Background A broad spectrum of skin diseases, including hair and nails, can be directly or indirectly triggered by COVID‐19. It is aimed to examine the type and frequency of hair and nail disorders after COVID‐19 infection. Methods This is a multicenter study conducted on consecutive 2171 post‐COVID‐19 patients. Patients who developed hair and nail disorders and did not develop hair and nail disorders were recruited as subject and control groups. The type and frequency of hair and nail disorders were examined. Results The rate of the previous admission in hospital due to COVID‐19 was statistically significantly more common in patients who developed hair loss after getting infected with COVID‐19 ( P < 0.001). Telogen effluvium (85%) was the most common hair loss type followed by worsening of androgenetic alopecia (7%) after COVID‐19 infection. The mean stress scores during and after getting infected with COVID‐19 were 6.88 ± 2.77 and 3.64 ± 3.04, respectively, in the hair loss group and were 5.77 ± 3.18 and 2.81 ± 2.84, respectively, in the control group ( P < 0.001, P < 0.001). The frequency of recurrent COVID‐19 was statistically significantly higher in men with severe androgenetic alopecia (Grades 4–7 HNS) ( P = 0.012; Odds ratio: 2.931 [1.222–7.027]). The most common nail disorders were leukonychia, onycholysis, Beau's lines, onychomadesis, and onychoschisis, respectively. The symptoms of COVID‐19 were statistically significantly more common in patients having nail disorders after getting infected with COVID‐19 when compared to the control group ( P < 0.05). Conclusion The development of both nail and hair disorders after COVID‐19 seems to be related to a history of severe COVID‐19.

SUMMARY OBJECTIVE: We aimed to detect the frequency of fibromyalgia syndrome in patients with rosacea and determine whether this frequency was affected by the severity of rosacea and the quality of life. METHODS: In this prospective, controlled, cross-sectional study, a total of 94 consecutive rosacea cases and 87 age- and sex-matched controls were enrolled. The severity of rosacea was assessed in light of the findings of the National Rosacea Society Ethics Committee. Dermatology Life Quality Index and Rosacea-specific Quality-of-Life instrument had been applied to the cases of rosacea. The diagnosis of fibromyalgia syndrome was established according to the 2016 revised fibromyalgia diagnostic criteria, and the Fibromyalgia Impact Questionnaire was used to determine the functional disability. RESULTS: The frequency of fibromyalgia syndrome was higher in the rosacea group than in the control group (p=0.01), and Dermatology Life Quality Index and Rosacea-specific Quality-of-Life instrument were higher in patients with rosacea with fibromyalgia syndrome (p=0.006 and p=0.004, respectively). A statistically significant weak positive correlation was observed between Dermatology Quality-of-Life Index, Rosacea-specific Quality-of-Life instrument, and Fibromyalgia Impact Questionnaire; symptom severity scale scores; and fibromyalgia score (r=0.35, r=0.259, and r=0.32 and r=0.376, r=0.305, and r=0.312, respectively). CONCLUSION: The patients with rosacea have higher rates and disability scores of fibromyalgia syndrome than healthy controls, independent of rosacea severity, and quality of life is correlated with fibromyalgia scores. We might point out that fibromyalgia syndrome accompanying rosacea has more restrictions in their daily routine activities than rosacea alone. As such, physicians should be aware of the possible coexistence of rosacea and fibromyalgia syndrome.

Ankylosing spondylitis, a form of axial spondyloarthritis (SpA), is a chronic inflammatory rheumatic disease and manifests itself by inflammatory back pain, radiographic sacroiliitis, and excess spinal bone formation, as well as non-skeletal manifestations such as uveitis, inflammatory bowel disease (IBD), or psoriasis 1 . Reported prevalence rates range between 0.1 and 0.5% 1,2 .Tumor necrosis factor-alpha (TNF-alpha) is a cytokine with a key regulatory role in the inflammatory response, and impaired regulation of TNF-alpha has been suggested to have a role in the pathogenesis of inflammatory conditions. Blocking the action of TNF-alpha has been used in the treatment of chronic inflammatory conditions, including ankylosing spondylitis. Adalimumab is a recombinant human IgG1 monoclonal antibody, specific for human TNF-alpha.Despite its revolutionary benefits in rheumatologic disease, adverse effects such as ocular complications, severe infection, demyelinating conditions, malignancies, a lupus-like syndrome, induction of autoantibodies, injection site reactions, and heart failure have been reported with the use of TNF-alpha inhibitors 3 . Reported ocular side effects include periorbital infection, oculomotor nerve palsy, optic neuritis, central vein occlusion, as well as a paradoxical adverse event uveitis [4][5][6][7][8] . Most data on ocular side effects come from anecdotal reports, and pathophysiological processes are mostly unknown³; thus, ocular structural changes during long-term TNF-alpha inhibitor use may shed light on the pathogenesis of these conditions.Optical coherence tomography (OCT) is a practical technique widely used in clinical practice, which enables detailed examination of the eye and allows the thicknesses of the choroid, retina, and peripapillary retinal nerve fiber layer (RNFL) to be measured.

Dear Editor,cne vulgaris is a chronic inflammatory disease affecting the pilosebaceous unit in the skin [1]. Isotretinoin is a synthetic vitamin A derivative using in severe cystic acne treatment. Pain and arthralgia are observed in 20% of patients treated with isotretinoin [2]; however sacroiliitis is rare and hip arthritis is even more rare. There was no article in the literature about a patient with sacroiliitis and hip arthritis together.A 30-year-old male patient who was suffering from severe pain on his left hip and leg for two days admitted to our clinic. His pain was very intense in the evening and the Visual analog scale (VAS) pain score was 8. He experienced morning stiffness for two days and about an hour on his left lower extremity. The patient had no history of inflammatory low back pain, skin lesion, bowel problem or infection. No pathology was found in rheumatologic examination. Family history was normal, however the patient was taking isotretinoin 20 mg/day for acne vulgaris about two months. The patient resorted to the brain surgery department before our clinic, the lumbar magnetic resonance imaging (MRI) was taken and no pathology was detected. The inspection of left leg and other body parts were normal but there was a pronounced skin dryness around the mouth periphery and face. There was mild sensitivity with palpation on left hip but the movements were limited and so painful. Flexion, abduction, and external rotation (FABER), flexion, adduction, and internal rotation (FADIR), sacroiliac compression, Mennel and Gaenslen tests were bilateral positive but more painful on left side. Lumbar range of motion was normal and there was no neurological deficit. Erythrocyte sedimentation rate (ESR) (33 mm/hr) and C-reactive protein (CRP) (3.84 mg/L) values were higher in the laboratory tests. Complete blood count, routine biochemical tests and HLA-B27 were negative. Bilateral bone narrow edema on iliac sides of sacroiliac joints and increased joint fluid on left hip was found on MRI (Figures 1a and 2a). As a result of all tests, the patient was diagnosed as bilateral sacroiliitis and left hip arthritis due to isotretinoin. The isotretinoin was ceased and nimesulide 2×100 mg, methylprednisolone 1×16 mg and lansoprazole 1×30 mg was started. A dramatic clinical response was obtained. A significant decrease was observed in the laboratory parameters on the seventh day (CRP: 0.06 mg/L, ESR: 5 mm/hr) and the VAS score was 3. Methylprednisolone was reduced and ceased. A repeat MRI performed five months later showed no evidence of left hip arthritis and sacroiliitis (Figures 1b and 2b) and the examination was completely normal.

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