ABSTRACT
Although atopic dermatitis (AD) is characterized by cytokine production predominantly mediated by T helper (Th) 2 cells, AD pathogenesis also involves innate immune and Th1 cells. To optimize the cytokine milieu required for accurate reproduction of AD-related gene expression profile in vitro, we evaluated the expression pattern of CCL22, CCL17, IL5, IL13, IL33, IL25, TSLP, FLG, and LOR in human lesional AD skin and cytokine-stimulated HaCaT cells. An increase in Th2 mediators (IL5, IL13, CCL22, CCL17, IL25, IL33, and TSLP) and a decrease in genes related to cornified cell envelope (filaggrin and loricrin) were observed in human AD lesions. Innate (tumor necrosis factor-α) and/or Th1/Th2 adaptive cytokines (interferon-γ/IL-4) were required for inducing these inflammatory changes in HaCaT cells, implying that a complex network of innate, Th1, and Th2 cytokines drives AD-like changes. Therefore, stimulation with various combinations of cytokines, beyond Th2 polarization, is necessary when HaCaT cell line is used to study genetic changes implicated in AD pathogenesis.
Subject(s)
Humans , Cell Line , Cytokines , Dermatitis, Atopic , Gene Expression , In Vitro Techniques , Interleukin-13 , Interleukin-33 , Interleukin-5 , Keratinocytes , Necrosis , Reproduction , Skin , Th1 Cells , TranscriptomeABSTRACT
BACKGROUND: Demodicosis is a parasitic skin disease caused by Demodex mites, and the determination of mite density per square centimeter is important to diagnose demodicosis. Standardized skin surface biopsy (SSSB) and direct microscopic examination (DME) are commonly used to determine Demodex mites density (Dd). However, no study has previously compared these two methods with respect to clinical types and distribution patterns of demodicosis. OBJECTIVE: The aim of this study was to compare the value of SSSB and DME findings in reference to the clinical types and distribution patterns of demodicosis. METHODS: The medical records of 35 patients diagnosed with demodicosis between December 2011 and June 2015 were retrospectively reviewed. Demodicosis was classified according to four clinical types (pityriasis folliculorum, rosacea type, acne type, and perioral type) and three distribution patterns (diffuse pattern, U-zone pattern, and T-zone pattern). Two samples, one for SSSB and one for DME, were obtained from a lesion of each patient. RESULTS: In all patients, mean Dd and the proportion with a high Dd (>5D/cm²) by DME (14.5±3.3, 80.0%, respectively) were higher than by SSSB (5.5±1.3, 37.1%, respectively; p<0.01, p=0.02, respectively). In terms of clinical types, for rosacea type, mean Dd and proportion with a high Dd by DME (12.4±3.5, 84.6%, respectively) were significantly greater than those determined by SSSB (3.6±1.2, 23.1%; p=0.04, p=0.04, respectively). In terms of distribution pattern, for the diffuse pattern, mean Dd and the proportion with a high Dd by DME (17.5±3.7, 100%, respectively) were significantly higher than those determined by SSSB (6.0±2.7, 26.7%; p<0.01, p<0.01, respectively). CONCLUSION: The results of our study revealed that DME is a more sensitive method for detecting Demodex than SSSB, especially in patients with diffuse pattern and suspected rosacea type. Further research is needed to confirm this finding.
Subject(s)
Humans , Acne Vulgaris , Biopsy , Medical Records , Methods , Mites , Retrospective Studies , Rosacea , Skin Diseases, Parasitic , SkinABSTRACT
Woringer-Kolopp disease, also known as localized pagetoid reticulosis, is a rare variant of mycosis fungoides that presents as a solitary localized hyperkeratotic patch or plaque on the extremities and follows a benign course. Effective treatments for Woringer-Kolopp disease include skin-directed therapies such as topical nitrogen mustard, high-potency topical steroids, and phototherapy. Surgical excision has been pursued in cases of small, localized lesions. A 39-year-old man presented with a 3-month history of an asymptomatic plaque on his hand. Physical examination showed a 10-mm-diameter solitary round erythematous hyperkeratotic plaque with a slightly raised edge on the dorsum of his left hand. A skin biopsy revealed that numerous atypical lymphocytes had infiltrated the upper dermis and expanded into the epidermis with a pagetoid pattern. These atypical pagetoid cells were strongly positive for CD3, CD8, and T-cell intracellular antigen-1; focally positive for CD4; and negative for CD20, CD30, and CD56. A subsequent general examination revealed no evidence of systemic involvement and the lesion was treated with surgical excision. Here we report a rare case of Woringer-Kolopp disease.
Subject(s)
Adult , Humans , Biopsy , Dermis , Epidermis , Extremities , Hand , Lymphocytes , Mechlorethamine , Mycosis Fungoides , Pagetoid Reticulosis , Phototherapy , Physical Examination , Skin , Steroids , T-LymphocytesABSTRACT
Sorafenib is an oral, multi-targeted tyrosine kinase inhibitor with anti-angiogenic and anti-proliferative activity. It is approved for the treatment of unresectable hepatocellular and advanced renal carcinomas. Cutaneous toxicity is relatively common in patients receiving sorafenib. The most frequent cutaneous side effect is the hand-foot syndrome. Other adverse skin reactions include facial erythema, acral erythema, erythema multiforme, subungual splinter hemorrhage, stomatitis, and alopecia. In Korea, two cases of scrotal and perianal dermatitis after sorafenib therapy were reported. We report a 54-year-old male patient with a 2-week history of scrotal eczema who had been treated for chronic hepatitis type B, liver cirrhosis, and hepatocellular carcinoma. After 2 weeks of oral sorafenib (800 mg/day) administration, thick, scaly patches appeared on his scrotum. A skin biopsy specimen from these lesions revealed superficial dermal perivascular lymphocytic and neutrophilic infiltration, and dilatation of the lymphatics in the superficial dermis. The lesions improved after treatment with a topical and systemic steroid for 2 weeks. Herein, we report a rare case of scrotal erythema associated with sorafenib.
Subject(s)
Humans , Male , Middle Aged , Alopecia , Biopsy , Carcinoma, Hepatocellular , Dermatitis , Dermis , Dilatation , Eczema , Erythema Multiforme , Erythema , Hand-Foot Syndrome , Hemorrhage , Hepatitis, Chronic , Korea , Liver Cirrhosis , Neutrophils , Protein-Tyrosine Kinases , Scrotum , Skin , StomatitisABSTRACT
BACKGROUND: Excessive exposure to reactive oxygen species (ROS) or decreased antioxidants leads to damage of proteins, lipids, and DNA. Previous studies suggest that oxidative stress may be important in the pathogenesis of atopic dermatitis. OBJECTIVE: To investigate whether oxidative stress is increased in atopic dermatitis patients compared to a normal control group, we examined DNA damage, lipid peroxidation, ROS production and antioxidant expression. METHODS: Patients with atopic dermatitis (n=16; mean Scoring Atopic Dermatitis [SCORAD] index=53.06) were investigated compared to a normal control group (n=25). To examine DNA damage in the cellular level, we performed comet assays on lymphocytes and granulocytes taken from patients and control group. To measure lipid peroxidation products, urine and plasma malondialdehyde (MDA) levels were analyzed. To examine intracellular redox in lymphocytes, ROS were measured using flow cytometry. Expression of superoxide dismutase (SOD) 1, 2 antioxidants were analyzed using reverse transcription polymerase chain reaction (RT-PCR). RESULTS: Atopic dermatitis patients showed severe DNA damage compared to the control group in both lymphocytes (1.89 and 1.51, respectively, p0.05), plasma MDA levels were significantly increased in atopic dermatitis patients compared to controls (1.45 and 0.80 microM/g respectively, p<0.005). ROS production by activated lymphocytes was increased in atopic dermatitis patients compared to controls. SOD 1, 2 were expressed in all atopic dermatitis patients without significant increase compared to controls. CONCLUSION: Increased DNA damage, lipid peroxidation and ROS production in lymphocytes as indices of oxidative stress were observed in moderate to severe atopic dermatitis patients compared to normal control. Although precise mechanism of oxidative stress on the pathogenesis of atopic dermatitis is not defined yet, decreasing ROS exposure or augmenting antioxidant defenses may be alternative therapeutic approaches for atopic dermatitis.
Subject(s)
Humans , Antioxidants , Comet Assay , Dermatitis, Atopic , DNA , DNA Damage , Flow Cytometry , Granulocytes , Lipid Peroxidation , Lymphocytes , Malondialdehyde , Oxidation-Reduction , Oxidative Stress , Plasma , Polymerase Chain Reaction , Reactive Oxygen Species , Reverse Transcription , Superoxide DismutaseABSTRACT
BACKGROUND: Topical calcineurin inhibitors (TCIs) have been successfully used to treat seborrheic dermatitis (SD) patients. Meanwhile, treatment of atopic dermatitis (AD) with low-dose, intermittent TCI has been proved to reduce disease flare-ups. This regimen is known as a maintenance treatment. OBJECTIVE: The aim of this trial was to investigate the efficacy and tolerability of a maintenance treatment with tacrolimus ointment in patients with facial SD. METHODS: During the initial stabilization period, patients with facial SD or AD applied 0.1% tacrolimus ointment twice daily for up to 4 weeks. Clinical measurements were evaluated on either in the whole face or on separate facial regions. When an investigator global assessment score 1 was achieved, the patient applied tacrolimus twice weekly for 20 weeks. We also compared our results with recent published data of placebo controlled study to allow an estimation of the placebo effect. RESULTS: The time to the first relapse during phase II was similar in both groups otherwise significantly longer than the placebo group. The recurrence-free curves of two groups were not significantly different from each other; otherwise the curve of the placebo group was significantly different. There were no significant differences between the 2 groups in the number of DEs, and treatment days for disease exacerbations (DEs). The adverse event profile was also similar between the 2 groups. During the 20 weeks of treatment, the study population tolerated tacrolimus ointment well. CONCLUSION: The results of this study suggest that maintenance treatment with tacrolimus may be effective in preventing the occurrence of facial SD exacerbations.
Subject(s)
Humans , Calcineurin , Dermatitis, Atopic , Dermatitis, Seborrheic , Placebo Effect , Recurrence , Research Personnel , TacrolimusABSTRACT
BACKGROUND: Topical calcineurin inhibitors (TCIs) have been successfully used to treat seborrheic dermatitis (SD) patients. Meanwhile, treatment of atopic dermatitis (AD) with low-dose, intermittent TCI has been proved to reduce disease flare-ups. This regimen is known as a maintenance treatment. OBJECTIVE: The aim of this trial was to investigate the efficacy and tolerability of a maintenance treatment with tacrolimus ointment in patients with facial SD. METHODS: During the initial stabilization period, patients with facial SD or AD applied 0.1% tacrolimus ointment twice daily for up to 4 weeks. Clinical measurements were evaluated on either in the whole face or on separate facial regions. When an investigator global assessment score 1 was achieved, the patient applied tacrolimus twice weekly for 20 weeks. We also compared our results with recent published data of placebo controlled study to allow an estimation of the placebo effect. RESULTS: The time to the first relapse during phase II was similar in both groups otherwise significantly longer than the placebo group. The recurrence-free curves of two groups were not significantly different from each other; otherwise the curve of the placebo group was significantly different. There were no significant differences between the 2 groups in the number of DEs, and treatment days for disease exacerbations (DEs). The adverse event profile was also similar between the 2 groups. During the 20 weeks of treatment, the study population tolerated tacrolimus ointment well. CONCLUSION: The results of this study suggest that maintenance treatment with tacrolimus may be effective in preventing the occurrence of facial SD exacerbations.
Subject(s)
Humans , Calcineurin , Dermatitis, Atopic , Dermatitis, Seborrheic , Placebo Effect , Recurrence , Research Personnel , TacrolimusABSTRACT
Even though atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases, its treatment remains a challenge in clinical practice, with most approaches limited to symptomatic, unspecific anti-inflammatory, or immunosuppressive treatments. Many studies have shown AD to have multiple causes that activate complex immunological and inflammatory pathways. However, aeroallergens, and especially the house dust mite (HDM), play a relevant role in the elicitation or exacerbation of eczematous lesions in many AD patients. Accordingly, allergen-specific immunotherapy has been used in AD patients with the aim of redirecting inappropriate immune responses. Here, we report three cases of refractory AD sensitized to HDM who were treated with sublingual immunotherapy.
Subject(s)
Humans , Dermatitis, Atopic , Desensitization, Immunologic , Immunotherapy , Pyroglyphidae , Skin Diseases , Sublingual ImmunotherapyABSTRACT
BACKGROUND: In vivo and/or in vitro diagnostic tests to identify possible allergens have been conducted for patients with chronic spontaneous urticaria (CSU) in order to identify any predisposing factors and avoid unnecessary restrictions. OBJECTIVE: The purpose of this study was to evaluate the diagnostic effectiveness of ImmunoCAP(R) ISAC (ISAC) in CSU patients. METHODS: A total of 31 patients with CSU were tested by ISAC and Multiple Allergen Simultaneous Test enzyme immunoassays (MAST-EIA). A skin prick test (SPT) was performed for 17 out of 31 patients. The results of ISAC and MAST-EIA were evaluated based on the SPT results. RESULTS: For 17 patients, with SPT used as the reference standard, ISAC compared with MAST-EIA showed lower sensitivity (22.2% vs. 26.5%), higher specificity (100% vs. 95.7%), higher positive predictive value (100% vs. 52.9%), and lower negative predictive value (86.9% vs. 87.7%). The agreement rate was more favorable for ISAC than for MAST-EIA (87.3% vs. 85.1%; kappa=0.324 vs. 0.263). For 31 patients, the agreement rate between ISAC and MAST-EIA was 83.9% for both Dermatophagoides farinae and Dermatophagoides pteronyssinus. Correlation coefficients (Rho) between ISAC and MAST-EIA for each allergen were 0.690 and 0.675, respectively. CONCLUSION: For CSU patients, specificity, positive predictive value, and the agreement rate of ISAC were similar or superior to those of MAST-EIA. In addition, ISAC provides valuable information on the possible sensitization to different allergen sources by elucidating cross-reactive components. With careful clinical correlations in interpretation, ISAC can be a useful diagnostic tool to detect allergens in CSU patients.
Subject(s)
Humans , Allergens , Causality , Dermatophagoides farinae , Dermatophagoides pteronyssinus , Diagnostic Tests, Routine , Immunoenzyme Techniques , Sensitivity and Specificity , Skin , UrticariaABSTRACT
BACKGROUND: Providing an educational program as part of a health care program for the management of atopic dermatitis (AD) patients has rapidly become popular. AD educational programs can be of benefit in measured outcomes for both dermatology specialists and patients. OBJECTIVE: To determine the effects of programmed education delivered by dermatology specialists on the management and knowledge of AD, we assessed the effectiveness of patient/parental education at improving AD knowledge, and determined the usefulness of the education. METHODS: The program consisted of five, 20-minutes sessions which were prepared, discussed, reviewed, and delivered by professors of dermatology. At the end of the program, AD knowledge was assessed using a standardized questionnaire. A total of 148 people were included. Fifty-eight patients/parents received the programmed education and the remaining 90 did not receive the programmed education. RESULTS: The mean questionnaire scores from both groups were compared. Mean knowledge scores were significantly higher for those who received the education (p=0.00). We analyzed the knowledge score according to factors such as gender, education level, marital status, and occupation. The data indicated that education level influences the subjects' knowledge level of AD, but gender, occupation, and marital status do not. CONCLUSION: An educational program can be an effective tool to improve patient quality of life and treatment compliance by providing psychological support to the patients and their parents.
Subject(s)
Humans , Compliance , Delivery of Health Care , Dermatitis, Atopic , Dermatology , Education , Marital Status , Occupations , Parents , Quality of Life , Specialization , Surveys and QuestionnairesABSTRACT
Bowen's disease is a squamous cell carcinoma in situ and has the potential to progress to a squamous cell carcinoma. The authors treated two female patients (a 39-year-old and a 41-year-old) with Bowen's disease in the vulva area using topical photodynamic therapy (PDT), involving the use of 5-aminolaevulinic acid and a light-emitting diode device. The light was administered at an intensity of 80 mW/cm2 for a dose of 120 J/cm2 biweekly for 6 cycles. The 39-year-old patient showed excellent clinical improvement, but the other patient achieved only a partial response. Even though one patient underwent a total excision 1 year later due to recurrence, both patients were satisfied with the cosmetic outcomes of this therapy and the partial improvement over time. The common side effect of PDT was a stinging sensation. PDT provides a relatively effective and useful alternative treatment for Bowen's disease in the vulva area.
Subject(s)
Adult , Female , Humans , Bites and Stings , Bowen's Disease , Carcinoma, Squamous Cell , Photochemotherapy , Recurrence , Sensation , VulvaABSTRACT
BACKGROUND: Various allergens play a role in the elicitation or exacerbation of eczematous skin lesions in atopic dermatitis (AD), and much research effort has been focused on improving diagnostic tests to identify causative allergens. OBJECTIVE: The purpose of this study was to evaluate the diagnostic effectiveness of a newly introduced microarray-based specific immunoglobulin E detection assay, ImmunoCAP ISAC, for use in AD patients. METHODS: The serum samples of 25 AD patients were tested by using ISAC and a multiple allergen simultaneous test-enzyme immunoassay (MAST-EIA). In addition, 10 of the 25 patients underwent skin prick testing (SPT). The positive reaction rates to allergens in each test and the agreements, sensitivities, and specificities of ISAC and MAST-EIA were evaluated versus the SPT results. RESULTS: For ISAC versus SPT, the overall results were as follows: sensitivity, 90.0%; specificity, 98.2%; positive predictive value (PPV), 90.0%; and negative predictive value (NPV), 98.2%. The total agreement and kappa value for ISAC versus SPT were 96.9% and 0.882, respectively. For MAST-EIA versus SPT, the sensitivity was 80.0%, specificity 92.7%, PPV 66.7%, and NPV 96.2%. The total agreement and kappa value for MAST-EIA versus SPT were 90.8% and 0.672, respectively. The overall agreement between the ISAC and MAST-EIA results was 88%. CONCLUSION: The ISAC results in AD correlated well with the SPT results, and compared favorably to the MAST-EIA results. This study demonstrates the potential of ISAC as a convenient allergic diagnostic method in AD patients.