Assessment of Interleukins IL-4, IL-6, IL-8, IL-10 in Acute Urticaria.

BACKGROUND: Urticaria is a skin disease that affects approximately 5% of the general population and manifests itself, not only as an acute but also as a chronic disease. The etiology of the disease varies as well as its clinical manifestations which extend from the presence of urticarial hives to the potentially mortal angioedema. There is a great interest to the disease not only due to its special clinical manifestation but also due to its pathogenetic mechanism. New data in the medical bibliography support the participation of interleukins (ILs) in the pathophysiology of urticaria. The aim of the study is to contribute in the comprehension of possible participation of certain ILs in the pathogenesis of acute urticaria. METHODS: Our study concerns four ILs, IL-4, IL-6, IL-8 and IL-10, simultaneously and their quantitative changes during the acute phase of urticaria as well as 2 weeks after drug administration. Moreover, ILs levels of patients were compared with those of matched healthy controls. All measurements have been done by the ELISA method. The statistical analysis was done by SPSS. RESULTS: The results present increased levels (in 51 patients vs. 22 matched healthy controls) of all four ILs during the acute phase. Especially for IL-4 this increase was statistically very significant (P < 0.001). Statistically marginally significant decrease was also observed for IL-10 concentrations (P < 0.059), for the two blood samples (acute phase and 2 weeks later). CONCLUSION: It is suggested by the present study that certain ILs might play an important role in the pathogenetic mechanism of urticaria. IL-4 and IL-10 participation seems to be relatively more significant. Possibly, ILs, liberated by mast cells, induce an influx of leukocytes in the dermis, therefore participating in the development of acute urticaria inflammation.

LC3A-positive "stone-like" structures in cutaneous squamous cell carcinomas.

This study was set to investigate the relation between autophagic activity and the aggressiveness of cutaneous squamous cell carcinomas (SCC), as indicated by tumor thickness and proliferative activity. The anti-LC3A antibody, recognizing both the soluble and the autophagosome-bound forms of the protein, and a standard immunohistochemical technique were applied to 75 cutaneous SCC of variable tumor thickness. The study was complemented by staining for MIB1. Three patterns of LC3A reactivity were recognized: diffuse cytoplasmic, cytoplasmic/perinuclear, and "stone-like" structures (SLS), that is, large, rounded, densely stained amorphous material, 5 µm on average, enclosed within cytoplasmic vacuoles. Higher numbers of SLS were counted in >6-mm-thick SCC compared with the intermediate-thickness tumors (2.1-6 mm) and the <2-mm-thick tumors; the mean recorded values, being 8.8, 4.55, and 1.55, respectively, were statistically significant. The diffuse cytoplasmic staining showed a nearly inverse trend, whereas the perinuclear pattern, expressed in <10% of the total, was not evaluated. With regard to MIB1 proliferation index, this increased with tumor thickness and, in linear regression analysis, was directly linked with SLS counts and inversely with the cytoplasmic pattern. These data suggest that autophagic activity in SCC, when expressed as high LC3A/SLS counts, can be regarded as an indicator of tumor aggressiveness.

Acquired reactive perforating collagenosis: current status.

Acquired reactive perforating collagenosis is a unique perforating dermatosis, characterized clinically by umbilicated hyperkeratotic papules or nodules and histologically by a focal hyperkeratosis in direct contact with transepidermal perforating dermal collagen. Several inflammatory or malignant systemic diseases may coexist with acquired reactive perforating collagenosis. The possible biochemical or immunological mechanisms of the systemic diseases, potentially responsible for the development and appearance of acquired reactive perforating collagenosis, are still under investigation. Several topical treatments, ultraviolet B phototherapy and allopurinol p.o. administration may be effective.

Iotandium-111 pentetreotide scintigraphy and CT scans after 3 years in the follow-up of patients with malignant melanoma.

Somatostatin receptor scintigraphy (SRS) has been used for the detection of neuroendocrine tumors. Melanoma is a malignant tumor of melanocytes, considered to derive from the neural crest. As the prognosis of melanoma is very poor, early detection of the disease, of recurrences and of distal metastases, is important. The aim of our study was to evaluate the clinical impact of indium-111-diaethyleno triamino pentaacetic acid-d-phe1-octreotide ((111)In-DTPA-octreotide or octreoscan or (111)In-O) in the management of melanoma patients after first diagnosis and first surgery and during three years of follow-up. We have studied 35 patients 20 female and 15 male, with histological proven melanoma. Scintigraphic images with single photon emission tomography gamma-camera (Millenium GE-USA) were performed after the administration of 220MBq (111)In-O. The scintigraphic data were compared to axial computerized tomography (CT). Patients were followed for 3 years after the initial diagnosis and surgery. Our results showed that during the 3 years follow-up period, 26/35 patients had a clinical recurrence. Twenty of them had positive (111)In-O scans with 56 lesions mainly metastatic, while 6 had negative scans. The CT scans showed only 31/56 lesions. In conclusion, SRS with (111)In-O, for diagnosing metastases from malignant melanoma, showed a sensitivity and specificity of 87% and 94% respectively and within the 3 years of follow-up, the stage of melanoma and surgical strategies were modified by 48% and 32%, respectively. Twenty five tumor sites, unsuspected by CT were visualized by (111)In-O.

Extensive cutaneous anthrax in an immunocompetent patient.

Bacillus anthracis disease constitutes an extremely important worldwide epidemiological problem. Interest in cutaneous anthrax resides in its skin manifestations, course, diagnostic methods and management. An extensive cutaneous anthrax of the whole left upper arm, accompanied by lymphadenopathy and high fever, in a 60 year-old male patient, a shepherd by profession, is reported. He was treated effectively by intravenously administered ciprofloxacin and clindamycin. In the event of clinical suspicion of cutaneous anthrax, the patient has to be treated by the recommended regimen of antibiotics because of the possibility of evolvution to an extensive or severe systemic disease, even in the absence of immuno-depressant factors.

Perifolliculitis capitis abscedens et suffodiens successfully controlled with topical isotretinoin.

Perifolliculitis capitis abscedens et suffodiens (or dissecting folliculitis of the scalp or dissecting cellulitis of the scalp or dissecting perifolliculitis of the scalp) is a rare entity and constitutes the equivalent over the scalp, of hidradenitis suppurativa and acne conglobata. Etiologic factors are unknown. Diagnosis is proven histologically. Management is very difficult and consists in systemic administration or intralesional injection of several drugs or in surgical manipulations. An 18 year-old white patient with cystic infiltrations, alopecia plaques, pustules and other inflammatory elements (clinicohistological features consistent with dissecting folliculitis of the scalp), is presented. Isotretinoin topical application assured successful control of the disease and averted the evolution of the clinical aspect to scarring alopecia and nodule formation. Topical isotretinoin exercises a curative, inhibitory and antiproliferative action, in perifolliculitis capitis abscedens et suffodiens.