Lichen planus is a relatively common papulosquamous skin disease of unknown etiology. It is chara... more Lichen planus is a relatively common papulosquamous skin disease of unknown etiology. It is characterized by flat-topped, shiny pinkish-purple papules and plaques on the skin or mucous membranes. The zosteriform type is a rare variant of lichen planus with dermatomal or zonal distribution. A 29-year-old female patient was admitted to our clinic with a 2-month history of a pruritic eruption on the dermatomes on the left between T6-T10. Based on clinical and histological findings, the patient was diagnosed with zosteriform lichen planus. The patient had undergone extracorporeal shock wave lithotripsy (ESWL) for left kidney stones two weeks before the appearance of the lesions. There was no history of skin diseases with dermatomal distribution including herpes zoster in the lesion area. This condition was considered as an isomorphic response following ESWL.
A 12-year-old boy presented to our department with firm papules on the fingers of both hands, ery... more A 12-year-old boy presented to our department with firm papules on the fingers of both hands, erythematous scaly plaques on the dorsum of the hands and elbow, and deformities and limitation of motion in the joints of the hands and feet. His parents reported that the eruption started 6 years prior to presentation. He was previously diagnosed with psoriasis by physicians and acitretin treatment was given. However, he did not benefit from the treatment. Case synopsis Physical examination revealed atrophic erythematous papules and plaques, 1-2 cm in diameter (Gottron papules), over metacarpophalangeal and proximal and distal interphalangeal joints and elbow (Figure 1-2). Skin-coloured painless papules and nodules were observed in the medial phalanx of the little finger and in the metacarpophalageal joint in the left hand, clinically recognized as calcinosis cutis (Figure 3). The nodules were circumscribed and firm. Figure 1. Atrophic erythematous papules and plaques over metacarpophalan...
Nicolau syndrome, also known as embolia cutis medicamentosa, is a well known but very rare compli... more Nicolau syndrome, also known as embolia cutis medicamentosa, is a well known but very rare complication occuring after intramuscular drug injections and presenting with local intense pain. Immediately after injection the skin blanches and within minutes to hours an erythematous macule develops, which evolves into a livedoid violaceous patch with dendrites. This condition is initially hemorrhagic, then it ulcerates, and eventually heals with an atrophic scar. Many different drugs have been reported to cause Nicolau syndrome. To date there have been no reports of Nicolau syndrome caused by intramuscular oxytocin injection. We would like to report two cases that occured after intramuscular injection of oxytocin.
Erythema ab igne (EAI) is a dermatosis characterised by reticulate red-brown pigmentation and tel... more Erythema ab igne (EAI) is a dermatosis characterised by reticulate red-brown pigmentation and telengiectasia resulting from long-term exposure to infrared radiation. It generally occurs in individuals using heating devices in the winter, those who frequently use hot compresses, and those who prefer hot environments. It generally occurs on the feet of women but may also occur on the hips and thighs. A 42-year-old male presented with red-brown spots and blisters on both thighs and behind the legs. He was diagnosed with EAI based on the clinical, historical, and histopathological features presented. Herein we present a case of bullous EAI associated with normochromic normocytic anemia and subclinical hypothyroidism.
Letter Nicolau syndrome following intramuscular injection of oxytocin in pregnant women: report o... more Letter Nicolau syndrome following intramuscular injection of oxytocin in pregnant women: report of two cases
Erythema multiforme is a skin disease, which occurs particularly in the acral region, and is char... more Erythema multiforme is a skin disease, which occurs particularly in the acral region, and is characterized by target-like erythematous macules and papules. Infections play an important role in the etiology of erythema multiforme. Other causes include drugs, vaccination, and hematological malignancies. Half of all cases may not have an identifiable etiology. This article presents a male patient who developed erythema multiforme as a result of levetiracetam use for epilepsy.
Lupus vulgaris is the most common chronic, progressive form of cutaneous tuberculosis. Lesions ar... more Lupus vulgaris is the most common chronic, progressive form of cutaneous tuberculosis. Lesions are generally solitary and found on the head and neck region. Cutaneous tuberculosis can present with different clinical appearances. Therefore, it does not necessarily have characteristic findings and can be difficult to diagnose. Although there were typical clinical findings, the diagnosis of our case was delayed because of its asymptomatic course.
A great number of skin manifestations have been related to the underlying internal malignancy (1)... more A great number of skin manifestations have been related to the underlying internal malignancy (1). Skin changes can often be the first sign of a serious problem. A relationship of some dermatoses with malignancy has been frequently determined and the associated dermatoses are accepted as paraneoplastic. The clinical manifestations of these dermatoses may precede, coincide with or follow the diagnosis of internal malignancy. In the current literature, many cases are presented with sudden appearance of multiple pruritic seborrheic keratoses related to the underlying internal malignancy (2-7). Although some authors have accepted that the sign of LeserTrélat is a cutaneous marker of internal malignancies, it is still a matter of debate whether the syndrome is a paraneoplastic disorder or not (8-13). A patient with the sign of Leser-Trélat presented to our clinic, but no internal malignancy could be determined despite detailed examination.
Jessner'in lenfositik infiltrasyonu (JLI) siklikla bas boyun bolgesinde yerlesim gosteren pem... more Jessner'in lenfositik infiltrasyonu (JLI) siklikla bas boyun bolgesinde yerlesim gosteren pembe-donuk kirmizi renkte papul, plak ya da noduler lezyonlarla karakterize, asemptomatik, kronik seyirli lenfoproliferatif bir dermatozdur. Hastaligin farkli bir antite mi oldugu yoksa diskoid lupus eritematozus ya da polimorf isik erupsiyonu spektrumuna ait bir tablo mu oldugu net degildir. 34 yasinda bayan hasta yuzun sag tarafinda hafif kasintili kizariklik ve kabariklik sikâyeti ile klinigimize basvurdu. Klinik ve histopatolojik bulgularla hastaya Jessner'in lenfositik infiltrasyonu tanisi kondu. Bu olgu sunumunda Jessner'in lenfositik infiltrasyonunun klinik ve histopatolojik ozellikleri vurgulanmakta, klinik ve histopatolojik olarak benzedigi dermatozlar ile ayrit edici ozellikleri tartisilmaktadir.
A 12-year-old boy presented to our department with firm papules on the fingers of both hands, ery... more A 12-year-old boy presented to our department with firm papules on the fingers of both hands, erythematous scaly plaques on the dorsum of the hands and elbow, and deformities and limitation of motion in the joints of the hands and feet. His parents reported that the eruption started 6 years prior to presentation. He was previously diagnosed with psoriasis by physicians and acitretin treatment was given. However, he did not benefit from the treatment. Case synopsis Physical examination revealed atrophic erythematous papules and plaques, 1-2 cm in diameter (Gottron papules), over metacarpophalangeal and proximal and distal interphalangeal joints and elbow (Figure 1-2). Skin-coloured painless papules and nodules were observed in the medial phalanx of the little finger and in the metacarpophalageal joint in the left hand, clinically recognized as calcinosis cutis (Figure 3). The nodules were circumscribed and firm.
Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia, Jul 11, 2017
There are only a few studies about epidemiological features of acne vulgaris in the literature. T... more There are only a few studies about epidemiological features of acne vulgaris in the literature. The aim of this study was to analyze demographic, clinical, familial and environmental characteristics of acne, the role of diet and aggravating factors and association of these factors with acne severity. Patients with a diagnosis of mild-moderate to severe acne were consecutively interviewed at the participating centers during the study period. A total of 3826 patients and 759 control patients were involved in this study. Mild acne was the most common type of acne, and most of the lesions were localized on face followed by the trunk. The severity of acne was worse in patients who had a positive family history of acne. The most common triggering factor was psychological stress. We found a positive correlation with chocolate, bread, green tea, milk, white sugar, ripe banana, ice cream, apple, orange, and red meat consumption. As we compare the acne severity according to geographical featu...
cumscribed ulcero-vegetative plaque with occasional yellow and green crusts and erythematous elev... more cumscribed ulcero-vegetative plaque with occasional yellow and green crusts and erythematous elevated borders located on the anterior abdomen (Figure 1). This ulcerated plaque lesion increased in size after its surgical excision (Figure 2). The patient had no subjective complaints and was healthy otherwise. A Giemsa stained smear from the lesion revealed numerous pale purple-blue, round or oval amastigotes (Leishman-Donovan bodies) on both the extracellular and intra cytoplasmic areas of the histiocytes. The case was diagnosed as cutaneous leishmaniasis (CL), following clinical and histopathological findings. The patient received intralesional antimoniate (Glucantime) treatments (twice weekly, for eight weeks). Cutaneous leishmaniasis is a parasitic disease caused by protozoa of the genus Leishmania. The disease is endemic in some countries and becomes a public health problem. It is estimated that leishmaniasis affects approxi-
Introduction: Cutaneous leishmaniasis (CL) is a common parasitic infectious disease caused by dif... more Introduction: Cutaneous leishmaniasis (CL) is a common parasitic infectious disease caused by different species of the leishmania genus. The skin lesions are usually found on exposed areas, especially the face, arms and legs. Although the disease does not cause significant morbidity, the lesions can be troublesome and unsightly. The disease have negative impacts in areas such as patients' psychological well-being, social life and daily activities in adults. Aim: To determine the frequency of psychiatric morbidity in children and adolescents who have cutaneous leishmaniasis (CL) and to determine the effect of CL on their levels of depression and anxiety and on their quality of life (QoL). Material and methods: Fifty-four patients with CL (29 males and 25 females), who were 7 to 18 years of age, were assessed with the Child Depression Inventory (CDI) and the State-Trait Anxiety Inventories for Children (STAIC). The patients and their mothers were assessed with the Pediatric Quality of Life Inventory Parent and Child Versions (PedQL-P and C, respectively). This questionnaires were filled in by the control group consisting of 40 healthy children and adolescents (20 males and 20 females) and their parents from the local community matched for age, gender, and education level of the parents. Results: Both the patient group and the control group had high scores on the depression measurement scale (t = 5.36, p < 0.05). These measurements also show significant differences between children and adolescents, who were defined as 12 years of age and under as well as older than 12 years, respectively (12 years of age and under (t = 3.14, p = 0.04); over 12 years (t = 5.37, p < 0.001)). However, there was no significant difference between the anxiety scores of the general patient group and the control group when classified according to age. The anxiety sensitivity index scores did not differ in either group from those of the control group. The patients' and the mothers' QoL scores for all of the scales, including all subscale scores, were significantly different from those of the control group (both 12 years of age and under as well as older than 12 years). Conclusions: The results have shown that the frequency of depressive symptoms is much higher in patients who have CL than in healthy controls. In addition, the QoL of children and adolescents with CL and of their mothers was found to be much lower than that of the control group. Therefore, the follow-up for patients with CL who are referred to dermatology clinics should include a psychiatric evaluation. If necessary, they should be referred for psychiatric support.
Discoid lupus erythematosus (DLE) is the most common form of chronic cutaneous lupus erythematosu... more Discoid lupus erythematosus (DLE) is the most common form of chronic cutaneous lupus erythematosus. It tends to heal with scarring, hair loss, and pigmentary changes if treatment is not initiated in the early phase of the disease. Classic DLE lesions are initially red-purple macules, papules, or small plaques that rapidly acquire a hyperkeratotic appearance. Only a minority of patients with DLE progress to develop systemic lupus erythematosus (SLE). A small percentage of patients with SLE have concomitant DLE. However, generalized DLE is more frequently associated with systemic involvement than classic DLE. The diagnosis of DLE is usually based on clinical features, although in some cases histopathological examination may be required to confirm the diagnosis. Standard therapy for cutaneous lupus erythematosus includes broad-spectrum sunscreens, topical and intralesional glucocorticoids, and antimalarial agents. A 63-year-old man presented with erythematous scaly patches that he had on the face for approximately eight months. Although the face was the main affected site, lesions were also noted on the scalp, neck, chest, shoulder, upper arms, and trunk. Histopathological examination verified the diagnosis of DLE. Laboratory examination and consultation with other departments did not reveal any systemic involvement. Imiquimod cream 5% was applied three times a week, every other week. After 24 applications over a period of two months, an almost complete recovery was achieved. Topical imiquimod may be an alternative treatment for generalized DLE.
A b s t r a c t Introduction: Cutaneous leishmaniasis (CL) is a common parasitic infectious disea... more A b s t r a c t Introduction: Cutaneous leishmaniasis (CL) is a common parasitic infectious disease, caused by different species of leishmania genus. The skin lesions are usually found on exposed areas, especially the face, arms and legs. Although the disease does not cause significant morbidity, the lesions can be troublesome and unsightly. The disease have negative impacts in areas such as patients' psychological well being, social life and daily activities in adults. Aim: The aim of this study is to determine the frequency of psychiatric morbidity in children and adolescents who have cutaneous leishmaniasis (CL) and to determine the effect of CL on their levels of depression and anxiety and on their quality of life (QoL). Material and methods:: Fifty-four patients with CL (29 male and 25 female), who were 7 to 18 years of age, were assessed with the Child Depression Inventory (CDI) and the State-Trait Anxiety Inventories for Children (STAIC). The patients and their mothers we...
To the Editor: Onychomycosis is a common nail disease that frequently is caused by dermatophytes ... more To the Editor: Onychomycosis is a common nail disease that frequently is caused by dermatophytes and is diagnosed by direct microscopy. Conventional diagnostic methods are often time consuming and can produce false-positive or false-negative results. We report a case of onychomycosis diagnosed by confocal microscopy and confirmed with routine potassium hydroxide (KOH) examination and fungal culture. Confocal microscopy is a reliable, practical, and noninvasive technique in the diagnosis of onychomycosis. A 46-year-old woman presented with yellow-brown discoloration and dystrophy of the toenails (Figure 1) that had become worse over a 5-year period. She was otherwise healthy and had no other dermatologic problems. Examination revealed yellow-brown discoloration, subungual hyperkeratosis, and onycholysis of the toenails. Clinically, a diagnosis of onychomycosis was made. Potassium hydroxide examination of a scraping from the subungual region showed fungal elements. Growth of Trichophyton rubrum on Sabouraud dextrose agar was determined. We performed both in vivo and in vitro confocal laser scanning microscopic examination of the nail of the right great toe (Figure 2). For the diagnosis of onychomycosis in our case, we used a multilaser reflectance confocal microscope (RCM) with a wavelength of 786 nm. In vivo confocal microscopy of the nail revealed branching hyphae just below the surface of the nail plate. Hyphae were seen as refractile, bright, linear structures along the laminates of the nail. Onychomycosis is a common condition affecting 5.5% of the population worldwide and representing 20% to 40% of all onychopathies and approximately 30% of cutaneous mycotic infections.1,2 There are many methods available to confirm the clinical diagnosis of onychomycosis by detecting the causative organisms. Direct microscopic examination of the scraping with a KOH culture, histopathologic assessment with periodic acid–Schiff staining, immunofluorescence analysis with calcofluor white staining, enzyme analysis, and polymerase chain reaction can be used for diagnosis of fungal infections. The most frequently used diagnostic method for onychomycosis
Introduction: Psoriasis is a chronic, inflammatory, T-cell-mediated and hyperproliferative skin d... more Introduction: Psoriasis is a chronic, inflammatory, T-cell-mediated and hyperproliferative skin disease characterized by erythematous, squamous, sharply circumscribed and infiltrated plaques. The metabolisms of the collagen proteins undergo considerable changes due to the acceleration of their turnovers as a result of increased prolidase activity in psoriasis patients. Aim: To determine the level of prolidase activity in psoriasis patients and evaluate its relationship with the oxidative system. Material and methods: The serum prolidase enzyme activity, total antioxidant levels and total oxidant levels of 40 psoriasis patients and a control group including 47 healthy individuals were analyzed by using their serum samples, and their oxidative stress indices were calculated. Results: The prolidase levels (p < 0.01), total oxidant levels (p < 0.01) and oxidative stress index levels (p < 0.001) of the patient group were higher than the corresponding parameters in the control group. The total antioxidant level was low (p < 0.01). Although a positive correlation was found between the prolidase and total antioxidant levels and the total oxidant level, no correlation was found between prolidase and the oxidative stress index. Conclusions: It has been determined that the activity of the prolidase enzyme increases due to the increased collage turnover in psoriasis patients. Increased serum oxidant levels and oxidative stress indices values may play a role in the pathogenesis of psoriasis.
Turkish Journal of Dermatology / Türk Dermatoloji Dergisi, 2013
Although close family members of patients with a dermatological illness experience many physical,... more Although close family members of patients with a dermatological illness experience many physical, social and psychological burdens, this secondary effect is usually ignored. While burden of care and treatment costs impose extra burdens to family members, emotional stress and social restriction due to disease may cause distruptions in family affairs. Moreover, some family members may face problems at work, because of patient's care and treatment or they can not pay necessary attention to their work. This condition causes big economic losses as well as deterioration of family harmony and resolutions. Secondary effect on family varies greatly depending on the diagnosis, duration and severity of skin disease, age of patient and, above all, harmony and relationship among the family members and the patient. For a dermatologist to be able to establish good patient and doctor relationship or increase patient compliance, he/ she must have comprehensive knowledge especially on the lives of families of patients with prevalent dermatological or inflammatory diseases. Family members, especially those who undertake care function should be accepted as active participants and should be actived to be a part of the solution about care planning and decision making.
Lichen planus is a relatively common papulosquamous skin disease of unknown etiology. It is chara... more Lichen planus is a relatively common papulosquamous skin disease of unknown etiology. It is characterized by flat-topped, shiny pinkish-purple papules and plaques on the skin or mucous membranes. The zosteriform type is a rare variant of lichen planus with dermatomal or zonal distribution. A 29-year-old female patient was admitted to our clinic with a 2-month history of a pruritic eruption on the dermatomes on the left between T6-T10. Based on clinical and histological findings, the patient was diagnosed with zosteriform lichen planus. The patient had undergone extracorporeal shock wave lithotripsy (ESWL) for left kidney stones two weeks before the appearance of the lesions. There was no history of skin diseases with dermatomal distribution including herpes zoster in the lesion area. This condition was considered as an isomorphic response following ESWL.
A 12-year-old boy presented to our department with firm papules on the fingers of both hands, ery... more A 12-year-old boy presented to our department with firm papules on the fingers of both hands, erythematous scaly plaques on the dorsum of the hands and elbow, and deformities and limitation of motion in the joints of the hands and feet. His parents reported that the eruption started 6 years prior to presentation. He was previously diagnosed with psoriasis by physicians and acitretin treatment was given. However, he did not benefit from the treatment. Case synopsis Physical examination revealed atrophic erythematous papules and plaques, 1-2 cm in diameter (Gottron papules), over metacarpophalangeal and proximal and distal interphalangeal joints and elbow (Figure 1-2). Skin-coloured painless papules and nodules were observed in the medial phalanx of the little finger and in the metacarpophalageal joint in the left hand, clinically recognized as calcinosis cutis (Figure 3). The nodules were circumscribed and firm. Figure 1. Atrophic erythematous papules and plaques over metacarpophalan...
Nicolau syndrome, also known as embolia cutis medicamentosa, is a well known but very rare compli... more Nicolau syndrome, also known as embolia cutis medicamentosa, is a well known but very rare complication occuring after intramuscular drug injections and presenting with local intense pain. Immediately after injection the skin blanches and within minutes to hours an erythematous macule develops, which evolves into a livedoid violaceous patch with dendrites. This condition is initially hemorrhagic, then it ulcerates, and eventually heals with an atrophic scar. Many different drugs have been reported to cause Nicolau syndrome. To date there have been no reports of Nicolau syndrome caused by intramuscular oxytocin injection. We would like to report two cases that occured after intramuscular injection of oxytocin.
Erythema ab igne (EAI) is a dermatosis characterised by reticulate red-brown pigmentation and tel... more Erythema ab igne (EAI) is a dermatosis characterised by reticulate red-brown pigmentation and telengiectasia resulting from long-term exposure to infrared radiation. It generally occurs in individuals using heating devices in the winter, those who frequently use hot compresses, and those who prefer hot environments. It generally occurs on the feet of women but may also occur on the hips and thighs. A 42-year-old male presented with red-brown spots and blisters on both thighs and behind the legs. He was diagnosed with EAI based on the clinical, historical, and histopathological features presented. Herein we present a case of bullous EAI associated with normochromic normocytic anemia and subclinical hypothyroidism.
Letter Nicolau syndrome following intramuscular injection of oxytocin in pregnant women: report o... more Letter Nicolau syndrome following intramuscular injection of oxytocin in pregnant women: report of two cases
Erythema multiforme is a skin disease, which occurs particularly in the acral region, and is char... more Erythema multiforme is a skin disease, which occurs particularly in the acral region, and is characterized by target-like erythematous macules and papules. Infections play an important role in the etiology of erythema multiforme. Other causes include drugs, vaccination, and hematological malignancies. Half of all cases may not have an identifiable etiology. This article presents a male patient who developed erythema multiforme as a result of levetiracetam use for epilepsy.
Lupus vulgaris is the most common chronic, progressive form of cutaneous tuberculosis. Lesions ar... more Lupus vulgaris is the most common chronic, progressive form of cutaneous tuberculosis. Lesions are generally solitary and found on the head and neck region. Cutaneous tuberculosis can present with different clinical appearances. Therefore, it does not necessarily have characteristic findings and can be difficult to diagnose. Although there were typical clinical findings, the diagnosis of our case was delayed because of its asymptomatic course.
A great number of skin manifestations have been related to the underlying internal malignancy (1)... more A great number of skin manifestations have been related to the underlying internal malignancy (1). Skin changes can often be the first sign of a serious problem. A relationship of some dermatoses with malignancy has been frequently determined and the associated dermatoses are accepted as paraneoplastic. The clinical manifestations of these dermatoses may precede, coincide with or follow the diagnosis of internal malignancy. In the current literature, many cases are presented with sudden appearance of multiple pruritic seborrheic keratoses related to the underlying internal malignancy (2-7). Although some authors have accepted that the sign of LeserTrélat is a cutaneous marker of internal malignancies, it is still a matter of debate whether the syndrome is a paraneoplastic disorder or not (8-13). A patient with the sign of Leser-Trélat presented to our clinic, but no internal malignancy could be determined despite detailed examination.
Jessner'in lenfositik infiltrasyonu (JLI) siklikla bas boyun bolgesinde yerlesim gosteren pem... more Jessner'in lenfositik infiltrasyonu (JLI) siklikla bas boyun bolgesinde yerlesim gosteren pembe-donuk kirmizi renkte papul, plak ya da noduler lezyonlarla karakterize, asemptomatik, kronik seyirli lenfoproliferatif bir dermatozdur. Hastaligin farkli bir antite mi oldugu yoksa diskoid lupus eritematozus ya da polimorf isik erupsiyonu spektrumuna ait bir tablo mu oldugu net degildir. 34 yasinda bayan hasta yuzun sag tarafinda hafif kasintili kizariklik ve kabariklik sikâyeti ile klinigimize basvurdu. Klinik ve histopatolojik bulgularla hastaya Jessner'in lenfositik infiltrasyonu tanisi kondu. Bu olgu sunumunda Jessner'in lenfositik infiltrasyonunun klinik ve histopatolojik ozellikleri vurgulanmakta, klinik ve histopatolojik olarak benzedigi dermatozlar ile ayrit edici ozellikleri tartisilmaktadir.
A 12-year-old boy presented to our department with firm papules on the fingers of both hands, ery... more A 12-year-old boy presented to our department with firm papules on the fingers of both hands, erythematous scaly plaques on the dorsum of the hands and elbow, and deformities and limitation of motion in the joints of the hands and feet. His parents reported that the eruption started 6 years prior to presentation. He was previously diagnosed with psoriasis by physicians and acitretin treatment was given. However, he did not benefit from the treatment. Case synopsis Physical examination revealed atrophic erythematous papules and plaques, 1-2 cm in diameter (Gottron papules), over metacarpophalangeal and proximal and distal interphalangeal joints and elbow (Figure 1-2). Skin-coloured painless papules and nodules were observed in the medial phalanx of the little finger and in the metacarpophalageal joint in the left hand, clinically recognized as calcinosis cutis (Figure 3). The nodules were circumscribed and firm.
Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia, Jul 11, 2017
There are only a few studies about epidemiological features of acne vulgaris in the literature. T... more There are only a few studies about epidemiological features of acne vulgaris in the literature. The aim of this study was to analyze demographic, clinical, familial and environmental characteristics of acne, the role of diet and aggravating factors and association of these factors with acne severity. Patients with a diagnosis of mild-moderate to severe acne were consecutively interviewed at the participating centers during the study period. A total of 3826 patients and 759 control patients were involved in this study. Mild acne was the most common type of acne, and most of the lesions were localized on face followed by the trunk. The severity of acne was worse in patients who had a positive family history of acne. The most common triggering factor was psychological stress. We found a positive correlation with chocolate, bread, green tea, milk, white sugar, ripe banana, ice cream, apple, orange, and red meat consumption. As we compare the acne severity according to geographical featu...
cumscribed ulcero-vegetative plaque with occasional yellow and green crusts and erythematous elev... more cumscribed ulcero-vegetative plaque with occasional yellow and green crusts and erythematous elevated borders located on the anterior abdomen (Figure 1). This ulcerated plaque lesion increased in size after its surgical excision (Figure 2). The patient had no subjective complaints and was healthy otherwise. A Giemsa stained smear from the lesion revealed numerous pale purple-blue, round or oval amastigotes (Leishman-Donovan bodies) on both the extracellular and intra cytoplasmic areas of the histiocytes. The case was diagnosed as cutaneous leishmaniasis (CL), following clinical and histopathological findings. The patient received intralesional antimoniate (Glucantime) treatments (twice weekly, for eight weeks). Cutaneous leishmaniasis is a parasitic disease caused by protozoa of the genus Leishmania. The disease is endemic in some countries and becomes a public health problem. It is estimated that leishmaniasis affects approxi-
Introduction: Cutaneous leishmaniasis (CL) is a common parasitic infectious disease caused by dif... more Introduction: Cutaneous leishmaniasis (CL) is a common parasitic infectious disease caused by different species of the leishmania genus. The skin lesions are usually found on exposed areas, especially the face, arms and legs. Although the disease does not cause significant morbidity, the lesions can be troublesome and unsightly. The disease have negative impacts in areas such as patients' psychological well-being, social life and daily activities in adults. Aim: To determine the frequency of psychiatric morbidity in children and adolescents who have cutaneous leishmaniasis (CL) and to determine the effect of CL on their levels of depression and anxiety and on their quality of life (QoL). Material and methods: Fifty-four patients with CL (29 males and 25 females), who were 7 to 18 years of age, were assessed with the Child Depression Inventory (CDI) and the State-Trait Anxiety Inventories for Children (STAIC). The patients and their mothers were assessed with the Pediatric Quality of Life Inventory Parent and Child Versions (PedQL-P and C, respectively). This questionnaires were filled in by the control group consisting of 40 healthy children and adolescents (20 males and 20 females) and their parents from the local community matched for age, gender, and education level of the parents. Results: Both the patient group and the control group had high scores on the depression measurement scale (t = 5.36, p < 0.05). These measurements also show significant differences between children and adolescents, who were defined as 12 years of age and under as well as older than 12 years, respectively (12 years of age and under (t = 3.14, p = 0.04); over 12 years (t = 5.37, p < 0.001)). However, there was no significant difference between the anxiety scores of the general patient group and the control group when classified according to age. The anxiety sensitivity index scores did not differ in either group from those of the control group. The patients' and the mothers' QoL scores for all of the scales, including all subscale scores, were significantly different from those of the control group (both 12 years of age and under as well as older than 12 years). Conclusions: The results have shown that the frequency of depressive symptoms is much higher in patients who have CL than in healthy controls. In addition, the QoL of children and adolescents with CL and of their mothers was found to be much lower than that of the control group. Therefore, the follow-up for patients with CL who are referred to dermatology clinics should include a psychiatric evaluation. If necessary, they should be referred for psychiatric support.
Discoid lupus erythematosus (DLE) is the most common form of chronic cutaneous lupus erythematosu... more Discoid lupus erythematosus (DLE) is the most common form of chronic cutaneous lupus erythematosus. It tends to heal with scarring, hair loss, and pigmentary changes if treatment is not initiated in the early phase of the disease. Classic DLE lesions are initially red-purple macules, papules, or small plaques that rapidly acquire a hyperkeratotic appearance. Only a minority of patients with DLE progress to develop systemic lupus erythematosus (SLE). A small percentage of patients with SLE have concomitant DLE. However, generalized DLE is more frequently associated with systemic involvement than classic DLE. The diagnosis of DLE is usually based on clinical features, although in some cases histopathological examination may be required to confirm the diagnosis. Standard therapy for cutaneous lupus erythematosus includes broad-spectrum sunscreens, topical and intralesional glucocorticoids, and antimalarial agents. A 63-year-old man presented with erythematous scaly patches that he had on the face for approximately eight months. Although the face was the main affected site, lesions were also noted on the scalp, neck, chest, shoulder, upper arms, and trunk. Histopathological examination verified the diagnosis of DLE. Laboratory examination and consultation with other departments did not reveal any systemic involvement. Imiquimod cream 5% was applied three times a week, every other week. After 24 applications over a period of two months, an almost complete recovery was achieved. Topical imiquimod may be an alternative treatment for generalized DLE.
A b s t r a c t Introduction: Cutaneous leishmaniasis (CL) is a common parasitic infectious disea... more A b s t r a c t Introduction: Cutaneous leishmaniasis (CL) is a common parasitic infectious disease, caused by different species of leishmania genus. The skin lesions are usually found on exposed areas, especially the face, arms and legs. Although the disease does not cause significant morbidity, the lesions can be troublesome and unsightly. The disease have negative impacts in areas such as patients' psychological well being, social life and daily activities in adults. Aim: The aim of this study is to determine the frequency of psychiatric morbidity in children and adolescents who have cutaneous leishmaniasis (CL) and to determine the effect of CL on their levels of depression and anxiety and on their quality of life (QoL). Material and methods:: Fifty-four patients with CL (29 male and 25 female), who were 7 to 18 years of age, were assessed with the Child Depression Inventory (CDI) and the State-Trait Anxiety Inventories for Children (STAIC). The patients and their mothers we...
To the Editor: Onychomycosis is a common nail disease that frequently is caused by dermatophytes ... more To the Editor: Onychomycosis is a common nail disease that frequently is caused by dermatophytes and is diagnosed by direct microscopy. Conventional diagnostic methods are often time consuming and can produce false-positive or false-negative results. We report a case of onychomycosis diagnosed by confocal microscopy and confirmed with routine potassium hydroxide (KOH) examination and fungal culture. Confocal microscopy is a reliable, practical, and noninvasive technique in the diagnosis of onychomycosis. A 46-year-old woman presented with yellow-brown discoloration and dystrophy of the toenails (Figure 1) that had become worse over a 5-year period. She was otherwise healthy and had no other dermatologic problems. Examination revealed yellow-brown discoloration, subungual hyperkeratosis, and onycholysis of the toenails. Clinically, a diagnosis of onychomycosis was made. Potassium hydroxide examination of a scraping from the subungual region showed fungal elements. Growth of Trichophyton rubrum on Sabouraud dextrose agar was determined. We performed both in vivo and in vitro confocal laser scanning microscopic examination of the nail of the right great toe (Figure 2). For the diagnosis of onychomycosis in our case, we used a multilaser reflectance confocal microscope (RCM) with a wavelength of 786 nm. In vivo confocal microscopy of the nail revealed branching hyphae just below the surface of the nail plate. Hyphae were seen as refractile, bright, linear structures along the laminates of the nail. Onychomycosis is a common condition affecting 5.5% of the population worldwide and representing 20% to 40% of all onychopathies and approximately 30% of cutaneous mycotic infections.1,2 There are many methods available to confirm the clinical diagnosis of onychomycosis by detecting the causative organisms. Direct microscopic examination of the scraping with a KOH culture, histopathologic assessment with periodic acid–Schiff staining, immunofluorescence analysis with calcofluor white staining, enzyme analysis, and polymerase chain reaction can be used for diagnosis of fungal infections. The most frequently used diagnostic method for onychomycosis
Introduction: Psoriasis is a chronic, inflammatory, T-cell-mediated and hyperproliferative skin d... more Introduction: Psoriasis is a chronic, inflammatory, T-cell-mediated and hyperproliferative skin disease characterized by erythematous, squamous, sharply circumscribed and infiltrated plaques. The metabolisms of the collagen proteins undergo considerable changes due to the acceleration of their turnovers as a result of increased prolidase activity in psoriasis patients. Aim: To determine the level of prolidase activity in psoriasis patients and evaluate its relationship with the oxidative system. Material and methods: The serum prolidase enzyme activity, total antioxidant levels and total oxidant levels of 40 psoriasis patients and a control group including 47 healthy individuals were analyzed by using their serum samples, and their oxidative stress indices were calculated. Results: The prolidase levels (p < 0.01), total oxidant levels (p < 0.01) and oxidative stress index levels (p < 0.001) of the patient group were higher than the corresponding parameters in the control group. The total antioxidant level was low (p < 0.01). Although a positive correlation was found between the prolidase and total antioxidant levels and the total oxidant level, no correlation was found between prolidase and the oxidative stress index. Conclusions: It has been determined that the activity of the prolidase enzyme increases due to the increased collage turnover in psoriasis patients. Increased serum oxidant levels and oxidative stress indices values may play a role in the pathogenesis of psoriasis.
Turkish Journal of Dermatology / Türk Dermatoloji Dergisi, 2013
Although close family members of patients with a dermatological illness experience many physical,... more Although close family members of patients with a dermatological illness experience many physical, social and psychological burdens, this secondary effect is usually ignored. While burden of care and treatment costs impose extra burdens to family members, emotional stress and social restriction due to disease may cause distruptions in family affairs. Moreover, some family members may face problems at work, because of patient's care and treatment or they can not pay necessary attention to their work. This condition causes big economic losses as well as deterioration of family harmony and resolutions. Secondary effect on family varies greatly depending on the diagnosis, duration and severity of skin disease, age of patient and, above all, harmony and relationship among the family members and the patient. For a dermatologist to be able to establish good patient and doctor relationship or increase patient compliance, he/ she must have comprehensive knowledge especially on the lives of families of patients with prevalent dermatological or inflammatory diseases. Family members, especially those who undertake care function should be accepted as active participants and should be actived to be a part of the solution about care planning and decision making.
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