Academic_Departments_and_Institutes RSS : Gourt

Panniculitis With Arthralgia in Patients With Melanoma Treated With Selective BRAF Inhibitors and Its Management [Observation]

Background Painful lobular panniculitis appears to be a novel cutaneous adverse effect of selective BRAF inhibitors. Observation We report the clinical course and management in 2 women with metastatic melanomas harboring the BRAFV600E mutation, who developed panniculitis with arthralgia during therapy with selective oral BRAF inhibitors. Panniculitis with arthralgia was the acute presenting adverse effect in both patients. Painful, red, nodular lesions were located on the upper and lower extremities. Biopsy specimens of the nodules showed a mild, predominantly lobular neutrophilic panniculitis. Analgesic and anti-inflammatory treatment improved panniculitis and arthralgia in both cases. It was also necessary to reduce the BRAF inhibitor dose in 1 patient. Conclusions During therapy with selective BRAF inhibitors, panniculitis with arthralgia represents a new adverse effect that can require dose reduction. In case of this adverse effect, treatment with nonsteroidal anti-inflammatory drugs, such as etoricoxib, should be initiated early to keep patients on treatment and to avoid drug discontinuation and tumor progression.

Phase I Clinical Trial of O6-Benzylguanine and Topical Carmustine in the Treatment of Cutaneous T-Cell Lymphoma, Mycosis Fungoides Type [Study]

Objectives To evaluate the toxic effects and maximum tolerated dose of topical carmustine [1,3-bis (2-chloroethyl)-1-nitrosourea] following intravenous O6-benzylguanine in the treatment of cutaneous T-cell lymphoma (CTCL), and to determine pharmacodynamics of O6-alkylguanine DNA alkyltransferase activity in treated CTCL lesions. Design Open-label, dose-escalation, phase I trial. Setting Dermatology outpatient clinic and clinical research unit at a university teaching hospital. Patients A total of 21 adult patients (11 male, 10 female) with early-stage (IA-IIA) refractory CTCL, mycosis fungoides type, treated with topical carmustine following intravenous O6-benzylguanine. Intervention Treatment once every 2 weeks with 120 mg/m2 intravenous O6-benzylguanine followed 1 hour later by whole-body, low-dose topical carmustine starting at 10 mg, with 10-mg incremental dose-escalation in 3 patient cohorts. Cutaneous T-cell lymphoma lesional skin biopsy specimens were taken at baseline and 6 hours, 24 hours, and 1 week after the first O6-benzylguanine infusion for analysis of O6-alkylguanine-DNA alkyltransferase activity. Main Outcome Measures Clinical response measured by physical examination and severity-weighted assessment tool measurements, safety data acquired by review of adverse events at study visits, and O6-alkylguanine-DNA alkyltransferase activity in treated lesion skin biopsy specimens. Results A minimal toxic effect was observed through the 40-mg carmustine dose level with 76% of adverse events being grade 1 based on the National Cancer Institute Common Terminology Criteria for Adverse Events. Mean baseline O6-alkylguanine-DNA alkyltransferase activity in CTCL lesions was 3 times greater than in normal controls and was diminished by a median of 100% at 6 and 24 hours following O6-benzylguanine with recovery at 1 week. Clinical disease reduction correlated positively with O6-alkylguanine-DNA alkyltransferase activity at 168 hours (P = .02) and inversely with area under the curve of O6-alkylguanine-DNA alkyltransferase over 1 week (P = .01). Twelve partial responses and 4 complete responses were observed (overall response, 76% [95% CI, 0.55-0.89]). Five patients discontinued therapy owing to adverse events with a possible, probable, or definite relationship to the study drug. Conclusion O6-benzylguanine significantly depletes O6-alkylguanine-DNA alkyltransferase in CTCL lesions and in combination with topical carmustine is well tolerated and shows meaningful clinical responses in CTCL at markedly reduced total carmustine treatment doses. Trial Registration clinicaltrials.gov Identifier: NCT00003613

Trends in Melanoma Mortality Among Non-Hispanic Whites by Educational Attainment, 1993-2007 [Study]

Objective To evaluate overall trends in melanoma mortality rates among non-Hispanic whites by educational level. Design Descriptive study. Setting Death certificate records from 26 states, representing approximately 45% of the US population as reported by the National Center for Health Statistics, with recorded educational level information and population data from the US Bureau of Census Current Population Survey. Patients Recorded deaths from malignant melanoma in non-Hispanic whites reported from 1993 through 2007. Main Outcome Measures Age-standardized mortality rates for melanoma were evaluated by educational attainment (a marker of socioeconomic status) among non-Hispanic whites (aged 25-64 years) from 1993 through 2007. Rate ratios assessed the time trend in age-adjusted death rates by sex and educational level. Mortality differentials in educational level were measured using the regression-based Relative Index of Inequality. All statistical tests were 2-sided. Results Melanoma mortality declined significantly between 1993-1997 and 2003-2007 in men (RR [rate ratio], 0.916; 95% CI, 0.878-0.954; P < .001) and women (RR, 0.907; 95% CI, 0.857-0.957; P < .001). However, these declines occurred only among the most educated persons (≥13 years of education irrespective of sex), and nonsignificant increases were found among the least-educated individuals, specifically men (P = .17). As a result, the Relative Index of Inequality by education in melanoma mortality in 2003-2007 relative to 1993-1997 (baseline) widened by 51.7% in men and by 35.7% in women. Conclusions Recent declines in melanoma mortality rates among non-Hispanic whites in the United States mainly reflect declines among the most-educated individuals. The widening disparities in melanoma mortality rates by education calls for early detection strategies to effectively target high-risk, less-educated, non-Hispanic white individuals.

The Children and Sunscreen Study: A Crossover Trial Investigating Children's Sunscreen Application Thickness and the Influence of Age and Dispenser Type [Study]

Objectives To measure the thickness at which primary schoolchildren apply sunscreen on school day mornings and to compare it with the thickness (2.00 mg/cm2) at which sunscreen is tested during product development, as well as to investigate how application thickness was influenced by age of the child (school grades 1-7) and by dispenser type (500-mL pump, 125-mL squeeze bottle, or 50-mL roll-on). Design A crossover quasiexperimental study design comparing 3 sunscreen dispenser types. Setting Children aged 5 to 12 years from public primary schools (grades 1-7) in Queensland, Australia. Participants Children (n = 87) and their parents randomly recruited from the enrollment lists of 7 primary schools. Each child provided up to 3 observations (n = 258). Intervention Children applied sunscreen during 3 consecutive school weeks (Monday through Friday) for the first application of the day using a different dispenser each week. Main Outcome Measure Thickness of sunscreen application (in milligrams per square centimeter). The dispensers were weighed before and after use to calculate the weight of sunscreen applied. This was divided by the coverage area of application (in square centimeters), which was calculated by multiplying the children's body surface area by the percentage of the body covered with sunscreen. Results Children applied their sunscreen at a median thickness of 0.48 mg/cm2. Children applied significantly more sunscreen when using the pump (0.75 mg/cm2) and the squeeze bottle (0.57 mg/cm2) compared with the roll-on (0.22 mg/cm2) (P < .001 for both). Conclusions Regardless of age, primary schoolchildren apply sunscreen at substantially less than 1.00 mg/cm2, similar to what has been observed among adults. Some sunscreen dispensers seem to facilitate thicker application than others.

Prediction of Sentinel Lymph Node Positivity by Growth Rate of Cutaneous Melanoma [Study]

Objective To determine whether growth rate (GR) of cutaneous melanoma predicts the histological sentinel lymph node (SLN) positivity. Design Retrospective cohort study. Setting Two tertiary melanoma referral centers. Patients A total of 698 patients with invasive primary cutaneous melanoma in whom the SLN was identified between January 1, 2000, and June 30, 2010. Main Outcome Measure Based on previous studies, a surrogate measure for GR in primary invasive melanoma was calculated as the ratio of Breslow thickness to time to melanoma development. Results The SLN was positive in 20.2% of patients. Multivariate logistic regression analysis revealed that GR, Breslow thickness, and the presence of microscopic satellitosis were independently associated with SLN positivity. The probability of SLN positivity was 8.2% for slow-growth melanomas (<0.10 mm/mo) compared with 19.8% for intermediate-growth melanomas (0.10-0.50 mm/mo) and 37.7% for fast-growth melanomas (>0.50 mm/mo). Growth rate was not an independent predictive factor for survival. Conclusion Growth rate of primary cutaneous melanoma, together with Breslow thickness and the presence of microscopic satellitosis, predicts the histological SLN positivity.

Communication About Family Members' Risk of Melanoma: Self-reported Practices of Dermatologists in the United States [Study]

Objectives To assess current self-reported communication and screening practices of dermatologists to their patients with melanoma about family members' risk of melanoma at the time of diagnosis and to understand the barriers that dermatologists encounter in communicating risk to patients. Design Descriptive survey study. Setting Office-based practicing physicians in the United States. Participants One thousand dermatologists. Main Outcome Measure Melanoma risk communication practices. Results Of 974 eligible dermatologists, 406 completed the survey (response rate, 41.7%). Almost 85% of dermatologists reported that they often or always communicate risk to patients with melanoma about their first-degree relatives, and almost 80% reported that they often or always advise their patients with melanoma that their older children (≥18 years) may be at greater risk of skin cancer. However, less than 50% of dermatologists routinely offered to screen first-degree relatives who live nearby, while only 19.7% used medical record reminders to note communication of melanoma risk to family members. Most dermatologists reported no major barriers to melanoma risk communication. However, the presence of "any risk communication barrier" (time constraints, absence of guidelines, or lack of written material) was associated with reduced melanoma risk communication practices by dermatologists. Conclusions The observed high rates of self-reported risk communication by dermatologists to patients with melanoma about their first-degree family members are encouraging. However, the reported low rates of actual screening of first-degree relatives warrant easy-to-administer office-based medical record reminders to facilitate and optimize screening of at-risk relatives.

A Cross-sectional Study Examining the Correlation Between Sunless Tanning Product Use and Tanning Beliefs and Behaviors [Study]

Objectives To establish the effect of sunless tanning products on tanning behaviors and to determine characteristics of sunless tanning product users. Design A cross-sectional survey study conducted between May 30, 2007, and December 4, 2007. Setting The Emory University campus and surrounding locations in Atlanta, Georgia. Participants Four hundred fifteen community and university-affiliated women. Main Outcome Measures Self-reported use of sunless tanning products and UV radiation tanning methods. Results Forty-eight percent of participants had used sunless tanning products, 70.6% had tanned in the sun, and 26.0% had used tanning beds at least once in the past year. Most participants (92.7%) believed that tanned skin is more attractive than untanned skin, and 79.2% reported feeling better about themselves when tan. Many sunless tanning product users reported decreased frequency of tanning in the sun (36.8%) or in tanning beds (38%) because of product use. Frequent users were more likely to have decreased their UV radiation exposure. Lighter complexion, frequent use of UV radiation tanning methods, feeling better about oneself when tan, and having a history of skin cancer were independently associated with sunless tanning product use. Conclusions The desire for tanned skin remains strong despite growing awareness of the dangers of UV radiation exposure. In some women, sunless tanning product use is associated with decreased UV radiation tanning frequency, especially in women who use them repeatedly. Improvements in the appearance of sunless tanning product tans may allow wider acceptance by the public and further decreases in UV radiation tanning practices.

Calcinosis Cutis Occurring in Association With Autoimmune Connective Tissue Disease: The Mayo Clinic Experience With 78 Patients, 1996-2009 [Study]

Objective To describe characteristics and treatment of patients with calcinosis cutis in the clinical setting of autoimmune connective tissue disease (ACTD). Design Retrospective study. Setting Tertiary referral center. Patients Seventy-eight patients with calcinosis cutis and ACTD between 1996 and 2009. Main Outcome Measures Clinical features, treatments, and outcomes of patients with calcinosis cutis in the clinical setting of ACTD. Results Of 78 patients (mean age at onset of calcinosis cutis, 40.1 years), 64 (82%) were female. The following diseases were associated with calcinosis cutis: dermatomyositis (n = 30) with classic (n = 15), juvenile (n = 14), and amyopathic (n = 1) subtypes; systemic sclerosis with limited cutaneous scleroderma (n = 24); lupus panniculitis (n = 4); systemic lupus erythematosus (n = 2); mixed connective tissue disease (n = 4); overlap connective tissue disease (n = 6); undifferentiated connective tissue disease (n = 6); polymyositis (n = 1); and rheumatoid arthritis (n = 1). Therapy for calcinosis cutis consisted of medical treatment alone (n = 19), surgical therapy alone (n = 11), combined medical and surgical treatment (n = 17), no treatment (n = 30), and unknown (n = 1). Diltiazem hydrochloride was the most commonly used medical therapy, with 9 of 17 patients having a partial response. Twenty-eight patients had surgical excision of 1 or more lesions of calcinosis cutis: 22 had a complete response, 5 had a partial response, and 1 had no response. Conclusions Dermatomyositis and systemic sclerosis were the most common ACTDs associated with calcinosis cutis. Although no treatment was uniformly effective, surgical excision of symptomatic lesions and medical treatment with diltiazem provided benefit for some patients.

A Systematic Review of Treatments for Hidradenitis Suppurativa [Study]

Objectives To conduct a systematic review of the effectiveness of various modalities to treat hidradenitis suppurativa (HS) and to establish recommendations on its appropriate management. Data Sources MEDLINE, Cochrane, and PubMed databases. Study Selection English-language prospective, retrospective, and case studies describing at least 4 patients with HS. Data Extraction Data quality and validity were addressed by multiple reviewers using independent extraction. Data Synthesis Studies were categorized as treatments using antibiotics, biological agents, laser surgery, excisional surgery, or miscellaneous modalities. Of 62 publications included in the review, 4 studies met criteria to be assigned the highest grade for quality of evidence. Conclusions Shown to be effective treatments for HS were a clindamycin-rifampin combination regimen, a course of infliximab, monthly Nd:YAG laser sessions, and surgical excision and primary closure with a gentamicin sulfate–collagen sponge. Most therapies used to treat HS were supported by limited or weak scientific evidence. A treatment approach is presented based on the evidence and on clinical experience at the Follicular Disorders Clinic, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan. This review emphasizes the need for large randomized controlled trials to evaluate treatment options for HS.

Poor Benefit/Risk Balance of Intravenous Immunoglobulins in DRESS [Research Letter]

Combination Treatments for Psoriasis: A Systematic Review and Meta-analysis [Evidence-Based Dermatology: Review]

Objective To summarize the current state of evidence for combination topical and systemic therapies for mild to severe psoriasis. Data Sources We performed a systematic search for all entries in PubMed, CINAHL, Cochrane Review, and EMBASE related to combination treatments for psoriasis through July 2010. Study Selection We included randomized controlled trials that reported proportion of disease clearance or mean change in clinical severity score (or provided these data through communication with study authors) for efficacy of a combination treatment for psoriasis compared with 1 or more corresponding monotherapies. Data Extraction Study data were extracted by 3 independent investigators, with disagreement resolved by consensus. The proportion of patients who achieved clearance, definition of clearance, means and standard deviations for baseline disease symptom score and final disease symptom score, and major design characteristics were extracted for each study. Data Synthesis Combination treatments consisting of vitamin D derivative and corticosteroid, vitamin D derivative and UV-B, vitamin A derivative and psoralen–UV-A, vitamin A derivative and corticosteroid, vitamin A derivative and UV-B, corticosteroid and hydrocolloid occlusion dressings, UV-B and alefacept, and vitamins A and D derivatives were more effective than 1 or more monotherapies using the likelihood of clearance as the outcome. Blinding status and potency of the corticosteroid treatment used were significant sources of heterogeneity between studies. Conclusions The results demonstrate the need for additional long-term trials with standardized outcome measures to evaluate the efficacy and adverse effects of combination therapies for psoriasis and highlight the possible effects of trial design characteristics on results.

Maggot Therapy for Wound Debridement: A Randomized Multicenter Trial [Study]

Objective To study the efficacy of bagged larvae on wound debridement compared with conventional treatment. Design Randomized, multicenter, controlled, prospective phase 3 trial with blinded assessment of outcome measures by a single observer. Setting Two hospital referral centers in Caen and Lyon, France. Patients Random sampling of 119 patients with a nonhealing, sloughy wound 40 cm2 or smaller, less than 2 cm deep, and an ankle brachial index of 0.8 or higher. Intervention During a 2-week hospital stay, patients received either maggot debridement therapy (MDT) or conventional treatment. At discharge, conventional dressings were applied and a follow-up visit occurred at day 30. Main Outcome Measure Percentage of slough in wounds at day 15. Results There was a significant difference between groups at day 8 (54.5% in the MDT group and 66.5% in the control group) (P = .04). The mean percentage of slough at day 15 was 55.4% in the MDT group and 53.8% in the control group (P = .78). Conclusions Although MDT shows no significant benefit at day 15 compared with conventional treatment, debridement by MDT is significantly faster and occurs during the first week of treatment. Because there is no benefit in continuing the treatment after 1 week, another type of dressing should be used after 2 or 3 applications of MDT. Trial Registration clinicaltrials.gov Identifier: NCT01211236

Melanoma Mimic: A Case of Multiple Pagetoid Spitz Nevi [Observation]

Background Differentiating Spitz nevi from melanoma can be difficult. Pagetoid spread of melanocytes is among the features making diagnosis difficult. Rare reports of isolated pagetoid Spitz nevi exist. Observations We present a unique case of multiple pagetoid Spitz nevi initially diagnosed as multiple in situ melanomas. Germline karyotyping, CDK4 and CDKN2A sequencing, and comparative genomic hybridization of HRAS, BRAF, KRAS, RAF1, CDKN2A, Rb1, MAP2K1, MAP2K2, PTEN, and PTPN11 genes did not identify mutations in this case. Germline and somatic sequencing of BRAF exon 15 revealed no mutations at V600D/E/K. In addition, single-nucleotide polymorphism microarray analysis (330K) on lesional and normal skin revealed no genome-wide copy number changes or loss of heterozygosity. Conclusions Clinicians should be aware of the occurrence of multiple pagetoid Spitz nevi to avoid morbidity associated with the misdiagnosis of multiple melanomas. The genetic mechanisms of pagetoid spread of melanocytes are not fully understood.

Association of Pharyngitis With Oral Antibiotic Use for the Treatment of Acne: A Cross-sectional and Prospective Cohort Study [Study]

Objective To prospectively evaluate the association between antibiotics used to treat acne and pharyngitis. Design Cross-sectional and 9-month prospective cohort. Setting Urban university setting. Participants University students. Intervention Participants were asked to fill out a survey form, were swabbed for culture, and had a visual examination for acne. Main Outcome Measure Report of pharyngitis. Results In the cross-sectional study, 10 of the 15 students receiving oral antibiotics for acne reported an episode of pharyngitis in the previous 30 days, whereas 47 of the 130 students not receiving oral antibiotics, but who had acne, reported an episode of pharyngitis in the prior month. The unadjusted odds ratio (OR) (95% CI) associating current oral antibiotic use in acne patients with a self-reported episode of pharyngitis was 3.53 (95% CI, 1.14-10.95). In the cohort study, there were 358 female and 218 male participants; 36 (6.2%) received oral antibiotics for acne during the study, and 96 (16.6%) received topical antibiotics for acne. Using mixed model logistic regression, the OR was 4.34 (95% CI, 1.51-12.47) associating oral antibiotic use with pharyngitis. Less than 1% of participants were colonized by group A streptococcus, which was not associated with pharyngitis. Conclusions Our studies show that that the odds of reporting pharyngitis is more than 3 times baseline in patients receiving oral antibiotics for acne vs those who are not receiving oral antibiotics. The true clinical importance of these findings needs to be evaluated further by prospective studies, but this finding is not associated with group A streptococcus.

Prevention of Glucocorticoid-Induced Osteoporosis in Immunobullous Diseases With Alendronate: A Randomized, Double-blind, Placebo-Controlled Study [Study]

Objective To evaluate the efficacy and safety of oral alendronate sodium therapy once daily in preventing glucocorticoid-induced bone loss in patients with immunobullous skin diseases treated with long-term glucocorticoid therapy. Design A 12-month randomized, double-blind, placebo-controlled trial. Setting A tertiary referral dermatology center in Singapore. Participants Patients newly diagnosed as having an immunobullous disease and deemed to require at least 6 months of systemic glucocorticoid therapy. Interventions The patients were randomized to receive either oral alendronate sodium (10 mg/d) or a matching placebo for 12 months. All patients also received concurrent calcium with vitamin D, 2 tablets daily. Main Outcome Measures Percent change in bone mineral density (BMD) at the lumbar spine and the femoral neck at 12 months. Results A total of 29 patients (alendronate [n = 15], placebo [n = 14]) were evaluated. The percent change in BMD in the alendronate group was +3.7% and +3.5% at the lumbar spine and the femoral neck, respectively, whereas in the placebo group, it was –1.4% and –0.7% at the lumbar spine and the femoral neck, respectively. The increase in BMD observed in the alendronate group compared with the placebo group was statistically significant at both the lumbar spine (P = .01) and the femoral neck (P = .01). There was also a statistically significant decrease in serum heat-labile alkaline phosphatase levels after 12 months (–32.6%, P < .01) in the alendronate group but not in the placebo group. Adverse events were generally minor, and the frequency of occurrence did not differ significantly between both treatment groups (P = .59). Conclusions There were statistically significant increases in BMD at both the lumbar spine (P = .01) and the femoral neck (P = .01) with alendronate therapy. It is imperative to use bisphophonate therapy in patients with immunobullous disorders who are receiving oral corticosteroids because it largely prevents the morbidity associated with low BMD.

Impact of Smoking in Cutaneous Lupus Erythematosus [Study]

Objective To investigate cigarette smoking in cutaneous lupus erythematosus (CLE). Design Prospective longitudinal cohort study. Setting Urban cutaneous autoimmune disease clinic. Participants A total of 218 individuals with CLE or systemic lupus erythematosus and lupus nonspecific skin disease seen between January 5, 2007, and July 30, 2010. Main Outcome Measures Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) scores to assess disease severity and response to treatment and Skindex 29+3 scores to assess patient quality of life. Results Current smokers with lupus erythematosus had higher median CLASI scores (9.5) than did never (7.0) and past (6.0) smokers with CLE (P = .02). Current smokers had higher median scores on all the Skindex 29+3 subsets. Current smokers taking hydroxychloroquine sulfate had higher quinacrine hydrochloride use than did nonsmokers (P = .04). Two to 7 months after enrollment, current smokers (median CLASI change, –3) treated with only antimalarial agents improved more than never (1) and past (0) smokers (P = .02). Eight months or more after enrollment, current smokers (CLASI change, 3.5) treated with antimalarial drugs plus at least 1 additional immunomodulator improved less than never (–1.5) and past (0) smokers (P = .04). Conclusions Current smokers with lupus erythematosus had worse disease, had worse quality of life, and were more often treated with a combination of hydroxychloroquine and quinacrine than were nonsmokers. Never and past smokers showed greater improvement when treated with antimalarial agents plus at least 1 additional immunomodulator. Current smokers had greater improvement when treated with antimalarial drugs only.

Soluble Adenylyl Cyclase Antibody Profile as a Diagnostic Adjunct in the Assessment of Pigmented Lesions [Study]

Objective To investigate the usefulness of a novel marker for melanocytic proliferations. Design Using a novel monoclonal antibody against soluble adenylyl cyclase (sAC), various benign and malignant melanocytic proliferations were immunostained. Setting Weill Medical College of Cornell University dermatopathology laboratory. Main Outcome Measures The results were qualitative, not quantifiable. Results The sAC immunostaining produced distinctive patterns that paralleled melanomagenesis. At one pole of the spectrum were benign nevi, including atypical nevi of special sites and recurrent nevi showing a distinct pattern of dotlike Golgi staining, while at the opposite pole was melanoma, in which many cells demonstrated an intense pannuclear expression pattern, often accompanied by loss of the Golgi expression pattern. Melanomas of lentigo maligna and acral lentiginous subtypes exhibited the most striking pannuclear expression, while nodular melanomas showed the least, although with supervening enhanced diffuse cytoplasmic expression. Loss of the Golgi expression pattern was a feature of malignant melanoma. Conclusion The sAC expression pattern is complex but seems discriminatory, with distinctive and variable staining patterns according to the nature of the lesion biopsied.

Hidradenitis Suppurativa: The Role of Deficient Cutaneous Innate Immunity [Study]

Objective To evaluate the expression of innate immunity markers at the site of nodules caused by hidradenitis suppurativa (HS). Design Prospective analysis of 12 patients with HS. Setting Unité de Cancéro-Dermatologie, Nantes Hospital, Nantes; Service de Dermatologie, Poitiers Hospital, Poitiers; and Service de Dermatologie, Clinique de Courlancy, Reims, France Patients Twelve patients (Hurley stage I or II) in whom the disease had progressed for at least 6 months and who had a minimum of 2 closed nodules in typical sites. Main Outcome Measures Two biopsies were performed at baseline: one in a closed inflammatory nodule and one in healthy adjoining skin. Patients were treated for 3 months with zinc gluconate at a dosage of 90 mg/d. A new biopsy was then performed in the same nodule. Innate immunity markers (toll-like receptors 2, 3, 4, 7, and 9; intercellular adhesion molecule 1; interleukin [IL] 6 and 10; tumor necrosis factor; α melanocyte stimulating hormone; transforming growth factor β; β-defensin 2 and 4; and insulinlike growth factor 1) were studied by immunohistochemical analysis. Results We observed significantly decreased expression (P < .001) of all the innate immunity markers studied except IL-10 in nonlesional and lesional HS skin. The downregulation of innate markers was significantly stronger in lesional HS skin compared with normal skin except for tumor necrosis factor. Three months of zinc treatment induced a significant increase in the expression of all the markers involved in innate immunity. Conclusion Our study demonstrates for the first time, to our knowledge, that a deficiency of the main innate immunity markers in typical HS sites may explain the development of chronic inflammatory nodules in this disease.

Efficacy and Safety of Apremilast in Chronic Cutaneous Sarcoidosis [Research Letters]

Natural Gene Therapy in Dystrophic Epidermolysis Bullosa [Observation]

Background Dystrophic epidermolysis bullosa is a genetic blistering disorder caused by mutations in the type VII collagen gene, COL7A1. In revertant mosaicism, germline mutations are corrected by somatic events resulting in a mosaic disease distribution. This "natural gene therapy" phenomenon long has been recognized in other forms of epidermolysis bullosa but only recently in dystrophic epidermolysis bullosa. Observations We describe a 21-year-old man with recessive dystrophic epidermolysis bullosa carrying the homozygous c.6508C>T (p.Gln2170X) nonsense mutation who reported an unaffected skin patch on his neck where blisters never had occurred. Immunofluorescent type VII collagen staining was normal in 80% of the unaffected skin biopsy; however, it was strongly reduced in the affected skin. In the unaffected skin, the somatic nucleotide substitution c.6510G>T reverted the germline nonsense codon to tyrosine (p.Gln2170Tyr), thereby restoring functional protein production. Conclusions Revertant mosaicism is considered rare in recessive dystrophic epidermolysis bullosa. However, it might be more common than previously anticipated because our patient is the third in whom revertant mosaicism was identified in a short period of time. The correction mechanism is different than that previously reported. Systematic examination of patients with recessive dystrophic epidermolysis bullosa, therefore, will likely reveal more patients with revertant patches. This is important because the natural gene therapy phenomenon may provide opportunities for revertant cell therapy.

Risk Factors for Lentigo Maligna Melanoma Compared With Superficial Spreading Melanoma: A Case-Control Study in Australia [Study]

Objective To investigate risk factors for lentigo maligna melanoma (LMM) compared with superficial spreading melanoma (SSM). Design Population-based case-control study in Queensland, Australia. Setting General community. Participants Population-based sample of 49 patients with LMM and 141 with SSM (in situ or invasive) aged 14 to 86 years at diagnosis in 1979 and 1980 and 232 control subjects. Response rates were 97.1% in cases and 91.8% in controls. Main Outcome Measures Risks of both subtypes in relation to phenotypic and environmental factors, estimated by multinomial logistic regression. Results The number of solar lentigines was the strongest determinant for LMM (odds ratio [OR], 15.93; P < .001 for trend) and significantly weaker for SSM (4.61; P < .001 for trend; P = .04 for homogeneity). Skin cancer history was significantly associated with LMM (OR, 2.84) but not with SSM (1.33; P = .07 for homogeneity). In contrast, the number of nevi was the strongest determinant for SSM (OR, 23.22; P < .001 for trend) while significantly weaker for LMM (3.60; P = .02 for trend; P < .001 for homogeneity). Multiple lifetime sunburns almost tripled the risk for SSM, whereas no association was detected with LMM (P = .04 for homogeneity). Shared risk factors for both subtypes were the number of solar keratoses (P < .001 for trend for both) and sun-sensitive complexion (ie, light eye/hair colors, sunburn propensity, and freckling) (2-fold to 5-fold increased risks). Conclusions A propensity to lentigines is a stronger predictor of LMM, whereas high nevus propensity is a stronger predictor of SSM. Skin cancer history appears to determine LMM risk only, whereas the number of lifetime sunburns determines SSM only. Prevention strategies could be tailored differently given these distinctive points of difference.

Tissue Eosinophilia: Not an Indicator of Drug-Induced Subacute Cutaneous Lupus Erythematosus [Study]

Objective To investigate whether tissue eosinophilia is a differentiating histopathologic feature of drug-induced subacute cutaneous lupus erythematosus (DI-SCLE) compared with non-DI–SCLE. Design Retrospective medical record review with prospective blinded histopathologic analysis. Setting University-affiliated dermatology and dermatopathology practice. Patients Fifty-nine patients with SCLE were divided into DI (n = 15) and non-DI (n = 44) groups. Main Outcome Measures A dermatopathologist masked to the etiologic associations reviewed corresponding histopathologic specimens. For each patient, an eosinophil ratio was calculated as the mean eosinophil score (averaging eosinophil counts from 10 high-power histologic fields) divided by the intensity of inflammation. Eosinophil ratios for both groups were compared using the Mann-Whitney test. Results No significant difference was found in mean eosinophil ratios in the DI vs non-DI groups (0.11 vs 0.004; P = .34). Mucin deposition was present in both populations and was not significantly different (P = .18). The inflammatory infiltrate was superficial and deep in 10 patients (67%) in the DI group vs 24 (55%) in the non-DI group. Periadnexal inflammation was observed in 12 patients (80%) in the DI group vs 37 (84%) in the non-DI group, and basal layer liquefaction with dyskeratosis was seen in 15 patients (100%) in the DI group and in 37 (84%) in the non-DI group. Conclusions Tissue eosinophilia is not a differentiating histopathologic feature of DI-SCLE. Careful review of a patient's drug history in correlation with clinical findings remains the standard for identifying a drug as an etiologic or exacerbating factor in patients with SCLE.

About This Journal [About This Journal]

This Month in Archives of Dermatology [This Month in Archives of Dermatology]

Blue Atrophy of the Skin From Cocaine Injections. [Archives a Century Ago]

Interstitial Granulomatous Dermatitis With Arthritis Responding to Tocilizumab [The Cutting Edge: Challenges in Medical and Surgical Therapies]

Error in Byline in: Erythematous Patches and Plaques on the Chest With Induration of the Breasts [Correction]

High Frequency of Genital Lichen Sclerosus in a Prospective Series of 76 Patients With Morphea: Toward a Better Understanding of the Spectrum of Morphea [Study]

Objective To compare the frequency of genital lichen sclerosus (LS) in patients with morphea with that of control patients. Design A prospective multicenter study. Setting Four French academic dermatology departments: Strasbourg, Montpellier, Tenon Hospital Paris, and Henri Mondor Hospital Créteil. Patients Patients were recruited from November 1, 2008, through June 30, 2010. Seventy-six patients with morphea and 101 age- and sex-matched controls, who underwent complete clinical examination, were enrolled. Interventions A complete clinical examination and, if deemed necessary, a cutaneous biopsy. Main Outcome Measure The frequency of genital LS. Results There were 58 women and 18 men (a 3:1 ratio) with a median age of 59 years. Mean (range) age at diagnosis was 54 (13-87) years. Forty-nine patients had plaque morphea, 9 had generalized morphea, and 18 had linear morphea. Three patients (3%) in the control group and 29 patients (38%) with morphea had LS (odds ratio, 19.8; 95% CI, 5.7-106.9; P < .001). Twenty-two patients with plaque morphea (45%) and only 1 patient with linear morphea (6%) had associated genital LS. Conclusions Genital LS is significantly more frequent in patients with morphea than in unaffected individuals. Forty-five percent of patients with plaque morphea have associated LS. Complete clinical examination, including careful inspection of genital mucosa, should therefore be mandatory in patients with morphea because genital LS bears a risk of evolution into squamous cell carcinoma and thus needs treatment with topical corticosteroids.

Missing Genital Lichen Sclerosus in Patients With Morphea: Don't Ask? Don't Tell?: Comment on "High Frequency of Genital Lichen Sclerosus in a Prospective Series of 76 Patients With Morphea" [Practice Gaps]

The Contribution of Nodular Subtype to Melanoma Mortality in the United States, 1978 to 2007 [Study]

Objective To gain insight into reducing melanoma mortality by examining epidemiologic trends by subtype with emphasis on the contribution of each subtype to melanoma-related death. Design Retrospective population-based cohort study. Setting Original 9 registries of the Surveillance, Epidemiology, and End Results Program from 1978 to 2007. Participants A total of 111 478 patients with histologically confirmed invasive melanoma. Main Outcome Measure Proportion of ultimately fatal melanomas by subtype. Results Among melanomas of known subtype, superficial spreading melanoma comprised 66% of incident melanomas and 46% of ultimately fatal melanomas; nodular melanoma comprised 14% of incident melanomas and 37% of ultimately fatal melanomas. For superficial spreading melanoma, overall incidence per 100 000 per year increased (from 4.28 to 6.63), ultimately fatal incidence remained stable (at 0.56 to 0.51), and 10-year relative survival increased (from 90.6% to 96.5%) when comparing successive 5-year intervals. In contrast, for nodular melanoma, the overall incidence (1.30-1.32), ultimately fatal incidence (0.46-0.44), and 10-year relative survival rate (61.8%-61.5%) remained stable. Epidemiologic trends of melanoma, not otherwise specified, were similar to superficial spreading melanoma. There was a strong negative correlation between the proportion of melanoma, not otherwise specified, among all melanomas, and the proportion of superficial spreading melanoma, among melanomas of known subtype (r = –0.80; P = .01), across the registries. Conclusions Superficial spreading and nodular melanoma constitute similar proportions of ultimately fatal melanomas. Although incidence of and survival from superficial spreading melanoma have increased from 1978 to 2007, neither the incidence of nor survival from nodular melanoma has changed. Public health efforts should include a focus on nodular melanoma for maximum reduction of melanoma mortality.

October 2011 Archives Web Quiz Winner [Archives Web Quiz Winner]

Relationship Between the Depth of Facial Wrinkles and the Density of the Retinacula Cutis [Study]

Objective To identify whether there is a relationship between the depth of facial wrinkles and the density of the retinacula cutis in the subcutaneous tissue of the skin. Design Wrinkle depth was assessed with image analysis on the forehead and the lateral canthus of human cadavers. The density of the retinacula cutis was measured in Azan-Mallory–stained skin sections obtained around the wrinkles. Setting Gross Anatomy Section, Kagoshima University Graduate School of Medical and Dental Sciences. Participants Fifty-five male and female cadavers (35-93 years old). Main Outcome Measures The maximum depth of each wrinkle was used to represent the wrinkle's degree. In the skin sections, the density of the retinacula cutis was measured around the deepest point of each wrinkle in a 1-mm-wide area (the wrinkle-specific area) and a 10-mm-wide area that included the wrinkle (the wrinkle-inclusive area). Results In both the wrinkle-specific and wrinkle-inclusive areas, the retinacula cutis densities became lower in the forehead and in the lateral canthus areas. When a wrinkle was shallow, the density was lower in the wrinkle-specific area than in the wrinkle-inclusive area. With wrinkle progression, the density difference between the wrinkle-specific and the wrinkle-inclusive areas gradually decreased until there was no apparent difference. Conclusions Facial wrinkles seem to develop above sites of reduced lower retinacula cutis density. As a wrinkle develops, the density decreases in both the wrinkle-specific and the wrinkle-inclusive areas, whereas the density difference between those areas vanishes.

Top-Accessed Article: On Beauty [The Best of the Best]

Comparable Effectiveness of Endovenous Laser Ablation and High Ligation With Stripping of the Great Saphenous Vein: Two-Year Results of a Randomized Clinical Trial (RELACS Study) [Study]

Objective To compare the clinical efficacy and safety of endovenous laser treatment (EVLT) with high ligation and stripping (HLS) as standard treatment for great saphenous vein (GSV) insufficiency. Design Two-center randomized controlled trial with 2-year follow-up. Setting Interventions were performed on ambulatory and hospitalized patients at 2 vein centers, a university dermatology department (EVLT-treated group), and a specialized vein clinic (HLS-treated group). Patients Random sample of 400 patients with GSV insufficiency. Interventions Patients were assigned (1:1) to EVLT or HLS of the GSV from September 2004 through March 2007; 185 and 161 patients (limbs), respectively, were treated per protocol. Main Outcome Measures Clinically recurrent varicose veins after surgery (REVAS classification, primary study objective), duplex-detected saphenofemoral recurrence, clinical venous severity scoring (Homburg Varicose Vein Severity Score), hemodynamics (venous refilling time), quality of life (Chronic Venous Insufficiency Questionnaire 2), adverse effects, and visual analog scale–based evaluations of patients' satisfaction. Results Clinically recurrent varicose veins after surgery were similarly observed in both groups: 16.2% (EVLT-treated group) vs 23.1% (HLS-treated group); P = .15. Duplex-detected saphenofemoral refluxes occurred significantly more frequently after EVLT (17.8% vs 1.3%; P < .001). Both treatments equally improved medical condition (Homburg Varicose Vein Severity Score) and disease-related quality of life. Endovenous laser treatment caused more adverse effects (phlebitic reaction, tightness, dyspigmentation) but revealed advantages concerning hemodynamics, recovery, and cosmetic outcome. Conclusions Both EVLT and HLS are comparably safe and effective procedures to treat GSV incompetence. The significantly higher rate and the course of duplex-detected saphenofemoral recurrences after EVLT remain a matter of further investigations. Trial Registration isrctn.org Identifier: ISRCTN18322872

Impact of Live Interactive Teledermatology on Diagnosis, Disease Management, and Clinical Outcomes [Study]

Objective To assess the impact of live interactive teledermatology consultations on changes in diagnosis, disease management, and clinical outcomes. Design We conducted a retrospective analysis of 1500 patients evaluated via live interactive teledermatology between 2003 and 2005 at the University of California, Davis. We compared diagnoses and treatment plans between the referring physicians and the teledermatologists. Patients with 2 or more teledermatology visits within a 1-year period were assessed for changes in clinical outcomes. Setting Academic medical center with an established teledermatology program since 1996. Participants Medical records were evaluated for 1500 patients who underwent live interactive teledermatology consultation. Patients seen for more than 1 teledermatology visit were included in the clinical outcome assessment. Intervention Live interactive teledermatology consultation. Main Outcome Measures Changes in diagnosis, disease management, and clinical outcome. Results Compared with diagnoses and treatment plans from referring physicians, the 1500 live interactive teledermatology consultations resulted in changes in diagnosis in 69.9% of patients and changes in disease management in 97.7% of patients. Among 313 patients with at least 2 teledermatology visits within 1 year, clinical improvement was observed in 68.7% of patients. Multivariate analysis showed that changes in diagnosis (P = .01), changes in disease management (P < .001), and the number of teledermatology visits (P < .001) were significantly associated with improved clinical outcomes. Conclusions Live interactive teledermatology consultations result in changes in diagnosis and disease management in most consultations. The numbers of live interactive teledermatology visits and changes in diagnosis and disease management are significantly associated with improved clinical outcomes.

Trends in Pediatric Psoriasis Outpatient Health Care Delivery in the United States [Study]

Objective To characterize patterns of childhood psoriasis health care delivery from 1979-2007. Design Retrospective, cross-sectional investigation using National Ambulatory Medical Care Survey data. Setting US ambulatory physician offices from 1979 through 2007. Patients Children with psoriasis ages 0 (birth) to 18 years. Main Outcome Measures Demographics, physician specialty, and medications prescribed. Results There were an estimated 3.8 million visits for psoriasis over the study interval with a median of 123 420 visits per year. Dermatologists saw 63% of patients, pediatricians saw 17%, and internists, 14%. The numbers of visits were equal between sexes but ranged by age group: patients ages 13 to 18 years accounted for 47% of visits, those ages 8 to 12 years for 35%, and those ages 0 to 7 for 18%. Ninety-three percent of patients were white. Topical corticosteroids were the most commonly prescribed medications. Children 0 to 9 years old received equally potent corticosteroids as children 10 to 18 years old. Among all patients, the most prescribed medication was topical betamethasone; among those ages 0 to 9 years, tacrolimus; and among those ages 10 to 18 years, betamethasone. By physician specialty, the most prescribed medications were high-potency steroids for dermatologists and internists, and topical tacrolimus for pediatricians. Topical calcineurin inhibitors were not among the top 20 most prescribed medications by dermatologists, and systemic antipsoriatic agents were not among the top 20 most prescribed medications in any age group. Conclusions Over the 28-year interval, outpatient visits for pediatric psoriasis were attended primarily by white children older than 8 years in equal number by sex. Dermatologists and pediatricians saw the majority, and treatment approach differed by physician specialty and patient age. Treatment guidelines for childhood psoriasis may help reduce treatment variability.

Prescribing Patterns by Dermatologists and Primary Care Providers for Pediatric Psoriasis: Comment on "Trends in Pediatric Psoriasis Outpatient Health Care Delivery in the United States" [Practice Gaps]

Banding Pattern on Polarized Hair Microscopic Examination and Unilateral Polymicrogyria in a Patient With Steroid Sulfatase Deficiency [Observation]

Background Several forms of ichthyosis are associated with neurologic manifestations, including Sjögren-Larsson syndrome, Refsum disease, and mental retardation–enteropathy-deafness-neuropathy-ichthyosis-keratoderma (MEDNIK) syndrome. We report a case of X-linked steroid sulfatase deficiency, ichthyosis, seizures, abnormal hair banding pattern, and unilateral polymicrogyria. Observations A 3-year-old Caucasian male with a history of ichthyosis since birth presented with generalized tonic seizures. Findings from a physical examination were remarkable for thin hair, retinitis pigmentosa, and poor dentition. Polarized light microscopic examination of all the hair samples demonstrated a banding pattern. Magnetic resonance imaging of the brain revealed left hemispheric polymicrogyria with decreased sulcal pattern and stable asymmetric dilation of the left lateral ventricle. Constitutional microarray revealed the typical approximately 1.5-Mb deletion of the steroid sulfatase gene. Conclusions Steroid sulfatase deficiency is a cause of X-linked ichthyosis; however, our patient also had retinitis pigmentosa, seizures, and abnormal hair findings. The presence of abnormal hair with a banding pattern on polarized microscopy may be helpful for diagnosis; however, this pattern is not specific to this disease. In addition, to our knowledge, the presence of a malformation of cortical development has not been previously reported in patients with steroid sulfatase deficiency.

Mikhail Bulgakov: The Master and Syphilis [Notable Notes]

Cutaneous Manifestations of DOCK8 Deficiency Syndrome [Observation]

Background Mutations in the dedicator of cytokinesis 8 gene (DOCK8) cause a combined primary immunodeficiency syndrome that is characterized by elevated serum IgE levels, depressed IgM levels, eosinophilia, sinopulmonary infections, cutaneous viral infections, and lymphopenia. Many patients with DOCK8 deficiency were previously thought to have a variant of Job's syndrome. Distinguishing between DOCK8 deficiency and Job's syndrome, also referred to as autosomal dominant hyper-IgE syndrome, on the basis of clinical findings alone is challenging. The discovery of the DOCK8 mutation has made it possible to differentiate the cutaneous manifestations of these hyper-IgE syndromes. Observations Twenty-one patients from 14 families with confirmed homozygous or compound heterozygous mutations in DOCK8 were evaluated. Clinical findings included dermatitis, asthma, food and environmental allergies, recurrent sinopulmonary infections, staphylococcal skin abscesses, and severe cutaneous viral infections. Malignant neoplasms, including aggressive cutaneous T-cell lymphoma, anal and vulvar squamous cell carcinomas, and diffuse large B-cell lymphoma, developed in 5 patients during adolescence and young adulthood. Conclusions DOCK8 deficiency and Job's syndrome share several clinical features, including elevated serum IgE levels, dermatitis, recurrent sinopulmonary infections, and cutaneous staphylococcal abscesses. However, the presence of recalcitrant, widespread cutaneous viral infections, asthma, and food and environmental allergies, as well as the absence of newborn rash and coarse facies, favors the clinical diagnosis of DOCK8 deficiency. Rates of malignancy and overall mortality in patients with DOCK8 deficiency were higher than in those with Job's syndrome, highlighting the value of distinguishing between these conditions and the importance of close monitoring for neoplasia.

A Novel Mutation in the PORCN Gene Underlying a Case of Almost Unilateral Focal Dermal Hypoplasia [Observation]

Background Focal dermal hypoplasia (also known as Goltz syndrome) is an X-linked dominant syndrome characterized by patchy hypoplastic skin with soft-tissue, skeletal, dental, and ocular defects that are secondary to mutations in the PORCN gene. To our knowledge, only 5 cases of focal dermal hypoplasia with unilateral presentation have been reported, and molecular studies were not performed in any of the cases. Observations A 17-year-old girl was seen with features of almost unilateral focal dermal hypoplasia. These included left cleft hand, dental dysplasia, left mammary hypoplasia, deviation of the sacral line, raspberrylike papillomas in the perianal region, syndactyly of the second and third digits of the left foot, and linear streaks of dermal hypoplasia and pigmented lesions on her left hemibody. Conclusions Mutation analysis of PORCN revealed a novel heterozygous mutation in exon 10, c.854-855insACCTGAC; [p.T285fsX316], resulting in a premature stop signal. Analysis of the X-chromosome inactivation status was performed on blood and skin DNA samples, showing random inactivation in blood and unaffected skin and skewed inactivation in affected skin, highlighting the role of X-chromosome inactivation in X-linked disease expression.

Tonsuring and the Western Wig and Hair Extension Market [Notable Notes]

Polarized Microscopy as a Helpful Tool to Distinguish Chronic Nonscarring Alopecia From Scarring Alopecia [Observation]

Background Nonscarring alopecia differs from scarring alopecia on pathologic examination by the preservation of follicular units and lack of follicular dropout. However, long-standing cases of active nonscarring hair loss can show follicular dropout on pathologic examination and can be difficult to interpret. Observations We describe a patient with nonscarring alopecia that was misdiagnosed as scarring alopecia due to difficulty in distinguishing between scarred tracts (follicular dropout) and long-persisting fibrovascular streamers. Polarized light microscopy permits us to distinguish follicular scars from fibrous streamers because the fibrous streamers are birefringent negative for collagen. The main advantages of polarized microscopy are that it is fast and cost free and can screen all sections within minutes; it is also easy to interpret for beginners because there is a built-in control of birefringent-positive dermal collagen. Conclusion Polarized light can be used in the pathological evaluation of hair loss to distinguish between the follicular scars in scarring alopecia and the fibrovascular streamers in long-standing nonscarring alopecia.

Consensus Guidelines for the Management of Plaque Psoriasis [Consensus Statement]

The Canadian Guidelines for the Management of Plaque Psoriasis were reviewed by the entire National Psoriasis Foundation Medical Board and updated to include newly approved agents such as ustekinumab and to reflect practice patterns in the United States, where the excimer laser is approved for psoriasis treatment. Management of psoriasis in special populations is discussed. In the updated guidelines, we include sections on children, pregnant patients or pregnant partners of patients, nursing mothers, the elderly, patients with hepatitis B or C virus infections, human immunodeficiency virus–infected patients, and patients with malignant neoplasms, as well as sections on tumor necrosis factor blockers, elective surgery, and vaccinations.

Cancer Risk in Patients With Chronic Urticaria: A Population-Based Cohort Study [Evidence-Based Dermatology: Study]

Objective To investigate the relative risk of cancer among patients with chronic urticaria in the Taiwanese population. Design Retrospective population-based cohort study. Setting The National Health Insurance Research Database of Taiwan from January 1, 1996, through December 31, 2008. Participants A total of 12 720 patients with chronic urticaria, with long-term antihistamine use and no history of malignant tumors, autoimmune diseases, atopy, or allergic diseases. Main Outcome Measure Relative cancer risk calculated by standardized incidence ratios. Results There were 704 cancers among chronic urticaria patients. An increased risk of cancer (standardized incidence ratio, 2.2; 95% CI, 2.0-2.3), especially hematologic malignant tumor (4.1; 3.1-5.4), was observed. The relative risk of cancer varied by age and was highest among those aged 20 to 39 years in comparison with the general population. Most cancer cases were detected within the first year of diagnosis. The risk of non-Hodgkin lymphoma was greatest (standardized incidence ratio, 4.4; 95% CI, 3.0-6.1) among the hematologic cancers. Conclusions Patients with chronic urticaria are at increased risk of cancer, especially hematologic malignant tumors. Further studies are needed to delineate the associations.

Charles Bukowski and Sylvia Plath on Moles and Melanoma [Notable Notes]

Imiquimod vs Cryotherapy for Molluscum Contagiosum: A Randomized Controlled Trial [Evidence-Based Dermatology: Research Commentary]

Maturation of an Idea: A Historical Perspective on the Association of Psoriasis With the Metabolic Syndrome and Cardiovascular Disease [Notable Notes]

Blistering Mucosal Eruption in a Young Woman With Systemic Lupus Erythematosus--Quiz Case [Off-Center Fold]

Blistering Mucosal Eruption in a Young Woman With Systemic Lupus Erythematosus--Diagnosis [Off-Center Fold]

Erythematous Patches on the Chest--Quiz Case [Off-Center Fold]

Erythematous Patches on the Chest--Diagnosis [Off-Center Fold]

Firm Nodule on the Shoulder--Quiz Case [Off-Center Fold]

Firm Nodule on the Shoulder--Diagnosis [Off-Center Fold]

Reticulate Hyperpigmentation of the Vulva--Quiz Case [Off-Center Fold]

Reticulate Hyperpigmentation of the Vulva--Diagnosis [Off-Center Fold]

A Small Study of the Relationship Between Abobotulinum Toxin A Concentration and Forehead Wrinkle Reduction [Research Letters]

Dilution, Reconstitution, and Complexity: Comment on "A Small Study of the Relationship Between Abobotulinum Toxin A Concentration and Forehead Wrinkle Reduction" [Practice Gaps]

Implementation of the Federal Excise Tax on Indoor Tanning Services in Illinois [Research Letters]

Attitudes Toward Indoor Tanning Among Users of Sunless Tanning Products [Research Letters]

Photodynamic Therapy With 5-Aminolevulinic Acid Intralesional Injection for Pyogenic Granuloma [Research Letters]

Acquired Epidermodysplasia Verruciformis Syndrome in HIV-Infected Pediatric Patients: Prospective Treatment Trial With Topical Glycolic Acid and Human Papillomavirus Genotype Characterization [Research Letters]

A Population-Based Study of Acne and Body Mass Index in Adolescents [Research Letters]

Narrowband UV-B Phototherapy During Pregnancy and Folic Acid Depletion [Correspondence]

Interferon-{gamma} Release Assay [Correspondence]

Resolution of Skin Maladies of the Trapped Chilean Miners: The Unplanned Underground Copper-Impregnated Antifungal Socks "Trial" [Correspondence]

An Acrochordon-Like Melanoma Metastasis [Correspondence]

A Novel Application of Topical Rapamycin Formulation, an Inhibitor of mTOR, for Patients With Hypomelanotic Macules in Tuberous Sclerosis Complex [Correspondence]

Atypical Gingivitis Heralding a Case of Orofacial Granulomatosis [Correspondence]

Congenital Mucinous Eccrine Nevi in an Infant With Chronic Granulomatous Disease [Correspondence]

White Shiny Structures in Melanoma and BCC [skINsight]

Monitoring Peripheral Blood CD4+ Intracellular Adenosine Triphosphate Concentration in Patients with Psoriasis Treated with Fumaric Acid Esters.

Monitoring Peripheral Blood CD4+ Intracellular Adenosine Triphosphate Concentration in Patients with Psoriasis Treated with Fumaric Acid Esters. Acta Derm Venereol. 2012 Feb 1; Authors: Gambichler T, Scola N, Rotterdam S, Höxtermann S, Haghikia A, Faissner S, Kreuter A, Bechara FG, Altmeyer P, Chan A PMID: 22294455 [PubMed - as supplied by publisher]

Phylloid Hypermelanosis in a Child with Psychomotor Delay, Cicatricial Alopecia, Hearing Loss and Polythelia.

Phylloid Hypermelanosis in a Child with Psychomotor Delay, Cicatricial Alopecia, Hearing Loss and Polythelia. Acta Derm Venereol. 2012 Feb 1; Authors: Bygum A, Petkov Y, Graakjaer J, Jensen UB, Fagerberg C PMID: 22294434 [PubMed - as supplied by publisher]

Impaired Expression of Tim-3 on Th17 and Th1 Cells in Psoriasis.

Impaired Expression of Tim-3 on Th17 and Th1 Cells in Psoriasis. Acta Derm Venereol. 2012 Feb 1; Authors: Kanai Y, Satoh T, Igawa K, Yokozeki H Abstract Psoriasis is a chronic skin disease mediated by Th17 and/or Th1 cells. Tim-3 is a cell surface molecule preferentially expressed on Th17 and Th1 cells. The interaction of Tim-3 with Tim-3 ligand inhibits cytokine production. To assess whether T cells in psoriasis have functional abnormalities, expression of cell surface Tim-3 on blood T cells producing interleukin-17 (Th17/Tc17 cells) or interferon-γ (Th1/Tc1 cells) was examined by flow cytometry. Psoriasis patients had higher numbers of Th17 and Tc17 cells, as well as Th1 and Tc1 cells, than healthy donors. However, Th17, Th1 and Tc1 cells in psoriasis did not efficiently express Tim-3 upon activation, compared with those from atopic dermatitis and healthy donors. Tim-3- cells showed more potent cytokine production than Tim-3+ cells. Impaired Tim-3 expression allows Th17, Th1 and Tc1 cells to escape from Tim-3-mediated negative regulatory systems and may contribute to the pathogenesis of psoriasis. PMID: 22294262 [PubMed - as supplied by publisher]

Beyond Zoster: Sensory and Immune Changes in Zoster-affected Dermatomes.

Beyond Zoster: Sensory and Immune Changes in Zoster-affected Dermatomes. Acta Derm Venereol. 2012 Feb 1; Authors: Ruocco V, Sangiuliano S, Brunetti G, Ruocco E Abstract Neuroepidermal tropism of varicella-zoster virus accounts for cutaneous and nerve lesions following herpes zoster. Skin lesions heal in a few weeks and may or may not leave visible scars. Nerve lesions involve peripheral sensory fibres, sometimes causing permanent damage that results in partial denervation of the affected dermatome. The effects of the nerve injury involve the sensibility function, thus causing neuralgia, itch, allodynia, hypo- or anaesthesia, as well as the immune function that is related to neuropeptide release, thus altering immune control in the affected dermatome. The neuro-immune destabilization in the zoster-infected site paves the way for the onset of many and various immunity-related disorders along the affected dermatome. PMID: 22294236 [PubMed - as supplied by publisher]

Methotrexate Reduces the Occurrences of Cerebrovascular Events among Taiwanese Psoriatic Patients: A Nationwide Population-Based Study.

Methotrexate Reduces the Occurrences of Cerebrovascular Events among Taiwanese Psoriatic Patients: A Nationwide Population-Based Study. Acta Derm Venereol. 2012 Feb 1; Authors: Lan CC, Ko YC, Yu HS, Wu CS, Li WC, Lu YW, Chen YC, Chin YY, Yang YH, Chen GS Abstract Psoriasis is a chronic inflammatory disease. The aim of this study was to evaluate the effects of methotrexate and retinoid on risks for developing cerebrovascular disease among psoriatic patients. A population-based nested case-control study was conducted using the Taiwanese National Health Insurance database. Cox proportional hazards models were adopted. The hazard ratio (HR) of newly developed cerebrovascular disease was 1.28 (95% confidence interval (CI) = 1.162-1.413; p < 0.0001) for psoriatic vs. non-psoriatic subjects. In terms of the effects of methotrexate or retinoid on the occurrence of cerebrovascular disease, a significant protection effect (HR = 0.50; 95% CI = 0.27-0.92; p = 0.0264) was found for patients with methotrexate prescription. Retinoid prescription showed no protective effect. Further analyses revealed that a low cumulative methotrexate dose is associated with significant protective effect (HR = 0.53; 95% CI = 0.28-1.00; p = 0.0486) while a high cumulative dose was not (HR 0.80; 95% CI = 0.11-5.68; p = 0.8214). These results suggest that psoriatic patients receiving low-dose methotrexate treatment may have reduced risk for developing cerebrovascular disease. Further prospective study should be performed to validate the vasculoprotective effect of this treatment strategy. PMID: 22294195 [PubMed - as supplied by publisher]

Acquired Dermal Melanocytosis Induced by Psoralen Plus Ultraviolet A Therapy.

Acquired Dermal Melanocytosis Induced by Psoralen Plus Ultraviolet A Therapy. Acta Derm Venereol. 2012 Feb 1; Authors: Nagase K, Hirashima N, Koba S, Inoue T, Misago N, Narisawa Y PMID: 22294134 [PubMed - as supplied by publisher]

Disseminated Cutaneous Glomangiomas in an Adolescent Boy.

Disseminated Cutaneous Glomangiomas in an Adolescent Boy. Acta Derm Venereol. 2012 Feb 1; Authors: Borovaya A, Kunte C, Flaig MJ, Albrecht K, Goldscheider I, Korting HC, Ruzicka T, Sárdy M PMID: 22294072 [PubMed - as supplied by publisher]

Eccrine Poromatosis Associated with Polychemotherapy.

Eccrine Poromatosis Associated with Polychemotherapy. Acta Derm Venereol. 2012 Feb 1; Authors: Fujii K, Aochi S, Takeshima C, Ohtsuka M, Hamada T, Asagoe K, Aoyama Y, Morizane S, Iwatsuki K Abstract Eccrine poroma frequently occurs as a solitary tumour, and only a few reports have described the occurrence of multiple lesions. Multiple eccrine poromas, or eccrine poromatosis, may occur in patients who have undergone radiotherapy and/or polychemotherapy. We report here four cases of multiple eccrine poromas in patients who were either undergoing, or had undergone, intensive chemotherapy (from 6 months to 16 years prior to onset). Three patients had non-Hodgkin's lymphoma and one had malignant fibrous histiocytosis. The number of lesions varied from 3 to > 20 in each patient, and all the lesions occurred on non-irradiated skin. The histopatho-logical features were consistent with those of eccrine poroma, Pinkus type. In addition to radiation therapy, intensive chemotherapy may play a role in the pathogenesis of multiple eccrine poromas even many years after treatment. PMID: 22294042 [PubMed - as supplied by publisher]

Acute Streptococcal Infection of the Vulva.

Acute Streptococcal Infection of the Vulva. Acta Derm Venereol. 2012 Feb 1; Authors: Veraldi S, Francia C, Marzano AV PMID: 22293992 [PubMed - as supplied by publisher]

Multiple Blisters Along the Lip Vermilion are a Clue to Bullous Lupus Erythematosus.

Multiple Blisters Along the Lip Vermilion are a Clue to Bullous Lupus Erythematosus. Acta Derm Venereol. 2012 Feb 1; Authors: Nico MM, Lourenço SV PMID: 22293956 [PubMed - as supplied by publisher]

Topical Tacrolimus and 50% Zinc Oxide Paste for Hailey-Hailey Disease: Less is More.

Topical Tacrolimus and 50% Zinc Oxide Paste for Hailey-Hailey Disease: Less is More. Acta Derm Venereol. 2012 Feb 1; Authors: Pagliarello C, Paradisi A, Dianzani C, Paradisi M, Persichetti P PMID: 22293917 [PubMed - as supplied by publisher]

Epstein-Barr Virus-positive Mucocutaneous Ulcers as a Manifestation of Methotrexate-associated B-cell Lymphoproliferative Disorders.

Epstein-Barr Virus-positive Mucocutaneous Ulcers as a Manifestation of Methotrexate-associated B-cell Lymphoproliferative Disorders. Acta Derm Venereol. 2012 Feb 1; Authors: Hashizume H, Uchiyama I, Kawamura T, Suda T, Takigawa M, Tokura Y PMID: 22293895 [PubMed - as supplied by publisher]

Incidental Gastric Signet-ring Cell Carcinoma Metastasis to the Skin in Basal Cell Carcinoma.

Incidental Gastric Signet-ring Cell Carcinoma Metastasis to the Skin in Basal Cell Carcinoma. Acta Derm Venereol. 2012 Feb 1; Authors: Nakamura Y, Satomi K, Noguchi M, Shibata-Ito M, Fujisawa Y, Kawachi Y, Otsuka F PMID: 22293867 [PubMed - as supplied by publisher]

Elastoderma: An Uncommon Cause of Acquired Hyperextensible Skin.

Elastoderma: An Uncommon Cause of Acquired Hyperextensible Skin. Acta Derm Venereol. 2012 Feb 1; Authors: de Waal AC, Blokx WA, Seyger MM, van Rossum MM PMID: 22293849 [PubMed - as supplied by publisher]

Mid-dermal Elastolysis: Another Dermatological Clue to Autoimmunity?

Mid-dermal Elastolysis: Another Dermatological Clue to Autoimmunity? Acta Derm Venereol. 2012 Feb 1; Authors: Martínez-Escala ME, Rozas E, Pujol RM, Herrero-González JE PMID: 22293825 [PubMed - as supplied by publisher]

No Association between Infections, HLA Type and Other Transplant-related Factors and Risk of Cutaneous Squamous Cell Carcinoma in Solid Organ Transplant Recipients.

No Association between Infections, HLA Type and Other Transplant-related Factors and Risk of Cutaneous Squamous Cell Carcinoma in Solid Organ Transplant Recipients. Acta Derm Venereol. 2012 Feb 1; Authors: Ingvar A, Smedby KE, Lindelöf B, Fernberg P, Bellocco R, Tufveson G, Höglund P, Adami J Abstract Recipients of solid organ transplants are at a markedly increased risk of cutaneous squamous cell carcinoma (SCC). We investigated potential associations between post-transplant infections, HLA type, and other transplant-related factors and risk of SCC, taking immuno-suppressive treatment into account. A population-based case-control study was conducted. All patients who developed SCC during follow-up (1970-1997) were eligible as cases (n = 207). Controls (n = 189) were individually matched to the cases on age and calendar period of transplantation. Detailed exposure information was collected through an extensive, blinded review of medical records. Odds ratios were computed with conditional logistic regression. There were no significant associations with any infectious agents, or with number and timing of infections, specific HLA-type, donor characteristics, or other transplant characteristics and risk of post-transplant SCC. These results suggest that risk of post-transplant SCC is neither closely related to specific post-transplant infectious disorders, nor to the infectious load or specific HLA types. PMID: 22293782 [PubMed - as supplied by publisher]

Isotopic Response of Graft Versus Host Disease Following Herpes Zoster Infection: Case Report and Review of the Literature.

Isotopic Response of Graft Versus Host Disease Following Herpes Zoster Infection: Case Report and Review of the Literature. Acta Derm Venereol. 2012 Feb 1; Authors: Mehra T, Metzler G, Bauer J, Köberle M, Garbe C PMID: 22293729 [PubMed - as supplied by publisher]

Serum Levels of CC Chemokine Receptor 4 and CXC Chemokine Receptor 3 Ligands in CD8+ Sézary Syndrome.

Serum Levels of CC Chemokine Receptor 4 and CXC Chemokine Receptor 3 Ligands in CD8+ Sézary Syndrome. Acta Derm Venereol. 2012 Feb 1; Authors: Uchi H, Hayashida S, Takahara M, Moroi Y, Furue M PMID: 22293715 [PubMed - as supplied by publisher]

Henoch-Schönlein Purpura Associated With Solid-organ Malignancies: Three Case Reports and a Literature Review.

Henoch-Schönlein Purpura Associated With Solid-organ Malignancies: Three Case Reports and a Literature Review. Acta Derm Venereol. 2012 Feb 1; Authors: Podjasek JO, Wetter DA, Pittelkow MR, A D Abstract Adult Henoch-Schönlein purpura (HSP) is rarely associated with solid-organ malignancies. We describe here three adult patients with HSP diagnosed within 3 months of the diagnosis of associated solid-organ malignancies, including pulmonary, prostate, and renal carcinomas. Two patients had complete remission with a combination of immunosuppressive therapies and treatment of the associated malignancy. The third patient had partial remission with immunosuppressive therapies, but never received treatment for the associated malignancy and did not achieve complete remission before his death 10 months after diagnosis of HSP. These cases suggest that HSP associated with solid-organ malignancies may be resistant to immunosuppressive therapies without treatment of the associated malignancy. Therefore, evaluation for solid-organ malignancies should be considered in adult patients without an identifiable cause of HSP, especially if the disease is not self-limited or does not respond appropriately to treatment. PMID: 22293661 [PubMed - as supplied by publisher]

First Reported Case of the Swedish New Variant of Chlamydia trachomatis (nvCT) in Eastern Europe (Russia), and Evaluation of Russian Nucleic Acid Amplification Tests Regarding Their Ability to Detect nvCT.

First Reported Case of the Swedish New Variant of Chlamydia trachomatis (nvCT) in Eastern Europe (Russia), and Evaluation of Russian Nucleic Acid Amplification Tests Regarding Their Ability to Detect nvCT. Acta Derm Venereol. 2012 Feb 1; Authors: Shipitsyna E, Hadad R, Ryzhkova O, Savicheva A, Domeika M, Unemo M PMID: 22293657 [PubMed - as supplied by publisher]

Treatment of Cutaneous Warts: An Evidence-Based Review

A Psychodermatology Clinic: The Concept, the Format, and Our Observations from Israel

Clinical Manifestations of Cutaneous Metastases: A Review with Special Emphasis on Cutaneous Metastases Mimicking Keratoacanthoma

Comparative Effectiveness of Topical Calcineurin Inhibitors in Adult Patients with Atopic Dermatitis

Trigeminal Trophic Syndrome from Stroke: An Under-Recognized Central Neuropathic Itch Syndrome

Plasma Cell Balanitis Presenting in a Patient with a History of Syphilis

Spotlight on Ustekinumab in Moderate To Severe Plaque Psoriasis

Treatment Options for Primary Hyperhidrosis

The stable cyclic adenosine monophosphate analogue, dibutyryl cyclo-adenosine monophosphate (bucladesine), is active in a model of acute skin inflammation

Abstract Anti-inflammatory therapeutic options for the topical treatment of skin diseases with inflammatory or allergic contribution are mostly limited to topical glucocorticoids and calcineurin inhibitors. Both compound classes induce adverse effects. Elevation of intracellular cyclic adenosine monophosphate (cAMP) by inhibition of phosphodiesterase 4 was shown to induce potent anti-inflammatory effects, but the safety profile of currently available compounds is not sufficient. A different approach to increase intracellular cAMP is the substitution of chemically stabilized cAMP analogues. Bucladesine is a stabilized cAMP analogue with an excellent safety profile which had been marketed as topical treatment of impaired wound healing. In the current study, a novel water free emulsion containing bucladesine was evaluated for anti-inflammatory effects. In the arachidonic acid induced ear oedema model in mice, single or multiple administration of an emulsion containing 1.5% was capable of significantly reducing the inflammatory oedema. The data indicate that bucladesine represents an interesting treatment option for skin diseases where an anti-inflammatory activity is indicated. Due to the established clinical safety, this agent may bridge the gap between potent agents such as glucocorticoids or calcineurin inhibitors and emollients without active compounds. Content Type Journal ArticleCategory Short CommunicationPages 1-5DOI 10.1007/s00403-012-1216-6Authors Chris Rundfeldt, Drug-Consult.Net, Toepfferspark 2a, 39108 Magdeburg, GermanyHartwig Steckel, Department of Pharmaceutics and Biopharmaceutics, Christian Albrecht University Kiel, Grasweg 9a, 24118 Kiel, GermanyTorben Sörensen, Department of Pharmaceutics and Biopharmaceutics, Christian Albrecht University Kiel, Grasweg 9a, 24118 Kiel, GermanyPiotr Wlaź, Department of Animal Physiology, Institute of Biology and Biochemistry, Maria Curie-Skłodowska University, Akademicka 19, PL-20033 Lublin, Poland Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Erratum to: Oral doxycycline for the treatment of chronic leg ulceration

Erratum to: Oral doxycycline for the treatment of chronic leg ulceration Content Type Journal ArticleCategory ErratumPages 1-1DOI 10.1007/s00403-012-1211-yAuthors Genevieve M. Sadler, Department of Dermatology, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, WA 6009, AustraliaHilary J. Wallace, Burn Injury Research Unit, School of Surgery, University of Western Australia, Crawley, AustraliaMichael C. Stacey, School of Surgery, Fremantle Hospital, University of Western Australia, Fremantle, Australia Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Studies of cell signaling in a reconstructed human epidermis exposed to sensitizers: IL-8 synthesis and release depend on EGFR activation

Abstract Models of reconstructed human epidermis (RHE) holding proliferating and fully differentiated cultured keratinocytes allow in vitro investigation of early molecular and cellular epidermal events during the complex response of keratinocytes at the onset of allergic contact dermatitis (ACD) or sensitization. In this study, data collected on RHE exposed to well-characterized sensitizing chemicals, such as dinitrofluorobenzene, oxazolone, cinnamaldehyde and isoeugenol, revealed a transient expression of IL-8 mRNA in association with abundant IL-8 cell release. Investigations of keratinocyte signaling illustrate transient activation by tissue exposure to sensitizing chemicals of the epidermal growth factor receptor (EGFR). This activation of EGFR tyrosine kinase is involved in the expression and release of IL-8. The IL-8 release appears also to be partially dependent on p38 and ERK 1/2 MAPK activation. Moreover, data suggest that heparin-binding EGF-like growth factor (HB-EGF) expression and release induced after exposure of RHE to sensitizing chemicals are also under the control of EGFR tyrosine kinase activity, independently of the IL-8 expression and release. Mechanistic approach of keratinocyte responses in the context of RHE underlying regulation of expression and release of epidermal cytokines and growth factors after topical application of sensitizing chemicals is proposed to identify biomarkers which could then be analysed for in vitro toxicological screening of new or undefined compounds. Content Type Journal ArticleCategory Original PaperPages 1-15DOI 10.1007/s00403-012-1209-5Authors Aurélie Frankart, Cell and Tissue Laboratory, URPHYM (Research Unit for Molecular Physiology), NARILIS, University of Namur (FUNDP), 61 Rue de Bruxelles, 5000, Namur, BelgiumAlain Coquette, Department of Biology, SGS Life Science, Wavre, BelgiumKlaus-Rudolf Schroeder, Henkel AG & Co., Düsseldorf, GermanyYves Poumay, Cell and Tissue Laboratory, URPHYM (Research Unit for Molecular Physiology), NARILIS, University of Namur (FUNDP), 61 Rue de Bruxelles, 5000, Namur, Belgium Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

DNA damage after acute exposure of mice skin to physiological doses of UVB and UVA light

Abstract Solar ultraviolet (UV) radiation is an important risk factor in skin carcinogenesis. This has been attributed mainly to the UVB waveband because the high-energetic photons are capable of interacting with DNA and inducing DNA damage. Recently, UVA light has also gained increasing interest in relation to DNA alteration. Although UVA photons are less energetic than UVB, they comprise a major fraction of sunlight UV radiation and penetrate deep into the skin. The study was carried out to compare the acute effects of UVA and UVB light on SKH-1 mice in relation to DNA damage and associated parameters. Mice were exposed to UVA (10 and 20 J/cm2) or UVB (200 and 800 mJ/cm2) radiation. The number of DNA single-strand breaks (SSB) in lymphocytes, amount of phosphorylated histone H2AX (gamma-H2AX) and apoptosis or DNA fragmentation (TUNEL-positive cells) in skin sections and level of gamma-H2AX, activated caspase-3 and phosphorylated p53 in skin were evaluated after 4 and 24 h. SSB analyzed by alkaline comet assay were found to be 4 and 24 h following UVB and UVA treatment, respectively. TUNEL and gamma-H2AX-positive cell were observed only in UVB exposed animals at both time intervals. The level of activated caspase-3 and phospho-p53 was increased 24 h after UVA and UVB radiation and was more apparent in UVB treated mice. The results indicate that the mechanism of DNA damage caused by acute UVA exposure includes formation of SSB (oxidative damage), but not double-strand breaks. Content Type Journal ArticleCategory Short CommunicationPages 1-6DOI 10.1007/s00403-012-1212-xAuthors Alena Rajnochová Svobodová, Department of Medical Chemistry and Biochemistry, Faculty of Medicine and Dentistry, Palacký University, Hněvotínská 3, 775 15 Olomouc, Czech RepublicAdéla Galandáková, Department of Medical Chemistry and Biochemistry, Faculty of Medicine and Dentistry, Palacký University, Hněvotínská 3, 775 15 Olomouc, Czech RepublicJarmila Šianská, Department of Medical Chemistry and Biochemistry, Faculty of Medicine and Dentistry, Palacký University, Hněvotínská 3, 775 15 Olomouc, Czech RepublicDalibor Doležal, Center for Laboratory Animals, Faculty of Medicine and Dentistry, Palacký University, Hněvotínská 3, 775 15 Olomouc, Czech RepublicRadka Lichnovská, Department of Histology and Embryology, Faculty of Medicine and Dentistry, Palacký University, Hněvotínská 3, 775 15 Olomouc, Czech RepublicJitka Ulrichová, Department of Medical Chemistry and Biochemistry, Faculty of Medicine and Dentistry, Palacký University, Hněvotínská 3, 775 15 Olomouc, Czech RepublicJitka Vostálová, Department of Medical Chemistry and Biochemistry, Faculty of Medicine and Dentistry, Palacký University, Hněvotínská 3, 775 15 Olomouc, Czech Republic Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Ichthyin/NIPAL4 localizes to keratins and desmosomes in epidermis and Ichthyin mutations affect epidermal lipid metabolism

Abstract Autosomal recessive congenital ichthyosis (ARCI) is a group of disorders characterized by abnormal desquamation of the skin and a disrupted epidermal water barrier. Ichthyin/NIPAL4 gene mutations have been identified in a subgroup of ARCI patients, but the role of ichthyin in epidermis remains elusive. In order to obtain new insights concerning the characteristics of ichthyin and the ARCI pathogenesis, we studied the expression and localization of ichthyin and related epidermal components in cultured keratinocytes and skin sections from patients with Ichthyin mutations and healthy controls. We observed an up-regulation of Ichthyin mRNA levels after in vitro differentiation of keratinocytes from both a patient with Ichthyin mutations and controls. Confocal and electron microscopy analyses of immunolabeled skin sections revealed that ichthyin localizes to desmosomes and keratins in both patients with mutant Ichthyin and controls, with an increased immunolabeling in patients. Nile red lipid analysis of skin sections exposed intra-cellular lipid accumulations in cells of the granular and cornified layers in patients but not in controls, consistent with the pathognomonic lipid membrane structures previously identified in epidermis from patients. Our combined findings indicate that ichthyin is associated with keratins and desmosomes in epidermis and is involved in lipid metabolism, possibly through processing of lamellar bodies. These results provide new clues to the understanding of the epidermal water barrier and the pathogenesis in ARCI. Content Type Journal ArticleCategory Original PaperPages 1-10DOI 10.1007/s00403-012-1207-7Authors Johanna Dahlqvist, Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, 75185 Uppsala, SwedenGunilla T. Westermark, Department of Medical Cell Biology, Uppsala University, 75123 Uppsala, SwedenAnders Vahlquist, Department of Medical Sciences, Uppsala University Hospital, 75185 Uppsala, SwedenNiklas Dahl, Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, 75185 Uppsala, Sweden Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Exploring the role of prolactin in psoriasis

Abstract Prolactin (PRL) is well recognised for its role(s) in mammary gland development and function. Moreover, its role in skin biology, including the potent regulation of human hair growth, is becoming clearer. Less widely appreciated, however, is the potential role of PRL in the pathobiology of psoriasis. While the relationship between PRL and psoriasis remains enigmatic, several recent publications on the PRL–psoriasis connection have demonstrated a reawakening of interest in this conundrum. We take the occasion of these reports to underscore the importance of dissecting the role(s) of PRL in the aetiopathology of psoriasis, not least since this may help to identify novel hormonal treatment strategies in its management. Content Type Journal ArticleCategory News & ViewsPages 1-4DOI 10.1007/s00403-012-1208-6Authors Ewan A. Langan, Dermatology Centre, Salford Royal NHS Foundation Trust, School of Translational Medicine, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UKChristopher E. M. Griffiths, Dermatology Centre, Salford Royal NHS Foundation Trust, School of Translational Medicine, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UKRalf Paus, Dermatology Centre, Salford Royal NHS Foundation Trust, School of Translational Medicine, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Ani s 1 and Ani s 7 recombinant allergens are able to differentiate distinct Anisakissimplex-associated allergic clinical disorders

Abstract Diagnosis in gastro-allergic anisakiasis (GAA) is straightforward, when clinical history is combined with further allergological evaluation of specific IgE by means of skin prick test and serum specific IgE. In Anisakis simplex sensitisation associated chronic urticaria (CU+), clinical evaluation of possible previous parasitism is difficult, and positive serum specific IgE could be due to cross-reactivity or other unknown factors. In this study, we evaluated the association between IgE seropositivity to the recombinant allergens Ani s 1 and Ani s 7 and several A. simplex-associated allergic disorders. Twenty-eight patients with GAA and 40 patients with CU+ were studied and their IgE responses were compared with a control group composed of patients with chronic urticaria not sensitized to A. simplex (CU−) according to the skin prick test, as well as a group of 15 healthy subjects not referring urticaria or currently A. simplex associated symptoms. 82.1% of GAA patients and 42.5% of CU+ patients were positive for Ani s 1 (P < 0.001), while the Ani s 7 allergen was recognized by 92.9 and 92.5% of sera from patients with GAA and CU+, respectively. The combined positivity obtained for both allergens reached 100% in GAA, and 95% in CU+. IgE determinations to Ani s 1 and Ani s 7 allergens are useful to diagnose the Anisakis infections and to differentiate among several A. simplex-associated allergic disorders. The IgE responses to Ani s 1 are mainly associated with GAA, while this molecule cannot be considered a major allergen in CU+ patients. Content Type Journal ArticleCategory Original PaperPages 1-6DOI 10.1007/s00403-012-1206-8Authors C. Cuéllar, Departamento de Parasitología, Facultad de Farmacia, Universidad Complutense, Madrid, SpainA. Daschner, Servicio de Alergia, Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa, C/Diego de León, 62, 28006 Madrid, SpainA. Valls, Servicio de Alergia, Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa, C/Diego de León, 62, 28006 Madrid, SpainC. De Frutos, Servicio de Alergia, Instituto de Investigación Sanitaria, Hospital Universitario de La Princesa, C/Diego de León, 62, 28006 Madrid, SpainV. Fernández-Fígares, Departamento de Parasitología, Facultad de Farmacia, Universidad Complutense, Madrid, SpainA. M. Anadón, Laboratorio de Parasitología, Facultad de Farmacia, Universidad de Santiago de Compostela, Santiago de Compostela, SpainE. Rodríguez, Servicio de Parasitología, Centro Nacional de Microbiología, Majadahonda, SpainT. Gárate, Servicio de Parasitología, Centro Nacional de Microbiología, Majadahonda, SpainM. Rodero, Departamento de Parasitología, Facultad de Farmacia, Universidad Complutense, Madrid, SpainF. M. Ubeira, Laboratorio de Parasitología, Facultad de Farmacia, Universidad de Santiago de Compostela, Santiago de Compostela, Spain Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Reduced expression of microtubule-associated protein 1 light chain 3 in hypertrophic scars

Abstract Autophagy is a tightly regulated physiological process essential for cellular maintenance, differentiation, development, and homeostasis. Aberration of this process associates with the pathogeneses of several diseases in mammals. Hypertrophic scar (HS) is characterized by an abundance of collagenous tissue with hypercellularity. However, the molecular mechanism in HS formation is poorly understood. We compared the autophagic capacity in HS and its normal skin (NS) counterparts and explored the molecular mechanism of autophagy during the formation of HS. Microtubule-associated protein 1 light chain 3 (LC3) proteins in HS and NS were detected by immunohistochemistry, Western blot and quantitative real-time PCR (qPCR). The data showed that LC3 positive staining in HS was less intensive relative to NS group (p < 0.05). Three forms of LC3, with molecular weights of about 19 kDa (proLC3), 18 kDa (LC3-I) and 16 kDa (LC3-II), respectively, expressed in NS by Western blot. In contrast, only proLC3 expressed while both LC3-I and LC3-II were significantly downregulated in HS. The protein level of beclin 1 in HS was significantly lower compared with NS (p < 0.05). LC3 and beclin 1 mRNA levels in HS were significantly lower than that in NS (p < 0.05). These results suggest that the generation of LC3-I and LC3-II are interrupted in HS, and that the resultant decrease of autophagic capacity may associate with the pathogenesis of HS. Content Type Journal ArticleCategory Original PaperPages 1-7DOI 10.1007/s00403-012-1204-xAuthors Ji-Hong Shi, Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, 17 Changle West Road, Xi’an, Shaanxi 710032, ChinaDa-Hai Hu, Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, 17 Changle West Road, Xi’an, Shaanxi 710032, ChinaZhan-Feng Zhang, Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, 17 Changle West Road, Xi’an, Shaanxi 710032, ChinaXiao-Zhi Bai, Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, 17 Changle West Road, Xi’an, Shaanxi 710032, ChinaHong-Tao Wang, Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, 17 Changle West Road, Xi’an, Shaanxi 710032, ChinaXiong-Xiang Zhu, Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, 17 Changle West Road, Xi’an, Shaanxi 710032, ChinaYing-Jun Su, Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, 17 Changle West Road, Xi’an, Shaanxi 710032, ChinaChao-Wu Tang, Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, 17 Changle West Road, Xi’an, Shaanxi 710032, China Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Protective effects of β-glucan against oxidative injury induced by 2.45-GHz electromagnetic radiation in the skin tissue of rats

Abstract In recent times, there is widespread use of 2.45-GHz irradiation-emitting devices in industrial, medical, military and domestic application. The aim of the present study was to investigate the effect of 2.45-GHz electromagnetic radiation (EMR) on the oxidant and antioxidant status of skin and to examine the possible protective effects of β-glucans against the oxidative injury. Thirty-two male Wistar albino rats were randomly divided into four equal groups: control; sham exposed; EMR; and EMR + β-glucan. A 2.45-GHz EMR emitted device from the experimental exposure was applied to the EMR group and EMR + β-glucan group for 60 min daily, respectively, for 4 weeks. β-glucan was administered via gavage at a dose of 50 mg/kg/day before each exposure to radiation in the treatment group. The activities of antioxidant enzymes, superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT), as well as the concentration of malondialdehyde (MDA) were measured in tissue homogenates of the skin. Exposure to 2.45-GHz EMR caused a significant increase in MDA levels and CAT activity, while the activities of SOD and GSH-Px decreased in skin tissues. Systemic β-glucan significantly reversed the elevation of MDA levels and the reduction of SOD activities. β-glucan treatment also slightly enhanced the activity of CAT and prevented the depletion of GSH-Px activity caused by EMR, but not statistically significantly. The present study demonstrated the role of oxidative mechanisms in EMR-induced skin tissue damages and that β-glucan could ameliorate oxidative skin injury via its antioxidant properties. Content Type Journal ArticleCategory Original PaperPages 1-7DOI 10.1007/s00403-012-1205-9Authors Ali Murat Ceyhan, Department of Dermatology, Medical Faculty, Suleyman Demirel University, 32200 Cunur, Isparta, TurkeyVahide Baysal Akkaya, Department of Dermatology, Medical Faculty, Suleyman Demirel University, 32200 Cunur, Isparta, TurkeyŞeyma Celik Güleçol, Department of Dermatology, Medical Faculty, Suleyman Demirel University, 32200 Cunur, Isparta, TurkeyBetül Mermi Ceyhan, Department of Medical Biochemistry, Medical Faculty, Suleyman Demirel University, Isparta, TurkeyFehmi Özgüner, Department of Physiology, Medical Faculty, Suleyman Demirel University, Isparta, TurkeyWenChieh Chen, Department of Dermatology and Allergy, Technische Universität München, Munich, Germany Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Psoriasis increased the risk of diabetes: a meta-analysis

Abstract To evaluate the association between psoriasis and risk of diabetes, pertinent studies were identified by searching electronic databases and by reviewing the reference lists of retrieved articles. We included observational studies that examined the association between psoriasis and risk of diabetes. Two reviewers independently assessed eligibility and used a standardized form to collect data from published studies. The study quality was assessed by the Newcastle–Ottawa Scale. A total of 22 eligible studies that included 3,307,516 participants fulfilled the inclusion criteria. Compared to individuals without psoriasis, subjects with psoriasis had a 1.42-fold increased risk of diabetes (95% CI, 1.40–1.45). Findings from this meta-analysis suggest that individuals with psoriasis may have a modestly increased risk of diabetes. Content Type Journal ArticleCategory Original PaperPages 1-7DOI 10.1007/s00403-011-1200-6Authors Juan Cheng, Department of Dermatology, Beijing 302 Hospital, Beijing, ChinaDayu Kuai, Department of Digestion, Lu He Hospital, Beijing, ChinaLi Zhang, Department of Dermatology, Beijing 307 Hospital, Beijing, ChinaXueqin Yang, Department of Dermatology, Air Force General Hospital, Beijing, ChinaBing Qiu, Civil Aviation Medicine Center of Civil Aviation Administration of China, Beijing, China Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Effects of low pseudoallergen diet on urticarial activity and leukotriene levels in chronic urticaria

Abstract Pseudoallergens and leukotrienes (LTs) may have a role in chronic urticaria (CU). The aim of our study is to evaluate the response to the low pseudoallergen diet therapy in patients with CU and the change in LT levels in diet responsive and non-responsive patients. 34 patients with CU were put on diet for 4 weeks. All patients kept a daily score sheet of pruritus and whealing symptoms. The urticarial activity score (UAS) of each patient was calculated with the sum of pruritus and wheal score. The sum score of the first 7 consecutive days (UAS7-first week) and last 7 days (UAS7-fourth week) were used to compare the clinical outcome of the diet. A reduction of ≥50% in UAS7-fourth week compared to UAS7-first week was considered as “response”. Urinary LTE4 (uLTE4) level of each patient was measured at baseline and after the 4 week of diet therapy. 14 of the patients (41.2%) were responsive to diet therapy. Baseline uLTE4 levels were similar between responsive and non-responsive patients (P = 0.540). Second uLTE4 levels (after the 4 week of diet therapy) were significantly lower in responsives than in non-responsive patients (P < 0.001). Second uLTE4 levels of responsives were significantly lower than the baseline values (P = 0.019), whereas this was not significant for non-responsives (P = 0.070). There was a significant correlation between the change in uLTE4 levels and the change in mean urticarial activity scores (r = 0.554, P = 0.001) in the whole study population. In conclusion, low pseudoallergen diet helps to reduce the urticarial activity in CU. The change in urticarial activity correlates with the change in LT levels. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00403-011-1203-3Authors Gulsen Akoglu, Department of Dermatology, Faculty of Medicine, Hacettepe University, P. O. 06100, Sihhiye, Ankara, TurkeyNilgun Atakan, Department of Dermatology, Faculty of Medicine, Hacettepe University, P. O. 06100, Sihhiye, Ankara, TurkeyBanu Çakır, Department of Public Health, Faculty of Medicine, Hacettepe University, Ankara, TurkeyOmer Kalayci, Pediatric Allergy and Asthma Unit, Faculty of Medicine, Hacettepe University, Ankara, TurkeyMutlu Hayran, Research Unit, Faculty of Medicine, Hacettepe University, Ankara, Turkey Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Kinetics of neuronal contribution during the development of a contact allergic reaction

Abstract The nervous system contributes to allergic contact dermatitis (ACD). Elucidation of the implication of the nervous system during different stages of ACD could be of therapeutic value. Our aim was to study the kinetics and contribution of the nervous system to ACD by investigating innervation and expression of neuropeptides in skin biopsies obtained at 0, 6, 24, 48 and 72 h post-challenge. Biopsies were stained using antisera against protein gene product (PGP) 9.5, growth associated protein (GAP)-43, substance P and its receptor (R) neurokinin (NK)-1, NKA and NK-2R, and calcitonin gene-related peptide (CGRP). GAP-43-immunoreactive (ir) nerves revealed a time-dependent increase that was more pronounced at 48 and 72 h, while PGP 9.5-ir nerves remained unaltered. Substance P-, NKA- and CGRP-ir nerves at 0 and 6 h were significantly higher compared to later time points, whereas NKA-, NK-1R- and NK-2R-ir cells were lower. A dramatic rise in cell numbers was noted at 24 h. Our findings demonstrate the implication of nerves and sensory neuropeptides during the kinetics of ACD and suggest a possibility to target this system at an early time point for therapy. Content Type Journal ArticleCategory Original PaperPages 1-9DOI 10.1007/s00403-011-1202-4Authors Reem Altawil, Dermatology and Venereology Unit, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, SwedenJonathan Lyström, Dermatology and Venereology Unit, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, SwedenHusameldin El-Nour, Dermatology and Venereology Unit, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Oral doxycycline for the treatment of chronic leg ulceration

Abstract This pilot study investigated oral doxycycline as an adjunct to compression therapy for non-healing venous leg ulcers. Ten patients received doxycycline 20 mg twice daily (low-dose doxycycline) and ten patients received doxycycline 100 mg twice daily (high-dose doxycycline). Utilising a pre-test post-test study design, ulcer area was measured and wound fluid was collected before and after 4 weeks of treatment. In the high-dose doxycycline group, the reduction in median ulcer area was 48% (p = 0.1) and there was a significant reduction in wound fluid total matrix metalloprotease-1 (p = 0.02). These effects were not observed with low-dose doxycycline. There were no significant changes in wound fluid tumour necrosis factor-α or quantitative bacteriology following treatment with low-dose or high-dose doxycycline. There was no significant relationship between change in ulcer area and matrix metalloprotease-1, -8 or -9 activities in wound fluid at the end of treatment. Median wound fluid doxycycline concentrations after 4 weeks of treatment were 0.2 (0.45 μM) and 2.3 (5.18 μM) in the low-dose and high-dose groups, respectively, which are lower than that previously shown to inhibit matrix metalloproteases and tumour necrosis factor-α. Our study suggests that doxycycline 100 mg twice daily may improve the healing rate of recalcitrant leg ulcers, however the mechanism remains unclear. Content Type Journal ArticleCategory Short CommunicationPages 1-7DOI 10.1007/s00403-011-1201-5Authors Genevieve M. Sadler, Department of Dermatology, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, WA 6009, AustraliaHilary J. Wallace, Burn Injury Research Unit, School of Surgery, University of Western Australia, Crawley, AustraliaMichael C. Stacey, School of Surgery, Fremantle Hospital, University of Western Australia, Fremantle, Australia Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Development and characterization of phyto-vesicles of β-sitosterol for the treatment of androgenetic alopecia

Abstract Alopecia is a psychologically distressing phenomenon. Androgenetic alopecia (AGA) is the most common form of alopecia, which affects millions of men and women worldwide, and is an androgen driven disorder. To study the effect of β-sitosterol phyto-vesicles on AGA, the testosterone-induced alopecia model was used. For the study, the albino rats were used and the period of study was 21 days. β-Sitosterol is a phytosterol which is chemically similar to cholesterol. This compound was found suitable for the preparation of phyto-vesicles by the process involving its complexation with phosphatidyl choline. Pharmacokinetic studies of β-sitosterol reveal its poor absorption through the intestine. The objective of the present study is to enhance the bioavailability of β-sitosterol by its complexation with phosphatidyl choline and then to formulate it as phyto-vesicles for the treatment of alopecia. The complex of β-sitosterol was prepared with phosphatidyl choline and characterized on the basis of solubility, melting point, TLC, UV, IR and NMR spectroscopy. This complex was then formulated as phyto-vesicles and then characterized. The results revealed that effect on alopecia is better in case of phyto-vesicles as compared to the complex, physical mixture and the β-sitosterol itself. Enhanced bioavailability of the β-sitosterol complex may be due to the amphiphilic nature of the complex, which greatly enhance the water and lipid solubility of the compound. The present study clearly indicates the superiority of phyto-vesicles over the complex and β-sitosterol, in terms of better absorption and improved activity for the treatment of alopecia. Content Type Journal ArticleCategory Original PaperPages 1-9DOI 10.1007/s00403-011-1199-8Authors Kirti Upadhyay, Department of Pharmaceutical Sciences, Dr. H. S. Gour Vishwavidyalaya, Sagar, 470003 Madhya Pradesh, IndiaNishant Kumar Gupta, Department of Pharmaceutical Sciences, Dr. H. S. Gour Vishwavidyalaya, Sagar, 470003 Madhya Pradesh, IndiaVinod Kumar Dixit, Department of Pharmaceutical Sciences, Dr. H. S. Gour Vishwavidyalaya, Sagar, 470003 Madhya Pradesh, India Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Role of COX-2 activity and CRP levels in patients with non-melanoma skin cancer. −765G>C PTGS2 polymorphism and NMSC risk

Abstract Non-melanoma skin cancer is one of the most common of all cancers and the incidence has increased in the last years as a result of many factors including increased tanning, life style and possible global climate change. Inflammation plays an important role in cancer development and is frequently evaluated by serum C-reactive protein (CRP) levels. PTGS2 −765C allele coding for COX-2 has been found to be associated with lower plasma levels of CRP. The objectives of this study are: evaluation of the association between PTGS2 −765G>C polymorphism and the occurrence of non-melanoma skin cancer, the relationship between this polymorphism and cyclooxygenase-2 activity in skin tissue, as well as the correlation with serum CRP levels in patients with non-melanoma skin cancer. We used PCR–RFLP technique to explore −765G>C PTGS2 gene polymorphism, colorimetric analysis for cyclooxygenase-2 activity in skin tissue and immunoturbidimetric assay for CRP serum levels in 174 patients with non-melanoma skin cancer [54 patients with basal cell carcinoma (BCC) and 120 patients with squamous cell carcinoma (SCC)] and 80 healthy subjects. PTGS2 −765G>C polymorphism failed to show an association with non-melanoma skin cancer risk. We observed a significant increase in COX-2 activity in SCC and BCC patients compared to control tissue (0.58 ± 0.11 and 0.63 ± 0.09 U/mg protein, respectively vs. 0.16 ± 0.01 U/mg protein). BCC and SCC intra-group analysis showed lower COX-2 activity in C-allele carriers versus non-carriers (p < 0.001 and p < 0.0001, respectively). In BCC and SCC patients with GG genotype, CRP level is significantly increased compared to control group (p < 0.0001 and p < 0.0001, respectively). Intra-group comparison of CRP levels showed significantly lower CRP levels in patients carrying C-allele compared to GG homozygotes in BCC (p = 0.0001) and SCC patients (p < 0.0001). PTGS2 −765G>C polymorphism failed to show an association with non-melanoma skin cancer risk. Regarding prognostic indicators, no consistent association emerged between PTGS2 −765G>C polymorphism and COX-2 activity or CRP levels. Content Type Journal ArticleCategory Original PaperPages 1-8DOI 10.1007/s00403-011-1194-0Authors Relu Cocoş, “Carol Davila” University of Medicine and Pharmacy, Bucharest, RomaniaSorina Schipor, “C. I. Parhon” National Institute of Endocrinology, Bucharest, RomaniaIlinca Nicolae, Dermatovenereological Center/Clinical Hospital of Dermato-venereology “Prof. Dr. Scarlat Longhin”, Bucharest, RomaniaCecilia Thomescu, Dermatovenereological Center/Clinical Hospital of Dermato-venereology “Prof. Dr. Scarlat Longhin”, Bucharest, RomaniaFlorina Raicu, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Association of serum interleukin-18 and other biomarkers with disease severity in adults with atopic dermatitis

Abstract Atopic dermatitis (AD) is a chronic inflammatory disease of the skin for which there are no reliable biomarkers to assess clinical severity. Serum interleukin-18 (IL-18) levels may be associated with AD severity. To identify putative biomarkers associated with clinical severity in adult AD patients, we enrolled 121 adult AD patients (mean age 35.7 years) and 50 healthy controls (mean age 31.7 years). We compared these groups for blood eosinophils and serum levels of IL-18, thymus and activation-regulated chemokine (TARC), total IgE, and lactate dehydrogenase (LDH). We also determined S. aureus enterotoxin B (SEB) specific IgE levels and the SCORingAD (SCORAD) scores for AD patients. For AD patients, stepwise logistic regression was used to estimate odds ratios (OR) for each biomarker for the likelihood of having AD, and multiple linear regression was used to identify biomarkers associated with SCORAD scores. Compared with healthy controls, adult AD patients had higher levels of IL-18, TARC, total IgE, eosinophils, and LDH. TARC levels had the highest OR for AD occurrence, while the OR for IL-18 was insignificant. Also, IL-18 was not related to the presence of SEB-IgE. Notably, IL-18 levels were significantly associated with SCORAD scores, as were TARC, total IgE, and LDH levels. A panel of biomarkers (IL-18, TARC, total IgE, and LDH) may be more useful to accurately assess clinical severity in adult AD patients. Content Type Journal ArticleCategory Original PaperPages 1-8DOI 10.1007/s00403-011-1198-9Authors Kenzen Kou, Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama City, 236-0004 JapanMichiko Aihara, Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama City, 236-0004 JapanTomoko Matsunaga, Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama City, 236-0004 JapanHuichin Chen, Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama City, 236-0004 JapanMasataka Taguri, Departments of Biostatistics and Epidemiology, Yokohama City University Medical Centre, 4-57 Urafunecho, Minami-ku, Yokohama City, 232-0024 JapanSatoshi Morita, Departments of Biostatistics and Epidemiology, Yokohama City University Medical Centre, 4-57 Urafunecho, Minami-ku, Yokohama City, 232-0024 JapanHiroyuki Fujita, Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama City, 236-0004 JapanYukie Yamaguchi, Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama City, 236-0004 JapanTakeshi Kambara, Department of Dermatology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama City, 232-0024 JapanZenro Ikezawa, Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama City, 236-0004 Japan Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Inflammatory peeling skin syndrome caused a novel mutation in CDSN

Abstract Generalized peeling skin syndrome (PSS) is a rare autosomal recessive dermatosis manifesting with continuous exfoliation of the stratum corneum. The inflammatory (type B) subtype of PSS was recently found to be caused by deleterious mutations in the CDSN gene encoding corneodesmosin, a major component of desmosomal junctions in the uppermost layers of the epidermis. In the present study, we assessed a 10-month-old baby, who presented with generalized superficial peeling of the skin. Using PCR amplification and direct sequencing, we identified the third PSS-associated mutation in CDSN, a homozygous 4 bp duplication in the second exon of the gene (c.164_167dup GCCT; p.Thr57ProfsX6). These data further support the notion that corneodesmosin deficiency impairs cell–cell adhesion in the upper epidermis, paving the way for an abnormal inflammatory response due to epidermal barrier disruption. Content Type Journal ArticleCategory Short CommunicationPages 1-5DOI 10.1007/s00403-011-1195-zAuthors Dana Fuchs Telem, Department of Dermatology, Tel Aviv Sourasky Medical Center, 6, Weizmann Street, 64239 Tel Aviv, IsraelShirli Israeli, Department of Dermatology, Tel Aviv Sourasky Medical Center, 6, Weizmann Street, 64239 Tel Aviv, IsraelOfer Sarig, Department of Dermatology, Tel Aviv Sourasky Medical Center, 6, Weizmann Street, 64239 Tel Aviv, IsraelEli Sprecher, Department of Dermatology, Tel Aviv Sourasky Medical Center, 6, Weizmann Street, 64239 Tel Aviv, Israel Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Increased miRNA-146a and miRNA-155 expressions in oral lichen planus

Abstract Oral lichen planus (OLP) is a chronic inflammatory disease T helper 1 lymphocytes (Th1)-mediated. Interferon-gamma (IFN-γ) plays a central role in local immune response in this disease. MicroRNAs (miRNAs) are endogenously expressed non-coding RNAs that have important biological and pathological functions due to their potential mechanism regulating gene expression. Recently, some studies have demonstrated that miRNA-146a and miRNA-155 participate in immune response regulation, and are important in several chronic inflammatory and autoimmune diseases. The purpose of the present study was to investigate the expression of the miRNA-146a and miRNA-155 in 31 OLP lesions compared to normal oral mucosa and blood samples. Quantitative real-time polymerase chain reaction was used to analyze miRNA expressions. Our results showed increased expression of miRNA-146a and miRNA-155 in OLP lesions. In conclusion, these data highlight the possibility of miRNA-146a and miRNA-155 involvement in the regulation of the immune response in OLP. Content Type Journal ArticleCategory Original PaperPages 1-5DOI 10.1007/s00403-011-1197-xAuthors Telma Cristina Arão, Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, BrazilAndré Luiz Sena Guimarães, School of Dentistry, Universidade Estadual de Montes Claros, Belo Horizonte, MG, BrazilAlfredo Maurício Batista de Paula, School of Dentistry, Universidade Estadual de Montes Claros, Belo Horizonte, MG, BrazilCarolina Cavaliéri Gomes, Department of Pathology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, BrazilRicardo Santiago Gomez, Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696