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The aim of this pilot study was to quantify the meibography changes in patients administered with oral isotretinoin. Methods: This prospective pilot study included 30 eyes of 30 patients who received oral isotretinoin treatment due to acne. Each patient underwent a general ophthalmological examination. After fluorescence staining of the ocular surface, the tear film break-up time (TFBUT) test, meibography and Schirmer test were carried out and noted. All of these procedures were applied before the treatment and repeated at 1, 3, and 6 months after the treatment. Results: The percentage of upper meibomian gland (MG) loss at 3 and 6 months after the treatment was 22.2% (p = 0.001) and 23.6% (p = 0.001), respectively. The percentage of lower MG loss at 3 and 6 months after the treatment was 18.7% (p = 0.001) and 20.7% (p = 0.001), respectively. The corneal fluorescein staining score at 3 and 6 months after treatment was 0.57 (p = 0.001), and 0.47 (p = 0.012), respectively. Conclusion: These findings show that oral isotretionin treatment may affect MG morphology. The study findings also suggest that isotretinoin may cause tear film instability with Meibomian gland dysfunction and may cause evaporative type of dryness.

Gürlevik, Uğur ( Aksaray, Yazar ), Purpose: To investigate the effect of oral isotretinoin use on refractive error, axial length, and anteroposterior segment parameters. Materials and methods: In this prospective study, 50 eyes of 50 patients using isotretinoin with a diagnosis of acne vulgaris and 50 eyes of 50 healthy control subjects were included. After detailed biomicroscopy, measurements were taken of axial length, lens thickness, central corneal thickness, anterior chamber depth, central retinal thickness, and subfoveal choroidal thickness. The pupils of both eyes were dilated with one drop of cycloplegic drops after refraction measurement. Visual acuity examination was performed with a Snellen chart the next day. The same procedure was repeated at the end of the third and sixth month of drug treatment. Results: Forty-seven patients with acne vulgaris and 45 healthy controls met the inclusion criteria and were included in the analysis. The mean ages of the patients and the controls were 21.7 ± 2.5 years (range, 18–28 years) and 22.6 ± 2.7 years (range, 19–27 years), respectively. No significant changes were observed in any parameters in the third and sixth month in the control group (p > 0.05). The most important result was significant increases in myopia and axial length in the sixth month of isotretinoin use (p = 0.01, p = 0.04, respectively). There were no significant relationships between increases in myopia and axial length and patients’ age, sex, drug dose, and initial refraction (p > 0.05). The changes in spherical equivalent and axial length differed significantly between the drug group and the control group (p = 0.001, p = 0.001, respectively). Conclusions: Isotretinoin is one of the important molecules in the aetiology of myopia. Oral isotretinoin treatment may increase myopia and axial length, although not to a clinically significant degree. However, as this was a pilot study, there is a need for further studies with more patients and longer follow-up periods.

*Çorum Şirin, Serpil ( Aksaray, Yazar ) *Kemeriz, Funda ( Aksaray, Yazar ), A 65-year-old woman was referred to our clinic with multiple erythematous plaques on the trunk and arms (Figure 1). The eruption occurred three days after starting a 75 mg daily dose of gabapentin prescribed by a physical medicine and rehabilitation specialist for neuropathic pain in her arm. The skin lesions were accompanied by a fever of 38.3°C. The laboratory investigations revealed a white blood count of 18.820/mm3 and neutrophilic leukocytosis with a percentage of 89.4%. Further investigations revealed no infectious condition.

*Kemeriz, Funda ( Aksaray, Yazar ) *Kayabaşı, Serkan ( Aksaray, Yazar ), Systemic isotretinoin is commonly used for severe acne treatment. It has many side effects, one of these is about hearing system, which has rarely been reported, also previous studies reported contradictory results about systemic isotretinoin and its association with hearing system. In this study, we aimed to investigate whether systemic isotretinoin affected on the hearing system or not. The study included 32 acne vulgaris patients (64 ears) who treated with oral isotretinoin 0.5 mg/kg body weight for at least 4 months and audiometric tests including pure-tone, speech, bilateral acoustic reflexes, and tympanometric measurements were performed at baseline, in the first week, in the first month, and third month of treatment, and sixth month after treatment. Audiometric tests were performed for right and left ears separately. A significant difference was found in the pure-tone thresholds (before treatment, first week, first month, third month of treatment, and sixth month after treatment) for the both ears at 8000 Hz (P < .001) and a significant decrease in the sixth month post-treatment pure-tone thresholds compared to pre-treatment thresholds at 8000 Hz. Additionally, a statistically significant increase was observed in serum LDL and triglyceride levels in the third month of treatment and a significant decrease at the sixth month after treatment (P < .001). Systemic isotretinoin caused bilateral hearing threshold changes in acne patients during the therapy but the changes improved after discontinuation. Therefore, our findings may provide safety using for dermatologists about hearing effects of isotretinoin, which is quite effective on severe acne.

*Kemeriz, Funda ( Aksaray, Yazar ) *Ordu, Melike ( Aksaray, Yazar ), Dear Editor Omalizumab is a humanized monoclonal antibody against human immunoglobulin E that is mainly indicated in asthma, allergic rhinitis, chronic spontaneous urticaria and is being increasingly used for other dermatological diseases, including atopic dermatitis, mastocytosis, hyper-IgE syndrome, and bullous pemphigoid.1,2 Rare cutaneous side effects, such as itching, skin rash, urticaria, and photosensitivity, have been reported to be associated with omalizumab use.

*Kemeriz, Funda ( Aksaray, Yazar ) *Tuncer, Sibel Çiğdem ( Aksaray, Yazar ), Background: C-reactive protein to albumin ratio (CAR) is an inflammatory marker that is considered to have prognostic value in many inflammatory diseases. Objectives: In this study, we aimed to investigate whether there is a correlation between CAR value and disease severity in patients with psoriasis. Methods: The study included 70 plaque-type psoriasis patients and 67 healthy controls. CAR value was calculated after C-reactive protein (CRP) and albumin analysis was performed, Psoriasis Area and Severity Index (PASI) scores were documented. CAR value was compared with PASI scores in patient group. White blood cell count, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, erythrocyte sedimentation rate (ESR), and mean platelet volume and CAR values were compared among these groups. We investigated the most significant parameter for disease severity. In addition, to detect relationship between CAR, disease duration and patients' age and healthy controls, correlation analysis was performed. Results: The median CAR value was found statistically significant higher in the patient group than in the control group (P < 0.001). A significant difference of median CRP, albumin, CAR (all P values are

Objective: This study aimed at investigating the correlation between preliminary diagnosis and pathological diagnosis of head and neck lesions after dermoscopic examination and excisional biopsy. Methods: We included 89 patients with head and neck lesions admitted to dermatology outpatient clinic. The correlation between preliminary diagnoses and pathology results of head and neck lesions were evaluated. Results: Lesions in 22 of 89 patients (24.7%) were melanocytic and 67 of 89 patients (75.3%) were nonmelanocytic. The number ofpreliminary diagnosis of all patients was no more than three. The clinicopathological correlation rate was 78.65% (70 patients) for the first preliminary diagnosis, 34.83% (31 patients) for the second preliminary diagnosis and 7.86% (7 patients) for the third preliminary diagnosis. Initial preliminary diagnosis and pathological diagnosis were found different in 13 cases. In 3 cases, nodular lesions were excised considering skin malignancy clinically and dermoscopically, but the histopathological results were reported as benign lesions. Conclusion: We think that the cooperation of clinicians and pathologists can increase the exact pathological diagnosis rate andclinicopathological correlation.

*Kemeriz, Funda( Aksaray, Yazar ) *Tuncer, Sibel Çiğdem( Aksaray, Yazar ), Acne vulgaris is a multifactorial skin disorder. Many etiological factors are speculated to contribute to the pathogenesis of acne, one of these is vitamin D deficiency. Previous studies reported contradictory results about serum 25 hydroxy vitamin D (25-OH vitamin D) levels, its association with acne, some claimed that acne lesion might improve with vitamin D supplementation. We aimed to assess serum 25-OH vitamin D levels in acne patients, identify their relation with disease severity in a larger study group. The study included 134 acne patients, 129 controls. Acne disease severity was identified with Global Acne Grading Scale (GAGS) scores. Serum 25-OH vitamin D levels were measured in all groups. Serum 25-OH vitamin D levels were significantly lower in acne patients than in controls (P

*Kemeriz, Funda ( Aksaray, Yazar ) *Kilitçi, Asuman ( Aksaray, Yazar ), LETTERLichen planus actinicus treated successfully with topicaltacrolimus 0.1%: A report of six casesDear Editor,Lichen planus actinicus (LPA) is a photodistributed variant of lichenplanus (LP) that frequently occurs individuals with dark complexionson sun-exposed areas.1,2All of the cases admitted to our clinics forasymptomatic discoloration and rash on different parts of the faces.Five of six cases were male and one of them was female. Lesions ofthree male patients were on the forehead; one of these was in torm of an annular brown-violaceous plaque and two of these were inthe form of hyperpigmented patch lesion (case-1, 3, 6). Other two ofthem had hyperpigmented patch lesions on the neck (case-2, 5).Hyperpigmented patch lesions of female patient were on perioralregion (case-4). Detailed demographic and clinical features of thecases were presented in Table 1, and clinical images of the cases wereshown in Figure 1. Histopathology results of all patients revealed

WOS: 000434217800006, PubMed: 29881552

Pasini ve Pierini’nin İdiyopatik Atrofoderması (PPİA) nadir görülen etyolojisi bilinmeyen bir dermal atrofi tipidir. Lezyonlar tek ya da birden fazla oval ya da yuvarlak, simetrik , deriden hafif çökük, keskin sınırlı plaklar şeklindedir. Çoğunlukla sırtta lokalize olan lezyonlar sonrasında göğüs ve abdominal bölgede de ortaya çıkabilmektedir. Lezyonların boyutu 1-20 cm arasında değişebilmektedir ve lezyonlar zaman içerisinde yavaşça genişler. Hastaların çoğu kadın olup, genelde ikinci-üçüncü dekatlarda görülmektedir. Nadiren PPİA ve morfea bir arada görülebilir. Bu makalede sırtında asemptomatik çökük kahverengi leke ile polikliniğimize başvuran, klinik ve histopatolojik bulgularla PPİA ve morfea tanısı konulan 27 yaşında bayan hasta sunulmaktadır.

Dear Editor, Pityriasis rubra pilaris (PRP) is a chronic, inflammatory, papulosquamous skin disorder that is characterized by follicular hyperkeratosis and reddish-orange, scaling dermatitis with islands of normal skin (1,2). PRP is classified into 5 groups based on clinical features. Type 4 PRP is characterized by well-demarcated, hyperkeratotic erythematous plaques localized on the elbows and knees with palmoplantar keratoderma (1,2). An 8-year-old girl presented to our clinic with erythematous plaques on both elbows, the legs, and the knees. Plantar keratoderma was noticed on clinical examination. The lesions had started on the elbows and knees about a year ago. The lesions on the leg were surrounded by an irregular, hyperpigmented border. On close inspection, the plaques were formed by follicular papules and mild desquamation was noticed. Upon questioning, it was learned that the lesions on the leg with hyperpigmented borders had emerged after a hot water burn three months ago and that they were localized exactly on the burned areas of the skin (Figure 1). A biopsy was performed on the new lesions, and histopathological evaluation revealed parakeratosis with alternating orthokeratosis, irregular hyperkeratosis, keratotic plugs, and a mild perivascular lymphocytic infiltration around the blood vessels (Figure 2). A diagnosis of PRP was established. The Koebner phenomenon (KP) is described as the development of lesions in previously normal skin after exposure to internal or external trauma such as surgical incisions, burns, friction, insect bites, and allergic and irritant reactions (3). The pathogenesis of KP is not fully understood, but epidermal cell injury and dermal inflammation have been proposed as having a role in the pathophysiology (4). Experimental studies on the mechanism of KP have been performed mostly on patients with psoriasis (3). Disease severity, early age of disease onset, and multiple previous therapies have been found to be associated with KP (5,6). KP has previously been reported after injury with the sharp end of a stick in type 3 PRP, a generalized PRP form (7). However, our patient was diagnosed with type 4 PRP, which is a localized form of the disorder. Griffiths reported type 4 PRP does not evolve to generalized forms (8). In this respect, our case was interesting as maximum Koebner response was observed despite the mild PRP. We therefore believe that disease severity is not a determining factor in KP and that the severity of skin damage plays a crucial role. We also think that changes in the cytokine milieu in the burn area may be responsible for KP, as levels of IL-17 and IL-22, which have been shown to be upregulated in burns, also play a role in PRP pathogenesis (9,10). The disease onset at an early age might have also had a contributing role in the Koebner response in this patient. The hyperpigmented borders of the Koebnerized plaques were also notable as they were spared from KP. Some spared areas were also seen within the Koebnerized plaques themselves. A threshold level of trauma is thought to be necessary for inducing KP (3). The clinical picture of our patient may indicate that the skin damage was much less severe in some areas of the burn, especially in the periphery, and that KP was therefore not observed in these areas. Our case clearly demonstrates that the Koebner response is not related to disease severity. We believe that the type of trauma is an important factor in determining the severity of skin damage and the changes in the cytokine milieu in the involved skin. Early disease onset also seems to contribute to the development of KP. Further studies investigating the mechanism of KP in various skin disorders are necessary. As far as we are aware, this is the first case reporting Koebnerization in the circumscribed juvenile form of PRP.

To evaluate the dry eye disase and meibomian gland dysfunction with meibography of Seborrheic Dermatit patients.A hundred-ten of 50 patients with Seborrheic Dermatitis (group 1) and 100 eyes of 50 healthy individuals (group 2) were enrolled in this prospective study. All subjects were performed a comprehensive ophthalmic examination including lid margin alterations and meibomian gland obstruction assessment, Ocular Surface Disease Index assessment, tear film break-up time test, corneal and conjunctival fluorescein staining assessment, Schirmer test. In addition, upper and lower lids were evaluated for meibomian gland loss with non-contact meibography. The Meibomian glands were graded from grade 0 (no loss of Meibomian glands) to grade 3 (gland loss2/3 of the total Meibomian glands).The mean ages of Group 1 and Group 2 were 29.1 ± 9.1(range, 18-48) and 30.6 ± 6.3(range, 20-49) years, respectively. MGD(n = 19, %34.5), Meibium gland loss(%36.4 ± 18.1), upper meiboscore (0.7 ± 0.8), lower meiboscore(0.6 ± 0.7) and DED (n = 10, %18.2) were significantly higher in the SD patients compared with the control participants (p = 0.002, p 0.001, p = 0.011, p = 0.005, p = 0.048, respectively). There was significant relationship between age with Meibomian gland loss, MGD and DED (p = 0.017, p = 0.004, p = 0.002, respectively).Seborrheic Dermatitis may influence meibomian gland morphology and as a result causing meibomian gland dysfunction and dry eye disase. For this reason, patients with Seborrheic Dermatitis should be evaluated for meibomian gland dysfunction and dry eye disase, and start treatment when needed.

No abstract available

WOS: 000451077200008, Basal cell carcinoma (BCC) is the most common skin cancer with several clinical and histopathological subtypes. Trauma and scar tissue have been implicated as possible etiological causes of BCC. Here, we report a case of a 37-year-old man with BCC arising on a longstanding cicatricial plaque with nearly 30 years' duration. Intractable pruritus, which had started two months ago and gradually intensified, was the patient's main complaint upon admission. The lesion presented as a linear, erythematous, excoriated cicatricial plaque in the left supraclavicular region. Pearly borders and the mildly atrophic center of the plaque, that were recognized upon close examination, were notable features and may indicate BCC. We believe that a detailed patient history and meticulous clinical examination are essential for diagnosing BCC arising in longstanding scars. Copyright (C) 2018, Taiwanese Dermatological Association. Published by Elsevier Taiwan LLC.

INTRODUCTION: Acne vulgaris is a pilosebaceous gland disease that usually affects people from puberty to young adulthood. It is seen especially on the face, neck, trunk and arms. Its severity differs from patient to patient and its pathogenesis is multifactorial. The main pathogenic factors of acne are high sebaceous gland secretion, follicular hyperproliferation, high androgen effects, propionibacterium acnes colonization and inflammation. Diet is always thought a probable reason for acne and many studies are done about acne and diet. AIM: To determine the effect of insulin resistance in severe acne vulgaris. MATERIAL AND METHODS: Two hundred and forty-three acne vulgaris patients and 156 healthy controls were enrolled into the study. The blood levels of insulin and glucose were measured. Homeostasis Model Assessment (HOMA) Index was calculated. The values were compared with the control group. RESULTS: All of the patients were in the severe acne group according to their scores on the global acne scoring scale. While fasting blood glucose levels were not different between the groups (p > 0.05, 82.91 ±9.76 vs. 80.26 ±8.33), the fasting insulin levels were significantly higher in the patient group than in the control group (p < 0.001, 14.01 ±11.94 vs. 9.12 ±3.53). Additionally, there was a highly significant difference between the patient and control groups in terms of HOMA values (p < 0.001, 2.87 ±2.56 vs. 1.63 ±0.65). CONCLUSIONS: These results suggest that insulin resistance may have a role in the pathogenesis of acne.

Background and Design: Interleukin-23 (IL-23) is a cytokine which is believed to have an important role in the pathogenesis of autoimmune diseases. Therefore, it can be used as a target molecule in the treatment of autoimmune diseases. The aim of our study was to determine serum IL-23 levels in patients with vitiligo to understand their possible roles in the disease etiology and to compare the results with the healthy controls. Materials and Methods: Fifty-one patients, who applied to the dermatology outpatient clinic and were diagnosed with vitiligo clinically and by wood lamp inspection, were enrolled in our study. Thirty-six age- and sex-matched healthy subjects were also enrolled as the control group. Serum IL-23 levels were studied in peripheral venous blood samples. Statistical analyses were made by SPSS version 16.0 for Windows. Results: Vitiligo group and control group were similar in terms of age and sex. Generalized type vitiligo was detected in 27 (52,9%), whereas focal, acrofacial, segmental and universal forms were detected in 13 (25,5%), 5 (9,8%), 3 (5,9%) and 3 (5,9%) of the patients, respectively. Mean serum IL-23 values were not significantly different between patient and control group (p=0.606). We also showed that serum IL-23 levels did not show any statistically significant difference in patients according to the size of the body surface area involved, involvement of the anogenital area, clinical manifestation, duration of disease and gender respectively (p=0.904, p=0.335, p=0.354, p=0.317, p=0.729, respectively). Conclusions: To our knowledge, this is the first study investigating IL-23 levels in vitiligo. According to our findings, IL-23 level was not higher in vitiligo patients. Because of the small number of subjects involved in our study, further studies involving larger groups are needed to verify our results in IL-23 levels in vitiligo patients.

Objective: To assess the working and training conditions and current challenges of the dermatology residents in Turkey and to propose solutions within this context. Methods: A survey on the problems of resident doctors and the solution proposals they offered was executed with dermatology residents who serve at the training and research hospitals and university hospitals in different clinics of Turkey. Results: A total of 121 dermatology residents from 39 training institutions (university and training research hospitals) were included in the study. Of the participants, 34 (28.1%) were having residency training program in training and research hospitals while 87 (71.9%) were having residency training program in university hospitals. The main problems were about residency training. Performing a fixed training program and central system examinations for each year, giving more importance to cosmetology education and increasing participation in conferences were the common opinion of resident doctors with regard to the solution proposals to the working conditions. Conclusions: The results of this study showed the necessity for a standard curriculum of dermatology residency education and central system examinations.

WOS: 000357389900008, PubMed: 26131865, BACKGROUND: Basal cell carcinoma is the most frequent cancer in fair-skinned populations and dermoscopy is an important, non-invasive technique that aids in the diagnosis of Basal cell carcinoma. OBJECTIVES: The aim of this study was to evaluate the relationship between histopathological subtypes and dermoscopic features of Basal cell carcinoma. METHODS: This study included 98 patients with clinically and histopathologically confirmed Basal cell carcinomas. The dermoscopic features of the lesions from each patient were analyzed before the histopathological findings were evaluated. RESULTS: Dermoscopic structures were observed in all 98 patients and irregular vascularity was identified in 78 patients (79.6%). The most common vascular pattern was the presence of arborizing vessels (42 patients, 42.9%) followed by arborizing microvessels (21 patients, 21.4%) and short fine telangiectasias (SFTs; 15 patients, 15.3%). White streaks (38 patients, 38.8%), translucency (31 patients, 31.6%), a milky-pink to red background (42 patients, 42.9%), and erosion/ulceration (29 patients, 29.6%) were also observed. Pigmented islands were seen as blue-gray globules (7 patients, 7.1%) and blue-gray ovoid nests (42 patients, 42.9%). The pigment distribution pattern was maple leaf-like areas in 9 patients (9.2%) and spoke wheel-like areas in 6 patients (6.1%). CONCLUSIONS: Basal cell carcinomas show a wide spectrum of dermoscopic features. Arborizing vessels were the most common dermoscopic findings in Basal cell carcinomas, while superficial Basal cell carcinomas displayed mainly milky-pink to red areas, and arborizing microvessels. The most common dermoscopic features of pigmented types were islands of pigment (blue-gray globules, blue-gray ovoid nests). In conclusion, dermoscopy can be used as a valuable tool for the diagnosis of Basal cell carcinomas and prediction of their histopathological subtypes.