Abstract
Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe dermatological emergencies. The role of cytokines and chemokines in the pathogenesis, progression of the ...disease, and histopathologic features is not fully elucidated. To address this gap, we conducted a retrospective study examining the associations between 42 serum biomarkers, histopathologic findings, and clinical outcomes in SJS/TEN patients. We reviewed the medical records of 23 patients diagnosed with SJS/TEN. Regarding histopathology, our study did not reveal any significant associations between the degree of epidermal necrosis, dermal mononuclear cell infiltration, and clinical outcomes. However, an intriguing observation was made regarding the degree of dermal infiltration of CD8 + cells, which showed a negative correlation with the severity of acute ocular complications. Notably, serum levels of IFN-γ positively correlated with the number of CD8 + cells in dermal infiltration. Additionally, higher serum levels of myeloperoxidase were associated with greater degrees of epidermal necrosis, while serum Fas ligand and stem cell factor levels were elevated in individuals with increased dermal mononuclear cell infiltration. Furthermore, the levels of S100A8/A9 were significantly correlated with the SCORTEN and mortality rate. These findings provide insights into the intricate pathogenesis of the disease.
Purpose: To evaluate the efficacy and safety of pulsed-dye laser (PDL) for discoid lupus erythematosus (DLE) in a double blinded, randomized, controlled fashion.
Method: Forty-eight DLE lesions from ...nine patients were recruited. The lesions on one side of the body were randomized into the treatment group and the other side served as a control. Treatments with the PDL (595 nm) were delivered every four weeks for four consecutive months. The patients were evaluated at weeks 0, 4, 8, 12, 16 and 24. Erythema index (EI) and Texture index (TI) were obtained by Antera3D
®
. Modified Cutaneous Lupus Erythematosus Disease Area and Severity Index (mCLASI) and physician global assessment (PGA) scores were assessed in every visit. Lesional skin biopsies before and after the PDL treatment were taken from four patients.
Results: The lesions treated with the PDL demonstrated significantly more decreases in EI, TI and improvement in PGA scores compared to the control. Though there was improvement of mCLASI in the laser group, the significance difference was not observed. Interestingly, real-time polymerase chain reaction showed a reduction in CXCL-9, 10, IFN-γ, IL-1β, TNF-α and TGF-β. Additionally, post-treatment DLE lesions demonstrated decreased CD3, CD4, CD8 and CXCR3-positive cells.
Conclusions: Improvements of DLE can be achieved with PDL.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background Spitz nevi and Spitzoid malignant melanomas are uncommon and may be difficult to distinguish histopathologically. Identification of clinical features associated with these lesions may aid ...in diagnosis. Objective We sought to identify clinical characteristics associated with Spitz nevi and Spitzoid malignant melanomas. Methods We conducted a retrospective cohort study of Spitz nevi and Spitzoid malignant melanomas from the Yale University Spitzoid Neoplasm Repository diagnosed from years 1991 through 2008. Descriptive statistics and multivariate logistic regression were used to compare select patient- and tumor-level factors associated with each lesion. Results Our cohort included 484 Spitz nevi and 54 Spitzoid malignant melanomas. Spitz nevi were more common ( P = .03) in females (65%; n = 316) compared with Spitzoid malignant melanomas (50%; n = 27), occurred more frequently in younger patients (mean age at diagnosis 22 vs 55 years; P < .001), and more likely presented as smaller lesions (diameter 7.6 vs 10.5 mm; P < .001). Increasing age (odds ratio 1.16, 95% CI 1.09, 1.14; P < .001) and male gender (odds ratio 2.77, 95% CI 1.17, 6.55; P < .02) predicted Spitzoid malignant melanoma diagnosis. Limitations Small sample size, unmeasured confounding, and restriction to a single institution may limit the accuracy and generalizability of our findings. Conclusions Age and gender help predict diagnosis of Spitz nevi and Spitzoid malignant melanomas.
Microscopic examination and culture are time consuming and require expertise to be reliable, while other screening tests for leishmaniasis such as enzyme-linked immunosorbent assay (ELISA), direct ...agglutination test (DAT), and rK39 dipsticks are not widely available. Boxes Key Learning Points * Leishmaniasis caused by L. siamensis is an emerging disease in Thailand and Myanmar. * L. siamensis infections were described in immunocompromised hosts such as individuals on systemic steroids and AIDS patients. * Patients infected by L. siamensis can present with visceral, disseminated cutaneous, and overlapping of disseminated cutaneous and visceral forms. * Diagnosis of L. siamensis can be performed by PCR using primers specific to the 18S rRNA gene of the ITS1, and saliva has been shown to be a good source of DNA for PCR. * Amphotericin B is an effective therapy for L. siamensis infection.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background Spitzoid malignant melanoma (SMM) shares many histopathologic features with Spitz nevus (SN). The distinction between SMM and SN remains one of the most difficult diagnostic problems in ...dermatopathology. Neuropilin-2 (NRP2) is a cytoplasmic/cell surface protein that is a mediator of melanoma-endothelial cell interaction. Objective The aim of this study was to evaluate NRP2 expression in SMM and SN and to determine whether it can reliably differentiate between the 2 groups. Methods We studied the expression of NRP2 in 19 cases of SMM and 19 cases of SN from Yale Spitzoid Neoplasm Repository, New Haven, Conn. Results All 19 cases of SMM (100%) expressed NRP2. Most SMM showed moderate- and high-intensity staining in the majority of the melanoma cells. Most of the SN (14/19, 74%) were negative for the marker. NRP2 labeled only 5 of 19 SN (26%) and all of them demonstrated mild staining intensity. NRP2+ staining was statistically significant in differentiating SMM from SN ( P < .05). Limitations Small study size is a limitation. Conclusions NRP2 expression in SMM and SN may be a useful adjunct marker, in addition to histopathologic evaluation, in the differentiation between these 2 entities.
Dowling-Degos disease (DDD) is a rare autosomal dominant trait characterized by numerous, symmetrical, progressive and pigmented macules over the axillae, groins, face, neck, arms and trunk as well ...as scattered comedo-like lesions (dark dot, follicles) and pitted acneiform scars. Histopathology is diagnostic testing using a distinctive form of acanthosis, characterized by an irregular elongation of thin branching rete ridges, with a concentration of melanin at the tips. We report cases of generalized DDD in a single family with autosomal dominant penetrance. DDD can be presented in a generalized form with hypopigmented lesions instead of reticulate hyperpigmentation confined to the flexor areas. This form can be differentiated from DUH by histopathology.
Discoid lupus erythematosus (DLE) can be clinically and histologically challenging to diagnose. Some laboratories provide immunofluorescence testing, but this requires fresh tissue. C3d staining for ...the diagnosis of DLE in formalin-fixed paraffin-embedded specimens was used to determine the sensitivity and specificity of detection of this complement protein. We tested 59 cases of DLE and a control set composed of 59 cases of lichen planus (LP), 9 cases of LP-like keratosis, 5 cases of cheilitis, and 3 cases of mucositis. Blinded assessment of the C3d staining was carried out by three pathologists. Fisher’s exact test, the independent t-test, and kappa analysis were used for analyzing the sensitivity and specificity of C3d, which were 44% and 97%, respectively. C3d staining in dermoepithelial junctions confirmed DLE and excluded LP. C3d staining in DEJ is specific for DLE but has low sensitivity.
Background
Methylene blue‐mediated photodynamic therapy as an antimicrobial has been reported to improve onychomycosis.
Objectives
To compare the short‐term efficacy of methylene blue‐mediated ...photodynamic therapy (MB‐PDT) and 5% amorolfine nail lacquer (AMO) for toenail onychomycosis using higher intensity and shorter total treatment period than previously reported.
Methods
Twenty‐seven toenails with onychomycosis were randomized to receive either six biweekly sessions of MB‐PDT or AMO for twelve weeks. Dermoscopic photography was used for onychomycosis severity index assessment under a dermoscopic inspection (d‐OSI) at baseline, weeks 6, 10, 14 and 22 as well as microscopic and microbiological tests. Adverse events were recorded.
Results
All subjects completed the study. Causative organisms found were exclusively non‐dermatophytes including Fusarium spp., Asperillus spp.,and yeasts. Fifteen toenails received MB‐PDT, whilst 12 received AMO. D‐OSI showed greater improvement in MB‐PDT than in AMO groups at weeks 6, 10, 14 as well as 22, with median changes of −2, −3, −4 (P = .055). and − 3 respectively in the MB‐PDT group. The AMO group displayed the median d‐OSI change of 0 throughout the study period. Mycological cure rate at 22 weeks in MB‐PDT and AMO group was 73.3% and 66.67% (P > .05). Clinical cure rate at 22 weeks in MB‐PDT (26.7%) was higher than AMO (16.7%), (P > .05). All patients only felt comfortably warm during the MB‐PDT treatment. No major adverse events were found in both groups.
Conclusions
MB‐PDT appeared to be more efficacious for non‐dermatophyte onychomycosis than AMO particularly in a limited period and moderately severe onychomycosis.
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