Demodex prevalence in mine, textile and food factory workers with dermatosis: a cross-sectional, multicenter study

Demodex, a type of mite, lives in human hair follicles. They can multiply very quickly in some conditions and then start to irritate the skin by causing skin disorders. This study aims to investigate if working environment conditions affect the prevalence of Demodex. A cross-sectional, multicenter study was conducted with three different occupational groups: mine, textile and food factory workers (n = 102). Determined industry workers who applied to our outpatient dermatology clinics with the complaint of dermatosis in three different cities were included in the study. Demodex positivity was checked by dermoscopy. Differences between categorical variables examined with Chi-square analysis and T test was used to compare continuous variables between groups. 50% Demodex positivity was found in mine workers, 45.3% in food factory workers and 66.7% in textile manufacturing workers. A high rate of Demodex positivity was observed in all three occupational groups. Although the highest positivity rate was observed in textile manufacturing workers, no significant difference was found between the groups (p = 0.320). The overall prevalence of Demodex in female workers was statistically significantly higher than in male workers (p = 0.029). Exposure of workers to a wide variety of factors in work environments such as textile factories and the fact that women are more sensitive to external factors may have caused the prevalence of Demodex to be higher in these groups. So, a change in the work environment or the use of suitable protective equipment may benefit the treatment of diseases caused by Demodex. But, further studies are needed with larger and various industry groups to make more certain views.

The rapid effect of pulsed dye laser on demodex density of facial skin

BACKGROUND

Recently, treatment with acaricides, which is aimed at reducing excessive proliferation of demodex mites, has gained popularity due to its providing a significant improvement in the symptoms of diseases, such as rosacea, seborrhoeic dermatitis, and perioral dermatitis. The effect of IPL on demodex mites was reported in skin biopsy specimens in three patients; however, to the best of our knowledge, no study exists to date, which evaluates the effect of pulsed dye laser (PDL) on demodex density (Dd) in larger patient group. We aim here in to observe the Dd before and after PDL therapy with two different skin biopsy techniques.

MATERIAL AND METHODS

Thirty-one patients diagnosed with rosacea were included in the study who received PDL treatment. Dds which were measured by using both the SSSB (standardized skin surface biopsy) and CTM (cellophane tape method) techniques before and after 3 weeks of PDL therapy were evaluated.

RESULTS AND DISCUSSION

The Dd of patients before PDL treatment was 13.0 (interquartile range (IQR): 5.0-28.0) and after 3 weeks of PDL treatment it was 6.0 (IQR: 3.0-12.0) with SSSB. After PDL treatment, the Dd was significantly lower than pretreatment the Dd (p = 0.002). The present study shows that PDL significantly reduced Dd in facial skin with one session.

The clinical response to omalizumab in chronic spontaneous urticaria patients is linked to and predicted by IgE levels and their change

BACKGROUND

Omalizumab is an effective and well-tolerated treatment for chronic spontaneous urticaria (CSU). Markers and predictors of response are largely unknown, but needed to optimize omalizumab treatment. Omalizumab targets IgE, and IgE levels may be linked to the effects of treatment. We evaluated whether response rates to treatment with omalizumab in patients with CSU are linked to their baseline IgE levels, their IgE levels after omalizumab treatment, and the ratio of on treatment IgE and baseline IgE levels.

METHODS

Chronic spontaneous urticaria (CSU) patients (n = 113) were treated with omalizumab 300 mg/4 weeks for 12 weeks, when their treatment responses, that is, no, partial, or complete response, were assessed by use of the urticaria activity score, physician and patient visual analog scale, and treatment effectiveness score. Total IgE levels were measured before treatment (bIgE) with omalizumab and 4 weeks thereafter (w4IgE).

RESULTS

Nonresponders to omalizumab had significantly lower bIgE levels (17.9, 17.0-55.0 IU/mL) than partial responders (82.0, 46.2-126.5 IU/mL, P = .008) and complete responders (73.7, 19.45-153.8 IU/mL, P = .032). Nonresponders also had lower w4IgE levels and lower ratios of w4IgE/bIgE levels than partial and complete responders (P < .001). Nonresponse to omalizumab was best predicted by patients' w4IgE/bIgE ratios, significantly better than by bIgE levels (P = .016).

CONCLUSIONS

In CSU, total IgE levels and their change predict the response to treatment with omalizumab. The assessment of pre- and post-treatment IgE levels and their ratio may help to improve the management of CSU in patients who require omalizumab treatment.

Case Report: Lupoid cutaneous leishmaniasis mimicking verruca plana

Cutaneous leishmaniasis (CL) is an infectious disease caused by various species of leishmania protozoan parasites. Lupoid CL is a rare form of CL that has a stunning similarity to other granulomatous cutaneous conditions of infectious or inflammatory origin. Verruca plana, also known as a "flat wart", is a benign proliferation of the skin resulting from infection with human papilloma virus (HPV). Herein, we presented a case of lupoid CL mimicking verruca plana on the face.

Can we use the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume values for the diagnosis of anterior uveitis in patients with Behcet's disease?

Introduction

The purpose of this study was to compare the value of hematological parameters, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV), as indicators of anterior uveal segment involvement in patients with Behcet’s disease (BD).

Patients and methods

Hospital-based records of a total of 912 patients with BD from the dermatology clinic and healthy volunteers from the checkup clinic were assessed retrospectively. After applying the exclusion criteria of the study, 71 of the BD patients with anterior uveitis, 69 of the BD patients without ophthalmological pathology and 151 healthy volunteers were included in the study. MPV, PLR, and NLR values of patients and healthy volunteers were compared.

Results

All MPV, PLR, and NLR values of patients who had anterior uveitis were significantly higher than those of other patients and healthy volunteers. Statistically, considering area under curves (ratio): NLR was 0.725 (0.653–0.797), P<0.001; PLR was 0.600 (0.523–0.676), P=0.012, and MPV was 0.358 (0.279–0.437), P<0.001.

Conclusion

MPV, PLR, and NLR are all valuable for assessment of anterior uveal segment involvement in patients with BD. However, the NLR seems to be better than the PLR and MPV for indicating anterior uveitis due to BD.

Case Report: Nicolau syndrome due to etofenamate injection

Nicolau syndrome, also known as embolia cutis medicomentosa, is a rare complication characterized by tissue necrosis that occurs after injection of drugs. The exact pathogenesis is uncertain, but there are several hypotheses, including direct damage to the end artery and cytotoxic effects of the drug. Severe pain in the immediate postinjection period and purplish discoloration of the skin with reticulate pigmentary pattern is characteristic of this syndrome. Diagnosis is mainly clinical and there is no standard treatment for the disease. Etofenamate is a non-steroidal anti-inflammatory drug and a non-selective cyclooxygenase inhibitor. Cutaneous adverse findings caused by etofenamate are uncommon. Herein, we present a case with diagnosis of Nicolau syndrome due to etofenamate injection, which is a rare occurrence.

Roles of white blood cells and subtypes as inflammatory markers in skin cancer

OBJECTIVE

Skin tumors are the most commonly seen cancer type worldwide. Regarding pathogenesis, it is thought that disruption of kinetics through T lymphocyte-mediated development of chronic inflammation may be involved. The present study was intended to identify role of inflammatory cells such as neutrophils, monocytes and lymphocytes in the determination of risk for skin cancer.

MATERIALS AND METHODS

We retrospectively reviewed charts of 569 cases diagnosed as having primary skin tumors. Data regarding age, gender and histopathological subtype were recorded. Blood parameters studied on the day before surgery including WBCs, neutrophils, and lymphocyte counts, neutrophil:lymphocyte and neutrophil:monocyte ratios were also recorded. Two-hundred and two healthy individuals presented for check-up in an outpatient clinic were selected as the control group. Parameters studied in cases with skin cancer were compared to those healthy individuals.

FINDINGS

Of the cases with skin cancer, 401 were basal cell carcinoma (BCC) while 144 were squamous cell carcinoma (SCC) and 13 were malignant melanoma (MM). WBC, neutrophil and monocyte counts and the neutrophil:lymphocyte ratio were found to be lower in the patient group than in the healthy control group (p<0.001) while no significant difference was found in other parameters reviewed (p>0.05). No significant difference was found in WBC, neutrophil, neutrophil: monocyte ratio according to gender (p>0.05). Monocyte count was found to be 0.68±0.61 in men and 0.55±0.25 in women, indicating strong statistical significance (p<0.001). WBC, neutrophil and monocyte values were highest in control group while lowest in BCC. When BCC and SCC groups were compared to controls, significant differences found (p<0.001). There were no significant differences in lymphocyte counts among groups (p=0.976). Neutrophil:lymphocyte ratios were 3.24 in BCC, 3.59 in SCC, 3.44 in MM and 5.06 in control group (p<0.001).

CONCLUSIONS

In our study, it was found that there were significant differences in complete blood count, neutrophil, monocyte and neutrophil:lymphocyte levels among groups. Neutrophil: lymphocyte ratio was found to be lowest in BCC among skin cancers.

A clinical evaluation of skin disorders of lower limb amputation sites

Amputee patients commonly experience skin problems that may result in social, mental, and economic difficulties. The purpose of this study was to evaluate the incidence of dermatological disorders and identify potential causes and symptomatic patterns among a population of lower limb amputees. Seventy lower limb amputees were enrolled. Complete examinations were performed by a dermatologist, who diagnosed and documented any skin disorders observed and recorded demographic characteristics of each patient. Mycological and bacteriological swabs were collected from the skin at the amputation site for culture analysis. In patients with suspected disease, patch tests were performed. Of the 70 patients, 58 (82.9%) were male and 12 (17.1%) female. Vascular insufficiency due to diabetes (n = 38, 54.3%) and trauma (n = 16, 22.9%) were the most common reasons for amputation. Skin problems were observed in 49 (70%) cases, and positive allergen reactions occurred in 16 (45.7%) of the 35 contact dermatitis cases. Fungal infection occurred in two patients and bacterial infection in seven. Seventy percent of the lower limb amputee patients in this cohort exhibited skin problems. This high percentage indicates that skin problems may reduce patients' quality of life. A multidisciplinary approach to the treatment of patients who have undergone amputation and early recognition and treatment of symptoms are therefore of critical importance.

Effect of the Syrian Civil War on Prevalence of Cutaneous Leishmaniasis in Southeastern Anatolia, Turkey

Background

Cutaneous leishmaniasis (CL) is a vector-mediated skin disease, characterized by chronic wounds on the skin and caused by macrophages in protozoan parasites. It is an endemic disease in the southern and southeastern Anatolia region and is still an important public health problem in Turkey. Because of the civil war in Syria, immigrants to this region in the last 3 years have begun to more frequently present with this disease. The aim of this study was to draw attention to the dramatic increase in new cases with CL after the beginning of the civil war in Syria.

Material/Methods

In this retrospective study, we evaluated demographic, epidemiological, and clinical features of 110 patients diagnosed with cutaneous leishmaniasis who were admitted to the Department of Dermatology at Kahramanmaras Sutcu Imam University Faculty of Medicine between January 2011 and June 2014.

Results

A total of 110 patients included in the study; 50 (45%) were males, and 60 (55%) were females. The age range of the study group was 1–78 years, and the infection was more prevalent in the 0–20 year age group. Of these patients, 76 (69%) were Syrian refugees living in tent camps and 34 (31%) were Turkish citizens. The majority of the cases were diagnosed between October and December.

Conclusions

Immigrations to endemic regions of Turkey from neighbouring countries where CL incidence is higher may lead to large increases in case numbers. In order to decrease the risk of exposure, housing conditions of the refugees must be improved, routine health controls must be performed, effective measures must be set in place for vector control, and infected individuals must be diagnosed and treated to prevent spread of the infection.

Emopamil binding protein mutation in conradi-hünermann-happle syndrome representing plaque-type psoriasis

Conradi-Hünermann-Happle syndrome (CDPX2, OMIM 302960) is an inherited X-linked dominant variant of chondrodysplasia punctata which primarily affects the skin, bones, and eyes. CDPX2 patients display skin defects, including ichthyotic lesions, follicular atrophoderma, cicatricial alopecia, and less frequently ichthyosiform erythroderma, cataracts, and skeletal abnormalities consisting of short stature, asymmetric shortening of the limbs, epiphyseal stippling, and craniofacial defects. CDPX2 results from mutations in emopamil binding protein (EBP) gene. The aim of our study is to identify EBP mutation in a unique case of Conradi-Hünermann-Happle syndrome with rare psoriasiform lesions.

Evaluation of etiological factors in patients with chronic urticaria

In the last few decades, increasing understanding of the pathomechanisms involved in chronic urticaria has highlighted the heterogeneity of different subtypes, and chronic urticaria is now classified as chronic spontaneous urticaria and inducible urticaria. Although many factors are thought to be involved in chronic urticaria, the etiology is yet to be clarified. The purpose of this study was to investigate etiological factors in patients with chronic urticaria. Five hundred patients with chronic urticaria, 351 women and 149 men, were studied for etiological factors. The autologous serum skin test was performed on 197 patients. Provocation testing for physical urticaria was performed on 354 patients. Patients with acute urticaria were excluded from the study. We determined at least one focus of infection that might be involved in the etiology of the disease in 18.8% of cases. Patients with infections were treated, and symptoms resolved after treatment in six cases (5.3%). Autologous serum skin tests were positive in 125 patients (63.5%). Provocation tests for physical urticaria were positive in 131 (37%) patients with urticaria. We suggest that physical stimuli and autoantibodies play an important role in the etiopathogenesis of urticaria.

Relationships between skin cancers and blood groups--link between non-melanomas and ABO/Rh factors

BACKGROUND

This investigation focused on possible relationships between skin cancers and ABO/Rh blood groups.

MATERIALS AND METHODS

Between January 2005 and December 2012, medical data of 255 patients with skin cancers who were admitted to Kayseri Training and Research Hospital, Radiation Oncology and Plastic Surgery Outpatient Clinics were retrospectively analyzed. Blood groups of these patients were recorded. The control group consisted of 25701 healthy volunteers who were admitted to Kayseri Training and Research Hospital, Blood Donation Center between January 2010 and December 2011. The distribution of the blood groups of the patients with skin cancers was compared to the distribution of ABO/Rh blood groups of healthy controls. The association of the histopathological subtypes of skin cancer with the blood groups was also investigated.

RESULTS

Of the patients, 50.2% had A type, 26.3% had O type, 16.1% had B type, and 7.5% had AB blood group with a positive Rh (+) in 77.3%. Of the controls, 44.3% had A type, 31.5% had 0 type, 16.1% had B type, and 8.1% had AB blood group with a positive Rh (+) in 87.8%. There was a statistically significant difference in the distribution of blood groups and Rh factors (A Rh (-) and 0 Rh positive) between the patients and controls. A total of 36.8% and 20.4% of the patients with basal cell carcinoma (BCC) had A Rh (+) and B Rh (+), respectively, while 39.2% and 27.6% of the controls had A Rh (+) and B Rh (+), respectively. A significant relationship was observed between the patients with BCC and controls in terms of A Rh (-) (p=0.001).

CONCLUSION

Our study results demonstrated that there is a significant relationship between non-melanoma skin cancer and ABO/Rh factors.

ABO blood groups, Rhesus factor, and Behçet's disease

INTRODUCTION

Recently, numerous studies have been carried out to explain the genetics and immunopathogenesis of Behçet's disease (BD). There is still insufficient understanding of its etiopathogenesis, but substantial genetic and immune system abnormalities have been suggested. Several studies have shown remarkable associations of ABO blood groups with various diseases. This study investigated the relationship between ABO and Rhesus (D) blood groups and Behçet's disease in Turkish patients.

METHODS

Clinical data on gender, ABO, and Rhesus blood type of patients with BD were collected at the Kayseri Education and Research Hospital from 2005 to 2012. A total of 115 patients with BD were assessed for their association with ABO or Rhesus (D) blood groups and compared with the distribution of the blood groups of 25,701 healthy donors admitted to the Kayseri Education and Research Hospital Blood Center in 2010 and 2011.

RESULTS

The distribution of ABO and Rhesus blood groups in patients with BD was similar to the healthy donors. No relationship was found between ABO or Rhesus blood groups and BD at our hospital.

CONCLUSION

Further studies with a larger series and in different centers may be valuable for identifying the association between ABO or Rhesus (D) blood groups and BD.

Teenage patients with ingrown toenails: treatment with partial matrix excision or segmental phenolization

Background:

Ingrown toenails (IT) is a very common problem leading to significant associated morbidity. The articles related to phenolization for matrix removal in teenagers with IT are not enough in the foot surgery literature.

Aims:

To compare the postoperative recovery periods, complication rate, and tolerability of partial matrix excision and segmental phenolization in teenagers with IT.

Materials and Methods:

Thirty-nine patients (13-17 years) with 48 IT were randomly divided into two groups and were treated with partial matrix excision (Group I) and segmental phenolization (Group II). We assessed the recurrence rates, postoperative complications, duration of analgesic usage, and time to return to daily activities.

Results:

There was no significant difference between the demographic and clinical data of the two groups. Three patients in Group I and two patients in Group II experienced moderate pain postoperatively. These patients used analgesics for 3 days. The rates of postoperative complications and recurrences between the two groups showed no statistically significant difference (P = 0.688). The time to return to normal daily activities was significantly shorter in Group II patients than in Group I patients (P < 0.05).

Conclusions:

Partial matrix excision is a very safe model of therapy in the surgical treatment of teenagers with IT. It has low recurrence rate and minimal postoperative morbidity. We concluded that segmental phenolization is also as safe as partial matrix excision in the treatment of IT and patients return to their daily activities in less time with this treatment modality.

Anaesthesia in Naxos disease: first case report

Naxos disease is a recessively inherited arrhythmogenic right ventricular cardiomyopathy in which the cardiac phenotype is associated with palmoplantar keratoderma and woolly hair. The hair phenotype is unique, characterized by congenital woolly, curly, rough, and light-colored scalp hair and sparse eyebrows. However, arrhythmias and severe cardiomyopathies are causes of severe life threatened intracardiac thrombus. Thrombus therapy needs private care and sedative, operative processes need to give close attention to these patients. In this case report, sedation given a patient who having severe congestive heart failure with huge mural thrombus in left ventriculus has been presented.

Does familial occurrence or family history of recurrent oral ulcers influence clinical characteristics of Behçet's disease?

Recently, family history and increased frequency of some isolated manifestations of the disease in relatives of patients have been thought to play an important role in the etiopathogenesis of Behçet's disease (BD). Family history has been proposed to participate in diagnostic criteria. Investigating features of patients with different family histories may give an additional insight in understandings BD. The aim of this study was to explore the effect of familial occurrence and family history of recurrent oral ulcers (ROUs) on the clinical features of BD. We analyzed retrospectively 141 BD patients according to the International Study Group criteria. Family history of BD was present in 31.2%, family history of ROUs without BD in 31.9%, and negative family history for BD and ROUs in 36.9% of study patients. All patients were evaluated with respect to demographic and clinical features. There was no significant difference in most clinical features among patients with different family histories (p>0.05). Besides, patients with family history of BD and/or ROUs had longer duration of ROUs before diagnosis and more frequent extragenital ulcers than patients with negative family history of BD and ROUs (p<0.05 and p<0.01, respectively). These findings did not show any strong effect of familial occurrence or positive family history of ROUs on all clinical characteristics of BD. However, sporadic ROUs should be considered an early predictor of probable BD in patients with family history of BD and/or ROUs, and they should be followed up carefully. Further studies including genetic testing of patients and their relatives are needed.

Treatment of superficial cutaneous vascular lesions: experience with the long-pulsed 1064 nm Nd:YAG laser

Recent published studies evaluating the long-pulsed 1064 nm Nd:YAG laser for superficial cutaneous vascular lesions have limited subjects and optimal treatment parameters have not been established. To determine the efficacy and safety of the long-pulsed 1064 nm Nd:YAG laser on superficial cutaneus vascular lesions and analyse retrospectively our experience of a 3-year period are the aims of this study. Over the 3-year period, 255 patients were treated [189 female and 66 male; median age 35 (range 7-65) years; Fitzpatrick skin types II-V]. Twenty-six patients with spider angioma, 130 with facial telangiectasia, and 99 with leg telangiectasia were treated. A long-pulsed 1064 nm Nd:YAG laser was used. A test dose was performed at the initial consultation and thereafter patients were reviewed and treated at 4-week intervals for 5 months. Of those patients who completed treatment and followup, 26/26 (100%) of spider angiomas, 125/130 (97%) of facial telangiectasia, and 80/99 (80,8%) of leg telangiectasia markedly improved or cleared. We suggest that the long pulsed Nd:YAG laser is a safe and effective treatment for common superficial cutaneous vascular lesions. However, it is not the first choise to use to treat superficial vessels on the face where depth is not the concern.