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BACKGROUND Recent data suggest that rosacea is related to cardiovascular diseases (CVD) due to its inflammatory nature and immune dysregulation. AIM The aim of this study was to evaluate the values of epicardial fat thickness (EFT) and the ankle-brachial index (ABI) in patients with rosacea, as indicators of subclinical atherosclerosis and CVD risk. METHODS This prospective case-control study was carried out on 62 participants, including 31 rosacea patients and 31 controls. The values of EFT and ABI were measured in all subjects. RESULTS The mean thickness of EFT was statistically higher in rosacea patients (0.54 ± 0.12 mm) than in the controls (0.39 ± 0.05 mm) (P

Background Dermatofibroma, also known as cutaneous benign fibrous histiocytoma, is a common skin tumour. Aim The aim of this paper was to present a rare variant of dermatofibroma, atrophic dermatofibroma, emphasizing histopathological and dermoscopic features. Patients/methods A case of atrophic dermatofibroma in a female patient with the characteristic histopathological features and newly demonstrated dermoscopic findings is presented. Results A 54-year-old female presented with a depressed reddish lesion on the back showing histopathological findings of atrophic dermatofibroma. The dermoscopy of the lesion revealed a peripheral pigment network surrounding a pink-reddish colouration around a central whitish scar-like patch with white-yellow scales which was not an exact match with the description in the literature. Conclusion Atrophic dermatofibroma is a rare variant that presents as an atrophic, depressed skin lesion which can easily be overlooked. Atrophic dermatofibroma should be considered in the differential diagnoses of atrophic, depressed lesions on the upper body of middle-aged women. The case of atrophic dermatofibroma presented here showed typical histopathologic findings with atypical dermoscopic features.

Johanson–Blizzard syndrome (JBS) is a rare autosomal recessive genetic disorder, characterized by exocrine pancreatic insufficiency, a distinct abnormal facial appearance and varying degrees of growth retardation. Ubiquitin protein ligase E3 component n-recognin 1 (UBR1) gene mutations are responsible for the syndrome. Here, we describe a 2-month-old female infant, who presented with oily diarrhea, facial dysmorphia, scalp defect, hearing defects, and growth impairment. Molecular genetic testing revealed a novel frameshift mutation in UBR1, c.4027_4028 del (p.Leu1343Valfs*7), which was not previously described in JBS in the literature.

H syndrome (OMIM 602782) is a recently defined autosomal recessive genodermatosis. Cutaneous findings of H syndrome include hyperpigmentation, hypertrichosis, and induration, while hearing loss, heart anomalies, hepatomegaly, hypogonadism, hyperglycemia (diabetes mellitus), low height (short stature), hallux valgus (flexion contractures), and hematological abnormalities are the extracutaneous abnormalities. We report a novel homozygous missense mutation, c.416T > C p.(Leu139Pro), in the SLC29A3 (NM_001174098.1) gene in two sisters with H syndrome presenting with different phenotypes.

Background/aim Malassezia colonization, sebaceous gland activity, hormones, immune system defects, environmental factors, and the interactions between these factors are thought to contribute to the pathogenesis of seborrheic dermatitis (SD). Zinc, an essential element, is involved in many biological processes including the ones that contribute to the development of SD. The aim of this study is to evaluate serum zinc levels in patients with SD. Materials and methods Forty-three patients with SD and 41 healthy controls were enrolled in the study. Disease activity was assessed by the Seborrheic Dermatitis Area and Severity Index by a single dermatologist. Serum zinc levels of all subjects were evaluated. Results Statistically significantly lower serum zinc levels were noted in SD patients than in the control group (79.16 ± 12.17 vs. 84.88 ± 13.59, respectively; P = 0.045). Conclusion The results of the study demonstrated that patients who had SD had lower levels of serum zinc levels than healthy subjects.

A higher incidence of gastrointestinal diseases has been well established in patients with rosacea. However, no screening tool has been introduced for gastrointestinal disease development in rosacea. Fecal calprotectin (FC) is a calcium-binding protein, mainly derived from polymorpho-nuclear cells, such as neutrophils. It has been established as a marker of gastrointestinal inflammation. The aim of the present study was to evaluate FC levels in patients with rosacea without any gastrointestinal diseases. A prospective, case-control study was planned to investigate the relationship between rosacea and gastrointestinal involvement by evaluating FC levels and the Gastrointestinal Symptom Rating Scale (GSRS). A total of 47 patients with rosacea and 39 healthy control subjects were included in the study. The FC levels were statistically significantly higher in rosacea group than in the control group (65.96 ± 58.86 ng/mL vs 31.99 ± 20.12 ng/mL, P = .026, respectively). A statistically significant difference was also observed in GSRS values between the patient and the control groups (30.26 ± 12.48 vs 22.62 ± 7.64, P = .001, respectively). A positive correlation was noted between FC levels and the values of GSRS in the study group (r: 0.354; P = .001) and in the rosacea group (r = 0.392, P = .006). The measurement of FC may be useful in the early detection of gastrointestinal system diseases that may accompany rosacea and may provide a pathway to develop treatment strategies targeting both skin and intestinal mucosa.

Recently, insulin-like growth factor-1 (IGF-1), forkhead box transcription factor (Fox) O1, and mechanistic target of rapamycin complex 1 (mTORC1) signaling have been introduced as key elements in acne pathogenesis. The aim of this study is to investigate the relationship between serum levels of IGF-1, insulin-like growth factor binding protein-3 (IGFBP-3), FoxO1 and mTORC1, and the components of metabolic syndrome (MS) and AV. This prospective case-control study was carried out on 89 participants, including 49 AV patients and 40 controls. The serum levels of IGF-1, IGFBP-3, insulin, FoxO1, and mTORC1 were measured along with the components of MS. The blood pressure (BP) measures were significantly higher in the AV patients than in the controls (P = .001). The mean high-density lipoprotein cholesterol (HDL-C) levels were significantly lower in the AV patients than in the controls (P = .040). The numbers of accompanying MS components were significantly higher in the AV patients than in the controls (P = .001). The IGFBP-3 levels were significantly higher in the AV patients than in the controls (P = .02). The IGF-1, mTORC1, and FoxO1 levels were higher in the AV patients than in the controls; neither were statistically significant (P = .093, P = .741, and P = .564, respectively). The higher BP and IGFBP-3 levels, the lower HDL-C levels and the common presence of MS components demand caution in terms of new therapeutic strategies and possible associated comorbidities.

Although stress has been considered a contributor in the development and exacerbation of psoriasis, few prospective studies have presented evaluations of the association between stress and psoriasis. The aim of this study was to evaluate the perceived stress, depression, and anxiety profiles in patients with psoriasis. A total of 195 patients with psoriasis and 114 healthy controls were enrolled in the study. The severity of psoriasis was assessed by a single dermatologist using the body surface area and the Physician Global Assessment (PGA). The questionnaires of Dermatology Life Quality Index, the Perceived Stress Scale, the Beck Depression Inventory, and the Beck Anxiety Inventory were obtained. The PSS scores were significantly higher in the psoriasis group than in the control group (25.14 ± 8.67 vs 23.0 ± 6.93, P

Recently, insulin-like growth factor-1 (IGF-1), forkhead box transcription factor (Fox) O1, and mechanistic target of rapamycin complex 1 (mTORC1) signaling have been introduced as key elements in acne pathogenesis. The aim of this study is to investigate the relationship between serum levels of IGF-1, insulin-like growth factor binding protein-3 (IGFBP-3), FoxO1 and mTORC1, and the components of metabolic syndrome (MS) and AV. This prospective case-control study was carried out on 89 participants, including 49 AV patients and 40 controls. The serum levels of IGF-1, IGFBP-3, insulin, FoxO1, and mTORC1 were measured along with the components of MS. The blood pressure (BP) measures were significantly higher in the AV patients than in the controls (P = .001). The mean high-density lipoprotein cholesterol (HDL-C) levels were significantly lower in the AV patients than in the controls (P = .040). The numbers of accompanying MS components were significantly higher in the AV patients than in the controls (P = .001). The IGFBP-3 levels were significantly higher in the AV patients than in the controls (P = .02). The IGF-1, mTORC1, and FoxO1 levels were higher in the AV patients than in the controls; neither were statistically significant (P = .093, P = .741, and P = .564, respectively). The higher BP and IGFBP-3 levels, the lower HDL-C levels and the common presence of MS components demand caution in terms of new therapeutic strategies and possible associated comorbidities.

Patients with rosacea have a higher incidence of depression, embarrassment, social phobia, stress, subjective disease perception and decreased quality of life. Sexual dysfunction is one of the main factors contributing to impaired life quality. The aim of this study is to evaluate the presence of sexual dysfunction in women with rosacea. A prospective case-control study was planned to investigate female sexual dysfunction in patients utilizing the Female Sexual Function Index (FSFI). A total of 85 patients with rosacea and 80 healthy control subjects were included in the study. The total FSFI scores were significantly lower in the rosacea group than in the control group (26.6 vs. 27.6, p

Introduction Inflammation, immune system disorders, Demodex infestation, neurovascular dysregulation and oxidative stress are thought to be contributory factors in the pathogenesis of rosacea. Aim To evaluate the presence of Demodex mites, the morphologic features of the nailfold capillaries, and the systemic oxidative stress status in patients with rosacea. Material and methods Thirty-one patients diagnosed with rosacea and 37 healthy age- and gender-matched subjects were included in this prospective case-control study. The presence of Demodex infestation, the findings of nailfold capillaroscopy (NFC), and the status of systemic oxidative stress measured by total oxidant capacity (TOC), total antioxidant capacity (TAC) and oxidative stress index (OSI) were evaluated. Results Demodex infestation rates were significantly higher in rosacea patients than in controls (p = 0.001). Increases in the diameters of the capillaries and the presence of avascular areas and crossing and abnormal structures were significantly more common in rosacea patients than in the healthy controls (p < 0.01, p = 0.016, p = 0.02, p < 0.001, respectively), and hairpin structures were significantly less common in rosacea patients than in the controls (p < 0.001). The presence of crossing capillaries was positively correlated with higher TOC levels (p = 0.05), while abnormal structures were found to be correlated with lower levels of TAC (p = 0.045). Conclusions Oxidative status and NFC may play diagnostic and prognostic roles in rosacea, which should be confirmed by studies with larger sample sizes.

Objective: The purpose of the study is to define the skin findings of gastroenterology inpatient clinic patients. Material and Method: Patients who were under treatment in the Gastroenterology Department of our hospital between November 2012-April 2013were included in the study. Patients’ age, gender and disease information were recorded. All patients were examined by the same dermatologist. Results: A total of 89 patients (37 (41.5%) female, 52 (58.4%) male) were included in the study. The mean age of the patients was 52.79 (20-85) years. The patients were followed up with the diagnosis of different gastrointestinal diseases, including inflammatory bowel diseases (33.7%), liver cirrhosis (33.7%), other hepatobiliary diseases (12.3%), malignancies (10.1%) and pancreatitis (8.9%). Dermatologic examination revealed that 36 patients (40.4%) had pigmentation disorders, 32 patients (35.9%) had xerosis cutis, 31 patients (34.8%) had bacterial and fungal infections and 21 (23.5%) had various nail changes. As spesific skin findings; 1 (1.1%) patient with ulcerative colitis had psoriasis vulgaris, 1 (1.1%) patient with Crohn’s disease had vitiligo, 1 (1.1%) patient with Kaposi’s sarcoma had the nodules of the Kaposi’s sarcoma in oral mucosa, 1 (1.1%) patient with liver cirrhosis had palmar erythema and 1 (1.1%) tuberculous peritonitis had erythema nodosum. Conclusion: In our study we defined a small number of spesific skin findings of gastrointestinal diseases.

Pyoderma gangrenosum (PG) is a rare inflammatory and ulcerative skin disease of unknown etiology characterized by neutrophilic infiltration of the dermis, mainly affecting the lower extremities. Bullous PG is a rare variant of this disease, usually associated with hematologic disorders. Here, we report a case of pathergy-positive bullous PG with subungual involvement associated with ulcerative colitis.

Background High-intensity focused ultrasound (HIFU) has recently been introduced in the treatment of facial wrinkles and laxity. Objective The purpose of the study was to evaluate efficacy and safety of HIFU in facial and neck rejuvenation. Methods High-intensity focused ultrasound treatment was performed on face and neck by using two different probes with focal depth of 3 mm and 4.5 mm. Two independent, blinded clinicians evaluated the clinical improvement at 3 months after treatment. The patients also scored their satisfaction with the treatment. Adverse effects were assessed up to 3 months post-treatment. Results Seventy-five patients (73 female, 2 male) with Fitzpatrick skin phototypes 2-4 were enrolled in the study. After treatment, improvement in nasolabial, jawline, submental, and neck areas was separately evaluated. The rate of improvement in each area was more than 80% according to the physicians' assessment, while patients' satisfaction degree in each area was over 78%. Most common adverse effect was pain, reported in 25.3% of the patients during the procedure while transient erythema was reported in 6.7%. Both resolved spontaneously after the procedure. Only one patient complained development of numbness on right mandibular region which resolved spontaneously within 10 days. Conclusion High-intensity focused ultrasound can be an effective noninvasive treatment modality in facial and neck rejuvenation with an acceptable safety profile.

Objectives To investigate the efficacy of erbium-doped yttrium aluminium garnet (Er:YAG) laser in the treatment of solar lentigines. Methods A retrospective study was conducted on patients treated with the only Er:YAG laser. In this study, 14 patients with multiple solar lentigines before treatment were included. Treatment parameters and all side effects were recorded. One independent, blinded dermatologist evaluated the clinical improvement and the patients also scored their satisfaction degree with the treatment. Results The mean age of the patients was 41.07±7.16 years. The number of mean treatment session for each patient was 1.79±1.05. At the final visit, excellent improvement (76-100% clearance) was reached in eight (57.1%) patients, while good improvement (51-75% clearance) was achieved in five (35.7%) patients. Ten patients (71.4%) were very satisfied and four (28.5%) patients were satisfied with the results of the treatment. No side effects occurred. Conclusion Er:YAG laser treatment may be an effective and safe optional modality for solar lentigines.

The orf virus, a member of poxvirus family, is a zoonotic parapoxvirus endemic in many countries, mostly seen among sheep, goats, oxen, and may be transmitted to humans. Orf virus infections may induce ulceration, papulonodular, pustular, or ecthyma lesions in the skin. Rarely, orf virus provokes extensive vasculoendothelial proliferation by encoding an apparent homolog of the mammalian vascular endothelial growth factor family of molecules. The vascular endothelial growth factor-like viral gene product is expressed early during infection and could be responsible for the induction of endothelial proliferation. Here, a 6-year-old male patient with poxvirus-induced widespread vascular angiogenesis is presented, which developed ten days after a thermal burn.

Objectives The purpose of the present study was to define the accompanying diseases of patients with autoimmune bullous diseases (ABDs). Methods One hundred forty-two patients with ABD who were followed up in the dermatology and venereology inpatient clinic of Sisli Hamidiye Etfal Training and Research Hospital between January 1999 and December 2015 were enrolled in the study. Age, gender, and accompanying diseases of the participants were recorded and compared with the healthy subjects. Results Eighty patients with pemphigus, 62 patients with pemphigoid, and 217 healthy subjects were included in the study. The pemphigoid group had a statistically significant higher prevalence of hypertension, diabetes mellitus, coronary artery diseases, cataract, malignancy, dementia, Alzheimer's disease, Parkinson's disease, and cerebrovascular events relative to the pemphigus and control groups (p

Lupus miliaris disseminatus faciei (LMDF) is a rarely seen, granulomatous disease of the face with an unknown etiology. Clinically, the disease is characterized by monomorphic, reddish-brown, dome-shaped papules symmetrically distributed on the face. Histopathologically, a perifollicular caseating granuloma is the hallmark. A 20-year-old male patient was referred to our outpatient clinic with multiple papules distributed on his face, and he was diagnosed with LMDF based on histopathological examination. The patient was unresponsive to the oral tetracycline treatment; however, he was successfully treated with systemic dapsone and topical tacrolimus. This is a rare case of LMDF, which showed rapid improvement with dapsone therapy.

Collagenomas are connective tissue naevi composed predominantly of collagen. Isolated collagenomas are usually localized to a single body region, acquired, and of rare occurrence. We describe a patient with an isolated collagenoma that showed an increase in size during pregnancy and regressed afterwards.

Background: Currently, no generally accepted laboratory marker for monitorizing the disease activity and therapy response of psoriasis is known. Objective: The aim of the study is to evaluate the effects of systemic therapies on C-reactive protein (CRP) and the neutrophil-lymphocyte ratio (NLR) in psoriasis. Methods: One hundred patients with psoriasis treated with narrow band ultraviolet B, acitretin, cyclosporine, methotrexate, adalimumab, etanercept, and ustekinumab were prospectively evaluated. At baseline and at week 12, CRP, NLR, and Psoriasis Area and Severity Index (PASI) were evaluated. Results: A statistically significant decrease was observed in PASI scores, CRP, and NLR values from the baseline to the 12-week visit (p=0.001, p=0.001, p=0.001, respectively). The reduction in PASI scores and NLR values was positively correlated (r=0.460, p=0.001). The comparisons between treatment groups revealed that the median decrease in NLR values was statistically higher in the adalimumab group than in the methotrexate group (p=0.007). And the median decrease in PASI scores was significantly higher in the adalimumab group compared with the methotrexate and acitretin therapy group (p=0.007, p=0.042, respectively). Conclusion: In the present study, systemic therapy of psoriasis was demonstrated to decrease the levels of CRP and NLR, which are known to be indicators of systemic inflammation and cardiovascular comorbidities. (Ann Dermatol 31(6) 601∼610, 2019)