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    Clinical Features and Natural Course of Hidradenitis Suppurativa in Turkey: A Multicenter Study
    (Karger, 2025) Alpsoy, Erkan; Fettahlıoğlu Karaman, Bilge; Demirseren, Duriye Deniz; Çınar, S. Levent; Kaçar, Nida; Turel Ermertcan, Aylın; Bülbül Başkan, Emel; Kılıç, Sevilay
    Introduction:The natural history, the progression of a diseaseprocess in an individual over time, has not yet been fully elu-cidated in hidradenitis suppurativa (HS). In this large multicenterstudy, we aimed to investigate the natural history of HS and itsgender differences.Methods:This cross-sectional study in-cluded 827 patients. The chronological order of the clinicalmanifestations for each patientwas recorded retrospectively.Sociodemographic characteristics, triggering factors, clinical,treatment, and prognostic features were also evaluated.Results:The mean age of disease onset was significantly younger inwomen than in men (22.42 +/- 9.28 vs. 27.06 +/- 20.56,p<0.001)and those with a family history (p<0.0001). The mean diseaseduration was 91.17 +/- 83.64 months. The most commonsymptom was purulent discharge (81%). The mean duration ofabscess was shorter in women than in men (3.11 +/- 2.65 vs.3.75 +/- 3.75,p= 0.01). The axilla was the most common onsetarea followed by the inguinal and gluteal regions. The diseaseran a more severe course in men. Abscess/inflammatory nodulewas defined in the last 6 months in 88.6% of the patients;however, thefirst 5 years of the disease were the most activedisease period in 67.5% of the patients. Multivariate analysisrevealed being male, older age, family history, involvement ofthe axillary, inguinal, and perianal regions independently as-sociated with HS severity. While antibiotic use was the mostimportant factor in improving thedisease symptoms, stress wasthe most common aggravating factor. Biological therapy in men,laser epilation and pregnancy in women were significant alle-viating factors, whereas weight gain was a more commonaggravating factor for women.Conclusion:HS shows a re-lentlessly progressive course with inflammatory attacks, but thefirst years of the disease are the most active period. This studyconfirms that environmental and hormonal factors may play animportant role in the disease course, probably with other en-dogenous or exogenous factors.(c) 2024 S. Karger AG, Basel
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    Epidemiological characteristics of different types of adult acne in Turkey: a prospective, controlled, multicenter study
    (Slovene Medical Society, 2023) Kutlu, Ömer; Karadağ, Ayşe Serap; Demirseren, Duriye Deniz; Tosun, Mustafa; Kalkan, Göknur; Kılıç, Sevilay
    Introduction: Acne occurring in adults over the age of 25 years is known as acne tarda or adult acne. Three types of adult acne are recognized: persistent, late-onset, and recurrent acne. Most studies do not compare the characteristics between the three variants. In addition, little is known about adult acne in males. This study describes the epidemiological factors of adult acne and investigates certain triggering factors by sex and different types of adult acne. Methods: A multicenter, prospective, descriptive study was conducted. Patients with adult acne and an acne-free control group were compared regarding medical history, family history, smoking and drinking habits, and dietary factors. In addition, triggering and prognostic factors were investigated by sex and three different types of acne: persistent, late-onset, and recurrent acne. Results: The participants included 944 (88.56%) female and 122 (11.44%) male patients with adult acne, and 709 (73.85%) female and 251 (26.15%) male control patients. The consumption of crackers, chocolate, and pasta was significantly more common in the acne group than in the control group (p = 0.017, 0.002, and 0.040, respectively). Male patients with adult acne had a significantly longer disease duration than female patients with adult acne (p = 0.024). The most common type of acne was recurrent acne, followed by persistent and late-onset acne. Among patients with persistent acne, 14.5% had polycystic ovary syndrome (PCOS), whereas 12.2% of patients with recurrent acne and 11.1% of patients with late-onset acne had PCOS. Severe acne was more common in the persistent acne type (28.13%). The cheek (59.90%) was the most common involvement area, and stress (55.23%) was the most common triggering factor regardless of sex. Conclusions: Although adult female and male patents with adult acne share similar triggering factors, the involvement areas can differ, which may indicate the additional hormonal etiology of female adult acne. Further epidemiological studies on adult acne in both sexes may illuminate the pathogenesis of the disease, thus making possible the development of new treatment strategies.
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    Rates of skincare product and cosmetic procedure use in patients with acne vulgaris and the effective factors: A multicenter study with 1,755 patients
    (Wiley Periodicals LLC, 2022) Kayıran, Melek Aslan; Karadağ, Ayşe Serap; Alyamaç, Gökçen; Cemil, Bengü Çevirgen; Demirseren, Duriye Deniz; Taş Demircan, Yuhanize; Aksoy, Hasan; Kılıç, Sevilay
    Background: Skincare products and cosmetic procedures are used as an adjunct or complementary to conventional drug therapy for acne vulgaris (AV). Objective: To evaluate the use of skincare products and the frequency of cosmetic procedures in AV treatment. Methods: A total of 1,755 patients with AV completed the survey prepared by the researchers and the Cardiff Acne Disability Index (CADI) questionnaire. The clinical findings and the Food and Drug Administration (FDA) severity scores were recorded by the dermatologists. Results: For AV, 66.7% of the patients stated that they used skincare products and 26.7% had undergone cosmetic procedures. The use of skincare products was statistically significantly higher in women (female: 74.5%, male: 57.7%, p < 0.0001); older people (users: 22 ± 7.6years, non-users: 21.2 ± 5.7 years, p < 0.0001); patients with a higher CADI score (users: 7 ± 3.7, non-users: 6.9 ± 4.3, p = 0.010); FDA severity score 2 and 3 (FDA-1: 58.1%; FDA-2: 72.4%, FDA-3: 73%, FDA-4: 67%, p < 0.0001); long-term disease (users: 57 ± 43 months; non-users: 47.7 ± 42.3 months, p < 0.0001); facial involvement (present: 70.2%, absent: 51.4%, p = 0.017); high income levels (users: 73.5%; non-users: 26.5%, p = 0.001); and graduate or post-graduate degrees (undergraduate≤%62.8, graduate≥%76.8, p < 0.0001). The rate of cosmetic procedures was higher in those with higher CADI scores (users: 7.8 ± 3.8; non-users: 7.1 ± 3.96, p < 0.0001); older patients (users: 22.7 ± 10.7 years; non-users: 21.3 ± 5 years, p < 0.0001); high school (25.6%); and graduate (28.9%) education (p = 0.043), those with lower disease severity (FDA-1: 31.1%; FDA-2: 28.5%, FDA-3: 27.1%, FDA-4: 20.4%, p = 0.022); smokers (smokers: 32.5%; non-smokers: 25.5%, p = 0.020), and those with AV in the family (present: 29.8%; absent: 24.2%, p = 0.009). The patients most frequently used cleansers (85.2%) as cosmetic products, and most commonly underwent skincare treatment (71%) as an interventional procedure. They mostly learned about such products and methods from the Internet, and 33.3% of the participants had undergone procedures performed by non-physicians. Conclusion: The patients generally choose skincare products as a result of their Internet search and sometimes have these procedures performed by non-physicians. Dermatologists should be aware of this situation and inform their patients about appropriate products and procedures.
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    The effect of COVID-19 on development of hair and nail disorders: a Turkish multicenter, controlled study
    (John Wiley and Sons Inc, 2023) Kutlu, Ömer; Taş Demircan, Yuhanize; Yıldız, Kenan; Kalkan, Göknur; Demirseren, Duriye Deniz; An, İsa; Oba, Muazzez Çiğdem; Kılıç, Sevilay
    Background: A broad spectrum of skin diseases, including hair and nails, can be directly or indirectly triggered by COVID-19. It is aimed to examine the type and frequency of hair and nail disorders after COVID-19 infection. Methods: This is a multicenter study conducted on consecutive 2171 post-COVID-19 patients. Patients who developed hair and nail disorders and did not develop hair and nail disorders were recruited as subject and control groups. The type and frequency of hair and nail disorders were examined. Results: The rate of the previous admission in hospital due to COVID-19 was statistically significantly more common in patients who developed hair loss after getting infected with COVID-19 (P < 0.001). Telogen effluvium (85%) was the most common hair loss type followed by worsening of androgenetic alopecia (7%) after COVID-19 infection. The mean stress scores during and after getting infected with COVID-19 were 6.88 ± 2.77 and 3.64 ± 3.04, respectively, in the hair loss group and were 5.77 ± 3.18 and 2.81 ± 2.84, respectively, in the control group (P < 0.001, P < 0.001). The frequency of recurrent COVID-19 was statistically significantly higher in men with severe androgenetic alopecia (Grades 4–7 HNS) (P = 0.012; Odds ratio: 2.931 [1.222–7.027]). The most common nail disorders were leukonychia, onycholysis, Beau's lines, onychomadesis, and onychoschisis, respectively. The symptoms of COVID-19 were statistically significantly more common in patients having nail disorders after getting infected with COVID-19 when compared to the control group (P < 0.05). Conclusion: The development of both nail and hair disorders after COVID-19 seems to be related to a history of severe COVID-19.
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    Use of complementary and alternative medicine among patients with acne vulgaris and factors perceived to trigger the disease: A multicentre cross-sectional study with 1571 patients
    (Wolters Kluwer Medknow Publications, 2022) Kayiran, Melek Aslan; Karadag, Ayse Serap; Alyamac, Gokcen; Cemil, Bengu Cevirgen; Demirseren, Duriye Deniz; Demircan, Yuhanize Tas; Aksoy, Hasan
    Background: Acne vulgaris (AV) is among the common skin diseases for which patients refer to complementary and alternative medicine (CAM). Aims and Objectives: To investigate the approaches to CAM methods and factors believed to increase the disease in 1,571 AV patients. Materials and Methods: The sociodemographic characteristics of the patients and disease severity according to the Food and Drug Administration criteria were recorded. The Cardiff Acne Disability Index (CADI) was used to assess the impact of acne on the patient's life and the history of CAM use was noted. The patients also listed the factors that they thought worsened their disease and reported their gluten-free diet experiences. Results: Of all the patients, 74.41% had a history of using CAM methods. CAM use was significantly higher in women, patients with severe AV, those with a higher CADI score and non-smokers. As a CAM method, 66.37% of the patients reported having used lemon juice. The respondents most frequently applied CAM methods before consulting a physician (43.94%), for a duration of 0-2 weeks (38.97%). They learned about CAM methods on the internet (56.24%) and considered CAM methods to be natural (41.86%). The patients thought that food (78.55%) and stress (17.06%) worsened their disease. They considered that the most common type of food that exacerbated their symptoms was junk food (63.84%) and a gluten-free diet did not provide any benefit in relieving AV (50%). Conclusion: Physicians need to ask patients about their CAM use in order to be able to guide them appropriately concerning treatments and applications with a high level of evidence.