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.

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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.

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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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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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Background: There are limited data on the safety of biological therapies in psoriasis patients with hepatitis B virus (HBV) infection in the literature, and are still ongoing controversies about HBV reactivation in patients treated with biologics for psoriasis. Aims: This was aimed to investigate the demographic, clinical, and laboratory characteristics of the patients with HBV seropositive receiving biological treatment for psoriasis. Study Design: This was a retrospective observational study. Materials and Methods: Ninety-seven patients with psoriasis treated with biologics in the outpatient clinic were evaluated retrospectively. Of these, 16 patients with HBV seropositive were included in the study. Patients with positive HBV serology were divided into three groups as chronic HBV infection, past HBV infection, and isolated core antibody positivity (HBV core-specific antibody [HBcAb]). The demographic, clinical, and laboratory characteristics of the patients were obtained from the records. Results: Of the patients, 5 patients were female (31.2%), and 11 were male (68.8%). The mean age of the patients was 55.81 ± 11.05. Thirteen of the patients had past HBV infection, three had isolated HBcAb positive. Infliximab (n = 13) was the most common biologic agent used, followed by adalimumab (n = 6), secukinumab (n = 4), ustekinumab (n = 2), and etanercept (n = 2). The mean duration of treatment was 3.59 ± 2.76 years. The HBV reactivation occurred in only one patient with past HBV infection receiving infliximab (6.2%). Conclusion: It remains unclear how exactly the biologic drugs for psoriasis impact viral reactivation. For the safe use of biological agents in psoriasis patients with HBV seropositive, screening tests must be performed with a triple serology, including HBV surface antigen, HBV surface-specific antibody, and HBcAb. The patients who have positive HBV serology must be monitored closely with reactivation markers and receive antiviral prophylaxis if they are at moderate-to-high risk of HBV reactivation.

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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.

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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.

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Although psoriasis and autoimmune blistering diseases are considered to be disorders with completely different etiopathogenesis, literature has documented a few cases of psoriasis associated with bullous diseases, particularly bullous pemphigoid. Here, we report the case of a 30-year-old male presenting with multiple flaccid blisters and erosions, clinically and histopathologically consistent with the diagnosis of pemphigus vulgaris. Although all these lesions resolved after two doses of dexamethasone cyclophosphamide pulse therapy, he returned 3 weeks later with multiple erythematous scaly plaques developing over the postinflammatory areas, compatible with the diagnosis of psoriasis vulgaris, which necessitated a modification in the treatment protocol. This rare case highlights the diagnostic and therapeutic challenges accompanying this unique scenario and attempts to elucidate the probable pathogenic mechanisms underlying the co-existence (simultaneous or sequential) of these two apparently unrelated dermatoses.

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Platelet-rich plasma (PRP) which is peripheral blood originated product contains high concentrated platelet and many growth factors. It has been used in dermatology for many indications, including alopecias and chronic nonhealing wounds. Pemphigus vulgaris (PV) is a chronic autoimmune bullous disease of the skin and mucous membranes. We report a case of PV induced after the treatment of PRP for female pattern hair loss. The first lesions of PV occurred on the application site of PRP in this case. The diagnosis of mucocutaneous PV was established according to the clinical, cytological, and serological findings. Many physical agents and drugs were reported to induce PV. As far as is known, there is no PRP-related PV case in the literature. An in vitro study demonstrated that PRP may trigger the acantholysis in a genetically susceptible patient and may lead to pemphigus. Virtually, there is no enough evidence showing PRP to cause pemphigus. However, PRP treatment should be performed carefully in such patients.

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Aims: Psoriasis is a chronic, inflammatory, hyperproliferative skin disease with etiopathogenesis not fully understood. The zinc transporter ZIP2 is associated with keratinocyte differentiation, whereas ZIP3 is associated with T-lymphocyte maturation. In our study, we aimed to show the correlation between psoriasis and ZIP2 and ZIP3 zinc transporters in psoriasis patients. Subjects and Methods: The patient group in the study included 60 patients aged with psoriasis vulgaris and a control group of 60 healthy adults. The levels of ZIP2 (SLC39A2) and ZIP3 (SLC39A3) zinc transporters were determined with the ELISA method. Results were compared with control group values and statistically assessed. Results: When the ZIP2 and ZIP3 levels are compared in controls and psoriasis patients, the levels were observed to significantly increase compared to controls (P < 0.05). When compared to the control group, the results appeared to be statistically significant (P < 0.05). Conclusions: With etiopathogenesis not fully known, there may be an important relationship between psoriasis development and ZIP2 (SLC39A2) and ZIP3 (SLC39A3) zinc transporters in psoriasis vulgaris patients. This situation may be an important result for understanding how the disease develops and in creating new approaches in terms of treatment for this disease without full cure available.

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Objective: Cutaneous small-vessel vasculitis (CSVV) is a disease characterized histologically by leukocytoclastic vasculitis (LCV) and immune-complex deposition in small vessel walls. We aimed to evaluate the type of deposited immune complexes in patients with LCV and to determine the relationship between the immune-complex types and clinical and laboratory parameters. Materials and Methods: Patients who had been diagnosed as LCV histopathologically between 2000 and 2018 were retrospectively evaluated. Patients' medical records and pathology databases were reviewed to determine the demographic characteristics, clinical, laboratory, and histopathological findings. Direct immune fluorescence (DIF) findings to determine the immune-complex subtypes, including immunoglobulin A (IgA), immunoglobulin M (IgM), immunoglobulin G (IgG) or C3 deposition, were evaluated. Results: Sixty-eight patients were included in the study. A total of 36 (53%) patients had deposition in the perivascular or vessel walls, with at least one of IgA, IgM, IgG, or C3. IgA deposition was detected in 29 (42.6%) patients, IgM in 13 patients (19.1%), IgG in four patients (5.9%), and C3 in 31 patients (45.6%). Clinical features of the patients, including triggering factors, extracutaneous involvement, lesion localization, and skin findings, were compared with DIF findings. It was found no statistically significant difference between DIF-positive and DIF-negative groups (P > 0.05, for all). There was also no statistically significant difference in terms of laboratory findings between the groups (P > 0.05, for all). Conclusions: Our study showed that DIF findings did not play a role in determining the clinical findings, and they did not affect laboratory parameters in CSVV.

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Objective: The objective of the study was to study the effect of coenzyme Q10 (CoQ10) supplementation on serum glutathione peroxidase (GSH-Px) levels and the severity of acne vulgaris (AV). Methods: A double-blind randomized controlled trial was carried out on 36 patients with AV classified according to severity. These patients were randomly divided into two groups (treatment group = 18 patients treated with tretinoin 0.025% cream and once-daily supplementation with a CoQ10 100 mg tablet; placebo group = 18 patients treated with tretinoin 0.025% cream and a once-daily placebo tablet). Blood samples were taken from a vein and examined by enzyme-linked immunosorbent assay. The study period was 8 weeks. Response to treatment was determined based on serum GSH-Px level and AV severity. The study used a pre- and post-test design for the two groups. The data were processed with SPSS for Windows version 25. Results: Administration of CoQ10 to AV significantly improved the severity of AV after 8 weeks compared to a placebo (P = 0.008). Serum GSH-Px levels after treatment with CoQ10 increase higher in the study than control group, but the statistical test result showed not significant in the study group (P = 0.3) and also control group (P = 0.07). Conclusion: CoQ10 supplementation may increase serum GSH-Px levels and improve the severity of AV, but there was no relationship between serum GSH-Px levels and the severity of AV.

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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.

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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.

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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.

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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.

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