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   Table of Contents - Current issue
Coverpage
April-June 2020
Volume 14 | Issue 2
Page Nos. 29-60

Online since Tuesday, June 16, 2020

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REVIEW ARTICLE  

Brain–skin connection: The contemporary perspective through neuroendocrinology p. 29
Ayşenur Botsali, Osman Köse
DOI:10.4103/TJD.TJD_44_19  
This review summarizes the novel and precious data on the direct effects of ancient neuroendocrinologic molecules on the skin and hair and additionally the active production of these hormones by resident skin cells. The data are extracted from PubMed using the keywords neuroendocrinology, hormones, skin, hair follicle, pituitary, hypothalamus, thyroid, and prolactin. The most important neuroendocrinologic axis is composed of corticotropin-releasing hormone, adrenocorticotropic hormone, and cortisol (CRH–ACTH–cortisol) and is related to stress. The CRH–ACTH–cortisol axis is demonstrated to be fully functional in the skin. This review furthermore points out to a possible neuroendocrinologic mechanism likely to explain the association between psychological stress and skin and hair diseases.
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ORIGINAL ARTICLES Top

Confusing acquired macular pigmentation of unknown etiology in children: Retrospective analysis of 10 years in single tertiary center p. 35
Selcen Kundak, Yasemin Çakır
DOI:10.4103/TJD.TJD_3_20  
Acquired Macular Hyperpigmentation: Ashy dermatosis (AD), lichen planus pigmentosus (LPP), erythema dyschromicum perstans (EDP), and idiopathic eruptive macular pigmentation (IEMP) are the spectrum of acquired macular pigmentation of unknown etiology (MPUE). The aim of this study is to investigate and reevaluate our pediatric patients who had clinically and histopathologically been diagnosed with aforementioned disorders, in consideration of the global consensus statement on acquired MPUE. Materials and Methods: A retrospective chart review of 23 pediatric cases that had applied to the dermatology unit between the years 2007 and 2017 and diagnosed with any of the acquired macular pigmentation was performed. Results: Of 23 patients, 16 were diagnosed with AD, 4 with LPP, and 3 with IEMP. In AD patients, major site of presentation at onset was the trunk (13/16) and brownish (15/16) were the most prominent coloring. Dermal melanophages (16/16), perivascular lymphohistiocytic infiltrate (14/16), and pigment incontinence (7/16) were the most prominent features. Upper limbs (3/4) were the most predilection area in LPP patients. Perivascular lymphohistiocytic (4/4), lichenoid infiltration (3/4), basal vacuolar degeneration (4/4), and dermal melanophages (4/4) were observed. The trunk was the major site of presentation (3/3) in IEMP patients. Brownish (2/3) and ashen-gray (1/3) was the coloring of lesions. Basal layer pigmentation (3/3) and dermal melanophages (3/3) were the most prominent findings. No basal vacuolar changes (0/3) were observed. Conclusion: Clinical and histopathological distinction between these conditions is challenging. We reevaluated our patients in this context. We predict that we have achieved more accurate terminology with the global consensus statement. Such a terminology might allow that these disorders may be compared with a collective terminology in the literature.
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The relationship between direct immunofluorescence findings and clinical and laboratory parameters in patients with cutaneous small vessel vasculitis p. 42
Duygu Gulseren, Ece Erbağcı, Özay Gököz, Nilgün Atakan
DOI:10.4103/TJD.TJD_13_20  
Objective: Cutaneous small-vessel vasculitis (CSVV) is a disease characterized histologically by leukocytoclastic vasculitis (LCV) and immune-complex deposition in small vessel walls. We aimed to evaluate the type of deposited immune complexes in patients with LCV and to determine the relationship between the immune-complex types and clinical and laboratory parameters. Materials and Methods: Patients who had been diagnosed as LCV histopathologically between 2000 and 2018 were retrospectively evaluated. Patients' medical records and pathology databases were reviewed to determine the demographic characteristics, clinical, laboratory, and histopathological findings. Direct immune fluorescence (DIF) findings to determine the immune-complex subtypes, including immunoglobulin A (IgA), immunoglobulin M (IgM), immunoglobulin G (IgG) or C3 deposition, were evaluated. Results: Sixty-eight patients were included in the study. A total of 36 (53%) patients had deposition in the perivascular or vessel walls, with at least one of IgA, IgM, IgG, or C3. IgA deposition was detected in 29 (42.6%) patients, IgM in 13 patients (19.1%), IgG in four patients (5.9%), and C3 in 31 patients (45.6%). Clinical features of the patients, including triggering factors, extracutaneous involvement, lesion localization, and skin findings, were compared with DIF findings. It was found no statistically significant difference between DIF-positive and DIF-negative groups (P > 0.05, for all). There was also no statistically significant difference in terms of laboratory findings between the groups (P > 0.05, for all). Conclusions: Our study showed that DIF findings did not play a role in determining the clinical findings, and they did not affect laboratory parameters in CSVV.
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Assessment of acne rosacea prevalence and quality of life between individuals aged 18 years and over in mahmudiye district center, Eskisehir, Turkey (A population-based study) p. 48
Gulsum Ozturk Emiral, Ozkan Ozay, Didem Arslantas, Alaettin Unsal, Isil Bulur, Hilal Kaya Erdogan
DOI:10.4103/TJD.TJD_14_20  
Objective: The aim of this study was to determine the prevalence of acne rosacea among adults, examine some related variables and evaluate the quality of life. Methods: This cross-sectional study including 2226 individuals with an age of 18 years old-above who lived in Mahmudiye-Eskisehir, Turkey. The study group was visited in their houses individually and agreed to participate the study. The researchers completed the survey forms during face-to-face interviews, performed the examinations. The Short Form-36 scale was used to assess the quality of life. The Chi-square, Mann-Whitney U test, Logistic Regression Analysis were used in the statistical analyses. Results and Conclusions: Of the study group 910 (40.9%) were male. Their ages ranged from 18-95 years (Mean age: 47.2±16.7). The prevalence of acne rosacea was 22.6% (n = 504). Being over the age of 55, obesity, primary school or lower education, history of complaints related to the face, family history of acne rosacea and personal history of head and/or neck treatment were identified as important risk factors for acne rosacea. Participants with acne rosacea had low quality of life based on the physical function subscale. It may be useful to perform intermittent screening, directing suspect cases to a specialist physician for early diagnosis- treatment and raise awareness.
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CASE REPORTS Top

A case of pemphigus vulgaris developing after platelet-rich plasma treatment p. 55
Ali Haydar Eskiocak, Cumhur İbrahim Başsorgun, Soner Uzun
DOI:10.4103/TJD.TJD_24_20  
Platelet-rich plasma (PRP) which is peripheral blood originated product contains high concentrated platelet and many growth factors. It has been used in dermatology for many indications, including alopecias and chronic nonhealing wounds. Pemphigus vulgaris (PV) is a chronic autoimmune bullous disease of the skin and mucous membranes. We report a case of PV induced after the treatment of PRP for female pattern hair loss. The first lesions of PV occurred on the application site of PRP in this case. The diagnosis of mucocutaneous PV was established according to the clinical, cytological, and serological findings. Many physical agents and drugs were reported to induce PV. As far as is known, there is no PRP-related PV case in the literature. An in vitro study demonstrated that PRP may trigger the acantholysis in a genetically susceptible patient and may lead to pemphigus. Virtually, there is no enough evidence showing PRP to cause pemphigus. However, PRP treatment should be performed carefully in such patients.
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A case of acrodermatitis enteropathica misdiagnosed as staphylococcal scalded skin syndrome p. 57
Priyanka Borde Bisht, Aradhana Sood
DOI:10.4103/TJD.TJD_23_20  
Acrodermatitis enteropathica (AE) is a rare genetic autosomal recessive disorder, characterized by periorificial dermatitis, alopecia, and diarrhea due to zinc deficiency. We report a case of a 9-month-old baby boy with hair loss for 2 months, diarrhea for 1.5 months, skin peeling starting around mouth, nose, anus, gradually spreading all over body over 1 month, and fever for 10 days. Due to superadded bacterial infections and altered clinical picture, he was diagnosed as a case of staphylococcal scalded skin syndrome. With low serum zinc levels and improvement of skin lesions and diarrhea within 8 days of starting oral zinc therapy, it was confirmed to be a case of acrodermatitis enteropathica. It is important to consider AE as one of the differential diagnoses in pediatric chronic diarrhea cases with acral and/or periorificial skin lesions to prevent delay in the zinc supplementation treatment and mortality.
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