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ABSTRACT: Abstract Background: Pruritus ani (PA) is defined as intense chronic itching affecting perianal skin. Objective: We aimed to determine the efficacy of topical tacrolimus treatment in atopic dermatitis (AD) patients who have PA. Methods: The study included 32 patients with AD who were suffering PA. Patients were randomized into two groups. In total, 16 patients used 0.03% tacrolimus ointment and 16 patients used Vaseline® as placebo. All groups applied topical treatments to their perianal area twice daily for 4 weeks. The treatments were then reversed for 4 weeks after a 2 weeks wash out period. Results: In total, 32 patients with AD who had refractory anal itching were enrolled in the present study. None of the patients had obtained successful results with previous treatments. There was a statistically significant decrease in the recorded EASI, DLQI and itching scores for the tacrolimus group compared to the placebo groupat weeks 4 and 6 of treatment (p < 0.05). Conclusion: Topical tacrolimus treatment was well tolerated and effective in controlling persistent PA in AD patients.
Journal of Dermatological Treatment 05/2013; · 1.23 Impact Factor
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ABSTRACT: Vitiligo and atopic dermatitis (AD) are two major cutaneous diseases that affect quality of life (QoL) by causing functional and psychosocial disorders. Our objective was to calculate Children's Dermatology Life Quality Index (CDLQI) scores in children with vitiligo and to compare these values with those in AD patients and healthy control subjects. The CDLQI was completed for 50 vitiligo and 50 AD patients presenting at the dermatology polyclinic, as well as for 50 age- and sex-matched healthy controls. All subgroups in the vitiligo patient group had significantly higher total CDLQI scores than healthy controls. Vitiligo patients were found to have increased scores on all parameters, except itch, clothes/shoes, and sleep, compared with the AD patient group. Scores on itch and sleep were significantly higher in the AD group than in the vitiligo patients. Quality of life in children with vitiligo is substantially lower than in children with AD. This decline in QoL is critical in the psychosocial development of the former group.
International journal of dermatology 01/2013; 52(1):96-101. · 1.18 Impact Factor
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ABSTRACT: Psoriasis is a common Th1-mediated skin disease whose etiology remains obscure. Loss of sweating caused by retention hyperkeratosis is seen in psoriasis plaques, which is likely to have resulted from autonomic dysfunction.
In the present study, we aimed to evaluate autonomic nervous system (ANS) functions with regard to psoriasis and to examine whether there is an underlying ANS dysfunction.
Fifty adult patients with plaque-type psoriasis and 20 healthy controls were enrolled in the present study. RESULTS In this study, R-R interval variation (RRIV) was used to evaluate the parasympathetic system. No statistically significant difference was detected when RRIV values of the patient and the control groups were evaluated during normal and deep breathing (P > 0.05). It was determined that parasympathetic activity in the patient group remained unaffected. The sympathetic skin response (SSR) method was used for the evaluation of the sympathetic system. It was found that SSR latency and amplitude values of upper and lower extremities of the patient group were prolonged in comparison to those of the control group. The change in SSR latency of the upper extremity was found to be statistically significant (P < 0.05), whereas the changes in hand amplitude, foot latency, and foot amplitude values were not statistically significant (P > 0.05). It was determined that sympathetic activity in the patient group was affected.
In conclusion, we detected that a dysfunction was present in sympathetic nervous systems of patients with psoriasis. The parasympathetic nervous system functions were normal in patients with psoriasis.
International journal of dermatology 05/2012; 51(5):557-63. · 1.18 Impact Factor
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ABSTRACT: Abstract Background: Alopecia areata (AA) is a non-scarring hair loss. Objective: We aimed the comparison of clobetasol propionate and pimecrolimus efficiency and tolerability in the treatment of AA. Methods: The study included a total of 100 consecutive patients with AA. Patients were randomized into four groups. 30 patients used 1% pimecrolimus cream, 30 patients used 0.05% clobetasol propionate cream, 20 patients used petrolatum as placebo. Scalp of 20 patients was divided into two equal areas and one area was treated with 1% pimecrolimus cream and the other area with 0.05% clobetasol propionate cream. Results: At week 12 of treatment, the recovery rate of the pimecrolimus group was 53.73 ± 44.49 and the recovery score was 3.63 ± 2.07; that of the clobetasol propionate group was 47.00 ± 44.80 and the recovery score was 3.33 ± 2.20; that of the placebo group was 35.50 ± 40.53 and the recovery score was 2.75 ± 1.88. There was no statistically significant difference among the groups in terms of the percentage of recovery and the recovery score (p < 0.05). Conclusion: In conclusion, we detected that topical pimecrolimus treatment is as effective as topical corticosteroids and is superior to topical corticosteroids in terms of side effects in the treatment of AA.
Journal of Dermatological Treatment 07/2011; · 1.23 Impact Factor
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ABSTRACT: Background. Atopic dermatitis (AD) is a common chronic inflammatory disease that is associated with significant psychosocial morbidity and a decrease in health-related quality of life. Attention deficit hyperactivity disorder may be present in atopic dermatitis patients. Objective. The present study aims to investigate the co-presence of ADHD in adult patients with AD. Material and method. The study registered 60 adult patients with AD (48 females and 12 males) and 50 non-atopic control subjects (38 females and 12 males). The AD patient group and the control group were assessed using the Turgay adult Attention-Deficit/Hyperactivity Disorder (ADD/ADHD) DSM-IV-Based Diagnostic Screening and Rating Scale (Turkish Version), which was studied by a team of psychologists and psychiatrists in Turkey for validity, reliability and norms. The scale covers three dimensions of the disease, namely inattention, hyperactivity and impulsivity, and associated features of ADHD. The groups were compared and contrasted in terms of their similarities and differences in ADD/ADHD symptoms. Results. Three sub-dimensions of ADD/ADHD scale (Attention Deficit, Hyperactivity/ Impulsivity and Problem subdivisions) in AD patients were found statistically significantly elevated relative to controls (P<0.001, P<0.001, P<0.001, respectively). Conclusions. In conclusion we established the co-presence of ADHD in AD patients in the adult age group.
10/2009; 13(4):292-297.
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ABSTRACT: Seborrhoeic dermatitis is a common, chronic, papulosquamous dermatosis. Treatment of seborrhoeic dermatitis includes topical treatments such as corticosteroids, antifungals, metronidazole and pimecrolimus.
This study aimed to compare and contrast the efficacy and tolerability of pimecrolimus cream 1%, methylprednisolone aceponate 0.1% cream and metronidazole 0.75% gel topical treatments in the treatment of facial seborrhoeic dermatitis.
The study included a total of 64 (32 males and 32 females) consecutive patients with facial seborrhoeic dermatitis. Patients were randomized into three equal groups. One group applied pimecrolimus 1% cream, another group applied methylprednisolone aceponate 0.1% cream, and the third group applied metronidazole 0.75% gel to their facial lesions twice daily for 8 weeks. Assessment of the disease severity was performed at baseline and at weeks 2, 4, and 8. Clinical measures assessed were erythema, scaling and pruritus, which were evaluated using a four-point scale (0-3).
Of the 64 patients, 17 (80%) in the metronidazole group, 21 (100%) in the pimecrolimus group and 22 (100%) in the methylprednisolone aceponate group completed the study. Four patients in the metronidazole group left the study. All of the therapeutic agents were found to be effective; however, the efficacy of pimecrolimus was higher than those of metronidazole and methylprednisolone (p < 0.05). When side effects associated with pimecrolimus and metronidazole were compared, the latter was found to be associated with more side effects (p < 0.05).
We suggest pimecrolimus to be a therapeutic option for seborrhoeic dermatitis cases that show an unfavourable response to methylprednisolone aceponate.
Journal of Dermatological Treatment 01/2009; 20(6):344-9. · 1.23 Impact Factor
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ABSTRACT: This study was carried out to evaluate the frequency and seasonal characteristics of dermatological problems of juvenile outpatients in the dermatology polyclinic.
Children under the age of 17 treated in an outpatient setting in our polyclinic within a 10-year period were retrospectively evaluated.
The study registered a total of 3244 patients, of whom 1651 (50.90%) were females, and 1593 (49.10%) were males. The largest group was infectious diseases, with 1031 patients (31.78%). This was followed by the dermatitis group with 635 patients (19.57%). The months when the number of presentations at the hospital was the highest were August and November, and the months with the lowest number of presentations were January and July.
In the present study we found that the most frequent cause of hospital visits of juvenile outpatients at our polyclinic was infectious diseases and dermatitis, and that there was significant correlation between diseases and seasons.
International journal of dermatology 12/2008; 47(11):1121-5. · 1.18 Impact Factor
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Yelda Karincaoglu,
Murat Borlu,
Semra Cikman Toker,
Ayse Akman,
Meltem Onder,
Suhan Gunasti,
Aysegul Usta,
Basak Kandi,
Cicek Durusoy,
Muammer Seyhan,
Serap Utas,
Hayriye Saricaoglu,
Muge Guler Ozden,
Soner Uzun,
Umit Tursen, Demet Cicek,
Levent Donmez,
Erkan Alpsoy
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ABSTRACT: Behçet's disease (BD) is a multisystemic inflammatory disorder of unknown origin. The disease usually occurs between the second and the fourth decades, whereas it is uncommon in children.
In this multicenter study, we aimed to describe the demographic and clinical features along with severity in juvenile- versus adult-onset BD.
Patients with initial symptoms at age 16 years or younger were considered as having juvenile-onset BD. In all, 83 patients with juvenile-onset BD (38 male and 45 female; mean age 19.6 +/- 7.6 years) and 536 with adult-onset (>16 years) BD (293 male and 243 female; mean age 39.2 +/- 10.1 years) who fulfilled the classification criteria of the International Study Group for BD were involved in the study.
Familial cases were more frequent in juvenile-onset compared with adult-onset BD (19% vs 10.3%; P = .017). The mean age of disease onset was 12.29 +/- 3.54 years in juvenile-onset BD and 31.66 +/- 8.71 years in adult-onset BD. Mucocutaneous lesions and articular symptoms were the most commonly observed manifestations in both groups. The frequency of disease manifestations was not different between juvenile- and adult-onset BD, except neurologic and gastrointestinal involvement, which were higher in juvenile-onset BD than adult-onset BD (P = .027 and P = .024, respectively). Oral ulcer was the most common onset manifestation of both juvenile-onset (86.74%) and adult-onset (89.55%) BD. The frequencies of onset manifestations of BD were similar, except genital ulcer, which was higher in adult-onset BD (P = .025).
Our study consisted of patients with BD mainly applying to dermatology and venerology departments. Therefore, it can be speculated that this study includes rather a milder spectrum of the disease.
Although the clinical spectrum of juvenile-onset BD seems to be similar to adult-onset BD, the frequency of severe organ involvement was higher. Because of the higher prevalence of familial cases in juvenile-onset BD, it can be speculated that genetic factors may favor early expression of the disease with severe organ involvement.
Journal of the American Academy of Dermatology 05/2008; 58(4):579-84. · 3.99 Impact Factor
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ABSTRACT: A 45-year-old man receiving oral sorafenib 400 mg twice daily for metastatic renal cell carcinoma developed pain and rash on his hands and feet 3 weeks after commencement of treatment. Dermatological examination revealed hyperkeratotic plaques surrounded by erythema and with a callus-like brownish-yellow appearance centrally, together with bullae with purulent content under the plaques. Histopathological examination revealed intense hyperkeratosis in the upper part of the epidermis and parakeratosis beneath the epidermis. The integrity of the epidermis was therefore compromised and intense neutrophilic infiltration was seen. The patient was diagnosed on clinical and histopathological grounds as having localized palmar-plantar hyperplasia associated with use of sorafenib, representing the second case reported in the literature. The patient's skin lesions improved markedly after the sorafenib dose was decreased to 200 mg twice daily, a regimen that he continues to take. In the authors' opinion, use of the term localized palmar-plantar hyperplasia, as diagnosed in this patient, is more appropriate in this clinical setting than related terms such as palmoplantar erythro-dysaesthesia or hand-foot syndrome.
Clinical Drug Investigation 02/2008; 28(12):803-7. · 1.82 Impact Factor
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ABSTRACT: Urticarial vasculitis (UV) is a disease characterized clinically by urticarial skin lesions and histologically by leukocytoclastic vasculitis caused by immunocomplex accumulation in post-capillary venules. Cases induced by various drugs such as cimetidine, diltiazem, potassium iodide, fluoxetine, and non-steroid inflammatory drugs have been reported in the literature. A 48-year-old female who developed pruritus and rash on her body 3 months after starting glatiramer acetate (GA) treatment for multiple sclerosis was diagnosed with UV after clinical and histopathological examination. This report presents the first case in the literature of UV induced by GA.
Journal of Dermatological Treatment 02/2008; 19(5):305-7. · 1.23 Impact Factor
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ABSTRACT: Objective.Atopic dermatitis is a chronic inflammatory skin disease associated with cutaneous hyperreactivity to environmental triggers and is often the first step in the atopic march that results in asthma and allergic rhinitis. Helper T cells and their cytokines, in addition to IgE and eosinophils, play a major role in the pathogenesis of atopic dermatitis. Natural killer T (NKT) cells may play a role in atopic dermatitis status.Methods.The authors examined the percentage of V24+CD161+ NKT cells and CD3+CD16+ CD56+ NKT cells in peripheral blood from 23 patients with atopic dermatitis aged 8 to 35 years (mean, 21.77±2.88 years) and 30 healthy controls aged 18 to 32 years (mean, 24.32±2.44 years) by using flow cytometric analysis. The mean percentages of V24+CD161+ NKT cell subtypes in the atopic dermatitis group and the healthy group were 0.29%±0.02% and 0.42%±0.05%, respectively (P<.001).Results.Percentages of V24+CD161+ NKT cell subtypes are significantly lower in patients with atopic dermatitis than healthy individuals. On the other hand, the CD3+CD16+CD56+ NKT cell subtype does not differ between the groups.Conclusions.The reduction of V24+CD161+ NKT cells subtypes may be involved in the immunopathogenesis of atopic dermatitis.
SKINmed 09/2007; 6(5):218 - 220.
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ABSTRACT: To determine the role of oxidative stress and the antioxidant defense mechanism in the etiopathogenesis of active and inactive Behçets disease. In line with this objective, the present study aimed to examine the levels of nitric oxide (NO) and malondialdehyde (MDA), which are the end products of oxidant stress, and vitamins, which are non-enzymatic antioxidants, for the diagnosis and particularly the follow-up of Behçet's disease.
The study group consisted of a total of 60 individuals: 40 of whom were Behçet's disease patients and 20 were healthy individuals. Of the 40 Behçet's patients, 29 had the active and 11 had the inactive (stable) form of the disease.
Although plasma MDA and NO (its stable form nitrite) levels in the total patient group were statistically significantly higher than those in the control group (p<0.06), there was no statistically significant difference as such between inactive Behçet's patients and the control group (p>0.05). Vitamin E, C, B1, B2 and flavin mononucleotide (FMN) values were significantly lower in the patient group in comparison with the control group (p<0.05). There was no statistically significant difference in other vitamin values.
It is contemplated that measurement of such oxidative stress factors as MDA and NO and an accompanying evaluation of the antioxidant defense system can be significant in the diagnosis and treatment follow-up of Behçet's disease.
Journal of Dermatological Treatment 02/2007; 18(2):69-75. · 1.23 Impact Factor
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ABSTRACT: We report a case of benign form of Degos' disease, a rare condition often characterized by multisystemic vasculopathy, and discuss the case by the light of the limited literature available. A 34-year-old male patient was admitted to our clinic with lesions on his neck and back and a history of not getting any benefit from previous acne medications. Dermatological examination revealed erythematous papules with hemorrhagic crusts on their surfaces and many well-defined atrophic scar tissues. Histopathological evaluation of a biopsy obtained from a lesion revealed the findings of Degos' disease. Further evaluation did not reveal any sign of systemic involvement. He was diagnosed with the benign form of Degos' disease.
The Journal of Dermatology 09/2004; 31(8):666-70. · 1.49 Impact Factor
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ABSTRACT: Complex regional pain syndrome type I (CRPS I) is a primary polymorphic condition of persistent pain and swelling that frequently occurs secondary to trauma associated with vasomotor disorders. The aim of this study was to evaluate the cutaneous findings in patients with CRPS I.
Eighteen patients with CRPS I were included in the study. Written informed consent was obtained from all participants.
Of the 18 patients with CRPS I, 9 (50%) had hyperhidrosis, while hypohidrosis was present in 2 patients (11.1%). Eight patients (44.4%) had hypertrichosis, and 1 patient (5.6%) had hypotrichosis. Five of the patients (27.8%) had nail changes.
These cutaneous changes are not rare in CRPS I and generate difficulties for the patient; therefore, they should be prevented during the early stages of CRPS I with use of an effective treatment.
SKINmed 6(3):118-21.
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ABSTRACT: A 23-year-old woman presented to our polyclinic complaining of itching, generalized dermatitis, and jaundice. She was in her 31st gestational week and had developed pruritus and the dermatitis since the first month of pregnancy; her jaundice started about a month before presentation. Her history included similar complaints in a previous pregnancy, which resulted in premature birth of a baby with a permanent brain defect. One of her sisters had had jaundice and itching in her 27th gestational week and delivered a healthy baby; a second sister had experienced itching and dermatitis in her second trimester and delivered a healthy baby. Physical examination of the patient showed that her eyes were jaundiced (Figure 1); skin examination revealed generalized erythematous excoriated papules, symmetrically distributed all over her body (Figure 2 Figure 3). Laboratory analyses revealed the following results: leukocyte count, 14.30/mm(3) (3.8-10.3/mm(3)); erythrocyte sedimentation rate, 25 mm/h (<20 mm/h); aspartate aminotransferase, 44 U/L (5-40 U/L); alanine aminotransferase, 63 U/L (5-40 U/L); lactate dehydrogenase, 1158 U/L (220-450 U/L); total bilirubin, 6.88 mg/dL (<1.10 mg/dL); and direct bilirubin, 3.27 mg/dL (<0.35 mg/dL). Urinalysis results were positive for bilirubin and urobilinogen. Positive serologic findings included rubella immunoglobulin G, 93 AU/mL (<15) and cytomegalovirus, 188 AU/mL (<10); negative findings included herpes simplex virus type 2 and hepatitis. Histopathologic examination of material collected from the left breast via punch biopsy showed parakeratosis, acanthosis, and perivascular lymphocyte infiltration in dermal vessels. Treatment with 2 g/d cholestyramine and a topical corticosteroid was effective in the patient, who was diagnosed with intrahepatic cholestasis of pregnancy and prurigo of pregnancy based on the clinical, histopathologic, and laboratory findings. To the authors' knowledge, this is the first such reported case in the literature.
SKINmed 6(6):298-301.
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ABSTRACT: Atopic dermatitis is a chronic inflammatory skin disease associated with cutaneous hyperreactivity to environmental triggers and is often the first step in the atopic march that results in asthma and allergic rhinitis. Helper T cells and their cytokines, in addition to IgE and eosinophils, play a major role in the pathogenesis of atopic dermatitis. Natural killer T (NKT) cells may play a role in atopic dermatitis status.
The authors examined the percentage of Valpha24+CD161+ NKT cells and CD3+CD16+ CD56+ NKT cells in peripheral blood from 23 patients with atopic dermatitis aged 8 to 35 years (mean, 21.77+/-2.88 years) and 30 healthy controls aged 18 to 32 years (mean, 24.32+/-2.44 years) by using flow cytometric analysis. The mean percentages of Valpha24+CD161+ NKT cell subtypes in the atopic dermatitis group and the healthy group were 0.29%+/-0.02% and 0.42%+/-0.05%, respectively (P<.001).
Percentages of Valpha24+CD161+ NKT cell subtypes are significantly lower in patients with atopic dermatitis than healthy individuals. On the other hand, the CD3+CD16+CD56+ NKT cell subtype does not differ between the groups.
The reduction of Valpha24+CD161+ NKT cells subtypes may be involved in the immunopathogenesis of atopic dermatitis.
SKINmed 6(5):218-20.
