The laboratory tests that should be performed and their frequency during isotretinoin treatment are controversial. We wanted to investigate muscle and joint pain and laboratory tests in acne patients who received isotretinoin. Between April 2019 and February 2023, serum CK, AST, ALT, and GGT levels were retrospectively evaluated in acne patients before and three months after systemic isotretinoin treatment. This study included 410 patients. The median serum AST, ALT, and GGT levels significantly increased, whereas serum CK levels were similar in all patients three months after treatment. 23 (5.6%) patients revealed muscle or joint pain after treatment. No significant difference was detected in patients with or without pain in the median serum CK, AST, ALT, and GGT levels after treatment. Isotretinoin treatment at a dose of 10 mg/day was more common in patients with pain than in those without pain, whereas none of the patients who received isotretinoin 40 mg/day developed muscle or joint pain. We suggest that routine evaluation of serum CK levels is unnecessary in acne patients treated with isotretinoin. However, muscle and joint pain may develop even at doses as low as 10 mg/day. Furthermore, monitoring AST, ALT, and GGT levels may be beneficial in acne patients treated with isotretinoin.
Psoriasis has been associated with metabolic syndrome and nonalcoholic fatty liver disease. We wanted to investigate the abdominal ultrasonography results of psoriasis patients before biological agent treatment. Between April 2019 and February 2022, abdominal ultrasonography results of psoriasis patients which were performed before biological agent treatment were reviewed retrospectively. This study included 90 patients, 45 females, and 45 males with a mean age of 48.91±13.43 years. The most common ultrasonography finding was increased echogenicity of the liver parenchyma due to steatosis (58.9%) which was followed by an increase in liver size (25.6%), kidney cysts (17.8%), gallstones (8.9%) and increase in spleen size (7.8%). Hepatic steatosis was more frequent in older patients (p<0.001), patients with diabetes (p=0.007), and patients who were previously treated with biological agents (p=0.007). 70.4% of the patients with moderate or severe hepatic steatosis were female. Herein, hepatic steatosis was detected in 53 (58.9%) patients. Nonalcoholic fatty liver disease which presents as hepatic steatosis in early stages has an asymptomatic course and poor prognosis in psoriasis patients. We suggest that abdominal ultrasonography should be performed in psoriasis patients before biological agent treatment, especially in females, patients with advanced age, patients who were previously treated with biological agents, and patients with diabetes.
COVID-19 has not been adequately investigated in patients with psoriasis. We wanted to evaluate the effect of COVID- 19 and COVID-19 vaccines on disease course in patients with psoriasis. We retrospectively reviewed the medical records of patients who were admitted for the treatment of psoriasis between March 2020 and May 2022. Afterward, patients were contacted by telephone call to collect data on COVID-19. This study included 257 patients, 118 females, and 139 males. 238 (92.6%) patients were vaccinated against COVID-19. The mean age of the vaccinated and unvaccinated patients was 49.23±14.60 and 40.37±11.66 years, respectively (p=0.010). Exacerbation of psoriasis after COVID-19 vaccination was detected in 32 (13.4%) patients. 114 (44.4%) patients had been diagnosed with COVID-19 and 18.4% of them stated exacerbation of psoriasis after COVID-19. No association was detected between COVID-19 and having an accompanying disease and psoriasis treatment (p=0.843, p=0.845, respectively). Hospitalization was required in 12 (10.5%) patients. Unvaccinated patients with psoriasis were significantly younger than those who were vaccinated. Exacerbation of psoriasis was reported in 13.4% of vaccinated patients and in 18.4% of patients after COVID-19. Nevertheless, accompanying disease and conventional or biological agent treatment were associated neither with COVID-19 nor COVID-19-related hospitalization.
Chronic inflammation and immunosuppressive treatment may play a role in the etiopathogenesis of cancer in psoriasis patients. We wanted to evaluate the Papanicolaou smear (Pap smear) results of female patients with psoriasis which were performed for cervical cancer screening before the initiation of biological agent treatment. Between April 2019 and November 2021, Pap smear results of female patients with psoriasis were reviewed retrospectively. This study included 70 female psoriasis patients with a mean age of 48.41±11.62 years. 49 (70%) patients were biologically naive, whereas 21 (30%) patients previously received biological agents. Obscuring inflammation was reported in 33 (47.1%) patients. Atrophy, intermediate cell predominance, reactive cellular changes due to inflammation, and both atrophy and reactive cellular changes were detected in 15 (21.4%), 7 (10%), 3 (4.3%) patients, and 1 (1.4%) patient, respectively. No malignancy or intraepithelial lesion was observed in 69 (98.6%) patients, whereas atypical squamous cells of undetermined significance were reported in 1 (1.4%) patient. Infections such as bacterial vaginosis, candidiasis, and actinomycosis were detected in 13 (18.6%) patients. Pap smear tests should be performed in female psoriasis patients to detect premalignant lesions of the cervix before the initiation of biological agent treatment. Moreover, psoriasis treatment guidelines should be updated accordingly.
