Publications by authors named "Ayse Serap Karadag"

162 Publications

New Coronavirus (SARS-CoV-2) Crossing Borders Beyond Cities, Nations, and Continents: Impact of International Travel.

Balkan Med J 2021 07;38(4):205-211

Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.

The third outbreak of coronavirus in the form of the COVID-19 infection started in Wuhan, China, in December 2019. The early and rapid spread of this infection across borders can be largely attributed to international air travel that has become a part of modern globalization. In this article, we analyze the spread of the novel coronavirus (SARS-CoV-2) along the routes of international travel, both by air and by sea. Pitfalls of various screening methods used at the airports and the importance of optimal aircraft ventilation are discussed. Also, we suggest measures that can be taken to reduce the risk of transmission associated with air travel.
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http://dx.doi.org/10.5152/balkanmedj.2021.21074DOI Listing
July 2021

Social media use in patients with acne vulgaris: What do patients expect from social media?

J Cosmet Dermatol 2021 Jun 4. Epub 2021 Jun 4.

Department of Dermatological and Venereal Diseases, Faculty of Medicine, Uludağ University, Bursa, Turkey.

Background: Acne vulgaris (AV) may affect external appearance and significantly deteriorate the quality of life of patients. Therefore, patients make various inquiries about their disease and seek treatment options.

Aims: To investigate the social media usage habits of patients with AV concerning their diseases, and their recommendations for dermatologists related to social media use.

Methods: A total of 1609 patients with AV completed the survey prepared by the authors and the Cardiff Acne Disability Index questionnaire. The Food and Drug Administration severity scores and clinical information of the patients were noted by their physicians.

Results: Of the 1,489 patients who stated that they used social media, 46.31% regularly and 28.77% sometimes referred to these sources to make inquiries about AV. Social media usage for AV was statistically significantly higher in women, participants with short term and severe disease, those with a moderate income level, and those using topical treatment and cosmetics. They mostly used Google (67%), Instagram (54%), and YouTube (49%). While 76% of the participants stated that they did not share what they saw on the Internet with their doctor. Of the respondents, 18.5% were trying to contact their dermatologists through the Internet, and 69.73% would prefer experts such as dermatologists to post-AV-related content.

Conclusions: Our study shows that patients frequently resort to social media to seek information about AV. In the changing digital world order, it is observed that there is a need for dermatologists to use social media more actively to share accurate information about AV.
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http://dx.doi.org/10.1111/jocd.14272DOI Listing
June 2021

Drug survival and predictor factors for discontinuation of methotrexate in psoriasis: a real-life multicenter study.

Int J Dermatol 2021 May 20. Epub 2021 May 20.

Department of Dermatology and Venereology, University of Health Sciences, Sisli Training and Research Hospital, Istanbul, Turkey.

Background: Drug survival is useful to evaluate long-term drug performance in daily practice. The aim of this study was to evaluate drug survival for methotrexate (MTX) monotherapy in patients with plaque-type psoriasis.

Methods: We reviewed 3,512 follow-up charts of patients with psoriasis at five tertiary referral centers between January 2012 and January 2020. We analyzed baseline data and treatment outcomes of patients under MTX monotherapy. Drug survival was analyzed using Kaplan-Meier and Cox regression analyses.

Results: Patients with psoriasis who were treated with MTX monotherapy were enrolled (N = 649). The median duration of drug survival was 15 months (95% CI: 13.2-16.8). The overall drug survival rate was 54.7%, 17.4%, and 8% after 1, 3, and 5 years, respectively. The main reasons for discontinuation were adverse effects (n = 209, 32.2%) and inefficacy (n = 105, 15.6%). Based on multivariate Cox regression analysis, the presence of nausea/vomiting (HR: 2.01, 95% CI: 1.49-2.71; P < 0.001) was observed as a statistically significant risk factor for drug discontinuation. Age over 50 years (HR: 0.68, 95% CI: 0.48-0.97; P = 0.03) and using MTX dose ≥15 mg/weekly were positive predictors for drug survival (HR: 0.72, 95% CI: 0.54-0.95; P = 0.02).

Conclusions: The average drug survival of MTX was 15 months. MTX is still the first-line treatment of moderate-to-severe plaque psoriasis, as highlighted in guidelines. To prevent premature discontinuation, physicians need to look at the response time of at least 16-24 weeks, especially when a stepwise dose increment is used. The presence of nausea/vomiting seemed to be associated with an approximately twofold risk of discontinuation.
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http://dx.doi.org/10.1111/ijd.15628DOI Listing
May 2021

Internalized Stigma in Pediatric Psoriasis: A Comparative Multicenter Study.

Ann Dermatol 2020 Jun 24;32(3):181-188. Epub 2020 Apr 24.

Department of Medical Education, Akdeniz University School of Medicine, Antalya, Turkey.

Background: Internalized stigma, adoption of negative attitudes and stereotypes of the society regarding persons' illness, has not been studied previously in pediatric psoriasis patients.

Objective: We aimed to investigate the internalized stigma in pediatric psoriasis patients and to determine differences according to factors affecting internalized stigma compared to adult psoriasis patients.

Methods: This multicenter, cross-sectional, comparative study included 125 pediatric (55 female, 70 male; mean age±standard deviation [SD], 14.59±2.87 years) and 1,235 adult psoriasis patients (577 female, 658 male; mean age±SD, 43.3±13.7 years). Psoriasis Internalized Stigma Scale (PISS), Dermatology Life Quality Index (DLQI), Perceived Health Status (PHS), and the General Health Questionnaire (GHQ)-12 were the scales used in the study.

Results: The mean PISS was 58.48±14.9 in pediatric group. When PISS subscales of groups were compared, the pediatric group had significantly higher stigma resistance (=0.01) whereas adult group had higher scores of alienation (=0.01) and stereotype endorsement (=0.04). There was a strong correlation between mean values of PISS and DLQI (r=0.423, =0.001). High internalized stigma scores had no relation to either the severity or localization of disease in pediatric group. However, poor PHS (=0.007) and low-income levels (=0.03) in both groups, and body mass index (r=0.181, =0.04) in the pediatric group were related to high PISS scores.

Conclusion: Internalized stigma in pediatric patients is as high as adults and is related to poor quality of life, general health, and psychological illnesses. Unlike adults, internalized stigma was mainly determined by psoriasis per se, rather than disease severity or involvement of visible body parts, genitalia or folds.
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http://dx.doi.org/10.5021/ad.2020.32.3.181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7992623PMC
June 2020

Periorbital ecchymosis and subconjunctival hemorrhage due to leech therapy for headache.

Arq Bras Oftalmol 2021 Mar-Apr;84(2):183-185

Department of Dermatomology, Istanbul Medeniyet University School of Medicine, Goztepe, Kadikoy, Istanbul, Turkey.

A 62-year-old woman was admitted to our clinic with the complaints of periorbital ecchymosis and subconjunctival hemorrhage that are visible, especially on the right eye. We noted that her complaints began the day after she underwent leech therapy on the glabella area for headache. On the glabella, 2 leech bites were observed close to the right side. Examination revealed ecchymosis on the bilateral eyelids and subconjunctival hemorrhage on the inferolateral and medial limbus on the right eye. No treatment was initiated, rather control measures were recommended. The follow-up after 1 month revealed that the patient's complaints had disappeared.
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http://dx.doi.org/10.5935/0004-2749.20210057DOI Listing
April 2021

A case of erythrodermic psoriasis in which adalimumab injection sites are preserved.

Dermatol Ther 2021 03 18;34(2):e14865. Epub 2021 Feb 18.

Department of Dermatology, Istanbul Medeniyet University School of Medicine Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.1111/dth.14865DOI Listing
March 2021

Alopecia universalis following DRESS, where rarities merge.

Dermatol Ther 2021 03 15;34(2):e14842. Epub 2021 Feb 15.

School of Medicine, Department of Dermatology, Istanbul Medeniyet University, Istanbul, Turkey.

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http://dx.doi.org/10.1111/dth.14842DOI Listing
March 2021

Drug survival and safety profile of acitretin monotherapy in patients with psoriasis: A multicenter retrospective study.

Dermatol Ther 2021 03 16;34(2):e14834. Epub 2021 Feb 16.

Department of Dermatology, Memorial Atasehir Hospital, Istanbul, Turkey.

Acitretin is a nonimmunosuppresive systemic agent used in the treatment of psoriasis. Despite its frequent use, research on drug survival and adverse effects is limited. This study aims to evaluate drug survival, factors associated with survival, and adverse effects. Database of the six tertiary referral center for psoriasis patients treated with acitretin between November 2014 and April 2020 were retrospectively analyzed. Demographics of patients, adverse effects, and also drug survival were analyzed. Of 412 patients, 61.2% were male, and 38.8% were female. Common clinical adverse effects were cheilitis (71.4%), dry skin (62.5%), and palmoplantar skin peeling (37.2%). High triglyceride and high total cholesterol levels were observed in 50.0% and 49.5% of patients, respectively. Median survival time (95% confidence interval [CI]) was 18 (13.6-22.4) months. Statistically significant risk factors affecting drug discontinuation were having psoriatic arthritis, age under 65, and receiving previous systemic treatment. Drug survival rates were 56.6%, 25.9%, and 19.8% at 1, 5, and 8 years, respectively. Although mucocutaneous adverse effects of the acitretin were quite frequent, severe, life-treatining ones were infrequent. This old, relatively inexpensive and safe treatment remains a good alternative for the treatment of psoriasis.
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http://dx.doi.org/10.1111/dth.14834DOI Listing
March 2021

Superficial CD34-Positive Fibroblastic Tumor: Report of an Extremely Rare Entity.

Indian J Dermatol 2020 Nov-Dec;65(6):526-529

Department of Pathology, Sağlık Bilimleri University, Sultan Abdulhamit Han Training Hospital, Istanbul, Turkey.

Superficial CD34-positive fibroblastic tumor (SCPFT), a newly described neoplasm is a rare mesenchymal neoplasm of intermediate malignancy. A 63-year-old man presented with a painless, slow-growing, skin-colored nodule of 8 × 4 mm in diameter on the right side of the neck. It was completely resected. Histologically, a tumor located in the subcutis with the minimally infiltrative pattern was detected. The tumor was composed of variably enlarged bizarre and pleomorphic spindle to polygonal cells. Tumor cells were stained strongly diffuse positive with CD34 and weak positive with keratin, negative with STAT6, FLI-1, ERG, S100, desmin, and smooth muscle actin. The fluorescence hybridization (FISH) analysis was negative for gene rearrangement. As per the findings, the case was diagnosed as a SCPFT. It is a borderline mesenchymal neoplasm occurring within the superficial soft tissues with distinctive morphological and immunohistochemical features.
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http://dx.doi.org/10.4103/ijd.IJD_585_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7810088PMC
January 2021

Analysis of 3702 patients with acne vulgaris and concomitant comorbidities in Turkey: a multi-centered, prospective, controlled study.

Int J Dermatol 2021 May 20;60(5):597-604. Epub 2021 Jan 20.

Bakırkoy Education and Research Hospital, Health Sciences University, Istanbul, Turkey.

Background: Acne vulgaris is a chronic inflammatory skin disease that affects the pilosebaceous unit. Although it is considered to be a skin-limited disease, different clinical studies have recently been published in which the disease is accompanied by systemic symptoms. In this study, systemic comorbidities accompanying acne vulgaris and the relationship between existing comorbidities and disease severity are investigated.

Methods: This prospective multicenter study was conducted by the Turkish Society of Dermatology Acne Study Group. Twelve dermatology clinics and 14 clinicians throughout Turkey participated in the study. A structured physician-administered questionnaire was used to collect patient demographics, clinical findings, and lifestyle data. Physicians recorded each participant's medical history, including current and past comorbidities, duration of any comorbidity, smoking, and drinking. Body mass index (BMI) was calculated.

Results: There were 3022 patients in the adolescent acne group and 897 in the control group. The incidence of nonmigraine headache in adolescents with acne was significantly higher than in the nonacne group (P = 0.019). There were 680 patients in the postadolescent acne group and 545 in the control group. In the postadolescent group, incidence of metabolic disease was lower than the control group (P = 0.003). In the postadolescent group, premenstrual syndrome (P < 0.001) and PCOS (P = 0.007) were more common than the control group.

Conclusions: In this study, we observed that acne vulgaris does not cause systemic comorbidities. There is also a need for new studies involving a large number of patients to illuminate systemic diseases accompanying acne vulgaris.
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http://dx.doi.org/10.1111/ijd.15406DOI Listing
May 2021

The impact of COVID-19 in patients with psoriasis: A multicenter study in Istanbul.

Dermatol Ther 2021 Jan 30;34(1):e14691. Epub 2020 Dec 30.

Department of Dermatology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

There is widespread concern about treatment of psoriasis in COVID-19 pandemic. We aimed to evaluate the epidemiological data, clinical characteristics, treatment features of the psoriasis patients during the pandemic period. We conducted a study in dermatology clinics of seven different tertiary centers. All adult psoriasis patients who were followed up between 11 March 2020 and 28 June 2020, were phone called or questioned in their visit to their follow-up clinics. A semistructured questionnaire was applied and patients' demographics and disease characteristics were recorded. Of 1322 patients, 52.4% were male, and 47.6% were female. According to the questionnaire responses, 964 (72.9%) of these patients could not communicate with their physician during this period, remained 358 (27.1%) patients contacted the physician by phone, email, or hospital visit. From the patients diagnosed as probable/confirmed COVID-19, 14 were female, and 9 were male. Nine of 23 (39.1%) patients were using biologic treatment. There was no statistically significant difference in terms of hospitalization from COVID-19 between the patients using biologics (n = 9) and those who did not (n = 14) (P = 1.00). No mortality was observed among them. Obesity, smoking, age, and accompanying psoriatic arthritis were not among the risk factors affecting the frequency of COVID-19. We only encountered an increased risk in diabetic patients. Also, an exacerbation of psoriasis was observed with the infection. No difference was found in patients with psoriasis in terms of COVID-19 infection in patients who use biologics and those who don't.
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http://dx.doi.org/10.1111/dth.14691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883044PMC
January 2021

Real-world evaluation of "Eczema in psoriatico": Bridging the gap between dermatology and dermatopathology.

Dermatol Ther 2021 01 23;34(1):e14672. Epub 2020 Dec 23.

Department of Dermatology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey.

The diagnosis of psoriasis is mainly made by clinical examination but on some occasions according to the localization or duration of the lesions when spongiosis is more prominent, it can be challenging and may be considered as overlapping eczema. To evaluate the patients for "eczema in psoriatico" and to present the differences between psoriasis. Biopsy outcomes of thirty-one patients who were histologically diagnosed with psoriasis and psoriasiform dermatitis because of the erythematous and scaly plaque lesions located on hands and feet, between 2013 and 2015, were evaluated retrospectively. Histopathologic findings compatible with psoriasis and accompanied by spongiosis and spongiotic vesicles were evaluated as eczema in psoriatico and compared with psoriasis. In this study thirty-one patients, including 18 patients with eczema in psoriatico and 13 patients with psoriasis of hands and/or feet were included. Of the 31 patients, 15 (48.4%) were women and 16 (51.6%) were men, in 61.3% of cases, biopsies were taken from hands (61.1% of "eczema in psoriatico", 61.5% of psoriasis) and 38.7% from feet (38.9% of "eczema in psoriatico", 38.5% of psoriasis). There was a statistically significant difference between two groups in terms of parakeratosis severity and distribution, the presence of neutrophil and plasma in stratum corneum, the presence of granular layer loss and suprapapillar plate thinning, the shape of retes, the presence of lymphocytic exocytosis, spongiosis and spongiotic vesicles, the intensity of infiltrates in the papillar dermis and the presence of dermal edema (P < .05). Histology supports a continuum between psoriasis and eczema that share histological similarities and at the same time should be considered a separate entity, eczema in psoriatico.
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http://dx.doi.org/10.1111/dth.14672DOI Listing
January 2021

Introduction of a novel quantitative scoring system for acanthosis nigricans and its validation in a pilot study.

Dermatol Ther 2020 11 7;33(6):e14450. Epub 2020 Nov 7.

Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany.

Inconsistent data exist regarding the diagnostic value of acanthosis nigricans (AN) or skin tags as clinical markers for obesity or diabetes. In an outpatient department-based prospective study, we designed a scoring for AN severity (SCANS) to evaluate AN and skin tags, their correlation with obesity or diabetes. Quantification of AN in six anatomic sites, in consideration of the affected skin surface areas, texture changes, number of skin tags, leads to a total severity score between 0 and 46. Among 336 adult patients (aged ≥18 years) with AN, a higher BMI was associated with AN (r = 0.299, P < .001), but not with diabetes (P = .43), as compared with 243 age- and sex-matched controls without AN. Among nondiabetics, AN scores were significantly correlated with waist circumference (r = 0.131, P = .024) and total cholesterol levels (r = 0.155, P = .04). Skin tags alone in the absence of AN were not associated with obesity (P = .333) or diabetes (P = .164). The total AN scores were positively correlated with the presence of skin tags (r = 0.132, P < .001), and the involvement of anterior neck (r = 0.668, P < .001) and axilla (r = 0.793, P < .001). Knuckles and groins were unaffected in our series. Our results indicate that combination of AN with skin tags can be used as clinical marker for obesity, but not for diabetes. Large-scale studies on patients of different ethnic background are required to further validate our proposed scoring.
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http://dx.doi.org/10.1111/dth.14450DOI Listing
November 2020

Evaluation of hirsutism and hormonal parameters in acne vulgaris patients treated with isotretinoin.

Int J Clin Pract 2021 Mar 13;75(3):e13791. Epub 2020 Nov 13.

Department of Dermatology, Faculty of Medicine, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.

Background: Although the effect of isotretinoin use on hormonal changes in acne pathogenesis is not fully known, there are limited studies on its effects on the development of hirsutism. In this study, it was aimed to evaluate the effect of isotretinoin use on hirsutism and hormonal parameters in patients with acne vulgaris.

Methods: In this study, 30 female acne patients and 30 healthy females were evaluated prospectively. Menstrual irregularity, LH, FSH, prolactin, progesterone, 17-OH progesterone, oestradiol, total testosterone, DHEA-S, insulin, glucose, TSH levels, Ferriman-Gallwey (FG) score and ultrasonography (USG) findings of control group and patient group were recorded.

Results: Pre-treatment progesterone (P = .007) and oestradiol (P = .001) levels of the patients were statistically lower than the control group. In the patient group, menstrual irregularity (P < 001) and FG hirsutism score at the third month of treatment were significantly higher than before treatment. In 10% of the patients, there were abnormal findings on pelvic USG in the third month of treatment.

Conclusion: In our study, it could not be revealed that isotretinoin has a significant effect on pituitary, adrenal hormones and insulin resistance. We found that 3 months of isotretinoin treatment caused an increase in menstrual irregularity and FG hirsutism score.
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http://dx.doi.org/10.1111/ijcp.13791DOI Listing
March 2021

Correlation of metabolic syndrome with serum omentin-1 and visfatin levels and disease severity in psoriasis and psoriatic arthritis.

Dermatol Ther 2020 11 21;33(6):e14378. Epub 2020 Oct 21.

Department of Biochemistry, Istanbul Medeniyet University, School of Medicine, Goztepe Training and Research Hospital, Istanbul, Turkey.

Psoriasis and psoriatic arthritis (PsA) have been linked to metabolic syndrome (MS). The impact of adipokines on psoriasis, PsA, and MS pathogenesis has recently received investigative attention. A total of 80 subjects with psoriasis, 40 subjects with PsA, and 60 healthy controls were enrolled. Serum omentin and visfatin levels were measured, and MS presence was determined. PASI and DAS28 were used to measure disease severity for psoriasis and PsA, respectively. The prevalence of MS was determined to be 49% in psoriasis, 48% in PsA, and 28% in control groups. Rates were similar in psoriasis and PsA groups and was significantly greater when compared to control (P = .028). Diastolic blood pressure and waist circumference were significantly greater in the psoriasis group. Although the presence of MS positively correlated with age and disease duration in the psoriasis group, no significant relationships with PASI and DAS28 were found. Among all groups combined, there was no significant relationship with omentin and visfatin levels. In the psoriasis group, omentin and visfatin levels were greater in those with MS compared to those without MS. The relationships between omentin and visfatin levels with MS in patients with psoriasis and PsA has not yet been fully elucidated. These results suggest that elevated omentin and visfatin levels seen in psoriasis may be linked to MS rather than psoriasis itself. Additional research is needed to investigate the utility of these measurements as indicators of MS in patients with psoriasis.
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http://dx.doi.org/10.1111/dth.14378DOI Listing
November 2020

Comparison of the tissue expressions of glutathione S transferase isoenzymes among patients with morphea and healthy controls: A preliminary study.

Dermatol Ther 2020 11 8;33(6):e14363. Epub 2020 Oct 8.

Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University, Dresden, Germany.

Morphea is an inflammatory connective tissue disorder, which is characterized by sclerosis in skin and subcutaneous tissues with a chronic progress. The oxidative stress in pathogenesis of sclerosing diseases was proposed in several studies with conflicting results. To explore the tissue expressions of Glutathione S transferase (GST) isoenzymes in patients with morphea and compare these expressions with healthy controls. Twenty-two morphea patients and 20 sex and age matched healthy controls were enrolled in this study. Four millimeter punch biopsies were performed from the active sclerotic plaques of morphea patients. Tissue samples of control group were obtained from nonlesional normal skin biopsy specimens. The protein expressions of GST isoenzymes were analyzed immunohistochemically. Tissue expressions of GSTP1, GSTT1, and GSTA1 isoenzymes in morphea patients were found to be significantly higher than in control tissues. There was no significant difference in GSTM1 isoenzyme expression between the two groups. The increased tissue expressions of GSTA1, GSTP1, and GSTT1 isoenzymes in morphea may represent the activated GST enzymes in response to excessive free radical formation and may also support the hypothesis of increased oxidative stress in morphea etiopathogenesis.
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http://dx.doi.org/10.1111/dth.14363DOI Listing
November 2020

Cause and management of lipedema-associated pain.

Dermatol Ther 2021 01 12;34(1):e14364. Epub 2020 Oct 12.

Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University, Dresden, Germany.

Lipedema is a painful, underdiagnosed adipose tissue disorder, characterized by symmetrical swelling of the extremities due to subcutaneous fat deposition in the buttocks, thighs, legs, and arms, sparing the most distal part of the extremities. Although etiology and pathogenesis of lipedema is unclear, possible role of hormonal and genetic factors have been proposed previously. Patients with lipedema suffer from pain, easy bruising, tenderness, and disfigurement. Pain is the leading symptom in lipedema. Since the pain is associated with depression and impaired quality of life, reduction of pain is the major therapeutic approach. Pain in lipedema is attributed to allodynia, exaggerated sympathetic signaling, and estrogens. Although the mechanism of pain in lipedema is uncertain, effective treatment of lipedema should provide a satisfactory pain reduction. Efficacy of the conservative treatment is a matter of debate. Microcannular tumescent liposuction is the most effective therapeutic option for lipedema. There is a large body of evidence that this procedure significantly reduces pain in patients with lipedema.
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http://dx.doi.org/10.1111/dth.14364DOI Listing
January 2021

Omics-Driven Biomarkers of Psoriasis: Recent Insights, Current Challenges, and Future Prospects.

Clin Cosmet Investig Dermatol 2020 25;13:611-625. Epub 2020 Aug 25.

Department of Dermatology, Istanbul Medeniyet University, School of Medicine, Goztepe Research and Training Hospital, Istanbul, Turkey.

Advances in omics technologies have made it possible to unravel biomarkers from different biological levels. Intensive studies have been carried out to uncover the dysregulations in psoriasis and to identify molecular signatures associated with the pathogenesis of psoriasis. In this review, we presented an overview of the current status of the omics-driven biomarker research and emphasized the transcriptomic, epigenomic, proteomic, metabolomic, and glycomic signatures proposed as psoriasis biomarkers. Furthermore, insights on the limitations and future directions of the current biomarker discovery strategies were discussed, which will continue to comprehend broader visions of psoriasis research, diagnosis, and therapy especially in the context of personalized medicine.
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http://dx.doi.org/10.2147/CCID.S227896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456337PMC
August 2020

Antibiotic Resistance in Acne: Mechanisms, Complications and Management.

Am J Clin Dermatol 2020 Dec;21(6):813-819

Dermatology and Cutaneous Biology, Jefferson Center for International Dermatology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.

Antibiotic resistance in acne was first observed in the 1970s, and since the 1980s has become a major concern in dermatologic daily practice. The mechanisms for this type of resistance include biofilm formation that promotes virulence and the transmission of resistant bacterial strains. Genetic mutations with modification of ribosomal RNA, alteration in efflux pumps, and enzymatic inactivation are able to create resistance to tetracyclines and macrolides. The state of art in acne treatment is no longer to use antimicrobials as monotherapy. There should be a time limit for its use plus the employment of non-antibiotic maintenance. Earlier initiation of oral isotretinoin therapy should be considered in patients with insufficient response to antimicrobials, severe acne, or a history of repeated antimicrobial use. A better understanding of acne pathogenesis, the subtypes of Propionibacterium (also known as Cutibacterium) acnes, homeostasis of the skin microbiota, and the mechanisms of antibiotic resistance would be useful in the selection of narrow-spectrum or species-specific antimicrobials, as well as the non-antimicrobial, anti-inflammatory treatment of acne. A number of novel treatments awaiting clinical proof may include the use of bacteriophages, natural or synthetic antimicrobial peptides, probiotics, and biofilm-targeting agents, as well as the reassessment of phototherapy.
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http://dx.doi.org/10.1007/s40257-020-00556-6DOI Listing
December 2020

Fusarium solani infection in a diabetic patient treated with itraconazole and debridement.

Dermatol Ther 2020 11 23;33(6):e14203. Epub 2020 Sep 23.

Department of Dermatology, School of Medicine, Göztepe Training and Research Hospital, İstanbul Medeniyet University, Istanbul, Turkey.

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http://dx.doi.org/10.1111/dth.14203DOI Listing
November 2020

Evaluation of the adverse effects of biological agents used in the treatment of psoriasis: A multicenter retrospective cohort study.

Dermatol Ther 2020 11 11;33(6):e14216. Epub 2020 Sep 11.

Department of Dermatology and Venereology, Istanbul Medeniyet University, School of Medicine, Göztepe Training and Research Hospital, Istanbul, Turkey.

The objective was to reveal and compare the adverse effects of infliximab, etanercept, adalimumab, ustekinumab and secukinumab, and determine possible risk factors. The follow-up files and computer-based records of patients with psoriasis were retrospectively screened between January 2007 and September 2019. The five biological agents were compared in terms of their adverse effects, and factors that might be related to these effects were explored. While there was no statistically significant difference between the agents in terms of the rate of serious adverse effects, when all the adverse effects were evaluated together, the highest rate was seen in the use of infliximab and the lowest in secukinumab (P = .001). The rates of adverse effects and related drug discontinuation were higher in the use of anti-TNF agents compared to interleukin inhibitors (P = .004 and P = .012, respectively). The agent with the highest drug discontinuation rate due to adverse effects was infliximab while the least discontinued agent was ustekinumab (P = .036). There were more side effects with anti-TNF than interleukin inhibitors, but the serious adverse effect rate was similar in both groups. The incidence of certain adverse effects increases depending on age, number of comorbidities, biological agent and its group, concomitant systemic therapy, and use of multiple agents.
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http://dx.doi.org/10.1111/dth.14216DOI Listing
November 2020

Evaluation of microvessel density with CD31 and CD105 in patients with psoriasis under methotrexate and acitretin therapy.

Postepy Dermatol Alergol 2020 Jun 16;37(3):422-427. Epub 2020 Jul 16.

Dermatology Clinic, İstanbul Ümraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Introduction: Methotrexate and acitretin are known to be effective in the treatment of psoriasis, but the mechanisms of the effects of these drugs are not fully known.

Aim: To investigate the effect of methotrexate and acitretin on microvessel density (MVD) in psoriasis.

Material And Methods: Eighteen patients with psoriasis treated with methotrexate and 9 patients with psoriasis treated with acitretin (AT) were included in this study. MVD was evaluated immunohistochemically by using CD31 and CD105 (endoglin) antibodies.

Results: In the methotrexate group, the decrease in CD31 levels after treatment was found to be statistically significant, while in the AT group it was found to be highly significant. In both methotrexate and AT group, there was a statistically highly significant decrease in CD105 levels after treatment. There was no statistically significant difference between CD31 measurements of methotrexate and AT groups. When CD105 levels were measured before and after treatment, no statistically significant difference was found between methotrexate and AT. According to the results of CD31 changes before and after treatment, the CD31 difference was not statistically significant in both groups while the difference was higher in the AT group. CD105 differences were not statistically significant in both treatment groups before and after treatment.

Conclusions: CD31 and CD105 dyes indicate the effects of therapies on vascular proliferation and may be indicators that can be used in daily routine and follow-up studies for psoriasis.
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http://dx.doi.org/10.5114/ada.2019.87279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394166PMC
June 2020

Biochemical and histopathologic assessment of effects of acitretin on epiphyseal growth plate in rats.

Postepy Dermatol Alergol 2020 Jun 16;37(3):346-352. Epub 2020 Jul 16.

Department of Dermatology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.

Introduction: Acitretin is a commonly used retinoid in dermatology. Although there are generally known side effects, the effects on the epiphyseal plaque and bone metabolism are not clear in the literature.

Aim: To histopathologically investigate the effects on the epiphyseal plate and assess variations in bone metabolism caused by acitretin.

Material And Methods: Three groups were formed with 10 rats in each group. The 1 group ( = 10, 5 male, 5 female) were administered 10 mg/kg/day oral acitretin solution and the 2 group ( = 10, 5 male, 5 female) were administered 3 mg/kg/day oral acitretin solution. The control group were given normal standard feed and water. Rats were sacrificed at the end of 4 weeks. The proximal tibias were excised and histopathologically and immunohistochemically assessed. Biochemical assessment was also carried out.

Results: Staining with haematoxylin-eosin found reductions in the epiphyseal plate in the 1 and 2 group compared to the control group, though this situation was not statistically significant. Immunohistochemical studies did not encounter Type II collagen in the epiphyseal bone, proliferative zone and hypertrophic zone in the control group, low dose acitretin solution group and high dose acitretin solution group. Type II collagen was not observed in osteoids and osteoblasts. Type I collagen was not observed in the hypertrophic zone and proliferative zone of any group.

Conclusions: Our data show that though acitretin caused degeneration of the epiphyseal plate, it did not cause clear thinning and we identified no significant variations in bone metabolism markers.
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http://dx.doi.org/10.5114/ada.2020.95983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394155PMC
June 2020

Psychodermatology of acne: Dermatologist's guide to inner side of acne and management approach.

Dermatol Ther 2020 11 7;33(6):e14150. Epub 2020 Sep 7.

Department of Psychodermatology, Central Michigan University, Saginaw, Michigan, USA.

Acne vulgaris (AV) is a skin disease that is commonly seen and causes scar formation especially when left untreated. It can cause serious psychological comorbidities due to the intense involvement of appeared areas such as face and also being common in adolescence in which the body perception is not yet well established. Although psychiatric comorbidities frequently accompany AV patients in dermatology, they almost never directed to dermatology-psychiatry liaison clinics. Depression, anxiety, stress, decreased self-esteem, suicidal thoughts and even suicide attempts are too frequent to ignore in these patients, and many studies have been conducted on the positive or controversial effects of acne treatments. For this reason, serious responsibilities fall to dermatologists. They should not treat AV lesions only, but also to determine the AV patients' psychological conditions and to direct them to get help when necessary.
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http://dx.doi.org/10.1111/dth.14150DOI Listing
November 2020

Dyshidrotic eczema and seborrheic dermatitis-like eczematous eruption following intravenous immunoglobulin therapy.

Dermatol Ther 2020 11 3;33(6):e14147. Epub 2020 Sep 3.

Department of Dermatology, Medical Faculty, Istanbul Medeniyet University, Göztepe Research and Training Hospital, Istanbul, Turkey.

Intravenous immunoglobulin (IVIg) is increasingly used for the treatment of inflammatory and autoimmune diseases. Although skin reactions to IVIg therapy are usually minor, rare, and not life-threatening, dermatologists need to recognize the nature of these adverse reactions. We describe a 33-year-old man suffering from demyelinating polyneuropathy who developed dyshidrotic eczema on the palms and flaky grayish-white scales on an erythematous base on his face after the administration of IVIg.
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http://dx.doi.org/10.1111/dth.14147DOI Listing
November 2020

Zosteriform cutaneous metastasis: A case series.

Dermatol Ther 2020 11 3;33(6):e14137. Epub 2020 Sep 3.

Department of Dermatology, Goztepe Research and Training Hospital, Istanbul Medeniyet University, Istanbul, Turkey.

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http://dx.doi.org/10.1111/dth.14137DOI Listing
November 2020

Atypical vascular proliferations of the neck.

Wien Med Wochenschr 2021 Mar 5;171(3-4):57-60. Epub 2020 Aug 5.

Department of Dermatology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey.

Atypical vascular proliferations (AVP) are a late complication after radiotherapy. Most cases have been reported in female breast cancer patients on the chest wall. These lesions are mostly of the lymphatic type. Herein, we report a blood vascular-type AVP in a male on the neck 60 years after radiotherapy for a benign hemangioma, which makes this case exceptional. We removed the whole chronic radiodermatitis surgically. Histopathology excluded vascular malignancies but confirmed AVP. We discuss the differential diagnoses and treatment.
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http://dx.doi.org/10.1007/s10354-020-00774-xDOI Listing
March 2021

Multiple ulcerations and devastating scars of skin popping on thighs in a middle-aged woman.

Dermatol Ther 2020 11 3;33(6):e14123. Epub 2020 Sep 3.

Department of Pathology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.1111/dth.14123DOI Listing
November 2020

Infantile digital fibromatosis successfully treated with topical imiquimod 5% combined with methylprednisolone aceponate 0.1.

Dermatol Ther 2020 11 6;33(6):e14012. Epub 2020 Aug 6.

Department of Orthopedics and Traumatology, Istanbul Medeniyet University, School of Medicine, Göztepe Education and Research Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.1111/dth.14012DOI Listing
November 2020

Desmoplastic Melanoma as a Diagnostic Pitfall.

Acta Dermatovenerol Croat 2020 Jul;28(1):49-50

Dear Editor, Desmoplastic melanoma (DM) is a rare histological subtype of melanoma, usually presenting as a slowly-growing, amelanotic, discoid, and/or firm lesion composed of spindle cells with abundant collagen (1). It is more common on sun-exposed areas, especially on head and neck in elderly patients (2). Regional lymph node involvement is reported to be less frequent than in other cutaneous melanomas (3). Desmoplastic melanoma can clinically mimic a wide spectrum of benign and malignant lesions, including Bowen's disease, desmoplastic nevus, basal cell carcinoma, squamous cell carcinoma, lentigo maligna, dermatofibrosarcoma protuberans, peripheral nerve sheath tumors, cysts, or hypertrophic/keloid scars (4). Regarding its appearance, at the time of diagnosis DM frequently presents as advanced lesions with deep infiltration. A 60-year-old man presented with an one-year history of an asymptomatic, erythematous, well-defined plaque in the right lumbar region (Figure 1). Dermatological examination revealed a 5×5 cm, pink/red infiltrated plaque accompanied by a 6 mm dark-brown melanocytic lesion. Dermoscopically, atypical vascular structures in the form of linear, irregular, and dotted vessels, milky-red areas, and atypical pigment network, and streaks were observed near the melanocytic lesion (Figure 2). A 4 mm punch biopsy was performed on the erythematous plaque next to the melanocytic lesion, and a dermal-based, paucicellular proliferation of atypical spindle cells without melanin in a sclerotic stroma was found histologically (Figure 3, a). Immunohistochemically, dermal spindle cells were stained with S-100 and HMB45 antibodies (Figure 3, b). The patient was histologically diagnosed with melanoma, of the desmoplastic subtype. The lesion was totally excised with 2 cm clear margins. A diagnosis of nonulcerated nodular melanoma with a Breslow thickness of 4 mm and a mitotic index 1/mm2 was established. Sentinel lymph node biopsy revealed no metastases. No systemic metastases were detected in PET-CT scanning and cranial magnetic resonance imaging. The patient remained under follow-up and has been free of any local recurrence or primary or systemic metastasis for 3 years. Dermoscopic characteristics of DM are not well known, probably due to it not being considered a melanocytic lesion. Debarbieux et al. first reported the dermoscopic features of desmoplastic melanoma in six cases (5). They found that only half of the cases presented one classical feature of a melanocytic lesion, whereas the other cases were diagnosed based on the presence of figures of regression such as white scar-like and "peppering", multiple (>4) color, and melanoma-related vascular patterns (five out of six) such as linear-irregular vessels and milky-red areas (5). In the largest DM case series, Jaime et al. reported that all DM featured at least 1 melanoma-specific structure, with atypical vascular structures being the most common (6). Similarly, in our patient dermoscopy showed an atypical pigment network and streaks, atypical vascular structures, and milky-red areas, which is predictive for melanoma. We reported this case to serve as a reminder to consider desmoplastic melanoma in the differential diagnosis of pink tumoral lesions despite its rarity and atypical localization.
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July 2020