Skin Microbiota in Atopic Dermatitis Hrestak, Dora; Matijašić, Mario; Čipčić Paljetak, Hana ...
International journal of molecular sciences,
03/2022, Letnik:
23, Številka:
7
Journal Article
Recenzirano
Odprti dostop
The skin microbiota represents an ecosystem composed of numerous microbial species interacting with each other, as well as with host epithelial and immune cells. The microbiota provides health ...benefits to the host by supporting essential functions of the skin and inhibiting colonization with pathogens. However, the disturbance of the microbial balance can result in dysbiosis and promote skin diseases, such as atopic dermatitis (AD). This review provides a current overview of the skin microbiota involvement in AD and its complex interplay with host immune response mechanisms, as well as novel therapeutic strategies for treating AD focused on restoring skin microbial homeostasis.
Dear Editor, The Leser-Trélat sign is a rare paraneoplastic cutaneous marker of internal malignancy characterized by sudden eruption of multiple seborrheic keratoses (SK). It is mostly associated ...with gastrointestinal adenocarcinomas (gastric, colon, rectal), and less frequently with breast cancer and lymphoproliferative disorders/lymphoma (1). It can be also associated with lung, kidney, liver, and pancreas malignancy (1). Pruritus occurs in half of the patients. Lesions rarely require any treatment, as they mostly tend to resolve once management of the underlying malignancy has started (2). A 32-year-old female patient with family history of colorectal cancer presented with an acute eruption of SK. She reported that the first symptoms were the loss of appetite and intense pruritus. The brown papules appeared over a period of 2-3 months, first on her back, then on the abdomen, thorax, neck, and lasty on the extremities (Figures 1a and b.). Physical examination showed numerous brown hyperkeratotic papules and plaques on the trunk, neck, and extremities. The patient complained of night sweating, epigastric pain, and heartburn. Over the last three months, she had lost over 15 kg. The patient had experienced an episode of acute gastritis 10 years ago and had been treated for Helicobacter pylori infection 4 years ago. Laboratory results showed elevated sedimentation rate and decreased levels of hemoglobin, erythrocytes, and hematocrit. CA-19-9 and CEA levels were elevated. Gastroscopy with multiple biopsies confirmed gastric adenocarcinoma. An abdominal CT scan revealed enlarged retroperitoneal lymph nodes. SK withdrew after total gastrectomy and commencement of chemotherapy. The Leser-Thrélat sign was named after two surgeons, Edmund Leser and Ulysse Trélat, who described the eruption of cutaneous lesions in patients with cancer (3). However, the correlation between multiple SK and internal malignancy was described by Hollander in 1900 (4). Acute eruption of SK has also been reported in some other cases, such as benign tumors, pregnancy, human immunodeficiency virus infections, use of adalimumab, and others, which indicates that the Leser-Trélat sign is not highly specific (5). It is also somewhat controversial whether a sudden appearance of SK can be considered a marker for internal malignancy, since both SK and malignancies occur more frequently in the elderly population, thus allowing for a higher likelihood of coincidence (6). However, the patient in this case was young and therefore less likely to suddenly develop such a large number of SK, which are more commonly seen after the age of 50 (7). Although the pathogenesis of Leser-Thrélat sign is not fully understood, there are data suggesting an association with tumor-secreting growth factors including epidermal growth factor and transforming growth factor-alpha, both of which can stimulate the epidermal growth factor receptor (8). Sudden appearance of eruptive SK is uncommon in young patients. This specific sign highlights the importance of considering internal malignancy in the differential diagnosis of patients presenting with eruptive SK.
Homemade topical preparations are becoming increasingly popular due to the widespread belief that herbal and natural products are a safer and better option in the treatment of various conditions. ...However, homemade topical preparations can precipitate allergic and irritant reactions, depending on the herbal composition of the preparation. Hypersensitivity reactions to such preparations range from contact allergic dermatitis, contact irritant dermatitis, contact urticaria, toxic reaction, photosensitivity, and phototoxic reaction. In Europe, and especially in the Mediterranean area, medicinal herbs from the Compositae family and aromatic Mediterranean herbs are most frequently used in the formulation of topical preparations. Although plants are regarded as strong sensitizers, the number of reported cases of hypersensitivity reactions is relatively small. The problems are limitations in diagnostics due to the lack of necessary patch test substances and the danger of active sensitization during testing. Caution is required in patients prone to allergies and those with existing dermatoses, who should be advised to use registered preparations. The first step in management is cessation of exposure, followed by implementation of topical corticosteroids. Systemic corticosteroid therapy is reserved for more severe cases.
Allergic contact dermatitis (ACD) caused by (meth)acrylates is traditionally an occupational disease among dentists, printers, and fiberglass workers. With the use of artificial nails, cases have ...been reported both in nail technicians and in users. ACD caused by (meth)acrylates used in artificial nails is a relevant problem for both nail artists and consumers. We present the case of a 34-year-old woman who was working in a nail art salon for two years prior to the appearance of severe hand dermatitis, especially on her fingertips together, with frequent appearance of face dermatitis. The patient had artificial nails for the last 4 months because her nails were more prone to splitting, so she was regularly using gel to "protect" them. While she was at her workplace, she reported multiple episodes of asthma. We performed patch test to baseline series, acrylate series, and the patient's own material. In the baseline series, the patient had positive reactions to nickel (II) sulfate (++/++/++), fragrance mix (+/+/+), and carba mix (+/+/+), 2-hydroxyethyl methacrylate (2-HEMA) (++/++/++), ethylene glycol dimethylacrylate (EGDMA) (++/++/++), hydroxyethyl acrylate (HEA) (++/++/++), and methyl methacrylate (MMA) (+/+/+). Semi-open patch test was positive to 11 of the patient's own items (10 out of 11 were made of acrylates). There has been a significant increase in the incidence of acrylate-induced ACD among nail technicians and consumers. Cases of occupational asthma (OA) induced by acrylates have been described, but respiratory sensitizations of acrylates are still insufficiently investigated. Timely detection of sensitization to acrylates is primarily necessary in order to prevent further exposure to allergens. All measures should be taken to prevent exposure to allergens.
Dear Editor, Photoallergic reactions are classic T-cell-mediated or delayed-type hypersensitivity reactions of the skin in response to a photoallergen (or a cross-reacting chemical) to which a ...subject was sensitized in the past (1). The immune system recognizes the changes caused by ultraviolet (UV) radiation; it produces antibodies and causes inflammation of the skin in the exposed areas (2). Common photoallergic drugs and ingredients are included in some sunscreens, aftershave lotions, antimicrobials (especially sulfonamides), non-steroidal anti-inflammatory drugs (NSAIDs), diuretics, anticonvulsants, chemotherapy drugs, fragrances, and other hygiene products (1,3,4). A 64-year-old female patient was admitted to the Department of Dermatology and Venereology with erythema and underlining edema on her left foot (Figure 1). A few weeks earlier, the patient had had a fracture of the metatarsal bones and since then she had been taking NSAIDs systemically every day to suppress pain. Five days before being admitted to our Department, the patient started applying 2.5% ketoprofen gel to her left foot twice daily and was frequently exposed to the sun. For the last twenty years, the patient had been struggling with chronic back pain and was frequently taking different NSAIDs (ibuprofen, diclofenac, etc.). The patient also suffered from essential hypertension and was regularly taking ramipril. She was advised to discontinue ketoprofen application, avoid sunlight, and apply betamethasone cream twice daily for 7 days, which lead to complete resolution of the skin lesions in a few weeks. Two months later, we performed patch and photopatch tests to baseline series and topical ketoprofen. Only the irradiated side of the body where ketoprofen-containing gel was applied showed positive reaction to ketoprofen. Photoallergic reactions manifest as eczematous, pruritic lesions, which may spread to involve other areas of the skin that were not previously exposed to the sun (4). Ketoprofen is a nonsteroidal anti-inflammatory drug composed of a benzoylphenyl propionic acid that is commonly used both topically and systemically for the treatment of musculoskeletal diseases because of its analgesic and anti-inflammatory effects and low toxicity, but it is one of the most frequent photoallergens (1,5,6). Ketoprofen-induced photosensitivity reactions usually present as photoallergic dermatitis characterized as acute dermatitis with edema, erythema, papulovesicles, blisters, or erythema exsudativum multiforme-like lesions at the application site 1 week to 1 month after the initiation of use (7). Depending on the frequency and intensity of sun exposure, ketoprofen photodermatitis may continue or reoccur up to 1 to 14 years after discontinuing the medication (6,8). Moreover, ketoprofen contaminates clothing, shoes, and bandages, and some cases of photoallergy relapses have been reported that were induced by ketoprofen-contaminated objects after they were used again in the presence of UV radiation (5,6). Due to their similar biochemical structure, patients with ketoprofen photoallergy should avoid using some drugs such as some NSAIDs (suprofen, tiaprofenic acid), antilipidemic agent (fenofibrate) and sunscreens based on benzophenones (6,9). Physicians and pharmacists should advise patients of the potential risks when topical NSAIDs are applied on the photoexposed skin.
Dear Editor, Pityriasis rosea (PR) is a common, self-limited erythematous papulosquamous dermatosis that mainly affects young adults. It is believed to represent a delayed reaction to viral ...infections and is usually associated with endogenous systemic reactivation of human herpesvirus (HHV) 6 and / or 7 (1). A 46-year-old man presented to our Department with a two-week history of skin rash associated with mild pruritus. He described the appearance of an erythematous centrally scaled lesion at the right part of his abdomen, followed by the spreading of red oval mildly scaling lesions on the trunk, neck, and proximal parts of the upper extremities, which showed in the physical examination (Figure 1, a and b). He was otherwise healthy and taking no medications. Six weeks prior to the appearance of the initial skin lesion, the patient had coronavirus disease 2019 (COVID-19) infection with mild clinical presentation (fever up to 38 °C lasting for four days and mild headache) and with symptoms of post COVID-19 syndrome (excessive tiredness). He denied oropharyngeal lesions. Potassium hydroxide, syphilis, and laboratory tests were within normal limits. Within two weeks of topical betamethasone dipropionate treatment, the lesions disappeared completely. In addition to reactivation of HHV-6 or HHV-7, PR can be triggered by some drugs (like angiotensin-converting enzyme inhibitors alone or in combination with hydrochlorothiazide, sartans plus hydrochlorothiazide, allopurinol, nimesulide, and acetyl salicylic acid (2) and vaccines (such as smallpox, poliomyelitis, influenza, human papillomavirus, diphtheria, tuberculosis, hepatitis B, pneumococcus, and yellow fever vaccines) (3). There is a growing number of published cases that link PR to COVID-19 infection, with PR appearing either in the acute phase of COVID-19 or, as in our patient, in the post COVID-19 period (4-9). Unlike in our patient, oropharyngeal lesions were observed in approximately 16% of patients with typical PR (10). It has been suggested that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces reactivation of other viruses, such as HHV-6, HHV-7, varicella zoster virus, and Epstein-Barr virus (5). PR has also been reported to follow COVID-19 vaccination (11). As our patient did not receive a COVID-19 vaccine, we cannot evaluate the latter based on the present case. We speculate that PR could be a delayed skin manifestation of COVID-19 infection, triggered either by SARS-CoV-2 immediately or indirectly by the reactivation of other viruses such as HHV-6 or HHV-7. However, the etiopathogenetic mechanisms remain largely unknown and further studies are needed in order to clarify the correlation between SARS-CoV-2 and PR.
Condyloma acuminatum relatively rarely involves the urethra, and when it does it is usually only in the most distal portion of the urethra. A number of treatments have been described for urethral ...condylomas. These treatments are extensive and variable, comprising laser treatment, electrosurgery, cryotherapy, and topical application of cytotoxic agents such as 80% trichloroacetic acid, 5-fluorouracil cream (5-FU), podophyllin, podophyllotoxin, and imiquimod. Laser is still considered to be therapy of choice for treatment of intrauretral condylomata. We present the case of a 25-year-old male patient with meatal intraurethral warts who was successfully treated with 5-FU, after many unsuccessful treatment attempts with laser treatment, electrosurgery, cryotherapy, imiquimod, and 80% trichloroacetic acid.
Nošenje zaštitne opreme i higijena ruku pripadaju u temeljne mjere prevencije širenja pandemije COVID-19. Pritom su pojedina zanimanja, poglavito zdravstveni radnici, izložena dugotrajnom kontaktu sa ...zaštitnom opremom, što može rezultirati brojnim kožnim promjenama, bilo kao novonastale promjene na koži ili pogoršanje postojećih dermatoza. Okluzivni učinak zaštitnih maski, uz pritisak i trenje, može dovesti do suhoće kože lica i pojave odnosno pogoršanja postojeće acne vulgaris („maskne“). Učestalo pranje ruku sapunima, dezinficijensima i antisepticima može dovesti ne samo do suhoće kože ruku, nego i do kontaktnoga iritativnog dermatitisa, pri čemu deterdženti i topla voda čine kombinaciju mehaničkih i kemijskih iritansa. Puder koji se nalazi unutar nekih rukavica također može imati iritativni učinak. Zaštitne maske, naočale i odijela zbog svojega okluzivnog učinka narušavaju zaštitnu kožnu barijeru, što također može dovesti do kontaktnoga iritativnog dermatitisa. Kontaktni alergijski dermatitis nešto se rjeđe javlja od kontaktnoga iritativnog dermatitisa, a predstavlja kasni tip preosjetljivosti na alergene koji se nalaze u zaštitnoj opremi (poglavito u maskama i rukavicama) te sredstvima za dezinfekciju. Rijetko se može javiti i kontaktna urtikarija kao posljedica korištenja zaštitne opreme, a najčešći je uzrok kontaktne urtikarije lateks koji se nalazi u zaštitnim rukavicama. Dugotrajno nošenje zaštitnih maski, naočala i štitnika za lice može dovesti i do mehaničkih oštećenja, od najblažih promjena kao što su crvenilo uz tragove na koži do mjehura, erozija i ulceracija. U ovom preglednom radu prikazani su rezultati dosadašnjih istraživanja o kožnim promjenama uzrokovanim nošenjem zaštitne opreme i sredstvima za dezinfekciju tijekom pandemije COVID-19.
Background
Quantitative risk assessment (QRA) for skin sensitization is used to derive safe use levels of sensitising fragrance ingredients in products. Post‐marketing surveillance of the prevalence ...of contact allergy to these ingredients provides relevant data to help evaluate the performance of these measures.
Objectives
To determine a suitable patch test concentration for five fragrance materials that had hitherto not been tested on a regular basis. These concentrations are then to be used in a surveillance study with patch testing consecutive patients over an extended monitoring period.
Materials and Methods
Furaneol, CAS.3658‐77‐3; trans‐2‐hexenal, CAS.6728‐26‐3; 4,8‐dimethyl‐4,9‐decadienal, CAS.71077‐31‐1; longifolene, CAS.475‐20‐7; benzaldehyde, CAS.10052‐7, were patch tested with other fragrance allergens in four clinics. Patch testing was conducted in three rounds, starting with the lowest concentrations of the five ingredients. The doses were increased in the subsequent rounds if no late‐appearing positive reactions and virtually no irritant reactions were reported.
Results
Overall, 373 patients were tested. No positive allergic reaction was reported to the five ingredients. Patch test results of other fragrance allergens are reported.
Conclusions
The highest test concentrations are each considered safe for patch testing consecutive patients. Further surveillance based on these preparations will evaluate the hypothesis that QRA‐driven consumer product levels of these fragrances can prevent sensitization.
We report a suitable patch test concentration for five fragrance materials that are then to be used in a surveillance study with patch testing consecutive patients over an extended monitoring period to evaluate the hypothesis that the quantitative risk assessment‐driven consumer product levels of these fragrances can prevent sensitization.
Skin barrier and dry skin in the mature patient Tončić, Ružica Jurakić, MD; Kezić, Sanja, PhD; Hadžavdić, Suzana Ljubojević, MD, PhD ...
Clinics in dermatology,
03/2018, Letnik:
36, Številka:
2
Journal Article
Recenzirano
Abstract Dry skin is the most common clinical manifestation of dermatologic diseases, and it presents with itching, redness, and desquamation—signs and clinical manifestations that are not only ...physically uncomfortable but also affect patients psychologically. The water content in the stratum corneum is largely dependent on the composition and amount of the intercellular lipids, which regulate the loss of water from the skin, and on the levels of hygroscopic substances of the natural moisturizing factors, which are responsible for retention of water in the stratum corneum. Prevention of water loss and penetration of potentially toxic substances and microorganisms into the body are the most important functions of the skin, which acts as a natural frontier between the inner organism and the environment. Skin barrier defects occur in several skin diseases, but the influence of aging on the skin barrier function is largely unknown and conflicting results have been reported. In this review, the structure and function of the barrier in relation to the aging process are discussed.
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