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Background Psoriasis is a chronic dermatologic disease affecting 2% of the general population. Tumour necrosis factor (TNF)-like weak inducer of apoptosis (TWEAK) is a newly defined member of the TNF family. Increased serum levels of TWEAK were reported in inflammatory diseases. The relationship between serum TWEAK levels and severity of psoriasis has not yet been proven. Our aim was to clarify the change in serum TWEAK levels in response to conventional and anti-TNF treatments. Material and methods Blood samples were collected from 103 moderate or severe chronic plaque psoriasis patients with or without arthritis who were referred to the Department of Dermatology, Istanbul University Cerrahpasa Medical Faculty between the years 2016 and 2018. Psoriasis Area and Severity Index (PASI) scores were calculated, and serum TWEAK levels were assessed with TWEAK ELISA kit. SPSS 20 was used for statistics. Results Serum TWEAK levels increased significantly and PASI scores decreased significantly after both conventional and anti-TNF treatments, but the two variables were not correlated. There was no significant difference between conventional and anti-TNF treatments, between patients with or without comorbid arthritis and between genders. Conclusions Lower serum TWEAK levels induce psoriasis and higher levels of TWEAK are observed after treatment. It is important to determine a threshold value. Such a cutoff value of serum TWEAK levels could not be calculated in our study similar to previous studies. If its serum levels were to be standardized in further studies, TWEAK can be used as a follow-up marker in psoriasis patients with the PASI score.

Background Surgical techniques have recently been introduced for patients with vitiligo. Randomized controlled trials have not been performed. Aim To compare the efficacy and side-effects of two surgical methods (suction blister vs. thin split-thickness graft technique) for the treatment of vitiligo. Methods Three suction blisters, approximately 0.8 cm in diameter, made with a special tool attached to a vacuum extractor, which were converted to erosions by removal of the roofs of the bullae, and one round erosion of approximately the same diameter, made using a silver knife, were created. One roof of a blister and two cutaneous thin split-thickness grafts taken from the gluteal region were transferred onto recipient vitiliginous areas; one was left alone. The results were evaluated by one non-blind and two blind observers bimonthly during the 3-month follow-up period. Results Repigmentation rates were 25-65% in the suction blister technique and 90% in the thin split-thickness graft technique (P < 0.001). Conclusions The thin split-thickness graft technique is superior to the suction blister technique in treating vitiligo.

Background Body composition parameters, such as weight, body mass index (BMI), and visceral fat rating, have been found to be associated with psoriasis. However, the associations of these parameters with psoriasis have not been demonstrated clearly. Objectives This study aimed to evaluate body composition parameters in patients with psoriasis. Methods The relationships between the various body composition parameters and psoriasis were retrospectively examined in 242 patients with plaque psoriasis (119 women, 123 men) over a 2-year period during 2010–2012. In addition, the correlations between body composition parameters and Psoriasis Area and Severity Index (PASI) score were evaluated in treated and untreated patients with psoriasis. Patients were divided into two groups according to whether or not they had received systemic therapy within the previous three months. Body composition values were measured using the Tanita SC-330 Body Composition Analyzer®. Results Statistically significant differences were recorded in terms of weight (kg), body fat percentage, fat mass (kg), total body water (TBW) percentage, metabolic age, visceral fat rating, BMI, and degree of obesity among treated and untreated patients and control subjects. Differences in fat-free mass (FFM) (kg), muscle mass (kg), TBW (kg), and bone mass (kg) were found to be close to the limit for significance. The treated and untreated groups showed no significant differences in any of the parameters evaluated. The correlations between PASI score and the various parameters provided some evidence for such relationships. Conclusions The present study provides evidence of a relationship between some body composition parameters and the occurrence of psoriasis. We suggest that body composition parameters should be analyzed not only in obese psoriasis patients but in all psoriasis patients upon their first diagnosis. Systemic therapy does not appear to cause any changes in body composition parameters.

Background Because there is an increased inflammatory response to trauma, particularly of the skin, in patients with Behcet's syndrome (BS), an alteration in wound healing in BS is expected. The aim of this study was to investigate the healing features of punch biopsy wounds in BS and acne vulgaris (AV) patients used as controls. Method Full-thickness skin punch biopsies (4 mm) were taken from the hairless sites of the non-dominant forearms in 20 BS and 20 AV patients. Each patient was examined on days 1, 2, 3, 4, 5, 8, and 10, and the biopsy wound area and induration were marked on sterile glass slides. Other inflammatory changes, such as suppuration and pain, were also recorded. No antiseptic solutions or ointment, except saline, were used. Results The wound area healed similarly in both groups (p > 0.05). Thirteen (65%) BS patients had erythematous haloes around the wound on the first day. The number of patients presenting inflammatory changes reached 18 (90%) on the second day in the BS group. The area of erythema around the wound in BS patients was significantly greater than that in AV patients (5; 25%). It gradually decreased day by day. Purulent changes were observed in four BS patients on day 1, and induration around the biopsy wound in six patients on day 2. Only one patient with AV had suppuration, which appeared on the second day, while no AV patient displayed induration. Conclusion Biopsy-induced trauma may cause increased inflammation in BS, but wound healing is not altered.

A 37-year-old man was first seen in November 1998 with a unilateral painful eruption of grouped small vesicles at the right side of his thorax. His general health was good. He was diagnosed as having herpes zoster, which was successfully, treated with oral acyclovir 800 mg, five times a day. Five months later, and after complete resolution of the herpes zoster, he developed a pustular eruption on exactly the same area of his first herpetic lesion. There was a diffuse distribution of pustules on the dorsal part of the dermatome, and a grouped pattern on the ventral side ( Fig. 1). A punch biopsy was performed for differential diagnosis of recurrent herpes zoster and folliculitis. Methicillin-resistant Staphylococcus aureus colonies were isolated from the bacterial culture of the pustular content. Cefadroxil monohydrate 500 mg twice a day and the application of fucidic acid ointment were prescribed. There was no improvement at the end of the second week of therapy. Figure 1. Clinical appearance Download figure to PowerPoint A histopathologic study demonstrated hyperkeratosis, acanthosis, focal accumulation of neutrophils and bacteria in the epidermis, and a perivascular and perifollicular infiltration of eosinophils, lymphocytes, and histiocytes in the dermis ( Fig. 2). After the diagnosis of eosinophilic pustular dermatosis was histopathologically confirmed, fungal folliculitis and immunosuppressive conditions were investigated. Routine blood tests were within the normal ranges. The human immunodeficiency virus (HIV), hepatitis C virus (HCV), and anti-hepatitis B surface antibody (anti-HBs) tests were negative, but the hepatitis B surface antigen (HBsAg) test was positive. Abundant fungal hyphae were seen in potassium hydroxide under direct microscopic examination of the pustule content, and a fungal culture was performed. Although no evidence of fungal infection was demonstrated in repeated periodic acid–Schiff (PAS) staining of punch biopsy specimens, Trichophyton rubrum was isolated from fungal culture. The patient was then given a regimen of itraconazole pulse therapy (400 mg/day, for 7 days a month, repeating the monthly cycle three times) and cycloproxolamine cream. Two months later, at the end of therapy, only a few pustules remained, and these completely disappeared after another 5 months. Figure 2. Eosinophilic pustular folliculitis: dense eosinophilic infiltration within and around the hair follicle (hematoxylin and eosin, × 400) Download figure to PowerPoint

Background In chronic urticaria, suspicious factors are Helicobacter pylori (HP) infection and autoimmunity, as well as other etiologic agents. Autologous serum injection is the first step to identify autoimmune urticaria. Our study was performed to determine the prevalence of HP infection in patients with chronic urticaria, and to evaluate the results of autologous serum testing in chronic urticaria patients who had HP antibodies. Methods HP immunoglobulin G (IgG) antibody was defined by an immunochromatographic method in 61 chronic urticaria patients and 15 healthy persons. Autologous serum testing was performed in 32 chronic urticaria patients. Results HP IgG antibody was found to be positive in 41% of chronic urticaria patients and 26% of healthy controls (χ2 = 7.82, P = 0.005). Autologous serum testing was positive in 40% of chronic urticaria patients who had HP IgG antibody. This ratio was 14.3% in chronic urticaria patients who did not have HP IgG antibody (χ2= 9.23, P = 0.002). Conclusions In this study, autologous serum testing was found to highly positive in chronic urticaria patients with HP IgG antibody, but the relationship between autoimmunity and HP infection requires further investigations.

Background Several studies have reported cigarette smoking to have a beneficial protective effect on recurrent aphthous stomatitis (RAS). In this study, we evaluated once again the incidence of smoking in RAS patients compared with controls. This study differs from most previous ones in that the patients were diagnosed by direct observation of active lesions by a dermatologist. Methods Thirty-four patients with RAS who were seen at the dermatology clinic during a period of 2 years were compared with 115 outpatients with other skin diseases and 20 healthy hospital personnel who had no history of aphthae, with regard to their smoking habits. Results Among the 34 patients with RAS, 8.8% were active smokers compared with a significantly higher percentage (25.2%) among the control subjects. Conclusions In agreement with others, we found a negative epidemiologic association between smoking and RAS. This finding can be used to clarify the cause and pathogenesis of the disease, and possibly to identify better treatment or preventive options than those currently available.

Atrophia maculosa varioliformis cutis (AVMC) was first described by Heidingsfeld in 1918, as a rarely reported form of idiopathic macular atrophy on the cheek (1). It is characterized, clinically, by shallow, sharply demarcated depressions in various shapes. Extrahepatic biliary atresia (2) and pachydermodactyly (3) have been the only conditions associated with AMVC reported in the past 80 years. Although keratosis pilaris is a common skin disorder, it is related to other idiopathic atrophic conditions considered in the differential diagnosis of AMVC, namely keratosis pilaris atrophicans (4). However, the two associations may be coincidental. We observed a patient with keratosis pilaris, and her brother and an unrelated young man, whose findings led to a diagnosis of AMVC.

A white man attended our outpatient clinic because of soft papules on the second finger of the left hand. They were livid red-colored, warty surfaced cysts, 1–2 cm in diameter, arranged in an annular configuration (Fig. 1). The patient showed prominent zygomatic bones and symmetric loss of buccal fat pads (Bichat's fats), leading to sunken cheeks (Fig. 2). The history of the patient could not be taken because of his debility. Figure 1. Soft papules on the second finger of the left hand Download figure to PowerPoint Figure 2. Symmetric loss of Bichat's fats Download figure to PowerPoint Laboratory findings included: hemoglobin, 14.5 g/dL; Htc, 41.6%; red blood cells (RBC), 4.67/µL; white blood cells (WBC), 10.3 × 103/µL; Plt, 274 × 103/µL; mean corpuscular volume (MCV), 89.1 fL; mean corpuscular hemoglobin (MCH), 31.0 pg; mean corpuscular hemoglobin concentration (MCHC), 34.8 g/dL; blood urea nitrogen, 33 mg/dL; creatinine, 0.7 mg/dL; cholesterol, 152 mg/dL; total protein, 8.1 g/dL; albumin, 4.6 g/dL; total bilirubin, 0.5 mg/dL; direct bilirubin, 0.1 mg/dL; calcium, 8.8 mg/dL; erythrocyte sedimentation rate, 6 mm/h; urinalysis, normal – there was no anomaly in the urine in 24 h. The patient was negative for antinuclear antibody (ANA), anti-DNA, anticentromer antibody, Scl 70 antibody, hepatitis B surface antigen (HBsAg), and human immunodeficiency virus (HIV). Chest X-ray was normal. Hand X-ray showed bone cysts on the distal phalanx of the second finger of the left hand. Histologic examination of the papules on the second finger of the left hand revealed multilobulated or, in other words, proliferating cystic structures lined by epithelium similar to the infundibular epithelium of the hair follicle. The cysts were connected with the surface of the skin and were filled with cornified cells in a basket-weave array (Fig. 3). Figure 3. Nodules composed of benign infundibulocystic proliferation (hematoxylin and eosin, × 40) Download figure to PowerPoint The IQ was measured as 50 indicating mental retardation. Audiogram could not be performed, but sensory neural hearing loss was suspected. After 1.5 months of pimozide therapy (Norofren, 2.5 mg/day), hearing loss was measured as 50% and a diagnosis of otosclerosis was made. The cystic lesions resolved completely and Bichat's fats regenerated partially.

In a prospective study of 150 patients with Behçet's disease, significant associations were shown between CRP positivity and the presence of erythema nodosum (p less than 0.02) and acute thrombophlebitis (p less than 0.05) and between ESR and erythema nodosum (p less than 0.01), acute thrombophlebitis (p less than 0.001), and acute arthritis (p less than 0.01). Mucocutaneous, ocular, or central nervous system activities did not show significant associations with these indices of inflammation. In 50 patients in whom quantitative CRP determinations were performed, clinical disease activity was accompanied by slight to moderate increases in CRP and ESR.

The epidemiology of scabies for the last twelve years has been studied in Turkey. Information was obtained from three regions (Istanbul, Ankara and Erzurum) having different climates. There has been an increase in scabies in the years following 1969 in Ankara and Erzurum and from 1967 on in Istanbul. It reached its maximum in 1978 in Erzurum, while this peak had been observed in early 1970s in other regions. Scabies incidence has significantly increased and decreased in winters and summers respectively, has been found to affect particularly the age group 15-44, and was observed more frequently in men than in women. Scabies seems to be moving to the eastern parts of Turkey.