Skin-penetrating methotrexate alleviates imiquimod-induced psoriasiform dermatitis via decreasing IL-17-producing gamma delta T cells.

Accumulating evidence has shown that the Toll-like receptor 7 agonist imiquimod (IMQ) induces psoriasiform skin inflammation in mice and that this inflammation is dependent on the IL-23/IL-17 axis. Moreover, it has been demonstrated that the main source of IL-17 is not Th17 but is dermal gamma delta (γδ) T cells in mouse psoriasiform skin. Recent advances in the understanding of immunopathogenesis of psoriasis led to an alteration in the treatment paradigm to the use of highly efficacious biologics. However, their high cost impedes the extensive use of these agents. Thus, inexpensive and safe medications are still considered valuable. In this study, we introduce the therapeutic efficacy of a newly formulated methotrexate (MTX), a chemical conjugate of MTX with cell permeable peptide, for the treatment of psoriasis. Topically applied skin-penetrating (SP)-MTX reduced the psoriasiform skin phenomenon, epidermal thickness and infiltrating immune cells into the dermis. IL-17A-producing dermal γδ T cells in the cellular infiltrate that contribute IL-23/IL-17 axis were well abrogated by SP-MTX. Furthermore, SP-MTX had no toxic effects on liver, kidney or myeloid cells, unlike systemic administration of MTX. In conclusion, topically applied SP-MTX ameliorated psoriasiform skin inflammation in mice with the criteria of clinical phenomenon, histopathology and immunology, without inducing systemic toxic effects.

Effect of subdermal 1,444-nm pulsed neodymium-doped yttrium aluminum garnet laser on the nasolabial folds and cheek laxity.

BACKGROUND: Wrinkle formation usually accompanies skin aging. In particular, accentuated nasolabial folds and loss of elasticity are early signs of skin aging. The use of 1,444-nm pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers has increased in popularity. OBJECTIVE: To evaluate the safety and efficacy of a novel 1,444-nm pulsed Nd:YAG laser in the treatment of NLF and cheek laxity using subdermal laser therapy. METHODS: Ten Korean patients with moderate to severe NLF were enrolled. Each received a single treatment session with a 1,444-nm Nd:YAG laser. Two blinded physicians evaluated clinical improvement by rating comparative photographs on a 5-point scale. Efficacy was also assessed by measuring elasticity and roughness. Skin biopsies were performed on five volunteers before treatment and 3 months after treatment. RESULTS: The 1,444-nm Nd:YAG laser effectively promoted clinical improvement of NLF and cheek laxity (p < .05). Significant differences in elasticity and roughness were observed (p < .05). Epidermal proliferation was stimulated as demonstrated by increases in epidermal thickness and Ki-67 expression (p < .05). Quantitative image analyses of pre- and post-treatment biopsies revealed that collagen fibers increased from baseline (p > .05). Transforming growth factor beta and heat shock protein-70 messenger RNA levels quantified using real-time reverse transcriptase polymerase chain reaction increased significantly from baseline (p < .05). CONCLUSION: The 1,444-nm Nd:YAG laser is an effective treatment modality with minimal complications for the treatment of NLF and cheek laxity, but further research with a larger group of patients is needed to confirm these findings.

Red blood cell distribution width is increased in patients with psoriasis vulgaris: A retrospective study on 261 patients.

Circulating inflammatory cytokines and markers are increased in patients with psoriasis. Recent studies have shown that a higher red blood cell distribution width (RDW) is associated with disease activity in various disorders. Our objective was to investigate whether RDW is increased in psoriasis patients, and to evaluate its possible association with disease severity. We conducted a retrospective study of psoriasis patients seen in a university hospital in South Korea. Information about demographics, hematological parameters and disease severity were collected. Statistical analysis was performed using Student's t-test, multivariable logistic regression, Fisher's exact test and Spearman's rank correlation coefficient analysis as appropriate. A total of 261 psoriasis patients and 102 healthy controls were included in our study. The mean RDW value was significantly increased in psoriasis patients compared with healthy control (P = 0.037). Compared with mild psoriasis patients (Psoriasis Area and Severity Index [PASI], <7), moderate to severe patients (PASI, ≥7) showed significantly higher RDW values (P = 0.044). However, RDW did not show significant correlation with PASI (P = 0.358). When patients were divided into two groups according to their RDW value (<14.6% and ≥14.6%), the mean value of PASI was not significantly different (P = 0.219). Patients with psoriasis showed increased RDW values compared with healthy controls. It was also higher in the moderate and severe disease group than the mild group. Though this is only a pilot study, it is possible that RDW value can reflect the inflammatory status of psoriasis patients.

Case of seborrheic keratosis with underlying basal cell carcinoma suggesting a collision tumor.

Reports of seborrheic keratosis (SK) with concurrent malignant tumors are rare, but previous and recent reports - especially the co-manifestation of basal cell carcinomas (BCC) have added to the ongoing debate of the possibility of the development of BCC from SK. We report a rare case of SK with underlying BCC with scarcely accounted histopathological characteristics - reticulated type and nodular type, respectively - that showed no direct histological link between the two entities. We also carefully suggest that differences in histopathology (whether the two lesions are connected or not) may account for the possibility of incidental co-habitation.

Cutaneous schwannoma presented as a pedunculated protruding mass.

Schwannoma is a benign neoplasm of the nerve sheath origin. It arises from the nerve sheath of large peripheral or cranial nerves and occurs at the level of the subcutaneous fat layer or deeper layer. Cutaneous schwannoma occurs more superficially and usually presents as a solitary dermal or subcutaneous nodule. We describe a case of cutaneous schwannoma that presented as an erythematous pedunculated protruding mass on the left flank of a 19-year-old female. It was clinically diagnosed as a granuloma pyogenicum. Shaving biopsy was conducted and histological examination revealed an encapsulated tumor mass containing dense, spindle-shaped cells whose nuclei are arranged back to back representing Verocay body, and a diagnosis of schwannoma was made. This is an unusual case of cutaneous schwannoma that presented as a pedunculated protruding mass.

Wells' syndrome associated with churg-strauss syndrome.

Churg-Strauss syndrome (CSS) is a multisystem granulomatous vasculitis that is characterized by peripheral eosinophilia and the infiltration of eosinophils into systemic organs. The skin lesions of CSS consist mainly of palpable purpura and nodules. Wells' syndrome (WS) is a rare inflammatory dermatosis that is associated with recurrent granulomatous dermatitis and eosinophilia. Since these two diseases are rare, any overlap between them is very unusual. Herein, we report a patient with CSS, who initially presented a skin eruption of erythematous urticarial-plaques, vesicles, and blisters. Upon biopsy, the histology of these plaques indicated eosinophilic infiltration and "flame figures" within the dermis, which was consistent with a diagnosis of WS. Although the association between WS and CSS that was observed in our patient may be purely coincidental, it could also suggest a common pathogenetic background of these two distinct diseases, as both share several many common features.