Subject(s)
Dermatitis, Atopic/chemically induced , Immunity, Cellular/drug effects , Skin/pathology , Ustekinumab/adverse effects , Administration, Topical , Dermatitis, Atopic/diagnosis , Dermatitis, Atopic/immunology , Dermatologic Agents/administration & dosage , Dermatologic Agents/adverse effects , Female , Humans , Interleukin-17/immunology , Interleukin-17/metabolism , Male , Middle Aged , Skin/drug effects , Th1 Cells/immunology , Th17 Cells/immunology , Ustekinumab/administration & dosage , Young AdultABSTRACT
BACKGROUND: Five per cent 5-fluorouracil (5-FU) cream is a well-established treatment for actinic keratosis (AK), and ingenol mebutate gel (IMB) is a novel topical field-directed therapy. OBJECTIVE: To compare the tolerability and safety of IMB with that of 5-FU for the treatment of facial AK. METHODS: An open-label, prospective, randomized, controlled clinical trial with 100 patients with AKs within a 25-cm(2) contiguous field on the face was conducted. IMB was applied daily for three consecutive days. 5-FU was applied twice a day for 4 weeks. The treatment effect and the adverse events were evaluated at baseline and on days 2, 3, 4, 8, 15, 22, 29, 36 and 43 for intent-to-treat populations. RESULTS: The mean (± SD) maximum local skin reactions (LSR) for patients treated with IMB was 10.85 (± 3.12), compared with 10.86 (± 3.55) for those who received 5-FU. Patients in the IMB group presented LSR that peaked at day 4 and almost completely regressed after 15 days. Differently, in the 5-FU group, the LSR peaked at day 29 and lasted until visit 36. Additionally, the area under the curve (LSR × visit) was significantly smaller for IMB. No differences between the treatments for pruritus, pain, tearing, conjunctival hyperaemia or headaches were noted, but the eyelid oedema rate was higher for IMB group. No significant difference in the proportion of dropouts was observed between groups. Both treatments demonstrated a suitable safety profile. CONCLUSION: For treating AKs, the local skin reactions in the IMB group were more short-lived compared with those of 5-FU, but both treatments seemed to be safe and tolerable.
Subject(s)
Diterpenes/administration & dosage , Drug Tolerance , Facial Dermatoses/drug therapy , Fluorouracil/administration & dosage , Keratosis, Actinic/drug therapy , Administration, Topical , Facial Dermatoses/diagnosis , Follow-Up Studies , Gels , Humans , Immunosuppressive Agents/administration & dosage , Keratosis, Actinic/diagnosis , Prospective Studies , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Atopic dermatitis (AD) in adults and profile of skin barrier proteins and inflammatory cytokines. OBJECTIVE: Evaluation of the expression of skin barrier proteins such as filaggrin, claudins 1 and 4 and of circulating inflammatory cytokines (Th1/Th2/Th17) in adults with AD. METHODS: Thirty-three adult patients with AD diagnosed according to the Hanifin & Rajkacriteria, and 25 healthy controls were enrolled in the study. AD severity was measured by Eczema Area and Severity Index (EASI). Laboratory assays included immunohistochemistry analysis of skin barrier proteins, such as filaggrin, claudins 1 and 4 and interleukin-17 (IL-17) from skin samples and determination of circulating cytokine levels (IL-2, 4, 5, 6, 10, 17A, TNF and IFN-γ) by flow cytometry (Cytometric Bead Array). RESULTS: We observed a reduced expression of filaggrin and claudin 1 in lesional skin of AD patients, when compared to controls. There was an inverse correlation of filaggrin expression and disease severity. In addition, IL-17 expression was enhanced in AD patients. Similarly, higher levels of inflammatory cytokines (IL-2, 5, 6, 10, 17A and IFN-γ) were found in AD patients. CONCLUSION: Our data reinforce the role of an altered skin barrier in the pathogenesis of AD. Our results show not only reduced expression of filaggrin and claudin 1 in lesional atopic skin but also inverse correlation of filaggrin expression and disease severity. Moreover, elevation of in situ IL-17 and of circulating interleukin levels in AD emphasize the systemic, inflammatory profile of this defective skin barrier dermatosis.
Subject(s)
Dermatitis, Atopic/metabolism , Interleukins/blood , Skin Physiological Phenomena , Skin/chemistry , Adolescent , Adult , Aged , Case-Control Studies , Claudin-1/analysis , Claudin-1/metabolism , Claudin-4/analysis , Claudin-4/metabolism , Female , Filaggrin Proteins , Humans , Interferon-gamma/blood , Interleukin-17/metabolism , Intermediate Filament Proteins/analysis , Intermediate Filament Proteins/metabolism , Male , Middle Aged , Severity of Illness Index , Tumor Necrosis Factor-alpha/blood , Young AdultABSTRACT
Divided or kissing naevi are located on adjacent parts of the body that are separated during embryogenesis. Divided naevus of the penis (DNP) is exceedingly rare, with < 15 cases reported in the English language literature. Divided penile naevi affect the glans penis and inner foreskin, which are anatomical structures believed to have a common embryological origin. We report the clinical, dermoscopic and histopathological findings of two children with DNP. To our knowledge, this is the first report of patients with DNP seen in South America, and the first in which dermoscopic findings are discussed; these included a large globular pattern in one patient, and homogeneous, streaked and globular patterns in the other.
