Handan Saçar

Bio: Handan Saçar is an academic researcher from Şifa University. The author has contributed to research in topics: Calcipotriol & Seborrheic dermatitis. The author has an hindex of 4, co-authored 24 publications receiving 34 citations.

Comparison of the Distributions of Seborrheic Dermatitis, Herpes Zoster and Pityriasis Rosea According to Seasons

Abstract: Amaç: Seboreik dermatit, herpes zoster ve pitriyazis rozean›n ortak özellikleri hava ›s›s›n›n düflük oldu¤u dönemlerde görülme s›kl›klar›n›n artmas›d›r. Biz çal›flmam›zda seboreik dermatit, herpes zoster ve pitriyazis rozea’n›n y›l içinde aylar ve mevsimler ile olan iliflkilerini saptamay› amaçlad›k. Gereç ve Yöntem: Aral›k 2006 Aral›k 2009 tarihleri aras›nda dermatoloji poliklini¤imize baflvuran 20397 hasta ve seboreik dermatit, herpes zoster ve pitriyazis rozea tan›s› alm›fl olan 1801 hasta otomasyon dosya sisteminden retrospektif olarak analiz edildi. Hastalar demografik verilere ve tan›lara göre grupland›r›ld›. Bulgular: Hastal›klar ile s›k görüldü¤ü mevsimler aras›nda istatistiksel olarak anlaml› iliflki tespit edildi (p<0,001). Seboreik dermatit %32,5 oran›nda sonbahar mevsiminde, herpes zoster %29,8 oran›nda sonbahar mevsiminde, pitriyazis rozea %31,0 oran›nda k›fl mevsiminde, tüm dermatolojik hastal›klar %29,1 oran›nda k›fl mevsiminde tespit edildi. Hastal›klar ile s›k görüldü¤ü aylar aras›nda istatistiksel olarak anlaml› iliflki tespit edildi (p<0,001). Seboreik dermatit %12,3 oran›nda kas›m ay›nda, herpes zoster %11,5 oran›nda eylül ay›nda, pitriyazis rozea %10,7 oran›nda ocak ay›nda, tüm dermatolojik hastal›klar %8,21 oran›nda flubat ay›nda tespit edildi. Sonuç: Çal›flma sonuçlar›m›z literatür bilgileri ile paralellik göstermektedir. Seboreik dermatit, herpes zoster, pitriyazis rozea ve tüm dermatolojik hastal›klar›n görülmesi aç›s›ndan sonbahar ve k›fl aylar› en yüksek oranda tespit edilmifltir. Ortam ›s›s›n›n düflmesi hücresel immun direncin deprese olmas›na neden olmakta, bunun da hastal›klara yatk›n bireylerde hastal›klar›n ortaya ç›kmas›na ya da nüksüne neden oldu¤unu düflünüyoruz. (Türkderm 2010; 44: 65-8) Anahtar Kelimeler: Seboreik dermatit, herpes zoster, pitriyazis rozea, mevsim, k›fl, sonbahar

Prevalence of Dermatosis During Childhood

Abstract: Amac: Cal›flmada cocukluk ca¤›ndaki deri hastal›klar›n›n da¤›l›m›n›n belirlenmesi amaclanm›flt›r. Gerec ve Yontem: Geriye donuk tan›mlay›c› bir cal›flma planland›. Eylul 2004 ile Kas›m 2009 tarihleri aras›nda Dermatoloji poliklini¤imize baflvuran 18318 hastadan 0 ile 12 yafl aras›ndaki 1756 cocuk hasta, otomasyon dosya sisteminden retrospektif olarak analiz edildi. Bulgular: Cal›flma suresince baflvuran toplam 1756 cocuk hasta cal›flmaya dahil edildi; hastalar›n 791’i (%45,05) erkek, 965’i (%54,95) k›z cocu¤uydu. En s›k gorulen hastal›k grubu ekzemalar (%26,0) olup bunu s›ras›yla infeksiyoz dermatozlar (%20,6), eritemli skuaml› dermatozlar (%9,9) izledi. Ekzema grubunda en s›k atopik dermatit (%8,0), infeksiyoz dermatoz grubunda en s›k viral dermatozlar (%11,7) ve eritemli skuaml› dermatoz grubunda da en s›k seboreik dermatit (%7,1) gorulmufltur. Sonuc: Tespit etti¤imiz hastal›klar›n %56.5’ini ekzemalar, infeksiyoz dermatozlar ve eritemli skuaml› dermatozlar›n oluflturdu¤u sonucuna var›lm›flt›r. (Turkderm 2010; 44: 132-7) Anahtar Kelimeler: Cocukluk ca¤›, deri hastal›klar›, ekzema, atopik dermatit, seboreik dermatit, viral dermatoz, retrospektif cal›flma

Basaloid follicular hamartoma on the upper eyelid

Abstract: Basaloid follicular hamartoma (BFH) is a benign rare neoplasm of the hair follicles whose clinical and histological appearance is very similar to basal cell carcinoma. Although these hamartomas are considered to be benign lesions, malignant differentiations have been reported. It may be generalized or localized, familial or sporadic, and BFH can be accompanied by systemic diseases. Although there are many clinical forms of BFH, they all have the same histopathological features. Basaloid follicular hamartoma is a folliculocentric tumor limited to the superficial dermis. Involvement of the deep reticular dermis or soft tissue is not seen in BFH [1]. We present a 52-year-old man with a solitary, hyperpigmented, asymptomatic, slow growing skin tumor on his left upper eyelid. A 52-year-old man presented with a slowly developing asymptomatic left upper eyelid lesion (over 4 years). Dermatological examination showed a solitary, smooth surfaced, hyperpigmented nodule measuring 1 cm in diameter (Figure 1), and there were no other similar skin lesions or significant internal diseases exhibited. He had no family history of similar lesions. The lesion was locally excised, and the specimen was grossly measured to be 1.2 × 0.7 × 0.2 cm. Figure 1 A solitary, smooth surfaced, hyperpigmented 1 cm nodule is located on the left upper eyelid of a 52-year-old man Low-power light microscopy revealed a well-circumscribed and completely removed lesion in the dermis, without connections to the epidermis (Figure 2). Microscopically, the tumor revealed strands and cords of small basaloid cells emanating from the infundibular portion of the hair follicle. The tumor stroma was scant and mildly fibrocellular. There was no nuclear pleomorphism, mitotic activity, apoptotic cells, or cleft formation between the tumor and the stroma (Figure 3), and upon immunohistochemical examination, Bcl-2 stained only in the outermost basal cells (Figure 4). Cd34 was positively stained in the peritumoral stroma and blood vessels (Figure 5), and CD10 was stained in the peritumoral stroma as well as the matrical cells (Figure 6). Figure 2 Low-power light microscopy revealed a well-circumscribed and completely removed lesion in the dermis, without connections to the epidermis (hematoxylin-eosin, original magnification at 40×) Figure 3 A biopsy specimen with basaloid follicular hamartoma shows strands and cords of small, basaloid cells emanating from the infundibular portion of the hair follicle. The tumor stroma was scant and mildly fibrocellular. There was no nuclear pleomorphism, ... Figure 4 Bcl-2 stains only the outermost basal cells in BFH (Bcl-2, 100×) Figure 5 CD34 is positive in the peritumoral stroma and blood vessels (CD34 100×) Figure 6 CD10 stains the peritumoral stroma of BFH, as well as the matrical cells (CD10 100×) Basaloid follicular hamartoma was first described in 1969 by Brown et al. as “generalized hair follicle hamartoma” with associated alopecia, aminoaciduria, and myasthenia gravis [2]. The term “basaloid follicular hamartoma” was first used for a patient who had a localized and solitary type of the lesion, without associated abnormalities, by Mehregan and Baker in 1985 [3]. Morohashi et al. described BFH as an abortive growth of secondary hair germs with a limited differentiation toward the upper follicular portion of the hair shaft [4]. Basaloid follicular hamartoma may manifest with different clinical presentations, such as a solitary lesion, or as multiple lesions with a generalized or localized distribution. Basaloid follicular hamartoma may present as individual or linearly distributed, small, skin-colored to brown papules or plaques, or as multiple lesions in a generalized distribution on the face, scalp, and occasionally, the trunk. Basaloid follicular hamartoma may be a familial, congenital, or acquired condition. Several forms of generalized BFH have been described: (1) sporadic form, multiple BFH without systemic disease; (2) generalized acquired form, female patients with generalized BFHs associated with alopecia and autoimmune diseases, such as myasthenia gravis or systemic lupus erythematosus, in which the lesions are found mainly on the face and periorificial areas; (3) generalized familial form, an autosomal dominant disease that may or may not be associated with hypotrichosis, hypohidrosis, and palmoplantar pitting, which appears on the face and genital region; (4) generalized congenital form, generalized BFH associated with other ectodermal defects, such as hypotrichosis and punctate keratotic pits, on the palms and soles and with cystic fibrosis [1]. The localized forms of BFH present as linear unilateral lesions or as plaques with alopecia [3–6]. The linear unilateral type of BFH is associated with lines of Blaschko and presents at birth or appears in early childhood [3, 5, 6]. Solitary BFH was first described in 1992 as a smooth plaque or a papule appearing most commonly on the face or scalp [7]. The pathogenesis of BFH has been linked to a mutation in the PTCH (patched) gene on chromosome band 9q23. However, this mutation is thought to be less severe than the PTCH gene mutation demonstrated in nevoid basal cell carcinoma syndrome (NBCS) [8–10]. The clinical differential diagnosis for BFH depends on its presentation. The most common misdiagnoses for individual lesions include basal carcinoma (BCC), intradermal melanocytic nevus, seborrheic keratosis, sebaceous hyperplasia, syringoma, angiofibroma, trichilemmoma, steatocystoma, trichoepithelioma (TE), basal cell hamartoma with follicular differentiation, and hamartoma of the sebaceous follicles. When presenting as a plaque, nevus sebaceous, lupus erythematosus, and sarcoidosis should be considered. Basaloid follicular hamartoma in a linear distribution may mimic linear epidermal nevus, lichen striatus, linear morphea, and basal cell nevus. The differential diagnosis of generalized BFH could include generalized follicular hamartoma syndrome, tuberous sclerosis, Cowden disease, multiple trichoepitheliomas, nevoid basal cell nevus syndrome, Rombo syndrome, and multiple tumors of the follicular infundibulum [11]. Basaloid follicular hamartoma is often misdiagnosed as trichoepithelioma or basal cell carcinoma, histopathologically [1]. Specifically, BFH consists of malformed and distorted hair follicles composed of cords and strands of basaloid cells. These cells are arranged in a radial, anastomosing fashion and may arise from the follicles and/or show an epidermal attachment. The tumor cells are bland, without nuclear pleomorphism, and mitotic activity is rare or absent, with little to no single cell necrosis. While the presence of peripheral palisading has been reported, this feature is typically lacking to the degree seen in BCC. The stroma is scant or absent, and when present, consists of eosinophilic compact collagen with no fibrocytes. Clefts within the fibrous stroma have been reported, and minimal clefting between the tumor and stroma has been observed, but it is not a well-accepted feature of BFH. Mucinous ground substance, if present, is usually subtle; furthermore, BCC displays a variety of histological patterns. The neoplastic cells may involve and destroy preexisting hair follicles and the interfollicular dermis, and sometimes, infiltrate the deeper dermis, subcutaneous fat, and skeletal muscle [12]. Differentiating BFH from BCC can be the most difficult aspect of the diagnosis, and additional immunohistochemical stains may help to separate BFH from BCC. Ki-67 (a proliferative marker associated with mitosis) and Bcl-2 staining are more prominent in BCC than in BFH. Bcl-2 stains only the outermost basal cells in BFH. CD 34 is an intercellular adhesion protein and cell surface glycoprotein; the ligand is CD62L (L-selectin). It is also called hematopoietic progenitor cell antigen and is a commonly used marker of hematopoietic progenitor cells and endothelial cells. CD34 also stains stromal cells and dendritic cells. In differential diagnosis it is important that the stromal cells of the BFH stain positive for CD34, but the stromal cells of BCC are negative [1, 12]. Although in BCC the stromal and tumor cells stain with CD10, in BFH, the peritumoral stroma and matrical cells stain with CD10 [13]. Histologically, TE has distinct islands of basaloid cells in a lacelike or adenoidal network and, occasionally, as solid aggregates; additionally, they exhibit a more nodular growth pattern than BFH. The tumor islands show peripheral palisading as in BCC; however, the stroma lacks the retraction artifact seen in BCC. In TE, the fibrocystic stroma is more prominent than in BFH, and it predominates over the epithelial portion. Additionally, in TE, normal follicular bulbs and papillae are seen [11]. While both BFH and TE have keratin cysts consisting of a fully keratinized center, surrounded by basophilic cells without high-grade atypia and mitoses, they are more prominent in TE. We report a case of solitary BFH that developed on the left upper eyelid of a man. Since only a few cases have been reported, presenting case reports will increase awareness of this disorder. Although BFH is a benign rare neoplasm of the hair follicles, it is important to differentiate it due to the malignancy risk and similar characteristics to other benign tumors.

Varicella and herpes zoster

Abstract: The identity of the virus for herpes zoster and chickenpox has long been guessed by pediatricians and eventually proven in 1958. The patients are infectious 2 days before the rash appears until 7 days later. Specific antibodies are found 2 days after the rash appeared. Varicella induce life long immunity which can weaken in old age or during immuno suppressive therapy, so that reactivation of the virus, most likely located in the spinal ganglia, causes the clinical symptoms of herpes zoster. About 7% of women in child-bearing age have no antibodies against the virus. Varicella during pregnancy may induce abortion or especially during the first 3 months severe embryopathies with organic lesions. Therefore young women who have not had the illness should be tested along with the test for rubella-antibodies, and subsequently vaccinated, at least 3 months before any planned pregnancy. The rather expensive varicella vaccination is justified in immunodeficient patients without varicella-antibodies, or in patients under immunosuppressive therapy without varicella-antibodies (minimal requirements of 1200 lymphocytes, interruption of cytostatics one week before and until 1 week after the vaccination, no irradiation for 3 months), or in women planning pregnancy, personnel caring for pregnant women or personnel who has no antibodies in intensive-care units for hematological-onkological patients.

Optical coherence tomography-guided laser microsurgery for blood coagulation with continuous-wave laser diode

Abstract: Blood coagulation is the clotting and subsequent dissolution of the clot following repair to the damaged tissue. However, inducing blood coagulation is difficult for some patients with homeostasis dysfunction or during surgery. In this study, we proposed a method to develop an integrated system that combines optical coherence tomography (OCT) and laser microsurgery for blood coagulation. Also, an algorithm for positioning of the treatment location from OCT images was developed. With OCT scanning, 2D/3D OCT images and angiography of tissue can be obtained simultaneously, enabling to noninvasively reconstruct the morphological and microvascular structures for real-time monitoring of changes in biological tissues during laser microsurgery. Instead of high-cost pulsed lasers, continuous-wave laser diodes (CW-LDs) with the central wavelengths of 450 nm and 532 nm are used for blood coagulation, corresponding to higher absorption coefficients of oxyhemoglobin and deoxyhemoglobin. Experimental results showed that the location of laser exposure can be accurately controlled with the proposed approach of imaging-based feedback positioning. Moreover, blood coagulation can be efficiently induced by CW-LDs and the coagulation process can be monitored in real-time with OCT. This technology enables to potentially provide accurate positioning for laser microsurgery and control the laser exposure to avoid extra damage by real-time OCT imaging.

Dermatological diseases in the geriatric age group: Retrospective analysis of 7092 patients

Abstract: AIM The aim of the present study was to retrospectively investigate the dermatological diseases seen in geriatric patients, and their distribution according to age, sex and season, making a significant contribution to the few previous prevalence studies. METHODS Data from 7092 geriatric patients examined at our dermatology clinic from 1 January to 31 December 2017 were retrospectively analyzed. The data were analyzed according to age, sex and seasons. RESULTS The seven most frequently occurring diseases were eczematous dermatitis, fungal infections, pruritus, precancerous and malignant neoplasm, xerosis cutis, benign neoplasms, and papulosquamous diseases, respectively. In the youngest group, the most frequent disease was eczematous dermatitis, whereas in the older group it was precancerous and malignant neoplasms. The most common disease for both men and women was eczematous dermatitis. Eczematous dermatitis, pruritus, xerosis cutis, rash and general drug eruptions, and papulosquamous diseases were most frequent in the winter, but less in the summer (P < 0.01). Fungal diseases were frequent in the spring and summer (P < 0.01). Pigmentation disorders were frequent in the summer (P < 0.01). CONCLUSIONS The present study, which is the largest prevalence study in the literature with 7092 geriatric patients, will raise awareness regarding the pattern and nature of dermatological diseases in geriatric patients. Geriatr Gerontol Int 2019; 19: 582-585.

Herpes Zoster in children: Evaluation of the sixty cases.

Abstract: Herpes Zoster (HZ), caused by the reactivation of the latent Varicella Zoster Virus infection is a disease that may rarely develop in childhood. HZ is considered to be a disease of adult, but recent reports show an increase in the number of cases in childhood. This study was designed to evaluate the demographic and clinical features of children with HZ. Data from patients under 18 years of age that were diagnosed with HZ at two different dermatology outpatient clinics were retrospectively evaluated between October 2012 and December 2018. Out of 60 cases enrolled in the study, 37 were male and 23 were female. The mean age of patients was 8 ± 4.93 years. Of all the cases, 46 had a history of chickenpox. Three patients had been vaccinated against chickenpox. Itching, observed in 48 subjects, was the most common symptom, while 38 subjects complained of pain. Acyclovir was prescribed as antiviral therapy in 33 cases. None of the cases showed any complication. HZ may occur in healthy children without any immunosuppression, too. Pain in children is less common than in adults whereas, itching is more frequent. Complications are rare in these subjects.