In situ carcinoma in a hybrid cyst: a case report.

Follicular hybrid cysts including two or more components of the epithelial skin adnexa are very rare. The epithelial lining of hybrid cysts varies, and either contains epidermis, and trichilemmal squamous epithelium, or other epithelia of the skin adnexa. Hybrid cysts may also be associated with neoplasia, such as in situ carcinoma, Bowen's disease and squamous cell carcinoma. A 37-year-old female was complaining of a cyst on her scalp. The unilocular cystic lesion was lined with markedly atypical squamous cells with trichilemmal differentiation. Marked nuclear and cytological atypia, pleomorphism, numerous mitotic figures and atypical mitosis was detected in the squamous epithelium. The epithelium of the cyst was also composed of ductal structures lined with cuboidal epithelium. Immunohistochemical staining was positive for cytokeratin 7 (CK7) in both squamous and glandular epithelium. Luminal staining was shown by carcinoembryonic antigen (CEA), although gross cystic disease fluid protein-15 (GCDFP-15) was negative in the glandular epithelium. In addition, p16 tumor suppressor gene was strongly positive in both the squamous and glandular epithelium. Overall, the unique cystic lesion reported contained pilar squamous epithelium with in situ carcinoma and eccrine ductal structures, which was interpreted as a hybrid cyst composed of in situ trichilemmal carcinoma and a ductal eccrine component.

Effects of loratadine and cetirizine on serum levels of neuropeptides in patients with chronic urticaria.

H1-receptor inhibiting drugs, namely loratadine and cetirizine, were frequently used in treatment of chronic urticaria. Urticarial weal and flare reactions, a neurogenic reflex due to neuropeptides, were reported to be more effectively inhibited by cetirizine than loratadine. The aim of this study was to determine and compare the effects of systemic loratadine and cetirizine treatments on serum levels of selected neuropeptides in chronic urticaria. Treatment groups of either systemic loratadine or cetirizine (10 mg/d), consisting of 16 and 22 patients, respectively, were included. Serum levels of stem cell factor (SCF), neuropeptide Y (NPY), calcitonin gene-related peptide (CGRP), nerve growth factor (NGF), vasoactive intestinal peptide (VIP), and substance P (SP) were detected before and after one week of treatment with antihistamines. Serum NPY and VIP levels were significantly decreased when compared before and after treatment with antihistamines (P < 0.001 and P < 0.01, respectively). SCF and NGF values were also decreased after antihistamine treatment (P < 0.05). Post-treatment levels of CGRP were significantly higher compared with pretreatment values, while no significant difference was detected between pre and post treatment levels of SP. Cetirizine was significantly more effective than loratadine on lowering serum levels of SCF among the other neuropeptides. Systemic loratadine and cetirizine treatments in patients with chronic urticaria precisely caused variations in serum levels of neuropeptides. The predominant effect of cetirizine compared to loratadine on reducing serum SCF levels might be explained with anti-inflammatory properties of cetirizine.

Evaluation of serum sCD40L and homocysteine levels with subclinical atherosclerosis indicators in patients with psoriasis: a pilot study.

Psoriasis is a chronic inflammatory process associated with an increased risk of cardiovascular risk factors. sCD40L has been suggested to have a possible role in the pathogenesis, of psoriasis and is known to be associated with inflammation, atherogenesis and cardiovascular events. This study investigated cardiovascular risk factors (sCD40L and homocysteine) as well as subclinical atherosclerosis indicators in psoriatic patients and control subjects. The study included 56 consecutive patients with chronic plaque-type psoriasis and 53 age and gender matched healthy controls admitted to a university hospital. Serum sCD40L and homocysteine levels were measured by ELISA. Carotid artery intima-media thickness and brachial artery flow mediated dilatation (FMD) measurements were determined ultrasonographically. Subjects who had a history of cardiovascular diseases and cardiovascular risk factors and receiving any systemic treatment were excluded from the study. Plasma sCD40L levels were significantly higher in psoriasis patients compared with healthy controls (1.33±0.72 vs. 0.98±0.70 ng/ml P=0.012), whereas plasma homocysteine levels did not differ significantly between the two groups. FMD was significantly reduced in the psoriasis group compared to the controls (3.83±5.03 vs. 8.45±7.27% P=0.0001). Multiple linear regression analyses indicated a significant association between psoriasis, sCD40L, and FMD. Psoriatic patients had higher sCD40L levels than healthy controls, which may lead to an increase in cardiovascular diseases. sCD40L may be a more reliable and early predictive marker of cardiovascular events in psoriatic patients. New treatmentoptions that will be developed over sCD40L will benefit in prevention of psoriasis and its cardiovascular comorbidities.

The role of helper and regulatory T cells in the pathogenesis of vitiligo.

BACKGROUND: Alterations in cellular immunity, including CD4(+) T and CD8(+) T lymphocytes, have been proposed in the pathogenesis of vitiligo. There is also a proposed role for cytokines in the depigmentation observed in vitiligo. However, previous reports on the role of cytokines in the pathogenesis of vitiligo have been few in number. OBJECTIVE: The purpose of this investigation was to assess the role of the major cytokines produced by T-helper 1 and 2 cells as well as T-helper 17 and regulatory T cells in the pathogenesis of vitiligo. METHODS: Forty patients with vitiligo and 40 age- and sex-matched healthy control subjects were enrolled in the study. Serum interleukin (IL)-4, IL-6, IL-10, IL-17, interferon-gamma, tumor necrosis factor-beta, and transforming growth factor-beta levels were detected by enzyme-linked immunosorbent assay in both groups. The correlations of serum cytokine levels with age of onset, sex, duration of disease, type and activity of vitiligo, percentage of involved body area, Koebner positivity, family history, and the presence of associated autoimmune diseases were assessed. RESULTS: Serum transforming growth factor-beta levels were significantly decreased in the vitiligo group compared with the control group (P = .004). No difference was detected between the patient and control groups in mean levels of serum IL-6, IL-10, and tumor necrosis factor-beta. In the patients with vitiligo, serum IL-17 levels were positively correlated with the extent of body area involvement (rho = 0.329, P = .038). LIMITATIONS: Tissue cytokines compared with those in the peripheral blood were not measured. CONCLUSION: Although multiple factors have been implicated in the pathogenesis of vitiligo, reduced serum transforming growth factor-beta levels, as observed in patients in the current investigation, may contribute to enhanced cellular immunity. This may facilitate the occurrence of vitiligo by leading to diminished maturation of regulatory T cells, followed by impaired inhibition of inflammation.

A case of erysipeloid cutaneous leishmaniasis: atypical and unusual clinical variant.

Cutaneous leishmaniasis has a number of morphologic variants such as acute paronychial, chancriform, annular, palmoplantar, zosteriform, and eczematoid, which depend on the immune condition of the patients, the subspecies of the Leishmania, and the area of the localization. In recent times, the number of reports of new and rare variants of cutaneous leishmaniasis has been increasing. In this report, we describe a very rare variant of Cutaneous leishmaniasis, presented with ulceration on glabellar region and infiltrative erythematous lesions covering the center of the face, resembling erysipelas.

Lack of response to isotretinoin in annular elastolytic giant cell granuloma.

Annular elastolytic giant cell granuloma is a rare disease characterized by annular configurated lesions with typical histopathologic findings. We report a case of annular elastolytic giant cell granuloma in a 50-year-old male patient. Treatment modalities for this disease are limited and mostly unsatisfactory, although isotretinoin was found to be effective in a single case. However, systemic isotretinoin treatment of 12 weeks' duration was of no benefit in the presented case.

The effect of thermal injury and melatonin on incisional wound healing.

BACKGROUND: Oxygen - free radicals are generated during inflammatory reactions and cause tissue damage when overproduced. The wounds, especially burn injuries which comprise several events, result in generation of reactive oxygen species and impairment of cellular functions as in wound healing process. This experimental study was done in order to investigate whether 20% body surface area, third degree burn injury creates systemic impairment in wound healing. Additionally, our aim was to evaluate the effects of melatonin on incisional cutaneous wound healing. METHODS: Fifty adult Wistar-Albino rats were included in the study. A group of animals were subjected to dorsal burn injury followed by full-thickness midline skin incision, 2 cm in length on the abdominal region which was primarily sutured. Melatonin was administered on incisional wounds and breaking strength, hydroxyproline, thiobarbituric acid reactive substance values and antioxidant enzyme activities in the wounded tissue were determined at day 7; to examine firstly the influence of thermal injury on systemic wound healing and secondly, whether melatonin possesses improving effects. RESULTS: No detrimental effect of 20% burn injury on unburned cutaneous incisional wound healing was determined. There was not any difference in breaking strength, hydroxyproline, thiobarbituric acid reactive substance and glutathione peroxidase values, except for significantly elevated catalase and superoxide dismutase activities in melatonin-treated animals comparing to the control group. CONCLUSION: This preliminary study disclosed that exogenous melatonin, at a dose of 10mg/kg for two days, exerted few variation in antioxidant status during wound repair. Nevertheless, half-life of melatonin is short and further studies are required, to investigate longer duration or higher dosage of administration which may be beneficial for cutaneous wound healing.

Generalized lichen planus in childhood: is dapsone an effective treatment modality?

Childhood lichen planus is generally atypical in appearance, prolonged in duration and resistant to therapy. Moreover, the risk in administration of systemic drugs because of several adverse effects limits their use and effective therapy remains a problem in this age group. We report a case of generalized lichen planus in a nine-year-old boy with oral mucosa and nail involvement who was treated with dapsone.

Comparison of the effects of tretinoin, adapalene and collagenase in an experimental model of wound healing.

Adapalene is a new naphthoic acid derivative with strong retinoid agonistic pharmacological properties. We propose that adapalene might contribute to the wound repairing process as is detected with retinoids. In this controlled study, the effects of topical adapalene, tretinoin and collagenase on full-thickness wound healing were compared in an animal model. Thirty-two adult male Wistar-Albino rats were used in the study. Two circular, full-thickness wounds were made for each animal with a standard 8-mm punch biopsy, on both sides of the midline on the back. No treatment was given to Group I rats (n:8) which comprised the control group. Tretinoin cream (0.1%) was applied topically in Group II (n:8), adapalene gel (0.1%) in Group III (n:8), and collagenase ointment in Group IV (n:8) once daily. On day 7, the wounds were photographed to measure the wound surface area. The wounds on the left side of each animal were excised on day 7, for histopathologic and biochemical examination. The treatments were continued for the right side wounds up to 14 days when the same procedure was repeated. In Group II, a significant decrease in hydroxylproline (HP) levels was detected at day 7 (p = 0.018), and an increase at day 14 (p = 0.002) compared to the control group. HP results revealed no difference either in Group III nor in Group IV versus control at day 7 or 14. However, findings of improved healing were more prominent in Groups II and III than the other groups in histopathologic examination. In conclusion, tretinoin and adapalene contributed to the wound healing process resulting in an enhancement of collagen production, angiogenesis and granulation tissue formation.

The effect of benzoyl peroxide and benzoyl peroxide/erythromycin combination on the antioxidative defence system in papulopustular acne.

Acne vulgaris is a common, inflammatory disease of the pilosebaceous duct. Propionibacterium acnes proliferated in sebum, produces chemotactic factors followed by phagocytosis and this process results in the production of reactive oxygen species which contribute to the inflammatory reaction in papulopustular type acne. Benzoyl peroxide (BP) and BP combination with erythromycin (BP/E) are effective topical medications for the treatment of mild and moderate acne vulgaris. In the present study, the effects of BP and BP/E on antioxidant defence enzymes in 40 patients with papulopustular type acne were evaluated. The activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT), and also thiobarbituric acid reactive substance (TBARS) levels were determined in peripheral blood leukocytes in all patients, as well as in tissues of a small group of patients before and at the end of 4 weeks of treatment. No difference was detected in leukocyte antioxidant enzyme activities and TBARS levels due to BP treatment. However, SOD, CAT and GSH-Px activities in leukocytes decreased and TBARS levels increased in BP/E-treated patients (p < 0.05). There was no statistically significant difference between pretreatment and posttreatment enzyme activities in tissue samples. The results of this preliminary study may be attributable to in vivo conditions and possible stability problems while compounding the mixture of the BP/E. Influence of the other ingredients of the formulations applied in the study must also be considered.