistent with impetigo herpetiformis. She was treated with systemic prednisolone and had a healthy baby without any complication. Three years later, the patient presented with impetigo herpetiformis again in the second trimester of her second pregnancy. After six weeks of oral prednisolone treatment, the lesions improved, but there were still new pustule formations and narrowband ultraviolet B treatment was added. Skin eruption cleared and she had a healthy baby in the 38th week of her second pregnancy. The corticosteroid dose was tapered gradually and stopped after delivery. Early diagnosis and treatment is crucial in impetigo herpetiformis because of the risk of maternal and fetal complications. When prednisolone is not enough to control the eruption alone, narrowband UVB can safely be added to the treatment.

Progressive symmetrical erythrokeratoderma - response to topical calcipotriol.

BACKGROUND: Progressive symmetrical erythrokeratoderma is characterized by well-demarcated, symmetrically distributed, erythtematous and hyperkeratotic plaques. Treatment options are topical retinoids, emollients, keratolytics and topical corticosteroids with limited or no success. Oral retinoids have been shown to be successful in some cases, but recurrence is to be expected on cessation of therapy. Topical calcipotriol is an established mode of treatment for psoriasis and also reported to be effective in many hyperkeratotic skin diseases. MAIN OBSERVATIONS: A 20-year-old female patient presented with reddish-brown lesions in her axillae, groins, submammary regions and on the eyelids. Clinical and histological findings were consistent with the diagnosis of progressive symmetrical erythrokeratoderma. She had noted that her lesions did not improve with topically applied steroids and emollients. We recommended our patient to use topical calcipotriol and observed a remarkable improvement within two weeks. CONCLUSION: When compared with the other treatment modalities, topical calcipotriol is a safe and effective drug with minimal side effects and it would be a good alternative.

Evaluation of depressive symptoms in acne patients treated with isotretinoin.

BACKGROUND: There have been concerns about the association between isotretinoin therapy and depressive symptoms. OBJECTIVE: The objective of this study is to evaluate whether there is an association between isotretinoin therapy and the onset of depression. METHODS: A total of 50 patients with moderate to severe recalcitrant acne and 30 healthy volunteer people were enrolled in the study. Depressive symptoms and anxiety status were assessed at baseline and then 1 and 4 months after the initiation of isotretinoin treatment. RESULTS: We detected improvement in Beck Depression Inventory (BDI) and State and Trait Anxiety Inventory (STAI) scores in acne patients after isotretinoin therapy. Statistically significant improvement in depressive symptoms began at the first month. Improvement in anxiety was detected later than the improvement in depressive symptoms and a statistically significant difference was detected between the first and the second follow-up. CONCLUSIONS: Our results provide no relationship between isotretinoin use and depression in acne patients.

Investigation of herpes simplex virus DNA in pityriasis rosea by polymerase chain reaction.

BACKGROUND: Pityriasis rosea (PR) is an acute, inflammatory disease of unknown cause. Clinical and experimental findings indicate an infectious etiology of PR. Our purpose is to examine the skin lesions and blood samples of PR patients by polymerase chain reaction (PCR) for the presence of HSV type 1 and 2 DNA. METHODS: The lesional skin biopsies from 10 patients and blood samples from two randomized patients with clinically and histologically confirmed pityriasis rosea were examined by PCR. RESULTS: No HSV 1 and HSV 2 DNA was detected in the lesional biopsy and blood samples. CONCLUSIONS: We could not identify a relationship between HSV 1, HSV 2 and PR.

Giant porokeratosis.

Porokeratosis is a disorder of keratinization characterized by annular plaques with an atrophic center surrounded by a raised, keratotic wall. It has several clinical forms including a porokeratosis of Mibelli, giant porokeratosis, linear porokeratosis, disseminated superficial actinic porokeratosis, palmoplantar porokeratosis and punctate porokeratosis. We report a patient with the rare condition of giant porokeratosis. Several variants of porokeratosis coexist in our patient.