Dermatology Outpatient Clinic Research Articles

Pigmented basal cell carcinoma in an old man treated with surgical excision and flap reconstruction: a case report

Background: Basal cell carcinoma (BCC) stands as the prevailing form of malignancy, and its prevalence is on the rise. While BCC carries a minimal risk of mortality, it can induce notable morbidity, chiefly due to localized damage. The incidence of BCC increases significantly after the age of 40 years, especially in women who are caused by exposure to ultraviolet (UV) rays. There are a variety of surgical and non-surgical treatments for BCC. In general, surgical methods are used more frequently because of their higher cure rates. We are reporting a case of pigmented basal cell carcinoma in an old Asian man who was treated with surgical excision with wound reconstruction using flap surgery. Case Report: A 70-year-old man sought consultation at the Dermatology and Venereology outpatient clinic of Dr. Soetomo Regional Public Hospital. His main complaint was a wound on his forehead from two years ago. Initially, it appeared as a small lump with skin color. Over time, the lump got bigger and then turned into a wound that got wider. He also felt pain and itchy on the wound. For the past year, the wound had become easily bleeding. Dermatological examination revealed an ulcer with a clean base, not sharply marginated, asymmetry, and a size of 1,8 x 1,6 cm, with a rolled-up margin and an elevated edge. There was a translucent hyperpigmented nodule on the edges and a sign of bleeding in the center of the ulcer. A dermoscopy examination showed a blue-gray ovoid nest, shiny white structureless area, arborizing vessels, and ulceration. Histopathological results from both biopsies showed the proliferation of anaplastic basal cells was a monotonous rounded nucleus, coarse chromatin, several prominent nuclei, and narrow cytoplasm to moderately that partially contained melanin. The patient was diagnosed with Pigmented BCC. The treatment plan was to use surgical excision with advancement flap reconstruction. Postoperative lesions showed improvement and healed after three weeks post-surgery. Conclusion: The management of BCC is determined based on the anatomical location and histological features. Widely used therapeutic approaches such as standard excision surgery or other invasive methods are significant therapeutic options.

A Study of Community-Acquired Pyodermas with Special Reference to Panton-Valentine Leukocidin (PVL)-Positive Methicillin-Resistant Staphylococcus Aureus.

Community-acquired (CA) pyodermas are one of the most common infections encountered in the dermatology outpatient clinics. A significant number of these conditions are caused by Staphylococcus aureus. CA-methicillin-sensitive Staphylococcus aureus (MSSA) and CA-methicillin-resistant Staphylococcus aureus (MRSA) have specific virulence genes which are associated with these diseases, particularly the Panton-Valentine leukocidin (PVL) genes. The presence of the PVL gene as a virulence factor may be associated with recurrent and severe skin infections. A prospective study was conducted with 205 cases of CA pyodermas, of which five were discarded due to mixed isolates. Clinical details were taken and wound exudate was sent for bacteriological examination. Further, the molecular study was performed on all MRSA (7) isolates and 13 randomly selected MSSA isolates using polymerase chain reaction for mecA and PVL genes. Staphylococcus aureus was the most common organism (90%) isolated from primary or secondary CA pyodermas. The prevalence of CA-MRSA among all pyodermas was 3.5% in our community. The PVL gene was not detected in all tested CA-MRSA and CA-MSSA isolates. While pyodermas are common, the prevalence of MRSA is low in the CA pyodermas in our region. PVL does not appear to be a virulence factor among the isolated MRSA. Larger, multicentric, and periodic studies are, however, required to further justify these claims.

Increased ambient outdoor temperatures are associated with increased disease flaring in hidradenitis suppurativa.

Despite evidence to suggest a relationship between time of year and hidradenitis suppurativa (HS) flaring, no studies have been conducted to date to establish a relationship directly between temperature and flaring. In this study, we aim to validate a classification approach based on administrative data for identifying medical encounters that likely represent HS flares in patient with a known diagnosis of HS within the Mass General Brigham Health System (MGB) and examine the relationship between average daily temperatures and HS disease flaring among patients in Boston. This is a retrospective cohort study. Participants were individuals with HS presenting to emergency departments or dermatology outpatient clinics with disease flares between January 2017 and January 2022. The average number of encounters for HS flares was compared with the temperature for that day and the 3- and 7-day periods prior. There were 2567 patient encounters for HS flares included in the study. Of the total identified HS flares, 75.6% occurred in females and 39.1% occurred in patients who identified as Black. Uniformly small but statistically significant relationships were noted between increased temperature and presentations for hidradenitis suppurativa flare with the highest correlation coefficient (0.0768) noted with a 3-day lag time between the heat experienced and day of presentation for flare. Increased temperature is associated with a small, but statistically significant increase in HS disease flaring. As such, HS disease flaring may rise as global temperatures do, suggesting an increase in the global burden of HS as climate change persists.

The Psychological Impact of Isotretinoin Therapy on Acne Vulgaris Patients.

Introduction Acne vulgaris is a dermatologic condition that affects the pilosebaceous unit. It is the most common skin disorder worldwide, and it is most prevalent during puberty. For patients with moderate to severe acne that is unresponsive to antibiotic treatment, the main treatment is oral isotretinoin. The objective of this study was to define the impact of isotretinoin and its well-established adverse effects on the psychological status of acne patients during treatment. Methods The sample cohort included 80 patients with acne vulgaris who were treated with isotretinoin. The sample size was calculated using the Raosoft [Raosoft.com (2015) Sample Size Calculator by Raosoft, Inc.] sample size calculator to maintain a confidence interval of 95% and a margin of error of 5%. The participants were assessed using the Depression and Anxiety Stress Scale-21 (DASS-21). The DASS-21 is a self-reporting scale used to measure the emotional states of depression, anxiety, and stress. This study was a cross-sectional survey conducted at the dermatology outpatient clinic at King Abdulaziz Medical City, Jeddah, Saudi Arabia. All patients diagnosed with acne vulgaris between January and April 2020 were included in the study. A multivariate regression analysis was also conducted to determine the presence of any significant independent factors associated with depression, anxiety, and stress. A P-value of ≤0.05 was considered statistically significant. Results We observed that the most prevalent psychiatric disorder among acne patients on isotretinoin therapy was anxiety. Our results also indicate that a history of mental illness is an independent risk factor for developing depression when isotretinoin is used. In addition, known adverse physical effects of isotretinoin treatment, including muscle pain, arthralgia, and headaches significantly increase the likelihood of patients developing psychiatric morbidity during therapy. Conclusion Isotretinoin is a highly potent therapy for acne. Overall, the physical side effects profile is well acknowledged, yet the exact psychological impact the treatment predisposes the patients to is yet to be determined.

Vitamin D Receptor Gene Polymorphisms and Association with Vitiligo in Indonesian Population.

Vitiligo is an acquired depigmenting skin disorder due to the loss of melanocyte function in the epidermis and hair follicles. The pathogenesis of vitiligo is multifactorial, with genetics being a predisposing factor. Previous studies had varying results regarding whether or not polymorphisms of vitamin D receptor (VDR) gene are associated with the risk of vitiligo in specific populations. This study investigated the association between three frequently analyzed VDR gene polymorphisms (ApaI, BsmI, TaqI) and susceptibility to vitiligo in Indonesian population. Thirty-four vitiligo patients and 34 age- and sex-matched healthy subjects aged ≥18 years old were recruited in the Dermatology and Venereology Outpatient Clinic of Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Genomic deoxyribonucleic acid (DNA) was extracted from the peripheral blood using a DNA isolation kit. VDR gene polymorphisms (ApaI, BsmI, and TaqI) were investigated using the polymerase chain reaction-restriction-fragment length polymorphism method. The differences of genotype distributions and allele frequencies were statistically compared between case and control groups using Chi-square test. VDR gene polymorphisms were identified in 68 participants, consisting of Aa (n = 14), aa (n = 20), Bb (n = 15), bb (n = 19), and TT (n = 34) genotypes in the case group. In the control group, Aa (n = 6), aa (n = 28), Bb (n = 17), bb (n = 17), and TT (n = 34) genotypes were identified. However, only subjects with ApaI Aa genotype polymorphism had a 3.267-fold increased risk of developing vitiligo. This study showed that ApaI Aa genotype polymorphism of the VDR gene increases the risk of vitiligo in Indonesian population.

Risankizumab for the Treatment of the Patients with Moderate to Severe Plaque Psoriasis During a 24-Week Period: Real-Life Experience.

Several authors have reported their experiences in real-world clinical practice, confirming the therapeutic efficacy of risankizumab in plaque psoriasis. We aimed to reflect our experience with risankizumab treatment in patients with psoriasis. Patients who presented to the dermatology outpatient clinics of two tertiary care centers between November 2021 and August 2022, diagnosed with psoriasis and treated with risankizumab, constituted the target population. Data including gender, age, weight, type of psoriasis, affected body sites, disease duration, previous treatments, duration of risankizumab treatment, psoriasis area and severity index scores, comorbidities, the reasons for drug discontinuation, adverse effects, and the patients' naïve or non-naïve status were obtained from electronic patient folders. Overall, 120 cases were included. While 73 (60.8%) cases were male, 47 (39.2%) were female. Eighty-six (68.3%) of all cases were biologic non-naive. A total of 49 patients (40.8%) had comorbidities. No significant correlations existed between biologic-naïve or non-naïve status, comorbidity status, and the PASI 75-90-100 responses. Risankizumab is an effective treatment option for both biologic naive or non-naive patients with or without comorbidities. However, long-term studies, including more extensive patient series, are needed to validate its efficacy and safety in real-life clinical settings.

Evaluation of the role of vitamin D in patients with psoriasis

Objectives: Investigate whether there is any association between the levels of vitamin D in the blood and the seriousness of psoriasis or its development. Methods: The study is characterized as observational, retrospective, composed of 40 patients with psoriasis who had serum vitamin D levels, who underwent clinical care at a dermatology outpatient clinic in Passo Fundo/RS, from August 2019 to June 2021. Results: Of the 40 interviewees, 60% were female and 40% male. Phototypes II and III prevailed. Regarding family health history, 50% had a history of the disease. Regarding the duration of psoriasis, the predominant group was between 1-10 years (57.5%). The most prevalent psoriasis subtype was vulgaris (62.5%). Regarding serum vitamin D results, the lowest index was 15.2 ng ̸ mL, the highest was 42.3 ng ̸ mL and the average was 25.99 ng ̸mL. In the predominant age group, between 20-40 years, the proportion of patients with vitamin D was less than 30 ng ̸mL is 83.33%. The lower the phototype, the greater the proportion of patients with suboptimal serum vitamin D. In the group of patients with disease duration > 10 years, vitamin D levels were lower. There is no extreme difference in the effectiveness of treatments when analyzing the average, minimum and maximum serum levels of vitamin D. Conclusion: There was no relationship between serum levels of 25-hydroxyvitamin D (25OHD) and the development of psoriasis or even control – worsening of the clinical picture of disease.

Individual Keratinocyte Necroses in the Epidermis Are Apoptotic Keratinocytes in the Skin.

The patient was a 44-year-old woman with Stevens-Johnson syndrome due to receiving Baktar® (sulfamethoxazole trimethoprim) medication at our outpatient dermatology clinic. The epidermis, dermis, and subcutaneous adipose tissue samples showed numerous necrotic keratinocytes in the epidermis. Apoptotic nuclei were visualized as diaminobenzidine brown deposits with immunoperoxidase staining for cleaved caspase-3. The cleaved caspase-3-positive findings were consistent with eosinophilic material that appeared to be necrotic cells within the epidermis. Therefore, these eosinophilic materials may be apoptotic bodies. Generally speaking, eosinophilic cells are considered necrotic keratinocytes, especially in Japan. To the best of our knowledge, no studies have used apoptotic immunohistochemical markers to examine whether these structures are apoptotic in a human specimen.

Abstract 8 — Risk of Liver Injury in Psoriasis and Rheumatoid Arthritis is Associated with Metabolic Risk Factors Rather than Methotrexate and Leflunomide

Objectives To assess the associations of hepatic injury and fibrosis in patients with psoriasis (PsO) and rheumatoid arthritis (RA). Methods A total of 318 patients attending dermatology and/or rheumatology out-patient clinics in Queen Mary Hospital, with clinical diagnosis of PsO, psoriatic arthritis (PsA) or RA were consecutively recruited from July 2020 to August 2022. Demographic data, comorbidities, and medications were recorded. Body mass index (BMI) was measured. Serum biomarkers for hepatic injury including autotaxin, matrix metalloproteinase (MMP) 3, MMP 8, and MMP 9 were determined. Transient elastography (TE) was performed to determine liver stiffness measure (LSM) and controlled attenuation parameter (CAP). Regression models were built to determine the association between methotrexate and leflunomide cumulative dosage, serum biomarkers and TE scores. Results A total of 67 (20.4%) patients had LSM>7.1 kPa. Multivariate linear regression showed methotrexate cumulative dosage was associated with autotaxin level (B=4.77, 95% CI 1.39; 8.15, p=0.001). There was no association between methotrexate cumulative dosage and MMP 3, MMP 8, MMP 9, LSM, CAP. There was also no association between leflunomide cumulative dosage and autotaxin, MMP 3, MMP 8, MMP 9, LSM, CAP. BMI (B=6.18, 95% CI 4.95; 7.41, p<0.001), hypertension (B=18.98, 95% CI 4.15; 31.82, p=0.01), hyperlipidaemia (B=20.21, 95% CI 3.50; 36.92, p=0.02) were associated with CAP. Conclusion Methotrexate and leflunomide have minimal hepatic risk in patient with PsO and RA. Metabolic risk factors had strong associations with hepatic injury.

Psoriasis and Psoriatic Arthritis Have a Major Impact on Quality of Life and Depressive Symptoms: A Cross-Sectional Study of 300 Patients.

Psoriasis (Pso) and psoriatic arthritis (PsA) can reduce the quality of life (QoL) and are known to be associated with depression. Within this study, we aimed to assess the burden of disease, functional capacity, quality of life, and depressive symptoms and identify factors predicting functional impairment and depression in patients with psoriatic disease. A cross-sectional survey was conducted in a cohort of 300 patients with psoriatic disease including 150 patients from a university hospital dermatology outpatient clinic and 150 patients from a university hospital rheumatology outpatient clinic. Questionnaire-based assessment of signs of arthritis (Psoriasis Epidemiology Screening Tool; PEST), functional status (Functional Questionnaire Hannover; FFbH), quality of life (World Health Organization Quality of Life Brief Version; WHOQOL-BREF), and depressive symptoms (Patient health questionnaire9; PHQ-9) and retrospective medical chart analysis were performed. Despite treatment, burden of disease was high. Joint pain was reported in multiple regions in patients with Pso (n = 111) and patients with PsA (n = 189), but with differences in frequency and distribution patterns of symptoms. Functional impairment in everyday life was independently associated with diagnosis of PsA (odds ratio [OR] 9.56, p = 0.005), depressive symptoms (OR 5.44, p < 0.001) and age (OR 1.04, p = 0.033). At least mild depressive symptoms were demonstrated in 54% and 69% of patients with Pso and PsA, respectively. In a logistic regression model, depressive symptoms were independently associated with functional impairment (OR 4.50, p = 0.003), axial complaints (OR 2.80, p = 0.030), diagnosis of psoriatic arthritis (OR 2.69, p = 0.046), and number of joint regions with complaints (OR 1.10, p = 0.032). Functional impairment, QoL, and depressive symptoms are mutually interdependent. Early diagnosis of PsA and initiation of anti-inflammatory therapy are essential to avoid long-term damage, disability, and mental health complications. However, despite therapy many patients with PsA, and especially female patients, report a substantial residual disease burden due to their psoriatic disease which will need to be addressed by a more patient-centered approach.

Non-specialized care of skin disorders: a cross-sectional survey of new patients attending dermatology clinic in a tertiary hospital in Jos, Northcentral Nigeria.

Given the paucity of skin health specialists in Nigeria and the low level of awareness amongst its populace, patients seek for care for skin related disorders from different sources and are given a variety of remedies before accessing specialist care. This study was aimed at describing outlets visited and medication received by patients with skin disorders prior to attending the dermatology outpatient clinic in JUTH. This was a cross sectional study conducted over one year. Information on socio-demography, sources and medication received prior to presentation was obtained and analysed using SPSS 23. The male: female ratio among 166 consenting new patients was 1:1.4. Prior to presentation patients sought care most frequently from Health facilities (68.1%), Patent medicine vendors-PMV (30.7%) and Traditional healers (21.7%). Overall, different steroid preparations were the most commonly used medications (56.6%) across all age groups with fixed combination preparations most frequently used (32.5%). Unconventional substances reportedly used by patients for skin disorders were urine, toothpaste, tomatoes, salt, water in which a life catfish had been kept and fats from a dead dog. Only 21.1% of the patients did not use any medication prior to presentation. There is need to increase capacity in the care of common skin diseases at all levels of the health care system to decrease patronage of unconventional providers. Raising awareness of the general public on the potential dangers of inappropriate treatment of skin diseases and strengthen referral system is imperative to reduce the burden of skin diseases in the country.

The Disease of All Times: A Retrospective Study of 272 Syphilis Cases

Purpose: This study aimed to investigate the changes in our syphilis cases over the years, their demographic and clinical characteristics, and their laboratory findings.&#x0D; Methods: The study included patients diagnosed with syphilis between 2018 and 2022 at a tertiary hospital's Dermatology and Infectious Diseases (ID) outpatient clinics. Patients'; demographic, clinical, and laboratory data evaluated at the time of diagnosis. The Statistical Package for the Social Sciences (SPSS) 20.0 program was used to analyze the data. &#x0D; Results: A total of 272 syphilis cases were included in the study. Among these cases, 82.4% were male, and 39.6% were 41–60 years old. In total, 7.4% were anti-HIV, and 2.9% were positive for HBsAg. The rates of the cases diagnosed at primary and secondary stages were 74.4%. Syphilis cases were detected more in 2018 than in other years (except 2020) and fewer in 2022 than in other years (p&lt; 0.001). Anti-HIV positive cases were diagnosed more frequently at ID outpatient clinics, and cases with clinical findings were diagnosed more at dermatology outpatient clinics (p&lt; 0.001). The rate of sexual partners not tested for syphilis was significantly higher in males than in females (p= 0.027). The rates of syphilis cases in the study and Turkey as a whole were similar in 2018–2019 but significantly different in 2020-2021-2022 (p&lt; 0.001).&#x0D; Conclusion: Reporting syphilis is essential to identify the at-risk population prevent complications, and reduce transmission. Monitoring the profile of syphilis cases admitted to the hospital can increase the detection rate of syphilis cases.

Determinants of appointment nonattendance among outpatients with hidradenitis suppurativa

AbstractBackgroundHidradenitis suppurativa (HS) is associated with several comorbidities and significant impairment of quality of life. Moderate to severe HS patients have often prolonged treatment courses at various hospitals. We investigated various factors that may be related to missed follow‐up visits during prolonged treatment courses among HS outpatients.ObjectivesTo highlight potential predictors for appointment absenteeism among HS patients.MethodsDuring a 12‐month period at a university hospital dermatology outpatient clinic, absenteeism and related factors were obtained for each visit at the hospital.ResultsOut of 161 unique follow‐up visits during a 12‐month period at a university hospital dermatology outpatient clinic, 37 patients (23.0%) were absentees. Patients with non‐attendance were more likely to be males (p = 0.02). Patients who were on biologic treatment for HS were less likely to miss appointments (p = 0.06).ConclusionsOur study showed that almost one in four hospital outpatients with HS fail to show up for their scheduled appointments. The data suggest an increased awareness of high risk of missed follow‐up visits during treatment of HS patients.

The effects of the COVID-19 pandemic on the Dermatology Outpatient Clinic of Aydın Adnan Menderes University Hospital

The effects of the COVID-19 pandemic on the Dermatology Outpatient Clinic of Aydın Adnan Menderes University Hospital

Evaluation of oxidative stress levels as biomarkers in vitiligo patients

Abstract Objective: Vitiligo is a skin disease that causes the loss of melanocyte cells, which produce pigment in the skin. There is evidence that oxidative stress plays an important role in vitiligo disease of unknown pathogenesis. Evidence suggests that there is increased oxidative stress in melanocytes in patients with vitiligo. The aim of this study is to investigate oxidative stress markers in patients with vitiligo. Materials and Methods: Blood samples were taken from 23 vitiligo patients and 23 healthy control groups without any disease in Bezmialem Vakıf University Hospital Dermatology and Venereal Diseases Outpatient Clinic. Total antioxidant levels (TAS) and total oxidant levels (TOS) were measured photometrically method with blood samples. The oxidative stress index (OSI) was calculated as the TOS to TAS level ratio. Results: When the results of the vitiligo patient group were compared with the control group, TOS and OSI were found to be significantly higher than the control group (P &lt; 0.05). No statistically significant result was found in TAS. Conclusions: Our results show that oxidative stress plays a role in the pathogenesis of vitiligo.

Translated article] What Proportion of the Spanish Dermatology Caseload Corresponds to Pediatric Dermatoses? Results From the DIADERM National Random Sampling Survey

BackgroundVisits for skin conditions are very common in pediatric primary care, and many of the patients seen in outpatient dermatology clinics are children or adolescents. Little, however, has been published about the true prevalence of these visits or about their characteristics. Material and methodsObservational cross-sectional study of diagnoses made in outpatient dermatology clinics during 2 data-collection periods in the anonymous DIADERM National Random Survey of dermatologists across Spain. All entries with an International Classification of Diseases, Tenth Revision code related to dermatology in the 2 periods (84 diagnoses) were collected for patients younger than 18 years and classified into 14 categories to facilitate analysis and comparison. ResultsIn total, the search found 20 097 diagnoses made in patients younger than 18 years (12% of all coded diagnoses in the DIADERM database). Viral infections, acne, and atopic dermatitis were the most common, accounting for 43.9% of all diagnoses. No significant differences were observed in the proportions of diagnoses in the respective caseloads of specialist vs. general dermatology clinics or public vs. private clinics. Seasonal differences in diagnoses (January vs. May) were also nonsignificant. ConclusionsPediatric care accounts for a significant proportion of the dermatologist's caseload in Spain. Our findings are useful for identifying opportunities for improving communication and training in pediatric primary care and for designing training focused on the optimal treatment of acne and pigmented lesions (with instruction on basic dermoscopy use) in these settings.

Prevalence Of Sunscreen Usage And Perception About Sun Exposure And Sunscreen: A Lower-Middle-Income Country's Perspective.

Sunlight is required for vitamin D synthesis but is also responsible for various adverse effects on human skin, including photo aging, sunburn, and skin cancer. To avoid this, regular use of sunscreens is recommended. The aim of the study was to evaluate the knowledge of a subset of our local population about exposure to sun and assess the attitude about the importance of sunscreen usage. This prospective cross-sectional study was conducted at the dermatology outpatient clinic using a predesigned questionnaire filled by the participants. A total of 200 patients were selected, out of which 135 were females and 65 were males. Forty-nine percent of the participants claimed to use sunblock; however, the majority (54%) used it only occasionally. Fifty-one percent of the participants were not aware that exposure to sun can cause darkening of the skin but more than 100(50%) were aware that this exposure has multiple side effects on the skin. It was also observed that participants had good knowledge about the side effects of sunblock. The study results concluded that participants have good perception of the effectiveness and side effects of sunscreen, most of them used it occasionally. It necessitates the need for a health education programme.

Body Dysmorphic Disorder and Self-esteem in Adolescents and Young Adults with Acne Vulgaris.

Body dysmorphic disorder is a mental health disorder characterized by a preoccupation with a perceived flaw, which is commonly seen among dermatology patients. The objective of this study was to determine the frequency of body dysmorphic disorder and assess self-esteem among a clinical sample of adolescents and young adults being managed for acne vulgaris. A total of 105 patients, age range 13-24 years, receiving acne treatment at 1 of 2 dermatology outpatient clinic were included. A self-report questionnaire was used, which included a body dysmorphic disorder screening tool (based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria) and the Rosenberg Self-Esteem Scale (RSES). Acne was graded with the Cook's acne grading scale. Out of 105 adolescents and young adults visiting a dermatologist due to acne, 13 (12.4%) screened positive for body dysmorphic disorder (95% confidence interval (95% CI) 6.8-20.2%). Patients with body dysmorphic disorder were more likely to have female gender (p = 0.020) and had lower self-esteem (RSES 15.8 vs 20.5, respectively, p = 0.013) compared with patients without body dysmorphic disorder. No differences were found in the frequency of body dysmorphic disorder with DSM-IV or DSM-5 criteria. This is the first study to report on the frequency of body dysmorphic disorder and self-esteem in adolescents and young adults with acne. Ultimately, more awareness of body dysmorphic disorder among adolescents and young adults presenting with dermatological disorders could lead to more rapid recognition and referral to psychiatric units.

Psychiatric co‐morbidity in patients with hidradenitis suppurativa: A cross‐sectional study of clinical characteristics and burden of disease

AbstractBackgroundPsychiatric co‐morbidity (PCM) constitutes a major complicating factor for patients with hidradenitis suppurativa (HS) but individuals at risk are ill defined.ObjectivesTo examine the differences in demographic and clinical characteristics, co‐morbidities, and disease burden in patients with HS with and without PCM.MethodsData were obtained through clinical examination and interviews. Disease burden was evaluated based on clinical severity, VAS‐10 for overall bother and pain, and dermatology life quality index. Analysis was conducted on all patients and amongst PCM‐subgroups. All current physician diagnosed psychiatric conditions were included.Results667 consecutive, adult patients with HS from a dermatological university outpatient clinic were included. Of these, 183 (27.4 %) had a diagnosis of PCM, with affective disorders (16.2%) being most prevalent.PCM was associated with being unemployed (52.5 vs. 18.7 %) OR 5.50 (3.73–8.10) p &lt; 0.001, Caucasian (88.5 vs. 80.6 %) OR 1.86 (1.12–3.09) p &lt; 0.05, younger at HS‐onset (23.6 vs. 26.2 years) p &lt; 0.01, obese (44.0 vs. 34.5 %) OR 1.50 (1.06–2.13) p &lt; 0.05 and smoker (89.6 vs. 73.2 %) OR 3.76 (2.20–6.40) p &lt; 0.001. Differences within PCM‐subgroups were also discovered.Patients with PCM were more likely to have asthma or/and chronic obstructive pulmonary disease (9.8 vs. 5.6 %) OR 1.94 (1.03–3.66) p &lt; 0.05. Patients with PCM had higher VAS‐10 bother scores (mean 7.3 vs. 6.7) p &lt; 0.05, but no differences in disease severity.Patients with HS‐onset before the age of 15 had the highest risk of developing PCM within the following 10 years, HR 3.37 (1.56–7.31) p = 0.002.ConclusionsPatients with PCM and HS vary in demographic and clinical characteristics, risk factors and burden of disease, compared to patients with HS without PCM. This calls for a multidisciplinary approach and increased awareness from the clinician.

Evaluation of Etiology in Patients Who Admitted to Dermatology Outpatient Clinic with Acute Urticaria

Objective: The purpose of this review is to describe the causes of patients with acute urticaria who admitted dermatology outpatient clinic.&#x0D; &#x0D; Materials and Methods: Adult patients (age &gt; 18 years) who were diagnosed with acute urticaria were included in our study. Our sample consisted of 159 patients with acute urticaria who applied to three different dermatology outpatient clinics between 2021-2022 years. Age, gender, duration of disease, history of angioedema, presence of triggering factor, history of chronic urticaria, and admission to the emergency department were collected retrospectively from records.&#x0D; Results: A total of 159 patients 102 (%64.1)were female and 57 (%35.8) were male. 82 (51.6%) patients had a triggering factor and no factor was detected in the remaining 77 (48.4%) patients. The total number of patients who admitted to the emergency department was 42 ( 26.4%). The most common triggering factor was drugs (n=31, 37.8%) followed by infections. The most commonly used drug type was Non-steroidal anti-inflammatory drugs and the most common infection was upper tract ınfections.&#x0D; Conclusion: Our study revealed that drugs and infections are common causative factors for acute urticaria consistent with the literature. When we examined patients with acute urticaria, especially in the emergency department or dermatology outpatient clinic, we need to keep in mind that detecting possible triggering factors can prevent the disease from recurring or the development of life-threatening symptoms.