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    Clinical course of psoriasis patients that discontinued biologics during the COVID-19 pandemic
    (Wiley, 2023) Demir, Filiz Topaloğlu; Ekinci, Algün Polat; Aytekin, Sema; Topkarçı, Zeynep; Kayıran, Melek Aslan; Akbulut, Tuğba Özkök; Topal, İlteriş Oğuz
    BackgroundSince psoriasis is a chronic disease, it is not recommended to discontinue the treatment agents used. However, in real life, the treatment of psoriasis patients may be interrupted for various reasons. During the pandemic period, the treatment of many patients was also interrupted. ObjectivesTo evaluate relapse and clinical worsening in psoriasis patients whose biological therapy was interrupted during the pandemic and reveal associated factors. MethodsThe study included patients aged >= 18 years, who were followed up with moderate and severe chronic psoriasis controlled by the last biological agent [Psoriasis Area Severity Index (PASI) 75 response achieved] but had to discontinue their treatment during the pandemic. The patients' demographic and clinical characteristics, clinical course after the discontinuation of these agents, presence of clinical worsening, and relapse were evaluated. Risk factors were analyzed with the logistic regression analysis. ResultsThe study included 169 patients, with a mean age of 47.3 +/- 14.5 (18-87) years. The mean biologics-free time was 18.2 +/- 12.3 (2-56) weeks. Clinical worsening was detected in 41.4% and relapse in 48.5% of the patients. The significant risk factors for clinical worsening and relapse in both univariate and multivariate analyses were alcohol use during the biologics-free period, total time off biologics, and the presence of an additional triggering factor. The use of secukinumab and ustekinumab was found to be a protective factor against clinical worsening in multivariate analyses. ConclusionAs the biologics-free period is prolonged, the likelihood of clinical worsening and relapse increases, therefore, we do not recommend discontinuing biological agents.
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    Etiological and Clinical Evaluation of Elderly Patients with Pruritus: A Retrospective Cross-sectional Analysis of 700 Patients
    (Eskişehir Osmangazi Üniversitesi, 2025) Zorlu, Özge; Günal, Umut; Albayrak, Hülya; Aytekin, Sema
    Pruritus is one of the most common symptoms in the elderly. It can be associated with dermatological, systemic, neurological, or psychogenic disorders. Identifing the underlying origin and appropriate management of patients are important due to its negative impact on quality of life. We aimed to investigate the demographic and clinical features, etiologies, laboratory work-up, and management of elderly patients with pruritus. A retrospective cross-sectional study was conducted on patients with pruritus aged ≥ 65 years who attended our outpatient clinic between January 2014 and June 2024. Etiological origins were categorized as dermatological, systemic, neurologic, psychogenic, drug-associated, or mixed. A total of 700 patients were included. Pruritus began between the ages of 65-75 years in 69%. Of the patients, 140 (20%) had acute and 560 (80%) had chronic pruritus. Pruritus was localized in 299 (42.7%) and generalized in 401 (57.3%) patients. The trunk, upper and lower extremities were the most common sites of pruritus. The most common causes of pruritus were dermatological (83.6%), followed by systemic (5.6%) and psychogenic (5.1%) origins. The most common dermatological cause of acute pruritus was scabies (20.5%), whereas chronic pruritus was xerosis (32.9%). Chronic renal failure was the leading systemic cause in both acute and chronic pruritus (30% and 42.5%, respectively). In conclusion, the demographics, clinical, and etiological factors of pruritus in the elderly can differ according to the geographic region, sample size, age groups, socioeconomics, lifestyle, and environmental factors. Each patient must be examined and treated individually.
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    Impact of oral isotretinoin on the inflammatory markers: can lymphocyte/HDL-C and platelet/HDL-C ratios be new indicators of inflammation in acne vulgaris patients?
    (Taylor & Francis Ltd, 2024) Zorlu, Ozge; Albayrak, Hulya; Aytekin, Sema
    Introduction: The effect of isotretinoin on inflammatory markers has been reported with conflicting results. No studies have been reported on the relationship between isotretinoin and lymphocyte/high-density lipoprotein cholesterol [HDL-C] ratio (LHR), neutrophil/HDL-C ratio (NHR), or platelet/HDL-C ratio (PHR) in acne patients. Objectives: We aimed to investigate how isotretinoin affects the inflammatory markers, including LHR, NHR, and PHR, in acne vulgaris patients. Methods: A total of 361 patients with moderate-to-severe acne vulgaris who received systemic isotretinoin for at least six months were included. Complete blood count and biochemical analyses, including monocyte/HDL-C ratio (MHR), NHR, LHR, PHR, neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), the aggregate index of systemic inflammation (AISI), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI), obtained at the treatment onset and the end of the first, third, and sixth months of treatment were investigated. Results: There was no significant difference in MHR and NHR levels between repeated measures. A significant increasing trend was seen in LHR and PHR (P = 0.001 and P = 0.011, respectively). HDL-C levels gradually and significantly declined during the six months (P < 0.001). Serum NLR, derived NLR, SII, SIRI, MLR, and AISI showed a significant decrease in line with clinical improvement in acne during the six months of therapy (P < 0.05). Conclusions: Declining levels of NLR, MLR, SII, SIRI, and AISI may indicate the anti-inflammatory effects of isotretinoin on the pilosebaceous unit, whereas increasing levels of LHR and PHR may show systemic inflammatory activity of isotretinoin.
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    Maladaptive Daydreaming in Psoriasis Patients
    (Galenos Publ House, 2024) Zorlu, Ozge; Beyazyuz, Elmas; Aytekin, Sema; Albayrak, Hulya
    Aim: Many psychiatric disorders are associated with psoriasis. A 16-item self-report maladaptive daydreaming (MD) scale (MDS-16) is described as a screening tool for MD. We aimed to explore whether MDS-16 scores differed in psoriasis patients compared to healthy individuals, hypothesizing higher scores and higher rates of probable maladaptive daydreamers (MDers) among psoriazis patients. Materials and Methods: We included 184 psoriazis patients and 93 age- and sex-matched people without any cutaneous disorders in this casecontrol, cross-sectional, and questionnaire-based study. Dermatology Quality of Life Instrument in Turkish (TQoL) and MDS-16 were applied. We considered the participants with a total MDS-16 score >50 as probable MDers. Results: Total MDS-16 score was higher in the psoriasis group (p=0.038). However, the difference between the frequencies of probable MDers was not significant (p=0.234). According to the multivariable analysis, psoriasis was not found as an independent risk factor for being probable MDer. In the psoriasis group, total MDS-16 scores were positively correlated with TQoL scores (r (s )=0.259, p=0.001), which were significantly higher in probable MDers (p=0.032). Conclusion: The association between psoriasis and MD may be related to the level of the impact of psoriasis on the quality of life.