Résumé
Background: pityriasis rosea [PR] is a common papulosquamous skin disease in which infective agent may be implicated. Reactivation of human herpes virus 7 [HHV-7] and, in some cases human herpes virus 6 [HHV-6] was suggested to occur in PR
Objective: we aimed to study the involvement of HHV-6 and HHV-7 in the aetiology of PR by nested polymerase chain reaction of both serum and skin lesions
Subjects and methods: this work was achieved through the study of 22 patients with PR [9 males, 13 females, age ranged from 14 to 42 years], 13 age and sex matched patients with other dermatological diseases [4 psoriasis vulgaris, 3 lichen planus, 3 alopecia areata and 3 acne vulgaris] and 8 age and sex matched healthy control. Serum samples were taken from all patients and control. Punch biopsies were taken from lesional skin of both patient groups and from non lesional skin of PR patients. All samples were tested by nested PCR for both HHV-6 and HHV-7 specific DNA sequences
Results: HHV-6 DNA was detected in 7/22 [31.82%] lesional skin, in 5/22 [22.73%] of non lesional skin and in 5/22 [22.73%] of serum samples in PR patients. In the group of other dermatologic diseases HHV-6 DNA was detected in 1/13 [7.69%] of lesional skin and 1/13 [7.69%] of serum samples of one case of psoriasis vulgaris. HHV-7 DNA was found in 10/22 [45.45%] of lesional skin, 6/22 [27.27%] of non-lesional skin and 7/22 [31.81%] of serum samples in PR patients. HHV-7 was detected in only one 1/8 [12.5%] serum sample of the healthy control
Conclusion: HHV-6 and HHV-7 may be implicated in the etiology and pathogenesis of PR in some patients
Résumé
Background: psoriasis is T cell mediated disorder in which the cytokine network is extremely complex, involving the actions and interactions of multiple cytokines. Psoriasis vulgaris was reported to be associated with T helper cell type 1 [Th1] upregulation and T helper cell type 2 [Th2] downregulation
Objective: this cross section study was aimed to evaluate the changes in serum levels of IFN-gamma and IL4 in psoriasis vulgaris patients and correlate these parameters with psoriasis area severity index score [PASI]
Subjects and methods: this work was achieved through the study of 24 psoriasis vulgaris patients [16 males, 8 females, age ranged from 24 to 62 years] and 12 age and sex matched healthy controls. They were subjected to thorough history taking, general and dermatological examination for patients and controls. PASI score was calculated for every one of psoriatic patients. IFN-gamma and IL4 serum levels were assessed for patients and control by quantitative sandwich enzyme immuneo-assay technique. The patients were classified into three groups according the duration of the disease, a group with duration up to 5 years [6 patients], a group with duration from 5 to 10 years [10 patients] and the third one with duration more than 10 years [8 patients], according to PASI score into two groups a group with PASI score up to 15 [14 patients] and a group with PASI score more than 15 [10 patients]
Results: the serum level of IFN-gamma was significantly higher in psoriasis vulgaris patients compared to controls and serum level of Il-4 was significantly lower in psoriasis vulgaris patients compared to controls. There was highly significant positive correlation between serum level of IFN-gamma and PASI score. There were significant inverse correlation between serum level of IL4 and each of PASI score and serum IFN-gamma. There was significant difference in the serum levels of IFN-gamma and IL4 between groups of psoriatic patients with different PASI scores, while the difference between groups with different duration of the disease was non-significant
Conclusion: psoriasis vulgaris is associated with high serum level of IFN-gamma indicating Th1 upregulation and low serum level of IL-4 indicating Th2 down regulation. These changes in IFN-gamma and IL-4 serum levels were significantly correlated to PASI score
Résumé
Necrolytic acral erythema [NAE] is unique in its acral location and strong association with hepatitis C virus [HCV] and altered immunological junctions. The aim of the present work was to evaluate HLA DRB1 alleles and association of some parameter of immune system functions [complements C3 and C4, antismooth muscle antibody [ASMA] and antinuclear antibody [ANA] in NAE. Response of cutaneous lesion to low dose interferon alpha [3 million unit [MU] / week] and hydroxychloroquine was also evaluated. This study included 22 patients with HCV- related NAE [group I], 45 chronic hepatitis C without NAE [group II as pathological controls] and 45 healthy subjects [group III, normal controls]. ANA was positive more in patients than normal controls [18.2% vs 0%, P <0.003], however no significant difference was seen between patients groups. ASMA was positive significantly more in patients with NAE than HCV patients, and in both patients groups than normal controls 59.1%, 17.3% and 0%; P<0.001 and 0.0001 respectively]. A significant decrease in C3 and C4 was found in NAE patients than HCV patients without NAE, [P<0.01] and in both patients groups than normal controls [P<0.001]. NAE was associated with HLA -DRB1 03, [77.7%, 16 of 22 vs 24.2%, 11 of 45 of normal controls, Pc <0.0009 and 35.6% 16 of 45 HCV patients without NAE, Pc=0.03. Clinical improvement and significant decrease in ALT [P<0.001] was observed in NAE patients after two months of interferon alpha and hydroxychloroquine therapy. Necrolytic acral erythema [NAE] appears to be an immune mediated response in chronic HCV patients, associated with, lower C3 and C4 and higher frequency of positive ASMA. The results suggest that the development of HCV related ANE is associated with HLA-DRB1 03 marker. And low dose interferon alpha [3 MU per week] and hydroxychloroquine are good treatment modalities for NAE