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Background/Objectives: Chronic spontaneous urticaria (CSU) is a common skin disorder which represents a challenge both for the patients and physicians. Guidelines and treatment algorithms have been created to help physicians to ease management. Our aim was to determine Turkish dermatologists' approach to CSU with regard to treatment, search for causative factors and use of instruments to assess the quality of life and severity of the disease. Methods: This was a cross-sectional methodological study which was performed by delivery of a questionnaire including ten questions about the management of CSU. Results: Analyses of 314 questionnaires revealed that the most common first-line treatments were non-sedating antihistamines in standard doses (65.6%), while second-line treatment was updosing antihistamines (59.9%) followed by addition of sedative-antihistamines (26.4%) and systemic steroids (19.1%). Third-line treatment option was omalizumab in 35% followed by systemic steroids. Twenty-two percent of the dermatologists referred the patients to a center experienced in urticaria. Most of them were performing laboratory testing for underlying causes including thyroid function tests, C-reactive protein, thyroid auto-antibodies, stool analyses, infection markers. Urticaria activity score and chronic urticaria quality of life questionnaire were used by 30 and 13%, respectively, while 56% were using none of the instruments. Conclusion: Our study showed that the therapeutic management of Turkish dermatologists was parallel to the European Urticaria Guidelines. The high utility of omalizumab as a third line regimen improved patient care. Nevertheless there is a need for centers experienced in urticaria to refer antihistamine-resistant patients where third-line treatment options can not be implemented. Keywords: Urticaria, Dermatologists, Therapeutics, Diagnosis, Guideline

Psoriasis is a common, chronic and inflammatory disease of the skin. Nail changes are frequent in psoriasis and being found in up to 50 percent of patients. Despite recent therapeutic advances, the management of nail psoriasis remains long time and sometimes unsatisfactory. We aimed in this article to review diagnostic methods and treatment options for nail psoriasis. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor commenting on shedding of the nails due to chemotherapy published in September 1998 issue of the Journal of the European Academy of Dermatology and Venereology.

Background: Patch testing with the European Baseline Series (EBS) is an essential diagnostic tool for the assessment of allergic contact dermatitis., Objective: The aims of the study were to describe the most common contact allergens identified with patch testing in Turkey and to establish the distribution of contact allergens among different regions in Turkey., Patients and Methods: Twelve centers consisting of tertiary health care institutions were included in the study. A total of 1169 patients were patch tested with the EBS from 2015 to 2017., Results: A total of 596 patients (51.0%) had 1 or more positive patch test reactions to the EBS. A total of 30.2% (n = 353) of those tested had clinical relevance. Contact sensitivity was more common in young patients. The most common 10 allergens were nickel sulfate (20.4%), followed by textile dye mix (8.6%), cobalt chloride (8.3%), potassium dichromate (8.0%), p-phenylenediamine base (4.5%), balsam of Peru (4.3%), methylchloroisothiazolinone/methylisothiazolinone (3.8%), thiuram mix (3.6%), fragrance mix I (3.0%), and methylisothiazolinone (2.9%)., Conclusions: This study provides a comprehensive profile of patch test results with the EBS in Turkey. An ongoing decrease in contact allergy to methylchloroisothiazolinone/methylisothiazolinone and methylisothiazolinone was observed. Textile dye mix and p-phenylenediamine are beginning to pose a new risk in Turkey., Competing Interests: The authors have no funding or conflicts of interest to declare., (Copyright © 2021 American Contact Dermatitis Society. All Rights Reserved.)

Background: Acne is one of the manifestations of the polycystic ovary syndrome (PCOS). Nowadays hyperinsulinemia and insulin resistance are well-known characteristics of PCOS. The aim of this study was to investigate the relation between isolated female acne and insulin resistance and to determine the effect of hyperandrogenemia in this possible relationship., Methods: Forty five women with acne and 24 healthy women aged 25-40 were included in the study. The global acne grading system (GAGS) was used to evaluate acne severity. Blood samples were drawn for measurements of hormone profile, basal insulin and fasting blood glucose (FBG). The oral glucose tolerance test (OGTT) was performed on another day. homeostasis model assessment (HOMA) score was used to assess insulin resistance (IR). All subjects underwent abdominopelvic sonography., Results: Thirty-six women with acne and 24 healthy women were analyzed after exclusion. Fifteen (42%) patients had moderate acne, 11 (30%) had severe acne and 10 (28%) had very severe acne. Basal insulin, FBG, AUC glucose, AUC insulin and HOMA values were significantly higher in patients with acne when compared with the control group (P<0.05). After excluding patients with hyperandrogenemia, we compared the patients (N.=22) and control group with regard to IR; the serum basal insulin, AUC-insulin and AUC-glucose as well as HOMA score were still significantly higher in patients (P<0.05)., Conclusions: We concluded that there is a relationship between female acne and IR. This association is independent of hyperandrogenemia. Anti-insulin drugs may an adjunctive treatment of female acne.

In the last few decades, increasing understanding of the pathomechanisms involved in chronic urticaria has highlighted the heterogeneity of different subtypes, and chronic urticaria is now classified as chronic spontaneous urticaria and inducible urticaria. Although many factors are thought to be involved in chronic urticaria, the etiology is yet to be clarified. The purpose of this study was to investigate etiological factors in patients with chronic urticaria. Five hundred patients with chronic urticaria, 351 women and 149 men, were studied for etiological factors. The autologous serum skin test was performed on 197 patients. Provocation testing for physical urticaria was performed on 354 patients. Patients with acute urticaria were excluded from the study. We determined at least one focus of infection that might be involved in the etiology of the disease in 18.8% of cases. Patients with infections were treated, and symptoms resolved after treatment in six cases (5.3%). Autologous serum skin tests were positive in 125 patients (63.5%). Provocation tests for physical urticaria were positive in 131 (37%) patients with urticaria. We suggest that physical stimuli and autoantibodies play an important role in the etiopathogenesis of urticaria.

Objective: To determine the frequency of physiologic and pathologic skin findings in the newborns hospitalized in our Newborn Unit., Methods: All of newborn infants hospitalized in the Newborn Unit of Erciyes University Medical School Hospital in Central Anatolia, Turkey from February 1 to November 30, 2003, were included prospectively in the study. A questionnaire regarding maternal gestational history, maternal and family history was administered to the parents of each child. All skin lesions were recorded and mapped on a body chart., Results: Of the 816 newborns, parents of 650 gave informed consent. Only 28 (4.3%) of the infants had no dermatologic examination findings. The most common 10 diagnoses were: xerosis/desquamation 257 (39.5%), sebaceous hyperplasia 207 (31.8%), transient toxic erythema 201 (30.9%), salmon patch 125 (19.2%), Mongolian spot 86 (13.2%), cutis marmorata 69 (10.6%), suction bulla 67 (10.3%), miliaria 55 (8.5%), hypertrichosis 51 (7.8%), and dermatitis (irritant, seborrheic, or diaper) 14 (2.1%)., Conclusions: This study confirms that skin changes in the newborn are common, particularly desquamation, sebaceous hyperplasia, and transient toxic erythema.

Objective: The presence of GH receptor in human skin and its appendages suggests a direct effect of GH on skin characteristics. The skin is usually thin and dry in patients with GH deficiency (GHD). Sheehan's syndrome classically refers to postpartum hypopituitarism and GH is one of the earliest pituitary hormones lost. While severe GHD is a well-established feature of Sheehan's Syndrome, skin characteristics and the effects of GH replacement therapy (GHRT) have been investigated neither in Sheehan's syndrome nor in other disorders of GHD. The aim of this study was to investigate the skin characteristics, including the sebum content, hydration (skin capacitance), transepidermal water loss (TEWL), pH and skin temperature, and particularly the effects of 6 months of GHRT on these parameters in GH deficient patients with Sheehan's syndrome., Patients and Design: Sixteen severely GH deficient women with Sheehan's syndrome (48.1 +/- 10.9 years), and 20 age and menopausal status similar women as control subjects were included. Ten patients received recombinant GH for 6 months (treatment group) and 6 patients received placebo (placebo group) during this period. Skin properties were measured at baseline and after 6 months of GHRT using noninvasive and well-established measuring methods., Results: At baseline the skin capacitance was significantly decreased on the forehead and forearm, and sebum content was significantly decreased on forehead in patients with Sheehan's syndrome compared to control subjects (P < 0.05). In the treatment group there was a significant increase in sebum content on forehead after 6 months of GHRT compared to the baseline value (P < 0.05). However there were no significant changes in other parameters including sebum content on the forearm, TEWL, Ph, skin capacitance and temperature of both the forearm and forehead. In the placebo group there were no changes in any of the evaluated parameters after 6 months of treatment compared to baseline values., Conclusions: The present study clearly shows that the sebum content on the forehead and skin hydration of the forehead and forearm are significantly decreased in GH deficient patients with Sheehan's syndrome. However 6 months of GHRT significantly increased only the sebum content on the forehead. These data suggest that GH and/or IGF-I may have a modulatory role on several skin characteristics.

Rosacea fulminans is a rare disease of unknown cause which occurs exclusively in women years after adolescence. Although the etiology is unknown, immunologic, hormonal, and vascular factors have been suggested. When rosacea fulminans occurs during pregnancy and in women taking oral contraceptive pills, hormonal factors may be a trigger. Rosacea fulminans is localized specifically to the face, with the chin, cheeks, and forehead bearing the brunt of the attack. A dull red, cyanotic erythema of all involved facial areas, extending beyond the inflammatory nodules, is typical. We present the case of a 31-year-old pregnant woman who had rosacea fulminans during the first trimester of her second pregnancy. She had multiple erythematous papules, pustules, nodules, and purulent discharging cysts on the face. Conventional therapeutic approaches with systemic corticosteroids were associated with clear improvement within 2 months, and subsequently only 0.75% metronidazole topical cream was used during the second trimester.

Background: Isotretinoin therapy and its alleged adverse psychiatric effects have received considerable media attention during the past years. The aim of this pilot study was to investigate whether there was any association between isotretinoin therapy and anxiety, depression or suicidal ideation., Methods: Forty-five patients with severe recalcitrant acne were enrolled in this study. Isotretinoin was administered at a dose of 0.5-1 mg/kg per day in two divided doses with food for 16 weeks. All patients received a complete dermatological examination and the severity levels of their acne were scored according to the Leeds Revised Acne Grading system at baseline (before isotretinoin treatment) and follow-up assessments at weeks 4, 8 and 16 of the treatment. Severity of anxiety and depressive symptoms were assessed with the Clinical Anxiety Scale and Montgomery-Asberg Depression Rating Scale before and upon completion of the 16-week isotretinoin treatment., Results: Twenty-three patients completed the final assessment. There was a statistically significant decrease in anxiety scores. Depression scores also decreased but were not statistically significant. No patient committed or attempted suicide., Conclusions: This pilot study was unable to detect an association between the use of isotretinoin and an increased risk for anxiety, depression, or suicidal thoughts.

Background: Narrow-band UVB (311 nm) lamps (TL01) are being increasingly used for phototherapy of psoriasis and other dermatoses, for their excellent effect compared with broad-band UVB sources and photochemotherapy. It is acknowledged that the TL01 lamp is probably two to three times more carcinogenic per minimum erythema dose than broad-band UVB, but the cumulative dose is considerably less than broadband UVB sources. Micronucleus (MN) test is used to detect both clastogenic (breaking) and aneugenic (abnormal segregation) effect of physical/chemical agents on chromosomes. The aim of this study is to evaluate MN frequencies in mitogen-stimulated lymphocytes of narrow-band UVB-treated patients., Methods: Frequency of micronuclei in 72 h cultivated/mitogen-stimulated lymphocytes of 36 patients (age 7-73 years, mean+/-SD: 25.33+/-18.54) have been evaluated at pretreatment and after 20, 40, 60 sessions of narrowband UVB treatment., Results: While the beginning MN frequency +/-SD (%) was 1.07+/-0.63, it increased to 1.47+/-0.92, 1.47+/- 0.77, 1.41+/-0.31 corresponding, respectively, to 20, 40, 60 sessions. These sessions reciprocally correspond to 0.85+/-0.23, 2.97+/-0.72, 5.68+/-1.46 J/cm(2) doses of narrow-band UVB. Difference of MN frequency was statistically significant (P=0.002). Significant differences have been observed between the initial MN frequency and after that of 20, 40, 60 sessions (P=0.001, 0.004, 0.002, respectively)., Conclusions: The results of this study show that narrow-band UVB treatment causes a detectable chromosome damaging effect.

We clinically evaluated roxithromycin (ROM) in a double blind, placebo-controlled, and crossover trial in patients with inflammatory acne. Patients with inflammatory acne who were attending our outpatient clinic for treatment and who had not received topical or systemic treatment for the previous month were enrolled in this study. Patients were randomly separated into two groups. Group I consisted of 26 patients. The patients received 2x150 mg/day ROM orally in the first period and 2x1 placebo tablets/day in the second period. Group II consisted of 20 patients. These patients received 2x1 placebo tablets/day in the first period and 2x150 mg/day ROM orally in the second period. The first period was the first four weeks, and then there was a washout period of two weeks (5th and 6th). The second period was the next four weeks (7th to 10th weeks) after the washout period. Median acne scores had clearly decreased in both groups at the end of the study. Differences of median acne scores were statistically significant in both groups between at baseline and at the end of the study (p<0.001). The results showed that ROM is a safe and effective alternative in the treatment of inflammatory acne with few side effects and good compliance.