We aimed to investigate the profile of the inflammatory infiltrate in lesional and nonlesional tissue in alopecia areata (AA) and look for possible associations between inflammatory mechanisms, neuropeptide expressions, and various clinical features. Twenty-four patch-type AA patients were included. Forty-eight lesional and nonlesional skin samples were stained immunohistochemically with antibodies for CD1a, CD3, CD4, CD8, CD20, CD57 (for natural killer cells), mast cell tryptase, nerve growth factor receptor (NGFR), and substance P (SP). Various clinical findings were recorded. Psychological distress levels and stress-related hormones were measured. Lesional skin showed statistically more CD3(+), CD8(+), and CD57(+) lymphocytes, mast cells, Langerhans cells, and more prominent immunoreactivities of NGFR and SP (P < 0.003). Most nonlesional skin showed CD3(+) and CD57(+) cells, mast cells, and NGFR(+) nerve fibers. NGFR and SP, and SP and perivascular mast cell infiltrates were correlated, whereas peribulbar mast cells and anagen follicle counts were inversely correlated in nonlesional skin (P < 0.05). Near half of the patients' distress levels were high. No relationship among biochemical, psychological, and clinical parameters could be shown. AA may involve the entire skin in which lesions occur as a result of local T cell-mediated cytotoxic inflammatory response initiated by Langerhans cells and mast cells activated via neuropeptides.

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Basosquamous carcinoma of the skin is a rare malignancy with specific histopathological features of both basal cell carcinoma and squamous cell carcinoma. Some authors believe that basosquamous carcinoma is a variant of basal cell carcinoma, while others suggest that this tumour may behave more aggressively. We present a 44-year-old female patient who was diagnosed with a basosquamous carcinoma histopathologically. She had extensive ulcero-vegetative lesions, involving the anterior half of the scalp, the left orbit and the left side of the face. With this case we aim to emphasize the aggressive nature of basosquamous carcinoma and review the literature.

Traumatic and various dermatological conditions resulting in skin and subcutaneous tissue loss on the lower limb cause a therapeutic challenge for the dermatological surgeon, because this anatomical location lacks adequate skin laxity and has limited local soft tissue, especially around the heel. In this report, we present our experience with the reverse sural artery flap on seven patients. The soft tissue defect was traumatic in two patients. We also treated three diabetic patients. There were no immediate or late surgical complications in four cases; flap and donor site healing was uneventful. The remaining three cases were diabetic, and all presented with the following complications: rejection of split skin graft at donor site, infection at the flap border and superficial flap necrosis. The flap necrosis was concluded to be at least in part due to the patient's noncompliance with postoperative measures. We conclude that the reverse sural artery flap is a satisfactory alternative in the reconstruction of lower limb defects, but we also feel that the importance of proper evaluation prior to surgery in terms of vascular impairment and patient compliance should be emphasized to ensure a successful surgical outcome.

Background and Design: The helper 17 (Th17) cells and interleukin-17 (IL-17) are thought to play a role in the pathogenesis of acne vulgaris (AV). Vitamin D, involved in bone metabolism, has also been shown to decrease proinflammatory cytokines through inhibition of Th17 cells and toll-like receptor 2 expression on monocytes.. We aimed to evaluate the effect of IL-17 and vitamin D levels in the pathogenesis of AV in our study. Materials and Methods: Between October 2015 and April 2017, 80 AV patients (49 women/31 men) and 80 healthy controls (40 women/40 men) were admitted to the study. Demographic and clinical features were recorded. Blood samples were collected from all participants. IL-17, was studied by sandwich ELISA method and vitamin D was studied by the chemiluminescence method. Results: In the patient group vitamin 25-Hydroxyvitamin D3 [25(OH)D3] level was significantly higher than the control group (p=0.038). There was no statistically significant difference between the two groups at IL-17 level (p=0.959). According to the global acne grading system, vitamin D level in the mild group was 18.5 (12.8-23.1) ng/mL while the vitamin D level in the moderate-severe group was 18.0 (11.2-23.1) ng/mL. There was no significant relationship between the severity of AV lesions and the vitamin 25(OH)D3 levels (p=0.623). IL-17 levels in the Amaç: Akne vulgaris (AV) patogenezinde T helper 17 (Th17) hücrelerinin ve interlökin-17'nin (IL-17) rolü olduğu düşünülmektedir. Kemik metabolizmasında rol aldığını bildiğimiz D vitaminin de monositler üzerinde Toll-like reseptörü 2 ekspresyonunu ve Th17 hücrelerini inhibe ederek proenflamatuvar sitokilerin üretimini azalttığı yolunda veriler bulunmaktadır. Çalışmamızda AV patogenezinde IL-17 ve D vitamini düzeylerinin etkisini değerlendirmek amaçlanmıştır. Gereç ve Yöntem: Çalışmaya Ekim 2015 ve Nisan 2017 arasında AV tanısı alan 80 olgu (49 kadın/ 31 erkek) ve 80 sağlıklı kontrol (40 kadın/40 erkek) dahil edildi. Demografik ve klinik özellikler takip formuna kaydedildi. Tüm katılımcılardan kan örnekleri toplandı. IL-17, sandviç ELISA yöntemiyle, D vitamini ise kemilüminesans yöntemiyle çalışıldı. Bulgular: Hasta grubunda 25-hidroksivitamin D3 [25(OH)D3] vitamini düzeyi kontrol grubuna göre anlamlı olarak yüksekti (p=0,038). IL-17 düzeyinde ise iki grup arasında istatistiksel olarak anlamlı fark bulunmadı (p=0,959). Global akne derecelendirme sistemine göre hafif şiddetli olan AV olgularında D vitamini düzeyi 18,5 (12,8-23,1) ng/mL iken orta-şiddetli grupta D vitamini düzeyi 18,0 (11,2-23,1) ng/mL olarak saptandı. Lezyonların şiddetiyle 25(OH)D3 vitamini düzeyi arasında anlamlı ilişki olmadığı gözlendi (p=0,623). Hafif şiddetli grupta IL-17 düzeyi 534,7 (207,4-640,0) pg/mL iken orta-şiddetli grupta IL-17 düzeyi 368,1 (137,6-640,0) pg/mL olarak saptandı. Hastalarda AV lezyonlarının şiddetiyle IL-17 düzeyi arasında anlamlı ilişki olmadığı gözlendi (p=0,256). Sonuç: AV hastalığının patogenezinde D vitamini ve IL-17 düzeylerinin rolü olup olmadığı araştırılan bu çalışmada AV hastalığı ...