Polymorphous cutaneous and chronic multisystem sarcoidosis.

Sarcoidosis is a systemic disorder in which cutaneous findings are often prominent. These may be polymorphous to the extent that sarcoidosis may mimic many other cutaneous diseases. We describe a 56-year-old woman with involvement of the skin, eyes, bones, heart, and lung. After an initial presentation 10 years earlier of erythema nodosum with bilateral hilar adenopathy, there were three types of cutaneous changes: subcutaneous, nut-sized palpable nodules localized along the upper and lower extremities, annular plaques on the shins, and erythema nodosum-like palpable and slightly tender nodules. It is very unusual to have all three types of skin lesions, especially the erythema nodosum-like histologically specific cutaneous ones in this setting, which is what prompted this report.

Interleukin-6 and some acute phase proteins plasma activity in drug-induced maculopapular eruptions.

The evaluation of inflammatory response in drug-induced maculopapular eruption was the aim of the study. Plasma concentrations of interleukin-6 (IL-6), C-reactive protein (CRP) and alpha-2 macroglobulin (alpha-2 MG) were measured in 40 patients with maculopapular eruptions using the immunoenzymatic ELISA method in acute stage of disease and after clearing of skin lesions due to effective therapy. In the acute stage of the disease mean plasma levels of the examined proteins were highly significantly elevated (p < 0.001) in comparison with healthy control. Regression of the clinical symptoms was connected with the deep decrease of protein concentrations in the peripheral blood. After treatment the plasma levels of IL-6 and alpha-2 MG were lowered towards the control values (p > 0.05), but CRP despite its deep decrease was still highly significantly elevated (p < 0.001) in comparison with control. The results of this study indicate that in drug-induced maculopapular eruptions the acute phase response can be initiated and that the observed increased activity of the examined proteins lasts longer than the clinical symptoms of the disease.

Drug-induced urticaria--activity of selected cytokines and acute phase proteins in plasma.

Plasma concentrations of 8 proteins, including cytokines: interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-alpha), receptors: soluble IL-2 receptor (sIL-2R), p55 soluble TNF receptor (p55 sTNF-R) and acute phase proteins: alpha-2 macroglobulin (alpha-2 MG), C-reactive protein (CRP) were examined in 33 patients with drug-induced urticaria. The activity of selected proteins was measured using the immunoenzymatic ELISA method: a) in the acute stage of disease before treatment was administered, and b) after clearing of skin lesions, after treatment. In the acute stage of disease elevated concentrations of the examined proteins (p<0.001) in comparison to the control were found. After clearing of clinical symptoms the concentrations of IL-2, IL-6, p55TNF-R and alpha-2 MG were not significantly different from the control values. But despite deep decrease, slL-2R, IL-10, TNF-alpha and CRP levels were still significantly elevated (p<0.001) when compared to the control. Results of this study indicate complex character of pathogenic phenomena in drug-induced urticaria in which elevated activity of mediators acting as promotors and modulators of cellular immune response can be found.

Drug-induced hyperergic vasculitis--activity of selected cytokines and acute phase proteins in plasma.

Plasma concentrations of 8 proteins, including cytokines: interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-alpha), receptors: soluble IL-2 receptor (slL-2R), p55 soluble TNF receptor (p55 sTNF-R) and acute phase proteins: alpha-2 macroglobulin (alpha-2 MG), C-reactive protein (CRP) were examined in 14 patients with drug-induced hyperergic vasculitis. The activity of selected proteins were measured using the immunoenzymatic ELISA method: a) in the acute stage of disease before treatment was administered, and b) after clearing of skin lesions, after treatment. In the acute stage of disease highly elevated concentrations of the examined proteins (p<0.001) in comparison to the control were found. After clearing of clinical symptoms the concentrations of IL-6 and alpha-2 MG were not significantly different from the control values. But despite deep decrease, plasma levels of remaining six proteins were still highly significant (p<0.001) or significant (p<0.01) when compared to the control. Results of this study indicate that in the course of drug-induced hyperergic vasculitis the systemic inflammatory and immune response is activated and elevated concentrations of the examined proteins are present in peripheral blood despite clearing of the clinical symptoms of the disease.

Plasma activity of interleukin-10 in drug-induced cutaneous reactions.

Plasma concentrations of interleukin-10 (IL-10) were examined in 126 patients with drug-induced cutaneous reactions: maculopapular eruptions (ME), erythema multiforme (EM), erythema multiforme coexisting with erythema nodosum (EMN), drug-induced urticaria (DU), hyperergic vasculitis (HV), Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). Activity of the cytokine was measured using the immunoenzymatic ELISA method: a) in the acute stage of disease before treatment was administered, and b) after clearing of skin lesions, after treatment. In the acute stage of disease highly elevated mean concentrations of IL-10 in all 6 groups of patients were found (p<0.001) in comparison with the control. After clearing of clinical symptoms IL-10 concentrations were decreased highly significantly (ME, EM, DU, HV) or significantly (EMN, SJS/TEN) in comparison with the values before treatment, but remained still considerably elevated (p<0.001; p<0.01) when compared with the healthy control. Results of this study indicate that the compensatory antiinflammatory response, expressed as elevated IL-10 activity, is induced as early as in the acute stage of skin lesions and lasts longer than clinical symptoms of drug-induced cutaneous reactions.

Interleukin-2 and its soluble receptor in selected drug-induced cutaneous reactions.

Plasma concentrations of interleukin-2 (IL-2) and its soluble receptor (sIL-2R) were examined in 126 patients with drug-induced skin reactions: maculopapular eruptions (ME), erythema multiforme (EM), erythema multiforme coexisting with erythema nodosum (EMN), drug-induced urticaria (DU), hyperergic vasculitis (HV), Stevens-Johnsson syndrome and toxic epidermal necrolysis (SJS/TEN). The activity of both proteins were measured using immunoenzymatic ELISA method: a) in the acute stage of disease, before treatment was administered, and b) after clearing of skin symptoms, after treatment. In the acute stage of disease highly elevated mean concentrations of IL-2 and sIL-2R in all 6 groups of patients were found (p<0.001) in comparison with the control. After clearing of skin lesions IL-2 mean concentrations were lowered to the level not different significantly from the control (p>0.05), but slL-2R mean plasma concentrations, despite the deep decrease, were still highly significantly elevated in comparison with control values (p<0.001).

Activity of Tumor Necrosis Factor-alpha (TNF-alpha) and its soluble type I receptor (p55TNF-R) in some drug-induced cutaneous reactions.

Plasma concentration of TNF-alpha and its type I receptor (p55TNF-R) was examined in 126 patients with drug-induced skin reactions using immunoenzymatic ELISA method. Patients were subdivided into 6 groups: maculopapular eruptions (ME), erythema multiforme (EM), erythema multiforme coexisting with erythema nodosum (EMN), hyperergic vasculitis (HV), Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). In the acute clinical stage highly significant (p<0.001) or significant (p<0.01) elevation of mean plasma concentrations of the cytokine and its receptor was found in all examined groups in comparison with the control. Clearing of clinical symptoms was connected with considerable decrease (p<0.001, p<0.01) of mean plasma levels of the both proteins in comparison with the before treatment values. TNF-alpha concentrations still remained significantly more elevated than those observed in the control. The results indicate that plasma activity of TNF-alpha and its p55 receptor change with the clinical course of the examined drug-induced skin reactions, which suggests the partake of both proteins in the pathogenesis of these diseases.

Plasma activity of interleukin-6 and some acute phase proteins in severe drug-induced skin adverse reactions.

Plasma concentrations of Interleukin-6 (IL-6), C-reactive protein (CRP) and alpha-2 macroglobulin (alpha-2 MG) were examined in 9 patients with severe drug-induced cutaneous reactions (3 patients with toxic epidermal necrolysis and 6 patients with Stevens-Johnson syndrome). The activity of selected protein was measured using the immunoenzymatic ELISA method: a) in the acute stage of disease, before the treatment was applied and b) after clearing of skin lesions due to effective treatment. In the acute stage of the disease considerably increased plasma levels of IL-6 (p < 0.05) and both acute phase proteins (p < 0.001) were found. After clearing of clinical symptoms the concentrations of the examined proteins lowered towards control. But despite deep decrease, CRP and alpha-2 MG levels were still highly significantly increased (p < 0.001) in comparison with the control values. The results of this study indicate that in severe drug-induced skin reactions the acute phase response can be initiated and that the increased activity of examined proteins is longer observed than clinical symptoms of the disease.

Collagenoses and cutaneous manifestations of hepar diseases.

The authors discuss cutaneous manifestations of some systemic diseases (collagenoses) and their connection with diseases of liver cells.