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Öğe Clinical, Demographic and Treatment Characteristics of Pediatric Psoriasis: A Multicenter Study of 150 Patients(Galenos Publ House, 2021) Demirbaş, Abdullah; Özyurt, Kemal; Elmas, Ömer Faruk; Metin, Mahmut Sami; Atasoy, Mustafa; Türsen, Ümit; Kilitci, AsumanBACKGROUND/AIMS: Many studies have focused on the epidemiological features of adult and childhood psoriasis. However, only a few studies have been conducted to demonstrate the clinical and demographic characteristics of pediatric psoriasis in Turkey. This study aimed to determine clinical, demographic, and treatment characteristics of childhood psoriasis in a multicenter series. MATERIALS and METHODS: This study was conducted in four different centers that are located in four cities of Turkey between June 2016 and June 2020. The demographic parameters, possible triggering factors (emotional stress, physical trauma, infection, and medication), and clinical characteristics (psoriasis type, psoriasis area severity index, involved areas, nail involvement, joint involvement, subjective symptoms, disease duration, last treatments and duration of use, and history of accompanying diseases) of pediatric patients with psoriasis were retrospectively analyzed. RESULTS: A total of 150 patients from four different centers were enrolled in the study, of whom 71 (47.30%) were males and 79 (52.70%) were females, with a mean age of 13.71 +/- 42 years (age range: 1-18 years). A family history of psoriasis was determined in 20 (13.33%) patients. Possible triggering factors included emotional stress (n=90, 60%), physical trauma (n=21, 14%), infection (n=14, 9.33%), and medication (n=1, 1.67%). The most common area of involvement was the trunk (n=69, 46%) followed by the scalp (n=42, 28%), hand (n=20, 13.33%), and face (n=19, 12.67%). The prevalence of clinical types was as follows: plaque (n=125,83.33%), guttate (n=10, 6.67%), palmoplantar (n=7, 4.67%), inverse (n=6, 4%), and pustular (n=2, 1.33%) psoriasis. Nail and joint involvement were observed in 30 (20%) and 15 (10%) patients, respectively. The last treatments received included topical treatment (n=101, 67.33%), phototherapy (n=23, 15.33%), acitretin (n=16,10.67%), methotrexate (n=9, 6%), and cyclosporine (n=1, 0.67%). CONCLUSION: In our cohort, the clinical types and treatments used for childhood psoriasis were similar to those of other studies, but the rate of family history was lower, whereas the incidence of emotional stress was higher. Addressing the psychological impacts of psoriasis along with its physical aspects may provide better treatment outcomes.Öğe Mycosis fungoides and Sezary syndrome: therapeutic approach and outcome in 113 patients(Wiley, 2005) Anadolu, Rana Yavuzer; Birol, Ahu; Şanlı, Hatice; Erdem, Cengizhan; Türsen, ÜmitBackground Mycosis fungoides (MF) and Sezary syndrome (SS) are the most common forms of cutaneous T-cell lymphoma (CTCL). Various topical and systemic therapeutic alternatives are available, but there is no standard or definite curative treatment regimen. When making a decision about the appropriate treatment modality, the age and compliance of the patient, stage of the disease, treatment accessibility, and previous treatment history should be considered. Aim To determine the therapeutic response of patients with MF and SS to different treatment modalities. Patients were evaluated with respect to their clinical and demographic features. Methods One hundred and thirteen patients diagnosed clinically and dermatopathologically with MF and SS between March 1984 and June 2001 were included in the study. Results Of the 113 patients studied, 110 had a diagnosis of MF and three had a diagnosis of SS; 101 patients (89.4%) were diagnosed with early stage (IA, IB, IIA) and 12 (10.6%) with late stage (IIB, III, IVA, IVB) disease. The age at diagnosis varied between 12 and 81 years (mean, 45.6 +/- 15.8 years). Fifty-five (48.7%) patients were male and 58 (51.3%) were female. The duration of the skin lesions varied between 1.5 months and 32 years (mean, 6.1 years). Psoralen plus UVA (PUVA) was the most commonly used initial treatment modality in early stage disease (91%), with a complete remission (CR) rate of 80.4%. With PUVA + interferon-alpha (INF-alpha) treatment, CR was 57% in the early stages and 33.3% in the late stages. For late stage disease, systemic therapies, such as pentostatin, gemcitabine, and fludarabine, alone or in combination with INF-alpha, were preferred. Of the 113 patients, eight (7% of the total and 57.1% of the advanced stage cases) died of MF; 21.4% of the late stage patients showed partial remission and 14.2% showed CR. None of the patients diagnosed with early stage disease died of MF, but two (1.9%) progressed to late stage disease. Conclusions PUVA and PUVA + INF-alpha are effective treatment modalities, especially for early stage MF. Once the disease has progressed, both MF and SS are very resistant to treatment regimens, including chemotherapeutic agents. It is important to diagnose and treat these diseases, especially MF, in the early stages for lasting remission.Öğe Potential utility of oral mucosal capillaroscopy as an indicator of microvascular damage in Behçet disease: A preliminary study(Mattioli 1885, 2021) Demirbaş, Abdullah; Elmas, Ömer Faruk; Demirbaş, Gözde Ulutaş; Atasoy, Mustafa; Türsen, Ümit; Lotti, TorelloIntroduction: Behçet disease (BD) is an auto-inflammatory condition characterized by multisystemic vasculitis. Oral mucosal capillaroscopy is an easy-to-use, repeatable, non-invasive method for evaluating mucosal microvasculature, contributing to the differential diagnosis and prognosis of various acute and chronic inflammatory diseases. Objectives: This study aims to characterize and describe the oral labial mucosal capillary findings in patients with BD using handheld dermatoscopy and to investigate the relationship between the capillary findings and the severity of the disease. Methods: This cross-sectional study included patients with BD and healthy subjects. Capillaroscopic examination of the oral labial mucosa in each subject was performed by a handheld dermatoscope using polarized light. The clinical severity of BD was evaluated using Krause's Clinical Severity Scoring for BD. Results: Sixty patients with BD and 60 healthy subjects were enrolled in the study. The frequencies of irregular capillaries, microhemorrhages, glomerular vessels, megacapillaries, and tortuous vessels were statistically significantly higher in the patient group when compared to the healthy individuals. In addition, a correlation was detected between the oral mucosal capillaroscopic findings and disease duration, severity, and vascular complications. Conclusions: Our study is the first to explore the potential role of oral mucosal capillaroscopic examination in patients with BD. Data obtained from this study indicated that oral mucosal capillaroscopy may be a useful tool to demonstrate microvascular damage in patients with BD. © 2021 Demirbaş et al.Öğe The role of oxidative stress in onychomycosis: Thiol/disulphide homeostasis(Wiley, 2021) Metin, Mahmut Sami; Elmas, Ömer Faruk; Demirbaş, Abdullah; Erel, Özcan; Atasoy, Mustafa; Türsen, Ümit; Lotti, TorelloObjectives Onychomycosis is the general term to define fungal nail infections that arise from dermatophytes, non-dermatophytic moulds and yeasts. Thiol/disulphide homeostasis is a new indicator of oxidative stress. In this study, we aimed to investigate the role of thiol/disulphide balance in the pathogenesis of onychomycosis. Methods This cross-sectional study included adult patients with onychomycosis who were admitted to the dermatology department and healthy adult volunteers without any dermatologic or systemic condition. The patients and controls were evaluated in terms of native thiol, total thiol, and disulphide levels, and disulphide/native thiol, disulphide/total thiol and native thiol/total thiol ratios. The possible association between these parameters and clinical subtypes of onychomycosis and demographic characteristics was also investigated. Results A total of 52 patients with onychomycosis and 50 healthy subjects were enrolled in the study. The patient group showed lower levels of total thiol, native thiol and native thiol/total thiol ratio, and higher ratios of disulphide/native thiol and disulphide/total thiol. No statistically significant relationship was found between the parameters, clinical subtypes of onychomycosis and demographic characteristics (p > .05). Conclusion Patients with onychomycosis showed a shifted thiol/disulphide homeostasis towards oxidative stress with a reduction in thiols and an increase in disulphide/native thiol, and disulphide/total thiol ratios. These findings may indicate the role of oxidative stress in the pathogenesis of onychomycosis.
