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REVIEW ARTICLE
Propionibacterium acnes (Cutibacterium acnes) and acne vulgaris: The latest updates of antimicrobial activity
Kaya Suer, Meryem Güvenir
April-June 2019, 13(2):57-59
DOI:10.4103/TJD.TJD_5_19  
Propionibacterium acnes is commonly recognized for its acne pathogenesis. P. acnes produces chemotactic substances and activates the complement system. Resistant P. acnes strains were explained more than 40 years ago. For that reason, new antimicrobial agents for the topical treatment of skin infections have been researched, and it has been determined that plant extracts may be an alternative treatment for acne. In this review, antimicrobial studies of P. acnes have been reviewed.
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ORIGINAL ARTICLES
Internalized stigma in patients with acne vulgaris, vitiligo, and alopecia areata
Asli Bilgiç Temel, Selen Bozkurt, Yesim Senol, Erkan Alpsoy
July-September 2019, 13(3):109-116
DOI:10.4103/TJD.TJD_14_19  
Background: Internalized stigma, another aspect of stigma, is the adoption of negative attitudes and stereotypes of the society regarding people's illness. Aims and Objectives: The primary aim of this study was to investigate the internalized stigma state of acne vulgaris (AV), vitiligo, and alopecia areata (AA) patients and to identify the factors influencing internalized stigma. Materials and Methods: A total of 150 patients (50 AV, 50 vitiligo, and 50 AA) who applied to the outpatient clinic were consecutively enrolled in this study. The sociodemographic characteristics of the patients were recorded. In addition, patients answered the Internalized Stigma Scale (ISS), the Dermatology Life Quality Index, the Perceived Health Status, the General Health Questionnaire, and the Acne Quality of Life Scale. Results: In this study, the Cronbach's alpha coefficient for the whole ISS scale was calculated as 0.91 for AV, 0.91 for vitiligo, and 0.93 for AA. Conclusion: The present study indicates that patients with AV, AA, and vitiligo internalize the negative stereotype judgment of the society for themselves. High levels of internalized stigma in the studied patients presented a parallel trend to the negative quality of life (QoL). Therefore, internalized stigma may be one of the major factors affecting the QoL in these diseases.
  2,296 305 1
An effective and practical diagnostic clinical method in primary scarring alopecia: Dermoscopy
Omer Faruk Elmas
April-June 2019, 13(2):72-76
DOI:10.4103/TJD.TJD_7_19  
Objective: There are several studies on the dermoscopy of the cicatricial alopecia. When the national literature is reviewed, however, only one original study focusing on the subject exists. Here, we aimed to investigate the dermoscopic features of the patients with primary cicatricial alopecia. Materials and Methods: In this study, dermoscopic findings of 40 patients with clinical and histopathological diagnosis of primary cicatricial alopecia were retrospectively reviewed. Dermoscopic examination was performed by a handheld dermoscope with 10-fold magnification. Photographing was performed using a dermoscope attached to a cell phone camera with 2-fold digital zoom. Results: Tubular perifollicular scale in lichen planopilaris (n = 12), cutaneous clefts with emerging hairs and three-dimensional yellow dots in dissecting cellulitis (n = 6), tufted hairs in folliculitis decalvans (n = 6), and follicular plugs and branching vessels in discoid lupus erythematosus (n = 6) were the main findings. No characteristic finding was found for pseudopelade of Brocq (n = 8) and frontal fibrosing alopecia (n = 2). Conclusion: Dermoscopy is a noninvasive, effective, and practical diagnostic tool for the differential diagnosis of primary cicatricial alopecia. The retrospective nature, lack of a control group, and relatively small number of the patients are the main limitations of our study.
  2,148 273 -
The efficacy of interfollicular epidermal stem cells versus bone marrow-derived mesenchymal stem cells in cutaneous wound healing in diabetic rats
Osman Kose, Aysel Pekel
July-September 2019, 13(3):117-122
DOI:10.4103/TJD.TJD_20_19  
Objective: Many sources of stem cells, such as bone marrow stem cells, embriyonic stem cells, adipose-derived stem cells, epidermal stem cells were used extensively for diabetic wound healing. This study investigated whether interfollicular epidermal stem cell versus bone marrow-derived mesenchymal stem cell effectiveness in the enhancement of diabetic wound healing. Methods: The streptozotocin-induced Spraque-Dowley rats with 5 mm punch biopsy were used. Rats were divided into three groups: group I diabetic controls receiving no stem cells; group II, rats receiving bone marrow-derived mesenchymal stem cells; group III, rats receiving interfollicular epidermal stem cells. Wound healing was assessed clinically that regarding healing time and wound size. Results: Clinical results showed that wound size was significantly reduced in mesenchymal and interfollicular epidermal stem cell-treated groups as compared with controls. Complete wound-healing times were 19.4±2.85 days in bone marrow-derived mesenchymal stem cells group versus 20.3±3.45 days in interfollicular epidermal stem cells group and 24.7±4.17 in the control group. In the measurement of the wound area, there were no significant differences between the bone marrow-derived mesenchymal stem cells group (P=0.115) and interfollicular epidermal stem cells group (P=0.085). Conclusions: Interfollicular epidermal stem cells were found as effective as bone marrow-derived mesenchymal cells in the treatment of the diabetic wound.
  2,152 257 -
Depression in patients with functional itch disorder
Melike Kibar Ozturk, Semaniye Karabacak
April-June 2019, 13(2):77-82
DOI:10.4103/TJD.TJD_4_19  
Objective: Patients with pruritus sine materia (PSM) are often misdiagnosed as idiopathic pruritus (pruritus of unknown origin) when the cause of pruritus is not found. Some of these patients may be diagnosed with functional itch disorder (FID) which is also known as psychogenic pruritus (pruritus of psychological origin). Since antidepressants can be used in the treatment of psychogenic pruritus, the differentiation of FID from idiopathic pruritus is important. The aim of this study was to investigate the prevalence of depression in patients with FID. Materials and Methods: A total of 117 patients with FID who were diagnosed as idiopathic pruritus or PSM in their previous assessments and 117 controls took part in the research. The psychiatric assessment for depression was conducted using the Beck Depression Inventory (BDI) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) major depression criteria. The study employed a descriptive and cross-sectional method. Results: Forty-four patients with FID (37.6%) had major depression (DSM-5) and 74 patients with FID (63.2%) had clinically significant depression (BDI). The frequency of depression among FID patients was significantly higher than controls. Conclusions: Our findings highlight the importance of diagnosing FID in patients with PSM. The presence of FID diagnostic criteria in a patient should prompt dermatologists for a psychiatry consultation.
  2,073 218 -
Dermoscopic features of cutaneous leishmaniasis lesions
Naime Eroglu, Isa An, Mustafa Aksoy
July-September 2019, 13(3):103-108
DOI:10.4103/TJD.TJD_9_19  
Objective: This study aimed at determining the dermoscopic characteristics of cutaneous leishmaniasis (CL) and comparing these characteristics to the previous results. Materials and Methods: The prospective study included a total of 225 lesions from 69 patients with the ages between 1 and 70 years who were admitted to our dermatology clinic between March 1, 2016, and August 1, 2016, diagnosed with CL using smears of skin lesions, and did not receive any previous antileishmanial treatment. Results: When the lesions were dermoscopically examined for their general characteristics, the most common findings were erythema (100%), teardrop-like structures (59.1%), and hyperkeratosis (53.3%). The most common vascular structures in the lesions were linear vessels (50.2%), dotted vessels (39.6%), and hairpin-like vessels (32.9%). Conclusion: Our data were comparable to those of the previous studies in literature. Although there is no specific dermoscopic feature specific to CL, we presume that dermoscopic findings may contribute to differential diagnosis in the presence of clinically similar cutaneous lesions.
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LETTER TO THE EDITOR
Bleomycin therapy using multipuncture technique for resistant warts
Asli Bilgic, Ayse Akman-Karakas
April-June 2019, 13(2):91-93
DOI:10.4103/TJD.TJD_11_19  
  1,866 225 -
REVIEW ARTICLE
Statins role in vitiligo: A mini-review
Hayder M Al-Kuraishy, Nawar R Hussian, Marwa S Al-Naimi, Ali I Al-Gareeb
January-March 2020, 14(1):1-7
DOI:10.4103/TJD.TJD_38_19  
Vitiligo is a chronic acquired disease of pigmentation disorder. Melanocytes damage and hypopigmentation relate to the induction of oxidative and autoimmune disorders. Different previous studies illustrated the possible role of statins in the treatment of different types of vitiligo. Therefore, objective of this study was to elucidate the role of statins in the management of vitiligo. In general, an endeavor of this study article was to present a mini-review regarding the potential therapeutic effect of statins in the therapy of vitiligo. Results of the present study illustrated that statins inhibit the production of interferon gamma, expression of major histocompatibily complex, and T-cells activation in patients with active vitiligo. Statins have significant anti-inflammatory and immune-modulating activates in different modalities of vitiligo. Statins, have a potential effect against oxidative stress through the activation of anti-oxidant capacity and reduction of ROS in human melanocytes by upregulation of nuclear erythroid 2-related factor in the melanocytes. Statins improve melanogenesis in melanocytes though increasing tyrosinase mRNA production and augment the stimulatory effect of α-melanocyte-stimulating hormone from the pituitary gland on the melanocytes. Finally, statins therapy may produce significant inhibition of inflammatory reactions through the inhibition of chemokines. In conclusion, this study highlighted the potential role of statins in the treatment of vitiligo either systemic or localized through significant suppressions of oxidative stress, autoimmunity, and inflammatory reactions. Bidirectional effects of statins on oxidative and autoimmunity/inflammatory pathway making it as a novel therapy for vitiligo.
  1,821 256 3
ORIGINAL ARTICLES
Comparison of serum dehydroepiandrosterone sulfate, testosterone, and dihydrotestosterone levels in males with various degrees of acne vulgaris severity
Arif Widiatmoko, Tantari Sugiman, Taufiq Hidayat, Krisna Ariaputra, Firmina Kus Setianingrum, Dhini Indah Nugriaty
April-June 2019, 13(2):60-64
DOI:10.4103/TJD.TJD_12_19  
Objective: This study compared the levels of dehydroepiandrosterone (DHEA) sulfate, testosterone, and dihydrotestosterone (DHT) in the serum of men with various degrees of severity grading of acne vulgaris. Methods: We conducted a cross-sectional analytic observational study and used the Combined Acne Severity Classification. Serum DHEA sulfate (DHEAS), testosterone, and DHT levels were measured by enzyme-linked immunosorbent assay. We recruited 63 males with acne vulgaris. Results: For mild, moderate, or severe acne, the mean serum level of DHEAS was 90.92, 153.54, and 166.67 ng/ml (P = 0.000); testosterone was 6.66, 8.11, and 8.97 ng/ml (P = 0.445); and DHT was 87.33, 111.72, and 124.71 (P = 0.01), respectively. Post hoc analysis showed significant differences for DHEAS and DHT serum levels. There were significant differences for DHEAS and DHT serum levels. Conclusion: There was no significant difference in serum testosterone levels between groups, although there was an increase in concentration by acne vulgaris severity.
  1,818 246 -
Quality of life in Turkish patients with autoimmune blistering diseases: Reliability and validity of the autoimmune bullous disease quality of life and the treatment of autoimmune bullous disease quality of life questionnaires
Asli Bilgic-Temel, Ceren Irican, Soner Uzun, Grant Y.H. Feng, Dedee F Murrell, Ayse Akman-Karakas
April-June 2019, 13(2):83-90
DOI:10.4103/TJD.TJD_16_19  
Background: The Autoimmune Bullous Disease Quality of Life (ABQOL) and the Treatment of Autoimmune Bullous Disease Quality of Life (TABQOL) questionnaires, which are specific for autoimmune blistering diseases (AIBDs), were developed in Australia. Aims and Objectives: The aim of this study was to validate the Turkish version of the ABQOL and TABQOL questionnaires and to assess the reliability of them in the Turkish population. Materials and Methods: The Turkish versions of the ABQOL and TABQOL questionnaires were produced by forward–backward translation of the original English version. The patients were requested to complete ABQOL and TABQOL questionnaires on day 0 and after 7 days for a 2nd time sent by post. Furthermore, patients also completed other health-related quality of life scales on day 0. Results: A total of 68 patients with AIBDs were recruited. A subset of 20 (29.4%) patients completed the day 7 questionnaire. Both the Turkish versions of the ABQOL and TABQOL questionnaires had a high internal consistency (0.86 and 0.88, respectively) and test–retest reliability (0.87 and 0.87, respectively). The correlation between ABQOL and TABQOL scores was moderate (Pearson's R = 0.609). Conclusion: We have shown that the Turkish versions of ABQOL and TABQOL questionnaires are valid and reliable instruments. They can be used to measure treatment burden in Turkish AIBD patients.
  1,796 253 -
Dermoscopy of oral labial mucosa according to age and sex in healthy adults: first observational dermoscopic study
Erhan Ayhan, Murat Öztürk, Isa An, Eşref Araç
October-December 2019, 13(4):135-139
DOI:10.4103/TJD.TJD_33_19  
Background/Aim: Information on dermoscopy of the labial mucosa is limited to dermoscopic examination of several dermatological diseases of the labial mucosa. In this study, we investigated whether dermoscopic features of labial mucosa differ in age and sex in healthy individuals. Materials and Methods: The study included 152 healthy individuals (76 females and 76 males) aged between 20 and 83 years who applied to the outpatient dermatology department. For the evaluation of dermoscopic features, the patients were divided into two groups as age under 40 years (Group 1) and over 40 years (Group 2). Dermoscopic data were analyzed by age and sex. Results: In Group 1, clear reticular arrangement (40.4% vs. 13.8%, P = 0.001) and honeycomb appearance (7.4% vs. 0%, P = 0.033) were significant. In Group 2, mixed reticular arrangement (61.7% vs. 82.8%, P = 0.006), grouped hairpin vessels (48.9% vs. 69%, P = 0.016), yellow background areas (87.2% vs. 98.3%, P = 0.018), dotted vessels (33% vs. 62.1%, P = 0.000), matchstick hairpin vessels (6.4% vs. 19%, P = 0.017), microaneurysm (3.2% vs. 32.8%, P = 0.000) were significant. While clear reticular arrangement and purple areas were more common in females, mixed reticular pattern and grouped hairpin vessels were more frequent in males. Conclusion: In this study, significant differences were found in dermoscopic features according to age and sex in healthy individuals. These results will serve as the basis for studies on the effect of systemic diseases on oral labial mucosa and studies on localized mucosal diseases.
  1,710 272 -
Where are we in cosmetics and esthetics practices in educational clinics in Turkey?
Ezgi Ozkur, Emre Kaynak, Mehmet Salih Gürel
July-September 2019, 13(3):95-98
DOI:10.4103/TJD.TJD_6_19  
Objective: Cosmetic dermatology has recently gained importance with the recent increase in demand. The aim of this study is to identify cosmetic dermatology training in Turkey and to assess instructors' attitudes toward cosmetic dermatology training during residency and current cosmetic dermatology practices. Methods: This is a cross-sectional questionnaire study conducted with instructors to investigate the practice of cosmetics dermatology, the technical equipments, number of patients, and their ideas in the clinics that provide dermatology specialty education in Turkey. Results: At least one cosmetic procedure was found to be performed in 69% of the clinics that participated in the study (n = 55), and no cosmetic procedure was performed in 31% of the clinics. The mean number of application was 13.2 ± 12.3 weekly in the clinics that performed cosmetics procedure. The most common procedures were botulinum toxin injection with 63.6% (n = 35), chemical peeling with 60% (n = 33), and platelet-rich plasma with 60% (n = 33), respectively. The most common laser application was neodymium-doped yttrium aluminum garnet (28/55). The mean time spent for cosmetic procedures was 1–5 h weekly in the clinics which performed cosmetic procedures. Seventy-six percent (n = 42) of the participants felt inadequate for performing cosmetics procedures, and 95% (n = 52) reported that cosmetic dermatology education was required. Conclusions: Both theoretical and practical education must be given in educational clinics, and the infrastructure must be created, and the educational schedule must be standardized.
  1,700 246 1
Comparison of serum Cyclooxygenase-2 level between Melasma and Nonmelasma patients in Dr. Saiful Anwar General Hospital, Malang, Indonesia
Sekar Puspita Lilasari, Santosa Basuki, Sinta Murlistyarini
April-June 2019, 13(2):65-71
DOI:10.4103/TJD.TJD_13_19  
Background: Melasma is the hypermelanosis skin disease on the sun exposed area. Ultraviolet exposure leads to inflammation in the epidermis and dermis, one of which is marked by an increase in Cyclooxygenase-2 (COX-2). COX-2 expression involves in the production of prostaglandin-E2 (PGE2) that take part in tyrosinase activation and melanogenesis. Aims and Objectives: This study aimed to determine the differences in serum COX-2 levels in melasma and non-melasma patients in Dr. Saiful Anwar General Hospital Malang, Indonesia. Materials and Methods: A cross-sectional study using continuous sampling in melasma and non-melasma patients at the Dermatology and Venereology out-patient clinic from November to December 2017. The COX-2 serum levels examined by ELISA method. Results: From the 23 melasma and 23 non-melasma subjects, the mean value of serum COX-2 levels in the melasma and nonmelasma groups was not significantly different (P > 0.05) with value of 82.23±61.08U/L and 52.66±28.62 U/L, respectively. Those might be influenced by the other unknown variables who were not included in this study. Based on Melasma Severity Score (MSS), serum COX-2 levels differed significantly in moderate severity (49.55±14.26 U/L) and severe (112.1±72.32 U/L) (P > 0.05) might related to the capacity of the enzyme that induces epidermal hyperpigmentation. Conclusion: There were differences in COX-2 levels in melasma and non-melasma patients, but the difference was not statistically significant. However, there is a tendency that as the COX-2 level increases, so as the severity of melasma. Therefore, the severity of melasma possibly influenced by inflammation markers.
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Histopathological findings in patients with lipoid proteinosis
Isa An, Muhammet Emin Güldür, Mustafa Aksoy, Yavuz Yeşilova, Murat Ozturk
July-September 2019, 13(3):99-102
DOI:10.4103/TJD.TJD_8_19  
Objective: Lipoid proteinosis (LP) is a rare autosomal recessive genodermatosis characterized by the accumulation of amorphous hyaline substance in the skin and mucous membranes. In this study, the histopathological findings of the patients who were admitted to our clinic and diagnosed with LP were examined. Materials and Methods: This prospective study included 18 patients who presented to our clinic between January 2014 and December 2018 and were confirmed by histopathological examination. A punch biopsy including epidermis, dermis, and subcutaneous tissues was obtained from the lesional skin of each patient evaluated clinically, and the material was stained with hematoxylin and eosin stain and periodic acid–Schiff (PAS) stain. These preparations were evaluated by a pathologist experienced in dermatopathology. Results: The most common histopathological findings in the epidermis were hyperkeratosis (88.8%) and pigmentary incontinence (83.3%) in the basal layer. The most common histopathological findings in the dermis were amorphous substance accumulation (100%), perivascular PAS positivity (33.3%), and PAS positivity around eccrine glands (11.1%). Conclusion: The findings of our study were similar to the histopathological findings of late-term skin lesions in LP patients previously described in the literature. In order to better understand the histopathological findings of skin lesions of LP patients, studies with a large number of patients including early skin lesions of LP are needed.
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Parents' knowledge about sun exposure and a comparison of their personal practices versus those used to protect their children against the sun
Ezgi Ozkur, Tuǧba Falay Gür, Sevil Savaş Erdoǧan, Ilknur Kıvanç Altunay
January-March 2020, 14(1):8-13
DOI:10.4103/TJD.TJD_35_19  
Objectives: Overexposure to the sun during childhood is a well-known risk factor for skin cancer. Childhood is a crucial period for establishing and continuing to develop healthy sun protection behaviors. The purpose of our study was to investigate parents' knowledge and compare their personal behaviors in regard to sun protection for themselves and for their children. Materials and Methods: We conducted a cross-sectional population-based study. A questionnaire was given to 738 parents, 700 of whom completed the questionnaire and were included in the study. Results: Among the 700 parents, 88% (n = 616) were female and 12% (n = 84) were male. The mean age of the parents and children was 35.1 ± 5.6 years and 5.2 ± 3.0 years, respectively. Eighty-three percent (n = 580) of the parents were aware of sun exposure during childhood as a risk factor for skin cancer, but approximately only 15% of the parents reported using sunscreen regularly for themselves and for their children. Fifty-two percent (n = 367) of the parents implied not using any protective clothing for their children. Conclusion: Our study showed that parents were aware of the risks of sun exposure and the need for sun protection for themselves and children, but protective practices were low overall. Parents should be included in educational interventions targeting sun protection behaviors toward themselves and their children.
  1,620 234 -
The effect of smoking on oral labial mucosa: A controlled dermoscopic study
Erhan Ayhan, Isa An, Murat Özt ürk, Esref Araç
January-March 2020, 14(1):14-17
DOI:10.4103/TJD.TJD_41_19  
Background/Aim: Although the effects of smoking on large blood vessels are known, research on the effects of smoking on microcirculation continues. In this study, we investigated whether the dermoscopic features of the labial mucosa of smokers differed from the healthy control group. Materials and Methods: In this study, 164 patients (82 smokers and 82 nonsmokers) aged between 20 and 75 years who were admitted to the dermatology department were included. Dermoscopically obtained data were analyzed. Results: Hemorrhagic dot (48.8% vs. 26.8%, P: 0.004), matchstick hairpin vessels (37.8% vs. 15.9%, P: 0.002), microaneursym (35.4% vs. 18.3%, P: 0.014), targetoid brown round areas (37.8% vs. 19.5%, P: 0.010), white dot (22% vs. 9.8%, P: 0.033), and hyperkeratosis (37.8% vs. 18.3%, P: 0.005) were found to be significant in terms of dermoscopic features.Conclusion: In this study, we think that structures such as hemorrhagic dot, matchstick hairpin vessels, microaneursym, which are found to be high in smokers, may be caused by microcirculation disorders.
  1,590 237 -
Thiol/disulfide homeostasis in patients with telogen effluvium: is oxidative stress important in the pathogenesis of telogen effluvium?
Unsal Savci, Mustafa Sahin, Engin Senel, Aynure Oztekin, Umran Muslu, Mustafa Sungur, Salim Neselioglu, Ozcan Erel
October-December 2019, 13(4):131-134
DOI:10.4103/TJD.TJD_26_19  
Objective: The aim of this study was to assess the correlation between telogen effluvium (TE) with the new oxidative stress (OS) indicator of thiol/disulfide balance and to research the role of OS in the pathogenesis of TE. Methods: Our study included 101 patients with TE diagnosis and 39 healthy individuals. Serum thiol/disulfide was measured with a new automated spectrometric method developed by Erel and Neselioglu, and results were compared statistically. Results: Among the six thiol/disulfide parameters, there were statistically significant differences for native thiol, total thiol, disulfide, disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol studied in the patient and control groups (P = 0.042, 0.044, <0.001, 0.013, 0.026, and < 0.001, respectively). Conclusions: Based on the results of this study, it can be said that OS is closely associated with TE pathogenesis. There is a need for new studies that will show the possible effects of OS on TE pathogenesis and research different OS markers in addition to thiol/disulfide parameters.
  1,529 274 1
Effectiveness of combined 10,600 nm fractional CO2and 1540 nm erbium GaAs laser therapy on acne scar score alteration in patients with atrophic acne scars
Erien Afrinia Asri, Retno Indar Widayati, Dian Adriani Malik
October-December 2019, 13(4):126-130
DOI:10.4103/TJD.TJD_25_19  
Aim: The aim of this study is to determine the effectiveness of combined 10,600 nm fractional CO2and 1540 nm erbium GaAs laser therapy on atrophic acne scars. Subjects and Methods: The design of this study was pre- and post-test on patients with atrophic acne scars before and after receiving the combination laser therapy of fractional CO2and erbium GaAs. The sample size consisted of 20 medical records. The Acne Goodman-Baron Scar Score was used to score acne scars, which included morphology, quantity, depth, and width of the acne scars. The therapy was administered three times at 1-month intervals. The power and wavelength of the laser were adjusted based on the degree of the severity of the acne scar in each patient. The data were analyzed the hypothesis statistically using the Wilcoxon test, using the SPSS for Windows program, version 16.0. Results: There were significant differences (P = 0.007) between the means of the Goodman–Baron acne scar scores before and after combined 10,600 nm fractional CO2and 1540 nm erbium GaAs laser therapy. Side effects occurred in 50% of patients, where 35% experienced erythema and 15% experienced pruritus. Conclusion: The combination of 1540 nm erbium GaAs and 10,600 nm fractional CO2laser therapy can be effective for treating atrophic acne scars on the face, with minimal side effects. However, longer therapy sessions are required for better results.
  1,579 205 -
Prevalence of skin diseases in children admitted to mersin university school of medicine, dermatology clinic
Pinar Dursun, Guliz Ikizoglu
October-December 2019, 13(4):123-125
DOI:10.4103/TJD.TJD_1_19  
Objective: Skin disorders constitute an important problem in children living in developing countries. The aim of the study was to evaluate the prevalence of skin diseases in children aged 0–16 years. Materials and Methods: In the present study, data on a total of 12,206 children aged 0–16 years, admitted to the outpatient clinic of Dermatology Department, Mersin University School of Medicine, between 2001 and 2010 were analyzed. Results: Male/female ratio was 1.1/1. 44.2% of the patients were adolescents. The most common diseases were acne (12.4%), warts (10.5%), and atopic dermatitis (9.3%). Conclusion: Studies of the pediatric population, which constitutes the cornerstone of the community, can play an important role in determining the policies of protective medicine and public health.
  1,474 252 -
Tattoos: Why do we get? What is our attitude?
Melek Aslan Kayiran, Elif Özkul, Mehmet Salih Gürel
January-March 2020, 14(1):18-22
DOI:10.4103/TJD.TJD_46_19  
Background: The inclination to get tattoos has been increasing in our country. While its history depends on the ancient past, feelings and thoughts of tattooed people about tattoos, and their awareness on complications and removal methods has not been investigated completely. Aims: Our aim is to learn the approach of individuals on tattoos and getting tattoos. Settings and Design: We have planned a cross-sectional survey study for tattooed and non-tattooed people. Materials and Methods: Twenty four multiple-choice and one open ended question were prepared for people with tattoos, and seven questions were prepared for people who don't have tattoos. Four questions were common in both groups. Statistical Analysis Used: For statistical analyses, SPSS (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp) was used. Statistical significance of the difference between common questions was determined with chi-square test, and the effect of different groups on answering the question was analyzed with Cramér's V test. p values below 0.05 were recognized as statistically significant. Results: About half of people with tattoos had their first tattoo when they were between ages 18-29, and 38.2% had a single tattoo. 16.7% of individuals got their first tattoo below age 18. Women often preferred their wrists and ankles for tattoos, while men preferred arms, neck, legs and trunk. While women preferred to get a tattoo about a loved one, men rather got tattoos to look cool. 37.7% of people who don't have tattoos said they did not get one since they might regret it later, 25.4% stated they did not get one since it did not comply with the rules of their religion. 20.2% did not like seeing tattoos in others. Conclusion: The rate of getting tattoos in minors is higher in our country compared to other countries. The majority of people who want their tattoos to be removed got tattooed when they were minors. There is a higher rate of men than women who want to get their tattoos removed. 4.2% of tattooed people regret their tattoos in the process of getting them. It was observed that tattooed people were not aware of the risk of disease transmission by getting tattooed.
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Confusing acquired macular pigmentation of unknown etiology in children: Retrospective analysis of 10 years in single tertiary center
Selcen Kundak, Yasemin Çakır
April-June 2020, 14(2):35-41
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.
  1,506 185 -
REVIEW ARTICLE
Brain–skin connection: The contemporary perspective through neuroendocrinology
Ayşenur Botsali, Osman Köse
April-June 2020, 14(2):29-34
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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CASE REPORTS
A case of acrodermatitis enteropathica misdiagnosed as staphylococcal scalded skin syndrome
Priyanka Borde Bisht, Aradhana Sood
April-June 2020, 14(2):57-60
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.
  1,154 156 -
A psoralen and ultraviolet A-aggravated dermatosis: Grover's disease
Emin Ozlu, Ayse Serap Karadag, Tugba Kevser Uzuncakmak, Seyma Ozkanli, Aysegul Erdem, Necmettin Akdeniz
January-March 2020, 14(1):25-27
DOI:10.4103/TJD.TJD_45_19  
Grover's disease (GD) is an acquired dermatosis called transient acantholytic dermatosis. The exact cause is unknown, but the factors blamed for the etiology include ultraviolet (UV), sweating, temperature rise, radiation, medications, and malignancies. Topical corticosteroids, topical retinoids, and topical calcipotriol are usually sufficient for treatment, and systemic retinoids, systemic steroids, phototherapy, and methotrexate are rarely used. The current report describes the case of GD in a female patient, which was aggravated by the psoralen and UVA phototherapy.
  1,095 175 -
Chronic tophaceous gout manifesting with bilateral diffuse pedal swelling: Cytology revisited with an update in its list of differentials
Krishnendu Mondal, Rupali Mandal
January-March 2020, 14(1):23-24
DOI:10.4103/TJD.TJD_39_19  
Gout, a disorder of purine metabolism, presents with acute or chronic arthritis and deposition of urate crystals in connective tissue and kidneys. Rarely, patients progress into chronic tophaceous gout (CTG). We emphasize on a 74-year-old male patient, who developed multiple gouty tophi over both his hands. In addition, both his feet were diffusely swollen. On detection of characteristic urate crystals from both his hands and feet lesions, the diagnosis of CTG was confirmed.
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