Clinical and Epidemiological Characteristics of Hidradenitis Suppurativa Patients with Paradoxical Psoriasiform Reactions following Treatment with Adalimumab.

Introduction: Immunomodulation using TNF-α inhibitors (anti-TNF-a), especially adalimumab, is highly effective in the treatment of hidradenitis suppurativa (HS) in cases that are poorly controlled by conventional treatments. However, paradoxical psoriasis represents a peculiar type of psoriasis that may occur de novo or as the worsening of pre-existent psoriatic lesions during treatment with adalimumab. Case Presentation: We reported 4 cases of patients suffering from HS, who developed paradoxical psoriasis after treatment with adalimumab for their HS, analyzing their clinical and epidemiological characteristics. All 4 cases were middle aged, smokers, overweight or obese. Half of the patients were males (50%). All of them were classified as Hurley stage III, with a mean duration of HS of 20 years. Two patients had a family history of psoriasis. All 4 patients had been on at least 5 months of successful treatment with adalimumab before the onset of the lesions. Conclusions: Paradoxical psoriasis emerged in 4 patients who received at least 5-month regimen of adalimumab for long-lasting HS. Although different mechanisms have been hypothesized for such events, the exact underlying pathogenetic pathway remains unclear. Consistent reporting of such rare cases, and on a larger scale, is encouraged in order to enrich the available literature.

The systemic influence of chronic smoking on skin structure and mechanical function.

One of the major functions of human skin is to provide protection from the environment. Although we cannot entirely avoid, for example, sun exposure, it is likely that exposure to other environmental factors could affect cutaneous function. A number of studies have identified smoking as one such factor that leads to both facial wrinkle formation and a decline in skin function. In addition to the direct physical effects of tobacco smoke on skin, its inhalation has additional profound systemic effects for the smoker. The adverse effects on the respiratory and cardiovascular systems from smoking are well known. Central to the pathological changes associated with smoking is the elastic fibre, a key component of the extracellular matrices of lungs. In this study we examined the systemic effect of chronic smoking (>40 cigarettes/day; >5 years) on the histology of the cutaneous elastic fibre system, the nanostructure and mechanics of one of its key components, the fibrillin-rich microfibril, and the micromechanical stiffness of the dermis and epidermis. We show that photoprotected skin of chronic smokers exhibits significant remodelling of the elastic fibre network (both elastin and fibrillin-rich microfibrils) as compared to the skin of age- and sex-matched non-smokers. This remodelling is not associated with increased gelatinase activity (as identified by in situ zymography). Histological remodelling is accompanied by significant ultrastructural changes to extracted fibrillin-rich microfibrils. Finally, using scanning acoustic microscopy, we demonstrated that chronic smoking significantly increases the stiffness of both the dermis and the epidermis. Taken together, these data suggest an unappreciated systemic effect of chronic inhalation of tobacco smoke on the cutaneous elastic fibre network. Such changes may in part underlie the skin wrinkling and loss of skin elasticity associated with smoking. © 2020 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.

Evaluation of dietary intake of vitamin E in the treatment of atopic dermatitis: a study of the clinical course and evaluation of the immunoglobulin E serum levels.

BACKGROUND: Vitamin E (VE) is a potent antioxidant that can improve the immune macrophage-mediated response, decrease the production and/or release of prostaglandins in humans, and decrease the serum levels of immunoglobulin E (IgE) in atopic subjects. AIM: To compare the effects of placebo (PL) and VE intake (400 IU/day) on subjective symptoms and serum IgE levels in 96 subjects with atopic dermatitis. MATERIALS AND METHODS: A single-blind clinical analysis was performed on 96 subjects randomly divided into two groups. Fifty subjects were given orally 400 IU (268 mg) of VE of natural origin, once a day for 8 months, and 46 took PL for the same period. Complete blood count, serum IgE levels, radioallergosorbent test (RAST) score, antinuclear antibodies (ANA), and biochemical analysis were obtained at the time of enrollment and every 15 days during the 8 months of the study. To evaluate VE therapy, a questionnaire was sent to each subject for completion at the end of the study. RESULTS: The results were as follows: (A) four subjects treated with VE worsened, compared to 36 in the PL group; (B) six subjects in the VE group and five in the PL group showed no change; (C) slight improvement was observed in 10 subjects in the VE group and four in the PL group; (D) 23 of the 50 subjects treated with VE showed great improvement, compared to only one in the PL group; and (E) there was almost complete remission of atopic dermatitis in seven of the 50 subjects in the VE group, but none in the PL group. Females showed less progression of atopic dermatitis than males in both groups and a higher percentage of almost complete remission (five females and two males). The range of serum IgE levels varied markedly from 1005 to 490 IU/mL in the VE group and from 1239 to 812 IU/mL in the PL group over 8 months. Subjects with great improvement and near remission of atopic dermatitis in the VE group demonstrated a decrease of 62% in serum IgE levels based on initial conditions, while, in subjects taking PL, the difference was approximately 34.4%. No complications were observed in either group. A remarkable improvement in facial erythema, lichenification, and the presence of apparently normal skin was reported. Eczematous lesions healed mostly as a result of decreased pruritus. CONCLUSIONS: The correlation between VE intake, IgE levels, and the clinical manifestations of atopy indicates that VE could be an excellent therapeutic tool for atopic dermatitis.

Evaluación de la ingesta dietética de vitaminaE en el tratamiento de la dermatitis atópica:estudio de la evolución clínica y valoraciónde las concentraciones séricasde inmunoglobulina E / Evaluation of dietary intake of vitamin E in the treatment of atopic dermatitis: a study of the clinical course and evaluation of the immunoglobulin E serum levels

Objetivo: La vitamina E (VE) es un potente antioxidante que puede mejorar la respuesta inmune mediada por macrófagos, reducir la producción y/o secreción de prostaglandinas en seres humanos y disminuir las concentraciones séricas de inmunoglobulina E (IgE) en sujetos con dermatitis atópica. Comparar los efectos de la ingesta de placebo (PL) y de VE (400 UI/día) sobre los síntomas subjetivos y las concentraciones séricas de IgE en 96 sujetos con dermatitis atópica. Materiales y métodos: Se realizó un análisis clínico ciego en 96 sujetos divididos aleatoriamente en dos grupos. Cincuenta sujetos recibieron 400 UI (268 mg) de VE de origen natural por vía oral, una vez al día durante 8 meses y 46 recibieron PL durante el mismo período. Al comienzo del estudio y cada 15 días durante los 8 meses del estudio se realizaron: recuento completo de células sanguíneas, determinación de las concentraciones séricas de IgE, test radio-alergosorbente (RAST), determinación de anticuerpos antinucleares (ANA) y análisis bioquímico. Para evaluar el tratamiento con VE se envió un cuestionario a todos los sujetos que debía rellenarse al final del estudio. Resultados: Los resultados fueron los siguientes: a) cuatro sujetos tratados con VE y 36 tratados con PL empeoraron; b) seis sujetos del grupo VE y cinco del grupo PL no experimentaron cambios; c) se observó mejoría en diez sujetos en el grupo VE y en cuatro en el grupo PL; d) 23 de los 50 sujetos tratados con VE experimentaron una mejoría importante y sólo uno del grupo PL; y e) hubo una remisión casi completa de la dermatitis atópica en siete de los 50 sujetos del grupo VE pero en ninguno del grupo PL.La progresión de la dermatitis atópica fue menor en mujeres que en hombres en los dos grupos y el porcentaje de remisión casi completa fue mayor (cinco mujeres y dos hombres). El intervalo de concentraciones séricas de IgE varió desde 1.005 a 490 UI/ml en el grupo VE y 1.239 a 812 UI/ml en el grupo PL durante los 8 meses. Los sujetos con mejoría importante y cercanos a la remisión de la dermatitis atópica del grupo VE mostraron un descenso del 62 por ciento en las concentraciones séricas de IgE, en relación con las condiciones iniciales, mientras que, en los sujetos que recibieron PL, la diferencia fue aproximadamente del 34,4 por ciento. No se observaron complicaciones en ningún grupo. Se observó una mejoría considerable en el eritema facial y en la liquenificación y se describió la presencia de piel aparentemente normal. Las lesiones eccematosas cicatrizaron principalmente como consecuencia del descenso del prurito. Conclusiones: La correlación entre la ingesta de VE, las concentraciones de IgE y las características clínicas de atopia indican que la VE puede ser un instrumento terapéutico excelente para tratar la dermatitis atópica (AU)