Comparison of sulfur ointment and permethrin treatments in scabies.

Scabies is a contagious, parasitic skin disease that adversely affects the quality of life and, can cause systemic complications if it is not properly treated. Sulfur ointment and permethrin cream are among the most used topical agents in the treatment of scabies. In this study, we aimed to compare the efficacy of sulfur ointment and permethrin cream in the treatment of scabies. In this single-center study, patients who were diagnosed with scabies in the dermatology outpatient clinics of Karabuk University Training and Research Hospital between April, 2021 and September, 2021 were investigated retrospectively. Age, gender, date of diagnosis, topical agent used for scabies treatment, and response to the treatment at the control examination in the second week were recorded. The patients were divided into two groups those receiving 5% permethrin cream or 10% sulfur ointment, and the treatment efficacy of both agents was compared. This study showed that 10% sulfur ointment was significantly more effective in treating scabies than 5% permethrin cream (p < 0.001). Moreover, younger patients with scabies responded better to both treatments. 10% Sulfur ointment can be considered a safe and effective topical option in the treatment of scabies. The resistance to 5% permethrin cream, which is the most commonly used agent for scabies, can be a concern as an unexpected low success rate was obtained in this study.

There is no evidence of cochlear and vestibular melanocyte damage in patients with alopecia areata.

PURPOSE: Follicular melanocytes are known to be damaged in alopecia areata (AA). However, it is not clear whether melanocytes are the primary target of autoimmunity and whether melanocytes in the inner ear are affected. This study aimed to detect possible cochlear and/or vestibular melanocyte damage in AA patients. METHODS: Thirty-two AA patients and 35 sex- and age-matched healthy volunteers were evaluated between November 2018 and March 2020 at the Karabük University Training and Research Hospital. The conventional pure tone audiometry test and distortion product otoacoustic emission test were performed to evaluate hearing. To evaluate the vestibular function, the following tests were performed: the vestibulospinal reflex tests (Romberg test, tandem stance test and tandem walking test); positional balance tests (Dix-Hallpike test, supine roll test and head hanging test); vestibulo-ocular reflex tests (caloric test, head shake test) and oculomotor tests (saccade, smooth pursuit and optokinetic). RESULTS: The mean age of AA patients was 31.94 ± 11.86 years (range, 15-67 years). There were no significant differences in the results of the hearing and balance tests between the groups. Furthermore, disease parameters (duration of the last attack, recurrence, positive family history, positive pull test, the severity of the disease, etc) were not associated with hearing loss and vestibular damage. CONCLUSION: AA patients did not exhibit hearing loss or balance abnormalities that would indicate cochlear and vestibular melanocyte damage. The lack of damage to the inner ear melanocytes in AA patients may indicate that follicular melanocytes are affected secondary to autoimmune damage in the hair bulb, and melanocytes are not the primary target in the pathogenesis of AA.

Investigation of hearing and outer hair cell function of the cochlea in patients with vitiligo.

Vitiligo is a systemic disease that affects not only the skin but also other areas that contain melanocytes, such as the inner ear. Studies of the effect of vitiligo on hearing loss have shown inconsistent results, and it is not clear which parameters related to the disease affect hearing. The aim of this study was to determine which disease-related parameters trigger damage to cochlear melanocytes in vitiligo patients and the effect of vitiligo on the outer hair cells and hearing. Thirty-one vitiligo patients and 40 sex- and age-matched healthy volunteers were evaluated. The conventional pure tone audiometry (C-PTA) test and the distortion product otoacoustic emission (DPOAE) test were performed. There was no significant difference between vitiligo patients and controls in C-PTA test results, but the DPOAE test results were abnormal in vitiligo patients. The duration of the disease was significantly related to hypoacusis. As the duration of the disease increases, cochlear dysfunction may increase. Especially in patients with longer disease duration, otoacoustic emission tests should be performed in addition to conventional audiometry tests for early detection of damage to the outer hair cells.

Evaluation of audiovestibular system in psoriasis patients without joint involvement.

Inner ear involvement may occur in systemic autoimmune diseases. Although there are studies evaluating hearing in psoriasis patients, its effect on the balance system is not clear. The aim of the present study was to evaluate the audiovestibular system in psoriasis patients without joint involvement. In this prospective study, the audiovestibular system of 32 psoriasis patients without joint involvement and 35 healthy volunteers were evaluated. The severity of the disease was determined by the psoriasis area severity index (PASI). There was no significant difference between the groups in terms of hearing test results, while the abnormal caloric test response was significantly higher in the psoriatic patients. PASI scores of psoriasis patients with abnormal caloric test results were higher than those with normal caloric test response. In psoriasis patients without joint involvement, the hearing was not affected, but the vestibular system was. The severity of the disease was associated with vestibular involvement. Particularly in patients with severe psoriasis, it must be considered that the vestibular system might be affected, and vestibular evaluations should be performed.

Intramuscular diclofenac is a cause of Nicolau syndrome in obese women: An observational study of consecutive ten patients.

Nicolau syndrome is a skin and underlying tissue necrosis resulting from vascular occlusion after various injections of certain drugs. Intramuscular injections are the most common cause but it may occur after other types of parenteral interventions. There are many medications reported as causative factors inducing Nicolau syndrome including penicillin, nonsteroidal anti-inflammatory drugs, corticosteroids, local anesthetics, and several others. We present an observational study of diclofenac induced Nicolau syndrome.

Long-term isotretinoin use does not cause parenchymal liver change: Ultrasonographic study in 50 patients.

The effect of isotretinoin on liver enzymes and lipid profile is reported as rare and reversible. However, possible parenchymal liver changes have not been demonstrated so far. The aim of this study was to evaluate the ultrasonography findings of the liver in patients receiving long-term isotretinoin therapy. We examined ultrasonographic findings of the liver together with serum alanin aminotransferase (ALT), aspartate aminotransferase (AST), and total cholesterol and triglyceride levels in 50 consecutive patients who have taken isotretinoin 10-40 mg daily for at least 6 months between January and December 2017. Of 50 patients examined, 40 were female, 10 were male. Mean age of the patients was 24.8 years. Five patients aged between 42 and 62 were found to have Grade 1 hepatosteatosis. Despite a moderate elevation, serum ALT, AST, and total cholesterol and triglyceride levels were in normal range in these five patients. Moreover, one patient had elevated ALT, and one another patient had elevated triglyceride level although both have normal liver ultrasonographic findings. Isotretinoin did not cause parenchymal liver changes as well as serum ALT, AST, and total cholesterol and triglyceride levels in patients who take it 10-40 mg daily for at least 6 months.

Matrix metalloproteinase-2 and -9 activity levels increase in cutaneous lupus erythematosus lesions and correlate with disease severity.

Lupus erythematosus is a chronic autoimmune disease characterized by remissions and exacerbations. Accumulated evidence indicated that matrix metalloproteinases (MMPs) are upregulated in inflammatory cells of cutaneous lupus erythematosus (CLE); however, the activity levels of these proteases have remained uncharacterized. To elucidate the significance of MMP-2, MMP-9, and TIMP-1 in CLE pathogenesis, gelatin zymography was used to investigate pro and active levels of MMP-2 and MMP-9 in lesional and perilesional skin biopsies obtained from twenty-two CLE patients. TIMP-1 protein levels were detected by ELISA in the biopsy specimens. The correlation between biochemical parameters and clinical characteristics of the disease was also evaluated. Significantly higher levels of active MMP-2, active MMP-9, proMMP-9, active/proMMP-2, and TIMP-1 were detected in lesional skin samples. Besides, the active/proMMP-9 was elevated in female and smoking patients. Active MMP-9 levels and active/proMMP-9 were also increased in elderly patients. Active MMP-9 levels were lower in patients who had smaller total damage score. Consistently, active/proMMP-9 and active/proMMP-2 were positively correlated with CLASI. Interestingly, in hydroxychloroquine or topical corticosteroid-treated patients, MMP-2/-9 activity levels were found to be higher compared to untreated patients. These findings suggest that increased MMP-2 and MMP-9 activities may contribute to the pathogenesis of CLE and cutaneous disease severity.

Onychomycosis is associated with subclinical atherosclerosis in patients with diabetes.

BACKGROUND: We aimed to investigate the association of toenail onychomycosis with subclinical atherosclerosis in patients with diabetes mellitus. PATIENTS AND METHODS: Consecutive diabetic patients who were seen at our outpatient clinic were enrolled. The carotid intima-media thickness (CIMT) was assessed and toenail onychomycosis was diagnosed with microscopic evaluation. RESULTS: We investigated 127 patients with diabetes melltus type 2. Overall, the prevalence of toenail onychomycosis was 37.8 % (48 of 127). Of the 127 patients, 60 (47.2 %) had subclinical atherosclerosis (CIMT ≥ 1 mm). Prevalence of male gender (43.3 % vs. 22.4 %, p = 0.012) and onychomycosis (53.3 % vs. 23.9 %, p = 0.001) was significantly higher in patients with subclinical atherosclerosis. Among biochemical parameters, low-density lipoprotein (122 ± 38 mg/dL vs. 108 ± 36 mg/dL, p = 0.039) and glycosylated hemoglobin levels (median 8.4 %, IQR: 2.1 % vs. median 7.5 %, IQR: 1.6 %, p = 0.002) were significantly higher in patients with subclinical atherosclerosis. Study groups were similar with respect to all other demographic, clinical, and laboratory parameters. After adjustment for all potential confounders, the presence of onychomycosis was independently associated with subclinical atherosclerosis (OR 2.77, 95 % CI 1.16 to 6.30) in multivariate logistic regression analysis. CONCLUSIONS: Presence of onychomycosis in patients with diabetes is associated with subclinical atherosclerosis. Onychomycosis may be a marker of atherosclerotic arterial involvement.