Unraveling the relation between vitiligo, Interleukin 17, and serum amyloid A.

BACKGROUND: There is debate concerning the precise etiopathogenesis of vitiligo. According to certain theories, a series of inflammatory responses that mediate the loss of melanocytes are caused by both cellular and humoral immune responses. It has also been demonstrated that Interleukin 17 (IL-17) promotes melanocyte death and inhibits melanogenesis through different mechanisms. Serum Amyloid A (SAA) levels are over-expressed in autoimmune diseases. Th17 cytokines are regulated by serum amyloid A proteins. AIMS: To measure serum levels of IL-17 and SAA in vitiligo patients aiming to explain their possible role in disease pathogenesis and the other aim is to correlate their levels with disease activity and severity. METHODS: This study included 60 vitiligo patients and 40 healthy age and sex controls. Enzyme-linked immunosorbent assay was used to measure serum levels of SAA and IL-17. RESULTS: This study revealed significant increase in levels of serum IL-17 and SAA in patients than controls (p < 0.05). Both markers showed significant positive correlations with VASI score and duration of vitiligo; only IL-17 showed statistically significant positive correlation with VIDA scores. Patients with vitiligo showed a statistically significant positive connection between serum IL-17 levels and SAA (γ = 0.992, p-value <0.05). CONCLUSION: Increased serum level of IL-17 and SAA in vitiligo patients together with their positive relation to vitiligo severity and the duration of the disease show that these two markers play a key role in the vitiligo development.

Elevation of Serum SSCCAII in Cutaneous and Oral Lichen Planus: Missing Link for Hidden Carcinogenic Potential?

CONTEXT: Lichen planus (LP) is an immune mediated inflammatory condition. SCCAII is a useful biomarker reflecting Th17 type inflammation. It is also a tumour marker, especially for Squamous cell carcinoma (SCC) Mechanism of carcinogenesis in LP is still unknown. Chronic inflammation may facilitate the development of cellular clones in the epidermis. AIMS: Estimation of serum level of SCCA II in patients with cutaneous and oral LP (OLP) to detect its role in LP pathogenesis, and to reveal the missing link in understanding mechanism of carcinogenesis in LP. METHODS AND MATERIAL: A case control study, where 100 subjects were included; 80 LP patients (40 cutaneous & 40 oral) and 20 apparently healthy controls. We obtained an informed written consent from each subject prior the participation. Cutaneous and oral LP were diagnosed clinically, SCCA II level was measured by ELISA technique. STATISTICAL ANALYSIS USED: Statistical analysis was done using SPSS vs.25. (IBM, Armonk, New York, United states). Numerical data was summarized as means and standard deviations or medians and ranges. RESULTS: Median SSCCAII level was significantly higher in LP cases compared to controls (P < 0.001) and was significantly higher in patients with OLP compared to patients with cutaneous LP (P ≤ 0.001). Post hoc analysis revealed that median SSCCAII was significantly higher in patients with ulcerative type compared to both reticular type and others. It was also significantly higher in patients with actinic type compared to both hypertrophic type and classic type. Median SSCCAII was significantly higher in patients with ulcerative OLP compared to actinic LP (P < 0.001). CONCLUSIONS: Our study revealed that serum SCCAII level was higher in patients with cutaneous and OLP. This might be linked to the pathogenesis of LP, especially actinic and erosive OLP. SCCAII level could facilitate the screening and early detection of patients at risk, a potential alarm to launch accurate assessment and continue follow up of cutaneous as well as O LP patients.

Serum Neurotensin: An Objective Mirror to Acne-induced Quality of Life and Psychological Impairment.

BACKGROUND: Acne is a multifactorial disorder, and stress potentially plays a role in its pathogenesis. OBJECTIVES: We aimed to assess the serum levels of neurotensin in patients with acne vulgaris (AV) and investigate the relationship of these levels to quality of life (QoL), depression, anxiety, and stress. METHODS: The study included 60 patients with AV classified into mild (n=20), moderate (n=20), and severe (n=20) groups and 20 healthy, age-matched, sex-matched, and body mass index (BMI)-matched individuals in a control group. Patient QoL was assessed using the Dermatology Life Quality Index (DLQI). Each participant completed the Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS-10). Serum levels of neurotensin were measured with enzyme-linked immunosorbent assay (ELISA). RESULTS: Neurotensin levels and scores from the three questionnaires were significantly higher among the patients with AV than the control subjects. They were also significantly elevated in patients with post-acne scars and hyperpigmentation and in those with severe acne. CONCLUSION: It is well known that acne greatly impacts QoL and might be associated with depression, anxiety, and stress. Further, serum neurotensin could be a promising marker to objectively evaluate the psychosocial impact of AV.

Serum levels of brain-derived neurotrophic factor in patients with acne vulgaris.

BACKGROUND: Many dermatological diseases have a great impact on the psychological state of patients, like urticaria, psoriasis, atopic dermatitis, and acne vulgaris. Finding a "gold standard" biomarker for chronic stress in acne patients is challenging because of the complex etiology of the chronic stress and its variable manifestations. AIMS: The aim of this study was to evaluate the correlation between serum levels of BDNF and the presence and severity of acne vulgaris and to assess the relationship of this biomarker to both the degree of psychological stress and the quality of patients' lives (QoL). PATIENTS AND METHODS: Sixty patients with acne vulgaris were included, together with twenty apparently healthy, age-, and sex-matched individuals as a control group. Patients filled a Dermatology Life Quality Index (DLQI) questionnaire; both patients and controls filled a Hospital Anxiety and Depression scale (HADS) and perceived stress scale-10 (PSS) questionnaires. Serum levels of BDNF were measured for patients and controls using ELISA technique. RESULTS: Patients with acne had significantly lower levels of BDNF and significantly higher HADS and PSS-10 questionnaires scores. A significant negative correlation was found between serum levels of BDNF and PSS questionnaire scores. CONCLUSION: Patients with acne are at a high risk to develop chronic stress, anxiety, and depression. BDNF is a good predictor for assessment of chronic stress in such patients.

Clinimetric analysis of recently applied quantitative tools in evaluation of vitiligo treatment.

BACKGROUND: Vitiligo affects about 1% of the world's population, however, there is currently no universally used standardized measure to assess its response to treatment. OBJECTIVE: To find the most effective technique for the quantitative assessment of therapeutic results in vitiligo patients. MATERIALS AND METHODS: The study was performed in three stages: (1) Conducting an adapted Delphi survey to check current dermatologists' attitudes regarding the topic of study. (2) Conducting a pilot study that involves testing the selected digital image analysis software in the laboratory to validate future tasks. (3) The chief clinimetric study that implicates selecting actual vitiligo lesion models and evaluating them. RESULTS: Regarding the surface area measuring techniques, the most accurate results were gained through the digital image analysis for surface area, followed by point-counting technique. The digital image analysis for color measurement was accurate and reliable in getting a percentage representation of color improvement within the vitiligo lesions, in response to therapy. LIMITATIONS: Many dermatologists lack understanding of basic concepts about imaging techniques. The study does not include a traditional assessment method such as vitiligo area scoring index. CONCLUSION: Our designated digital image analysis technique was able to efficiently assess the changes that occur both on surface area and the color of vitiligo lesions in response to therapy.

Assessment of seminal granulysin in infertile men with varicocele.

Varicocele has a common association with male infertility, but its exact role is still debated. Apoptosis has been suggested as one of the mechanisms of varicocele-associated infertility. Granulysin is a molecule that plays a role in apoptosis with no previous study about its role in male infertility. This case-controlled study aimed to assess seminal plasma granulysin level in infertile patients with varicocele. This study involved 90 men that were allocated into fertile normozoospermic men (n = 20), infertile men without varicocele (n = 30) and infertile men with varicocele (n = 40). These men were subjected to history taking, clinical examination, semen analysis and estimation of seminal granulysin. In general, seminal granulysin level was significantly elevated in infertile men compared with fertile men. Infertile men with varicocele showed significantly higher seminal granulysin compared with infertile men without varicocele, in bilateral varicocele cases and in grade III varicocele. Seminal granulysin level was negatively correlated with sperm concentration, sperm motility, sperm normal forms percentage and testicular volumes. It is concluded that increased seminal granulysin has a negative impact on spermatogenesis in infertile men in general and in infertile men associated with varicocele in particular.

Interleukin-18 expression and the response to treatment in patients with psoriasis.

INTRODUCTION: The aim of the study was to demonstrate interleukin-18 (IL-18) expression in keratinocytes from psoriatic lesions in comparison to keratinocytes from uninvolved skin and to study the change of expression after therapeutic interventions. MATERIAL AND METHODS: This study included 16 patients of different clinical subtypes of psoriasis. Interleukin-18 gene expression analysis was performed using real time quantitative PCR. Three biopsies were obtained from each patient. Two were taken from the lesional psoriatic skin and from uninvolved skin before starting treatment. A third lesional skin biopsy was taken at the end of 2 months of treatment. The treatment was in the form of topical steroids or oral systemic methotrexate. RESULTS: Of all 16 studied patients, significantly increased IL-18 expression was noted in keratinocytes from psoriatic lesions before and after treatment when compared to keratinocytes from uninvolved skin (p = 0.001 and p = 0.002 respectively). The IL-18 expression in the skin lesions after treatment was significantly lower than lesional skin before treatment (p = 0.023). In psoriatic skin lesions of all studied patients IL-18 expression was significantly correlated with disease duration (r = 0.40 and p = 0.01) and clinical severity of psoriasis (r = 0.72 and p = 0.001). CONCLUSIONS: Increased IL-18 expression in keratinocytes from psoriatic lesions of our patients and its correlation with disease duration and severity supported the concept of psoriasis as a T cell mediated autoimmune disease. This could establish therapeutic and preventive approaches for psoriasis that ultimately lead to improved outcomes for patients.

Interleukin-18 expression and the response to treatment in patients with psoriasis.

INTRODUCTION: The aim of the study was to demonstrate Interleukin-18 (IL-18) expression in keratinocytes from psoriatic lesions in comparison to keratinocytes from uninvolved skin and to study the change of expression after therapeutic interventions. MATERIAL AND METHODS: This study included 16 patients of different clinical subtypes of psoriasis. IL-18 gene expression analysis was performed using real-time quantitative PCR. Three biopsies were obtained from each patient. Two were taken from the lesional psoriatic skin and from uninvolved skin before starting treatment. A third lesional skin biopsy was taken at the end of two months' treatment course. The treatment was in the form of topical steroids or oral systemic methotrexate. RESULTS: Of all 16 studied patients significantly increased IL-18 expression was noted in keratinocytes from psoriatic lesions before and after treatment when compared to keratinocytes from uninvolved skin (P = 0.001 and 0.002 respectively). The IL-18 expression in the skin lesions after treatment was significantly lower than lesional skin before treatment (P = 0.023). In psoriatic skin lesions of all studied patients IL-18 expression was significantly correlated with disease duration (r = 0.40 and P = 0.01) and clinical severity of psoriasis (r = 0.72 and P = 0.001). CONCLUSIONS: Increased IL-18 expression in keratinocytes from psoriatic lesions of our patients and its correlation with disease duration and severity supported the concept which views psoriasis as a T-cell-mediated autoimmune disease. This could establish therapeutic and preventive approaches for psoriasis that ultimately lead to improved outcomes for patients.