Significance of the angiotensin I/angiotensin II/angiotensin-(1-7) axis in the pathogenesis of systemic sclerosis

BACKGROUND

Systemic sclerosis (SSc) is a multisystemic disease with an extensive microvasculopathy. Previously, disturbances in plasma levels of angiotensin II (Ang II) and its antagonistic angiotensin-(1-7) (Ang-(1-7)) were found in patients with SSc. Their significance in a pathogenesis of SSc stays unclear due to discrepancies of earlier studies.

OBJECTIVES

To evaluate a significance of disturbances in production pathway of angiotensins in a development of SSc.

METHODS

There were enrolled 27 patients with established SSc, 23 subjects with very early SSc and 23 healthy controls. The diagnosis of SSc was established in patients who met EULAR/ACR 2013 classification criteria. Very early SSc described patients with Raynaud's phenomenon having SSc-specific antinuclear antibodies and SSc-like abnormalities in nailfold videocapillaroscopy. Patients were submitted to evaluation of internal organ involvement and blood sampling to assay plasma levels of angiotensin I, angiotensin II and angiotensin-(1-7) with ELISA technique.

RESULTS

Plasma level of angiotensin-(1-7) was significantly reduced in both SSc group (median = 47.2 pg/mL; P < 0.001) and ones with very early SSc (median = 102.7 pg/mL; P = 0.002) when compared to healthy controls (median = 176.1 pg/mL). A tendency to higher than in control group (median = 214 pg/mL) plasma level of angiotensin I was seen in SSc group (median = 392 pg/mL; P = 0.059). Differences in plasma level of angiotensin II were insignificant between all study groups. Those disturbances produced unfavourable angiotensin-(1-7)/angiotensin II (%) ratio in both groups of patients, which achieved statistical significance in subjects with established SSc (P < 0.001). Production pathway of angiotensins showed a dependence on a subtype of SSc, immune profile and a presence of interstitial lung disease.

CONCLUSIONS

Production of angiotensin-(1-7) was significantly reduced in both SSc patients and those ones with very early SSc, although a significant imbalance between angiotensin II and angiotensin-(1-7) occurred only in subjects with established disease.

A systematic review of tools for determining activity of localized scleroderma in paediatric and adult patients

Localized scleroderma (LoS) is a rare inflammatory skin disorder that affects the dermis and sometimes subcutaneous tissues. LoS can have very long periods of quiescence followed by reactivation, but the progression or activity of the disease is difficult to measure. To review the measuring tools used for the evaluation of LoS activity, to choose the most appropriate technique to facilitate progress towards properly assessing the disease, a systematic review of the literature was carried out using the PubMed MEDLINE. Sixty-three studies describing groups of children, adults or both were reviewed and included in the analysis. Case reports were excluded. The analysed papers were published between June 1986 and February 2016. Data were extracted with a focus on instruments measuring the clinical signs of LoS, health-related quality of life (HRQoL), laboratory tests and imaging techniques. Perusal of the literature confirmed that clinical characteristics of the lesions were used to identify activity and scoring systems that focused on a series of signs, and were initially validated in cases of childhood-onset disease; however, there were no data concerning the adult-onset form of the disease. Adult patients with LoS scored lower on HDLQI than those with paediatric-onset LoS. No validated biological markers were available as correlative laboratory parameters of LoS activity. For infrared thermography, ultrasound and other imaging techniques, the features of active lesions were described, but were only useful with appropriate clinical correlation. Measuring tools have not been prospectively validated yet. Summarizing, scoring methods seem to provide the most adequate assessment of LoS and deserve to be further investigated. Combined imaging techniques create optimal conditions for the proper interpretation of the temperature at the skin surface, as well as the structure and vascularity of LoS lesions. Additional scores, musculoskeletal or neuroimaging techniques and laboratory parameters are needed for the specific disease subtypes to monitor extracutaneous manifestations.

Von recklinghausen disease: one patient - various problems

von Recklinghausen disease (vRD), more widely known as neurofibromatosis type 1, belongs to a group of genetic disorders and it is considered to be the most common genodermatosis. The disease has an autosomal dominant pattern of inheritance that involves mutations within the NF1 gene located on chromosome 17 in locus q11.2. The product of the NF1 gene is neurofibromin and the protein is well known to be a tumor suppressor factor. This counteracts possible overactivity of RAS (protein)/MAPK (mitogen-activated protein kinase) and RAS/PI3K/AKT/mTOR (phoshatydyloinositol-3-kinase/V-akt murine thy-moma viral oncogene homologue/mammalian target of rapamycin) signaling transduction pathways, preventing from uncontrolled cell proliferation and subsequent tumor formation. A loss of proper functioning of this protein leads to a development of vRD; however, a large variability in a phenotype of the disease and the onset of cutaneous findings, not necessarily in childhood, may provide a clinical diagnosis of the disease late in adulthood. We present a 52-year-old male in whom the diagnosis of vRD was proposed in the sixth decade of life, despite of multiple nodular lesions disseminated over the skin of the whole body and different neurological disturbances, not considered for a long time as manifestations of genodermatosis.

Paraneoplastic type of acanthosis nigricans in patient with hepatocellular carcinoma

Paraneoplastic acanthosis nigricans is connected with malignancies in adults in almost 100% of cases. The typical skin changes include: thickening and hyperpigmentation in typical localization with mucocutaneous involvement.

PURPOSE

The authors report a case of a malignant type of acanthosis nigricans in 42-year-old female patient with hepatocellular carcinoma.

CASE REPORT

First skin lesions appeared in 2000. The patient died within 22 months (of the first appearance of skin symptoms), because of hepatocellular carcinoma. Herein we report the clinical picture, skin involvement and diagnostic procedures in acanthosis nigricans.

CONCLUSIONS

Paraneoplastic type of acanthosis nigricans--in patient with hepatocellular carcinoma is not frequently reported in the literature. In the aspect of clinical occurrence of skin lesions suggesting acanthosis nigricans the diagnostics should be focused on internal malignancies.

Multifocal type of pilomatrixoma

Pilomatrixoma is a benign skin neoplasm that arises from hair follicle matrix cells. The skin lesion occurs usually as a solitary tumor and the multifocal types are very rare. Skin changes can be described as a firm to hard, non-painful, oval-shaped tumor that is covered by normal skin. It commonly occurs on a scalp, face, neck and rarely back and extremities. Complete surgical excision with the proper margin is the treatment of choice, what guaranteed the radical therapy of pilomatrixoma. In this paper case of 16-years-old male patient with many solid tumors in subcutaneous tissue on both arms will be reported. The first skin lesion appeared on the left arm 6 years ago. Clinically the disturbance was diagnosed as an atheroma, and it was excised. One year after surgical procedure the patient observed the appearance of new nodules on both arms. In the therapy surgical excision was performed with histopathological examination of the tissues. Histopathological test has proved the clinical diagnosis of pilomatrixoma. The case of multifocal pilomatrixoma, which is rarely diagnosed and described in professional literature, will be presented.

Pyoderma gangrenosum coexisting with acute myelogenous leukaemia

The frequency of occurrence of malignant neoplasms in the cases of pyoderma gangrenosum is not exactly determined, but it can be assessed to be at 7%. The aim of the study was to report a 26-year-old male patient with pyoderma gangrenosum coexisting with acute myelogenous leukaemia. The first skin lesions on both tibia occurred in June 2001. Prior to the proper diagnosis of pyoderma gangrenosum, the patient was treated surgically. Because of the dramatic dermatological and general condition in November 2001, the patient was admitted to the Dermatological Department of the Silesian Medical Academy in Katowice where the diagnosis of pyoderma gangrenosum was established. On the clinical and biochemical picture, the diagnosis of pyoderma gangrenosum within acute myelogenous leukaemia was made. Initially, cyclosporin A 200 mg orally per day in the therapy of pyoderma gangrenosum was administered to achieve a slight clinical improvement. Although chemotherapy leukaemia was performed, the patient died after 4 months of the confirmation of the acute myelogenous leukaemia diagnosis.

A decreased serum leptin level in patients with systemic sclerosis

Serum leptin levels were determined in 31 women with systemic sclerosis and 24 age-matched healthy controls. Both groups were divided into premenopausal and postmenopausal subgroups. A decreased serum leptin was found in the patients with systemic sclerosis. The premenopausal patients and controls had higher serum leptin than those in the postmenopausal subgroups. Serum leptin correlated with body mass index in the patients with systemic sclerosis.

[Interleukin-2 and interleukin-6 in serum as markers of disease progression in systemic sclerosis]

It is hypothesized that abnormalities of cell-mediated immunity participate in the pathogenesis of systemic sclerosis (SSc). However, the role of many cellular markers of immune activation remain still not well known, particularly as comparable with clinical status. The aim of this study was to examine the levels of some cytokines: IL-2, IL-6, TNF-alpha and to evaluate their role as parameters of disease activity and severity in systemic sclerosis. Fourty-seven patients with SSc we included in the study. Concentrations of cytokines were determined by an-enzyme-linked immunosorbent assay--ELISA. Controls were healthy age-and-sex marched volunteers. Interleukin-2 was identified in 45% of sera from patients with SSc, predominantly among patients with the rapidly progressive disease and with the diffuse SSc. The presence of IL-2 in SSc sera may also be indicative of disease activity. The frequency of positivity for IL-6 in examined SSc sera was similarly and was 50%. The prominently frequent incidence of the IL-6 in early stage of disease and in patients with severe systemic involvement indicated a potential role of this cytokine as a parameter of disease activity. TNF-alpha was not detected in the examined sera.

[The role of cell-mediated immune response in pathogenesis of alopecia areata]

Recent studies have suggested that cell-mediated immune response play a critical role in the pathogenesis of alopecia areata (AA). Eighteen patients with AA were included in the study. Fifteen healthy subjects served as controls. Serum levels of sTNF alpha RI and sIL-2R were measured using enzyme-linked immunosorbent assay technique. The serum levels of sTNF alpha RI were significantly elevated in patients with AA in comparison with control group. The serum levels of sIL-2R were higher in AA patients than in healthy subjects but not significantly. These results indicate, that immune mechanisms in AA are characterized by activation of T cells and other cells, possibly keratinocytes.

[Scalp diseases inducing cicatricial alopecia]

The etiology of cicatricial alopecia is unusually heterogenous and in many cases unknown. If we know the cause of alopecia it is possible to stop next evolution of the disease by proper drug treatment but only at the beginning. However the surgical treatment of cicatrices is an effective method.

[Evaluation of vitamin B6 and calcium pantothenate effectiveness on hair growth from clinical and trichographic aspects for treatment of diffuse alopecia in women]

The aim of the study was the clinical and trichological examination (trichogram and hair loss evaluation) conducted comparatively before and after the treatment in 46 women between pubescence and 30 years of age who had symptoms of diffuse alopecia. Calcium pantothenate was administered twice a day orally in doses 100 mg for 4-5 months. Vitamin B6 was injected every day (i ampoule intramusculary) for the period of 20 to 30 days and repeated again after 6 month. On the basis of clinical and trichological studies it was revealed that vitamin B6 administered parenterally for a period of several weeks induces improvement in the hair condition in a number of women and it reduces the hair loss especially in alopecia of telogenic patomechanism. Whereas calcium pantothenate in feminine diffuse alopecia did not show clearly the positive effect.

[Anetoderma--a clinical and therapeutic problem]

Current views on etiopathogenesis of anetoderma have been presented on the grounds of literature data. Disorders of elastin metabolism are distinctive for the disease causing elastin fibres becoming disintegrated and atrophied. Apart from mechanism of anetoderma plaques evolution clinical observation and full diagnostication of systemic collagenosis seems to be important. Despite of numerous therapeutic trials it appears that medication of anetoderma lesions is inefficacious.

[Trichological examinations in women suffering from diabetes mellitus]

The lack of data on the process of alopecia in women suffering from diabetes mellitus made us undertake research in this area. The aim of this paper was the assessment of the state of head hair in trichological and clinical examinations, and on the basis of questionnaire. 50 women (age 44-82 years) were included in the study. Alopecia in women with diabetes mellitus is diffuse, located on the apex of the head and basic hair loss lies in telogenic pathomechanism. The highest percentage of telogenic hair is found in women treated with biguanides, and the lowest one in female patients taking insulin.

[Diffuse alopecia in women: classification and views of etiopathogenesis]

Contemporary views of feminine diffuse alopecia's etiopathogenesis have been presented on the grounds of literature data. In the considerable part of cases feminine diffuse alopecia is a symptom of many systemic diseases and hypovitaminosis. Sideropenia is often diagnosed. However it seems that neuroses and psychic traumas provoke alopecia in some cases.

[Monilethrix--rare syndrome of structural hair abnormalities]

Monilethrix is a rare structural disorder of hair. Characteristic abnormalities in the form of alternating thinning and fusiform thickening are observed in most of hair shafts that we call beaded hair. Macroscopic estimation shows lustreless, dry, rough, fragile hair. Trichological examination usually reveals a considerable percentage of anagenic hair. According to our own experiences and literature data systemic therapy (vitamins) and topical treatment (desquamative ointments) are not effective sufficiently. Spontaneous regression of symptoms often appears with time. Five cases of familial occurrence of monilethrix have been presented.

[Acne vulgaris as a therapeutic problem]

Acne vulgaris, the most frequent skin disease of adolescence, because of its location, particularly long lasting course and in, case of some patients, leaving deformations in a form of scars can lead to disturbances in the psychosocial sphere. Medications used in the topical and systemic therapy of acne should reveal such proportions as: anti-seborrhoeic, bactericidal, bacteriostatic, antiphogistic, comedoleitis, anti-comedoformative. Both, in the topical and systemic therapy of acne vulgaris antibiotics such as tetracyclines, erythromycin and clindamycin are used. Other medicaments prescribed for the topical therapy of acne are azelaic acid and benzoil peroxide, retinoic acid--tretinoin and 13-cis-Retinoic acid--isotretinoin. Isotretinoin--13-cis-Retinoic acid used in the systemic therapy is the most potent drug--treating acne which has not reacted to any conventional methods of therapy.

[Cognitive function in patients with systemic sclerosis]

Central nervous system involvement is seldom reported in patients with systemic sclerosis (SSc). Cognitive functions were determined in 21 patients with definite SSc and 42 healthy controls. Thyroid function was also measured in order to eliminate the effect of hypothyroidism on cognitive functioning. It was found that the SSc patients with normal thyroid function showed defective long-term and recent memory, learning ability, criticism, perception and visuo-perceptual skills, their simple reaction time was prolonged. Similar but less advanced cognitive defects were shown in the SSc patients with overt or latent hypothyroidism. The obtained results indicate that the central nervous system involvement is more common in patients with SSc than it has been reported earlier.

[The effect of cryoapplication time using liquid nitrogen for effectiveness of basocellular epithelioma treatment]

Cryosurgery is well suited to treat skin tumors. A cure rate of high percentage is achieved paying attention to freeze time. The course of treatment of 217 basaliomas was analysed. The duration of follow-up after treatment was from 6 to 14 months. 147 lesions were treated with one-cycle cryosurgery. In 64 (45.5%) cases cure was achieved after the first cycle of treatment and in 83 (56.5%) cases the second cycle brought complete healing. 70 basaliomas treated with double freeze-thaw cycle were cured in 100% of cases.

[Clinical evaluation of serious forms of acne treated with autovaccine]

In this paper a clinical assessment of the treatment of serious forms of acne vulgaris with the use of autovaccines containing Propionibacterium strains was presented. It was shown that the associative therapy including parallel administration of both autovaccine and the antibiotic is remarkably efficacious.

[Epidemiology of contact hypersensitivity to rubber components in manufacturers of automobile tires at the Stomil plant]

Dermatological examination and patch tests with 34 rubber components were carried out in 114 tire manufacturers, 78 women and 36 men aged 29 years on average, with a mean duration of work in the plant 7 years. For correct interpretation of the obtained results patch tests with the same components were done in two control groups that is in 120 healthy subjects and 120 patients with contact dermatitis. Patch tests with proper concentrations of the studied components were evaluated after 48, 72 and 96 hours. Positive patch tests were found most frequently with antioxidants--16.6% (including IPPD--8.6%), followed by vulcanization accelerators--10.6%, and other rubber components--11.4% in all. During about 3 years of follow-up in 4 manufacturers contact allergic eczema was noted and polyvalent hypersensitivity to antioxidants and vulcanization accelerators without clinical manifestations of this hypersensitivity was diagnosed in 3 other subjects.

[Evaluation of the methods of treatment of epithelioma basocellulare at the I Dermatology Clinic, Silesian Medical Academy, in Katowice]

The therapeutic results are presented in cases of basocellular epithelioma treated by three methods. The best and most radical results were obtained by the surgical method, followed in the order of effectiveness by radiotherapy (45-55 kV) in a total dose of 4500-6000 R. In case of contraindications to these methods local chemotherapy was applied which was associated with a high proportion of failures (28.6%).

[Akne-Mycyna in the local treatment of acne]

Akne-Mycyna, a new preparation for external treatment of acne containing 1% erythromycin, was used in 30 cases of acne: 12 cases of papulo-pustolous acne, 13 with pustulous acne, 5 with acne conglobata. The age of the patients ranged from 16 to 27 years, the mean duration of acne was 3.5 years. Selected lesions were smeared with Akne-Mycyna twice daily, mostly on one side of the face; symmetrical lesions were treated by conventional external methods. In the light of the study it is concluded that Akne-Mycyna is a very effective preparation for external treatment of papulo-pustulous acne and in milder cases of pustulous acne, with the duration of treatment at least 3 weeks. In deep forms of acne, particularly acne conglobata, Akne-Mycyna may be a valuable supplementation of systemic treatment.

[Study of the effect of vinblastine on hair growth in rats]

In the trichological studies on the model of Wistar rats aged 4-5 weeks intraperitoneal vinblastine in doses of 0.008-0.030 mg/100 g of body weight caused initially mixed (dystrophic-telogenic) hair loss. After higher doses and longer drug administration the mechanism of hair loss was transformed to dystrophic. In both forms of hair loss signs of advanced diffuse alopecia were found.

[Levamisole in the treatment of crural ulcers]

In a clinical study on 74 patients with 102 crural ulcers levamisole 150 mg was given for 1 or 2 successive days daily during 3 to 17 weeks, besides conventional treatment. The method seems to raise the per cent of favourable therapeutic results in such cases. Drug tolerance was good and no dangerous complications were observed in any case.

[Phencarol in the treatment of allergic dermatoses of various pathological mechanisms]

Phencarol produced in the USSR is an antihistaminic drug highly effective in allergic dermatoses with the pathological mechanism of humoral and cellular type. The best results were obtained in acute allergic dermatoses and in acute recurrences of chronic allergic diseases. In comparative studies with difergan a greater efficiency of phencarol was noted, which was expressed as a higher proportion regression of lesions and more rapid action of the drug. The duration of phencarol treatment was about 3 weeks, the daily dose was 50-75 mg in adults. The drug was well tolerated.

[Studies on the effect of bleomycin on hair growth dynamics in rats]

In investigations on Wistar rats aged 4-5 weeks it was found that intraperitoneal administration of Bleomycin in doses from 0.015 to 0.045 mg/100 g of body weight caused disturbances of hair growth. Initially hair loss had a telogenic mechanism, and after higher doses administered for longer time periods it changed to poorly evidenced alopecia with a dystrophic-telogenic pathological mechanism, without clinical signs of fur thinning.