Nail changes in female pemphigus vulgaris patients on immunosuppressive therapy.

BACKGROUND: Pemphigus vulgaris (PV) patients receiving immunosuppressive therapy may develop nail alterations resulting from infection, skin disorder, or drug regimen. OBJECTIVE: This study aims to describe nail changes in PV female patients receiving immunosuppressive therapy and to report the frequency of associated fungal and bacterial growth in the patients' nails. METHODS: Twenty-five female PV patients who had at least one acquired finger or toenail abnormality and had been administered at least one immunosuppressive drug were included in the study. Nail alterations were recorded. Nail scrapings were collected from abnormal nails for fungal and bacterial examination. RESULTS: Positive fungal and bacterial cultures were detected in 20 (80%) of patients' nail samples. Five patients reported nail alterations coinciding with disease onset, whereas 13 reported nail changes after administration of immunosuppressive therapy. LIMITATIONS: Lack of a control group (patients on similar immunosuppressive medications for conditions other than PV) which would have further supported the findings demonstrated in this observational study. CONCLUSION: Nail abnormalities in severe PV patients are frequently associated with fungal and bacterial growth. Immunosuppressive therapy potentially initiates such changes.

Acroosteolysis presenting with brachyonychia following exposure to cold.

BACKGROUND: A vast number of conditions ranging from simple trauma to hereditary and collagen vascular disease had been described in association with acroosteolysis. OBJECTIVE: To demonstrate that severe cold exposure not mounting to frostbite may be associated with acroosteolysis. METHODS: A 16-year-old girl with acroosteolysis presenting with brachyonychia was fully investigated for possible cause of her nail and bone deformity. RESULTS: Lab investigations including Parathormone levels, Anti Scl 70, ANA, Anti-CCP and RF levels were all normal. X-ray imaging revealed resorption of the tufts of the terminal phalanges bilaterally. Disruption of nail fold capillaries with sluggish flow in capillary loops was evident on capillaroscopy. CONCLUSION: It had been repeatedly reported that frostbite, Raynaud's disease and diseases associated with repeated chilblains may be associated with secondary cold-induced acroosteolysis. Here, we present a case of acroosteolysis associated with brachyonychia following exposure to severe cold not mounting to frostbite.

1064 Nd:YAG laser for the treatment of chronic paronychia: a pilot study.

Paronychia, which can be acute or chronic, is characterized by erythema, edema, and tenderness at the proximal and occasionally lateral nail folds. Causes of chronic paronychia include excessive moisture, contact irritants, trauma, and candida infection. Chronic paronychia is usually multifactorial and difficult to treat. The aim of the present work was to assess the role of neodymium-doped yttrium aluminium garnet (Nd:YAG) laser as a new modality for the treatment of chronic paronychia. In this interventional pilot study, eight female patients suffering from long-standing paronychia received 2-5 Nd:YAG laser sessions (4 weeks apart). Fluences ranged between 70 to 80 J/cm(2), using a 2.5-mm spot size handpiece, and pulse duration was set at 0.7 ms. Patients were digitally photographed and clinically evaluated before starting the treatment and at each session. Seven of our patients showed various degree of improvement regarding erythema and swelling of their proximal nail folds. Nail plate abnormalities also improved in six patients. These preliminary results document the efficacy and feasibility of Nd:YAG laser as one of the treatments that could ameliorate chronic paronychia.

Tumor volume as a prognostic factor in resectable malignant melanoma.

BACKGROUND: Vertical tumor thickness according to Breslow and histological ulceration are still the most powerful predictors for the clinical outcome of resectable cutaneous malignant melanoma (MM) without lymph node infiltration. It has been proposed that tumor volume in MM may also be of prognostic relevance. METHODS: We retrospectively analyzed the prognostic impact of tumor volume and other established risk factors in 122 MM patients with a median follow-up period of 39.7 months. RESULTS: We found the logarithmic tumor volume to be a better prognostic factor compared to Breslow tumor thickness in multivariate analysis. MM with a tumor volume below a threshold of 140 mm(3) had a significantly higher relapse-free survival after 5 years of 98% compared to 47% in larger MMs (p < 0.0001). CONCLUSION: In some melanomas with a low tumor thickness, a higher tumor volume appeared to be linked to a higher risk of disease recurrence. Inclusion of tumor volume into the risk assessment of resectable MM may be of benefit in the future.

Estimation of vitamin D levels in patients with pemphigus vulgaris.

BACKGROUND: Keratinocyte acantholysis as a result of pathogenic Dsg3-antibodies production by B cells leads to Pemphigus vulgaris (PV). Vitamin D, through its participation in several immune modulatory functions including B cells apoptosis, Th2 cell differentiation, apoptotic enzyme regulation and Tregs functions, may be actively involved in the immune regulation of PV. OBJECTIVE: To evaluate Vitamin D status in PV patients in comparison to controls in an attempt to determine its role in this autoimmune disease. METHODS: Using ELISA technique, 25-hydroxyvitamin D (25OHD) was determined for 34 pemphigus vulgaris patients and 20 healthy volunteers. Phosphorus and parathormone were also determined in the patient group. RESULTS: 25OHD was significantly lower in patients than controls (P = 0.008). There was a statistically significant difference between both groups regarding suboptimal Vit. D levels (P = 0.007). CONCLUSION: Patients with PV have significantly lower serum vitamin D levels in comparison to controls and that these low levels were not related to age, BMI or pattern of sun exposure. The associated Vitamin D insufficiency in patients with PV may possibly exacerbate their disease through various immune related mechanisms.

Serum ferritin and vitamin d in female hair loss: do they play a role?

AIM: Evaluation of serum ferritin and vitamin D levels in females with chronic telogen effluvium (TE) or female pattern hair loss (FPHL), in order to validate their role in these common hair loss diseases. METHODS: Eighty females (18 to 45 years old) with hair loss, in the form of TE or FPHL, and 40 age-matched females with no hair loss were included in the study. Diagnosis was based upon clinical examination as well as trichogram and dermoscopy. Serum ferritin and vitamin D2 levels were determined for each participant. RESULTS: Serum ferritin levels in the TE (14.7 ± 22.1 µg/l) and FPHL (23.9 ± 38.5 µg/l) candidates were significantly lower than in controls (43.5 ± 20.4 µg/l). Serum vitamin D2 levels in females with TE (28.8 ± 10.5 nmol/l) and FPHL (29.1 ± 8.5 nmol/l) were significantly lower than in controls (118.2 ± 68.1 nmol/l; p < 0.001). These levels decreased with increased disease severity. Serum ferritin cut-off values for TE and FPHL were 27.5 and 29.4 µg/l, respectively, and those for vitamin D were 40.9 and 67.9 nmol/l. CONCLUSION: Low serum ferritin and vitamin D2 are associated with hair loss in females with TE and FPHL. Screening to establish these levels in cases of hair loss and supplementing with them when they are deficient may be beneficial in the treatment of disease.

Insulin-like growth factor-1 in psoriatic plaques treated with PUVA and methotrexate.

BACKGROUND: The pathogenesis of psoriasis is thought to depend on the activation of immune cells and their secreted cytokines, chemokines and growth factors like IGF-1 which may contribute to the epidermal hyperplasia of psoriasis. Treatment of psoriasis with PUVA and methotrexate are associated with clinical improvement and decrease in epidermal hyperplasia. OBJECTIVE: To examine the effects of PUVA and methotrexate therapy on IGF-1 expression in psoriatic plaques and whether this change correlates with clinical response. METHODS: For 24 psoriatic patients, the PASI score and levels of lesional IGF-1 and its mRNA were determined by RT-PCR before and after treatment with either methotrexate or PUVA. Skin biopsies from 12 healthy volunteers served as control for IGF-1 levels in normal skin. RESULTS: Lesional skin of psoriatic patients showed a statistically significant elevation in IGF-1 and its mRNA levels in comparison to control (P = 0.0001). Both methotrexate and PUVA treatment were associated with a significant decrease in both PASI scores and lesional IGF-1 after 10 month treatment. CONCLUSION: Both methotrexate and PUVA therapy for psoriasis are associated with a decrease in PASI score and IGF-1. The IGF-1 down-regulation may possibly be a consequence of the decrease in cytokines and inflammatory cellular infiltrate that occur following treatment with either modalities or due to their effect on local fibroblast activity and proliferation.

Design and evaluation of a bioadhesive patch for topical delivery of gentamicin sulphate.

The use of aminoglycoside antibiotics for the topical treatment of gram positive and gram negative infections especially bums and wounds has increased markedly in recent years. Patch formulation for topical delivery can be advantageously used as an alternative to conventional topical dosage forms. The present study aims to prepare and evaluate gentamicin sulphate patches for topical application and to study the effect of different bioadhesive polymers on diverse characteristics of prepared patches. Drug patches were evaluated for weight and thickness uniformity, moisture absorption capacity, tensile strength and percentage elongation. In vitro release patterns of these patches were studied and analyzed. Skin irritation and susceptibility testing of gentamicin sulphate formulae were also evaluated and compared to commercially available gentamicin sulphate cream. The thickness of the films was found to be uniform. Tensile strength of the patches prepared using HPMC as bioadhesive polymer was the lowest compared to the other patches. The in vitro release of the patches followed a pattern close to diffusion model. Patches formulated using HPMC gave the most superior results as compared to other compositions.

Serum and tissue expression of transforming growth factor beta 1 in psoriasis.

BACKGROUND: In psoriasis, keratinocyte hyperplasia may be explained by imbalance of growth factors responsible for epidermal proliferation and altered metabolism of their receptors. Transforming growth factor-beta 1 (TGF-beta1) implications in the pathogenesis of psoriasis can be attributed to several mechanisms besides keratinocyte cell cycle inhibition. OBJECTIVES: To evaluate the relation between serum and tissue levels of TGF-beta1 in psoriasis and their correlation with disease parameters. PATIENTS AND METHODS: Serum and punch biopsy of involved and non-involved skin of 22 patients with psoriasis vulgaris and 10 controls were collected for quantification of TGF-beta1 by enzyme-linked immunosorbent assay kit. RESULTS: Serum level of TGF-beta1 in psoriatic patients was higher than controls in a statistically non-significant manner. Correlations between serum level of TGF-beta1 and extent of the disease (P = 0.007) and Psoriasis Area and Severity Index (PASI) score (P = 0.005) were observed. Mean tissue levels of TGF-beta1 were highest in psoriatic lesions in contrast to normal skin of psoriatic patients and healthy controls, but not statistically significant. Correlation between tissue levels of TGF-beta1 in non-involved skin and extent of the disease (P = 0.007) and PASI score (P = 0.013) was detected. Correlation was detected between levels of TGF-beta1 in psoriatic plaques and serum of patients (P = 0.035), but not between levels of TGF-beta1 in non-involved skin and serum. CONCLUSIONS: Tissue expression of TGF-beta1 in psoriasis may be affected by the stage of development of the lesion. The direct relation between TGF-beta1 in psoriatic plaques and serum imply that the mechanisms for TGF-beta1 production and release in both these compartments may be related.

Expression of insulin-like growth factor-I in lesional and non-lesional skin of patients with morphoea.

BACKGROUND: Morphoea (scleroderma) is a chronic disorder characterized by circumscribed sclerotic plaques with the hallmark of increased fibroblast activation and fibrosis. Through its effect on connective tissue cells and immune cells, insulin-like growth factor (IGF)-I has been found to play a role in some autoimmune connective tissue diseases and has been implicated in the pathogenesis of several fibrotic disorders. OBJECTIVES: To evaluate the role of IGF-I in the pathogenesis of morphoea. METHODS: The study was carried out on 15 patients with morphoea and nine healthy controls. Two 5-mm punch skin biopsies were taken from every patient (one from lesional and one from non-lesional skin) and a single biopsy was taken from the normal skin of each control. A 10-mL blood sample was also taken from each patient and control. Quantitative detection of tissue and serum levels of IGF-I was done using an enzyme-linked immunosorbent assay technique. RESULTS: IGF-I in lesional skin was significantly higher than in non-lesional and control skin (P = 0.001 and P = 0.021, respectively). Moreover, a significantly higher level of IGF-I was detected in patient serum when compared with control serum (P < 0.001). A direct significant correlation existed between lesional and non-lesional skin level (r = 0.618, P = 0.014), and between lesional skin level and Rodnan score (r = 0.538, P = 0.039). CONCLUSIONS: Despite the small sample size, this study suggests that IGF-I plays an important role in the pathogenesis of fibrosis, characteristic of morphoea. Studies on a larger number of patients with morphoea as well as on patients with systemic sclerosis are recommended. Furthermore, therapeutic trials using IGF-I antagonist (octreotide) are highly recommended in patients with morphoea.

Tinea versicolor: histologic and ultrastructural investigation of pigmentary changes.

A comparative histopathologic study is made between the hypopigmented and hyperpigmented skin lesions of pityriasis versicolor and normal skin areas utilizing histochemical stains and electron microscopy. There were no differences found between the population of Dopa-positive melanocytes within the hypopigmented and hyperpigmented lesions and the normal skin areas. The total epidermal pigmentation was diminished in hypopigmented lesions. The keratin layer was found to be significantly thicker in hyperpigmented lesions and contained more organisms. In hypopigmented lesions, melanocytes contained fewer and smaller melanosomes and exhibited signs of degenerative cellular changes.