Increased expression of the interleukin-36 cytokines in lesions of hidradenitis suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) is a recalcitrant chronic skin disease with poorly understood immunopathogenic mechanisms. Previous studies reported that the interleukin-36 (IL-36) cytokines [IL-36α, IL-36ß, IL-36γ and IL-36 receptor antagonists (IL-36RA)] are important players in the pathogenesis of psoriasis (PS). OBJECTIVE: We aim to determine whether the IL-36 cytokines are upregulated in patients with HS. For this purpose, we analysed local expression and systemic levels of the IL-36 cytokines in patients with HS and compared the results to healthy donors and patients with PS. METHODS: Skin biopsies from healthy donors and HS and PS patients were analysed for expression of the IL-36 cytokines by immunohistochemistry and semiquantitative real-time PCR. The enzyme-linked immunosorbent assay (ELISA) was used to measure systemic levels of the IL-36 cytokines in the serum of the three donor groups. RESULTS: The agonists IL-36α, IL-36ß and IL-36γ were found to be upregulated in HS both systemically and lesionally, while the IL-36RA was not differently regulated in comparison to healthy donors. CONCLUSION: Our findings suggest that the agonistic IL-36 isoforms are upregulated in HS. The relevance of the enhanced production of IL-36 cytokines in HS pathogenesis remains to be determined.

Interleukin-32 is highly expressed in lesions of hidradenitis suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. Its immunopathogenic mechanisms are still poorly understood. Previous studies demonstrated that the proinflammatory cytokine interleukin (IL)-32 is implicated in the pathogenesis of other inflammatory diseases. OBJECTIVES: To investigate the tissue expression and systemic levels of IL-32, as well as its cellular sources, in patients with HS in comparison with healthy donors and patients with two other inflammatory skin diseases: psoriasis and atopic dermatitis (AD). METHODS: Tissue samples were obtained from healthy skin and lesional HS, psoriatic and AD skin to analyse the expression of IL-32 by immunohistochemistry and semiquantitative real-time polymerase chain reaction. The cellular source of the cytokine was determined by double immunofluorescence staining. Serum from the four donor groups was used to measure systemic levels of IL-32 by enzyme-linked immunosorbent assay. RESULTS: IL-32 was upregulated in patients with HS in both lesional skin and serum when compared with healthy donors and patients with AD or psoriasis. In HS, IL-32 was found to be expressed by natural killer cells, T cells, macrophages and dendritic cells in highly infiltrated areas of the dermis. High IL32 mRNA levels in lesional HS skin coincided with high amounts of T cells and macrophages. Additionally, IL32 mRNA levels in lesional HS skin correlate positively with interferon-γ and IL-17A and negatively with IL-13. CONCLUSIONS: Our findings suggest that IL-32 is overexpressed in HS. Targeting IL-32 may therefore represent a new therapeutic option for the treatment of this recalcitrant disease.

Current trends in Swiss hospital pediatrics (including pediatric surgery). Increasing importance of collaboration with child psychiatry.

The patients of a general pediatric hospital servicing a representative population are analyzed. 3% of the age group below 16 are admitted, whereof 2/3 as emergencies. The morbidity of boys is distinctly higher than for girls. 1/4 is less than 2 years old. Hospitalization rate for infants is much higher than for older age groups. Surgery slowly outnumbers medicine for inpatients. The most frequent single diagnoses are surgical ones, whereas in medicine diagnoses are scattered over a much broader spectrum. Over 11% of all patients had social, psychosomatic or psychological conflicts significantly contributing to the symptomatology presented, for medicine alone it was one out of five patients! Paternal profession, social failures and family quarrels are important for this cohort. A setting of child psychiatry on a consultant basis should complement the traditional framework of pediatric medicine and surgery; hospital pediatrics can then best offer the necessary structures. The pediatrician's role has to remain central, but additional training is mandatory.