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Background Some studies have investigated the relationship between Behcet's disease (BD) and insulin resistance; however, since they did not exclude obese patients from their sample, it remains unclear whether BD itself causes insulin resistance independently of obesity. Methods The study included 60 patients with BD and 45 age-, gender-, and body mass index (BMI)-matched healthy controls. Obese patients with a BMI of ≥30 kg/m² were excluded. Insulin resistance according to the homeostasis model assessment for insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI), fasting plasma glucose, and one-hour and two-hour plasma glucose in the oral glucose tolerance test (OGTT 1-h and OGTT 2-h PG, respectively) were evaluated in all patients. Results The mean fasting plasma glucose levels and the rate of those with impaired glucose tolerance according to OGTT 2-h PG were significantly higher in the BD patients compared to the controls. The rates of those with insulin resistance according to HOMA-IR and QUICKI were significantly higher in the BD patients than in the controls. When compared to the control group, the rates of those with impaired fasting glucose and impaired glucose tolerance were significantly higher, and the mean QUICKI value was significantly lower in the active group, in contrast to the inactive group. Conclusions Insulin resistance occurs in BD patients independently of obesity. In the follow-up of BD patients, especially in the active phase, not only fasting blood glucose but also other diagnostic tests for insulin resistance should be added to the examination panels.

Background: Primary cutaneous aggressive epidermotropic CD8+ cytotoxic T-cell lymphoma (AECTCL) is a rare and aggressive lymphoma characterised by ulcerated lesions and a poor prognosis. Objectives: To present a case series of four previously misdiagnosed AECTCL patients and discuss the importance of early diagnosis. Materials and methods: All patients in this study were identified from the database of the Dermatology Department of the Medical School of Bezmialem Vakif University, based on clinical and histopathological diagnosis of AECTCL between 2010 and 2018. Results: AECTCL cases may mimic many benign dermatoses and accurate diagnosis may be delayed. Conclusion: Because of its poor prognosis, early diagnosis of AECTCL may be helpful in improving the likelihood of patient survival, but further study is needed to address the challenges in diagnosing this rare and aggressive lymphoma.

Background. Psoriasis is a multifactorial immune-mediated inflammatory disease triggered by both genetic and environmental factors. The strong association between psoriasis and HLA-C⁎06 allele has been demonstrated in various races. The HLA-C⁎12 allele is closely related to the HLA-C⁎06 family of alleles and shares identical sequences. To the best of our knowledge, there is no information about the relationship between HLA-C⁎12 and psoriasis in the Turkish population. The present study aims to determine this relationship. Methods. This case control study involved 150 patients with plaque-type psoriasis and 145 age- and gender-matched healthy individuals. Severity of psoriasis was measured using the PASI scores of all patients and joint involvement was investigated with CASPAR criteria. HLA-C alleles were determined with a Tepnel-Lifecodes system. Results. HLA-C⁎06, HLA-C⁎12, and HLA-C⁎04 alleles were most commonly observed in psoriasis patients. HLA-C⁎06 and HLA-C⁎12 were significantly more frequent in the psoriasis group. HLA-C⁎06 was 4.11 times more common in psoriasis patients. An increase in PASI (Psoriasis Area Severity Index) scores was compatible with HLA-C⁎12 positivity. A need for systemic treatment was highly noticeable in patients with the HLA-C⁎12 allele. Conclusions. HLA-C⁎12 was found as the second most frequent allele with psoriasis in Turkish population and was associated with severe psoriasis. Our study is limited as we could not investigate other potentially related alleles other than HLA-C alleles and risk factors increasing severity of psoriasis.

Introduction Sunbed use has been significantly associated with increased risk of melanoma and non-melanoma skin cancer (NMSC), but its relationship with melanoma's risk factors such as high nevus count, atypical nevi and lentigines is poorly studied. Euromelanoma is a skin cancer prevention campaign conducted all over Europe. It offers a once-a-year screening during which participants' data, including sunbed use and phenotype, are collected via questionnaires. Objectives To investigate the association of sunbed use with nevus count, atypical nevi, lentigines and suspicion of skin cancer. Methods To ensure reliability of the data, we defined inclusion and exclusion criteria for countries' eligibility for the risk analysis. Multivariate logistic regression models (including age, gender, education, skin type, family history of melanoma, personal history of skin cancer, any sun exposure and any sunscreen use) were used to calculate summary odds ratios (SORs) of each clinical endpoint for ever sunbed use. Results Overall, 227 888 individuals from 30 countries completed the Euromelanoma questionnaire. After the data quality check, 16 countries were eligible for the multivariate analysis, for a total of 145 980 participants (64.8% females; median age 43 years; 62.3% highly educated; 28.5% skin type I-II; 11.0% ever sunbed use). Ever sunbed use was independently associated with nevus count >50 [SOR = 1.05 (1.01-1.10)], atypical nevi [SOR = 1.04 (1.00-1.09)], lentigines [SOR = 1.16 (1.04-1.29)] and suspicion of melanoma [SOR = 1.13 (1.00-1.27)]. Conversely, no significant association was found between ever sunbed use and suspicion of NMSC [SOR = 1.00 (0.91-1.10)]. Conclusions Indoor tanning is significantly associated with well-recognized risk factors for melanoma (including high nevus count, presence of atypical nevi and lentigines) as well as suspicion of melanoma within the Euromelanoma screenees. In order to reduce the prevalence of melanoma risk factors, avoidance/discontinuation of sunbed use should always be encouraged, especially but not exclusively for individuals with high-risk phenotypes.

There have been a number of investigations of the efficacy and safety of etanercept. This study was performed to obtain long-term drug survival data (i.e. time to drug discontinuation) for etanercept, and the reasons for its discontinuation. The study population consisted of patients with psoriatic arthritis and psoriasis followed up by our clinic, registered in the Turkish Psoriasis Registry (PSR-TR) and treated with etanercept for at least 4 weeks between January 1, 2005, and January 31, 2020. The efficacy of etanercept was evaluated in terms of the Psoriasis Area and Severity Index (PASI) 75, PASI 90 and PASI 100 response rates at 12, 24, 36 and 48 weeks, and annually thereafter. The behaviours of the patients with respect to the use of etanercept, and the outcomes of those who continued to use it during the COVID-19 pandemic, were also investigated. This article is protected by copyright. All rights reserved.

It is known that omalizumab (OMA) is an effective and safe treatment option in the treatment of chronic spontaneous urticaria (CSU). In the literature, there are vary studies about effect of OMA treatment in CSU such as different response rates to treatment, different dose / time regime and different relapse rates after treatment. To investigate the evaluate the effect of at least 1 year continuous OMA treatment on relapse in CSU patients. Fifty patients were included in this study. There was a significant decreased between UAS7 score before and after OMA treatment. There was no significant difference between the sixth and 12th month after OMA for UAS 7 scores. At the end of 12 month,84% of patients had complete or good response to OMA treatment. Twenty-three of 34 patients (67.6%) who discontinued treatment had relapse and 11 patients had no relapse. Duration of disease was significantly higher in patients who had relapse. Based on our study result we suggest that long disease duration may increase the risk of relapse. Although it is not statistically significant, without interruption OMA treatment for more than 1 year may decrease relapse risk in patients who respond well to the therapy.

CoronoVac is a non-viable vaccine for severe acute respiratory syndrome coronavirus 2 (SARSCoV-2). Nowadays, there has been vaccination program for at-risk groups and older adults in Turkey. We here present 72-year-old male psoriasis patient who developed generalized pustular psoriasis flare after administration of CoronoVac. The COVID-PCR test was negative and investigations for flare etiology were all normal. He was first (to the best of our knowledge) psoriasis patient who developed an erythrodermic flare after the first dose of CoronaVac vaccine.

Introduction : Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disorder. Vitamin D is a liposoluble vitamin synthesized mainly in the skin. Vitamin D has several effects on the skin. Aim : To assess the serum level of vitamin D in children with AD and determine its relation to AD severity. Material and methods : Sixty patients with AD were enrolled in the study. We evaluated disease severity using the SCORing Atopic Dermatitis (SCORAD) index. The control group consisted of 37 healthy subjects. Results : The mean serum concentration of 25(OH)D3 in patients with AD was not statistically different from control subjects (p = 0.065). The vitamin D level was significantly lower in moderate and severe AD compared with mild AD, and this difference was statistically significant (p = 0.001 and p = 0.004). Vitamin D showed a negative correlation with serum total IgE levels (p = 0.007). There was no significant correlation between total IgE levels and SCORAD scores (p = 0.089). Conclusions : This study suggests that a low serum vitamin D level is inversely associated with severity of AD in children. Vitamin D has not been included in the routine treatment of AD because of the conflicting results of various studies. Thus, there is a need for more detailed and prospective studies.

BACKGROUND Although considered as a first-group carcinogen, indoor tanning is a common practice in Europe. Euromelanoma is a pan-European skin cancer prevention campaign. OBJECTIVES To compare several European countries in terms of the prevalence and determinants of sunbed use. METHODS Participants in the Euromelanoma campaigns filled in questionnaires containing demographics and risk factors, including type/duration of sunbed use. Multivariate analyses adjusted for age, gender, education, skin type and year of survey were employed to assess factors independently associated with sunbed use in each country. RESULTS In total, 227 888 individuals (67.4% females, median age 44, 63.4% highly educated, 71.9% skin types III-VI) from 30 countries participated. Overall, the prevalence of sunbed ever use was 10.6% (≤19-year-olds: 5.9%; 20 to 35-year-olds: 17.0%; >35-year-olds: 8.3%). Females displayed a higher prevalence than males in all countries. Balkan countries displayed the highest female/male ratios (≥4). Sunbed use was significantly more prevalent among skin type III-VI (14/30 countries) and highly educated participants (11/30 countries). Significant correlations were found between sunbed use prevalence and countries' latitude (P

Psoriasis is associated with cutaneous and systemic overexpression of several proinflammatory cytokines. The aim of this study was to investigate the relationship between susceptibility to psoriasis and polymorphisms of tumor necrosis factor alpha (TNF-alpha), interferon gamma (INF-gamma), interleukin (IL-10), IL-6 and transforming growth factor beta (TGF-beta). Eighty-nine patients with psoriasis and 201 healthy controls were enrolled into the study. The patient group was divided into 2 subgroups as early-onset (group 1) and late-onset (group 2). The cytokine gene polymorphisms in each group were determined by polymerase chain reaction-single specific primer. When the whole and only group 1 patients were compared with the controls, TGF-beta TT/GC genotype was significantly high in the whole and group 1 patients. When we compared the group 1 and group 2, the frequency of IFN-gamma AA genotype was found to be significantly high in group 1 which lost significance after Bonferroni correction. Patients with moderate symptoms had a significantly high frequency of IL-10 GCC/GCC genotype that did not remain significant after correction. These data from our small group of patients demonstrated that the only significant difference between the whole patient group and the controls was for TGF-beta TT/GC genotype with a higher frequency in the patients. Due to the involvement of many other genes relating to the activity of Th1 cytokines, further studies are required to determine the molecular basis of the susceptibility to psoriasis.

Background: There is limited data about the relationship between psoriasis and melanocytic lesions and melanoma. Immunologic pathways which were implicated in psoriasis induce a reduction in the number of melanocytic nevi. Aims and Objectives: To investigate the number of melanocytic nevi in psoriatic patients compared with controls and its relationship with disease severity and type of treatment. Methods: We performed a prospective study in 100 psoriatic patients and 100 controls. Clinical data were recorded for all participants. Results: As compared with controls, patients had overall fewer nevi congenital nevi. Among psoriatic patients, biologic agents and disease severity did not correlate with the number of nevi. Conclusions: Psoriatic patients have fewer nevi than controls. Frequency of nevi in psoriatic patients is not related to treatment and disease severity.

The data on long-term efficacy, safety and drug survival rates of conventional systemic therapeutics in pediatric psoriasis is lacking. The primary aim of this study is to investigate acitretin, methotrexate, cyclosporin efficacy, safety and drug survival rates in pediatric patients as well as predictors of drug survival. This is a multicenter study including 289 pediatric cases being treated with acitretin, methotrexate and cyclosporin in four academic referral centers. Efficacy, adverse events, reasons for discontinuation, 1, 2- and 3-year drug survival rates, and determinants of drug survival were analyzed. A 75% reduction of Psoriasis Area and Severity Index score or better response rate was obtained in 47.5%, 34.1% and 40% of the patients who were treated with acitretin, methotrexate and cyclosporin, respectively. One-year drug survival rates for acitretin, methotrexate and cyclosporin were 36.3%, 21.1% and 15.1%, respectively. The most significant determinant of drug survival, which diminished over time, was treatment response whereas arthritis, body mass index and sex had no influence. Although all three medications are effective and relatively safe in children, drug survival rates are low due to safety concerns at this age group. Effective disease control through their rational use can be expected to improve survival rates. Pfizer Novartis Merck & Company - Schering Plough Corporation AbbVie Merck & Company Johnson & Johnson - Johnson & Johnson USA - Janssen Biotech Inc

The aims of this study were to determine the prevalence of H. pylori seropositivity in patients with psoriasis, to evaluate the relationship between PASI (Psoriasis Area and Severity Index) scores and H. pylori infection, and to assess the impact of H. pylori infection on the response to treatment. A total of 300 patients with psoriasis and 150 non-psoriatic healthy controls were enrolled in the study. Patient PASI scores were recorded and H. pylori stool antigen tests performed in both patients and controls. Fifty patients with H. pylori infections were randomly assigned to one of two groups, one of which received acitretin with H. pylori treatment and the other acitretin alone. Statistical analyses were performed using chi-square and logistic regression tests. PASI scores were significantly higher in patients with H. pylori infections. Treatment aimed at eradicating H. pylori infection enhanced the effectiveness of acitretin therapy and shortened response times. Our results suggest that H. pylori infection plays a role in the severity of psoriasis, and that eradicating such infections enhances the effectiveness of psoriasis treatment.

Background Even though several case studies have reported a relationship between Cutaneous T Cell Lymphoma (CTCL) and atopic diathesis, this association is still controversial. The aim of this study was to investigate the actual presence of atopic status in CTCL patients. Methods A total of 78 patients with both clinical and histological features typical of CTCL and 77 control cases from our outpatient dermatology clinic were included in this study. After initial evaluation and staging, all patients were investigated for history of atopic disease, serum total IgE and eosinophil cationic protein concentration (ECP), eosinophil count, serum specific IgE, and skin prick test positivity. Results Personal atopy in CTCL group was 23,1% (n = 18) and familial atopy was 9.0% (n = 7) whereas in the control group, these values were 11.7% (n = 9) and 7.8% (n = 6), respectively. There was no statistically significant difference, however, the number of atopic patients were higher in CTCL group than the control group (p = 0.151). Serum total IgE levels were significantly increased in patients with CTCL when compared to control group (p = 0.04). Serum specific IgE panel and prick test positivity between patients and controls were significantly different, respectively (p = 0. 03) (p = 0. 00). Eosinophil counts and ECP levels were not significantly different, respectively (p = 0.10) (p = 0.885). In high stages of CTCL, patients were found to have elevated IgE, ECP levels and eosinophil count. These results were statistically significant (p = 0.011) (p = 0.009) (p = 0.007). Conclusion Eventhough the number of patients with atopy in the CTCL group was higher than the control cases, there was no significant different. On the other hand high levels of serum IgE, elevated eosinophil count and specific IgE positivity may be found in CTCL patients with or without atopic disease, especially with high stages.

Background: Psoriasis vulgaris is one of the most common chronic inflammatory skin disorders. Patients with psoriasis are at risk of developing atrial fibrillation (AF). The electromechanical delay (EMD) is the time interval from the onset of the P wave on surface electrocardiography (ECG) to the beginning of the A wave. Prolonged atrial EMD is an independent risk factor for the development of AF. Aim: This study investigated the intra- and interatrial EMD in patients with psoriasis. Methods: This study included 85 adults with psoriasis vulgaris (Group 1) and 46 age- and sex-matched healthy individuals (Group 2). ECGs were obtained from all subjects, and atrial EMD variables were calculated. Results are reported as means ± standard deviations and percentages. Continuous variables were analysed using Student’s t-test. A p-value < 0.05 was considered statistically significant. Results: Interatrial electromechanical delay (IA-EMD) and intra-left atrial electromechanical delay (ILA-EMD) were significantly longer in the psoriasis group compared with controls. A correlation analysis between psoriasis severity (PASI score) and the atrial conduction parameters revealed a significant positive correlation between PASI and IA-EMD (r = 0.261, p < 0.001). In addition, there was a positive correlation between high-sensitivity C-reactive protein (hsCRP) and IA-EMD (p = 0.022). Conclusions: The atrial conduction time was longer in patients with psoriasis vulgaris and it correlated with the severity of disease and hsCRP. Since the association between delayed conduction and AF is known, the measurement of intra-atrial conduction times could be a practical tool to estimate the AF risk in these patients.

First described in 1963, eccrine syringofibroadenoma (ESFA) is a rare benign tumor that proliferates with differentiation toward ductal eccrine structures. There are many clinical presentations, including plaques, papules, verrucous plaques, keratotic tumors, and solitary tumors. The age of onset varies, with presentation between 16 and 80 years; however, solitary lesions are seen most commonly in the seventh and eighth decades. Here, we present the case of a 72-year-old woman referred to our outpatient clinic with a nodule on her leg. The histopathology result was ESFA. The lesion regressed after six cryotherapy sessions. Physicians should consider the possibility of ESFA and must remember its malignant potential in elderly patients.

Molluscum contagiosum is a viral infection of the skin. It may occur anywhere on the skin surface but is most common in skinfolds, on the face, and in the genital region. Atypical presentations are usually seen in conditions with altered immunity, but they may occur in immunocompetent patients as well. We present a case of an unusual presentation of molluscum contagiosum lesions (multiple normal and one giant) on the plantar area of the foot in an adult.

The concomitant occurrence of psoriasis and bullous pemphigoid has been described previously, but the pathogenic mechanism of this relationship is still unknown. We describe a 34-year-old woman with a 22-year history of plaque-type psoriasis. On the third day of hospitalization, disseminated tense bullae developed on her neck and upper extremities. Histologic examination of biopsy specimen obtained from a vesicular lesion demonstrated a subepidermal blister. Direct immunofluorescence revealed IgG and C3 deposition in a linear pattern at the basement membrane zone. Both diseases were successfully treated with cyclosporine. However, the coexistence of these conditions represents a difficult therapeutic challenge. (Turkderm 2010; 44: 167-9)

Background. Behcet’s disease (BD) could be regarded as an autoimmune disease in many aspects. Autoimmune thyroid disease (ATD) is frequently accompanied by other various autoimmune diseases. Nevertheless, there is not still enough data showing the association between BD and ATD. In addition, no controlled study is present in the PubMed, which evaluates thyroidal autoimmunity using antithyroid peroxidase antibody in a large series of patients with BD.Methods. We aimed to investigate the frequency of ATD in patients with BD. The study included 124 patients with BD and 99 age- and sex-matched healthy volunteers.Results. Autoimmune thyroiditis was noted in 21 cases (16.9%) with BD. In the control group, 22 cases (22.22%) were diagnosed as autoimmune thyroiditis. There was no difference between the groups in respect to thyroid autoantibodies (). There were no statistically significant differences between baseline TSH levels of the BD patients and of the controls (). Statistically, the mean serum free T4 levels of the patients with BD were higher than those of the controls ().Conclusions. No association could be found between BD and ATD. Therefore, it is not of significance to investigate thyroid autoimmunity in BD.

Background: Psoriasis vulgaris is one of the most prevalent chronic, inflammatory skin disorders. Patients with psoriasis have excess risk of essential hypertension. Masked hypertension (MH), defined as normal office blood pressure (BP) with elevated ambulatory BP (ABPM), has been drawing attention recently due to its association with increased risk of developing sustained hypertension, cardiovascular morbidity, and mortality. The aim of this study was to investigate the prevalence of MH in psoriatic patients. Material and Methods: On hundred and ten middle-aged, normotensive, non-obese patients with psoriasis vulgaris and 110 age- and sex-matched normotensive controls were included in the study. ABPM was performed in all participants over a 24-h period. The clinical severity of the disease was determined according to current indexes. Results: The prevalence of MH among subjects with psoriasis vulgaris was 31.8% and increased compared to control subjects (p

ejd.2012.1697 Auteur(s) : Nahide Onsun1 nonarir2011@hotmail.com, Ozlem Su1, Serpil Pirmit2, Sirin Korkmaz1, Yasemin Arzu Korkut3, Murat Akaydin4, Naciye Arda5 1 Department of Dermatology, Bezmialem Vakif University, 34093 Fatih Istanbul, Turkey 2 Department of Dermatology, Hakkari State Hospital, Hakkari, Turkey 3 Department of Otolaryngology, Sisli Etfal Hospital, Istanbul, Turkey 4 Department of Surgery, Taksim Hospital, Istanbul, Turkey 5 Department of Pathology, Yedikule Chest Disease Centre Istanbul, [...]

Pustulotic arthro-osteitis, first described by Sonozaki, is a relatively rare disorder. Its prevalence is however probably underestimated in dermatological literature. Early recognition of the signs can prevent misdiagnosis. We describe a Turkish patient who presented with palmoplantar pustulosis and involvement of the sternoclavicular joint and peripheral oligoarthritis.