Browsing by Author "Gunduz, K"

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    T cell subpopulations and IL-2R in vitiligo
    Gunduz, K; Ozturk, G; Terzioglu, E; Sebik, F
    Immunological alterations have been implicated in the etiopathogenesis of vitiligo. The aim of this study was to determine peripheral lymphocyte subpopulations and interleukin-2 receptor (IL-2R) in patients with vitiligo. Forty-five vitiligo patients (24 female, 21 male) and 34 healthy controls (I I female, 23 male) were included into the study. Eight (17.8%) of the patients had the segmental type, and 37 (82.2%) had generalized vitiligo. The disease was active in 25 (55.6%) patients; the other 20 (44.4%) patients had static vitiligo. Flow cytometry was used to determine the percentages of total T-lymphocytes, B-lymphocytes, helper/inducer T cells, suppressor/cytotoxic T cells, natural killer (NK) cells, activated T cells and interleukin-2 receptor (IL-2R) with the use of CD3, CD19, CD4, CD8, CD 16, HLA-DR and CD25 monoclonal antibodies, respectively. The mean value of helper T cells showed a significant difference (p=0.01) between the two groups with the value being 32.5% in patients and 38.1% in control subjects. CD4/CD8 was significantly lower in vitiligo patients (p=0.04). There was also a statistically significant difference in the mean percentage of activated T cells between vitiligo patients and control subjects (4.7 and 8.1, respectively; p=0.001). No statistically significant differences were found when the values were compared between segmental and generalized vitiligo patients, or between active and static cases. In conclusion, T helper/inducer cells, CD4/CD8 ratio and activated (HILA-DR+) T cells are decreased in vitiligo patients, suggesting a role for changes in cellular immunity.
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    Oxidative stress impairs endothelial nitric oxide levels in Behcets' disease
    Onur, E; Kabaroglu, C; Inanir, I; Var, A; Guvenc, Y; Gunay, O; Gunduz, K
    Background: Behcet's disease (BD) is an inflammatory vasculitis. Endogenous nitric oxide (NO), produced by endothelial cells, has pleiotropic effects such as vasodilatator, antiplatelet, antiproliferative. Reactive oxygen species (ROS) are produced at sites of endothelial inflammation. ROS target polyunsaturated lipids, which results in malondialdehyde (MDA) production. Objective: The aim was to investigate the oxidative stress in BD patients by measuring MDA and total antioxidant status (TAS) levels and to establish a possible relationship with respect to NO levels regarding disease activity. Materials and methods: 55 BD patients (30 active/25 inactive) and 20 healthy volunteers were included in the study. Blood samples were drawn following an overnight fasting. TAS and MDA levels were determined spectrophotometrically. Serum nitrite (NO2-) and nitrate (NO3-) levels were measured to estimate NO production. Data were expressed as mean +/- SD. Results: TAS levels were significantly lower in BD patients than the controls (1.19 +/- 0.34 vs. 3.29 +/- 0.89 mmol/L). In the active BD group, MDA levels (0.36 +/- 0.19 nmol/mL) were significantly higher than both the inactive BD group (0.25 +/- 0.18 nmol/mL) and controls (0.18 +/- 0.41 nmol/mL). NO levels were significantly lower in the active group compared to the inactive group (18.0 +/- 2.80 vs. 19.40 +/- 2.70 mu mol/L). MDA levels correlated negatively with NO levels in the active group. Conclusion: Decreased NO levels mediated by increased oxidative stress significantly contribute to endothelial dysfunction observed in BD.
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    Erythrocyte superoxide dismutase, catalase activities and plasma nitrite and nitrate levels in patients with Behcet disease and recurrent aphthous stomatitis
    Gunduz, K; Ozturk, G; Sozmen, EY
    Behcet disease (BD) and recurrent aphthous stomatitis (RAS) are two distinct diseases of unknown aetiology which are both characterized by oral aphthae. The aim of this study was to determine the possible association of both diseases with antioxidant status and nitric oxide levels. Twenty-six patients (17 female, nine male) with RAS, 28 patients (17 female, 11 male) with BD and 31 (22 female, nine male) healthy control subjects were included in the study. Blood samples were studied for erythrocyte superoxide dismutase (SOD) and catalase (CAT) activities and plasma nitric oxide (NO) levels. Erythrocyte SOD activity in BD patients was significantly higher than in RAS patients and controls. Although SOD activity in RAS patients was higher than in controls, the difference was not statistically significant. No significant differences in CAT activities or NO levels were found between the three groups. In conclusion, changes in SOD activity may be important in the inflammatory reactions observed in BD and RAS, but NO does not seem to play a primary role in the aetiopathogenesis.
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    Imiquimod 5% cream for isolated lichen planus of the lip
    Gencoglan, G; Inanir, I; Sahin, O; Gunduz, K
    Lichen planus (LP) of the lips is a rare condition that is generally associated with other parts of the oral mucosa. Lip localization has an increased risk, since external trauma, smoking and ultraviolet light trigger malignant transformation. Only a few cases of isolated LP of the lips have been reported up to now, but results of larger series on oral LP suggest that it might be underestimated. Treatment of oral LP is usually difficult and lesions are generally resistant or recur, so that novel therapy alternatives are necessary. Here we report four cases of isolated LP of the lip successfully treated with imiquimod 5% cream. It was applied twice daily, 5 days a week, for 2 weeks. Two weeks after therapy, complete clinical and histopathological resolution was observed. No recurrence was observed during the 5, 10 and 18 months' follow-up period in cases 4, 3 and 1, respectively. Clinical and histopathological cure was also observed in case 2, but the patient showed clinical activation after 6 months. We suggest that imiquimod 5% cream is a safe and effective therapeutic treatment for oral LP.
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    Analysis of melanocytic naevi by dermoscopy during pregnancy
    Gunduz, K; Koltan, S; Sahin, MT; Filiz, EE
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    Targetoid haemosiderotic haemangioma
    Sahin, MT; Demir, MA; Gunduz, K; Özturkcan, S; Türel-Ermertcan, A
    Targetoid haemosiderotic haemangioma represents a new, rarely reported, distinctive, benign vascular tumour, characterized histopathologically by a biphasic growth pattern of dilated vascular structures in the superficial dermis lined by prominent hobnail endothelial cells and collagen dissecting, rather narrow neoplastic vessels in deeper parts of the lesion. In the initial stage, the lesion is seen as a small purple or violaceous papule, 2-3 mm in diameter. Over time, the ecchymotic ring expands peripherally until it disappears spontaneously. In the later stages, however, the central papule remains as a slightly raised dermal lesion with a purple to brownish discolouration. We report three cases whose repetitive cyclic morphological changes of targetoid haemosiderotic haemangiomas were monitored dermoscopically at 3-month follow-ups. Histopathological examination of each lesion identified the features of targetoid haemosiderotic haemangioma. To the best of our knowledge, our three cases are the first reported in the literature of targetoid haemosiderotic haemangiomas that were regularly monitored by dermoscopic examinations, enabling development of the different stages of the same lesion to be followed.
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    Relationship between ossification of the stylohyoid ligament and enthesopathy: A comparative study
    Unlu, Z; Tarhan, S; Gunduz, K; Goktan, C
    Objective Stylohyoid apparatus might be an anatomic region in the cervical spine involved by enthesopathy. The aim of this study was to assess the elongation and/or ossification at the stylohyoid apparatus in the degenerative or inflammatory diseases such as ankylosing spondylitis (AS), psoriatic arthropathy (PsA) and cervical spondylo-arthrosis (CS) in which cervical spine involvement can be seen. Methods Twenty-eight patients with AS, 25 patients with PsA, 31 patients with CS and 50 controls who did not have any complaints or symptoms related with elongated styloid process (SP) were included in the study. On the lateral cervical radiographs, the anterior and posterior aspects of each vertebral body and intervertebral disk were carefully. evaluated for the presence and severity of syndesmophytes, osteophytes or ossification of the adjacent longitudinal ligaments in the patient group. The entire osseous length of the SP was measured on the lateral and lateral oblique mandibular or cervical views or the anteroposterior views radiographs in the patients and controls. Results There were statistically significant differences between the patients with AS and control group and between the patients with PsA and control group with respect to the length of SP. The dimension of syndesmophytes or ligamentous ossification of the cervical spine involving C5-6 intervertebral disk level were significantly correlated with length of SP in the patients with AS. Conclusion Elongated SP might be another manifestation of enthesopaty in cervical spine of the spondyloarthropathies.
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    Evaluation of sequential effect of isotretinoin on the haematological parameters in patients with acne vulgaris
    Gencoglan, G; Inanir, I; Miskioglu, M; Gunduz, K
    Purpose: Isotretinoin is the most effective drug for acne with some side effects. Few studies exist regarding the effects of isotretinoin on haematological parameters with different results. Mostly, baseline values with a single value during or at the end of the treatment were compared. In this study, we aimed to determine the differences in haematological parameters during isotretinoin treatment until reaching the cumulative dose of 120mg/kg.Materials and methods: The study included 118 patients with moderate-to-severe acne vulgaris. Patients with preexisting liver disease, anaemia, iron deficiency, abnormal liver function tests, thrombocytopenia/thrombocytosis or hyperlipidaemia were excluded. Laboratory monitoring for haematological parameters was performed at baseline and monthly during treatment. Parameters at the baseline, at the first and second months and at the end of the therapy were taken into account.Results: According to general linear model analysis, platelets and plateletcrit increased at the first month of the treatment and then decreased to baseline. White blood cells and neutrophils decreased at the first month, then increased to baseline value at the second month, and were found to be decreased again at the end of the treatment. Mean corpuscle volume was found to be increased at the end of the treatment. Other parameters in CBC did not show statistically significant differences.Conclusions: Although some changes occur in haematological parameters during isotretinoin therapy, all of these changes remain within the normal range. Evaluating the spot values at any time during treatment may cause misinterpretations.
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    Expression of matrix metalloproteinases (MMP-2, MMP-3, and MMP-9) and fibronectin in lichen planus
    Gunduz, K; Demireli, P; Inanir, I; Nese, N
    Background: Keratinocyte damage and lichenoid-interface reaction are the two major pathologic findings in lichen planus (LP). Matrix metalloproteinases (MMPs) are proteinases that participate in extracellular matrix (ECM) degradation and may play an important role in basal membrane (BM) damage in LP. Fibronectin (FN) mediates a variety of cellular interactions with ECM and plays important roles in cell adhesion, migration, growth and differentiation. Objective: To determine MMP-2, MMP-3, MMP-9 and FN expressions in LP and discuss the possible associations. Materials and methods: Skin biopsy samples of 55 patients with LP and 11 normal skin were investigated. Five discoid lupus erythematosus (DLE) and 5 chronic dermatitis (CD) samples were also examined for comparison. Immunochemical stainings were performed for MMP-2, MMP-3, MMP-9 and fibronectin. Results: Weak or absent expressions of MMP-2 and MMP-3 in epidermis; and dense MMP-9 expression in dermal inflammatory infiltrate cells were detected in LP. FN expression was lost in epidermal basal layer and papillary dermis. Conclusion: Loss of MMP-2, MMP-3 and FN in LP can be explained with the destruction of the epidermal basal layer. Similar expressions of MMP-2 and MMP-3 both in LP and DLE implied that these MMPs may be involved in the pathogenesis of interface dermatitis.
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    Epidemiological profile of onychomycosis in the elderly living in the nursing homes
    Gunduz, T; Gunduz, K; Degerli, K; Limoncu, ME
    Introduction: Few data is available about the prevalence and the causative microorganisms of onychomycosis in the elderly. The aim of this study was to determine the prevalence and types of onychomycosis in the elderly people living in the nursing homes and to determine the responsible fungal agents. Methods: Elderly people living in nursing homes were examined for onychomycosis. Nails with color and structure changes were suspected of onychomycosis. Scraping materials were evaluated by direct KOH examination and fungal cultures were performed. Results: Totally, 214 elderly persons (59 female, 155 male) from nursing homes were studied. Onychomycosis was suspected clinically in 102 cases and scraping materials were obtained from 122 nails. Clinical types of onyhomycosis were distal subungual in 87, proximal subungual in 21 and white superficial in 14 cases. Fungal spores were seen in 81 (37.8%) samples (3 hand nails, 78 toenails) with direct KOH examination and fungal culture was positive in 54 (25.2%) (3 hand nails, 51 toenails) of them. Trichophyton rubrum was the most frequently isolated fungus (75.9%) followed by Candida glabrata (12.9%). Conclusions: In the elderly, onychomycosis is more common than the general population. However causative fungi are similar; dermatophytes are the most common causative organisms followed by yeasts. (C) 2013 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.
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    Primary cutaneous anaplastic CD30+ large-cell lymphoma that completely regressed after incisional skin biopsy
    Gencoglan, G; Ozturk, F; Inanir, I; Miskioglu, M; Temiz, P; Gunduz, K
    We describe a 48-year-old woman with three erythematous nodules localized on the left forearm, with 2 months evolution. Histological and immunohistochemical examination revealed a CD30(+) large-cell lymphoma. Systemic involvement was not detected. The tumor regressed spontaneously within a week, after the incisional skin biopsy. In control skin biopsy, there was not any histological feature of lymphoma. No reactivation or any symptom of systemic disease was observed during the 10-month follow-up period.
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    Therapeutic Hotline: Treatment of prurigo nodularis and lichen simplex chronicus with gabapentin
    Gencoglan, G; Inanir, I; Gunduz, K
    Psychocutaneous conditions are frequently encountered in dermatology practice. Prurigo nodularis and lichen simplex chronicus are two frustrating conditions that are classified in this category. They are often refractory to classical treatment with topical corticosteroids and antihistamines. Severe, generalized exacerbations require systemic therapy. Phototherapy, erythromycine, retinoids, cyclosporine, azathiopurine, naltrexone, and psychopharmacologic agents (pimozide, selective serotonin reuptake inhibitor antidepressants) were tried with some success. Here five cases with lichen simplex chronicus and four cases with prurigo nodularis, who responded well to gabapentin, are presented.
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    Serum homocysteine, vitamin B12, folic acid levels and methylenetetrahydrofolate reductase (MTHFR) gene polymorphism in vitiligo
    Yasar, A; Gunduz, K; Onur, E; Calkan, M
    The aim of this study was to determine serum vitamin B12, folic acid and homocysteine (Hcy) levels as well as MTHFR (C677, A1298C) gene polymorphisms in patients with vitiligo, and to compare the results with healthy controls. Forty patients with vitiligo and 40 age and sex matched healthy subjects were studied. Serum vitamin B12 and folate levels were determined by enzyme-linked immunosorbent assay. Plasma Hcy levels and MTHFR polymorphisms were determined by chemiluminescence and real time PCR methods, respectively. Mean serum vitamin B12 and Hcy levels were not significantly different while folic acid levels were significantly lower in the control group. There was no significant relationship between disease activity and vitamin B12, folic acid and homocystein levels. No significant difference in C677T gene polymorphism was detected. Heterozygote A1298C gene polymorphism in the patient group was statistically higher than the control group. There was no significant relationship between MTHFR gene polymorphisms and vitamin B12, folic acid and homocysteine levels. In conclusion, vitamin B12, folate and Hcy levels are not altered in vitiligo and MTHFR gene mutations (C677T and A1298C) do not seem to create susceptibility for vitiligo.
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    Flexural follicular lichen planus
    Gunduz, K; Sacar, T; Inanir, I; Demireli, P
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    Coexistence of psoriasis and bullous pemphigoid: remission with low-dose methotrexate
    Gunay, U; Gunduz, K; Ermertcan, AT; Kandiloglu, AR
    The coexistence of psoriasis vulgaris and bullous pemphigoid is rare. Here, we report a 90-year-old patient with a 20-year history of psoriasis. She developed vesicles and bullae suddenly and was diagnosed as bullous pemphigoid. Low-dose methotrexate therapy quickly cleared both psoriatic and bullous lesions.
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    The efficacy of adalimumab therapy in recalcitrant hidradenitis suppurativa: retrospective analysis
    Cingoz, K; Gunduz, K; Gencoglan, G; Bilac, C; Sahin, MT; Inanir, I; Ermertcan, AT
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    Malignant acanthosis nigricans associated with ileocecal adenocarcinoma
    Gunduz, K; Coban, M; Öztürk, F; Ermertcan, AT
    Malignant acanthosis nigricans (MAN) is a cutaneous sign of internal malignancy, usually an adenocarcinoma. With this report, we aim to present a rare case of concomitant colon cancer and acanthosis nigricans (AN). A 62-year-old woman with hyperpigmentation, velvety cutaneous thickening and verrucous excrescences involving the axillary, inframammar, and inguinal regions with a history of 10 years is presented. Hyperpigmentation and thickening existed also on the nape, umbilicus, and periorbital regions. Histopathological findings of skin lesions were consistent with AN. Computed tomography of the abdomen revealed cecal wall thickening and multiple enlarged lymph nodes in pericolic fat tissue. The tumor was resected surgically and the diagnosis of poor differentiated adenocarcinoma of the colon with lymphatic metastasis was established. Although MAN is mostly reported in the course of abdominal malignancies, this is a very rare case report of MAN associated with adenocarcinoma of the colon.
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    Systemic comorbidities associated with rosacea: a multicentric retrospective observational study
    Aksoy, B; Ekiz, Ö; Unal, E; Yavuz, GO; Gonul, M; Cakmak, SK; Polat, M; Bilgic, Ö; Selcuk, LB; Una, I; Karadag, AS; Kilic, A; Balta, I; Kutlu, Ö; Uzuncakmak, TK; Gunduz, K
    BackgroundOnce considered a disorder limited to the skin, rosacea is now known to be associated with systemic disorders. The aim of this study was to determine what systemic comorbidities accompany rosacea and to determine the relationship between the type, severity, and duration of rosacea, and the presence of and type of systemic comorbidities. MethodsThis retrospective multicenter study was conducted by the Turkish Society of Dermatology Acne Study Group. Thirteen dermatology clinics throughout Turkey participated in the study. A structured physician-administered questionnaire was used to collect patient demographics, clinical findings, and lifestyle data. The principal rosacea subtype, physician global assessment of severity, and duration of rosacea were recorded. Physicians recorded each participant's medical history, including current and past comorbidities, duration of any such comorbidity, and the use of medications to treat any comorbidities. ResultsThe study included 1,195 rosacea patients and 621 controls without rosacea aged 18-85years. As compared to the controls, more of the rosacea patients had respiratory tract, gastrointestinal system, and metabolic and hepatobiliary system disorders in a rosacea's severity- and duration-dependent manner. ConclusionClinicians must be aware of the potential for systemic comorbidities in rosacea patients, which becomes more likely as disease duration and severity increase.
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    Internalized stigma in psoriasis: A multicenter study
    Alpsoy, E; Polat, M; Fettahlioglu-Karaman, B; Karadag, AS; Kartal-Durmazlar, P; Yalcin, B; Emre, S; Didar-Balci, D; Bilgic-Temel, A; Arca, E; Koca, R; Gunduz, K; Borlu, M; Ergun, T; Dogruk-Kacar, S; Cordan-Yazici, A; Dursun, P; Bilgic, O; Gunes-Bilgili, S; Sendur, N; Baysal, O; Halil-Yavuz, I; Yagcioglu, G; Yilmaz, E; Kavuzlu, U; Senol, Y
    Internalized stigma is the adoption of negative attitudes and stereotypes of the society regarding a person's illness. It causes decreased self-esteem and life-satisfaction, increased depression and suicidality, and difficulty in coping with the illness. The primary aim of this study was to investigate the internalized stigma state of psoriatic patients and to identify the factors influencing internalized stigma. The secondary aim was to identify the correlation of internalized stigma with quality of life and perceived health status. This multicentre, cross-sectional study comprised 1485 patients. There was a significant positive correlation between mean values of Psoriasis Internalized Stigma Scale (PISS) and Psoriasis Area and Severity Index, Body Surface Area, Dermatological Life Quality Index and General Health Questionnaire-12 (P < 0.001 in all). Lower percieved health score (P = 0.001), early onset psoriasis (P = 0.016), family history of psoriasis (P = 0.0034), being illiterate (P < 0.001) and lower income level (P < 0.001) were determinants of high PISS scores. Mean PISS values were higher in erythrodermic and generalized pustular psoriasis. Involvement of scalp, face, hand, genitalia and finger nails as well as arthropathic and inverse psoriasis were also related to significantly higher PISS scores (P = 0.001). Our findings imply that psoriatic patients experience high levels of internalized stigma which are associated with psoriasis severity, involvement of visible body parts, genital area, folds or joints, poorer quality of life, negative perceptions of general health and psychological illnesses. Therefore, internalized stigma may be one of the major factors responsible from psychosocial burden of the disease.