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Öğe Association between IL4 (-590), ACE (I)/(D), CCR5 (Delta 32), CTLA4 (+49) and IL1-RN (VNTR intron 2) gene polymorphisms and vitiligo(John Libbey Eurotext Ltd, 2009) Pehlivan, Sacide; Özkınay, Ferda; Alper, Sibel; Onay, Huseyin; Yuksel, Eda; Pehlivan, Mustafa; Özkınay, CihangirVitiligo is a common skin disorder characterized by patterned depigmentation, because of a decrease of melanin pigment resulting from apparent melanocyte loss. The aim of this study was to investigate interleukin 4 (IL4), Angiotensin Converting Enzyme (ACE), C-C Chemocine Receptor 5 (CCR5), Cytotoxic T Lymphocyte-associated Antigen Receptor 4 (CTLA4) and Interleukin 1 Receptor Antagonist (IL1RN) gene polymorphisms in 48 Turkish vitiligo patients and 50 healthy controls. Polymorphisms for the genes ACE insertion(I)/deletion(D), CCR5 (Delta 32), IL1-RN (VNTR in intron 2) were detected by PCR methods. IL4 (-590) and CTLA4 (+49) gene polymorphisms were typed using PCR-RFLP methods. No significant differences in either the genotype distribution or allele frequencies of IL4, CCR5 and ACE gene polymorphisms were observed. GG genotype and G allele in CTLA4 genes were found to be significantly higher in vitiligo patients compared to the controls. (0.002, 0.000). CTLA4 ( AA) and IL1-RN (1/5) genotypes and 5 allele frequency in the IL1-RN gene were found to be significantly lower in vitiligo patients compared to healthy controls ( p: 0.014, 0.015, 0.016, respectively). As a conclusion, CTLA4 and IL1-RN genes might play roles in the genetic etiology of vitiligo.Öğe Atopic Dermatitis(Deri Zuhrevi Hastaliklar Dernegi, 2011) Alper, Sibel; Turk, Bengu GercekerAtopic dermatitis is one of the important public health problems of the industrialized communities, and the prevalence of the disease has been increasing in our developing country. In this paper, etiopathogenesis, clinical characteristics and current therapeutic approaches of atopic dermatitis is reviewed under highlights of recently published guidelines and the literature. (Turkderm 2011; 45:168-73)Öğe Atopik dermatitte lenfosit değişiklikleri(Ege Üniversitesi, 1990) Alper, SibelSONUÇ VE ÖZET Çalışmaya alınan atopik dermatitli hastalarda monoklonal antikorlar kullanılarak T4, T8 ve B lenfosit sayıları tayin edilmiş, ayrıca İgE düzeyleri ölçülmüştür. Supresör T hücrelerde (T 8) belirgin bir azalma tesbit edilirken, helper T hücrelerinin (T 4) sayısında normale göre bir fark dikkati çekmemiştir. B lenfositlerin de monoklonal antikorlarla tayini sonucunda bariz bir yükselme ortaya çıkmıştır. Âtopik dermatitli hastalardaki IgE düzeyi ise normalin çok üstünde bulunmuştur. T lenfositleri subpopül asyonundaki dengesizlik, yani supresör T hücrelerinin sayısının atopik dermatitli şahıslarda az olması çevresel antijenlere karşı oluşan IgE'de artışa neden olmaktadır. IgE'nin B lenfositler tarafından yapımı da supresör T lenfositlerin kontrolü altında olduğundan T 8 sayısındaki azalma bu kontrolde de bir yetersizlik doğurmakta dır. Elde edilen sonuçlar ışığında, yetersiz supresör T hücreleri bulunmasının helper T lenfosit artışına ve İgE supresyonunda azalmaya neden olduğu, dolayısıyla T 8 hücrelerin Tip 1 ve Tip IV hipersensitivite reaksiyonlarındaki düzenleyici rollerinin bozularak atopik dermatitteki doku hasarına yol açtığı kanısına varılmıştır. 46Öğe Comparison of psoriasis area and severity index and physician's global assessment in determining psoriasis severity(Kuwait Medical Assoc, 2021) Acar, Ayda; Bozkurt, Ada; Yenipazar, Gizem Kocabas; Alper, Sibel; Ceylan, CanObjective: In clinical studies, it is crucial to assess psoriasis severity accurately and with no substantial variation between different raters. The Psoriasis Area and Severity Index (PASI) and Physician Global Assessment (PGA) are the two most commonly used tools for the assessment of psoriasis severity. The aim of this study was to evaluate the intra-rater and inter-rater reliability of these methods and to determine whether inter-rater reliability is affected by rater experience. Design: An open uncontrolled study Setting: Dermatology Department of Ege University, Medical Faculty Subjects: Fifty-five patients with plaque psoriasis who were examined between 15 August 2012 and 15 November 2012 in the dermatology department of Ege University Interventions: Three dermatology residents with varying experience evaluated the patients individually using both the PASI and PGA for each patient (in that order). Main Outcome Measure: PASI and PGA Results: PASI and PGA scores showed high intra-rater correlation for all three residents. Inter-rater reliability for PASI was high between the most experienced and second most experienced resident and between the most experienced and least experienced resident. However, inter-rater reliability for PGA was high between the most experienced and second most experienced residents, but only moderate between the most experienced and least experienced resident. Conclusions: There were no significant interrater differences between PGA and PASI scores in our study. However, because PGA is more subjective and may be affected by rater experience, PASI is considered to be a more reliable method for assessing severity of psoriasis.Öğe Discrete Papular Dermal Mucinosis With Hashimoto Thyroiditis: A Case Report(Quadrant Healthcom Inc, 2011) Ertam, Ilgen; Karaca, Nezih; Ceylan, Can; Kazandi, Alican; Alper, SibelThe cutaneous focal mucinoses are a group of connective tissue disorders characterized by deposition of mucin found either focally or diffusely in the dermis. A 47-year-old woman presented with asymptomatic flesh-colored papules On the neck, inguinal area, intergluteal area, vulvar area, and extremities of 5 months',duration. There was no history of preceding trauma or insect bites. The patient had undergone a subtotal thyroidectomy 21 years prior but had not used any thyroid medication before she was referred to our clinic. Thyroid ultrasonography was consistent with Hashimoto thyroiditis. During dermatologic examination, flesh-colored, well-defined, smooth papules that measured approximately 1.5x1 cm in size on the genital region, fingers, face, and scalp were seen. Histopathologic examination of a lesional biopsy revealed no abnormalities in the epidermis. Alcian blue staining showed that abundant deposits of dermal mucin had replaced collagen in the dermis. Cutis. 2011;87:143-145.Öğe Disease burden, clinical management and unmet treatment need of patients with moderate to severe alopecia areata; consensus statements, insights, and practices from CERTAAE (Central/Eastern EU, Russia, Türkiye AA experts) Delphi panel(Frontiers Media Sa, 2024) Rudnicka, Lidia; Trzeciak, Magdalena; Alpsoy, Erkan; Arenberger, Petr; Alper, Sibel; Benakova, Nina; Bobko, SvetlanaObjectives This study aims to update the understanding of Alopecia Areata (AA) in Poland, Czechia, Russia, and T & uuml;rkiye, focusing on the disease burden, clinical management, and patient journey. It seeks to establish a consensus on optimal management strategies for AA in these regions.Methods A modified 2-round Delphi panel was conveyed with 23 Dermatologists (Russia; 4, T & uuml;rkiye; 7, Poland; 6, and Czechia; 6). The Delphi questionnaire consisted of 61 statements and 43 questions designed to obtain an overall understanding of the perception and acceptance of available information regarding the care of patients with alopecia areata.Results The study revealed that moderate-to-severe AA significantly impacts patients' and their families' QoL, consistent with previous studies. AA was found to cause more substantial impairment when additional lesions appeared in visible areas besides the scalp. Work and productivity impairment were notably higher in adults with moderate-to-severe AA. Diagnostic consensus highlighted the importance of skin biopsies and trichoscopy, while the need for more practical severity scoring systems was emphasized. Current treatments, including topical therapies, corticosteroids, and systemic immune modifiers, were deemed insufficient, highlighting the unmet medical need.Conclusion The Delphi study underscores a significant disease burden and unmet medical needs in patients with moderate-to-severe AA. It highlights the necessity of access to novel treatments and further research to develop more effective therapies with a tolerable safety profile. The findings align with global research, emphasizing the psychosocial impact of AA and the need for standardized, effective treatment protocols.Öğe Disease burden, clinical management and unmet treatment need of patients with moderate to severe atopic dermatitis; consensus statements, insights and practices from CERTADE (Central/Eastern EU, Russia, Turkiye AD Experts) Delphi panel(Frontiers Media Sa, 2024) Trzeciak, Magdalena; Rudnicka, Lidia; Arenberger, Petr; Engin, Burhan; L'vov, Andrey; Alper, Sibel; Alpsoy, ErkanBackground There is limited insight into the current disease burden and everyday clinical management of moderate-to- severe AD in Poland, Czechia, Russia, and Turkiye. Therefore, this study aimed to get information-driven insights regarding the current disease burden and clinical management of patients with moderate-to-severe AD with common and differentiating aspects of the patient journey and establish a consensus. Methods In this modified 2-round Delphi panel, 133 questions were asked in total to 27 dermatologists. A consensus was achieved when 70% of the panel members strongly agreed or agreed (or strongly disagreed or disagreed) with an item. Statements with <40% agreement dropped from the Delphi rounds and were not repeated. Results The results state that AD has a significant impact on the quality of life for both patients and their families with social and economic consequences in these countries. While there were significant dissimilarities regarding the current treatment approach by preference order and treatment duration among participants, there was also a high percentage of consensus on literature and guideline-based statements. Current topical therapies and the immune response modifiers were not found to be sufficient by panelists to cover the therapeutic needs of patients with moderate-to-severe AD. Moreover, panelists highlighted the significant burden of adverse events with the off-label use of currently available immunosuppressants. Conclusions These results underlined that there is a significant disease burden with an unmet treatment need for patients with moderate-to-severe AD in Poland, Czechia, Russia, and Turkiye.Öğe Effectiveness of Intense Pulsed Light treatment in solar lentigo: a retrospective study(Turkish Soc Dermatology Venerology, 2014) Ertam, Ilgen; Turk, Bengu Gerceker; Karaarslan, Isil Kilinc; Unal, Idil; Alper, SibelBackground and Design: Intense Pulsed Light (IPL) is a light system of 500-1200 nm wavelength which is used for hair removal and non-ablative skin resurfacing as well as for the treatment of hyperpigmentation and superficial vascular lesions. The mechanism of action is thought to be the focal epidermal coagulation due to selective photothermolysis in the epidermal keratinocytes and melanocytes. A variety of laser systems can be used in the treatment of solar lentigo. The aim of this study was to investigate the effectiveness of IPL in solar lentigo. Materials and Methods: We retrospectively reviewed the medical records of patients with the diagnosis of solar lentigo in our Cosmetology Unit from March 2007 to November 2010. There were 139 files of patients who received clinical and dermoscopic diagnosis of solar lentigo and treated by IPL (L900 A&M). Informed consent was taken from all patients. Among them, 42 patients, who had attended regular follow-up visits and had pictures taken both before and after treatment, were included in the study. Results: A total of 52 lesions in 42 female and 1 male patients were included in the study. The mean age of the patients was 42 +/- 9.6 (33-88) years. Thirty-seven lesions (51.9%) were on the cheek, 7 lesions (13.5%) were on the zygoma, 6 lesions (11.5%) were on the chin, 4 lesions (7.7%) were on the hands, 4 lesions (7.7%) were on the forehead, 2 lesions (3.8%) were on the nose, and 2 lesions (3.8%) were on the forearm. The mean number of sessions was 3.28, ranging between 1 and 7. After treatment, more than 75% improvement was observed in 57.7% of the lesions, 50-75% in 17.3% of the lesions, 25-50% in 17.3% of the lesions, and less than 25% improvement was obtained in 7.7% of the lesions. Conclusion: According to the results of our work, IPL can be considered to be an effective, cheap and safe method in terms of its side effects in the treatment of solar lentigo.Öğe Farklı Gen (CAT,CTLA-4 EXON 3, CTLA-4 +49) polimorfizmleri ile Vitiligo?ya duyarlılığın araştırılması(Ege Üniversitesi, 2005) Alper, Sibel; Pehlivan, Sacide[Abstract Not Available]Öğe Granuloma faciale: Is it a new indication for pimecrolimus? A case report(Taylor & Francis Ltd, 2006) Ertam, Ilgen; Ertekin, Banu; Unal, Idil; Alper, SibelGranuloma faciale is a benign, chronic disease which is characterized by red-brown facial nodules and plaques. This quite rare disease is mostly seen in middle-aged males. A 41-year-old female patient consulted our department with a facial lesion of 4 years' duration. A dermatological examination revealed a pink-brown plaque of 165 cm over the nasal dorsum extending to the left malar region. Her personal and family histories were unremarkable. The routine hemogram and biochemical tests were normal, antinuclear antibody was negative. In the histopathological examination of the biopsy material which was taken from the lesion, the epidermis was intact; grenz zone was observed in the papillary dermis and with diffuse infiltrate with leukocytoclastic vasculitis and eosinophils, polymorphonuclear leukocytes and lymphocytes in the dermis were observed. With these findings, the patient was diagnosed with granuloma faciale and treatment with topical pimecrolimus cream 1% was started. The patient applied this treatment twice a day for 2 months and a dramatic recovery was observed after this period. The case is discussed in comparison with the literature.Öğe Interleukin-1 receptor antagonist and tumour necrosis factor-alpha gene polymorphisms in Turkish patients with allergic contact dermatitis(Wiley-Blackwell Publishing, Inc, 2009) Ertam, Ilgen; Itirli, Gulcin; Onay, Huseyin; Alper, Sibel; Özkınay, FerdaBackground It has been shown that the family of interleukin-1 receptor antagonist (IL-1 RA) and tumour necrosis factor-alpha (TNF alpha) genes are polymorphic and related to some inflammatory diseases. Allergic contact dermatitis is the classic presentation of delayed-type hypersensitivity responses to exogenous agents. A number of genes playing role in inflammatory response may be associated with allergic contact dermatitis. Objectives To investigate whether there is an association between IL-1RA and TNF alpha gene polymorphisms and allergic contact dermatitis in Turkish patients with allergic contact dermatitis. Methods This study was performed by the collaboration of Departments of Dermatology and Medical Genetics, Ege University, Faculty of Medicine. A total of 50 patients (31 females and 19 males) with allergic contact dermatitis, and 100 age- and sex-matched controls (58 females and 42 males) were included in the study. IL-1RA Variable Number of Tandem Repeats (VNTR) polymorphism in intron 2 and TNF alpha-308G-A polymorphism were genotyped by using polymerase chain reaction and agarose gel electrophoresis. Results The frequency of IL-1RA 1/2 (48%) genotype was significantly higher (P = 0.002) in patient group than that is found in control group (22%). The frequency of TNF alpha (TNF G-308A) G/G genotype was significantly higher in patient group (68%) than that is found in control group (31%) (P = 0.008). Conclusions Our findings suggest that TNF alpha (G/G) gene polymorphism may play role in susceptibility to allergic contact dermatitis in Turkish patients.Öğe Is it necessary to have routine blood tests in patients treated with isotretinoin?(Taylor & Francis Ltd, 2006) Ertam, Ilgen; Alper, Sibel; Unal, IdilObjectives: Several side effects can be observed from isotretinoin use, which has been used in acne therapy for years. In this study, the side effects of isotretinoin on skin and mucosa, blood test changes and their relation with total dose were investigated in patients who used equal doses of isotretinoin. Materials and methods: A total of 91 outpatients with acne vulgaris (57 females and 34 males; age range 17-28 years, mean 21 +/- 2.19 years) were enrolled in this study. Skin and mucosal findings and pre- and post-treatment blood tests and their correlation with the total dose were investigated. Student's t-test and the Mann-Whitney U-test were used in the statistical analyses. Results: In all, 89 out of 91 patients completed the study. Cholesterol (p = 0.00), triglyceride (p = 0.00) and low density lipoprotein (LDL) (p = 0.001) levels were found to be significantly elevated. But these values were not over the double of the upper limits. No correlations were found among the total dose and the skin and mucosal changes as well as the blood test results. Conclusion: It is concluded that examination of cholesterol, triglyceride and LDL-cholesterol should be performed monthly if the initial blood tests are close to the upper limits; otherwise, examinations at 2- or 3-month intervals are sufficient, which would save unnecessary costs.Öğe Malassezia furfur onychomycosis in an immunosuppressed liver transplant recipient(Wolters Kluwer Medknow Publications, 2007) Ertam, Iigen; Aytimur, Derya; Alper, SibelÖğe Might there be a link between mannose binding lectin and vitiligo?(John Libbey Eurotext Ltd, 2007) Onay, Huseyin; Pehlivan, Mustafa; Alper, Sibel; Özkınay, Ferda; Pehlivan, SacideMannose binding lectin (MBL) is a calcium dependent lectin that causes predisposition to infections and autoimmune diseases. This study aimed to examine the presence of any association between MBL2 gene variants and vitiligo. Codon 54 (allele B) and codon 57(allele C) polymorphisms in the exon 1 of the MBL2 gene were investigated in samples belonged to 50 healthy controls and 40 patients diagnosed as vitiligo. The PCRRFLP method was used to investigate the polymorphisms in the MBL2 gene. Codon 57 polymorphism was not detected in any of the subjects from either group. The frequencies of low level MBL2 genotypes for codon 54 (AB and 1313) polymorphisms were found to be significantly higher in the patient group compared to controls (37.5% vs. 6%) (p < 0.001). B allele frequency was also significantly higher in the patient group (20%) compared to the control group (3%). These results suggested that codon 54 polymorphism in the MBL2 gene may play a role in susceptibility to vitiligo.Öğe TUR-PSO: A cross-sectional, study investigating quality of life and treatment status of psoriasis patients in Turkey(Wiley-Blackwell, 2016) Atakan, Nilgun; Yazici, Ayca Cordan; Ozarmagan, Guzin; Inaloz, Huseyin Serhat; Gurer, Mehmet Ali; Sabuncu, Ilham; Kiremitci, Ummuhan; Alper, Sibel; Aytekin, Sema; Arican, Ozer; Polat, Mualla; Dogan, Sibel; Aldinc, EmrePsoriasis is a common inflammatory disease that has a severe impact on quality of life. There is lack of data regarding epidemiological and clinical features of psoriasis patients in Turkey, a country with a population of 76million. The aim of this study was to define the demographic and clinical characteristics, quality of life and treatment patterns of psoriasis patients in Turkey. A cross-sectional observational study was conducted at 40 centers, chosen from geographically diverse locations in Turkey. Patients diagnosed with psoriasis were assessed by investigators who were specialists of dermatology using standardized study questionnaire forms. Dermatology Life Quality Index (DLQI) and EuroQol-5 dimension (EQ-5D) forms were also filled out by each patient. 3971 psoriasis patients were included in this study. 24.2% of plaque psoriasis patients had moderate to severe psoriasis (Psoriasis Area and Severity Index, 10). Mean DLQI was 7.03 +/- 6.02; quality of life was moderately, severely or very severely affected in 49.2% of patients. The most severely affected component of EQ-5D was anxiety/depression. Among all patients, 22.9% were not receiving any treatment, 39.8% were receiving only topical treatment, 11.5% were on phototherapy, 26.1%, were taking conventional systemic agents and 4.1% were on a biologic treatment. 31.3% of psoriasis patients with moderate to severe disease were treated with only topical agents and only 30.5% of moderate to severe psoriasis patients were receiving systemic therapy. Moderate to severe psoriasis has a considerable impact on quality of life. Treatment in Turkey of patients with moderate to severe psoriasis is insufficient.Öğe The Turkish guideline for the diagnosis and management of atopic dermatitis-2018(Deri Zuhrevi Hastaliklar Dernegi, 2018) Ertam, Ilgen; Su, Ozlem; Alper, Sibel; Saricaoglu, Hayriye; Karadag, Ayse Serap; Demirsoy, Evren Odyakmaz; Borlu, MuratBackground and Design: Atopic dermatitis (AD) has a complicated etiopathogenesis and difficulties in diagnosis and treatment from time to time. Because of the disease which different approaches can be seen rationalize the need for an algorithm for the diagnosis, classification, etiopathogenesis, diagnostic tests and therapeutic approach. Therefore, authors from Dermatoallergy Working Group of the Turkish Society of Dermatology aimed to create an AD guideline for the diagnosis, treatment and followup. Materials and Methods: Each section of the guideline has been written by a different author. The prepared sections were evaluated in part by e-mail correspondence and have taken its final form after revision in the last meeting held by the participation of all authors. Results: The guideline includes the diagnosis, classification, etiopathogenesis, diagnostic tests and therapeutic approach of AD. Lesions show age-related morphology and distribution. There are no in vivo/in vitro tests that have high sensitivity and specificity that can be used to identify AD and trigger factors. The first step of treatment consists of moisturizers, topical corticosteroids and calcineurin inhibitors, respectively. Moisturizers are used therapeutically in all forms of AD. Topical corticosteroids are the first agents to be used when moisturizers are inadequate. Topical calcineurin inhibitors should be used in lesions resistant to corticosteroids, for proactive treatment, special areas. Antimicrobials agents and antiseptics should only be added to treatment when clinical signs of infection are present. And in topical treatment-resistant cases, second-line treatment is phototherapy or oral cyclosporine. The biologic agent, dupilumab, is promising in the treatment of severe AD. Conclusion: AD is a disease that can be challenging for the physician in terms of treatment and follow-up. Depending on evidence-based data (and individual experiences), this guideline will have a leading role in the diagnosis and treatment of AD and help the physician to overcome the challenges in the management.Öğe Turkish Guidelines for the Management of Psoriasis with Biologic Agents(Deri Zuhrevi Hastaliklar Dernegi, 2008) Alper, Sibel; Atakan, Nilguen; Gurer, Mehmet Ali; Onsun, Nahide; Ozarmagan, Guzin; Grubu, Kilavuz CalismaÖğe Updated Turkish Guidelines for the Management of Psoriasis with Biologic Agents(Turkish Soc Dermatology Venerology, 2010) Alper, Sibel; Atakan, Nilguen; Gurer, Mehmet Ali; Onsun, Nahide; Ozarmagan, Guzin
