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    Clinical course of psoriasis patients that discontinued biologics during the COVID-19 pandemic
    (Wiley, 2023) Demir, Filiz Topaloglu; Ekinci, Algun Polat; Aytekin, Sema; Topkarci, Zeynep; Kayiran, Melek Aslan; Akbulut, Tugba Ozkok; Topal, Ilteris Oguz
    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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    Habits of Using Social Media and the Internet in Psoriasis Patients
    (Mattioli 1885, 2022) Kayiran, Melek Aslan; Karadag, Ayse Serap; Topal, Ilteris Oguz; Adisen, Esra; Kilic, Sevilay; Keskin, Nuray; Polat, Asude Kara
    Introduction: Psoriasis significantly affects the patients quality of life, which often leads patients to seek online information about this disease. Objectives: To explore the habits of patients with psoriasis related to their use of social media (SM) and the internet to obtain information about their disease. Methods: 1,520 patients completed the survey and the Dermatology Life Quality Index (DLQI) -questionnaire. The Psoriasis Area Severity Index scores (PASI) and clinical data of the patients were recorded by their physicians. Results: Of the 1,114 patients that reported using SM and internet, 48.38% regularly and 31.14% sometimes resorted to obtain information about psoriasis. The use of SM and internet for psoriasis was statistically significantly higher among young people (P = 0.000), those with university or higher education (P = 0.009), higher DLQI (P = 0.000) and PASI (P = 0.011) scores, facial (P = 0.050), scalp (P = 0.032), hand (P = 0.048), genital (P = 0.001) and inverse (P = 0.000) involvement, and arthralgia/arthritis (P = 0.006). The participants mostly used the Google (86%) and Facebook (41%). More than half of the participants (62.8%) expected dermatologists to inform society that psoriasis is not contagious. Conclusions: Internet and SM being widely available and offering substantial information to be easily accessed make it very attractive for patients to use these platforms to investigate diseases, including psoriasis. If what is presented on SM conflicts with what the physician says, patients mostly trust the latter, but at the same time, they tend not to share the results of their online inquiries with their physicians.
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    Patient Use of Complementary and Alternative Medicine for Psoriasis Vulgaris and Factors Believed to Trigger the Disease: a Multicenter Cross-Sectional Study With 1621 Patients
    (Mattioli 1885, 2022) Kayiran, Melek Aslan; Karadag, Ayse Serap; Topal, Ilteris Oguz; Emre, Selma; Adisen, Esra; Kilic, Sevilay; Keskin, Nuray
    Introduction: Due to the chronic recurrent nature of psoriasis vulgaris (PV) and lack of definitive treatment for the disease, patients often resort to alternative treatments. Physicians seem to have low awareness of this issue. Objectives: To elicit the perceptions of 1,621 PV patients on complementary and alternative medicine (CAM) and examine factors reported to worsen PV. Methods: The patients sociodemographic characteristics, Psoriasis Area Severity Index (PASI), Dermatology Life Quality Index (DLQI), disease duration, and severity were recorded, and the patients CAM use was questioned in detail. The patients were also asked about factors that worsened PV and their experiences with a gluten-free diet. Results: Of the patients, 56.51% had used CAM. The mean age, illness duration, PASI scores and DLQI of those using CAM were significantly higher. CAM use was significantly higher in those with facial, genital involvement, and arthralgia/arthritis. The patients mostly referred to CAM when PV became severe (46.4%). Of the CAM users, 45.52% used herbal topicals. The physicians of 67.03% did not inquire whether they used CAM. Of the participants, 37.73% considered that stress worsened their disease. Gluten-free diet did not affect PV symptoms in 52.22%. Conclusions: Patients CAM use is often overlooked by dermatologists. Our results showed that more than half the patients used CAM and did not share this information with their physicians. Therefore, the awareness of physicians should be increased and patients should be asked about the use of CAM and directed to the appropriate medical treatment options by physicians.
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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, 2022) Kayiran, Melek Aslan; Karadag, Aye Serap; Alyamac, Gokcen; Cemil, Bengu Cevirgen; Demirseren, Duriye Deniz; Demircan, Yuhanize Tas; Aksoy, Hasan
    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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    Social media use in patients with acne vulgaris: What do patients expect from social media?
    (Wiley, 2021) Kayiran, Melek Aslan; Karadag, Ayse Serap; Alyamac, Gokcen; Cemil, Bengu Cevirgen; Demirseren, Duriye Deniz; Aksoy, Hasan; Kilic, Sevilay Oguz
    Background Acne vulgaris (AV) may affect external appearance and significantly deteriorate the quality of life of patients. Therefore, patients make various inquiries about their disease and seek treatment options. Aims To investigate the social media usage habits of patients with AV concerning their diseases, and their recommendations for dermatologists related to social media use. Methods A total of 1609 patients with AV completed the survey prepared by the authors and the Cardiff Acne Disability Index questionnaire. The Food and Drug Administration severity scores and clinical information of the patients were noted by their physicians. Results Of the 1,489 patients who stated that they used social media, 46.31% regularly and 28.77% sometimes referred to these sources to make inquiries about AV. Social media usage for AV was statistically significantly higher in women, participants with short term and severe disease, those with a moderate income level, and those using topical treatment and cosmetics. They mostly used Google (67%), Instagram (54%), and YouTube (49%). While 76% of the participants stated that they did not share what they saw on the Internet with their doctor. Of the respondents, 18.5% were trying to contact their dermatologists through the Internet, and 69.73% would prefer experts such as dermatologists to post-AV-related content. Conclusions Our study shows that patients frequently resort to social media to seek information about AV. In the changing digital world order, it is observed that there is a need for dermatologists to use social media more actively to share accurate information about AV.
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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.