Lichen planus is a chronic disease affecting the skin, appendages, and mucous membranes. A cutaneous lichen planus is a rare disease occurring in less than 1% of the general population, while oral ...illness is up to five times more prevalent; still, both forms equally impair the patient's quality of life. The etiology of lichen planus is not entirely understood. Yet, immune-mediated mechanisms have been recognized since environmental factors such as hepatitis virus infection, mechanical trauma, psychological stress, or microbiome changes can trigger the disease in genetically susceptible individuals. According to current understanding, lichen planus immunopathogenesis is caused by cell-mediated cytotoxicity, particularly cytotoxic T lymphocytes, whose activity is further influenced by Th1 and IL-23/Th-17 axis. However, other immunocytes and inflammatory pathways complement these mechanisms. This paper presents a comprehensive insight into the actual knowledge about lichen planus, with the causal genetic and environmental factors being discussed, the immunopathogenesis described, and the principal effectors of its inflammatory circuits identified.
Abstract Vitiligo and halo nevus are immune-mediated skin diseases that have a similar pathogenesis and involve cellular cytotoxicity mechanisms that are not yet fully understood. In this study, we ...investigated the expression patterns of the cytolytic molecule granulysin (GNLY) in different cytotoxic cells in skin samples of vitiligo and halo nevus. Skin biopsies were taken from perilesional and lesional skin of ten vitiligo patients, eight patients with halo nevus and ten healthy controls. We analysed the expression of GNLY by immunohistochemistry in CD8+ and CD56+ NK cells. A significantly higher accumulation of GNLY+, CD8+ GNLY+ and fewer CD56+ GNLY+ cells was found in the lesional skin of vitiligo and halo nevus than in the healthy skin. These cells were localised in the basal epidermis and papillary dermis, suggesting that GNLY may be involved in the immune response against melanocytes. Similarly, but to a lesser extent, upregulation of GNLY+ and CD8+ GNLY+ cells was observed in the perilesional skin of vitiligo and halo nevus compared to healthy controls. In this study, we demonstrated for the first time an increased expression of CD8+ GNLY+ T lymphocytes and CD56+ GNLY+ NK cells in lesions of vitiligo and halo nevus, indicating the role of GNLY in the pathogenesis of both diseases.
Alopecia areata (AA) is an autoimmune-mediated disorder in which the proximal hair follicle (HF) attack results in non-scarring partial to total scalp or body hair loss. Despite the growing knowledge ...about AA, its exact cause still needs to be understood. However, immunity and genetic factors are affirmed to be critical in AA development. While the genome-wide association studies proved the innate and acquired immunity involvement, AA mouse models implicated the IFN-γ- and cytotoxic CD8+ T-cell-mediated immune response as the main drivers of disease pathogenesis. The AA hair loss is caused by T-cell-mediated inflammation in the HF area, disturbing its function and disrupting the hair growth cycle without destroying the follicle. Thus, the loss of HF immune privilege, autoimmune HF destruction mediated by cytotoxic mechanisms, and the upregulation of inflammatory pathways play a crucial role. AA is associated with concurrent systemic and autoimmune disorders such as atopic dermatitis, vitiligo, psoriasis, and thyroiditis. Likewise, the patient’s quality of life (QoL) is significantly impaired by morphologic disfigurement caused by the illness. The patients experience a negative impact on psychological well-being and self-esteem and may be more likely to suffer from psychiatric comorbidities. This manuscript aims to present the latest knowledge on the pathogenesis of AA, which involves genetic, epigenetic, immunological, and environmental factors, with a particular emphasis on immunopathogenesis.
Vitiligo is an acquired immune-mediated disorder of pigmentation clinically characterized by well-defined depigmented or chalk-white macules and patches on the skin. The prevalence of vitiligo varies ...by geographical area, affecting 0.5% to 2% of the population. The disease imposes a significant psychological burden due to its major impact on patients’ social and emotional aspects of life. Given its autoimmune background, vitiligo is frequently associated with other autoimmune diseases or immune-mediated diseases. Vitiligo is a multifaceted disorder that involves both genetic predisposition and environmental triggers. In recent years, major predisposing genetic loci for the development of vitiligo have been discovered. The current findings emphasize the critical role of immune cells and their mediators in the immunopathogenesis of vitiligo. Oxidative-stress-mediated activation of innate immunity cells such as dendritic cells, natural killer, and ILC-1 cells is thought to be a key event in the early onset of vitiligo. Innate immunity cells serve as a bridge to adaptive immunity cells including T helper 1 cells, cytotoxic T cells and resident memory T cells. IFN-γ is the primary cytokine mediator that activates the JAK/STAT pathway, causing keratinocytes to produce the key chemokines CXCL9 and CXCL10. Complex interactions between immune and non-immune cells finally result in apoptosis of melanocytes. This paper summarizes current knowledge on the etiological and genetic factors that contribute to vitiligo, with a focus on immunopathogenesis and the key cellular and cytokine players in the disease’s inflammatory pathways.
We present a 70-year-old female patient diagnosed with epidermal growth factor receptor-mutated metastatic non-small cell lung cancer (T4N2M1a), who developed afatinib-induced toxic epidermal ...necrolysis (TEN). We have also performed a PubMed/Medline literature review to detect other possible cases of TEN/Stevens-Johnson syndrome associated with afatinib treatment and found only 5 other cases reported. To our best knowledge, this is the first case of afatinib-induced TEN successfully treated with cyclosporine.
Psorijaza je imunološki posredovana kronična upalna bolest kože i zglobova. Najčešći oblik psorijaze jest vulgarna ili kronična stacionarna psorijaza, a očituje se pojavom eritematoznih plakova ...prekrivenih srebrnkastim ljuskama, praćenih svrbežom. Rjeđi oblici psorijaze jesu kapljičasta, eritrodermijska i pustulozna psorijaza te psorijaza praćena psorijatičnim artritisom. Procjena težine bolesti vrši se pomoću kliničkih bodovnih sustava, a važna je zbog odabira prikladne terapije. Prvu liniju liječenja blage do srednje teške psorijaze čini lokalna terapija, dok je kod težih oblika bolesti te pacijenata koji nemaju adekvatan odgovor na lokalnu terapiju ili fototerapiju, indicirana sustavna terapija. Postoji mogućnost kombiniranja lokalne i sustavne terapije, a u određenim slučajevima i fototerapije. U skladu sa smjernicama Hrvatskog dermatovenerološkog društva prva linija lokalnog liječenja psorijaze jest fiksna kombinacija kalcipotriola i betametazon propionata jednom dnevno uz mogućnost proaktivnog liječenja dva puta tjedno. U terapiji održavanja prvenstveno se preporučuje fiksna kombinacija kalcipotriola i betametazon propionata jednom ili dva puta tjedno. U slučaju psorijaze lica i intertriginoznih regija preporučuje se započeti liječenje lokalnim kortikosteroidima, a potom nastaviti s lokalnim inhibitorima kalcineurina. Lokalni pripravci u liječenju psorijaze neizostavan su dio liječenja blage do srednje teške psorijaze, ali i potpora liječenju težih oblika psorijaze uz sustavnu terapiju.
Psoriasis is an immune-mediated chronic inflammatory skin and joint disease. Psoriasis vulgaris, also known as chronic plaque psoriasis, is the most common type of psoriasis and is characterized by the appearance of erythematous squamous plaques accompanied by itching. Guttate psoriasis, erythrodermic and pustular psoriasis, and psoriasis associated with psoriatic arthritis are less common forms of psoriasis. Clinical scoring systems are used to assess the severity of the disease, which is important for selecting the appropriate therapy. Local therapy is the first line of treatment for mild to moderate psoriasis, while systemic therapy is indicated for more severe forms of the disease and patients who do not respond to local therapy or phototherapy. Combining local and systemic therapy, as well as phototherapy, is an option in some cases. According to the Croatian Dermatovenerological Society's guidelines, the first line of topical treatment for psoriasis is a fixed combination of calcipotriol and betamethasone propionate once daily, with the option of proactive treatment twice a week. A fixed combination of calcipotriol and betamethasone propionate once or twice a week is recommended in maintenance therapy. Topical corticosteroids, followed by topical calcineurin inhibitors, are the treatment of choice for psoriasis of the face and intertriginous regions. Topical psoriasis treatment is essential in the treatment of mild to moderate psoriasis, but it also complements systemic therapy in patients with severe psoriasis.
Psorijaza je kronična, upalna, imunosno posredovana bolest kože i drugih organskih sustava, koja zahvaća 2-3 % cjelokupne svjetske populacije i predstavlja značajan javnozdravstveni problem. Poželjno ...je da suvremena terapija psorijaze ima dugoročnu učinkovitost i dobar sigurnosni profil, a danas obuhvaća upotrebu lokalne i sustavne terapije, kao i fototerapije i fotokemoterapije. Fototerapija se provodi izlaganjem sunčevoj svjetlosti te ultraljubičastom A i B zračenju, dok konvencionalna fotokemoterapija podrazumijeva zajedničku upotrebu ultraljubičastog zračenja i fotosenzibilizirajućeg lijeka. Oba su se oblika terapije pokazala iznimno učinkovitima, posebice pri njihovoj kombiniranoj primjeni s određenim lokalnim ili sustavnim lijekovima. U današnje vrijeme je, također, sve više zastupljen holistički pristup liječenju psorijaze poput balneofototerapije, zahvaljujući kojoj su brojne zemlje postale poznata odredišta lječilišnog turizma.
Psoriasis is a chronic, inflammatory, immune-mediated disease of the skin and other organ systems, which affects 2-3 % of the entire world population and represents a significant public health problem. It is desirable that modern psoriasis therapy has long-term efficacy and a good safety profile, and today includes the use of local and systemic therapy, as well as phototherapy and photochemotherapy. Phototherapy is carried out by exposure to sunlight and ultraviolet A and B radiation, while conventional photochemotherapy involves using of ultraviolet radiation and a photosensitizing drug. Both forms of therapy have proven to be highly effective, especially when combined with certain local or systemic medications. Nowadays, a holistic approach to treating psoriasis, such as balneophototherapy, is also increasingly common, thanks to which numerous countries have become well-known health resort destinations.
Psorijaza je kronična imunološki posredovana bolest od koje boluje 2-5 % svjetske populacije. Većina pacijenata sa srednjim i teškim oblikom psorijaze treba sustavno liječenje. Unatoč razvoju ...biološke terapije, tradicionalna sustavna terapija i dalje ostaje važan izbor u liječenju psorijaze, zbog dobrih rezultata i ekonomičnosti. Najčešće korišteni tradicionalni lijekovi jesu metotreksat, ciklosporini, acitretin i fumarati. Jedna od negativnih strana tradicionalne sustavne terapije jesu moguće teške nuspojave, koje se uz redovito praćenje pacijenta mogu dobro kontrolirati.
Psoriasis is a chronic immune-mediated disease that affects 2-5% of the world's population. Most patients with moderate to severe psoriasis require systemic treatment. Despite the development of biological therapy, traditional systemic drugs remain an important therapeutic option due to their efficacy and affordability. The most commonly used traditional drugs are methotrexate, ciclosporin, acitretin, and fumarate. One of the disadvantages of traditional systemic medication is the possibility of side effects, which can be successfully controlled with regular patient monitoring.
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