[Dysbalance between the immune system and skin microbiome in chronic inflammatory dermatoses]

BACKGROUND

The skin is an organ frequently affected by chronic diseases. Inflammatory, immune-mediated dermatoses such as atopic dermatitis and psoriasis show a high prevalence as well as a significant impact on the quality of life of those affected. In a large proportion of cases, atopic dermatitis is associated with a marked change in microbial colonization of both clinically healthy and affected skin. In psoriasis, changes to this effect have been described, but clinical relevance remains elusive.

AIM

In recent years, increasing knowledge has been gained in microbiome research with resulting clinical relevance. The present article deals with the disturbed balance of the immune system and the skin microbiome in chronic inflammatory dermatoses on the basis of atopic dermatitis and psoriasis vulgaris.

MATERIALS AND METHODS

A literature search was performed in PubMed and Medline databases (entries until 09 April 2021).

RESULTS

Staphylococcus aureus is known to play a central pathophysiological role in atopic dermatitis. This is revisited in light of new insights regarding biodiversity and immunoregulatory processes. In psoriasis, a more heterogeneous body of data emerges regarding the microbiome and its contribution to disease development.

DISCUSSION

While topical applications to directly influence the microbiome are already being tested in atopic dermatitis, further knowledge regarding the pathophysiological significance of the microbiota is still needed in psoriasis.

Atopy Associated With Positive Patch Test and Possible Allergic Contact Dermatitis

BACKGROUND

Atopy is a genetic predisposition to the development of allergic reactions and the increased production of immunoglobulin E (IgE) upon exposure to environmental antigens. Clinical manifestations of atopy include asthma, atopic dermatitis (AD), and allergic rhinoconjunctivitis (ARC).

OBJECTIVE

To determine if cutaneous delayed hypersensitivity reactions (CDHRs) as assessed by patch testing are higher among patients with a history of atopy and with a familial predisposition to atopy.

METHODS

For this study, we reviewed the patch test database of the UBC Contact Dermatitis Clinic over a 4-year time span. A personal history of asthma, AD, and ARC was recorded. In addition, a family history was obtained and manifestations of atopy in family members were noted.

RESULTS

A total of 1515 patients were included in this study. Our data show that the odds ratio (OR) of a positive patch test with a personal history of atopy was 1.39, while the OR of a positive patch test with a family history of atopy was 1.69. Conversely, a personal history of respiratory atopy did not significantly affect the probability of a positive patch test, with an OR of 1.03.

CONCLUSION

We conclude from our study that patients with a personal or family history of atopy have an increased risk of allergic contact dermatitis (ACD). These results provide further evidence for the link between atopy and ACD and suggest that children of atopic parents should avoid potential contact allergens and would likely benefit from prophylactic emollient use.

Personality and achievement along medical training: Evidence from a cross-lagged analysis

INTRODUCTION

Evidence on personality traits change implies it should be studied as an outcome and not only as an explanatory effect. Therefore, we aimed to assess how personality and academic achievement sway each other. Three cohorts of medical students (n = 181) comprised of school leavers and graduates, completed NEO-FFI when admitted (baseline) and later on medical training (follow-up). Previous achievement was measured as mean scores on national school examinations, and academic achievement as medical course average. Causal relations were studied by cross-lagged analysis.

RESULTS

Cross-sectional analysis at baseline showed differences between graduates and school leavers on personality, with graduates scoring lower on neuroticism (β = -12.344, p<0.001), and higher on openness to experience (β = 5.257, p<0.001), conscientiousness (β = 2.345, p = 0.004,) and agreeableness (β = 6.993, p<0.001). Longitudinal analyses indicated that personality traits and achievement tracked over time. Cross-lagged analysis found a positive significant association between academic achievement and neuroticism at baseline (β = 0.031, p = 0.014) and with being a graduate student (β = 0.766, p = 0.006). After adjusting, no association was found between previous achievement and personality at follow-up.

CONCLUSIONS

Some neuroticism may enhance medical academic achievement. The blurring of the initial differences between graduates and school leavers suggests a reasonable possibility of personality traits change along the medical course. Future research on medical selection processes cannot afford to ignore the influence of the medical school environment on personality traits change.