Establishment of an Intradermal Ear Injection Model of IL-17A and IL-36γ as a Tool to Investigate the Psoriatic Cytokine Network.

Psoriasis is a chronic skin disease affecting 2-3% of the global population. The proinflammatory IL-17A is a key cytokine in psoriasis. Accumulating evidence has revealed that IL-36γ plays also a pathogenic role. To understand more precisely the role of the IL-17A-IL-36γ cytokine network in skin pathology, we used an ear injection model. We injected IL-17A or IL-36γ alone and in combination into the ear pinnae of mice. This resulted in a significant increase in ear thickness measured over time. Histological evaluation of IL-17A + IL-36γ-treated skin showed a strong acanthosis, hyperparakeratosis and infiltration of neutrophils. The same histological features were found in mice after injection of IL-36γ alone, but to a lesser extent. IL-17A alone was not able to induce psoriasis-like changes. Genes encoding proteins of the S100 family, antimicrobial peptides and chemo-attractants for neutrophils were upregulated in the IL-17A + IL-36γ group. A much weaker expression was seen after the injection of each cytokine alone. These results strengthen the hypothesis that IL-17A and IL-36γ drive psoriatic inflammation via a synergistic interaction. Our established intradermal ear injection model can be utilized in the future to monitor effects of various inhibitors of this cytokine network.

Stevens-Johnson syndrome and toxic epidermal necrolysis: a 10-year experience in a burns unit.

OBJECTIVE: Stevens-Johnson syndrome (SJS) and its more severe counterpart, toxic epidermal necrolysis (TEN), are skin hypersensitivity reactions defined by epidermal blistering and necrosis. The exact pathophysiology of SJS/TEN is yet to be deciphered, but a number of risk factors have been identified including adverse drug reactions. The diagnosis of SJS/TEN is made on a clinical basis, and treatment consists of supportive care and occasionally immunosuppressants, such as cyclosporin, high-dose intravenous immunoglobulins and/or corticosteroids. Mortality rates can reach 20-25% in adults but are reduced with early intervention. To identify optimal treatment regimens, to better understand the patient cohort affected, and to help identify key risk factors for mortality, we report our experience with the treatment and management of SJS/TEN patients. METHODS: A retrospective review of consecutive patients with SJS and/or TEN admitted to a single burns centre in Germany, between 2008 and 2018, was conducted. The primary outcomes of demographics, clinical course, treatment and patient-reported outcomes were recorded and compared with a control group of patients with burns without a diagnosis of SJS/TEN. RESULTS: A total of 23 patients with SJS/TEN met the inclusion criteria: 17 (74%) with TEN; four (17%) with SJS/TEN overlap; and two (9%) with SJS. Of the patients, 14 (61%) were female and nine (39%) were male. Patient age ranged from 32-78 years (mean: 52 years). A matched cohort of 23 patients with burns served as the control group. All patients received standard of care with a multidisciplinary team. Compared with the control group, SJS/TEN patients had higher mortality rates (n=6, 26% versus n=8, 35%, respectively). The average age of death was 69 years in SJS/TEN patients versus 63 years in control group patients. Age and SCORTEN scores were significant predictors of mortality. CONCLUSIONS: SJS and TEN are rare but extreme reactions of the skin and mucosa, associated with high disease mortality rates. This 10-year single-centre retrospective review contributes to the bank of information for reviews evaluating the management of SJS/TEN patients.

The assessment of dermatological emergencies in the emergency department via telemedicine is safe: a prospective pilot study.

The aim of the study was to examine the feasibility and safety of telemedicine for dermatological emergency patients in the emergency department. This observational study was monocentric, open, prospective and two-arm randomized [control group (n = 50) and teledermatology group (n = 50)]. The control group was conventionally recruited directly by a dermatologist. In the teledermatology group patients, images of the skin lesions and clinical parameters were transferred to a tablet PC (personal computer) by an emergency physician and telemedically assessed by a dermatologist without patient contact. Subsequently, the dermatologist, who was previously telemedically contacted, then personally examined the patient in the emergency department. The treatment time between the control group and the teledermatology group was also recorded and compared. The agreement in suspected diagnosis between teledermatological evaluation and clinical evaluation of the same physician in the teledermatology group was 100%. The treatment time [mean (minutes) ± standard deviation] of the control group was 151 ± 71, that of the teledermatology group was 43 ± 38 (p < 0.001). The use of emergency telemedicine is safe and effective and provides a viable alternative for clinical care of emergency patients.

Accelerated wound healing with a dexpanthenol-containing ointment after fractional ablative CO2 laser resurfacing of photo-damaged skin in a randomized prospective clinical trial.

Background: Laser therapy with an ablative CO2 laser is a prominent treatment option for photo-damaged skin. The healing process and therefore the success of a laser can be supported by an appropriate postoperative treatment of the laser-treated skin. Objective: The effect of a dexpanthenol-containing ointment with petroleum jelly on wound healing after fractional ablative CO2 laser therapy of photo-damaged skin. Methods: A total of 38 patients with photo-damaged skin received fractional ablative CO2 laser treatment. Occlusive wound care was conducted for a period of 7 days. The complete wound area was divided into two sections: one that was treated with a dexpanthenol-containing ointment and a section that was treated with petroleum jelly. This study had three primary outcome measures: (1) Overview images as well as dermatoscopic images of the laser treated skin were taken immediately after laser treatment and on days 1, 2, 5 and 14 (study visits). Dermatoscopic images were analysed to determine changes of the diameter of the individual lesions between the study visits. (2) Wound-healing rate was visually assessed, based on the measure of re-epithelialization. (3) Cosmetic results were evaluated during study visits by patients and physicians applying a visual analogue scale (VAS). Results: Measuring the diameter of laser-generated lesions revealed a significantly faster cure of the lesions in wound sections that were treated with the dexpanthenol-containing ointment on days 1 and 2, in comparison to the lesions that were treated with petroleum jelly. Concordantly, visual evaluation of the wounds revealed significantly better cosmetic results and re-epithelialization on days 1, 2 and 5 after laser treatment in wound sites that were treated with the dexpanthenol-containing ointment. All patients exhibited a completed wound healing on day 14 after laser treatment. Conclusion: In this comparative study, post-operative treatment of laser-treated skin with a dexpanthenol-containing ointment led to a significantly faster wound closure in comparison to petroleum jelly, especially during the early phase of wound healing. Moreover, assessment of the cosmetic result exhibited beneficial effects of the dexpanthenol-containing ointment in the post-operative wound care after laser treatment. These results emphasize that the use of a dexpanthenol-containing ointment in the post-operative phase following CO2 laser therapy could be a promising alternative to the routinely used treatment with petroleum jelly.