Do Heavy Metals Accumulated in Saliva Involve in the Etiopathogenesis of Recurrent Aphthous Stomatitis?

Recurrent aphthous stomatitis (RAS) is one of the most common diseases of oral mucosa characterized by recurrent painful ulcers. Although many factors have been implicated in its etiology, they are not fully identified. To investigate the involvement of heavy metals accumulated in saliva in the etiopathogenesis of RAS. This is a prospective, comparative, and controlled clinical study investigating the relationship between heavy metal exposure and RAS. The study consisted of 75 patients with idiopathic RAS who presented to our clinic with recurrent oral wound complaints and 74 healthy volunteers. All subjects were interviewed regarding age, acute or chronic diseases, dietary habits, and possible chemical exposure. Lead (Pb), cadmium (Cd), mercury (Hg), copper (Cu), and manganese (Mn) was measured in saliva by inductively coupled plasma-mass spectrometer (ICP-MS). Significance was considered at p < 0.05. Salivary levels of Pb (15.2 ± 1.1 vs. 7.6 ± 9.9 µg/l; p < 0.003), Hg (0.50 ± 0.60 vs. 0.13 ± 0.30 µg/l; p < 0.001; p < 0.001), Cd (0.11 ± 0.14 vs. 0.06 ± 0.13 µg/l; p < 0.021), and Cu (34.9 ± 22.5 vs. 21.6 ± 21.9 µg/l; p < 0.001) were significantly higher in the patient group than that in the control group. There was no significant difference between Mn levels (57.9 ± 41.6 µg/l). Higher heavy metal content of saliva in the patients with RAS may induce apoptosis and ulcer in oral mucosa cells through triggering release of reactive oxygen species resulting from oxidative stress resulting DNA damage.

HLA class I and class II genotyping in patients with chronic urticaria.

OBJECTIVES: Chronic urticaria (CU) is a common disease in which pathogenesis is unclear and which is resistant to therapy. Recent investigations have indicated that autoimmunity plays a role in nearly one third of CU patients. The present study aimed to investigate the relationship between human leukocyte antigen (HLA) class I and class II antigens and immune pathogenesis of CU. METHODS: HLA class I and class II antigens were investigated in 40 patients diagnosed with CU, utilizing serologic techniques and polymerase chain reactions. The study was performed between October 2005 and May 2006. Further HLA typing in patient subsets was done depending on the response of patients to intradermal injection of autologous serum. About 30 healthy and genetically unrelated individuals formed the control group for evaluation. RESULTS: The results revealed that HLA-B44 frequency was significantly higher (25%) in the patient group as compared with the matched control group (3.33%) (p = 0.033, OR = 9.667). There was no significant difference in HLA-A allelic distribution between the patient and control groups. In the genotyping of class II HLA alleles, HLA-DRB1*01 (25%) (p = 0.033, OR = 9.667) and HLA-DRB*15 (25%) (p = 0.033, OR = 9.667) were predominant alleles in the patient group. CONCLUSION: The association of HLA-B44, HLA-DRB1*01 and HLA-DRB*15 alleles with idiopathic CU suggests that there is a genetic component in the pathogenesis of CU.

Multiple cutaneous metastases from male breast carcinoma.

Skin involvement as a symptom, or even the presenting sign, of this breast cancer in men is not well known by dermatologists. In fact, a review of the English-language literature reveals few references about this subject. We report a case of breast carcinoma in a 58-year-old man with rapidly progressive cutaneous metastases that did not respond to any treatment schedules.

Association of HLA class I and class II alleles with psoriasis vulgaris in Turkish population. Influence of type I and II psoriasis.

OBJECTIVE: To investigate the role of human leukocyte antigen (HLA) in susceptibility to psoriasis vulgaris in the Northeast region of Turkey and to contribute to the data related to HLA and psoriasis. METHODS: The study included 72 unrelated psoriatic patients (43 men and 29 women; aged 11-76 years) admitted to the Dermatology Department, University Research Hospital, Erzurum, Turkey between April 2002 and November 2003. We studied the distribution of HLA class I and II antigens in patients with psoriasis: 72 patients were divided into 2 groups according to the onset of psoriasis before age 40 years with family history (type I) and onset after age 40 without family history (type II). The HLA class I and II antigens were analyzed using the PCR-SSP method in 72 patients and in 104 controls. RESULTS: We found an increase in HLA-A*30 and A*68, B*7, B*13, B*57, Cw6, and DRB1*07 antigens in psoriatic patients compared with controls. As we compared type I and type II psoriasis with control group, B*57, Cw6 and DRB1*07 alleles were more significant in patients with type I psoriasis. Our patients with type II psoriasis represented a significant association with the HLA-B*13. CONCLUSION: Our findings along with previous HLA studies on psoriasis vulgaris patients from different racial groups showed that HLA-B*57 and DRB1*07 alleles are associated with the disease.

Treatment of confluent and reticulated papillomatosis with azithromycin.

Confluent and reticulated papillomatosis (CRP) is a relatively rare disorder of unknown origin, mostly affecting young female adults. We here present the case of a 21-year-old male patient with confluent and reticulated papillomatosis. Skin examination revealed brownish, verrucous, hyperkeratotic, 2 to 5 mm papules, which formed confluent patches and plaques with a reticulate network on the interscapular area. The patient was initially treated with ketoconazole cream for two weeks without improvement. The disease can be rather persistent and resistant to topical therapy. Our case showed a satisfactory response to treatment with azithromycin. Although this treatment is known to be effective in some cases, the action mechanism of azithromycin on CRP is not fully understood.