Evaluation of the Factors Influencing Mortality in Patients with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Multicenter Study of 166 Patients.

INTRODUCTION: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening acute mucocutaneous disorders usually triggered by drugs. In this study, we aimed to evaluate the factors affecting mortality in patients with SJS-TEN. METHODS: Our study is a retrospective cohort study, analyzing data collected from a total of 12 tertiary care centers between April 2012 and April 2022. RESULTS: The study included 59 males and 107 females, a total of 166 patients, with an average age of 50.91 ± 21.25 years. Disease classification was TEN in 50% of cases, SJS in 33.1%, and SJS-TEN overlap in 16.9%. The average SCORTEN within the first 24 h was 2.44 ± 1.42. Supportive care was provided to 99.4% of patients. The most commonly used systemic immunomodulatory treatments were systemic steroids (84.3%), IVIG (intravenous immunoglobulin) (49.3%), and cyclosporine (38.6%). Plasmapheresis was administered to five patients. While 66.3% of patients were discharged, 24.1% resulted in exitus. Our comparative analysis of survivors and deceased patients found no effect of systemic steroids, IVIG, and cyclosporine treatments on mortality. Univariate analysis revealed that the SCORTEN scores on days 1 and 3 as well as the rates of detachment at the onset and during follow-up were significantly higher in deceased patients compared to survivors. The rates of fever, positive blood cultures, and systemic antibiotic use were higher in deceased patients compared to survivors. The presence of comorbidities, diabetes, and malignancy were significantly more common in deceased patients. Multivariate regression analysis indicated that over SCORTEN 2, the mortality risk exponentially rose with each SCORTEN increment, culminating in an 84-fold increase in mortality at SCORTEN 5-6 (odds ratio [95% confidence interval]: 13.902-507.537, p < 0.001) compared to SCORTEN 0-1. Additionally, the utilization of plasmapheresis was associated with a 22-fold increase in mortality (odds ratio [95% confidence interval]: 1.96-247.2, p = 0.012). CONCLUSION: Our study found that a high SCORTEN score within the first 24 h and the use of plasmapheresis were related to increased mortality, while systemic steroids, IVIG, and cyclosporine treatments had no impact on mortality. We believe that data gathered from one of the most comprehensive studies which we conducted on SJS-TEN will enrich the literature, although additional research is warranted.

Evaluation of Patch Test Results in Paediatric Patients in a Tertiary Dermatology Clinic.

Background and Objectives: Allergic contact dermatitis is common in childhood as well as in adulthood. Children could be affected by numerous allergens. Allergen sources could change by region. In this study, we aimed to identify the most common allergens that cause contact sensitivity in paediatric patients in our region to make a standardized patch test series and define the ways of exposure to these allergens. Materials and Methods: Between June 2013 and January 2021, a total of 61 patients' European baseline series patch test results were evaluated. Results: Among 61 patients, 36 (%59) were female and 25 (%41) were male. The mean age was 10.4 years. Positivity with at least one allergen was present in 39 (64%) cases. The most common allergens with positive reactions were balsam of Peru (BOP) in 11 (18%) patients, nickel in eight (13.1%) patients, and fragrance mix-1 in seven (11.4%) patients. No statically significant difference was found between patch test results and gender (P = 0.109), atopy (P = 0.774), atopic dermatitis (P = 0.662), hobby (P = 0.377) and side of lesions (P = 0.826). However, there was a significant relationship between the duration of complaints and patch test results (P = 0.007). Conclusion: The responsible allergen in paediatric patients may vary especially by region, thus this could be challenging for diagnosis. Therefore, each region should create its own specific standardized paediatric patch tests.

Methyl(chloro)isothiazolinone contact allergy: a monocentric experience from Turkey.

INTRODUCTION: Due to their ubiquitous use, isothiazolinones caused allergic contact dermatitis epidemics and their use was restricted by legal regulations. OBJECTIVES: We aimed to evaluate demographic data, clinical findings, and patch test features of patients with methylisothiazolinone (MI) and/or methylchloroisothiazolinone(MCI) sensitivity in our study. METHODS: This study is a bidirectional and cross-sectional study, between July 2020 and September 2021. A total of 616 patients, including prospective and retrospective populations, demographic data, clinical findings, and patch test results were reviewed. Patients' demographics, patch test results, allergen sources, presence of occupational contact, and the characteristics of dermatitis attacks were recorded. RESULTS: A total of 50 patients with MI and MCI/MI sensitivity, 36 male (72%) and 14 female (28%), were included in our study. The overall prevalence of MI and MCI/MI between 2014 and 2021 was 8.4% (52/616) with two peak levels in 2015(21%) and 2021 (20%). A statistically significant relationship was found between shampoo use and facial involvement (p = 0.031), shower gel use and arm involvement (p = 0.027), wet wipe use and hand involvement (p = 0.049), detergent use and the pulps (p = 0.026) and the lateral aspects of fingers involvement (p = 0.048), water-based dye use and periungual involvement (p = 0.047). CONCLUSION: Although legal regulations related to MI and MCI/MI cause a decrease in the frequency of their sensitivities were still common causes of allergic contact dermatitis.

Could there be an association between Hashimoto's thyroiditis and demodex infestation?

BACKGROUND: Human demodex mites are parasites that live in the pilosebaceous unit and can result in the disease demodicosis. While demodicosis may occur as a primary skin disease; immunosuppression, and topical or systemic immunosuppressive treatments can cause secondary demodicosis. It is known that thyroid hormones may cause skin changes, such as xerosis, and thereby may also modulate immune responses in the skin. OBJECTIVES: The aim of this study is to investigate whether or not that the changes occurring in the skin of patients with Hashimoto's Thyroiditis (HT) predispose to demodex infestation. METHODS: Seventy-eight patients being followed for a diagnosis of HT at Kocaeli University Endocrinology Outpatient Clinic, between January 2019 and March 2020, constituted the patient group. The control group consisted of 41 patients who did not have any chronic systemic or dermatological disease and were shown to have no thyroid disease by laboratory tests. Demodex intensity in the malar regions of the patient and control groups was determined using the standardized skin surface biopsy (SSSB) method and compared with each other. RESULTS: HT patients were significantly more likely to have increased demodex density and suggestive SSSB results than the controls (p < 0.001, p = 0.012, respectively). A significant correlation was found between demodex intensity and the findings of xerosis (p = 0.010, p = 0.011) and spiny follicular papules (p = 0.008, p = 0.008) in the patient or control groups, respectively. However, a significant correlation was identified between the demodex density and the symptoms of burning-stinging (p = 0.028), and feelings of dryness (p = 0.018) roughness (p = 0.028) only in the control group. CONCLUSION: Xerotic skin and/or impaired immune responses as a result of autoimmune changes in patients with HT may lead to secondary demodicosis.

Imiquimod 5% Cream Versus Cryotherapy in Classic Kaposi Sarcoma.

BACKGROUND: Classic Kaposi sarcoma usually remains on the skin and has a slow progression; thus, local treatment methods are preferable. Imiquimod is an immunomodulatory agent with antiviral, antitumoural, and antiangiogenic properties that is expedient against Kaposi sarcoma. OBJECTIVES: We aimed to clarify whether imiquimod is effective on classic Kaposi sarcoma lesions by comparing imiquimod treatment with cryotherapy, which is the most-used treatment method in our department for this disease. METHOD: Patients with classic Kaposi sarcoma were included. All lesions of each patient were evaluated and measured by the blinded investigator considering infiltration and surface diameters. Then, lesions were categorized into 2 groups by the other investigator (nonblinded), and imiquimod 5% cream was administered 3 times per week without occlusion in 1 group. Cryotherapy was performed every 3 weeks in the other group. All lesions were reevaluated and measured at the end of 12 weeks by the blinded investigator. Initial and last measurements were compared between the treatment methods. RESULTS: Fifty lesions of 8 patients were included in this study. Imiquimod and cryotherapy were applied to 26 and 24 lesions, respectively. At the end of the study, statistically significant decreases were detected in all scores between weeks 0 and 12 with both treatment methods. Mean percentages of change in scores were not significantly different between the methods. CONCLUSIONS: Based on a limited number of patients and lesions treated, we believe imiquimod may be a suitable option to use for the treatment of classic Kaposi sarcoma.

Contact sensitivity to textile dyes in patients with pigmented purpuric dermatosis.

Purpose: The aetiology of pigmented purpuric dermatoses is unclear. Recent studies speculate about contact sensitivity to play a role in the aetiology of the disease. In most patients, the lesions begin and stay limited on the lower extremities as textile products are in tight contact with the skin. Also, textile dyes can cause contact dermatitis of purpuric type. This study was conducted in order to understand whether the contact sensitivity plays a critical role in the aetiology of pigmented purpuric dermatoses. Materials and methods: Patients with diagnosis of pigmented purpuric dermatoses were included in the study. Patch tests were applied at the back of all patients with textile series (Chemotechnique Diagnostics TF-1000) which have 33 allergens containing textile dyes, material and protectors by IQ Ultra Chamber. Test sites were evaluated at 48, 72, 96. h and on the 7th day according to the criteria of the International Contact Dermatitis Research Group. The evaluation results were recorded in patient files and the results were statistically compared. Results: Eighteen males (60%) and 12 females (40%), a total of 30 patients were included in the study. Schamberg disease in 23 patients (76.7%), lichen aureus in 5 patients (16.7%) and Majocchi disease in 2 patients (6.7%) were described out of total 30 patients. No contact sensitivity was detected in any of the patients. Conclusion: Contact sensitivity to textile dyes was not found as an etiologic factor in our study group.

Eosinophilic pustular folliculitis of infancy suppressed with cetirizine.

Eosinophilic pustular folliculitis of infancy is a rare inflammatory disease characterized by recurrent, itchy sterile pustules mainly located on the scalp. Topical agents are mostly effective to suppress the symptoms in the majority of cases. However, systemic agents that are safe for long-term use are required for patients with widespread or resistant lesions. We present a case with eosinophilic pustular folliculitis of infancy whose disease was suppressed with cetirizine but recurred after ceasing the drug.

The effects of isotretinoin on the ovarian reserve of females with acne.

There are some side effects of isotretinoin in many organs. However, a study investigating the effects of isotretinoin on the human ovarian reserve has not been reported previously. The study was conducted to investigate possible effects of isotretinoin on ovarian reserve. Serum anti-Müllerian hormone (AMH) levels were measured at the beginning and at the end of isotretinoin treatment in 22 patients with acne and in 22 women without. The mean AMH level before treatment was 5.77 ng/mL in the study group and 3.79 ng/mL in the control group (p = 0.008). Following treatment, the mean AMH level was 4.69 ng/mL in the study group. This mean AMH level after treatment was statistically lower than the AMH level before treatment (p = 0.012). There was no significant difference between the mean AMH level at the end of treatment and that of the control group (p = 0.20). The high level of pre-treatment AMH levels could be an evidence of hyperandrogenism in women with acne, even if they are not identified as having polycystic ovary syndrome (PCOS) or hyperandrogenism. Decrease in AMH levels following exposure to isotretinoin may suggest that it has a detrimental effect on the ovaries.

Effectiveness of systemic treatment agents on psoriatic nails: a comparative study.

BACKGROUND: Nails, one of the most visible sites of body, are frequently involved in psoriasis and accepted as the most difficult site for topical treatment because of their anatomical structure. Healing of the psoriatic nails usually occurs when systemic therapy is initiated to treat severe skin psoriasis or joint involvement, but sometimes systemic therapy is essential for severe nail psoriasis, although Psoriasis Area and Severity Index (PASI) score is low or none of the joints are affected. In this case, knowing which systemic agent is most potent on nail findings is important. AIM: We aimed to evaluate the effect of systemic antipsoriatic agents on nail findings. METHODS: Eighty-seven psoriatis patients with fingernail involvement who required systemic treatment but had not used any systemic treatment in the previous 12 weeks were included in this study. Different systemic treatment agents were given to patients, considering factors such as age, sex, and joint involvement, but not nail involvement. The control group was recruited from psoriatis patients with nail involvement who were not receiving any systemic treatment. Baseline and week 16 Nail Psoriasis Severity Index (NAPSI) and PASI were detected in all groups. At the end of the study, effects of the agents on both PASI and NAPSI were compared statistically. RESULTS: Patients were divided into 5 groups to receive either: 1) methotrexate, 2) narrow-band ultraviolet B phototherapy, 3) biological agents, 4) acitretin, or 5) no treatment (control group). None of the conventional treatment agents caused any significant difference on NAPSI at the end of week 16 compared with control group, although PASI decreased significantly. Rate of NAPSI changes were more prominent in the biological treatment group, and a statistically significant difference was detected when compared with the control group.

Effects of isotretinoin on serum vitamin E levels in patients with acne.

Anecdotal reports suggest that using retinoids with vitamin E leads to improvements of some side effects due to isotretinoin. However, vitamin E blood levels have not been reported previously in patients with acne treated with isotretinoin. We aimed to investigate the serum vitamin E levels before and after isotretinoin therapy in patients with acne. A total of 70 patients treated with isotretinoin for acne in our dermatology department were included in this study. The serum vitamin E levels were measured as baseline before isotretinoin treatment. All patients received 0.6-0.8 mg/kg/d isotretinoin. The treatment was finished within 5-7 months while ensuring that the cumulative dose was 120 mg/kg. Serum vitamin E levels were measured again in the last month of treatment. The mean serum vitamin E levels before and after treatment were compared. Forty-six patients completed the study. It was detected that the mean serum vitamin E level was 20.22 mg/dl before isotretinoin treatment. In the last month of treatment, the mean serum vitamin E level was 16.24 mg/dl. Serum vitamin E levels decreased in all patients except three. The mean serum vitamin E level after treatment was statistically decreased in comparison with the mean serum vitamin E level before treatment. Our results showed that vitamin E levels decreased during isotretinoin treatment. We considered that some of the side effects due to isotretinoin treatment might be related to this, and supplementation vitamin E may be useful during isotretinoin treatment.

Comparison of effects of 5 and 10 mg oral desloratadine and levocetirizine on histamine-induced wheal and flare response in healthy volunteers.

BACKGROUND: Levocetirizine and desloratadine are mostly used as H1-antihistamines in the treatment of allergic disease in 5 and 10 mg doses. OBJECTIVE: In this study, the efficacy of single oral dosages of 5 and 10 mg desloratadine and levocetirizine were compared by using histamine-induced wheal and flare reactions. METHODS: Eighty healthy volunteers were randomized for four double-blinded treatment with desloratadine 5 and 10 mg and levocetirizine 5 and 10 mg. Wheal and flare responses were produced by histamine. Measurements were performed just before the ingestion of antihistamines (baseline) and afterward at 30, 60, 240 min and 24 h. The values obtained for each antihistamine were compared with baseline values. RESULTS: It was found that except the flare reactions at 30th min, levocetirizine 5 and 10 mg suppressed histamine-induced wheal and flare reactions more than desloratadine 5 and 10 mg did. There were not any significant differences between desloratadine 5 and 10 mg in all periods. Levocetirizine 10 mg suppressed wheal and flare reactions significantly more than levocetirizine 5 mg only at 24th h. CONCLUSION: In this study, it was observed that levocetirizine 5 and 10 mg had a higher activity than desloratadine 5 and 10 mg.

Contact sensitivity in Behçet's disease.

CONTEXT: Behçet's disease (BD) is a multisystemic inflammatory disorder with unknown etiology. Many immunological changes were reported in BD previously and these changes may affect the frequency of contact sensitivity in these patients. OBJECTIVE: We aimed to identify whether there is an interaction between contact sensitivity and BD. METHODS: The 'European standard series' with 27 allergens were performed on the upper backs of patients and healthy volunteers according to international standards using the IQ-Chamber. The test-units which contain these allergens were removed after 2 days. According to International Contact Dermatitis Research Group Recommendations test areas were evaluated on days 2, 3 and 7 to detect any delayed allergic reactions. The results of both groups were compared by using chi-square test. RESULTS: One hundred adult persons (50 BDs and 50 healthy controls) were tested. Positive patch test reaction to 1 or more allergens was observed in 7 (14%) patients in BD group and in 12 (24%) persons in control group. There was no statistically significant difference between these two groups. CONCLUSIONS: The frequency of contact sensitivity in BD is not different from healthy persons.

The spectrum of renal abnormalities in patients with psoriasis.

OBJECTIVE: Kidney involvement secondary to psoriasis is a controversial issue. In this study, we evaluated the prevalence of urinary abnormalities in patients with psoriasis. MATERIALS AND METHODS: Forty-five psoriasis patients (28 women, 17 men, mean age 44 ± 14 years) and 45 age- and gender-matched control subjects without hypertension or diabetes were enrolled in the study. Psoriasis area and severity index (PASI) was used to assess the severity of psoriasis. Urinalysis by dipstick and microscopic evaluation and 24-h proteinuria and albuminuria were measured in all patients and controls. Pathologic albuminuria was defined as albumin excretion of more than 30 mg/24 h. Renal biopsy was performed in psoriasis patients with urinary abnormalities. RESULTS: Patients with psoriasis and controls were not significantly different with respect to the prevalence of abnormal urinalysis (17.7% vs. 13.3%, P = 0.56), mean 24-h proteinuria (145 ± 66 mg/24 h vs. 141 ± 71 mg/24 h, P = 0.54), and albuminuria (21 ± 34 mg/24 h vs. 8 ± 9 mg/24 h, P = 0.31). However, patients with psoriasis had an increased prevalence of pathologic albuminuria compared with controls (24% vs. 2%, P = 0.005). PASI scores in psoriasis patients correlated significantly with 24-h albuminuria (r = 0.458, P = 0.007). Of the eight patients with psoriasis who had urinary abnormalities, four underwent renal biopsy. Two of them had biopsy-proven glomerulonephritis: mesangial proliferative glomerulonephritis in one and IgA nephropathy in the other. CONCLUSION: The presence of abnormal urinalysis was not more common in patients with psoriasis than in controls. However, the increased prevalence of pathologic albuminuria and its positive correlation with psoriasis severity may suggest subclinical glomerular dysfunction in these patients.

Narrowband ultraviolet B phototherapy for alopecia areata.

Although narrowband ultraviolet B (NB UVB) phototherapy is a well-established treatment in many dermatosis, there is little evidence of efficacy of this method for alopecia areata (AA) treatment in the literature. We undertook a retrospective review of the 25 AA patients treated with NB UVB. Intramuscular triamcinolone acetonide injections per month were used as concomitant treatment in some patients who did not have any contraindication. Eight patients (32%) received monthly intramuscular corticosteroid injections. Four (22.2%) and two (20%) patients achieved excellent response in extensive patchy hair loss patients and entire scalp hair loss patients, respectively. Four of six patients who achieved excellent response also received monthly intramuscular corticosteroid injections. When patients receiving systemic corticosteroid injections were compared with patients given only NB UVB with respect to the treatment responses, a statistically significant difference was seen in patients who achieved excellent response. NB UVB is not an effective treatment with only 20% excellent treatment responses in patients with severe AA, most of whom were also treated with systemic corticosteroids.

Angioma serpiginosum with sole involvement.

Angioma serpiginosum, which is characterized by multiple, minute, angiomatous puncta, is mainly located on the lower extremities of girls under the age of 16. Although any region of the body may be involved, lesions located on the palms and soles have never been reported. The lesions occur in groups, forming serpiginous patterns and rarely follow Blaschko's lines. Increased levels of estrogens have been proposed in the development of angioma serpiginosum. Here, we describe a 16-year-old girl with AS following the Blaschko's lines along the whole left lower extremity, also involving the left sole. Immunohistochemical studies showed the absence of estrogen and progesterone receptors within the involved blood vessels, indicating no role of hormonal stimuli in the initiation of this clinical picture.