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Objective: The aim of the present study was to investigate the predictive factors of peripheral arterial disease (PAD) in home care patients. Method: This descriptive study was conducted in Istanbul with 285 homebound patients who applied for the first time to receive services from the Home Health Care Unit of a tertiary hospital between 01.07.2014 and 01.12.2014. The patients having known PAD diagnosis were excluded. Sociodemographic characteristics, home dependency duration, chronic diseases, medications used and smoking status were recorded. Then, deformities in the patients' toenails, peripheral hair loss, foot wounds were recorded, and the patients' functional status and skinfold thickness were evaluated peripheral arterial disease was evaluated by ankle--brachial index (ABI). An ABI below 0.9 was considered indicative of PAD. A chi-square test, Mann--Whitney U test and a logistic regression analysis were used in the statistical analysis. Results: The mean age of the participants was 75.84±1.17 years (34% M; 65% F). Peripheral artery disease was detected in 16.8% (n=48) of the patients. Current or former smoking (β: 4.09), peripheral hair loss (β: 3.42), deformity of toenails (β: 3.02), and increased skinfold thickness (β: 1.124) were identified as predictors of PAD. Conclusions: The findings of the present study suggest that home health care providers should inquire about the patient's smoking history, assess skinfold thickness, and examine the toes for hair loss and deformities, to predict PAD. [ABSTRACT FROM AUTHOR]

Aim: Psoriatic arthritis (PsA) is a chronic inflammatory disease that can cause musculoskeletal involvement in the form of sacroiliitis, spondylitis, enthesitis, dactylitis, and arthritis and can cause disability in patients. PsA does not have a single blood test that can show disease activity; therefore, complex and difficult-to-apply composite indexes are often used in activity tracking. The serum platelet-toalbumin ratio (PAR), calculated as the ratio of one positive and one negative phase response parameter, is a newly defined index and has been shown to be related to activation and disease survival in inflammatory diseases and malignancies. In this study, we investigated the relationship of this index with disease activity and disease processes in patients with PsA. Material and Methods: The study was conducted on 66 patients diagnosed with PsA according to the CASPAR criteria. Physician global assessment, patient global assessment, Disease Activity in Psoriatic Arthritis (DAPSA), Psoriasis Area Severity Index (PASI), Psoriasis Nail Severity Index (NAPSI), and Leeds Enthesitis Index (LEI) were evaluated. The erythrocyte sedimentation rate, which is a routine test, was measured by the Westergren method (mm/hour), and C-reactive protein (CRP) was measured as nephelometric (mg/dL). Results: A positive correlation was detected between PAR and DAPSA and CRP levels in patients with PsA (p<0.05). In addition, a correlation was detected between the onset of nail disorder and joint pain, but no relationship was detected between the duration of rash. On the other hand, there was no significant relationship between PAR and other measures of disease activity, including patient global assessment, physician global assessment, PASI, NAPSI, LEI, and sedimentation (p>0.05). Conclusion: In this study, we found a significant positive correlation between serum PAR and DAPSA, which is the disease activity score for PsA, and CRP, which is an acute phase marker. These results suggest that PAR may be a biomarker for monitoring PsA activity. [ABSTRACT FROM AUTHOR]

Background: Generalized pustular psoriasis (GPP) is a rare and severe inflammatory disease characterized by widespread and superficial sterile pustules on an erythematous background. Objectives: This multicentre study aimed to determine the clinical profile and course in a large cohort of patients with GPP. Methods: One hundred and fifty‐six GPP patients (mean age, 44.2 ± 18.7 years) who met the diagnostic criteria of the European Consensus Report of GPP were included in the study. Sociodemographic characteristics, quality of life, triggering factors of the disease, clinical, laboratory, treatment and prognostic features were evaluated. Results: 61.5% of the patients were female. The rate of working at or below the minimum wage (≤$332.5/month) was 44.9%. Drugs (36.5%) were the most common trigger. While hypocalcaemia (35.7%) was the most important cause of GPP during pregnancy, systemic steroid withdrawal (20%) was the most frequently reported trigger for infantile/juvenile and mixed‐type GPP (15%) (P < 0.05). Acute GPP (53.8%) was the most common clinic. Nails were affected in 43.6% of patients, and subungual yellow spots (28.2%) were the most common change. In annular GPP, fever (P < 0.001) and relapse frequency (P = 0.006) were lower than other subtypes, and the number of hospitalizations (P = 0.002) was lower than acute GPP. GPP appeared at a later age in those with a history of psoriasis (P = 0.045). DLQI score (P = 0.049) and joint involvement (P = 0.016) were also higher in this group. Infantile/juvenile GPP was observed in 16.02% of all patients, and arthritis was lower in this group (24.4 vs. 16%). GPP of pregnancy had the worst prognosis due to abortion observed in three patients. Conclusions: Recent advances in treatment have improved mortality associated with GPP, but abortion remains a significant complication. Although TNF‐α inhibitors have proven efficacy in GPP, they can also trigger the disease. Mixed‐type GPP is more similar to acute GPP than annular GPP with systemic manifestations and course. [ABSTRACT FROM AUTHOR]

Aim: Psoriasis is a chronic disease and requires follow-up settings to manage. The aim of the study is to evaluate the clinical characteristics, disease course, the factors associated with the psoriasis area severity score index (PASI), comorbidities, and treatment of psoriasis in our follow-up psoriasis outpatient clinic. Methods: Clinical data from patients who were followed in the University of Health Sciences Turkey, Haseki Training and Research Hospital psoriasis outpatient clinic between January 2015 and March 2021 were examined. The relationships between age, age of the disease onset, gender, joint involvement, and nail involvement were analyzed. Results: In total, 618 patients were included in our study (320 males and 298 females). The median age of the patients was 42 (1- 87) years. Family history was present in 25.9% of the patients. The most common clinical type was plaque psoriasis (80.2%). The median value of the PASI was 8.1. The disease course of the patients was progressive (46.4%), remission and exacerbations (37%), and regressive (16.7%). Nail involvement and joint involvement were observed in 58.1% and 24.2% of the patients, respectively. A significant correlation was found between PASI and joint involvement (p=0.009). Onycholysis (a type of nail involvement) was a positive predictive indicator for joint involvement (p=0.004). Comorbidity was present in 34.5% of the patients. Obesity, hypertension, diabetes mellitus, and dyslipidemia were the most common comorbidities. While 19.9% of the patients received only topical treatment, 80.1% underwent systemic treatment. Conclusions: The socio-demographic and enriched clinical data of psoriasis highlight the features that should be considered, especially in follow-up outpatient clinics. Patients showing an early onset of the disease should be investigated for severe involvement, such as the presence of onycholysis in the nail or evidence of joint involvement. The follow-up and treatment of patients with psoriasis are important in terms of comorbidities. [ABSTRACT FROM AUTHOR]

Summary: Background: Palmoplantar pustulosis (PPP) is a rare, chronic, inflammatory skin disease characterized by sterile pustules on palmar or plantar areas. Data on PPP are scarce. Aim: To investigate the clinical characteristics and risk factors for disease severity in a large cohort of Turkish patients with PPP. Methods: We conducted a cross‐sectional, multicentre study of patients with PPP recruited from 21 tertiary centres across Turkey. Results: In total, 263 patients (165 women, 98 men) were evaluated. Most patients (75.6%) were former or current smokers. The mean Palmoplantar Pustulosis Area and Severity Index (PPPASI) was 8.70 ± 8.06 and the mean Dermatology Life Quality Index (DLQI) score was 6.87 ± 6.08, and these scores were significantly correlated (r = 0.52, P < 0.001). Regression analysis showed that current smoking was significantly associated with increased PPPASI (P = 0.03). Coexisting psoriasis vulgaris (PsV) was reported by 70 (26.6%) patients. Male sex prevalence, PPP onset incidence, disease duration, DLQI, and prevalence of nail involvement and psoriatic arthritis (PsA) were significantly increased among patients with PPP with PsV. Of the 263 patients, 18 (6.8%) had paradoxical PPP induced by biologic therapy, and these patients had significantly increased mean DLQI and prevalence of PsA (r = 0.03, P = 0.001). Conclusion: Our data suggest that smoking is a risk factor for both PPP development and disease severity. Patients with PPP with PsV present distinct clinical features and patients with biologic therapy‐induced paradoxical PPP have reduced quality of life and are more likely to have PsA. [ABSTRACT FROM AUTHOR]

Background and Design: Psoriasis nail involvement is clinically similar to onychomycosis. Especially subungual hyperkeratosis and onycholysis are also common in both nail diseases. These two diseases may be seen separetely or together. The aim of this study was to compare the frequency of onychomycosis with control group in patients with psoriasis and to determine the factors predisposing to onychomycosis in patients with psoriasis. Materials and Methods: The study included 43 patients with psoriasis who were admitted to İstanbul Medipol Mega University, Clinic of Dermatology between 2017 and 2018 and 43 control patients who did not have psoriasis and had nail dystrophy. Participants who received systemic corticosteroid, methotrexate, cyclosporine, and systemic antifungal treatment 4 months ago and who received topical antifungal treatment 4 weeks ago were excluded from the study. The nail samples were examined histochemically with periodic acid-Schiff (PAS) stain. Results: Onychomycosis was detected in 11 patients with psoriasis (25.6%) (hand and/or foot), while in 17 patients (39.5%) in control group. There was no statistically significant difference between two groups (p=0.170). In control group, toe nail onychomycosis was significantly higher than in the psoriatic group (p=0.024). It was noteworthy that onychomycosis was statistically significant in the group with high educational level and low Psoriasis Area Severity Index (p<0.05 and p=0.021, respectively). Conclusion: In this study, we determined that nail psoriasis is not a risk factor for onychomycosis by histopathological examination of fungal samples with PAS staining. [ABSTRACT FROM AUTHOR]

Background and Design: Darier's disease is a genetic disorder of keratinization with autosomal dominant inheritance. In the article presented here, demographical, clinical and histopathological findings and treatment outcome of Darier's disease are discussed with 9 cases. Materials and Methods: We performed a retrospective study of all the patients diagnosed with Darier's disease at the Department of Dermatology of Istanbul Training and Research Hospital, between 2008 and 2016. Results: During the observation period, we identified 9 patients with Darier's disease; 6 males and 3 females with a mean age of 32.5 years. Two cases were from the same family (mother and child) and no family history was found in the other seven patients. Skin lesions in the form of keratotic papules were noted in seborrhoeic areas, essentially the head-neck and trunk. Four patients had hand involvement, five patients had nail lesions. Conclusion: Darier's disease is a rare genodermatosis and should be considered in the differential diagnosis of dermatoses with keratotic papular lesions. [ABSTRACT FROM AUTHOR]

Background and Design: To evaluate the prevalence of skin changes in patient with chronic renal failure undergoing hemodialysis. Material and Methods: Over 18 year of age, 100 randomly selected patients were enrolled in the study. The patients were divided into 7 groups in terms of primary disease causing chronic renal failure, and were divided into two groups according to duration of hemodialysis (?3 years and >3 years). The association of diagnosed skin disorders with age, gender and duration of hemodialysis, were assessed using the t-test and chi-square test. Results are presented as mean}standard deviation and a p value less than 0.05 was considered statistically significant. Results: Many skin diseases, at least one, were found in all patients. The most common skin changes were xerosis (98%), nail changes (93%), melanocytic nevus (78%), seborrheic keratosis (54%), pigmentation changes (51%), uremic pruritus (49%), tinea pedis (34%), actinic keratosis (23%), skin tags (16%), onychomycosis (17%), lentigo (16%), and cherry angioma (11%). The most frequently observed nail changes were longitudinal ridging, half and half nails, absence of lunula and splinter hemorrhages. Conclusion: Various skin changes are often accompanied by chronic renal failure. A detailed dermatological examination may play an important role in the diagnosis of chronic renal failure. [ABSTRACT FROM AUTHOR]

Background and Design: Pediatric dermatology is a new topic in our country, and epidemiologic data is limited in this area. Therefore, we decided to perform a retrospective analysis to investigate the prevalence of skin diseases among children living in the Istanbul region. Material and Method: 850 children-439 girls (51.6%) and 411 boys (48.4% -aged 0-17 (mean: 6.83±4.69) years, who had been referred to the pediatric dermatology outpatient clinic, Goztepe Training and Research Hospital between January 2007 and January 2009 were retrospectively analyzed using the computer database. Results: The most common skin disease groups and their prevalence were: eczema (32.7%), non-classifiable dermatoses (28.5%), infectious diseases (13.4%), erythematous and squamous disorders (5.5%), nevi/hamartomas (5.4%), hair disorders (3.8%), acne (3.5%), urticaria (3.2%), vitíligo (2.2%), nail disorders (1.6%). Conclusion: We found that eczema was the most frequent skin disease group in our study. Further epidemiological studies on pediatric dermatology patients as well as educational programs and preventive measures are needed in order to decrease the prevalence of skin diseases among children. [ABSTRACT FROM AUTHOR]

Psoriatic arthritis is an autoimmune, chronic, systemic inflammatory disorder characterized by the association of arthritis with psoriasis. In this paper, we explore the characteristics of joint and nail involvement in Turkish patients with psoriatic arthritis. Forty patients with psoriasis (M/F, 18/22) and 49 (M/F, 25/24) subjects with psoriatic arthritis were included in the study. Clinical characteristics of the patients were recorded. The distribution of the subjects with arthritis: (according to the clinical and radiological findings): polyarticular, 65%; oligoarticular, 23%; isolated axial involvement, 7.7%; arthritis mutilans, 3.8%; sacroiliitis, 19%. Nail involvement was significantly higher among patients with arthritis; i.e., 91 versus 32%; ( P < 0.05). There were no correlation between the skin involvement pattern and the arthritis type ( P > 0.05). Nevertheless, no relation was observed between the psoriasis duration and arthritis ( P > 0.05). Nail involvement is a frequent feature of the psoriatic arthritis which may be a useful finding for differential diagnosis of psoriatic arthritis from other inflammatory arthropathies. [ABSTRACT FROM AUTHOR]