Person: SEÇKİN GENÇOSMANOĞLU, DİLEK
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SEÇKİN GENÇOSMANOĞLU
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DİLEK
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Publication Metadata only Psoriasis and the liver: problems, causes and course(WILEY, 2017) SEÇKİN GENÇOSMANOĞLU, DİLEK; Tula, Elona; Ergun, Tulin; Seckin, Dilek; Ozgen, Zuleyha; Avsar, ErolBackground/ObjectivesPsoriasis patients have a higher risk of liver abnormalities such as non-alcoholic fatty liver disease (NAFLD), drug-induced hepatitis, alcoholic hepatitis and neutrophilic cholangitis, than the general population. Associated liver disease limits therapeutic options and necessitates careful monitoring. The aim of the study was to identify liver problems in psoriasis patients and to investigate the underlying causes as well as their course. MethodsThe files of 518 psoriasis patients were retrospectively reviewed. Among these, 393 patients with relevant laboratory data were analysed for liver enzymes and their relation to the known risk factors for liver disease (obesity, diabetes mellitus, alcohol consumption, hepatotoxic medications, dyslipidemia, psoriatic arthritis and infectious hepatitis). ResultsAmong 393 patients, 24% and 0.8% developed liver enzyme abnormalities and cirrhosis, respectively. The most common factors associated with pathological liver enzymes were drugs (57%) and NAFLD (22%). Other rare causes were alcoholic hepatitis, viral hepatitis, neutrophilic cholangitis, autoimmune hepatitis and toxic hepatitis due to herbal therapy. Drug-induced liver enzyme abnormalities were reversible whereas in patients with NAFLD transaminases tended to fluctuate. One patient with herbal medicine-related cirrhosis died of sepsis. ConclusionLiver enzyme abnormalities are common in psoriasis patients and are mostly associated with drugs and NAFLD. Although most cases can be managed by avoiding hepatotoxic medications and close follow up, severe consequences like cirrhosis may develop.Publication Metadata only Secukinumab and infectious adverse effects: A real-life experience of 63 psoriasis patients(2021) SEÇKİN GENÇOSMANOĞLU, DİLEK; Ergun, Tulin; Seckin, Dilek; Demir, Gizem; Direskeneli, HanerPublication Metadata only Topical 8-methoxypsoralen increases the efficacy of narrowband ultraviolet B in psoriasis(WILEY-BLACKWELL PUBLISHING, INC, 2009) SEÇKİN GENÇOSMANOĞLU, DİLEK; Seckin, Dilek; Usta, Inan; Yazici, Zuleyha; Senol, AsliBackground: A combination of oral psoralen with narrowband ultraviolet B (UVB), defined as 'psoralen-narrowband UVB', was shown to have a superior efficacy than UVB alone and even a comparable efficacy to psoralen and ultraviolet A in psoriasis. Objective: To find out whether topical psoralen-narrowband UVB provides any additional benefit to narrowband UVB alone in psoriasis. Methods: Nineteen patients with plaque psoriasis were included. Phototherapy was given three times per week. Two symmetrical lesions were selected as target lesions. in the first 12 sessions of phototherapy, the target lesion on one side was treated with 1% 8-methoxypsoralen (MOP) gel 30 min before UVB radiation whereas the target lesion on the other side served as a control. Target lesion scores were assessed at baseline, third, sixth, ninth and 12th sessions. Side effects were recorded. Results: Sixteen patients completed the Study. Target lesion scores decreased significantly on both sides (P < 0.0001). The mean percentage of decreases was greater on the 8-MOP-applied sides compared with the control sides for all assessments, but the difference was statistically significant only at the ninth session (37.7%, vs. 58.6%, P = 0.043). Pigmentation was frequently seen in 8-MOP gel-applied lesions. Conclusion: Topical 8-MOP gel plus narrowband UVB has greater efficacy than narrowband UVB alone in psoriasis.Publication Metadata only Assessment of left atrial volume and function in patients with psoriasis by using real time three-dimensional echocardiography(SPRINGER WIEN, 2015) ÇİNÇİN, AHMET ALTUĞ; Atas, Halil; Kepez, Alper; Bozbay, Mehmet; Gencosmanoglu, Dilek Seckin; Cincin, Altug; Sunbul, Murat; Bozbay, Ayfer Yildiz; Darvishova, Ramila; Ergun, TulinBackground Left atrial (LA) volume has been identified as a predictor of adverse cardiovascular outcomes, both in the general population and in selected clinical conditions. The aim of this study was to evaluate the effect of psoriasis on LA volume and mechanical function. Methods A total of 40 consecutive normotensive psoriasis patients free of any cardiovascular disease and 39 healthy volunteers were included. All participants underwent comprehensive transthoracic echocardiographic examination. LA volume and mechanical function were evaluated using real-time three-dimensional echocardiography (RT3DE). Results There were no significant differences between psoriasis and control groups with regard to conventional echocardiographic parameters. Individuals with psoriasis had a higher incidence of left ventricular diastolic dysfunction (LVDD) than the controls; nine people with psoriasis (23 %) and three control individuals (8 %) had LVDD (p = 0.06). With regard to the parameters obtained from RT3DE, LA maximum, LA minimum, passive stroke volume, and passive emptying fraction were significantly higher; whereas LA active emptying fraction, LA total emptying fraction, LA expansion index, and active stroke volume values were significantly lower in individuals with psoriasis compared with controls. Disease duration and Psoriasis Area of Severity Index (PASI) score correlated with the majority of volume parameters. Conclusion Individuals with psoriasis had higher LA phasic volumes and impaired LA mechanical function compared with healthy controls. LA volume and functional analysis with RT3DE may facilitate recognition of subtle LA dysfunction in patients with psoriasis.Publication Metadata only Enhanced functional stability of plasminogen activator inhibitor-1 in patients with livedoid vasculopathy(SPRINGER, 2011) SEÇKİN GENÇOSMANOĞLU, DİLEK; Agirbasli, Mehmet; Eren, Mesut; Eren, Fatih; Murphy, Sheila B.; Serdar, Zehra A.; Seckin, Dilek; Zara, Tuba; Mat, M. Cem; Demirkesen, Cuyan; Vaughan, Douglas E.Livedoid vasculopathy (LV) is a chronic, recurrent, painful cutaneous disease with distinctive clinical features and an uncertain etiology. The skin lesions are recognizable by focal purpura, depigmentation and shallow ulcers. Thrombophilic conditions occur frequently in patients with LV. While no definitive treatment exists for LV, smoking cessation, antiplatelet therapy, immunosuppressive treatment, and anabolic steroids are often included in the therapeutic ladder. Recently, a possible link between LV and impaired fibrinolysis was established as cutaneous LV lesions responded to tissue plasminogen activator (t-PA) infusion suggesting that inhibition of the fibrinolysis through plasminogen activator inhibitor-1 (PAI-1) activity may determine the disease course in patients with LV. In this study, we investigated PAI-1 antigen (Ag) and activity levels in 20 patients with biopsy proven LV (mean age 26 +/- 11, M/F = 7/13, median disease duration 3.5 years). All patients received antiplatelet treatment with aspirin and/or dipyrimadole and 14 patients received anabolic steroids or immunosuppressive treatment. Fasting PAI-1 Ag and activity levels were measured at 9 AM in all patients. Both Ag (34 (26) ng/ml) (median (interquartile range)) and specific activity (17 (23) IU/fmole) levels of PAI-1 were moderately elevated in LV patients compared to the controls, however, PAI-1 kinetic studies demonstrated markedly enhanced stability of PAI-1 activity in plasma from patients with LV. Specific activity at 16 h was significantly higher than expected specific activity levels (7 (11) vs. 0.07 (0.09) IU/fmole, P < 0.01). While the exact mechanism of increased stability of PAI-1 activity is not known, it may be due to post-translational modifications or increased binding affinity for a stabilizing cofactor. In conclusion, enhanced stability of PAI-1 may contribute to the pathophysiology of LV, and systemic or local treatment with PAI-1 inhibitors may offer a potential treatment alternative in patients with LV.Publication Metadata only Erosive pustular dermatosis of the leg in a young girl successfully treated with sulfasalazine and 308 nm monochromatic excimer light(2020) SEÇKİN GENÇOSMANOĞLU, DİLEK; Seckin, Dilek; Tekin, Burak; Güneş, Pembegül; Demirçay, ZeynepPublication Metadata only Erosive Pustular Dermatosis of the Leg: An Overlooked Entity?(B C DECKER INC, 2009) SEÇKİN GENÇOSMANOĞLU, DİLEK; Seckin, Dilek; Gurbuz, Oya; Demirkesen, CuyanBackground. Erosive pustular dermatosis is a distinctive clinical entity that has been described on either the scalp or legs. Chronic, shallow erosions covered by yellow crusts develop in atrophic or fibrotic skin. The scalp is the most commonly encountered localization, whereas erosive pustular dermatosis of the leg has also been reported in several cases. The histopathologic picture is nonspecific, and the disease is usually considered as a diagnosis of exclusion. Objective and Conclusion: We report two patients with erosive pustular dermatosis of the leg who were unresponsive to antibacterial and antifungal medications but were successfully treated with systemic steroids in combination with topical pimecrolimus in one of them and topical clobetasol in the other. The condition is simply overlooked, which accounts for its rare description in literature.Publication Metadata only Sistemik antipsoriatik tedavinin depresyonun subjektif ve biyokimyasal göstergelerine etkisi(2019-04-10) ERGUN, SAFİYE ATLAS TÜLİN; PEKER EYÜBOĞLU, İREM; SEÇKİN GENÇOSMANOĞLU, DİLEK; CÖBEK ÜNALAN, GÜLRU PEMRA; AKKİPRİK, MUSTAFA; AKSOY H., ERGUN S. A. T., AKKİPRİK M., PEKER EYÜBOĞLU İ., SEÇKİN GENÇOSMANOĞLU D., CÖBEK ÜNALAN G. P., YÖNEY T. H.GİRİŞ VE AMAÇ: Psoriasis, depresyon riskini arttıran bir hastalıktır. Depresyon patogenezinde kronik inflamatuar süreçlerin, nöron maturasyonunu ve sağ kalımını etkileyen nörotropinleri baskılaması suçlanmaktadır. İyi bilinen bir nörotropin olan Brain derived neurostimulatory factor (BDNF), depresyonun moleküler belirteci olarak kullanılabilmektedir. Bu çalışmada, psoriasis hastaları ile hasta ve sağlıklı kontrol gruplarının subjektif ölçeklerle ve laboratuvar belirteçleriyle ölçülecek olan depresyon ve kaygı düzeyleri açısından karşılaştırılması ve psoriasis hastalarına verilen sistemik antipsoriatik tedavinin, depresyonun sübjektif ve biyokimyasal belirteçlerine etkisinin değerlendirilmesi amaçlanmıştır. YÖNTEM: Çalışmaya 18-65 yaş arasında, 31 psoriasis hastası, 31 hasta kontrol ve 31 sağlıklı gönüllü alındı. Her üç gruba ilk vizitte Beck Depresyon Ölçeği (BDÖ) ve Spielberger Sürekli Kaygı Ölçeği (SKÖ) uygulandı, serum BDNF ve serum proBDNF düzeyleri ölçüldü. Çalışma ve hasta kontrol gruplarına Dermatoloji Yaşam Kalite İndeksi (DYKİ) uygulandı. Tüm ölçekler ve laboratuvar testleri 3 aylık tedavi sonunda psoriasis hasta grubunda tekrarlandı. Psoriasis hastalarında hastalık şiddeti, tedavi öncesi ve sonrasında, doktor tarafından Psoriasis Alan Şiddet İndeksi (PAŞİ) ile değerlendirildi BULGULAR: Psoriasis hastalarında depresyon ve kaygı düzeyleri sağlıklı kontrol grubuna göre anlamlı derecede yüksek saptandı. Psoriasis hastalarında yaşam kalitesinin, hasta kontrol grubuna göre daha olumsuz etkilendiği belirlendi. Psoriasis hastalarında, tedavi öncesinde, BDNF ve proBDNF’de kontrollere göre anlamlı bir farklılık saptanmadı. Ancak sistemik antipsoriatik tedavi ile yaşam kalitesinde düzelme ve bununla ilişkili olarak depresyon düzeyinin anlamlı derecede azaldığı belirlendi. Tedavi sonrasında depresyonun laboratuvar belirteçlerinden proBDNF düzeylerinde anlamlı derecede azalma saptanırken, BDNF düzeylerinde değişim gözlenmedi. SONUÇ: Psoriasis, yaşam kalitesindeki etkilenmeye bağlı olarak depresyon ve kaygı düzeylerini arttırmakla birlikte, depresyonun biyokimyasal belirteçleri olan BDNF ve proBDNF düzeylerini etkilememiştir. Ancak, sistemik antipsoriatik tedavi ile depresyonun sübjektif ölçeğinde (BDÖ) iyileşme ve laboratuvar belirteçlerinden proBDNF’de azalma olması, sistemik antipsoriatik tedavinin depresyon riskini azaltabileceğini desteklemektedir. Tedavi sonunda BDNF düzeylerinde değişmenin olmaması, BDNF’nin, depresyonun biyokimyasal belirteci olduğu bilgisiyle çelişmektedir. Bunun olası nedeni, karmaşık bir patogenezi olan psoriasiste, depresyona neden olan nöromediatörlerin ve mekanizmaların farklı olması olabilir.Publication Metadata only Leukemic vasculitis: An unusual manifestation of leukemia cutis(MOSBY-ELSEVIER, 2009) SEÇKİN GENÇOSMANOĞLU, DİLEK; Seckin, Dilek; Senol, Asli; Gurbuz, Oya; Demirkesen, CuyanLeukemia cutis is frequently observed as papules, nodules, and plaques, but unusual clinical manifestations rarely occur. We report a 64-year-old woman with acute myeloid leukemia M1 who presented with erythematous papules and vesiculobullous lesions limited to the arms, hands, and neck in addition to purpuric papules on the legs. Because Of the symmetric distal involvement and vesiculobullous nature of the skin lesions, the differential diagnosis included erythemia multiforme and vasculitis. However, a skin biopsy specimen revealed infiltration with a striking predominance of blast cells in the dermis. These cells were also observed within the walls of the venules along with fibrin. Leukemia cutis associated with vasculitis was diagnosed. A few blast cells can be observed in many reactive dermatoses in patients with leukemia. However, in this patient a predominance of blast cells in the dermis and infiltration of vessel walls by these cells favored leukemic vasculitis. (J Am Acad Dermatol 2009;61:519-21.)Publication Metadata only Assessment of arterial stiffness and cardiovascular hemodynamics by oscillometric method in psoriasis patients with normal cardiac functions(SPRINGER, 2015) SEÇKİN GENÇOSMANOĞLU, DİLEK; Sunbul, Murat; Seckin, Dilek; Durmus, Erdal; Ozgen, Zuleyha; Bozbay, Mehmet; Bozbay, Ayfer; Kivrak, Tarik; Oguz, Mustafa; Sari, Ibrahim; Ergun, Tulin; Agirbasli, MehmetArterial stiffness is associated with increased cardiovascular risk. Pulse wave velocity (PWV) and augmentation index (AIx) are non-invasive markers for assessment of arterial stiffness. Increased arterial stiffness is associated with atherosclerosis in patients with psoriasis. Previous studies have shown that high neutrophil-to-lymphocyte ratio (NLR) predicts poor cardiovascular outcome. The aim of this study was to evaluate arterial stiffness and cardiovascular hemodynamics by oscillometric method in psoriasis patients with normal cardiac functions. Fifty consecutive patients with the diagnosis of psoriasis and 50 controls were included in the study. NLR was calculated as the ratio of neutrophil count to lymphocyte count. All patients underwent echocardiographic examination. Measurements of arterial stiffness were carried out using a Mobil-O-Graph arteriograph system. Fifty patients with psoriasis (26 male, mean age 43.3 +/- 13.2 years) and 50 controls (33 male, mean age 45.0 +/- 6.1 years) were included into the study. The distribution of cardiovascular risk factors was similar between the two groups, and NLR was significantly higher in patients with psoriasis (2.74 +/- 1.78 versus 1.82 +/- 0.52, p = 0.002). There was a weak correlation between NLR and PASI score without reaching statistical significance (r = 0.300, p = 0.060). While echocardiographic and hemodynamic parameters were comparable between psoriasis and control groups, heart rate was significantly higher in psoriasis group (81.5 +/- 15.1 and 75.2 +/- 11.8 beats/min, p = 0.021). Psoriasis patients had significantly higher AIx and PWV values as compared to controls (25.8 +/- 13.1 versus 17.4 +/- 12.3 %, p = 0.001 and 6.78 +/- 1.42 versus 6.18 +/- 0.80 m/s, p = 0.011, respectively). AI and PWV were significantly associated with psoriasis when adjusted by heart rate (p = 0.005, odds ratio 1.04, 95 % confidence interval 1.01-1.08 and p = 0.035, odds ratio 1.52, 95 % confidence interval 1.02-2.26, respectively). PWV significantly correlated with blood pressure, lipid levels, and several echocardiographic indices. AIx only correlated with left atrial diameter (r = 291, p = 0.040). Linear regression analysis was performed to find predictors of PWV. Central systolic blood pressure, left atrial diameter, and total cholesterol were independent predictors of PWV. PWV and AIx were significantly higher in patients with psoriasis. Assessment of arterial stiffness parameters may be useful for early detection of cardiovascular deterioration in psoriasis patients with normal cardiac functions. Novel inflammatory biomarkers such as NLR may elucidate the mechanism of vascular dysfunction in such patients.