Summary
Skin cancer, nonmelanoma skin cancer (NMSC) and cutaneous malignant melanoma (CMM), is the most frequent cancer worldwide. It is amenable to early detection, and screening for skin cancer has ...the potential to reduce mortality and morbidity. However, there are no recommendations for population‐based skin cancer screening programmes due to the lack of evidence for the effectiveness from epidemiological studies. In 2008 the first nationwide screening programme for NMSC and CMM in the world was established in Germany. The decision for implementing such a programme was based on the results and evidence of a pilot study that was conducted from 2003 to 2004. The pilot study revealed that a population‐based screening programme for skin cancer is feasible and effective. Careful evaluation of the nationwide programme is crucial to generate strong evidence for long‐term public health benefits.
Background Estimates of psoriatic arthritis (PsA) prevalence among psoriasis patients vary widely (5–40%). The time to development of PsA in patients with plaque psoriasis also remains unclear.
...Objectives To examine whether length of time since diagnosis of psoriasis affects risk of developing PsA, and to assess differences in quality of life (QoL), work‐related issues, comorbidities and healthcare resource utilization (HCRU) for patients with PsA vs. psoriasis.
Methods This large cross‐sectional observational study was conducted in the UK, Italy, France, Spain and Germany in 2006. Dermatologists who actively treated patients with psoriasis recruited 10 consecutive patients with psoriasis. Presence of PsA, body surface area (BSA) affected with psoriasis and HCRU were recorded; patients completed EUROQoL (EQ5D) and employment disadvantages questionnaires.
Results Patients with psoriasis (n = 1560) included 126 with PsA. Ninety per cent of these patients with PsA were seen by dermatologists who involved a rheumatologist in the care of their patients with PsA. Survival analysis indicated that the incidence of PsA among psoriasis patients remained constant (74 per 1000 person‐years), while the prevalence increased with time since diagnosis of psoriasis, reaching 20.5% after 30 years. In addition, those with high BSA currently affected by psoriasis were more likely to have developed PsA (P < 0.028). PsA patients reported reduced QoL compared with psoriasis patients (EQ5D score: 0.56 vs. 0.82: P < 0.0005), as well as more work problems. PsA patients were more likely to be hospitalized (0.27 ± 0.84 vs. 0.14 ± 0.71 per year; P < 0.0005) and have additional comorbidities than those without PsA.
Conclusions The incidence of PsA was constant after initial diagnosis of psoriasis, leading to a higher prevalence of concomitant PsA over time. PsA is associated with decreased QoL and increased work‐related problems, HCRU and comorbidities. Dermatologists should screen for PsA in their patients, especially long‐standing patients who did not initially present with PsA.
Immune response profiles in human skin Meyer, T.; Stockfleth, E.; Christophers, E.
British journal of dermatology (1951),
December 2007, Letnik:
157, Številka:
s2
Journal Article
Recenzirano
Summary
In addition to the function as a physical barrier human skin has been shown to be an important immune organ displaying various defense mechanisms, which can be divided into three major ...functional compartiments: (i) Epithelial defense, which is characterized by antimicrobial peptides and proteins (AP) and which can be induced in inflammatory lesions but also in the absence of inflammation. (ii) Innate‐inflammatory immunity, which involves recognition of microbial compounds by particular receptors like Toll‐like receptors (TLR) and subsequent activation of signalling pathways resulting in expression of pro‐inflammatory cytokines and interferons, as well as genes of adaptive immunity. Interferon α (IFNα) produced by plasmacytoid dendritic cells (DC) may stimulate myeloid DC to produce IL‐12 resulting in classical T‐cell activation or to produce IL‐23 activating IL‐17 producing T‐cells (IL‐23/IL‐17 pathway). (iii) Adaptive immunity, which is based on antigen presenting cells, T‐cells and B‐cells and which is characterized by specificity and memory. In contrast to epithelial defense and innate‐inflammatory immunity, adaptive immune functions provide slowly reacting protection. Recent improvements of our knowledge of dysregulated immune pathways associated with inflammatory skin diseases represent an important basis of novel immunomodulatory treatment modalities.
Disease concomitance in psoriasis Henseler, Tilo; Christophers, Enno
Journal of the American Academy of Dermatology,
06/1995, Letnik:
32, Številka:
6
Journal Article
Recenzirano
Background
: Psoriasis is a multifactorial disease of unknown origin.
Objective
: Our purpose was to determine the frequency of skin disorders concomitantly seen in patients with psoriasis.
Methods
: ...We analyzed data from more than 40,000 patients and calculated sex- and age-adjusted ratios of expected and observed incidence rates of associated disorders.
Results
: The results demonstrate that, compared with age-matched control patients without psoriasis, cutaneous immune disorders such as allergic contact dermatitis, atopic dermatitis, and urticaria are underrepresented in patients with psoriasis. In contrast, certain systemic disorders such as diabetes, heart insufficiency, and obesity occur significantly more often in patients with psoriasis than in control subjects. Increased resistance to cutaneous bacterial infections was noted only in patients with early-onset psoriasis.
Conclusion
: Our observations show that a distinct pattern of associated diseases exists in patients with psoriasis. Although systemic disorders such as obesity, diabetes, and heart disease may be related to dietary habits and nutritional status, the relative resistance to cutaneous infections together with decreased immune responsiveness suggest a genetically determined selection.
To avoid opportunistic infections, plants and animals have developed antimicrobial peptides in their epithelia that can form pores in the cytoplasmic membrane of microorganisms. After contact with ...microorganisms, vertebrate skin, trachea and tongue epithelia are rich sources of peptide antibiotics, which may explain the unexpected resistance of these tissues to infection. Here we report that human skin is protected in a similar way by an inducible, transcriptionally regulated, antibiotic peptide, which resembles those in other mammals.
Summary
Background A reduction of symptoms of atopic dermatitis (AD) in small infants by the administration of Lactobacillus rhamnosus has been reported in a few studies. One study with older ...children and adolescents failed to show any effect.
Objectives We conducted a prospective study to reassess the efficacy of orally administered L. rhamnosus strain GG (LGG) in infants with AD.
Methods In a randomized, double‐blind, placebo‐controlled study, 54 infants aged 1–55 months with moderate to severe AD were randomized to daily 10 × 109 colony‐forming units of LGG or to placebo during an 8‐week intervention phase. Emollients, class I–II topical corticosteroids and antihistamines were permitted.
Results The treatment with LGG was well tolerated. At the end of treatment there were no significant differences between the groups with respect to clinical symptoms (SCORAD, pruritus, sleep loss), the use of topical corticosteroids and antihistamines, immunological parameters, or health‐related quality of life of the parents.
Conclusions Our results could not confirm LGG as an effective treatment of AD in infancy.
Despite psoriasis being a common skin disease, there are still a number of unanswered questions. One of these is the prevalence of the disease, as there is a lack of specific data, with the majority ...of studies reporting estimates only. Population based studies are rare and longitudinal observations on changing prevalence rates are lacking. This contrasts with other T‐cell mediated autoimmune diseases where the number of those affected is rising.
Epidemiological studies revealed that a distinct group of diseases is quite frequently associated with psoriasis, e.g. arthritis, colitis, diabetes and hypertension. In contrast, atopic dermatitis and allergies are less frequently seen compared to normal rates of occurrence. As the psoriatic immune response pattern relates to activated Th‐1 cells, psoriasis and atopic dermatitis appear to be mutually exclusive due to the Th‐1/Th‐2 dichotomy.
Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease commonly associated with respiratory allergies such as rhinitis and asthma, and a high serum level of IgE. In contrast to ...the ‘classic’ IgE‐mediated allergic (extrinsic) form of AD, approximately 20% of the patients are reported to show normal IgE levels, lack of sensitizations towards environmental allergens, and absence of associated respiratory allergies. Accordingly, these patients are assigned to a nonallergic (intrinsic) form of the disease.
Objectives: In order to define these two forms of AD more closely, 259 adult patients with AD were investigated.
Results: After a thorough diagnostic workup there were 18 patients (6.9%), who fulfilled the criteria of intrinsic AD. After follow‐up, four additional patients had developed respiratory allergies or IgE‐mediated sensitizations resulting in an overall proportion for intrinsic AD of 5.4%.
Conclusions: Based on these figures the nature and relevance of the intrinsic form of AD deserves further evaluation.
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