Interplay between Humoral and CLA+ T Cell Response against Candida albicans in Psoriasis.

Candida albicans (CA) infections have been associated with psoriasis onset or disease flares. However, the integrated immune response against this fungus is still poorly characterized in psoriasis. We studied specific immunoglobulins in plasma and the CA response in cocultures of circulating memory CD45RA- cutaneous lymphocyte antigen (CLA)+/- T cell with autologous epidermal cells from plaque and guttate psoriasis patients (cohort 1, n = 52), and also healthy individuals (n = 17). A complete proteomic profile was also evaluated in plaque psoriasis patients (cohort 2, n = 114) regarding their anti-CA IgA levels. Increased anti-CA IgA and IgG levels are present in the plasma from plaque but not guttate psoriasis compared to healthy controls. CA cellular response is confined to CLA+ T cells and is primarily Th17. The levels of anti-CA IgA are directly associated with CLA+ Th17 response in plaque psoriasis. Proteomic analysis revealed distinct profiles in psoriasis patients with high anti-CA IgA. C-C motif chemokine ligand 18, chitinase-3-like protein 1 and azurocidin were significantly elevated in the plasma from plaque psoriasis patients with high anti-CA levels and severe disease. Our results indicate a mechanism by which Candida albicans exposure can trigger a clinically relevant IL-17 response in psoriasis. Assessing anti-CA IgA levels may be useful in order to evaluate chronic psoriasis patients.

Risk factors for early-onset basal cell carcinomas and the trend towards their female predominance.

BACKGROUND: A dramatic rise in the incidence rates of basal cell carcinoma (BCC) in young women has been reported. OBJECTIVES: We investigate potential risk factors (RF) for sporadic BCC in young patients and the current distribution of such RF in the general population of Catalonia, comparing the differences among men and women. PATIENTS AND METHODS: A case-control study was performed, 69 BCCs diagnosed in patients ≤ 45 years of age vs. 69 healthy controls. Afterward, 1,078 participants from the general population completed an RF questionnaire. RESULTS: Repeated sunburns were more frequent in instances of early-onset BCC in covered skin than in sun-exposed skin (P  =  0.029). In the general population, 39.1 % of participants reported sunbed use (50.1 % in women, 10.9 % in men). Sunbed use was the only relevant RF more predominant in women than men, favoring the trend to female predominance of BCCs above other RF. Additionally, we found a significant trend in young participants for reduced sunbed use (P < 0.001), although they had the same percentage of repeated sunburns. Repeated sunburns are the most relevant RF for early-onset BCCs that can be targeted in prevention campaigns. CONCLUSIONS: We should be aware of the more relevant RF for early-onset BCCs and their distribution among the general population to address preventive campaigns.

Metástasis cutáneas de adenocarcinoma pancreático como forma de presentación de recidiva tumoral / Cutaneous metastasis from a pancreatic adenocarcinoma as a form of presentation of tumoral recurrence

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Teledermatología / Teledermatology

La teledermatología se define como la práctica de la dermatología a distancia. Para ello se emplean dos sistemas: la videoconferencia en directo y el sistema en diferido. En el primero el médico consultor, desde el centro de atención primaria, toma las imágenes con una cámara de video. El médico de familia, el paciente y el dermatólogo están conectados en directo y por tanto el dermatólogo puede interrogar al paciente. Este sistema es altamente formativo para el médico consultor ya que se comentan los detalles que definen la dermatosis, pero es un sistema que consume mucho tiempo y el equipa miento es relativamente caro. El sistema en diferido consiste en remitir al dermatólogo, por correo electrónico, una fotografía digital de las lesiones del paciente junto con un resumen de la historia clínica. Las imágenes son de mayor calidad pero el dermatólogo se siente más inseguro con el diagnóstico emitido ya que no puede interaccionar con el paciente. Se espera que los sistemas de teledermatología faciliten el acceso al dermatólogo de pacientes situados en localidades remotas, lo que mejorará el cuidado de los mismos, y que permita reducir las listas de espera, ya que se puedan seleccionar mejor los pacientes y escoger más fácilmente la prioridad de las mismas

Teledermatology is defined as the practice of the dermatology at a distance. It can be applied in one of two ways: in real-time videoconference, or by store-and-forward methods. In the first case, the consulting doctor, from the primary care center, takes the images with a camcorder. The family practitioner, the patient and the dermatologist are connected on-line and therefore the dermatologist can interrogate the patient. This system is highly educational for the consulting doctor since the details that define the dermatosis are commented. But it is more time-consuming and the equipment is relatively expensive. In the store-forward system a digital image of the patient's skin lesions along with a summary of its clinical history is send by e-mail to the dermatologist. The images are of greater quality but the dermatologist feels more uncertain with the emitted diagnosis since he cannot interact with the patient. It is hoped that the teledermatology systems facilitate the patients located in remote areas access to the dermatology care, and, since the patients can be selected better, that it will result in fewer conventional consultations, and in a reduction in the waiting lists