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Turk Dermatoloji Dergisi, 2016

Turk Dermatoloji Dergisi, 2016

Case Reports in Dermatological Medicine, 2017

Background. Bullous pemphigoid is an autoimmune subepidermal blistering skin disease in which aut... more Background. Bullous pemphigoid is an autoimmune subepidermal blistering skin disease in which autoantibodies are directed against components of the basement membrane. The disease primarily affects the elderly people and in most of the patients inducing factors cannot be identified. Herein, we report a case of BP that occurred in a patient who was receiving PUVA therapy for the treatment of mycosis fungoides. Main Observation. A 26-year-old woman with mycosis fungoides developed blisters while receiving PUVA therapy. On physical examination tense bullae on the normal skin, remnants of blisters, and erosions were observed on her breasts, the chest wall, and the upper abdomen. Histopathological investigations revealed subepidermal blisters with eosinophilic infiltration and in direct immunofluorescence examination linear deposition of IgG along the basement membrane zone was observed. The diagnosis of bullous pemphigoid was also confirmed by ELISA and BIOCHIP mosaic-based indirect immu...

Indian Journal of Dermatology, Venereology, and Leprology, 2016

Sir, A 55‐year‐old woman reported to our clinic for asymptomatic bluish pigmentation over the lef... more Sir, A 55‐year‐old woman reported to our clinic for asymptomatic bluish pigmentation over the left ear lobe which first appeared 6 years ago and gradually extended to involve the helix, the postauricular area and neck. There was no history of preceding inflammation, trauma or cosmetic use except for hair dye. She denied a family history of similar lesions. On dermatologic examination, there was bluish‐gray, mottled macular pigmentation affecting the whole of the left helix, left ear lobe, left postauricular area and neck corresponding to the dermatome innervated by the third cervical spinal nerve [Figure 1a and b]. There was no mucosal involvement. Neurologic examination revealed lesional hypoesthesia when compared with the trigeminal areas of the face, contralateral ear lobe and post‐auricular skin.

Case Reports in Dermatological Medicine, 2016

Pemphigus vulgaris (PV) is a chronic autoimmune bullous disease of the skin and mucous membranes.... more Pemphigus vulgaris (PV) is a chronic autoimmune bullous disease of the skin and mucous membranes. Although there is some evidence pointing towards a genetic predisposition by some human leukocyte antigen (HLA) genes, familial occurrence of PV is very rare. Most of the familial PV cases so far reported have been in mother and daughter and in siblings. PV in father and son, as presented here, has not been reported in the literature before, except an unconfirmed report. The diagnosis of PV was established by histologic, cytologic studies and enzyme linked immunosorbent assay (ELISA) in Case1and by ELISA and BIOCHIP indirect immunofluorescence test in Case2. The son was responsive to moderate doses of methylprednisolone, with the treatment continuing with tapered doses. The father was in a subclinic condition; consequently, only close follow-up was recommended. HLA typing studies revealed identical HLA alleles of HLA-DR4 (DRB1⁎04) and HLA-DQB1⁎03in both of our cases; this had been found...

Turkish Journal of Dermatology / Türk Dermatoloji Dergisi, 2016

Otoimmün büllöz hastalıklar, epidermis veya dermoepidermal bileşkenin yapısal proteinlerine karşı... more Otoimmün büllöz hastalıklar, epidermis veya dermoepidermal bileşkenin yapısal proteinlerine karşı otoantikor gelişimi ve klinik olarak deri ve/veya mukozalarda bül ve erezyon oluşumu ile karakterize nadir görülen bir hastalık grubudur. Klinik özellikler bu grup hastalıklardan şüphelenmekte önemli yol gösterici bulgulardır. Tanı klinik özellikler, histopatolojik ve immünolojik bulgular bir arada değerlendirilerek konur. Bu grup hastalıklarda altın standart dokuda depolanmış ve/veya serumda dolaşan otoantikorların gösterilmesidir. Bu amaca yönelik metodlar; direkt ve indirekt immünofloresan, Enzyme Linked Immunosorbent Assay (ELISA), immünopresipitasyon ve immünoblottingdir. Bu yazının amacı otoimmün büllöz hastalıkların tanısında serolojik tanı yöntemlerinin yerini gözden geçirmek ve son dönemlerdeki gelişmeleri aktarmaktır.

International Journal of Dermatology, 2016

Background Pemphigus vulgaris (PV) is a severe, chronic, and potentially life-threatening autoimm... more Background Pemphigus vulgaris (PV) is a severe, chronic, and potentially life-threatening autoimmune blistering disease that affects the skin and mucous membranes. Rituximab is a monoclonal anti-CD20 antibody which has been used increasingly in the therapy of PV. Methods The present study sought to test the efficacy and safety of rituximab as an adjuvant therapy by retrospective analysis of clinical and immunological data for 29 patients with PV who were treated with rituximab between 2010 and 2015. Response to therapy, duration of clinical remission, serology of the response, and adverse effects of rituximab were evaluated. Results The mean AE standard deviation (SD) follow-up time was 17.48 AE 13.18 months. In all patients, findings showed either a decrease in antibody titers or that antibodies were completely undetectable after therapy. Rituximab use resulted in a significant reduction in steroid dosage during follow-up. At the end of the follow-up period, 26 patients (96.2%) had achieved complete remission with or without therapy (one patient had no follow-up and one patient had died, most probably as the result of a thromboembolic event). In 44.4% of patients, a clinical relapse occurred after a mean AE SD period of 13.1 AE 4.7 months after the initiation of rituximab therapy. Relapses were managed with additional infusions of rituximab. Conclusions Rituximab is a beneficial and relatively safe adjuvant treatment for PV that facilitates prolonged clinical remission and has a significant steroid-sparing effect.

Turkish Journal of Dermatology / Türk Dermatoloji Dergisi, 2016

Ülkemizde saç hastalıkları başvurularına ait tanımlayıcı veriler oldukça azdır. Bu çalışmada, mez... more Ülkemizde saç hastalıkları başvurularına ait tanımlayıcı veriler oldukça azdır. Bu çalışmada, mezuniyet öncesi ve sonrası eğitim programlarının oluşturulmasına katkı sağlayacağı düşüncesiyle, bölgemizde gözlenen saç hastalıkları hakkında bilgi sahibi olmak, ünitemize başvuran hastaların özelliklerini tanımlamak ve saç hastalıklarında tanısal yaklaşıma katkı sağlayabilecek verileri belirlemek amaçlanmıştır. Yöntemler: Tanımlayıcı epidemiyolojik çalışmamızda, üniversitemiz Saç Hastalıkları Ünitesi'ne Mayıs 2011-Mayıs 2014 tarihleri arasında başvuran, ardışık 1,617 yeni hastanın verileri geriye dönük olarak değerlendirildi. Bulgular: Genel poliklinik başvuruları arasında saç hastalıkları %7 oranında saptandı. Hastaların yaş ortalaması 32,28±15,45 yaş (0-84 yaş) olup kadın/erkek oranı 2,26 olarak bulundu. Yakınmaların %60 hastada kronik persistan seyir gösterdiği ve hastaların %69,1'inin başvuru anında yakınma sürelerinin yıllarla ifade edildiği saptandı. En sık, androgenetik alopesi (AGA), telojen effluvium ve alopesi areata tanıları konmuştu (sırasıyla; %45,8, %39,4, %17,8). Tanı amacıyla 339 hastada (%20,9) trikoskopi yapılmış ve bunların %85'inde saptanan bulgular tanıya yardımcı olmuştu. Sonuç: Bölgemizde saç sorunları nedeniyle başvuru oranı genel poliklinik sayısı içinde önemli bir miktardadır. AGA, telojen effluvium ve alopesi areatanın iyi tanınması ve muayenede trikoskopi gibi yardımcı yöntemlerin kullanılabilmesi saç hastalıkları alanında başarıyı arttıracaktır.

Medical science monitor : international medical journal of experimental and clinical research, 2013

Soluble CD200 (sCD200) is a novel immuno-effective molecule, which acts to regulate inflammatory ... more Soluble CD200 (sCD200) is a novel immuno-effective molecule, which acts to regulate inflammatory and acquired immune responses. Recently, our study group showed that sCD200 was present in serum and blister fluid in a patient with bullous pemphigoid and a patient with toxic epidermal necrolysis. We therefore planned this study to evaluate the sCD200 levels of autoimmune and inflammatory skin disorder patients and to compare them with that of healthy controls. Our study included 30 consecutive patients with psoriasis vulgaris, 15 with pemphigus vulgaris, and 15 healthy controls. Clinical examination and laboratory tests were performed on the same day. Psoriasis patients were also assessed with the Psoriasis Area and Severity Index (PASI) and pemphigus patients were assessed using the Pemphigus Disease Area Index (PDAI). Levels of sCD200 in the serum samples were quantified using ELISA kits. The serum sCD200 level was observed to be statistically significantly higher in patients with p...

Acta dermatovenerologica Croatica : ADC, 2017

Autoimmune bullous diseases (ABD) are a rarely seen group of diseases, of which pemphigus and bul... more Autoimmune bullous diseases (ABD) are a rarely seen group of diseases, of which pemphigus and bullous pemphigoid (BP) are the major groups. Diagnosis is generally based on the combination of clinical features, histopathologic and immunofluorescence (IF) findings, and/or enzyme-linked immunosorbent assay (ELISA). Aims of the work were to determine the value of the innovative BIOCHIP mosaic-based indirect IF technique in the diagnosis of pemphigus and BP in Turkish patients. A total of 63 patients (45 pemphigus and 18 BP) in the active phase of the disease alongside 35 healthy controls were included in the study. All sera from patients and controls were tested using the BIOCHIP technique, and the results were compared with direct IF and/or ELISA. The sensitivity and specificity of this new technique were calculated for validity. The sensitivity and specificity of BIOCHIP in the diagnosis of pemphigus was found to be 91.1% and 97.1%, respectively. In detection of anti-Dsg1 and anti-Dsg...

Journal of the American Academy of Dermatology, 2016

Turk Dermatoloji Dergisi, 2016

Turk Dermatoloji Dergisi, 2016

Case Reports in Dermatological Medicine, 2017

Background. Bullous pemphigoid is an autoimmune subepidermal blistering skin disease in which aut... more Background. Bullous pemphigoid is an autoimmune subepidermal blistering skin disease in which autoantibodies are directed against components of the basement membrane. The disease primarily affects the elderly people and in most of the patients inducing factors cannot be identified. Herein, we report a case of BP that occurred in a patient who was receiving PUVA therapy for the treatment of mycosis fungoides. Main Observation. A 26-year-old woman with mycosis fungoides developed blisters while receiving PUVA therapy. On physical examination tense bullae on the normal skin, remnants of blisters, and erosions were observed on her breasts, the chest wall, and the upper abdomen. Histopathological investigations revealed subepidermal blisters with eosinophilic infiltration and in direct immunofluorescence examination linear deposition of IgG along the basement membrane zone was observed. The diagnosis of bullous pemphigoid was also confirmed by ELISA and BIOCHIP mosaic-based indirect immu...

Indian Journal of Dermatology, Venereology, and Leprology, 2016

Sir, A 55‐year‐old woman reported to our clinic for asymptomatic bluish pigmentation over the lef... more Sir, A 55‐year‐old woman reported to our clinic for asymptomatic bluish pigmentation over the left ear lobe which first appeared 6 years ago and gradually extended to involve the helix, the postauricular area and neck. There was no history of preceding inflammation, trauma or cosmetic use except for hair dye. She denied a family history of similar lesions. On dermatologic examination, there was bluish‐gray, mottled macular pigmentation affecting the whole of the left helix, left ear lobe, left postauricular area and neck corresponding to the dermatome innervated by the third cervical spinal nerve [Figure 1a and b]. There was no mucosal involvement. Neurologic examination revealed lesional hypoesthesia when compared with the trigeminal areas of the face, contralateral ear lobe and post‐auricular skin.

Case Reports in Dermatological Medicine, 2016

Pemphigus vulgaris (PV) is a chronic autoimmune bullous disease of the skin and mucous membranes.... more Pemphigus vulgaris (PV) is a chronic autoimmune bullous disease of the skin and mucous membranes. Although there is some evidence pointing towards a genetic predisposition by some human leukocyte antigen (HLA) genes, familial occurrence of PV is very rare. Most of the familial PV cases so far reported have been in mother and daughter and in siblings. PV in father and son, as presented here, has not been reported in the literature before, except an unconfirmed report. The diagnosis of PV was established by histologic, cytologic studies and enzyme linked immunosorbent assay (ELISA) in Case1and by ELISA and BIOCHIP indirect immunofluorescence test in Case2. The son was responsive to moderate doses of methylprednisolone, with the treatment continuing with tapered doses. The father was in a subclinic condition; consequently, only close follow-up was recommended. HLA typing studies revealed identical HLA alleles of HLA-DR4 (DRB1⁎04) and HLA-DQB1⁎03in both of our cases; this had been found...

Turkish Journal of Dermatology / Türk Dermatoloji Dergisi, 2016

Otoimmün büllöz hastalıklar, epidermis veya dermoepidermal bileşkenin yapısal proteinlerine karşı... more Otoimmün büllöz hastalıklar, epidermis veya dermoepidermal bileşkenin yapısal proteinlerine karşı otoantikor gelişimi ve klinik olarak deri ve/veya mukozalarda bül ve erezyon oluşumu ile karakterize nadir görülen bir hastalık grubudur. Klinik özellikler bu grup hastalıklardan şüphelenmekte önemli yol gösterici bulgulardır. Tanı klinik özellikler, histopatolojik ve immünolojik bulgular bir arada değerlendirilerek konur. Bu grup hastalıklarda altın standart dokuda depolanmış ve/veya serumda dolaşan otoantikorların gösterilmesidir. Bu amaca yönelik metodlar; direkt ve indirekt immünofloresan, Enzyme Linked Immunosorbent Assay (ELISA), immünopresipitasyon ve immünoblottingdir. Bu yazının amacı otoimmün büllöz hastalıkların tanısında serolojik tanı yöntemlerinin yerini gözden geçirmek ve son dönemlerdeki gelişmeleri aktarmaktır.

International Journal of Dermatology, 2016

Background Pemphigus vulgaris (PV) is a severe, chronic, and potentially life-threatening autoimm... more Background Pemphigus vulgaris (PV) is a severe, chronic, and potentially life-threatening autoimmune blistering disease that affects the skin and mucous membranes. Rituximab is a monoclonal anti-CD20 antibody which has been used increasingly in the therapy of PV. Methods The present study sought to test the efficacy and safety of rituximab as an adjuvant therapy by retrospective analysis of clinical and immunological data for 29 patients with PV who were treated with rituximab between 2010 and 2015. Response to therapy, duration of clinical remission, serology of the response, and adverse effects of rituximab were evaluated. Results The mean AE standard deviation (SD) follow-up time was 17.48 AE 13.18 months. In all patients, findings showed either a decrease in antibody titers or that antibodies were completely undetectable after therapy. Rituximab use resulted in a significant reduction in steroid dosage during follow-up. At the end of the follow-up period, 26 patients (96.2%) had achieved complete remission with or without therapy (one patient had no follow-up and one patient had died, most probably as the result of a thromboembolic event). In 44.4% of patients, a clinical relapse occurred after a mean AE SD period of 13.1 AE 4.7 months after the initiation of rituximab therapy. Relapses were managed with additional infusions of rituximab. Conclusions Rituximab is a beneficial and relatively safe adjuvant treatment for PV that facilitates prolonged clinical remission and has a significant steroid-sparing effect.

Turkish Journal of Dermatology / Türk Dermatoloji Dergisi, 2016

Ülkemizde saç hastalıkları başvurularına ait tanımlayıcı veriler oldukça azdır. Bu çalışmada, mez... more Ülkemizde saç hastalıkları başvurularına ait tanımlayıcı veriler oldukça azdır. Bu çalışmada, mezuniyet öncesi ve sonrası eğitim programlarının oluşturulmasına katkı sağlayacağı düşüncesiyle, bölgemizde gözlenen saç hastalıkları hakkında bilgi sahibi olmak, ünitemize başvuran hastaların özelliklerini tanımlamak ve saç hastalıklarında tanısal yaklaşıma katkı sağlayabilecek verileri belirlemek amaçlanmıştır. Yöntemler: Tanımlayıcı epidemiyolojik çalışmamızda, üniversitemiz Saç Hastalıkları Ünitesi'ne Mayıs 2011-Mayıs 2014 tarihleri arasında başvuran, ardışık 1,617 yeni hastanın verileri geriye dönük olarak değerlendirildi. Bulgular: Genel poliklinik başvuruları arasında saç hastalıkları %7 oranında saptandı. Hastaların yaş ortalaması 32,28±15,45 yaş (0-84 yaş) olup kadın/erkek oranı 2,26 olarak bulundu. Yakınmaların %60 hastada kronik persistan seyir gösterdiği ve hastaların %69,1'inin başvuru anında yakınma sürelerinin yıllarla ifade edildiği saptandı. En sık, androgenetik alopesi (AGA), telojen effluvium ve alopesi areata tanıları konmuştu (sırasıyla; %45,8, %39,4, %17,8). Tanı amacıyla 339 hastada (%20,9) trikoskopi yapılmış ve bunların %85'inde saptanan bulgular tanıya yardımcı olmuştu. Sonuç: Bölgemizde saç sorunları nedeniyle başvuru oranı genel poliklinik sayısı içinde önemli bir miktardadır. AGA, telojen effluvium ve alopesi areatanın iyi tanınması ve muayenede trikoskopi gibi yardımcı yöntemlerin kullanılabilmesi saç hastalıkları alanında başarıyı arttıracaktır.

Medical science monitor : international medical journal of experimental and clinical research, 2013

Soluble CD200 (sCD200) is a novel immuno-effective molecule, which acts to regulate inflammatory ... more Soluble CD200 (sCD200) is a novel immuno-effective molecule, which acts to regulate inflammatory and acquired immune responses. Recently, our study group showed that sCD200 was present in serum and blister fluid in a patient with bullous pemphigoid and a patient with toxic epidermal necrolysis. We therefore planned this study to evaluate the sCD200 levels of autoimmune and inflammatory skin disorder patients and to compare them with that of healthy controls. Our study included 30 consecutive patients with psoriasis vulgaris, 15 with pemphigus vulgaris, and 15 healthy controls. Clinical examination and laboratory tests were performed on the same day. Psoriasis patients were also assessed with the Psoriasis Area and Severity Index (PASI) and pemphigus patients were assessed using the Pemphigus Disease Area Index (PDAI). Levels of sCD200 in the serum samples were quantified using ELISA kits. The serum sCD200 level was observed to be statistically significantly higher in patients with p...

Acta dermatovenerologica Croatica : ADC, 2017

Autoimmune bullous diseases (ABD) are a rarely seen group of diseases, of which pemphigus and bul... more Autoimmune bullous diseases (ABD) are a rarely seen group of diseases, of which pemphigus and bullous pemphigoid (BP) are the major groups. Diagnosis is generally based on the combination of clinical features, histopathologic and immunofluorescence (IF) findings, and/or enzyme-linked immunosorbent assay (ELISA). Aims of the work were to determine the value of the innovative BIOCHIP mosaic-based indirect IF technique in the diagnosis of pemphigus and BP in Turkish patients. A total of 63 patients (45 pemphigus and 18 BP) in the active phase of the disease alongside 35 healthy controls were included in the study. All sera from patients and controls were tested using the BIOCHIP technique, and the results were compared with direct IF and/or ELISA. The sensitivity and specificity of this new technique were calculated for validity. The sensitivity and specificity of BIOCHIP in the diagnosis of pemphigus was found to be 91.1% and 97.1%, respectively. In detection of anti-Dsg1 and anti-Dsg...

Journal of the American Academy of Dermatology, 2016