Abstract | Full Text PDF

Amaç: Bu çalýþmada; plak tip psoriazis tedavisinde asitretin ve dar bant UVB ile plasebo ve dar bant UVB kombinasyonunun tedavideki etkinliklerinin karþýlaþtýrýlmasý, ayrýca psoriazis ve tedavisinin yaþam kalitesine olan etkisinin belirlenmesi amaçlandý.
Gereç ve yöntem: Bu çalýþmada vücut yüzey alanýnýn %10’undan fazlasý tutulmuþ plak tip psoriazisi olan 50 hasta, yaþ ve cinsiyet açýsýndan farklýlýk olmayan 25’er kiþilik 2 gruba ayrýldý. Birinci gruba dar bant UVB ile birlikte 25 mg/gün oral asitretin tedavisi, ikinci gruba dar bant UVB ile plasebo tedavisi verildi. Hastalar 12 hafta boyunca 2 haftada bir olacak þekilde deðerlendirildi. Her kontrolde baðýmsýz bir gözlemci tarafýndan PASI deðerlendirildi. Hasta tarafýndan deðerlendirilen SAPASI hesaplandý. Tedavi öncesi ve sonrasýnda hastalarýn yaþam kalitesi Skindex 29 ile deðerlendirildi.
Bulgular: Çalýþmaya 18 ila 71 yaþlarý arasýnda 25’i (%50) erkek ve 25’i (%50) kadýn toplam 50 hasta alýndý. Haftalara göre PASI ve SAPASI deðiþimlerine bakýldýðýnda iki grup arasýnda 2.haftada anlamlý farklýlýk saptandý (p< 0.05). Ýki grubun 4.hafta, 6.hafta, 8.hafta, 10.hafta ve 12.hafta PASI ve SAPASI deðerleri arasýnda anlamlý farklýlýk saptandý (p<0.001). Asitretin ve dar bant UVB kombinasyonunu ile tek baþýna dar bant UVB tedavisi alanlara göre klinik yanýtýn daha iyi olduðu gözlendi. Yaþam kalitesine etkisi açýsýndan her iki tedavi protokolününde de Skindex 29’un semptom, fonksiyon ve emosyon skalalarý skorlarýnda ileri düzeyde anlamlý düzelme saðladýðý gözlendi.
Sonuç: Dar bant UVB ve asitretin almaya uygun psoriazis vulgarisli hastalarda kýsa sürede iyi yanýt alýnmasý nedeniyle kombinasyon tedavisi tercih edilebilir. Psoriazis hastanýn yaþam kalitesini önemli düzeyde etkileyen bir hastalýk olarak ele alýnmalý ve yaþam kalitesi ölçekleri kullanýlmalýdýr.

Background and Design: In this study, we aimed to compare effects of acitretin and narrow-band UVB with the combination of placebo and narrow-band UVB on the treatment of plaque type psoriasis.
Material and Method: A total of 50 patients with plaque type psoriasis in whom more than 10% of body surface area affected were divided into 2 groups of 25 subjects. The first group of patients was treated with narrow-band UVB and 25 mg/day oral acitretin and the second group of patients was treated with narrow-band UVB and placebo. Patients were evaluated every 2 weeks during 12 weeks period. In each patient visit, PASI was evaluated by an independent observer. SAPASI which is assessed by the patient was calculated. Pre- and post-treatment quality of life was evaluated by Skindex 29.
Results: The study included a total of 50 patients (25 female, 25 male) aged 18-71 years. When PASI and SAPASI changes were evaluated, there were significant differences between two groups at second week (p<0.05). Also, there were significant differences in terms of PASI and SAPASI values at 4 th, 6 th, 8 th, 10 th and 12 th weeks of two groups (p<0.001). Clinical response was found to be better in patients treated with the combination of acitretin and narrow-band UVB compared to those treated with narrow-band UVB therapy alone. Both treatment protocols were found to lead to significant improvement in the symptoms, function and emotional scales scores of Skindex 29.
Conclusion: Because of short and better response of combination treatment clinicians may prefer combination treatment for patients who have psoriasis vulgaris and are suitable for taking narrow-band UVB and acitretin. Psoriasis is considered a kind of disease that has significant impacts on quality of life.

Abstract | Full Text PDF

Amaç: Þiddetli ve tedaviye dirençli pemfigus hastalýðýnda plazmaferez ve daha geliþmiþ bir yöntem olan immunadsorpsiyon hýzlý remisyon saðlayan tedavi yöntemleri arasýndadýr. Pemfigus vulgaris ve paraneoplastik pemfiguslu hastalarýmýzda plazmaferez veya immunadsorpsiyon tedavisi uygulanmýþ olgulardan edindiðimiz klinik deneyim ile bu tedavilerin etkinliði ve yan etkilerinin deðerlendirilmesi amaçlanmýþtýr.
Gereç ve Yöntem: Büllü hastalýklar polikliniðinde 1987-2013 yýllarý arasýnda takip edilen histopatoloji ve/veya immunfloresan yöntemlerle pemfigus tanýsý konulan hastalar arasýndan plazmaferez veya immunadsorpsiyon tedavisi uygulanan 7 hasta (5’i PV, 2’si PNP) retrospektif olarak deðerlendirildi.Bu hastalardan üç üne klasik plazmaferez, 2 hastaya double filtrasyon plazmaferez, 1 hastaya immunadsorbsiyon; 1 hastaya önce klasik plazmaferez, hemodinamik parametrelerde bozukluk geliþmesi üzerine sonrasýnda immunadsorbsiyon tedavisi uygulanmýþtý.Hastalarýn tedavi öncesi ve sonrasý klinik bulgularý, antikor titreleri ile immunolojik yanýtlarý,tedavi dozlarý ve yan etkileri, takip dosyalarýndan edinilen bilgilere göre deðerlendirmeye alýndý.
Bulgular:
Pemfigus vulgaris’li hastalardan 4 ’ünde (1,3,4,5. hastalar) tam klinik yanýt, 1 hastada (2. hasta) deri lezyonlarýnda kýsmi gerileme görüldü. Paraneoplastik pemfigus tanýsýyla izlenen 2 hastada (6. ve 7. hastalar) geliþen komplikasyonlar nedeniyle tedavi sonlandýrýldý. Tedavi öncesi ve sonrasý yapýlan dolaþan antikor ölçümlerinde, deðerlendirme yapýlan hastalarýn tamamýnda tedavi sonrasý antikor titresi baþlangýca göre düþük saptandý. Yan etki olarak 2 hastada hipoalbuminemi, 2 hastada katater infeksiyonu geliþti.
Sonuç:
Plazmaferez veya immunadsorbsiyon,özellikle tedaviye dirençli pemfiguslu hastalarda hastalýðýn þiddetini azaltacak iyi bir ara tedavi yöntemi olarak seçilebilirse de, tedavi sonrasýnda alevlenme görülebileceði,bu nedenle immunsupresifler ile birlikte kullanýlmasýnýn gerektiði ve uzun dönem için etkili olmadýðý hatýrda tutulmalýdýr.

Background and Design: Plasmapheresis or immunoadsorption which is a more advanced method are among the treatment options that induce a rapid remission in severe and resistant pemphigus. The aim of this study is to evaluate the efficacy and safety of plasmapheresis or immunoadsorption therapies via the clinical experience gained from our patients with pemphigus vulgaris and paraneoplastic pemphigus.
Materials and Methods: Among patients who were diagnosed with pemphigus according to the histopathology and/or immunofluorescence methods and followed-up at our bullous diseases outpatient clinic between the years 1987 and 2013, 7 patients (5 PV, 2 PNP), who were treated with plasmapheresis or immunoadsorption, were retrospectively analyzed. Among these patients, 3 were treated with classical plasmapheresis, whereas 2 with double-filtration plasmapheresis, 1 with immunoadsorption, and 1 initially with classical plasmapheresis followed by immunoadsorption due to impairment of the hemodynamic parameters. The clinical findings, antibody titers, and immunological responses before and after the therapy, the therapy dosages and adverse effects were evaluated according to the data gained from the patient files.
Results: In 4 patients (1., 3., 4. and 5. patients) with pemphigus vulgaris, complete clinical response was achieved, while 1 patient (2. patient) showed partial regression in skin lesions. In both of the patients (6.,7. patients) with paraneoplastic pemphigus the therapy discontinued due to complications. In all of the evaluated patients, the analysis of the antibody titers before and after the therapy revealed lower levels in comparison to those detected at the initiation of the therapy. In 2 patients hypoalbuminemia and in 2 patients catheter infection were developed as the side effects of the therapy.
Conclusion: Even though plasmapheresis or immunoadsorption may be chosen as a good mid-treatment method to decrease the severity of the disease especially in resistant patients with pemphigus, it must be borne in mind that because of the exacerbations that may be seen after the treatment, these therapies should be used in combination with immunosuppressives, and are not effective in the long-term.

Abstract | Full Text PDF

Amaç: Dermoskopi, çýplak gözle görülemeyen yapýlarýn ayýrt edilebilmesine yardým eden, invaziv olmayan bir araçtýr. Ekstremitelerdeki malign melanomlarýn dermoskopik ve klinik özellikleri literatürde iyi bir þekilde tanýmlanmamýþtýr. Bu yüzden, biz bu çalýþmada ekstremitelerdeki melanomlarýn dermoskopik ve klinik özelliklerini tanýmlamayý amaçladýk.
Gereç ve Yöntem: Ekstremitelerinde melanomu olan 40 hasta çalýþmaya dahil edildi. Dermoskopik ve klinik görüntüleri, histopatolojik ve klinik bilgileri incelendi. Breslow kalýnlýðý ve dermoskopik özellikler arasýndaki iliþkiler deðerlendirildi.
Bulgular: Kadýnlarda en sýk yerleþim yeri alt ekstremiteler olmakla birlikte, erkeklerde en sýk yerleþim yeri üst ekstremiteydi. Melanomun ekstremitelerde gözlenen en sýk alt tipi yüzeyel yayýlýmlý malign melanomdu. Ekstremitesinde melanomu olan erkeklerde ortalama yaþ 56,21 ± 15,20 iken, ekstremitesinde melanomu olan kadýnlarda ortalama yaþ 53,09 ± 13,96 idi. Ekstremite melanomlarýndaki en sýk dermoskopik özellik düzensiz noktalardý (% 85). Breslow kalýnlýðý ile çap arasýnda, lezyonda 3 veya daha fazla rengin bulunmasýyla, mavi-beyaz peçe yapýsýyla ve lineer beyaz çizgilerle arasýnda pozitif korelasyonlar saptandý (p< 0.005, r= +0.462) (p< 0.001, r= +0.550) (p< 0.001, r= +0.606) (p< 0.001, r= +0.662).
Sonuç: Literatürde araþtýrabildiðimiz kadarýyla, çalýþmamýz ekstremite melanomlarýnýn dermoskopik ve klinik özelliklerini araþtýran ilk çalýþmadýr. Alt ekstremite melanomlarýnýn erkek hastalara göre kadýn hastalarda daha sýk görüldüðünü, alt ekstremite melanomu olan hastalarýn üst ekstremite melanomu olan hastalara göre daha genç olduðunu, Breslow kalýnlýðý ile dermoskopik özellikler arasýnda iliþki olduðunu söyleyebiliriz.

Objectives: Dermoscopy is a noninvasive tool that helps to differentiate structures which can not be seen by naked eye. Dermoscopic and clinical features of malignant melanomas on the extremities are not well described in the literature. Therefore, in this study we aim to determine dermoscopic and clinical characteristics of melanoma on the extremities.
Materials and Methods: 40 patients with melanoma on the extremities were included in this study. Their dermoscopic and clinical images, histopathological and clinical data were assessed. The relations between Breslow thickness and dermoscopic characteristics were evaluated.
Results: The most frequent localization for women was lower extremities, whereas it was upper extremities for men. The most common subtype of melanoma was superficial spreading melanoma on the extremities. The mean age of patients with extremity melanoma was 56,21 ± 15,20 in men, as well as the mean age of patients with extremity melanoma was 53,09 ± 13,96 in women. The most common dermoscopic feature for extremity melanoma was irregular dots (85%). There were positive correlations between Breslow thickness and diameter, 3 or more colors in lesion, blue-white veil and lineer white streaks, respectively (p< 0.005, r= +0.462) (p< 0.001, r= +0.550) (p< 0.001, r= +0.606) (p< 0.001, r= +0.662).
Conclusions: To our knowledge, this is the first study investigating dermoscopic and clinical features in patients with extremity melanomas. We should suggest that melanomas on the lower extremities are more common in women than men and the patients with lower extremity melanomas were younger than the patients with upper extremity melanomas and there are associations between Breslow thickness and some dermoscopic characteristics.

Abstract | Full Text PDF

Amaç: En sýk görülen kronik ürtiker formu olan kronik spontan ürtiker (KSÜ), altý haftadan uzun süren spontan ürtikeryal lezyonlar ve/veya anjiyoödem ile karakterizedir. Ürtikeryal vaskülit (ÜV) ise bir küçük damar vasküliti olmasýna raðmen, bazý yazarlar tarafýndan çeþitli kronik ürtiker sýnýflama sistemlerine de dahil edilmiþtir. Çalýþmamýzda KSÜ ve ÜV’li olgularýn demografik, klinik ve laboratuvar bulgularý yanýnda eþlik eden durumlarýn sýklýðýnýn belirlenerek birbiriyle karþýlaþtýrýlmasý amaçlanmýþtýr.
Gereç ve yöntemler: Bu çalýþmada Ocak 2010-Aralýk 2013 tarihleri arasýnda kliniðimizde yatan KSÜ (n=146) ve ÜV (n=43)’li olgularýn dosyalarý demografik verileri, hastalýða özgün öyküleri, eþlik eden hastalýklarý, medikasyonlarý ve laboratuar bulgularý açýsýndan retrospektif olarak taranmýþtýr.
Bulgular: Her iki grup arasýnda yapýlan karþýlaþtýrmada KSÜ grubunda kiþisel atopi ve anjiyoödem öyküsünün, ÜV grubunda ise kadýn olgularýn ve sistemik semptomlarýn varlýðýnýn istatistiksel olarak anlamlý oranda daha fazla olduðu belirlenmiþtir. Serolojik tetkiklerden ortalama eritrosit sedimentasyon hýzý ve C-reaktif protein deðerleri, antinükleer antikor pozitifliði ve hipokomplemantemi varlýðý ÜV grubunda KSÜ grubuna göre anlamlý olarak daha yüksek oranda saptanmýþtýr. Eþlik eden faktörler her iki grupta da sýklýk sýrasýna göre enfeksiyonlar, medikasyonlar, otoimmün hastalýklar ve maligniteler olarak belirlenmiþ, ancak sadece otoimmün hastalýklarýn ÜV grubunda KSÜ grubuna göre anlamlý olarak daha yüksek oranda saptandýðý görülmüþtür.
Sonuç: Çeþitli yazarlar tarafýndan ÜV’li olgularýn önemli bir kýsmýnda (%40-60’ýna varan oranlarda) klinik olarak KSÜ lezyonlarýndan ayýrdedilemeyecek þekilde sadece kaþýntýlý kabarýklýklar görülebileceði bildirilmiþ olsa da, özellikle sistemik semptom tanýmlayan, otoimmün bir hastalýðý olan, yapýlan incelemelerde hipokomplemantemi ve serolojik inflamatuar parametrelerinde yükseklik saptanan olgularda ÜV’in ön planda düþünülmesinin daha uygun olacaðý kanaatindeyiz.

Background and Design: Chronic spontaneous urticaria (CSU), the most common form of chronic urticaria, is characterized by spontaneous wheals and/or angioedema lasting longer than six weeks. Urticarial vasculitis (UV) is a small vessel vasculitis; but is also included in the various classification systems of chronic urticaria by some authors. The aim of our study was to evaluate the frequency of accompanying conditions, and to compare the demographic, clinical and laboratory features of patients with CSU and UV.
Materials and Methods: In this study, the files of CSU (n=146) and UV (n=43) patients who had been hospitalized between January 2010-December 2013 were retrospectively reviewed in terms of demographic data, disease-specific history, accompanying diseases, medications and laboratory findings.
Results: When comparing between the two groups for statistical differences, it was found that the frequencies of personal atopy and angioedema were significantly higher in patients with CSU; however, the patients with UV had significantly higher rates for female gender and the presence of systemic symptoms compared to those with CSU. It was determined that the mean values for erythrocyte sedimentation rate and C-reactive protein, as well as the rates of antinuclear antibody positivity and hypocomplementemia were significantly higher in the UV group, compared with those in the CSU group. Accompanying factors were determined as infections, medications, autoimmune diseases and malignities in order of frequency in both CSU and UV groups, but only the frequency of autoimmune diseases was significantly higher in patients with UV group.
Conclusion: Although various authors have reported that a large number (up to 40-60%) of patients with UV may present only with wheals (clinically indistinguishable from CSU); we assumed that it would be more appropriate to be considered UV as a priority in patients especially who had systemic symptom, autoimmune disease, hypocomplementemia and raised serologic inflammatory parameters.

Abstract | Full Text PDF

Amaç: Pemfigus vulgaris, otoimmün kökenli, deride bül oluþumuyla seyreden bir deri hastalýðýdýr. Bu çalýþmada pemfigus vulgarisli hastalarda T helper 1 (Th1) ve T helper 2 (Th2) ve T helper 17 (Th17) tiplerindeki sitokinlerin düzeylerini araþtýrmayý ve saðlýklý kontrollerle karþýlaþtýrmayý hedefledik.
Gereç-Yöntem: Çalýþmaya 37 pemfigus vulgaris hastasý ile 35 saðlýklý birey dahil edildi. Hastalar deri ve mukoza tutulum derecesine göre hafif, orta ve þiddetli hastalýk olarak üç alt grupta sýnýflandýrýldý. Serum interlökin(IL)-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-17A ve interferon (IFN)-γ düzeyleri enzyme-linked immunosorbent assay yöntemiyle ölçüldü. Serum sitokin düzeyleri, hasta alt gruplarý arasýnda ve hastalar ile kontroller arasýnda SPSS 15.0 programý kullanýlarak karþýlaþtýrýldý.
Bulgular: Serum IL-2, IL-4, IL-6 düzeyleri pemfigus vulgarisli hastalarda kontrollere göre anlamlý derecede yüksekti (sýrasýyla p<0.001, p<0.001, p<0.001). IL-6 düzeyleri hastalýk þiddeti ile koreleydi (r=0.490, p=0.003). Serum sitokin düzeyleri hastalýk alt gruplarý arasýna göre anlamlý deðildi.
Sonuç: Çalýþmamýzda pemfigus vulgariste Th2 sitokinlerdeki artýþýn ön planda olduðu saptanmýþtýr. Sonuçlar, Th2 tipindeki sitokin yanýtlarýnýn pemfigus vulgarisin patogenezinde önemli rol oynadýðýný desteklemektedir.

Background and Design: Pemphigus vulgaris is an autoimmune blistering skin disease. The aim of this study was to compare levels of T helper 1 (Th1), T helper 2 (Th2) and T helper 17 (Th17) type cytokines in pemphigus vulgaris patients and healthy controls.
Materials and Methods: The study population included 37 patients with PV and 35 healthy individuals. The patients were grouped into mild, moderate and severe disease groups according to the severity of skin and mucosal involvement. Serum interleukin(IL)-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-17A and interferon(IFN)-γ levels were assessed using the enzyme-linked immunosorbent assay method. Serum cytokine levels of patients versus controls and between patient subgroups were compared. Analysis of data was done using SPSS 15.0.
Results: Serum IL-2, IL-4, IL-6 levels were significantly higher in the patient group compared to the control group (p<0.001, p<0.001, p<0.001, respectively). IL-6 levels were found to be correlated with the severity of disease (r=0.490, p=0.003). Serum cytokine levels of the patient subgroups were not statistically different.
Conclusion: Th2 type cytokines were found to be increased in serum of patients with pemphigus vulgaris. These results support that the Th2 cytokine response plays a major role in the etiopathogenesis of pemphigus vulgaris.

Abstract | Full Text PDF

Amaç: Bu çalýþmayla ülkemizdeki dermatologlarýn Tamamlayýcý ve Alternatif Týp (TAT) yöntemleri hakkýndaki bilgi ve yaklaþýmlarýný deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: Bu tanýmlayýcý ve kesitsel çalýþma Mayýs 2012 ve Mayýs 2013 tarihleri arasýnda yapýldý. On dört sorudan oluþan anket elektronik posta ile dermatologlara gönderildi. Çalýþmamýza, sorularýmýzý tam ve hatasýz doldurulan anketler dâhil edildi.
Bulgular: Ýki yüz anket deðerlendirmeye alýndý. Katýlýmcýlarýn %25,5’inin üniversite hastanelerinde, %20’sinin eðitim ve araþtýrma hastanelerinde, %21’inin devlet hastanelerinde ve %33’ünün de özel hastanelerde çalýþtýðý gözlendi. Katýlýmcýlarýn %80,5’i “az, çok az ve hiç yok”, % 16’sý “orta”, %3,5’i “çok iyi ve iyi” düzeyde bilgi sahibi olduklarýný belirtti. En sýk önerilen yöntemler sýrasýyla; topikal bitkisel ürünler %59,6; oral bitkisel ürünler %48,1; bitkisel þampuanlar %46,2; gýda desteði %38,5; akupunktur ve kaplýca %32,7 þeklindeydi.
Sonuç: Birçok meslektaþýmýzýn TAT konusundaki bilgileri sýnýrlý olmasýna karþýn birçoðunun günlük yaþantýsýnda mesleklerini icra ederken TAT önerdikleri anlaþýlmýþtýr. Dermatologlarýmýzýn önemli bir oraný TAT yöntemleri hakkýnda daha fazla bilgi sahibi olmayý istemektedirler.

Background and Design: This study aimed to evaluate the knowledge of dermatologists on Complementary and Alternative Medicine (CAM), common methods that are widely used in their daily practices and their general approach about CAM.
Materials and Methods: This cross-sectional and descriptive study was carried out between May 2012 and May 2013. A questionnaire comprising 14 questions was sent to dermatologists via electronic mail. The questionnaires which were returned completely and correctly were included in the study.
Results: Two hundred questionnaires were taken into consideration. 25.5% of participants were working at universities, while 20% were working at training and research hospitals, 21% were working at public hospitals and the other 33% were working at private hospitals. 80.5% of participants have “little, a little and not at all”, 16 % moderate and the other 3.5% of them had only “a lot, very much” level of information about CAT. The most frequently recommended methods among the dermatologist were topical herbal treatment (59.6%), oral herbal treatment (48.1%), herbal shampoo (46.2%), and dietary supplement and thermal spring (38.5%), respectively.
Conclusion: Although many of our colleagues have lack of information about CAM, a considerable number of them could use CAM in their daily practices. A substantial proportion of dermatologists would like to be better informed about CAM.

Abstract | Full Text PDF

Giriþ ve Amaç: Alopesi areata (AA), skar yapmayan saç kaybý ile alevlenme ve remisyonlarla seyreden bir hastalýktýr. Etyopatogenezi tam olarak bilinmemekle beraber otoimmün hipotez üzerinde durulmaktadýr. Alopesi areata olgularýnýn klinik ve demografik özellikleri incelenerek Türkiye’de AA’nýn epidemiyolojik özelliklerine katký saðlanmasý ve hastalýk seyrine etkili kötü prognostik faktörlerin ortaya konulmasý amaçlandý.
Gereç ve Yöntem: Ýstanbul Üniversitesi, Ýstanbul Týp Fakültesi Deri ve Zührevi Hastalýklar Anabilim Dalý Polikliniðine baþvurmuþ 134 hasta çalýþmaya alýndý. Hastalar yaþ, cinsiyet, klinik tip, alopesi tutulum alaný, hastalýk þiddeti, atak sayýsý, hastalýk süresi, hastalýk baþlangýç yaþý, nevus flammeus varlýðý, týrnak tutulumu, emosyonel ve/veya fiziksel stres öyküsü, ailede AA öyküsü, ailede ve hastada atopi öyküsü açýsýndan retrospektif olarak incelendi.
Bulgular: Çalýþmaya alýnan 134 hastanýn 79’u erkek (%59), 55’i kadýn (%41), erkek: kadýn oraný 1.4: 1, klinik olarak %86.5 AA, %3.7 alopesi totalis (AT), %9.7 alopesi universalis (AU) idi. Her iki cinste en sýk saçlý deri tutulumu vardý ve %92.1 (n=93) yama idi. Þiddetli tutulum; kadýnlar (p=0.029), juvenil baþlangýç (p=0.001), ≥1 yýl hastalýk süresi (p=0,001), nevus flammeus varlýðý (p=0.017) ve týrnak tutulumunda (p=0.015) anlamlý bulundu. Olgularýn %27.6’sýnda ailede AA hikayesi vardý ve juvenil grupta yüksek idi (p=0.034). Hastalýk þiddeti ile atopi arasýnda iliþki yoktu (p>0.05).
Sonuç: Alopesi areata; kadýnlar, juvenil baþlangýç, týrnak tutulumu, nevus flammeus varlýðý, uzun hastalýk öyküsü, ailede AA hikayesinde þiddetli seyretmektedir.

Background and Design: Alopecia areata (AA) is characterized by non-scatricial hair loss with exacerbations and remissions. Although its etiopathogenesis is not known, autoimmune factors have been suggested. Our aim was to make contribution to the epidemiological properties of AA in Turkey, and to determine the bad prognostic factors that affect the course of the disease.
Materials and Methods: One hundred and thirty-four patients who applied to the Dermatology and Venereology Polyclinic in Istanbul Medical Faculty, Istanbul University were included in the study. The patients were investigated retrospectively in terms of the age, gender, clinical type, involved area of alopecia, severity of the disease, number of relapses, disease duration, age at disease onset, presence of nevus flammeus, nail involvement, history of emotional and/or physical stress, history of AA within the family, and history of atopia within the patients and their relatives.
Results: Of the 134 patients, 79 (59 percent) were male, 55 (41 percent) were female and M/F: 1.4/1. The clinical type was AA in 86.5%, alopecia totalis (AT) in 3.7% and alopecia universalis (AU) in 9.7% of the cases. The most common involment was the scalp in both genders and clinically 92.1% was patchy. Severe involvement was found significant in the female patients (p=0.029), in the juvenile onset (p=0.001), in ≥1 year of disease duration (p=0.001), in the presence of nevus flammeus (p=0.017) and in the nail involvement (p=0.015). In the 27.6% of the cases, the family history of AA was present and that was higher in the juvenile group (p=0.034).There was no association between the severity of the disease and atopia.
Conclusion: Alopecia areata follows a more severe course in the female patients, juvenile onset patients, patients with nail involvement, patients with nevus flammeus, patients with long disease duration, and patients with the family history of AA than the others.

Abstract | Full Text PDF

Amaç: Psoriazis etyolojisi net olmayan, immün aracýlý mekanizmalarla geliþen, kronik inflamatuar bir deri hastalýðýdýr. Kronik inflamasyonun, vasküler ve metabolik bozukluklarýn geliþmesine neden olarak, psoriazise eþlik eden komorbiditelerin patogenezinde rol oynadýðý düþünülmektedir. Özellikle metabolik sendrom komponentlerinden olan obeziteyle psoriazis arasýnda güçlü bir iliþkiden bahsedilmekte, psoriazis, beden kitle indeksi (BKÝ) ve psoriazis tedavisinin karmaþýk iliþkisi üzerinde durulmaktadýr. Bu çalýþmada, metotreksat, siklosporin ve biyolojik ajan olmak üzere sistemik tedavi baþlanýlan psoriazisli hastalarda, vücut kompozisyon analizlerini, eþlik eden komorbiditeleri ve ilgili laboratuar bulgularýný deðerlendirerek, bu tedavi ajanlarýnýn bakýlan parametrelere ve komorbiditelere olan etkisini deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: Çalýþmamýza metotreksat, siklosporin ve biyolojik ajan tedavisi alan 79 psoriazisli hasta dahil edildi. Tedavi öncesi ve tedavinin 12. haftasýnda olmak üzere, hastalarýn demografik özellikleri, vücut kompozisyon analizleri, eþlik eden komorbiditeler ve bunlarla ilgili laboratuar bulgularý deðerlendirilmiþ olup, sonuçlar tedavi öncesi ve sonrasýnda, tedavi gruplarý arasýnda karþýlaþtýrýldý.
Bulgular: Biyolojik ajan tedavisi alan hastalarda, eþlik eden komorbidite ve metabolik sendromun daha sýk izlendiði görüldü. Biyolojik ajan tedavisiyle vücut yað oranýnýn arttýðý ve yine anti tümör nekrozis faktör alfa (anti-TNF-α) tedavisinin kilo alýmýna neden olduðu tespit edildi.
Sonuç: Çalýþmamýzýn sonuçlarý, metabolik sendromun, hastalýk süresinin daha uzun ve hastalýðýn daha þiddetli olmasý nedeniyle, komorbidite patogenezindeki kronik inflamasyona daha uzun süre ve þiddetli bir þekilde maruz kalan olgularda daha sýk izlendiðini düþündürmektedir.

Background and Design: Psoriasis is a chronic inflammatory immun mediated skin disorder with unknown etiology. The chronic inflammation in psoriasis have role in the development of metabolic and vascular disorders related with associating comorbidities. Recent studies have suggested a strong association exists between metabolic syndrome, obesity and complexity of the association between psoriasis, body mass index (BMI) and psoriasis tratment. In this study, our aim was to investigate the effect of psoriasis treatment with methotrexate, cyclosporine and biological agents on body composition, comorbidities and associated laboratory findings.
Materials and Methods: Seventy-nine patients treated with methotrexate, cyclosporin and biological agents were included in our study. Demographic characteristics, body composition analysis, psoriasis related comorbidities and laboratory examinations were evaluated before and after 12 weeks of systemic treatment.
Results: Comorbidities and metabolic syndrome tended to be more frequent in the anti tumor necrosis factor alpha (anti-TNF-α) treated group. Increase in body fat and weight detected in patiens receiving biologic drug therapy.
Conclusion: The results of our study showed that severe psoriasis patients with longer disease duration were more likely to have metabolic syndrome because of severe and long term inflammation in pathogenesis of comorbidities.

Abstract | Full Text PDF

Amaç. Ýçselleþtirilmiþ damgalanma, bireyin toplum tarafýndan oluþturulan hastalýkla ilgili olumsuz kalýp yargýlarý kabullenmesi ve deðersizlik, utanç gibi duygulanýmlarla kendisini toplumdan geri çekmesidir. Ulaþabildiðimiz güncel literatür bilgileri içselleþtirilmiþ damgalanmanýn psoriasisde çalýþýlmadýðýný göstermektedir. Çalýþmada psoriasis hastalarýnda içselleþtirilmiþ damgalanma ölçeðinin geçerlik ve güvenirliðini saptamak ve psoriasis için kullanýlabilirliðini göstermek amaçlanmýþtýr.
Gereç ve Yöntemler. Çalýþmaya … Dermatoveneroloji Anabilim Dalý Psoriasis Ünitesi’nde takip edilen, gönüllü, 100 ardýþýk hasta (48 kadýn, 52 erkek; ortalama yaþ±SS; 40.59±15.44 yýl) alýndý. Hastalarda baþvuru günü PASI ve VYA hekim tarafýndan (A.B.) hesaplandý. Ayný zamanda hastalar Psoriasis Ýçselleþtirilmiþ Damgalanmasý Ölçeði (PÝDÖ), DYKÝ’yi ve genel saðlýðý tek soruyla irdeleyen “Algýlanan Saðlýk Sorusu” (Likert puanlamasý 1, 2, 3 “iyiden kötü”, 4 ve 5 “iyi” olarak sýnýflandýrýldý)’ nu yanýtladý.
Bulgular. PÝDÖ alt ölçeklerine ait Cronbach alfa katsayýsý yabancýlaþma için 0.83, kalýp yargýlarýn onaylanmasý için 0.70, algýlanan ayrýmcýlýk için 0.70, sosyal geri çekilme için 0.84, damgalanmaya karþý direnç için 0.68, tüm ölçek için 0.89 olarak hesaplandý. PÝDÖ ve DYKÝ’ nin toplam puan ortalamasý sýrasýyla 58.8±12.6 ve 10.0±9.4 olarak bulundu. DYKÝ ile PÝDÖ toplam puaný arasýnda ortalama deðerlerin korelasyonu açýsýndan istatistiksel olarak anlamlý bir iliþki bulundu (r=,726, p=0,001). Benzer bir iliþki, hastalýk süresi ile PÝDÖ arasýnda da saptandý (r=,209, p=0,047). PASI veya VYA ile PÝDÖ arasýnda anlamlý iliþki gözlenmedi. Algýlanan saðlýðýný “iyiden kötü” olarak belirtenlerde ortalama DYKÝ puaný 12.1±7.3, “iyi” olarak belirtenlerde 5.0±4.3 bulundu (p=0.001). Algýlanan saðlýklarý iyiden kötü olanlarýn ortalama PÝDÖ puanlarý iyi ve çok iyi olanlara göre istatistiksel olarak anlamlý derecede yüksekti (sýrasýyla 63.3±13.5 ve 54.4±9.9; p=0.001).
Sonuç. Çalýþmamýz psoriasis için PÝDÖ’nün içselleþtirilmiþ damgalanmayý belirlemede geçerli ve güvenilir bir ölçek olduðunu göstermektedir. Sonuçlar psoriasis hastalarýnda içselleþtirilmiþ damgalanmanýn yüksek düzeyde olduðuna iþaret etmektedir. Ýçselleþtirilmiþ damgalanmanýn belirginliði ile olumsuz yaþam kalitesi bir birine paralel eðilim göstermektedir. Yaþam kalitesi belirgin derecede etkilenenlerde algýlanan saðlýk da kötüleþmektedir.

Backround and design. Internalized stigma involves endorsing negative feelings and beliefs such as insignificance, shame and withdrawal triggered by applying these negative stereotypes to one self. Internalized Stigma Scale has not been applied to psoriasis patients. We aimed to evaluate the reliability and validity of Internalized Stigma Scale in psoriasis patients.
Materials and Methods. 100 consecutive, volunteer psoriasis patients (48 female, 52 male; aged, 40.59±15.44 years) were enrolled in the study. PASI and BSA were evaluated by physician (A.B.). Patients responded contemporaneously to Psoriasis Internalized Stigma Scale (PISS), DQoL, and Perceived Health Status (PHS), single-item self-rated general health question, of which Likert scores 1, 2, and 3 were classified as “from fair to very poor”, and 4, 5 as “good”.
Results. Cronbach's alpha coefficient of PISS subscales was 0.83 for alienation, 0.70 for stereotype endorsement, 0.70 for perceived discrimination, 0.84 for social withdrawal and 0.68 for stigma resistance. The same value was 0.89 for the total scale. PISS and DQoL scores mean values were 58.8±12.6 and 10.0±9.4, respectively. PISS was significantly correlated with the patients' DQoL scores (r=,726, p=0,001). PISS was also significantly correlated with disease duration (r=,209, p=0,047). There was no any significant relationship between PASI or BSA and PISS. Mean DQoL scores in patients reporting their PHS as “from fair to very poor” and “good” were 12.1±7.3 and 5.0±4.3, respectively. Mean values of PISS in patients reporting their PHS as “from fair to very poor” was significantly increased compared with patients reporting their PHS as “good” (p=0.001).
Conclusion. PISS can be used as a reliable and valid tool in assesing internalized stigmatization in psoriasis patients. Our results indicate a high level of stigmatization in psoriasis patients. Low DQoL scores show a correlation with increased levels of internalized stigmatization. PHS is also worse in patients with Low DQoL scores.

Abstract | Full Text PDF

Amaç: Yapýlan çalýþmalarda vitamin D eksikliði ile birçok otoimmün hastalýk arasýnda muhtemel bir iliþki gözlenmiþtir. Bu çalýþmada sýk görülen otoimmün dermatolojik bir hastalýk olan alopesi areata(AA) ile D vitamini düzeyi arasýndaki iliþkinin araþtýrýlmasý amaçlandý.

Gereç ve Yöntem: AA tanýsý alan 40 hasta ile ile yaþ grubu, cinsiyet ve deri fenotipi eþleþtirilmiþ 40 kiþilik kontrol grubunun 25 hidroksi vitamin D3 (25 OH D)düzeyleri karþýlaþtýrýldý. Tüm hastalarýn 25 OH D düzeyleri ölçüldü ve “normal” (>30 ng/ml), “eksik”(15-30 ng/ml) ve “yetersiz” (<15 ng/ml) olarak sýnýflandýrýldý.

Bulgular: Çalýþma ve kontrol gruplarýnýn her ikisi de 21 kadýn ve 19 erkekten oluþmaktaydý. Ortalama yaþ gruplar için sýrasýyla 31.23±7.34 (21-50) and 30.58±7.19 (21-48) idi. Hasta grubunun vitamin D3 düzeyleri [normal: %2.5(n=1), yetersiz: %15(n=6), eksik: %82.5(n=33)] kontrol grubundan [normal: %2.5(n=1), eksik: %25(n=10) yetersiz: %72.5(n=29)] farksýz bulundu(p>0,05). Her iki grupta da 25 OH D düzeyi normalin altýnda saptanan hasta oraný %97.5’ ti.

Sonuç: Çalýþmada AAlý hastalar ve kontrol grubunun vitamin D düzeyleri benzerdi. Bu benzerlik AA ile vitamin D arasýnda baðlantý olmadýðýna iþaret ediyor olabilir. Ancak aradaki iliþkinin Vitamin D düzeyi deðil Vitamin D reseptörü(sayý ve/veya yapý) üzerinden olmasýndan da kaynaklanabilir.

Background and Design: Current studies link a possible relationship between vitamin D deficiency and many autoimmune diseases. Alopecia areata(AA) is a frequent autoimmune dermatological disease. The aim of this study was to investigate the relationship between vitamin D levels and alopecia areata; a frequent autoimmune dermatological disease.

Materials and Methods: The 25 hydroxyvitamin D (25 OH D) levels of 40 patients with alopecia areata and age, gender and skin phototype matched healthy controls were evaluated. Serum 25 OH D was measured in all subjects, grouped as normal/sufficient (> 30 ng/ml), insufficient (15-30 ng/ml) and deficient (< 15 ng/ml).

Results: Both the study and control group were composed of 21 female and 19 males. The mean age were 31.23±7.34 (21-50) and 30.58±7.19 (21-48) respectively. 25 OH D level of study[2.5% (n=1) normal, 15%(n=6) insufficient, 82.5%(n=33)deficient] and control group[2,5%(n=1)normal, 25%(n=10)insufficient, 72,5%(n=29) deficient] were not different(P>0,05). In both groups 97,5% of patients had 25 OH D levels under normal range.

Conclusion: Vitamin D levels of patients with AA was similar with the control group This similarity may suggest that a connection between vitamin D and AA does not exist. However, it may also indicate that the relationship between AA and Vitamin D is not via the level but receptor (number and / or structure) of vitamin D.

Abstract | Full Text PDF

Amaç: Akne vulgaris pilosebase ünitenin multifaktöriyel, kronik inflamatuar bir hastalýðýdýr. Hafif-orta þiddetli aknede topikal antibiyotik ve antiinflamatuar tedavi ön plandadýr. Klindamisin topikal antibiyotik olarak sýk kullanýlan bir ajandýr, nadifloksasin ise göreceli olarak daha yeni kullanýlmaya baþlayan bir ajandýr. Nadifloksasinin tedavi etkinliðinin karþýlaþtýrýldýðý sýnýrlý sayýda çalýþma mevcuttur. Yaþam kalitesi üzerine olan etkisi ise daha önce deðerlendirilmemiþtir. Bu çalýþmada bu iki ajanýn etkisinin karþýlaþtýrýlmasý ve yaþam kalitesi üzerine olan etkisinin deðerlendirilmesi planlandý.
Gereç ve yöntemler: Hafif ve orta þiddetli akne vulgarisi olan 80 hasta, yaþ, cinsiyetiyet ve akne dereceleri açýsýndan farklýlýk olmayan 40’ar kiþilik 2 gruba ayrýldý. Birinci grupta hastalar topikal klindamisin ve %5 benzoil peroksit kombinasyonu jel tedavisini günde 2 kez, ikinci grupta hastalar nadifloksasin krem ve %5 benzoil peroksit jel kombinasyonu tedavisini günde 2 kez olmak üzere 12 hafta süreyle kullandý. 0, 2, 4, 8 ve 12. haftalarda inflamatuar ve inflamatuar olmayan lezyonlarýn sayýsý kaydedildi, oluþan yan etkiler deðerlendirildi. Ýyileþme hasta ve doktor için ayrý olmak üzere tedavi sonunda deðerlendirildi. Tedavi öncesi ve sonrasýnda hastalarýn yaþam kalitesi dermatolojiye özel yaþam kalite ölçeði olan Skindeks-29 ile deðerlendirildi. 
Bulgular: Her iki grupta da tedavinin, hem inflamatuar hem de noninflamatuar lezyonlara istatistiksel olarak anlamlý azalma saptandý. Hastalar tarafýndan iyi tolere edildi. Her iki tedavi grubunda da yaþam kalitesi üzerinde istatistiksel olarak anlamlý düzelme saðlandý. Ýki tedavi yöntemi arasýnda etkinlik, yan etki ve yaþam kalitesinin düzelmesi açýsýndan istatistiksel olarak anlamlý fark saptanmadý. 
Sonuç: Nadifloksasin krem %5 benzoil peroksit kombinasyonu, klindamisin ve %5 benzoil peroksit kombinasyonu kadar tedavide ve yaþam kalitesinin düzelmesinde etkilidir.

Background and Design: Acne vulgaris is a multifactorial chronic inflammatory disase of the pilosebaceous unit. Topical antibiotics and anti-inflammatory treatment are used for mild and moderate acne. Clindamycin is frequently used for acne treatment, altough nadifloxacin is a relatively new agent. There are few studies evaluating nadifloxacin efficacy. It's impact on quality of life has not been determined previously. In this study, it is aimed to compare the effect of these two agents, and to evaluate the effect of these treatments on quality of life. 
Materials and Methods: Eighty patients with mild-moderate acne vulgaris were divided in two groups of 40 people that had no difference in terms of age, gender and acne severity. The combination of topical clindamycin and 5% benzoyl peroxide gel twice a day was given to group 1 for 12 weeks. The combination of nadifloxacin cream and 5% benzoyl peroxide gel twice a day was given to group 2 for 12 weeks. The number of the inflammatory and non-inflammatory lesions were recorded at baseline and on weeks 2, 4, 8, 12 and side effects were recorded and evaluated. Global improvement was evaluated separately by patients and doctor after the treatment. Before and after the treatment, the quality of life of the patients were evaluated with Skindex-29. 
Results: Both treatment group regimens were significantly effective on inflammatory and non-inflammatory lesions and were well tolerated by patients in terms of side effects. It was also observed that there was statistically significant recovery after treatment in terms of clinical severity and quality of life. There was not any statistically significant difference between two treatment methods in terms of effectiveness, side effect and quality of life.
Conclusion: Nadifloxacin and 5% benzoyl peroxide combination is effective in the treatment and improvement of quality of life in acne patients.

Abstract | Full Text PDF

Amaç: Saðlýklý cildin devamý için deri tiplerine özel hazýrlanmýþ temizleme ve kozmetik ürünlerinin (besleyici, nemlendirici, güneþ koruyucu gibi) kullanýlmasý ve/veya uygulanmasý “deri bakýmý” olarak isimlendirilir. Çalýþmamýzda dermatoloji polikliniðine baþvuran olgularýn deri bakýmý hakkýnda bilgi seviyesini, deri bakýmý ürünü kullanma alýþkanlýklarýný, nemlendiriciler hakkýnda bilgi seviyeleri ve bu ürünleri kullanma alýþkanlýklarýný deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: Mart – Mayýs 2013 tarihleri arasýnda herhangi bir nedenle dermatoloji polikliniðine baþvuran olgulara deri bakým ürünleri ve nemlendiricileri, kullanma alýþkanlýklarý, deri bakýmý ile ilgili bilgileri nereden edindikleri, ürün seçiminde dikkat ettikleri noktalar, ürünleri kime danýþarak ve nereden aldýklarý, alýrken neye dikkat ettiklerini sorgulayan anket doldurtuldu.
Bulgular: Araþtýrmaya katýlan 984 olgunun 608’i (%61,8) kadýn, 376’sý (%38,2) erkekti. Çalýþmamýzda 474 olgu (% 48,2) deri bakýmý deyince temizlik anladýðýný, 337 olgu (%34,2) ise cilt hastalýðýnýn olmamasý olduðunu belirtti. 303 (%30,8) olgu bir ürün, 213(%21,6) iki ürün, 284 (%28,9) üç ve daha fazla ürün biliyorken, 184 (%18,7) olgu deri bakým ürünlerini bilmiyordu. Deri bakým ürünlerini 200’ü düzenli ve 328’i bazen olmak üzere 528 (%53,7) olgu kullanmakta, 456 (%46,3) olgu da kullanmamaktaydý. Olgularýmýz deri bakým ürünlerini seçerken; 648 (%65,9) olgu dermatoloðundan, 154 (%15,7)’si internetten, 106 (%10,8)’ý reklamlardan, 37’si (%3,8) komþusundan, 39’u (%4) eczacýsýndan yardým almaktaydý. Çalýþmamýzda; olgularýn 300’ü (%30,5) nemlendiricileri kullanýrken, 340’ý (%34,6) bazen kullanmaktaydý, 344 (%35) olgu da nemlendirici kullanmadýðýný belirtti.
Sonuç: Düzenli deri bakým ürünü kullanma alýþkanlýðý olgularýmýzýn çoðunda bulunmamaktadýr. Toplumun düzenli deri bakýmý ve nemlendiricilerin doðru seçimi, uygun yerlerden alýmý ve kullanýlmasýyla ilgili bilgilendirilmesine ihtiyaç duyulmaktadýr.

Background and Design: For having a healthy skin; there are cleaning and cosmetic products that are specially prepared (nourishing,moisturizing,sunscreen, etc.) should be used and/or referred to as "skin care". In our study we aimed to determine knowledge and behaviors about skin care and moisturizers of dermatology patients.
Materials and Methods: Between March-May 2013, we filled dermatology patients a questionary about their skin care products and moisturizers, behaviours abuot using them, how to use them, where they get knowledge about them, what are the attension points about choosing them, who they are asking for these products, where they buy these products, what are they looking for buying them.
Results: The study involved 984 patients.608 (61.8%) were female, 376 (38.2%) were male. In our study; (48.2%) 474 of patient specified that they understand skin care is cleaning, (% 34.2) 337 patient spesified that the lack of skin disease. 303 (30.8%) of patients knew one skin care product, 213% (21.6) of patients knew two skin care products, 284 (28.9%) of patients knew more product, 184% (18.7) of patients didn’t know skin care products. 528 (%53,7) patient were using skin products, 200 of them patients were using regularly, 328 were using sometimes. 456 (%46,3) patient were not using skin care products.
When they are choosing their skin care products; 648 (%65,9) of them get information from dermatologists, 154 (%15,7) internet, 106 (%10,8) advertisements, 37 (%3,8) their neighbours, 39 (%4) phamacy. 300 (%30,5) patients were using moisturizers, 340 (%34,6) patients were using sometimes, 344 (%35) were not using moisturizers.
Conclusion: Our patients did not have the behavior of using skin care products regularly. Our society needs to be informed about regular skin care, and choosing the right moisturizers, buying these products from appropriate places as well as using these products correctly.

Abstract | Full Text PDF

Giriþ ve Amaç: Erzurum'daki büllöz pemfigoidli hastalarýn epidemiyolojik, klinik, laboratuvar ve radyolojik özelliklerini ve büllöz pemfigoidli hastalarýn komorbit hastalýklar ile iliþkisini ortaya koymak.
Gereç ve Yöntem: Çalýþmamýzda, 2003 ile 2013 yýllarý arasýnda biyopsi ile taný konulan ve kliniðimizde yatýrýlarak takip edilen 38 büllöz pemgigoidli hastanýn hastane kayýtlarý retrospektif olarak deðerlendirilmiþtir.
Bulgular: Hastalarýn 15 (%39,5)’i erkek ve 23 (%60,5)’ü kadýndý. Taný konulduðu zaman hastalarýn yaþ ortalamasý 62.4 ± 21(yaþ aralýðý: 1–93). Direk immün floresan çalýþmalarý sonucunda en sýk tutulum IgG ve C3 birlikteliðiydi. Hastalarda ilk þikâyetlerinin baþlamasý ile taný konulmasý arasýnda geçen sürenin ortalamasý 72,7 ± 104,3 gündü. Tedavide baþlangýç steroid dozu 54,7 ± 26.01 mg/gün idi. Büllöz pemfigoid için hastanede kalýþ süresi ortama 22,6 ± 23,5 gündü.
Sonuç: Büllöz pemfigoid ile malignite ve komorbit hastalýklarýn iliþkilisi tespit edilemedi. Buna karþýn eozinofili tespit edildi. Büllöz pemfigoid hastalarýnda malignite tespiti için rutin laboratuvar ve radyolojik incelemeler gerekli deðildir.

Background and Design: Bullous pemphigoid is a rare autoimmune blistering disease. Aim of the study is to reveal the epidemiology and clinical, laboratory, and radiological features of patients in Erzurum with bullous pemphigoid and to evaluate the association of bullous pemphigoid with comorbid diseases.
Methods and Methods: Medical records of 38 patients diagnosed with bullous pemphigoid after biopsy and hospitalized in our clinic between 2003 and 2013 were retrospectively studied.
Results: Fifteen (39.5%) of the 38 patients were male, and 23 (60.5%) were female. The mean age at the time of diagnosis was 62.4 ± 21 years. Analyses of the results of direct immunofluorescence showed that the most common findings were the presence of IgG and C3 (42.1%). The average time since the first presentation until diagnosis was 72.7 ± 104.3 days. The mean of the initial dose of corticosteroid was 54.7 ± 26.01 mg/day. The mean of hospitalization for bullous pemphigoid was 22.6 ± 23.5 days.
Conclusions: We did not detect any malignancy or comorbid diseases associated with bullous pemphigoid. However, eosinophilia was detected. Routine laboratory and radiological investigations are not necessary to detect malignancy in patients with bullous pemphigoid.

Abstract | Full Text PDF

Muir-Torre sendromu (MTS) sebase tümörlere ve/veya keratoakantomlara eþlik eden visseral malignitelerle karakterize, nadir görülen bir genodermatozdur. Herediter nonpolipozis kolorektal kanser sendromunun bir subtipi olarak kabul edilir. Karakteristik sebase neoplaziler; sebase adenom, sebase karsinom, sebaseoma ve sebase diferansiyasyon gösteren keratoakantomu içermektedir. En sýk görülen internal maligniteler kolorektal ve genitoüriner sistem tümörleridir.
Olgu: Kýrkyedi yaþýnda erkek hasta burunda iki adet kabarýk yara þikayetiyle polikliniðimize baþvurdu. Dermatolojik muayenesinde burun sol yanýnda 1 cm çapýnda, sarýmsý-beyaz renkte parlak papüllerden oluþan, hafif umblike, üzerinde telenjiektazilerin izlendiði plak ve burun ucunda 3 mm çapýnda, soluk eritemli, ortasýnda keratotik týkaç bulunan kubbemsi papül mevcuttu. Daha önce kolon kanseri nedeniyle parsiyel kolon rezeksiyonu yapýlmýþ olan hastada ailesel Lynch 2 sendromu öyküsü mevcuttu. Sebase adenomun dermoskopik incelemesinde az sayýda sarý komedon benzeri globüller ve dallanan damarlanmalar izlendi. Reflektans konfokal mikroskopi (RKM), histopatoloji ile iyi bir korelasyon göstermekteydi. Sebase lobüller hiporefraktil koyu nükleuslu ve parlak hiperrefraktil sitoplazmalý ovoid hücre kümelerinden oluþmaktaydý. Bazý alanlarda sebase duktus ile uyumlu yuvarlak ve oval þekilde koyu alanlar mevcuttu. Kiþisel ve ailesel öykü, dermoskopik, RKM ve histopatolojik incelemeler ýþýðýnda hastaya MTS tanýsý konuldu.
Sonuç olarak;biyopsi ile kanýtlanmýþ sebase adenom olgularýnda MTS araþtýrýlmalýdýr. Erken taný MTS’li hastalarda hayat kurtarýcýdýr. Sebase neoplazilerin RKM özelliklerinin daha iyi ortaya konulmasý, MTS’li hastalarda ve akrabalýk iliþkisi olanlarda erken tanýya olanak saðlayacaktýr.

Muir-Torre syndrome (MTS) is a rare autosomal dominant genodermatosis characterized by the occurrence of sebaceous gland neoplasms and/or keratoacanthomas associated with visceral malignancies. It is considered as a subtype of hereditary nonpolyposis colorectal cancer syndrome. Characteristic sebaceous gland neoplasms include sebaceous adenoma, sebaceous carcinoma, sebaceoma, and keratoacanthoma with sebaceous differentiation. The most common visceral malignancies are colorectal and genitourinary tumors.

CASE: A 47year-old male patient admitted to our clinic complaining of two lesions on the nose. Dermatological examination revealed a plaque in 1 cm diameter consisting of bright yellowish-white coloured papules with slightly umblicated appearance and telangiectasias on the left site of the nose and had a dome shaped papule in 3 mm diameter with hyperkeratotic plug on the tip of the nose. He had personal history of partial colon resection because of colon cancer and familial Lynch 2 syndrome. On dermoscopic examination of sebaceous adenoma, a few yellow comedo-like globules and branching arborizing vessels were detected. Reflectance confocal microscopy (RCM) revealed a good histopathologic correlation. Sebaceous lobules were composed by clusters of ovoid cells with hyporefractile dark nuclei and bright, hyperrefractile glistening cytoplasm. Numerous roundish to ovoid dark spaces corresponding to sebaceous ducts were detected. The diagnosis of MTS was established based on the personal and family history, dermoscopic, RCM and histopathologic findings.

CONCLUSIONS: MTS evaluation is required in patients with biopsy-proven sebaceous adenoma. Early diagnosis may be lifesaving in patients with MTS. A better characterization of RCM features of sebaceous tumors will allow early diagnosis of the patients with MTS.

Abstract | Full Text PDF

Diskoid lupus eritematozus (DLE) sýklýkla güneþ gören deri bölgelerinde ortalarý atrofik kenarlarý hiperpigmente plaklar þeklinde görülür. Nadir olarak yüz ve boyunda eþlik eden eritem, yapýþýk skuam ya da atrofi olmadan diffüz hiperpigmente plaklar þeklinde ortaya çýkabilir. Bu durum melanotik lupus eritematozus olarak adlandýrýlýr ve literatürde oldukça nadir bildirilmiþtir. Bu durumun ayýrýcý tanýsýnda yüzde pigmentasyon yapan melazma, Riehl melanozu, liken planus pigmentozus, ilaca baðlý hiperpigmentasyon gibi diðer hastalýklar düþünülmelidir. Burada 66 yaþýnda tüm yüzde diffüz mavi- kahverengi hiperpigmentasyonu olan ve klinik, histopatolojik ve immünfloresan bulgularý ile melanotik DLE olarak taný alan bir erkek hasta sunulmuþtur.

Discoid lupus erythematosus (DLE) is characterized by atrophic patches with peripheral hyperpigmentation on sun exposed skin areas. It rarely presents with diffuse hyperpigmented patches without erythema, adherent scale and atrophy on face and neck. This presentation is called as melanotic lupus erythematosus and it is rarely reported in literature. Other diseases that cause facial pigmentation as melasma, Riehl melanosis, lichen planus pigmentosus, drug related pigmentation should be considered in the differential diagnosis. We herein report a 66 year old male patient with diffuse blue-brown pigmentations on his face which was diagnosed as melanotic lupus erythematosus with the clinical, histopathological and immunofluoresence findings.

Abstract | Full Text PDF

Leflunomid, özellikle romatoid artrit ve psoriatik artrit baþta olmak üzere inflamatuar artritlerin tedavisinde yaygýn olarak kullanýlan immünomodülatuar bir ilaçtýr. Lenflunomidin yan etkileri genellikle hafif ve geçici özellik göstermekle birlikte en sýk izlenen yan etkileri hepatopati, hipertansiyon, gastrointestinal rahatsýzlýklar ve geçici saç kaybýdýr. Leflunomide baðlý geçici saç kaybý oluþabileceði bildirilmiþ olmasýna karþýn, alopesi areata geliþimi bugüne kadar sadece bir olguda bildirilmiþtir. Bu olgu sunumunda, leflunomid tedavisi sonrasýnda alopesi areata geliþen 38 yaþýnda bir erkek hastayý sunuyoruz.

Leflunomide is an immunomodulatory drug widely used in the treatment of inflammatory arthritis especially in rheumatoid arthritis and psoriatic arthritis. The common side effects of leflunomide are hepatopathy, hypertension, various gastrointestinal complaints and transient hair loss, which were mild and reversible. Although leflunomide is associated with transient hair loss, leflunomide induced alopecia areata was reported previously only in one case. In this case report, we present a 38-year-old male patient who suffered from alopecia areata after leflunomide therapy.

Abstract | Full Text PDF

Otuz yedi yaþýndaki erkek hasta göz kapaklarýnda, kulaklarýnda, boyun ön ve yan yüzleri ile ensesinde þiþlik ve hafif kaþýntý þikayeti ile polikliniðimize baþvurdu. Dermatolojik muayenesinde göz kapaklarýnda ve kulaklarýnda soluk eritem ve ödem; yüz derisinde kabalaþma ve alýn bölgesinde oluklanmalar saptandý. Hastanýn öyküsünden yaklaþýk iki aydýr ürtiker-anjioödem tanýlarý ile sistemik kortikosteroid, antihistaminik ve adrenalin tedavilerinin verildiði fakat bu tedavilerden hiç fayda görmediði öðrenildi. Klinik, histopatolojik ve laboratuar bulgularýnýn ýþýðýnda hastaya monoklonal gamopatisiz atipik skleromiksödem tanýsý konuldu. Hastaya asitretin (35 mg/gün) tedavisi baþlandý. Ýki ay sonra lezyonlarda belirgin düzelme gözlendi.

A 37-year-old male patient was admitted our clinic with complaints of edema and mild pruritus on the eyelids, ears, and neck. On dermatological examination there were pale erythema and edema on eyelids and ears; also coarsening of the facial skin and grooving in the forehead lines. In his medical history, it was learned that systemic corticosteroids, antihistamines and epinephrine treatments were given with the diagnosis of urticaria, angioedema for about two months, but he did not benefit from these treatments. A diagnosis of atypical scleromyxedema without monoclonal gammopathy was done according to the clinical, histopathological and laboratory findings. Acitretin treatment with a dose of 35 mg/day was started. Marked regression in the lesions was observed two months later.

Abstract | Full Text PDF

Lupus eritematozus (LE) ve eritema multiforme (EM) birlikteliði, ANA, anti-SS-B/La ve RF pozitifliði saptanan hastalar 1962 yýlýnda Rowell ve ark. tarafýndan yeni bir sendrom olarak tanýmlanmýþtýr. 2012 yýlýnda Torchia ve ark. tarafýndan ise Rowell Sendromu (RS) için yeni taný kriterleri tanýmlanmýþtýr. Ancak literatürde sadece sistemik ve/veya kutanöz LE ile EM benzeri lezyonlarýn birlikteliði de taný kriterlerini tam olarak saðlamasa bile RS olarak bildirilmiþtir. Daha sonra bu olgular EM benzeri lezyonlarýnýn subakut kutanöz LE’nin alt tipi olabileceði yönünde deðerlendirilmiþtir. Bu makalede histopatolojik inceleme ile taný konulmuþ DLE ile EM benzeri lezyonlarýn varlýðý, benekli ANA pozitifliði, tetikleyici bir faktörün olmamasý, malar raþ, diskoid raþ ve ANA pozitifliði ile EM benzeri lezyonlarýn tipik yerleþim göstermemesi gibi özellikleri olan ve oral siklosporine iyi yanýt veren 34 yaþýnda kadýn hasta sunulmuþtur. Yeni literatürler ýþýðýnda olgumuz yeni RS taný kriterlini tamamlamamasý nedeni ile EM benzeri lezyonlarla aktive olan sistemik lupus eritematozus olarak deðerlendirilmiþtir.

The association of lupus erythematosus (LE) and erythema multiforme (EM) inthe presence of ANA, anti-SS-B/La and RF positivity was described as a new syndrome by Rowell et al in 1962. In 2012, Torchia et al. suggested a novel diagnostic criteria for Rowell syndrome (RS). However, a number of cases which lack thefull spectrum of either set ofdiagnostic criteria, have been reported as RS in the literature. The EM-like lesions seen in these cases have been proposed as a subtype of subacute cutaneous LE. This article presents the case of a 34-year-old female patient with histopathologicallydiagnosed discoid LE, EM-like lesions, and speckled-pattern ANA positivity. Localizations of malar rash, discoid rash and EM-like lesions of patient were not typical in the patient, and there was no triggering factor. Due to the lack of fully novel diagnostic criteria forRS, we concludethat our case is an instance of SLE exacerbated with EM-like lesions.

Abstract | Full Text PDF

Ksantogranuloma en sýk rastlanýlan Non-Langerhans hücreli histiosiyozdur. Sýklýkla infantil ve çocukluk döneminde gözlenmesi nedeniyle juvenil ksantogranuloma (JKG) olarak adlandýrýlmýþtýr. Literatürde çok ender olarak, eriþkin yaþta baþlangýç gösteren olgulara da rastlanabilmektedir. Burada klinik ve histopatolojik bulgularla eriþkin tip ksantogranüloma tanýsý konulan 21 yaþýnda bir erkek hasta sunulmuþtur.

Ksantogranuloma en sýk rastlanýlan Non-Langerhans hücreli histiosiyozdur. Sýklýkla infantil ve çocukluk döneminde gözlenmesi nedeniyle juvenil ksantogranuloma (JKG) olarak adlandýrýlmýþtýr. Literatürde çok ender olarak, eriþkin yaþta baþlangýç gösteren olgulara da rastlanabilmektedir. Burada klinik ve histopatolojik bulgularla eriþkin tip ksantogranüloma tanýsý konulan 21 yaþýnda bir erkek hasta sunulmuþtur.

Abstract | Full Text PDF

Abstract | Full Text PDF

Abstract | Full Text PDF