I. Aydingoz, İ. Bi̇ngül, P. Vural, S. Doǧru-Abbasoǧlu
Background: Autoimmunity has been implicated in the etiopathogenesis of vitiligo. Aim: We sought to determine whether polymorphisms in the major histocompatibility complex class I-related chain A (MICA) and macrophage migration inhibitory factor (MIF) genes may have a role in the pathogenesis of vitiligo. Materials and Methods: We conducted a study including 100 patients with vitiligo and age- and sex-matched 172 control subjects to examine the role of single-nucleotide polymorphisms of MICA gene rs1051792 and MIF genes rs755622 and rs2096525 as risk factors for vitiligo. Real-time PCR combined with the melting curve analysis using fluorescence-labeled hybridization probes was used for genotyping analyses. Mann–Whitney, Kruskal–Wallis, and chi-square (χ2) tests as well as multivariate logistic regression adjusted for age and gender were used for statistical evaluation. Linkage disequilibrium (LD) and haplotype frequencies were also performed. Results: No significant association was observed between the variant alleles of studied genes and vitiligo. Haplotype analysis demonstrated that there was a strong LD between rs755622 and rs2096525 loci of MIF gene (D′ = 0.92, r2 = 0.827). However, haplotype frequencies in patients were similar to those in controls. Conclusion: These preliminary results suggest that the polymorphic variants of MIF rs755622, MIF rs2096525, and MICA rs1051792 genes do not play a critical role in the etiopathogenesis of vitiligo.
{"title":"Major histocompatibility complex class I-related chain A and macrophage migration inhibitory factor gene polymorphisms in a Turkish patient population with vitiligo","authors":"I. Aydingoz, İ. Bi̇ngül, P. Vural, S. Doǧru-Abbasoǧlu","doi":"10.4103/tjd.tjd_52_22","DOIUrl":"https://doi.org/10.4103/tjd.tjd_52_22","url":null,"abstract":"Background: Autoimmunity has been implicated in the etiopathogenesis of vitiligo. Aim: We sought to determine whether polymorphisms in the major histocompatibility complex class I-related chain A (MICA) and macrophage migration inhibitory factor (MIF) genes may have a role in the pathogenesis of vitiligo. Materials and Methods: We conducted a study including 100 patients with vitiligo and age- and sex-matched 172 control subjects to examine the role of single-nucleotide polymorphisms of MICA gene rs1051792 and MIF genes rs755622 and rs2096525 as risk factors for vitiligo. Real-time PCR combined with the melting curve analysis using fluorescence-labeled hybridization probes was used for genotyping analyses. Mann–Whitney, Kruskal–Wallis, and chi-square (χ2) tests as well as multivariate logistic regression adjusted for age and gender were used for statistical evaluation. Linkage disequilibrium (LD) and haplotype frequencies were also performed. Results: No significant association was observed between the variant alleles of studied genes and vitiligo. Haplotype analysis demonstrated that there was a strong LD between rs755622 and rs2096525 loci of MIF gene (D′ = 0.92, r2 = 0.827). However, haplotype frequencies in patients were similar to those in controls. Conclusion: These preliminary results suggest that the polymorphic variants of MIF rs755622, MIF rs2096525, and MICA rs1051792 genes do not play a critical role in the etiopathogenesis of vitiligo.","PeriodicalId":42454,"journal":{"name":"Turk Dermatoloji Dergisi-Turkish Journal of Dermatology","volume":"11 1","pages":"11 - 15"},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73218482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dear Editor, Androgenetic alopecia (AGA) is a chronic disorder associated with miniaturization of hair. Research has shown that in AGA, the number hair follicular stem cell number remains the same but the number of proliferating progenitor CD200 and CD34 positive cells is reduced.[1] Gentile et al.[2,3] have performed CD200-rich progenitor cell transplant by autologous micrografts using manual mechanical detachment and mechanical device Rigenera™. Non-cultured melanocyte transplantation (NCMT) is a well-established procedure for treatment of vitiligo. Trypsin enzyme is used to prepare a cell suspension of melanocytes and which is applied to dermabraded vitiliginous skin. Gupta et al.[4] have used hair follicles as a source of melanocytes. They used trypsin to separate the melanocytes from hair follicles. They have shown promising results in vitiligo. Incidentally, they found the presence of CD200 positive progenitor cell in their suspension indicating that same suspension may be useful in treatment of AGA. This is a retrospective report of a case where trypsin-isolated single cell suspension was used to treat AGA. A flow cytometric analysis was done. One patient, aged 22 years, having grade III androgenetic alopecia, was treated with cell suspension of occipital follicular units. 24 mL blood was drawn to prepare platelet-rich plasma (PRP). The patient underwent follicular unit extraction (FUE) of 25 hair follicles (HF) using 0.9 mm punch. HF were washed with saline and collected in DMEM (Dulbecco’s modified Eagle’s medium) (Melanotrans kit, Cryobank Fertility Research Center, Jalna, Maharashtra, India). HF were incubated in 0.25% trypsin-EDTA (Melanotrans kit) at 37°C for 60 min. Before adding HF to trypsin, they were split longitudinally, slicing through the outer root sheath, to expose the bulge area to the trypsin. During incubation the HF were shaken every 5 min achieving an efficient separation of cells. After 1 h, only keratinous shafts remained in the suspension [Figure 1] and trypsin was inactivated using trypsin inhibitor. The suspension was filtered through a 40 μ filter ensure a single cell suspension. The suspension was then pelleted and redissolved in 5 mL of PRP. 0.05 mL was injected per cm2 and hair growth was measured using trichoscopy before the procedure and after 8 weeks. Cell suspension from one case was sent for flow cytometry to ascertain the number of CD34 positive cells and CD200 positive cells. HF cells were washed with phosphate buffered saline (PBS) and suspended in 100 μL staining buffer (0.5% bovine serum albumin in PBS). 1 μL of antibody (FITC anti-human CD34 and PE anti-human CD200, BioLegend, San Diego, California) was added per 1 × 105 cells and the cells were incubated in dark for 15 min at room temperature. CD34 +ve and CD200 +ve cells were quantified using flow cytometer. Result showed an increase in hair density of 21 hairs/cm2. On flowcytometry, 9.1% cells were CD34 positive and 4.2% cells were CD200 positive
亲爱的编辑，雄激素性脱发(AGA)是一种与头发小型化相关的慢性疾病。研究表明，在AGA中，毛囊干细胞数量保持不变，但增殖祖细胞CD200和CD34阳性细胞数量减少。[1]Gentile等人[2,3]使用手动机械脱离和机械装置Rigenera™进行了富含cd200的自体微移植物祖细胞移植。非培养黑素细胞移植(NCMT)是一种成熟的治疗白癜风的方法。胰蛋白酶酶用于制备黑素细胞的细胞悬浮液，并应用于脱毛的白癜风皮肤。Gupta等人[4]利用毛囊作为黑色素细胞的来源。他们用胰蛋白酶从毛囊中分离黑素细胞。它们在白癜风方面显示出了令人鼓舞的效果。顺便说一句，他们在他们的悬浮液中发现了CD200阳性祖细胞的存在，这表明相同的悬浮液可能对治疗AGA有用。这是一个病例的回顾性报告，胰蛋白酶分离单细胞悬浮液用于治疗AGA。流式细胞术分析。1例22岁的III级雄激素性脱发患者采用枕滤泡细胞悬浮液治疗。取血24ml，制备富血小板血浆(PRP)。患者使用0.9 mm穿孔器对25个毛囊进行了毛囊单位摘除(FUE)。用生理盐水洗涤HF，并在DMEM (Dulbecco改良Eagle培养基)中收集(Melanotrans试剂盒，Cryobank Fertility Research Center, Jalna, Maharashtra，印度)。HF在0.25%胰蛋白酶- edta (Melanotrans试剂盒)中37℃孵育60分钟。在加入胰蛋白酶之前，将HF纵向切开，穿过外根鞘，使突出区域暴露于胰蛋白酶。在孵育期间，每5分钟摇一次HF，实现细胞的有效分离。1 h后，悬浮液中只剩下角状轴[图1]，使用胰蛋白酶抑制剂灭活胰蛋白酶。悬浮液通过40 μ过滤器过滤，确保单细胞悬浮液。将悬浮液制成颗粒，再溶于5ml的PRP中。每cm2注射0.05 mL，术前和8周后用毛发镜测量毛发生长情况。用流式细胞术检测1例细胞悬液中CD34和CD200阳性细胞的数量。用磷酸缓冲盐水(PBS)洗涤HF细胞，悬浮于100 μL染色缓冲液(PBS中0.5%牛血清白蛋白)中。每1 × 105个细胞加入1 μL抗体(FITC anti-human CD34和PE anti-human CD200, BioLegend, San Diego, California)，室温暗孵育15 min。流式细胞仪定量CD34 +ve和CD200 +ve细胞。结果显示毛发密度增加21根/cm2。在流式细胞术中，9.1%的细胞CD34阳性，4.2%的细胞CD200阳性[图2]。图1:(A)胰蛋白酶细胞分离开始前的FUE毛囊。(B)经胰蛋白酶完全分解后的FUE毛囊。(C)治疗前雄激素性脱发患者的顶点照片。(D)治疗后8周雄激素性脱发患者顶点照片。图2:流式细胞术采用BD Accuri C6 +流式细胞仪(Becton, Dickinson and Company, Franklin Lakes, New Jersey)。(A)在未染色细胞的帮助下开发的门控策略，以识别整个毛囊细胞群，并从分析中去除细胞碎片。(B)使用未染色的细胞设置象限门，用于定量CD34 +ve和CD200 +ve细胞。用单个染色细胞补偿荧光溢出。(C)毛囊细胞中CD34 2D阳性细胞占9.1%。4.2%细胞CD200阳性。在本例中，我们定量检测了CD34阳性和CD200阳性毛囊祖细胞。Gentile等人利用头皮皮肤活检样本作为祖细胞的来源，使用Rigenera™和机械剥离细胞进行细胞的机械分离，并在其悬浮液中显示出2.6±0.3%的CD200阳性细胞。在我们的病例中，可能更高的产率(4.2%)可能是因为使用FUE毛囊而不是使用皮肤活检样本。劈开外根鞘以暴露凸起区域的细胞的创新方法也可能允许更高的产量。我们将传统的NCMT方法重新用于AGA。需要进一步的研究来证实使用这种方法治疗AGA的可行性。财政支持及赞助无。利益冲突没有利益冲突。
{"title":"Treatment of androgenetic alopecia with autologous CD200 positive cell suspension","authors":"Shuken Dashore, Vinnyfred Vincent","doi":"10.4103/tjd.tjd_32_23","DOIUrl":"https://doi.org/10.4103/tjd.tjd_32_23","url":null,"abstract":"Dear Editor, Androgenetic alopecia (AGA) is a chronic disorder associated with miniaturization of hair. Research has shown that in AGA, the number hair follicular stem cell number remains the same but the number of proliferating progenitor CD200 and CD34 positive cells is reduced.[1] Gentile et al.[2,3] have performed CD200-rich progenitor cell transplant by autologous micrografts using manual mechanical detachment and mechanical device Rigenera™. Non-cultured melanocyte transplantation (NCMT) is a well-established procedure for treatment of vitiligo. Trypsin enzyme is used to prepare a cell suspension of melanocytes and which is applied to dermabraded vitiliginous skin. Gupta et al.[4] have used hair follicles as a source of melanocytes. They used trypsin to separate the melanocytes from hair follicles. They have shown promising results in vitiligo. Incidentally, they found the presence of CD200 positive progenitor cell in their suspension indicating that same suspension may be useful in treatment of AGA. This is a retrospective report of a case where trypsin-isolated single cell suspension was used to treat AGA. A flow cytometric analysis was done. One patient, aged 22 years, having grade III androgenetic alopecia, was treated with cell suspension of occipital follicular units. 24 mL blood was drawn to prepare platelet-rich plasma (PRP). The patient underwent follicular unit extraction (FUE) of 25 hair follicles (HF) using 0.9 mm punch. HF were washed with saline and collected in DMEM (Dulbecco’s modified Eagle’s medium) (Melanotrans kit, Cryobank Fertility Research Center, Jalna, Maharashtra, India). HF were incubated in 0.25% trypsin-EDTA (Melanotrans kit) at 37°C for 60 min. Before adding HF to trypsin, they were split longitudinally, slicing through the outer root sheath, to expose the bulge area to the trypsin. During incubation the HF were shaken every 5 min achieving an efficient separation of cells. After 1 h, only keratinous shafts remained in the suspension [Figure 1] and trypsin was inactivated using trypsin inhibitor. The suspension was filtered through a 40 μ filter ensure a single cell suspension. The suspension was then pelleted and redissolved in 5 mL of PRP. 0.05 mL was injected per cm2 and hair growth was measured using trichoscopy before the procedure and after 8 weeks. Cell suspension from one case was sent for flow cytometry to ascertain the number of CD34 positive cells and CD200 positive cells. HF cells were washed with phosphate buffered saline (PBS) and suspended in 100 μL staining buffer (0.5% bovine serum albumin in PBS). 1 μL of antibody (FITC anti-human CD34 and PE anti-human CD200, BioLegend, San Diego, California) was added per 1 × 105 cells and the cells were incubated in dark for 15 min at room temperature. CD34 +ve and CD200 +ve cells were quantified using flow cytometer. Result showed an increase in hair density of 21 hairs/cm2. On flowcytometry, 9.1% cells were CD34 positive and 4.2% cells were CD200 positive","PeriodicalId":42454,"journal":{"name":"Turk Dermatoloji Dergisi-Turkish Journal of Dermatology","volume":"137 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135749574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Psoriasis neurodermiformis (PN) and verrucous psoriasis (VP) are two distinct forms of psoriasis characterized by thickened plaques, whose proper description in most dermatologic texts is still lacking. Psoriasiform keratosis (PK) is a recently described clinical entity characterized by a solitary keratotic plaque whose microscopic findings simulate psoriasis. Aim: To compare and evaluate the clinical and histological profile of PN, VP and PK, and systematically characterize each of them. Settings and Design: This was a prospective, descriptive study done on a total of 51 patients, who were diagnosed with PN, VP and PK based on certain clinical criteria. The study was done at a teaching hospital in eastern India. Methods and Materials: The study was carried out on a total of 51 patients presenting with thickened psoriasiform plaques, who visited our outpatient department, over a period of 9 months. They were then carefully evaluated clinically (along with their demographic profile), followed by meticulous microscopic assessment. Each biopsy specimen was then categorically evaluated to enable a precise diagnostic conclusion. Statistical Analysis: As all values in our study were qualitative, they were expressed as numeric values and percentages. Results: Out of 51 patients, 18 were diagnosed as PN, 19 with VP and 14 with PK. PN demonstrated an equal gender distribution, whereas in VP and PK a male preponderance was apparent. History of past/present psoriasis was positive in only one patient diagnosed with VP. Intensity of pruritus was marked in 88.88%, 21.05% and 14.28% of patients with PN, VP and PK respectively. Dorsa of feet was the commonest site of involvement in PN and VP. In PK, the shin was the predominating site. VP presented clinically as mammillated, verrucous and crateriform phenotypes. PN and PK however, demonstrated single clinical patterns. Microscopically, none of the specimens satisfied all the 7 epidermal criteria set forth by Ackerman. In each slide Trozak’s histologic psoriasiform numeric score was >10. Conclusion: PN, VP and PK are certainly not as rare as previously considered. Mammillated VP closely mimics PN clinically. Crateriform VP is an extremely rare phenotypic expression encountered. Histological findings of papillomatosis, buttressing and anastomosing rete ridges and a dense dermal lymphocytic infiltrate point more in favor toward VP. Detecting solitary keratotic plaques with a psoriasiform histology should allow clinicians to consider the possibility of PK.
{"title":"Psoriasis neurodermiformis, verrucous psoriasis, and psoriasiform keratosis: A clinicopathological evaluation","authors":"N. Patil, A. Bubna","doi":"10.4103/tjd.tjd_67_22","DOIUrl":"https://doi.org/10.4103/tjd.tjd_67_22","url":null,"abstract":"Background: Psoriasis neurodermiformis (PN) and verrucous psoriasis (VP) are two distinct forms of psoriasis characterized by thickened plaques, whose proper description in most dermatologic texts is still lacking. Psoriasiform keratosis (PK) is a recently described clinical entity characterized by a solitary keratotic plaque whose microscopic findings simulate psoriasis. Aim: To compare and evaluate the clinical and histological profile of PN, VP and PK, and systematically characterize each of them. Settings and Design: This was a prospective, descriptive study done on a total of 51 patients, who were diagnosed with PN, VP and PK based on certain clinical criteria. The study was done at a teaching hospital in eastern India. Methods and Materials: The study was carried out on a total of 51 patients presenting with thickened psoriasiform plaques, who visited our outpatient department, over a period of 9 months. They were then carefully evaluated clinically (along with their demographic profile), followed by meticulous microscopic assessment. Each biopsy specimen was then categorically evaluated to enable a precise diagnostic conclusion. Statistical Analysis: As all values in our study were qualitative, they were expressed as numeric values and percentages. Results: Out of 51 patients, 18 were diagnosed as PN, 19 with VP and 14 with PK. PN demonstrated an equal gender distribution, whereas in VP and PK a male preponderance was apparent. History of past/present psoriasis was positive in only one patient diagnosed with VP. Intensity of pruritus was marked in 88.88%, 21.05% and 14.28% of patients with PN, VP and PK respectively. Dorsa of feet was the commonest site of involvement in PN and VP. In PK, the shin was the predominating site. VP presented clinically as mammillated, verrucous and crateriform phenotypes. PN and PK however, demonstrated single clinical patterns. Microscopically, none of the specimens satisfied all the 7 epidermal criteria set forth by Ackerman. In each slide Trozak’s histologic psoriasiform numeric score was >10. Conclusion: PN, VP and PK are certainly not as rare as previously considered. Mammillated VP closely mimics PN clinically. Crateriform VP is an extremely rare phenotypic expression encountered. Histological findings of papillomatosis, buttressing and anastomosing rete ridges and a dense dermal lymphocytic infiltrate point more in favor toward VP. Detecting solitary keratotic plaques with a psoriasiform histology should allow clinicians to consider the possibility of PK.","PeriodicalId":42454,"journal":{"name":"Turk Dermatoloji Dergisi-Turkish Journal of Dermatology","volume":"66 1","pages":"19 - 27"},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76284413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION Verruca plana, especially on the face, is a disease that can cause cosmetic and social concerns, leading patients to seek therapy. Commonly used treatment options include cryotherapy, topical retinoids, imiquimod, salicylic acid, topical immunotherapies, photodynamic therapy, etc. However, these therapeutic options may have various side effects, such as hyperpigmentation, edema, scarring, itching, and pain.[1,2] Therefore, there is a need for new effective treatment options with better cosmetic results. CASE REPORT A 23-year-old woman presented to our clinic with a 1-year history of multiple verruca, increasing in number over time. Dermatologic examination revealed skin-colored papules with flat tops on the backs of the hands, arms, shoulders, neck, and face [Figure 1]. She was unresponsive to other treatments. Thus, we applied solely blue light phototherapy with a wavelength of 420 nm and a distance of approximately 15 cm to the area [Figure 2]. A total of 10 sessions were applied twice weekly, each session lasting 20 min. No side effects were observed. After 10 sessions, all lesions were completely regressed [Figure 3]. Written informed consent was obtained from the patient before the application.Figure 1: Grouped skin-colored flat papules on the left jawline (black arrow)Figure 2: Blue light phototherapyFigure 3: Several papulopustular acne vulgaris lesions in the malar region, with regression of previously existing papules on the left jawlineDISCUSSION AND CONCLUSION Various treatments are used for verruca plana in clinical practice. However, no treatment has been proven to be 100% effective.[3,4] Therefore, new treatment modalities are being sought that will provide effective and cosmetically better results. The mechanisms of action of blue light include a decrease in keratinocyte and fibroblast proliferation, as well as the ability to cause regression of human papilloma virus by regulating T-cell functions and cytokine release through chromophores that can be found in its own structure.[5] In our case, the regression of the existing lesions in a short period of time (5 weeks), obtaining a good cosmetic result, having an easy application method without the need for any photosensitizer, being inexpensive, and having a low risk of side effects support the consideration of blue light as a possible treatment option for verruca plana. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
{"title":"A case of verruca plana juvenile responding to blue light phototherapy","authors":"Hüseyin Baytimur, Aslı Bilgiç","doi":"10.4103/tjd.tjd_60_23","DOIUrl":"https://doi.org/10.4103/tjd.tjd_60_23","url":null,"abstract":"INTRODUCTION Verruca plana, especially on the face, is a disease that can cause cosmetic and social concerns, leading patients to seek therapy. Commonly used treatment options include cryotherapy, topical retinoids, imiquimod, salicylic acid, topical immunotherapies, photodynamic therapy, etc. However, these therapeutic options may have various side effects, such as hyperpigmentation, edema, scarring, itching, and pain.[1,2] Therefore, there is a need for new effective treatment options with better cosmetic results. CASE REPORT A 23-year-old woman presented to our clinic with a 1-year history of multiple verruca, increasing in number over time. Dermatologic examination revealed skin-colored papules with flat tops on the backs of the hands, arms, shoulders, neck, and face [Figure 1]. She was unresponsive to other treatments. Thus, we applied solely blue light phototherapy with a wavelength of 420 nm and a distance of approximately 15 cm to the area [Figure 2]. A total of 10 sessions were applied twice weekly, each session lasting 20 min. No side effects were observed. After 10 sessions, all lesions were completely regressed [Figure 3]. Written informed consent was obtained from the patient before the application.Figure 1: Grouped skin-colored flat papules on the left jawline (black arrow)Figure 2: Blue light phototherapyFigure 3: Several papulopustular acne vulgaris lesions in the malar region, with regression of previously existing papules on the left jawlineDISCUSSION AND CONCLUSION Various treatments are used for verruca plana in clinical practice. However, no treatment has been proven to be 100% effective.[3,4] Therefore, new treatment modalities are being sought that will provide effective and cosmetically better results. The mechanisms of action of blue light include a decrease in keratinocyte and fibroblast proliferation, as well as the ability to cause regression of human papilloma virus by regulating T-cell functions and cytokine release through chromophores that can be found in its own structure.[5] In our case, the regression of the existing lesions in a short period of time (5 weeks), obtaining a good cosmetic result, having an easy application method without the need for any photosensitizer, being inexpensive, and having a low risk of side effects support the consideration of blue light as a possible treatment option for verruca plana. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.","PeriodicalId":42454,"journal":{"name":"Turk Dermatoloji Dergisi-Turkish Journal of Dermatology","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135749571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dear Editor, Warts of the nail unit are commonly seen in daily dermatology practice. Although, various treatments such as topical salicylic and lactic acids and 5-fluorouracil, cryotherapy, and electrosurgery are frequently used in the treatment of warts, they may not be effective in some cases and can cause permanent nail deformity.[1-3] Because of these difficulties, alternative treatment options are increasing in the literature. Application of bleomycin with the prick technique is an effective and good treatment for nail unit warts.[1-3] Herein, we report two cases of nail unit warts which were resistant to previous therapies and treated successfully with bleomycin using the prick technique. CASE 1 A 19-year-old female patient admitted to our outpatient clinic with periungual and subungual warts, which had been present for two years on her right thumb nail and resistant to many topical treatments and cryotherapy sessions. Following failure of these therapies, intralesional bleomycin with the prick technique was planned for the patient. The vial containing 15 mg of powdered bleomycin sulfate was diluted with 15 mL of physiological saline. The nail unit was cleaned with povidone iodine. Approximately 0.5 mL of 2% lidocaine was injected bilaterally into the proximal and lateral nail fold junction and along with the lateral nail folds for local anesthesia (distal wing block) and after that a tourniquet was applied to prevent bleeding [Figure 1A]. After the bleomycin solution was dripped onto the wart with an insulin injector [Figure 1B], a large number of holes were drilled with a 27-gauge sterile syringe needle with 1 mm intervals (prick technique), allowing the drug to penetrate into the wart [Figure 1C]. The procedure was performed for two sessions with four-week intervals. Between sessions, the bleomycin solution was stored in the refrigerator at 4°C. In the follow-up of the patient at 12th week, the nail unit wart was completely healed [Figure 1D].Figure 1: (A) Distal wing block and tourniquet application. (B) Bleomycin application as drops onto the wart. (C) Puncturing into the wart with a syringe. (D) Follow-up of the patient at 12th week with complete resolutionCASE 2 A 36-year-old female patient to our outpatient clinic with periungual and subungual warts on her left thumb nail, which had been present for ten years [Figure 2A]. In her history, several methods were applied to the warts. After a punch biopsy which ruled out squamous cell carcinoma, bleomycin treatment with the prick technique was planned for the patient.Figure 2: (A) 36-year-old female patient with periungual and subungual warts on her left thumb nail. (B) Follow-up of the patient at 12th week with complete resolutionWith the method described in the first case, 1 IU/mL bleomycin was administered with prick technique for three sessions. In the follow-up at 12th week, the wart was completely healed [Figure 2B]. Bleomycin has antiviral and antitumoral activities by inhibiting
{"title":"An effective treatment method in periungual and subungual warts: Bleomycin application with prick technique","authors":"Hande Yelgen, SezgiS Solak","doi":"10.4103/tjd.tjd_58_23","DOIUrl":"https://doi.org/10.4103/tjd.tjd_58_23","url":null,"abstract":"Dear Editor, Warts of the nail unit are commonly seen in daily dermatology practice. Although, various treatments such as topical salicylic and lactic acids and 5-fluorouracil, cryotherapy, and electrosurgery are frequently used in the treatment of warts, they may not be effective in some cases and can cause permanent nail deformity.[1-3] Because of these difficulties, alternative treatment options are increasing in the literature. Application of bleomycin with the prick technique is an effective and good treatment for nail unit warts.[1-3] Herein, we report two cases of nail unit warts which were resistant to previous therapies and treated successfully with bleomycin using the prick technique. CASE 1 A 19-year-old female patient admitted to our outpatient clinic with periungual and subungual warts, which had been present for two years on her right thumb nail and resistant to many topical treatments and cryotherapy sessions. Following failure of these therapies, intralesional bleomycin with the prick technique was planned for the patient. The vial containing 15 mg of powdered bleomycin sulfate was diluted with 15 mL of physiological saline. The nail unit was cleaned with povidone iodine. Approximately 0.5 mL of 2% lidocaine was injected bilaterally into the proximal and lateral nail fold junction and along with the lateral nail folds for local anesthesia (distal wing block) and after that a tourniquet was applied to prevent bleeding [Figure 1A]. After the bleomycin solution was dripped onto the wart with an insulin injector [Figure 1B], a large number of holes were drilled with a 27-gauge sterile syringe needle with 1 mm intervals (prick technique), allowing the drug to penetrate into the wart [Figure 1C]. The procedure was performed for two sessions with four-week intervals. Between sessions, the bleomycin solution was stored in the refrigerator at 4°C. In the follow-up of the patient at 12th week, the nail unit wart was completely healed [Figure 1D].Figure 1: (A) Distal wing block and tourniquet application. (B) Bleomycin application as drops onto the wart. (C) Puncturing into the wart with a syringe. (D) Follow-up of the patient at 12th week with complete resolutionCASE 2 A 36-year-old female patient to our outpatient clinic with periungual and subungual warts on her left thumb nail, which had been present for ten years [Figure 2A]. In her history, several methods were applied to the warts. After a punch biopsy which ruled out squamous cell carcinoma, bleomycin treatment with the prick technique was planned for the patient.Figure 2: (A) 36-year-old female patient with periungual and subungual warts on her left thumb nail. (B) Follow-up of the patient at 12th week with complete resolutionWith the method described in the first case, 1 IU/mL bleomycin was administered with prick technique for three sessions. In the follow-up at 12th week, the wart was completely healed [Figure 2B]. Bleomycin has antiviral and antitumoral activities by inhibiting ","PeriodicalId":42454,"journal":{"name":"Turk Dermatoloji Dergisi-Turkish Journal of Dermatology","volume":"82 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135749583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Psoriasis is a chronic inflammatory disorder and is associated with obesity, diabetes mellitus, and hypertension. There is an increased expression of inflammatory cytokines (interleukin [IL]-17, tumor necrosis factor [TNF]-α, IL-22, vascular endothelial growth factor [VEGF]) in the serum of psoriasis patients. Serum levels of IL-10, another anti-inflammatory cytokine, have been found at varying values in psoriasis in different regions of the world. Aims and Objectives: The aim of this article is to assess the serum IL-10 and serum VEGF in psoriasis patients with no co-morbidities and healthy controls. Materials and Methods: This study was conducted on 46 serum samples (23 psoriasis subjects and 23 healthy controls). After informed consent, 3 mL of serum was obtained and stored at -70°C. The samples were quantitatively assessed for VEGF-A and IL-10 by the enzyme-linked immunosorbent assay. Results: This study revealed that the mean (±SD) value of serum VEGF in cases was significantly higher than that in controls (cases = 235.21 ± 138.71; controls = 104.73 ± 36.01 pg/mL). However, levels of serum IL-10, although increased in cases (2.37 ± 1.61 pg/mL) when compared with controls (1.64 ± 0.89 pg/mL), showed no statistical significance. Conclusion: In this study, serum VEGF and IL-10 levels were increased in psoriasis when compared with controls but were not significantly related to the Psoriasis Area and Severity Index. The significant correlation between serum VEGF and IL-10 levels in cases when compared with controls suggests their role in the pathogenesis of psoriasis. Persistently increased values in psoriasis patients may lead to the development of comorbidities.
{"title":"Relevance of serum vascular endothelial growth factor (VEGF) and serum interleukin-10 in the severity of psoriasis in South Indian patients: A case–control study","authors":"D. Patil, T. Sumathy, A. Shyamprasad","doi":"10.4103/tjd.tjd_46_22","DOIUrl":"https://doi.org/10.4103/tjd.tjd_46_22","url":null,"abstract":"Background: Psoriasis is a chronic inflammatory disorder and is associated with obesity, diabetes mellitus, and hypertension. There is an increased expression of inflammatory cytokines (interleukin [IL]-17, tumor necrosis factor [TNF]-α, IL-22, vascular endothelial growth factor [VEGF]) in the serum of psoriasis patients. Serum levels of IL-10, another anti-inflammatory cytokine, have been found at varying values in psoriasis in different regions of the world. Aims and Objectives: The aim of this article is to assess the serum IL-10 and serum VEGF in psoriasis patients with no co-morbidities and healthy controls. Materials and Methods: This study was conducted on 46 serum samples (23 psoriasis subjects and 23 healthy controls). After informed consent, 3 mL of serum was obtained and stored at -70°C. The samples were quantitatively assessed for VEGF-A and IL-10 by the enzyme-linked immunosorbent assay. Results: This study revealed that the mean (±SD) value of serum VEGF in cases was significantly higher than that in controls (cases = 235.21 ± 138.71; controls = 104.73 ± 36.01 pg/mL). However, levels of serum IL-10, although increased in cases (2.37 ± 1.61 pg/mL) when compared with controls (1.64 ± 0.89 pg/mL), showed no statistical significance. Conclusion: In this study, serum VEGF and IL-10 levels were increased in psoriasis when compared with controls but were not significantly related to the Psoriasis Area and Severity Index. The significant correlation between serum VEGF and IL-10 levels in cases when compared with controls suggests their role in the pathogenesis of psoriasis. Persistently increased values in psoriasis patients may lead to the development of comorbidities.","PeriodicalId":42454,"journal":{"name":"Turk Dermatoloji Dergisi-Turkish Journal of Dermatology","volume":"1 1","pages":"6 - 10"},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90689176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Özge Kaya, Nesrin Demir, Zeynep Keskinkaya, Sevilay Oğuz Kiliç, Alper Ekinci, Ümit Karadeli
INTRODUCTION Rosacea is a chronic inflammatory cutaneous disorder that usually occurs in adults between 20 and 50 years old.[1-3] The etiopathogenesis of rosacea is poorly understood. Genetic predisposition, environmental triggers, immune dysregulation, inflammatory reactions to cutaneous microorganisms, neurovascular dysregulation, and vascular dysfunction are the possible underlying factors. Various triggers are known to aggravate rosacea symptoms, such as ultraviolet exposure, diet, smoking, alcohol consumption, obesity, and stress.[4-7] In addition, rosacea has been associated with several disorders such as inflammatory bowel disease, malignancies, metabolic, autoimmune, allergic, urogenital, and cardiovascular disease (CVD).[8,9] However, there is no clear explanation for these associations. The chronic inflammatory nature of rosacea and the vascular dysfunction in its pathogenesis might play a central role in the development of comorbid disorders.[8] Salusin-alpha (α) and salusin-beta (β) are mediators that were first identified in the human embryo and are expressed in a variety of tissues, including vascular tissues.[10] In studies conducted on psoriasis vulgaris, rheumatoid arthritis (RA), and CVD, it has been reported that salusin levels differed in patient groups compared with the controls.[11-13] Thus, there may be changes in salusin levels in rosacea, as well. Interleukin (IL)-35 and IL-39 are recently discovered ILs belonging to the IL-12 family.[14,15] IL-35 generates an immunosuppressive effect by increasing T-regulatory (Treg) cell proliferation and inhibiting T-helper (Th) 17 cell differentiation.[15] IL-39 is another proinflammatory cytokine whose expression is increased in some chronic inflammatory skin disorders such as psoriasis and atopic dermatitis.[16] To the best of our knowledge, the salusin-α, salusin-β, IL-35, and IL-39 levels have not been studied in patients with rosacea. We aimed to define the relationship between the levels of salusin-α, salusin-β, IL-35, IL-39, and rosacea. MATERIALS AND METHODS Fifty patients with rosacea who were followed up at 2–3 months intervals in our tertiary dermatology outpatient clinic were enrolled in the study as the patient group, whereas 50 subjects from a similar age group were included in the control group. None of the subjects in the patient group had received topical or systemic treatment for rosacea. The exclusion criteria were tobacco consumption (including passive smoking), history of any chronic inflammatory disorder, known malignancy or active acute/chronic infection, and use of corticosteroids or other immunosuppressive therapy. Written and verbal consent of the patients, who voluntarily agreed to participate, was taken before the study. Serum samples were obtained from the patients and the control group from the venous blood. Salusin-α, salusin-β, IL-35, and IL-39 were studied by enzyme-linked immunosorbent assay method. The test results were statistically compared between
{"title":"The role of salusins and interleukin 12 family in the rosacea pathogenesis","authors":"Özge Kaya, Nesrin Demir, Zeynep Keskinkaya, Sevilay Oğuz Kiliç, Alper Ekinci, Ümit Karadeli","doi":"10.4103/tjd.tjd_36_23","DOIUrl":"https://doi.org/10.4103/tjd.tjd_36_23","url":null,"abstract":"INTRODUCTION Rosacea is a chronic inflammatory cutaneous disorder that usually occurs in adults between 20 and 50 years old.[1-3] The etiopathogenesis of rosacea is poorly understood. Genetic predisposition, environmental triggers, immune dysregulation, inflammatory reactions to cutaneous microorganisms, neurovascular dysregulation, and vascular dysfunction are the possible underlying factors. Various triggers are known to aggravate rosacea symptoms, such as ultraviolet exposure, diet, smoking, alcohol consumption, obesity, and stress.[4-7] In addition, rosacea has been associated with several disorders such as inflammatory bowel disease, malignancies, metabolic, autoimmune, allergic, urogenital, and cardiovascular disease (CVD).[8,9] However, there is no clear explanation for these associations. The chronic inflammatory nature of rosacea and the vascular dysfunction in its pathogenesis might play a central role in the development of comorbid disorders.[8] Salusin-alpha (α) and salusin-beta (β) are mediators that were first identified in the human embryo and are expressed in a variety of tissues, including vascular tissues.[10] In studies conducted on psoriasis vulgaris, rheumatoid arthritis (RA), and CVD, it has been reported that salusin levels differed in patient groups compared with the controls.[11-13] Thus, there may be changes in salusin levels in rosacea, as well. Interleukin (IL)-35 and IL-39 are recently discovered ILs belonging to the IL-12 family.[14,15] IL-35 generates an immunosuppressive effect by increasing T-regulatory (Treg) cell proliferation and inhibiting T-helper (Th) 17 cell differentiation.[15] IL-39 is another proinflammatory cytokine whose expression is increased in some chronic inflammatory skin disorders such as psoriasis and atopic dermatitis.[16] To the best of our knowledge, the salusin-α, salusin-β, IL-35, and IL-39 levels have not been studied in patients with rosacea. We aimed to define the relationship between the levels of salusin-α, salusin-β, IL-35, IL-39, and rosacea. MATERIALS AND METHODS Fifty patients with rosacea who were followed up at 2–3 months intervals in our tertiary dermatology outpatient clinic were enrolled in the study as the patient group, whereas 50 subjects from a similar age group were included in the control group. None of the subjects in the patient group had received topical or systemic treatment for rosacea. The exclusion criteria were tobacco consumption (including passive smoking), history of any chronic inflammatory disorder, known malignancy or active acute/chronic infection, and use of corticosteroids or other immunosuppressive therapy. Written and verbal consent of the patients, who voluntarily agreed to participate, was taken before the study. Serum samples were obtained from the patients and the control group from the venous blood. Salusin-α, salusin-β, IL-35, and IL-39 were studied by enzyme-linked immunosorbent assay method. The test results were statistically compared between","PeriodicalId":42454,"journal":{"name":"Turk Dermatoloji Dergisi-Turkish Journal of Dermatology","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135749586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Oral isotretinoin is one of the most frequently used treatment options in moderate and severe acne. Abnormal laboratory results may occur during the treatment and there may be differences in approach to these abnormal laboratory results among dermatologists. Aim: In this study, we aimed to retrospectively evaluate the differences in approach to abnormal laboratory results and treatment modifications of dermatologists during oral isotretinoin treatment. Materials and Methods: Data of 207 patients who had oral isotretinoin treatment for acne between January 2013 and October 2020 were included in this study. Baseline and follow-up laboratory results were reviewed. All treatment modifications were noted and evaluated with relevant literature. Results: Among 207 patients, 28 (13.5%) had treatment modifications due to the abnormal laboratory results, and all of them were due to elevation of lipid and liver enzyme levels. The dose was reduced in 24 (11.6%) patients and the treatment was discontinued in 4 (1.9%) patients. Treatment modification was not compulsory in the vast majority of patients (26 of 28) according to the relevant literature. Conclusion: The results of the present study showed that unnecessary treatment modifications due to the abnormal laboratory results can be made by dermatologists during oral isotretinoin treatment for acne. Educational programs for dermatologists and more detailed guidelines may prevent these unnecessary treatment modifications.
{"title":"Evaluating the differences among dermatologists’ approaches to abnormal laboratory results of patients using oral isotretinoin treatment for acne","authors":"S. Sarıkaya Solak, Hande Yelgen, İmran Boğa","doi":"10.4103/tjd.tjd_58_22","DOIUrl":"https://doi.org/10.4103/tjd.tjd_58_22","url":null,"abstract":"Background: Oral isotretinoin is one of the most frequently used treatment options in moderate and severe acne. Abnormal laboratory results may occur during the treatment and there may be differences in approach to these abnormal laboratory results among dermatologists. Aim: In this study, we aimed to retrospectively evaluate the differences in approach to abnormal laboratory results and treatment modifications of dermatologists during oral isotretinoin treatment. Materials and Methods: Data of 207 patients who had oral isotretinoin treatment for acne between January 2013 and October 2020 were included in this study. Baseline and follow-up laboratory results were reviewed. All treatment modifications were noted and evaluated with relevant literature. Results: Among 207 patients, 28 (13.5%) had treatment modifications due to the abnormal laboratory results, and all of them were due to elevation of lipid and liver enzyme levels. The dose was reduced in 24 (11.6%) patients and the treatment was discontinued in 4 (1.9%) patients. Treatment modification was not compulsory in the vast majority of patients (26 of 28) according to the relevant literature. Conclusion: The results of the present study showed that unnecessary treatment modifications due to the abnormal laboratory results can be made by dermatologists during oral isotretinoin treatment for acne. Educational programs for dermatologists and more detailed guidelines may prevent these unnecessary treatment modifications.","PeriodicalId":42454,"journal":{"name":"Turk Dermatoloji Dergisi-Turkish Journal of Dermatology","volume":"55 1","pages":"16 - 18"},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80289257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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