Background: To investigate the relationships among nail disorders, various clinical factors, and commonly used quality of life scales. Methods: A prospective cross-sectional study was conducted on 188 patients older than 18 years who applied to the Dermatology and Venereology Department of Ufuk University Hospital (Ankara, Turkey). The Turkish Quality of Life instrument, the Hospital Anxiety and Depression Scale, and the 36-Item Short-Form Health Survey were used for the analyses. Eight groups were formed based on 1) sex, 2) age (18-45 years, >45 years), 3) duration of nail disease (#1 year, >1 year), 4) number of affected nails (1, 2, >= 3), 5) type of nail disease (nail thickening, ingrown toenail, pincer nail, and other nail diseases), 6) presence of onychomycosis, 7) fingernail involvement, and 8) pain score (0-5, 6-10), and the quality of life scales were compared between these groups. In addition, correlation analyses were performed between age, number of affected nails, duration of disease, presence of onychomycosis, chronic diseases and medications, and body mass index and the quality of life scale scores. Results: Nail disorders were associated with decreased quality of life in affected individuals. Moreover, age, duration of disease, type of nail disorder, body mass index, comorbid conditions, and pain scores had significant effects on quality of life scale scores. Conclusions: Management of nail disorders is challenging, and generally, a long period is necessary to achieve favorable outcomes. Both physcians and patients should be persistent during the treatment process. In addition, emotional and social support should be provided to patients.

Background: We evaluated the clinical characteristics of ingrown toenails in one of the big -gest reference centers in Turkey.Methods: This retrospective cohort study was conducted on patients admitted to Ufuk University Hospital with ingrown toenail between January 1, 2014, and December 31, 2019. Clinical characterstics and demographic features of all of the participants were evaluated, and then the study population was divided into two groups: group 1 (patients #20 years old) and group 2 (patients >20 years old). These groups were compared in terms of clinical findings.Results: Disease duration, body mass index, rate of medications for chronic diseases, and rate of joint diseases were significantly higher in group 2. Rates of hyperhidrosis and sudden weight gain were significantly higher in group 1 (P < .05). Severity of ingrown toenail was significantly different between groups (P = .006). Stage 1 was the most common stage in both groups, and rate of stage 3 was higher in group 1. Onycoshisis and was more common in group 1, and nail thickening was more common in group 2 (P < .05). Nail wire and aluminum chloride were the most common treatment modalities in groups 2 and 1, respectively (P < .05). Periungual edema, presence of pus, hypertrophy, and granulation were more common in group 1 (P < .05). Thin nail plate was more common in group 1, and normal and thick nail nail plates were more common in group 2 (P < .05). Conclusions: Clinical characteristics of ingrown toenail vary between younger and older populations. Thus, an individualized approach is preferred in the management of ingrown toenail for different age groups. (J Am Podiatr Med Assoc 112(4), 2022)

BACKGROUND/AIM:To evaluate the correlation of systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) with disease severity in recurrent aphthous stomatitis (RAS). METHODS:The present retrospective cohort study was performed on patients with RAS. Patients were divided into three groups: 1) Major (n = 75), 2) Minor (n = 123), and 3) Herpetiform aphthae (n = 17). The study groups were compared in terms of demographic features, acute phase proteins, and complete blood cell count parameters. Moreover, correlation analyses were performed for the correlation of ulcer severity score (USS) with C-reactive protein (CRP), SII, erythrocyte sedimentation rate (ESR), ferritin, dNLR, NLR, and PLR. RESULTS:Significantly higher values were observed for USS, neutrophil count, ferritin, SII, NLR, and dNLR (p < 0.05 for all) in the major and herpetiform aphthae groups compared to the minor aphthae group. Positive, strong, significant correlations were observed between USS, SII, and NLR (r = 0.80 for SII, r = 0.74 for NLR and p < 0.001 for both). Positive, moderate, significant correlations were observed between USS, PLR, ESR, and CRP (r = 0.54 for PLR, r = 0.39 for ESR, r = 0.36 for CRP, and p < 0.001 for all). Positive, weak, significant correlations were observed between USS, dNLR, and ferritin (r = 0.13 and p = 0.05 for ferritin, r = 0.27 and p < 0.001 for dNLR). CONCLUSION:Higher values of SII, NLR, dNLR, and PLR were associated with disease severity in patients with RAS.

Background Alopecia areata (AA) and generalized form, universalis (AU) are common causes of noncicatricial alopecia, targeting anagen hair follicles. A dominant interferon-gamma transcriptional signaling and cytotoxic T lymphocytes were accused as the main drivers of disease pathogenesis. Tofacitinib is a Janus kinase inhibitor that has been proven to interfere with the positive feedback loop between the follicular cell and the cytotoxic T lymphocytes in AA. There is an increasing number of studies reporting success with tofacitinib in AA. Aims We aimed to assess oral tofacitinib's safety and efficacy in 13 recalcitrant AA and AU patients. Methods This is a retrospective pilot study performed between 2017 and 2020. The demographic features and the treatment responses were evaluated with Severity of Alopecia Tool score changes. Results Thirteen recalcitrant alopecia areata patients (3 AA, 10 AU), aged between 17 and 49, were included in the study. The treatment duration was 3-15 months. All three AA patients responded well; however, the therapy was unsuccessful in five of ten AU patients. Relapse was observed in one of the AA and three of the AU responders. Acneiform lesions and elevation of transaminases were the major side effects. Conclusion Tofacitinib seems to be more promising and thriving in the treatment of AA than AU. Starting the therapy earlier can bring more successful results. Unfortunately, even in the cases that fully respond to treatment, relapse can be observed after discontinuation of the treatment. It is essential to inform patients about this situation in reducing the frustrations that may occur later.

Objective Pathogenesis of Behcet disease (BD) has not yet been clearly revealed and there is no ideal test for the estimation of disease activation at present. This study aimed to assess the efficiencies of IgG/IgM and IgA/C3 ratios in determining activation of BD. Method This retrospective cohort study consisted of 140 patients with BD. Patients were divided into two groups: (1) active BD (n = 89) and (2) inactive BD (n = 51) and were compared in terms of demographic features, clinical characteristics and laboratory test results. IgA/C3 and IgG/IgM ratios were compared according to organ system involvement; receiver operating characteristic (ROC) curve analysis was performed in order to assess the performance of IgA/C3 and IgG/IgM ratios in determining patient disease status. Results Significantly higher levels of erythrocyte sedimentation rate, C-reactive protein, IgA, G, C4, IgA/C3, IgG/IgM ratios (p = .007 for IgA and p < .001 for others) and significantly lower levels of IgM and C3 were observed in patients with active BD (p < .001). The IgG/IgM ratio was significantly higher in patients with vascular involvement (p = .017) and the IgA/C3 ratio was significantly higher in patients with arthritis (p = .007). Cut-off values of 0.019 (70.8% sensitivity, 62% specificity) and 7.08 (84.3% sensitivity, 80% specificity) were determined for IgA/C3 and IgG/IgM ratios, respectively. Conclusion IgA/C3 and IgG/IgM ratios may be used as additional parameters for the assessment of BD status.

BACKGROUND:To evaluate the perspectives of dermatology specialists and residents on coronavirus disease 2019 (COVID-19) vaccines.METHODS:Present questionnaire-based study was conducted on dermatology residents and specialists between January 5 and 20. A non-validated online questionary evaluating the attitude of the participants about the COVID-19 vaccine was performed. In the first step of the study, data related to the demographic features, all participants' clinical characteristics, and working conditions were recorded. Thereafter answers given to 12 specific questions were recorded. The study population was divided into two groups: dermatology residents (n = 138) and specialists (n = 159). Mentioned variables were compared between the two defined groups. Furthermore, a correlation analysis was performed to assess the relationship between vaccination acceptance and various study parameters.RESULTS:Majority of the cases had positive attitudes against COVID-19 vaccines. However, there were significant differences between the resident and specialist groups related to the source of information, working conditions, degree of concern, and type of vaccines. Statistically significant negative, weak correlations were observed for age and duration of medical practice (r = -.128, P = .028; r = -.132, P = .041 respectively). Statistically significant positive weak correlations were observed for chronic diseases, level of knowledge about COVID-19 vaccines, number of information sources about COVİD-19, and previous COVİD-19 infection (r = .133, P = .021; r = .207, P < .001; r = .335, P < .001; r = .176, P = .002 respectively).CONCLUSION:The acceptance of COVID-19 vaccination may be affected by working conditions, medical experience, level of knowledge and the presence of risk factors for severe disease among dermatology residents and specialists.

Background Onychocryptosis, frequently termed ''ingrown toenail'' is a common foot problem in routine dermatology and orthopaedic clinical practice which leads to pain and disability. Although the aetiology of ingrown toenail is not well understood various associated risk factors have been identified with the pathogenesis. Material and methods This study was a retrospective investigation of 170 patients with hallux valgus and lateral border ingrown toenail of all stages. The patients were compared with a control group. The radiologic assessment in both groups included right hallux valgus angle, left hallux valgus angle, right first and second intermetatarsal angle, and left first and second intermetatarsal angle. Results There were 121 female and 49 male patients in the case group and 68 female and 32 male in the control group. The mean age of the case group was 41.1 years and 41.1 years in the control group. A statistically significant difference was found between the case and the control groups in terms of the right hallux valgus angle variable. Conclusion The abnormal hallux valgus angle and the abnormal intermetatarsal angle plays an important role in ingrown toenail aetiology. The X-rays of the feet should be performed to determine the susceptibility of the patients who are admitted to the hospital for ingrown toenail in order to prevent other toes ingrown toenail and for planning the treatment of the patients with an ingrown toenail.

The objective of this paper is to evaluate the attitudes of patients with various dermatologic diseases towards coronavirus disease (COVID-19) vaccines. The present questionnaire-based study was conducted on patients admitted to the outpatient clinic of the Department of Dermatology and Venereology, Ufuk University Hospital, between January 1 and 31, 2021. The study population was divided into two groups based on their ages: (1) < 40 age group (n = 188) and (2) ≥ 40 age group (n = 111), and answers given to 35 specific questions were compared between the groups. The older group had significantly higher levels of anxiety compared to the younger group (p = 0.017). Although approximately 60% of cases in the older group were dedicated to being vaccinated, 40% of the younger participants were not sure about vaccination (p < 0.001). The most frequently demanded vaccine types were the inactivated and mRNA vaccines in the elderly and young groups, respectively (p < 0.001). Statistically significant positive weak correlations were observed for age, chronic disease of medication, and presence of severe COVID 19 cases in the environment (r = 0.125 p = 0.031, r = 0.184 p = 0.001, r = 0.122 p = 0.035, respectively). Dermatologic patients had generally positive attitudes towards COVID-19 vaccination, and their preferences were affected by age.

Objectives:We aimed to share our data on Behçet's disease (BD) collected in the last fourteen years (demographic and clinical characteristics of the patients) and to update our knowledge on BD by comparing it with the results of similar studies conducted in our country.Materials and Methods: This is a retrospective study conducted by examining the clinical and demographic characteristics of a total 197 patients, including 111 females and 86 males, who were admitted to the Ufuk University Dermatology and Venereal Diseases Polyclinic between January 2006 and January 2020 and who were diagnosed with BD according to the International BD Study Group Criteria (IBSG) and taken into the follow-up system in our BD Center.Results: One hundred eleven female and eighty-six male patients between the ages of 16 and 65 years were included in the study.The ratio of 10 men/women in patients was 0.77.The mean age of the patients at the time of presentation was 37.38±13.91years, and the mean age at onset of disease was 27.07±9.77years.Oral aphthae were observed in 100% of the patients because the IBSG criteria were used.Family history was positive in 20.8%.Genital ulcer was detected in 71%, erythema nodosum in 43.6% and papulopustular lesions in 54.3%.Pathergy test was positive in 42.6% of the patients.Eye involvement was detected in 38.8% of the patients, articular in 21.3%, vascular in 7.6%, gastrointestinal in 0.5% and pulmonary in 1.5%.Conclusion: BD is a multisystemic disease, morbidity of which can be reduced and mortality of which can be prevented with early diagnosis and treatment.Due to the high prevalence in our country and the fact that it is a disease that requires a multidisciplinary approach, the number of experienced centers that will deal with the disease in every aspect should be increased.

Ingrown nail is a common nail disorder. Being a painful entitiy and having various types render treatment difficult. Although medical guidelines often mention surgical treatments more and more conservative treatment options are being introduced and arc preferred by patients. Correction of risk factors leading to development of ingrown nails will lead conservative treatments to reach lasting results.

The aim of this study was to evaluate the changing trends in dermatology clinical practice at a tertiary center during the coronavirus disease 2019 (COVID-19) pandemic. This retrospective cohort study was conducted on patients who were admitted to Ufuk University Hospital with dermatologic complaints/diseases before and during the pandemic. The patients were divided into two groups: (a) the pre-pandemic period (March-May 2019) and (b) the Pandemic period (March-May 2020). Demographic features, clinical characteristics, dermatologic diseases/complaints, dermatologic procedures/interventions, hospitalization rate, and use of biologic agents were compared between the two groups. Total number of hospital admissions have decreased from 1165 to 717. Admission rates for acne, dermatophytosis, and benign neoplasm of the skin significantly lower during the pandemic period (Pvalues were .02, .04, and .006, respectively). Contact dermatitis, acne accompanying dermatitis, cicatricial hair loss, lichen planus, and zona zoster infection rates were significantly higher (Pvalues were .007, <.001, .009, .04, and .03, respectively). Rates of biopsy and electrocautery procedures were decreased significantly (Pvalues were <.001 and .002, respectively). The hospitalization rate was similar between the groups (P= .51). However, the use of biologic agents significantly decreased during the pandemic period (P= .01). Updated clinical protocols should be established for the new normal period in accordance with these findings.

Citation: Gd Y?ld?r?m D. Erdo?an FG, Kaya B, Do?an H. Solitary bullous mastocytoma with dermoscopic features in a neonate. Dermatol Pract Concept. 2019;9(4):302-303. DOI: https://doi.org/10.5826/dpc.0904a12

Chronic spontaneous urticaria can be treated with several drugs such as antihistamines, leukotriene antagonists, cyclosporine, doxepin, hydroxychloroquine, colchicine, and corticosteroids. However, treatment-resistant urticaria significantly reduces quality of life. In recent years, omalizumab has been considered to be an effective treatment option in treatment-resistant cases. We aimed to investigate the clinical efficacy of omalizumab in urticaria and its possible association with serum IgE levels, total eosinophil counts, and basophil percentages. Medical records of 11 patients with chronic spontaneous urticaria treated with omalizumab were reviewed retrospectively. Treatment response, urticaria activity score, serum basophil percentages, eosinophil, and IgE levels evaluated before and at the end of the therapy. Ten patients healed completely with omalizumab. One patient did not respond to therapy. No correlation was observed between serum IgE levels and treatment outcome. However, serum eosinophil levels decreased and basophil percentages increased with omalizumab treatment. Omalizumab is a safe and effective treatment choice in patients with chronic spontaneous urticaria. We suggest that omalizumab may have an effect in the treatment of urticaria through eosinophils.

Aims and Objectives: The aim of this study was to identify the fungal agents causing onychomycosis that were unresponsive to antifungal treatment and to treat these cases by placing under-nail cushions with a mild keratolytic to clear the fungus-invaded tissue. Materials and Methods: Fungal agents were identified by the matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) technique. Results: Nine patients had Aspergillus spp. (7 Aspergillus niger,2 Aspergillus flavus); four had Candida species and one had Trichophyton rubrum. All patients were free of infection at the end of treatment. Conclusion: As per the results, we may state that onychomycosis that is unresponsive to treatment in immunocompetent patients seems to be mostly associated with molds. Direct application of a mild keratolytic to the fungus-invaded part, e.g., the nail plate and/or nail bed and removal of fungal elements may provide a successful treatment outcome.

Objective: Narrow-band ultraviolet B (NB-UVB) is a proven treatment modality in the management of psoriasis, inflammatory skin diseases and pigmentation disorders. However, recurrence is an important problem both for the patient and the clinician. The long-term effects of narrow-band ultraviolet B treatment on different dermatological indications cause concern. The aim of this study is to evaluate the effectiveness and the recurrence rates of the NB-UVB treatment in several dermatological diseases. Material and Methods: A total of 126 patients aged 18 years or older who received narrow-band ultraviolet B treatment due to various indications were included in the study. Treatment response and recurrence rates were retrospectively evaluated and compared in different disease groups. In addition, a statistical comparison was made between the recurrent and non-recurrent groups in terms of some variables that might affect relapse. Results: Complete remission, partial remission and unresponsiveness were detected in 74.6%, 13.5% and 11.9% of the patients respectively. The mean follow up period was 27.3±23.8 months. Recurrence was observed in 46.8% of patients with complete remission. Of the patients who developed recurrence, 59.1% had psoriasis, 13.6% mycosis fungoides, 13.6% atopic dermatitis, 6.8% vitiligo and 6.8% idiopathic pruritus. Conclusion: Based on our study findings, narrow-band ultraviolet B treatment may reduce the relapse rate in all dermatoses when scheduled in the early period. In addition to its widespread use in the treatment of psoriasis, it would be beneficial to consider narrow-band ultraviolet B as an effective treatment method in patients with idiopathic pruritus in the long-term period.

Rota, Didem D MD; Tamer, Funda MD; Onder, Meltem MD; Erdogan, Fatma Gulru MD; Yildirim, Dilsun MD Author Information

Behçet's disease is a rare disorder of unknown etiology that is classified as a systemic vasculitis.The prevalence of the disease is high in countries in the Far East, Mediterranean Basin, and East Asia.Thus, it is also known as the Silk Road Disease.Behçet's disease is characterized by recurrent oral aphthous ulcers, genital sores, and ocular lesions.However, it can present with severe clinical manifestations as a result of cardiovascular system, central nervous system, and gastrointestinal tract involvement.The disease causes serious complications, morbidity, and mortality, especially in male patients with early age onset.Here we present a rare case of Behçet's disease exhibiting multiple organ involvement in a 26-year-old Caucasian female.

Objectives: Skin biopsy is a diagnostic tool that dermatologist often use in the differential diagnose.However depending on many factors sometimes it may be insufficient for definitive diagnosis.In this study it is aimed to evaluate retrospectively the clinicopathological compliance of skin biopsies from adult patients who applied to our dermatology outpatient clinic.Materials and Methods: Two hundred thirty three patients who have been performed skin biopsy and pathological examination over 18 years were included.The compliance between the pathology result and the each preliminary diagnose were evaluated.Statistical comparison was done in terms of age, gender, biopy site between groups with and without clinicopathological compliance.Results: Clinicopathological consistency ratio was determined as 89.7%.When dermatoses were classified clinicopathological consistency was detected with first prediagnose in 154 patient, with second prediagnose in 77 patients, with third prediagnose in 41 patients and with fourth prediagnosis in 11 patients.Consistency between pathological diagnosis and first, second, fourth prediagnose was revealed mostly in papülosquamous disease group and consistency between pathological diagnose and third prediagnose was revealed mostly in dermatitis group.No statistically meaningful difference was detected between gruops with and without clinicopathological consistency in terms of age, gender and biopsy type. Conclusion:In the light of our study findings, clinicopathological consistency seems to be high especially in papulosquamous diseases.We think that this compatibility can be improved in all dermatoses by using the skin biopsy method more effective with cooperation of clinician and pathologist.

Onychomycosis is a common disorder which is characterized with thickness and discoloration of nails. It accounts for the half of the nail disorders. Diabetic patients are particularly susceptible to fungal infections due to modifications that occur in their immunological system. Studies detected an increased risk among all three major groups of organisms that can cause onychomycosis in diabetic patients: dermatophytes, yeasts, and non-dermatophyte molds . We present a case of onychomycosis due to Aspergillus flavus 41-year-old male patient with diabetes mellitus and pancreas cancer because of the improvement of nails after chemotherapy with 5-Fluorouracil.