Expert recommendations for biological treatment in patients with psoriasis.

In recent years, the introduction of a series of biological drugs for the treatment of psoriasis has considerably increased the therapeutic armamentarium of doctors, and thus a strongly positive impact on the control of this condition has been achieved. With the purpose to provide the best recommendations for the use of these biological agents in patients with psoriasis, the Mexican group of psoriasis experts, PSOMEX, has developed recommendations in order to improve the understanding and therapeutic positioning of this type of medications.

En los últimos años, la introducción de diversos medicamentos biológicos para el tratamiento de la psoriasis ha aumentado considerablemente el arsenal terapéutico del médico, con lo cual se ha logrado un fuerte impacto positivo en el control de la enfermedad. Con el fin de proveer de las mejores recomendaciones para el uso de estos biológicos en los pacientes afectados de psoriasis, el grupo mexicano de expertos en psoriasis PSOMEX ha formulado recomendaciones para mejorar la comprensión y el posicionamiento terapéutico de este tipo de medicamentos.

Subgingival Microbiota and Periodontal Clinical Status in Patients with Plaque Psoriasis: A Cross-Sectional Study.

Plaque Psoriasis (PP) and periodontitis are inflammatory disorders with a bidirectional association. They both have a qualitatively similar immune-modulatory cascade, cytokine profile, and a recently described dysbiosis. Different oral bacterial species compositions in the periodontal pocket might play a role in the development of PP. To describe the subgingival microbiota of the Mexican population with PP and the periodontal conditions. Subjects were divided into two groups: periodontal health (PH) (PH-non-PP, PH-PP) and periodontitis (PD) (P-non-PP, PD-PP). Following clinical examination, the patients were classified into three groups according to the degree of psoriasis as measured by the Psoriasis Area Severity Index (PASI) and the periodontal status according to the parameters of the American Academy of Periodontology (AAP). Subgingival microbiota samples of each patient were used to determine 40 species of periodontal bacteria by checkerboard DNA-DNA hybridization. IL-2 and IL-6 were measured by ELISA. Of the forty-eight patients with PP, 21 patients had PH and 27 patients had PD. PD-PP group has a significant increase in the percentage of plaque, gingival redness, pocket probing depth, and clinical attachment loss (P<0.001) compared to PH-PP group. Microbiologically PD-PP exhibited significantly higher mean counts for A. georgiae, A. israelii, A. naeslundii from blue complex (P<0.001) than PD-non-PP. Moreover, the counts of these Actinomyces in PD-PP increased according to the severity of index PASI. The concentration of IL-2 and IL-6 were increased in saliva from PH-PP and PD-PP patients compared to PH non-PP. PP individuals harbored a particular sub-gingival microbiota profile different from non-PP. The severity of psoriasis was related to dysbiosis of microbiota -PASI > 5 related to periodontitis with the predominance of Actinomyces periodontal, irrespective of their periodontal condition. Finally, the severity of psoriasis could be unbalanced in subgingival microbiota and increase the risk to develop periodontitis.

Pemphigus vulgaris: accumulation of apoptotic cells in dermis and epidermis possibly relates to pathophysiology through TNF-alpha production by phagocytes.

Apoptotic cells are present in the epidermis of pemphigus vulgaris (PV) patients and their accumulation has been linked to chronic inflammatory disorders. TNF-α is elevated in sera of PV patients and has only been detected in acantholytic and periacantholytic keratinocytes (KC), therefore another TNF-α source might exist. We analyzed, in lesional and perilesional skin of 5 active untreated PV patients, the presence of apoptotic cells, TNF-α and phagocytic infiltrate. In vitro, we analyzed whether phagocytosis of apoptotic KCs by monocytes causes TNF-α release. We found a significant increase of apoptotic cells in the epidermis and dermis of PV patients, by TUNEL, and activated caspase-3. TNF-α was present in the skin of PV patients, especially in the dermis. Phagocytic CD14+ cells were increased, mostly in the dermis of PV patients. In vitro phagocytosis of apoptotic KCs by monocytes caused enhanced TNF-α production, which correlated with the number of apoptotic KCs in the co-culture. Thus, accumulation of apoptotic cells in PV could promote TNF-α production by monocytes, which could, in turn, cause further apoptosis, closing a vicious circle.

[Assessment of quality of life illness in adult patients with atopic dermatitis]. / Evaluación de afección en calidad de vida en adultos con dermatitis atópica.

BACKGROUND: Atopic dermatitis (AD) is a disease with an impact on the patient's quality of life (QoL). Several tools have been designed to assess the clinical severity of the disease, such as the Eczema Area and Severity Index (EASI), while specific instruments have been created to assess QoL, such as the Dermatology Life Quality Index (DLQI) and the Quality of Life Index for Atopic Dermatitis (QoLIAD). OBJECTIVE: To define which tool is the best to assess the QoL condition of adult patients with AD in relation to the EASI. MATERIAL AND METHODS: Patients with AD (> 18 years old) were selected who agreed to complete the DLQI and QoLIAD questionnaires, as well as to have a dermatologic examination reported according to the EASI. Three simple linear regression models were fitted in order to quantify the association between EASI with DLQI and QoLIAD. A value of p < 0.05 was considered statistically significant. The CV condition model with the highest pseudo R2 value was considered to have the strongest association with EASI. RESULTS: A total of 72 patients were included. Simple quantile regression models revealed a regression coefficient of 0.243 for DLQI (p = 0.002) and 0.252 for QoLIAD (p = 0.003). The pseudo R2 values were 0.15 for DLQI and 0.10 for QoLIAD, so DLQI had a higher correlation with EASI. CONCLUSIONS: DLQI proved to be the best instrument to assess CV impairment in adult patients with AD.

INTRODUCCIÓN: la dermatitis atópica (DA) es una enfermedad con repercusión en la calidad de vida (CV) del paciente. Para la evaluación de la gravedad clínica de la enfermedad se han diseñado diversas herramientas como el Eczema Area and Severity Index (EASI), mientras que para la evaluación de la CV se han creado instrumentos específico, como el Dermatology Life Quality Index (DLQI) y el Quality of Life Index for Atopic Dermatitis (QoLIAD). OBJETIVO: definir cuál es la mejor herramienta para evaluar la afección a la CV de pacientes adultos con DA, en relación con el EASI. MATERIAL Y MÉTODOS: se seleccionaron pacientes con DA (> 18 años) que aceptaran responder a los cuestionarios DLQI y QoLIAD, así como tener una exploración dermatológica reportada según el EASI. Se ajustaron tres modelos de regresión lineal simple para poder cuantificar la asociación entre el EASI con el DLQI y el QoLIAD. Un valor de p < 0.05, se consideró de significancia estadística. El modelo de afección a CV con el valor más alto de pseudo R2, se consideró como el que tuvo mayor asociación con EASI. RESULTADOS: se captaron en total 72 pacientes. Los modelos de regresión cuantílica simple revelaron un coeficiente de regresión de 0.243 para DLQI (p = 0.002) y 0.252 para QoLIAD (p = 0.003). Los valores de pseudo R2 fueron de 0.15 para DLQI y 0.10 para QoLIAD, por lo que el DLQI tuvo una mayor correlación con el EASI. CONCLUSIONES: el DLQI resultó ser el mejor instrumento para evaluar la afección a la CV en pacientes adultos con DA.

MMP-2 salivary activity in type 2 diabetes mellitus patients.

BACKGROUND: Type 2 diabetes mellitus (T2DM) and periodontitis are chronic inflammatory diseases with a bidirectional relationship. The uncontrolled levels of glucose in T2DM patients change the pathophysiology and balance of inflammatory mediators. Matrix Metalloproteinase-2 (MMP-2) is a zinc-dependent endopeptidase that is responsible for tissue remodeling and degradation of the extracellular matrix in periodontal tissue. Therefore, the uncontrolled levels of glucose in T2DM could lead to an imbalance in MMP-2 activity in saliva, favoring the development of periodontitis. METHODS: Ninety-seven T2DM patients from Hospital Dr. Donato Alarcon were included in the study. Following clinical examination, the patients were classified into four groups according to the presence and degree of periodontal disease and glycemic control. Blood and whole saliva samples (WSS) were collected from each patient. Blood samples were used for Hba1c and polymorphonuclear cells count determination, while WSS were used to determine MMP-2 activity, TIMP-1 and nitrite. MMP-2 activity was determined by zymography. TIMP-1 were determined by Western blotting, and nitric oxide (NO) levels were determined by the Griess method. RESULTS: Of the 97 patients with T2DM, 66 had periodontitis of different severities: 18 patients had mild periodontitis, 15 had moderate and 33 had severe. Salivary MMP-2 activity, HbA1c and TIMP-1 were positively correlated with the severity of periodontitis. On the other hand, the increase in HbA1c was negatively correlated with MMP-2 activity and quantity of TIMP-1 but was positively correlated with nitrite levels. CONCLUSIONS: T2DM with glycemic uncontrol conditions, distinct clinical alterations in periodontal tissue were identified, including a decrease in the gingival redness, increased the clinical attachment loss and imbalance of MMP-2/TIMP-1, as the possible causes of disorders promoting the progression of periodontitis. Accelerated periodontitis development with poor glycemic uncontrol likely results from the altered response of host defenses and decreased activity of polymorphonuclear cells. Taken together, these findings identify MMP-2 as a promising molecular market for periodontitis.

Evaluación de afección en calidad de vida en adultos con dermatitis atópica / Assessment of quality of life illness in adult patients with atopic dermatitis

Introducción: la dermatitis atópica (DA) es una enfermedad con repercusión en la calidad de vida (CV) del paciente. Para la evaluación de la gravedad clínica de la enfermedad se han diseñado diversas herramientas como el Eczema Area and Severity Index (EASI), mientras que para la evaluación de la CV se han creado instrumentos específico, como el Dermatology Life Quality Index (DLQI) y el Quality of Life Index for Atopic Dermatitis (QoLIAD). Objetivo: definir cuál es la mejor herramienta para evaluar la afección a la CV de pacientes adultos con DA, en relación con el EASI. Material y métodos: se seleccionaron pacientes con DA (> 18 años) que aceptaran responder a los cuestionarios DLQI y QoLIAD, así como tener una exploración dermatológica reportada según el EASI. Se ajustaron tres modelos de regresión lineal simple para poder cuantificar la asociación entre el EASI con el DLQI y el QoLIAD. Un valor de p < 0.05, se consideró de significancia estadística. El modelo de afección a CV con el valor más alto de pseudo R2, se consideró como el que tuvo mayor asociación con EASI. Resultados: se captaron en total 72 pacientes. Los modelos de regresión cuantílica simple revelaron un coeficiente de regresión de 0.243 para DLQI (p = 0.002) y 0.252 para QoLIAD (p = 0.003). Los valores de pseudo R2 fueron de 0.15 para DLQI y 0.10 para QoLIAD, por lo que el DLQI tuvo una mayor correlación con el EASI. Conclusiones: el DLQI resultó ser el mejor instrumento para evaluar la afección a la CV en pacientes adultos con DA.

Background: Atopic dermatitis (AD) is a disease with an im- pact on the patient's quality of life (QoL). Several tools have been designed to assess the clinical severity of the disease, such as the Eczema Area and Severity Index (EASI), while specific instruments have been created to assess QoL, such as the Dermatology Life Quality Index (DLQI) and the Quality of Life Index for Atopic Dermatitis (QoLIAD). Objective: To define which tool is the best to assess the QoL condition of adult patients with AD in relation to the EASI. Material and methods: Patients with AD (> 18 years old) were selected who agreed to complete the DLQI and QoLIAD questionnaires, as well as to have a dermatologic examination reported according to the EASI. Three simple linear regression models were fitted in order to quantify the association between EASI with DLQI and QoLIAD. A value of p < 0.05 was considered statistically significant. The CV condition model with the highest pseudo R2 value was considered to have the strongest association with EASI. Results: A total of 72 patients were included. Simple quantile regression models revealed a regression coefficient of 0.243 for DLQI (p = 0.002) and 0.252 for QoLIAD (p = 0.003). The pseudo R2 values were 0.15 for DLQI and 0.10 for QoLIAD, so DLQI had a higher correlation with EASI. Conclusions: DLQI proved to be the best instrument to assess CV impairment in adult patients with AD.

Recomendaciones de expertos para el tratamiento biológico en pacientes con psoriasis / Expert recommendations for biological treatment in patients with psoriasis

Resumen En los últimos años, la introducción de diversos medicamentos biológicos para el tratamiento de la psoriasis ha aumentado considerablemente el arsenal terapéutico del médico, con lo cual se ha logrado un fuerte impacto positivo en el control de la enfermedad. Con el fin de proveer de las mejores recomendaciones para el uso de estos biológicos en los pacientes afectados de psoriasis, el grupo mexicano de expertos en psoriasis PSOMEX ha formulado recomendaciones para mejorar la comprensión y el posicionamiento terapéutico de este tipo de medicamentos.

Abstract In recent years, the introduction of a series of biological drugs for the treatment of psoriasis has considerably increased the therapeutic armamentarium of doctors, and thus a strongly positive impact on the control of this condition has been achieved. With the purpose to provide the best recommendations for the use of these biological agents in patients with psoriasis, the Mexican group of psoriasis experts, PSOMEX, has developed recommendations in order to improve the understanding and therapeutic positioning of this type of medications.

Interleukin-13 receptor in psoriatic keratinocytes: overexpression of the mRNA and underexpression of the protein.

Although several cytokines and their receptors have been involved in the development of psoriasis, the etiology is still unknown. In this study we looked for genes possibly involved in the disease by the reverse transcription-polymerase chain reaction differential display technique in lesional and nonlesional skin biopsies from psoriatic patients. We found the mRNA of the alpha1 chain of the interleukin-13 receptor expressed differentially in psoriatic biopsies. By reverse transcription-polymerase chain reaction, we confirmed an overexpression of the alpha1 chain of the IL-13 receptor and alpha chain of the interleukin-4 receptor mRNA in lesional skin psoriatic biopsies, when compared with skin biopsies from healthy subjects (p<0.01). The nonlesional skin obtained from a region close to a lesional zone in psoriatic patients presented also an overexpression of these mRNA in 50% of the samples. Interleukin-13 and interleukin-4 were not detected either as mRNA or as the proteins in any of the biopsies from psoriatic patients or healthy subjects. A monoclonal antibody to the alpha1 chain of the interleukin-13 receptor detected the receptor in the epidermal keratinocytes of psoriatic patients and of healthy subjects; however, the positive antibody reaction was stronger in skin tissue from healthy subjects than in psoriatic lesional skin tissue (p<0.01), although the mRNA was overexpressed. As interleukin-13 is a pleiotropic immunoregulatory cytokine with a variety of effects on different cell types, including monocytes, B lymphocytes, mast cells, and keratinocytes, we suggest, based on our results, that the interleukin-13 receptor possibly plays an important part in the early inflammatory process of psoriasis; however, its function is lost in the psoriatic keratinocytes.

Retinaldehyde/hyaluronic acid fragments: a synergistic association for the management of skin aging.

BACKGROUND: Retinaldehyde (RAL) was proven effective in treating photodamaged skin. Topical treatments with specific intermediate-size hyaluronate fragments (HAFi, 50-400 kDa) have been shown to stimulate keratinocytes proliferation and epidermal hyperplasia. The aim of this open, multicentric, international study was to assess the efficacy of the combination RAL-HAFi in the correction of skin photoaging. PATIENTS/METHODS: Either RAL 0.05%-HAFi 0.5% (Eluage® cream; group 1) or RAL 0.05%-HAFi 1% (Eluage® antiwrinkle concentrate; group 2) or both products (group 3) were applied daily to the 1462 subjects during 90 days. Overall photoaging severity was evaluated in the three groups by the dermatologists at D0, D30, and D90 based on the Larnier's scale. Wrinkles and/or furrows and clinical signs of aging were evaluated using a 4-point scale. The skin microrelief of the crow's feet, evaluated by optical profilometry, was performed in subjects from group 3. RESULTS: The 3-month application significantly improved overall photoaging through decrease of the Larnier's score in the three groups (P<0.001). At D90, significant improvement of wrinkles was shown in groups 2 and 3 [forehead wrinkles (-19% and -10%, respectively, P<0.001), nasolabial folds (-20% and -16%, P<0.001), crow's feet (-27% in the two groups, P<0.001), and perioral wrinkles (-34% and -23%, P<0.001)]. Clinical signs of photoaging on the entire face improved significantly in groups 1 and 3 [elasticity (-32% and -33%, respectively, P<0.001), hyperpigmentation (-34% and -31%, P<0.001), and ptosis (-18% and -22%; P<0.001)]. Results were confirmed using an optical profilometry technique. Products were very well tolerated. CONCLUSION: This clinical study showed the efficacy and value of the RAL-HAFi combination in the management of aging skin in a large cohort of patients.

Annular atrophic lichen planus.

A 30-year-old woman presented with a 1-year history of a pruritic eruption on the extremities, characterized by several annular plaques. The patient had been treated unsuccessfully with medium-potency topical steroids. The lesions had an erythematous papular border with an atrophic center (width, 1-4 cm) (Fig. 1). No oral, genital, or nail lesions were observed. A skin biopsy from one of the plaques was performed. Histopathologic examination of the raised border showed hyperkeratosis of the stratum corneum, focal thickening of the granular layer, basal liquefaction degeneration of the epidermis, and a band-like subepidermal infiltration with numerous Civatte bodies. In the center of the lesion, the epidermis became thinner (Fig. 2). Elastic fibers were reduced or absent in the papillary dermis. The patient was treated with high-potency topical steroids for 2 months with clinical improvement.

Under-expression of VHL and over-expression of HDAC-1, HIF-1alpha, LL-37, and IAP-2 in affected skin biopsies of patients with psoriasis.

BACKGROUND: A feature of psoriasis is the rapid proliferation of keratinocytes, during which apoptosis is blocked and angiogenesis starts. It is known that tumor hypoxic cells produce histone deacetylase-1 (HDAC-1), which up-regulates hypoxia-inducible factor-1alpha (HIF-1alpha) and down-regulates von Hippel-Lindau (VHL) protein by up-regulating vascular endothelial growth factor (VEGF) expression. It has been reported recently that the porcine peptide PR39 (homologous to human LL-37) has angiogenic and antiapoptotic activity. Thus, LL-37, induced by insulin-like growth factor-1 (IGF-1), could help in the production of VEGF. PR39 also induces the expression of inhibitor of apoptosis protein-2 (IAP-2), which blocks apoptosis. The purpose of this work was to analyze whether these genes and their proteins are expressed in psoriatic biopsies. METHODS: Using semiquantitative reverse transcriptase-polymerase chain reaction (RT-PCR) messenger RNA (mRNA) expression and immunohistochemical staining, we studied VHL, IAP-2, and related genes in skin biopsies from psoriatic patients and healthy subjects. RESULTS: An over-expression of the mRNA for HDAC-1, HIF-1alpha, LL-37, and IGF-1 in psoriatic skin, in comparison with skin from healthy subjects, was found. The antiangiogenic VHL mRNA and protein were under-expressed in psoriatic skin and highly expressed in healthy skin. The antiapoptotic IAP-2 was over-expressed in dermal endothelial cells from psoriatic skin. The pro-apoptotic Bax, Fas, and FasL mRNAs were expressed. CONCLUSIONS: These findings suggest that there could be an association of HDAC-1, HIF-1alpha, LL-37, VHL, and IAP-2 with angiogenic and apoptotic mechanisms in psoriasis.

IgG class antibodies from psoriasis patients recognize the 60-KDa heat-shock protein of Streptococcus pyogenes.

BACKGROUND: We have previously found that psoriatic patients have IgG autoantibodies that recognize lesions but not autologous normal skin. The reactivity of the autoantibodies can be adsorbed with streptococcal antigens. METHODS: IgG antibodies were determined by immunoblot and ELISA to streptococcal antigens and by ELISA to the recombinants HSP60Sp, HSP70Sp, HSP60Ec and HSP60Hu, in plaque (PP) and guttate (GP) psoriasis patients, in healthy subjects (HC) and in individuals with streptococcal throat infections and high ASO titers, but without history of dermatological disease (ISp). RESULTS: We found by immunoblot that the IgG response to 71-, 60-, and 14-kDa protein fractions of Streptococcus pyogenes is important in psoriasis. We also found by ELISA that the response to the rHSP60Sp in PP was higher than in all the other three groups studied (P < 0.05) with an odds ratio of 11.11 (CI95% of 4.33-28.49). The PP infected with S. pyogenes had higher titers of the antirHSP60Sp, high ASO, and high PASI. The PP patients did not significantly recognize the HSP60Ec or the HSP60Hu. The GP patients had a higher response to the rHSP60Sp than the healthy controls or ISp patients (P < 0.05) but showed no association with the disease. The response of the ISp patients to the HSP60Sp was similar to the healthy controls. The response to the rHSP70Sp was similar in the PP patients and the healthy controls. CONCLUSION: Results suggest that a high response to the HSP60Sp could be associated with the chronic form of psoriasis.

Talidomida: una nueva oportunidad / Thalidomide: Another chance

La talidomida originalmente se comercializó como un agente sedante desde 1956 en Alemania Oriental y poco tiempo después en otros países. Por no originar alteraciones en la coordinación motora ni en la función respiratoria, rápidamente fue muy popular. En 1961, sin embargo, se reportó focomelia y otras alteraciones congénitas severas por el uso de la talidomida durante el embarazo. Por lo anterior es retirada del mercado y se restringe su uso. No obstante, al emplearse en dos pacientes con eritema nudoso leproso (ENL) que experimentaron una mejoría espectacular, se convirtió en el medicamento de elección para esta condición. Así, en décadas subsecuentes, se empleó en múltiples enfermedades dermatológicas y no dermatológicas en virtud de que se han descubierto diversas acciones biológicas predominantemente inmunomoduladoras, tales como la inhibición del factor de necrosis tumoral alfa (FNT-æ ). Se analizan los principales aspectos farmacológicos, nuevos mecanismos de acción, así como los reportes sobre su uso en enfermedades como el lupus eritematoso, enfermedad de Behüet, prúrigo actínico, estomatitis aftosa, prúrigo nodular, enfermedad de injerto contra huésped e infección por virus de la inmunodeficiencia humana (VIH), entre otras.

Pénfigo vegetante tipo hallopeau: presentación de un caso / Vegeutingpemphigus hallopeau type: presentation of a case

El pénfigo vegetante, variante rara de pénfigo vulgar, corresponde al 5 por ciento de los pacientes con pénfigo. Se divide en tipo Neumann y tipo Hallopeau, el primero caracterizado por ampollas fláccidas que al erosionarse forman vegetaciones o proliferaciones papilomatosas, especialmente en áreas intertriginosas. La variante Hallopeau se inicia con pústulas, es menos grave y remite más fácilmente con el tratamiento. Se describe un caso de pénfigo vegetante tipo Hallopeau, se trata de una mujer de 64 años con dermatosis a nivel de mucosa oral, pliegues submamario e inguinocrural y áreas perianal y vulvar, constituida por exulceraciones, neoformaciones vegetantes, ampollas fláccidas y pústulas. El estudio histológico y de inmunofluorescencia directa confirman el diagnóstico. Recibió tratamiento con prednisona a dosis de 1 mg/kg/día con remisión clínica completa.

Diacronía del jiote / Diachrony of the so-called jiote skin lesion

Se señala la importancia del estudio nosológico de las enfermedades tradicionales, tomando en cuenta la ventaja que ofrece la dermatología por su enfoque morfológico y analizando el término jiote a través del tiempo (diacronía), lo tomamos como ejemplo representativo de las dermatosis tradicionales. Asi mismo, con base en un estudio de cien dermatosis referidas por los pacientes como jiotes, se postula la existencia del síndrome jiote

Deflazacort+ en el tratamiento de los pénfigos: estudio piloto / Deflazacort in the treatment of pemphigus: pilot study

Se reportan cuatro casos de pacientes del sexo femenino con pénfigo tratado con deflazacort (1.25 mg/kg/día), glucocorticoide semejante a la prednisona, pero con menos efectos en el metabolismo del calcio y carbohidratos. Se realizaron evaluaciones de variables de eficacia, como días para el control (ausencia de nuevas ampollas), y de seguridad, como glucemia y densitometría ósea. En un promedio de 28.7 días se logró el control del pénfigo con una dosis total promedio de deflazocort de 2,3175 mg. El deflazacort resultó eficaz en el control del pénfigo, con mínimos efectos secundarios. Son deseables ensayos clínicos controlados comparativos con prednisona y de mayor seguimiento

Determinación de marcadores celulares por citrometría de flujo como auxiliar en el diagnóstico etiopatogénico de las eritrodermias / flow cytometry for determination of cell markers as an auxilliary method for the diagnosis of erythroderma

La eritodermia es una entidad sindromática para la cual puede ser difícil establecer el diagnóstico etiológico, tanto desde el punto de vista clínico como del histopatológico. Aproximadamente en el 23 por ciento de los pacientes no es posible determinar la causa, denominándose entonces como eritrodermia idiopática. Se ha considerado a ésta como el estadio inicial de una micosis fungoide, ya que aparentemente hasta el 30 por ciento de estos pacientes pueden evolucionar hacia esta entidad. En la piel y sangre de pacientes con micosis fungoide y síndrome de Sézary, respectivamente, se han encontrado niveles elevados de la molécula de adhesión asociada a la función leucocitaria-1 y de las células T cooperadoras. Con el objetivo de medir por citometría de flujo en sangre venosa: célular NK (®natural killer¼), células T cooperadoras, células T citotóxicas, índice célular T cooperadoras/citotóxicas y las moléculas de adhesión asociada a la función leucocitaria alfa y beta en los diferentes grupos etiológicos de eritrodermia, se realizó un estudio tansversal, observacional prospectivo, de casos y controles. Se incluyeron 22 pacientes con diagnóstico clínico de eritrodermia de diferente etiología (dermatosis preexistentes, medicamentos, neoplasias e indiopáticas) además de 12 controles sanos. Se demostró una disminución estadísticamente significativa en las células NK, en todos los grupos problema; elevación también estadísticamente significativa en los linfocitos T cooperadores y en la molécula asociada a la función leucocitaria beta sólo en el grupo de eritrodermia idiopática. Las determinaciones del índice células T cooperadoras/citotóxicas y de la molécula asociada a la función leucocitaria alfa no variaron significativamente en comparación al grupo control. La elevación de células T cooperadoras y de la molécula asociada a la función leucocitaria beta puede representar un marcador de las eitrodermias idiopáticas; grupo de riesgo para el desarrollo de micosis fungoide. Se requiere a futuro de estudios longitudinales para la obsevación del comportamiento de estos marcadores celulares durante la evolución del cuadro eritrodérmico