Biofilm propensity of Staphylococcus aureus skin isolates is associated with increased atopic dermatitis severity and barrier dysfunction in the MPAACH pediatric cohort.

BACKGROUND: Atopic dermatitis (AD) patients are often colonized with Staphylococcus aureus, and staphylococcal biofilms have been reported on adult AD skin lesions. The commensal S epidermidis can antagonize S aureus, although its role in AD is unclear. We sought to characterize S aureus and S epidermidis colonization and biofilm propensity and determine their associations with AD severity, barrier function, and epidermal gene expression in the first US early-life cohort of children with AD, the Mechanisms of Progression of Atopic Dermatitis to Asthma in Children (MPAACH). METHODS: The biofilm propensity of staphylococcal isolates was assessed by crystal violet assays. Gene expression of filaggrin and antimicrobial alarmins S100A8 and S100A9 was measured in keratinocyte RNA extracted from skin tape strips. Staphylococcal biofilms sampled from MPAACH skin were visualized using scanning electron microscopy. RESULTS: Sixty-two percent of staphylococcal isolates (sampled from 400 subjects) formed moderate/strong biofilms. Sixty-eight percent of subjects co-colonized with both staphylococcal species exhibited strains that formed cooperative mixed-species biofilms. Scanning electron microscopy verified the presence of staphylococcal biofilms on the skin of MPAACH children. Staphylococcus aureus strains showing higher relative biofilm propensity compared with S epidermidis were associated with increased AD severity (P = .03) and increased lesional and nonlesional transepidermal water loss (P = .01, P = .03). CONCLUSIONS: Our data suggest a pathogenic role for S aureus biofilms in AD. We found that strain-level variation in staphylococcal isolates governs the interactions between S epidermidis and S aureus and that the balance between these two species, and their biofilm propensity, has important implications for AD.

Events in Normal Skin Promote Early-Life Atopic Dermatitis-The MPAACH Cohort.

BACKGROUND: Nonlesional skin in atopic dermatitis (AD) is abnormal, but the pathobiology of lesional and nonlesional skin and the definition of endotypes are poorly understood. OBJECTIVE: To define lesional and nonlesional endotypes of AD by building the first US-based early-life prospective cohort of children with AD, the Mechanisms of Progression from AD to Asthma in Children cohort. METHODS: We assessed lesional and nonlesional skin transepidermal water loss, filaggrin (FLG) and alarmin (S100A8, S100A9) expression, staphylococcal colonization, and patterns of aeroallergen and food sensitization to define nonlesional and lesional phenotypes and endotypes. RESULTS: Pathophysiologic changes were present in lesional and nonlesional skin and were associated with SCORing for Atopic Dermatitis. Nonlesional skin had features characteristic of diseased skin including low FLG and high alarmin expression, and increased colonization with Staphylococcus aureus. In a multivariate model, nonlesional, but not lesional, FLG expression was associated with the development of cosensitization and moderate to severe AD. Lesional skin was characterized by further deficits in FLG expression (P < .001), but alarmin expression was the same as observed in nonlesional skin. CONCLUSIONS: This study reveals that events in the nonlesional, not the lesional, skin promote the subsequent development of AD severity and cosensitization, which is a key risk factor for allergic comorbidities. Collectively, these data suggest the presence of a subclinical eczema endotype that may predispose to the development of allergic disease in the absence of overt eczema. This may represent a new definition of the atopic march that starts with skin barrier dysfunction rather than eczema.

CD8+ and FoxP3+ T-cell infiltration in actinic cheilitis.

BACKGROUND: Differences in immune profile between actinic cheilitis (AC), a precursor of lip squamous cell carcinoma, and normal lip vermillion (NL) have not been elucidated. OBJECTIVES: To compare density, distribution, and ratios of CD8+ and FoxP3+ cells between AC and NL and assess their associations with clinicopathologic variables. METHODS: Samples of AC and NL obtained between 2001 and 2013 at the College of Dentistry of the University of Concepcion, Chile, were retrospectively analyzed for immunohistochemical detection of CD8+ and FoxP3+ cells. Differences between groups were tested by Mann-Whitney U and Fisher's exact tests. Independent effects of cell densities and CD8/FoxP3 ratio with AC were assessed by multiple logistic regression analysis after adjustment for potential confounding. RESULTS: A total of 62 AC and 24 NL biopsies were included. Densities of CD8+ and FoxP3+ cells in AC were significantly higher than in NL. Conversely, the CD8+/FoxP3+ ratio was significantly lower in AC as compared to NL. After adjustment for sun exposure, age, gender, and smoking status, a stromal FoxP3+ cell density higher than 0.35 cells/field was significantly associated with increased odds of AC (odds ratio [OR] = 5.01, 95% confidence interval [CI]: 1.18-21.31), while a stromal CD8+/FoxP3+ ratio higher than 5.91 was associated with decreased odds of AC (OR = 0.29, 95% CI: 0.08-1.08). CONCLUSIONS: AC is characterized by increased FoxP3+ cell infiltration and a reduced CD8/FoxP3 ratio as compared to NL. Therefore, increased infiltration of FoxP3+ cells relative to CD8+ cells may contribute to the transition from normal to preneoplastic stages in lip carcinogenesis.

Epidermodisplasia verruciforme / Epidermodysplasia verruciformis

La epidermodisplasia verruciforme (EV) es una genodermatosis rara, caracterizada por el desarrollo de verrugas planas y lesiones similares a pitiriasis versicolor, asociada a infección crónica por Virus Papiloma Humano. Se reporta el caso de EV. Mujer de 49 años con múltiples lesiones verrucosas de larga evolución distribuidas en las cuatro extremidades y antecedente familiar de cuadro similar. Biopsia a los 19 años evidenció verrugas sin atipia. Nuevo estudio histológico informó carcinoma escamoso, decidiéndose extirpación de lesiones. La clínica inicia en edades tempranas, con elevado riesgo de transformación maligna. No existe tratamiento específico. Es esencial la fotoprotección estricta y manejo precoz de lesiones para prevención de progresión a carcinoma.

Epidermodysplasia verruciformis (EV) is a rare genodermatosis, characterized by the development of plane warts and pityriasis versicolor-like lesions, associated with chronic infection caused by the Human Papilloma virus. An EV case is reported. 49 year-old woman with multiple long standing warty lesions distributed on the four limbs and family background of similar cases. Biopsy at 19 years old evidenced warts without atypia. New histological study reported squamous cell carcinoma, deciding the removal of the lesions. The clinic begins at early age, with high risk of malignant transformation. There is no specific treatment. Strict photoprotection and early management of the lesions is essential to prevent the progression to carcinoma.

Melanoma anorrectal / Anorectal melanoma

El melanoma anorrectal es infrecuente, su clínica inespecífica y su diagnóstico tardío, acompañándose de pronóstico ominoso. Se reporta el caso de melanoma anorrectal. Mujer de 62 años con historia de baja de peso y masa rectal, estudio histológico evidencia melanoma anorrectal, realizándose cirugía respectiva y posterior radioterapia hipofraccionada. La clínica del melanoma anorrectal dificulta el diagnóstico, presentándose en edades propias de patologías más frecuentes y benignas como hemorroides. El tratamiento de elección es quirúrgico. Se recomienda un elevado índice de sospecha para manejo oportuno.

Anorrectal melanoma is rare, his clinic is unspecific and his diagnostic is late, accompanied by ominous prognosis. The case of anorrectal melanoma is reported. A 62 year old female presented weight loss and rectal mass, histology study showed melanoma anorrectal, resection surgery and radiotherapy hypofractionated were performed. Anorrectal melanoma clinical is a difficult diagnosis, this appears in ages where others diseases benign are more frequent, such as hemorrhoids. The treatment of choice is surgical. A high index of suspicion for timely management is recommended.

Hidrosadenitis supurativa (Parte II) / Suppurative hidrosadenitis (Part II)

La Hidrosadenitis Supurativa (HS) es una enfermedad inflamatoria,folicular, crónica, recurrente y debilitante de la piel, caracterizadapor la presencia de abscesos y/o nódulos recurrentes, formación de fístulas y cicatrices. Las lesiones inflamatorias son dolorosas profundas y se localizan en zonas del cuerpo que poseen glándulas sudoríparas apocrinas, principalmente en la región axilar, inguinal y anogenital. Es una patología que presenta gran retraso en laconsulta y diagnóstico, ya que la mayoría de los casos leves sonreportados tardíamente. La resolución espontánea es poco probable y la discapacidad progresiva es comúnmente experimentada. Hay gran compromiso de la calidad de vida el que se correlaciona con la gravedad de la enfermedad. En esta segunda parte revisaremos las enfermedades asociadas a HS, complicaciones y alternativas terapéuticas de tipo médico y quirúrgico.

Hidradenitis suppurativa (Hs) is a chronic inflammatory, follicular,recurrent and debilitating disease characterized by painful and recurrent nodules forming extensive, fibrous anddisfigured scars. Inflammatory lesions are painful and affect primarily the axillae, inguinal and anogenital areas. Is a late disease in being diagnosed because of late consultation andreport. Spontaneous resolution is very rare and progressive disable is common. There is great quality of life involvementand related with the severity of the disease. In this second Part associated diseases, complications, and medical and surgery treatments are discussed.

Factores de riesgo y protección para el consumo de sustancias psicoactivas en estudiantes universitarias / Factors of risk and protection for the consumption of psychoactive substances in university students

El reporte de la II Encuesta Nacional sobre Prevención y Consumo de Drogas 2002 (DEVIDA, 2003) señala como dato restaltante el incremento del consumo de estupefacientes en la población femenina. Es así como el Centro de Orientación de la Unifé, con el fin de aplicar estrategias de prevención consideró necesario analizar las componentes personales de las ingresantes que juegan un factor de riesgo y las que presentan un factor protector en el consumo de sustancias psicoactivas relacionadas con características individuales. Se escogió para este fin el Test de Inteligencia Emocional ICE Bar-On, considerando los componentes relacionados con factores de riesgo y protección para el consumo de sustancias.