Inflammatory marker alteration in response to systemic therapies in psoriasis

Substantial research has focused on the presence of biomarkers involved in both the pathogenesis of psoriasis and its comorbidities. The identification of these biomarkers has a crucial role in establishing the diagnosis and prognosis, in understanding the physiopathological mechanism and in determining the therapeutic response. The aim of this study was to emphasize the alteration in inflammatory markers in response to systemic therapies in psoriasis. Evolution of inflammatory marker alteration was studied in 194 patients with psoriasis, aged between 7 and 87 years. Two groups were set up: the first comprised of patients treated with methotrexate (n=51), while the second comprised patients treated with biological therapy (n=143). Each group was evaluated for blood values of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and fibrinogen before and after treatment, the fluctuation of these values according to the treatment, the interrelation between inflammatory markers and inflammatory activity of the disease and the evolution of the disease after treatment. In group I, 46 out of 51 patients had elevated levels of acute phase reactants before treatment. After treatment with methotrexate 7.5 mg/week, 12 out of 46 patients had elevated blood levels of ESR and 18 out of 46 patients of CRP and fibrinogen. Before treatment with biological therapy, 138 patients out of 143 presented abnormal high range for acute phase reactants. After treatment with biological therapy, 18 patients out of 138 had elevated blood levels of ESR and 37 patients out of 138 had elevated CRP and fibrinogen. A favorable evolution was noted in 98 patients out of 138. It was concluded that the systemic treatment with both methotrexate and biological therapy showed a marked decline in the patients with abnormal values of CRP, ESR and fibrinogen, indirectly showing a decline in the inflammatory activity of psoriasis.

Toxic Epidermal Necrolysis - A Case Report

Toxic epidermal necrolysis (TEN) is an acute, life-threatening muco-cutaneous disease, often induced by drugs. It is characterized by muco-cutaneous erythematous and purpuric lesions, flaccid blisters which erupt, causing large areas of denudation. The condition can involve the genitourinary, pulmonary and, gastrointestinal systems. Because of the associated high mortality rate early diagnosis and treatment are mandatory.

This article presents the case of a sixty-six years old male patient, known to have cirrhosis, chronic kidney failure, and diabetes mellitus. His current treatment included haemodialysis. He was hospitalized as an emergency to the Dermatology Department for erythemato-violaceous, purpuric patches and papules, with acral disposition, associated with rapidly spreading erosions of the oral, nasal and genital mucosa and the emergence of flaccid blisters which erupted quickly leaving large areas of denudation. Based on the clinical examination and laboratory investigations the patient was diagnosed with TEN, secondary to carbamazepine intake for encephalopathic phenomena. The continuous alteration in both kidney and liver function and electrolyte imbalance, required him to be transferred to the intensive care unit. Following pulse therapy with systemic corticosteroids, hydro-electrolytic re-equilibration, topical corticosteroid and antibiotics, there was a favourable resolution of TEN.

The case is of interest due to possible life-threatening cutaneous complications, including sepsis and significant fluid loss, in a patient with associated severe systemic pathology, highlighting the importance of early recognition of TEN, and the role of a multidisciplinary team in providing suitable treatment.

Histopathological aspects in autoimmune cutaneous manifestations associated with hepatitis C virus infection

Autoimmunity is characterized by activation of the immune system that attacks and destroys wrongly, the body's own structures. All body tissues can be affected (erythrocytes, leukocytes, platelets, blood vessels, muscle tissue, endocrine system, and other), including the skin. Autoimmune diseases have an increased frequency in women, especially in adulthood, and they are associated with hereditary factors. Although the etiology of autoimmune diseases is incompletely elucidated, there is an association between chronic infection with hepatitis C and autoimmunity, association highlighted and well documented in clinical studies. Other viral infections do not have the same connotation in the context of autoimmunity, but it is recognized that they are an important triggering factor in the pathophysiological mechanism. The cases associating chronic hepatitis C treated with interferon and ribavirin, with multiple autoimmune diseases substrate, raising the discussion of a possible pathophysiological correlation between them.

THE AUTOIMMUNE CONSTELLATION IN LICHEN AMYLOIDOSIS

Localized cutaneous amyloidosis is a rare disease among white people, being more common in South-Asia, China and South America. The disease is characterized by deposition of amyloid material in the papillary dermis without visceral involvement. Nevertheless, there is a growing list of immune-mediated disorders that have been linked to cutaneous amyloidosis. We present two cases of concomitant occurrence of lichen amyloidosis and autoimmune thyroiditis/atopic dermatitis in two Caucasian women.

Study regarding the microscopic aspects of pilo-sebaceous units after antiandrogen treatment in hirsute women

AIM

To analyze the morphological data of pilo-sebaceous units in hirsute women before and 12 months after the antiandrogen treatment with Cyproterone acetate (CPA) 100 mg÷day.

MATERIALS AND METHODS

Fourteen female patients with idiopathic hirsutism that followed an antiandrogen treatment with CPA were biopsied from the androgen-dependent area of the chin before and 12 months after the treatment. Routine sections were stained with Hematoxylin-Eosin, Masson, Van Gieson, Sirius red and picric-indigocarmine, while additional sections were immunostained for S100 protein and vimentin. Electron microscopy was performed in two cases with Langerhans cell hyperplasia.

RESULTS

On biopsies-stained sections, an increased number of hair follicles, the deeper part of the epithelial sheath of the hair follicle with epithelial buds, hyperplasia of sebaceous glands, and no inflammatory infiltrate were noticed. Langerhans cells identified with S100 protein and vimentin were normal in terms of numbers and distribution. After the administration of the treatment, atrophy of the pilo-sebaceous units was visible in nine (64.2%) cases, while inflammatory infiltrate and cells included in the vacuoles of the basal layer of the epidermis became apparent. In six of the cases treated with antiandrogens, a marked hyperplasia of Langerhans cells was noticed. In conclusion, the benefit of antiandrogen treatments is supported by atrophy of the hair follicle and the sebaceous glands. The activation of Langerhans cells associated with inflammatory infiltrate in the dermis and hair follicles could be considered as a local consequence of the involution process of hair follicles after the administration of the treatment.

Chronic venous disease cases at the Iaşi dermatology clinic

Chronic venous disease (CVD) is defined as a disturbance of blood return to the deep venous system, superficial venous system, and communicating (perforating) veins. Once present, CVD persists throughout life, so like heart failure it is nowadays considered "a condition for life". Severe CVD of the lower limbs is one of the most common medical problems, affecting up to 25% of the general adult population of industrialized countries.

AIM

to determine the incidence of CVD among the cases admitted to the Dermatology Clinic of the' "Sf. Spiridon" Emergency Clinical Hospital Iasi, CVD incidence by sex, age, area of residence and the main pathogens incriminated in super infection of ulcerative lesions.

MATERIAL AND METHODS

We did a retrospective study of patients admitted to the Dermatology Clinic of the Iasi "Sf. Spiridon" Emergency Hospital over a five years period.

RESULTS

Of the total number of patients admitted to our clinic (9375), 57% were diagnosed with CVD and 26.61% of them were with CEAP 6 class chronic venous insufficiency. There was an approximately equal sex distribution and most patients (44%) were older than 65 years.

CONCLUSIONS

We did a large epidemiological study of venous disease, based on revised CEAP classification, showing again that it is not only a very important medical problem, with various clinical manifestation and multidisciplinary approach, but also an important issue for health insurance system.

Pachydermodactyly--role of local corticotherapy

Pachydermodactyly is a rare skin disease, defined as a benign form of digital fibromatosis. It is clinically characterized by painless hypertrophy of the skin around the proximal interphalangeal joints of the fingers, more common in males. This rare condition can affect both hands and is often associated with mechanical injury of the skin. Although there is no specific therapy, cessation of mechanical trauma associated with topical corticosteroid therapy can lead to satisfactory results. We present 3 sporadic cases of classical pachydermodactyly, anatomopathologically confirmed by the presence hyperkeratosis and acanthosis, which responded favorably to topically applied corticosteroids under occlusive dressings.

Epidemiological and pathological aspects of skin cancer in North East of Romania

In the last years skin cancer has become the most frequent cancer in humans, with the majority made up of two tumors: malignant melanoma (MM) and non-melanoma skin cancer (NMSC).

AIM

To provide for the first time in the North East region of Romania, descriptive epidemiological data of melanoma and non-melanoma skin cancers.

MATERIAL AND METHODS

We undertook a retrospective study over a five year period on the most frequent forms of skin cancer, basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and MM, which included a total number of 1231 patients, hospitalized and treated in the Plastic Surgery Department of "St. Spiridon" Emergency Clinical Hospital, Iaşi from 2008 until 2012. Results: BCC was diagnosed in a total of 675 patients, representing 54.9%. SCC was found in 217 patients, representing 17.6% and melanoma was diagnosed in 119 cases, a percent of 9.7% of the total number. The predominance of cutaneous malignancies waried with age, major site distribution was face and neck for BCC and SCC and the trunk for MM.

RESULTS

This article describes the most common forms of skin cancer in our region, BCC (almost 55%), SCC (17.6%), and less in number MM (near to 10%); these results are similar to those published abroad in the last years.

CONCLUSIONS

Future more elaborate interventional studies are necessary to identify the main risk factors in order to design the best preventive methods and, according to the skin cancer trend to specify the needs for dermatology network in our country.

A rare case of multiple clear cell acanthoma with a relatively rapid development of the lower legs

Clear cell acanthoma, firstly described by Degos as "an epidermal tumor with a particular aspect", although quite a rare lesion, raised an important interest because it may be easily confused with other dermatologic lesions, in the absence of a histopathological examination. Its clinical aspect is of a solitary nodule, with a red-brown varying color, with a size of 3 mm to 2 mm, sometimes covered with a thin scall. We present a case of a multiple rare cell acanthoma (seven nodular formations), having a rapid development (about two months) diagnosed in a 71-year-old patient within the lower 1/3 of the right shin.

The importance of histopathology findings in lymphomatoid papulosis

Lymphomatoid papulosis, part of the controversial group of cutaneous lymphoproliferative pseudolymphoma disorders, raises important clinical and histopathological problems. It is a chronic, recurrent, clinically characterized by popular necrotic lesions and papulo-pustular nodules, sometimes self-limiting and characterized by histopathological changes suggestive of cutaneous lymphoma (CD30-positive). Since its introduction, in 1968, the term "lymphomatoid papulosis" was subject to dispute in terms of classification in malignancies, premalignant or benign skin disease. We submit for consideration the case of a man with papulo-necrotic skin lesions evolving for about one year with post therapeutic remission and relapses, with histopathology of lymphomatoid papulosis. The evolution under systemic glucocorticoids has been favorable, with remission of skin lesions in about three months without relapses to date.

[Lichen planus-like eruption. Case report]

Cutaneous adverse drug reactions are among the most common adverse drug reactions. Thise reactions to drugs can comprise a broad spectrum of clinical and histopathological features, with an important capacity to mimic numerous dermatological diseases, making the diagnose very difficult. We present the case of a patient, under immunomodulating treatment (TNFalpha antagonist and leflunomide), with a muco-cutaneous lichen planus-like eruption.

[Fungal infections and nail psoriasis]

Onychomycosis and psoriasis are common diseases and it is possible that they coexist in the same patient. Psoriasis is a common cause of disturbance of the nail morphology. Nail disorders was reported in 10-80% of patients with psoriasis and may be associated with all clinical forms of disease. It has been suggested that the nail dystrophy in patients with psoriasis produce the lose of the natural protective barrier and increase vulnerability to fungal infections. But most authors report that in patients with psoriasis the prevalence of onychomycosis is no higher than in the general population. We conducted an observational analytical retrospective study of case report forms of patients with nail psoriasis hospitalized in Iasi Dermatology Clinic, 2004-2008. 360 patients were hospitalized with psoriasis. Of these 32 patients had nail disorders.