Cagri Turan

and 1 more

An unusual localization of genital ulcer in Behçet’s disease: external urethral meatusRunning head: Unusual genital ulcer in Behçet’s diseaseÇağrı Turan1, İbrahim Karabulut 21Department of Dermatology and Venereology, the Republic of Turkey, Health Sciences University Erzurum Regional Training and Research Hospital, Turkey2Department of Urology, the Republic of Turkey, Health Sciences University Erzurum Regional Training and Research Hospital, TurkeyCorresponding Author : Çağrı TURAN; Department of Dermatology and Venereology, the Republic of Turkey, Health Sciences University Erzurum Regional Training and Research Hospital, Turkey; Üniversite Mahallesi, Çat Yolu Cd., Yakutiye/Erzurum, Post Code: 25070e-mail: cagrituranmd@gmail.com, telephone number: +905445252504Word count: 471Table count: 0Supplementary table: 0Figure count: 1Funding sources : We declare no financial support or relationships that may pose a conflict of interest.Conflict of interest: There is no conflict of interest.The paper has not been published or submitted for publication elsewhere.All authors have contributed significantly, and all authors agree with the content of the manuscript.Informed consent form was obtained from the patient.Key words: Behçet’s disease, genital ulcer, Urethra, VasculitisDear editor,Behçet’s disease (BD) is a chronic, recurrent, multisystemic vasculitis which can affect all vascular system. The most common symptom is genital ulcer accompanying oral aphthae, and its diagnosis is currently made according to the International Criteria for Behçet’s Disease (ICBD). Providing two points for oral aphthae, genital ulcers, and ocular involvement and one point for the other skin lesions (erythema nodosum, papulopustular/acneiform lesions in post-adolescent), vascular involvement, and neurological findings are evaluated if the patient scores reach four or more; the patient is considered to be BD1, 2. In men, genital aphthous ulcers occur in 60 to 65% of cases and are most common in the scrotum, shaft and glans penis, and rarely in the groin and perineum, extremely rare in the urethral orifice2, 3We presented a patient with a complaint of painful micturition, ultimately diagnosed with BD. A 34-year-old male patient was consulted from the urology following the evaluation of his painful voiding complaint 10 days accompanying wound in the periurethral orifice. On genital examination, an oval, and sharp circumscribed aphthous ulcer with a serous floor, approximately 4 mm in diameter, was seen on the external urethral orifice (Figure 1a). The patient who had no known disease has refused to use any medication, similar complaints, suspicious sexual contact, except for oral aphthae recurring 8-10 times a year (Figure 1b). After noticing a few pustular lesions with peripheral partial erythema on his back, we focused on BD and inflammatory bowel diseases in the examination (Figure 1c). We learned that the patient had no family history and other related symptoms. Bowel habits were normal. Hepatitis, HIV, syphilis serologies were negative. CRP and sedimentation were 3.2 mg/dl (0-5 mg/dl) and 27 mm/hour (0-20 mm/hour); respectively. Other hematological and biochemical parameters were within normal limits. Complement levels, antinuclear antibody, anti-dsDNA, p-ANCA, c-ANCA and rheumatoid factor were normal. Pathergy test was positive. The patient was diagnosed with BD with a score of 6 according to the current ICBD, and no pathology was found in the eye and cardiology consultations. His complaints improved within 1 week without leaving any scar, after treatment with topical betamethasone valerate applied to the urethral orifice and oral colchicine 1.5 mg/day. No clinical progression has been observed for 2 years in the follow-up.A urethral ulcer is an unusual finding in BD. Aktaş recently reported a 27-year-old male patient with clinical features quite similar to our case, but with negative pathergy4. Interestingly, Cobilinschi et al. reported that a 34-year-old female patient with BD who was admitted with progressive dysuria, pain in the right lumbar region, and hydronephrosis was determined a necrotic ulcer in the ureter whose histopathology was compatible with vasculitis5.We present this case to draw attention to the aphthous ulcer in the urethra as an unusual genital involvement for BD, and the importance of physical examination.

Nurcan Metin

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Purpose: We aimed to reveal the relationship of uric acid with MHR and other inflammatory markers acne patients before and after isotretinoin treatment. In this way, we can try to shed light on the relationship between isotretinoin treatment and atherosclerosis. Methods: Two hundred twenty-four acne patients who administered isotretinoin (0.5-1 mg/kg/day) were enrolled in the study. In the pre-treatment phase and 3 months after treatment, MHR, SUA, mean platelet volume, plateletcrit, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio, monocyte-lymphocyte ratio, serum triglyceride, total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) levels of the patients were analyzed. Results: Compared to the pre-treatment phase, three months after treatment, there was a statistically decrease in neutrophil count and an increase in lymphocyte count (p: 0.002, p: 0.011; respectively). Accordingly, there was a statistically significant decrease in NLR (p: 0.001). It was noteworthy that MHR and SUA levels increased significantly (p: 0.042, p: 0.010; respectively) and there was a positive correlation between SUA level and MHR (r: 0.212, p: 0.012). Serum total cholesterol, LDL, and triglyceride levels increased and HDL levels decreased significantly after treatment (p: 0,001). Conclusion: This study contributes to the comprehension of the relationship between isotretinoin treatment and atherosclerosis, which has been frequently reported in the literature. It was thought that the isotretinoin-induced uric acid increase might be related to dyslipidemia. Isotretinoin may initiate the atherosclerotic process in vascular endothelial and smooth muscles, with uric acid increase and HDL decrease. An increase in MHR is also an inflammatory marker indicating this process.

Cagri Turan

and 2 more

Aims We aim to reveal the effect of the crisis period and normalization process after COVID-19 on dermatology practice, to anticipate future health problems, and demonstrate the necessity of teledermatology as a solution. Results The number of patients in the normalization (32.3%) increased compared to the crisis period (11.5%) but also it was found significantly lower than before the pandemic (56.2%). It was remarkable that the change in the distribution of stress-related diseases, such as idiopathic generalized pruritus, alopecia areata, and zona zoster, stably paralleled each other and the trend of increase and decrease during the crisis period and the normalization process, respectively. The increase in the frequency of contact dermatitis, which was not reflected in the crisis period, became evident in the normalization process (p<0.001). There was no significant change in the rate of scabies but a decrease in the number of patients (p=0.276). Discussion The decrease in stress-related diseases indicates that social stress started to decrease with normalization. Rates and the number of patients give an idea about the problems we may encounter aftermath pandemic. Scabies and venereal diseases, which concern public health, should not be neglected. We predicted that much more significant increases in the frequency of scabies will be recorded aftermath of COVID-19. Conclusion The extraordinary conditions that occur after the pandemic will make the management of some diseases, especially scabies, difficult in the future. The chaos that will occur when the unusually decreasing number of patients returns to normal can be alleviated by teledermatology.