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Saraç, Esra

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Esra

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Saraç

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2018 - 201912020 - 20237

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    Differences between adult and pediatric chronic spontaneous urticaria from a cohort of 751 patients: clinical features, associated conditions and indicators of treatment response
    (John Wiley and Sons Inc, 2023) Özçeker, Deniz; Can, Pelin Kuteyla; Terzi, Özlem; Örnek, Sinem Ayşe; Değirmentepe, Ece Nur; Kızıltaç, Kübra; Saraç, Esra; Kocatürk Göncü, Özgür Emek; Faculty Member; Faculty Member; School of Medicine; School of Medicine; 172724; 217219
    Background: Chronic spontaneous urticaria (CSU) is a common disease both in the pediatric and in the adult population. However, there are differences between the two patient populations with respect to etiological factors, comorbidities, and treatment responses. Our aim was to determine differences between pediatric and adult CSU in terms of clinical characteristics, laboratory parameters, comorbidities, response to treatment, and indicators of response. Methods: A retrospective analysis of CSU patients was performed. Data regarding differences between pediatric and adult CSU patients were analyzed. Indicators of treatment response were determined separately in both pediatric and adult patients. Results: Of 751 CSU patients (162 pediatrics and 589 adults), female dominancy (48.8% vs. 69.6%) and rate of angioedema (19.1% vs. 59.8%) were lower, and disease duration (5 months vs. 12 months) was shorter in pediatric patients. Anti-TPO positivity (24.7% vs. 9%), elevated CRP (46.5% vs. 11.1%), eosinopenia (38.5% vs. 18.1%), and skin prick test positivity (39.3% vs. 28.8%) were significantly more frequent in adult patients. Response to antihistamines was higher in the pediatric group, and only 7% used omalizumab versus 20.8% in the adults. The comparisons were also performed between <12-year and ≥12-year patients and yielded similar results. Conclusion: Pediatric CSU shows distinct characteristics such as lower incidence of angioedema and antithyroid antibodies, and it responds better to antihistamines. These suggest that CSU becomes more severe and refractory in adolescents and adults. Adolescent CSU shows features similar to adult CSU rather than pediatric CSU.
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    Late recurrence of melanoma after 10 years - is the course of the disease different from early recurrences?
    (Wiley, 2020) Wilhelmi, Jasmin; Thomas, Ioannis; Leiter, Ulrike; Keim, Ulrike; Eigentler, Thomas K.; Garbe, Claus; Amaral, Tatiele; N/A; Saraç, Esra; Faculty Member; School of Medicine; Koç University Hospital; 172724
    Background: It is known that melanoma can metastasize and recur many years after the first diagnosis. Although predictive and prognostic factors for melanoma are well defined, there is still insufficient information about the factors affecting the recurrence period and the effect of the recurrence time to survival. Objectives: This study investigates the course of melanoma to show prognostic factors comparing early and late recurrence patients. The main objective is to uncover the effect of the recurrence time on the progression of the disease. Methods: In this retrospective study, late recurrence (LR) was defined as melanoma recurrence 10 years after the first diagnosis and early recurrence (ER) was defined as recurrence within 10 years. Gender, age, localization of primary tumour, time to first metastasis, survival rates, histological subtype, stage, tumour thickness, invasion level, ulceration and regression of the primary melanoma were documented. Survival curves were evaluated using the Kaplan-Meier and compared with the log-rank test. Multivariate Cox proportional hazard models were used to identify significant independent prognostic factors for melanoma-specific survival (MSS). Results A total of 1537 melanoma patients were analysed. Early metastasis was developed in 1438 patients (93.6%), and 99 patients (6.4%) developed late metastasis. Late recurrence patients were younger (P < 0.001) and had fewer ulcerated (P = 0.005), fewer head/neck localized (P = 0.009) and thinner (P < 0.001) melanomas than ER patients. The MSS time (mean +/- SD) was nearly identical for LR (31 +/- 4.4 months 95% CI [22.3-39.7]) and ER (32 +/- 1.9 months [28.3-35.7]). Multivariate regression analysis revealed male gender (hazard ratio [HR = 1.4, P < 0.001), truncal tumour localization (HR = 1.7, P < 0.001), tumour thickness (HR = 1.4, P < 0.045) and ulceration (HR = 1.3, P < 0.008) as significant independent prognostic factors for MSS. Conclusion: Although ER and LR patients are found to have different clinicopathologic features, the time of the first recurrence after diagnosis do not seem to have an effect on the survival.
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    Effect of a pseudoallergen-free diet in chronic spontaneous urticaria: a pilot study
    (Bilimsel Tip Yayinevi) Can, Pelin Kuteyla; Saraç, Esra; Kocatürk Göncü, Özgür Emek; Faculty Member; Faculty Member; School of Medicine; 172724; 217219
    Objective: The role of dietary factors in the etiopathogenesis of chronic spontaneous urticaria (CSU) has been a matter of discussion and it is widely accepted that most urticaria cases triggered by food are caused by pseudoallergic reactions. In this prospective study, our aim was to investigate the effect of a pseudoallergen-free diet (PAFD) on disease activity, the need for antihistamine use, and the quality of life in patients with CSU. Materials and Methods: The study included adult patients who were on follow up for CSU for a duration of at least 6 months and had symptoms every day or every other day. The patients were given a food diary, which also included assessment of daily disease activity. The daily Urticaria Activity Score (UAS), the Chronic Urticaria Quality of Life Questionnaire score at baseline and at the 4th week, and frequency of antihistamine use were obtained. According to the change in UAS (Delta UAS), the patients' response to PAFD was classified as strong (Delta UAS >= 8), partial (8>Delta UAS >= 4), or no response (Delta UAS<4). Results: Twenty-three patients, 19 females (82.6%) and 4 males (17.4%), completed the study, the mean age was 43 +/- 4.6 years. According to Delta UAS, 6 patients (26.1%) had strong response, 6 (26.1%) had partial response, and 11 (47.8%) were unresponsive to PAFD. The mean Delta UAS value of the patients who responded to PAFD was 8.1 (min:4, max:15). At the end of the study, 9 (39.1%) patients had a significant improvement in their quality of life. There were 6 (26%) patients who both responded to PAFD and had improved quality of life scores. The frequency of antihistamine use decreased in 10 (43.5%) patients. Conclusion: PAFD may help decrease disease activity in CSU. We observed that the frequency of antihistamine use could be reduced and the patient's quality of life could be improved by adding PFAD to antihistamine therapy.
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    Impact of psoriasis in the quality of life of children, adolescents and their families: a cross-sectional study
    (2018) Salman, Andaç; Yücelten, Ayşe Deniz; Sarıçam, Merve Hatun; Perdahli-Fis, Neşe; N/A; Saraç, Esra; Faculty Member; School of Medicine; Koç University Hospital; 172724
    Background: Psoriasis is a chronic and inflammatory disease that impairs quality of life and causes psychological symptoms. Despite the high prevalence of psoriasis in pediatric patients, studies investigating the impact of psoriasis in the quality of life of children, adolescents and families are sparse. Objective: To investigate the impact of psoriasis in the quality of life of children and adolescents with psoriasis and their families and to determine depression and anxiety levels of the patients. Methods: A total of 58 patients with psoriasis aged 7-18 years (median age: 11) and a family member of each patient were included in the study. Children's Dermatology Life Quality Index (CDLQI), Family Dermatology Life Quality Index (FDLQI), Children's Depression Inventory (CDI) and State-Trait Anxiety Inventory for Children (STAIC) were used in the study. Results: The median PASI score of the patients included in the study was 1.8. The median CDLQI and FDLQI scores in the study groups were 5 and 10, respectively. The median CDI score, STAIC-state and STAIC-trait scores of the patients were 6, 28 and 32.5, respectively. Study limitations: Lack of a control group and patient assessment of disease severity. Relatively mild disease severity of the subjects. Conclusions: Psoriasis has a negative impact in the quality of life of children, adolescents and their families, even in the presence of mild disease. Considering that impairment in quality of life may be associated with psychosocial morbidity, a combined approach with medical therapy, family counseling and quality of life assessment may be beneficial in this patient group.
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    Facial hypertrichosis after isotretinoin therapy: Is it a side effect or coincidence?
    (Turkderm-Turkish Archives of Dermatology and Venereology, 2022) Ünal, Alkım; N/A; Saraç, Esra; Faculty Member; School of Medicine; Koç University Hospital; 172724
    Background and Design: Excessive hair growth after isotretinoin treatment for acne vulgaris is not common, but may be one of the most undesirable side effects of the drug. The aim of this study is to investigate the relationship between systemic isotretinoin use and facial hypertrichosis. Materials and Methods: Female acne patients in premenopausal age were included in this prospective study. Laboratory tests [beta-human chorionic gonadotropin, total cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, aspartate aminotransferase, alanine aminotransferase] were evaluated initially and monthly during the study period. Hormone levels [luteinizing hormone, follicle stimulating hormone, total testosterone, free testosterone, dehydroepiandrosterone-sulfate (DHEAS), prolactin, 17-hydroxyprogesterone, glucose, and insulin] and abdominopelvic/transvaginal ultrasonography were also evaluated when there was a complaint or clinical findings of excessive hair growth. Body mass index (BMI) was calculated at the beginning of the study. Severity of the acne was assessed with Global Evaluation Acne Scale (GEAS). Hirsutism scores were calculated with Modified Ferriman-Gallwey score (m-FGS). Baseline and monthly taken digital dermoscopic photographs from the chin and cheeks were transferred to the ImageJ program to count the hair. Hair increases of >5% at the end of the treatment according to the basal hair count was accepted as hypertrichosis. Results: Thirty patients aged between 18-34 (median: 21.5) participated in the study. Mean duration of the therapy was 6.2±0.6 months. Facial hair growth was detected in three (10%) patients. One patient had an elevated DHEAS level with normal abdominal ultrasonography findings. Without the cessation of isotretinoin therapy, DHEAS level decreased to normal limits after two months. There was no statistically significant difference found between the mean GEAS (p=0.52), basal m-FGS (p=0.42), and BMI (p=0.71) of three patients with facial hypertrichosis, and in the remaining 27 patients. Facial hypertrichosis disappeared spontaneously 2 months (1-3 month) after the treatment courses were completed. Conclusion: The patho-mechanism of isotretinoin induced facial hair growth is not fully clarified. Since the facial hypertrichosis disappeared spontaneously when the treatment was ended, we think that this may be due to a temporary drug induced hormonal imbalance in susceptible individuals. / Amaç: İzotretinoin tedavisi sonrası görülen kıl artışı sık olmamasına rağmen ilacın en rahatsız edici yan etkilerinden biri olabilir. Bu çalışmanın amacı, sistemik izotretinoin kullanımı ile yüzde gelişen hipertrikoz arasındaki ilişkinin araştırılmasıdır. Gereç ve Yöntem: Bu prospektif çalışmaya premenapozal dönemdeki kadın akne vulgaris hastaları dahil edildi. Laboratuvar testleri (beta-insan koryonik gonadotropin, total kolesterol, trigliserid, düşük yoğunluklu lipoprotein, yüksek yoğunluklu lipoprotein, aspartat aminotransferaz, alanin aminotransferaz) tedavi başında ve çalışma boyunca aylık olarak değerlendirildi. Çalışmanın başında vücut kitle indeksi (VKİ) hesaplandı. Hastaların kıl artışı şikayeti olduğunda veya artış hekim tarafından gözlendiğinde ek olarak hormon [lüteinleştirici hormon, folikül uyarıcı hormon, total testosteron, serbest-testosteron, dehidroepiandrosteron-sülfat (DHEAS), prolaktin, 17-hidroksiprogesteron, glikoz, insülin] seviyeleri ve abdominopelvik/transvajinal ultrasonografi değerlendirildi. Akne şiddeti Global Akne Değerlendirme Ölçeği (GADÖ) ile, hirsutizm skoru modifiye Ferriman-Gallwey (m-FGS) skoru ile hesaplandı. Çene ve yanakların bazal ve aylık çekilen dijital dermoskopik fotoğrafları kıl sayımı için ImageJ programına aktarıldı. Bazal kıl sayısına göre tedavi sonunda %5’ten fazla kıl artışı hipertrikoz olarak kabul edildi. Bulgular: Çalışmaya 18-34 (ortanca: 21,5) yaş arasındaki 30 hasta katıldı. Ortalama tedavi süresi 6,2±0,6 aydı. Yüzde kıl artışı 3 (%10) hastada tespit edildi. Bir hastada DHEAS seviyesi yüksek olup bu hastanın abdominal ultrasonografisi normaldi. İzotretinoin tedavisi kesilmeden DHEAS seviyesi 2 ay sonra normale döndü. Yüzde kıllanma artışı olan 3 hasta ile diğer 27 hastanın ortalama GADÖ (p=0,52), bazal m-FGS (p=0,42) ve VKİ (p=0,71) değerleri karşılaştırıldığında istatiksel olarak anlamlı fark bulunmadı. Tedavi kürleri tamamlandıktan ortalama 2 (1-3) ay sonra hipertrikozun spontan olarak kaybolduğu gözlendi. Sonuç: İzotretinoinle indüklenen yüzde kıl artışının patomekanizması tam olarak aydınlatılamamıştır. Tedavi tamamlandıktan sonra kıllanmanın spontan olarak düzelmesi, bu durumun duyarlı kişilerde ilaca bağlı geçici bir hormonal dengesizlik sonucu oluşabileceğini düşündürmektedir.
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    PublicationOpen Access
    Facial hypertrichosis after isotretinoin therapy: is it a side effect or coincidence?
    (Galenos Yayınevi, 2022) Ünal, Alkım; Saraç, Esra; Faculty Member; School of Medicine; Koç University Hospital; 172724
    Background and design: excessive hair growth after isotretinoin treatment for acne vulgaris is not common, but may be one of the most undesirable side effects of the drug. The aim of this study is to investigate the relationship between systemic isotretinoin use and facial hypertrichosis. Materials and methods: female acne patients in premenopausal age were included in this prospective study. Laboratory tests [beta-human chorionic gonadotropin, total cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, aspartate aminotransferase, alanine aminotransferase] were evaluated initially and monthly during the study period. Hormone levels [luteinizing hormone, follicle stimulating hormone, total testosterone, free testosterone, dehydroepiandrosterone-sulfate (DHEAS), prolactin, 17-hydroxyprogesterone, glucose, and insulin] and abdominopelvic/transvaginal ultrasonography were also evaluated when there was a complaint or clinical findings of excessive hair growth. Body mass index (BMI) was calculated at the beginning of the study. Severity of the acne was assessed with Global Evaluation Acne Scale (GEAS). Hirsutism scores were calculated with Modified Ferriman-Gallwey score (m-FGS). Baseline and monthly taken digital dermoscopic photographs from the chin and cheeks were transferred to the Image., program to count the hair. Hair increases of >5% at the end of the treatment according to the basal hair count was accepted as hypertrichosis. Results: thirty patients aged between 18-34 (median: 21.5) participated in the study. Mean duration of the therapy was 6.2 +/- 0.6 months. Facial hair growth was detected in three (10%) patients. One patient had an elevated DHEAS level with normal abdominal ultrasonography findings. Without the cessation of isotretinoin therapy, DHEAS level decreased to normal limits after two months. There was no statistically significant difference found between the mean GEAS (p=0.52), basal m-FGS (13=0.42), and BMI (p=0.71) of three patients with facial hypertrichosis, and in the remaining 27 patients. Facial hypertrichosis disappeared spontaneously 2 months (1-3 month) after the treatment courses were completed. Conclusion: the patho-mechanism of isotretinoin induced facial hair growth is not fully clarified. Since the facial hypertrichosis disappeared spontaneously when the treatment was ended, we think that this may be due to a temporary drug induced hormonal imbalance in susceptible individuals. / Amaç: izotretinoin tedavisi sonrası görülen kıl artışı sık olmamasına rağmen ilacın en rahatsız edici yan etkilerinden biri olabilir. Bu çalışmanın amacı, sistemik izotretinoin kullanımı ile yüzde gelişen hipertrikoz arasındaki ilişkinin araştırılmasıdır. Gereç ve yöntem: bu prospektif çalışmaya premenapozal dönemdeki kadın akne vulgaris hastaları dahil edildi. Laboratuvar testleri (beta-insan koryonik gonadotropin, total kolesterol, trigliserid, düşük yoğunluklu lipoprotein, yüksek yoğunluklu lipoprotein, aspartat aminotransferaz, alanin aminotransferaz) tedavi başında ve çalışma boyunca aylık olarak değerlendirildi. Çalışmanın başında vücut kitle indeksi (VKİ) hesaplandı. Hastaların kıl artışı şikayeti olduğunda veya artış hekim tarafından gözlendiğinde ek olarak hormon [lüteinleştirici hormon, folikül uyarıcı hormon, total testosteron, serbest-testosteron, dehidroepiandrosteron-sülfat (DHEAS), prolaktin, 17-hidroksiprogesteron, glikoz, insülin] seviyeleri ve abdominopelvik/transvajinal ultrasonografi değerlendirildi. Akne şiddeti Global Akne Değerlendirme Ölçeği (GADÖ) ile, hirsutizm skorumodifiye Ferriman-Gallwey (m-FGS) skoru ile hesaplandı. Çene ve yanakların bazal ve aylık çekilen dijital dermoskopik fotoğrafları kıl sayımı için ImageJ programına aktarıldı. Bazal kıl sayısına göre tedavi sonunda %5’ten fazla kıl artışı hipertrikoz olarak kabul edildi. Bulgular: çalışmaya 18-34 (ortanca: 21,5) yaş arasındaki 30 hasta katıldı. Ortalama tedavi süresi 6,2±0,6 aydı. Yüzde kıl artışı 3 (%10) hastada tespit edildi. Bir hastada DHEAS seviyesi yüksek olup bu hastanın abdominal ultrasonografisi normaldi. İzotretinoin tedavisi kesilmeden DHEAS seviyesi 2 ay sonra normale döndü. Yüzde kıllanma artışı olan 3 hasta ile diğer 27 hastanın ortalama GADÖ (p=0,52), bazal m-FGS (p=0,42) ve VKİ (p=0,71) değerleri karşılaştırıldığında istatiksel olarak anlamlı fark bulunmadı. Tedavi kürleri tamamlandıktan ortalama 2 (1-3) ay sonra hipertrikozun spontan olarak kaybolduğu gözlendi. Sonuç: izotretinoinle indüklenen yüzde kıl artışının patomekanizması tam olarak aydınlatılamamıştır. Tedavi tamamlandıktan sonra kıllanmanın spontan olarak düzelmesi, bu durumun duyarlı kişilerde ilaca bağlı geçici bir hormonal dengesizlik sonucu oluşabileceğini düşündürmektedir.
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    PublicationOpen Access
    Relationship between disease severity, perceived stress, and depression in patients with seborrheic dermatitis
    (Marmara University School of Medicine, 2022) Saraç, Esra; Kocatürk Göncü, Özgür Emek; Faculty Member; School of Medicine; 172724; 217219
    Objective: a significant proportion of patients with seborrheic dermatitis state that disease attacks are triggered by psychological stress and disease severity increases during stressful times. This study aimed to determine the relationship between disease severity and perceived stress and depression levels in patients with seborrheic dermatitis. Patients and methods: the patients' demographic characteristics, medical history, and Seborrheic Dermatitis Area Severity Index (SDASI), Perceived Stress Scale (PSS), and Beck Depression Inventory (BDI) scores were recorded, and the relationship between disease severity and the scale scores were statistically analyzed by comparing disease severity groups and using correlation analyses. Results: the study included 120 patients with seborrheic dermatitis. The mean age of the patients was 29.5 +/- 8.2 years, and the female/ male ratio was 49/71. According to disease severity, 66 (55%) patients were classified as mild, 30(25%) moderate, and 24 (20%) as severe seborrheic dermatitis. When the scale scores were evaluated, a significant positive correlation was found between SDASI and PSS (r=0.767, p<0.001), between SDASI and BDI (r=0.663, p<0.001), and between PSS and BDI (r=0.687, p<0.001). Conclusion: a significant relationship was observed between disease severity, stress, and depression in patients with seborrheic dermatitis. There is a need for a multidisciplinary approach involving a dermatologist and psychiatrist in the follow-up and treatment of these patients.
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    PublicationOpen Access
    Diagnostic accuracy of electrical impedance spectroscopy in non-melanoma skin cancer
    (Medical Journals Sweden AB, 2020) Meiwes, Andreas; Eigentler, Thomas K.; Forchhammer, Stephan; Kofler, Lukas; Hafner, Hans-Martin; Garbe, Claus; Saraç, Esra; Faculty Member; Koç University Hospital
    Electrical impedance spectroscopy is a non-invasive technique that can help clinicians in diagnosing malignant skin tumours. Depending on the cellular irregularity of the lesion, electrical impedance spectroscopy can reveal changes in the structure and form of the cells, using a harmless electrical current applied to the skin. A score between 0 and 10 is generated by the electrical impedance spectrometer, where 0 is considered benign and 10 is malignant. This prospective study was conducted in 101 patients with a total of 200 skin lesions; 62 benign and 138 malignant. There was a significant difference between the electrical impedance of malignant and benign lesions (p < 0.001). The sensitivity, specificity, positive predictive value and negative predictive value of electrical impedance spectroscopy for non-melanoma skin cancer were 94.2%, 41.9%, 78.3% and 76.5%, respectively, when the cut-off for the electrical impedance spectroscopy score was set between 5 and 6. The area under the curve in receiver operating characteristics analyses was 0.758.
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    Prognostic factors in 161 patients with mucosal melanoma: a study of German Central Malignant Melanoma Registry
    (Wiley, 2020) Amaral, T.; Keim, U.; Leiter, U.; Forschner, A.; Eigentler, T. K.; Garbe, C.; Saraç, Esra; Faculty Member; Koç University Hospital
    Background: mucosal melanoma is a rare malignancy which represents approximately 1% of all melanomas. It is shown that mucosal melanomas have a different biology and less favourable prognosis than its cutaneous counterpart. Objectives: predictive and prognostic factors of survival for mucosal melanoma have not yet been elucidated. The aim of this study was to investigate risk factors affecting the course of mucosal melanoma patients followed in our clinic. Methods: one hundred and sixty-one patients with mucosal melanoma prospectively documented in the German Central Malignant Melanoma Registry (CMMR) were included in this study. Gender, age, localization, stage at first medical examination, tumour thickness and mutational status were documented. The American Joint Committee on Cancer (AJCC), 7th edition was used to define tumour stage. Kaplan-Meier survival curves were evaluated compared with the log-rank test. Multivariate Cox proportional hazard models were used to identify significant independent prognostic factors. Results: according to the localization, patients were categorized in 44.7% oral-nasal, 28.6% genital, 20.5% anorectal and 6.2% visceral. Genital mucosal melanomas had the most favourable 5-year OS rate (58.6%) followed by visceral (58.3%) and oral-nasal (39.3%). Anorectal melanomas had the worst OS time (median: 21 +/- 4.8 months) and 5-year survival rate (22.7%). Patients <60 years had a better survival than the older group (P = 0.013). Tumour stage at the time of the first medical examination was also a significant factor for survival (P = 0.001). Gender and mutational status were found to have no effect on survival. Age (HR = 2.1) and stage at first medical examination (Stage I vs. Stage IV; HR = 8.2) are shown to be significant independent prognostic factors on multivariate Cox regression analysis, but not localization. Conclusion: in this study, we observed that older age and advanced stage have significant negative effects on the survival of mucosal melanoma. Thus, the AJCC staging system is applicable for mucosal melanoma.