Skin-homing T-cell responses associated with Demodex infestation and rosacea

AIMS

Our aim was to investigate the skin-homing T-cell immune responses triggered in patients with Demodex infestation and/or rosacea.

METHODS

Collected whole blood samples were divided into four groups: control subjects; nonrosacea patients with Demodex infestation (Demodex group); papulopustular rosacea (PPR) patients without Demodex infestation (Rosacea group); and PPR patients with Demodex infestation (Rosacea/Demodex group). Following ex vivo activation, skin-homing CLA+CD4+ T-cell subset levels were monitored by flow cytometry.

RESULTS

When compared with control subjects, among skin-homing CD4+ T-cell subsets analysed, Demodex patients had higher T_H 9 and T_reg cell levels; Rosacea subjects displayed elevated T_H 1 cell levels; and Rosacea/Demodex patients exhibited increased frequencies of T_H 9 and T_H 22 cells. In contrast to Rosacea subjects, Rosacea/Demodex group members displayed higher T_H 2 cell levels; and when compared with Demodex groups, they had higher T_H 1 and T_H 2 but lower T_reg cell levels. Demodex group members also exhibited higher T_reg but lower T_H 1 and T_H 22 levels than Rosacea/Demodex group subjects.

CONCLUSIONS

The skin-homing T-cell responses associated with Demodex infestation and rosacea formation seem to influence each other. The present as well as future studies could contribute to the development of effective treatment strategies for demodicosis and rosacea.

A case of Graham-Little-Piccardi-Lasseur syndrome

Graham-Little-Piccardi-Lasseur Syndrome (GLPLS) is a variant of lichen planopilaris, which is characterized by progressive cicatricial alopecia of scalp, non-cicatricial alopecia of axillae and pubic regions, and keratosis pilaris-like follicular papules over trunk and extremities. GLPLS is a disease of unknown etiology. However, recent reports support a central role for a T-cell-mediated immune response in the pathogenesis of GLPLS. Besides, although GLPLS is believed to occur sporadically, a genetic predisposition also has been implicated in the pathogenesis. On the other hand, GLPLS typically affects middle-aged women, particularly of the postmenopausal age group. A diagnosis of GLPLS is generally apparent with the presence of characteristic findings in a postmenopausal woman. Herein, we report a case of GLPLS in a 75-year-old woman with the typical triad of alopecia of the scalp, non-cicatricial alopecia of axillae and pubis, and a follicular keratotic eruption on the trunk.

A case of trichotillomania with recently defined trichoscopic findings

Trichotillomania (TTM) is an impulse control disorder characterized by repetitive behavior of hair pulling resulting in secondary alopecia. It is among the psychocutaneous diseases known to be associated with psychiatric comorbidity, social, and functional impairment. Although most of the time, an experienced dermatologist easily recognizes the key features of TTM, a history and physical examination alone might not be enough to make a definitive diagnosis. As an effective noninvasive technique for the evaluation of scalp and hair diseases, trichoscopy also has proven to be a valuable tool in the diagnosis of TTM. Currently, new trichoscopic findings of TTM have been described. Here, we report a case of TTM with recently defined trichoscopic features.

Specialists are not qualified enough to recognize and define dermatologic diseases

Dermatology is a specific branch of medicine which includes dermatologic manifestations of systemic underlying diseases as well as primary cutaneous diseases. In this study, specialists' abilities of defining and diagnosing dermatologic diseases were assessed. 381 hospitalized patients who were referred to the Dermatology Clinic were reviewed via electronic medical charts. 121 of the clinicians (31.2%) made a dermatologic definition when referring their patients to dermatology. 136 of the the clinicians (35.1%) made a pre-diagnosis for their patients' dermatologic condition of which 90 (66,2%) were correct and 46 (33,8%) were non-relevant. Internists wrote a definitive dermatologic examination note significantly more often than surgeons (P=0.03). However, there was not a significant difference between internists and surgeons when we compared the ratio of correct and complete dermatologic definitions of patient condition (P=0.503). There was also no difference between surgeons and internists in terms of making a pre-diagnosis, making a correct diagnosis, and making a wrong diagnosis (P>0.05 for each comparison). In conclusion, dermatologic consultations are crucial and necessary for the improvement of patient care and treatment. Specialists lack basic skills to recognize and define dermatologic conditions they are confronted with.

Serum lipoprotein (a) levels and Behçet's disease: is there an association?

BACKGROUND

Behçet's disease (BD) is a multisystemic inflammatory disorder found in individuals with a particular genetic background. Hemostatic studies in BD support an imbalance towards a prothrombotic state at different levels. Lipoprotein (a) (Lp(a)) has atherogenic and thrombogenic properties. It is mostly under genetic regulation. We investigated the possible relationship between Lp(a) and BD.

METHODS

Forty patients diagnosed with BD and 40 healthy controls were enrolled. The clinical characteristics of the patients were recorded. Serum total cholesterol, high-density lipoprotein (HDL), very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL), apolipoprotein A1, apolipoprotein B, and Lp(a) levels of the two groups were assessed and compared statistically.

RESULTS

All patients (100%) had oral aphthous ulcers. Thirty (75%) had genital ulceration, 37 (92.5%) had either erythema nodosum or papulopustular lesions, and 10 (25%) had eye involvement. Twelve (30%) had a positive pathergy test. Four (10%) had vascular involvement. The Lp(a) level of the patient population was 19.6+/-18.8 mg/dL. This level was higher than that of the controls, but not statistically significant. The Lp(a) levels of the four patients with vascular complications were within normal limits.

CONCLUSIONS

Lp(a) is of interest, as it is a genetically determined parameter that was found to be high in BD patients in our study group. The levels were independent of thrombotic complications, perhaps suggesting a different role for this lipoprotein in the etiopathogenesis of BD. Further studies with a larger number of patients are essential to discover the exact role of Lp(a) in BD.

Efficacy of erythromycin for psoriasis vulgaris

Psoriasis is characterised by the presence of neutrophil overactivation and overproduction of interleukin (IL)-6 and IL-8 from keratinocytes. It is now clear that macrolide antibiotics have anti-inflammatory effects, such as inhibition of IL-6, IL-8 and tumour necrosis factor-alpha, perhaps by suppressing the transcription factor nuclear factor-kappaB or activator protein-1, and reduction of neutrophil activity. It is thus possible that macrolides might be a candidate for adjunctive treatment of psoriasis. In this study, we investigated the effectiveness of treatment with the macrolide antibiotic, erythromycin, for skin lesions and pruritus of patients with psoriasis. In total, 60 patients with psoriasis, especially pruritic psoriasis, were included. This was an open-label study and the analysis was on an intention-to-treat basis. Oral macrolide antibiotics and topical corticosteroids were given to the study group of 36 patients. The control group (24 patients) were treated only with topical corticosteroids. After a 4-week treatment period, scores on the Psoriasis Area and Severity Index (PASI) at baseline and at the end of the treatment, and the effectiveness in reducing itching were compared within and between both groups. Although there was no statistically significant difference between the baseline mean PASI of the two groups (P=0.81), there was a statistically significant difference between the mean PASI of the two groups at the end of the treatment (P=0.023, 95% confidence interval: - 3.45 to - 0.27). The comparison of the mean difference in PASI yielded a statistically significant difference (P=0.03, 95% confidence interval 0.73-3.55). Our study suggests that macrolides could be used as one of the adjunctive therapies for psoriasis vulgaris.

Imatinib-induced erythrodermia in a patient with chronic myeloid leukemia

This article does not have an abstract.