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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.

This study aimed to evaluate the usefulness and accuracy of the delta neutrophil index (DNI), an index expressing the number of immature granulocytes as a proportion of the total, as an inflammatory marker in predicting serious bacterial infections (SBIs).Paediatric patients admitted to our hospital with fever were divided into four groups: SBI, non-SBI, COVID-19 and control group. White blood cell count, absolute neutrophil count, C-reactive protein and the DNI were recorded, and their accuracy in predicting SBI was evaluated.Mean DNI was 4.96 ± 8.38 in the SBI group (150 patients), 0.67 ± 1.68 in the non-SBI group (397 patients), 0.29 ± 0.99 in the COVID-19 group (112 patients) and 0.14 ± 0.21 in the control group (102 patients). The DNI was significantly higher in the SBI group compared with the non-SBI (P 0.001); the non-SBI group also had higher levels than the COVID-19 group (P = 0.005). One percent increase in the DNI increased the SBI rate 1.36 times (odds ratio 1.36 (95% confidence interval 1.23-1.49), P 0.001). Based on the determined cut-off value (2.5%), the DNI (odds ratio 6.27 (95% confidence interval 3.85-10.21), P 0.001) significantly predicted SBIs with 90.4% specificity and 47.7% sensitivity.SBIs in childrenare associated with an increase in DNI levels. Compared to other biomarkers, the DNI had higher specificity in predicting SBIs. The DNI may also be usefulin differentiating bacterial and non-bacterial infections in individualclinical syndromes. Currently, there is no evidence that serum DNI aids indifferentiating COVID-19 and upper respiratory tract infection.

Background: Rosacea may result in emotional distress and anxiety. However, data on the presence of generalized anxiety disorder in rosacea patients are scarce. Objective: The aim of the study was to detect the frequency and level of anxiety and depression in patients with rosacea. Methods: A total of 194 consecutive rosacea patients and 194 age- and sex-matched controls were enrolled. Severity of rosacea was assessed in patients according to the criteria of the National Rosacea Society Ethics Committee. Both patients and controls were evaluated by the Generalized Anxiety Disorder 7-item scale, and severity was measured by the Generalized Anxiety Disorder-Adult. Results: Individuals who were diagnosed with an anxiety and/or depressive disorder were more common in patient group (24.7% vs. 7.2%, p < 0,01). Female patients were particularly at risk for having generalized anxiety disorder (OR = 2.8; 95% CI 1.15-7.37; p = 0.02). Study limitations: Single center study and limited sample size. Conclusions: Rosacea patients show greater risk of having anxiety disorders, including generalized anxiety disorder. Female patients, those with lower educational levels, those with phymatous subtype, untreated patients, and patients with prior psychiatric morbidity may be at particular risk for anxiety. It is essential to consider the psychological characteristics of patients to improve their well-being.

Panitumumab is a recombinant, fully humanized IgG2 monoclonal antibody targeting the epidermal growth factor receptor (EGFR). Panitumumab is indicated for patients with metastatic colorectal cancer with progressive refractory disease. Targeted therapies are well known to be well tolerated; however, they may induce toxicities that are distinct from those of classical chemotherapeutic agents. For instance, EGFR inhibitors (EGFRIs) are associated with some specific dermatological adverse effects, one of which is nail toxicity. Since panitumumab is fully humanized, unlike most of the other EGFRIs, it has been reported to have reduced incidence of adverse reactions. Nail-related adverse effects are frequently observed with EGFRIs. A literature search has yielded a list of reviews describing panitumumab-induced nail toxicity. However, as far as we know, there is no case report detailing this adverse effect of panitumumab. Here, we present a case of panitumumab-induced paronychia in a 60-year-old woman with metastatic colon cancer. With this case report, we would like to review the literature and discuss the possible underlying mechanisms of this condition.

Background: Internalized stigma, adoption of negative attitudes and stereotypes of the society regarding persons' illness, has not been studied previously in pediatric psoriasis patients. Objective: We aimed to investigate the internalized stigma in pediatric psoriasis patients and to determine differences according to factors affecting internalized stigma compared to adult psoriasis patients. Methods: This multicenter, cross-sectional, comparative study included 125 pediatric (55 female, 70 male; mean age±standard deviation [SD], 14.59±2.87 years) and 1,235 adult psoriasis patients (577 female, 658 male; mean age±SD, 43.3±13.7 years). Psoriasis Internalized Stigma Scale (PISS), Dermatology Life Quality Index (DLQI), Perceived Health Status (PHS), and the General Health Questionnaire (GHQ)-12 were the scales used in the study. Results: The mean PISS was 58.48±14.9 in pediatric group. When PISS subscales of groups were compared, the pediatric group had significantly higher stigma resistance (p=0.01) whereas adult group had higher scores of alienation (p=0.01) and stereotype endorsement (p=0.04). There was a strong correlation between mean values of PISS and DLQI (r=0.423, p=0.001). High internalized stigma scores had no relation to either the severity or localization of disease in pediatric group. However, poor PHS (p=0.007) and low-income levels (p=0.03) in both groups, and body mass index (r=0.181, p=0.04) in the pediatric group were related to high PISS scores. Conclusion: Internalized stigma in pediatric patients is as high as adults and is related to poor quality of life, general health, and psychological illnesses. Unlike adults, internalized stigma was mainly determined by psoriasis per se, rather than disease severity or involvement of visible body parts, genitalia or folds. Copyright © The Korean Dermatological Association and The Korean Society for Investigative Dermatology.

AMAÇ: Herpes zoster (HZ), varisella zoster virüsünün reaktivasyonu sonucu meydana gelir. Öncelikle yaşlılarda ve bağışıklık sistemi baskılanmış kişilerde sık görülür. Zoster aşısının kullanılmaya başlamasının ardından HZ sıklık ve komplikasyonlarında azalma izlenmekle birlikte HZ, gelişmekte olan ülkeler için halen sorun teşkil etmektedir. Bu çalışmanın amacı HZ tanısıyla takip edilen hastaların demografik özellikleri, hastalıkla ilişkili klinik özellikleri ve laboratuvar bulgularını değerlendirmektir. GEREÇ VE YÖNTEM: Mayıs 2014- Mayıs 2018 tarihleri arasında dermatoloji kliniğine HZ tanısıyla başvuran hastalar ICD 10 kodları (B02, B02.3, B02.8, B02.9) taranarak belirlendi. Üç bin sekiz yüz elli altı hastanın elektronik dosya kayıtları geriye dönüşlü olarak incelendi ve hastalık özellikleri kaydedildi. BULGULAR: Hastaların %47,6’sı kadın %52,4’ü erkekti. Ortalama yaş 50,89 (±18.3) olarak hesaplandı. HZ insidansında mevsimlere göre farklılık izlenmedi (ilkbahar: %27,1; yaz: %22,9; sonbahar: %25,6; kış: %24,4). Ancak, hospitalizasyon ve oküler komplikasyon sıklığında sırasıyla ilkbahar (ilkbahar: %36; yaz: %23; sonbahar: %25; kış: %16) ve sonbahar (ilkbahar: %23,1; yaz: %7,7; sonbahar: %53,8; kış: %15,4) aylarında artış görüldü. Oftalmik tutulum hospitalize edilen hastaların %13’ünde izlendi ve yapılan lojistik regresyon analizi yaş, mevsim ve kan platelet dağılım genişliği (PDW) düzeylerinin oküler komplikasyon riski ile ilişkili olduğunu gösterdi. Sonbahar mevsiminde başvuran hastalar diğer mevsimler ile karşılaştırıldığında oftalmik tutulum için artmış riske sahiplerdi. Mevsime ek olarak PDW düzeylerindeki her bir birimlik azalma ve yaştaki her bir yıllık artış oküler komplikasyon riskini 1,29 (%95 GA: 1,01-1,69; p=0,048) ve 1,08 (%95 GA: 1,009-1,156; p=0,026) kat arttırmaktaydı. SONUÇ: HZ epidemiyolojisi ve oftalmik tutulum için risk faktörlerinin belirlenmesi hasta yönetiminde klinisyene yardımcı olabilir.

Oral liken planus (OLP), etiyolojisi henuz tum yonleriyle aydinlatilamamis kronik immun aracili bir dermatozdur. Oral mukozanin en sik hastaliklari arasinda kabul edilen OLP, premalign bir durum olarak tanimlanmasindan bu yana cok daha fazla ilgi goren bir hastalik haline gelmistir. Oral likenoid kontakt reaksiyonlar (OLKR), OLP’den gerek klinik, gerekse histopatolojik olarak neredeyse ayirt edilemez, bu nedenle OLP lezyonlarinin analogu olarak gorulurler. Hali hazirda, OLP iliskili malign oral skuamoz hucreli karsinomaya neden olan tetikleyici hastaligin, OLP ya da OLKR’den hangisinin oldugu konusunda suregelen tartismalar vardir. Dahasi, gunumuzde halen kayda deger sayida OLKR tanili hasta, altta yatan spesifik etiyolojiler arastirilmadan OLP olarak kabul edilmekte ve tedavi gormektedir. Dental restoratif materyaller OLKR’in en onemli tetikleyicileri arasindadir. Biz de burada, dental restoratif materyal iliskili OLKR tanisi koydugumuz ve bize basvurmadan once OLP’nin neden oldugu oral mukozanin iyi diferansiye malign oral skuamoz hucreli karsinoma tanisiyla marjinal mandibulektomi ve boyun diseksiyonu uygulanan bir olguyu sunmak istiyoruz. Biz, her OLP ve OLKR olgusunda olasi etiyolojik faktorlerin aydinlatilmasi gerektigi kanaatindeyiz, cunku yapilacak bir bazal yama testi hastaligin klinik seyrini tamamiyla degistirebilir.

WOS: 000408928500016, PubMed: 28407292, Internalized stigma is the adoption of negative attitudes and stereotypes of the society regarding a person's illness. It causes decreased self-esteem and life-satisfaction, increased depression and suicidality, and difficulty in coping with the illness. The primary aim of this study was to investigate the internalized stigma state of psoriatic patients and to identify the factors influencing internalized stigma. The secondary aim was to identify the correlation of internalized stigma with quality of life and perceived health status. This multicentre, cross-sectional study comprised 1485 patients. There was a significant positive correlation between mean values of Psoriasis Internalized Stigma Scale (PISS) and Psoriasis Area and Severity Index, Body Surface Area, Dermatological Life Quality Index and General Health Questionnaire-12 (P < 0.001 in all). Lower percieved health score (P = 0.001), early onset psoriasis (P = 0.016), family history of psoriasis (P = 0.0034), being illiterate (P < 0.001) and lower income level (P < 0.001) were determinants of high PISS scores. Mean PISS values were higher in erythrodermic and generalized pustular psoriasis. Involvement of scalp, face, hand, genitalia and finger nails as well as arthropathic and inverse psoriasis were also related to significantly higher PISS scores (P = 0.001). Our findings imply that psoriatic patients experience high levels of internalized stigma which are associated with psoriasis severity, involvement of visible body parts, genital area, folds or joints, poorer quality of life, negative perceptions of general health and psychological illnesses. Therefore, internalized stigma may be one of the major factors responsible from psychosocial burden of the disease.

Chronic inflammatory diseases such as psoriasis, rheumatoid arthritis, and inflammatory bowel diseases have been reported to be associated with the development of metabolic syndrome (MetS), which is characterized by central obesity, elevated triglycerides (TG), reduced high-density lipoproteins (HDL), impaired fasting blood glucose (FBG), and hypertension. Behçet disease (BD) is a chronic, immuno-inflammatory disease with multisystemic involvement.The aim of this study was to investigate the prevalence and risk factors for MetS in patients with BD.All patients had BD according to the criteria of the International Study Group. Diagnosis of MetS was established according to National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Mean waist circumference, body mass index (BMI), FBG, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), total cholesterol, HDL, very low-density lipoprotein (VLDL), low-density lipoprotein (LDL), TG, systolic BP, and diastolic BP were measured and analyzed.A total of 86 patients and 72 healthy controls were included. MetS was detected in 35.4 % of patients and 20 % of controls (p = 0.04). Patients with BD had a 2.67-fold higher risk for MetS than healthy controls (p 0.05). Significant risk factors for developing MetS according to multivariate analyses were BD, age, and BMI. Age at onset of the disease, duration of disease, BMI, gastrointestinal system involvement, and neurological involvement were correlated with increased MetS risk (p 0.05). MetS tended to increase with age and the duration of the disease and was higher in women under the age of 40 years compared with healthy controls in the same age group.All BD patients should be closely monitored for hypertension, hyperlipidemia, and diabetes mellitus to avoid MetS development.

Psoriasis is characterised by the presence of neutrophil overactivation and overproduction of interleukin (IL)-6 and IL-8 from keratinocytes. It is now clear that macrolide antibiotics have anti-inflammatory effects, such as inhibition of IL-6, IL-8 and tumour necrosis factor-alpha, perhaps by suppressing the transcription factor nuclear factor-kappaB or activator protein-1, and reduction of neutrophil activity. It is thus possible that macrolides might be a candidate for adjunctive treatment of psoriasis. In this study, we investigated the effectiveness of treatment with the macrolide antibiotic, erythromycin, for skin lesions and pruritus of patients with psoriasis. In total, 60 patients with psoriasis, especially pruritic psoriasis, were included. This was an open-label study and the analysis was on an intention-to-treat basis. Oral macrolide antibiotics and topical corticosteroids were given to the study group of 36 patients. The control group (24 patients) were treated only with topical corticosteroids. After a 4-week treatment period, scores on the Psoriasis Area and Severity Index (PASI) at baseline and at the end of the treatment, and the effectiveness in reducing itching were compared within and between both groups. Although there was no statistically significant difference between the baseline mean PASI of the two groups (P=0.81), there was a statistically significant difference between the mean PASI of the two groups at the end of the treatment (P=0.023, 95% confidence interval: - 3.45 to - 0.27). The comparison of the mean difference in PASI yielded a statistically significant difference (P=0.03, 95% confidence interval 0.73-3.55). Our study suggests that macrolides could be used as one of the adjunctive therapies for psoriasis vulgaris.

Aquagenic papulotranslucent acrokeratoderma (APA) is an acquired, unusual condition characterized by bilateral, symmetric, translucent-to-white papules located on the hands and feet. These lesions are accentuated following a short period of water exposure. Since its first description in 1973 as hereditary papulotranslucent acrokeratoderma, only a few cases of APA have been reported. We report two cases of teenage girls with APA. Both patients responded well to 5% salicylic acid ointment but recurrence of lesions still occurred. The close temporal proximity of presentation of these two cases may indicate that APA is not as rare as previously thought.

WOS: 000301684900007 PubMed ID: 22240400 Regardless of methicillin resistance, PantonValentine leucocidin (PVL)-positive Staphylococcus aureus isolates are associated with various types of infections and outbreaks. Limited data exist about the PVL content of S. aureus strains in Turkey. In this multicentre study, we aimed to assess the PVL positivity and antimicrobial susceptibilities of S. aureus isolates recovered from skin and soft tissue samples of both community and nosocomial origin in the study period, 200708. Two hundred and forty-two [92 community-acquired (CA) and 150 hospital-acquired (HA)] isolates were included in the study. Analysis of mecA and PVL was carried out using PCR. All isolates underwent susceptibility testing according to the CLSI. Out of 242 isolates, 77 were mecA positive. PVL was not found among methicillin-resistant S. aureus (MRSA) isolates, but 8 (5.3) HA methicillin-susceptible S. aureus (MSSA) and 14 (15.2) CA-MSSA, mostly isolated from furuncles (71.4), were positive for PVL. Among PVL-positive strains, the penicillin resistance rate was 90.9. Low resistance rates, 10, were detected for erythromycin, fusidic acid and co-trimoxazole. PVL-positive strains showed higher rates of susceptibility to erythromycin, gentamicin and rifampicin than negative isolates. Based on the findings of this study, infection related to PVL-carrying CA-MRSA is not at an alarmingly high level, but population-based surveillance studies should be done to determine the real status.

Acute generalized exanthematous pustulosis (AGEP) is a cutaneous reaction principally induced by drugs. Spontaneous resolution is observed in most patients. However, severe cases required systemic corticosteroid administration. Hydroxychloroquine, which is used to treat some dermatologic and rheumatologic diseases because of its anti-inflammatory and immunosuppressive effects, is an uncommon cause of AGEP. A 67-year-old female patient presented with severe AGEP due to hydroxychloroquine treatment. She was recalcitrant to supportive care and systemic corticosteroid treatment butwas successfully treated with cyclosporine. Hydroxychloroquine-induced AGEP occurs in women with underlying rheumatologic diseases, has a longer latent period, and has a severe course usually requiring systemic treatment.

To evaluate the effects of MEFV genotypes and the major histocompatibility complex class I chain-related gene A (MICA) triplet repeat polymorphism on the severity and clinical features of familial Mediterranean fever (FMF) and amyloidosis in a group of Turkish FMF patients.We evaluated 105 adult FMF patients (with or without amyloidosis, 33 and 72, respectively) along with 107 healthy controls who were neither related to the patients nor had a family history of FMF or Behcet's disease. After recording the demographic and clinical data, the predominant mutations in the MEFV gene locus (M694V, M680I, V726A, M694I, and E148Q) were investigated by direct sequencing. MICA transmembrane polymorphisms in exon 5 were studied by vertical gel electrophoresis and fragment analysis of the amplicons obtained from MICA locus with appropriate primers.Earlier age at onset, increased frequency of attacks, arthritis attacks, erysipelas-like erythema, increased severity scores and amyloidosis were significantly more common in M694V homozygous patients compared to the patients not M694V homozygous (P = 0.005, OR 4.55; P = 0.001, OR 7.60; P = 0.003, OR 4.57; P = 0.002, OR 7.58; P = 0.004, OR 5.15 and P = 0.018, OR 3.33, respectively). We did not detect any modifying effects of MICA alleles as an independently risk factor on the amyloidosis development. However, when we examined the effects of MICA alleles on the course of the disease and development of amyloidosis in the M694V homozygous patients, A5 allele had a protective effect against the development of amyloidosis (P = 0.038, OR(adj) 0.26 with A5 and P = 0.009, OR(adj) 4.42 without A5).Though the effects of the MEFV genotypes seem clear, there are definitely other modifying factors or genes on the development of amyloidosis and on the course of the disease. For example, some MICA alleles have a protective effect on the prognostic factors in FMF.

A healthy 65-year-old man presented with a 4-month history of left flank pain and nocturia. Dermatologic examination revealed multiple eruptive seborrheic keratoses, which he reported had developed over the previous 1 to 2 years (Panels A and B). Abdominal ultrasound examination and computed tomography (CT) revealed a localized mass (7 cm by 5 cm in diameter) of the left lower renal pole with central necrosis. A left total nephrectomy was performed, and histopathological examination confirmed a renal-cell carcinoma. The tumor infiltrated to, but did not penetrate, Gerota's fascia. The cutaneous findings were consistent with the diagnosis of the Leser–Trelat sign, . . .