Narrow-band reflectance spectrophotometry and infrared thermography for assessment of skin lesions in localized scleroderma.

BACKGROUND: Infrared thermography (IRT) is a useful method to detect activity/inflammation in localized scleroderma (LoS); however, inactive skin lesions with a severe degree of dermal and subcutaneous atrophy may show false-positive results. Narrow-band reflectance spectrophotometry (NBRS) is an objective, non-invasive technique of measuring erythema and hyperpigmentation severity, yet has not been extensively studied in LoS. OBJECTIVES: The aim of this research was to compare the spectrophotometric results with thermographic examination of LoS lesions. METHODS: The lesions were assessed using the Localized Scleroderma Assessment Tool (LoSCAT), Dyspigmentation, Induration, Erythema, and Telangiectasias (DIET) score, NBRS and IRT. The difference in the erythema index (ΔEI), melanin index (ΔMI) and average temperature Tavg (ΔTavg) were calculated between each lesion and its normal control. RESULTS: Fifty-five patients with 49 active and 64 inactive LoS lesions were examined. The ΔEI strongly correlated with the erythema (rs = 0.62, P < 0.0000002) and DIET score (rs = 0.66, P < 0.0000001) and moderately correlated with the telangiectasias score (rs = 0.58, P < 0.00001). ΔMI showed strong correlation with the dyspigmentation score (rs = 0.65, P < 0.0000001). There was a strong correlation between the ΔTavg and the erythema score (rs = 0.7, P < 0.000001). A moderate correlation between the Δ EI and ΔTavg was found in active LoS lesions (rs = 0.53, P < 0.0001). CONCLUSION: Narrow-band reflectance spectrophotometry may be a complementary method for determining erythema in LoS active lesions, although this technique remains inferior to IRT, because is unable to distinct between active and inactive lesions. However, NBRS enables to evaluate the severity of hyperpigmentation and telangiectasias, and it can be useful for the assessment of disease severity which is poorly evaluated by IRT.

Does maternal diet during pregnancy influence clinical and laboratory characteristics of infantile-onset atopic dermatitis?

Summary: Background. Prenatal environmental factors are suggested to be implicated in the dramatic increase in Atopic Dermatitis (AD) in recent years. The aim of this study was to investigate the possible associations between pregnant woman's diet and clinical and laboratory variables of AD in offsprings. Methods. A cross-sectional study was performed in children 3-36 months of age with infantile-onset AD. Maternal dietary habits during pregnancy were evaluated in terms of the usual intake of dairy foods, eggs, red meat and poultry, fish, fruits and vegetables. Results. One hundred pairs of mothers and their children with AD were included. A higher serum total IgE and peripheral eosinophila in children were associated with a lower maternal egg intake during pregnancy. Except for a strong trend toward significance of correlation between fish consumption and the lack of atopic multimorbidity, no relationships were revealed between clinical variables of child's AD (the age of onset of AD, its severity, atopic multimorbidity) and the mother's dietary habit. Conclusions. Our preliminary findings suggest that maternal egg intake during pregnancy might be a factor influencing laboratory markers of atopy in offsprings. Prospective cohort studies are needed to confirm and clarify this relationship.

Detecting and quantifying activity/inflammation in localized scleroderma with thermal imaging.

BACKGROUND: The disease phase in localized scleroderma (LoS) is commonly assessed by clinical investigation using the LoS cutaneous assessment tool (LoSCAT). There is a need for more objective methods for assessing the degree of activity/inflammation in LoS. The aim of our work was to evaluate the correlation between severity of the LoS lesions scored using LoSCAT and the degree of hyperthermia observed with infrared thermography (IRT). MATERIALS AND METHODS: The LoS lesions were examined using the LoSCAT and IRT independently by two examiners. The average temperature (Tavg) of the LoS lesional dermis were measured in the area of each lesion with the highest score for erythema (ER), skin thickness (ST), dermal atrophy (DAT) and subcutaneous atrophy (SAT). Measurements were compared to the contralateral healthy skin. The difference of the Tavg (ΔTavg) was calculated between each lesion and its normal control. RESULTS: One hundred and four LoS lesions were examined in 40 adults. Thirty-one lesions were erythematous, 26 were sclerotic, 35 presented as atrophy of the dermis and 11 as atrophy of the subcutaneous tissue. The sensitivity and specificity of IRT for detecting activity/inflammation were 80.7% and 86.3%, respectively. The positive predictive value was 71%, negative predictive value 91%. Statistically significant positive correlation was found between the ΔTavg and the clinical ER and DAT scores. CONCLUSION: IRT may be a useful method for assessing erythematous LoS lesions and quantifying the degree of activity/inflammation. Knowing the patient, false positive results attributable to more severe degree of skin and subcutaneous fat atrophy can be easily recognized.

Serum androgens and prostate-specific antigen levels in androgenetic alopecia: is there a difference between frontal and vertex baldness?

BACKGROUND: Androgenetic alopecia (AGA) seems to be a marker of increased risk of prostate cancer (PCa). OBJECTIVE: We sought to investigate potential pathophysiological differences between frontal and vertex balding that might have the impact on the incidence of PCa. METHODS: Serum concentrations of testosterone (T), dihydrotestosterone (DHT) and prostate-specific antigen (PSA) were measured in 88 subjects with AGA. RESULTS: We have examined sixty patients with frontal baldness and 28 patients with vertex baldness. The subgroups did not differ significantly in age, BMI and as regards age of AGA onset, duration of AGA and comorbidities. The mean value of DHT in serum of the men with vertex baldness was higher than those in the men with frontal baldness with statistical significance (P < 0.05). The groups did not show significant differences in mean value of serum T and PSA levels, and DHT/T ratio. No correlation was found between the serum PSA level and serum androgen levels as well as DHT/T ratio. CONCLUSIONS: Vertex baldness may signal higher exposures to circulating DHT. Serum PSA level cannot serve as surrogate diagnostic marker of increased androgenic activity in men with AGA.

Localized scleroderma: clinical and epidemiological features with emphasis on adulthood- versus childhood-onset disease differences.

BACKGROUND: Localized scleroderma is a rare inflammatory skin disorder that affects the skin and sometimes underlying subcutaneous tissue, muscles or bones. The disease has two modes of onset: juvenile- (JLS) and adult-onset (aLoS). Clinical features have impact on diagnostic and treatment recommendations, but no consensus on the disease management depending on the age at diagnosis was given. OBJECTIVE: To identify these features which differentiate aLoS from JLS. METHODS: A review of the literature was carried out using the MEDLINE to identify studies assessing demographics, subtype distribution, extracutaneous manifestations, comorbidities, delay at diagnosis and outcome in JLS and aLoS. Non-English articles, reviews, case reports, treatment trials that did not investigate long-term outcomes and studies with the fused data for children and adults were excluded. The analysed papers were published between June 1986 and December 2016. RESULTS: Fifty-five studies describing JLS or/and aLoS were included for analysis. Female: male ratio in aLoS was higher than in JLS. Adults presented with plaque and generalized subtype more often than paediatric patients. Linear subtype, musculoskeletal, neurologic and ophthalmologic involvement were more frequent, among children. aLoS was likely to be associated with increased prevalence of lichen sclerosus. There was significant delay in diagnosis in both groups of patients. Recurrences of disease were independent of its onset mode. aLoS patients had more poor quality of life scores than did JLS patients. As only a few studies or no studies assessing specified disease subtypes were identified, this limited the ability to compare the adult and paediatric patients with these subtypes. CONCLUSION: Despite more favourable course of aLoS, a thorough understanding of the broad spectrum of domains related to physical, mental, emotional and social functioning of patients seems to be important to the proper management of disease. LoS heterogeneity makes it important to develop universal classification criteria.

A systematic review of tools for determining activity of localized scleroderma in paediatric and adult patients.

Localized scleroderma (LoS) is a rare inflammatory skin disorder that affects the dermis and sometimes subcutaneous tissues. LoS can have very long periods of quiescence followed by reactivation, but the progression or activity of the disease is difficult to measure. To review the measuring tools used for the evaluation of LoS activity, to choose the most appropriate technique to facilitate progress towards properly assessing the disease, a systematic review of the literature was carried out using the PubMed MEDLINE. Sixty-three studies describing groups of children, adults or both were reviewed and included in the analysis. Case reports were excluded. The analysed papers were published between June 1986 and February 2016. Data were extracted with a focus on instruments measuring the clinical signs of LoS, health-related quality of life (HRQoL), laboratory tests and imaging techniques. Perusal of the literature confirmed that clinical characteristics of the lesions were used to identify activity and scoring systems that focused on a series of signs, and were initially validated in cases of childhood-onset disease; however, there were no data concerning the adult-onset form of the disease. Adult patients with LoS scored lower on HDLQI than those with paediatric-onset LoS. No validated biological markers were available as correlative laboratory parameters of LoS activity. For infrared thermography, ultrasound and other imaging techniques, the features of active lesions were described, but were only useful with appropriate clinical correlation. Measuring tools have not been prospectively validated yet. Summarizing, scoring methods seem to provide the most adequate assessment of LoS and deserve to be further investigated. Combined imaging techniques create optimal conditions for the proper interpretation of the temperature at the skin surface, as well as the structure and vascularity of LoS lesions. Additional scores, musculoskeletal or neuroimaging techniques and laboratory parameters are needed for the specific disease subtypes to monitor extracutaneous manifestations.

Paraneoplastic type of acanthosis nigricans in patient with hepatocellular carcinoma.

UNLABELLED: Paraneoplastic acanthosis nigricans is connected with malignancies in adults in almost 100% of cases. The typical skin changes include: thickening and hyperpigmentation in typical localization with mucocutaneous involvement. PURPOSE: The authors report a case of a malignant type of acanthosis nigricans in 42-year-old female patient with hepatocellular carcinoma. CASE REPORT: First skin lesions appeared in 2000. The patient died within 22 months (of the first appearance of skin symptoms), because of hepatocellular carcinoma. Herein we report the clinical picture, skin involvement and diagnostic procedures in acanthosis nigricans. CONCLUSIONS: Paraneoplastic type of acanthosis nigricans--in patient with hepatocellular carcinoma is not frequently reported in the literature. In the aspect of clinical occurrence of skin lesions suggesting acanthosis nigricans the diagnostics should be focused on internal malignancies.