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1.
Am J Dermatopathol ; 39(10): 776-781, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-28930107

RESUMEN

Cutaneous Rosai-Dorfman disease (CRDD), a benign histiocytosis of unknown etiology, typically presents as a solitary or clusters of lesions. Although the histopathology is fairly distinctive, the laboratory abnormalities are not; past reports note elevated erythrocyte sedimentation rate, anemia, and polyclonal hyperglobulinemia. We describe a 61-year-old African American diabetic gentleman who presented with nodules in a linear distribution on the flank. Histopathologic examination of a biopsied nodule revealed a pandermal sheet-like infiltrate of plasma cells and histiocytes, some demonstrating elastophagocytosis and emperipolesis. The lesional histiocytes were S100 and CD68 positive and CD1a negative-findings consistent with a diagnosis of CRDD. Additional laboratory work-up performed 12 weeks after the biopsy was taken revealed an elevated serum κ light chain concentration of 37.26 mg/L (reference range: 3.30-19.40 mg/L), which correlated with an M-protein spike identified as IgG κ proteins per serum protein electrophoresis. Given the difficulty in excising a large area and preexisting diabetes, a course of low-dose methotrexate was selected for therapy with a recommendation of close follow-up for the monoclonal gammopathy. To the best of our knowledge, this is the first report of CRDD associated with a linear distribution of lesions and serum protein electrophoresis-confirmed monoclonal gammopathy.


Asunto(s)
Histiocitosis Sinusal/complicaciones , Histiocitosis Sinusal/patología , Gammopatía Monoclonal de Relevancia Indeterminada/complicaciones , Enfermedades de la Piel/complicaciones , Enfermedades de la Piel/patología , Humanos , Masculino , Persona de Mediana Edad
2.
Dermatol Online J ; 23(3)2017 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-28329514

RESUMEN

We report a rare case of a 53-year-old womanpresenting with diffuse, late-onset disseminatedhyperkeratotic papules. Biopsy showed massivehyperkeratosis overlying a crateriform epidermaldepression and hypergranulosis with mild epidermalhyperplasia. There was no parakeratosis, cornoidlamella, or dyskeratosis. Based on the clinical findingsand histopathological features, a diagnosis ofdisseminated punctate keratoderma was made. Thisis a rare subtype of palmoplantar keratoderma, whichhas a putative increased risk of malignancy. This casereport emphasizes the importance of identifyingthe clinical and histological presentation of this rarecondition; referral of the patient for age-appropriatemalignancy screening is appropriate. We also presenta concise review of treatment options.


Asunto(s)
Queratodermia Palmoplantar/diagnóstico , Corticoesteroides/uso terapéutico , Femenino , Humanos , Queratodermia Palmoplantar/clasificación , Queratodermia Palmoplantar/patología , Queratodermia Palmoplantar/terapia , Queratolíticos/uso terapéutico , Persona de Mediana Edad , Terapia PUVA , Retinoides/uso terapéutico
3.
Wound Repair Regen ; 24(2): 215-22, 2016 03.
Artículo en Inglés | MEDLINE | ID: mdl-26704519

RESUMEN

Scar formation, with persistent alteration of the normal tissue structure, is an undesirable and significant result of both wound healing and fibrosing disorders. There are few strategies to prevent or to treat scarring. The transforming growth factor beta (TGF-ß) superfamily is an important mediator of tissue repair. Each TGF-ß isoform may exert a different effect on wound healing, which may be context-dependent. In particular, TGF-ß1 may mediate fibrosis in adults' wounds, while TGF-ß3 may promote scarless healing in the fetus and reduced scarring in adults. Thus, TGF-ß3 may offer a scar-reducing therapy for acute and chronic wounds and fibrosing disorders.


Asunto(s)
Cicatriz/prevención & control , Fibrosis/terapia , Esclerodermia Sistémica/terapia , Factor de Crecimiento Transformador beta/metabolismo , Factor de Crecimiento Transformador beta/uso terapéutico , Cicatrización de Heridas/fisiología , Heridas y Lesiones/terapia , Fibrosis/patología , Humanos , Péptidos y Proteínas de Señalización Intercelular , Isoformas de Proteínas , Esclerodermia Sistémica/patología , Fenómenos Fisiológicos de la Piel , Factor de Crecimiento Transformador beta1/metabolismo , Factor de Crecimiento Transformador beta1/uso terapéutico , Factor de Crecimiento Transformador beta3/metabolismo , Factor de Crecimiento Transformador beta3/uso terapéutico , Heridas y Lesiones/patología
4.
Dermatol Online J ; 22(10)2016 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-28329588

RESUMEN

Cutaneous Crohn disease (CD) affecting the vulva, perineum, and perianal skin, is a rare entity, which may accompany or precede gastrointestinal CD. Vulvar involvement, if untreated, may ultimately require extensive surgery including vulvectomy to gain control of the disease. Both gastrointestinal and cutaneous CD respond to biologics, which block TNF. In addition, ustekinumab, which targets both IL-12 and IL-23 cytokines, is effective in patients with gastrointestinal CD who fail TNF blockade. However, it is unclear if ustekinumab is effective for cutaneous CD. Herein we present a patient with cutaneous CD affecting the vulva and perianal skin, which, at seven months, had a marked response to ustekinumab administered at higher doses than typically used for psoriasis.


Asunto(s)
Enfermedad de Crohn/terapia , Fármacos Dermatológicos/uso terapéutico , Enfermedades de la Piel/tratamiento farmacológico , Ustekinumab/uso terapéutico , Enfermedades de la Vulva/tratamiento farmacológico , Colectomía , Enfermedad de Crohn/complicaciones , Femenino , Humanos , Persona de Mediana Edad , Enfermedades de la Piel/etiología , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Enfermedades de la Vulva/etiología
5.
Ann Intern Med ; 161(5)2014 Sep 02.
Artículo en Inglés | MEDLINE | ID: mdl-25178582

RESUMEN

This issue provides a clinical overview of Common Cutaneous Parasites focusing on prevention, diagnosis, treatment, practice improvement, and patient information. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of science writers and physician writers. Editorial consultants from ACP Smart Medicine and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult http://smartmedicine.acponline.org, http://mksap.acponline.org, and other resources referenced in each issue of In the Clinic.


Asunto(s)
Enfermedades Cutáneas Parasitarias/diagnóstico , Enfermedades Cutáneas Parasitarias/terapia , Corticoesteroides/uso terapéutico , Animales , Antiparasitarios/uso terapéutico , Chinches , Infestaciones por Pulgas/diagnóstico , Infestaciones por Pulgas/tratamiento farmacológico , Infestaciones por Pulgas/prevención & control , Humanos , Insecticidas/uso terapéutico , Infestaciones por Piojos/diagnóstico , Infestaciones por Piojos/tratamiento farmacológico , Infestaciones por Piojos/prevención & control , Educación del Paciente como Asunto , Escabiosis/diagnóstico , Escabiosis/tratamiento farmacológico , Escabiosis/prevención & control , Enfermedades Cutáneas Parasitarias/prevención & control
8.
J Invest Dermatol ; 132(11): 2642-51, 2012 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-22718118

RESUMEN

Squamous cell carcinomas (SCCs) are sun-induced skin cancers that are particularly numerous and aggressive in immunosuppressed individuals. SCCs evade immune detection at least in part by downregulating E-selectin on tumor vessels, thereby restricting entry of skin-homing T cells into tumors. We find that nitric oxide (NO) potently suppresses E-selectin expression on human endothelial cells and that SCCs are infiltrated by NO-producing iNOS(+) CD11b(+) CD33(+) CD11c(-) HLA-DR(-) myeloid-derived suppressor cells (MDSCs). MDSCs from SCCs produced NO, transforming growth factor-ß (TGF-ß), and arginase, and inhibited endothelial E-selectin expression in vitro. MDSCs from SCCs expressed the chemokine receptor CCR2 (chemokine (C-C motif) receptor 2) and tumors expressed the CCR2 ligand human ß-defensin 3 (HBD3), suggesting that CCR2/HBD3 interactions may contribute to MDSC recruitment to SCCs. Treatment of SCCs in vitro with the inducible nitric oxide synthase (iNOS) inhibitor N(ω)-nitro-L-arginine(L-NNA) induced E-selectin expression at levels comparable to imiquimod-treated SCCs undergoing immunologic destruction. Our results suggest that local production of NO in SCCs may impair vascular E-selectin expression. We show that MDSCs are critical producers of NO in SCCs and that NO inhibition restores vascular E-selectin expression, potentially enhancing T-cell recruitment. The iNOS inhibitors and other therapies that reduce NO production may therefore be effective in the treatment of SCCs and their premalignant precursor lesions, actinic keratoses.


Asunto(s)
Carcinoma de Células Escamosas/metabolismo , Selectina E/metabolismo , Células Mieloides/metabolismo , Óxido Nítrico/metabolismo , Neoplasias Cutáneas/metabolismo , Antígenos de Diferenciación de Linfocitos T/metabolismo , Arginasa/genética , Arginasa/metabolismo , Antígeno CD11b/metabolismo , Antígeno CD11c/metabolismo , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/patología , Dermis/citología , Selectina E/genética , Células Endoteliales/citología , Células Endoteliales/metabolismo , Inhibidores Enzimáticos/farmacología , Regulación Neoplásica de la Expresión Génica/fisiología , Antígenos HLA-DR/metabolismo , Células Endoteliales de la Vena Umbilical Humana , Humanos , Glicoproteínas de Membrana/metabolismo , Células Mieloides/patología , Óxido Nítrico Sintasa de Tipo II/antagonistas & inhibidores , Óxido Nítrico Sintasa de Tipo II/metabolismo , Nitroarginina/farmacología , Receptores CCR2/genética , Receptores CCR2/metabolismo , Neoplasias Cutáneas/genética , Neoplasias Cutáneas/patología , Linfocitos T/metabolismo , Linfocitos T/patología
9.
Proc Natl Acad Sci U S A ; 101(7): 1969-74, 2004 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-14762166

RESUMEN

IL-15 and IL-2 possess similar properties, including the ability to induce T cell proliferation. However, whereas IL-2 can promote apoptosis and limit CD8(+) memory T cell survival and proliferation, IL-15 helps maintain a memory CD8(+) T cell population and can inhibit apoptosis. We sought to determine whether IL-15 could enhance the in vivo function of tumor/self-reactive CD8(+) T cells by using a T cell receptor transgenic mouse (pmel-1) whose CD8(+) T cells recognize an epitope derived from the self/melanoma antigen gp100. By removing endogenous IL-15 by using tumor-bearing IL-15 knockout hosts or supplementing IL-15 by means of exogenous administration, as a component of culture media or as a transgene expressed by adoptively transferred T cells, we demonstrate that IL-15 can improve the in vivo antitumor activity of adoptively transferred CD8(+) T cells. These results provide several avenues for improving adoptive immunotherapy of cancer in patients.


Asunto(s)
Linfocitos T CD8-positivos/inmunología , Interleucina-15/inmunología , Melanoma Experimental/inmunología , Traslado Adoptivo , Animales , Linfocitos T CD8-positivos/citología , Linfocitos T CD8-positivos/metabolismo , Linfocitos T CD8-positivos/trasplante , Células Cultivadas , Femenino , Humanos , Inmunoterapia , Interleucina-15/genética , Interleucina-15/farmacología , Interleucina-2/inmunología , Interleucina-2/farmacología , Glicoproteínas de Membrana/inmunología , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Ratones Transgénicos , Proteínas de Neoplasias/inmunología , Receptores de Antígenos de Linfocitos T/genética , Receptores de Antígenos de Linfocitos T/inmunología , Antígeno gp100 del Melanoma
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