RESUMO
Diabetes is a debilitating, life-threatening disease accounting in 2015 for the death of 5 million people worldwide. According to new estimations, 415 million adults currently suffer from the disease, and this number is expected to rise to 642 million by 2040. High glucose blood levels also affect the skin among systemic organs, and skin disorders can often predict the onset of this metabolic disorder. In this review, we address the pathomechanistic effects of diabetes on the skin and give an overview on the most common skin diseases associated with diabetes.
Assuntos
Complicações do Diabetes , Diabetes Mellitus , Dermatopatias/etiologia , HumanosRESUMO
Restoration of tissue integrity is essential for host defense and protection of the organism. The efficacy and quality of skin repair varies significantly over a person's lifetime. Whereas prenatal wound healing is characterized by regeneration and scarless healing, scarring, fibrosis, and loss of function are features of postnatal repair. In fact, aging is the prominent risk factor for chronic wounds, skin fragility, infections, comorbidities, and decreased quality of life. Current strategies for restoration of tissue integrity and wound therapy are not sufficient and require further investigation of the underlying pathomechanisms and the development of causal-based concepts.
Assuntos
Envelhecimento , Lacerações/patologia , Lacerações/fisiopatologia , Pele/patologia , Pele/fisiopatologia , Cicatrização/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Avaliação Geriátrica , Humanos , Masculino , Modelos BiológicosRESUMO
In an ever-aging society, a better understanding of the underlying mechanisms accompanying skin aging has become essential. Most age-related morphological skin changes are triggered by a combination of intrinsic factors (e.g., genetics, hormones) and extrinsic ones (e.g., ultarviolet/infrared light exposure, smoking, pollution). In this article, new insights on the latest findings regarding the pathogenesis of skin aging are summarised, addressing the extent to which the aforementioned factorsmay influence the progress of skin aging and identifying the consequences on the morphology and physiology of skin.
Assuntos
Absorção de Radiação/fisiologia , Hormônios/metabolismo , Modelos Biológicos , Envelhecimento da Pele/patologia , Envelhecimento da Pele/fisiologia , Fumar/fisiopatologia , Animais , Humanos , Envelhecimento da Pele/efeitos da radiaçãoRESUMO
A 68-year-old man presented with a papulovesicular exanthem, fever and malaise after a safari in South Africa. Based on the history, the typical clinical picture with an exanthema and eschar as well as the detection of antibodies against rickettsioses of the spotted fever group, we diagnosed African tick-bite fever which is due to R. africae. During treatment with doxycycline 200 mg/d, all symptoms resolved completely within 11 days. Rickettsioses should always be considered in patients presenting with exanthema, fever and malaise. Particularly the presence of one or multiple eschars on the skin manifesting as erythematous plaques with central necrosis is a pathognomic sign. The serological detection of antibodies against rickettsia species of the spotted fever group is the established diagnostic standard. Due to extensive cross-reactions it is not possible to distinguish between the members of one rickettsial group. Furthermore antibody titers rise late in the disease, frequently 2 or 3 weeks after the onset of symptoms. This underscores the importance of the clinical diagnosis.
Assuntos
Doxiciclina/uso terapêutico , Toxidermias/diagnóstico , Toxidermias/tratamento farmacológico , Infecções por Rickettsia/diagnóstico , Infecções por Rickettsia/tratamento farmacológico , Doenças Transmitidas por Carrapatos/diagnóstico , Doenças Transmitidas por Carrapatos/tratamento farmacológico , Idoso , Diagnóstico Diferencial , Humanos , Masculino , África do Sul , Viagem , Resultado do TratamentoRESUMO
BACKGROUND: Plaque psoriasis is an inflammatory disease affecting approximately 2% of the population. The clinical hallmarks of psoriasis are sharply demarcated, erythematous plaques with thick scales. Photochemotherapy (psoralen plus ultraviolet A, PUVA) is one of the most effective therapies of psoriasis. The photosensitizer 8-methoxypsoralen (8-MOP) can be applied either orally (system PUVA) or topically in a warm water bath (bath PUVA). OBJECTIVES: To compare bath PUVA and system PUVA in the treatment of plaque psoriasis. METHODS: This was a randomized, open, prospective, multicentre trial. We included 74 patients with moderate-to-severe plaque psoriasis during a 6-week treatment and a 4-week follow-up period. Of the patients enrolled in the study, 38 received bath PUVA and 36 system PUVA. RESULTS: Both treatment modalities significantly reduced the median Psoriasis Area and Severity Index (PASI) score in the intention-to-treat population. Within 6 weeks bath PUVA reduced the median PASI by 74% (16·4 to 4·2) while system PUVA did so by 62% (15·3 to 5·8). The difference between the two modalities was not significant with regard to treatment efficacy (P = 0·389). CONCLUSION: There is no difference between bath PUVA and system PUVA in the treatment of psoriasis.
Assuntos
Banhos , Metoxaleno/administração & dosagem , Terapia PUVA/métodos , Fármacos Fotossensibilizantes/administração & dosagem , Psoríase/tratamento farmacológico , Administração Cutânea , Administração Oral , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto JovemAssuntos
Colágeno/biossíntese , Everolimo/farmacologia , Imunossupressores/farmacologia , Animais , Bleomicina/toxicidade , Proliferação de Células/efeitos dos fármacos , Colágeno Tipo I/metabolismo , Cadeia alfa 1 do Colágeno Tipo I , Colágeno Tipo III/metabolismo , Combinação de Medicamentos , Fator 2 de Crescimento de Fibroblastos/farmacologia , Humanos , Camundongos , RNA Mensageiro/metabolismo , Regulação para Cima/efeitos dos fármacosAssuntos
Melanoma/cirurgia , Doenças da Unha/cirurgia , Tratamento de Ferimentos com Pressão Negativa , Neoplasias Cutâneas/cirurgia , Transplante de Pele , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Doenças da Unha/patologia , Neoplasias Cutâneas/patologiaRESUMO
To determine the role of CD11/CD18 complexes in neutrophil emigration, inflammation was induced in the skin, lungs, or peritoneum of mutant mice deficient in CD18 (CD18-/- mutants). Peripheral blood of CD18-/- mutants contained 11-fold more neutrophils than did blood of wild-type (WT) mice. During irritant dermatitis induced by topical application of croton oil, the number of emigrated neutrophils in histological sections of dermis was 98% less in CD18-/- mutants than in WT mice. During Streptococcus pneumoniae pneumonia, neutrophil emigration in CD18-/- mutants was not reduced. These data are consistent with expectations based on studies using blocking antibodies to inhibit CD11/CD18 complexes, and on observations of humans lacking CD11/CD18 complexes. The number of emigrated neutrophils in lung sections during Escherichia coli pneumonia, or in peritoneal lavage fluid after 4 h of S. pneumoniae peritonitis, was not reduced in CD18-/- mutants, but rather was greater than the WT values (240 +/- 30 and 220 +/- 30% WT, respectively). Also, there was no inhibition of neutrophil emigration during sterile peritonitis induced by intraperitoneal injection of thioglycollate (90 +/- 20% WT). These data contrast with expectations. Whereas CD11/CD18 complexes are essential to the dermal emigration of neutrophils during acute dermatitis, CD18-/- mutant mice demonstrate surprising alternative pathways for neutrophil emigration during pneumonia or peritonitis.
Assuntos
Antígenos CD11/fisiologia , Antígenos CD18/fisiologia , Movimento Celular/imunologia , Síndrome da Aderência Leucocítica Deficitária/imunologia , Pulmão/imunologia , Neutrófilos/imunologia , Peritônio/imunologia , Pele/imunologia , Animais , Antígenos CD11/biossíntese , Antígenos CD18/biossíntese , Antígenos CD18/genética , Moléculas de Adesão Celular/biossíntese , Dermatite Irritante/genética , Dermatite Irritante/imunologia , Edema/genética , Edema/imunologia , Síndrome da Aderência Leucocítica Deficitária/genética , Leucocitose/genética , Leucocitose/imunologia , Pulmão/patologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Peritônio/patologia , Peritonite/genética , Peritonite/imunologia , Pneumonia Bacteriana/genética , Pneumonia Bacteriana/imunologia , Edema Pulmonar/genética , Edema Pulmonar/imunologia , Pele/patologia , Esplenomegalia/genética , Esplenomegalia/imunologiaRESUMO
A null mutation was prepared in the mouse for CD18, the beta2 subunit of leukocyte integrins. Homozygous CD18 null mice develop chronic dermatitis with extensive facial and submandibular erosions. The phenotype includes elevated neutrophil counts, increased immunoglobulin levels, lymphadenopathy, splenomegaly, and abundant plasma cells in skin, lymph nodes, gut, and kidney. Very few neutrophils were found in spontaneously occurring skin lesions or with an induced toxic dermatitis. Intravital microscopy in CD18 null mice revealed a lack of firm neutrophil attachment to venules in the cremaster muscle in response to N-formyl- methionyl-leucyl-phenylalanine. A severe defect in T cell proliferation was found in the CD18 null mice when T cell receptors were stimulated either by staphylococcal enterotoxin A or by major histocompatibility complex alloantigens demonstrating a greater role of CD11/CD18 integrins in T cell responses than previously documented. The null mice are useful for delineating the functions of CD18 in vivo.
Assuntos
Antígenos CD18/genética , Síndrome da Aderência Leucocítica Deficitária/etiologia , Úlcera Cutânea/genética , Linfócitos T/imunologia , Animais , Antígenos CD18/fisiologia , Adesão Celular/genética , Adesão Celular/fisiologia , Divisão Celular/genética , Modelos Animais de Doenças , Enterotoxinas/farmacologia , Histocitoquímica , Humanos , Camundongos , Camundongos Knockout , Neutrófilos/metabolismo , Fenótipo , Receptores de Antígenos de Linfócitos T/metabolismo , Explosão Respiratória/genética , Streptococcus pneumoniae/patogenicidade , Zimosan/farmacologiaRESUMO
A 44-year-old woman developed punctate erythematous maculae on the backs of her hands, arms and shoulders following a pregnancy. Laboratory evaluation was unremarkable. Our differential diagnosis includes idiopathic teleangiectases, teleangiectasia eruptiva perstans, angioma serpiginosum and angiokeratoma corporis diffusum Fabry. Microscopic examination showed increased numbers of the small vessels of the upper vascular plexus with dilated capillaries. This coupled with the clinical findings led us to the diagnosis of angioma serpiginosum with symmetrical distribution involving the shoulder girdle, upper aspects of the arms, and the backs of the hands. We treated with a pulsed dye laser and noted some regression after two sessions.
Assuntos
Angioceratoma/complicações , Angioceratoma/diagnóstico , Mãos/patologia , Ceratose/diagnóstico , Ceratose/etiologia , Macula Lutea/patologia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , HumanosRESUMO
The case described in this paper shows that malignant atrophic papulosis can occur in connection with antiphospholipid syndrome (APS) and should be interpreted as a cutaneous manifestation of APS. In patients with clinically suspected malignant atrophic papulosis, it is therefore vital to conduct more comprehensive diagnostic procedures to rule out APS.
Assuntos
Abdome/patologia , Síndrome Antifosfolipídica/diagnóstico , Papulose Atrófica Maligna/diagnóstico , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Necrose/patologiaAssuntos
Úlcera da Perna/diagnóstico , Úlcera da Perna/genética , Livedo Reticular/diagnóstico , Livedo Reticular/genética , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Pele/patologia , Diagnóstico Diferencial , Marcadores Genéticos/genética , Humanos , Masculino , Pessoa de Meia-Idade , NecroseRESUMO
BACKGROUND: The aim of this study was to assess the effect of day of the week and wearing a device (reactivity) on objectively measured physical activity (PA) in older people. METHODS: Walking duration as a measure for PA was recorded from 1333 German community-dwelling older people (≥65 years, 43.8% women) over 5 days using accelerometers (activPAL). Least-square means of PA with 95%-confidence intervals (95%-CI) from multi-level analysis were calculated for each day of the week and each measurement day (days after sensor attachment). RESULTS: Walking duration on Sundays was significantly lower compared to working days (Sunday vs. Monday-Friday: - 12.8 min (95%-CI: - 14.7; - 10.9)). No statistically significant difference compared to working days was present for Saturdays. The linear slope for measurement day and walking duration was marginal and not statistically significant. CONCLUSIONS: Studies using PA sensors in older people should assess Sundays and working days to adequately determine the activity level of the participants.
RESUMO
OBJECTIVE: Systemic sclerosis (SSc) is a rare, heterogeneous disease, which affects different organs and therefore requires interdisciplinary diagnostic and therapeutic management. To improve the detection and follow-up of patients presenting with different disease manifestations, an interdisciplinary registry was founded with contributions from different subspecialties involved in the care of patients with SSc. METHODS: A questionnaire was developed to collect a core set of clinical data to determine the current disease status. Patients were grouped into five descriptive disease subsets, i.e. lcSSc, dcSSc, SSc sine scleroderma, overlap-syndrome and UCTD with scleroderma features. RESULTS: Of the 1483 patients, 45.5% of patients had lcSSc and 32.7% dcSSc. Overlap syndrome was diagnosed in 10.9% of patients, while 8.8% had an undifferentiated form. SSc sine scleroderma was present in 1.5% of patients. Organ involvement was markedly different between subsets; pulmonary fibrosis for instance was significantly more frequent in dcSSc (56.1%) than in overlap syndrome (30.6%) or lcSSc (20.8%). Pulmonary hypertension was more common in dcSSc (18.5%) compared with lcSSc (14.9%), overlap syndrome (8.2%) and undifferentiated disease (4.1%). Musculoskeletal involvement was typical for overlap syndromes (67.6%). A family history of rheumatic disease was reported in 17.2% of patients and was associated with early disease onset (P < 0.005). CONCLUSION: In this nationwide register, a descriptive classification of patients with disease manifestations characteristic of SSc in five groups allows to include a broader spectrum of patients with features of SSc.
Assuntos
Escleroderma Sistêmico/epidemiologia , Adulto , Distribuição por Idade , Idade de Início , Idoso , Estudos Transversais , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Medicina , Pessoa de Meia-Idade , Sistema de Registros , Esclerodermia Difusa/epidemiologia , Esclerodermia Difusa/patologia , Esclerodermia Limitada/epidemiologia , Esclerodermia Limitada/patologia , Escleroderma Sistêmico/classificação , Escleroderma Sistêmico/patologia , EspecializaçãoRESUMO
Chronic leg ulcers affect about 1% of the German population. The intense search for the underlying cause of impaired wound healing is an essential requirement for successful therapy. The most common causes comprise chronic venous insufficiency (70%), peripheral arterial occlusive disease (10%) and diabetes mellitus. Besides vasculitis, infectious diseases and tumors, genetic diseases may constitute the underlying cause for impaired wound healing. In this review various rare genetic diseases causing chronic wounds like the Klinefelter-Syndrome, immunological diseases including the TAP-deficiency-syndrome and the leukocyte adhesion deficiency-syndromes, red blood cell disorders, thalassemia, thrombotic diseases, progeroid syndromes and inherited connective tissue disorders are presented.
Assuntos
Úlcera da Perna , Ferimentos e Lesões , Diagnóstico Diferencial , Predisposição Genética para Doença , Humanos , Úlcera da Perna/diagnóstico , Úlcera da Perna/genética , Úlcera da Perna/terapia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/genética , Ferimentos e Lesões/terapiaRESUMO
We report on a patient with AIDS stage C3, who received haemodialysis for terminal renal insufficiency and presented with Kaposi sarcoma-like skin lesions on the left hand, distal of his dialysis shunt. Histology, immunohistochemistry and PCR analysis did not support the initially favoured diagnosis of a Kaposi sarcoma, but revealed a pseudo-Kaposi sarcoma related to the Stewart-Bluefarb-syndrome.