Psoriasis (Ps) is a T-cell-mediated chronic inflammatory disorder of the skin seen in about 3.5% of the population. One-third of Ps cases in dermatology center are pediatric patients. Pediatric Ps consists broadly of three age groups of psoriatic patients: infantile Ps, a self-limited disease of infancy, Ps with early onset and pediatric Ps with psoriatic arthritis. Timely diagnosis and appropriate management can not only arrest progression but also minimize the psychosocial burden imposed by this illness thereby averting disfiguring states and its evolution into a metabolic syndrome requiring extensive treatment. This review will cover almost all aspects of pediatric Ps including the rare clinical form congenital erythrodermic Ps and present the latest update especially on the etiopathogenesis and treatment options.
The 3rd Continental Congress of the International Society of DermatologyDurban, South Africa, Kwa-Zulu Natal, 24–27 October 2012The Nelson R Mandela School of Medicine (University of Kwa-Zulu Natal, Durban, South Africa), Dermatology Department, under the auspices of the Dermatology Society of South Africa, together with the International Society of Dermatology hosted the 3rd Continental Congress of the International Society of Dermatology in Durban, South Africa from 24 to 27 October 2012. The main purpose of the meeting was to provide a venue for bringing an international perspective to a regional dermatological meeting with international speakers and a broader international attendance. About 400 faculty members and delegates participated in the meetings, which had over 30 sessions. Topics of interest ranged from ethnic skin and hair, drug reactions, infections, sexually transmitted diseases and HIV dermatoses to dermatologic surgery, Botox and fillers with exciting diagnostic interactive sessions, rapi...
Ultrasound imaging has been increasingly used in dermatologic research over the past four decades. This paper aims to review its use as a disease severity and treatment efficacy assessment tool, with emphasis on the past five years. Quantitative parameters such as skin thickness, overall echogenicity, echogenicity distribution, dermal–subcutaneous interface length or area are used. The authors review skin aging, cellulite, striae, fillers, scleroderma, hypertrophic scar, wounds and psoriasis studies, and discuss correlation between sonographic findings and clinical assessment and/or validated scores. Data are still insufficient to support ultrasound imaging use as an unique efficacy assessment method in a trial, but favor that it is a valuable adjuvant assessment tool that brings objectiveness to subjective clinical assessment. Further studies and technology improvement will expand its applications in dermatology.
Lyme disease is currently the most common tick-borne disease in temperate regions of the northern hemisphere. The pathogen Borrelia burgdorferi is a slow growing, microaerophile, Gram-negative spirochete. The spirochete is transmitted by ticks of the Ixodes ricinus species complex. Borreliosis has a variety of presentations at different stages of infection. It often leads to various skin affections, but it might also compromise multiple organs, especially the central and peripheral nervous system, joints and muscles. The diagnostic detection methods for this organism in skin biopsies have recently been improved with focus ‘floating microscopy’ and allowed the reliable detection of spirochetes in other ‘non classical’ skin disorders. Although Lyme disease has been known for almost 20 years, the known spectrum of its skin manifestations is continuously expanding and cannot be regarded as completed. Therapeutic choices are variegated and should be adequately chosen regarding the clinical manifestation.
Systemic sclerosis (SSc) is an autoimmune disease marked by excessive extracellular matrix deposition in the skin and internal organs. Although the etiology of SSc remains unknown, three major abnormalities are considered to play important roles in the pathophysiology of SSc: autoimmunity, vasculopathy and fibrosis. Mouse models are critical tools for further understanding of the pathophysiology underlying this disease. The bleomycin-induced scleroderma model and TSK/+ mice are the primary SSc models; however, emerging models of SSc, such as Fra-2 Tg mice and the hypochlorous acid (HOCl)-induced scleroderma model, have provided novel insights into the pathophysiology of SSc. Importantly, a growing number of studies suggests a role for B cells, including regulatory B cells, in the pathogenesis of SSc. Thus, for the development of therapies, targeting of profibrogenic cytokines, such as transforming growth factor-β is still a very active area of investigation and B cell-targeted therapies also represent potential treatment options. Furthermore, approaches to antagonize IL-6 or IL-17A signaling or to inhibit signaling pathways that utilize peroxisome proliferator-activated receptor-γ, Wnt or hedgehog are also being explored for the treatment of SSc. Here, we review murine models of SSc as well as recent updates regarding the development of therapeutic approaches using murine models of SSc.
Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease associated with autoantibodies directed against two components of junctional adhesion complexes in stratified epithelia, BPAG2 and BPAG1-e. BP typically develops in the elderly and manifests with widespread eczematous, urticated and bullous lesions. In up to 20% of the affected patients, obvious blistering is lacking and the clinical features of BP are misleading and closely mimic a variety of other inflammatory conditions. Diagnosis of BP, which should be rather called cutaneous pemphigoid, relies on direct immunofluorescence microscopy studies to detect tissue-bound IgG and/or C3 immune deposits along the epidermal basement membrane zone. Here, the clinical presentations of BP and the diagnostic algorithm with the immunopathological studies available to classify affected patients are reviewed. Finally, the need for widely accepted criteria for the classification of BP patients is emphasized, since in a number of patients with features characteristic for BP, the results of the immunopathological studies are not conclusive or are incomplete.
Psoriasis is a chronic, immune-mediated inflammatory skin disease that is associated with multiple comorbidities including psoriatic arthritis, cardiometabolic diseases, malignancies, nonalcoholic fatty liver disease, autoimmune diseases, inflammatory-bowel disease, obstructive sleep apnea and chronic obstructive pulmonary disease. Cardiovascular disease including myocardial infarction, stroke and subclinical atherosclerosis as well as obesity, metabolic syndrome, diabetes, hypertension and hyperlipidemia, are associated with psoriasis. Shared inflammatory pathways may be the basis for these disease associations, especially in the case of cardiovascular disease and its risk factors. Reduced quality of life, depression, anxiety, smoking and alcoholism are also seen in psoriasis patients. Awareness and understanding of the relationships between psoriasis and its comorbidities is important in managing patients with psoriasis. The multiple comorbidities associated with psoriasis will be discussed here, focusing on presenting available data pertaining to each disease, its relationship to psoriasis pathology and the implications for physicians and psoriatic patients.
Scleroderma is one of the autoimmune diseases characterized by tissue fibrosis of the skin and internal organs. The understanding of its pathogenesis and the development of new diagnostic tools or effective therapeutic approaches are urgent.miRNAs 19–25 nucleotides in length, directly bind to complementary sequences in the three prime untranslated regions (3´ UTRs) of target mRNAs, leading to the modulation of gene expression. Various miRNAs including miR-29, -206, -125b, -21, -145, -196, -150, -129-5p, -92a, and let-7g may be associated with the fibrosis in scleroderma via regulating the expression of collagens, integrins or matrix metalloproteinases. In addition, serum levels of miR-29a, -196a, -150, -92a, and -142-3p are correlated with the diagnosis or disease activity of this disease. On the other hand, miRNA treatment may become a promising therapeutic strategy in various human diseases. Systemic administration of let-7-attenuated bleomycin-induced mice skin fibrosis, suggesting an antifibrotic effe...
71st Meeting of the American Academy of DermatologyMiami Beach, FL, USA, 1–5 March 2013The 71st meeting of the American Academy of Dermatology took place in Miami Beach from 1st to 5th March 2013. The meeting was a big success in terms of scientific output and number of participants, being the most attended meeting in the history of the Academy up to now. The scientific sessions covered basically all the fields of dermatology, encompassing the newest updates from oncologic to cosmetic dermatology. Herein, we focus on cutaneous oncology sessions, including melanoma and non-melanoma skin cancer, resuming both diagnostic and therapeutic updates with special attention to skin cancer prevention and the fascinating frontiers of the new available treatments.
Psychotropic medications can be associated with dermatologic side effects. The aim of this review is to explore the skin reactions of such psychotropic medications. In our method we conducted a PubMed literature search using the key words; psychotropics, antipsychotics, antidepressants, mood stabilizers, anticonvulsants, cutaneous reactions and skin reactions. The results of this review indicate that psychotropic medications can contribute to several adverse cutaneous manifestations with varied severity ranging from benign skin reactions to rare life-threatening ones such as toxic epidermal necrolysis and Stevens-Johnson syndrome. Psychotropic medications can also aggravate pre-existing skin conditions or trigger the manifestation of dormant one such as lithium-induced psoriasis. Cross sensitivity reactions may exist between medications of the same class or between the medications of different class. Careful history taking and continued monitoring and observation of psychotropic medications is important f...
Systemic sclerosis (SSc) is a severe, chronic autoimmune disease of the connective tissue. The disease typically becomes clinically apparent on the skin and subsequently spreads to several internal organs, in particular the gastrointestinal system, lung, heart and kidney (in decreasing frequency). The pathogenesis evolves via activation of the vascular and immune system, finally leading to a fibrotic response of the connective tissue and resulting in progressive dysfunction of the affected organs. Although the etiology still remains elusive, the knowledge of genetic factors associated with SSc has increased remarkably in recent years. It can be shown that SSc shares a number of genetic risk factors with other autoimmune diseases, in particular lupus erythematosus. New pathways such as Wnt signaling have been identified, which improve our understanding of the initiation of fibrosis in this still enigmatic disease. The enhanced insight into distinct steps of the organotypic pathophysiology of SSc, for example in pulmonary arterial hypertension, has led to considerable therapeutic improvement, resulting in enhanced life quality and life expectancy in subgroups of SSc patients in recent years.
External genital warts (EGW) are currently the most common form of viral sexually transmitted disease found in the general population. EGW have been shown to occur as a direct result of infection with the human papillomavirus (HPV). Malignancy is typically associated with high-risk types of HPV; however, low-risk type association has been observed. Numerous therapies are presently indicated for use in the treatment of EGW, which can target lesions through multiple modalities including topically, surgically or via immune modulation. Therapies often differ dramatically with respect to cost, side-effect profiles, dosing schedules, duration of treatment and overall effectiveness. Routine HPV vaccination may play a powerful role in reducing the burden of disease by preventing viral infection and transmission. As HPV vaccination continues to gain widespread approval, it may prove instrumental in decreasing the incidence of HPV infection and eventually eradicating genital warts.
Psoriasis is a major inflammatory disorder in the dermatological field. Phototherapy is effective and safe for psoriasis vulgaris. Narrow-band ultraviolet (UV) B and psoralen plus UVA are known to be the common modality as conventional non-targeted phototherapy. Non-targeted phototherapy making unnecessary irradiation to the unaffected skin may cause long-term adverse effects of UV. Targeted phototherapies with advantages, for example, higher dosages for lesional skin, a rapid clearing and longer remission rates, have been developed. Targeted phototherapies are preferably used for childhood, palmoplantar psoriasis, scalp and nail psoriasis as well as refractory lesions remained after whole-body UV therapy. Light sources of targeted phototherapy include broad-band UVB, narrow-band UVB, 308-nm excimer laser and light, 307-nm excimer light and 312-nm flat-type fluorescent lamp. This comprehensive review focuses recent evolution of target phototherapy for the treatment of psosriasis.
Rhinosporidial lesions in the skin are pathogenetically classified as primary, secondary and as components of disseminated disease. Estimates of the incidence of rhinosporidiosis in various sites vary between 1 and 8% of all cases of rhinosporidiosis. The disease is mainly of occupational origin after exposure to ground waters and is noncontagious and noninfectious. Cutaneous rhinosporidial lesions are diverse in morphologies, and definitive diagnosis is provided by skin-histopathology with the conventional H&E stain, while discharges are diagnosed by cytology using the periodic acid-Schiff stain. Surgery is the treatment of choice on accessible sites with single or a few nodules, supplemented with drugs, notably dapsone; multiple extensive sessile growths, when surgery is difficult, will need drug therapy. Surface application of biocides is ineffective.
Leser–Trélat sign is a cutaneous manifestation that presents with rapid onset of multiple seborrheic keratoses on the trunk and extremities. In the majority of cases, seborrheic keratoses increase in number within short periods (usually within 6 months). Seborrheic keratoses are commonly seen in elderly people; however, Leser–Trélat sign is important because it may be a clue to the discovery of occult internal malignancies. Adenocarcinomas involving the stomach, intestine and breast are commonly associated with Leser–Trélat sign, however, hematological malignancies have also been detected. Several reports have shown that Leser–Trélat sign is associated with benign neoplasms. Although the etiology of Leser–Trélat sign is largely unknown, several speculations have been proposed. EGF and TGF-α are derived from the original tumor cells, while EGF-receptor (EGF-R) is expressed on the epidermis. This suggests that the development of seborrheic keratoses may be accelerated via EGF-R-mediated signaling pathways. Other paraneoplastic signs showing epidermal proliferation include acanthosis nigricans, acquired ichthyosis and Bazex syndrome. The collision of these paraneoplastic signs and Leser–Trélat sign is sometimes reported. These findings suggest that tumor-derived factors exert some effects on keratinocytes. Rarely, seborrheic keratoses regress either spontaneously or possibly via apoptotic process, however, in the majority of cases, the condition is stable in number, even after internal cancers are surgically removed. To date, there is still little evidence of seborrheic keratoses alterations at the clinical and/or molecular levels. In this review, current findings on the possible pathomechanisms of Leser–Trélat sign are discussed.
Sensitive skin is a clinical condition defined by the self-reported facial presence of different sensory perceptions, including tightness, stinging, burning, tingling, pain and pruritus. Sensitive skin may occur in individuals with normal skin, with skin barrier disturbance, or as a part of the symptoms associated with facial dermatoses such as rosacea, atopic dermatitis and psoriasis. Although experimental studies are still pending, the symptoms of sensitive skin suggest the involvement of cutaneous nerve fibres and neuronal, as well as epidermal, thermochannels. Many individuals with sensitive skin report worsening symptoms due to environmental factors. It is thought that this might be attributed to the thermochannel TRPV1, as it typically responds to exogenous, endogenous, physical and chemical stimuli. Barrier disruptions and immune mechanisms may also be involved. This review summarizes current knowledge on the epidemiology, potential mechanisms, clinics and therapy of sensitive skin.
Actinic keratosis is a complex clinical disease for which no clear method exists to predict whether a given lesion will regress, remain stable or progress to non-melanoma skin cancer. Treating all (including subclinical) lesions with field-directed therapy to lower the risk of malignant transformation has been an important evolution in actinic keratosis management. In selected patients, lesion-directed approaches continue to occupy an important role. Despite the associated issues, cryotherapy remains standard of care. Early evidence with a new topical lesion-directed treatment containing low-dose-5-fluorouracil 0.5%/salicylic acid 10% suggests relevant advantages over cryotherapy in terms of sustained lesion clearance. For a condition with such a high global prevalence, remarkably little is known about the economic burden of actinic keratosis and relative cost–effectiveness of the various treatment modalities. Several questions need to be addressed if the challenges of increasing numbers of cases in years ahead are to be met.
The diagnosis of lentigo maligna (LM) is often challenging for both clinicians and pathologists. LM is widely regarded as a form of melanoma in situ occurring in severely sun-damaged skin with characteristic clinical and pathologic features. However, compared with other forms of in situ melanoma, it often has a long-term clinical course for evolution to invasive melanoma. Some authorities advocate dividing LM into premalignant/precursor and in situ melanoma (LM in situ melanoma) phases, implying a lesser risk of the former for developing invasive melanoma. However, this subtle morphologic distinction does not necessarily correlate well with clinical outcome. An initial tissue sample for histologic diagnosis is commonly a small proportion of the lesion and may not be representative/diagnostic of LM. New clinical diagnostic tools including dermoscopy and in vivo confocal microscopy have improved the accuracy of both clinical diagnosis of LM and also defining the peripheral extent of the lesion for definitiv...
