Seray Külcü Çakmak

This multicenter study aimed to evaluate treatment adherence and satisfaction among patients with acne vulgaris. A total of 2,349 patients from 18 dermatology centers across Türkiye completed structured questionnaires. The participants were predominantly female (79.4%) with a mean age of 21.6 years. Overall, 48% reported consistent adherence to therapy, with significantly lower adherence among males (p < 0.001). The most frequent reasons for nonadherence were forgetfulness (28.7%), dislike of the treatment (26.4%), and reluctance to maintain long-term therapy (21.5%). Treatment adherence was positively associated with higher educational levels (p = 0.006) and greater acne severity (p < 0.001). Logistic regression revealed that systemic oral therapy (OR = 4.37, 95% CI: 3.147-6.086; p < 0.001) and oral isotretinoin (OR = 4.81, 95% CI: 3.379-6.869; p < 0.001) significantly increased adherence compared to topical therapy. Oral treatment was also independently associated with greater satisfaction (OR = 2.33, 95% CI: 1.767-3.095; p < 0.001). Moreover, mild acne severity (OR = 1.67, 95% CI: 1.216-2.297; p = 0.002) and older age (per year; OR = 1.05, 95% CI: 1.020-1.088; p = 0.001) predicted higher satisfaction. Systemic therapies-particularly oral isotretinoin-were associated with improved adherence and satisfaction.

Purpose: After the emergence of the pandemic caused by the COVID‐19 virus, vaccination with various vaccines has started to be implemented across the world. To identify dermatological reactions developing after the COVID‐19 vaccines administered in Turkey and determine their clinical features and risk factors that may play a role in their development.Materials and Methods: The study included patients aged ≥18 years, who presented to 13 different dermatology clinics in Turkey between July 2021 and September 2021 after developing dermatological reactions following the administration of the COVID‐19 vaccine. After providing written consent, the patients were asked to complete a standard survey including questions related to age, gender, occupation, comorbidities, the regular medication used, the onset of cutaneous reactions after vaccination, and localization of reactions. Dermatological reactions were categorized according to whether they developed after the first or second dose of the vaccine or whether they occurred after the inactivated or messenger RNA (mRNA) vaccine. The relationship between dermatological reactions and some variables such as gender and comorbidities was also evaluated.Results: A total of 269 patients [116 women (43.1%), 153 men (56.9%)] were included in the study. It was observed that the dermatological diseases and reactions that most frequently developed after vaccination were urticaria (25.7%), herpes zoster (24.9%), maculopapular eruption (12.3%), and pityriasis rosea (4.5%). The rate of dermatological reactions was 60.6% after the administration of the mRNA vaccine and 39.4% after that of the inactivated vaccine. There was a statistically significantly higher number of reactions among the patients that received the mRNA vaccine (p = 0.001).Conclusion: The most common reactions in our sample were urticaria, herpes zoster, and maculopapular eruption. Physicians should know the dermatological side effects of COVID‐19 vaccines and their clinical features.

Sir, Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic. Several cutaneous manifestations associated with COVID-19 have been reported, including chilblains or chilblain-like lesions, erythematous rash, viral exanthem, urticaria, livedo reticularis, acral ischemia, palpable purpura, and erythema multiforme. These were thought to be useful in the early diagnosis and triage of COVID-19 patients and their risk stratification [1]. However, there are limited reports on the nail manifestations of COVID-19, including several cases of Beau lines, leukonychia, orange discoloration, and onychomadesis [2]. An exceptionally rarely reported manifestation of COVID-19 is the red half-moon-nail sign [3,4]. A 46-year-old male presented to our outpatient clinic with transversal red bands surrounding the distal margin of the nail’s lunula on all of the fingernails, which the patient noticed a week previously (Fig. 1). One month before, with symptoms of fever, shortness of breath, and coughing present for three days, he had been given the diagnosis of COVID-19 following a positive nasopharyngeal swab polymerase chain reaction test. Computed tomography of the lungs revealed generalized ground-glass opacities and paraseptal emphysema in the upper lobes, and the patient was hospitalized for one week and treated with favipiravir for five days and was on oxygen therapy. He was discharged from the hospital one week later with partial remission of the respiratory symptoms. He also had hypertension, atherosclerotic heart disease, and Behçet’s disease, and had been using metoprolol, amlodipine, edoxaban, irbesartan, hydrochlorothiazide, and colchicine. After two weeks of follow-up, the bands remained present and became wider (Fig. 2). The red-half-moon sign was first described by Neri et al. as half-moon-shaped transversal red bands after SARS-CoV-2 infection. The patient was a sixty-year-old female and the bands appeared two weeks after the onset of symptoms of COVID-19. The patient was hospitalized and received oxygen therapy and several other treatments, including hydroxychloroquine and lopinavir/ritonavir. As in our patient, the bands remained present and became wider after one month of follow-up [3]. Mendez-Flores et al. reported a case of the red half-moon nail sign in a 37-year-old female with COVID-19. The patient noticed the changes two days after the COVID-19 symptoms appeared, and these lasted for one week before gradually returning to normal. The patient was managed at home and required no oxygen therapy [4]. The pathogenesis of the red half-moon sign is unknown. Neri et al. proposed that localized microvascular injury secondary to an inflammatory immune response and procoagulant state may play a role. It is thought that, because of the location, the distal subungual arcade’s capillary network may be affected in these cases [2,3]. We also agree that the red half-moon sign could be associated with microvascular injury or a procoagulant state connected to an inflammatory immune response. Recently, Natalello et al. reported nailfold capillaroscopy abnormalities in COVID-19 patients, including microvascular alterations in the nailfold capillary bed ranging from microthrombosis to altered capillary structures, according to the COVID-19 phase supporting this theory [5]. We also think that the persistence of the bands might be related to the severity of the disease, as both our and Neri et al.’s patients were hospitalized and had a more severe disease course than Mendez-Florez et al.’s patient. We think that, similarly to skin findings, nail findings may be a clue in the diagnosis and prognosis of COVID-19 as well as the pathogenesis of the disease, and clinicians should search for nail findings in COVID-19 patients.

Background and Aim: Interferon-induced helicase (IFIH1) is a gene locus that has been recently defined as a candidate for susceptibility to generalized vitiligo (GV). The objectives of this study were to assess the association of IFIH1 gene, rs2111485 and rs1990760 single-nucleotide polymorphisms (SNP) with susceptibility to GV and the autoimmune diseases accompanying to GV. Materials and Methods: We prospectively studied GV patients and frequency-matched healthy controls by age and gender. The genotypes of the participants were determined for rs1990760 and rs2111485 SNPs of IFIH1. Dominant, recessive and additive models were evaluated for each SNP adjusted for age and gender. Results: The patients and their controls were demonstrated to be in the Hardy-Weinberg equilibrium for SNP1 (2q24.2, rs1990760, IFIH1, T/C) and SNP2 (2q24.2, rs2111485, IFIH1, G/A) respectively (all p> 0.7). For SNP1 every T allel addition was significantly associated with 1.53 times protectiveness in terms of vitiligo risk (P= 0.033). As for SNP2 every G allel addition was associated with 1.42 times protectiveness, close to statistical significance (P= 0.100). Conclusions: We detected that for SNP1 each T allel and for SNP2 each G allel are protective in terms of vitiligo development. Hereby, we confirmed that IFIH1 gene locus has a role in GV susceptibility. Keywords: Vitiligo, single nucleotide polymorphism, genes

Autoimmune bullous diseases are heterogeneous group of disorders characterized by intraepidermal and subepidermal bullae formation. Autoantibodies to major players of skin integrity cause devastating symptoms in autoimmune bullous diseases that may result with morbidity and even mortality in the affected patients. These group of diseases can be categorized by the level of splitting in the skin and by structural proteins that are targeted by autoantibodies. Autoimmune bullous diseases can be divided into four basic subgroups: pemphigus, pemphigoid, epidermolysis bullosa acquisita and dermatitis herpetiformis, although their different subtypes have been defined. In this chapter, the structure and tasks of desmosomes and basement membrane zone, which consist of the major antigens of the skin integrity targeted by autoantibodies, are examined, and the relation of target antigens and autoimmune bullous diseases is discussed.

Pigmented purpuric dermatoses (PPD) are a group of chronic and relapsing cutaneous disorders characterized by a distinct purpuric rash. The diagnosis is made with clinical and histopathological findings. Dermoscopy has rarely been used in the diagnosis of PPD. The aim of our study is to describe the dermoscopic findings in patients with PPD. Eighteen patients who were clinically and histopathologically diagnosed with PPD were studied prospectively. The type and duration of PPD, associated diseases, and medication history of the patients were noted. Dermoscopic examination was performed in all of the patients. Four of the patients were women and 14 of them were men. 16 (88.8%) of them had Shamberg's disease, 1 of them had lichen aureus, and 1 had purpura annularis telangiectoides. Dermoscopic examination revealed multiple irregular red dots, globules and/or patches and brown-coppery coloration on the background in all of the patients, a network of interconnected brown lines in 8, linear vessels in 9, brown dots in 3, grey dots in 3, twisted red loops in 5, comma-like vessels in 2, and red lacunae in 1 patient. The dermoscopic examination of PPD might improve the accuracy of clinical diagnosis.