Impact of lipid emulsions in parenteral nutrition on platelets: a literature review

Lipid emulsions are essential components of parenteral nutrition solutions that provide energy and essential fatty acids. The complexity of the formulations of lipid emulsions may lead to adverse outcomes such as platelet reactivity and changes in platelet aggregation and related coagulation. Platelets are responsible for haemostasis; they activate and demonstrate morphological changes upon extracellular factors to maintain blood fluidity and vascular integrity. Although parenteral nutrition lipid emulsions are generally found safe with regard to modulation of platelet activity, studies are still accumulating. Thus, this review aims to investigate platelet-related changes by parenteral nutrition lipid emulsions in human studies. Studies have pointed out patients at risk of bleeding and increased platelet aggregation responses due to the administration of lipid emulsions. Lipid emulsions may further benefit patients at high risk of thrombosis due to anti-thrombotic effects and should be cautiously used in patients with thrombocytopenia. The reported platelet-related changes might be associated with the fatty acid change in the plasma membranes of platelets following changes in platelet synthesis and plasma levels of eicosanoids. In conclusion, studies investigating platelets and parenteral nutrition should be supported to minimize the adverse effects and to benefit from the potential protective effects of parenteral nutrition lipid emulsions.

Effect of Treatment With Biologic Agents on the Novel Inflammatory Biomarkers Systemic Immune Inflammation Index and Systemic Inflammation Response Index for Psoriasis

INTRODUCTION

Psoriasis is a chronic cutaneous disorder with underlying systemic inflammation. The systemic immune inflammation (SII) and systemic inflammation response indexes (SIRI) are novel biomarkers that indicate systemic inflammation.

OBJECTIVES

We aimed to evaluate the effect of biological agent treatment on SII and SIRI in psoriasis patients.

METHODS

Between April 2019 and October 2022, SII and SIRI were retrospectively evaluated in patients with psoriasis before and three months after the initiation of biological agents.

RESULTS

This study included 220 patients, 101 females and 119 males. SIRI was significantly higher in male patients compared to females (P < 0.001). Although not statistically significant, SII and SIRI were higher in obese patients, patients with severe psoriasis, longer disease duration, nail involvement and patients who received previous biological agent treatment. SII was also higher in patients with hypertension, diabetes, hepatic steatosis, depression and coronary artery disease (P = 0.801, P = 0.752, P = 0.706, P = 0.079, P = 0.861, respectively), whereas SIRI was higher in patients with diabetes and depression (P = 0.263, P = 0.777, respectively). Both SII and SIRI statistically significantly decreased after treatment with adalimumab, infliximab, ixekizumab, secukinumab, ustekinumab and risankizumab.

CONCLUSIONS

SII and SIRI may indicate the severity of psoriasis as well as SII may be associated with psoriatic arthritis, hypertension, hepatic steatosis and coronary artery disease in patients with psoriasis. There is no consensus on the biomarkers that can be used to create an optimized treatment strategy in psoriasis. Therefore, SII and SIRI may be helpful in making the choice of treatment and in the follow-up of patients with psoriasis treated with biological agents.

Triglyceride glucose index: a novel biomarker in the management of patients with psoriasis

OBJECTIVE

Triglyceride glucose index is a recently described biomarker that has been associated with various systemic disorders such as cardiovascular diseases. Within this study, we evaluated the effect of biological agent treatment on triglyceride glucose index in patients with psoriasis.

PATIENTS AND METHODS

Between April 2019 and October 2022, the triglyceride glucose index was retrospectively reviewed in patients with psoriasis before and three months after the initiation of biological agent treatment.

RESULTS

This study included 91 patients, 37 females and 54 males, with a mean age of 46.27±12.39 years. The mean triglyceride glucose index in patients with and without psoriatic arthritis was 8,137.20±5,294.01 and 6,310.04±3,341.63, respectively (p=0.047). The median triglyceride glucose index in all patients before and after biological agent treatment was 6,048 (4,597) and 5,095.5 (4,123), respectively (p=0.003). When evaluated according to the treatment groups, the decrease in triglyceride glucose index after treatment was statistically significant only in patients treated with tumor necrosis factor-alpha (TNF-α) inhibitors (p=0.026).

CONCLUSIONS

Since triglyceride glucose index has been associated with atherosclerosis in psoriasis, treatment with TNF-α inhibitors might indicate a positive impact in psoriasis patients, especially with increased risk for cardiovascular diseases. Furthermore, the triglyceride glucose index was significantly higher in patients with psoriatic arthritis compared to those without arthritis. Therefore, we suggest that triglyceride glucose index may be used as a novel diagnostic biomarker in patients with psoriatic arthritis.

Does biological agent treatment have an impact on serum uric acid levels in patients with psoriasis?

OBJECTIVE

High serum uric acid levels have been associated with psoriasis as well as cardiovascular diseases and metabolic syndrome. The aim of this study was to evaluate the effect of biologic agent treatment on serum uric acid levels in patients with psoriasis.

METHODS

Between April 2019 and September 2022, serum uric acid levels were retrospectively evaluated in patients with psoriasis before and 3 months after biologic agent treatment.

RESULTS

This study included 224 patients, 100 females and 124 males, who were treated with TNF-α, IL-17, IL-12/23, and IL-23 inhibitors. Uric acid levels were significantly higher in men compared to women (p < 0.001), higher in overweight and obese patients compared to those with normal weight (p = 0.004), and higher in patients with severe versus mild psoriasis (p = 0.028). The mean serum uric acid level decreased significantly from 5.89 ± 1.53 mg/dL to 5.41 ± 1.39 mg/dL in all patients 3 months after biological agent treatment (p < 0.001). A statistically significant decrease in serum uric acid levels was detected in patients treated with adalimumab (p < 0.001), infliximab (p = 0.002), ixekizumab (p = 0.001), secukinumab (p = 0.012), and ustekinumab (p < 0.001).

CONCLUSIONS

Since high serum uric acid levels have been associated with increased risk for cardiovascular diseases and metabolic syndrome, treatment of psoriasis with adalimumab, infliximab, ixekizumab, secukinumab, and ustekinumab may have a positive impact on cardiometabolic comorbidities.

Monocyte to high-density lipoprotein cholesterol ratio decreased in patients with psoriasis treated with ixekizumab

Background

Monocyte to high-density lipoprotein cholesterol ratio (MHR) is a novel inflammatory biomarker which has been associated with cardiovascular diseases.

Objective

To study MHR in patients with psoriasis treated with biological agents.

Methods

Between April 2019 and August 2022, MHR was retrospectively evaluated in patients with psoriasis before and 3 months after treatment with infliximab, adalimumab, etanercept, ixekizumab, secukinumab, and ustekinumab in a university hospital in Ankara, Turkey.

Results

This study included 128 patients, 53 females and 75 males. 39 (30.5%) patients were treated with infliximab, 26 (20.3%) with adalimumab, 8 (6.3%) with etanercept, 18 (14.1%) with ixekizumab, 12 (9.4%) with secukinumab, and 25 (19.5%) with ustekinumab. The median MHR was 0.0127 (0.0086-0.0165) in females and 0.0146 (0.0119-0.0200) in males (p = 0.011). The median MHR decreased after treatment with adalimumab, ixekizumab, secukinumab, and ustekinumab, whereas it increased after treatment with infliximab and etanercept (p = 0.790, p = 0.015, p = 0.754, p = 0.221, p = 0.276, p = 0.889, respectively).

Conclusion

MHR significantly decreased in patients with psoriasis after treatment with ixekizumab. Since high MHR levels have been associated with poor clinical outcomes in patients with cardiovascular diseases, ixekizumab might have a positive impact in the treatment of psoriasis patients who had cardiovascular diseases. We suggest that MHR may be useful both in establishing appropriate biological agent treatment and in the follow-up of patients with psoriasis treated with biological agents.

Characteristics of pruritus in various clinical variants of psoriasis: Final report of the binational, multicentre, cross-sectional study

BACKGROUND

Pruritus, which is the most frequent subjective symptom of psoriasis, may cause significant discomfort, embarrassment and even interfere with patients normal daily activities. However, the perception of itch in various psoriasis subtypes remains unknown.

OBJECTIVES

The aim of this study was to investigate and to characterize pruritus in different clinical variants of psoriasis.

METHODS

This cross-sectional, binational, multicentre study included 295 subjects suffering from nine different clinical subtypes of psoriasis: large-plaque psoriasis (n = 45), nummular psoriasis (n = 32), guttate psoriasis (n = 31), scalp psoriasis (n = 32), inverse psoriasis (n = 23), erythrodermic psoriasis (n = 33), palmoplantar psoriasis vulgaris (n = 33), palmoplantar pustular psoriasis (n = 42) and generalized pustular psoriasis (n = 23). Measures included sociodemographic and anthropometric data, detailed pruritus characteristics including but not limited to pruritus intensity, frequency and extend, as well as psoriasis severity.

RESULTS

The lifetime prevalence of pruritus in each clinical variant of psoriasis was similar and quite high, reaching up to 100% in some disease subtypes (i.e., nummular psoriasis, scalp psoriasis and generalized pustular psoriasis). Psoriasis severity correlated with pruritus intensity in scalp psoriasis, palmoplantar pustular psoriasis and generalized pustular psoriasis. The age, duration of psoriasis and BMI did not interfere with the intensity of itch.

CONCLUSIONS

Pruritus is highly prevalent in each clinical variant of psoriasis. However, the sensation of itch is very individual, difficult to universally describe even in the same subtype.

Tuberculosis screening guidelines should be updated and quantiferon test should be a prerequisite prior to the initiation of treatment of psoriasis with biological agents

OBJECTIVE

With the current study, we aimed at evaluating the quantiferon test results of psoriasis patients treated with biological agents.

PATIENTS AND METHODS

Between April 2019 and June 2021, medical records of patients with psoriasis who were evaluated for latent tuberculosis infection before the initiation of biological agent treatment were reviewed retrospectively.

RESULTS

This study included 132 patients, 50 (37.9%) female and 82 (62.1%) male. The mean disease duration was 16.42±10.99 years (range: 1-49 years). None of the patients had a previous history of tuberculosis. Quantiferon test was negative in 109 (82.6%) patients and positive in 23 (17.4%) patients. Patients with positive quantiferon test results were older than those who had negative quantiferon test results; the mean ages were 50.21±10.79 and 42.98±11.81 years, respectively (p=0.006).

CONCLUSIONS

Within this study, 17.4% of patients with psoriasis had positive quantiferon test results. We suggest that quantiferon test should be performed in all patients with psoriasis especially in the elderly for latent tuberculosis screening before the initiation of biological agent treatment. Moreover, we suggest that psoriasis treatment guidelines with biological agents should include detailed information on the necessity of chest radiograph, choosing tuberculin skin test or interferon gamma release assays such as quantiferon and T-spot test. In addition, controversies on the requirement of screening for latent tuberculosis and prophylactic tuberculosis treatment before the initiation of novel biological agents such as IL-17 and IL-23 inhibitors should be clarified. An international consensus on the duration of latent tuberculosis treatment and the interval between tuberculosis prophylaxis and the initiation of biological agents should be achieved.

The Impact of Pruritus on the Quality of Life and Sleep Disturbances in Patients Suffering from Different Clinical Variants of Psoriasis

Background: Quality of life (QoL) and sleep, which are essential for well-being in the mental, physical, and socioeconomic domains, are impaired in psoriatic patients. However, the exact role of the clinical subtype of psoriasis in this aspect remains poorly studied. Objectives: The aim of this study was to investigate differences in QoL impairment and sleeping problems in patients suffering from various clinical subtypes of psoriasis and to evaluate the effects of pruritus on QoL. Methods: This cross-sectional, multicenter study included 295 eligible subjects with diagnosed psoriasis. Each patient was examined with the use of the same questionnaire. Measures included predominant subtype of psoriasis, disease severity, pruritus scores, patients’ health-related QoL and the incidence of sleep disturbance. Results: The QoL of most patients was decreased irrespectively of clinical psoriasis subtype, however, the most impaired QoL was in patients with erythrodermic psoriasis. The majority of patients reported sleep disturbances caused by pruritus, albeit there was no relevant differences between analyzed subgroups in this aspect of patients’ well-being. Pruritus was an important factor determining QoL and sleeping problems in the studied population. Conclusions: Identifying the most disturbing area of life and recognizing the most bothersome subjective symptoms of psoriasis are pivotal to focusing on the most relevant treatment goal and achieving therapeutic success.

Should Mammography Be a Prerequisite Prior to Initiation of Biological Agents in Patients With Psoriasis?

Introduction

Psoriasis patients may be susceptible to malignancy due to chronic inflammation. Moreover, biological agents which are used in the treatment of psoriasis might increase the risk of malignancy due to their immunosuppressive effect.

Objectives

We evaluated the mammography results of female patients with psoriasis aged over 40 years before the initiation of biological agent treatment. We aimed to determine whether breast cancer screening with mammography should be a prerequisite before the initiation of biological agent treatment for psoriasis.

Methods

Between April 2019 and March 2021, medical records of female psoriasis patients aged over 40 years were reviewed retrospectively.

Results

This study included 42 female psoriasis patients (mean age: 53.52 ± 7.09). BI-RADS score was 2 in 18 (42.9%) patients, 1 in 13 (31%) patients, 3 in 9 (21.4%) patients and 4A in 1 (2.4%) patient. Isodense masses were detected in 10 (23.8%) patients, while 6 (14.3%) patients had intramammary lymph nodes. Mammography revealed microcalcifications in 6 (14.3%) patients, macrocalcifications in 1 (2.4%) patient and a hamartoma in 1 (2.4%) patient. Isodense masses, calcifications and intramammary lymph nodes were associated with long disease duration (> 10 years). Intramammary lymph nodes were more common in patients treated with biological agents previously compared to biologic-naive patients.

Conclusions

We suggest that female patients over 40 years, especially those who had a long disease duration, family history of breast cancer and previous history of treatment with biological agents should undergo mammography before the initiation of biological agents for the treatment of psoriasis.

Nutrition phytochemicals affecting platelet signaling and responsiveness: implications for thrombosis and hemostasis

Cardiovascular disease, in particular due to arterial thrombosis, is a leading cause of mortality and morbidity, with crucial roles of platelets in thrombus formation. For multiple plant-derived phytochemicals found in common dietary components, claims have been made regarding cardiovascular health and antiplatelet activities. Here we present a systematic overview of the published effects of common phytochemicals, applied in vitro or in nutritional intervention studies, on agonist-induced platelet activation properties and platelet signaling pathways. Comparing the phytochemical effects per structural class, we included general phenols: curcuminoids (e.g., curcumin), lignans (honokiol, silybin), phenolic acids (caffeic and chlorogenic acid), derivatives of these (shikimic acid) and stilbenoids (isorhapontigenin, resveratrol). Furthermore, we evaluated the flavonoid polyphenols, including anthocyanidins (delphinidin, malvidin), flavan-3-ols (catechins), flavanones (hesperidin), flavones (apigenin, nobiletin), flavonols (kaempferol, myricetin, quercetin), isoflavones (daidzein, genistein); and terpenoids including carotenes and limonene; and finally miscellaneous compounds like betalains, indoles, organosulfides (diallyl trisulfide) and phytosterols. We furthermore discuss the implications for selected phytochemicals to interfere in thrombosis and hemostasis, indicating their possible clinical relevance. Lastly, we provide guidance on which compounds are of interest for further platelet-related research.

Characteristics of Pruritus in Various Clinical Variants of Psoriasis: Results of the Multinational, Multicenter, Cross-Sectional Study

Psoriasis is a chronic, inflammatory skin disease present in about 3% of the world’s population. The clinical symptoms manifest diversely, therefore one can distinguish several subtypes of psoriasis. The majority of patients with psoriasis experience pruritus, which is an unpleasant sensation that decreases patients’ quality of life. The knowledge on pruritus in different subtypes of psoriasis is limited. We have performed a cross-sectional, prospective, and multicenter study to evaluate the relationship between clinical subtypes of psoriasis (large-plaque, nummular, guttate, palmoplantar, inverse, erythrodermic, palmoplantar pustular, generalized pustular psoriasis, and psoriasis of the scalp) and the prevalence, intensity, and clinical manifestation of itch. We introduced a questionnaire assessing various aspects of pruritus to a total of 254 patients. Out of these, 42 were excluded. Pruritus was present in 92.9% of the remaining patients and its prevalence did not depend on the clinical subtype. A correlation between the severity of psoriasis and the intensity of itch was explicitly noticeable in palmoplantar pustular psoriasis and scalp psoriasis (p < 0.05). The itch sensation was individual and differed among subtypes of psoriasis. In conclusion, pruritus is a frequent phenomenon, and its presentation is different in various subtypes of psoriasis.

Novel Inflammatory Biomarkers in Patients with Mycosis Fungoides Treated with Bexarotene

Mycosis fungoides (MF) is a skin lymphoma characterised by atypical T lymphocyte infiltration, which may present with patches and tumors in advanced stages. Treatment options in MF aim to reduce symptoms, since patients usually do not achieve complete cure. Bexarotene is used for treatment-resistant early stage MF and advanced stages of the disease. It has been suggested that white blood cell (WBC)/absolute lymphocyte count, WBC, absolute lymphocyte and eosinophil counts might be prognostic factors in MF. Therefore, we investigated the changes in complete blood count (CBC) parameters and CBC-derived inflammatory biomarkers in patients with MF treated with bexarotene. The results revealed that neutrophil (NE)%, NE numbers, neutrophil/lymphocyte, derived neutrophil/lymphocyte, (neutrophil × monocytes)/lymphocyte and (neutrophils × monocytes × platelets)/lymphocyte counts decreased in all patients three months after bexarotene treatment. We suggest that these inflammatory biomarkers can be used in the follow-up of patients with MF receiving bexarotene treatment. Moreover, these results indicate that decrease in these inflammatory biomarkers may signify improvement of the disease. Key Words: Bexarotene, İnflammatory biomarkers, Mycosis fungoides.

Serum C-reactive protein to albumin ratio as a novel inflammation biomarker in psoriasis patients treated with adalimumab, ustekinumab, infliximab, and secukinumab: a retrospective study

Aim

To assess C-reactive protein to albumin ratio (CAR) before and after treatment with biological agents in patients with psoriasis to determine whether CAR can be used as an inflammation biomarker.

Methods

Medical records of patients with psoriasis treated with biological agents at the Department of Dermatology, Gazi University Hospital were retrospectively evaluated between June 2018 and August 2019. The patients were divided into four groups based on the type of treatment (adalimumab, ustekinumab, infliximab, secukinumab). CAR was evaluated before and three months after treatment.

Results

The study enrolled 157 patients with psoriasis vulgaris (91 male) aged between 18 and 85. CAR significantly decreased in all treatment groups (adalimumab group P < 0.001; ustekinumab P = 0.006; infliximab P = 0.007; secukinumab P < 0.001). The most prominent decrease in CAR was observed in patients treated with secukinumab (median CAR before treatment 1.52 [1.01-3.04] and after treatment 0.84 [0.62-0.99]).

Conclusion

CAR may be a good indicator of systemic inflammation in psoriasis patients treated with biological agents.

Pre-treatment vitamin B12, folate, ferritin, and vitamin D serum levels in patients with warts: a retrospective study

Aim

To compare the serum levels of 25-hydroxyvitamin D, ferritin, folate, vitamin B12, zinc, and thyroid stimulating hormone between patients with warts and healthy individuals.

Methods

This retrospective study enrolled 40 patients with warts and 40 healthy individuals treated at the Ufuk University Hospital, Ankara, between July and December 2017. Serum levels of 25-hydroxyvitamin D, ferritin, folate, vitamin B12, zinc, and thyroid stimulating hormone status were evaluated retrospectively.

Results

Participants with and without warts had similar mean serum 25-hydroxyvitamin D, ferritin, folate, zinc, and thyroid stimulating hormone levels. However, patients with warts had significantly lower mean serum vitamin B12 level (P = 0.010). Patients with warts non-significantly more frequently had decreased serum levels of 25-hydroxyvitamin D, ferritin, and folate (P = 0.330, P = 0.200, P = 0.070, respectively).

Conclusion

Patients with warts may require evaluation of serum levels of vitamin B12, folate, ferritin, and vitamin D.

Hepatic cholesterol synthesis and lipoprotein levels impaired by dietary fructose and saturated fatty acids in mice: Insight on PCSK9 and CD36

OBJECTIVES

The aim of this study was to investigate the uncertain effects of high saturated fatty acids (SFAs) or fructose intake on cholesterol and lipoproteins with an insight of proprotein convertase subtilisin/kexin type 9 (PCSK9)- and cluster of differentiation 36 (CD36)-induced mechanisms.

METHODS

Forty male C57 BL/6 mice (8 wks of age) were divided into four groups and fed ad libitum with standard chow or three isocaloric diets containing high SFAs (SFA group), monounsaturated fatty acids (MUFA group, vehicle), or fructose for 15 wks. Subsequently, mice were sacrificed and blood, liver, and heart were collected for further analysis.

RESULTS

Consequently, fructose or SFA intake resulted in higher plasma and liver total cholesterol (TC) levels, plasma low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (HDL-C), apolipoprotein (Apo)-B levels, TC/HDL-C, and LDL-C/HDL-C ratios, and lower plasma levels of HDL-C and Apo-A1 (P < 0.05). Levels of 3-hydroxy-3-methylglutaryl-CoA reductase and acetyl-CoA acetyltransferase 1 enzymes in liver and CD36 levels in plasma were elevated by high SFAs and fructose intake (P < 0.05), whereas plasma PCSK9 levels were not significantly changed. Fructose and SFA intake increased PCSK9 and CD36 levels in the heart, along with increased CD36 levels in the liver (P < 0.05). Furthermore, plasma LDL-C was found to be positively correlated with liver PCSK9 (r = 0.85, P = 0.02), and CD36 (r = 0.70, P = 0.02) in the SFA and fructose groups.

CONCLUSION

High intakes of dietary SFAs and fructose might induce dysregulations in the cholesterol synthesis and blood lipoprotein levels via proposed nutrient-sensitive biomarkers PCSK9 and CD36 in liver and extrahepatic tissues involved in cholesterol homeostasis.

Colonoscopy in patients with psoriasis before the initiation of treatment with biological agents

Psoriasis may lead to subsequent colorectal cancer, since chronic systemic inflammation is the common etiologic factor in both psoriasis and colorectal cancer. It is a matter of dispute whether biological agents used in the treatment of psoriasis cause predisposition to colorectal cancer as a result of their immunosuppressive effect. Medical records of psoriasis patients who underwent colonoscopy before biological agents were reviewed. Colonoscopy was performed in all patients who were aged 50 years and older and in patients younger than 50, if they had positive fecal occult blood test results. The study included 95 patients between the age of 34 to 84. Colonoscopy results revealed tubular adenoma in 16 (16.8%) patients, hyperplastic polyps in 7 (7.4%) patients, villous adenoma in 1 (1.1%) patient, and tubulovillous adenoma in 1 (1.1%) patient. Two patients were diagnosed with colon cancer detected by a former colonoscopy, which was recommended by their dermatologist before the biological agent treatment plan. These results revealed that adenomatous polyps which can evolve to colon adenocarcinoma were the most frequent polyp type in patients with psoriasis. We suggest that routine colonoscopy should be performed before the initiation of biological therapy in psoriasis patients who are aged 50 years old and over.

Serum ferritin and vitamin D levels should be evaluated in patients with diffuse hair loss prior to treatment

INTRODUCTION

Various factors like physiological and emotional stress, drugs and nutritional deficiencies can result in hair loss. Results of laboratory tests examining the underlying aetiology of hair loss vary in patients.

AIM

We aimed to compare the serum levels of ferritin, folate, vitamin B12, zinc, thyroid stimulating hormone and vitamin D in patients complaining of diffuse hair loss and in healthy individuals.

MATERIAL AND METHODS

Fifty-four patients with hair loss (47 females, 7 males) and 55 healthy individuals within the control group (47 females, 8 males) were included in this study. Serum levels of ferritin, folate, vitamin B12, zinc, thyroid stimulating hormone and 25-hydroxyvitamin D were evaluated in all participants retrospectively.

RESULTS

Serum concentrations of folate, vitamin B12, zinc and thyroid stimulating hormone were similar in the two groups. However, the mean serum ferritin and 25-hydroxyvitamin D levels were significantly lower in patients with hair loss than in healthy individuals. The mean serum ferritin levels of the patients and healthy individuals were 14.72 ±10.70 ng/ml and 25.30 ±14.41 ng/ml, respectively. The mean serum 25-hydroxyvitamin D levels of the patients and healthy individuals were 14.03 ±8.09 ng/ml and 17.01 ±8.59 ng/ml, respectively. Eleven (20.4%) patients had low serum ferritin levels, while 43 (79.6%) patients had low vitamin D levels.

CONCLUSIONS

The results obtained from this study reveal that serum ferritin and 25-hydroxyvitamin D levels are generally low in patients complaining of hair loss. Therefore, serum ferritin and vitamin D levels should be evaluated and supplemented prior to treatment in all patients complaining of diffuse hair loss.

Omalizumab does not lead to a distinct alteration in hematological parameters and complete blood count-derived inflammation biomarkers except for basophil count

PURPOSE

Omalizumab is a monoclonal anti-IgE antibody used to treat patients with chronic spontaneous urticaria by decreasing free IgE levels. Omalizumab may have an anti-inflammatory effect by inhibiting T-cell activation and inducing eosinophil apoptosis. In this study, we evaluated the effect of omalizumab on hematological parameters and inflammation biomarkers in patients with chronic spontaneous urticaria.

METHODS

Between July 2018 and November 2019, medical records of 60 patients (44 female, 16 male) with chronic spontaneous urticaria who were treated with omalizumab were reviewed retrospectively. Hematological parameters and inflammation biomarkers including the neutrophil/lymphocyte, monocyte/lymphocyte, platelet/lymphocyte and mean platelet volume/platelet count ratios were compared before and after 12 weeks of omalizumab treatment.

RESULTS

The absolute count of basophils and percentage of basophils increased significantly after omalizumab treatment (p = 0.04, p = 0.004). The absolute count of eosinophils, percentage of eosinophils, neutrophil/lymphocyte, monocyte/lymphocyte, and mean platelet volume/platelet ratios decreased, while platelet/lymphocyte ratio increased after omalizumab treatment. Nevertheless, these changes were not statistically significant.

CONCLUSIONS

Increased basophil counts suggest that omalizumab has a crucial effect through basophils in chronic spontaneous urticaria. Further studies focussing on basophils may contribute to the literature both to elucidate the etiopathogenesis of urticaria and to improve novel treatment agents for the disease. On the other hand, our study revealed that omalizumab did not have a distinct effect on complete blood count-derived inflammation biomarkers and thus inflammation.

Efficacy of Omalizumab in Patients with Chronic Spontaneous Urticaria and Its Association with Serum IgE Levels and Eosinophil Count

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.

Is mean platelet volume an inflammatory marker in acne patients treated with isotretinoin?

INTRODUCTION

Isotretinoin is a commonly used systemic retinoid for treating acne. However, isotretinoin may lead to elevated serum levels of triglycerides and cholesterol, and it may affect liver function tests. Moreover, the effect of isotretinoin on hematological parameters remains controversial. This study examines changes in the blood chemistry panel, hematological parameters, and inflammation biomarkers of patients diagnosed with acne and treated with isotretinoin.

METHODS

The study included 70 patients (59 females and 11 males, between ages 18 and 37) with moderate to severe acne vulgaris treated with isotretinoin. The medical records and laboratory findings of the participants were reviewed retrospectively between March 2017 and September 2018. All the patients whose necessary laboratory test results could be obtained from the collected data were included in the study.

RESULTS

Serum total cholesterol, HDL, LDL, triglyceride, mean corpuscular hemoglobin levels, and platelet/lymphocyte ratio increased, whereas white blood cell count and mean platelet volume (p = 0.036) decreased after isotretinoin treatment.

CONCLUSIONS

The results of this study revealed that mean platelet volume decreased significantly 3 months after the initiation of isotretinoin treatment. Therefore, we suggest considering mean platelet volume as an inflammatory marker in patients with acne treated with isotretinoin. However, this research should be replicated under more randomized conditions in a prospective study to reach a definitive conclusion.

Multiorgan involvement of Behçet's disease in a young woman

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.

Estrogen receptor positive, progesterone receptor negative, leiomyoma of the areola of a male patient

Leiomyoma of the nipple and areola is a rare subtype of genital leiomyoma. The etiology of the tumor is not well understood. However, sex hormones like estrogen and progesterone have been implicated in the tumorigenesis. Hereby, we report a 47-year-old man with an estrogen receptor positive, progesterone receptor negative, leiomyoma of the areola.

Staphylococcus aureus is the most common bacterial agent of the skin flora of patients with seborrheic dermatitis

Background

Seborrheic dermatitis is an inflammatory skin disease that affects 1–3% of the general population. The Malassezia species has been implicated as the main causative agent; however, the bacterial flora of the skin may also play role in the etiopathogenesis. Therefore, we investigated the most common bacterial agent of the skin flora of patients with seborrheic dermatitis.

Materials and Methods

Fifty-one patients with seborrheic dermatitis and 50 healthy individuals are included in this study. Sterile cotton swabs were rubbed on the scalp of the participants for bacterial culture. Colonial morphology was identified with gram stain and catalase test.

Results

Staphylococcus aureus was isolated from 25 (49%) patients with seborrheic dermatitis and 10 (20%) healthy individuals within the control group. Coagulase-negative staphylococci were isolated from 24 (47.1%) patients with seborrheic dermatitis and 17 (34%) healthy individuals within the control group. Diphtheroids were present in 2 (3.9%) patients and 1 (2%) subject within the control group. Gram-negative bacilli were present only in 1 (2%) patient. Hemolytic streptococci and bacilli were identified in 1 (2%) subject from each group. Colonization of coagulase-negative staphylococci, diphtheroids, gram-negative bacilli, hemolytic streptococci, and bacillus did not differ between patients and healthy controls. However, S. aureus colonization was significantly more common in patients with seborrheic dermatitis than in healthy controls.

Conclusion

Within this study we revealed that S. aureus colonization was significantly higher among the patients. Therefore, we propose that, in addition to the Malassezia species, S. aureus may play a role in the etiopathogenesis of seborrheic dermatitis.

Non-surgical minimally invasive rhinoplasty: tips and tricks from the perspective of a dermatologist

INTRODUCTION

Rhinoplasty is one of the most common aesthetic procedures performed by plastic surgeons all over the world. In recent years, a non-surgical nose job has become the preferred option for most patients and specialists. Minimally invasive techniques already result in high satisfaction rates. Moreover, patients do not need anesthesia and there is no post-operative recovery period.

METHODS

Between January 2016 and January 2017, 35 patients (33 female, 2 male) that had undergone nonsurgical rhinoplasty with dermal fillers were included in the study. Clinical and demographic features of the patients, our technique, satisfaction rates, and complications were discussed.

RESULTS

We recorded an extremely high satisfaction rate and did not observe any complications. All of the patients returned to their normal daily activities immediately after the procedure.

CONCLUSIONS

Non-surgical nose augmentation with dermal fillers is an easy, safe, and comfortable technique. It appears that dermatologists need to assume a more active role in rhinoplasty.

Surgical treatment of pyoderma gangrenosum following deep inferior epigastric perforator flap breast reconstruction

Pyoderma gangrenosum is a chronic inflammatory disease characterized by painful cutaneous ulcers. The etiology remains unknown; however, pyoderma gangrenousm can be triggered by surgery. Here we report the case of a 34-year-old Caucasian female that developed pyoderma gangrenosum following deep inferior epigastric perforator flap breast reconstruction. The patient was successfully treated with systemic immunosuppressive therapy and primary closure.

Coexistence of erythema dyschromicum perstans and vitiligo: a case report and review of the literature

Erythema dyschromicum perstans is a rare, chronic, pigmentary disorder with unknown etiology. It clinically presents with oval to round, gray, blue, or brown macules of various sizes. The etiology remains unknown; however, cobalt allergy, radio contrast media, intestinal parasites, human immunodeficiency virus, and hypothyroidism have been proposed as causative factors. In addition, vitiligo is characterized by depigmented macules and patches that are widely andsymmetrically distributed. It has been suggested that autoimmune mechanisms play an important role in the etiopathogenesis of vitiligo. Physical and emotional stress can trigger vitiligo in genetically predisposed patients. However, coexistence of erythema dyschromicum perstans and vitiligo is extremely rare, and similar immune mechanisms have been implicated in the pathogenesis of these cutaneous pigmentary disorders.

A rare clinical manifestation of spinulate demodicosis

Demodicosis is a chronic skin disease caused by Demodex mites such as Demodex folliculorum and Demodex brevis. Demodex mites live in pilosebaceous units and they are regarded as a part of the normal skin flora. Nevertheless, it has been suggested that the presence of five or more mites per cm² by the standardized skin surface biopsy technique could be considered as pathogenic.