Serum magnesium concentrations in vitiligo patients.

Hypomagnesemia has been shown to contribute to oxidative stress and inflammation. This study was designed to evaluate the serum magnesium (Mg) concentration in vitiligo patients versus controls. Twenty-seven patients with vitiligo were enrolled in this study, along with 27 age and sex-matched healthy controls. The mean serum Mg concentrations in the case and control groups were 0.75 ± 0.07 and 0.77 ± 0.07 mmol/L, respectively. No significant difference in the mean concentrations of Mg between the two groups was noted (P = 0.95). However, interestingly, we noticed a positive correlation between serum Mg concentration and Vitiligo Area Severity Index (VASI) score as well as the total body surface area (TBSA) concerned by the disease. Further research on the role of Mg in vitiligo is therefore warranted.

Serum levels of hypersensitive-C-reactive protein in moderate and severe acne.

BACKGROUND: Elevation of C-reactive protein (CRP) has been reported to occur in psoriasis, urticaria, acne, rosacea and many other dermatological and nondermatological conditions. Chronic systemic inflammation has been implicated in the development of neuropsychiatric/degenerative disorders, atherosclerosis, coronary artery disease, diabetes mellitus and even carcinogenesis. The present study is designed to determine whether the level of inflammation created by acne vulgaris could be high enough to raise the serum levels of high-sensitive CRP. MATERIALS AND METHODS: Forty-two patients with moderate and severe acne vulgaris were enrolled, along with 44 age and sex matched healthy blood donors as controls. Hypersensitive-CRP (Hs-CRP) was measured in both groups. RESULTS: Hypersensitive-C-reactive protein levels in the case group varied between 0 and 28.1 µg/ml with an average of 2.24 ± 4.87 µg/ml (mean ± standard deviation) and a median of 0.6 µg/ml (interquartile range [IQR] =0.3, 1.4 µg/ml). Hs-CRP levels of the control group varied between 0 and 14 µg/ml with an average of 3.12 ± 3.67 µg/ml and a median of 1.5 µg/ml (IQR = 0.55, 5.0 µg/ml). No significant difference of Hs-CRP level between the two groups was seen (t = -0.961, 95% confidence interval: Lower = -2.6942, upper = 0.9377; P = 0.339). Additionally, no significant difference in the level of Hs-CRP was noted between the moderate and severe acne groups (95% confidence interval: Lower = -5.2495, upper = 1.6711; P = 0.165). CONCLUSION: Acne vulgaris, even in its severe grades (excluding acne fulminans and acne conglobata), does not induce significant inflammation at the systemic level.

An unusually large squamous cell carcinoma mass arising from the lower lip.

Squamous cell carcinoma (SCC) of the lip is a relatively common malignancy of the head and neck region. Tumor thickness, grading, and perineural invasion are significant prognostic indicators. We report an 81-year-old, otherwise healthy woman presenting with a huge friable mass originating from her lower lip. The lesion had started as a small papule 8 years before. It later became eroded and ulcerative and transformed into a slow growing, flesh-colored mass that began interfering with her speaking and eating. Radiologic studies showed no evidence of bone involvement. The lesion was diagnosed histopathologically as squamous cell carcinoma. The patient was advised to undertake palliative treatment such as surgery or chemotherapy, but she refused any intervention.

Proton pump inhibitors: predisposers to Alzheimer disease?

The abnormal processing of amyloid-beta peptide (A beta) and resultant formation of fibrillar A beta (fA beta) are major events in the pathogenesis of Alzheimer disease (AD). Microglia as the phagocytic cells of the brain can engulf and digest fA beta within their acidic lysosomes. The lysosomes of AD patients are less acidic and therefore less capable of clearance of fA beta. Vacuolar proton pumps (V-ATPases) which are found abundantly in microglia and macrophages, acidify lysosomes by pumping protons into these structures. Proton pump inhibitors (PPIs) can inhibit V-ATPases of the lysosomes. These drugs are shown to penetrate the blood-brain barrier in animals. PPIs are consumed for long periods in conditions such as gastroesophageal reflux disease, with the resultant exposure of the human brain to the substantial amounts of PPIs. We hypothesize that by blocking the V-ATPases on microglial lysosomes, PPIs may basify lysosomes and hamper degradation of fA beta. Chronic consumption of PPIs may thus be a risk factor for AD.

The remarkable beneficial effect of adding oral simvastatin to topical betamethasone for treatment of psoriasis: a double-blind, randomized, placebo-controlled study.

BACKGROUND: Psoriasis is a common chronic inflammatory disease with unpredictable prognosis. Given the immunomodulatory effects of statins, the present study was conducted to determine whether the addition of orally administered simvastatin to the topical betamethasone, a standard antipsoriatic treatment, can produce a more powerful therapeutic response against this clinical conundrum. METHOD: In a double-blind study, 30 patients with plaque type psoriasis were randomly divided into two equal treatment groups. Group 1 received oral simvastatin (40 mg/d) plus topical steroid (50% betamethasone in petrolatum) for 8 weeks and group 2 received oral placebo plus the same topical steroid for the same time period. Psoriasis Area and Severity Index (PASI) score was checked before and at the end of the treatment period. RESULTS: PASI score decreased significantly in both groups, but the decline of PASI score was more significant in patients who received simvastatin (Mann-Whitney test; P-value = 0.001). No side effect or any laboratory abnormality was detected in patients. CONCLUSION: Our work, which is the first double-blind, randomized, placebo-controlled study on this subject, shows that oral simvastatin enhances the therapeutic effect of topical steroids against psoriasis. The increased risk of cardiovascular accidents in psoriatic patients and the protective effect of statins against cardiovascular disease further encourages their use in the treatment of this clinical conundrum.

Rubeosis faciei diabeticorum: a common, but often unnoticed, clinical manifestation of diabetes mellitus.

In this clinical image, we present the picture of a diabetic patient with rubeosis faciei diabeticorum, a relatively common, but usually unnoticed, microangiopathic complication of diabetes mellitus that could herald other more notorious microangiopathic complications of diabetes mellitus, such as retinopathy. This case will help other physicians to consider rubeosis faciei diabeticorum whenever they face similar cases.

Is there any relation between serum insulin and insulin-like growth factor-I in non-diabetic patients with skin tag?

BACKGROUND: Skin tags are common benign lesion occurring mainly on the neck and major flexures as a small soft pedunculated protrusion. This study evaluate insulin and insulin-like growth factor-I (IGF-I) in non-diabetic ones. METHODS AND MATERIALS: A case-control study was conducted in non-diabetic persons. Comparing insulin and IGF-I between matched cases (n = 40) and controls (n = 40) by radioimmunoassay test. Cases and controls were recruited from patients consecutively seen at an academic outpatient dermatology clinic. RESULTS: The insulin level in patients with skin tags was significantly higher than controls (P = 0.00) but IGF-I level was not significantly different (P = 0.43). CONCLUSION: These results show an increased insulin level in non-diabetics ones and overall importance of insulin effect in pathogenesis of skin tags.

Self-inflicted non-healing genital ulcer: a rare form of factitious disorder.

Dermatitis artefacta is a factitious dermatological disorder with many forms of presentation that may occur on any part of the body. A diagnosis of dermatitis artefacta is often reached after rigorous and repeated investigations. Here we present the case of a 49-year-old single man complaining of a 4- month history of ulceration on the dorsal surface of the glans penis. In view of the unusual appearance of the lesion and the negative findings from clinical investigations, a diagnosis of dermatitis artefacta was made and the patient was referred for psychiatric evaluation. He was started on 20 mg/day of citalopram and titrated up to 40 mg/day by the 4th week, leading to complete remission in the following weeks. Thus, although rare, artefactual dermatitis should be considered in the differential diagnosis of unusual penile lesions.

Cytochrome-P450 enzymes and autoimmunity: expansion of the relationship and introduction of free radicals as the link.

The Cytochrome-P-450 enzymes (CYP) are among the most important xenobiotic-metabolizing enzymes, which produce reactive oxygen species (ROS) as the result of metabolizing xenobiotics. ROS are believed to play important roles in the pathophysiology of autoimmune diseases. ROS can alter the structure of cellular antigens to produce a "neo-antigen" which could mount an autoimmune response against the original antigen through molecular mimicry. ROS are involved in apoptosis, activation of antigen presenting cells and initiation or amplification of diverse immunologic reactions. Taking all these facts together, it could be speculated that CYP may be involved in the initiation and/or amplification of autoimmune phenomena.