Association of insertion/deletion polymorphism of the angiotensin-converting enzyme gene with angio-oedema accompanying chronic urticaria but not chronic urticaria without angio-oedema or the autologous serum skin test response.

BACKGROUND: Chronic urticaria is defined as the daily or almost daily occurrence of weals for more than 6 weeks. The underlying pathophysiology is reported to be mast cell activation, with release of mast cell mediators, predominantly histamine. Substance P is a neuropeptide and has the capacity to provoke histamine release from skin mast cells. Angiotensin-converting enzyme (ACE), widely expressed in skin, is one of the major peptidase for the degradation of substance P. An insertion/deletion polymorphism (I/D) in the ACE gene has been reported to be related to the levels of enzyme. OBJECTIVE: An increase in substance P levels due to a polymorphism in ACE gene might be related to the pathology. Thus, we aimed to investigate whether there is an association between ACE I/D polymorphism and chronic ordinary urticaria. METHODS: Ninety-five patients with chronic ordinary urticaria were recruited and divided into two groups according to autologous serum skin test status and accompanying angio-oedema. One hundred and sixty-one healthy subjects were enrolled as control group. All participants were genotyped for I/D polymorphism in intron 16 of the ACE gene by polymerase chain reaction. RESULTS: A statistically significant association was not found between ACE I/D polymorphism and chronic ordinary urticaria. Further analyses of chronic ordinary urticaria patients showed that ACE I/D polymorphism was not associated with autologous serum skin test status of patients. However, the frequencies of II genotype and I allele were statistically significantly higher in chronic ordinary urticaria patients with accompanying angio-oedema with regard to angio-oedema-negative patients (II genotype: 24% vs. 9%, P = 0.0002; I allele: 58% vs. 27%, P = 0.0001) and control group (II genotype: 24% vs. 19%, P = 0.01; I allele: 58% vs. 41%, P = 0.03). CONCLUSION: The results of this study suggest no evidence of an association between ACE I/D polymorphism and risk of developing chronic ordinary urticaria. However, it can be a contributing factor to susceptibility of angio-oedema in chronic ordinary urticaria.

Association of insertion/deletion polymorphism of the angiotensin-converting enzyme gene with psoriasis.

BACKGROUND: Genetic factors are likely to be of fundamental importance in the pathogenesis of psoriasis. There are reports concerning the induction or/and exacerbation of psoriasis by angiotensin-converting enzyme (ACE) inhibitors, which have been attributed to the ACE inhibitor-induced augmentation of kinin levels in skin. However, to the best of our knowledge there has been no molecular genetic study investigating whether ACE insertion/deletion (I/D) polymorphism may contribute to the genetic background in psoriasis. OBJECTIVES: To assess the role of ACE I/D polymorphism in psoriasis. METHODS: A group of 86 patients with psoriasis and 154 control subjects were analysed for ACE I/D polymorphism by polymerase chain reaction. RESULTS: The distribution of ACE I/D polymorphism and allele frequencies in psoriatic patients was not significantly different from controls. Further analyses of psoriasis patients showed that ACE I/D polymorphism was not associated with age at onset of disease, clinical type of psoriasis or gender. However, the frequency of the I allele was significantly higher in patients with a positive family history of psoriasis than in those with no family history (sporadic psoriasis) (48% vs. 32%; P =0.03). In addition, the I allele was found significantly more frequently in type I psoriasis patients (onset < 40 years and positive family history) than in type II psoriasis patients (onset >/= 40 years, no family history) (48% vs. 27%; P = 0.04). CONCLUSIONS: Our results suggest that the presence of the I allele may confer susceptibility to development of psoriasis in individuals from psoriatic families.

Churg-Strauss syndrome in an HCV seropositive patient.

Churg-Strauss syndrome was considered rare until leukotriene modifiers were introduced into medical practice in 1996. Since then, an increasing number of reports considering a possible relationship between leukotriene receptor antagonists and the Churg-Strauss syndrome have been published. Hepatitis C virus (HCV) is a blood-borne infection and a major health problem with an increasing prevalence worldwide. Previously, numerous reports suggested a relationship between HCV and certain autoimmune disorders such as cryoglobulinaemia and polyarteritis nodosa. We present a patient with HCV seropositive Churg-Strauss syndrome and a history of systemic corticosteroid and leukotriene receptor antagonist use, and discuss the possible risk factors in the aetiology of Churg-Strauss syndrome.

The significance of mast cells associated with basal cell carcinoma.

In the stroma of basal cell carcinoma (BCC), the numbers of mast cells are increased, but their significance remains unknown. In a retrospective histological study of 74 cases, we investigated the significance of mast cells related to BCC and the possible relationship between increased numbers of mast cells and clinical and histological parameters including the patients' age, sex, subtype of BCC, and severity of peritumoral inflammation. We found a significant increase in peritumoral mast cell numbers over those in uninvolved skin (p<0.0001). Morpheaform BCCs had significantly more mast cells than did the other variants (p=0.047). No significant relationship was found between mast cell number and the degree of peritumoral inflammation, patient age, or gender. Our results support previous reports indicating that mast cell numbers are increased in RCC, particularly in its morphoeic variant, implying a contributory role for mast cells in the aggressiveness of BCC.

Biweekly serial glycolic acid peels vs. long-term daily use of topical low-strength glycolic acid in the treatment of atrophic acne scars.

BACKGROUND AND OBJECTIVE: Treatment of atrophic acne scars is difficult and generally unsatisfactory. Although many clinical studies have been performed to investigate the efficacy of glycolic acid in the treatment of acne vulgaris, to the best of our knowledge no placebo-controlled study has been carried out to ascertain the effect of glycolic acid on atrophic postacne scars. DESIGN: A single, blind, placebo-controlled, randomized comparative clinical study was conducted in 58 women with atrophic acne scars. The subjects were randomly divided into three study groups. Glycolic acid peels with 20%, 35%, 50%, and 70% concentrations were applied serially at 2-week intervals to 23 patients in Group A. Twenty patients in Group B used a 15% glycolic acid cream once or twice daily for a period of 24 weeks. The remaining 15 patients in Group C applied a placebo cream twice daily during the same period. RESULTS: The differences between the results in the different groups were statistically significant at week 24 (P<0.001). Home application of low-strength glycolic acid was better tolerated and had less side-effects than glycolic acid peels; however, repeated short-contact 70% glycolic acid peels provided superior results compared with the maintenance regimen (P<0.05), and apparently good responses were observed only in the peel group (P<0.01). CONCLUSIONS: Glycolic acid peeling is an effective modality for the treatment of atrophic acne scars, but repetitive peels (at least six times) with 70% concentration are necessary to obtain evident improvement. Long-term daily use of low-strength products may also have some useful effects on scars and may be recommended for patients who cannot tolerate the peeling procedure.

A case of recurrent impetigo herpetiformis with a positive family history.

Impetigo herpetiformis is a rare non-infectious pustular dermatosis of pregnancy. A few non-gestational cases due to oral contraceptive use have also been reported. Although the disorder is not thought to have a genetic background, there are some familial case reports in the literature. We describe a case of recurrent impetigo herpetiformis in an 18-year-old pregnant woman who had normal serum calcium levels and responded well to prednisolone therapy. Interestingly, the patient's mother had also experienced a generalised pustular dermatosis associated with hypocalcaemia during oral contraceptive use, which was diagnosed clinically and histologically as impetigo herpetiformis.

The prevalence of hepatitis C virus infection in patients with lichen planus in Gaziantep region of Turkey.

The purpose of this case-control study was to investigate the association between lichen planus (LP) and hepatitis C virus (HCV) infection in Gaziantep region of Turkey. Seventy-three patients with LP and a control group of patients (n: 73) with a dermatological disorder other than LP were detected for HCV infection using a third generation enzyme-linked immunosorbent assay (ELISA). A serological positivity for HCV was found in five of LP patients (6.84%), whereas it was positive for only one patient of the control group (1.36%). A statistically significant difference was found between LP and control groups (p < 0.05). We conclude that the coexistence of the two diseases is probably more than coincidental.

The significance of Demodex folliculorum density in rosacea.

BACKGROUND: Demodex folliculorum has been reported in rosacea in a number of clinical studies. As the Demodex mite is also present in many healthy individuals, it has been suggested that the mite may have a pathogenic role only when it is present in high densities. Moreover, some authors have proposed that a mite density above 5/cm2 may be a criterion for the diagnosis of inflammatory rosacea. In this study, the possible role of D. folliculorum and the importance of mite density in rosacea were investigated using a skin surface biopsy technique. METHODS: Thirty-eight patients with rosacea and 38 age-and-sex-matched healthy subjects entered the study. With the skin surface biopsy technique, we obtained samples from three facial sites. We then determined the mite positivities, the mean mite counts in both study groups, the mean mite densities at each facial site and in the rosacea subgroups, and the mite densities above 5/cm2. RESULTS: The mean mite count in the rosacea group (6,684) was significantly higher than that in controls (2,868; p < 0.05). The cheek was the most frequently and heavily infested facial region. Ten rosacea patients and five normal subjects had mite densities over 5/cm2; the difference was not statistically significant (p > 0.05). CONCLUSIONS: Rosacea is a disease of multifactorial origin, and individual properties may modify the severity of the inflammatory response to Demodex. We suggest that a certain mite density is not an appropriate criterion in the diagnosis of the disease; nevertheless, large numbers of D. folliculorum may have an important role in the pathogenesis of rosacea, together with other triggering factors.