[Cutaneous infection caused by Alternaria alternata in an immunocompetent host]. / Immün sistemi saglam bir konakta Alternaria alternata ile olusan deri enfeksiyonu.

Human infections caused by Alternaria alternata are more frequently reported in immunosupressive hosts. In this report, a rarely seen cutaneous infection, caused by A. alternata in an immunocompetent patient was presented. The patient (71-years-old, male) was admitted to the dermatology unit with complaints of an erythematous and squamatous lesion of 5 cm diameter on left malleolar region. The case was evaluated as immunocompetent based on the normal serum total immunoglobulin and complement levels, anti-HIV negativity, and no known underlying disease. A number of Alternaria spp. conidia and hypha were seen in the microscopical examination of KOH treated cutaneous scrapings of the lesion obtained in two different days. Fungal cultures of the skin scrapings yielded the growth of a fungus identified as A. alternata. Although fungal elements were not detected in haematoxylene-eosin stained smears of the skin biopsy, A. alternata was again isolated in the culture of the biopsy specimen. The identification of the fungus was confirmed by a reference center (Mycology Section of Scientific Institute of Public Health, Belgium) and it was integrated to BCCM/IHEM collection under accession number IHEM 22598. Antifungal susceptibility test efforts failed due to a problem in the preparation of fungal suspension. Oral itraconazole (200 mg/day) and bifonazole cream was used for the treatment and the lesion regressed after the 19th day of the therapy. The treatment was continued with oral and local terbinafine for two weeks and the patient fully recovered. Since A. alternata was demonstrated both in the skin scrapings and tissue biopsy through microscopic examination and culture, it was evaluated as the causative agent of skin infection rather than colonization. This was the first A. alternata infection in an immunocompetent patient in the light of the current literature.

[Susceptibility to atherosclerosis in patients with psoriasis and psoriatic arthritis as determined by carotid-femoral (aortic) pulse-wave velocity measurement]. / Vulnerabilidad a la aterosclerosis en pacientes con psoriasis y artritis psoriásica, según las determinaciones de la velocidad de la onda de pulso carótido-femoral (aórtica).

INTRODUCTION AND OBJECTIVES: In this study we analyzed the susceptibility to atherosclerosis of patients with psoriasis and psoriatic arthritis (PsA) by determining the femoral-carotid pulse wave velocity (PWV), which is a measure of the viscoelastic properties of blood vessels. METHODS: The study included 25 patients with psoriasis (age 18-63 years; 13 male), of whom nine had arthritis, as well as 39 sex- and age-matched healthy control subjects (age 24-70 years, 25 male). The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, body mass index (BMI) and waist-to-hip ratio (WHR) of all participants were recorded and, in patients, skin lesions were assessed using the psoriasis area and severity index (PASI). Arterial distensibility was determined by automatic carotid-femoral PWV measurement using the Complior Colson device. RESULTS: Mean PWV, SBP and DBP were significantly higher in psoriatic patients than in control subjects (P=.036, P< .001, and P=.005, respectively). In PsA patients, the mean WHR, SBP, DBP and PWV were all significantly higher than in control subjects (P=.001, P=.031, P=.001, and P=.014, respectively). CONCLUSIONS: The carotid-femoral PWV is increased in patients with psoriasis and PsA.

Vulnerabilidad a la aterosclerosis en pacientes con psoriasis y artritis psoriásica, según las determinaciones de la velocidad de la onda de pulso carótido-femoral (aórtica) / Susceptibility to atherosclerosis in patients with psoriasis and psoriatic arthritis as determined by carotid-femoral (aortic) pulse-wave velocity measurement

Introducción y objetivos. En este estudio hemos analizado la vulnerabilidad a la aterosclerosis de los pacientes con psoriasis y artritis psoriásica (APs) mediante la determinación de la velocidad de la onda del pulso (VOP) carótido-femoral, que es una medida de las propiedades viscoelásticas de los vasos sanguíneos. Métodos. Se incluyó en el estudio a 25 pacientes con psoriasis (edad, 18-63 años; 13 varones), de los que 9 presentaban artritis, así como a 39 individuos control sanos, emparejados por sexo y edad (edad, 24-70 años; 25 varones). Se registraron los valores de presión arterial sistólica (PAS), presión arterial diastólica (PAD), frecuencia cardiaca, índice de masa corporal (IMC) y cociente cintura/cadera (CCC) de todos los participantes, y en los pacientes se evaluaron las lesiones cutáneas con el empleo del Psoriasis Area and Severity Index (PASI). Se determinó la distensibilidad arterial con una medición automática de la VOP carótido-femoral utilizando el dispositivo Complior Colson. Resultados. Los valores medios de VOP, PAS y PAD fueron significativamente mayores en los pacientes con psoriasis que en los individuos de control (p = 0,036, p < 0,001 y p = 0,005, respectivamente). En los pacientes con APs, los valores medios de CCC, PAS, PAD y VOP fueron significativamente superiores que en los individuos de control (p = 0,001, p = 0,031, p = 0,001 y p = 0,014, respectivamente). Conclusiones. La VOP carótido-femoral está aumentada en los pacientes con psoriasis y APs (AU)

Introduction and objectives. In this study we analyzed the susceptibility to atherosclerosis of patients with psoriasis and psoriatic arthritis (PsA) by determining the femoral-carotid pulse wave velocity (PWV), which is a measure of the viscoelastic properties of blood vessels. Methods. The study included 25 patients with psoriasis (age 18-63 years; 13 male), of whom nine had arthritis, as well as 39 sex- and age-matched healthy control subjects (age 24-70 years, 25 male). The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, body mass index (BMI) and waist-to-hip ratio (WHR) of all participants were recorded and, in patients, skin lesions were assessed using the psoriasis area and severity index (PASI). Arterial distensibility was determined by automatic carotid-femoral PWV measurement using the Complior Colson device. Results. Mean PWV, SBP and DBP were significantly higher in psoriatic patients than in control subjects (P=.036, P<.001, and P=.005, respectively). In PsA patients, the mean WHR, SBP, DBP and PWV were all significantly higher than in control subjects (P=.001, P=.031, P=.001, and P=.014, respectively). Conclusions. The carotid-femoral PWV is increased in patients with psoriasis and PsA (AU)

Joint and nail involvement in Turkish patients with psoriatic arthritis.

Psoriatic arthritis is an autoimmune, chronic, systemic inflammatory disorder characterized by the association of arthritis with psoriasis. In this paper, we explore the characteristics of joint and nail involvement in Turkish patients with psoriatic arthritis. Forty patients with psoriasis (M/F, 18/22) and 49 (M/F, 25/24) subjects with psoriatic arthritis were included in the study. Clinical characteristics of the patients were recorded. The distribution of the subjects with arthritis: (according to the clinical and radiological findings): polyarticular, 65%; oligoarticular, 23%; isolated axial involvement, 7.7%; arthritis mutilans, 3.8%; sacroiliitis, 19%. Nail involvement was significantly higher among patients with arthritis; i.e., 91 versus 32%; (P<0.05). There were no correlation between the skin involvement pattern and the arthritis type (P>0.05). Nevertheless, no relation was observed between the psoriasis duration and arthritis (P>0.05). Nail involvement is a frequent feature of the psoriatic arthritis which may be a useful finding for differential diagnosis of psoriatic arthritis from other inflammatory arthropathies.

A review of the use of adapalene for the treatment of acne vulgaris.

Acne is a disease of the pilosebaceous unit with involving abnormalities in sebum production, microbial flora changes, abnormal keratinization, and inflammation. There are several therapeutic options like topical and systemic retinoids, antibiotics, and systemic hormonal drugs. The topical retinoids a play very important role in the treatment of acne vulgaris. However, their use is limited due to skin irritation. A new generation product, adapalene is a good choice in the treatment of acne vulgaris with less side effects and high efficacy confirmed by numerous clinical studies.

Cutaneous findings in patients with primary Sjogren's syndrome.

Sjogren's syndrome (SS) is an autoimmune disease that is characterized by exocrine gland involvement. It is reported that the skin is affected in nearly half of SS patients. Cutaneous manifestations consist of xerosis, angular cheilitis, eyelid dermatitis, pruritus, cutaneous vasculitis (frequently manifesting as palpable purpura), and erythema annulare. Most of them are nonspecific and less severe than the oral, ocular, or musculoskeletal symptoms. We present two patients with primary SS who have many cutaneous manifestations including erythema annulare and pernio-like lesions and review the literature about this topic.

Nasopharyngeal carcinoma with extensive nodular skin metastases: a case report.

Skin metastasis from nasopharyngeal carcinoma is a rare clinical finding. The most common form of appearance is a few solitary skin nodules. However, massive and extensive nodular dissemination or diffuse dermal lymphatic infiltration is extremely rare. We here present a case of a 40-year-old man with widespread nodular skin metastases from undifferentiated nasopharyngeal carcinoma.

Benzoyl peroxide, adapalene, and their combination in the treatment of acne vulgaris.

Benzoyl peroxide and adapalene are among the most effective topical agents used in the treatment of acne. We planned an open-labeled, prospective study to compare the effects and side effects of these two drugs alone and in combination in the treatment of acne vulgaris. One hundred and five consecutive patients (30 men and 75 women) with acne vulgaris were included in this study. The patients were randomly divided into three groups with 35 patients in each. The groups were randomly assigned to 0.1% adapalene gel, 5% benzoyl peroxide lotion, or combination of 0.1% adapalene gel +5% benzoyl peroxide treatment. Acne lesions were classified as noninflammatory (open and closed comedones) and inflammatory (papule, pustule, nodule, cyst), and the lesions on the face were counted before the therapy, during the control visits, and after the treatment. Erythema, dryness, burning, and other side effects were recorded during the treatment. The mean age of the patients was 18.44 +/- 3.75 years. Eight patients were excluded because of noncompliance with the treatment regimen or the follow-up schedule, and four patients were excluded due to allergic contact dermatitis. The study revealed that all three therapy protocols were effective in treating noninflammatory and inflammatory lesions in acne vulgaris (p<0.05) and that there was no significant difference between the groups in efficacy or side effects (p>0.05). Adapalene and benzoyl peroxide are effective and well tolerated agents for acne vulgaris; combination therapy has no superiority over adapalene or benzoyl peroxide alone.

Coexistence of Darier's disease and acrokeratosis verruciformis of Hopf.

Darier's disease and acrokeratosis verruciformis are inherited with the same pattern and they share similar clinical properties. We present a patient with both Darier's disease and acrokeratosis verruciformis. The patient had had brownish and skin-colored papules, initially on her face and neck, since the age of 25. Similar lesions had gradually spread to various parts of her body and lastly the dorsal aspect of her feet. On dermatological examination, brownish and skin-colored, 2 to 5 mm, keratotic papules were observed on her face, neck, both axillae, inframammary regions, and dorsa of the hands and feet. The nail examination revealed "V" shaped notches and longitudinal ridges on the fingers of both hands. The biopsy taken from the neck showed typical findings for Darier's disease. The biopsy from the dorsa of the left foot revealed the distinctive structures of acrokeratosis verruciformis. In this article the clinical and histopathological findings of these diseases are reviewed based on our patient.

The treatment of common warts with infrared coagulation.

Treatment of warts can involve medical and surgical methods. Infrared coagulation is a surgical method very rarely used in the treatment of warts. We planned an open-labeled prospective study to research the effect of infrared coagulation in the treatment of common warts, comparing it with electrocoagulation, and discussing its applicability as an alternative therapy regimen. Eighteen patients with common warts were included in this study. There were 49 warts of various sizes (1 mm to 1 cm) in these 18 patients. Twenty-seven warts were treated with infrared coagulation, and 22 warts were treated with electrocoagulation. Sixteen patients were treated with both infrared coagulation and electrocoagulation; two patients were treated with only infrared coagulation. The patients were followed-up for six months after treatment. Changes in sizes of warts, healing times, and cure rates were compared by Mann-Whitney U test. The mean healing time was 35.5 +/- 5.7 days with infrared coagulation and 32.9 +/- 4.0 days with electrocoagulation. There was not any significant difference between healing times (p > 0.05). Bacterial infection was seen on seven (31.8%) warts treated with electrocoagulation, but no side effects were seen with infrared coagulation. There was a significant difference between side effect rates in two groups (p < 0.01). Nine (33.3%) of the warts treated with infrared coagulation and seven (31.8%) of the warts treated with electrocoagulation recurred in the six-month follow-up period. The overall cure rates at the end of the follow-up period were 66.7% and 68.2% respectively. There was not any significant difference between the cure rates in the two groups (P > 0.05). We conclude that infrared coagulation is a safe and cheap method and should be kept in mind as an alternative modality for the treatment of common warts.

Serum lipid levels in psoriasis.

A predisposition to occlusive vascular diseases has been reported in patients with psoriasis and it has been suggested that some of these patients have some disorders of lipid metabolism. In this study, serum lipid levels were investigated in psoriatic patients to explore to the knowledge of this relationship. One hundred psoriatic patients and 100 non- psoriatic controls were included in the study. Total cholesterol, triglyceride, high-density lipoprotein-cholesterol (HDL-cholesterol), low-density lipoprotein-cholesterol (LDL-cholesterol), and very low-density lipoprotein-cholesterol (VLDL-cholesterol) levels were measured. In patients with psoriasis, total cholesterol and LDL-cholesterol levels were found to be significantly higher than those of controls. No significant differences were found in the other parameters. We concluded that psoriatic patients should be evaluated and followed up for the risk of hyperlipidemia and obstructive vascular diseases.