Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, life-threatening conditions with a high mortality rate. SJS and TEN are used to denote a group of disorders closely related to each other, characterized by extensive epidermal necrolysis, and usually induced by drugs. Keratinocyte apoptosis is the main reason for widespread epidermal detachment. Drugs or their methobolites can act as a hapten after binding to the keratinocyte surface and initiate cytotoxic immunological attack. Drug-
specific CD8+cytotoxic T cells mediate keratinocyte apoptosis by the Fas/FasL pathway and perforin/granzyme pathway. Although numerous drugs have been noted as responsible, sulfonamide class of antibiotics, anticonvulsants, beta-lactam antibiotics,
allopurinol, nonsteroidal anti-inflammatory drugs, nevirapine and thiacetazone are the most frequently reported causative ones. Early diagnosis and withdrawal of suspected drug or drugs are one of the most important steps in the treatment. Other diseases resembling SJS/TEN should be excluded as soon as possible. Although various topical and systemic treatments have recently been used, ideal supportive care is still the most important and effective therapeutic approach. SCORTEN, a scoring system used to
predict mortality in TEN, has been widely used in recent years. Transfer to a burn unit or intensive care unit is recommended for patients with a SCORTEN 3 (mortality rate; 35.3%) or over. In this paper, we aimed to review clinical findings, aetiopathogenesis and treatment of these syndromes in the light of current literature.

Background and Design: The allergens responsible for allergic contact dermatitis vary among countries and even between different geographical regions within the same country over time. It is of great importance to perform the patch test at certain intervals, to evaluate the results in different centers and to compare them afterwards. Our aim was to evaluate the patch test results in our patients with allergic contact dermatitis.
Material and Method: The records of the patients with allergic contact dermatitis, who had been patch tested between May 1997 and March 2009, were analyzed retrospectively. The demographic features such as age and sex, localization of the contact dermatitis, and the patch test results were recorded.
Results: Of the 775 patients, 581 (75.2%) were females and 194 (25%) males. Of all patients, 735 were patch tested with the European Standard Series, 318 - with both the European Standard Series and cosmetic series, and 40-with cosmetic series alone. Of the patients tested with the European Standard Series, 255 (34.7%) had at least one positive reaction. The most frequent allergen in the European Standard Series was nickel sulfate (17.3%), followed by cobalt chloride (7.2%), potassium dichromate (3%), fragrance mix (2.9%), and p-phenylenediamine base (2.6%). Of the 358 patients tested with cosmetic series, 82 (22.9%) had at least one positive reaction. The 5 most frequently observed cosmetic series allergens were octyl gallate (3.9%), thimerosal (2.2%), sorbitan sesquioleate (2%), Euxyl K 400 (2%) and methyldibromo glutaronitrile (1.4%).
Conclusion: Our study shows the contact allergen profile of our center over 12 years. The most common allergens and their frequency differ between centers in various cities in Turkey. Those geographical differences should be re-evaluated by further studies performed in the certain time period. The high frequency of reactions to octyl gallate is an important finding in patients suspected of cosmetic allergy and who underwent patch testing with cosmetic series.

Background and Design: Our aim was to evaluate the hypersensitivity to cosmetic chemicals in patients with clinically suspected cosmetic-induced contact dermatitis in Bursa and the South Marmara Region (Turkey) by patch testing with standard and cosmetic series.
Material and Method: Seventy-three patients with clinically suspected contact dermatitis due to cosmetics were patch
tested by the European standard series and cosmetic series. The patch test results were analyzed as percentages. x2 test was used to demonstrate the relationship between cosmetic products and cosmetic allergens.
Results: 90.4% of patients in our study group were female and 9.6% were male; the median age was 37.5 (range 16-71) years. The most commonly involved parts of the body were the face (49.3%), hands (16.4%), periocular region (6.8%), lips (6.8%), and the neck (5.5%). The most common offending cosmetic products causing allergic contact dermatitis were soaps and cleansing lotions (32.8%), moisturizer creams (21.9%), make-up (15.0%), and hair dyes (9.6%). 41.0% of patients showed positive reaction to at least one cosmetic allergen included in either standard or cosmetic series. The cosmetic allergens in the standard series and the rates of positivity were as follows: fragrance mix (6.8%), lanolin alcohols (5.5%), paraphenylenedaimine (2.7%), colophony (1.4%), paraben mix (1.4%), formaldehyde (1.4%), and methylchloroisothiazolinone (Kathon CG) in descending order. The most common offending cosmetic allergen groups were preservatives (21.9%), antioxidants (8.2%) and fragrances (6.8%).
Conclusion: Allergic or irritant contact dermatitis due to cosmetics should be considered in cases of eczema involving face, neck, eyelids, lips, scalp or hands. Patch testing with cosmetic series beside standard series would be more helpful in detecting the responsible allergen(s).

Background and Design: Psoriasis is a common, chronic, relapsing skin disease, characterized by the formation of typical scaly papules or plaques. The three factors well-recognized as triggering the onset, causing new lesions or inducing a flare in the disease are: stress, skin injury and infection. Various microorganisms are associated with provocation and/or exacerbation of psoriasis. The aim of this study was to investigate the relationship between parvovirus B19 (PVB19) and psoriasis/psoriasis area severity index (PASI).
Material and Method: Sixty patients with psoriasis (36 men, 24 women) and 40 healthy volunteers (22 men, 18 women) were included in our study. PVB19 DNA was quantified by real-time polymerase chain reaction.
Results: PVB19 DNA was detected in 27 of 60 subjects in the patient group (45%) and in 9 of 40 controls (22.5%) (p<0.05). Viral load was quantitatively detected as mean 9011768.5±6921223.3 copies/ml in the patient group and 10688.4±46828.1 copies/ml in the control group (p<0.05). There was no correlation between viral load and PASI (p>0.05). The relationship between the viral load and the subtypes of psoriasis was not statistically significant (p>0.05).
Conclusion: According to the results of this study, it was concluded that a relationship may be present between psoriasis and PVB 19 infection.

Background and Design: Psoriasis is one of the chronic inflammatory systemic diseases, such as rheumatoid arthritis, systemic lupus erythematosus and Crohn's disease, in which the inflammation is responsible for the pathogenesis. Recently, some studies reported the importance of chronic inflammation in the pathogenesis of atherosclerosis and an association of chronic inflammatory systemic diseases with atherosclerosis and metabolic syndrome. The aim of this study is to determine coexistence of psoriasis vulgaris with various severity and metabolic syndrome.
Material and Method: One hundred psoriasis vulgaris patients and one hundred sex- and age-matched healthy controls were included in this study. The Psoriasis Area and Severity Index (PASI) was used for evaluating the disease severity in psoriasis patients. A PASI score below 7 was accepted as mild, between 7-12 as moderate, and above 12 as severe. We evaluated metabolic syndrome in both patient and control groups by using the Adult Treatment Panel III (ATP III) metabolic syndrome criteria. SPSS 10.0 for Windows was used in analyzing data. For comparison, the student’s-t test, the Mann-Whitney U test and the chi-square test were used. A p-value less than 0.05 was considered statistically significant.
Results: Metabolic syndrome, hypertension, elevated fasting plasma glucose and triglyceride levels, high waist circumference and lower high-density lipoprotein levels were more common in patients with psoriasis than in controls. However, there was no statistically significant difference in these parameters between these two groups (p>0.05). We found that the mean value of triglyceride levels was statistically higher in the psoriasis group (p<0.05), and the mean value of HDL cholesterol levels was statistically lower in psoriasis patients when compared with controls (p<0.05). There was no statistically significant difference in the association between these parameters and severity of psoriasis (p>0.05).
Conclusion: No significant difference was observed between patients with mild, moderate, severe psoriasis and controls for the prevalence of metabolic syndrome. However, the mean value of triglyceride levels in psoriasis patients was higher and the mean value of HDL cholesterol levels was lower than those in the controls.

Background and Design: Leptin is a hormone, which regulates neuroendocrine function and also is involved in inflammatory processes. Proinflammatorycytokines, important inducers in the pathogenesis of Behçet’s disease, up-regulate the leptin levels. In this study, we aimed to compare leptin levels in patients with Behcet’s disease to those in controls and to investigate the correlation between leptin levels and disease activity.
Material and Method: Fifty-three patients with Behçet’s disease (28 active and 25 inactive) composed the study group and 22 subjects-the control group. Leptin analyses were done by ELISA method using commercial kits. Erythrocyte sedimentation rate and C-reactive protein levels were also measured.
Results: Leptin levels were increased in patients with Behçet’s disease compared to controls. Leptin did not correlate with disease activity.
Conclusion: Leptin might have a possible role in the pathogenesis of Behcet’s disease.

Background and Design: Immunological factors are considered to have an important role in the multifactorial ethiopathogenesis of Behçet’s disease (BD). Especially, Th1 cells function by expressing proinflammatory cytokines and neutrophil-attracting chemokines. Levels of IL-2R, IL-6 and IL-8 were evaluated in patients with BD in this study.
Material and Method: Sixty-six patients with BD (36 with inactive and 30 with active) composed the study group and 22 subjects – the control group. Cytokine analyses were done with ELISA method by using commercial kits. ESR and CRP levels were also measured.
Results: IL-2R, IL-6 and IL-8 levels in all patients, including the inactive ones, were not different from those in controls. CRP and ESR levels in patients were higher than in controls. IL-8 and CRP levels were increased in patient with active BD (p<0.05) when compared to those with inactive BD.
Conclusion: Our study demonstrated elevated levels of serum IL-8, a chemokine activating monunuclear cells and neutrophils, in patients with active BD. IL-8 may be considered as an activity marker for BD.

Background and Design: Vitiligo is an acquired hypomelanotic disorder characterized by circumscribed depigmented macules in the skin resulting from the loss of functional melanocytes. Narrowband-ultraviolet B (NB-UVB)has been used in vitiligo treatment. Possible mechanisms by which NB-UVB induces repigmentation in vitiligo are: regulation of the immune response, melanocyte proliferation and melanocyte migration. In melanocyte migration, the efficacy of NB-UVB might derive from induction of metalloproteinase-2 (MMP-2). In our study, we aimed to test whether there would be an increase in MMP-2 levels by NB-UVB treatment.
Material and Method: Twenty-three adult vitiligo patients without any systemic disease and who have not received treatment previously were included in this study. The patients were treated with NB-UVB irradiation. Biopsy specimens taken from all patients before and after the treatment were compared in terms of MMP-2 immunoreactivity.
Results: There were statistically significant differences in MMP-2 immunostaining between the tissue specimens taken before and after the treatment.
Conclusion: Our study results suggest that the NB-UVB therapy can increase the MMP-2 activity, and MMP-2 may have an important role in vitiligo repigmentation process.

Unilateral nevoid telangiectasia (UNT) is a rare cutaneous disorder characterized by superficial telangiectasias distributed unilaterally. UNT can be congenital or acquired. Acquired UNT may be seen during pregnancy, puberty, and in association with cirrhosis and hepatitis C. Besides, the disease has been reported in healthy individuals. In the etiology, elevated blood estrogen levels and/or increased estrogen and progesterone receptors in the involved skin are suggested to cause this disorder. Here, we present four male patients aged 26-33 years, without an identified underlying disease and an 18-year-old female hepatitis B carrier with diagnosis of acquired UNT. Since UNT is seen rarely, it is discussed in the light of the literature data.

Acquired aquagenic keratoderma is a rare type of acquired palmoplantar keratoderma localized frequently and symmetrically to palms and occurs following short period of water exposure. A 42-year-old male patient applied to the outpatient clinic with complaints of elevated lesions and pores located on the hands and precipitated by water exposure and perspiration. On dermatological examination, whitish keratodermic macerated plaques and dilated punctae were observed over the dorsum of the hands following exposure of patient’s hands to water for a short period of time. These findings regressed gradually after drying the hands. The patient was clinically diagnosed to have acquired aquagenic keratoderma. This case turned out to be interesting as it is the third case of acquired aquagenic keratoderma with localization on the dorsum of the hands, and it has been added to the ones already present in the literature. Here, we have reviewed the literature about acquired aquagenic keratoderma and reported our case.

Acrokeratoelastoidosis (AKE) is a rare papular palmoplantar keratosis characterized by small, firm, yellow papules distributed on the margins of the hands and feet. Both autosomal dominant and sporadic forms of the disease have been reported. Histologic findings consist of hyperkeratosis, acanthosis and marked decrease in dermal elastic fibers. No curative treatment of AKE has been reported to date. In this article, we present a sporadic case of a 15-year-old female patient diagnosed with AKE and discuss the differential diagnosis.

Cornu cutaneum is a lesion with hyperkeratoses resembling that of an animal horn and its length varies from a few millimeters to centimeters. Cornu cutaneum is most commonly located in face, ears and other exposed areas. Cornu cutaneum may be associated with benign, pre-malignant and malignant lesions. In this case report we present a 71 years old woman suffering from two cornu cutaneum of which one is called giant cornu cutaneum located in the right cheek for 5 years.