Browsing by Author "Balci, DD"
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Item Risankizumab for the Treatment of the Patients with Moderate to Severe Plaque Psoriasis During a 24-Week Period: Real-Life ExperienceGönülal, M; Balci, DD; Öztürkcan, SIntroduction: Several authors have reported their experiences in real-world clinical practice, confirming the therapeutic efficacy of risankizumab in plaque psoriasis. We aimed to reflect our experience with risankizumab treatment in patients with psoriasis.Materials and Methods: Patients who presented to the dermatology outpatient clinics of two tertiary care centers between November 2021 and August 2022, diagnosed with psoriasis and treated with risankizumab, constituted the target population. Data including gender, age, weight, type of psoriasis, affected body sites, disease duration, previous treatments, duration of risankizumab treatment, psoriasis area and severity index scores, comorbidities, the reasons for drug discontinuation, adverse effects, and the patients' naive or non-naive status were obtained from electronic patient folders. Results: Overall, 120 cases were included. While 73 (60.8%) cases were male, 47 (39.2%) were female. Eighty-six (68.3%) of all cases were biologic non-naive. A total of 49 patients (40.8%) had comorbidities. No significant correlations existed between biologic naive or non-naive status, comorbidity status, and the PASI 75-90-100 responses.Conclusion: Risankizumab is an effective treatment option for both biologic naive or non-naive patients with or without comorbidities. However, long-term studies, including more extensive patient series, are needed to validate its efficacy and safety in real-life clinical settings.Item Ixekizumab for the treatment of the patients with moderate to severe plaque psoriasis: Clinical data from a real-world experienceGönülal, M; Altunay, IK; Dogan, S; Türkmen, M; Balci, DD; Öztürkcan, SReal-life data about any particular treatment is very helpful for clinicians, particularly when managing a chronic disease such as psoriasis. In our study, we aimed to reflect our clinical experience during 48 weeks with an IL-17 antagonist ixekizumab. This study was designed as a retrospective multi-center study. Four tertiary referral centers participated into the study. The patients who did not present to the clinics for 3rd month follow-up were excluded. Data including gender, age, weight, type of psoriasis, additional sites on the body, disease duration, previous treatments, duration of medication of ixekizumab, psoriasis area and severity index scores, previous treatments, and comorbidities, the reasons for drug discontinuation, adverse effects and the patients' naive or non-naive status were retrieved from electronic patient folders. Although 267 patients met the inclusion criteria, 28 patients were excluded since they did not present to the clinic for 3rd month follow-up so 239 cases were included mmune research. We determined significant correlations between naive and non-naive cases about getting PASI 75 and PASI 90 responses for all cases (p = 0.005 and p = 0.028, respectively) and between comorbid and non-comorbid cases about getting PASI 90 and PASI 100 responses for all cases (p = 0.021 and p = 0.029, respectively). When we investigate as female and male patients separately, non-comorbid female cases can achieve PASI 100 response significantly easier than comorbid female patients (p = 0.019). Clinicians can use ixekizumab safely mmune treatment of their patients with psoriasis and get PASI 75-90-100 responses quickly. Ixekizumab is more effective for naive cases but it may also be a treatment option for biologic experienced patients. The ratio of PASI 75-90-100 responses are better in non-comorbid cases than comorbid patients nevertheless ixekizumab is a quite effective agent mmune treatment of comorbid cases.Item EFFECTIVENESS AND SAFETY OF ANTI-TNF AGENTS IN TREATMENT OF MODERATE TO SEVERE PSORIASIS VULGARIS: RESULTS OF WORK PRODUCTIVITY AND DAILY ACTIVITY IMPAIRMENTKoc, E; Ozarmagan, G; Alper, S; Ozgoztasi, O; Tekin, NS; Balci, DD; Onsun, N; Tuzun, Y; Atakan, N; Ozturkcan, S; Kokturk, AItem Analysis of factors influencing target PASI responses and side effects of methotrexate monotherapy in plaque psoriasis: a multicenter study of 1521 patientsErduran, F; Emre, S; Hayran, Y; Adisen, E; Polat, AK; Üstüner, P; Öztürkcan, S; Öztürk, P; Ermertcan, AT; Selçuk, LB; Aksu, EK; Akbas, A; Kalkan, G; Demirseren, D; Kartal, SP; Topkarci, Z; Kilic, A; Yaldiz, M; Aytekin, S; Hizli, P; Gharehdaghi, S; Borlu, M; Isik, L; Botsali, BR; Solak, EO; Albayrak, H; Gönülal, M; Balci, DD; Polat, M; Daye, M; Ataseven, A; Yildiz, S; Özer, I; Zorlu, O; Dogan, S; Erdemir, VA; Dikicier, BSMethotrexate (MTX) is commonly used as first-line systemic treatment agent in psoriasis. We aimed to evaluate the clinical characteristics and treatment responses of patients with psoriasis undergoing MTX monotherapy. Data from adult patients with plaque psoriasis who received MTX monotherapy for at least 3 months between April 2012 and April 2022 were retrospectively evaluated in 19 tertiary care centers. Our study included 722 female and 799 male patients, a total of 1521 participants. The average age of the patients was 44.3 +/- 15.5 years. Mode of treatment was oral in 20.4% of patients while in 79.4% it was subcutaneous. The median treatment duration was 8 months (IQR = 5-15). The median weekly dose was 15 mg (IQR = 11-15). 1448 (95.2%) patients were taking folic acid supplementation. At week 12, 16.3% of the patients achieved PASI (Psoriasis Area and Severity Index) 90 response while at week 24, 37.3% achieved it. Logistic regression analysis for week 12 identified the following independent factors affecting PASI 90 achievement positively: median weekly MTX dose <= 15 mg (P = 0.011), subcutaneous administration (P = 0.005), no prior systemic treatment (< 0.001) and folic acid use (0.021). In logistic regression analysis for week 24; median weekly MTX dose <= 15 mg (P = 0.001), baseline PASI >= 10 (P < 0.001), no prior systemic treatment (P < 0.004), folic acid use (P = 0.001) and absence of comorbidities (P = 0.009) were determined as independent factors affecting the achievement of PASI 90. Adverse effects were observed in 38.8% of the patients, with nausea/vomiting (23.9%) and transaminase elevation (13%) being the most common. The most common reasons for interruptions (15.3%) and discontinuations (27.1%) of the treatment were patient related individual factors. The use of MTX as the first systemic treatment agent, at doses <= 15 mg/week and concurrent folic acid application are positive predictive factors for achieving the target PASI response both at weeks 12 and 24. In our study, which is one of the most comprehensive studies on MTX treatment in psoriasis, we observed that MTX is an effective and safe treatment option.Item The natural history study of hidradenitis suppurativa: A large-scale multicenter study in turkeyAlpsoy, E; Karaman, BF; Demirseren, D; Cinar, L; Kacar, N; Ermertcan, AT; Baskan, EB; Ucmak, D; Mammadli, K; Kilinç, F; Yazici, S; Temiz, SA; Akbulut, TÖ; Ataseven, A; Aktürk, AS; Saricaoglu, H; Türkmen, M; Gülbasaran, F; Engin, B; Ozden, HK; Durmaz, K; Ozden, MG; Ozdemir, H; Cemil, BC; Solak, SS; Yavuz, IH; Yavuz, GO; Guven, M; Ekinci, AP; Atici, T; Balci, DD; Oztürk, A; Altunay, IK; Ozkur, E; Ugurer, E; Karadag, AS; Kalkan, G; Erdogan, B; Yayli, S; Selcuk, LB; Donmez, L; Bilgic, AItem Clinical characteristics, quality of life and risk factors for severity in palmoplantar pustulosis: a cross-sectional, multicentre study of 263 patientsSolak, SS; Polat, AK; Kilic, S; Topal, IO; Saricaoglu, H; Karadag, AS; Canpolat, F; Kartal, SP; Deveci, BN; Kacar, N; Ekinci, AP; Guner, R; Polat, M; Dogan, G; Ozden, MG; Baskan, EB; Yavuz, GO; Adisen, E; Gulekon, A; Tanribilir, ME; Yilmaz, O; Karakas, AA; Ozturk, P; Balci, DD; Gonulal, M; Yondem, H; Ermertcan, AT; Sendur, N; Topyildiz, H; Korkmaz, S; Alpsoy, EBackground Palmoplantar pustulosis (PPP) is a rare, chronic, inflammatory skin disease characterized by sterile pustules on palmar or plantar areas. Data on PPP are scarce. Aim To investigate the clinical characteristics and risk factors for disease severity in a large cohort of Turkish patients with PPP. Methods We conducted a cross-sectional, multicentre study of patients with PPP recruited from 21 tertiary centres across Turkey. Results In total, 263 patients (165 women, 98 men) were evaluated. Most patients (75.6%) were former or current smokers. The mean Palmoplantar Pustulosis Area and Severity Index (PPPASI) was 8.70 +/- 8.06 and the mean Dermatology Life Quality Index (DLQI) score was 6.87 +/- 6.08, and these scores were significantly correlated (r = 0.52, P < 0.001). Regression analysis showed that current smoking was significantly associated with increased PPPASI (P = 0.03). Coexisting psoriasis vulgaris (PsV) was reported by 70 (26.6%) patients. Male sex prevalence, PPP onset incidence, disease duration, DLQI, and prevalence of nail involvement and psoriatic arthritis (PsA) were significantly increased among patients with PPP with PsV. Of the 263 patients, 18 (6.8%) had paradoxical PPP induced by biologic therapy, and these patients had significantly increased mean DLQI and prevalence of PsA (r = 0.03, P = 0.001). Conclusion Our data suggest that smoking is a risk factor for both PPP development and disease severity. Patients with PPP with PsV present distinct clinical features and patients with biologic therapy-induced paradoxical PPP have reduced quality of life and are more likely to have PsA.Item Internalized Stigma in Pediatric Psoriasis: A Comparative Multicenter StudyAlpsoy, E; Polat, M; Yavuz, IH; Kartal, P; Balci, DD; Karadag, AS; Bilgic, A; Arca, E; Karaman, BF; Emre, S; Adisen, E; Sendur, N; Bilgic, O; Yazici, AC; Yalcin, B; Koca, R; Gunduz, K; Borlu, M; Ergun, T; Dursun, P; Bilgili, SG; Adanir, AS; Gulekon, A; Yagcioglu, G; Yilmaz, E; Kavuzlu, U; Senol, YBackground: 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 (p = 0.01) whereas adult group had higher scores of alienation (p = 0.01) and stereotype endorsement (p = 0.04). There was a strong correlation between mean values of PISS and DLQI (r = 0.423, p = 0.001). High internalized stigma scores had no relation to either the severity or localization of disease in pediatric group. However, poor PHS (p = 0.007) and low-income levels (p = 0.03) in both groups, and body mass index (r = 0.181, p = 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.Item Internalized Stigma in Hidradenitis Suppurativa: A Multicenter Cross-Sectional StudyBilgic, A; Karaman, BF; Demirseren, DD; Cinar, L; Kacar, N; Ermertcan, AT; Baskan, EB; Güven, M; Yazici, S; Akbulut, TÖ; Ucmak, D; Ataseven, A; Temiz, SA; Engin, B; Aktürk, AS; Saricaoglu, H; Özden, MG; Özdemir, H; Mammadli, K; Durmaz, K; Gülbasaran, F; Kilinc, F; Özden, HK; Gönülal, M; Balci, DD; Cemil, BÇ; Solak, SS; Selçuk, LB; Yavuz, GÖ; Yavuz, IH; Dönmez, L; Alpsoy, EBackground: Hidradenitis suppurativa (HS) causes significant physical, social, and psychological burdens. Internalized stigma, acceptance of negative attitudes and stereotypes of society regarding a person's illness, has not been studied previously in HS. Objectives: The objective of this study was to investigate the internalized stigma state of HS patients and identify the factors affecting it. Methods: This multicenter, prospective, cross-sectional study included 731 patients. Internalized Stigma Scale (ISS), Hurley staging, Physician Global Assessment, Dermatology Life Quality Index (DLQI), Skindex-16, Beck Depression Inventory-II (BDI-II), and Visual Analog Scale (VAS)-pain score were used in the study. Results: The mean ISS value (57.50 +/- 16.90) was comparable to the mean ISS values of studies in visible dermatological and various psychiatric diseases. A significant correlation was found between the mean values of ISS and all disease activity scores, quality of life measures, BDI-II, and VAS-pain scores. Obesity, family history, low education and income level, vulva/scrotum involvement and being actively treated are significant and independent predictive factors for high internalized stigma in multivariate analysis. Conclusions: HS patients internalize society's negative judgements, which may create a profound negative effect on access to health care. Therefore, in addition to suppressing disease activity, addressing internalized stigma is fundamental for improving health care quality.Item Clinical Features and Natural Course of Hidradenitis Suppurativa in Turkey: A Multicenter StudyAlpsoy, E; Karaman, BF; Demirseren, DD; Cinar, SL; Kacar, N; Ermertcan, AT; Baskan, EB; Ucmak, D; Mammadli, K; Kilinc, F; Yazici, S; Temiz, SA; Akbulut, TO; Ataseven, A; Aktürk, AS; Saricaoglu, H; Türkmen, M; Gülbasaran, F; Engin, B; Özden, HK; Durmaz, K; Özden, MG; Özdemir, H; Cemil, BÇ; Solak, SS; Bilgili, SG; Yavuz, IH; Yavuz, GÖ; Güven, M; Ekinci, AP; Atci, T; Balci, DD; Oztürk, A; Altunay, IK; Özkur, E; Ugurer, E; Karadag, AS; Kalkan, G; Kilic, S; Erdogan, B; Yayli, S; Selcuk, LB; Dönmez, L; Bilgic, AIntroduction:The natural history, the progression of a diseaseprocess in an individual over time, has not yet been fully elu-cidated in hidradenitis suppurativa (HS). In this large multicenterstudy, we aimed to investigate the natural history of HS and itsgender differences.Methods:This cross-sectional study in-cluded 827 patients. The chronological order of the clinicalmanifestations for each patientwas recorded retrospectively.Sociodemographic characteristics, triggering factors, clinical,treatment, and prognostic features were also evaluated.Results:The mean age of disease onset was significantly younger inwomen than in men (22.42 +/- 9.28 vs. 27.06 +/- 20.56,p<0.001)and those with a family history (p<0.0001). The mean diseaseduration was 91.17 +/- 83.64 months. The most commonsymptom was purulent discharge (81%). The mean duration ofabscess was shorter in women than in men (3.11 +/- 2.65 vs.3.75 +/- 3.75,p= 0.01). The axilla was the most common onsetarea followed by the inguinal and gluteal regions. The diseaseran a more severe course in men. Abscess/inflammatory nodulewas defined in the last 6 months in 88.6% of the patients;however, thefirst 5 years of the disease were the most activedisease period in 67.5% of the patients. Multivariate analysisrevealed being male, older age, family history, involvement ofthe axillary, inguinal, and perianal regions independently as-sociated with HS severity. While antibiotic use was the mostimportant factor in improving thedisease symptoms, stress wasthe most common aggravating factor. Biological therapy in men,laser epilation and pregnancy in women were significant alle-viating factors, whereas weight gain was a more commonaggravating factor for women.Conclusion:HS shows a re-lentlessly progressive course with inflammatory attacks, but thefirst years of the disease are the most active period. This studyconfirms that environmental and hormonal factors may play animportant role in the disease course, probably with other en-dogenous or exogenous factors.(c) 2024 S. Karger AG, BaselItem Clinical and demographic features of hidradenitis suppurativa: a multicentre study of 1221 patients with an analysis of risk factors associated with disease severityÖzkur, E; Karadag, AS; Üstüner, P; Aksoy, B; Esme, P; Çaliskan, E; Akoglu, G; Kalkan, G; Demirseren, DD; Polat, M; Ozden, MG; Kilinç, F; Iyidal, AY; Altunay, IK; Türkmen, M; Ugurer, E; Baysak, S; Karaman, BF; Mammadli, K; Selçuk, LB; Türkoglu, Z; Atci, T; Balci, DD; Adisen, E; Temel, B; Aktan, S; Kaçar, N; Gündüz, K; Ertmertcan, AT; Özdemir, M; Çakiter, AÜ; Çölgeçen, E; Uçmak, D; Kelekçi, H; Ataseven, A; Durmaz, K; Özden, HK; Engin, B; Yazici, S; Alpsoy, EBackground Hidradenitis suppurativa (HS) is a chronic, relapsing and debilitating inflammatory disease associated with profound morbidity. Aim In this multicentre study, we investigated the demographic and clinical features of HS, and determined risk factors of disease severity. Methods In total, 1221 patients diagnosed with HS from 29 centres were enrolled, and the medical records of each patient were reviewed. Results The mean age of disease onset was 26.2 +/- 10.4 years, and almost 70% (n = 849) of patients were current or former smokers. Mean disease duration was 8.9 +/- 8.4 years with a delay in diagnosis of 5.8 +/- 3.91 years. Just over a fifth (21%; n = 256) of patients had a family history of HS. The axillary, genital and neck regions were more frequently affected in men than in women, and the inframammary region was more frequently affected in women than in men (P < 0.05 for all). Acne (40.8%), pilonidal sinus (23.6%) and diabetes mellitus (12.6%) were the most prevalent associated diseases. Of the various therapies used, antibiotics (76.4%) were most common followed by retinoids (41.7%), surgical interventions (32.0%) and biologic agents (15.4%). Logistic regression analysis revealed that the most important determinants of disease severity were male sex (OR = 2.21) and involvement of the genitals (OR = 3.39) and inguinal region (OR = 2.25). More severe disease was associated with comorbidity, longer disease duration, longer diagnosis delay and a higher number of smoking pack-years. Conclusions Our nationwide cohort study found demographic and clinical variation in HS, which may help broaden the understanding of HS and factors associated with disease severity.