Evaluation of effects of platelet-rich plasma on human facial skin.

INTRODUCTION: Platelet-rich plasma (PRP) has been used for rapid healing and tissue regeneration in many fields of medicine. This study was conducted to evaluate the effects of PRP application procedure on human facial skin. METHODS: PRP was applied thrice at 2-week intervals on the face of ten healthy volunteers. It was applied to individual's forehead, malar area, and jaw by a dermaroller, and injected using a 27-gauge injector into the wrinkles of crow's feet. Participants were asked to grade on a scale from 0 to 5 for general appearance, skin firmness-sagging, wrinkle state and pigmentation disorder of their own face before each PRP procedure and 3 months after the last PRP procedure. While volunteers were evaluating their own face, they were also assessed by three different dermatologists at the same time by the same five-point scale. RESULTS: There was statistically significant difference regarding the general appearance, skin firmness-sagging and wrinkle state according to the grading scale of the patients before and after three PRP applications. Whereas there was only statistically significant difference for the skin firmness-sagging according to the assessment of the dermatologists. CONCLUSION: PRP application could be considered as an effective procedure for facial skin rejuvenation.

Effects of paroxetine on cutaneous wound healing in healthy and diabetic rats.

OBJECTIVE: The aim of this study was to evaluate the histologic effects of acute paroxetine administration on wound healing in healthy and streptozotocin-induced diabetic rats. DESIGN: This study has a randomized controlled experimental design. SETTING: Healthy (n = 32) and diabetic (n = 32) rats were further divided into 2 groups of saline or paroxetine administration. PARTICIPANTS: Sixty-four male Sprague-Dawley rats were used in this study. INTERVENTIONS: Paroxetine was injected intraperitoneally every day. Full-thickness excision wounds were created with a 4-mm dermal punch on the back of all rats. The healing wound area was removed with a 6-mm dermal punch at postwounding days 1, 3, 7, and 14. MAIN OUTCOME MEASURES: Polymorphonuclear leukocyte, mononuclear inflammatory cell, fibroblast, and blood vessel counts and epithelialization were evaluated under light microscope. MAIN RESULTS: There was no statistically significant difference observed in the polymorphonuclear leukocyte, mononuclear inflammatory cell, and blood vessel counts in the healthy and diabetic rats with and without paroxetine administration. The number of fibroblasts was significantly higher at postwounding day 14 of the paroxetine-administered healthy rats compared with the saline-administered healthy rats (P = .04). However, the number of fibroblasts did not show any difference by paroxetine administration in the diabetic rats. There was no statistically significant difference in epithelialization regarding all the postwounding days, but complete epithelialization was observed in all rats on postwounding day 14 in the healthy and paroxetine-administered group. CONCLUSION: Short-term paroxetine administration may enhance cutaneous wound healing by increasing the number of fibroblasts and causing better epithelialization over time in healthy rats but not in diabetic rats.

Impaired heart rate recovery indices in psoriasis patients.

BACKGROUND: Psoriasis is a systemic inflammatory disease associated with increased risk of cardiovascular diseases. The heart rate recovery index (HRRI) is an indicator of autonomic nervous system function and is an independent prognostic risk factor for cardiovascular diseases. The aim of this study was to evaluate the heart rate recovery indices in patients with psoriasis. MATERIAL AND METHODS: Thirty-three psoriasis patients (22 male; mean age 41 ± 11 years) and 26 healthy individuals (15 male; mean age 39 ± 11 years) as a control group were included in the study. Baseline electrocardiography, transthoracic echocardiographic examinations, and exercise stress tests were performed in psoriasis and control groups. The heart rate recovery of the psoriasis group at 1, 2, 3, 4, and 5 minutes after maximal exercise were calculated and compared to those of the control group. RESULTS: Baseline demographic and clinical characteristics of psoriasis and control groups including age, sex, body mass index, systolic blood pressure, and echocardiographic parameters were similar. Total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels were significantly higher and high-density lipoprotein cholesterol levels were significantly lower in the psoriasis group (p<0.05). Heart rate recovery at 1, 2, 3, 4, and 5 minutes after maximal exercise were found to be significantly lower in the psoriasis group (p<0.05). Additionally, baseline heart rates before exercise were significantly higher in the psoriasis group (p<0.05). CONCLUSIONS: We found that impaired HRRI in psoriasis patients, which indicates the underlying autonomic nervous system dysfunction, is a pathophysiologic mechanism for increased cardiovascular disease risk.

Cancer-free survival of psoriasis patients treated with methotrexate and cyclosporine combination.

CONTEXT: Combination of methotrexate and cyclosporine was used and reported to be effective for recalcitrant psoriasis patients. Also each agent is accused for development of malignancies. OBJECTIVE: To evaluate the cancer-free survival of psoriasis patients who received methotrexate and cyclosporine treatment at the same time. METHODS: Psoriasis patients who had been treated with combination of cyclosporine and methotrexate between March 2000 and April 2005 were questioned in 2011. A diagnosis of new cancer during follow-up period was asked and also each patient was evaluated by a questionnaire. RESULTS: Seventeen psoriasis patients were not treated due to a diagnosis of new cancer during the follow-up period. Also none of them complained of possible symptoms of skin or lymphoproliferative malignancies. The median follow-up time was 76 months. CONCLUSION: Psoriasis patients who had been treated with methotrexate and cyclosporine combination did not report a detected malignant disease.

Treatment of melasma with a depigmentation cream determined with colorimetry.

BACKGROUND: Melasma is a pigmentary disorder often recalcitrant to treatment. Few studies have objectively evaluated the efficacy of treatment colorimetrically. AIM: To evaluate the safety and efficacy of a depigmentation cream, including mainly glycolic acid and Rumex occidentalis. METHOD: Twenty-seven patients applied the cream twice daily for the first 3 months and twice weekly for the following 3 months. L*, C* and h* values of the target lesions and the perilesional area were analyzed at baseline, 12 and 24 weeks colorimetrically. The physician and patient evaluated the clinical response rate. These results were compared statistically between the lesional and perilesional area. RESULTS: There was a significant difference between 0-12, 0-24 (L*, C* and h* values) and 12-24 weeks (L* value) (p <0.001). For C* and h* values, the difference was not significant between 12 and 24 weeks (p = 0.464 and 0.151, respectively). Statistical significance was detected only between 3 and 6 months for C* value (p < 0.05) for the lesional and the perilesional areas. Clinical response rate was significant (p < 0.05). CONCLUSION: Our depigmentation cream is a moderate effective agent, well tolerated and can be considered as an alternative treatment of melasma. Twice-daily application may enhance the efficacy of treatment instead of twice-weekly application in the maintenance period.

Comparison of the 532-nm KTP and 1064-nm Nd:YAG lasers for the treatment of cherry angiomas.

BACKGROUND: Laser therapy is the treatment of choice for cherry angiomas since it is more effective and has better cosmetic results. There is no comparative study about the treatment efficacies with KTP and Nd:YAG lasers for cherry angiomas. OBJECTIVE: To compare the efficacy and side effects of 532-nm KTP and 1064-nm Nd:YAG lasers for the treatment of cherry angiomas. METHODS: Two comparable lesions of the same patient were chosen. One of them was treated with the KTP laser while the other was treated with the Nd:YAG laser. Sessions were repeated every 4 weeks until complete clearance was achieved. Side effects were evaluated using a severity scale (0 to 4). RESULTS: The number of sessions was significantly higher with the KTP than with the Nd:YAG laser (p = 0.002). Erythema, edema, pain and scar formation were higher in the Nd:YAG laser group (erythema: p = 0.001; edema: p < 0.001; pain: p < 0.001; scar: p < 0.001). The hyperpigmentation rate was statistically higher with the KTP laser (p = 0.01). CONCLUSION: Both KTP and Nd:YAG lasers were found to be effective methods. The Nd:YAG laser offered fewer treatment sessions, but a higher risk of scar formation. The KTP laser seems more advantageous, but in dark-skinned patients the Nd:YAG laser may be preferable.

Clinical comparison of potassium-titanyl-phosphate (KTP) versus neodymium:YAG (Nd:YAG) laser treatment for lower extremity telangiectases.

BACKGROUND: The Nd:YAG laser has been considered the gold standard of treatment for leg veins, but pain and side effects have fueled physicians to use treatment alternatives. OBJECTIVE: To compare the clinical efficacy of the long-pulsed 1064-nm Nd:YAG laser with KTP laser irradiation in the treatment of leg telangiectasia. METHODS: A series of 16 patients with size-matched superficial telangiectases of the lower extremities were randomly assigned to receive three consecutive monthly treatments with the long-pulsed 1064-nm Nd:YAG on one leg and 532-nm KTP laser irradiation on the other. RESULTS: For the 16 patients who completed the study, 64 leg vein sites were treated. Average clinical improvement scores were 1.94 and 1.25 for the KTP laser-treated leg and 3.38 and 3.50 for the Nd:YAG laser-treated leg with thin (≤ 1 mm) and large (1-3 mm) vessels, respectively. After the third treatment session, average improvement scores of 2.44, 1.31 and 3.75, 3.23 were given for the KTP and Nd:YAG laser-treated sides, respectively. CONCLUSION: Both the 1064-nm Nd:YAG and KTP lasers are effective in the treatment of lower extremity telangiectases. However, the KTP laser has very low efficacy with vessels larger than 1 mm and should not be elected when treating such vessels.

Evaluation of nailfold capillaries in familial Mediterranean fever patients.

Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent inflammatory febrile attacks, abdominal, chest or joint pain, myalgia, and erysipelas-like skin lesions. Several types of vasculitis are associated with FMF such as polyarteritis nodosa and Henoch-Schönlein purpura. We aimed to determine microvascular abnormalities in FMF patients via nailfold capillaroscopy using a dermoscope. Thirty-one FMF patients were assessed; capillary enlargement, tortuosity, avascular areas and microhemmoraghes were investigated. Capillary enlargement was found in five patients and microhemorrhages in one patient. Our study supports that nailfold capillary abnormalities, which are nonspecific, can be seen in FMF patients, but more studies are needed to clarify the importance of these findings.

Narrow-band ultraviolet B as a potential alternative treatment for resistant psychogenic excoriation: an open-label study.

Narrow-band ultraviolet therapy has been used successfully for the treatment of inflammatory skin disorders and generalized pruritus. We have prospectively evaluated seven consecutive patients with resistant psychogenic excoriation (PE) treated with narrow-band ultraviolet B (NB-UVB). Approximately 70% of all patients showed improvement in their condition. NB-UVB therapy was well tolerated, with no serious side effects. We may conclude that, when treating a patient with PE, NB-UVB in combination with other approaches may provide extra benefit in resistant cases.

Comparison of the efficacy of narrow band ultraviolet B and narrow band ultraviolet B plus topical catalase-superoxide dismutase treatment in vitiligo patients.

Accumulation of free radicals in the epidermis and the role of oxidative stress have been demonstrated in the pathogenesis of vitiligo. So, new treatment modalities that support antioxidant systems may be a choice for treatment. We sought to determine the clinical efficacy of narrow band ultraviolet B plus topical formulation including Cucumis melo superoxide dismutase and catalase (Vitix), over the narrow band ultraviolet B treatment alone. Thirty vitiligo patients (18 female, 12 male; mean age 34 +/- 13 years) were included in this study. 15 patients in Group 1 were treated only with narrow band ultraviolet B whereas 15 patients in Group 2 were treated with narrow band ultraviolet B plus topical Vitix for 6 months. Areas of 21 lesions from each group were measured by point counting methods at the beginning and at the end of the treatment. Efficacy of treatment was graded as perfect, good, moderate and poor according to healing percentages of measured areas and both groups were compared statistically. In Group 1 two moderate; in Group 2 one perfect, four moderate healings were observed at the end of the treatment. There was no statistically significant difference according to healing percentages between the two groups (p > 0.05). No adverse effect was reported in either group. The superiority of narrow band ultraviolet B plus topical Vitix treatment over narrow band ultraviolet B treatment could not be demonstrated statistically. There is a need for further studies involving large case series to clarify the results of our preliminary study.

Characteristics of pruritus in children on peritoneal dialysis.

BACKGROUND/AIMS: The aim of this study was to evaluate the characteristics of pruritus in pediatric patients undergoing peritoneal dialysis. PATIENTS AND METHODS: Twenty-seven patients (16 females, 11 males), aged between 5 and 18 years, were evaluated for the presence, intensity, onset, activation time, duration, characteristics, localization and increasing factors for pruritus. The intensity of pruritus was scored using a visual analog scale. Patients were grouped according to the existence of pruritus and other clinical and laboratory parameters (dialysis duration, dialysis adequacy, hemoglobin, blood urea nitrogen, creatinine, Ca, P, albumin, bicarbonate, parathyroid hormone (PTH), C-reactive protein (CRP)) were compared between the 2 groups. RESULTS: The mean age of patients was 11.85 +/- 4.4 years. There were 21 patients (77.7%) without pruritus and 6 patients with pruritus (22.2%). Serum P, PTH, CRP levels and CaxP product were significantly higher in patients with pruritus compared to patients without pruritus (p = 0.027, p = 0.03, p < 0.026, p = 0.031, respectively). In a stepwise logistic regression model, P (p = 0.01), CaxP product (p = 0.09), PTH (p = 0.03) and CRP (p = 0.02) were independently associated with pruritus. CONCLUSION: Our study indicates that pruritus remains a common but not troublesome symptom in children on peritoneal dialysis. Higher serum P, CaxP product, PTH and CRP concentrations appear to be important factors associated with uremic pruritus in this group.

A practical method for the estimation of vitiligo surface area: a comparison between the point counting and digital planimetry techniques.

The accurate measurement of vitiligo surface area is fundamental to the evaluation of treatment efficacy. Digital photography, planimetry and clinical evaluation by the clinician have been used for assessment. Although digital photography with computerized planimetry is a reliable and accurate method, it is labour intensive and expensive. The aim of this study was to evaluate the accuracy and reliability of the point counting method and to compare it with digital planimetry techniques for the estimation of vitiligo surface area. Surface areas of 31 vitiligo lesions of five volunteers were estimated using the point counting and digital planimetry methods. Three independent observers evaluated the outlined areas twice using the point counting technique with an interval of 2 weeks. The same lesions were also measured by one observer applying digital planimetry. The estimation results of three observers were compared using inter and intra-observer correlation analysis test. There was significant inter- and intra-observer agreement for all measurements. There was also significant coincidence between each observer's estimation of the point counting and digital planimetry method. No significant differences on the results of surface area obtained using the two methods were found (p > 0.05). The point counting method may be used as a direct and reliable technique to measure the vitiligo surface area.

Lack of association between the G-2548A polymorphism of the leptin gene and psoriasis in a Turkish population.

BACKGROUND: Psoriasis is a multifactorial disease in which genetic and inflammatory factors play important roles. Leptin is classified as a cytokine and plays an important role in the regulation of the T-helper response. A common polymorphism in the promoter of the human leptin gene (G-2548A) may have a role in the pathogenesis of psoriasis. AIM: To investigate the association between psoriasis and leptin gene polymorphism (G-2548A). METHODS: The study involved 109 patients with psoriasis and 125 healthy controls. Analyses of G-2548A polymorphism of the leptin gene were made by the polymerase chain reaction-restriction fragment length polymorphism technique. The genotypes (GG, GA, and AA of leptin gene G-2548A) and alleles (G and A) were scored and the frequencies were estimated. The frequencies of alleles and genotypes in patients and controls were compared. The relationship between leptin gene polymorphism and the clinical features of the patients was analyzed. RESULTS: Both genotype [odds ratio (OR), 0.921; 95% confidence interval (CI), 0.501-1.694; P = 0.792] and allele (OR, 0.864; 95% CI, 0.600-1.242; P = 0.429) frequencies were not significantly different between patient and control groups. In addition, there was no significant association between genotype and allele frequencies and the clinical characteristics of psoriasis. CONCLUSION: In this case-control study, no evidence of association between the G-2548A variant of the leptin gene and psoriasis was found.

Lack of evidence for association between endothelial nitric oxide synthase gene polymorphism (glu298asp) with Behçet's disease in the Turkish population.

Endothelial nitric oxide synthase (eNOS) could be a candidate gene for Behçet's disease (BD). This study investigated the relationship of the eNOS Glu298 --> Asp polymorphism with the presence and severity of BD in the Turkish population. Ninety-two patients with BD and 100 controls were studied. Analyses of Glu298Asp polymorphism in exon 7 of the eNOS gene were made by the polymerase chain reaction (PCR)-restriction fragment length polymorphism technique. The frequencies of the eNOS genotypes were similar for BD patients (GG:GT:TT = 58.7%:38%:3.3%) and controls (59.2%:33.7%:7.1 %), P = 0.335. No evidence of difference was found in the frequency of the T allele between BD patients (22.3%) and controls (24%), [OR = 0.91, 95% CI (0.55-1.50), P = 0.690]. Glu298 --> Asp polymorphism of the eNOS gene does not appear to be associated with the presence of BD in the Turkish population.

Genotoxicity assessment using comet assay in Behcet's disease patients.

Behcet's disease (BD) was originally described by Turkish dermatologist, Hulusi Behcet in 1937. BD is an inflammatory disorder of unknown cause, characterized by recurrent oral aphthous ulcers, genital ulcers, uveitis, and skin lesions. All these common manifestations are self-limiting except for ocular attacks. The aims of this study were to assess whether BD patients have more genotoxicity than healthy controls and whether colchicine (COL) treated BD patients are different from those not using COL in terms of genotoxicity. A few dozens of methods have been developed and used for the assessment of genotoxicity. The most popular method is based on single cell gel electrophoresis (COMET assay) in alkaline condition. After electrophoresis, captured images are subjected to digital image analysis to find the values for percent tail DNA from comet assay parameters consistent with genotoxicity. COMET assay was performed in isolated lymphocytes from 42 COL treated Behcet's disease patients, 9 BD patients not using COL, and 36 healthy controls. In the COL-BD patients and non-COL-BD patients, the mean age (range 14-56 years) and mean disease duration (range 0.5-24 years) did not differ between the two groups. We found statistical differences in percent tail DNA between BD and the healthy controls (13.38+/-9.58 versus 2.77+/-1.45, P<0.0001). No difference in percent tail DNA was observed between users and non-users of COL, whereas it was more different in inactive BD patients than active ones (19.75+/-10.49 versus 11.83+/-8.79, P<0.05, respectively). Genotoxicity, as assessed by COMET assay, is increased in BD patients. These results suggest that genotoxicity is associated with BD itself rather than COL use.

Granulomatous glossitis: a case report.

A 50-year-old man was admitted to our clinic with a complaint of lingual enlargement. Detection of non-caseous epithelioid granuloma on histopathological examination led to a diagnosis of a granulomatous glossitis. Extensive investigation for the presence of associated disorders yielded negative results. Metranidazole and clofazimine were totally ineffective and tetracycline led to a minimal improvement. No associated disorder was detected at a 4-year follow-up examination. The position of granulomatous glossitis within the spectrum of orofacial granulomatous conditions is discussed.

Cutaneous linear atrophy following intralesional corticosteroid injection in the treatment of tendonitis.

It is well-known that local and systemic side effects due to intralesional corticosteroid injections are common. We report the case of a 28-year-old woman with cutaneous linear atrophy along the abductor pollicis longus tendon, which appeared after an injection of intralesional corticosteroid in the treatment of de Quervain tendonitis.