Person:

ÖZGEN, ZÜLEYHA

2017, SEÇKİN GENÇOSMANOĞLU, DİLEK, Tula, Elona; Ergun, Tulin; Seckin, Dilek; Ozgen, Zuleyha; Avsar, Erol

Background/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.

2015, SEÇKİN GENÇOSMANOĞLU, DİLEK, Ergun, Tulin; Seckin, Dilek; Bulbul, Emel Baskan; Onsun, Nahide; Ozgen, Zuleyha; Unalan, Pemra; Alpsoy, Erkan; Karakurt, Sait

BackgroundTumor necrosis factor-alpha (TNF-) antagonist treatment is associated with 1.6 to 27 times higher risk of tuberculosis (TB). ObjectiveTo find TB incidence of psoriasis patients treated with TNF- antagonists and define risk factors related with this condition in a country with moderately high risk of TB. MethodsThree hundred seventy psoriasis patients treated by anti-TNF agents in four referral centers were included. The data on the characteristics of the patients, TB history, tuberculosis skin test results, anti-TNF agent type and exposure time, localization of TB, and isoniazide prophylaxis state were analyzed. ResultsFour patients (1.08%) developed TB, three pulmonary and one gastrointestinal, 2-23months after initiating anti-TNF agents. Other than the patient with gastrointestinal TB, who was using methotrexate and corticosteroid concomitantly, none had contributing risk factors for TB. Two patients developed pulmonary TB in spite of chemoprophylaxis. Three patients with pulmonary TB completely recovered following antiTB treatment whereas patients with gastroinrestinal TB developed renal failure. LimitationsThe major limitation of the study is the lack of a diseased control group, which enables us to compare the risk of psoriatics with that of patients having other inflammatory diseases. ConclusionTuberculosis is a rare but a severe complication of anti-TNF treatment and may develop in spite of chemoprophylaxis. The risk of TB in psoriasis patients in the present study is comparable to literature mostly based on rheumatology patients.

2015-04, SEÇKİN GENÇOSMANOĞLU, DİLEK, Sunbul, Murat; Cagman, Zeynep; Gerin, Fethullah; Ozgen, Zuleyha; Durmus, Erdal; Seckin, Dilek; Ahmad, Sarfraz; Uras, Fikriye; Agirbasli, Mehmet

ObjectivesAn increased risk for cardiovascular disease with psoriasis has been reported. Growth Arrest-Specific 6 (GAS6) amplifies pro-inflammatory endothelial cell activation via TAM receptors. However, it also inhibits inflammation by multiple mechanisms including phagocytosis. The objective of this study was to investigate whether plasma GAS6 levels are associated with conventional cardiometabolic (CM) risk factors in patients with psoriasis. MethodsForty patients diagnosed with psoriasis (22 male, mean age: 43.313.8years) and 40 age-/sex-matched healthy controls (22 male, mean age: 39.38.9years) were included in the study. CM risk factors (hypertension, hyperlipidemia, diabetes mellitus, and cigarette smoking) were identified. GAS6 levels were measured by ELISA. ResultsThere were no significant differences between the plasma GAS6 levels of patients with psoriasis compared to the control group (6.6 +/- 2.0ng/mL, 7.6 +/- 2.8ng/mL, respectively, P>0.05). However, GAS6 levels of patients with psoriasis having a smoking history (n=11) were significantly lower than both patients with psoriasis who had no smoking history (n=29) and controls (5.5 +/- 1.7ng/mL, 6.9 +/- 1.9ng/mL, 7.6 +/- 2.8ng/mL, respectively, P<0.05). Similarly, psoriasis patients with at least one CM risk factor showed lower GAS6 levels compared to subjects without any CM risk factor (5.7 +/- 1.7ng/mL, 7.3 +/- 2.0ng/mL, P<0.01). There was no correlation between the GAS6 level, disease duration or PASI score (r=0.150, -0.150, and P=0.310, 0.398, respectively). ConclusionsThis pilot study provides the first evidence in humans for an association between low plasma GAS6 levels and conventional risk factors in psoriasis. Further large scale, prospective studies are needed to confirm these results.

2013-09-05, SEÇKİN GENÇOSMANOĞLU, DİLEK, Ozgen, Zuleyha; Seckin, Dilek

Immunological effects have an important role in the action mechanisms of the majority of topical and systemic agents, and even some physical treatment modalities in dermatology. Depending on the disease being treated, these effects may be suppression or stimulation of the immune system as well as modulation of the existing functions. Agents that show their effects mainly by immunmodulation in the treatment of dermatological diseases are discussed in the present article. Treatment alternatives included in the article, azathioprine, mycophenolate mofetil, cyclosporine, glucocorticosteroids, topical calcineurin inhibitors, photo(chemo)therapy, intravenous immunoglobuline, interferon, rituximab, omalizumab, imiquimod and extracorporeal photopheresis are discussed focusing especially on their immunomodulatory effects without any mention on their prescribing details, treatment protocols and monitorization aspects.

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, Mehmet

Arterial 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.