Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Bir Üniversite Hastanesinin Dermatoloji Polikliniğine Başvuran Hidradenitis Süpürativa Hastalarının Demografik ve Klinik Özellikleri: Prospektif Bir Çalışma
Clinical and Demographic Characteristics of Hidradenitis Suppurativa Patients Application to the Dermatology Clinic of a University Hospital: A Prospective Study
Bilal SULAa , Ümit EKİNCİa
aDicle Üniversitesi Tıp Fakültesi Hastanesi, Deri ve Zührevi Hastalıkları ABD, Diyarbakır, Türkiye
Turkiye Klinikleri J Med Sci. 2023;43(2):171-7
doi: 10.5336/medsci.2022-93830
Article Language: TR
Full Text
ÖZET
Amaç: Hidradenitis süpürativa (HS) veya akne inversa, çoğunlukla puberte sonrası ortaya çıkan ağrılı, derin yerleşimli, iltihaplı lezyonlarla karakterize kronik, inflamatuar, tekrarlayıcı bir deri hastalığıdır. Aksiller, inguinal ve anogenital bölgeler gibi vücudun apokrin bezlerden zengin bölgelerinde daha sık görülür. Çalışmamızda, dermatoloji polikliniğine başvuran HS tanılı ve ilk defa HS tanısı alan hastaların klinik ve sosyodemografik özelliklerini değerlendirdik. Gereç ve Yöntemler: Çalışmaya, dermatoloji ana bilim dalı polikliniğine başvuran HS tanılı ve ilk defa HS tanısı alan 50 hasta dâhil edildi. Çalışmaya dâhil edilen hastaların sosyodemografik özellikleri ve klinik bulguları kaydedildi. HS tanı kriterlerini karşılayan tüm hastalar çalışmaya dâhil edildi. Bulgular: HS ortalama başlangıç yaşı 22,52 yıl olup, erkeklerde daha ileri yaşlardaydı (p=0,001). HS tanısında ortalama gecikme süresi 73,66 ay olup, erkeklerde daha kısaydı (p=0,003). Hastaların %68'i fazla kilolu, obez ve morbid obez kategorisindeydi. Hastaların %72'sinde sigara öyküsü vardı. Hasta yoğunluğu orta ve şiddetli Hurley evrelerinde daha fazlaydı (evre II %48 ve evre III %32). En sık aksiller bölge (%90), inguinal bölge (%70) ve meme arası-altı bölgesi (%46) etkilenmişti. Erkeklerde aksiller ve atipik yerleşim bölgeleri, kadınlarda ise meme arası ve altı bölgesi yerleşimi anlamlıydı (p<0,05). Sigara öyküsü, yerleşim yerinin aksiller, inguinal ve gluteal bölge olması, toplam etkilenen bölge sayısı, foliküler oklüzyon bileşenlerinin eşlik etmesi ile hastalık şiddeti ilişkiliydi (p<0,05). Sonuç: Çalışmamızda hasta sayısı sınırlı olsa da ülkemiz HS epidemiyolojisine de katkıda bulunacaktır. Elde ettiğimiz veriler; ülkemiz ve diğer ülke verilerine benzemekle beraber birtakım farklılıklar göstermektedir. Bu da HS etiyopatogenezinde genetik ve etnik faktörlerin, sigara ve beslenme alışkanlıklarının rolü olabileceğini düşündürmektedir.

Anahtar Kelimeler: Epidemiyoloji; hidradenitis süpürativa; Hurley evrelemesi; klinik özellikler; sosyodemografik özellikler
ABSTRACT
Objective: Hidradenitis suppurativa (HS) or acne inversa is a chronic, inflammatory, recurrent skin disease characterized by painful, deeply located, inflammatory lesions that occur mostly after puberty. It is more common in areas of the body rich in apocrine glands, such as the axilla, inguinal and anogenital regions. In our study, we evaluated the clinical and sociodemographic characteristics of patients diagnosed with HS and diagnosed with HS for the first time, who applied to the dermatology policlinic. Material and Methods: Fifty patients diagnosed with HS and diagnosed with HS for the first time, who applied to the dermatology department polyclinic were included in the study. Sociodemographic characteristics and clinical findings of the patients included in the study were recorded. All patients who met the diagnostic criteria for HS were included in the study. Results: The mean age of onset of HS was 22.52 years and it was more advanced in males (p=0.001). The mean delay time in the diagnosis of HS was 73.66 months and it was shorter in men (p=0.003). 68% of the patients were in the overweight, obese and morbidly obese categories. 72% of the patients had a history of smoking. In our study, the patient density was higher in moderate and severe Hurley stages (Hurley stage II 48% and stage III 32%). The axillary region (90%) and inguinal region (70%) and interbreast and submammary region (46%) were most frequently affected. In men, axillary and atypical localization regions were significant, while in women, the location between and below the breasts was significant (p<0.05). The severity of the disease was associated with smoking history, localization in the axilla, inguinal and gulteal region, total number of affected areas, and accompanying follicular occlusion components (p<0.05). Conclusion: Although the number of patients in our study was limited, it will also contribute to the epidemiology of HS in our country. The data we obtained; although it is similar to the data of our country and other countries, it shows some differences. This suggests that genetic and ethnic factors, smoking and dietary habits may play a role in the etiopathogenesis of HS.

Keywords: Epidemiology; hidradenitis suppurativa; Hurley staging; clinical features; sociodemographic features
REFERENCES:
  1. Zouboulis CC, Desai N, Emtestam L, Hunger RE, Ioannides D, Juhász I, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol. 2015;29(4):619-44. [Crossref]  [PubMed] 
  2. von der Werth JM, Williams HC. The natural history of hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2000;14(5):389-92. [Crossref]  [PubMed] 
  3. Sung S, Kimball AB. Counterpoint: analysis of patient claims data to determine the prevalence of hidradenitis suppurativa in the United States. J Am Acad Dermatol. 2013;69(5):818-9. [Crossref]  [PubMed] 
  4. Vinding GR, Miller IM, Zarchi K, Ibler KS, Ellervik C, Jemec GB. The prevalence of inverse recurrent suppuration: a population-based study of possible hidradenitis suppurativa. Br J Dermatol. 2014;170(4):884-9. [Crossref]  [PubMed] 
  5. van der Zee HH, van der Woude CJ, Florencia EF, Prens EP. Hidradenitis suppurativa and inflammatory bowel disease: are they associated? Results of a pilot study. Br J Dermatol. 2010;162(1):195-7. [Crossref]  [PubMed] 
  6. Scheinfeld N. Diseases associated with hidranitis suppurativa: part 2 of a series on hidradenitis. Dermatol Online J. 2013;19(6):18558. [Crossref]  [PubMed] 
  7. Scala E, Cacciapuoti S, Garzorz-Stark N, Megna M, Marasca C, Seiringer P, et al. Hidradenitis suppurativa: where we are and where we are going. Cells. 2021;10(8):2094. [Crossref]  [PubMed]  [PMC] 
  8. Napolitano M, Megna M, Timoshchuk EA, Patruno C, Balato N, Fabbrocini G, et al. Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment. Clin Cosmet Investig Dermatol. 2017;10:105-15. [Crossref]  [PubMed]  [PMC] 
  9. Vinkel C, Thomsen SF. Hidradenitis suppurativa: causes, features, and current treatments. J Clin Aesthet Dermatol. 2018;11(10):17-23. [PubMed]  [PMC] 
  10. Pink A, Anzengruber F, Navarini AA. Acne and hidradenitis suppurativa. Br J Dermatol. 2018;178(3):619-31. [Crossref]  [PubMed] 
  11. Schneider-Burrus S, Jost A, Peters EMJ, Witte-Haendel E, Sterry W, Sabat R. Association of hidradenitis suppurativa with body image. JAMA Dermatol. 2018;154(4):447-51. [Crossref]  [PubMed]  [PMC] 
  12. Revuz JE, Jemec GB. Diagnosing hidradenitis suppurativa. Dermatol Clin. 2016;34(1):1-5. [Crossref]  [PubMed] 
  13. Schrader AM, Deckers IE, van der Zee HH, Boer J, Prens EP. Hidradenitis suppurativa: a retrospective study of 846 Dutch patients to identify factors associated with disease severity. J Am Acad Dermatol. 2014;71(3):460-7. [Crossref]  [PubMed] 
  14. Revuz JE, Canoui-Poitrine F, Wolkenstein P, Viallette C, Gabison G, Pouget F, et al. Prevalence and factors associated with hidradenitis suppurativa: results from two case-control studies. J Am Acad Dermatol. 2008;59(4):596-601. [Crossref]  [PubMed] 
  15. Garg A, Kirby JS, Lavian J, Lin G, Strunk A. Sex- and age-adjusted population analysis of prevalence estimates for hidradenitis suppurativa in the United States. JAMA Dermatol. 2017;153(8):760-4. [Crossref]  [PubMed]  [PMC] 
  16. Choi E, Chandran NS. Rethinking the female predominance in hidradenitis suppurativa. Int J Dermatol. 2019;58(3):e57-8. [Crossref]  [PubMed] 
  17. Özkur E, Karadağ AS, Üstüner P, Aksoy B, Eşme P, Çalışkan E, et al. Clinical and demographic features of hidradenitis suppurativa: a multicentre study of 1221 patients with an analysis of risk factors associated with disease severity. Clin Exp Dermatol. 2021;46(3):532-40. [Crossref]  [PubMed] 
  18. Vural S, Gündoğdu M, Akay BN, Boyvat A, Erdem C, Koçyiğit P, et al. Hidradenitis suppurativa: clinical characteristics and determinants of treatment efficacy. Dermatol Ther. 2019;32(5):e13003. [Crossref]  [PubMed] 
  19. Yüksel M, Basım P. Demographic and clinical features of hidradenitis suppurativa in Turkey. J Cutan Med Surg. 2020;24(1):55-9. [Crossref]  [PubMed] 
  20. Chandran NS, Lee JH, Kurokawa I. Hidradenitis suppurativa in South-East Asia and East Asia. Exp Dermatol. 2021;30 Suppl 1:23-6. [Crossref]  [PubMed] 
  21. Saunte DM, Boer J, Stratigos A, Szepietowski JC, Hamzavi I, Kim KH, et al. Diagnostic delay in hidradenitis suppurativa is a global problem. Br J Dermatol. 2015;173(6):1546-9. [Crossref]  [PubMed] 
  22. Von Der Werth JM, Williams HC, Raeburn JA. The clinical genetics of hidradenitis suppurativa revisited. Br J Dermatol. 2000;142(5):947-53. [Crossref]  [PubMed] 
  23. Yang JH, Moon J, Kye YC, Kim KJ, Kim MN, Ro YS, et al; Korean Society for Acne Research. Demographic and clinical features of hidradenitis suppurativa in Korea. J Dermatol. 2018;45(12):1389-95. [Crossref]  [PubMed] 
  24. Kurokawa I, Hayashi N; Japan Acne Research Society. Questionnaire surveillance of hidradenitis suppurativa in Japan. J Dermatol. 2015;42(7):747-9. [Crossref]  [PubMed] 
  25. Hoffman LK, Ghias MH, Lowes MA. Pathophysiology of hidradenitis suppurativa. Semin Cutan Med Surg. 2017;36(2):47-54. [Crossref]  [PubMed] 
  26. Vazquez BG, Alikhan A, Weaver AL, Wetter DA, Davis MD. Incidence of hidradenitis suppurativa and associated factors: a population-based study of Olmsted County, Minnesota. J Invest Dermatol. 2013;133(1):97-103. [Crossref]  [PubMed]  [PMC] 
  27. Acharya P, Mathur M. Hidradenitis suppurativa and smoking: a systematic review and meta-analysis. J Am Acad Dermatol. 2020;82(4):1006-11. [Crossref]  [PubMed] 
  28. Kohorst JJ, Kimball AB, Davis MD. Systemic associations of hidradenitis suppurativa. J Am Acad Dermatol. 2015;73(5 Suppl 1):S27-35. [Crossref]  [PubMed] 
  29. Kromann CB, Deckers IE, Esmann S, Boer J, Prens EP, Jemec GB. Risk factors, clinical course and long-term prognosis in hidradenitis suppurativa: a cross-sectional study. Br J Dermatol. 2014;171(4):819-24. [Crossref]  [PubMed] 
  30. Canoui-Poitrine F, Revuz JE, Wolkenstein P, Viallette C, Gabison G, Pouget F, et al. Clinical characteristics of a series of 302 French patients with hidradenitis suppurativa, with an analysis of factors associated with disease severity. J Am Acad Dermatol. 2009;61(1):51-7. [Crossref]  [PubMed] 
  31. Vankeviciute RA, Polozovaite B, Trapikas J, Raudonis T, Grigaitiene J, Bylaite-Bucinskiene M. A 12-year experience of hidradenitis suppurativa management. Adv Skin Wound Care. 2019;32(1):1-7. [Crossref]  [PubMed] 
  32. Matusiak L, Bieniek A, Szepietowski JC. Psychophysical aspects of hidradenitis suppurativa. Acta Derm Venereol. 2010;90(3):264-8. [Crossref]  [PubMed] 
  33. Kimball AB, Sundaram M, Gauthier G, Guérin A, Pivneva I, Singh R, et al. The comorbidity burden of hidradenitis suppurativa in the United States: a claims data analysis. Dermatol Ther (Heidelb). 2018;8(4):557-69. [Crossref]  [PubMed]  [PMC] 
  34. Wertenteil S, Strunk A, Garg A. Overall and subgroup prevalence of acne vulgaris among patients with hidradenitis suppurativa. J Am Acad Dermatol. 2019;80(5):1308-13. [Crossref]  [PubMed] 
  35. Omine T, Miyagi T, Hayashi K, Yamaguchi S, Takahashi K. Clinical characteristics of hidradenitis suppurativa patients in Okinawa, Japan: differences between East Asia and Western countries. J Dermatol. 2020;47(8):855-62. [Crossref]  [PubMed] 

.: Up To Date

.: Process List

Login



Contact


Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com