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Background@#The phenotypic heterogeneity of psoriasis is suspected to reflect differences in its pathogenesis, but not yet completely elucidated. Studies of the Th1 and Th17 cytokines associated with different phenotypes of psoriasis have yielded inconsistent results. @*Objective@#To investigate the tissue expression levels of Th1 and Th17 cytokines among patients with chronic plaque psoriasis, acute guttate psoriasis, and healthy control. @*Methods@#A total of 20 patients with psoriasis (10 with chronic plaque type and 10 with acute guttate type) and 5 healthy controls were enrolled. The tissue mRNA and protein levels of following cytokines were measured: interleukin (IL)-12, IL-2, interferon (IFN)-γ, IL-23, IL-17A, and IL-22. @*Results@#The tissue mRNA levels of IL-12, IFN-γ, IL-23, IL-17A, IL-22 and the protein levels of IL-12, IL-2, IFN-γ, IL-17A, IL-22 were significantly increased in the psoriasis patients compared with the healthy controls. In comparisons of the subtypes, the tissue mRNA level of IFN-γ was increased in acute guttate psoriasis, whereas the protein levels of IL-12 and IL-17A were significantly increased in chronic plaque psoriasis. The cytokine ratios of IL-17A/IL-2 and IL-22/IL-2 were significantly higher in chronic plaque psoriasis than in acute guttate psoriasis. @*Conclusion@#We confirmed that the tissue levels of Th1 and Th17 cytokines were increased in psoriasis patients compared with healthy controls. The increased IFN-γ mRNA level in acute guttate psoriasis and increased IL-12 and IL-17A protein levels in chronic plaque psoriasis suggest that an imbalance between Th1 and Th17 cytokines may play a role in the phenotypic transition of psoriasis.
RESUMO
In Asian countries, acupuncture with gold threads has been widely used in the treatment of pain. However, several reports have suggested that the implanted gold threads can become fragmented and migrate to other parts of the body, damaging surrounding tissues. A 75-year-old female presented with diffuse erythematous edema with multiple vesicles on the right lower leg for 3 days. She had previously suffered from cellulitis on the same region twice for the last 1year. Her past medical history included acupuncture with gold threads on the back due to lumbar herniated nucleus pulposus (HNP) about 10 years ago. Histopathological examination demonstrated marked subepithelial edema and diffuse perivascular infiltrate of inflammatory cells in the dermis. Simple radiography of the leg revealed numerous radiodense threads in the soft tissue. Since the patient did not receive acupuncture on any other sites except on the back, we hypothesized that the gold threads injected on the back may have migrated through the vessels to the leg. These metal fragments can cause inflammatory reaction and make the tissues more susceptible to secondary infections. The lesion gradually improved after treatment with systemic steroid and antibiotics for 1 week.
RESUMO
In Asian countries, acupuncture with gold threads has been widely used in the treatment of pain. However, several reports have suggested that the implanted gold threads can become fragmented and migrate to other parts of the body, damaging surrounding tissues. A 75-year-old female presented with diffuse erythematous edema with multiple vesicles on the right lower leg for 3 days. She had previously suffered from cellulitis on the same region twice for the last 1year. Her past medical history included acupuncture with gold threads on the back due to lumbar herniated nucleus pulposus (HNP) about 10 years ago. Histopathological examination demonstrated marked subepithelial edema and diffuse perivascular infiltrate of inflammatory cells in the dermis. Simple radiography of the leg revealed numerous radiodense threads in the soft tissue. Since the patient did not receive acupuncture on any other sites except on the back, we hypothesized that the gold threads injected on the back may have migrated through the vessels to the leg. These metal fragments can cause inflammatory reaction and make the tissues more susceptible to secondary infections. The lesion gradually improved after treatment with systemic steroid and antibiotics for 1 week.
RESUMO
Immunoglobulin G4-related disease (IgG4-RD) is a recently discovered condition that was first reported in 2001. It is characterized by IgG4-positive plasma cell infiltration. Cutaneous involvement is rare but increasingly reported. A 48-year-old male presented with multiple, black-brown, indurated plaques on his trunk and axillae. Laboratory examination revealed anemia of unknown etiology and hyperglobulinemia with markedly elevated serum IgG and IgG4 levels. Histopathologic examination showed lymphoplasmacytic infiltration with abundant IgG4-positive plasma cells. The bone marrow biopsy results were consistent with the skin biopsy. Computed tomography demonstrated multiple lymph node involvement. Under the care of the rheumatology department, the patient has been treated with a systemic steroid and immunosuppressive agents, and he has shown gradual improvement in the laboratory findings.
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An eccrine poroma (EP) is a benign adnexal tumor that typically presents as a single lesion. Eccrine poromatosis defined as multiple EPs is an uncommon presentation. A 54-year-old male had undergone operation for stomach cancer 10 years prior and insisted that he had also taken adjuvant chemotherapy. The patient presented with six reddish papules and nodules scattered on the trunk and extremities for 3 years. The histopathologic findings from all six lesions were consistent with EP. No local recurrence was observed after complete removal through punch biopsies. We report a rare case of eccrine poromatosis in the patient with gastric cancer, suspected of being caused by chemotherapy.
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Metastatic calcinosis cutis refers to the deposition of calcium salts in normal tissue secondary to an underlying defect in calcium and/or phosphate metabolism. It commonly affects periarticular areas in patients with chronic renal failure. We report a case of a 51-year-old man with a past medical history of peritoneal dialysis for chronic renal failure, who presented with multiple yellowish nodules on his right thumb. In view of the asymptomatic non-inflamed fluctuating nodules, the differential diagnoses included bacterial, tuberculous, atypical mycobacterial, or fungal infections. Histopathological and radiological examinations revealed calcifications in the right thumb and shoulder with elevated serum phosphorus and parathyroid hormone levels. The lesions improved after the patient was switched from peritoneal dialysis to hemodialysis. We report a case of metastatic calcinosis cutis in a patient with chronic renal failure. We emphasize the importance of imaging for accurate diagnosis and follow-up of calcinosis cutis and that hemodialysis scores over peritoneal dialysis in the treatment of this condition.