The systemic autoinflammatory disorders for dermatologists. Part 2: disease examples

The importance of ADAM10 and ADAM17 metalloproteinases in the pathogenesis of psoriasis

BACKGROUND

Psoriasis is a chronic inflammatory skin disorder characterized by inflammation, hyperproliferation, andneoangiogenesis. The disease pathogenesis has not been fully elucidated. ADAM17 and ADAM10 are important proteases serving as regulators of inflammation.

OBJECTIVES

This study aimed to determine the role of ADAM17 and ADAM10 in the pathogenesis of Psoriasis through the comparison of serum ADAM17 and ADAM10 levels between Psoriasis patients and healthy controls.

METHODS

A total of 179 subjects, including 90 psoriasis patients and 89 healthy controls, were included in the study. Serum ADAM17 and serum ADAM10 levels were measured by the ELISA method for each participant from the patient and control groups. The statistical data analysis was performed using the SPSS 19.0 program. P-value < 0.05 was considered statistically significant.

RESULTS

The mean values for serum ADAM10 and ADAM17 were respectively 3.1±2.2 and 76.5±31.1 in the patient group, whereas 8.6±3.7 and 29.5±22.4 in the control group. A statistically significant difference was detected between the patient and control groups regarding ADAM10 and ADAM17 levels (p=0.0001).

CONCLUSIONS

Considering the high levels of ADAM17 in Psoriasis patient group, ADAM17 protease might have a crucial role in the pathogenesis of psoriasis, while the low levels of ADAM10 might be attributed to its regulatory effect on keratinocyte differentiation and proliferation.

Cutaneous Manifestations of Autoinflammatory Diseases

Autoinflammatory diseases (AIDs) are a heterogeneous group of disorders in which recurrent or continuous aseptic inflammation arises primarily through antigen-independent hyperactivation of the innate immune system. The skin is frequently involved with a wide variety of cutaneous manifestations, most of which are non-specific. Recognition of skin lesions in AIDs may sometimes provide clues for a correct diagnosis. In this review, the cutaneous involvements of >20 selected AIDs were summarized and organized into different categories based on their characteristic manifestations, such as urticarial dermatosis, neutrophilic dermatosis, granulomatosis, chilblain, lipodystrophy, and hyperkeratosis. With this classification scheme, cutaneous manifestations in AIDs could be more easily identified to facilitate diagnosis in clinical practice.

Towards a combined pediatric rheumatology-dermatology clinic: One-year experience

OBJECTIVE:

Dermatological findings may be the sole complaints of diseases in pediatric rheumatology practice. Evaluating patients with a multi-disciplinary approach may facilitate access to an accurate diagnosis. Herein, we reported our one-year experience in collaborative pediatric rheumatology-dermatology.

METHODS:

Patients were initially evaluated separately in pediatric rheumatology-dermatology outpatient clinics. Subsequently, once a week, the final diagnoses of patients with suspected skin rash were collaboratively discussed by two pediatric rheumatologists and a dermatologist.

RESULTS:

A hundred and one patients were included in this study. Of these 101 patients, 65 attended to dermatology outpatient clinic initially, while the remaining 36 applied to the pediatric rheumatology outpatient clinic. The most common mucocutaneous finding was squamous lesions in 30 patients, followed by erythematous lesions in 28 and mucosal ulcers in 14. Finally, 69 patients were diagnosed with a rheumatic disease while 32 had differential diagnoses apart from rheumatic diseases.

CONCLUSION:

Patients with rheumatologic diseases frequently present with only mucocutaneous findings. Thus, a detailed examination of the mucosa, skin and its attachments is of paramount importance in rheumatology practice. We suggest that a close interaction between pediatric rheumatology-dermatology and the formation of consensus clinics are going to assist clinicians in making easier and accurate diagnoses.