Increased epidermal growth factor receptors in seborrheic keratoses and acrochordons of patients with the dysplastic nevus syndrome

Efficacy and Tolerability of Topical Polyphenon E in Multiple "Seborrheic Keratosis-Like" Lesions of the Groin in an Immunocompetent 26-Year-Old Man

Polyphenon E 10%, a green tea extract containing epigallocatechin gallate (EGCG) as the main active compound, is a topical formulation indicated for the treatment of genital warts. Polyphenon E has also shown to be very effective in the treatment of periungual and plane warts. Here, we report a dramatic clinical effect of topical treatment with polyphenon E in a subject with multiple "seborrheic keratosis-like" lesions of the genital area. An immunocompetent 26-year-old Caucasian man came to our attention in October 2018. The subject, a regular blood donor, presented several (more than 100) light brown dome-shaped papular lesions in the groin area and in the penile shaft. A clinical diagnosis of Bowenoid papulosis-like multiple condylomata of the groin was made. A 2-month imiquimod treatment did not induce any relevant improvement in terms of volume and number of lesions. A treatment with Polyphenon E, a topical green tea extract with 10% of EGCG (Veregen®), was therefore started. After 2 months of Polyphenon E treatment, a dramatic reduction of the majority of the lesions was observed. After 3 months of treatment, all the lesions disappeared with only hyperchromic residues. Histological and immunohistological findings supported seborrheic keratosis as the conclusive diagnosis. This case report suggests that topical green tea extract could be very effective in the treatment of "seborrheic keratosis-like" lesions of the inguinal area.

Associação entre acrocórdons e resistência à insulina

FUNDAMENTOS: Acrocórdons são lesões dermatológicas comuns na população e estão associados ao diabetes mellitus, à obesidade, à resistência insulínica e à aterosclerose. A identificação precoce de pacientes com resistência insulínica pode ter papel preventivo primário. OBJETIVO: Avaliar a associação entre presença de acrocórdons cervicais ou axilares e resistência insulínica. MÉTODOS: Estudo transversal com pacientes dermatológicos adultos atendidos em hospital universitário. Casos foram definidos como portadores de mais de cinco acrocórdons cervicais e/ou axilares. A resistência insulínica foi estimada pelo índice HOMA-IR. Resultados foram ajustados pelas demais covariáveis de risco para resistência insulínica conhecidos, a partir de regressão logística múltipla. RESULTADOS: Avaliaram-se 98 casos e 103 controles, que não diferiram entre si quanto à idade ou ao gênero. Acrocórdons se associaram diretamente aos valores de HOMA-IR (Odds Ratio = 1,4), hipertrigliceridemia e índice de massa corpórea, independentemente do ajuste por diabetes mellitus, idade, fototipo, gênero, história de diabetes mellitus familiar e relação cintura/quadril. Níveis qualitativamente elevados de HOMA-IR (> 3,8) também evidenciaram associação significativa (Índice de probabilidade = 7,5). CONCLUSÕES: Presença de múltiplos acrocórdons se associou à resistência insulínica, independentemente dos demais fatores de risco.

The significance of immunohistochemistry in the diagnosis and therapy of neoplasms

This review article details the diagnostical significance of immunohistochemistry, which has developed during the last quarter of the century. Certainly, the advancement of monoclonal antibody technology has been of great significance in assuring the place of immunohistochemistry in the modern accurate microscopic diagnosis of human neoplasms, as a method of choice in histopathology. The fact still remains that in order to properly assess any immunohistochemical reactivity used for differential diagnostic purposes, the target cells have to be identified as neoplastically transformed cells by routine histopathological techniques. Selected groups of target molecules of great significance in cancer biology are discussed. The discovery of neoplasm-associated antigens has not only made the more accurate diagnosis of human cancer feasible but has also shed light on the extensive immunophenotypical heterogeneity of even the most closely linked human malignancies. The identification of disseminated neoplastically transformed cells by immunohistochemistry has allowed for a clearer picture of cancer invasion and metastasis, as well as the evolution of the tumour cell associated immunophenotype towards increased malignancy. Some possibilities of neoplasm-associated antigen targeted, receptor-directed immunotherapy are discussed and reviewed in this manuscript. Future antineoplastic therapeutical approaches should see the inclusion of a variety of immunotherapies, in the form of an individualised 'cocktail' specific for the particular immunophenotypical pattern associated with each individual patient's neoplastic disease.

Hormone replacement therapy and the skin

Estrogens have a profound influence on skin. The hypoestrogenism occurring after the menopause leads to measured deterioration in the skin. Estrogen receptors have been identified in the skin and the concentration of these receptors varies in the different parts of the body. Estrogen improves skin in more than one way, the collagen content and quality is improved, skin thickness is increased, while vascularisation is enhanced. The extracellular matrix responsible for the tone and appearance of the skin is also improved. It is not just the skin that shows an improvement with estrogen therapy but also skin appendages, such as hair. Estrogens have been shown to increase the hair follicle life cycle. Skin aging is not totally estrogen dependent because the ravages of age and the external environment play very important roles. The effects of estrogen on skin need further elucidation and with the emergence of newer techniques it is now possible to study more clearly the changes occurring at the cellular level. Estrogen replacement reverses the deleterious effect of estrogen deprivation on the skin, which is thus yet another organ that benefits from hormone replacement therapy.

Epidermal growth factor receptor distribution in burn wounds. Implications for growth factor-mediated repair

Epidermal growth factor (EGF) along with several related peptide growth factors has been shown both in vivo and in vitro to accelerate events associated with epidermal wound repair. EGF and transforming growth factor alpha act by binding to a common EGF receptor tyrosine kinase thereby initiating a series of events which ultimately regulate cell proliferation. This study examined the immunohistochemical localization of EGF receptor (EGF-R) in burn wound margins, adjacent proliferating epithelium, and closely associated sweat ducts, sebaceous glands, and hair follicles. Tissue specimens removed during surgical debridement were obtained from full and partial thickness burn wounds in 32 patients with total body surface area burns ranging from 2 to 88%. In the early postburn period (days 2-4), prominent staining for EGF-R was found in undifferentiated, marginal keratinocytes, adjacent proliferating, hypertrophic epithelium, and both marginal and nonmarginal hair follicles, sweat ducts, and sebaceous glands. During the late postburn period (days 5-16), EGF-R was depleted along leading epithelial margins; however, immunoreactive EGF-R remained intensely positive in the hypertrophic epithelium and all skin appendages. Increased detection of immunoreactive EGF-R and the presence of [125I]EGF binding in the hypertrophic epithelium correlated positively with proliferating cell nuclear antigen distributions. Thus, the presence of EGF-R in the appropriate keratinocyte populations suggests a functional role for this receptor during wound repair. Dynamic modulation in EGF receptor distribution during the temporal sequence of repair provides further evidence that an EGF/transforming growth factor alpha/EGF-R-mediated pathway is activated during human wound repair.

Increased epidermal growth factor receptors in melanocytic lesions

BACKGROUND

Epidermal growth factor receptors (EGF/R) have been reported to be absent in melanomas or, in contrast, to be markers for potential malignancy in melanocytic lesions.

OBJECTIVE

Our purpose was to evaluate the literature discrepancies regarding the presence of EGF/R in melanocytic lesions and to determine whether EGF/R presence correlates with the potential for malignancy of melanocytic lesions.

METHODS

An EGF/R-specific polyclonal antibody was used to study melanomas, dysplastic nevi, congenital nevi, and nevocellular nevi.

RESULTS

All melanocytic cell types (nevus and melanoma cells) in the lesions studied had immunoreactive EGF/R. EGF/R immunoreactivity was also observed throughout the epidermal basal to granular cell layers overlying the melanocytic lesions, although dermal fibroblasts were negative.

CONCLUSION

The pattern of increased immunoreactive EGF/R in both benign and malignant nevocellular lesions suggests that although EGF/R are not a specific marker of potential malignancy in melanocytic lesions, they may mediate or coordinate growth of keratinocytes and nevus cells.

Modulation of epidermal growth factor receptors in psoriatic lesions during treatment with topical EGF

Active psoriatic lesions have increased EGF/TGF alpha receptors, historically known as the EGF-R. This increase is due to their persistence into the outer parakeratotic layers as measured by autoradiography, immunohistochemistry, and mRNA assays. When psoriatic lesions in patients resolve due to therapy with different modalities, the EGF-R persistently expressed in the outer layers of the epidermis either disappear or resume a basal location presumably due to receptor downregulation. To test whether EGF could downregulate EGF-R and biologically affect psoriatic epidermis, split-thickness skin grafts of active psoriatic lesions were sutured onto the dorsal surface of nude mice. After 3 weeks, the mice were treated daily for a 6-week period with placebo, or 10 or 50 micrograms/ml EGF. Immunostaining showed persistent EGF-R in all epidermal layers in the untreated, placebo-, and 10 micrograms/ml EGF-treated groups. Those grafts receiving a high dose of EGF (50 micrograms/ml) showed either no immunoreactive EGF-R or faint basilar staining. As an additional check for functional activity of the EGF-R, an abundant substrate for this receptor, PLC-gamma 1 was also evaluated following EGF treatment. A similar distribution and modulation pattern following treatment were observed in the grafts immunostained for PLC-gamma 1, suggesting that exogenous EGF treatment affected metabolic pathways subsequent to ligand receptor binding. Morphologic alterations characteristic of a regressing psoriatic phenotype (a decrease in acanthosis, thickness, and the resumption of the orthokeratotic mode of differentiation) were noted in those lesions receiving the 50 micrograms/ml EGF treatment. This study indicates that persistent EGF-R in psoriasis vulgaris are biologically active in vivo and may serve a pivotal role in the regulation of psoriatic lesions.