Turkiye Klinikleri Journal of Dermatology

.: SCIENTIFIC EVENTS
Türkiye Hidradenitis Süpürativa Tanı ve Tedavi Kılavuzu
The Turkish Guideline for the Diagnosis and Management of Hydradenitis Suppurativa
Murat BORLU a, Erkan ALPSOY b, Nilgün ATAKAN c, Emel Bülbül BAŞKAN d, Burhan ENGİN e, Beyza ÖZÇINAR f, Fatma Figen ÖZGÜRg, Metin ÇAKMAKÇI h
aErciyes Üniversitesi Tıp Fakültesi, Deri ve Zührevi Hastalıkları ABD, Kayseri, TÜRKİYE
bAkdeniz Üniversitesi Tıp Fakültesi, Deri ve Zührevi Hastalıkları ABD, Antalya, TÜRKİYE
cHacettepe Üniversitesi Tıp Fakültesi, Deri ve Zührevi Hastalıkları ABD, Ankara, TÜRKİYE
dUludağ Üniversitesi Tıp Fakültesi, Deri ve Zührevi Hastalıkları ABD, Bursa, TÜRKİYE
eİstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi, Deri ve Zührevi Hastalıkları ABD, İstanbul, TÜRKİYE
fİstanbul Üniversitesi Tıp Fakültesi, Genel Cerrahi ABD, İstanbul, TÜRKİYE
gHacettepe Üniversitesi Tıp Fakültesi, Plastik ve Rekonstrüktif Cerrahi ABD, TÜRKİYE
hAnadolu Sağlık Merkezi, Johns Hopkins Hastanesi, Genel Cerrahi Kliniği, Kocaeli, TÜRKİYE
Turkiye Klinikleri J Dermatol. 2021;31(1):57-80
doi: 10.5336/dermato.2020-80699
Article Language: TR
Full Text
ÖZET
 Hidradenitis süpürativa (HS), şiddeti çok değişken olan, birçok tedavi alternatifi önerilen, oldukça karmaşık yapıda bir hastalıktır. Hastalığın birden fazla disiplinle ilgili olması ve bilimsel kontrollü çalışmaların eksikliği bu konuda metaanaliz yapılmasını ve kılavuzlar hazırlanmasını zorlaştırmaktadır. HS, erişkinlerde ortaya çıkan ve sıklığı %0,03-4,1 arasında değişen bir hastalıktır. Kıl follikülünden kaynaklanan inflamasyon sıklığına göre sırasıyla inguinal bölge ve uyluk iç kısımları, pubik ve perineal, skrotal, vulvar, perianal, aksiller bölge, meme araları ve altları ile gluteal bölgelerde görülür. HS, yaşam kalitesini kötü yönde etkileyen ve komplikasyonları sık görülen bir hastalıktır. Hastalığı ortaya çıkışını alevlenmesini etkileyen birçok çevresel faktör ve kişisel davranış biçimleri bulunmaktadır. Hastalığın klinik sınıflaması, şiddet ölçümü ve tedavi etkinliğinin değerlendirilmesinde çeşitli skorlama sistemleri geliştirilmiştir. Hastalığın tedavisinde cerrahi ve medikal yöntemler, önleyici ve destekleyici tedaviler bir arada düşünülmelidir. HS tedavisi dermatoloji ve cerrahi disiplinlerin birlikte çalışmasını gerektiren özelliklere sahiptir. Hastalığın, klinik, histopatolojik ve laboratuvar bulgularının değerlendirildiği tedavi yöntemlerinin sınıflandırıldığı Türkiye'ye yönelik bir rehbere ihtiyaç duyulmaktadır. HS konusunda deneyimli dermatoloji ve cerrahi disiplinlerden oluşturulan yazar ekibinin ortak çalışması ile bu rehber hazırlanmıştır.

Anahtar Kelimeler: Hidradenitis süpürativa; apse; cerrahi; tedavi; biyolojikler
ABSTRACT
 Hydradenitis suppurativa (HS) is a highly complex disease with varying severity and many treatment options are proposed. The fact that the disease is related to more than one discipline and lack of scientific controlled studies makes it difficult to conduct meta-analysis and to prepare guidelines. HS occurs in adults and ranges between 0.03-4.1%. According to the incidence of inflammation caused by hair follicle, inguinal region and thigh inner parts, pubic and perineal, scrotal, vulvar, perianal, axillary region, breast gap and bottom and gluteal regions are affected respectively. HS is a disease that has a negative effect on quality of life and its complications are common. There are many environmental factors and personal behaviors affecting the exacerbation of the disease. Various scoring systems have been developed in order to evaluate the clinical classification, severity measurement and treatment efficiency of the disease. Surgical and medical methods, preventive and supportive treatments should be considered in the treatment of the disease. HS treatment has the characteristics that require the cooperation of dermatology and surgery disciplines. A guide is needed to evaluate the clinical, histopathological, laboratory findings and treatment methods of the disease for Turkey. This guide has been created with the collaboration of the team of experienced dermatologists and surgeons.

Keywords: Hydradenitis suppurative; abscess; surgery; treatment; biologics
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  95. Mendes RRDS, Zatz RF, Modolin MLA, Busnardo FF, Gemperli R. Radical resection and local coverage of hidradenitis suppurativa-acne inversa: analysis of results. Rev Col Bras Cir. 2018;45(3):e1719.[Crossref] [PubMed] 
  96. Burney RE. 35-Year Experience with Surgical Treatment of Hidradenitis Suppurativa. World J Surg. 2017;41(11):2723-30.[Crossref] [PubMed] 
  97. Posch C, Monshi B, Quint T, Vujic I, Lilgenau N, Rappersberger K. The role of wide local excision for the treatment of severe hidradenitis suppurativa (Hurley grade III): Retrospective analysis of 74 patients. J Am Acad Dermatol. 2017;77(1):123-129.e5.[Crossref] [PubMed] 
  98. Kofler L, Schweinzer K, Heister M, Kohler M, Breuninger H, Häfner HM. Surgical treatment of hidradenitis suppurativa: an analysis of postoperative outcome, cosmetic results and quality of life in 255 patients. J Eur Acad Dermatol Venereol. 2018;32(9):1570-4.[Crossref] [PubMed] 
  99. Clemmensen OJ. Topical treatment of hidradenitis suppurativa with clindamycin. Int J Dermatol. 1983;22(5):325-8.[Crossref] [PubMed] 
  100. Boer J, Jemec GB. Resorcinol peels as a possible self-treatment of painful nodules in hidradenitis suppurativa. Clin Exp Dermatol. 2010;35(1):36-40.[Crossref] [PubMed] 
  101. Jemec GB, Wendelboe P. Topical clindamycin versus systemic tetracycline in the treatment of hidradenitis suppurativa. J Am Acad Dermatol. 1998;39(6):971-4.[Crossref] [PubMed] 
  102. Gener G, Canoui-Poitrine F, Revuz JE, Faye O, Poli F, Gabison G, et al. Combination therapy with clindamycin and rifampicin for hidradenitis suppurativa: a series of 116 consecutive patients. Dermatology. 2009;219(2):148-54.[Crossref] [PubMed] 
  103. Mendonça CO, Griffiths CE. Clindamycin and rifampicin combination therapy for hidradenitis suppurativa. Br J Dermatol. 2006;154(5):977-8.[Crossref] [PubMed] 
  104. British Medical Association.; Royal Pharmaceutical Society of Great Britain.British National Formulary (Bnf). 63. Londra: BMJ Group: Pharmaceutical Press; 2012.[Link] 
  105. Gupta AK, Ellis CN, Nickoloff BJ, Goldfarb MT, Ho VC, Rocher LL, et al Oral cyclosporine in the treatment of inflammatory and noninflammatory dermatoses. A clinical and immunopathologic analysis. Arch Dermatol. 1990;126(3):339-50.[Crossref] [PubMed] 
  106. Rose RF, Goodfield MJ, Clark SM. Treatment of recalcitrant hidradenitis suppurativa with oral ciclosporin. Clin Exp Dermatol. 2006;31(1):154-5.[Crossref] [PubMed] 
  107. Buckley DA, Rogers S. Cyclosporin-responsive hidradenitis suppurativa. J R Soc Med. 1995;88(5):289P-290P.[PubMed] [PMC] 
  108. Sawers RS, Randall VA, Ebling FJ. Control of hidradenitis suppurativa in women using combined antiandrogen (cyproterone acetate) and oestrogen therapy. Br J Dermatol. 1986;115(3):269-74.[Crossref] [PubMed] 
  109. Stellon AJ, Wakeling M. Hidradenitis suppurativa associated with use of oral contraceptives. BMJ. 1989;298(6665):28-9.[Crossref] [PubMed] [PMC] 
  110. Mortimer PS, Dawber RP, Gales MA, Moore RA. A double-blind controlled cross-over trial of cyproterone acetate in females with hidradenitis suppurativa. Br J Dermatol. 1986;115(3):263-8.[Crossref] [PubMed] 
  111. Haslund P, Lee RA, Jemec GB. Treatment of hidradenitis suppurativa with tumour necrosis factor-alpha inhibitors. Acta Derm Venereol. 2009;89(6):595-600.[Crossref] [PubMed] 
  112. Scheinfeld N. A comprehensive review and evaluation of the side effects of the tumor necrosis factor alpha blockers etanercept, infliximab and adalimumab. J Dermatolog Treat. 2004;15(5):280-94.[Crossref] [PubMed] 
  113. Shuja F, Chan CS, Rosen T. Biologic drugs for the treatment of hidradenitis suppurativa: an evidence-based review. Dermatol Clin. 2010;28(3):511-21, 523-4; quiz 522-3.[Crossref] [PubMed] 
  114. Diel R, Hauer B, Loddenkemper R, Manger B, Krüger K. Empfehlungen für das Tuberkulose-Screening vor Gabe von TNF-alpha-Inhibitoren bei rheumatischen Erkrankungen [Recommendations for tuberculosis screening before initiation of TNF-alpha-inhibitor treatment in rheumatic diseases]. Z Rheumatol. 2009;68(5):411-6.[Crossref] [PubMed] 
  115. Zouboulis CC, Bechara FG, Fritz K, Kurzen H, Liakou AI, Marsch WC, et al; Deutsche Interessegemeinschaft Akne inversa; Deutsche Gesellschaft fur Psychosomatische Medizin; European Society of Dermatology and Psychiatry; European Society of Laser Dermatology. S1-Leitlinie zur Therapie der Hidradenitis suppurativa/Acne inversa* (ICD-10 Ziffer: L73.2) [S1 guideline for the treatment of hidradenitis suppurativa / acne inversa * (number ICD-10 L73.2)]. J Dtsch Dermatol Ges. 2012;10 Suppl 5:S1-31.[Crossref] [PubMed] 
  116. Arenbergerova M, Gkalpakiotis S, Arenberger P. Effective long-term control of refractory hidradenitis suppurativa with adalimumab after failure of conventional therapy. Int J Dermatol. 2010;49(12):1445-9.[Crossref] [PubMed] 
  117. Blanco R, Martínez-Taboada VM, Villa I, González-Vela MC, Fernández-Llaca H, Agudo M, et al. Long-term successful adalimumab therapy in severe hidradenitis suppurativa. Arch Dermatol. 2009;145(5):580-4.[Crossref] [PubMed] 
  118. Sotiriou E, Apalla Z, Vakirlis E, Ioannides D. Efficacy of adalimumab in recalcitrant hidradenitis suppurativa. Eur J Dermatol. 2009;19(2):180-1.[Crossref] [PubMed] 
  119. Goo B, Chung HJ, Chung WG, Chung KY. Intramuscular immunoglobulin for recalcitrant suppurative diseases of the skin: a retrospective review of 63 cases. Br J Dermatol. 2007;157(3):563-8.[Crossref] [PubMed] 
  120. Maarouf M, Clark AK, Lee DE, Shi VY. Targeted treatments for hidradenitis suppurativa: a review of the current literature and ongoing clinical trials. J Dermatolog Treat. 2018;29(5):441-9.[Crossref] [PubMed] 
  121. Wang SC, Wang SC, Alavi A, Alhusayen R, Bashash M, Sibbald RG. Hidradenitis suppurativa: a frequently missed diagnosis, part 2: treatment options. Adv Skin Wound Care. 2015;28(8):372-80; quiz 381-2.[Crossref] [PubMed] 
  122. Mustafa EB, Ali SD, Kurtz LH. Hidradenitis suppurativa: review of the literature and management of the axillary lesion. J Natl Med Assoc. 1980;72(3):237-43.[PubMed] [PMC] 
  123. Smith HS, Chao JD, Teitelbaum J. Painful hidradenitis suppurativa. Clin J Pain. 2010;26(5):435-44.[Crossref] [PubMed] 
  124. Kearney PM, Baigent C, Godwin J, Halls H, Emberson JR, Patrono C. Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ. 2006;332(7553):1302-8.[Crossref] [PubMed] [PMC] 
  125. Trelle S, Reichenbach S, Wandel S, Hildebrand P, Tschannen B, Villiger PM, et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ. 2011;342:c7086.[Crossref] [PubMed] [PMC] 
  126. Feito-Rodríguez M, Sendagorta-Cudós E, Herranz-Pinto P, de Lucas-Laguna R. Prepubertal hidradenitis suppurativa successfully treated with botulinum toxin A. Dermatol Surg. 2009;35(8):1300-2.[Crossref] [PubMed] 
  127. Adams DR, Gordon KB, Devenyi AG, Ioffreda MD. Severe hidradenitis suppurativa treated with infliximab infusion. Arch Dermatol. 2003;139(12):1540-2.[Crossref] [PubMed] 
  128. O'Reilly DJ, Pleat JM, Richards AM. Treatment of hidradenitis suppurativa with botulinum toxin A. Plast Reconstr Surg. 2005;116(5):1575-6.[Crossref] [PubMed] 
  129. Sommer B, Bergfeld D, Sattler G. Konsensusempfehlungen zum gebrauch von botulinumtoxin a in der ästhetischen medizin--klinische erfahrungen und empfehlungen langjähriger anwender [Consensus recommendations on the use of botulinum toxin type A in aesthetic medicine]. J Dtsch Dermatol Ges. 2007;5 Suppl 1:S1-S29.[Crossref] [PubMed] 
  130. Finley EM, Ratz JL. Treatment of hidradenitis suppurativa with carbon dioxide laser excision and second-intention healing. J Am Acad Dermatol. 1996;34(3):465-9.[Crossref] [PubMed] 
  131. Hazen PG, Hazen BP. Hidradenitis suppurativa: successful treatment using carbon dioxide laser excision and marsupialization. Dermatol Surg. 2010;36(2):208-13.[Crossref] [PubMed] 
  132. Madan V, Hindle E, Hussain W, August PJ. Outcomes of treatment of nine cases of recalcitrant severe hidradenitis suppurativa with carbon dioxide laser. Br J Dermatol. 2008;159(6):1309-14.[Crossref] [PubMed] 
  133. Tierney E, Mahmoud BH, Hexsel C, Ozog D, Hamzavi I. Randomized control trial for the treatment of hidradenitis suppurativa with a neodymium-doped yttrium aluminium garnet laser. Dermatol Surg. 2009;35(8):1188-98.[Crossref] [PubMed] 
  134. Mahmoud BH, Tierney E, Hexsel CL, Pui J, Ozog DM, Hamzavi IH. Prospective controlled clinical and histopathologic study of hidradenitis suppurativa treated with the long-pulsed neodymium:yttrium-aluminium-garnet laser. J Am Acad Dermatol. 2010;62(4):637-45.[Crossref] [PubMed] 
  135. Highton L, Chan WY, Khwaja N, Laitung JKG. Treatment of hidradenitis suppurativa with intense pulsed light: a prospective study. Plast Reconstr Surg. 2011;128(2):459-66.[Crossref] [PubMed] 
  136. Gold M, Bridges TM, Bradshaw VL, Boring M. ALA-PDT and blue light therapy for hidradenitis suppurativa. J Drugs Dermatol. 2004;3(1 Suppl):S32-5.[PubMed] 
  137. Strauss RM, Pollock B, Stables GI, Goulden V, Cunliffe WJ. Photodynamic therapy using aminolaevulinic acid does not lead to clinical improvement in hidradenitis suppurativa. Br J Dermatol. 2005;152(4):803-4.[Crossref] [PubMed] 
  138. Sotiriou E, Apalla Z, Maliamani F, Ioannides D. Treatment of recalcitrant hidradenitis suppurativa with photodynamic therapy: report of five cases. Clin Exp Dermatol. 2009;34(7):e235-6.[Crossref] [PubMed] 
  139. Schweiger ES, Riddle CC, Aires DJ. Treatment of hidradenitis suppurativa by photodynamic therapy with aminolevulinic acid: preliminary results. J Drugs Dermatol. 2011;10(4):381-6.[PubMed] 
  140. Fröhlich D, Baaske D, Glatzel M. Strahlentherapie der Hidradenitis axillaris--heute noch aktuell? [Radiotherapy of hidradenitis suppurativa--still valid today?]. Strahlenther Onkol. 2000;176(6):286-9.[PubMed] 
  141. Zeligman I. Temporary x-ray epilation therapy of chronic axillary hidradenitis suppurativa. Arch Dermatol. 1965;92(6):690-4.[Crossref] [PubMed] 
  142. Iwasaki J, Marra DE, Fincher EF, Moy RL. Treatment of hidradenitis suppurativa with a nonablative radiofrequency device. Dermatol Surg. 2008;34(1):114-7.[Crossref] [PubMed] 
  143. Bong JL, Shalders K, Saihan E. Treatment of persistent painful nodules of hidradenitis suppurativa with cryotherapy. Clin Exp Dermatol. 2003;28(3):241-4.[Crossref] [PubMed] 
  144. Ozdemir Y, Uzun G, Mutluoglu M, Gulec B. Hyperbaric oxygen therapy for the management of postsurgical wounds in hidradenitis suppurativa. Am Surg. 2010;76(12):E237-8.[Crossref] [PubMed] 
  145. Uzun G, Ozdemir Y, Mutluoğlu M, Güleç B. Hyperbaric oxygen therapy as an adjunct to surgical treatment of extensive hidradenitis suppurativa. World J Surg. 2010;34(4):861-2.[Crossref] [PubMed] 

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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