Analysis of factors influencing target PASI responses and side effects of methotrexate monotherapy in plaque psoriasis: a multicenter study of 1521 patients.

Methotrexate (MTX) is commonly used as first-line systemic treatment agent in psoriasis. We aimed to evaluate the clinical characteristics and treatment responses of patients with psoriasis undergoing MTX monotherapy. Data from adult patients with plaque psoriasis who received MTX monotherapy for at least 3 months between April 2012 and April 2022 were retrospectively evaluated in 19 tertiary care centers. Our study included 722 female and 799 male patients, a total of 1521 participants. The average age of the patients was 44.3 ± 15.5 years. Mode of treatment was oral in 20.4% of patients while in 79.4% it was subcutaneous. The median treatment duration was 8 months (IQR = 5-15). The median weekly dose was 15 mg (IQR = 11-15). 1448 (95.2%) patients were taking folic acid supplementation. At week 12, 16.3% of the patients achieved PASI (Psoriasis Area and Severity Index) 90 response while at week 24, 37.3% achieved it. Logistic regression analysis for week 12 identified the following independent factors affecting PASI 90 achievement positively: median weekly MTX dose ≤ 15 mg (P = 0.011), subcutaneous administration (P = 0.005), no prior systemic treatment (< 0.001) and folic acid use (0.021). In logistic regression analysis for week 24; median weekly MTX dose ≤ 15 mg (P = 0.001), baseline PASI ≥ 10 (P < 0.001), no prior systemic treatment (P < 0.004), folic acid use (P = 0.001) and absence of comorbidities (P = 0.009) were determined as independent factors affecting the achievement of PASI 90. Adverse effects were observed in 38.8% of the patients, with nausea/vomiting (23.9%) and transaminase elevation (13%) being the most common. The most common reasons for interruptions (15.3%) and discontinuations (27.1%) of the treatment were patient related individual factors. The use of MTX as the first systemic treatment agent, at doses ≤ 15 mg/week and concurrent folic acid application are positive predictive factors for achieving the target PASI response both at weeks 12 and 24. In our study, which is one of the most comprehensive studies on MTX treatment in psoriasis, we observed that MTX is an effective and safe treatment option.

Risankizumab for the Treatment of the Patients with Moderate to Severe Plaque Psoriasis During a 24-Week Period: Real-Life Experience.

Introduction: Several authors have reported their experiences in real-world clinical practice, confirming the therapeutic efficacy of risankizumab in plaque psoriasis. We aimed to reflect our experience with risankizumab treatment in patients with psoriasis. Materials and Methods: Patients who presented to the dermatology outpatient clinics of two tertiary care centers between November 2021 and August 2022, diagnosed with psoriasis and treated with risankizumab, constituted the target population. Data including gender, age, weight, type of psoriasis, affected body sites, disease duration, previous treatments, duration of risankizumab treatment, psoriasis area and severity index scores, comorbidities, the reasons for drug discontinuation, adverse effects, and the patients' naïve or non-naïve status were obtained from electronic patient folders. Results: Overall, 120 cases were included. While 73 (60.8%) cases were male, 47 (39.2%) were female. Eighty-six (68.3%) of all cases were biologic non-naive. A total of 49 patients (40.8%) had comorbidities. No significant correlations existed between biologic-naïve or non-naïve status, comorbidity status, and the PASI 75-90-100 responses. Conclusion: Risankizumab is an effective treatment option for both biologic naive or non-naive patients with or without comorbidities. However, long-term studies, including more extensive patient series, are needed to validate its efficacy and safety in real-life clinical settings.

Ixekizumab for the treatment of the patients with moderate to severe plaque psoriasis: Clinical data from a real-world experience.

Real-life data about any particular treatment is very helpful for clinicians, particularly when managing a chronic disease such as psoriasis. In our study, we aimed to reflect our clinical experience during 48 weeks with an IL-17 antagonist ixekizumab. This study was designed as a retrospective multi-center study. Four tertiary referral centers participated into the study. The patients who did not present to the clinics for 3rd month follow-up were excluded. Data including gender, age, weight, type of psoriasis, additional sites on the body, disease duration, previous treatments, duration of medication of ixekizumab, psoriasis area and severity index scores, previous treatments, and comorbidities, the reasons for drug discontinuation, adverse effects and the patients' naïve or non-naïve status were retrieved from electronic patient folders. Although 267 patients met the inclusion criteria, 28 patients were excluded since they did not present to the clinic for 3rd month follow-up so 239 cases were included mmüne research. We determined significant correlations between naive and non-naive cases about getting PASI 75 and PASI 90 responses for all cases (p = 0.005 and p = 0.028, respectively) and between comorbid and non-comorbid cases about getting PASI 90 and PASI 100 responses for all cases (p = 0.021 and p = 0.029, respectively). When we investigate as female and male patients separately, non-comorbid female cases can achieve PASI 100 response significantly easier than comorbid female patients (p = 0.019). Clinicians can use ixekizumab safely mmüne treatment of their patients with psoriasis and get PASI 75-90-100 responses quickly. Ixekizumab is more effective for naive cases but it may also be a treatment option for biologic experienced patients. The ratio of PASI 75-90-100 responses are better in non-comorbid cases than comorbid patients nevertheless ixekizumab is a quite effective agent mmüne treatment of comorbid cases.

Chronic actinic damage of facial skin.

Chronic actinic damage of the skin manifests itself as extrinsic skin aging (photoaging) and photocarcinogenesis. During the last decade, substantial progress has been made in understanding cellular and molecular mechanisms of photoaging. DNA photodamage and ultraviolet-generated reactive oxygen species are the initial events that lead to most of the typical histologic and clinical manifestations of chronic photodamage of the skin. Chronic actinic damage affects all layers of the skin. Keratinocytes, melanocytes, fibroblasts, and endothelial cells are altered by ultraviolet radiation and can result in numerous changes in human skin, particularly the skin of fair-skinned individuals. These changes include actinic keratosis, thickening and wrinkling, elastosis, telengiectasia, solar comedones, diffuse or mottled hyperpigmentation, and skin cancers. There are many options in the treatment of changes caused by chronic actinic damage. The most effective measure of prevention of the photoaging and photocarcinogenesis is sun protection.

Dermatologic diseases of the external ear.

The external ear is composed of the auricle (pinna) and the external auditory canal. Both of these structures contain elastic cartilage (except the earlobe) and a small amount of subcutaneous fat, which are covered by skin. The skin of the cartilaginous canal contains hair cells, sebaceous (lipid-producing) glands, and apocrine (ceruminous) glands; this is in contrast with the osseous canal, which contains neither glands nor hair follicles. The auricle is susceptible to environmental influences and trauma. Due to its exposed locale, the ear is particularly vulnerable to the effects of ultraviolet light and, consequently, to preneoplastic and neoplastic skin lesions. The ear also has a sound-receiving function and a location that is both visible and aesthetically obvious, thereby drawing considerable attention from the patient. Dermatologic diseases on the external ear are seen in a variety of medical disciplines. Dermatologists, otorhinolaryngologists, family practitioners, and general and plastic surgeons are regularly consulted about cutaneous lesions on the ear. These lesions can be grouped into three main categories: (1) infectious; (2) tumoral; and (3) noninfectious inflammatory. The purposes of this contribution are to review various dermatologic diseases of the external ear and to update current diagnosis and treatment information related to these conditions.

Comparison of the effects of Contractubex® gel in an experimental model of scar formation in rats: an immunohistochemical and ultrastructural study.

BACKGROUND: Contractubex® gel, a commercial treatment for scars, consists of a mixture of onion extract (cepea extract), heparin sodium, and allantoin. It exerts a softening and smoothing effect on indurated, hypertrophic, painful, and cosmetically-disfiguring scar tissue. AIM: To compare and discuss the immunohistochemical and ultrastructural effects of treatment of an experimental scar in a rat model with Contractubex gel. METHODS: Thirty-two Sprague-Dawley rats were divided into four groups. Skin biopsies were taken to develop full thickness wounds. After 10 days, Contractubex gel, heparin, and allantoin were topically applied daily to groups 2, 3, and 4, respectively. Group 1 was the control group. On the 30th day, scar tissues were excised to investigate the immunohistochemical and ultrastructural effects of these agents. For this purpose we used TGF-beta, laminin, and fibronectin primary antibodies. RESULTS: Increased immunoreactivities of laminin, fibronectin, and TGF-beta in control group, moderate immunoreactivities in heparin and allantoin groups, and mild immunoreactivities in the Contractubex gel group were observed. In semi-thin sections, Group 2 showed the thinnest epidermis of the four groups. In electron micrographs of Group 2, completely keratinized and normally appearing cells could be seen. CONCLUSIONS: Immunohistochemical and ultrastructural observations demonstrated that the Contractubex gel significantly improved the quality of wound healing and reduction of scar formation. Also, it was a more appropriate treatment choice than heparin monotherapy and allantoin monotherapy in keloidal and hypertrophic scars.

Environmental risk factors in pediatric psoriasis: a multicenter case-control study.

To analyze the effect of possible risk factors, including breastfeeding, on the development of childhood-onset psoriasis, a multicenter case-control study with prospective collection of data was performed. Using a standard questionnaire, personal and specific variables including family history of psoriasis, maternal and environmental tobacco smoke exposure, body mass index (BMI), exclusive and partial breastfeeding for at least 3 and 12 months, cow's milk intake before 1 year, birth delivery method, and stressful life events were collected during 2009 from 537 patients with psoriasis and 511 controls younger than 18. Overall, patients more frequently reported exposure to environmental tobacco smoke at home and stressful life events in the year preceding the diagnosis than controls. The odds ratios (OR) for smoking and stressful life events were 2.90 (95% confidence interval [CI]=2.27-3.78) and 2.94 (95% CI=2.28-3.79), respectively. In addition, children with psoriasis were more likely to have a higher BMI (>26) than controls (OR=2.52; 95% CI=1.42-4.49). High BMI, environmental tobacco smoke exposure at home, and stressful life events may influence the development of pediatric psoriasis.

Risk factors for delaying treatment seeking in obsessive-compulsive disorder.

BACKGROUND: Despite the multiple alternatives of treatment, it is well known that patients with obsessive-compulsive disorder (OCD) delay seeking treatment. In this study, the aim was to determine the risk factors for delaying treatment seeking in OCD patients. METHODS: The sample consisted of 132 OCD who completed the Yale-Brown Obsessive-Compulsive Scale, Yale-Brown Obsessive-Compulsive Scale Symptom Checklist, and Beck Depression Inventory. RESULTS: In univariate analyses with risk evaluation, income level, being single or divorced, having a history of psychiatric treatment, poor insight for the symptoms, and obsessions of hoarding were the variables that were found to be significant. In the regression model, history of psychiatric treatment and duration of OCD were the 2 variables that remained statistically significant. CONCLUSION: This was the first study wherein the sample included patients who were recruited from a nonpsychiatric department: the dermatology clinic. Application to dermatology has not been determined as a risk factor for delaying treatment seeking in OCD patients.

Sorafenib-induced erythema multiforme in metastatic renal cell carcinoma.

Sorafenib is a new therapeutic agent being used in metastatic renal cell carcinoma, hepatocellular carcinoma, and malignant melanoma. The most frequently seen cutaneous side effects due to sorafenib are erythema, exfoliative dermatitis, acne vulgaris, and flushing. Folliculitis, eczema, and erythema multiforme are other, rare side effects of sorafenib. A 59-year-old man underwent left radical nephrectomy due to renal cell carcinoma 8 months ago, and after the operation he received immunochemotherapy and then sorafenib. On the third day of sorafenib therapy his lesions occurred. His dermatologic examination revealed multiple erythematous papules on his neck, arms, and legs and bullae and iris lesions on his palms and soles. He was diagnosed as having erythema multiforme. In the literature we found only 1 other erythema multiforme case due to sorafenib. We present this interesting case to show and discuss cutaneous side effects of sorafenib, especially erythema multiforme as a very rare cutaneous side effect.

Calciphylaxis with recalcitrant ulcers in the presence of moderate renal insufficiency.

A 69-year-old woman with painful crural ulcers of 3 months' duration presented at the authors' outpatient clinic. Dermatological examination revealed a necrotic ulceration with eschar formation localized on the anterior left crural region and the lateral malleolus of the right ankle. According to the clinical and histopathological findings, she was diagnosed with calciphylaxis. She had moderate renal insufficiency and secondary hyperparathyroidism due to hypertension. The ulcers improved significantly after 3 months of topical wound therapy. This case of calciphylaxis with recalcitrant ulcers in the presence of moderate renal insufficiency is presented to stress the importance of early diagnosis and management in this life-threatening disorder.

Acute generalized exanthematous pustulosis (AGEP) due to exposure to sulfuric acid and bromic acid vapor: a case report.

Acute generalized exanthematous pustulosis (AGEP, toxic pustuloderma, pustular drug eruption) is a not uncommon cutaneous reaction pattern that is usually related to drug administration. The eruption is of sudden onset and appears 7-10 days after the medication is started. A 22-year-old male patient who was a student at a chemical faculty attended our outpatient clinic with a complaint of pustular eruption on his face. According to his history, the eruption started with pruritus and erythema on his chin 3 days ago and spread to his face and chest. He explained that he had performed an experiment with sulfuric acid and bromic acid and was exposed to their vapor. His dermatological examination revealed erythema and pustules on his cheeks, on his chin, above his upper lip, and on his eyebrows. He also had a few pustules on his chest. There were no ocular, mucous membrane, or pulmonary symptoms. Histopathological examination of the skin biopsy specimen revealed superficial orthokeratosis, focal subcorneal pustule formation, and perivascular chronic inflammatory cell infiltration in superficial dermis. After administration of systemic antihistamines and wet dressing topically, we observed rapid healing of the lesions. Because there was no systemic drug intake in his history, we were concerned that exposure to sulfuric acid and bromic acid vapor caused AGEP in this patient. We present this rare case to show that the vapor of chemical materials may cause AGEP or other drug eruptions.

Comparison of the effects of collagenase and extract of Centella asiatica in an experimental model of wound healing: an immunohistochemical and histopathological study.

In this study, we compared the effects of collagenase and Centella asiatica in the rat model. Twenty-seven female rats were divided into three groups, and two full-thickness wounds were made for each animal. Collagenase ointment was applied topically to Group I and C. asiatica ointment to Group II rats. In Group III, no treatment was applied. On the third day of treatment, wounds on the left side of three animals of each group were excised. On the fifth and eighth day of the treatments, the same procedure was performed for the remaining animals. Indirect immunohistochemical examination was performed to detect transforming growth factor beta (TGF)-beta, endothelial and inducible nitric oxide synthase (eNOS and iNOS), vascular endothelial growth factor, TGF-alpha, laminin, fibronectin, collagen I, and interleukin-1beta. According to the measurements of the wound areas and wound healing periodo, collagenase was superior to the control group. Immunohistochemical examinations showed strong (+++) iNOS and TGF-beta immunoreactivities in C. asiatica group. eNOS immunoreactivity was moderate (++) in this group. For the collagenase group, iNOS, eNOS, and TGF-beta immunoreactivities were moderate (++). In the collagenase group, while TGF-beta and iNOS immunoreactivities were weaker, laminin and fibronectin reactivities were stronger than in C. asiatica and control groups. Collagenase was superior to C. asiatica according to the immunohistochemical findings. Collagenase ointment significantly improves the quality of wound healing and scar formation and is a more appropriate treatment choice than extract of C. asiatica in the early stages of the wound healing process.

Sexual dysfunction in patients with chronic hand eczema in the Turkish population.

INTRODUCTION: Hand eczema can cause considerable psychosocial disorders, such as anxiety, depression, and difficulties at work, and it may also cause sexual dysfunction. AIM: The aim of this study was to investigate sexual function in patients with hand eczema and to find out whether concomitant depression has an additional negative effect on sexual function in these patients. MAIN OUTCOME MEASURES: Sexual functions were evaluated in hand eczema patients. METHODS: Ninety-one female (43 patients vs. 48 controls) and 79 male (45 patients vs. 34 controls) subjects were enrolled in the study. Hand eczema severity index was used to determine severity of hand eczema. The Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF) were used to assess sexual function. Quality of life was assessed with the Dermatology Life Quality Index. Diagnosis of depression was made based on the Structured Clinical Interview for the DSM-IV, while the Hamilton Depression Rate Scale was used for grading depression. RESULTS: Among 43 female subjects with hand eczema, 26 had depression (60.46%); of the 45 male patients, 11 had depression (24.44%). FSFI total score was found to be significantly decreased in female patients with both eczema and depression compared with controls (20.84 +/- 9.19 vs. 24.04 +/- 3.40, P < 0.05). FSFI total score was found to be significantly decreased in female patients with both eczema and depression compared with those without depression (20.84 +/- 9.19 vs. 22.23 +/- 5.82, P < 0.05). IIEF total score was also found to be significantly decreased in male patients with or without depression compared with controls (52.36 +/- 14.83 vs. 59.88 +/- 5.65 vs. 62.03 +/- 11.04, P < 0.05). CONCLUSIONS: The results of the study demonstrated that patients with hand eczema had sexual dysfunction, and concomitant depression had an additional negative effect on sexual dysfunction. Patients with hand eczema should be evaluated with regard to sexual function and depression to provide a better quality of life.

Sexual dysfunction in patients with psoriasis.

Psoriasis can have a significant impact upon sexual function. The aim of this study was to investigate sexual function in females and males with psoriasis and to evaluate whether coexistent depression has an additional negative effect on sexual function in these patients. A total of 66 female subjects (39 with psoriasis and 27 healthy volunteers as a control group) and 70 male subjects (39 with psoriasis and 31 healthy volunteers as a control group) were enrolled in the study. A Psoriasis Area and Severity Index (PASI) was used to determine the severity of psoriasis for the patient groups. The Female Sexual Function Index (FSFI) was used to assess female sexual function and the International Index of Erectile Function (IIEF) was used to evaluate male sexual function. Quality of life was assessed with the Dermatology Life Quality Index (DLQI). The diagnosis of depression was made according to the Structured Clinical Interview for DSM-IV (SCID-I) interview and Hamilton Depression Rate Scale (HDRS) was used for grading depression. FSFI total score was found to be significantly decreased in female psoriatic patients without depression and psoriatic patients plus depression compared with healthy controls (24.09 +/- 5.33 vs. 24.25 +/- 4.52 vs. 28.12 +/- 3.48, respectively, p = 0.004). However, FSFI score was not significantly different between patients with psoriasis without depression and those with psoriasis plus depression (p > 0.05). IIEF total score was also found to be significantly decreased in male psoriasis without depression and psoriasis plus depression patients compared with healthy controls (54.21 +/- 13.07 vs. 52.0 +/- 14.73 vs. 61.69 +/- 9.49, respectively, p = 0.023). The difference in IIEF scores between patients with psoriasis without depression and in those with psoriasis plus depression were not statistically significant (p > 0.05). The results of the study demonstrated that patients with psoriasis, especially females have distinct sexual dysfunction compared with healthy controls, and coexistent depression has no additional negative effect on sexual dysfunction in our patients. Patients with psoriasis should be evaluated in terms of sexual function in order to provide a better quality of life.

Cross validation of the Turkish version of dermatology life quality index.

BACKGROUND: The aim of this study was to test the linguistic validation of the Turkish version of the Dermatology Life Quality Index (DLQI) for Turkish speaking dermatology patients. METHODS: The DLQI is a 10-item dermatology specific index developed originally in English. The methodology of this study consists of four consecutive sections: Translation, cognitive debriefing, field testing and statistical analysis. Translation steps: (a) Two forward independent translations into Turkish, (b) reconciliation of these translations by a dermatologist, (c) backward translation of the consensus Turkish version by a bilingual person into its original language (English), (d) and comparing the original questionnaire with the backward translated one. Cognitive debriefing: Sessions were performed on five patients from each of the seven different dermatological diagnosis groups. Field testing: The final Turkish version on which the face validity was approved by specialists on a total of 79 inpatients/outpatients with various dermatological diagnoses treated at Celal Bayar University Hospital. STATISTICAL ANALYSIS: Internal consistency (using Cronbach a) and item-total score correlations (Pearson correlation) were used for reliability analysis. Validity analysis was carried out by construct testing (principal components factor analysis), convergent (Pearson correlation) and (discriminate Student's t-test and Mann-Whitney U-test) validity, and SF-36 was used in parallel with DLQI in order to test convergent validity. The data were analyzed by the SPSS version 10.0 (SPSS Inc., Chicago, IL, USA) statistical package. RESULTS: The mean age of the patients in the study was 30.77+/-15.91 years; the mean score of DLQI was 7.61+/-6.12. The median of item-total correlation coefficient was found to be 0.66, within a range of 0.48-0.81. The internal consistency of the index was found to be highly sufficient (alpha=0.85). The DLQI was found to be highly related to the physical domain of SF-36. Life quality score was found to be significantly low for the inpatients compared with outpatients (differential validity). CONCLUSION: It was found that the Turkish version of the DLQI was an acceptable index for dermatologists and dermatology patients and, moreover, to be valid and reliable in a cross-sectional level. The responsiveness of the Turkish version of the DLQI needs to be tested further on a variety of dermatological conditions with different severities.

Erythromelanosis follicularis faciei et colli associated with keratosis pilaris in two brothers.

Erythromelanosis follicularis faciei et colli is characterized by well-demarcated erythema, hyperpigmentation, and follicular papules. Since the original description, it has seldom been reported in the literature. We present two adolescent brothers who had this disorder associated with keratosis pilaris on the shoulders and the extensor surfaces of the arms. Dermatologic examination found brown-red pigmentation, erythema, and follicular papules on both maxillary, preauricular regions, and the cheeks. The lesions of the older brother were more prominent. Histopathologic examination of skin biopsy specimens taken from both brothers revealed hyperpigmentation of the basal layer, follicular plugging, dermal vascular dilatation and congestion, and perivascular inflammatory infiltration. We suggest that the coexistence of these two conditions in brothers implies a genetic inheritance and a possible relationship between the disorders.