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Vaskülitler damar duvarýnýn inflamasyonudur. Sistemik vaskülitler büyük heterojen bir klinikopatolojik antite grubunu ifade eder. 1952' de Zeek, nekrotizan vaskülitlerin sýnýflamasýný inflamatuar sürecin tuttuðu damarlarýn büyüklüðü üzerine kurarak klinikopatolojik bulgularý birleþtiren ilk otorite oldu. Daha sonralarý bir dizi alternatif sýnýflandýrma teklif edildi. bu önerilerde farklý isimler ayný hastalýða, ayný isimler ise farklý hastalýklara atfedildi. 1993' te Chappel Hill Konsensun Konferansýnda vaskülitlerin tanýsý konusunda deneyim sahibi komitenin önerdiði tutulan damar çapýna göre sýnýflandýrma, halen geçerliliðini sürdüren sýnýflandýrmadýr.

Vasculitis is inflammation of a vessel wall. The systemic vasculitides represent a highly heterogeneous group of clinicopathological entities. In 1952, Zeek became the first author to incorporate a clinicopathological assessment based on the size of the vessels involved in the inflammatory process in her classification of necrotizing vasculitis. A number of alternative classification systems were proposed later. In this respect, different names were suggested to the same diseases, where as different diseases were referred by the same. During the Chappel Hill Consensus Conference in 1993, the classification proposed by a commitee experienced in the diagnosis of vasculitis based on the diameter of the effected vessels, is still valid.

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Alopesi areatanýn (AA) patogenezinde psikolojik faktörlerin rolü çok uzun zamandýr tartýþýlmaktadýr. Bu kontrol gruplu çalýþmada stres verici yaþam olaylarý ve diðer psikolojik faktörlerin AA' nýn etiyopatogenezindeki önemini belirlemek amaçlanmýþtýr. Hastalýðýn yaþam kalitesi üzerine olan etkisi de araþtýrýlmýþtýr. AA tanýsý alan 52 yetiþkin hasta (18 kadýn, 34 erkek) ile kontrol grubu olarak yaþ ve cinsiyetleri hasta grubu ile uyumlu, saç dökülme þikayeti bulunmayan 52 hastane personeli, ana yaþam olaylarý listesi, Beck depresyon ve Beck anksiyete envanterleri ve kýsa-form 36 ölçekleri (KF-36) ile deðerlendirildi. Stres verici yaþam olaylarý, depresyon ve anksiyete total puanlarý göz önüne alýndýðýnda hasta ve kontrol grubu arasýnda istatistiksel olarak anlamlý bir fark saptanmadý. KF-36' nýn 8 alt ölçeðinden üç tanesinde (vitalite, sosyal fonksiyonlar, mental saðlýk skorlarý) iki grup arasýnda anlamlý bir fark olduðu bulundu. Çalýþmamýzýn sonuçlarý AA' nýn patogenezinde psikolojik faktörlerin rol oynadýðý görüþünü desteklememektedir. Öte yandan, verilerimiz AA' nýn yaþam kalitesini kýsmen de olsa olumsuz etkilediðini göstermektedir, dolayýsýyla etkili bir tedavi için seçilmiþ hastalara psikolojik yönden destek tedavide uygulanmasýnýn faydalý olacaðý görüþündeyiz.

Background and design: The role of psychological factors in the pathogenesis of alopecia areata (AA) has long been a subject of debate. This case-control study was undertaken to determine the significance of stressful life events and the other psychological factors in the etiopathogenesis of AA. The impact of the disease on quality of life was also assessed. Materials and Methods: Fifty-two adult patients (18 females, 34 males) diagnosed with AA and 52 age- and sex-matched individuals selected from hospital personal without any hair loss as a control group were evaluated with major life events scale, Beck depression and Beck anxiety inventories, and 36-item short form health
survey (SF-36). Results: There was no statistical difference between the patient and control groups regarding the total scores of the stressful life events, depression and anxiety. Of the 8 subscales of SF-36, three of them (vitality, social functioning and mental health scores) turned out to be statistically significant between the two groups. Conclusions: Our data provides no evidence that psychological factors are involved in the pathogenesis of AA. On the other hand, our findings indicate that AA has a partly negative impact on quality of life, so we think that psychologic intervention should be useful in selected patients for an effective treatment.

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Psoriasis toplumun %1-2' sini etkileyen, hiperproliferatif ve papüloskuamöz bir hastalýktýr. Etyolojisi yapýlan çok sayýda araþtýrmaya raðmen tam olarak aydýnlatýlmamýþtýr. Son yýllarda psoriatik hastalarda gluten hipersensitivitesi ve buna baðlý olabilecek bir enteropatinin varlýðýndan sözedilmektedir. Buðday gibi tahýl ürünlerini oldukça fazla tüketen toplum olarak, psoriasiste gluten hipersensitivitesinin varlýðýný ve hastalýðýn genel özellikleri ile iliþkisini araþtýrdýk. Bu amaçla 127 psoriatik hasta, 31 kiþilik kontrol grubu ve 6 kiþilik Çölyak hasta grubu, serumda antigliadin IgA ve IgG tip antikorlar ölçülerek karþýlaþtýrýldý. Ayrýca, psoriatik hastalarda, antikorlarýn varlýðý ile gastrointestinal þikayetler, artropati, týrnak tutulumu, klinik prezantasyon, hastalýðýn baþlangýç yaþý ve ailede psoriatik bireyin mevcudiyeti arasýndaki olasý iliþki de araþtýrýlmýþtýr. Psoriatik hastalarda %16.5 oranýnda antigliadin IgA antikor pozitifliði saptanmýþ ancak kontrol grubuna (%9.6) kýyasla anlamlý bir bulgu olmadýðý görülmüþtür. Antigliadin antikorlarýnýn varlýðý hiçbir klinik parametre ile iliþkili bulunmamýþtýr. Psoriasiste antigliadin antikorlarýnda, çok anlamlý olmasa da, bir artýþ olduðu görülmektedir. Gastrointestinal sisteme yönelik þikayetlerden baðýmsýz ve antigliadin antikorlarý pozitif olan alt grubunun mevcudiyeti dikkati çekmektedir. Yapýlan diðer araþtýrmalarýn ýþýðýnda, bu alt grubu saptamak ve yapýlabildiði ölçüde glutensiz diyet uygulamak, bu hastalar için yeni bir ümit kaynaðý olabilir.

Background: Psoriasis is a hyperproliferative and papulosquamous skin disorder that affects 1-2% of the population. Despite extensive studies done, aetiology is still to be elucidated. Recently, gluten hypersensitivity and a possible enteropathy are being investigated in psoriasis. As a population, with a diet mainly based on cereals like wheat, we have studied the presence of gluten hypersensitivity in psoriasis and its possible influence on the general manifestations of the disease.
Materials and methods: IgG and IgA type antibodies to gliadin were quantified in 127 patients with psoriasis, the age and sex matched control group of 31 individuals and 6 patients with celiac sprue. A possible impact of the presence of antigliadin antibodies on the disease characteristics, namely arthropathy, clinical presentation, age of onset, gastrointestinal symptoms and the presence of a psoriatic family member, was investigated. Results: It was found that 16.5% of patients with psoriasis had serum levels of IgA antibodies to gliadin. Despite being relatively a high percentage when compared to those of the control group (%9.6), it was not a statisticallysignificant increase. The presence of antibodies to gliadin had no influence on the disease characteristics. Conclusion: Despite being insignificant, an increase in the presence of antibodies to gliadin was noted in patients
with psoriasis. There seems to be a subgroup of psoriasis patients with positive antibodies to gliadin but without gastrointestinal symptoms. Along with other studies, it seems to be important to try to identify this subgroup, which might benefit from a gluten-free diet.

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Etyopatogenezi tam olarak bilinmeyen psoriazis vulgarisin (PV) otoimmun bir hastalýk olan gluten duyarlýlýðý enteropatisi (GDE) ile olan birlikteliðine son yýllarda yapýlan çalýþmalarda dikkat çekilmektedir. Çalýþmamýzda aktif dönemindeki PV hastalarýnda GDE ile iliþkili otoantikorlar olan IgA ve IgG antigliadin antikor (AGA) pozitifliði ve bunlarýn HLA antijenleri ile olan iliþkileri araþtýrýldý. Bu amaçla, klinik ve patolojik olarak PV tanýsý konan 42 olguda serum IgA AGA ve IgG AGA, serum immunglobulinleri, kompleman C3c ve C4, eozinofil katyonik protein (ECP), total IgE ve gluten spesifik IgE test sonuçlarý ile HLA sýnýf I (ABC) ve sýnýf II (DR,DQ) antijenleri incelendi. Saðlýklý ve akrabalýk iliþkisi olmayan 40 kiþi serolojik incelemeler için, 71 kiþi de HLA antijenlerinin karþýlaþtýrýlmasý için kontrol grubu olarak alýndý. Araþtýrma grubunda saptanan IgA AGA test pozitifliði kontrol grubu ile karþýlaþtýrýldýðýnda istatistiksel olarak anlamlý farklýlýk yokken (p=0.056) IgA ve/veya IgG AGA test pozitifliði açýsýndan farklýlýk saptandý (sýrasýyla p=0.001, p=0.03). Araþtýrma grubunda, IgA ve/veya IgG AGA (+) ve (-) hastalar arasýnda, total IgE, serum ECP ve gluten spesifik IgE test sonuçlarý açýsýndan farklýlýk bulunmadý. IgA AGA (+) ve IgA ve/veya IgG AGA (+) olgularda serum IgA düzeylerinde anlamlý oranda artýþ saptandý (sýrasýyla p< 0.01, p<0.05). Araþtýrma grubu HLA sýnýf I antjenleri kontrol grubu ile karþýlaþtýrýldýðýnda IgG AGA 8+) olanlarda HLA-A32' de artma (p=0.02,), IgG AGA (-) olanlarda HLA-A30' da artma (sýrasýyla p=0.02, p=0.04) bulundu. HLA sýnýf II antijenlerinde ise IgA AGA (+) olanlarda HLA-DQ1' de artma (P=0.01), IgA AGA (-) olanlarda, HLA-DR14' de artma saptandý (p=0.01). Sonuç olarak aktif PV olgularýnda farklý genetik alt yapýlar gluten sensitif otoantikorlarýn oluþumunda risk faktörü olabilir. Geliþen bu antikorlar PV etyopatogenezinde faktör ya da kofaktör rolü oynayabilir. Bu sonuçlarýn baþka prospektif çalýþmalarla da desteklenmesinin yararlý olacaðý düþünüldü.

Background and Design: Recent reports about the association of gluten sensitive enteropathy (GSE) and psoriasis vulgaris (PV) of unknown etiology are noteworthy. In our study we investigated the positivity of IgA and IgG antigliadin antibodies (AGA) which are related with GSE in PV patients as well as their relation with HLA antigens. Materials and Methods: IgA AGA and IgG AGA, immunoglobulins, complement C3c and C4, eosinophil cationic protein(ECP), total IgE levels, gluten spesific IgE antibodies and HLA class I(ABC) and class II (DR, DQ) antigens were investigated in 42 cases diagnosed as psoriasis vulgaris clinically and histopathologically, the control group included 40 healthy volunteers for serological comparison, 71 healthy volunteers were also evaluated for HLA antigens. Results: While there was no statistically difference between study and control groups in respect with IgA AGA positivity (p=0.056). Positivity for IgG AGA, IgA or/and IgG AGA were statistically different (p=0.001, p=0.03 respectively). In the study group there was no difference of total IgE level, ECP and gluten spesific Ig E results in IgA and /or IgG AGA positive and negative patients. Serum total IgA antibody level was significantly elevated in IgA AGA positive and IgA and/or IgG AGA positive patients (p<0.01, p<0.05 respectively). When HLA Class I antigens were compared in study and control group, HLA-A32 positivity was significantly more frequent in IgG AGA positive patients (p=0.02), HLA-A30 was found to be elevated in IgG AGA negative and IgA AGA negative patients. Elevations of HLA-DR16 and HLA-DQ1 were found in IgG AGA positive patients
(p=0.01, p=0.006 respectively) and HLA-DQ1 was found to be elevated in IgA AGA positive patients
(p=0.01). HLA-DR14 was elevated in IgA AGA negative patients(p=0.01). Conclusion: In conclusion, different genetic structures may be risk factor for the formation of gluten sensitive autoantibodies in active PV. The development of these antibodies may be factors or cofactors in PV etiopathogenesis.
We suggest that the results of our preliminary study should be confirmed with further research.

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Kasým 1987-Mayýs 1997 tarihleri arasýnda Uludað Üniversitesi Týp Fakültesi’nde Mikozis Fungoides tanýsýyla takip edilen, yaþlarý 44-60 arasýnda deðiþen 5’i kadýn, 11’i erkek toplam 16 hastaya ait bulgular gözden geçirildi.Biyopsi ile taný konulduðu tarihte, mevcut lezyonlarýn tipi, lokalizasyonu ve histopatolojik sonuçlarýna göre TNM sýnýflandýrmasý ile klinik evrelendirilmeleri deðerlendirildi. Buna göre, 10 hasta (% 62.50) evre I B, 1 hasta (%6.25) evre II A, 3 hasta (% 18.75) evre II B, 1 hasta (7.25) evre III B, 1 hasta (6.25) evre IV B olarak kabul edildi. Olgularýn % 62.5’unun evre I B aþamasýnda baþvurduðunu saptadýðýmýz çalýþma sonuçlarýmýz, erken evrede tedaviye yanýtýn daha iyi olduðu görüþlerini desteklemektedir.

Background: Mycosis Fungoides is the most common primary skin lymphoma and clinical stating of this disease is very important for determination of the treatment and prognosis. Method: The clinical signs of 16 patients, aged between 44 and 60, who had been followed from November 1987 to May 1997 in Uluda¤ University Medical Faculty with a diagnosiss of Mycosis Fungoides were reviewed.
Result: Ten of the patients were in stage I B, 1 in II A, 3 in II B and 1 in IV B. Conclusions: The results of study, which has shown that 62.5 % of cases applied to our clinic in stage I B, supports the idea of better clinical response in eraly stages as well.

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Akne vulgaris en sýk deri hastalýklarýndan biridir. Akne genellikle adelosan dönemin bir hastalýðý olarak düþünülür. Adelosan dönemde akne prevalansýný deðerlendiren çok sayýda çalýþma vardýr, oysa özellikle puberte öncesi dönemde akne vulgaris epidemiyolojisine ait literatürde birkaç çalýþma vardýr. bu çalýþmanýn amacý Sivas' da ilköðretim çaðýndaki çocuklarda akne vulgaris prevalansýný ve þiddetini belirlemekti. Bin sekiz yüz doksan iki öðrenci fasyal akne yönünden muayene edildi. Akne þiddeti hafif, orta ve þiddetli olarak tanýmlandý. Akne vulgaris prevalansý istatistiksel olarak analiz edildi. ilköðretim çaðý çocuklarýnda akne vulgaris prevalansý %16.7 olarak bulundu. Akne erkeklerin %13.4' ünde, kýzlarýn ise %20.2' sinde tespit edildi. akne vulgarisli çocuklarýn çoðu (%94.94) aknesinin farkýndaydý. Ýlköðretim çaðý çocuklarýnda akne vulgarisin deðerlendirilmesinde yaþ, cinsiyet, çevresel ve sosyoekonomik faktörler göz önüne alýnmalýdýr.

Background and design: Acne vulgaris is one of the most common skin diseases. Acne is usually considered a disorder of adolescence. A number of studies have examined the prevalance of acne in adolescent population, however, there are few studies in the literature concerning the epidemiology of acne vulgaris, especially early stages of puberty. The aim of this study was to assess the prevalance and severity of acne vulgaris in primary school children in Sivas.
Methods: One thousand eight hundred ninety two children were examined for facial acne. The severity of acne vulgaris has been defined as mild, moderate, and severe. The prevalance of acne vulgaris was analysed statistically. Results: We found that the prevalance of acne vulgaris in primary school children was 16.7%. Acne was present in 13.4% of males and 20.2% of females. The majority of children with acne vulgaris (94.94%) were aware from their acnes. Conclusion: It should be taken into consideration age, gender, environmental factors, and socioeconomic factors
in the evaluation of acne vulgaris in primary school chidren.

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Rudimanter polidaktili, fazla sayýdaki parmaðýn fötal dönemde destrüksiyonu sonucu geliþen, beþinci parmak lateral yüzüne iliþik ufak papüllerle karakterize bir ampütasyon nöromasýdýr. Dikkat çekici histopatolojik bulgular, dermiste belirgin nöral proliferasyon ve dermal papillada artmýþ Wagner-Meissner cisimleridir. Burada, tipik klinik ve histopatolojik bulgularýyla bilateral rudimanter polidaktili tanýsý alan 21 yaþýndaki bir kadýn hasta sunulmakta ve ayýrýcý taný gözden geçirilmektedir.

Rudimentary polydactyly is an amputation neuroma secondary to the destruction of supernumerary digits in utero, characterised by small papules attached to the lateral aspect of the fifth finger. The striking histopathologic features are the marked neural proliferation in the dermis and the large number of Wagner-Meissner bodies in the dermal papillae. Here, we present a 21-year-old female patient with bilateral rudimentary polydactyly representing typical clinical and histopathological features and, we review the differential diagnosis of the case.

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Hipohidrotik ektodermal displazi, olgularýn hemen tümünde X' e baðlý geçiþ göstermektedir. Baþlýca özellikleri, hipotrikoz, azalmýþ veya tamamen kaybolmuþ terleme ve parsiyel veya tam anodontiya'dýr. Nadir görülmesi sebebiyle, bilateral meme baþý yokluðu gösteren hipohidrotik ektudermal displazili bir erkek infant sunuyoruz.

Hypohidrotic ectodermal dysplasia (HED) shows X-linked recessive inheritance in almost all cases. The main features are hypotrichosis, absent or reduced sweating and partial or total anodontia. We present a male infant who has HED with bilateral athelia, because it is rarely seen.

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Akut jeneralize ekzanmatöz püstülozis yakýn zamanda tanýmlanmýþ, nadir görülen püstüler bir dermatozdur. Etyopatogenezinde baþlýca antibiyotikler olmak üzere ilaçlar, virüsler, civaya maruz kalma ve besin zehirlenmesi suçlanmaktadýr. Klinik bulgular, akut baþlangýç gösteren, yaygýn eritemli bir zeminde ortaya çýkan, foliküler yerleþimli olmayan, çok sayýda, steril, yüzeyel püstüllerle karakterizedir. Ateþ ve lökositozun sýklýkla eþlik ettiði bu dramatik tabloda kýsa sürede spontan düzelme olmasý tipiktir. Burada, oral penisilin tedavisi sonrasýnda akut jeneralize ekzantematöz püstülozis geliþen 24 yaþýndaki bir erkek hasta sunulmaktadýr.

Acute generalized exanthematous pustulosis is a rare pustular dermatosis that has been recently described. Drugs mainly antibiotics, viruses, contact with mercury and food poisoning have been implicated in the etiopathogenesis of this disorder. The clinical manifestations are characterized by the acute onset of numerous, nonfollicular, sterile, superficial pustules located on widespread erythema. Fever and leukocytosis may frequently accompany this dramatic situation where rapid spontaneous recovery is typical. Herein, we present a 24-year-old male patient who had acute generalized exanthematous pustulosis after penicilline treatment.

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Malin ekrin poroma, ekrin ter bezinin intraepidermal ve dermal kanalý yönünde diferensiasyon gösteren nadir bir neoplazidir. 70 yaþýnda sol bacaðýnda malin ekrin poroma saptanan kadýn hasta literatür bilgileri ýþýðýnda gözden geçirilerek tanýmlanmýþtýr. Lezyon cerrahi eksizyon sonrasýnda rutin histopatoloji ve immunohistokimyasal boyama ile incelendi. Histopatolojik deðerlendirmede tümör hücreleri epidermisten baþlayan kordonlar ve adalar oluþturmak suretiyle dermise doðru uzanmaktaydý. Tümör hücreleri nükleer atipi, pleomorfizm ve anormal mitoz göstermekteydi. Ayrýca tümör hücreleri arasýnda duktal diferensiasyon sahalarý ve diskeratotik hücreler gözlendi. Ýmmunohistokimyasal olarak ise duktal diferansiasyon alanlarýnda karsinoembriyonik antijen pozitif boyanma özelliði gösterdi. Ýki yýllýk takip sonucu metastaz veya rekürrens bulgusu saptanmadý.

Malignant eccrine poroma is an uncommon neoplasm which shows differentiation throughout intraepidermal and dermal duct of eccrine sweat gland. A case of malignant eccrine poroma on the left leg in a 70-year-old female is described with a review of the literature. Following the surgical excision, the lesion was evaluated by routine histopathology and immuno-histochemical staining. In the histopathological evaluation, the tumour cells arise from epidermis extended into the dermis forming chordons and islands. The tumour cells showed nuclear atypia, pleomorphism and abnormal mitotic figures. In addition, dyskeratotic cells and ductal differentiation areas were seen among tumour cells. ‹mmunohistochemically, carcinoembryonic antigen was positive in the areas of ductal differentiation. Two years of follow-up revealed no recurrence or metastasis of the tumour.

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Pyoderma sýklýkla kronik inflamatuar veya malin hastalýklarla birlikte olabilen ülseratif bir deri hastalýðýdýr. Ülseratif kolit, romatoid artrit, Crohn hastalýðý, IgA monoklonal gammopati, kronik aktif hepatit, HIV enfeksiyonu, hematolojik ve lenforatiküler maliniteler pyoderma gangrenozum ile birlikte olabilen hastalýklardandýr. Burada, demonstratif olmasý nedeniyle romatoid artritin eþlik ettiði bir pyoderma gangrenozum olgusu sunulmaktadýr.

Pyoderma gangrenosum is an ulcerating skin disease which often occur in association with chronic inflammatory or malignant disease: Ulcerative colitis, rheumatoid arthritis, Crohn’s disease, IgA monoclonal gammopathy, chronic active hepatitis, HIV enfection, and hematologic and lymphoreticular malignancies are among the many diseases seen in conjunction with pyoderma gangrenosum. We present a rheumatoid arthritis patient with typical lesions of pyoderma gangrenosum.

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Oksidatif stres ve UV radyasyonunun oluþturduðu deri hasarý, inflamasyon, erken deri yaþlanmasý ve deri kanserleri gibi pek çok hastalýkta rol oynamaktadýr. Yeþil çayýn %3' unu oluþturan polifenoller güçlü antioksidanlardýr. Hayvan modelleri ve gönüllü insanlarda yapýlan çalýþmalarda yeþilçay polifenollerin UV radyasyonu öncesi sistemik ve yerel kullanýmýnýn antiinflamatuvar ve antkarsinojenik etki saðlayabileceði gösterilmiþtir.

Oxidative stress and UV irridation have significant effects on the development of skin inflammation, premature aging and skin tumors. Polyphenols have strong antioxidative effects and green tea is a rich source of polyphenols (%30). The results of the studies done with animal models and volunteer humans established that the topical and systemic use of green tea can protect skin from the harmfull effects of UV and prevent carcinogenesis.

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