The Immunogenetics of Systemic Sclerosis.

Systemic sclerosis (SSc) is a rare disease with a prevalence ranging from 7 to 700 cases per million. Like with most autoimmune diseases, both environmental and genetic factors are involved in the pathogenesis of the SSc. Though the incidence of SSc in the family members of those affected and the concordance rate in twins is very low, inheritance is still the strongest risk factor of SSc. Thus, multiple studies have been conducted to identify the genes responsible for this inheritance including candidate gene association studies and genome-wide analyses. Variations and mutations in the genes encoding cytokines, adhesion molecules, and signaling proteins involved in the interaction between endothelial cells, fibroblasts, and immune cells have been found to be associated with SSc susceptibility. In this chapter, these genes and their contribution to the pathogenesis of the SSc are discussed in detail. These genes are categorized into five major groups of HLA genes, genes involved in the innate immune responses, genes affecting adaptive immune responses, genes with a role in the fibrogenesis pathways, and apoptosis, autophagy, and pyroptosis-related genes.

Immunogenetics of Lupus Erythematosus.

Lupus erythematosus (LE) is a heterogeneous disease with a wide range of manifestations ranging from localized lesions in cutaneous lupus erythematosus (CLE) to severe disseminated disease in systemic lupus erythematosus (SLE).Lupus results from a complex interaction between genetic and epigenetic backgrounds and environmental triggers that cause loss of tolerance to self-antigens and the formation of autoantibodies. Genetic susceptibility plays a key role in the pathogenesis of lupus erythematosus. In most cases, multiple common alleles with modest effect sizes are combined to result in the polygenic inheritance of the disease but monogenic variants of lupus have also been described. Genes from the innate and adaptive immune system along with genes involved in apoptosis and immunoglobulin clearance have been linked to SLE. This chapter aims to explore the functions of these genes and their contribution to the pathogenesis of the disease.

The impact of COVID-19 pandemic on psoriasis patients, and their immunosuppressive treatment: a cross-sectional multicenter study from Turkey.

BACKGROUND: Immunosuppressive therapy has been a great concern during the pandemic. This study aimed to evaluate the pandemic's impact on psoriasis patients treated with immunosuppressive drugs. MATERIAL AND METHODS: The multicenter study was conducted in 14 tertiary dermatology centers. Demographic data, treatment status, disease course, and cases of COVID-19 were evaluated in patients with psoriasis using the immunosuppressive treatment. RESULTS: Of 1827 patients included, the drug adherence rate was 68.2%. Those receiving anti-interleukin (anti-IL) drugs were more likely to continue treatment than patients receiving conventional drugs (OR = 1.50, 95% CI, 1.181-1.895, p = .001). Disease worsening rate was 24.2% and drug dose reduction increased this rate 3.26 and drug withdrawal 8.71 times. Receiving anti-TNF or anti-IL drugs was associated with less disease worsening compared to conventional drugs (p = .038, p = .032; respectively). Drug withdrawal causes were 'unable to come' (39.6%), 'COVID concern' (25.3%), and 'physician's and patient's co-decision' (17.4%). Four patients had COVID-19 infection with mild symptoms. The incidence was 0.0022% while it was 0.0025% in the general population. CONCLUSION: Our study shows that psoriasis patients using systemic immunosuppressive do not have a higher, but even lower COVID-19 risk than the general population, and treatment compliance with biological drugs is higher.

Complementary and alternative medicine use among patients with psoriasis on different treatment regimens.

The aim of this study was to explore habitudes about the use of complementary and alternative medicine (CAM) in patients with psoriasis. We conducted a face-to-face interview with 374 psoriasis patients to collect information about CAM use. All treatments for psoriasis used in the last 12 months, demographic data of patients, Dermatology Quality of Life Index (DLQI), and Psoriasis Area Severity Index (PASI) were recorded. Topical and systemic CAM, dietary supplements, and diet were investigated. Tendency to use CAM in patients using biological agents was statistically significant lower than other groups. Patients using biological agent have lower DLQI and PASI values. This situation can be the cause of low tendency in this group.

Transdermal patches in dermatology.

Transdermal patches are effective treatment modalities which have variety of advantages. Active ingredient in these systems are absorbed from skin and reach to blood circulation via capillaries. Bypassing hepatic metabolism, providing constant plasma levels of drug for long time, and fewer drug interactions are the main advantages of this method. It is also practical to use. Nowadays transdermal patches are used by dermatologist for variety of indications.

Effects of structured home-based exercise program on depression status and quality of life in burn patients.

BACKGROUND: Burns can cause life-threatening injuries and severe limitations. This study aimed to evaluate the effects of the structured home-based exercise program on depression status and quality of life in burn patients. MATERIALS AND METHODS: This study was carried out in the Wound and Burn Treatment Department of University of Health Sciences, Dr. Lütfi Kirdar Kartal Education and Research Hospital, Istanbul. Thirty burn patients voluntarily participated in this study. Patients' demographic data such as burn area and grade, percentage, type, number of grafts, and duration of hospitalization were recorded. The quality of life was evaluated using the Short Form-36 (SF-36), and depression status was evaluated using Beck Depression Inventory (BDI). The home-based exercise program was defined by the clinical physiotherapist on the day when the patient was discharged. The home-based exercise program was applied for 3 weeks. Evaluations were performed at discharge and repeated after 3 weeks at the end of the exercise program. RESULTS: Of the 30 patients who completed the study (age range, 21-61 years; mean, 34.9±12.99 years), 96.7% (n=29) were male and 3.3% (n=1) were female. A statistically significant difference was observed between BDI and SF-36 scores before and after the home-based exercise program (p<0.05). BDI scores decreased after the home-based exercise program, whereas SF-36 scores increased. CONCLUSION: Our study concludes that burn patients who underwent the structured home-based exercise programs attained acceleration of their physical, social, and psychological integrity. Thus, establishing a structured home-based exercise program according to the burn type and clinical course should be continued.

Autoimmune skin diseases and the metabolic syndrome.

The metabolic syndrome represents an important association of cutaneous maladies with cardiovascular illnesses. Chronic inflammation, shared risk factors (ie, smoking and alcohol consumption), treatment (ie, immunosuppressive agents and drugs that alter the lipid profile), and shared genetic risk loci have been proposed to the cause metabolic syndrome and cardiovascular morbidity of autoimmune diseases. There are many possible inflammatory mediators that are suggested to play a role in insulin resistance pathogenesis, such as tumor necrosis factor-α, interleukin-6, leptin, and adiponectin. These mediators are also abnormal in autoimmune skin disorders. We discuss several autoimmune skin diseases, connective tissue diseases, bullous diseases, vitiligo, psoriasis, lichen planus, chronic urticaria, and atopic dermatitis.